Ventricle Diastolic Dysfunction Research Articles

Left ventricle diastolic dysfunction in idiopathic inflammatory myopathies: A meta-analysis and systematic review.

Recent studies have confirmed that heart failure is one of the most important causes of death in patients with idiopathic inflammatory myopathy (IIM). Left ventricle diastolic dysfunction (LVDD) is closely associated with heart failure. Our aim is to determine if the prevalence of LVDD is increased in IIM patients. We performed a time- and language-restricted literature search to identify studies conducted to compare the echocardiographic parameters in IIM patients and controls. Mean differences were used to calculate the effect sizes of the echocardiographic parameters. A total of 13 studies met the inclusion criteria and comprised a total of 227 juvenile dermatomyositis (JDM) patients, 391 adult IIM patients, and 550 controls. The adult IIM patients had lower mitral annular early diastolic velocity (e') and peak of early diastolic flow velocity/peak of late diastolic flow velocity (E/A) ratio compared to controls. The mean left atrial dimension and E/e' ratio was higher in adult IIM patients as compared to controls. Similarly, in JDM patients, the decreased e' was also observed. Patients with IIM were more likely to have echocardiographic parameters indicative of diastolic dysfunction. The early heart assessments should be performed in IIM patients.

Left atrial ejection fraction is an indicator of left ventricular diastolic function

Left atrial ejection fraction (LAEF) has been previously shown to accurately distinguish between patients with and without clearly defined left ventricle diastolic dysfunction (LVDD) by ASE/EACVI criteria, but indeterminate cases were excluded. We sought to determine if LAEF could accurately distinguish between normal, indeterminate and LVDD patients. A retrospective cohort of 125 patients who underwent transthoracic echocardiography was studied. Comprehensive echocardiographic study was performed with measurement of validated diastolic parameters. Subjects were assigned LVDF ASE/EACVI categories. ANOVA test was used to compare means between groups and binary logistic regression and ROC curves to assess diagnostic accuracy. Mean LAEF was statistically different between groups (p < 0.001): 56.3% ± 4.5 for normal patients, 50.2% ± 5.5 for indeterminate patients and 44% ± 8.5 for patients with LVDD. LAEF distinguished LVDD from patients without diastolic dysfunction (OR = 0.73, 95% CI 0.63-0.65, p < 0.001) and ROC curve reveals excellent discriminative power (AUC 0.91, 95% CI 0.84-0.97, p < 0.001). LAEF also distinguished indeterminate patients from LVDD (OR = 0.9, 95% CI 0.83-0.95, p < 0.001) and ROC curve revealed good discriminative power (AUC 0.72, 95% CI 0.62-0.82, p < 0.001). LAEF can accurately differentiate between normal, indeterminate and LVDD patients and could be considered as an additional parameter in the study of diastolic function.

Relation of endothelial and cardiac autonomic function with left ventricle diastolic function in patients with type 2 diabetes mellitus.

Background and aimsDiabetes mellitus (DM) is a risk factor for left ventricle (LV) diastolic dysfunction. Aim of this study was to investigate whether endothelial and/or autonomic dysfunction are associated with LV diastolic dysfunction in DM patients.MethodsWe studied 84 non‐insulin‐dependent type 2 DM (T2DM) patients with no heart disease by assessing: 1) LV diastolic function by echocardiography; 2) peripheral vasodilator function, by measuring flow‐mediated dilation (FMD) and nitrate‐mediate dilation (NMD); 3) heart rate variability (HRV) on 24‐h Holter electrocardiographic monitoring.ResultsTwenty‐five patients (29.8%) had normal LV diastolic function, while 47 (55.9%) and 12 (14.3%) showed a mild and moderate/severe diastolic dysfunction, respectively. FMD in these 3 groups was 5.25 ± 2.0, 4.95 ± 1.6 and 4.43 ± 1.8% (p = 0.42), whereas NMD was 10.8 ± 2.3, 8.98 ± 3.0 and 8.82 ± 3.2%, respectively (p = 0.02). HRV variables did not differ among groups. However, the triangular index tended to be lower in patients with moderate/severe diastolic dysfunction (p = 0.09) and a significant correlation was found between the E/e’ ratio and both the triangular index (r = −0.26; p = 0.022) and LF amplitude (r = −0.29; p = 0.011).ConclusionsIn T2DM patients an impairment of endothelium‐independent, but not endothelium‐dependent, dilatation seems associated with LV diastolic dysfunction. The possible role of cardiac autonomic dysfunction in diastolic dysfunction deserves investigation in larger populations of patients.

