Systolic Variability Research Articles

Seismocardiography and echocardiography: the correlation in the systolic complex

Aim. This study aimed to investigate the correlation between seismocardiographic and echocardiographic systolic variables and whether a decrease in preload could be detected by the seismocardiography (SCG). Methods. This study included a total of 34 subjects. SCG and electrocardiography were recorded simultaneously followed by echocardiography (echo) in both supine and 30◦ head-up tilted position. The SCG signals was segmented into individual heartbeats and systolic fiducial points were defined using a detection algorithm. Statistical analysis included correlation coefficient calculations and paired sample tests. Results. SCG was able to measure a decrease in preload by almost all of the examined systolic SCG variables. It was possible to correlate certain echo variables to SCG time intervals, amplitudes, and peak to peak intervals. Also, changes between supineand tilted position of some SCG variables were possible to correlate to changes in echo variables. LVET, IVCT, S’, strain, SR, SV, and LVEF were significantly correlated to relevant SCG variables. Conclusion. This study showed a moderate correlation, between systolic echo and systolic SCG variables. Additionally, systolic SCG variables were able to detect a decrease in preload.

VITAMIN D AND INDICATORS OF AMBULATORY BLOOD PRESSURE MONITORING IN WOMEN WITH ARTERIAL HYPERTENSION IN THE EARLY POSTMENOPAUSAL PERIOD

Objective: To assess plasma 25(OH)D levels and indicators of ambulatory blood pressure monitoring (ABPM) in women with arterial hypertension (AH) stage II risk 3 in the early postmenopausal period. Design and method: We investigated 52 women with AH stage II risk 3 aged 52 (50; 54) years of age who are in the early postmenopausal period - group I. Serum level of 25(OH)D was determined by the immunoenzymatic assay. The level of 25(OH)D in the blood plasma was determined by enzyme immunoassay. In group I we identified subgroup IB (n=21) with vitamin D deficiency/insufficiency - level of 25(OH)D<30ng/ml and subgroup IA (n=31) without vitamin D deficiency. ABPM was carried out with a Watch BP 03. Statistical analysis was performed by means of «STATISTICA 10.0». Results: The level of 25(OH)D was lower (p<0,05) in subgroup IB (18,2±9,5 ng/ml) than in the comparable to subgroup IA (27,4±10,5 ng/ml). In subgroup IB, compared with subgroup IA, the values of mean night diastolic (DBP) were higher (p<0,05) (73,0 (69,0;79,0) mm Hg versus 68,8±7,4 mm Hg), time index (TI) DBP at night (14,3 (12,5; 33,4)%, versus 12.5 (0,0;12,5)%,), speed of morning rise DBP (16,5(11,0;22,0) mm Hg/hour versus 10,0(8,5;17,3) mm Hg/hour), systolic variability (SBP) during the day (36,0(29,0;43,0) mm Hg versus 25,0(22,0; 38,0) mmHg). TI DBP at night exceeded the threshold value in 42,9% of women in subgroup IB versus 17,2% (p< 0,05) of subjects in subgroup IA. Morning rise speed DBP in subgroup IB did not correspond to the norm in 81% of cases compared to subgroup IA – 37,9% (p = 0,004). Inverse moderate correlations were established in subgroup IB between the level of 25(OH)D in the blood plasma and a number of ABPM indicators: average night SBP (R =-0,37, p=0,004), TI SBP night (R=-0,42, p=0,04), average night DBP (R=-0,43, p=0,03), TI DBP night (R=-0,39, p=0,05). Conclusions: In women with AH stage II risk 3 in the early postmenopausal period, with a deficiency/insufficiency of the level of 25(OH)D in the blood plasma, excess of a number of ABPM indicators was more common than with its optimal level.

Hyperoxia-induced deterioration of diastolic function in anaesthetised patients with coronary artery disease – Randomised crossover trial

BackgroundThere are no current recommendations for oxygen titration in patients with stable coronary artery disease. This study investigates the effect of iatrogenic hyperoxia on cardiac function in patients with coronary artery disease undergoing general anaesthesia. MethodsPatients scheduled for elective coronary artery bypass graft surgery were prospectively recruited into this randomised crossover clinical trial. All patients were exposed to inspired oxygen fractions of 0.3 (normoxaemia) and 0.8 (hyperoxia) in randomised order. A transoesophageal echocardiographic imaging protocol was performed during each exposure. Primary analysis investigated changes in 3D peak strain, whereas secondary analyses investigated other systolic and diastolic responses. ResultsThere was no statistical difference in systolic function between normoxaemia and hyperoxia. However, the response in systolic function to hyperoxia was dependent on ventricular function at normoxaemia. Patients with a normoxaemic left ventricular (LV) global longitudinal strain (GLS) poorer than the derived cut-off (>–15.4%) improved with hyperoxia (P<0.01), whereas in patients with normoxaemic LV-GLS <–15.4%, LV-GLS worsened with transition to hyperoxia (P<0.01). The same was seen for right ventricular GLS with a cut-off at –24.1%. Diastolic function worsened during hyperoxia indicated by a significant increase of averaged E/e′ (8.6 [2.6]. vs 8.2 [2.4], P=0.01) and E/A ratio (1.4 (0.4) vs 1.3 (0.4), P=0.01). ConclusionsAlthough the response of biventricular systolic variables is dependent on systolic function at normoxaemia, diastolic function consistently worsens under hyperoxia. In coronary artery disease, intraoperative strain analysis may offer guidance for oxygen titration. Clinical trial registrationNCT04424433.

