Subclinical Left Ventricular Diastolic Dysfunction Research Articles

Assessment of subclinical left ventricular systolic and diastolic dysfunction in patients with type 2 diabetes mellitus under follow-up at Tikur Anbessa specialized hospital, Ethiopia: a case-control study

BackgroundIndividuals with diabetes mellitus are at increased risk of cardiovascular diseases, which in turn are the most common cause of morbidity and mortality in the diabetic population. A peculiar feature of cardiovascular diseases in this population is that they can have significant cardiac disease while remaining asymptomatic. There is a paucity of data regarding subclinical cardiac imaging features among diabetic adults in Africa, particularly in Ethiopia. This study was conducted to compare the magnitude and spectrum of left ventricular systolic and diastolic dysfunction among asymptomatic type 2 diabetic adults versus a normotensive, non-diabetic control group and to evaluate the determinants of left ventricular diastolic and systolic dysfunction.MethodsThis was a case-control study conducted at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. A standard transthoracic echocardiography was done for all study participants with type 2 diabetes mellitus and their normotensive and non-diabetic controls. Structured questionnaires were used to collect demographic and clinical characteristics and laboratory test results. Statistical analysis was done using the SPSS 25.0 software. The data was summarized using descriptive statistics. Bivariate and multivariate analysis was performed to determine the association between variables and echocardiographic parameters. The strength of statistical association was measured by adjusted odds ratios and 95% confidence intervals, with significant differences taken at p < 0.05.ResultsWe analyzed age- and sex-matched 100 participants in the study (diabetic) group and 200 individuals in the control group. Left ventricular systolic and diastolic dysfunction were significantly more prevalent among diabetic adults than their sex and age matched controls. Among diabetic individuals, ages of 60 years and above, dyslipidemia, use of Metformin and Glibenclamide, high serum triglyceride level, presence of neuropathy and use of statins correlated significantly with the presence of left ventricular diastolic dysfunction. Chronic kidney disease and neuropathy were determinants of left ventricular systolic dysfunction.ConclusionLeft ventricular systolic and diastolic dysfunction were significantly more prevalent among diabetic patients than their sex- and age-matched controls in our study. We recommend early screening for subclinical left ventricular dysfunction, especially in the elderly and in those with chronic kidney disease, dyslipidemia, and microvascular complications such as neuropathy.

The effect of hyperlipidemia and body fat distribution on subclinical left ventricular function in obesity: a cardiovascular magnetic resonance study

BackgroundObesity is often associated with multiple comorbidities. However, whether obese subjects with hyperlipidemia in the absence of other complications have worse cardiac indices than metabolically healthy obese subjects is unclear. Therefore, we aimed to determine the effect of hyperlipidemia on subclinical left ventricular (LV) function in obesity and to evaluate the association of cardiac parameters with body fat distribution.Materials and methodsNinety-two adults were recruited and divided into 3 groups: obesity with hyperlipidemia (n = 24, 14 males), obesity without hyperlipidemia (n = 25, 13 males), and c ntrols (n = 43, 25 males). LV strain parameters (peak strain (PS), peak diastolic strain rate (PDSR), peak systolic strain rate) derived from cardiovascular magnetic resonance tissue tracking were measured and compared. Dual-energy X-ray absorptiometer was used to measure body fat distribution. Correlations of hyperlipidemia and body fat distribution with LV strain were assessed by multivariable linear regression.ResultsObese individuals with preserved LV ejection fraction showed lower global LV longitudinal, circumferential, and radial PS and longitudinal and circumferential PDSR than controls (all P < 0.05). Among obese patients, those with hyperlipidemia had lower longitudinal PS and PDSR and circumferential PDSR than those without hyperlipidemia (− 12.8 ± 2.9% vs. − 14.2 ± 2.7%, 0.8 ± 0.1 s−1 vs. 0.9 ± 0.3 s−1, 1.2 ± 0.2 s−1 vs. 1.4 ± 0.2 s−1; all P < 0.05). Multivariable linear regression demonstrated that hyperlipidemia was independently associated with circumferential PDSR (β = − 0.477, P < 0.05) in obesity after controlling for growth differences, other cardiovascular risk factors, and central fat distribution. In addition, android fat had an independently negative relationship with longitudinal and radial PS (β = − 0.486 and β = − 0.408, respectively; all P < 0.05); and visceral fat was negatively associated with longitudinal PDSR (β = − 0.563, P < 0.05). Differently, gynoid fat was positively correlated with circumferential PS and PDSR and radial PDSR (β = 0.490, β = 0.481, and β = 0.413, respectively; all P < 0.05).ConclusionHyperlipidemia is independently associated with subclinical LV diastolic dysfunction in obesity. Central fat distribution (android and visceral fat) has a negative association, while peripheral fat distribution (gynoid fat) has a positive association on subclinical LV function. These results suggest that appropriate management of hyperlipidemia may be beneficial for obese patients, and that the differentiation of fat distribution in different regions may facilitate the precise management of obese patients.Clinical trials registration Effect of lifestyle intervention on metabolism of obese patients based on smart phone software (ChiCTR1900026476).

