Effects of dichloroacetate in patients with congestive heart failure

Background: Conventional approaches to management of congestive heart failure (CHF) rely on drugs that increase myocardial contractility or reduce ventricular afterload. These approaches often improve cardiac symptoms and survival, but may be associated with significant deleterious effects. An alternative approach is to enhance myocardial energy production. Dichloroacetate (DCA) stimulates pyruvate dehydrogenase activity and accelerates aerobic glucose, pyruvate, and lactate metabolism in myocardial cells. These alterations would be expected to improve myocardial function. Hypothesis: The purpose of the investigation was to assess the efficacy of DCA in patients with left ventricular systolic dysfunction and to examine the mechanism by which improvement occurs. Methods: A total of 25 patients (16 men, 9 women; age range 31-72 years, mean 59) with CHF and ejection fraction ≤40% received an intravenous infusion of 50 mg/kg DCA over 15 min. Indices of systolic and diastolic function were obtained by two-dimensional and Doppler echocardiography performed at baseline, 30 min, and 60 min following completion of DCA infusion. Results: Baseline ventricular ejection fraction was 27.3 ± 9.1%; 17 patients (68%) had nonischemic cardiomyopathy. Heart rate increased after DCA infusion from 73.9 ± 14.5 to 79.2 ± 14.9 beats/min at 60 min; p = 0.02. Left ventricular diastolic and systolic volumes increased at 30 min compared with baseline (248.7 ± 98.1 vs. 259.6 ± 99.6; p = 0.04, and 180.1 ± 80.4 vs. 192.2 ± 84.9; p = 0.002, respectively), but stroke volume (49.2 ± 19.1 vs. 48.9 ± 18.1; p = 0.9) and ejection fraction (27.3 ± 9.1 vs. 25.7 ± 9.8; p = 0.2) were un changed. Indices of diastolic function were also unchanged. Conclusion: Dichloroacetate infusion in patients with CHF is not associated with improvement in noninvasively assesse left ventricular function.     

Diastolic heart function in RA patients

The results of some epidemiological studies point to the presence of an increased risk of cardiovascular disease (CVD), particularly atherosclerosis and congestive heart failure (CHF) in rheumatoid arthritis (RA). At least 50% of abnormalities remained asymptomatic. Pathological conditions contributing to myocardial dysfunction such as high serum levels of IL-6, C-reactive protein (CRP) and TNF alpha are present both in RA and CHF patients. The most common pathological mechanism leading to the development of heart failure is left ventricular (LV) diastolic dysfunction, which remains clinically asymptomatic for a long time. The aim of this study was to assess the systolic and diastolic functions of the LV in RA patients without clinically evident cardiovascular disease, using pulsed Doppler echocardiography. Our purpose was also to estimate whether there is a correlation between the duration and severity of RA and the degree of LV diastolic dysfunction. A comparison of the average values of echocardiographic measurements was made between the RA group and control group, which constituted healthy volunteers. Left ventricular mass index in RA group was significantly greater than in the control group (105.2 ± 32.6 vs. 87.9 ± 16.8; p < 0.05) so were the interventricular septum end-diastolic thickness (1.01 ± 0.33 vs. 0.86 ± 0.12; p < 0.05), the LV posterior wall end-diastolic thickness (0.94 ± 0.08 vs. 0.83 ± 0.11; p < 0.0001) and the aortic root diameter (3.18 ± 0.31 vs. 3.10 ± 0.63, p < 0.001). The ejection fraction in RA group was significantly lower than in the control group (64.4 ± 1.3 vs. 66.3 ± 1.3; p < 0.0001). The assessment of diastolic function parameters revealed significantly longer isovolumetrc relaxation time (IVRT) and shorter deceleration time (DT) in RA patients compared to the control group. Patients in stage II or III revealed significantly lower LV mass index (99 ± 17 vs. 131 ± 42; p < 0.05) and the interventricular septum end-diastolic thickness (0.94 ± 0.10 vs. 1.28 ± 0.5; p < 0.05) than those in stage IV. Mean aortic diameter was significantly greater in individuals in stages III and IV (3.73 ± 0.28) than in the stage II of the disease (2.77 ± 0.21), p < 0.05. No differences in echocardiographic parameters’ values were observed between seropositive, seronegative, nodule-present and nodule-absent persons. Echocardiographic examination revealed valvular heart disease in 24 (80%) RA and 6 (20%) control patients (p < 0.0001).     