Abstract P011: Blood Pressure Postural Changes Variability Is Associated With Cognitive Decline: The S.ages Cohort

Introduction: Over the past decade, higher blood pressure (BP) variability has been associated with cognitive decline (CD). To date, only one study investigated the specific impact of visit-to-visit BP postural changes variability on dementia but its association with cognition is still unknown. We aimed to investigate the association between BP postural changes variability and cognitive function in noninstitutionalized subjects aged ≥ 65 years. Methods: The S.AGES (Sujets Å;gés) cohort followed for three years noninstitutionalized subjects aged ≥ 65 years without major neurocognitive impairment at inclusion. At each visit, an orthostatic systolic BP (SBP) ratio was calculated using the formula (sitting SBP/standing SBP) x 100. An orthostatic diastolic BP ratio was computed using the same method. Subjects with a SBP ratio &gt; 100% had sitting SBP &gt; standing SBP. We assessed the visit-to-visit BP postural changes variability according to several indicators: standard deviation, coefficient of variation (CV), variation independent of mean, residual standard deviation, average real variability, and successive variation. Cognitive performances were evaluated using the Mini-Mental State Examination. Linear mixed models were used for the analyses. Results: We included 2,974 subjects (mean age 78 years, women 56%). After adjustment for age, sex, education, baseline body mass index, smoking, alcohol intake, atrial fibrillation, congestive heart failure, transient ischemic attack or stroke, coronary artery disease, type 2 diabetes, dyslipidemia, seated SBP/DBP and antihypertensive treatment, greater visit-to-visit systolic BP postural changes variability was significantly associated with CD over time (adjusted β [95% CI] = -0.17 [-0.29; -0.06], p= 0.004 for CV). Similar results were found for visit-to-visit diastolic BP postural changes variability (adjusted β [95% CI] = -0.14 [-0.25; -0.03], p= 0.017 for CV). Conclusion: Greater visit-to-visit BP postural changes variability was associated with CD. Further studies are needed to assess whether controlling orthostatic BP instability over time could be a promising interventional target to preserve cognition among older adults.

Abstract 16476: Visit-to-Visit Blood Pressure Variability is Associated With Incident Frailty: The Multidomain Alzheimer Preventive Trial (MAPT)

Introduction: Visit-to-visit blood pressure variability (BPV) has been associated with greater cardiovascular and all-cause mortality, cognitive impairment, and incident dementia. It may also represent a decline in homeostatic mechanisms in blood pressure (BP) regulation associated with frailty, one of the most problematic expression of population aging. Hypothesis: We hypothesized that visit-to-visit systolic (SBPV), diastolic (DBPV), mean arterial (MAPV) and pulse pressure (PPV) variability are associated with greater incident frailty. Methods: We included 1,394 non-frail community-dwelling participants aged ≥ 70 years from the Multidomain Alzheimer Preventive Trial (MAPT) who underwent repeated clinical examinations over a 5-year follow-up period. SBPV, DBPV, MAPV and PPV were evaluated using standard deviation, coefficient of variation (CV), average real variability, successive variation, variation independent of mean and residual standard deviation. Incident frailty was assessed using the Fried phenotype. Cox proportional hazards models were used for the analyses. Results: Higher SBPV was significantly associated with increased risk of incident frailty (1-sd increase of CV: HR = 1.18, 95% CI [1.02-1.37], p=0.03) after adjustment for demographics, body mass index, stroke, ischemic heart disease, diabetes, heart failure, antihypertensive drugs, systolic BP, MAPT intervention groups and baseline pre-frail status. Similar results were observed with all indicators of variability. DBPV and MAPV were not associated with incident frailty (p=0.6 and p=0.2, respectively). Interestingly, higher PPV was also associated with a greater risk of developing frailty over time (1-sd increase of CV: HR = 1.17, 95% CI [1.01-1.35], p=0.03). Conclusion: Independently of BP, higher SBPV and PPV are major clinical predictors of incident frailty. Our findings support the concept of BP physiological dysregulation underlying the frail state and suggest that controlling BP instability could be a promising interventional target in preventing frailty.