Bidirectional Association Between Frailty and Cardiac Structure and Function: The Atherosclerosis Risk in Communities Study.

Background Frailty and heart failure frequently coexist in late life. Limited data exist regarding the longitudinal associations of frailty and subclinical cardiac dysfunction. We aim to quantify the association of frailty with longitudinal changes in cardiac function and of cardiac function with progression in frailty status in older adults. Methods and Results Participants in the Atherosclerosis Risk in Communities cohort underwent frailty assessments at Visit 5 (V5; 2011-2013), V6 (2016-2017), and V7 (2018-2019), and echocardiographic assessments at V5 and V7. We assessed the association between frailty status at V5 and changes in frailty status from V5 to V7 and changes in cardiac function over 6 years. We then evaluated the association of cardiac function measured at Visit 5 with progression in frailty status over 4 years. Multivariable regression models adjusted for demographics and comorbidities. Among 2574 participants free of heart failure at V5 and V7 (age 74±4 years at V5 and 81±4 years at V7), 3% (n=83) were frail. Frailty at V5 was associated with greater left atrial volume index and E/e' ratio at V5 and 7. Participants who transitioned from robust at V5 to frail at V7 demonstrated greater increases in left ventricular mass index, left atrial volume index, and E/e' over the same period. Among 1648 robust participants at Visit 5, greater left ventricular mass index and mean wall thickness, lower tissue Doppler imaging e', and higher E/e' ratio at Visit 5 were associated with progression in frailty status. Conclusions Among robust, older adults free of heart failure, progression in frailty and subclinical left ventricular remodeling and diastolic dysfunction are interrelated.

#6391 MARKERS OF SUBCLINICAL LEFT VENTRICULAR DYSFUNCTION ARE ASSOCIATED WITH MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS WITH PRESERVED EJECTION FRACTION

Abstract Background and Aims Cardiac dysfunction is frequent in chronic kidney disease (CKD) patients and contributes to high morbidity and mortality in this category. The aim of our study is to evaluate the association between markers of subclinical left ventricular (LV) dysfunction and mortality in CKD patients with preserved left ventricular ejection fraction. Method We prospectively enrolled CKD patients (pts) in pre-dialysis. Parameters of cardiac structure and function were evaluated by echocardiography: systolic and diastolic left ventricular (LV) volumes, LV mass index (LVMI), left atrial volume index (LAVI), LV ejection fraction (LVEF), global longitudinal strain (GLS), ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/E`) and ratio between the early maximal ventricular filling velocity and the late filling velocity (E/A). Cardiac functional status was stratified according to NYHA criteria. Al patients were followed until death or loss from records. Primary endpoint was all-cause mortality. Secondary endpoints were cardiovascular mortality and a composite cardiac endpoint comprising coronary heart disease, heart failure hospitalization and new-onset arrhythmia. Results We prospectively enrolled 39 CKD patients (5 pts CKD stage 2, 27 pts CKD stage 3, 7 pts CKD stage 4) mean age 64.3 ± 10.2 years, men = 28 (71.8%). At baseline all pts had LVEF ≥ 50%; 11 pts (28.2%) were classified as NYHA 1, 18 pts (46.2%) were NYHA 2 and 10 pts (25.6%) were NYHA 3. Mean follow up period was 98.1 ± 43.2 months (range 6 - 144 months). GLS, as a marker of subclinical LV systolic dysfunction, was significantly less negative in males (-16.6 ± 2.5 vs −18.4 ± 3.2, p&amp;lt; 0.05), in pts with symptomatic heart failure (−16.5 ± 2.6 vs -18.9 ± 2.8, p&amp;lt; 0.05), and in pts with diabetes mellitus (−15.8 ± 1.9) and hypertensive nephropathy (−16.8 ± 2.8) compared with patients with tubulointerstitial diseases (−18.1 ± 2.5) and chronic glomerulonephritis (vs −21.1 ± 3.6) (p&amp;lt; 0.05). E/E`, as a marker of subclinical LV diastolic dysfunction, was significantly higher in pts with symptomatic heart failure (12.2± 3.4 vs 9.5 ± 1.9, p&amp;lt; 0.05), in pts with diabetes mellitus (13.3± 3.5 vs 10.2 ± 2.5, p&amp;lt; 0.05), All-cause mortality was 17.9% (7 events), while cardiovascular mortality was 10.3% (4 events). Composite cardiac endpoint was recorded in 13 pts (33.3%). Baseline profile in patients who died during follow up period included significantly lower eGFR (30.1 ± 10.9 vs 46.1 ± 16.9 ml/min/1.73 m2, p&amp;lt;0.05), higher LAVI (55.5 ± 11.1 vs 37.4 ± 11.9 m/m2, p&amp;lt;0.05), higher LVMI (149.8±36.1 vs 115±28.5 g/m2, p &amp;lt; 0.05), and higher E/E` (15.2±3.3 vs 10.7 ± 2.8, p &amp;lt; 0.05). Death was significantly correlated with GLS (p = 0.042), E/E` (p = 0.002), LVMI (p = 0.008) and LAVI (p = 0.007), while CV mortality was correlated with E/E` (p = 0.019) and LVMI (p = 0.041). Composite cardiac endpoint was significantly correlated with LVMI (p = 0.01) and LAVI (p = 0.006). Cox regression analysis identified only E/E` as a predictor for all-cause mortality (p = 0.002) and also for cardiovascular mortality (p = 0.015). Conclusion In our study population of CKD patients, cardiac imaging parameters of subclinical LV dysfunction (GLS and E/E`) were associated with all-cause mortality. Marker of LV diastolic dysfunction E/E` proved to be the only predictor of all-cause and cardiovascular mortality. Thus, in CKD patients, evaluation of the cardiac function should focus not only on ejection fraction measurement, but also on the parameters of subclinical LV dysfunction.