Long-acting calcium channel antagonist pranidipine prevents ventricular remodeling after myocardial infarction in rats

Summary The purpose of this study was to examine the effects of the long-acting calcium channel antagonist pranidipine on ventricular remodeling, systolic and diastolic cardiac function, circulating humoral factors, and cardiac mRNA expression in myocardial infarcted rats. Myocardial infarction (MI) was produced by ligation of the coronary artery in Wistar rats. Three mg/kg per day of pranidipine was randomly administered to the infarcted rats. Hemodynamic measurements, Doppler echocardiographic examinations, analyses of the plasma levels of humoral factors, and myocardial mRNA expression were performed at 4 weeks after myocardial infarction. Left ventricular end-diastolic pressure (LVEDP) and central venous pressure (CVP) increased to 24.2 ± 1.2mmHg and 5.4 ± 0.6mmHg. Pranidipine reduced LVEDP and CVP to 13.6 ± 1.4mmHg (P < 0.01) and 2.5 ± 0.4mmHg (P < 0.01). The weight of the left and right ventricles in MI was significantly higher than in the sham-operated rats (sham, 2.02 ± 0.04 and 0.47 ± 0.02g/kg; MI, 2.18 ± 0.05 and 0.79 ± 0.04g/kg;P < 0.01). Left ventricular end-diastolic dimension (LVDd) in MI increased to 10.3 ± 0.3mm (P < 0.01) (sham, 6.4 ± 0.3mm). Pranidipine prevented an increase in the weight of the left and right ventricles (2.02 ± 0.04 and 0.6 ± 0.03g/kg,P < 0.01) and LVDd (7.9 ± 0.2mm,P < 0.01 to MI). Plasma renin activity (PRA), and plasma epinephrine, norepinephrine, and dopamine concentrations in MI were higher than those of the sham-operated rats. Pranidipine decreased the PRA and plasma cathecolamine levels of the myocardial infarcted rats to the level of the sham-operated rats. Moreover, the rats in MI showed systolic dysfunction, shown by decreased fractional shortening (sham, 31 ± 2% vs MI, 15 ± 1%;P < 0.01) and diastolic dysfunction shown by the E-wave deceleration rate (sham, 12.8 ± 1.1 m/s²; MI, 32.6 ± 2.1m/s²;P < 0.01). Pranidipine significantly prevented systolic and diastolic dysfunction. The increases in β-myosin heavy chain (MHC), α-skeletal actin, and atrial natriuretic polypeptide mRNAs in the noninfarcted left ventricle and right ventricle at 4 weeks after the myocardial infarction were significantly suppressed by the treatment with pranidipine. On the other hand, depressed α-MHC was restored to normal levels by pranidipine in both regions. In conclusion, pranidipine prevents the left ventricular remodeling process accompanied by systolic and diastolic dysfunction, and inhibits abnormal cardiac gene expression after myocardial infarction.     

