Impact of body mass index on left ventricular diastolic dysfunction

Background: The prevalence of obesity is increasing in the developed and developing world. It is an independent risk factor for heart failure. Left ventricular (LV) diastolic dysfunction has been demonstrated to be a strong predictor of heart failure. In the present study we aimed to assess the impact of body weight on LV diastolic function. Methods: The study was conducted on 2,228 participants (1,424 women, 804 men with a mean age of 49). Traditional and tissue Doppler echocardiographic examination were performed in all of the participants. The demographic and echocardiographic data were compared. Multivariate logistic regression analysis was used to assess the independent predictors of association of LV diastolic function. The study sample was divided into four groups: group 1 (body mass index [BMI] < 25.0 kg/m²), group 2 (BMI 25.0–29.9 kg/m²), group 3 (BMI ≥ 30–39.9 kg/m²), and group 4 (BMI ≥ 40 kg/m²). Results: Septal E was significantly lower in groups 2 and 3 compared to group 1 (P = 0.003). Septal A and septal A’ were significantly higher whereas septal E’ and lateral E’ were significantly lower in the groups 2, 3, and 4 compared to the normal weight group (P < 0.001). Lateral A’, deceleration time, and ejection time were significantly higher in obese when compared to the normal weight (P = 0.025, P < 0.001, and P = 0.009, respectively). The E/E’ ratio was significantly higher in groups 2, 3, and 4 compared to the group 1 (P < 0.001). Logistic regression analysis revealed that age, BMI (OR = 1.060 [95% CI = 1.040 and 1.080]; P < 0.001), hypertension, and diabetes mellitus were independent predictors of LV diastolic dysfunction. Conclusion: BMI is an independent predictor of LV diastolic dysfunction along with age, hypertension, and diabetes mellitus. (Echocardiography 2012;29:647‐651)     

Tei指数评价左心室射血分数正常的尿毒症患者的左心室功能

目的利用Tei指数评价左心室射血分数（left ventricular ejection fraction, LVEF）正常的尿毒症患者的左心功能,以了解其临床应用价值。方法选取80例LVEF正常的尿毒症患者设为尿毒症组,50名健康人设为对照组,使用Vivid7pro对两组进行检测。检测左心房内径（LAD）、左心室舒张期末内径（LVDd）、左心室收缩期末末内径（LVDs）、室间隔（IVS）及左心室后壁厚度（LVPW）、LVEF、左心室短轴缩短率（LVFS）、二尖瓣血流频谱E峰及A峰、E／A比值、左心室等容收缩时间（ICT）及等容舒张时间（IRT）、主动脉射血时间（ET）,并计算左心室Tei指数。结果尿毒症组左心房内径、左心室舒张期末内径、左心室收缩期末内径、室间隔、左心室后壁厚度均较对照组增大,差异有统计学意义（P均〈O．01）。尿毒症组的二尖瓣血流频谱E峰及A峰较对照组明显增大（P均〈0．05）、左心室等容舒张时间比对照组延长（P〈0．01）、主动脉射血时间比对照组缩短（P〈0．01）、Tei指数比对照组明显延长（0．50±0．18眠0．33±0．12,P〈0．叭）,差异有统计学意义;尿毒症组E／A比值、左心室等容收缩时间、LVEF及左心室短轴缩短率与对照组比较,差异无统计学意义（P均〉0．05）。结论测量Tei指数能比单纯LVEF更好地评价尿毒症患者的左心功能,而且方便、快捷、有效。     

射血分数正常的充血性心力衰竭患者收缩功能储备的研究

目的:探讨射血分数正常的充血性心力衰竭(HFnEF)患者左室收缩功能的储备情况。方法:入选HFnEF患者40例,将同期40例经临床和超声心动图排除心力衰竭者设为对照组,所有入选对象行超声心动图检查、核素心血池显像测定静息及分级小剂量多巴酚丁胺负荷后心率(HR)、左室射血分数(LVEF)、高峰射血率(PER)、高峰射血时间(TPER),并计算各指标的最大变化率(ΔHR、ΔLVEF、ΔPER、ΔTPER)。结果:与对照组相比,HFnEF组左房内径、左室收缩期末内径、左室舒张期末内径明显增大,室间隔厚度、左室后壁厚度均显著增加(P<0.05);HFnEF组ΔHR、ΔLVEF、ΔPER、ΔTPER均较对照组降低,分别为54.8%±13.5%对78.8%±15.1%、29.9%±8.2%对40.7%±5.7%、83.0%±28.8%对124.5%±40.3%和46.3%±10.5%对57.3%±8.1%(P均<0.05)。结论:HFnEF患者左室收缩功能储备明显下降。     

