Prevalence Of Diastolic Dysfunction Research Articles

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

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

Abstract 12977: Prevalence and Incidence of Diastolic Dysfunction in Patients With Functional Tricuspid Regurgitation

Introduction: Isolated functional tricuspid regurgitation (FTR) in the absence of structural heart disease may develop secondary to elevation in left heart pressures caused by left ventricular diastolic dysfunction (DD), as in heart failure with preserved ejection fraction (HFpEF). FTR may also herald the presence of occult DD or indicate greater risk for new-onset DD. However, prevalence and incidence of diastolic dysfunction (DD) in isolated FTR have not been studied. Aims: Investigate the prevalence and incidence of DD across the different severities of FTR of unclear cause. Methods: Adults with normal EF and without structural heart disease undergoing echocardiography at a tertiary medical center with a repeat study ≥6 months from baseline were identified. Severe DD was defined by ≥3/4 abnormal DD parameters (medial e’, medial E/e’, tricuspid regurgitation velocity, left atrial volume index) and moderate DD by ≥2. Results: Among 30,428 patients (median age 60; 50% women), FTR was absent in 73%, mild in 22%, moderate in 4%, and severe in 0.4%. Severe DD was present in 2%, 5%, 11%, and 13% patients, respectively, (p&lt;.001) and moderate DD in 9%, 19%, 31%, and 48%, respectively (p&lt;.001). The association of DD with increasing FTR was independent of all clinical characteristics. Over median 3.0 (IQR 1.5-5.4) years, incident severe and moderate DD developed more frequently with increasing FTR severity ( Figure) . Findings were confirmed in a propensity-matched subset where patients were matched for age, sex, BMI, atrial fibrillation, and comorbidities and in patients without lung disease or ≥moderate right ventricular enlargement. Conclusions: Patients with FTR of undefined etiology commonly have DD suggesting the presence of underlying left heart disease. Patients without apparent DD or HF at baseline who have FTR remain at significantly increased risk of developing DD over follow-up and may be a target population for therapies to prevent progression to clinical HFpEF.

Left ventricular structural abnormalities in the assessment of diastolic function in the elderly: source of discrepancies between the 2009 and 2016 criteria.

Diastolic dysfunction (DD) is routinely evaluated in echocardiography to support diagnosis, prognostication, and management of heart failure, a condition highly prevalent in elderly patients. Clinical guidelines were published in 2009, and updated in 2016, pursuing to standardize and improve DD categorization. We aimed to assess the concordance of DD between these two documents in an elderly population and to investigate how left ventricular structural abnormalities (LVSA) impact the reclassification. To evaluate this we analyzed the 308 consecutive transthoracic echocardiograms in patients older than 60 years (70.4 ± 7.7 years-old, 59% women) that fulfilled the inclusion criteria out of the 1438 echocardiograms performed in a tertiary hospital. We found that the prevalence of DD was lower according to the 2016 criteria (64% vs. 91%; p < 0.001), with 207 (67.2%) patients changing category, indicating poor agreement between the guidelines (kappa = 0.21). There were 188 (61%) patients with LVSA, which drove most of the reclassifications in 2016 Grade I DD cases. The prevalence of elevated filling pressures by Doppler halved in this elderly population using the updated recommendations (20.9% vs. 39.2%; p < 0.001). In conclusion the prevalence of DD was lower applying the 2016 guidelines, with a poor agreement with 2009 guidelines in all DD grades. The role of LVSA in reclassifications was particularly evident in Grade I DD, while Doppler parameters drove reclassifications among the more severe grades. If not properly addressed, these discrepancies may undermine the reliance on DD as a diagnostic and prognostic tool, particularly in an elderly population at a higher risk of heart failure.

