Systolic dysfunction and diastolic dysfunction do not influence medium-term prognosis in patients with cirrhosis

ObjectiveMyocardial dysfunction has been described in patients with cirrhosis and may contribute to haemodynamic disturbances in advanced disease states. However, the prognostic impact of cardiac systolic and diastolic dysfunction in cirrhosis is controversial. We aimed to evaluate the performance of echocardiographic parameters of cardiac function as medium-term prognostic markers, in a cohort of cirrhotic patients.MethodsNinety-eight patients (52 discharged after hospitalization for decompensated cirrhosis and 46 ambulatory) were prospectively evaluated. A comprehensive echocardiographic study, including tissue-Doppler and speckle tracking analysis, was performed at baseline. Patients were followed-up for 6 months for the occurrence of death.ResultsTwenty patients died during the follow-up. None of the echocardiographic parameters were associated with the occurrence of death. A Child score > 10 points (HR 13.1, 95% CI 3.79–45.0, p < 0.001) and a mean arterial pressure below the median (HR 3.2, 95% CI 1.14–8.80, p = 0.028) were the only independent predictors of mortality in Cox regression multivariate analysis. In previously hospitalized patients, cardiac output, C-reactive protein and albumin levels were associated with 6-month mortality in univariate analysis; this association was lost after adjusting for Child score.ConclusionsMedium-term mortality in cirrhosis seems to be mainly determined by liver disease severity rather than by myocardial dysfunction. Modern echocardiographic indices of systolic and diastolic function do not seem to be useful in identifying patients at increased risk of dying.     

Immediate impact of successful percutaneous balloon mitral valvuloplasty on right and left ventricular functions: An echocardiographic study using load independent tissue velocity imaging indices

BackgroundThe impact of successful percutaneous balloon mitral valvuloplasty (PBMV) on left ventricular (LV) function has been a controversial subject. This study aimed to determine the immediate impact of PBMV on biventricular function using recent Tissue Velocity Imaging (TVI) derived load-independent indices.Methods and resultsA total of 30 patients with severe mitral stenosis (MS) who underwent PBMV at a tertiary center of India from August 2012 to December 2013 were included in the study. Thirty age-matched and gender-matched healthy controls were also enrolled.Out of 30 patients, 27(90%) were female. Mean mitral valve area (MVA) of patients before and after PBMV was 0.78 and 1.82 cm² (p < 0.001), respectively. All TVI-derived LV and RV basal systolic (IVCV, Sm and the relatively load independent IVA) and diastolic velocities (Em, Em/Am) were significantly decreased in patients with MS compared to controls (p < 0.001 for all) which improved significantly after PBMV (6.4 ± 0.7 vs 11 ± 1.6; 5.8 ± 0.7 vs 9.9 ± 1.6; 1.5 ± 0.3 vs 4.2 ± 0.6; 6.4 ± 0.6 vs 13.1 ± 2.1; 0.7 ± 0.1 vs 1.7 ± 0.2 for mitral annulus respectively, p < 0.001 for all). Increment in MVA positively correlated with Tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular Sm and isovolumic contraction velocity (IVCV) and inversely with left atrium (LA) size and Pulmonary arterial systolic pressure (PASP) (p = 0.01 for LA size; p < 0.001 for others) while no such correlation was found with mitral annulus isovolumic acceleration (IVA) (r = −0.078; p = 0.679).ConclusionThe improved right ventricular (RV) function appears to be predominantly due to afterload reduction, while that of LV appears to be more due to the acute relief of mechanical restraint.     

