Ventricular Diastolic Function Parameters Research Articles

The Relationship between Left Ventricular Diastolic Function Parameters and Coronary Artery Disease Severity.

The relationship between diastolic function parameters and the severity of coronary artery disease (CAD) is controversial. This study aimed to determine the relationship between left ventricular diastolic function and the severity of CAD. This cross-sectional study included 63 patients with Ischemic heart disease (IHD) or those suspected of having IHD, who underwent angiography. The study was conducted in Shafa Hospital, Kerman, Iran, from 2021 to 2022. Two-dimensional (2D) strain echocardiography was used to assess left ventricular (LV) function parameters, followed by coronary angiography. Based on the severity of the disease, patients with significant CAD were placed in the case group, and patients with insignificant CAD were placed in the control group. The correlation between the CAD severity and the severity of LV diastolic dysfunction was computed. Descriptive tests, independent t tests, and Spearman correlation coefficients were used. P<0.05 was considered statistically significant. The results indicated that there was no correlation between E/e' (P=0.103), left atrial volume index (LAVI) (P=0.168), tricuspid regurgitation velocity (TRV) (P=0.217), myocardial performance index (MPI) (P=0.106), E wave deceleration time (dt) (P=0.644), and late diastolic strain rate (P=0.502) with CAD severity based on SYNTAX score. However, there was a correlation between left atrial (LA) strain (P=0.017), global longitudinal strain (GLS) (P<0.001), early diastolic strain rate (P<0.001), and systolic strain rate (P=0.047) with SYNTAX score. Besides, there was a correlation between LA strain (P=0.017), GLS (P<0.001), early diastolic strain rate (P<0.001), and late diastolic strain rate (P=0.035) with numbers of epicardial coronary arteries with significant lesions. In contrast with 2D strain echocardiography, this study showed that conventional echocardiography parameters had no significant relationship with CAD severity. GLS had the strongest correlation with CAD severity, and diastolic strain rates had a weaker correlation with CAD severity.

Effect of stereotactic body radiation therapy on left ventricular diastole function in symptomatic patients with hypertrophic obstructive cardiomyopathy

Abstract Background We applied stereotactic body radiotherapy (SBRT) for the first time in the treatment of patients with hypertrophic obstructive cardiomyopathy (HOCM), and significant improvements in symptoms and diastolic function were observed after treatment. Objectives To evaluate the impact of SBRT on cardiac structure, function, and clinical indicators in patients with HOCM. Methods This study included 12 drug-refractory symptomatic HOCM patients (6 who underwent SBRT and 6 who received pharmacological treatment alone) and conducted a retrospective analysis of their clinical data. Transthoracic echocardiography was used to assess various ultrasound parameters, including interventricular septal thickness, left ventricular outflow tract diameter, peak pressure gradient and diastolic function before treatment and at 1, 3, and 6 months after treatment. Additionally, assessments were made for symptoms; laboratory test results (NT-proBNP, cTnT, CK-mb, and CRP); 6-minute walk test results; New York Heart Association (NYHA) functional classification; and Kansas score before and 6 months after treatment. Results HOCM patients showed significant improvement in mitral valve systolic anterior motion after SBRT. Compared to that at baseline, the interventricular septum thickness gradually decreased at 1, 3, and 6 months after treatment (-8.8%, -8.0%, -14.4%, respectively) (P&amp;lt;0.05). Compared to those in the drug group, the left ventricular diastolic function and structural parameters, including the interventricular septum thickness (mean change from baseline of -3 mm [95% CI: -5.2 to -0.8 mm] and 1.3 mm [95% CI: 0.5 to 2.2 mm]; P&amp;lt;0.05), and the LA GLS (change of 2.1% [-0.03% to 4.2%] and -0.9% [-3.1% to 1.3%]; P&amp;lt;0.05), were significantly improved in HOCM patients at 6 months posttreatment. Similarly, the clinical indicators, including KCCQ, increased from baseline (61 (range, 47.3-70) to 84 (range, 70-89.5) at 6 months posttreatment (P&amp;lt;0.05), and the 6-minute walk test score increased from 187 meters (range, 50-370) to 401 meters (range, 280-540) (P&amp;lt;0.05). Conclusion SBRT significantly improved left ventricular diastolic function and reduced interventricular septum thickness in HOCM patients. Symptoms, exercise capacity and clinical indicators improved after SBRT in HOCM patients.

Echocardiographic and Impedance Cardiography Analysis of Left Ventricular Diastolic Function in Acromegaly Patients.