CARDIAC FUNCTION EVALUATION THROUGH ECHOCARDIOGRAM IN RECENTLY DIAGNOSED TYPE 2 DIABETES MELLITUS PATIENTS

Introduction: Diabetes mellitus being a modern day disease has occupied a significant place in burdening the health care system.The abnormalities in the glucose metabolism have a significant impact on the cardiovascular system and usually is an unfavourable outcome.In this study, persons with type II diabetes mellitus were assessed for developing cardiac dysfunction (Left ventricular) and its prevalence by comparing with asymptomatic control group. Age and gender were matched among these two groups. Objectives: The primary objective was toevaluate the left ventricular reserve (systolic &amp; diastolic) in recently diagnosed type 2 diabetes mellitus patients. The secondary objective is to assess the risk factorscontributing in the development of heart failure among diabetic patients. Methods: This case control study was explored among the recently diagnosed diabetes mellitus (Type 2) patients who were visitingdiabetic OPD. Approval for the conductance of the study was obtained from the Institutes scientific committee and the Institutes ethics committee. The study period was from January, 2022 to March, 2023. In study group recently diagnosed type 2 diabetes mellitus patients were considered as the participants based on the revised criteria for diagnosing diabetes mellitus taken from American Diabetes Association. LV systolic functionwas assessed from the following calculated with the M- mode echocardiogram. Results: Incidence of diastolic dysfunction in study population was 28%, whereas in control population was 10%. Diastolic dysfunction based on the distribution amongst study population is 50% between 40-50 years. Gender distribution of derangement in diastolic function amongst study population were 31.25% amongstfemales, 22% amongst males and in controls was 10% amongst females, 10% amongst males. Conclusion: The incidence of abnormal diastolic function was notablyincreasing in recently diagnosed diabetes mellitus (type 2) patients as paralleled to participants with normal glucose metabolism. Prevalence of diastolic dysfunction amongst newly diagnosed male and female diabetics is in the ratio of 2:1. Risk factors like advanced age, abnormal BMI, PPBS, raised HbA1c, elevated cholesterol and triglyceride values are significantly associated with diastolic dysfunction.

Evaluation of diastolic dysfunction in children with hypertrophic cardiomyopathy and its relationship with development of myocardial fibrosis

BackgroundPatients with hypertrophic cardiomyopathy may develop symptoms of shortness of breathing due to diastolic dysfunction which is not related to the severity of left ventricular outflow tract obstruction. As these patients usually develop a non-ischemic pattern of myocardial fibrosis, this may represent a mechanism for increased myocardial stiffness leading to impaired diastolic filling. The study aimed to determine the prevalence of myocardial fibrosis assessed by magnetic resonance imaging in children with hypertrophic cardiomyopathy and to evaluate its relationship with echocardiographic parameters including left ventricle diastolic dysfunction and to find echocardiographic indices which correlates with myocardial fibrosis as detected by cardiac magnetic resonance. A cross-sectional study was done for data of 50 children with hypertrophic cardiomyopathy from July 2018 to July 2021, patients were divided into (group 1) having myocardial fibrosis and (group 2) with no myocardial fibrosis, and results of echocardiographic parameters were compared between the two groups.ResultsResults showed strong relationship between presence of myocardial fibrosis and each of the following: Interventricular septum thickness, lower lateral and septal early diastolic tissue velocities (E′), E/E′ ratio, presence of left ventricular out flow tract obstruction and the grade of diastolic dysfunction.ConclusionsThe trans-mitral lateral and septal E/E′ (early mitral inflow to early diastolic mitral annular velocity ratio) allows early detection of left ventricular diastolic dysfunction in children with hypertrophic cardiomyopathy. The prevalence of diastolic dysfunction is higher in obstructive hypertrophic cardiomyopathy. The diastolic dysfunction severity is higher in patients with myocardial fibrosis.

Left ventricular function in type 2 diabetics

Diabetic cardiomyopathy has been proposed as an independent cardiovascular disease and many mechanisms, such as microvascular disease, autonomic dysfunction, metabolic disorders, and interstitial fibrosis, have been suggested as causative factors. However, the exact causes and mechanisms of diabetic cardiomyopathy remain unclear. Several studies have demonstrated evidence for preclinical left ventricular (LV) diastolic dysfunction in patients with diabetes mellitus (DM) independent of coronary disease or hypertension. The prevalence of diastolic dysfunction in asymptomatic patients with type 2 diabetes mellitus or its relation with other diabetic complications (nephropathy, retinopathy, and neuropathy) is not well defined and data are controversial. A case series study of ninety patients with type 2 diabetes mellitus was designed to determine the frequency of asymptomatic left ventricular diastolic dysfunction in type 2 diabetes patients and its relation to patients’ duration, control of diabetes and other factors, the setting was at Diabetes Clinic, Echocardiography Unit and wards of Ibn Sina Teaching Hospital. During the period from the 1st of July to 31st of December 2011, eighty seven consecutive normotensive diabetic patients type 2 (mean age 51.35+8.21 years) and having no coronary artery disease on non invasive testing, were studied for assessment of left ventricular diastolic function using pulsed Doppler at the tip of mitral valve, the peak late (atrial) transmitral flow velocity (A wave), the peak early transmitral flow velocity (E wave),the (E wave) deceleration time and the ratio between (E wave) and (A wave) were assessed. Tissue Doppler was also used to assess the basal septal (medial) mitral valve annular velocities, the peak early basal annular velocity ( E` wave ) and the peak late basal annular velocity (A` wave) in addition E/E` ratio was assessed, left ventricular diastolic function was classified as left ventricular diastolic dysfunction positive and left ventricular diastolic dysfunction negative, further classification in to normal, impaired relaxation and Pseudonormal groups was made, age gender duration of diabetes, atherogenic index, obesity were studied in relation to left ventricular diastolic dysfunction using Chi square and Fissures exact tests, T-tests and ANOVA were used to calculate means and to compare them.