Asymptomatic systolic and diastolic dysfunction in patients with risk factors referred for echocardiography. The DAVES study by the Italian Society of Cardiovascular Echography

ObjectivesThis study aims to determine the prevalence of left ventricular dysfunction in subjects without signs and symptoms of heart failure referred for echocardiography essentially for the presence of one or more cardiovascular risk factors.Materials and methodsThe DAVES study (Disfunzione Asintomatica del Ventricolo Sinistro, left ventricular asymptomatic dysfunction) is a multicenter cross-sectional observational study based on echocardiography. Among 16,099 screened subjects from 75 Centers, we enrolled 3,537 subjects without signs or symptoms of heart failure. The prevalence of depressed left ventricular systolic (left ventricular ejection fraction ≤ 50%) and diastolic function was analyzed.ResultsThe overall prevalence of asymptomatic left ventricular systolic dysfunction was 9.4%, while diastolic dysfunction was detected in 39.1% of subjects. The rate of systolic and diastolic dysfunction increased proportionally to the number of cardiovascular risk factors (1 or ≥ 5 risk factors), ranging from 8.1% to 27.1% and from 37.5% to 45.0%, respectively. At multivariate analysis, independent variables predictive for systolic dysfunction were male gender (p < 0.001), family history of cardiovascular disease (p = 0.002) and diabetes (p = 0.027); while for diastolic dysfunction they were age (p < 0.001), hypertension (p < 0.001) and diabetes (p < 0.05).ConclusionsIn a large sample of subjects without symptoms of heart failure referred to echocardiography, we found a significant prevalence of left ventricular systolic and diastolic dysfunction, both related to the number of cardiovascular risk factors.     

Comparison between left atrial features in well-controlled hypertensive patients and normal subjects assessed by three-dimensional speckle tracking echocardiography

BackgroundThree-dimensional speckle tracking echocardiography (3D-STE) has a major advantage in the improvement of accuracy in the evaluation of cardiac chamber volume without any geometrical assumption. Thus, the aim of this study was to use 3D-STE to elucidate the features of left atrial (LA) volume and function that are altered by hypertension (HTN) by comparing well-controlled HTN patients with normal subjects.MethodsConventional echocardiographic parameters and LA phasic volume and function were measured from apical view by 3D-STE in 40 patients with well-controlled HTN [systolic blood pressure (BP) <140 and diastolic BP <90 mmHg for more than one year] and 40 normotensive subjects.ResultsThe passive LA emptying function (EF) in the patients with well-controlled HTN significantly decreased (16 ± 7% vs. 22 ± 8%, p = 0.0013) and the active LAEF in patients with well-controlled HTN significantly increased (35 ± 10% vs. 30 ± 9%, p = 0.029) compared with the values in normotensive subjects. Multivariate logistic regression analysis revealed that E/e′ was an independent determinant of well-controlled HTN. The maximum LA volume index was correlated with elevated E/e′ (r = 0.30, p = 0.0064), whereas the maximum LA volume index was not correlated with LV mass index or systolic BP. This change was independent of age.ConclusionsThese results suggest that LV diastolic dysfunction occurs before structural changes of left atrium and left ventricle even in patients with well-controlled HTN.     

Association entre tissu adipeux epicardique et dysfonction systolique infraclinique détectée par strain longitudinal chez les diabétiques mal équilibrés

ObjectiveThe aim of this study is to assess the association between epicardial adipose tissue (EAT) and infraclinical myocardial dysfunction detected by strain imaging in diabetic patients (T2DM) with poor glycemic control.Methods22 patients with T2DM and 22 healthy control subjects of similar age and sex were prospectively recruited. Echocardiographic parameters were investigated.ResultsIn comparison to controls, diabetic patients had significantly higher body mass index (27.7 vs. 24.6; P < 0.01), waist perimeter (103 vs. 84; P < 0.001) and usCRP level (5.4 vs. 1.5; P < 0.01). On echocardiography; no differences were found in terms of ejection fraction or ventricular mass; however, patients with T2DM had significantly thicker EAT (8.7 ± 0.7 vs. 3.0 ± 1.0; P < 0.001) and altered systolic longitudinal strain (−18.8 ± 3.2 vs. 22.3 ± 1.6; P < 0.001). On multivariate analysis, EAT was identified as an independent contributor (β=0,46, P = 0.001) to systolic longitudinal strain.ConclusionIn patients with T2DM and poor glycemic control; EAT was associated with infraclinical systolic dysfunction evaluated by global longitudinal strain despite normal at rest ejection fraction and no coronary artery disease.     

