Ventricular Diastolic Dysfunction In Patients Research Articles

Arterial Stiffness is Significantly Associated with Left Ventricular Diastolic Dysfunction in Patients with Clinical Cardiovascular Disease

Arterial Stiffness is Significantly Associated with Left Ventricular Diastolic Dysfunction in Patients with Clinical Cardiovascular Disease

Effect of type 2 diabetes on the left ventricular diastolic dysfunction in patients with chronic kidney disease, 3 and 4 stages

Patients with chronic kidney disease (CKD) and coexisting diabetes mellitus (DM) are likely to have cardiological complications. We assessed whether patients with moderate kidney dysfunction, with coexisting type 2 DM and preserved left ventricular (LV) systolic function, demonstrate a more advanced LV diastolic dysfunction. The study group consisted of 58 ambulatory patients with CKD, stages 3 and 4. The patients were assigned to groups based on the presence of type 2 DM. The first group (DM+) consisted of 21 patients with type 2 DM while second one (DM−) consisted of 37 patients without type 2 DM. Standard echocardiography was performed in all patients with tissue Doppler echocardiography for evaluation of the systolic velocity and both diastolic velocities of LV. The following laboratory parameters were measured: serum creatinine concentration, estimated glomerular filtration rate, and the levels of urea, phosphorus, calcium, parathormone, platelets count, hemoglobin level and N-terminal pro-B-type natriuretic peptide levels. LV diastolic dysfunction was defined as EmLV less than 8 cm/s. Patients in DM+ group, as compared to patients in DM− group, were characterized by higher values of left and right ventricular end-diastolic dimension, left atrial diastolic dimension, interventricular septal diastolic diameter, LV posterior wall dimension at diastole and of LV mass index, smaller LV ejection fraction and LV fractional shortening. In tissue Doppler echocardiography patients of DM+ group, as compared to patients of DM− group, did not differ in value of EmLV (7.4 ± 2.4 cm/s vs. 7.6 ± 2.1 cm/s, P = .723), respectively, and were characterized by similar estimated LV diastolic filling pressure as indicated by E /EmLV (10.1 ± 3.7 vs. 8.8 ± 2.6, P = .119). CKD patients in the moderate stage, with coexisting type 2 DM were not characterized by higher risk of developing LV diastolic dysfunction.

Atrial Mechanics after Surgical Repair of Tetralogy of Fallot

Ventricular diastolic dysfunction in patients with repaired tetralogy of Fallot (TOF) may affect atrial mechanics. This study aimed to explore right atrial (RA) and left atrial (LA) mechanics in repaired TOF patients and their relationship with ventricular diastolic function. Fifty-four patients (36 males), aged 17.8 ± 8.3 years, who had undergone TOF repair at 3.9 ± 3.3 years and 40 healthy subjects aged 16.9 ± 6.3 years (P = 0.57) were studied. Right and LA peak positive, peak negative, and total strain, strain rate at ventricular systole (SRs ), early diastole (SRed ), and atrial contraction (SRac ), and electromechanical delay were determined using speckle tracking echocardiography (STE). Ventricular diastolic function was assessed by tissue Doppler imaging and STE. Ventricular volumes and pulmonary regurgitant volume were derived from 3D echocardiography. Compared with controls, patients had significantly lower RA and LA peak positive and total strain, SRs , SRed , and SRac (all P < 0.001). The timing of RA (178 ± 33 msec vs. 152 ± 17 msec, P < 0.001) and LA (170 ± 32 msec vs. 152 ± 24 msec, P = 0.006) electromechanical coupling (EMC) was significantly longer in patients than in controls. The RA total strain, SRs , SRed , SRac , and EMC correlated positively with corresponding LA parameters (all P < 0.001). The RA and LA total strain and SRed were associated positively with diastolic annular velocities and strain rates of respective ventricles (all P < 0.05). The LA SRed correlated negatively with pulmonary regurgitant volume (r = -0.33, P = 0.016) and RV end-diastolic volume (r = -0.33, P = 0.015). Mechanics of both atria are impaired in patients after repair of TOF and are associated with diastolic performance of the respective ventricles.