Correlation of lipid profile with diastolic dysfunction in normotensive young patients under 40 years of age

Background: Diastolic dysfunction in young adults is associated with increased morbidity and mortality. The identification of risk markers associated with diastolic dysfunction could allow for targeted primary prevention efforts. Aims and Objectives: The aim of the study was to study whether dyslipidemia is associated with diastolic dysfunction independent of systemic hypertension in young patients under 40 years of age. Materials and Methods: This was a cross-sectional analytical study done from April 2021 to March 2022 in SSMC and SGMH Rewa (M.P.), 214 normotensive cases under 40 years of age were taken as cases by simple random sampling. Sample size calculated by standard formula with confidence level of 95% and margin of error was &lt;5%. Lipid profiles (S. Triglyceride [TG], S. Cholesterol, and S. low-density lipoprotein [LDL]) of all the patients were checked. 2D echocardiogram of patients was done to check for diastolic dysfunction. All data were compiled and compared with the previous studies. Results: We found that the prevalence of diastolic abnormalities in adults under 40 years of age was 21.9%. It was found that there was significant correlation between dyslipidemia and presence of diastolic dysfunction in patients. Patients with higher than normal levels of S. TG, S. Cholesterols, and S. LDL were found to have more prevalence of diastolic dysfunction then patients with normal levels of S. TG, S. Cholesterols, and S. LDL. Higher grades of diastolic dysfunction were found in patients with dyslipidemia as compared to patients without dyslipidemia. High levels of TG and LDL and even Borderline high levels of LDL can be good predictors of diastolic dysfunction. Conclusion: Dyslipidemia is associated with diastolic dysfunction in young patients even without systemic hypertension.

Diastolic dysfunction of the left and right ventricles in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis

The frequency and risk factors for the development of diastolic function in patients with calcium pyrophosphate crystal deposition disease (CPPD) and osteoarthritis (OA) have not been studied.The aim – to determine the frequency and to identify risk factors (RF) for the development of diastolic dysfunction (DD) of the left (LV) and right (RV) ventricles in patients with calcium pyrophosphate crystal deposition disease and osteoarthritis.Material and methods. 26 patients (18–65 years) each were included with CPРD and with knee OA, matched in age and gender, without cardiovascular disease (CVD), type 2 diabetes mellitus, rheumatic diseases. Traditional risk factors of CVD were assessed, echocardiography was performed.Results. The frequency of DD in patients with CPРD and OA was quite high and almost did not differ in both groups: it was detected in 19 patients, of which 11 (42%) with CPРD and 8 (31%) with OA (p=0.39). Type 1 LV DD was detected in 10 (39%) patients with CPРD and in 8 (31%) with OA (p=0.11); type 1 RV DD – in 8 (31%) patients with CPРD and in 7 (27%) patients with OA (p=0.17); type 1 LV DD and RV DD – in 7 (27%) patients with both CPРD and with OA. DD types 2 and 3 were not detected in both groups. There were no differences in both groups in CV risk factors, except for the level of C-reactive protein (CRP) – it was higher in CPРD (p=0.03). In the CPРD group, mean values of LV E/E′ (p=0.02), LV DT (p=0.03), LV MI (p=0.04) were significantly higher than in patients with OA. On the contrary, in patients with OA, the following indicators: EDV (p=0.004), TVC (p=0.02) were higher.There were direct correlations between diastolic function indices and the following factors in CPРD: LVL, PWLV and PTH level (r=0.7; p&lt;0.005), LV E′ and PTH level (r=0.7; p&lt;0.005); inverse correlations – the level of PTH and IS (r=–0.5; p&lt;0.005), LV MI (r=–0.5; p&lt;0.005), the level of vitamin D and VD DT (r=–0.6; p&lt;0.005). Direct correlations in OA: the level of CRP and PVAdiast (r=0.6; p&lt;0.005), and the level of sUA (r=0.7; p&lt;0.005), the level of vitamin D and E/E′ LV (r=0.6; p&lt;0.005).Conclusion. A high prevalence of LV and RV DD was found in patients with CPРD and OA. The presence of DD in CPРD was associated with lower vitamin D levels, and in OA with a higher level of sUA and a lower level of PTH.

Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes Mellitus and its Association with Age, Gender, Duration and Glycosylated Haemoglobin: A Cross-sectional Study

Introduction: Diabetes Mellitus (DM) is a group of metabolic disorders resulting in hyperglycaemia with disturbances in carbohydrate, fat, and protein metabolism. Hyperglycaemia when present for a long period of time leads to a host of metabolic abnormalities and also results in end organ damage. Diastolic dysfunction is an early sign of diabetic heart muscle disease preceding systolic and diastolic damage. Only a few studies have been conducted in central India to establish this prevalence and association in diabetic patients. Aim: To assess Left Ventricular Diastolic Dysfunction (LVDD) in diabetic patients and its association with age, gender, duration, and glycosylated haemoglobin (HbA1c). Materials and Methods: In this cross-sectional study, 150 normotensive patients with type 2 DM and no clinical evidence of cardiovascular disease were enrolled by simple random selection in the Department of General Medicine, Shyam Shah Medical College, Rewa, Madhya Pradesh, India. The sample size was calculated by standard formula with a confidence interval of 95% and an error margin of less than 5%. A semi-structured proforma was used to record the demographic profiles with full medication history, as well as, anthropometric measurements like height, weight, and waist circumference. Blood pressure was measured and blood was drawn for complete blood count, liver function test, renal function test, fasting and postprandial blood sugar, HbA1c, and lipid profile. Electrocardiographic and Echocardiographic studies were performed to assess LVDD. Data obtained by various methods was analysed statistically using Statistical Package for the Social Sciences (SPSS), version 20.0 and Chi-square test. Results: The present study showed that 85 out of 150 types 2 diabetic patients had diastolic dysfunction, out of which 80 had grade I diastolic dysfunction and, five of them had grade II diastolic dysfunction. The prevalence of diastolic dysfunction was increased with age, duration, and HbA1c (≥7%) and was not affected by gender. Conclusion: The study concluded that asymptomatic normotensive patients of type 2 DM have Heart Failure with preserved Ejection Fraction (HFpEF). LVDD were associated with age, gender, duration of diabetes, and HbA1c.

Assessment of lest ventricular hypertrophy and left ventricular diastolic dysfunction cardiovascular in patients of chronic renal failure by echocardiography

Introduction - Chronic renal failure, regardless of the cause, is the presence of kidney damage or a reduced level of kidney function for three months or longer. It is a group of signs and symptoms brought on by slow and long-term renal damage. The most frequent cardiovascular finding in people on dialysis is LVH. Objective - To estimate the prevalence of left ventricular hypertrophy and left ventricular diastolic dysfunction by echocardiography in patients with chronic renal failure. Method – this was an observational cross-sectional study at the Department of General Medicine among IPD patients, Tertiary Care Hospital, Surat. Result - Left ventricular hypertrophy out of 34 cases 22 (64.71%) cases were show left ventricular hypertrophy with an odd ratio of 3.208 (1.049, 9.81) and a p-value 0.0378 which was statically significant. prevalence of diastolic dysfunction was 79%. comparison of renal function test and echocardiographic change of chronic renal failure. In the renal function test serum, creatinine and EGFR were show a p-value &lt; 0.001 which was statistically significant. Conclusion - Cardiac dysfunction and LVH are frequently noted in individuals with chronic renal failure at the time of commencement of dialysis. cardiovascular abnormalities in the form of LVH and diastolic dysfunction which antedate severe systolic dysfunction are frequently observed in milder degrees of chronic renal failure

Diastolic function and cardiovascular risk among patients with severe obesity referred to a lifestyle-program – a pilot study