Left Ventricular Myocardial Mechanics in Cirrhosis: A Speckle Tracking Echocardiographic Study

Cirrhosis is commonly associated with impaired left ventricular (LV) myocardial contractile reserve to stress and diastolic dysfunction. The aim of this study was to assess LV systolic performance at rest, using both “standard” echocardiographic indices and novel deformation–rotational parameters, in order to elucidate the pathophysiologic basis of cardiac dysfunction in cirrhosis. Seventy‐seven men with cirrhosis (mean age 54.4 ± 9.7) of variable Child–Pugh class (A, B, C) and 20 healthy control subjects were prospectively evaluated by standard as well as speckle tracking echocardiography. Left ventricular ejection fraction (LVEF) was significantly higher in patients with cirrhosis compared to controls (64.6 ± 5.7% in controls vs. 71 ± 9.5%, 71.2 ± 7.1%, and 73 ± 7% in Child–Pugh classes A, B, and C, respectively, P = 0.002). Interestingly, LV systolic function augmentation was not associated with changes in LV longitudinal deformation (LV strain ?19 ± 1.9% in controls vs. ?20.1 ± 5.3% in class A vs. ?21.3 ± 2.6% in class B vs. ?21 ± 3.4% in class C, P = NS), but a statistically significant increase in LV apical systolic rotation and accordingly in LV twist was observed (LV twist 13.0 ± 3° in controls vs. 14.9 ± 5° in class A vs. 16.5 ± 2.8° in class B vs. 18.2 ± 2.9° in class C, P < 0.0005). Despite the increase in LV rotation, time to both basal and apical peak systolic rotation was significantly delayed in patients compared to healthy controls (P = 0.015 and P = 0.017 accordingly). Increased EF in cirrhosis could be attributed to increased LV torsion. Despite the “improved” rotation values at rest, there is a significant time delay in succeeding peak systolic rotation, hampering also the consequent untwisting–diastolic period.     

Cardiac dysfunction in cirrhosis is not associated with the severity of liver disease

BackgroundCirrhotic cardiomiopathy is described as the presence of cardiac dysfunction in cirrhotic patients. The aim of the study was to investigate factors associated with cardiac dysfunction in cirrhotic patients.Patients and methodsSeventy-four cirrhotic patients and twenty-six controls performed a conventional echocardiography and Tissue Doppler Imaging (TDI) for systolic and diastolic function. Results were analyzed by using the Guidelines of American Society of Echocardiography.ResultsIn patients with cirrhosis, left ventricular end-diastolic diameter was increased (p < 0.001) , peak systolic velocities were decreased (11.3 ± 2.7 vs 13.9 ± 1.4 cm/s; p < 0.001) and left atrial volumes were increased (32.7 ± 8.3 vs 24 ± 8.5 ml, p < 0.001) as well as cardiac mass (90.6 ± 23 vs 70.5 ± 22 g/m², p < 0.001). Forty-seven cirrhotic patients (64%) showed diastolic dysfunction at rest: grade I in 37 and grade II in 10 patients. Systolic and/or diastolic dysfunction were not influenced by a more severe liver impairment. Diastolic dysfunction was more prevalent in patients with ascites vs those without (77% vs 56%; p = 0.04).ConclusionA mild diastolic dysfunction at rest is frequent in cirrhotic patients but cardiac load conditions are confounding factors in this diagnosis. We did not identify an association between severity of liver disease and cardiac dysfunction.     

Left Ventricular Longitudinal Myocardial Function in Overt Hypothyroidism: A Tissue Doppler Echocardiographic Study