Aortic Pulse Wave Velocity is Associated with Measures of Subclinical Target Organ Damage in Patients with Mild Hypertension

We evaluated the temporal association between aortic arterial stiffness and subclinical target organ damage, including renal function decline, left ventricular geometric remodeling, and left ventricular diastolic dysfunction in patients with mild hypertension. Automatic pulse wave velocity (PWV) measuring system was applied to examine carotid-femoral PWV (CFPWV) reflecting aortic arterial stiffness in 644 essential hypertensive patients. Clinical data were collected, and cardiac structure and function were assessed by echocardiography. CFPWV was significantly and positively associated with left ventricular mass index (r = 0.153, P = 0.018), relative wall thickness (r = 0.235, P < 0.001), and left atrial diameter (r = 0.192, P = 0.003), and negatively with E/A ratio (r = -0.361, P < 0.001) and creatinine clearance (r = -0.248, P < 0.001). Logistic regression analysis demonstrated that CFPWV remained significantly correlated with renal function decline (P = 0.011), left ventricular diastolic dysfunction (P = 0.009) and left ventricular geometric remodeling (P = 0.020). Higher CFPWV was independently associated with greater burden of subclinical disease in renal impairment, left ventricular geometric remodeling and diastolic dysfunction.

PM090 Is there any correlation between Brain Natriuretic and the left ventricular diastolic dysfunction in patients with acute coronary syndrome

Jennifer M. Coller*, Duncan J. Campbell, Henry Krum, Michele McGrady, Louise Shiel, Chris Reid, Umberto Boffa, Rory Wolfe, Simon Stewart, David L. Prior Department of Medicine, St Vincent’s Hospital, St Vincent’s Institute, Centre for Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, University of Adelaide, Adelaide, Baker IDI, St Vincent’s Hospital, Melbourne, Australia

Left Ventricular Diastolic Dysfunction in Patients with Dermatomyositis Without Clinically Evident Cardiovascular Disease

To assess left ventricular (LV) diastolic function in patients with dermatomyositis (DM) without clinically evident cardiovascular (CV) disease and to estimate whether there is an association between the duration of DM and LV diastolic dysfunction (LVDD). The study included 51 patients with DM (43 women and 8 men) who had no clinically evident CV disease and 51 age-matched and sex-matched healthy controls. Echocardiographic and Doppler studies were conducted in all patients and controls. Early diastolic flow velocity/mitral annular early diastolic velocity (E/Em) was considered a marker for diastolic dysfunction. E/Em was elevated in 39 patients (76.5%) versus 27 controls (52.9%; p < 0.05). There were significant differences between patients versus control group in late diastolic flow velocity (A), E/A ratio, Em, Em/Am (mitral annular late diastolic velocity) ratio, E/Em ratio, and deceleration time (DT; p < 0.05). There was a weak correlation with disease duration between A (r = 0.373, p = 0.007), E/A ratio (r = -0.467, p = 0.001), Em (r = -0.474, p < 0.001), Em/Am ratio (r = -0.476, p < 0.001), E/Em ratio (r = 0.320, p = 0.022), and DT (r = 0.474, p < 0.001). Disease duration was associated with E/Em after controlling for age, sex, and other factors (p < 0.05). Our study confirms a high frequency of LVDD in DM patients without evident CV disease. The association between transmitral flow alteration and disease duration may suggest a subclinical myocardial involvement with disease progression.