Blood Pressure-Lowering Profiles and Clinical Effects of Angiotensin Receptor Blockers Versus Calcium Channel Blockers.

Blood pressure-lowering drugs have different blood pressure-lowering profiles. We studied if differences in blood pressure mean and variability can explain the differences in risks of cardiovascular events and death among 15 245 high-risk hypertensive patients randomized to valsartan or amlodipine and followed for 4.2 years in the VALUE trial (Valsartan Antihypertensive Long-Term Use Evaluation). We selected patients with ≥3 visits and performed Cox regression analyses, defining mean blood pressure as a time-dependent covariate and visit-to-visit and within-visit blood pressure variability as the SD. Of 14 996 eligible patients, participants in the valsartan group had higher systolic mean blood pressure by 2.2 mm Hg, higher visit-to-visit systolic variability by 1.4 mm Hg, and higher within-visit systolic variability by 0.2 mm Hg (P values <0.0001). The higher risks of myocardial infarction and stroke in the valsartan group was attenuated after adjustment for mean and variability of systolic blood pressure, from HR 1.19 (95% CI, 1.02-1.39) to 1.11 (0.96-1.30) and from HR 1.13 (0.96-1.33) to 1.00 (0.85-1.18), respectively. The lower risk of congestive heart failure in the valsartan group was accentuated after adjustment, from HR 0.86 (0.74-1.00) to 0.76 (0.65-0.89). A smaller effect was seen on risk of death, from 1.01 (0.92-1.12) to 0.94 (0.85-1.04). In conclusion, the higher risks of myocardial infarction and stroke in patients randomized to valsartan versus amlodipine were related to the drugs' different blood pressure modulating profiles. The risk of congestive heart failure with valsartan was lower, independent of the less favorable blood pressure modulating profile.

Blood Pressure measurements are site dependent in a cohort of patients with neurological illness

Blood pressure (BP) management is a crucial part of critical care that directly affects morbidity and mortality. While BP has become a mainstay in patient care, the accuracy and precision of BP measures across commonly used sites (left upper arm, right upper arm, etc.) and methods have not been established. This study begins to fill this gap in literature by testing the null hypothesis that BP measurement does not vary according to site. This is a prospective, non-randomized, cross-sectional study of 80 neurocritical care unit patients. Near simultaneous non-invasive blood pressure (NIBP) readings from 4 different locations (bilateral upper arm, bilateral wrist) and, when available, intra-arterial blood pressure readings (IABP) were included. Pearson correlation coefficients and one-way repeated measures ANOVA were used to observe the systolic, diastolic, and mean arterial pressure (MAP) correlations. The BP measured at the four most common sites (left upper arm, left wrist, right upper arm, right wrist) had adequate correlation coefficients but were statistically significantly different and highly unpredictable. The median inter-site systolic variability was 10 mmHg (IQR 2 to 10 mmHg). The median inter-site MAP variability was 6mmHg with an interquartile range (IQR) of 3 to 9 mmHg. As expected, the values correlated to show that patients with high BP in one site tended to have high BP in another site. However, the unpredictable inter-site variability is concerning within the clinical setting where oftentimes BP measurement site is not standardized but resulting values are nevertheless used for treatment. There is prominent inter-site variability of BP measured across the 4 most common measurement sites. The variability persists across non-invasive (NIBP) and invasive (IABP) methods of assessment.

High frequency of nocturnal hypertension in lupus nephritis: should ABPM be implemented in usual practice?

Hypertension management in lupus nephritis (LN) is guided by in-office blood pressure (BP); however, recent studies demonstrate that lupus patients frequently have nocturnal hypertension and reduced BP dipping. The aim of the study was to evaluate 24-h blood pressure in patients with active LN and after response to treatment. Seventy active LN patients were evaluated during a LN flare by ambulatory blood pressure monitoring (ABPM). Later, 10 patients with complete response were re-evaluated after 12 months along with 20 matched controls. Overall, daytime and nightime BP, day-to-night dipping, BP load and variability, and the incidence of abnormal BP patterns were assessed. Blood pressure levels were correlated with clinical and histologic parameters and independent associations evaluated by linear regression. Overall systolic hypertension occurred in 25 (36%) patients and diastolic hypertension in 28 (40%). Nighttime systolic and diastolic hypertension occurred in 35 (50%) and 44 (63%) of patients, respectively. Nocturnal systolic day-to-night BP decrease was abnormal in 59 (84%) patients. Only 18 (26%) were diagnosed with HT by in-office evaluation while 29 (41%) had masked hypertension (MH)/masked uncontrolled hypertension (MUCH), and 3 (4%) had white coat hypertension. Patients with MH had lower eGFR, complement C3, hemoglobin, and higher systolic variability compared with patients with normal BP. Systolic and diastolic BP levels were associated with the years under corticosteroid treatment, activity biomarkers (proteinuria, complement C3), and the degree of interstitial inflammation in the kidney biopsy. A re-evaluation at 12 months showed that although 9 out of 10 patients had normal in-office BP and BP loads improved, still 5 patients remained with MH due to nocturnal hypertension, and 7 remained with abnormal day-to-night dipping. These numbers were higher than those of matched controls. Due to the high frequency of nocturnal hypertension and abnormal day-to-night dipping, office BP measurements alone may not be sufficient to guide hypertension management in patients with LN.Key Points• Nocturnal hypertension and abnormal BP patterns are frequent and not detectable by the standard in-office BP evaluation in LN patients.• BP abnormalities may not be fully corrected after a complete clinical response to treatment in lupus nephritis and are only detectable by ABPM.• The degree of interstitial inflammation in the kidney biopsy in LN patients is associated to BP levels. This supports the hypotheses underlining the role of interstitial inflammation in salt sensitivity and hypertension.