Objectives. Severe obesity is associated with a high risk of comorbidities and alterations of cardiac structure and function. The primary aim of the study was to investigate the proportion of diastolic dysfunction (DD) at baseline, and changes in cardiac function from baseline (T1) to 6 months follow-up (T2) among participants with severe obesity attending a lifestyle-intervention. The secondary aim was to explore changes in body mass index (BMI), physical fitness (VO2peak) and cardiovascular risk from T1 to T2 and 12 months follow-up (T3). Design. This was an open single-site prospective observational study. Patients were recruited from an obesity clinic to a lifestyle-intervention consisting of three 3-weeks intermittent stays over 12-months period. Echocardiography was performed at T1 and T2 and BMI, VO2peak and cardiovascular risk measured at T1, T2 and T3. Results. Fifty-six patients were included (mean age 45.1 years; BMI 41.9). Six of 52 patients (12%) had grade 1 DD at T1, while five subjects had DD at T2. E/A ratio (11%, p = .005) and mitral deceleration time (9%, p = .014) were improved at T2. A reduction in BMI (–1.8, p < .001) and improvement in VO2peak (1.6 mL/kg min, p = .026) were assessed at T2 and this improvement persisted at T3. The total cardiovascular risk score was not significantly changed. Conclusion. The patients with severe obesity had low prevalence of DD. For all participants, an improvement in diastolic parameters, and an important initial weight loss was observed. Clinical Trial number: NCT02826122

Decreased left atrial function in obesity patients without known cardiovascular disease

Obesity is a risk factor for heart failure with preserved ejection fraction (HFpEF). We hypothesized that assessment of left atrial (LA) strain may be useful to reveal precursors of HFpEF in obesity patients. Echocardiograms of obesity patients without known cardiovascular disease who underwent bariatric surgery, and echocardiograms of age- and gender matched controls were analyzed. The echocardiogram was repeated 1 year after bariatric surgery. LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contractile strain (LASct) were measured. 77 Obesity patients were compared with 46 non-obese controls. Obesity patients showed a significantly decreased LA function compared with non-obese individuals (LASr 32.2% ± 8.8% vs. 39.6% ± 10.8%, p < 0.001; LAScd 20.1% ± 7.5% vs. 24.9% ± 8.3%, p = 0.001; LASct 12.1% ± 3.6% vs. 14.5% ± 5.5%, p = 0.005). There was no difference in prevalence of diastolic dysfunction between the obesity group and controls (9.1% vs. 2.2%, p = 0.139). One year after bariatric surgery, LASr improved (32.1% ± 8.9% vs. 34.2% ± 8.7%, p = 0.048). In the multivariable linear regression analysis, BMI was associated with LASr, LAScd, and LASct (β = − 0.34, CI − 0.54 to − 0.13; β = − 0.22, CI − 0.38 to − 0.06; β = − 0.10, CI − 0.20 to − 0.004). Obesity patients without known cardiovascular disease have impairment in all phases of LA function. LA dysfunction in obesity may be an early sign of cardiac disease and may be a predictor for developing HFpEF. LASr improved 1 year after bariatric surgery, indicating potential reversibility of LA function in obesity.

Higher body mass index and disease duration are associated with increased risk of left ventricular diastolic dysfunction in women with systemic lupus erythematosus.

Patients with systemic lupus erythematosus (SLE) have an increased cardiovascular (CV) risk. Insulin resistance (IR), which is higher in patients with SLE, adversely impacts left ventricular (LV) remodeling and function. The aims were to determine LV dysfunction and evaluate the influence of potential risk factors on subclinical LV dysfunction in women with SLE, including IR. This cross-sectional study included adult women with SLE without diabetes mellitus (DM), hypertension or severe obesity. Diastolic dysfunction (DD) was verified according to current guidelines. Insulin resistance was estimated using the Quantose score. We included 77 women. The frequency of IR was 65%. All participants had a normal ejection fraction (EF), and 11 (15.7%) had abnormal LV global longitudinal strain (GLS). Twenty-three (32.8%) had DD. The GLS% and global circumferential strain (GCS)% did not differ in patients with and without IR (-20.8 ± 3.1 vs -20.5 ± 2.1; p = 0.61 and -27.9 ± 4.4 vs -27.4 ± 3.7; p = 0.57, respectively). The prevalence of DD was 38.1% in patients with IR versus 25% in those without (p = 0.30). E/e' and E/A ratios did not differ between groups (6.6 ± 1.9 vs 6.6 ± 1.5; p = 0.98 and 1.3 ± 0.3 vs 1.3 ± 0.2; p = 0.27). Higher BMI (OR: 1.2, 95% CI 1.1-1.5) and disease duration (OR: 1.2, 95% CI 1.1-1.4) were associated with DD. Patients with overweight/obesity may be at higher risk of LV dysfunction. Although IR was high in our patients with SLE was not associated with systolic dysfunction or DD. Body mass index and disease duration were associated with an increased risk of DD.