Myocardial Performance Index (Tei Index): A simple tool to identify cardiac dysfunction in patients with diabetes mellitus

BackgroundCardiac dysfunction is the major cause of morbidity and mortality in diabetes. Myocardial Performance Index (MPI/Tei Index) includes both systolic and diastolic time intervals to assess the global cardiac dysfunction. Our aim was to assess the MPI in patients with type 2 diabetes.Material and methodsThis hospital-based analytic observational study was performed in the tertiary care center. The conventional Doppler parameters, tissue Doppler-derived E/E′ and MPI, were measured in all patients.Results100 patients with type 2 diabetes were included in the study. 65 patients showed diastolic dysfunction, 33 with Grade I diastolic dysfunction, 23 with Grade II diastolic dysfunction, and 14 patients with Grade III diastolic dysfunction. The conventional Doppler showed abnormality in 44% of patients (33 patients with Grade I and 14 patient with Grade III). 23 patients were in Grade II diastolic dysfunction (12 patients showed reversal E/A on valsalva maneuver and 11 patients showed abnormality in tissue Doppler-derived E/E′, E/E′ > 15). MPI with cut-off 0.36 was found to have 94% sensitivity, 100 specificity, and 94% PPV for the detection of cardiac dysfunction. MPI negatively correlated with systolic dysfunction (rho = 0.455, p < 0.001) and positively correlated with grade of diastolic dysfunction (rho = 0.832, p < 0.001) and NYHA grading of dyspnea (rho = 0.872, p < 0.001)ConclusionsMPI as a single parameter can be used for assessment in diabetic cardiac dysfunction.     

Guideline-adherent therapy for stroke prevention in atrial fibrillation in different health care settings: Results from RAMSES study

ObjectiveNo studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies.MethodsBaseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared.ResultsOf the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8 ± 9.8 vs. 68.7 ± 11.4 years, p < 0.001), had a lower socioeconomic status, had a higher CHA₂DS₂VASc and HASBLED scores (3.4 ± 1.4 vs. 3.1 ± 1.7, p < 0.001 and 1.7 ± 1.0 vs. 1.6 ± 1.1, p < 0.001 respectively), and had more comorbidities than patients treated in THs. Inappropriate oral anticoagulant use was more prevalent in SHs than THs (31.4% vs. 25.6%, p < 0.001). When over- and undertreatment rates were compared among hospital types, overtreatment was more prevalent in THs (7.6% vs. 0.9%, p < 0.001) while undertreatment was more common in SHs (30.5% vs. 17.9%, p < 0.001).ConclusionThis study demonstrates the marked disparity between patient groups with AF presenting at SHs and THs. The use of guideline-recommended therapy is not adequate in either type of centre, overtreatment was more prevalent in THs and undertreatment was more prevalent in SHs.     

Lean versus obese diabetes mellitus patients in the United States minority population

ObjectiveTo identify special characteristics in large group of lean diabetes minority patients in comparison to obese type 2 diabetes.Methods1784 lean (BMI < 25) diabetes patients were identified and compared with 8630 obese (BMI ≥ 30) patients. Patients with Type 1 Diabetes (N = 523) were excluded. Patient data, including demographics, psychosocial factors, insulin use, and complications was analyzed.ResultsIn lean compared to obese, there was male predominance (62% vs 48%, p < 0.001), higher prevalence of insulin use (49% vs 44%, p = 0.001), lower TG/HDL (2.28 vs 3.4, p < 0.001), and higher prevalence of alcoholism (5.7% vs 2.4%, p < 0.001) and pancreatitis (3.6% vs 0.9%, p < 0.001). In both groups, African Americans and Latinos were the prevalent ethnicities (38%, 34% vs. 53%,31%).When comparing patients within the lean group who were on insulin (49%) to those on oral medications, there were more males (65% vs. 59%, p < 0.001), earlier age of onset (40 ± 14 vs. 47 ± 12, p < 0.001), lower BMI (22.1 ± 2 vs.22.6 ± 1.7, p < 0.001) and lower TG/HDL (2.18 vs. 2.42, p = 0.021).ConclusionsA subset of diabetes patients in the United States minority population are lean and may have rapid beta cell failure. The etiology is not clear and acquired factors, genetics, and autoimmunity may be contributory.     