Effect of Dynamic Hyperinflation on Cardiac Response to Exercise of Patients With Chronic Obstructive Pulmonary Disease

IntroductionAlthough the major limitation to exercise performance in patients with COPD is dynamic hyperinflation (DH), little is known about its relation with cardiac response to exercise. Our objectives were to compare the exercise response of stroke volume (SV) and cardiac output (CO) between COPD patients with or without DH and control subjects, and to assess the main determinants. MethodsFifty-seven stable COPD patients without cardiac comorbidity and 25 healthy subjects were recruited. Clinical evaluation, baseline function tests, computed tomography and echocardiography were conducted in all subjects. Patients performed consecutive incremental exercise tests with measurement of operating lung volumes and non-invasive measurement of SV, CO and oxygen uptake (VO2) by an inert gas rebreathing method. Biomarkers of systemic inflammation and oxidative stress, tissue damage/repair, cardiac involvement and airway inflammation were measured. ResultsCOPD patients showed a lower SV/VO2 slope than control subjects, while CO response was compensated by a higher heart rate increase. COPD patients with DH experienced a reduction of SV/VO2 and CO/VO2 compared to those without DH. In COPD patients, the end-expiratory lung volume (EELV) increase was related to SV/VO2 and CO/VO2 slopes, and it was the only independent predictor of cardiac response to exercise. However, in the regression models without EELV, plasma IL-1β and high-sensitivity cardiac troponin T were also retained as independent predictors of SV/VO2 slope. ConclusionDynamic hyperinflation decreases the cardiac response to exercise of COPD patients. This effect is related to systemic inflammation and myocardial stress but not with left ventricle diastolic dysfunction.

Features of speckle tracking echocardiography for diagnosis of myocardial dysfunction

Despite the undoubted success in the diagnosis of heart failure using echocardiography, the issue of detecting diastolic dysfunction of the left ventricle of the heart in the early stages remains insufficiently studied. The article describes a non-invasive ultrasound method for evaluating myocardial function, which allows early detection of left ventricle diastolic dysfunction due to myocardial fibrosis.

БАЛЛЬНАЯ ШКАЛА ОЦЕНКИ РИСКА ВЫЯВЛЕНИЯ ДИАСТОЛИЧЕСКОЙ ДИСФУНКЦИИ ПРАВОГО ЖЕЛУДОЧКА II ТИПА ПРИ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ

Odjectives. To develop a scoring scale for assessing the risk of detecting right ventricle (RV) diastolic dysfunction (DD) of type II in chronic heart failure (CHF). Material and methods. In 2017-2018, a clinical and instrumental examination of 247 patients aged 40-86 years was performed on the basis of Health Care Institution «The 1st City Clinical Hospital» in Minsk, in 2019-2020, 129 patients at the age of 39-84 years were examined in the State Institution «Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology». Study inclusion criteria: sinus rhythm, essential arterial hypertension (AH), chronic ischemic heart disease (IHD), CHF, informed voluntary consent of the patient to participate in the study. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or replacement, congenital heart defects, acute and chronic diseases of the lungs and kidneys. Results. The sum of points&gt;52 obtained using a scoring scale that includes scientifically based ultrasound criteria for global cardiac remodelling: RV early diastolic filling index E/eʹ &gt;4.08 (sensitivity (S) 81.1%, specificity (Sp) 56.9%) - 15 points, the amplitude of the systolic displacement of the lateral part of the tricuspid annulus in systole to the apex (TAPSE) ≤20 mm (S 74.1%, Sp 83.3%) - 49 points, pulmonary artery systolic pressure ˃32.6 mm Hg (S 85.2%, Sp 79.5%) - 31 points, indicates a high risk of detecting RV DD of type II in CHF (AUC 0.99, S 93.9%, Sp 100.0%). The reproducibility of the results is shown in an independent examination sample of patients with CHF with preserved left ventricular ejection fraction. (AUC 0.99, S 90.0%, Sp 100%, +PV 100.0%, - PV 34.5% with a cut-off threshold &gt;52). Conclusions.When using the scale, the score is &gt; 52, it is recommended to perform a comprehensive targeted assessment of global cardiac remodelling to determine RV DD of type II in a patient with CHF, complicating essential AH, chronic IHD.