BACKGROUND Due to the chronic effects of excess growth hormone (GH) and insulin-like growth factor-1 (IGF-1), patients with acromegaly (AC) may develop acromegalic cardiomyopathy with biventricular hypertrophy, systolic and diastolic dysfunction, resulting in congestive heart failure. This study aimed to evaluate the echocardiographic parameters of left ventricular (LV) diastolic function and impedance cardiography (ICG) parameters of cardiovascular hemodynamics in patients with AC. MATERIAL AND METHODS A total of 33 patients (male to female ratio: 1.2; mean age 47 years) newly diagnosed with AC based on the blood hormone levels and imaging study findings were included into this observational cohort study. The echocardiographic parameters of LV diastolic function included early diastolic velocity of the average mitral annulus (e'avg), ratio of early diastolic mitral inflow velocity to early diastolic mitral annular tissue velocity (E/e'ratio), mitral flow early (E) and late (A) phase ratio (E/A). The ICG parameters included stroke volume index (SI), cardiac index (CI), acceleration index (ACI), systemic vascular resistance index (SVRI), total arterial compliance index (TACI) and thoracic fluid content (TFC). RESULTS Poorer parameters of LV diastolic function corresponded to the parameters assessed via ICG: 1) lower ratio E/A was associated with lower SI (P<0.001), CI (P=0.007), VI (P=0.04), ACI (P=0.02), TACI (P=0.005) and higher SVRI (P<0.001), 2) lower E/e' ratio was associated with higher TFC (P=0.03); 3) lower e'avg was associated with lower SI (P=0.01) and CI (P=0.048) and higher SVRI (P=0.03), despite normal LV ejection fraction. CONCLUSIONS Impaired LV diastolic function in AC is associated with impaired pumping function of the heart and higher afterload as assessed on ICG.

Changes of Left Ventricular Global Longitudinal Strain and Diastolic Function Parameters in Patients Undergoing Primary Percutaneous Coronary Intervention with TIMI Flow Grade III after Anterior ST Segment Elevation Myocardial Infarction

Abstract Background STEMI is the most serious presentation of atherosclerotic CAD carrying the most hazardous consequences. STEMI is caused by occlusion of a major coronary artery and primary PCI is the recommended reperfusion therapy over fibrinolysis if performed by an experienced team as soon as possible. Myocardial infarction makes significant changes in composition, shape, and contractile function of myocardium. Especially left ventricle which is the major contributor to the contractile function of the heart, so it affects the systolic and diastolic functions of the heart. Objective To study the dynamic changes of left ventricular global longitudinal strain and diastolic function parameters in patients undergoing primary percutaneous coronary intervention with TIMI flow grade III after anterior STEMI Methods This study is a prospective observational study that was conducted at Ain Shams university hospitals, in the time interval from October 2022 till June 2023. A total of 100 Patients with anterior STEMI Results Our study showed significant improvement in LV systolic function, GLS and diastolic function parameters after PCI during the follow-up. Age &amp;gt; 53, DM, Chest pain to door &amp;gt; 7 hours and CK-total &amp;gt; 4356 were associated with no GLS recovery in Univariate analysis. In multivariate analysis, Chest pain to door &amp;gt; 7 hours was independently associated with no GLS recovery at follow-up with a sensitivity 90 % and specificity 95%. Conclusion In the present study we found Our study showed significant improvement in LV systolic function, GLS and diastolic function parameters after PCI during the follow-up. Age &amp;gt; 53, DM, Chest pain to door &amp;gt; 7 hours and CK-total &amp;gt; 4356 were associated with no GLS recovery in Univariate analysis. In multivariate analysis, Chest pain to door &amp;gt; 7 hours was independently associated with no GLS recovery at follow-up with a sensitivity 90 % and specificity 95%.

Evaluation of cardiac function in paediatric Wilson's disease patients with advanced echocardiographic modalities (strain and strain rate echocardiography).