Assessment of Left Ventricular Diastolic Reserve in Diabetic Patients by Stress Echocardiography

Background: Patients with type 2 diabetes mellitus (DM) may develop cardiomyopathy independent of traditional risk factors such as hypertension and epicardial coronary artery disease (CAD). The spectrum of myocardial dysfunction may range from subclinical left ventricular (LV) diastolic and systolic dysfunction through to overt systolic dysfunction. Aim and objectives: to determine whether diastolic reserve differs in type 2 DM compared with non-DM, and to identify clinical, anthropological, metabolic and resting echocardiographic correlates of impaired diastolic reserve in patients with DM. Subjects and methods: This study included one hundred consecutive patients (50 patient with DM type II and 50 patient without DM), who underwent rest and exercise echocardiography. Clinical data collected included anthropometric, cardiac risk factors, duration of DM, medications and presence of macrovascular and microvascular complications. Mitral septal é and septal E/é were measured at rest, immediately post, and 10 min into recovery. Results: LDL, cholesterol, triglyceride, creatinine and BMI was significantly higher in in diabetic group than non-diabetic group (P value < 0.05). Regarding rest echocardiography parameters, Septal E/é, Septal é and EF were insignificant between both studied groups. Regarding stress echocardiography parameters, septal E/é was significantly higher and septal é was significantly decreased among diabetic patients among diabetic patients compared to the other group(p

Aortic valve sclerosis and subclinical LV dysfunction in the general population with normal LV geometry.

Aortic valve sclerosis (AVS) without hemodynamically significant obstruction is related to cardiovascular morbidity and mortality independent of left ventricular (LV) hypertrophy, although the underlying mechanisms remain unknown. This study investigated the prevalence of AVS and its association with subclinical LV systolic and diastolic dysfunction in individuals with normal LV geometry free of cardiovascular disease. We examined 962 participants with normal LV geometry and free from significant AV stenosis who underwent standard and speckle-tracking echocardiography. AVS was categorized into 4 groups as follows: no AVS, AV thickening, calcification on one leaflet and calcification on ≥2 leaflets. Among the 962 participants, 767 (79.7%) individuals were classified as no AVS, 74 (7.7%) as AV thickening, 87 (9.0%) as calcification on one leaflet, and 34 (3.5%) as calcification on ≥2 leaflets. The prevalence of subclinical LV diastolic dysfunction (E/e' ratio ≥13) and systolic dysfunction (LV global longitudinal strain (GLS) > -17.0% for men and > -18.0% for women) were greater in AVS groups than those in no AVS group. Subclinical LV diastolic impairment was evident from AV thickening and systolic dysfunction was observed at AV calcification. Multivariable logistic regression analysis demonstrated that AV thickening as well as calcification were independently associated with subclinical LV diastolic impairment (all p < 0.05), while only AV calcification on ≥2 leaflets conferred significant increased risk of impaired LVGLS. AVS was observed in approximately 20% individuals without cardiac disease and was associated with subclinical LV diastolic and systolic function even in the absence of LV morphological change.