Atorvastatin influence on cardiac function and rhythm variability in patients with chronic lymphocytic leukemia in remission

Purpose – to evaluate atorvastatin influence on cardiac hemodynamics and rhythm variability in patients with chronic lymphocytic leukemia (CLL) in remission.Materials and methods. One hundred fifty-seven subjects with chronic lymphocytic leukemia in full or partial remission were enrolled in the study. Atorvastatin at doses 20 mg/d and 40 mg/d were prescribed for patients with hypercholesterinemia, dyslipidemia, coronary artery disease risk factors. All patients and control subjects underwent echocardiography, and 24-hour Holter monitoring with continuous time-dependent and spectral analysis of heart rate variability at baseline, after 1 year and after 3 years of observation period. Cardiovascular events were evaluated for 3 years observation period.Results. In one year after reaching remission of CLL in comparing with baseline there is a statistical decrease in E (0.98 ± 0.15 м/с and 0.89 ± 0.16 м/с; P < 0.001), A (0.98 ± 0.16 м/с and 0.92 ± 0.15 м/с; p=0.023). E/A (P = 0.011) were significantly lower in group of patients without atorvastatin treatment (P = 0.011) and in group treated with atorvastatin in dose 20 mg a day (P = 0.002). In three year EF decreased in comparing with baseline (55.43 ± 4.75 % and 51.52 ± 6.40 % і; P = 0.009) in patients without atorvastatin treatment.In three year global circular systolic strain (-17.42 ± 3.24% and -16.78 ± 3.56 %; P = 0.035), global longitudinal systolic strain (-18.13 ± 2.15 % and -17.04 ± 2.07 %; P = 0.008), global longitudinal systolic strain rate (-1.03 ± 0.23с-1 and -0.91 ± 0.33с-1; P = 0.024) were significantly decreased in patients without atorvastatin treatment. The LF values of group of patients treated without atorvastatin of patients were significantly lower than those of controls, and HF values of patients with CLL (P = 0.043) and HNL (P = 0.04) were lower.Conclusions. Among patients with chronic lymphocytic leukemia in remission systolic and diastolic function, regional systolic contractility and variability of cardiac rhythm were significantly worse in three year especially in patients without atorvastatin treatment.

The degree of hepatic steatosis associates with impaired cardiac and autonomic function

Cardiovascular disease is the principle cause of death in patients with elevated liver fat unrelated to alcohol consumption, more so than liver-related morbidity and mortality. The aim of this study was to evaluate the relationship between liver fat and cardiac and autonomic function, as well as to assess how impairment in cardiac and autonomic function is influenced by metabolic risk factors. Cardiovascular and autonomic function were assessed in 96 sedentary individuals: i) non-alcoholic fatty liver disease (NAFLD) (n = 46, hepatic steatosis >5% by magnetic resonance spectroscopy), ii) Hepatic steatosis and alcohol (dual aetiology fatty liver disease [DAFLD]) (n = 16, hepatic steatosis >5%, consuming >20 g/day of alcohol) and iii) CONTROL (n = 34, no cardiac, liver or metabolic disorders, <20 g/day of alcohol). Patients with NAFLD and DAFLD had significantly impaired cardiac and autonomic function when compared with controls. Diastolic variability and systolic variability (LF/HF-sBP [n/1]; 2.3 (1.7) and 2.3 (1.5) vs. 3.4 (1.5), p <0.01) were impaired in patients with NAFLD and DAFLD when compared to controls, with DAFLD individuals showing a decrease in diastolic variability relative to NAFLD patients. Hepatic steatosis and fasting glucose were negatively correlated with stroke volume index. Fibrosis stage was significantly negatively associated with mean blood pressure (r = -0.47, p = 0.02), diastolic variability (r = -0.58, p ≤0.01) and systolic variability (r = -0.42, p = 0.04). Hepatic steatosis was independently associated with cardiac function (p ≤0.01); TNF-α (p ≤0.05) and CK-18 (p ≤0.05) were independently associated with autonomic function. Cardiac and autonomic impairments appear to be dependent on level of liver fat, metabolic dysfunction, inflammation and fibrosis staging, and to a lesser extent alcohol intake. Interventions should be sought to moderate the excess cardiovascular risk in patients with NAFLD or DAFLD. Increased levels of fat in the liver impair the ability of the cardiovascular system to work properly. The amount of fat in the liver, metabolic control, inflammation and alcohol are all linked to the degree that the cardiovascular system is affected.