In Wilson's disease (WD), copper accumulation in the organs and/or damage caused by oxygen free radicals occurs due to disturbances in copper excretion. In our study, we aimed to evaluate cardiac involvement with advanced echocardiographic modalities (tissue Doppler echocardiography, strain and strain-rate echocardiography). Twenty WD patients and 20 healthy children from the Pediatric Gastroenterology Department of Diyarbakır Children's Hospital were included in the study between 2022 and 2023. The mean age of the WD patients was 12.89 ± 3.79 years. Left ventricular wall thicknesses and diameters (diastolic interventricular septum thickness, diastolic left ventricular posterior wall thickness, left ventricular end-diastolic diameter), left ventricular diastolic function parameters (E, A, E/A, deceleration time) and left ventricular ejection fraction and tricuspid annular plane systolic excursion were similar and not statistically significantly different in the WD and control groups. Mitral lateral e', mitral septal e' and tricuspid lateral e' velocities were lower in the WD patients and statistically significantly different from the controls (p = 0.02, 0.04 and 0.005, respectively), as assessed by tissue Doppler echocardiography. Global longitudinal systolic strain was similar in the WD and control groups and no statistically significant difference was detected. Longitudinal early diastolic strain rate was lower in the WD patients and statistically significantly different (p = 0.002). Subclinical early diastolic dysfunction and segmental systolic dysfunction were detected in WD patients with advanced echocardiographic modalities, in addition to normal cardiac function as assessed by conventional echocardiography. Advanced echocardiographic modalities can be used in the follow up of WD patients.

Assessment of the Relationship between Periodontitis and Cardiac Parameters in Patients with Early Chronic Heart Failure: A Cross-Sectional Study.

Periodontal disease (PD) is considered a risk factor for cardiovascular events. However, its relationship to chronic heart failure (CHF) is unclear. The aim was to compare cardiac and inflammatory parameters in CHF patients with (PG) versus without periodontitis (NPG). The following parameters were recorded in 58 patients: periodontal screening and recording (PSR), troponin T, NT-proBNP, C-reactive protein (CRP), interleukin-6 (IL-6), blood pressure, heart rate, ejection fraction (EF), ventricular systolic and diastolic function parameters, incremental test, and three questionnaires (Mediterranean Diet Adherence Screener, MEDAS; Oral Health Impact Profile, OHIP-14; Patient Health Questionnaire, PHQ). The serum levels of NT-proBNP and troponin T were significantly higher in the PG, and the left ventricular systolic and diastolic function parameters were significantly lower. The correlation analysis showed age as the only independent risk factor for periodontitis and cardiac biomarkers. No significant group differences were found in the MEDAS, OHIP-14, and PHQ scores, or in CRP, IL-6, and cardiocirculatory parameters. Overall, the BMI correlated significantly with the mean PSR and total cholesterol. The occurrence of increased PSR together with increased age and cardiac risk parameters does not exclude an association between periodontitis and CHF, though no positive correlation was calculated. Periodontitis may be a modifiable risk factor for CHF. Its treatment may help to control the inflammatory burden.

Left atrial functional changes and its predictive value in the early period after cryoballoon ablation for paroxysmal atrial fibrillation

Abstract Introduction/Purpose In patients with paroxysmal atrial fibrillation (PAF), functional changes are observed in the left atrium (LA) after the pulmonary vein isolation (PVI) procedure. Although previous studies have investigated the altered mechanical functions of the LA with radiofrequency (RF) ablation, changes in the LA functions in the early period after cryoablation (CB-2) and the relationship between early period serial echocardiographic follow-ups after cryoablation and recurrence of atrial fibrillation/atrial tachycardia (AF/AT) have not been clearly demonstrated. This study aims to determine changes in the mechanical functions of LA in patients with PAF during the early period after cryoablation and whether these changes are effective in predicting the risk of recurrence by using echocardiographic parameters including Doppler and strain parameters. Methods Consecutive seventy-seven patients (mean age: 57.5±11.2 years; 57% men) with PAF underwent CB-2 and were prospectively analyzed. All patients were in sinus rhythm before and after the procedure. The LA dimensions, the LA reservoir strain (LASr), the LA atrial contractile strain (LASct), the LA conduit strain (LAScd) and left ventricular diastolic function parameters were evaluated by Doppler echocardiography before and 3 months after the procedure. Patients were monitored with 48-hour Holter at 1-3-6-12th months after the procedure to evaluate for recurrence. Results Acute procedural success was achieved in all cases. No major complications were observed. LASr and LASct showed significant recovery after the procedure (28.3±12.8% vs 34.6±13.8%, p&amp;lt;0.001 and -10.8±7.9% vs -13.9±9.3%, p=0.014 respectively). No significant change was demonstrated in other echocardiographic parameters. During the one-year follow-up after the procedure late recurrence (&amp;gt;3 months) of AF/AT was observed in 9 (11.7%) patients. Although the power of echocardiographic parameters in predicting recurrence was found to be not statistically significant, a downward trend especially in the values of LASr (p=0.068) and LASct (p=0.058) was observed at the 3rd month control echocardiographic results in patients with recurrence. Conclusion Significant improvement in mechanical functions may occur even in the early period after cryoballoon ablation in patients with PAF. In addition, as our study points out strain parameters, indicators of mechanical function tend to decline in patients with late term recurrence.