Impact of 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging Recommendations for the Evaluation of Left Ventricular Diastolic Function on Predicting Outcomes in Patients with Diabetes and Hypertension without a History of Cardiovascular Disease

Background: The prognostic value of diastolic dysfunction estimates in clinical settings is not well established. We aimed to evaluate the impact of the 2016 American Society of Echocardiography and the European Association of Cardiovascular Imaging recommendations on estimates of diastolic dysfunction and predicting cardiovascular outcomes in patients with diabetes and hypertension. Methods: In total, 111 patients with diabetes and hypertension without a known history of cardiovascular diseases were enrolled. All patients had preserved left ventricular ejection fraction on echocardiography at screening. Echocardiography was performed at baseline. The 2009 and 2016 algorithms were applied in diastolic function assessment. All patients were followed up for 1 year to assess clinical outcomes. Results: There were 65 (58.6%) female patients. The mean age was 59.86 ± 7.45 years, and the mean duration of diabetes was 10.5 ± 5.41 years. Fifty-five (50.5%) patients had left ventricular hypertrophy on echocardiography. The prevalence of diastolic dysfunction was lower and that of indeterminate diastolic function was higher with 2016 recommendations. Concordance between 2016 and 2009 recommendations was poor with a reclassification rate of 41.4%. No patients diagnosed with indeterminate and normal diastolic function using the 2016 algorithm and diastolic dysfunction using the 2009 algorithm developed major adverse cardiac events at 1 year. Two of 11 patients diagnosed with diastolic dysfunction using both recommendations and two of five patients diagnosed with diastolic dysfunction and indeterminate diastolic function using 2016 and 2009 recommendations, respectively, developed major adverse cardiac events at 1 year. The 2016 algorithm showed better accuracy in predicting major adverse cardiac events at 1 year. Conclusion: The updated 2016 criteria detect more advanced diastolic dysfunction cases and predict 1-year cardiovascular outcomes. Further studies are warranted to investigate the prognostic impact of these criteria. Trial registration number: NMRR-16-436-29619.

Cardiac dysfunction in patients with end-stage liver disease, prevalence, and impact on outcome: a comparative prospective cohort study

BackgroundWithout firm diagnostic criteria, the exact prevalence of cirrhotic cardiomyopathy still remains unknown. Its estimation is rather a difficult task as the disease is generally latent and shows itself only when the patient is subjected to overt stress such as body position changes, exercise, drugs, hemorrhage, and surgery. In this study, we aim to assess cardiac dysfunction in patients with end-stage liver disease, study the correlation between cardiac dysfunction and Child-Pugh classification of patients with liver cell failure, and study the prevalence and impact of cardiac dysfunction on the clinical outcome of patients with child B and child C liver disease.ResultsDiastolic dysfunction was more prevalent among the patients’ group (p < 0.001). It was absent in 28 (70%) of control group, with grade 1 diastolic dysfunction in 12 (30%). Only one patient (2.5%) had no diastolic dysfunction, 21 patients (52.5%) had grade 1 diastolic dysfunction, 12 (30%) patients had grade 2 diastolic dysfunction, and 6 patients (15%) had grade 3 diastolic dysfunction. QTc interval was significantly prolonged in the patients’ group when compared to controls (p < 0.001). Echocardiographic parameters and QTc interval were comparable in child B and child C patients. All patients were followed up for a period of 3 months. Sixteen of 40 patients died in this period of time. Only child classification was found to significantly predict mortality, and patients with child C liver cirrhosis had worse survival when compared to patients with child B liver cirrhosis.ConclusionMost of the patients had cardiac dysfunction, mainly diastolic dysfunction (87.5%). The study detected the prevalence of diastolic dysfunction among end-stage liver disease when measuring E/É using TDI which proved to be more accurate than E/A ratio. Diastolic dysfunction is proved to be the most sensitive parameter in the diagnosis of cirrhotic cardiomyopathy, being the most parameter affected early. No correlation was found between cardiac dysfunction and the severity of hepatic illness, but the severity of hepatic illness affects the outcome rather than cardiac dysfunction.

The Impact of Metabolic Syndrome and Obesity on the Evolution of Diastolic Dysfunction in Apparently Healthy Patients Suffering from Post-COVID-19 Syndrome.