Impact of left ventricular ejection fraction on endothelial function in patients with coronary artery disease

BACKGROUND: Endothelial dysfunction is present in patients with coronary artery disease (CAD) or with congestive heart failure. HYPOTHESIS: This study was performed to evaluate the impact of systolic heart function on endothelial function in patients with CAD. METHODS: The study population consisted of 283 consecutive patients (mean age 59 years, 176 men) undergoing coronary angiography. Endothelial function was assessed by measuring flow-mediated vasodilation (FMD) of the brachial artery. RESULTS: Patients (n = 236) with an ejection fraction (EF) > or = 55% on routine echocardiogram were younger (mean age 58 vs. 62 years), showed a lower prevalence of diabetes (15 vs. 38%) and myocardial infarction (13 vs. 66%), and showed a higher FMD (4.8 +/- 2.4 vs. 4.0 +/- 2.0%, p < 0.05) than patients (n = 47) with an EF < 55%. The correlation coefficient between FMD/endothelial function and EF/systolic heart function was 0.149 (p < 0.02) in the overall study population. Multivariate analysis showed that of age, gender, frequency of diabetes mellitus, myocardial infarction, and CAD extent, EF was the only significant independent parameter correlating with FMD in patients with CAD. CONCLUSIONS: Compared with the other tested risk factors, EF surprisingly was the only significant independent parameter correlating with endothelial function in patients with CAD. Our results support the view that endothelial function is an independent prognostic factor in patients with CAD.     

Usefulness of Tei index in patients with rheumatic mitral regurgitation and apparently normal left ventricular ejection fraction

Background and aim

Rheumatic mitral regurgitation is rather common in developing countries. It usually progresses insidiously, because the heart compensates for increasing regurgitant volume by left-atrial enlargement, causes left-ventricular overload and dysfunction, and yields poor outcome when it becomes severe. Doppler-echocardiographic methods can be used to quantify the severity of mitral regurgitation. It is known that ejection fraction underestimates the presence of left ventricular dysfunction in these patients. This study aimed to study global cardiac function of these patients by using LV Tei index.

Methods

One hundred patients with rheumatic mitral regurge predominantly were included (40 males and 60 females; aged 10–24 years, median 20.6 years). All participants were subjected to full echocardiographic study including total isovolumic index (Tei index = isovolumic relaxation time IRT + isovolumic contraction time ICT/ejection time ET) for the left ventricle. Special attention was paid to grading of severity of the mitral regurgitation.

Results

LV ejection fraction was preserved in all cases but, however, the total left isovolumic index was prolonged 0.56 ± 3 in 64 of them (34 females and 30 males) denoting masked LV dysfunction P < .00001. There was a correlation of increasing severity of dysfunction with the degree of mitral regurgitation.

Conclusion

Ejection fraction underestimates the presence of left ventricular dysfunction in these patients. However, this was unmasked by the Tei index which could be an additive data for detecting early left ventricular dysfunction.     

Impact of diabetes on left ventricular diastolic function in patients with arterial hypertension

AIMS: To analyse the effect of diabetes (DM) on diastolic function in hypertensive patients. METHODS: 439 hypertensive patients were selected for participation in this study. All participants had an echocardiographic evaluation of systolic and diastolic function. The overall degree of diastolic function and specific parameters (e.g. E/Ea ratio) were analysed. RESULTS: We divided the cohort (63+/-10 years) into those with diabetes mellitus (DM(+), n=124) and without diabetes mellitus (DM(-), n=315). The prevalence of normal diastolic function was lower in DM(+) than DM(-) (19.4% vs. 30.8%); mild (65.3% vs. 60.0%) and moderate/ severe diastolic dysfunction were more frequent in DM(+) (15.3% vs. 9.2%, p=0.022). The E/Ea ratio, an estimate of left ventricular end-diastolic pressure, was significantly higher in DM(+) (12.3+/-4.4) as compared to DM(-) (10.8+/-3.6, p<0.001). Sex-specific analysis revealed that the effect of DM on diastolic function was mainly limited to the male subgroup. Multivariate logistic regression analysis showed that diabetes affected diastolic function in males independent of blood pressure, left ventricular mass index, concomitant medication and prevalence of coronary artery disease. CONCLUSION: Diabetes negatively affects diastolic function in patients with arterial hypertension. This effect is mainly confined to the male subgroup.     