Diastolic Function Assessment of Left and Right Ventricles by MRI in Systemic Sclerosis Patients.

Heart involvement is frequent although often clinically silent in systemic sclerosis (SSc) patients. Early identification of cardiac involvement can be improved by noninvasive methods such as MRI, in addition to transthoracic echocardiography (TTE). To assess the ability of phase-contrast (PC)-MRI to detect subclinical left (LV) and right (RV) ventricular diastolic dysfunction in SSc patients. Prospective. Thirty-five consecutive SSc patients (49 ± 14 years) and 35 sex- and age-matched healthy controls (48.6 ± 13.5 years) who underwent TTE and MRI in the same week. 5 T/PC-MRI using a breath-hold velocity-encoded gradient echo sequence. LV TTE (E/E') and LV and RV PC-MRI indices of diastolic function (LV early and late transmitral [EM , EfM , AM , AfM ] and RV transtricuspid [ET , EfT , AT , AfT ] peak filling flow velocities and flow rates, as well as LV [ ] and RV [ ] peak longitudinal myocardial velocities during diastole) were measured. Two-tailed t-test, Wilcoxon test, or Fischer test for comparison of variables between SSc and healthy control groups; sensitivity, specificity, receiver-operating-characteristic (ROC) area under the curve (AUC) to assess discriminative ability of variables. A P-value <0.05 was considered statistically significant. TTE LV E/E' and MRI EM / and ET / were significantly higher in SSc patients than in controls (8.27 ± 1.25 vs. 6.70 ± 1.66; 9.43 ± 2.7 vs. 6.51 ± 1.50; 6.51 [4.70-10.40] vs. 4.13 [3.22-5.75], respectively) and separated SSc patients and healthy controls with good sensitivity (68%, 71%, and 80%), specificity (85%, 94%, and 62%), and AUC (0.787, 0.807, and 0.765). LV EfM was significantly higher in SSc patients than in controls (347.1 ± 113.7 vs. 284.7 ± 94.6) as RVAfT (277 [231-355] vs. 220 [154-253] mL/sec) with impaired relaxation pattern (EfT /AfT , 0.95 [0.87-1.21] vs. 1.12 [0.93-1.47]). MRI was able to detect LV and RV diastolic dysfunction in SSc patients with good accuracy in the absence of LV systolic dysfunction at echocardiography. Use of MRI can allow to better assess the early impact of myocardial fibrosis related to SSc. 1 TECHNICAL EFFICACY STAGE: 2.

Evaluation of diastole by echocardiography for detecting early cardiac dysfunction: an outcome study.

AimsTimely detection of subclinical left ventricular diastolic dysfunction (LVDDF) is of importance for precise risk stratification of asymptomatic subjects. Here, we evaluated the prevalence of LVDDF and its prognostic significance in the general population using two grading approaches: the 2016 ASE/EACVI recommendations and population‐derived, age‐specific criteria.Methods and resultsWe randomly recruited 1407 community‐dwelling participants (mean age, 51.2 years; 51.1% women; 53.5% with cardiovascular risk factors). We measured left heart dimensions, strain, tricuspid regurgitation, transmitral blood flow, and mitral annular tissue velocities using conventional echocardiography and Doppler imaging. We utilized these measurements to grade of LVDDF according to the 2016 recommendations and population‐derived, age‐specific approach. According to the 2016 recommendations, 26 subjects (1.85%) were classified as having the advanced stage (Grade 2), whereas in 109 participants (7.75%) diastolic function was indeterminate. When applying the population‐derived criteria, the prevalence of advanced LVDDF was 17.9% (n = 252). During the follow‐up period (8.4 years), 100 participants experienced adverse cardiac events. After full adjustment, we did not observe any significant differences in the risk of events between subjects with indeterminate or any grade of LVDDF and subjects with normal diastolic function when classified according to the 2016 recommendation (P ≥ 0.25). In contrast, the adjusted risks of adverse cardiac events (HR = 1.28; P = 0.0045) were significantly elevated in participants with LVDDF when classified according to the population‐derived criteria.ConclusionsOur study underscored the importance of considering age‐ and population‐derived thresholds in LVDDF grading in subjects at high cardiovascular risk which led to a better risk stratification and outcome prediction.