(1) Background: Coronavirus disease 2019 (COVID-19) has a worse prognosis in individuals with obesity and metabolic syndrome (MS), who often develop cardiovascular complications that last throughout recovery. (2) Methods: This study aimed to analyze the evolution of diastolic dysfunction (DD), assessed by transthoracic echocardiography (TTE), in 203 individuals with and without obesity and/or MS diagnosed with post-COVID-19 syndrome. (3) Results: DD was frequently diagnosed in patients with MS and obesity, but also in those without obesity (62.71% and 56.6%, respectively), in comparison to 21.97% of subjects without MS (p ˂ 0.001). Almost half of the patients with obesity and MS had more severe DD (types 2 and 3). As for evolution, the prevalence and severity of DD, particularly types 1 and 2, decreased gradually, in parallel with the improvement of symptoms, progress being more evident in subjects without MS. DD of type 3 did not show a significant reduction (p = 0.47), suggesting irreversible myocardial damages. Multivariate regression analysis indicated that the number of MS factors, the severity of initial pulmonary injury, and protein C levels could explain DD evolution. (4) Conclusions: DD was commonly diagnosed in individuals with post-COVID-19 syndrome, particularly in those with MS and obesity. After 6 months, DD evolution, excepting that of type 3, showed a significant improvement, mostly in patients without MS.

Prevalence of Cardiac Dysfunction in Cirrhosis and Its Relation With Meld Score

Background: Cardiac structural and functional abnormalities have been described in patients of liver cirrhosis. The constellation of these abnormalities is termed as cirrhotic cardiomyopathy (CCM) and its prevalence remains unknown, mostly because the disease is latent and shows itself when the patient is subjected to stress. This study was designed to evaluate the prevalence of cardiac dysfunction in patients of liver cirrhosis and to analyze its relation with model for end-stage liver disease (MELD) score. Methods: Hundred patients of liver cirrhosis were enrolled for the study and divided into 3 groups according to MELD score: ≤9, 10-19, and ≥20. All study participants underwent detailed cardiac assessment with Doppler echocardiography. Prevalence of cardiac dysfunction and its relation with MELD score was determined. Results: Prevalence of CCM and diastolic dysfunction (DD) was 48% and 30%, respectively. A total of 82%, 59%, and 50% patients had prolonged corrected QT interval (QTc), isovolumic relaxation time (IVRT), and deceleration time (DT), respectively. Prevalence of CCM, DD and prolonged QTc, IVRT, and DT had significant correlation with MELD score ( P &lt; .05). Conclusion: Patients with cirrhosis had impaired cardiac function, mainly present as CCM and DD, and the extent of dysfunction was correlated with the MELD score. Hence, MELD scoring system can be used to predict risk of occurrence of cardiac dysfunction in cirrhosis.

MO327: Acute Kidney Injury in Post Liver Transplantation in a Hospital in BogotÁ, Colombia

Abstract BACKGROUND AND AIMS Liver transplantation is a mandatory treatment for many cirrhotic patients worldwide. Nonetheless, frequently there is high systemic morbidity and considerable mortality in post transplantation [1]. Our aim was to calculate acute kidney injury incidence (KDIGO), need of renal replacement therapy, early liver graft dysfunction (first week post transplantation: Bilirubin &amp;gt; 10 mg/dL, INR &amp;gt; 1.5, ALT or AST &amp;gt; 2000 UI) and calculate mortality between liver transplantation and end of evaluation. METHOD We reviewed clinical registries from our transplantation service in La Cardio Hospital in Bogotá, Colombia, and included adult patients with diagnosis of cirrhosis and liver transplantation (Ltx) between 1 January 2005 and 31 July 2021. We excluded patients with acute liver failure without indication of transplantation, previous transplant or multiorganic transplantation (e.g. liver–kidney), heart failure and GFR &amp;lt; 30 mL/min/1.73 (CKD EPI). RESULTS We had 550 Ltx patients, of whom 397 (54.4% male) were included according to our inclusion criteria. Mean age of population was 56 year old at the moment of Ltx. Medical history of comorbidity was hypertension (15.8%), diabetes (24.1%) and smoking (25.44%). Mean Charlson index was 4.4 (Ds ± 1.5). Main etiologies of cirrhosis were alcohol (17.8%), idiopathic (16%), hepatitis C virus (15.3%). In terms of cirrhosis severity, 52.3% had CHILD B, and 26% CHILD C. Average MELD-Na was 16 (Ds ± 6). Anhepatic time was 57 min (RIQ: 47–69). Mean time in ICU was 2 days. There was early graft dysfunction in 32 patients (8%). AKI was diagnosed in 21% of patients. Renal replacement therapy was initiated in 29 patients. Global mortality was 15.1% during the time of study. We performed a classification and regression tree (CART) analysis, using mortality, graft dysfunction and AKI as variables. In CART for mortality, patients with BMI &amp;lt; 19 had 56% of probability of death. The absence of RRT need was related to a 95% probability of being alive at the end of the follow-up. A BMI &amp;gt; 19 and &amp;lt; 24 in need of RRT was associated to a 55% of probability of death (Graphic 1). In terms of graft dysfunction, it was present in 8% of patients. Patients taken to RRT had 55% of probability to death. Acute kidney injury was diagnosed in 21% of patients, classified according to KDIGO: 1: 38%, 2: 32% and 3: 30%. Patients who needed RRT showed a higher prevalence of diastolic dysfunction (88%). The majority of KDIGO 3 patients did not need RRT (Graphic 2). CONCLUSION Acute kidney injury was present in almost one quarter of liver transplantation patients and was related to an increase in mortality. We consider that those results highlight the importance of kidney function evaluation from the early post-operative state in a nephrology rapid response team scheme aligned with transplantation surgery, ICU and anaesthesia to improve AKI prevalence.