Background: The aim of this study was to assess left ventricular (LV) myocardial regional function in overt hypothyroidism by use of tissue Doppler imaging and to compare the results to the hormonal profile and standard Doppler echocardiographic examination. Methods: Hypothyroidic (Group 1, n = 25) and euthyroidic patients (Group 2, n = 25) underwent transthorasic echocardiography, strain and strain rate imaging. Results: Standard echocardiography showed that patients with overt hypothyroidism had significantly longer isovolumic contraction time (IVCT) (P < 0.05), deceleration time (DT) (P = 0.014) and isovolumic relaxation time (IVRT) (P = 0.022). Tissue Doppler imaging showed that the mean peak systolic strain (SI) (16.47 ± 1.45 vs. 20.63 ± 1.51, P < 0.001), the mean peak systolic strain rate (SSR) (1.05 ± 0.13 vs. 1.47 ± 0.11, P < 0.001), the mean peak early diastolic strain rate (ESr) (1.72 ± 0.38 vs. 2.03 ± 0.25, P < 0.05) and the mean peak late diastolic strain rate (ASr) (1.22 ± 0.31 vs. 1.46 ± 0.32, P < 0.05) were significantly lower in Group 1 compared to Group 2. For all patients, the systolic strain and systolic strain rate parameters negatively correlated with thyroid stimulating hormone levels and positively correlated with the levels of free triiodothyronine (fT₃) and free tetraiodothyronine (fT₄). Conclusion: These results indicate that overt hypothyroidism is associated with early impairment in LV longitudinal myocardial function, and that tissue Doppler echocardiography is useful for the grading of disease and detection of early impairment. (ECHOCARDIOGRAPHY 2010;27:505‐511)     

Diastolic dysfunction characterizes cirrhotic cardiomyopathy

Aim

Present study aims to study the occurrence of cirrhotic cardiomyopathy and its correlation to hepatorenal syndrome by assessing the cardiac status in patients with cirrhosis of liver and healthy controls.

Methods

Thirty alcoholic cirrhotic, thirty non-alcoholic cirrhotic and thirty controls were enrolled for the study. Cardiac parameters were assessed by color doppler echocardiography. Patients were followed up for twelve months period for development of hepatorenal syndrome.

Results

Mild diastolic dysfunction was present in 18 cirrhotic patients (30%): grade I in fifteen patients and grade II in three. Diastolic dysfunction was unrelated to age; sex and etiology of cirrhosis. Among all the echocardiographic parameters, only deceleration time was found to be statistically significant. Echocardiographic parameters in systolic and diastolic function were not different in compensated vs decompensated patients in different Child-Pugh classes or cirrhosis aetiologies.At one year follow-up, no significant differences were found in survival between patients with or without diastolic dysfunction. Hepatorenal syndrome developed in only two patients and its correlation with diastolic dysfunction was not statistically significant.

Conclusions

Present study shows that although diastolic dysfunction is a frequent event in cirrhosis, it is usually of mild degree and does not correlate with severity of liver dysfunction. There are no significant differences in echocardiographic parameters between alcoholic and non-alcoholic cirrhosis. HRS is not correlated to diastolic dysfunction in cirrhotic patients. There is no difference in survival at one year between patients with or without diastolic dysfunction. Diastolic dysfunction in cirrhosis is unrelated to circulatory dysfunction, ascites and HRS.     

The pathophysiological relationship and clinical significance of left atrial function and left ventricular diastolic dysfunction in β‐thalassemia major

Iron deposition in combination with inflammatory and immunogenetic factors is involved in the pathophysiology of cardiac dysfunction in β‐thalassemia major. We investigated the mechanical and endocrine function of the left atrium and ventricle to identify early signs of dysfunction. We studied 90 patients (mean age: 29 ± 11 years) with β‐thalassemia and normal left ventricular function and 90 age and sex‐matched healthy controls. Patients and controls underwent a thorough cardiac echocardiographic study and measurements of the b‐type (NT‐proBNP) and atrial natriuretic peptides (proANP). Patients underwent 24‐hr Holter recordings for arrhythmia monitoring. In the patient group, atria were affected early during the course of the disease, prior to diastolic and systolic left ventricular dysfunction. The E/E′ratio (E Doppler mitral fast inflow to the corresponding tissue Doppler E) continually increased with age (P < 0.05) and reached levels indicating left ventricular diastolic dysfunction (E/E′ > 15) in the third decade whereas indexes of active and passive atrial function decreased gradually throughout life. In controls, the E/E′ ratio continually increased with age but with later (fifth decade) appearance of diastolic dysfunction and a compensatory increase in atrial active function. Both natriuretic peptides were significantly increased in patients compared to controls (558 ± 141 and 2,580 ± 1,830 fmol/mL for NT‐proBNP and proANP versus 332 ± 106 and 1,331 ± 1,134 fmol/mL, respectively). Atrial fibrillation was found in a subgroup of 23 (26%) patients, older in age with mild diastolic function and enlarged, depressed atria. In conclusion, atrial mechanical depression seems to be a very early sign of cardiac damage. It may become echocardiographically evident even before diastolic and systolic dysfunction and is associated to supraventricular arrhythmias. Am. J. Hematol. 89:13–18, 2014. © 2013 Wiley Periodicals, Inc.     