Assessment of Subclinical Left Ventricular Systolic and Diastolic Dysfunction in Patients with Type 1 DM with and without Good Metabolic Control

Background: Diabetic patients with normal left ventricular ejection fraction (LVEF)are frequently associated with diastolic dysfunction. However, LVEF is known not to be a sensitive marker for the detection of subclinical LV systolic dysfunction. This study aimed to assess left ventricular systolic and diastolic function in asymptomatic type 1 diabetic patients by conventional, tissue Doppler and two-dimensional speckle tracking echocardiography to assess subclinical left ventricular systolic and diastolic dysfunction.&#x0D; Methods: Case-control study was conducted at 150 patients aged 15-35 y were subdivided into three equal groups: Group A: with type 1 diabetes mellitus (T1DM) with good metabolic control (Hb A1C &lt;7.0), Group B: T1DM with poor metabolic control (Hb A1C&gt;7.0), and Group C: Control group: included 50 normal healthy subjects.&#x0D; Results: Tissue Doppler, diastolic function and strain parameters, AP4C LS, AP2C LS, AP3C LS, and GLS were significantly impaired among the three groups. AP4C LS, AP2C LS, AP3C LS, and GLS were significantly lower in group B than group A and group C and was significantly lower in group A than group C, A velocity was significantly impaired among the three groups. A velocity was significantly higher in group B than group A and group C and was insignificantly impaired in group A than group C.&#x0D; Conclusion: Conventional echocardiography parameters were insignificantly different between the study groups. 2D speckle tracking and tissue Doppler echocardiography showed that subclinical left ventricular systolic function may be affected even before affection of diastolic function. Longer duration and poor glycemic control of diabetes significantly affect GLS.

Mean and Variability of Lipid Measurements and Risk for Development of Subclinical Left Ventricular Diastolic Dysfunction.

BackgroundSubclinical left ventricular diastolic dysfunction (LVDD) is an emerging consequence of increased insulin resistance, and dyslipidemia is one of the few correctable risk factors of LVDD. This study evaluated the role of mean and visit-to-visit variability of lipid measurements in risk of LVDD in a healthy population.MethodsThis was a 3.7-year (interquartile range, 2.1 to 4.9) longitudinal cohort study including 2,817 adults (median age 55 years) with left ventricular ejection fraction >50% who underwent an annual or biannual health screening between January 2008 and July 2016. The mean, standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average real variability of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein B (apoB), non-HDL-C, and triglycerides were obtained from three to six measurements during the 5 years preceding the first echocardiogram.ResultsAmong the 2,817 patients, 560 (19.9%) developed LVDD. The mean of no component of lipid measurements was associated with risk of LVDD. CV (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.10 to 1.67), SD (HR, 1.27; 95% CI, 1.03 to 1.57), and VIM (HR, 1.26; 95% CI, 1.03 to 1.55) of LDL-C and all the variability parameters of apoB were significantly associated with development of LVDD. The association between CV-LDL and risk of LVDD did not have significant interaction with sex, increasing/decreasing trend at baseline, or use of stain and/or lipid-modifying agents.ConclusionThe variability of LDL-C and apoB, rather than their mean, was associated with risk for LVDD.

Characteristics of Myocardial Perfusion in Type 2 Diabetes Mellitus and Its Association with Left Ventricular Diastolic Dysfunction: A Study of Myocardial Contrast Echocardiography.

BackgroundDiabetic cardiomyopathy (DCM) will gradually progress to heart failure without intervention. The timely identification of left ventricular diastolic dysfunction (LVDD) in the early stage and active intervention helps delay the onset of heart failure. Although myocardial contrast echocardiography (MCE) allows an accurate evaluation of myocardial perfusion (MP), the characteristics of MP in early-stage or even sub-clinical LVDD are still unclear.ObjectiveThis study aims to reveal the characteristics of MP in asymptomatic and normotensive patients with type 2 diabetes mellitus (T2DM) using MCE and investigate its association with LVDD development.MethodsA total of 327 T2DM patients were retrospectively analyzed. Patients diagnosed with LVDD were included in the LVDD+ group (n = 76), and those with normal left ventricular diastolic function were included in the LVDD– group (n = 251). The clinical characteristics, general echocardiographic findings, and MCE parameters were compared between the two groups. The accuracy of MCE parameters in the diagnosis of LVDD and their correlations with characteristics of T2DM were evaluated.ResultsIn the LVDD+ group, the A×β (derived from the replenishment curve of MCE, presenting myocardial blood flow) was significantly lower, and the HbA1c and diabetes duration were significantly higher compared to the LVDD– group (all P < 0.05). The decrease of A×β helped warn the occurrence of LVDD although it was not suitable for the independent diagnosis of LVDD (AUC = 0.745). A×β was negatively correlated with diabetes duration and HbA1c (r = −0.350 and −0.226, both P < 0.001).ConclusionMCE was feasible for detecting MP abnormalities in asymptomatic T2DM patients. Although the A×β values of T2DM patients with subclinical LVDD were better than those with diagnosed LVDD, it impaired with the increase of HbA1c and diabetes duration. It suggested that MCE might be useful for monitoring glycemic control in T2DM patients with DCM.