Left Atrial Strain in Patients With Systemic Lupus Erythematosus.

In patients with systemic lupus erythematosus (SLE), left ventricle diastolic dysfunction (LVDD) may be the only manifestation of cardiac involvement in anticipation of systolic dysfunction. It has been seen that myocardial deformation of the left atrium (LA), through the LA global longitudinal strain (LAGLS), may be useful in assessing diastolic function. To evaluate LA function through myocardial deformation in patients with LES, and compare the LA strain in patients with active, inactive and controls. Fifty patients with SLE were included and compared with 50 healthy controls paired by age and gender. Myocardial deformation was measured by transthoracic echocardiogram, to investigate the LAGLS, the strain of the three phases of the LA cycle and the strain rate. The differences between groups were compared in univariate analysis. LAGLS in SLE patients was less than in the controls (41.6% vs. 50.5%; p=.02), and in the 3 phases of the LA cycle. There were no differences in the LA strain rate in both groups (SLE 2.5s-1 vs. controls 2.75s-1; p=.1). It was also found that the LAGLS was lesser in active patients than controls and inactive. SLE patients have lower myocardial deformation of the LA, which is expressed as a lower diastolic function correlating with early subclinical myocardial damage.

Left atrial strain in patients with systemic lupus erythematosus

BackgroundIn patients with systemic lupus erythematosus (SLE), left ventricle diastolic dysfunction (LVDD) may be the only manifestation of cardiac involvement in anticipation of systolic dysfunction. It has been seen that myocardial deformation of the left atrium (LA), through the LA global longitudinal strain (LAGLS), may be useful in assessing diastolic function. ObjectiveTo evaluate LA function through myocardial deformation in patients with LES, and compare the LA strain in patients with active, inactive and controls. MethodsFifty patients with SLE were included and compared with 50 healthy controls paired by age and gender. Myocardial deformation was measured by transthoracic echocardiogram, to investigate the LAGLS, the strain of the three phases of the LA cycle and the strain rate. The differences between groups were compared in univariate analysis. ResultsLAGLS in SLE patients was less than in the controls (41.6% vs 50.5%; p?=?.02), and in the 3 phases of the LA cycle. There were no differences in the LA strain rate in both groups (SLE 2.5 s-1 vs controls 2.75 s-1; p?=?.1). It was also found that the LAGLS was lesser in active patients than controls and inactive. ConclusionsSLE patients have lower myocardial deformation of the LA, which is expressed as a lower diastolic function correlating with early subclinical myocardial damage.

Assessment of Left Ventricle Diastolic Dysfunction in Chronic Kidney Disease Patients

Introduction: Cardiovascular disease (CVD) remains the most common cause of mortality in chronic kidney disease (CKD). Objective: to determine the prevalence and quantify the relation of LV diastolic dysfunction and CKD. Methods: Prospective study carried on 100 patients (ages: 20-86 years) with CKD, divided into 4 groups according to their estimated glomerular filtration rate (eGFR): i) Group 1: GFR= 60-89 (12 patients), ii) Group 2: GFR=30–59 (33 patients), iii) Group 3: GFR= 15–29 (33 patients) and iv) Group 4: GFR < 15 or on dialysis (22 patients) and 20 healthy subjects (ages: 50-75 years) as control group referred the department of Cardiology- Faculty of Medicine- Mansoura University, for routine evaluation during the period from October 2017 to June 2018. Conventional pulsed wave Doppler (cPWD) echocardiography and tissue Doppler imaging (TDI) were performed in all patients Results: Comparison of the 4 groups of CKD patients regarding grades of LV diastolic dysfunction; grades II & III, LV diastolic dysfunction were more prevalent among patients of group 3 and group 4 CKD patients (p < 0.001), concerning correlation between GFR and echocardiographic parameters in the study population; there was significant direct correlation between GFR and E/MED E' (R: 0.42; P<0.001) and Lat E' (R: 0.30; P=0.001), While there was significant inverse correlation between GFR and LA size (R: -0.21; P=0.018), E/A (R: -0.19; P=0.029), E(R: -0.49; P<0.001), E/LAT E'(R: -0.53; P<0.001) and grades of diastolic dysfunction (R: -0.54; P<0.001).Conclusion: LV diastolic dysfunction is an indicator of damage to the myocardium before heart failure becomes clinically apparent.