脉压指数与原发性高血压左心室舒张功能相关性研究

目的探讨脉压指数(PPI)与原发性高血压患者左心室舒张功能损害程度的关系。方法162例经外周肱动脉压力测定收缩压(SBP)、舒张压(DBP)以PPI≤0.40、>0.40分组,2组进行分析。比较2组左心形态、左心室收缩功能和舒张功能情况。结果PPI>0.40组左心房内径明显增大(P<0.000 5);左心室内径无明显改变(P>0.05);室间隔、左心室后壁明显增厚,E/A值降低(P<0.0005),而左心室射血分数差异无显著性(P>0.05)。结论对于原发性高血压患者左心室舒张功能异常出现早于左心室收缩功能异常,PPI>0.400提示高血压患者早期合并有舒张功能异常。     

应用多普勒左心射血等容时间指数综合评价慢性左心功能不全

目的 :探讨应用多普勒左心射血等容时间指数 （Total ejection isovolume index,Tei index）综合评价慢性左心功能不全的临床价值。方法 :1使用 Agilent- 5 5 0 0型超声诊断仪 ,测定陈旧性心肌梗死 （OMI）患者的二尖瓣血流图、肺静脉血流图、Tei index和左心射血分数 （L VEF）。2选择 L VEF（Biplane Sim pson法 ）小于 5 8%的 OMI 36例 ,按二尖瓣血流图和肺静脉血流图结果分为收缩舒张功能障碍组 （OMI- 1组 ）和收缩舒张功能障碍而二尖瓣血流图假性正常组 （OMI- 2组 ） ;健康人 2 2名作为对照组。结果 :Tei index对照组为 0 .4 2± 0 .0 4 ,OMI- 1组为 0 .73± 0 .16 ,OMI- 2组为 0 .90± 0 .2 3。 OMI- 1,OMI- 2组与对照组比较 ,均 P<0 .0 1;OMI- 2组与 OMI- 1组比较 ,P<0 .0 1。结论 :Tei index可用于临床综合评价慢性左心功能不全 ,并且可作为鉴别二尖瓣血流图假性正常化的参考指标之一。     

氯沙坦治疗轻中度高血压对左心室重量指数和舒张功能的影响

目的观察氯沙坦的降压疗效及对左心室重量指数和舒张功能的影响。方法对64例高血压患者使用氯沙坦治疗6个月,观察血压变化及对左心室功能影响。结果治疗6个月后患者血压明显下降,收缩压平均下降25．1mmHg,舒张压平均下降15mmHg,总有效率78．1％,左心室舒张末期内径及左心室重量指数均明显下降。结论氯沙坦有较好的降压疗效,不良反应轻微。并可逆转左心室肥厚及改善左心室舒张功能。     

玉树大地震高原肺水肿患者心肌作功指数和左心室射血分数的变化

目的观察高原肺水肿（HAPE）患者心肌作功指数（Tei指数）和左心室射血分数（LVEF）的变化。方法对26例HAPE患者在治疗前后测定了Tei指数和LVEF的变化,并与30例当地健康人作对比。结果 HAPE患者治疗前Tei指数（0.656±0.088）显著高于治愈后（0.493±0.078）和对照组（0.487±0.074）,分别t=6.358、7.246,均P〈0.01;LVEF[（32.856±3.633）%]显著低于治愈后[（52.612±4.232）%]和对照组[（53.571±4.576）%],分别t=16.667、17.206,均P〈0.01;治愈后与对照组之间比较无统计学意义（均P〉0.05）。结论 HAPE患者存在明显的心功能下降,治愈后又恢复到正常水平。     

高血糖对冠心病支架植入术后远期左室舒张功能改善的影响

目的探讨血糖控制对冠状动脉内支架植入术后左室舒张功能恢复的影响,评价病情及预后转归。方法126例冠心病患者以糖化血红蛋白（HbA1 c）筛选分为血糖异常（B组）与血糖控制良好者（A组）。应用多普勒超声心动图检测二尖瓣血流、舒张早期最大流速（E）、舒张晚期最大流速（A）、E/A比值、舒张早期快速充盈减速时间（DT）,用组织多普勒成像技术（TD I）测量二尖瓣前后叶瓣环运动的舒张早期运动速度（Em）。结果A组DT术后3、6个月均较术后24 h内减少,E/A值、Em在术后24 h内、3、6个月3组间均有显著性改变（P〈0.01）;B组DT仅术后6个月较术后24 h内相比有显著性改变（P〈0.05）,E/A值术后3、6个月较术后24 h内改善,但术后3~6个月没有改善,Em无改善。结论支架植入术后,血糖控制不佳的患者左室舒张功能远期没有改善,提示对于冠心病患者血糖控制的重要性不容忽视。     