Echocardiographic predictors of change in left ventricular diastolic pressure in heart failure patients receiving nesiritide

Background: To evaluate the usefulness of currently accepted echocardiographic parameters of diastolic function to assess the acute change in left ventricular end‐diastolic pressure (LVEDP) following the administration of nesiritide in a heart failure population. Methods: In 25 heart failure patients (15 with systolic dysfunction, 10 with preserved ejection fraction [EF]), Doppler echocardiography, right and left heart catheterization, and invasive biventricular pressure hemodynamics were obtained at baseline and 30 minutes after nesiritide infusion. Results: Twenty‐four patients had sufficient echocardiographic images for analysis. The mean age was 60 ± 11 years, 48% were male, 56% had coronary artery disease, and 64% had hypertension. Right ventricular systolic pressure (RVSP) had the highest correlation with LV filling pressure: pulmonary capillary wedge pressure (PCWP), pre‐A wave LV, and LVEDP (r = 0.66, P = 0.0009; r = 0.63, P = 0.002; r = 0.72, P = 0.0002, respectively). Following nesiritide administration, the mean PCWP decreased from 17.1 ± 7.8 mmHg at baseline to 9.6 ± 6.2 mmHg (P < 0.001). Change in RVSP had the highest correlation with change in PCWP (r =?0.67, P = 0.10) and change in LVEDP (r =?0.71, P = 0.07). Conclusion: Echocardiographic parameters are frequently assessed in attempts to estimate left heart diastolic pressures. In heart failure patients, RVSP appears to be the best predictor of LVEDP, outperforming tissue Doppler E/E′. RVSP was found to be the best echocardiographic predictor of change in LV filling pressure with intravenous vasodilator therapy in heart failure patients. RVSP may provide a noninvasive means of assessing response to cardiac therapy.     

Detection of Early Cardiac Dysfunction in Patients with Beta Thalassemia by Tissue Doppler Echocardiography

Backgrounds: In this study we tried to evaluate the prognostic significance of several echocardiographic parameters on the occurrence of heart failure or arrhythmias in patients with beta thalassemia. Methods: We investigated possible differences in myocardial function between a population of 37 asymptomatic patients with beta thalassemia and 25 age‐matched healthy controls, all of whom underwent an echocardiographic study, including tissue Doppler imaging (TDI), moreover plasmatic levels of N‐terminal pro‐BNP (NT‐pro BNP) were measured in all patients. We followed the patients for 22 ± 8 months to evaluate adverse cardiac events. Results: Conventional echocardiographic parameters of left ventricle were comparable in both groups. Whereas TDI peak systolic velocity (Sm) and diastolic parameter (E/Em ratio) were significantly abnormal in patients with thalassemia. Moreover eleven adverse cardiac events were observed during follow‐up. Baseline systolic velocity (Sm) <7.9 cm/s was significantly associated with cardiac complications (P < 0.05). We also demonstrated that systolic velocity is inversely related to NT‐proBNP plasmatic levels (P < 0.001). Conclusions: Our study suggests that mitral annular systolic velocity <7.9 cm/s is associated to the onset of adverse cardiac events. (Echocardiography 2011;28:175‐180)     

Left ventricular function assessment in cirrhosis: Current methods and future directions