The Effect of Percutaneous Coronary Intervention on Left Ventricular Diastolic Dysfunction in Patients with Coronary Artery Disease Assessed by Strain Rate Imaging

Introduction: Coronary artery disease (CAD) is the most common cause for left ventricular dysfunction. Unfortunately, the treatment strategies of regional myocardial diastolic dysfunction in patients with CAD have not been well characterized and benefit of percutaneous coronary intervention (PCI) as a treatment strategy is not clear. So the present study aimed to assess the effects of PCI on regional and global left ventricular diastolic dysfunction in patients with CAD assessed by strain rate (SR) imaging. Methods: Thirty adult symptomatic patients with coronary artery disease that underwent coronary angiography and candidate for PCI on left anterior descending artery were enrolled to our study. Echocardiographic findings and early diastolic SR were measured before and 48 hours after PCI. Results: Mean age of the patients was 59.9 ± 8.3 years. Most of the left ventricular diastolic parameters showed significant difference before and after elective PCI; while mitral E velocity, DT, E/A and pulmonary vein flow before and after PCI did not show significant difference assessed by statically test. Also before PCI, mean (SD) of peak early diastolic SR in ischemic regions (1.89 ± 0.22) was smaller than of non-ischemic regions (2.53 ± 0.26) while after PCI this parameter became similar in ischemic regions (2.55 ± 0.27) and non-ischemic regions (2.55 ± 0.26). Conclusion: Most of the left ventricular diastolic parameters improved after PCI in CAD patients. Also regional myocardial relaxation as measured by peak early diastolic SR (ESR) in the ischemic segments improved significantly compared with that in non-ischemic segments.

Assessment of the relationship between aortic stiffness and left ventricular functions with echocardiography in patients with Sjögren's syndrome

Capable of multi-organ involvement in Sjogren's syndrome (SS), cardiac findings of pulmonary effusion, left ventricular diastolic dysfunction and pulmonary hypertension are seen in patients with SS. Aortic stiffness (AS) reflects the mechanical tension and elasticity of the aorta. In this study, our aim is to determine if there is any differences in AS and left ventricular function between patients diagnosed as SS and healthy control groups. We enrolled 50 patients with SS and 47 healthy volunteers with similar demographic characteristics. It was found that isovolumetric relaxation time (IVRT) and deceleration time (DT) were significantly longer and early diastolic wave (E) was significantly lower in patients with SS, but there was no difference in the other parameters. When tissue Doppler echocardiography (TDE) findings were compared between the two groups, it was found that myocardial systolic wave (Sm), myocardial early diastolic wave (Em) and Em/Am ratio were significantly lower, and myocardial isovolumetric relaxation time (IVRTm) and myocardial performance index (MPI) values were significantly higher in patients with SS. A significant positive correlations between aortic strain and Sm (r=0.35, P<0.001), Em (r=0.42, P<0.001) and Em/Am (r=0.26, P=0.008) and negative correlations in IVRTm (r=-0.36, P<0.001) and MPI (r=-0.24, P=0.01) were detected. A significant positive correlation between aortic distensibility and Sm (r=0.36, P<0.001), Em (r=0.44, P<0.001), Em/Am (r=0.26, P=0.009) and negative correlation of IVRTm (r=-0.22, P=0.02) were determined. There is a significant relationship between AS and left ventricular diastolic dysfunction in patients with SS in this study. The parameters of aortic elasticity measured by 2D echocardiographic methods can be beneficial in predicting early cardiovascular risk in SS.

Hypocalcemia is related to left ventricular diastolic dysfunction in patients with chronic kidney disease