曲美他嗪对老年高血压患者舒张功能的影响

目的利用观察组织多普勒显像(TDI)技术评价曲美他嗪对不伴有左心室肥厚的老年高血压患者舒张功能的影响。方法选择合并舒张功能不全的老年高血压患者68例,排除左心室肥厚,随机分为2组:治疗组,除常规治疗外给予口服曲美他嗪20mg,每日3次;对照组给予常规治疗;2组疗程均为3月。2组治疗前后用TDI技术测量二尖瓣环侧壁舒张早期运动速度(e波)、舒张晚期运动速度(a波)并计算e/a比值,测量血流多普勒指标二尖瓣口舒张早期血流速度(E波)、舒张晚期血流速度(A波)及E/A比值。结果 2组3月后E波、E/A、e波、e/a较治疗前升高(P<0.05),2组间比较无明显差异。结论曲美他嗪在常规治疗基础上并不能明显改善老年高血压患者左室舒张功能。     

Correlation analysis of the triglyceride glucose index and heart failure with preserved ejection fraction in essential hypertensive patients

BackgroundTriglyceride glucose index (TyG index) is a novel marker of insulin resistance. Studies have shown that TyG index is closely associated with the occurrence of hypertension and cardiovascular disease. However, little is known about the correlation between TyG index and the occurrence of heart failure with preserved ejection fraction (HFpEF) in hypertensive patients.HypothesisOur study assumes that TyG index strongly correlates with occurence of HFpEF in hypertensive patients.MethodsThis research enrolled 559 hypertensive patients (273 patients with HFpEF and 286 without HFpEF) admitted to the Department of Cardiology of Jiading Branch of Shanghai General Hospital from 2020 to 2021 as the study subjects. Gender, age, diastolic blood pressure, systolic blood pressure (SBP), and heart rate (HR) were recorded at admission. Medication history and fasting blood samples were harvested after admission to detect laboratory index. Cardiac function and ventricular structure index were measured by echocardiography. Pearson correlation analysis was conducted to identify the correlation of TyG index with cardiac function and ventricular structure. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of TyG index in HFpEF with hypertension.ResultsHFpEF patients had higher diuretic use frequencies, fasting plasma glucose, NT‐proBNP, triglycerides, TyG index, left atrial diameter (LAD), left ventricular mass index (LVMI), the ratio of peak E‐velocity of mitral orifice to peak velocity of early diastolic mitral annulus (E/e′), and SBP but lower ratio of peak E of early diastolic maximum blood flow velocity to peak A of late diastolic maximum blood flow velocity of mitral orifice (E/A) and average e′ than non‐HFpEF patients. Moreover, TyG index was correlated with LAD, left ventricular ejection fraction (LVEF), LVMI, average e′, E/e′, and NT‐proBNP. The multivariate regression analysis suggested that TyG index, E/e′, and NT‐proBNP were independent risk factors for HFpEF in hypertensive patients. Compared with E/e′ and NT‐proBNP, the area under the ROC curve (0.778 [95% confidence interval: 0.707–0.849]) was the largest for TyG index.ConclusionTyG index is higher in HFpEF patients than in non‐HFpEF patients and related to cardiac diastolic function, which strongly correlates with occurrence of HFpEF in hypertensive patients.     

Impact of body mass index on markers of left ventricular thickness and mass calculation: results of a pilot analysis

Specific correlations between body mass index (BMI) and left ventricular (LV) thickness have been conflicting. Accordingly, we investigated if a particular correlation exists between BMI and echocardiographic markers of ventricular function. METHODS: A total of 122 patients, referred for routine transthoracic echocardiography, were included in this prospective pilot study using a 3:1 randomization approach. Patient demographics were obtained using a questionnaire. RESULTS: Group I consisted of 80 obese (BMI was >30 kg/m2), Group II of 16 overweight (BMI between 26 and 29 kg/m2), and Group III of 26 normal BMI (BMI < 25 kg/m2) individuals. No difference was found in left ventricular wall thickness, LV end-systolic cavity dimension, fractional shortening (FS), or pulmonary artery systolic pressure (PASP) among the groups. However, mean LV end-diastolic cavity dimension was greater in Group I (5.0 +/- 0.9 cm) than Group II (4.6 +/- 0.8 cm) or Group III (4.4 +/- 0.9 cm; P < 0.006). LV mass indexed to height(2.7) was also significantly larger in Group I (61 +/- 21) when compared to Group III (48 +/- 19; P < 0.001). Finally, left atrial diameter (4.3 +/- 0.7 cm) was also larger (3.8 +/- 0.6 and 3.6 +/- 0.7, respectively; P < 0.00001). DISCUSSION: We found no correlation between BMI and LV wall thickness, FS, or PASP despite the high prevalence of diabetes and hypertension in obese individuals. However, obese individuals had an increased LV end-diastolic cavity dimension, LV mass/height(2.7), and left atrial diameter. These findings could represent early markers in the sequence of cardiac events occurring with obesity. A larger prospective study is needed to further define the sequence of cardiac abnormalities occurring with increasing BMI.