Tissue Doppler assessment of right ventricular function in female patients with limited form of systemic sclerosis

BackgroundCardiac involvement in systemic sclerosis (SSc) is often clinically occult. The aim of this study was the evaluation of early subclinical right ventricular (RV) involvement in patients with limited form of systemic sclerosis by tissue Doppler.MethodsTwenty female patients with limited cutaneous SSc and 20 control female subjects, matched for age were studied with transthoracic echocardiography and tissue Doppler imaging (TDI) to assess RV function. Patients with pulmonary hypertension, chronic renal failure, diabetes mellitus, hypertension, heart failure, left ventricular hypertrophy, ischemic or rheumatic heart disease were excluded.ResultsPatients with limited form SSc had significant lower tricuspid annulus peak systolic velocities (S_T) (9.95 ± 1.78 vs. 11.05 ± 1.53 cm/s, p < 0.044), early (E_T) (9.65 ± 1.30 vs. 12.50 ± 1.23 cm/s, p < 0.0001), late (A_T) diastolic velocity (12.60 ± 2.01 vs. 18.15 ± 1.81 cm/s, p < 0.0001), and tricuspid annular plane systolic excursion (TAPSE) (23.05 ± 3.50 vs. 26.50 ± 1.90, p < 0.001) compared to controls. Myocardial performance index (MPI) of the RV was higher in SSc patients compared to controls (0.41 ± 0.05 vs. 0.30 ± 0.02, p < 0.0001). There were significant correlations between disease duration and S_T and RV MPI (r = ?0.883, p < 0.0001; r = 0.686, p < 0.001, respectively).ConclusionsPatients with limited form of SSc present with pulsed-tissue Doppler imaging indices indicative of right ventricle dysfunction, which had significant correlations with disease duration. Tissue Doppler is a valuable non-invasive tool for detecting RV myocardial involvement in patients with limited SSc.     

Assessment of left ventricular function and aortic elastic properties in patients with Behçet’s disease using conventional and tissue Doppler echocardiography

BackgroundBehçet disease (BD) is a multisystemic, chronic inflammatory disorder of unknown etiology with diffuse clinical manifestations including the cardiovascular system.Aim of the workTo assess left ventricular (LV) function and thoracic aorta elastic properties in BD patients using Doppler echocardiography and to correlate echocardiographic findings with disease activity.Patients and methodsThe LV functions and thoracic aorta elastic properties were assessed in 30 BD patients and 30 controls using conventional and Tissue Doppler Imaging (TDI) echocardiography. Disease activity was evaluated using Behçet’s disease current activity form (BDCAF). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), cholesterol and triglyceride levels were measured.ResultsIn BD patients, ESR and CRP were significantly elevated while cholesterol and triglycerides were comparable to the levels in the control. In conventional echocardiography, BD patients had significantly higher aortic diastolic diameter (p < 0.05), aortic stiffness index (p < 0.001), isovolumic relaxation time (p < 0.001), flow propagation velocity (FPV) and peak E-wave velocity/FPV (E/FPV) (p < 0.001) than the control group while aortic strain was significantly lower in BD patients (p < 0.05). Lateral mitral TDI echocardiography showed that myocardial performance index was statically higher in BD patients (p < 0.001) while peak myocardial velocity and myocardial acceleration during isovolumic contraction were significantly lower (p < 0.001). The BDCAF showed a significant correlation with different echocardiographic parameters of systolic and diastolic dysfunction.ConclusionsBehçet disease patients have impaired LV systolic and diastolic functions and altered aortic elastic properties that correlate with disease activity. TDI is more sensitive than conventional echocardiography for the detection of early ventricular dysfunction in patients with BD.     