Proteome analysis demonstrates involvement of endoplasmic reticulum stress response in human myocardium with subclinical left ventricular diastolic dysfunction.

Heart failure is increasing in Japan, in particular that with preserved ejection fraction (HFpEF) prevalent in older-aged patients. The purpose of this study was to investigate the pathophysiology during the early stage of left ventricular (LV) diastolic dysfunction by the quantitative proteome analysis of human myocardium. Among 331 post-mortem autopsy patients, we selected 23 patients (aged 79 ± 9.6 years) with echocardiographic data and without major comorbidities, except hypertension. Cryopreserved autopsy tissue of the LV myocardium was subjected to proteome analysis. LV diastolic function was evaluated by echocardiographic data. Thirteen patients were classified into the impaired diastolic function (IDF) group, and 10 the normal cardiac function group. We performed comparative proteome analysis between the IDF and normal groups by isobaric tags for relative and absolute quantitation (iTRAQ) using nano-liquid chromatography-tandem mass spectrometry. The iTRAQ-based proteome analysis revealed 57 differentially expressed proteins in the IDF group. Molecular network analysis of differentially expressed proteins indicated that endoplasmic reticulum (ER) stress was a potentially important event. Furthermore, the expressions of proteins associated with the ER stress response, such as glucose-regulated protein 78 kDa, inositol-requiring kinase 1α and spliced X-box binding protein 1, were significantly decreased in the IDF group. This study suggested that reduced ER stress responses were involved during the early stage of LV diastolic dysfunction. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; 21: 577-583.

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.

Effect of Sodium Valproate on Cardiac Function in Epileptic Children by Tissue Doppler Echocardiography

The antiepileptic Valproic acid (VPA) changes the oxidative/ anti-oxidative balance that results in oxidative stress and maybe an increased risk of cardiac dysfunction. The aim of this study was to investigate the effect of VPA on ventricular function in epileptic children. We designed a study to evaluate ventricular function in epileptic children who had received VPA for at least one year. All subjects were evaluated using standard echocardiography, pulsed wave Doppler (PWD), and tissue Doppler imaging (TDI). This study consisted of 60 patients with epilepsy (mean age 10.30±3.21 years) and 60 healthy subjects in the control group (mean age 10.28±3.18 years). The duration of antiepilepsy medication ranged from 1.4 to 10 years, and the dose of VPA was 5-30 mg/kg. The ejection fraction and fractional shortening (P=0.841 and 0.064, respectively) were not significantly different between the two groups. The present study reports subclinical right and left ventricular systolic and diastolic dysfunction along with longitudinal ventricular motion disorder. It is recommended the evaluation of subclinical cardiac dysfunction in children treated by VPA.

P279 Subclinical left ventricular dysfunction in patients with insulin resistence and hypovitaminosis D