Peculiarities of cardiac remodeling and myocardial dysfunction in metabolic syndrome

Introduction. In 2016, updated recommendations for echocardiographic diagnosis of diastolic dysfunction were developed. It requires a review of the degree of metabolic syndrome (MS) influence on the heart and blood vessels remodeling and the development of left ventricle (LV) diastolic dysfunction (DD).Purpose. Assessment of the MScontribution to the heart and blood vessels remodeling, as well as to the development of LVDD with an analysis of the LV remodeling types and the degree of LVDD.Materials and methods. The main group: 130 patients with MS (62 (47,7%) — men, 68 (52,3%) — women; average age — 59,8±9,5 years) who underwent in-patient examination and treatment in the cardiology department for arterial hypertension (AH) in 2015-2017. The control group included 36 patients with AH (18 (50%) — men, 18 (50%) — women; average age — 56,0±12,7 years) without abdominal obesity, not meeting the criteria of MS International Diabetes Federation.Results. MS is associated with increased prevalence of adverse LV remodeling and DD. In MS group concentric LV hypertrophy was detected significantly commoner than in group without MS, in which concentric remodeling was the most frequent structural abnormality. Eccentric LV hypertrophy was diagnosed only in pts with so-called complete MS. Moreover DD was detected in all pts with complete MS. Type 2 DD was present predominantly in subgroup with complete MS, reflecting relationship between the degree of LV DD and severity of MS in AH pts.Conclusions. Obtained results confirm adverse influence of central obesity and MS on LV myocardial structure and function.

English

BACKGROUND Thyroid disease is more common in people with diabetes mellitus than in general population. Among thyroid disorders, subclinical hypothyroidism is more common than the overt form. Hypothyroidism is associated with dyslipidaemia, hypertension and cardiac disease. Subclinical hypothyroidism has also been reported to have these features. With this background, we aimed to determine the prevalence of subclinical thyroid disorder and its influence on the metabolic profile of patients with type 2 diabetes mellitus (DM). METHODS 234 type 2 diabetes patients, 117 males and 117 females, who were previously not known to have thyroid disease, were screened for thyroid dysfunction using serum free T3, free T4, and thyroid stimulating hormone (TSH) levels. Patients were evaluated for clinical features of thyroid disease and investigated for microvascular complications of DM, dyslipidaemia and cardiac disease. Individuals with subclinical hypothyroidism were further screened for anti-thyroid peroxidase (TPO) antibodies. RESULTS In this study, subclinical hypothyroidism was present in 29 (12.4 %) of 234 type 2 diabetics; no case of subclinical hyperthyroidism was detected. 25 of these 29 patients with subclinical hypothyroidism were females. Elevated TPO antibody levels were present in 82.8 % (24 out of 29) subclinical hypothyroidism (SCH) patients. SCH was found to be associated with higher body mass index (BMI) and patients aged more than 50 years. No significant difference was found in glycaemic profile or lipid profile between patients with SCH and euthyroid subjects. There was no significant difference among SCH patients with and without microvascular complications. Left Ventricle (LV) diastolic dysfunction was present in 34.4 % of SCH patients. CONCLUSIONS SCH is common among type 2 diabetics, especially in females and most commonly due to autoimmune thyroid disease. SCH in type 2 DM is associated with a higher BMI and an older age group, but it does not seem to have an influence on glycaemic profile, lipid profile or microvascular complications of diabetes. KEYWORDS Thyroid Stimulating Hormone (TSH), Type 2 Diabetes Mellitus (T2DM), Subclinical Hypothyroidism (SCH), BMI, Anti–TPO (Thyroid Peroxidase) Antibody