The Blood Lead, Blood Pressure Connection: An Evaluation of Apparently Healthy Lead Exposed Workers in Nigeria

Objective: There is a paucity of evidence on the lead exposure and blood pressure association in Nigeria where lead exposure is still prevalent and poorly regulated. The objective of this study was to evaluate the association between lead exposure using blood lead level and blood pressure in Port Harcourt Nigeria. Methodology: A prospective cross sectional comparative study of adult subjects with occupational lead exposure and controls, performed in Port Harcourt, South-south Nigeria. Blood lead measured by atomic absorption spectrophotometry was used as the biomarker of lead exposure while systolic and diastolic blood pressures and other relevant variables were measured and analysed. Results: The mean systolic blood pressure was significantly higher in lead exposed subjects 118.49 (14.67) mmHg compared to controls 113.62 (11.31) mmHg (p = 0.008). No difference was observed in the mean diastolic blood pressure. A higher proportion of subjects had systolic and diastolic pressure > 140 mmHg and >90 mmHg compared to controls 9.47% vs. 1.25% and 10.51% vs. 2.54%, with (p = 0.016), OR = 8.27 , RR = 1.38 and (p = 0.028), OR = 4.59 , RR = 1.33 respectively. There was no significant statistical correlation between blood lead and blood pressure. Conclusion: The results of this study indicate a significant systolic blood pressure elevation and prevalence of hypertension among lead exposed workers in Port Harcourt Nigeria. Lager longitudinal research is needed to evaluate lead exposure and elevated blood pressure association in Nigeria. The findings call for better regulation of occupational lead exposure in Nigeria.

Evaluation of systolic and diastolic cardiac functions and heart rate variability in patients with juvenile myoclonic epilepsy

Purpose: To explore if patients with juvenile myoclonic epilepsy (JME) have differences in heart rate variability (HRV) associated with risk of arrhythmias and in systolic and diastolic functions. Method: This single-center prospective study included 50 patients with JME followed up at the out-patient clinic of epilepsy of Antalya Training and Research Hospital’s Neurology Department (34 female, mean age: 26±7.58 years) and 45 healthy controls (30 female, mean age: 26.71±5.14 years). Two patients were excluded since they had hypertension, one patient was excluded due to diabetes mellitus and one patient was excluded due to rheumatic mitral stenosis and 46 patients were included in the study. All patients and controls were evaluated by conventional echocardiography and Tissue Doppler Imaging (TDI) for systolic and diastolic functions (e.g. left ventricular ejection fraction, left ventricle diameters and volumes, deceleration time, pulmonary forward flows) and performing 24-hour holter monitoring to explore time domain (e.g. standard deviation of the normal-to-normal (NN) interval (SDNN), the square root of the mean squared differences of successive NN intervals (RMSSD)) and frequency domain parameters of HRV. Results: There were no significant differences between the holter parameters of the two groups with respect to HRV. Echocardiographic investigation did not reveal any significant differences except the ratio of pulmonary venous systolic and diastolic forward flows to one another (PVS/PVD) (p=0.008). Conclusions: In this study, we did not find anything else about cardiac involvement other than increased ratio of PVS/PVD and also we did not find autonomic dysfunction in patients with JME. This may be due to well seizure control.

Abstract P233: Blood Pressure Variability and Rhythmicity in Adolescents With Spurious Hypertension