BackgroundLeft ventricular (LV) diastolic dysfunction in patients with chronic kidney disease (CKD) is of a complex nature and is the predominant cause of congestive heart failure in this group of patients. This work aimed to evaluate the potential effect of disturbances in calcium-phosphorus (Ca-P) metabolism in patients with CKD on LV diastolic function as assessed by echocardiography. Materials and methodsThe study group consisted of 81 ambulatory patients with CKD, stages 2–5, with preserved LV systolic function–LV ejection fraction >50% and with sinus rhythm. Standard echocardiography was performed in all patients with tissue Doppler echocardiography for the evaluation of the systolic velocity and both diastolic velocities of LV (EmLV and AmLV). The following laboratory parameters were measured: serum creatinine concentration, estimated glomerular filtration rate, and the levels of urea, P, Ca, parathormone, platelet count, hemoglobin level, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Patients were divided into two groups according to the results of EmLV: group with LV diastolic dysfunction (EmLV<8cm/s) DF (+) and group with normal LV diastolic function DF (−), when EmLV was ≥8cm/s. ResultsPatients in DF (+) group, as compared to DF (−) patients, manifested a lower serum Ca level and an elevated NT-proBNP level [9.03±0.76mg/dL vs 9.44±0.78mg/dL, p=0.02, and 257.9 (32.6–12,633)pg/ml vs 149 (11.7–966)pg/ml, p=0.035, respectively]. The area under the receiver operating characteristics (ROC) curve of Ca for diastolic dysfunction was 0.627, 95% CI (0.511–0.734), p=0.04, whereas ROC derived Ca value of ≤9.82mg/dL was characterized by a sensitivity of 91.8% and specificity of 38.1% for diagnosing LV diastolic dysfunction. The only independent variable predicting LV diastolic dysfunction as measured by a multivariate logistic regression analysis was Ca level≤9.82mg/dL with odds ratio=8.81 (95% CI 1.49–51.82), p=0.014. ConclusionsHypocalcemia is an independent predictive factor for LV diastolic dysfunction in patients with CKD.

Accumulation of epicardial fat rather than visceral fat is an independent risk factor for left ventricular diastolic dysfunction in patients undergoing peritoneal dialysis

BackgroundSymptoms of heart failure with preserved left ventricular systolic function are common among patients undergoing peritoneal dialysis (PD). Epicardial fat (EpF) is an ectopic fat depot with possible paracrine or mechanical effects on myocardial function. The aim of our current study is to assess the association between EpF and Left ventricular diastolic dysfunction (LVDD) in patients undergoing PD and to clarify the relationships among EpF, inflammation, and LVDD in this population.MethodsThis was a cross-sectional study of 149 patients with preserved left ventricular systolic function who were undergoing PD. LVDD was diagnosed (according to the European Society of Cardiology guidelines) and EpF thickness measured by echocardiography. The patients without LVDD were used as controls. The serum inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) was measured. The location and amount of adipose tissue were assessed by computed tomography (CT) at the level of the fourth lumbar vertebra.ResultsSubjects with LVDD had higher levels of hsCRP, more visceral and peritoneal fat, and thicker EpF (all p < 0.001) than controls. Visceral adipose tissue, hsCRP, and EpF all correlated significantly (p < 0.05) with LVDD. Multivariate regression analysis rendered the relationship between visceral adipose tissue and LVDD insignificant, whereas EpF was the most powerful determinant of LVDD (odds ratio = 2.41, 95% confidence interval = 1.43–4.08, p < 0.01). EpF thickness also correlated significantly with the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e’; r = 0.27, p < 0.01).ConclusionEpF thickness is significantly independently associated with LVDD in patients undergoing PD and may be involved in its pathogenesis.

Characterization of Cardiovascular Involvement in Pseudoxanthoma Elasticum Families