Effect of Percutaneous Coronary Intervention on Diastolic Function in Coronary Artery Disease

Background:Left ventricle (LV) diastolic dysfunction is often present in patients with significant coronary artery disease (CAD), even in the absence of regional or global LV systolic dysfunction. It has been suggested that abnormalities in LV diastolic function may actually precede LV systolic dysfunction, and therefore, serve as an early and sensitive marker of ischemia. This study aims to find improvement of diastolic function after percutaneous coronary intervention (PCI) in patients with stable or unstable angina.Methods:In this single-center hospital-based study, we enrolled 309 patients with either stable or unstable CAD and with normal systolic function who underwent successful PCI. Two-dimensional transthoracic echocardiography was performed at baseline (before PCI) and repeated 48 h after PCI. LV diastolic parameters were compared before and after PCI using paired samples t-test results.Results:Mean age of study population was 56.65 ± 9.65 years. Majority of patients were male (63%). There was significant increase in mitral E-wave velocity (68.39 ± 17.52 cm/s vs. 71.64 ± 18.23 cm/s), E/A ratio (0.85 ± 0.29 vs. 0.89 ± 0.32), and early diastolic mitral annular motion (e') (7.02 ± 0.89 cm/s vs. 8.45 ± 0.86 cm/s) following PCI (P < 0.0001). Left atrial volume index (22.53 ± 4.43 vs. 20.81 ± 4.14), tricuspid jet velocity (0.91 ± 0.57 m/s vs. 0.76 ± 0.67 m/s), and E/e' ratio (10.03 ± 3.5 vs. 8.62 ± 2.61) decreased significantly following PCI (P < 0.001).Conclusion:This study suggests that LV diastolic filling pattern is modified significantly as early as 48 h after successful PCI. Improvement in impaired relaxation appears to be most likely explanation for these changes. PCI may be potential therapeutic target to improve diastolic function in patients with CAD.

Understanding the association between endothelial dysfunction and left ventricle diastolic dysfunction in development of coronary artery disease and heart failure.

Cardiovascular diseases (CVDs) have been the most common cause of death worldwide for decades. Until recently the most affected patients were middle-aged and elderly, predominantly males, with more frequent ST elevation myocardial infarction (STEMI) caused by obstructive coronary artery disease (CAD). However, in the last two decades we have noticed an increased incidence of ischemia with non-obstructive coronary arteries (INOCA), which includes myocardial infarction with non-obstructive coronary arteries (MINOCA) and non-myocardial infarction syndromes, such as microvascular and vasospastic angina, conditions that have been particularly pronounced in women and young adults - the population we considered low-risky till than. Therefore, it has become apparent that for this group of patients conventional methods of assessing the risk of future cardiovascular (CV) events are no longer specific and sensitive enough. Heart failure with preserved ejection fraction (HFpEF) is another disease, the incidence of which has been rising rapidly during last two decades, and predominantly affects elderly population. Although the etiology and pathophysiology of INOCA and HFpEF are complex and not fully understood, there is no doubt that the underlying cause of both conditions is endothelial dysfunction (ED) which further promotes the development of left ventricular diastolic dysfunction (LVDD). Plasma biomarkers of ED, as well as natriuretic peptides (NPs), have been intensively investigated recently, and some of them have great potential for early detection and better assessment of CV risk in the future. (www.actabiomedica.it)

Structure-function indices of echocardiography in civil aviation pilots of senior age groups