Cirrhotic cardiomyopathy has been defined as a chronic cardiac dysfunction in patients with cirrhosis characterized by impaired contractile responsiveness to stress and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of other known cardiac disease. Non-invasive cardiovascular imaging modalities play a major role in unmasking systolic and diastolic dysfunction in patients with cirrhosis. Echocardiography has been the most commonly used modality for assessing myocardial function in these patients. Conventional echocardiographic indices rely on several assumptions that may limit their applicability in patients with a hyperdynamic circulation. Newer imaging modalities may contribute to a more accurate diagnosis of cardiovascular abnormalities in cirrhotic patients, thereby influencing clinical management. We aimed to review the different non-invasive imaging technologies currently used for assessing left ventricular systolic and diastolic function in cirrhosis, as well as to describe new imaging modalities with potential clinical applicability in the near future.     

Right Ventricular Remodeling after Transcatheter Closure of Atrial Septal Defect

Background: Right ventricular (RV) volume overload is a well‐known cardiac consequence of atrial septal defect (ASD) shunt, accounting for most of its long‐term complications. Thus cardiac volumetric unloading is a major aim of transcatheter ASD closure. We set to study the right ventricular remodeling after transcatheter ASD closure in patients with secundum ASD. Methods: We enrolled 46 patients who underwent successful transcatheter closure of ASD. We performed routine transthoracic echocardiographic studies, including three‐dimensional echocardiography and right ventricular myocardial performance index (RVMPI), before transcatheter ASD closure, and 3 days, 1 month after transcatheter ASD closure. Results: We found that: (1) the right ventricular end‐diastolic volume (RVEDV) and right ventricular end‐systolic volume (RVESV) (respectively 106.54±25.97 vs 69.78±10.46 mL, P < 0.05; 59.73±17.59 vs 33.84±7.18 mL, P < 0.05) were enlarged in patients with ASD compared with those in control subjects, resulting in a marked decrease of the right ventricular ejection fraction (RVEF) (44.82%±4.51% vs 54.11%±5.89%, P < 0.05) from normal values; (2) the isovolumic relaxation and isovolumic contraction times (respectively [77.61±16.49] ms vs (64.09±11.82) ms, P < 0.05; [28.04±9.57] ms vs [20.45±6.53] ms, P < 0.05) were prolonged and ejection time ([250.02±24.21] ms vs [272.73±20.51] ms, P < 0.05) was shortened in patients with ASD compared with that in control subjects, resulting in a marked increase of the MPI (0.41±0.07 vs 0.31±0.05, P < 0.05) from normal values; and (3) after transcatheter closure, the RVEDV and RVESV decreased and the RVEF increased markedly and RVMPI decreased markedly. Conclusions: Transcatheter closure of ASD results in rapid normalization of RV volume overload and improvement of RV function. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

Olmesartan ameliorates myocardial function independent of blood pressure control in patients with mild-to-moderate hypertension

Angiotensin II receptor blockers (ARBs) are suggested to be protective against myocardial hypertrophy and fibrosis, although such beneficial effects remain to be elucidated in the human heart. The aim of the present study was to examine the effect of a novel ARB, olmesartan, on myocardial function of the left ventricle in patients with mildto-moderate hypertension. We investigated 10 patients (6 men and 4 women, 62 ± 7 years of age) who were stable with a single regimen of amlodipine, which was switched to olmesartan. Before and 8 months after changing medications, patients underwent echocardiographic examination and blood sampling, including measurement of the plasma high-sensitivity C-reactive protein (hsCRP) level. Peak velocities at the mitral annulus were determined by tissue Doppler imaging and used as measures of myocardial function. Olmesartan did not significantly alter blood pressure (BP) (systolic BP, 122 ± 12 to 121 ± 8 mmHg, P = 0.9; diastolic BP, 79 ± 6 to 75 ± 4 mmHg, P = 0.06) or parameters of global left ventricular systolic and diastolic function. Tissue Doppler imaging, however, revealed significant increases in the systolic (8.2 ± 1.3 to 8.9 ± 1.1 cm/s, P < 0.01) and early diastolic (6.7 ± 0.9 to 7.6 ± 1.0 cm/s, P = 0.02) velocities at the mitral annulus. This was associated with decreases in the left ventricular mass index (83 ± 15 to 73 ± 19 g/m², P = 0.09) and hsCRP (683 ± 555 to 655 ± 450 ng/ml, P = 0.07). In conclusion, olmesartan improves myocardial function independent of BP reduction in hypertensive patients. Attenuated inflammatory changes as well as myocardial hypertrophy may play an important role.     