Pseudoxanthoma elasticum (PXE) is an autosomal recessive connective tissue disorder with involvement of the skin, the retina, and the cardiovascular system. Cardiovascular involvement is mainly characterized by mineralization and fragmentation of elastic fibers of blood vessels and premature atherosclerosis. We conducted an ultrasound study to investigate the cardiovascular phenotype and to propose recommendations for the management of patients with PXE and heterozygous ABCC6 mutation carriers. Thirty-two patients, 23 carriers, and 28 healthy volunteers underwent cardiac and vascular ultrasound studies. Cardiac imaging revealed left ventricular diastolic dysfunction in patients with PXE with a significantly prolonged deceleration time and lower septal early diastolic velocities of the mitral annulus compared with controls. Carriers also demonstrated significantly prolonged deceleration time. Carotid-to-femoral pulse wave velocity was significantly increased in patients with PXE when compared with carriers and controls. Vascular imaging revealed a high prevalence of peripheral artery disease in both patients and carriers and a significantly higher carotid intima-media thickness compared with controls. The results of this study clearly demonstrate impaired left ventricular diastolic function, impairment of the elastic properties of the aorta, and a high prevalence of peripheral artery disease in patients with PXE. Carriers also seem to exhibit a cardiovascular phenotype with mainly mild diastolic dysfunction and accelerated atherosclerosis. Increased awareness for cardiovascular events in both patients and heterozygous carriers is warranted.

MiR-21 and miR-133 levels in peripheral blood mononuclear cells associate with left ventricular diastolic dysfunction in patients with diastolic heart failure

Purpose: MicroRNAs (miRs) are essential regulators of gene expression implicated in cardiovascular function and disease. MiR-21 and miR-133 have been shown to play a role in heart hypertrophy and fibrosis. They have also been shown to regulate proliferation and phenotypic switch of vascular smooth muscle cells. However, there are limited data regarding their role in Left Ventricular (LV) diastolic dysfunction. The aim of this study is to investigate miR-21 and miR-133 levels in peripheral blood mononuclear cells in patients with LV diastolic dysfunction. Methods: We included 29 patients with symptoms and signs of heart failure who had LVEF >50% and evidence of LV diastolic dysfunction (19 males, aged 54±10 years. Blood samples were also obtained from 29 healthy volunteers for comparison (17 males, aged 52±8 years). All subjects underwent a complete echocardiographic study. Peripheral Blood Mononuclear Cells (PBMCs) were isolated and microRNA levels were determined by quantitative real time reverse transcription PCR. Results: MiR-21 levels were found to be higher (3.2±0.45 versus 2.05±0.31, p < 0.05), while miR-133 levels were found to be lower (10.16±4.81 versus 37.03±8.18, p<0.05) in patients with LV diastolic dysfunction compared to healthy controls. MiR-21 levels showed strong negative correlations with E/e' (r=-0.41, p<0.001) while miR-133 levels showed strong positive correlations with E/e' (r=0.42, p<0.001). Conclusions: Patients with LV diastolic dysfunction were shown to have a strong relationship with miR-21 and miR-133 levels in peripheral blood mononuclear cells. Our findings contribute to the understanding of pathogenesis of diastolic heart failure and might offer a future therapeutic target

Epicardial fat rather than abdominal visceral fat is associated with left ventricular diastolic dysfunction in patients with preserved left ventricular ejection fraction

Epicardial fat rather than abdominal visceral fat is associated with left ventricular diastolic dysfunction in patients with preserved left ventricular ejection fraction

Left Ventricular Diastolic Dysfunction — Early Cardiac Impairment in Patients with Polymyositis/Dermatomyositis: A Tissue Doppler Imaging Study

To investigate early cardiac involvement in patients with polymyositis/dermatomyositis (PM/DM), and to evaluate the risk factors for early cardiac impairment. The study population included 46 patients with PM/DM who did not have overt cardiovascular manifestations and 21 age- and sex-matched healthy controls. Traditional echocardiography and tissue Doppler imaging (TDI) were used to evaluate cardiac function in both groups. Clinical characteristics were recorded. Multivariate logistics regression analysis was applied to investigate risk factors for early cardiac impairment in patients with PM/DM. No significant difference was found between patients and controls by traditional echocardiography. However, compared to controls, PM/DM patients had a significantly lower ratio of early diastolic mitral annulus velocity to late diastolic mitral annulus velocity (Em/Am; 1.23 ± 0.52, 1.79 ± 0.37, respectively; t = -4.485, p < 0.001) and a higher ratio of peak early diastolic transmitral flow velocity to Em (E/Em; 8.26 ± 2.57, 6.76 ± 1.17; t = 3.287, p < 0.05) as found by TDI measurements. There was no significant difference between the TDI variables of patients with PM and DM. The multivariate regression analysis showed that female sex (OR 11.044, 95% CI 1.066-114.357, p = 0.044), late onset (OR 1.157, 95% CI 1.047-1.278, p = 0.004), and duration of disease (OR 1.060, 95% CI 1.008-1.115, p = 0.023) were risk factors for abnormal left ventricular filling pressures. TDI is useful for detecting early cardiac impairment in patients with PM/DM. Left ventricular diastolic dysfunction is an early feature of cardiac involvement. Female sex, late onset, and long course of disease are 3 independent risk factors for predicting left ventricular diastolic dysfunction in patients with PM/DM.