Cardiovascular risk factors profile in patients with acute coronary syndrome with particular reference to left ventricular ejection fraction

BackgroundAcute coronary syndrome (ACS) remains a leading cause of death in the United States. Numerous studies have shown that the degree of LV systolic dysfunction is a major if not the most important determinant of long-term outcome in ACS.ObjectivesTo identify the most important risk factors and other clinical predictors which might have impact on left ventricular ejection fraction in patients with ACS.ResultsThe total patients (299) admitted to our center from July, 2015 till December, 2015; with established diagnosis of ACS were classified in to two groups: Group I: 193 patients with impaired LVEF < 40% (64.5%), Group II: 106 patients with LVEF equal or > 40% (35.5%). The patients of group I were significant elderly compared to those of group II (60.9 ± 11.2 vs 56.9 ± 10.6; p = 0.002), had significant history of DM and CKD (66.3% and 31.1% VS 49.1% and 19.8%; p = 0.004 and 0.036 respectively), presented mainly with STEMI- ACS (51.3% VS 28.3% respectively; p < 0.001) with +v cardiac biomarker (troponin) (90.2% VS 66.0%; p < 0.001). Moreover, patients of group I had more significant ischemic MR compared to the patients of group II (24.9% VS 3.8% respectively; p < 0.001) with higher rate of LV thrombus discovered by echocardiography (25.4% VS 1.9%; p < 0.001). Extensive significant CAD disease was observed to be higher among patients of group I (69.4% VS 57.5%; p = 0.039) and those patients treated mainly with PCI revascularization therapy (68.9% VS 52.8%; p = 0.002) compared to patients of group II who mainly treated medically (34.9% VS 17.6 %; p < 0.001). Multiple logistic regression analysis demonstrated that DM (odd ratio (OR): 2.64, 95% confidence interval (CI): 1.45-4.79, P = 0.01), presence of significant ischemic MR (OR: 13.7, 95% CI:2.84-66.1, p = 0.001)and presence of significantly diseased coronary vessels (odd ratio (OR): 5.06, 95% confidence interval (CI): 1.14-22.6, P = 0.033,) all were independent predictors for significant LV dysfunction (LVEF < 40%) which predict poor outcome in ACS patients.ConclusionWe concluded that DM, presence of significant ischemic MR, and increased number, severity of diseased coronaries all were independent predictors of LV dysfunction (LVEF < 40%) which is known to predict poor outcome. Identification of those risk predictors upon patient evaluation could be helpful to identify high risk-patients, in need of particular care, aggressive therapy and close follow-up to improve their poor outcome.     

Arterial stiffness,carotid atherosclerosis and left ventricular diastolic dysfunction in postmenopausal women

BackgroundPostmenopausal women have an increased cardiovascular morbidity that may be due to the increase in classical cardiovascular risk factors and also to the arterial structure and function alterations. The aim of our study was to evaluate the association of aortic pulse wave velocity (PWV), and carotid intima–media thickness (IMT), with left ventricular diastolic dysfunction (LVDD) in postmenopausal women.Patients and methodsIn 96 women without overt cardiovascular disease (age 62 ± 7.7 years), and with normal left ventricular systolic function, aortic PWV was assessed by using an oscillometric device, intima–media thickness was measured by B-mode ultrasonography and the parameters of left ventricular diastolic function were evaluated by a transthoracic echocardiographic study.ResultsLVDD, defined as an E/A ratio ≤ 1 was found in 50 patients (52%). All of them had mild LVDD. In these patients we found significant increase in age (p < 0.001), aortic PWV (p < 0.001), carotid IMT (p = 0.002) and plaque score (p = 0.004) when compared with patients without LVDD. In a logistic regression analyzed, after adjusting for age, only aortic PWV was a significant predictor of LVDD (2.15, 95% CI 1.39–3.31, p = 0.0006).ConclusionsThis study among postmenopausal women provides evidence that increased arterial stiffness as measured by aortic PWV and not carotid IMT may be a marker or a risk factor for LVDD, independent of other classical risk factors.     