Objective: Spurious hypertension (sHTN) is characterized by elevated systolic blood pressure (BP) in peripheral arteries but normal central BP. The BP variability and characteristics of BP rhythms in sHTN is unknown. We therefore analyzed BP variability and rhythmicity in adolescents with sHTN in comparison with other forms of hypertension (HTN). Patients and Methods: We studied 265 children (54 girls; 15.1 ±2.5 years) referred with arterial HTN, in whom secondary HTN was excluded. We assessed BP levels - office BP, ABPM, central systolic BP (cSBP), systolic BP average real variability (SBPARV) and mean MAP rhythmicity (amplitudes and acrophases). Anova with TukeyHSD post hoc test was used to compare groups. One tailed t-test was used to compare MAP amplitudes and acrophases with normative values for children with Bonferroni correction for multiple tests. Results: 115 subjects had white coat hypertension (WCH; office BP&gt;95 th perc+ABPM&lt;95 th perc), 25 had ambulatory prehypertension (preHTN; office BP&lt;95 th perc+ABPM&lt;95 th perc+ABPM load &gt;25%), 43 had sHTN (office BP+ABPM &gt;95th perc+cSBP&lt;95 th perc), 82 had true hypertension (tHTN; office BP+ABPM+cSBP &gt;95th perc. There were no significant differences between groups in age, weight and BMI. The median SBPARV was 8.87 in WCH, 8.63 in preHTN, 9.25 in sHTN and 9.28 in tHTN (not significantly different between groups). The prevalence of 24h rhythms ranged from 77 to 88%, not significantly from norms or among groups. The prevalence of 12h rhythms was not significantly different compared to norms and ranged from 50 to 60% (NS among groups). There were also no significant differences in the prevalence of 8h and 6h rhythms. All groups had significantly decreased 24h amplitudes compared to norms, but not significantly different among groups. There were no differences in 12h, 8h and 6 amplitudes between WCH, preHTN, sHTH, tHTN and norms. 24h acrophases were significantly prolonged in sHTN, 12h acrophases were significantly prolonged in preHTN, sHTN and tHTN. Conclusions: Adolescents with spurious hypertension have significantly lower prevalence of 24h rhythms, decreased 24h amplitudes and prolonged 24h and 12h acrophases suggesting increased sympathetic drive similarly to patients with other hypertensive phenotypes.

Extent of size, shape and systolic variability of the left ventricular outflow tract in aortic stenosis determined by phase-contrast MRI

PurposeLeft ventricular outflow tract (LVOT) dimensions are important for calculation of aortic valve areas and planning of valve repair. Mostly, LVOT areas are calculated from echocardiographic longitudinal measurements with the assumption of a round shape. Here, orthogonal phase contrast (PC) MRI with dynamic assessment of LVOT was compared to standard longitudinal cine MRI and 2D echocardiography. MethodsIn 19 patients with aortic stenosis (5 female; 69±10years), LVOT areas were determined on orthogonal PC images, either by planimetry (Aplan) or by two-diameter measurement (Aellip). Data were analyzed in early, middle and late systole (t1/t2/t3). Additionally, standard diameter-based calculation (A3CV) of LVOT on longitudinal three-chamber view (3CV) MRI images and 2D echocardiography was performed. ResultsCalculated PC LVOT areas strongly correlated to planimetry (r=0.95; p<0.001) with almost identical areas (Aplan 5.1±1.1cm2 vs. Aellip 5.3±1.0cm2). In PC changes of LVOT-eccentricity during systole were most pronounced in late systole (t1 vs. t3plan −7.4±18%). Cine 3CV calculation resulted in lower LVOT areas compared to Aplan (A3CV 3.7±0.9cm2; p<0.001), yet correlating to Aplan (r=0.66; p=0.002). 3CV LVOT areas correlated to echocardiography (r=0.56; p=0.014). ConclusionsCalculated LVOT areas seem to be sufficient for daily routine. Compared to the orthogonal view, standard long-axis 3CV underestimates the LVOT size and overestimates the systolic reduction of LVOT-size. Systolic changes are most pronounced in late systole.

Blood pressure variability and cognitive decline in older people: a 5-year longitudinal study.

Cognitive impairment is common in later life. Identifying potential modifiable risk factors for cognitive decline may ameliorate the burden of disease. Cross-sectional studies show an association between blood pressure (BP) variability and impaired cognitive function in patients with hypertension and/or dementia. However, research examining the association between BP variability and cognitive function in the general older population is scarce. In this study, we examined the association between BP variability and cognitive function over 5-year follow-up in an unselected community-dwelling cohort. Ambulatory BP monitoring was performed in 353 community-dwelling people aged at least 65 years. Cognitive assessment, using the Mini Mental State Examination (MMSE) and Cambridge Cognitive Examination (CAMCOG), was performed at baseline and at 5-year follow-up. BP variability was calculated using the coefficient of variation. Cognitive change over 5 years was defined as baseline score minus follow-up score. Increased daytime systolic variability was associated with poorer performance on the CAMCOG total score and subscores. Daytime diastolic variability was associated with poorer performance on total CAMCOG, CAMCOG executive score, and MMSE. These findings were independent of demographic and cardiovascular risk factors. Daytime systolic variability was also independently associated with greater decline in total CAMCOG and MMSE scores over 5-year follow-up. Increased BP variability is associated with poorer cognitive function in older people and may represent a novel modifiable risk factor for cognitive decline.