Echocardiography is an important method for non-invasive evaluation of the structural and functional indicators of the cardiovascular system, which is valuable in early detection of the cardiovascular pathology, especially in older people, because, the prevalence of the most cardiovascular diseases significantly increases with age. Material and methods. 1189 civil aviation pilots aged 54–68 years who underwent routine in-patient examination at the Central Clinical Hospital of Civil Aviation on a regular basis were examined with further medical assessment at the Central Medical Flight Expert Commission of Civil Aviation of the Russian Federation in 2009–2010. The average age was 56.75 ± 0.07. Transthoracic echocardiography was performed in 1170 flight personnel (98.4%) for evaluation of the structural and functional indicators of the cardiovascular system. Results. Echocardiography abnormalities were detected in 95.7% of pilots of the senior age group, 14.1% of these changes were in mixt form. Signs of atherosclerosis of the thoracic aorta were most common — 94% of cases. Left ventricle diastolic dysfunction of type I was noted in 60.3% of pilots. Structural and/or functional changes of the heart valves were noted in 18.2% of the subjects, most of them were localized in the aortic valves: 16% of cases. Dilation of the heart chambers were detected in 4.8% of the examined. LVH was found in 1% of pilots of the senior age group, and signs of LV concentric remodeling — in 60.7% of individuals. The decrease in LV myocardial contractility was detected only in one pilot with EF 53%. Small heart abnormalities were identified only in 0.6% of cases. Conclusions. Echocardiography abnormalities are quite common in pilots of the senior age group, however, «gross» echocardiographic changes are much less common than in the population, which is natural, because these individuals undergo initial medical screening and subsequent follow-up. The use of this method for screening in civil aviation pilots of senior age groups is reasonable, because the prevalence of cardiovascular disease in this group is increasing.

2D Speckle Tracking echocardiography in the prognostication of left ventricle diastolic dysfunction

The aim of the study: to develop prediction comprehensive criteria for the diastolic dysfunction (DD) of the left ventricle (LV) according to 2D Speckle Tracking echocardiography (STE).Materials and methods. A clinical and instrumental study of 91 patients aged 64.0 was performed [58.0; 70.0] years in the Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology in 2019. Criteria for inclusion: sinus rhythm, essential arterial hypertension, chronic coronary artery disease, previous left myocardial infarction, after which at least six months have passed to stabilize the LV structural and functional parameters, chronic heart failure, patient informed consent. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or prosthetics, congenital heart defects, acute and chronic diseases of the kidneys, lungs. Transthoracic echocardiography and STE was performed on ultrasound machine Vivid E9 (GE Healthcare, USA).Results. The leading functional anomalies, interconnected in the development of LV DD, are decline of the LV longitudinal diastolic, regional and global systolic strain, LV mechanical dispersion and dyssynergy. Correlations between LV DD type II and the mechanical dispersion index (r = 0.69, p &lt; 0.001), delta of LV time to peak longitudinal deformation (r = 0.66, p &lt; 0.001), LV global post-systolic index (r = 0.58, p &lt; 0.001), GLSAVG (r = 0.63, p &lt; 0.001) were established. LV DD is characterized by early diastolic longitudinal strain E of the LV basal lateral segment &gt; −6.75%, LV basal septal segment &gt; −5.22%, early and late diastolic longitudinal strain ratio E/A of the LV basal lateral segment ≤0.91, basal-septal segment ≤0.69. LV DD type I is characterized by an LV mechanical dispersion index &gt;49.34 ms, LV delta time to peak longitudinal strain &gt;157 ms. Prognostic values for LV DD type II are LV mechanical dispersion index &gt;49.34 ms, delta time to peak longitudinal strain is &gt;136 ms, global post-systolic index &gt;6.24%, mechanical dyssynergy index &gt;4.60%, global LV peak longitudinal displacement ≤9.88 mm, GLSAVG &gt; −18.5% (sensitivity 88.2%, specificity 83.3%).Conclusions. The use of the developed STE prediction value in practical public health will increase the efficiency of diagnosis of LV DD.

Effect of Dynamic Hyperinflation on Cardiac Response to Exercise of Patients With Chronic Obstructive Pulmonary Disease