Abstract Introduction Patients with subclinical left ventricular diastolic and systolic dysfunction are at risc of future cardiac events. Insulin resistance (IR) has been reported to be a strong risk factor for cardiovascular disease (CVD). Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction and vitamin D deficiency is also associated with increased risk of CVD, including hypertension, heart failure, and ischemic heart disease. Aim The aim has been to explore association of IR and vitamin D deficiency with subclinical left ventricular disfunction. Method The study consisted of 79 patients divided into two groups according IR, evaluated at baseline by the homeostasis model assessment method (HOMA-IR). v The HOMA1-IR index was calculated by the formula: HOMA1-IR = fasting plasma insulin (µU/ml) x fasting plasma glucose (mmol/L). The HOMA2-IR index was obtained by the program HOMA Calculator (free) download Windows version. The cut-off values for IR were: HOMA1-IR &amp;gt; 2.7 and HOMA2-IR &amp;gt; 1.8; group of 41 patients, and group od 38 patients without of IR. Parameters of left atrial and ventricular geometry were estimated by echocardiography. Tissue Doppler velocities were measured from medial and lateral annulus (e, a, s) including isovolumic contraction velocity (IVCv) and E/e Global longitudinal strain (GLS) was derived from two-dimensional speckle-tracking. Results In IR group level of 25-OH-D was deficient in 25 (61.2%), insufficient in 10 (25%) and sufficient in 6 (13.8%) patients and significantly lower compared to control group (46.8 ± 25.5 vs 61.5 ± 33.8, p &amp;lt; 0.001). Importantly, 25-OH-D was associated with global longitudinal strain (r= −0.21, &amp;lt;0.05). Values of GLS (-19.9 ± 2.8 vs -26.6 ± 2.9; p &amp;lt; 0.001) and IVCv (0.07 ± 0.02m/s vs 0.09 ± 0.03m/s; p &amp;lt; 0.05) were significantly lower and E/e (9.11 ± 2.24 vs 7.18 ± 1.65; p &amp;lt; 0.001) significantly higher in group of patients with IR. Conclusion The results showed that insulin resistence is asociated with subclinical LV diastolic and systolic dysfunction. Level of 25-OH-D was significantly lower in patients with insulin resistence suggests that vitamin D deficiency may have a certain contribution to the development of myocardial dysfunction in these patients. Fortunately insulin resistance and vitamin D deficiency are a modifiable risk factors; the reduction of insulin resistance and increase the level of 25-OH-D may reduce CV risk in this group of patients.

The presystolic wave was not sufficient for diagnosing subclinical left ventricular diastolic dysfunction in hemodialysis patients

Purpose: In hemodialysis patients, detection of left ventricul diastolic dysfunction as early as possible is critically important. The presystolic wave occurs in the left ventricul outflow tract and it’s associated with left ventricul stiffness and compliance. The aim of this study was to evaluate the clinical significance of presystolic wave in the detection of diastolic dysfunction in hemodialysis patients. Materials and Methods: In this cross-sectional study, eighty hemodialysis patients and 88 healthy controls were included in the study. The laboratory parameters were tested before the dialysis. The conventional B-mode, pulsed doppler parameters, doppler tissue-imaging, and presystolic wave measurements were performed at echocardiography. Results: Presystolic wave was detected in 46.0% of patients and 18.1% of the control group. There was no statistically significant difference between patients in terms of MPI, mitral E and A wave velocity, E/A and e’/a’ ratio, deceleration time, septal a’ and e’ wave velocity, and Sao in either presence or absence of presystolic wave. In the univariate model, higher Eao velocity and septal E/e’ ratio, and reduced duration of hemodialysis were determined as risk factors for the presence of presystolic wave.Conclusion: The assessment of presystolic wave on echocardiography examination may provide important information about the left ventricul diastolic function. But we have demonstrated in this study that presystolic wave is not entirely associated with left ventricul diastolic dysfunction in hemodialysis patients.

Left ventricular systolic dysfunction potentially contributes to the symptoms in heart failure with preserved ejection fraction.

Left ventricular diastolic dysfunction (LVDD) is considered a key factor associated with heart failure (HF) symptoms in patients with preserved ejection fraction (HFpEF). However, LV systolic performance, including LV systolic function and synchrony, has not been well characterized in these patients. The aims of this study were to assess to investigate the underlying relationship and differences between subclinical LVDD and HFpEF. Eighty-six patients with LVDD were recruited (58 with HFpEF and 28 with subclinical LVDD). Systolic left ventricular (LV) longitudinal strain (LS), systolic longitudinal strain rate (LSrS), early diastolic longitudinal strain rate (LSrE), and late diastolic longitudinal strain rate (LSrA) were measured using speckle tracking echocardiography. LV diastolic and systolic dyssynchrony (Te-SD and Ts-SD) were calculated. Forty age- and sex-matched healthy individuals were enrolled as a control group. LV global LS and LSrS were decreased in patients with HFpEF than in normal controls and subclinical LVDD patients (P<.05). Te-SD and Ts-SD were significantly more prolonged in subclinical LVDD and HFpEF patients than in the control group (P<.05). Reduced LS was associated with HF symptoms in LVDD patients, and a cutoff value of -18% for LS could differentiate HFpEF from subclinical LVDD with 73% sensitivity and 69% specificity. LV systolic function and mechanical dyssynchrony were impaired in HFpEF patients. Deteriorated LV longitudinal systolic function was likely correlated with the symptoms of HFpEF.