Association between C-reactive protein level and echocardiography assessed left ventricular function in first ST-segment elevation myocardial infarction patients who underwent primary coronary intervention

BackgroundAn elevated C-reactive protein (CRP) level is associated with adverse outcomes in patients with acute myocardial infarction (AMI). Although CRP levels have been shown to be associated with left ventricular (LV) systolic function and remodeling in AMI, little is known about their relation to early LV diastolic function.MethodsWe retrospectively studied 173 consecutive patients <75 years of age with first ST-segment elevation MI (STEMI) that was treated by primary percutaneous coronary intervention (PPCI). They had presented within 24 h of chest pain onset and their CRP levels were determined within 6 h of hospital admission. They all underwent echocardiography within 3 days of admission and were stratified by CRP tertiles.ResultsThe cut-off points for the CRP tertiles were <2.6 mg/L, 2.6–7.9 mg/L, and >7.9 mg/L. Patients with higher CRP levels had a significantly higher mean mitral inflow E wave velocity (68 ± 16 cm/s vs 77 ± 19 cm/s vs 76 ± 17 cm/s; p = 0.02), a higher E/average e′ (8.9 ± 1.9 vs 9.8 ± 2.8 vs 10.4 ± 3.2; p = 0.02), and a higher systolic pulmonary artery pressure (27 ± 6 mmHg vs 30 ± 8 mmHg vs 32 ± 10 mmHg; p = 0.04). Elevated CRP levels were associated with more advanced diastolic dysfunction than normal CRP levels (p = 0.04). The admission CRP level was an independent predictor of average E/e′ ratio (multivariate analysis).ConclusionAdmission CRP levels are associated with echocardiographic parameters of elevated LV filling pressure in patients with STEMI treated with PPCI.     

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 < 8 cm/s) DF (+) and group with normal LV diastolic function DF (−), when EmLV was ≥8 cm/s.ResultsPatients in DF (+) group, as compared to DF (−) patients, manifested a lower serum Ca level and an elevated NT-proBNP level [9.03 ± 0.76 mg/dL vs 9.44 ± 0.78 mg/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 ≤9.82 mg/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 ≤ 9.82 mg/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.     

Detection of occult right ventricular dysfunction in young Egyptians with type 1 diabetes mellitus by two-dimensional speckle tracking echocardiography

BackgroundType 1 diabetes mellitus (T1DM) is a common chronic disorder of childhood and adolescence. T1DM induced cardiomyopathy has a different entity than T2DM as it relies on different pathophysiological mechanisms, and rarely coexists with hypertension and obesity. Evaluation of right ventricular (RV) function in diabetic patients has been neglected despite the important contribution of RV to the overall cardiac function that affects the course and prognosis of diabetic cardiomyopathy (DCM).ObjectiveTo assess RV myocardial performance in asymptomatic T1DM using speckle tracking and standard echo parameters and correlate it with functional capacity using treadmill stress test.Patients and methodsThirty-nine patients with TIDM (Group 1, mean age 18.2 ± 1.7y, BMI = 26.2 ± 3.9 kg/m²), without cardiac problems and 15 apparently healthy matched subjects as a control group (Group 2, mean age 18.8 ± 2.3 y, BMI = 22.8 ± 3.3 kg/m²) were enrolled. RV function was evaluated using conventional, tissue Doppler and 2D speckle tracking echocardiography (2D-STE). The peak RV global longitudinal strain (RV-GLS) was obtained. Functional capacity was assessed by treadmill exercise test and estimated in metabolic equivalent (METs).ResultsIn this study; the diabetic group showed statistically highly significant decrease in the average RV-GLS (−14.0 ± 6.9 in group 1 vs. −22.7 ± 2.5 in group 2, P < 0.001), significant decrease in RV S velocity (9.5 ± 2.2 in group 1 vs. 11.5 ± 1.8 in group 2, P < 0.05), significantly reduced E/A ratio (1.0 ± 0.2 in group 1 vs. 1.1 ± 0.1 in group 2, P < 0.05), and highly significant increased E/Em ratio (7.9 ± 3.2 in group 1 vs. 5.2 ± 0.7 in group 2, P < 0.001). We did not found any significant differences between the two groups regarding the other echocardiographic or functional capacity parameters.ConclusionIn asymptomatic patients with T1DM, in addition to RV diastolic dysfunction, early (subclinical) RV systolic dysfunction is preferentially observed with normal RV and left ventricular (LV) ejection fraction (EF). 2D-STE has the ability to detect subclinical RV systolic dysfunction.     