IntroductionAlthough the major limitation to exercise performance in patients with COPD is dynamic hyperinflation (DH), little is known about its relation with cardiac response to exercise. Our objectives were to compare the exercise response of stroke volume (SV) and cardiac output (CO) between COPD patients with or without DH and control subjects, and to assess the main determinants. MethodsFifty-seven stable COPD patients without cardiac comorbidity and 25 healthy subjects were recruited. Clinical evaluation, baseline function tests, computed tomography and echocardiography were conducted in all subjects. Patients performed consecutive incremental exercise tests with measurement of operating lung volumes and non-invasive measurement of SV, CO and oxygen uptake (VO2) by an inert gas rebreathing method. Biomarkers of systemic inflammation and oxidative stress, tissue damage/repair, cardiac involvement and airway inflammation were measured. ResultsCOPD patients showed a lower SV/VO2 slope than control subjects, while CO response was compensated by a higher heart rate increase. COPD patients with DH experienced a reduction of SV/VO2 and CO/VO2 compared to those without DH. In COPD patients, the end-expiratory lung volume (EELV) increase was related to SV/VO2 and CO/VO2 slopes, and it was the only independent predictor of cardiac response to exercise. However, in the regression models without EELV, plasma IL-1β and high-sensitivity cardiac troponin T were also retained as independent predictors of SV/VO2 slope. ConclusionDynamic hyperinflation decreases the cardiac response to exercise of COPD patients. This effect is related to systemic inflammation and myocardial stress but not with left ventricle diastolic dysfunction.

Myocardial fibrosis, diastolic dysfunction and elevated liver stiffness in the Fontan circulation

IntroductionSingle ventricle diastolic dysfunction and hepatic fibrosis are frequently observed in patients with a Fontan circulation. The relationship between adverse haemodynamics and end-organ fibrosis has not been investigated in adolescents...

Left ventricle diastolic dysfunction in a sample of prediabetic adults from Baghdad, Iraq

Prediabetes is a metabolic state in which people are not diabetics but also cannot be considered normal in terms of cutoff points of glycated hemoglobin or fasting plasma glucose. Those people are at higher risk of progression to type 2 diabetes mellitus and to develop many of the diabetes micro- and macro-vascular complications even before a diagnosis of diabetes has been established. One of the earliest cardiac manifestations of diabetic heart failure is left ventricle diastolic dysfunction. To identify diastolic dysfunction as early complication of prediabetes among adults in Baghdad, Iraq, and to determine associated risk factors among those individuals. This cross-sectional study enrolled 38 adults (20–79 years) with prediabetes in the setting of primary healthcare centers in Baghdad, Iraq, compared with 38 adults (age and sex matched) without prediabetes. People with any condition that interfere with glycated hemoglobin level were excluded. Data were collected through direct interview. Anthropometric measurements and laboratory analysis were done to measure fasting plasma glucose, glycated hemoglobin, and lipid profile. Echocardiography was done to assess left ventricle diastolic function. Prediabetes was significantly associated with left ventricle diastolic dysfunction (95% CI 0.23, 0.53) than those without prediabetes (95% CI 0.03, 0.21) (p = 0.013). Left ventricle diastolic dysfunction is an early manifestation of cardiac abnormalities associated with prediabetes. Those people share same factors with those having type 2 diabetes mellitus. More attention should be paid to identify those individuals correctly in order to intervene instantly.