Left ventricular diastolic dysfunction and transmitral blood flow parameters in patients after COVID-19

Background. People who previously had COVID-19 infection have an increased risk of developing cardiovascular diseases. Left ventricular diastolic dysfunction is an early marker of the development of cardiac pathology. Its early detection is important for the adequate therapy order and dynamic monitoring of patients. In this regard, it seems relevant to study the effect of a recent COVID-19 infection on the left ventricular diastolic function and transmitral blood flow parameters in apparently healthy individuals without clinical and instrumental signs of cardiovascular pathology. The aim of the study. To assess the changes in the diastolic and systolic function of the left ventricle, its anatomical parameters and transmitral blood flow parameters in two groups of apparently healthy individuals: those who had and those who had not COVID-19 infection. Materials and methods. Transthoracic echocardiography was performed according to the standard technique and its results were analyzed in 66 examined patients who were recognized as apparently healthy according to the results of regular comprehensive clinical and instrumental studies. The first group included 30 individuals who underwent an echocardiographic study before or during the COVID-19 pandemic, but did not have a coronavirus infection; the second group consisted of 36 people who recovered from COVID-19. The indicators of the presence of left ventricular diastolic dysfunction and the transmitral blood flow parameters were assessed. The study was approved at a meeting of the Medical Ethics Committee under the Ministry of Health of the Republic of Karelia and of Petrozavodsk State University (Minutes No. 47 of 01.11.2023). Results. The frequency of the left ventricular diastolic dysfunction did not differ in the first and second groups of patients. Statistically significant differences were recorded in the average flow deceleration time for both early and late filling of the left ventricle in people who had and did not have COVID-19 infection. A change in the phase structure of the transmitral blood flow may be an early manifestation of intracardiac hemodynamic disorders in people who have recovered from COVID-19.

Left atrial functions in the early period after cryoballoon ablation for paroxysmal atrial fibrillation.

In patients with paroxysmal atrial fibrillation (PAF), functional changes are observed in the left atrium (LA) after pulmonary vein isolation (PVI) procedure. Although previous studies have investigated the altered mechanical functions of the LA with radiofrequency (RF) ablation, changes in the LA functions in the early period after cryoablation (CB-2) have not been clearly demonstrated. This study aims to explore the early periodical changes in mechanical functions of the LA in patients with PAF who underwent CB-2 based ablation through the help of echocardiographic methods which contain Doppler and strain parameters. Consecutive 77 patients (mean age: 57.5 ±11.2; 57% men) with PAF underwent CB-2 were prospectively analyzed. All patients were in sinus rhythm before and after the procedure. The LA dimensions, the LA reservoir strain, the LA atrial contractile strain and the LA conduit strain and left ventricular diastolic function parameters were evaluated by Doppler echocardiography before and 3 months after the procedure. Acute procedural success was achieved in all cases. No major complications were observed. LA reservoir strain and LA contractile strain showed significant recovery after the procedure. (28.3±12.8vs. 34.6±13.8, p<.001 and -10.8±7.9 vs. -13.9±9.3, p=.014 respectively). No significant change was demonstrated in other echocardiographic parameters. Significant improvement in mechanical functions may occur even in the early period after cryoballoon ablation in patients with PAF.

Left ventricular diastolic function in the fifth decade of life in women with a history of spontaneous preterm birth