Left Ventricular Function After Prolonged Exercise in Equine Endurance Athletes.

BackgroundProlonged exercise in human athletes is associated with transient impairment of left ventricular (LV) function, known as cardiac fatigue. Cardiac effects of prolonged exercise in horses remain unknown.ObjectivesTo investigate the effects of prolonged exercise on LV systolic and diastolic function in horses.AnimalsTwenty‐six horses competing in 120–160 km endurance rides.MethodsCross‐sectional field study. Echocardiography was performed before and after rides, and the following morning, and included two‐dimensional echocardiography, anatomical M‐mode, pulsed‐wave tissue Doppler imaging, and two‐dimensional speckle tracking. Correlation between echocardiographic variables and cardiac troponin I was evaluated.ResultsEarly diastolic myocardial velocities decreased significantly in longitudinal (baseline: −17.4 ± 2.4cm/s; end of ride: −15.8 ± 3.2cm/s (P = .013); morning after: −15.4 ± 3.0cm/s (P = .0033)) and radial directions (−32.8 ± 3.4cm/s; −28.1 ± 5.8cm/s (P < .001); −26.4 ± 5.5cm/s (P < .001)). Early diastolic strain rates decreased significantly in longitudinal (1.58 ± 0.27s−1; 1.45 ± 0.26s−1 (P = .036); 1.41 ± 0.25s−1 (P = .013)) and circumferential directions (2.43 ± 0.29s−1; 1.96 ± 0.46s−1 (P < .001); 2.11 ± 0.32s−1 (P < .001)). Systolic variables showed ambiguous results. No correlations with serum cardiac troponin I concentrations were evident.Conclusions and Clinical ImportanceProlonged exercise in horses is associated with impaired LV diastolic function. Reduced ventricular filling persisted for 7–21 hours despite normalization of biochemical indicators of hydration status, indicating that the observed changes were not entirely related to altered preload conditions. The clinical relevance of cardiac fatigue in horses remains uncertain.

Carvedilol-Enriched Cold Oxygenated Blood Cardioplegia Improves Left Ventricular Diastolic Function After Weaning From Cardiopulmonary Bypass.

To investigate whether adding carvedilol, a nonselective β- and selective α1-receptor blocking agent with antioxidant properties, to oxygenated blood cardioplegia improves myocardial function after weaning from bypass. A randomized controlled study. A university laboratory. Twenty anesthetized pigs, Norwegian Landrace. On cardiopulmonary bypass, cardiac arrest was induced with cold (12°C), oxygenated blood cardioplegia, enriched with carvedilol or vehicle, and repeated every 20 minutes. After 100 minutes, the heart was reperfused and weaned. Left ventricular function was evaluated with pressure-volume loops, local myocardial systolic strain, and strain rate from Speckle tracking analysis and multilayer short-axis tissue Doppler Imaging. In the carvedilol group, the load-independent logarithmic end-diastolic pressure volume relationship, β, decreased from 1 to 3 hours of reperfusion and was low, 0.028±0.004 v 0.042±0.007 (p<0.05) in controls at 3 hours, demonstrating improved left ventricular compliance. The diastolic relaxation constant τ was decreased, 28.9±0.6 ms v 34.6±1.3 ms (pg<0.035), and dP/dtmin was more negative,-1,462±145 mmHg/s v-1,105±105 mmHg/s (pg = 0.024), for carvedilol v control group. The systolic variables, preload recruitable stroke work and end-systolic pressure-volume relationship, did not differ between groups, neither did left ventricular systolic strain and strain rate. Myocardial oxidative stress, measured as tissue levels of malondialdehyde, was reduced by carvedilol, 0.19±0.01 compared to 0.24±0.01 nmol/mg (p = 0.004) in controls. Carvedilol added to blood cardioplegia improved diastolic cardiac function and reduced oxidative stress during the first 3 hours after reperfusion in a porcine model, with 100 minutes of cardioplegic arrest.

Phase contrast and cardiac cine MRI for non-invasive assessment of hepatic haemodynamic and cardiac systolic function in a rodent model of chronic liver disease