Association of TNF-α with left ventricular diastolic dysfunction in patients with hepatitis C virus infection

Association of TNF-α with left ventricular diastolic dysfunction in patients with hepatitis C virus infection

The Relationship Between Artery Stiffness and Left Ventricular Diastolic Function in Patients With Multiple Cardiovascular Risks

To evaluate the relationship between artery stiffness and left ventricular diastolic function. A total of 79 patients with multiple cardiovascular risks were recruited and divided into two groups according to the value of E/Em: diastolic dysfunctional group (E/Em≧10, n=25) and control group (E/Em<10, n=54). The arterial stiffness parameters of carotid artery and endothelium-independent dilation (EID) of brachial artery were evaluated by ET for two groups. The arterial stiffness parameters of carotid artery and EID of brachial artery in diastolic dysfunctional group were higher than that in controls (p > 0.05), and were associated to diastolic function parameters of left ventricular (p < 0.05). The arterial stiffness is closely related to the diastolic function of left ventricular, and maybe an important factor to impact on it. The increased arterial stiffness is useful in predicting left ventricular diastolic dysfunction in patients with multiple cardiovascular risks.

Effect of epicardial adipose tissue on diastolic functions and left atrial dimension in untreated hypertensive patients with normal systolic function

BackgroundAdipose tissue is the source of many adipokines affecting the cardiovascular system either locally or systemically. Although hypertension is one of the most important factors in diastolic dysfunction (DD), the exact cause of this relationship is unknown. There is no specific study in the current literature regarding the association of epicardial adipose tissue (EAT) with left ventricular DD in patients with essential hypertension. MethodsThe present study was cross-sectional and observational, including 127 patients with untreated hypertension who underwent a complete transthoracic echocardiographic examination as well as measurements of EAT and diastolic parameters. ResultsEAT was significantly correlated with left atrial dimension, DD parameters, and left ventricular (LV) mass as well as age and blood pressure measurements. EAT was also correlated with Framingham risk score (p<0.001). Age and EAT were significantly increased in patients with high grades of DD compared to those with low values (p<0.001 and p=0.001, respectively). Linear regression analyses revealed EAT as an independent predictor of all DD parameters. The area under the curve values of EAT were similar to age and higher than those of LV mass and mean BP for both the presence of DD and grade two DD. ConclusionBased on our findings, increased EAT may be associated with diastolic dysfunction and left atrial dilatation due to local or systemic effects in untreated hypertensive patients. This relationship is independent of and stronger than abdominal obesity, implicating the clinical importance of measuring EAT thickness.