Assessment of Left Ventricular Diastolic Dysfunction by 2D Speckle Tracking in Hemodialysis Patients

Background: Diastolic dysfunction is widespread among patients on dialysis and is associated with increased morbidity and mortality. Echocardiographic speckle tracking strain rate analysis may allow assessment of left ventricular diastolic function. Objectives: The purpose of this study was aimed to test the capability of speckle tracking diastolic strain rate to assess the clinical and subclinical left ventricular diastolic dysfunction in end stage renal disease patients who are on dialysis. Subjects and Methods: This prospective study included a total of 45 subjects, 30 of them were on dialysis, attending at the Outpatient Clinic, Department of Cardiology, Faculty of Medicine, Al-Azhar University Hospital and Nasr City Police Hospital. The included subjects were divided into three groups; Group (A) included fifteen healthy control subjects, Group (B) included fifteen patients with dialysis with normal diastolic function and Group (C) included fifteen patients with dialysis with diastolic dysfunction. Results: No significant differences were observed between control subjects and study population as regard age, sex, DM, smoking and Dyslipidemia. In the current study, comparison between the three groups revealed statistically significant difference in mean values of HTN. Comparison between the three groups revealed highly statistically significant differences in echocardiographic parameters that included E/A, E/e, LA volume, TR velocity and speckle tracking diastolic strain rate used in evaluation of Diastolic function “ P value 0.001 ”. Conclusion: Two-dimensional speckle tracking could be used in assessment of diastolic dysfunction among people on dialysis dependent on speckle tracking diastolic strain rate.

Assessment of Left Ventricular Diastolic Dysfunction by 2D Speckle Tracking in Hemodialysis Patients

Background: Diastolic dysfunction is widespread among patients on dialysis and is associated with increased morbidity and mortality. Echocardiographic speckle tracking strain rate analysis may allow assessment of left ventricular diastolic function. Objectives: The purpose of this study was aimed to test the capability of speckle tracking diastolic strain rate to assess the clinical and subclinical left ventricular diastolic dysfunction in end stage renal disease patients who are on dialysis. Subjects and Methods: This prospective study included a total of 45 subjects, 30 of them were on dialysis, attending at the Outpatient Clinic, Department of Cardiology, Faculty of Medicine, Al-Azhar University Hospital and Nasr City Police Hospital. The included subjects were divided into three groups; Group (A) included fifteen healthy control subjects, Group (B) included fifteen patients with dialysis with normal diastolic function and Group (C) included fifteen patients with dialysis with diastolic dysfunction. Results: No significant differences were observed between control subjects and study population as regard age, sex, DM, smoking and Dyslipidemia. In the current study, comparison between the three groups revealed statistically significant difference in mean values of HTN. Comparison between the three groups revealed highly statistically significant differences in echocardiographic parameters that included E/A, E/e, LA volume, TR velocity and speckle tracking diastolic strain rate used in evaluation of Diastolic function “ P value 0.001 ”. Conclusion: Two-dimensional speckle tracking could be used in assessment of diastolic dysfunction among people on dialysis dependent on speckle tracking diastolic strain rate.

Stress echocardiography for left ventricular diastolic dysfunction detection in patients with non-severe chronic obstructive pulmonary disease: a cross-sectional study

AimTo assess whether the simultaneous performance of exercise stress echocardiography and cardio-pulmonary testing (ESE-CPET) may facilitate the timely diagnosis of subclinical left ventricular diastolic dysfunction (LVDD) in patients with non-severe chronic obstructive pulmonary disease (COPD), preserved left ventricular systolic function, and exertional dyspnea or exercise intolerance.MethodsThis cross-sectional study, conducted between May 2017 and April 2018, involved 104 non-severe COPD patients with exertional dyspnea and preserved ejection fraction who underwent echocardiography before CPET and 1-2 minutes after peak exercise. Based on the peak E/e’ ratio, patients were divided into the group with stress-induced LVDD – E/e’>15 and the group without stress-induced LVDD. We assessed the association between LVDD and the following CPET variables: minute ventilation, peak oxygen uptake (VO2), ventilatory efficiency, heart rate reserve, and blood pressure.ResultsDuring ESE-CPET, stress-induced LVDD occurred in 67/104 patients (64%). These patients had lower work load, peak VO2, O2 pulse, and minute ventilation (VE), and higher VE/VCO2 slope than patients without stress-induced LVDD (35.18 ± 10.4 vs 37.01 ± 11.11, P < 0.05). None of the CPET variables correlated with E/e’.ConclusionCombined ESE-CPET may distinguish masked LVDD in patients with non-severe COPD with exertional dyspnea and preserved left ventricular systolic function. None of the CPET variables was a predictor for subclinical LVDD.