BackgroundProfound vascular changes occur in cirrhosis, but they are poorly understood because of the invasive methods required for measurement. In this study, we used non-invasive imaging to investigate hepatic haemodynamic and cardiac systolic variables in a rodent model of cirrhosis. MethodsA cross-sectional in-vivo study with 9.4T MRI was undertaken in sham and bile-duct ligated (BDL) rats after 4 weeks. Phase-contrast MRI was used to measure total liver blood flow, portal venous flow, and hepatic arterial flow (seven sham rats, nine BDL rats) and cardiac cine MRI to measure cardiac output, stroke volume, left ventricular ejection fraction (LVEF), and cardiac index (13 sham rats, 12 BDL rats). Unpaired t tests were used for comparisons. Ethics committee approval was obtained. FindingsMean total liver blood flow and portal venous flow were higher in sham than in BDL rats (214·3 mL/min per 100 g [SD 44·1] vs 152·3 [56·0] p=0·0308, and 181·4 [31·9] vs 68·5 [30·5] p<0·0001, respectively) but hepatic arterial flow was higher in BDL than in sham rats (83·8 [57·4] vs 33·0 [29·9], p=0·0526). No significant difference in heart rate was demonstrated but mean stroke volume, cardiac output, LVEF, and cardiac index were higher in BDL than in sham rats (0·59 mL [0·12] vs 0·46 [0·07], p=0·0030; 197·6 mL/min [41·8] vs 151·4 [23·5], p=0·0022; 76·6% [9·5] vs 68·0 [9·3], p=0·0311; and 469·0 mL/min per kg [92·4] vs 313·0 [50·3], p<0·0001; respectively). No significant difference in total liver blood flow relative to cardiac output was demonstrated but hepatic arterial flow relative to cardiac output was higher in BDL than in sham rats (13·9% [7·1] vs 3·4 [2·4], p=0·0027). InterpretationWe found reduced total liver blood flow in BDL rats despite rises in hepatic arterial flow. BDL rats have features of cirrhotic cardiomyopathy and fail, despite increased liver to body-mass ratio, to increase hepatic perfusion demands from the systemic circulation. Our findings support further investigation of MRI biomarkers and monitoring for therapies to optimise systemic and hepatic haemodynamics in cirrhosis. FundingWellcome Trust (grant WT092186).

The relationship between blood pressure variability and cardiovascular risk factors in patients with primary hypertension

Abstract Objective: The aim of the study is to assess 24-hour blood pressure variability, circadian blood pressure profile and its relation to 24-hour blood pressure and cardiovascular risk factors in primary hypertension without any associated disease versus associated with a disease such as diabetes or chronic kidney disease. Methods: This observational study included 90 hypertensive patients, 49 with primary hypertension without associated disease and 41 patients with primary hypertension and diabetes or chronic kidney disease. Circadian blood pressure profile and 24-hour variability were assessed using ambulatory monitoring. Laboratory data regarding cardiovascular risk factors and demographic data were collected in a questionnaire. Results: The number of dipper patients was higher in the group without associated disease, but the difference was not statistically significant (p=0.27). In both groups a positive correlation was found between 24-hour systolic blood pressure variability and 24-hour systolic blood pressure (p=0.029) and was related to age (p=0.031). In the second group, systolic variability showed a positive correlation with serum triglycerides (p=0.006, r=0.416, CI: 0.1252 to 0.6422). Conclusion: Our findings suggest that systolic blood pressure variability is related to age, systolic blood pressure values and serum lipid levels. To prevent end organ damage in hypertension, the assessment of ambulatory monitoring derived 24-hour systolic blood pressure variability and its reduction may be at least as important as blood pressure lowering.

Beat-to-beat, reading-to-reading, and day-to-day blood pressure variability in relation to organ damage in untreated Chinese

Whether target organ damage is associated with blood pressure (BP) variability independent of level remains debated. We assessed these associations from 10-minute beat-to-beat, 24-hour ambulatory, and 7-day home BP recordings in 256 untreated subjects referred to a hypertension clinic. BP variability indices were variability independent of the mean, maximum-minimum difference, and average real variability. Effect sizes (standardized β) were computed using multivariable regression models. In beat-to-beat recordings, left ventricular mass index (n=128) was not (P≥0.18) associated with systolic BP but increased with all 3 systolic variability indices (+2.97-3.53 g/m(2); P<0.04); the urinary albumin-to-creatinine ratio increased (P≤0.03) with systolic BP (+1.14-1.17 mg/mmol) and maximum-minimum difference (+1.18 mg/mmol); and pulse wave velocity increased with systolic BP (+0.69 m/s; P<0.001). In 24-hour recordings, all 3 indices of organ damage increased (P<0.03) with systolic BP, whereas the associations with BP variability were nonsignificant (P≥0.15) except for increases in pulse wave velocity (P<0.05) with variability independent of the mean (+0.16 m/s) and maximum-minimum difference (+0.17 m/s). In home recordings, the urinary albumin-to-creatinine ratio (+1.27-1.30 mg/mmol) and pulse wave velocity (+0.36-0.40 m/s) increased (P<0.05) with systolic BP, whereas all associations of target organ damage with the variability indices were nonsignificant (P≥0.07). In conclusion, while accounting for BP level, associations of target organ damage with BP variability were readily detectable in beat-to-beat recordings, least noticeable in home recordings, with 24-hour ambulatory monitoring being informative only for pulse wave velocity.