ObjectiveCardiovascular disease (CVD) is the number one cause of death in women and defining its risk factors is necessary to reduce its prevalence. A history of preeclampsia is shown to be associated with hypertension and alterations in left ventricular (LV) diastolic function parameters. Because of overlapping mechanisms between preeclampsia and spontaneous preterm birth (SPTB), our most recent study investigated the association between SPTB and hypertension, and found an almost 2 times higher prevalence of hypertension after SPTB. No previous studies have focused on the association between SPTB and LV diastolic function. The aim of this study is to investigate LV diastolic function as potential early parameter of CVD in women with a history of SPTB. Study designWe included cases with a history of SPTB between 22 and 37 weeks and controls who had a term birth. Women with hypertensive disorders or gestational diabetes in any of their pregnancies, were excluded. Both groups underwent cardiovascular risk assessment and transthoracic echocardiography 9 to 16 years after pregnancy. Echocardiographic measures were adjusted using a linear regression analysis accounting for hypertension and other risk factors known to be associated with CVD. A subgroup analysis was performed based on hypertension at follow-up. ResultsA total of 94 cases and 94 controls were included, on average 13 years after pregnancy. There were no significant differences in LV diastolic function parameters. Women with a history of SPTB and diagnosed hypertension at follow-up, showed significant higher late diastolic mitral flow velocity, lower e’septal velocity and higher E/e’ratio, compared to women with a history of SPTB without hypertension, although within normal ranges. ConclusionsWhen a history of SPTB is accompanied by hypertension at follow-up, significant changes in LV diastolic function were seen. Therefore, hypertension is the central factor in preventive screening methods, and transthoracic echocardiography has no additional value at this follow-up duration.

Comparison of Left Ventricular Diastolic Function Parameters between Patients with Unplanned and Planned Hemodialysis Initiation: A Cross-Sectional Study

Despite the increasing number of dialysis patients, there is still no clear consensus regarding when a permanent access device should be prepared and renal replacement treatment should be undertaken. The purpose of this study was to evaluate left ventricular diastolic function at the start of dialysis between patients in a planned or unplanned manner according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI). We designed a single-center, cross-sectional study to use echocardiography to evaluate and compare left ventricular diastolic function at the onset of dialysis between patients in planned and unplanned groups. A total of 21 patients were included in our analysis (11 initiated dialysis in a planned manner and 10 did so in an unplanned manner). E/A and E/E′ were significantly high in the unplanned dialysis initiation group (p = 0.048 and p = 0.003, respectively). Furthermore, the number of patients with an E/E′ ratio of &gt;14 and tricuspid regurgitation velocity of &gt;2.8 was also significantly high in the unplanned dialysis initiation group (80% vs. 18%; p = 0.009, 40% vs. 0%; p = 0.035, respectively). According to the American Society of Echocardiography and the European Association of Cardiovascular Imaging Recommendation in 2016, the number of patients with left ventricular diastolic dysfunction was significantly high in the unplanned dialysis initiation group (80% vs. 18%; p = 0.009). The current study demonstrated that left ventricular diastolic dysfunction is more apparent in incident dialysis patients in an unplanned manner. Our findings suggest that the assessment of left ventricular diastolic function by echocardiography may be an indication of when to create a permanent access device and initiate dialysis.

Diastole/Body Mass Index Ratio Can Predict Post-Thoracoscopic Surgery Metastasis in Stage I Lung Adenocarcinoma.

According to recent animal models for lung adenocarcinoma metastasis, cardiac function may be related to the clinical outcome. The aim of this study is to identify a predictable index for postoperative metastasis (POM) that is associated with cardiac function. Two hundred and seven consecutive patients who underwent thoracoscopic resection for stage I lung adenocarcinoma were included. Disease-free survival (DFS), overall survival (OS), and patients' clinical and pathological characteristics were analyzed. Among the 207 patients, 17 cases demonstrated metastasis, 110 cases received a preoperative echocardiogram, and six cases had POM. Mitral valve peak A velocity, which is one of the left ventricular diastolic function parameters affected by BMI (MVPABMI), was associated with a negative factor for POM (hazard ratio (HR): 2.139, p = 0.019) and a poor 5-year DFS in the above median (100% vs. 87%, p = 0.014). The predictable rate increased from 30.7% to 75% when the MVPABMI was above the median = 3.15 in the solid subtype). MVPABMI is a novel index for POM prediction in early-stage lung adenocarcinoma. This is a pilot study and the first attempt at research to verify that the diastole and the BMI may be associated with POM in early-stage lung adenocarcinoma.

Left atrial functions in the early period after cryoballoon ablation for paroxysmal atrial fibrillation

Abstract Introduction In patients with paroxysmal atrial fibrillation (PAF), functional changes are observed in the left atrium (LA) after pulmonary vein isolation (PVI) with catheter ablation. Although previous studies have investigated the altered mechanical functions of LA with radiofrequency (RF) ablation, changes in LA functions in the early period after cryoablation have not been clearly demonstrated. Methods Thirty three patients (mean age: 57±11; 54.5% men) with PAF underwent cryoablation procedure with second generation cryoballoon (CB-2). All patients were in sinus rhythm before and after the procedure. LA dimensions, LA strain parameters (LAsr-LAscd-LAsct) and left ventricular diastolic function parameters were evaluated by Doppler echocardiography before and 3 months after the procedure. Results Acute procedural success was achieved in all cases. No major complications were occurred. A significant recovery in LA reservoir strain (p=0.009) was observed. No significant change was demonstrated in remaining echocardiographic parameters. Conclusion LA reservoir strain is an indicator of left atrial compliance and significant improvement in mechanical functions may occur even in the early period after cryoballoon ablation in patients with PAF in contrast to LA function deterioration observed in RF ablation. Funding Acknowledgement Type of funding sources: None.