Echocardiographic assessment of the left ventricular diastolic function in patients with non-alcoholic liver cirrhosis

AimTo assess the left ventricular diastolic function in patients with non-alcoholic liver cirrhosis and correlate the degree of diastolic dysfunction to the severity of liver impairment.MethodsThirty-five patients with non-alcoholic liver cirrhosis in addition to 16 age- and sex-matched healthy controls were studied. Severity of liver impairment was assessed using the Child-Pugh score. All participants were subjected to echocardiographic assessment using both the conventional and tissue Doppler echocardiography. The left ventricular filling pressure was derived from the transmitral and mitral annular velocities.ResultsPatients with non-alcoholic liver cirrhosis (mean age; 53 ± 6) had significantly higher heart rate compared with the controls (86 ± 6.5 vs 72 ± 4 bpm, p = 0.04). Mild degree of left ventricular diastolic dysfunction was detected in 26% of patients using the transmitral diastolic parameters. Compared with controls, the calculated left ventricular filling pressure was statistically significantly higher in patients with non-alcoholic liver cirrhosis (10 ± 3 vs 9 ± 1, p = 0.002). Elevated left ventricular filling pressure was detected in only 4 patients. These patients had more advanced form of liver impairment, and were categorized as having normal left ventricular diastolic function based on the mitral inflow indexes.ConclusionsOne fourth of patients with non-alcoholic liver cirrhosis had mild degree of left ventricular diastolic dysfunction using the conventional echocardiographic parameters. Elevated resting left ventricular filling pressure was detected in 11% of patients. The use of multiple parameters to assess the left ventricular diastolic function in patients with liver cirrhosis could unmask cases with pseudonormal pattern.     

Systolic and diastolic function in patients with systemic sclerosis

BackgroundClinical and epidemiological findings indicate that symptomatic heart disease in patients with systemic sclerosis (SSc) predicts poor prognosis, but cardiac involvement may occur years before clinical manifestation. The aim of this study was to evaluate the cardiac function in patients with SSc and to correlate the echocardiographic parameters with others that quantify the diseases' severity.MethodsTwenty consecutive patients with SSc were investigated with transthoracic echocardiography (TTE). Two dimensional, pulsed Doppler and pulsed tissue Doppler imaging (TDI) techniques were used, in all the patients, to assess the systolic and diastolic function for left ventricle (LV). Correlations were made between echocardiographic measurements and some clinical and serological features of the patients.ResultsNone of the patients had any clinical signs of cardiac involvement, nor ECG or TTE systolic function impairment; there are significant differences between systemic sclerosis patients and control group for peak A velocity (0.75 ± 0.22 vs 0.57 ± 0.32, P = 0.05), E/A ratio (1.14 ± 0.22 vs 1.48 ± 0.26, P = 0.01), E/Ea ratio (8.25 ± 1.57 vs 7 ± 2.2, P = 0.05), which account for filling impairment of LV. There are also significant correlations between some other parameters, like the mean duration of Raynaud's phenomenon and E/Ea ratio (r = 0.48, P < 0.05).ConclusionsThe analysis of SSc heart disease, mainly at a preclinical level, is important in all the cases as an asymptomatic patient may have diastolic dysfunction which can be treated and should be closely observed.     

Assessment of right ventricular function by myocardial performance index in diabetic patients

BackgroundAssessment of right ventricular (RV) function remains difficult because of the RV complex shape. Data regarding RV performance in patients with diabetes are incomplete The aim of this study was to assess the feasibility of pulsed wave tissue Doppler imaging and myocardial performance index (MPI) for the assessment of right ventricular function in diabetic patients without coronary artery disease.MethodsThe study included 20 diabetic patients, 20 diabetic hypertensive and 20 gender and age matched healthy subjects underwent standard echocardiography with tissue Doppler imaging (TDI) to assess RV function. Patients with myocardial ischemia, impaired left ventricular systolic function, valvular heart disease or other diseases which could alter the right ventricular performance were excluded.ResultsMyocardial performance index was significantly higher in diabetes compared to control group (0.41 ± 0.05 versus 0.27 ± 0.04, p = 0.001). Peak myocardial systolic velocity (Sa), early diastolic myocardial velocity (Ea), and late diastolic myocardial velocity (Aa) were significantly lower in patients with diabetes mellitus (DM) compared to the control group (p = 0.0001). Isovolumetric relaxation time (IVRT) was significantly higher in DM group compared to control group (p = 0.003). MPI was significantly higher in diabetic hypertensive group versus DM alone group (0.46 ± 0.050 versus 0.41 ± 0.05, p = 0.01). There was no correlation between MPI and blood glucose level and duration of diabetes.ConclusionMyocardial performance index is a useful noninvasive tool for the detection of early right ventricular systolic and diastolic dysfunction in diabetic patients, regardless of coexisting hypertension.     