A high-normal thyrotropin level is associated with the severity of left ventricular diastolic dysfunction in patients with hypertrophic cardiomyopathy

Impaired left ventricular (LV) diastolic function is a common pathophysiological feature of patients with hypertrophic cardiomyopathy (HCM). High-normal thyrotropin (thyroid-stimulating hormone, TSH) levels may alter the performance of the left ventricle. To ascertain whether the severity of impaired LV diastolic function in HCM patients might worsen with elevating TSH levels within the reference range. This study included 152 HCM patients and 119 healthy controls with euthyroidism. Blood samples were taken to test for serum TSH, free triiodothyronine (FT3) and free thyroxine (FT4) levels. LV diastolic function was quantified by determining the ratio of the transmitral early LV filling velocity to the early diastolic mitral annulus velocity (E/Ea ratio). The E/Ea ratio was significantly higher in patients with high-normal TSH levels (25.7 ± 5.6 vs. 17.7 ± 4.9, p < 0.001). There was a significant correlation between the E/Ea ratio and the TSH levels within the high reference range (β = 0.268, p = 0.021). Univariate logistic regression showed that high-normal TSH levels were predictors of severe heart failure. However, after adjusting for the effect of LV diastolic dysfunction, high-normal TSH levels were no longer independent predictors of severe heart failure. The HCM patients with high-normal TSH levels had a higher degree of LV diastolic dysfunction. Mild TSH level changes within the high reference range can influence the severity of impaired LV diastolic function. In HCM patients, high-normal TSH levels may affect the development of heart failure through their association with LV diastolic impairment.

Left Ventricular Diastolic Dysfunction in Patients With Mitral Stenosis Undergoing Percutaneous Mitral Balloon Valvotomy

ObjectiveTo investigate the effect of left ventricular diastolic dysfunction on outcome in patients with mitral stenosis undergoing percutaneous mitral balloon valvotomy (PMBV). Patients and MethodsWe evaluated consecutive patients with mitral stenosis who underwent PMBV from November 1, 2002, through October 30, 2011, at our institution. ResultsOf 107 total patients, 35 (32.7%) had diastolic dysfunction, defined as a preprocedural elevation in left ventricular end-diastolic pressure (LVEDP) (>15 mm Hg). The LVEDP was normal in the remaining 72 patients (≤15 mm Hg). Clinical factors associated with diastolic dysfunction were body mass index (32±7 vs 28±5; P=.004) and diabetes mellitus (29% vs 6%; P=.002), but no differences were found in severity of pulmonary hypertension or degree of improvement in mitral valve hemodynamics after PMBV between the 2 groups. Survival free of recurrent severe symptoms, repeated PMBV, or mitral valve replacement was worse in patients with elevated LVEDP vs normal LVEDP (1-year estimate, 42% vs 81%; hazard ratio, 2.83; 95% CI, 1.62-4.96). ConclusionIn patients referred for treatment of symptomatic mitral stenosis, left ventricular diastolic dysfunction may contribute to elevated left atrial pressure, and its presence is associated with a greater risk of failure of PMBV to improve symptoms. These data have implications for counseling and patient selection for PMBV.

Severity of diabetic retinopathy is associated with left ventricular diastolic dysfunction in patients with type 2 diabetes

AimThe aim of the study was to examine the association of severity of diabetic retinopathy (DR) with left ventricular diastolic dysfunction (LVDD). MethodsThe subjects were 120 patients with type 2 diabetes mellitus (T2DM). All patients underwent clinical evaluation, laboratory tests, and echocardiographic examination. Doppler echocardiographic indices including peak early diastolic mitral annular velocity (e′) and early diastolic myocardial velocity (E) were obtained in each patient. ResultsThe patients were divided into three groups based on the presence and severity of DR: no DR (n=80), simple DR (n=20), and preproliferative or proliferative DR (n=20). No patients showed systolic impairment of left ventricular ejection fraction (LVEF>50%), whereas impaired LV diastolic function (E/e′>8) occurred in 104 cases (87%) and LVDD (E/e′>15) was detected in 19 cases (16%). E/e′ was correlated with age, sex, diabetic duration, DR stage, systolic blood pressure, and serum creatinine level. In multiple regression analysis, age (β=0.322, p<0.001) and DR stage (β=0.266, p=0.002) were independently correlated with E/e′. ConclusionsThe results of the study show that almost all subjects had asymptomatic LVDD and that the severity of DR was associated with LVDD in patients with T2DM.