Unsupervised Machine Learning for Assessment of Left Ventricular Diastolic Function and Risk Stratification

The 2016 American Society of Echocardiography guidelines have been widely used to assess left ventricular diastolic function. However, limitations are present in the current classification system. The aim of this study was to develop a data-driven, unsupervised machine learning approach for diastolic function classification and risk stratification using the left ventricular diastolic function parameters recommended in the 2016 American Society of Echocardiography guidelines; the guideline grading was used as the reference standard. Baseline demographics, heart failure hospitalization, and all-cause mortality data were obtained for all adult patients who underwent transthoracic echocardiography at Mayo Clinic Rochester in 2015. Patients with prior mitral valve intervention, congenital heart disease, cardiac transplantation, or cardiac assist device implantation were excluded. Nine left ventricular diastolic function variables (mitral E- and A-wave peak velocities, E/A ratio, deceleration time, medial and lateral annular e' velocities and E/e' ratio, and tricuspid regurgitation peak velocity) were used for an unsupervised machine learning algorithm to identify different phenotype clusters. The cohort average of each variable was used for imputation. Patients were grouped according to the algorithm-determined clusters for Kaplan-Meier survival analysis. Among 24,414 patients (mean age, 63.6±16.2years), all-cause mortality occurred in 4,612 patients (18.9%) during a median follow-up period of 3.1years. The algorithm determined three clusters with echocardiographic measurement characteristics corresponding to normal diastolic function (n=8,312), impaired relaxation (n=11,779), and increased filling pressure (n=4,323), with 3-year cumulative mortality of 11.8%, 19.9%, and 33.4%, respectively (P<.0001). All 10,694 patients (43.8%) classified as indeterminate were reclassified into the three clusters (n=3,324, n=5,353, and n=2,017, respectively), with 3-year mortality of 16.6%, 22.9%, and 34.4%, respectively. The clusters also outperformed guideline-based grade for prognostication (C index=0.607 vs 0.582, P=.013). Unsupervised machine learning identified physiologically and prognostically distinct clusters on the basis of nine diastolic function Doppler variables. The clusters can be potentially applied in echocardiography laboratory practice and future clinical trials for simple, replicable diastolic function-related risk stratification.

Excursão Sistólica do Anel Tricúspide e do Anel Mitral: Correlação com Função Diastólica Ventricular Esquerda

Introduction: Tricuspid annular plane systolic excursion and mitral annular systolic excursion are parameters used to assess the systolic function of the right ventricle and left ventricle, respectively. Little is known about its relationship with left ventricular diastolic function. Objective: To assess whether the values of mitral annular systolic excursion and tricuspid annular plane systolic excursion correlate with parameters used in the evaluation of left ventricular diastolic function. Method: Observational cross-sectional study. Two hundred nine individuals were selected, 116 women, with both ventricles normal systolic function. The analyzes were performed for men and women, through Pearson correlation coefficient and Sperman correlation coefficient. Tricuspid annular plane systolic excursion, mitral annular systolic excursion, atrial volumes and left ventricular diastolic function parameters on transthoracic echocardiogram were obtained. Results: In women, mitral annular systolic excursion was positively correlated with lateral e ‘(Sperman correlation coefficient of 0.22; p=0.016) and tricuspid annular plane systolic excursion was positively correlated with E / A ratio (Sperman correlation coefficient of 0.23; p=0.037), lateral e’ (Sperman correlation coefficient of 0.28; p=0.012), and septal e’ (Sperman correlation coefficient of 0.28; p=0.012), and negatively with the E/e’ ratio (Pearson correlation coefficient of -0.27; p=0.018), and A wave (Pearson correlation coefficient of -0.29; p=0.009). In men, only mitral annular systolic excursion correlated positively with E wave (Pearson correlation coefficient of 0.21; p=0.037), lateral e’ (Sperman correlation coefficient of 0.34; p &lt;0.001) and the septal e’ (Sperman correlation coefficient of 0.26; p=0.008). There was no correlation between mitral annular systolic excursion and tricuspid annular plane systolic excursion and atrial volumes. Hypertension and diabetes mellitus influenced tricuspid annular plane systolic excursion and mitral annular systolic excursion values correlated to E and A waves, E/A ratio, septal and lateral e’ waves, and E/e’ ratio. Conclusion: In the present study, mitral annular systolic excursion and tricuspid annular plane systolic excursion values showed a significant correlation with some parameters of left ventricular diastolic function, with stronger evidence on female sex.