Prediction clinical profile to distinguish between systolic and diastolic heart failure in hospitalized patients

BackgroundIn recent decades, the growing incidence of patients with heart failure who have preserved systolic function, underlines the need to differentiate between heart failure due to diastolic dysfunction and that due to systolic dysfunction.ObjectiveTo develop a prediction profile of clinical parameters that enables clinicians to differentiate between patients with systolic and diastolic heart failure.Methods164 patients admitted for congestive heart failure to the cardiology department of an academic tertiary care hospital, whose left ventricular systolic and diastolic function had been evaluated echocardiographically and who satisfied the Framingham criteria for heart failure, were prospectively recruited. All patients answered a questionnaire which included, in addition to other clinical variables, the Framingham criteria.ResultsPatients with diastolic heart failure (61.6%) were more likely to be older, female, and to present left ventricular hypertrophy (LVH), with a lower proportion of smokers, alcohol drinkers, coronary disease, q wave and left bundle branch block (all p < 0.005). The predicting model obtained on the logistic regression analysis was very significant, with three variables and 72.3% of correct predictions (x² value = 40,457, p < 0.001). These three variables, predictors of diastolic as opposed to systolic heart failure, were female sex (OR = 3.546), left ventricle hypertrophy (OR = 4.011) and absence of coronary disease (OR = 3.547).ConclusionThree variables which can be easily evaluated, female sex, left ventricular hypertrophy and presence or absence of coronary disease, may enable clinicians to differentiate between patients with systolic or diastolic heart failure.     

Ambulatory blood pressure monitoring in stroke survivors: Do we really control our patients?

BackgroundWe aim to evaluate prospectively the long-term changes of blood pressure (BP) in stroke survivors using ambulatory BP monitoring (ABPM) and compare them with the clinic conventional measurements.MethodsWe studied 101 patients who were admitted within 24 h after stroke onset. To study the circadian rhythm of BP a continuous BP monitor (Spacelab 90207) was used. After six and twelve months follow-up a new ABPM was undertaken. Data were analyzed using the SSPS 12.0.ResultsWe studied 62 males and 39 females, mean age: 70.9 ± 10.7 years. We included 88 ischemic strokes and 13 hemorrhagic strokes. In the acute phase mean 24 h BPs were 136 ± 19/78.6 ± 11.4 mm Hg. The normal diurnal variation in BP was abolished in 88 (87.1%) patients. After six months, 74 patients were assessed. Mean office readings were 137.5 ± 23.8/76.4 ± 11.4 mm Hg, and high systolic BPs and diastolic BPs were found in 37% and 11% of the subjects respectively. ABPM revealed a mean BP of 118.5 ± 20.1/70.3 ± 8.6 (p < 0.0001). In 57 (76.9%), the normal BP pattern remained abolished (p < 0.001). After one year, 63 patients were assessed. Mean office readings were 130.8 ± 26.3/77.6 ± 9.3 mm Hg, and high systolic BPs and diastolic BPs were found in 23.8% and 10% of the subjects respectively. Mean 24 h BPs were 117 ± 12.5/69.7 ± 7.2 (p < 0.001). The normal diurnal variation in BP was now abolished in 47 (74.6%) patients (p < 0.001).ConclusionSurvivors of stroke, both hypertensive and non-hypertensive patients, present a chronic disruption of circadian rhythm of BP. Conventional clinical recordings are an unreliable method of controlling these patients and ABPM should be routinely performed in this population.