AN OBSERVATIONAL STUDY ON DIASTOLIC FUNCTION IN POST MYOCARDIAL INFARCTION PATIENTS IN A TERTIARY CARE CENTRE IN KANCHEEPURAM DISTRICT

Background: Diastolic dysfunction may be the earliest marker which leads to progressive cardiac failure. Thus the importance of detecting diastolic dysfunction using tissue doppler echocardiography helps in preventing the progression of patients to symptomatic congestive cardiac failure Objectives: 1. To find the prevalence of diastolic dysfunction in post myocardial infarction patients 2. To study the association between left ventricular diastolic dysfunction and variables such as smoking, Diabetes, Hypertension, Killip class,Type of Myocardial Infarction Methodology: Study design: Cross sectional study Study population : Post Myocardial infarction patients between 30 to 60 years of age Study period :18 months Sample size :144 Sampling technique :Convenient sampling Results:Prevalence of left ventricular diastolic dysfunction is 56%.There is statistically significant association between risk factors like smoking ,hypertension ,diabetes and occurrence of left ventricular diastolic dysfunction(P&lt;0.05).There is no association between type of Myocardial infarction and left ventricular diastolic dysfunction . Conclusion: Worsening diastolic function can be detected even in apparently healthy persons. Although confirmation in other studies would be helpful, our data suggest that persistence or progression of diastolic dysfunction is a risk factor for heart failure in post myocardial infarction patients.

Prevalence and renal prognosis of left ventricular diastolic dysfunction in non-dialysis chronic kidney disease patients with preserved systolic function.

Left ventricular (LV) diastolic dysfunction is common in non-dialysis chronic kidney disease (ND-CKD) patients; however, the prevalence estimated according to the new diagnostic criteria as well as the prognostic role of diastolic dysfunction on CKD progression remain unknown. We longitudinally evaluated consecutive ND-CKD patients and preserved systolic function (LV ejection fraction > 50%). According to the recently updated guidelines, LV diastolic dysfunction was assessed by four echocardiographic variables (annular e' velocity, average mitral valve E-wave/e' ratio, left atrial volume index and tricuspid regurgitation). Patients were classified as diastolic dysfunction, indeterminate and normal. Time-dependent estimated glomerular filtration rate (eGFR) change was assessed by mixed-effects regression model. Cumulative incidence of composite renal outcome (eGFR decline > 50% or chronic dialysis) was also estimated. Among 140 patients (age 66.2 ± 14.5 years; 61% males; eGFR 39.8 ± 21.8 ml/min per 1.73m2; 43.6% diabetics), diastolic dysfunction occurred in 22.9%, indeterminate in 45.7% and normal in 31.4%. Prevalence of diastolic dysfunction was much lower than that estimated with older criteria (62.7%). Logistic regression (odds ratio, 95% confidence interval [CI]) showed that diastolic dysfunction was associated with lower eGFR (0.97, 0.94-0.99), older age (1.04, 1.01-1.06) and night-time systolic blood pressure (1.04, 1.00-1.07). Across 1702 eGFR measurements collected during a median follow-up of 4.6 years, eGFR decline (ml/min per 1.73m2; per year) was faster in patients with diastolic dysfunction (-2.12, 95% CI from -2.68 to -1.56) and in the indeterminate (11.2/100 pts per year) as compared to normal (-1.14, 95% CI from -1.64 to -0.63). Incidence of composite renal outcome was significantly higher in diastolic dysfunction (13.8/100 pts/year) than in normal group (3.5/100 pts per year)'. In ND-CKD population, LV diastolic dysfunction is less frequent than previously described and acts as independent predictor of CKD progression.