Correlations between left atrial strain and left atrial pressures values in patients undergoing atrial fibrillation ablation.

We aimed to investigate the correlations between left atrial strain (LAS) assessed by speckle tracking echocardiography and directly measured left atrial pressures (LAP) values and to estimate the features of patients with lower LAS values. A prospective, observational study was performed on patients with atrial fibrillation (AF) undergoing ablation. Detailed transthoracic echocardiography with the speckle tracking method was used to estimate the LAS reservoir (LASr) and direct measurements of LAP during ablation in all patients. A total of 172 patients were included (98 with sinus rhythm [SR] and 74 with AF). The patients with lower LASr (first tercile) compared to those with higher (third tercile), were older, more often female, presented with a larger left atrium (LA) (per the LA area and volume index), and had more impaired left ventricular (LV) diastolic function parameters (e', E/e'). The correlation analysis of the echocardiographic parameters with the LAP revealed the most significant correlations in the SR group, where the E/e' ratio, LASr, and LAS contraction (LASct) values were all associated with LAP. The cut-off value of LASr estimating high elevated mean LAP (≥15 mm Hg) was 21.88 (Area Under Curve [AUC], 0.81; 95% confidence interval [CI], 0.72-0.90; P <0.0001) for the SR group and 11.25 (AUC, 0.66; 95% CI, 0.53-0.80; P = 0.016) for the AF group. AF patients with lower LASr are older, more often female, have a larger LA, and have more impaired LV diastolic function. Low LASr and LASct and high E/e' ratio values are associated with higher LAP in AF patients with SR.

Heart Model A.I. Three-Dimensional Echocardiographic Evaluation of Left Ventricular Function and Parameter Setting.

ObjectiveThis study aims to explore the feasibility of HeartModel A.I. (HM) three-dimensional echocardiography (3DE) to assess left ventricular function and discover suitable border parameter settings.MethodsA total of 113 patients that underwent echocardiography in our hospital were eligible for inclusion. The HM 3DE (HM method) and conventional 3DE (3D method) were used to analyze echocardiography images. The HM was set to different border settings (end-diastolic [ED] and end-systolic [ES] settings) to assess different left ventricular systolic function parameters including left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), and left ventricular ejection fraction (LVEF), and left ventricular diastolic function parameters including maximal left atrium volume (LAVMAX). All of these parameters were evaluated using the HM method and then compared with the 3D method.ResultsThe differences in LVEDV, LVESV, and LVEF measured with different HM border settings were statistically significant (P<0.05) and were strongly correlated with the 3D method. For LVEF, the reading using the HM method with ED and ES = 70 and 30 showed the best agreement with the 3D method, and the difference in the readings was not statistically significant (P > 0.05). For LVEDV and LVESV, the reading using the HM method with ED and ES = 40 and 20 showed the best agreement with the 3D method, but the difference in the readings was statistically significant (P < 0.05). The measurements taken using the HM method were more reproducible than those taken using the 3D method (P<0.05). The measurement time when using the HM method was significantly less than the 3D method (P<0.05). In terms of LAVMAX, the correlation between the HM and 3D methods was strong, but the requirements for agreement were not satisfied.ConclusionEvaluation of the left ventricular function using HM 3DE is feasible, saves time, and is reproducible. To assess the left ventricular function, the border parameter setting of ED and ES = 70 and 30 provided the best fit for the Chinese population.