P0809LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PATIENTS WITH DIABETIC CHRONIC KIDNEY DISEASE

Abstract Background and Aims Left ventricle diastolic dysfunction (LVDD) is common cardiac changes in diabetic patients without renal insufficiency. LVDD is also frequently occurs in chronic kidney disease (CKD). Diabetic patients with CKD are at increased risk of developing cardiovascular diseases. Therefore, early detection and prevention of risk factors are critical. The aim of this study was to evaluate the impact of type 2 diabetes on left ventricular (LV) diastolic function among CKD stage 3 and 5 patients, and whether markers of fluid balance can predict LVDD. Method A total of 409 patients (age and sex matched non-diabetic CKD stage 3 [nDMCKD3], n = 106; diabetic CKD stage 3 [DMCKD3], n = 106; non-diabetic CKD stage 5 [nDMCKD5], n = 73; diabetic CKD stage 5 [DMCKD5], n = 124) were analyzed. The stage 3 CKD patients were retrospectively reviewed, and stage 5 CKD patients were prospectively analyzed. All cohort patients with stage 5 CKD were hospitalized to plan their first dialysis treatment. The following exclusion criteria were applied: ejection fraction less than 45%, history of coronary artery disease and/or intervention treatment, history of angina or myocardial infarction, abnormalities of cardiac rhythm, moderate or severe valvular heart diseases, systemic immunologic diseases, liver cirrhosis, malignancy, infection, and previous renal transplantation. Coronary artery disease having regional wall motion abnormalities on echocardiographic examination was also ruled out. Clinical and echocardiographic parameters were compared among groups. Echocardiography, bioimpedance spectroscopy, and serum NT-proBNP were analyzed in patients with stage 5 CKD. The LVDD was defined as E/é ratio greater than 15. Extracellular water/total body water (ECW/TBW) and NT-proBNP were used as markers of fluid balance. Results Patients with E/é ratio &amp;gt; 15 presented with more advanced stages of CKD. Prevalence of LVDD in patients with diabetes was higher compared to those without diabetes. Patients in DMCKD5 group demonstrated higher E/é ratios compared to those with nDMCKD5, DMCKD3, and nDMCKD3 (16.63±5.04 vs. 14.12±4.60 vs. 14.69±4.65 vs. 13.07±3.76, p &amp;lt; 0.001). The E/é ratio in patients with DMCKD5 were significantly higher than those with DMCKD3 (16.63±5.04 vs. 14.69±4.65, p = 0.003). In contrast, the E/é ratio was not significantly different between nDMCKD3 and nDMCKD5 patients (13.07±3.76 vs. 14.12±4.60, p = 0.099). The ECW/TBW in patients with DMCKD5 were significantly higher than nDMCKD5 patients (0.51±0.04 vs. 0.48±0.05, p &amp;lt;0.001). In a multiple regression analysis, the presence of diabetes, serum albumin level, NT-proBNP, and ECW/TBW were significantly associated with LVDD in CKD5 patients. Conclusion Our results suggest that an echocardiographic examination and assessment of volume status should routinely be performed in patients with type 2 DMCKD. Early detection of LVDD before clinical symptoms are apparent is important, regardless of the stage of DMCKD. Fluid overload could be one of the aggravating factors of LVDD in DMCKD patients. Early evaluation of volume status and control of fluid overload should be considered important therapeutic approaches for LVDD in DMCKD patients, especially for those in advanced stages.

Heart failure in human immunodeficiency virus-infected patients

Aim. To determine the features of heart failure (HF) development in patients with human immunodeficiency virus (HIV) infection.Material and methods. In a general hospital, 160 patients were examined during the year. All of them were divided into 2 groups: group 1 (n=100) — HIV-infected patients with specific clinical picture of HF; group 2 (n=60) — patients without HIV infection and with HF verified by echocardiography and concentration of N-terminal prohormone of brain natriuretic peptide (NT-proBNP).Results. In comparison with group 2, HIV-infected patients had the following statistically significant differences: lower left ventricular ejection fraction (LVEF), lower prevalence and severity of left ventricle diastolic dysfunction, higher LV mass index (LVMI), and lower NT-proBNP. HIV-infected patients had statistically significant moderate inverse relationship of LVEF (r=-0,43; p=0,015), E/e’ (r=-0,32; p=0,045), LVMI (r=-0,46; p=0,002) and strong relationship of NT-proBNP (r=-0,54; p&lt;0,001) with CD4 T-lymphocyte count in 1 mm3 in the presence of HF symptoms and signs and an increase in NT-proBNP over 125 pg/ml. In group 1, there was a significantly higher prevalence of smoking, chronic alcoholism, drug use, chronic hepatitis C and cirrhosis (especially manifested by hepatomegaly and splenomegaly in combination with ascites and hepatic cytolysis), chronic pancreatitis, pneumonia and inflammatory diseases accompanied by higher erythrocyte sedimentation rate and C-reactive protein concentration, and lower hemoglobin level. HIV-infected patients were statistically less likely to use all groups of drugs for HF treatment, with the exception of spironolactone, and more likely to use drugs for multimorbidity treatment.Conclusion. The HF prevalence in hospitalized HIV-infected patients, estimated on the basis of symptoms and NT-proBNP increase &gt;125 pg/ml, was 54%; on the basis of LVEF decrease &lt;50% — 32%. The clinical picture of HIV-infected patients is characterized by various symptoms, including those typical for HF with normal NT-proBNP level, due to the high prevalence of comorbidities and concurrent medication.