Echocardiographic evaluation in type 1 diabetes mellitus

Type 1 diabetes (T1D) is a chronic disease with peak incidence in adolescence; it has a major impact on morbidity and mortality, especially cardiovascular. Diabetic cardiomyopathy is characterized by structural and functional lesions in the absence of other diseases and is involved in the progression to heart failure. Echocardiography has led to the identification of early cardiac lesions, despite controversial results in the literature in patients with T1D.The objective of this study is to assess cardiac changes in individuals with TD1 compared to the control group using conventional two-dimensional Doppler and advanced speckle tracking echocardiography.This is a case-control study with 40 asymptomatic, normotensive T1D patients aged 20 to 50 years and 40 healthy subjects. Two-dimensional echocardiography was performed to measure myocardial thickness and cardiac chambers. Tissue Doppler echocardiography was used for diastolic analysis and speckle tracking echocardiography to quantify ventricular systolic function.The mean age was 33 years in both groups, with an average T1D duration of 18 years; 20% of patients with T1D had diabetic retinopathy; 12.5% kidney injury; and 10% peripheral neuropathy. There were differences in the left ventricular diastolic function parameters (lateral E', middle E' and S/D ratio) and right ventricle (tricuspid E and tricuspid E'/A' ratio). The mean value of the global longitudinal strain was -21.7% (+- 2.3) in the T1D group and -21.0% (+-2.0) in the control group (p=0.21).Echocardiography revealed a reduction in indices of diastolic function in T1D compared to the control group, which may be the initial cardiac lesion in diabetes.

Avaliação ecocardiográfica na diabetes mellitus tipo 1

IntroductionType 1 diabetes (T1D) is a chronic disease with peak incidence in adolescence; it has a major impact on morbidity and mortality, especially cardiovascular. Diabetic cardiomyopathy is characterized by structural and functional lesions in the absence of other diseases and is involved in the progression to heart failure. Echocardiography has led to the identification of early cardiac lesions, despite controversial results in the literature in patients with T1D. ObjectiveThe objective of this study is to assess cardiac changes in individuals with TD1 compared to the control group using conventional two‐dimensional Doppler and advanced speckle tracking echocardiography. MethodsThis is a case‐control study with 40 asymptomatic, normotensive T1D patients aged 20 to 50 years and 40 healthy subjects. Two‐dimensional echocardiography was performed to measure myocardial thickness and cardiac chambers. Tissue Doppler echocardiography was used for diastolic analysis and speckle tracking echocardiography to quantify ventricular systolic function. ResultsThe mean age was 33 years in both groups, with an average T1D duration of 18 years; 20% of patients with T1D had diabetic retinopathy; 12.5% kidney injury; and 10% peripheral neuropathy. There were differences in the left ventricular diastolic function parameters (lateral E’, middle E’ and S/D ratio) and right ventricle (tricuspid E and tricuspid E’/A’ ratio). The mean value of the global longitudinal strain was ‐21.7% (+‐ 2.3) in the T1D group and ‐21.0% (+‐2.0) in the control group (p=0.21). ConclusionEchocardiography revealed a reduction in indices of diastolic function in T1D compared to the control group, which may be the initial cardiac lesion in diabetes.

Association of epicardial fat thickness with left ventricular diastolic function parameters in a community population

BackgroundWe examined the relationship between epicardial fat thickness (EFT) measured by echocardiography and left ventricular diastolic function parameters in a Beijing community population.MethodsWe included 1004 participants in this study. Echocardiographic parameters including E and A peak velocity, the early diastolic velocities (e′) of the septal and lateral mitral annulus using tissue doppler imaging, E/e′, and EFT were measured. EFT1 was measured perpendicularly on the right ventricular free wall at end diastole in the extension line of the aortic root. EFT2 was the maximum thickness measured perpendicularly on the right ventricular free wall at end diastole. Multivariable linear regression was used to analyze the relationship between EFT and the mean e′ and E/e′.ResultsThe mean age of the participants was 63.91 ± 9.02 years, and 51.4% were men. EFT1 and EFT2 were negatively correlated with lateral e′, septal e′, and mean e′ (p < 0.05), and the correlation coefficient for EFT1 and EFT2 and mean e′ was − 0.138 and − 0.180, respectively. EFT1 and EFT2 were positively correlated with lateral E/e′, septal E/e′, and mean E/e′ (p < 0.05), and the correlation coefficient for EFT1 and EFT2 and mean e′ was 0.100 and 0.090, respectively. Multivariable egression analysis showed that EFT2 was independently and negatively associated with e′ mean (β = − 0.078 [95% confidence interval = − 0.143, − 0.012, p = 0.020]). There were no interactions between EFT2 and any covariates, including age or heart groups, sex, BMI, or presence of hypertension, diabetes, or coronary heart disease, in relation to left ventricular diastolic dysfunction.ConclusionsEFT2 was negatively and independently associated with e′ mean, which suggests that more attention to this type of adipose fat is required for cardiovascular disease therapy.