The assessment of cardiac functions by tissue Doppler-derived myocardial performance index in patients with Behcet’s disease

Vascular involvement is one of the major characteristics of Behcet’s disease (BD). However, there are controversial findings regarding cardiac involvement in BD. Although early reports demonstrated that there is diastolic dysfunction in BD, conflicting results were found in the following trials. Hence, a new method for more objectively estimating the cardiac functions is needed. For this aim, we used high-usefulness tissue Doppler echocardiography for detailed analysis of cardiac changes in BD patients because this method was superior to other conventional echocardiographic techniques. The study population included 42 patients with BD (19 men, 23 women; mean age, 35 ± 10 years, mean disease duration, 2.7 ± 1.6 years) and 30 healthy subjects (14 men, 16 women; mean age, 38 ± 7 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Peak systolic myocardial velocity at mitral annulus, early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), Em/Am, and myocardial performance index (MPI) were calculated by TDI. The conventional echocardiographic parameters and tissue Doppler measurements were similar between the groups. Tissue Doppler derived mitral relaxation time was longer (75 ± 13 vs 63 ± 16 msn, p = 0.021) in patients with BD. There was statistically significant difference between the two groups regarding left ventricular MPI (0.458 ± 0.072 vs 0.416 ± 0.068%, p = 0.016), which were calculated from tissue Doppler systolic time intervals. There was also significant correlation between the disease duration and MPI (r = 0.38, p = 0.017). We have demonstrated that tissue Doppler-derived myocardial left ventricular relaxation time and MPI were impaired in BD patients, although systolic and diastolic function parameters were comparable in the patients and controls.     

Progression of Subclinical Myocardial Dysfunction in Type 2 Diabetes after 5 years Despite Improved Glycemic Control

Background: Patients with uncomplicated diabetes have reduced left ventricular long‐axis function, related to poor glycemic control and increased conduit arterial stiffness, with increased radial function. It is unknown if improved control of risk factors can reverse these subclinical changes. Patients and methods: We studied 27 patients with type 2 diabetes (18 men) 57 ± 1 months (mean ± SD) after an initial visit when they were compared with healthy age‐ and sex‐matched controls. On both visits patients had detailed echocardiographic studies including tissue Doppler, noninvasive tests of conduit arterial function, and metabolic and lipid profiling. Results: Mean age at this second review was 63.4 ± 8.1 years; 48% of patients received insulin. Mean HbA1c had decreased by 13% to 8 ± 1.6% and cholesterol by 17% to 4.3 ± 1.3 mmol/L (both, P < 0.01), but long‐axis systolic and early diastolic myocardial velocities had also declined, by 13% and 20%, respectively (both, P < 0.001). Body mass index had increased by 4%, arterial pulse pressure by 17% (both P < 0.01), and carotid arterial stiffness by 49% (P < 0.01). Fractional shortening (by 21%, P < 0.001), radial systolic velocity (by 13%, P < 0.05), and ejection fraction (by 9% to 68 ± 7%, P < 0.01) had all declined. Reductions in longitudinal function were best predicted by its baseline measurements, duration of diabetes, fasting triglycerides, and arterial stiffness (epsilon index). Conclusions: Despite improved diabetic control, subclinical left ventricular dysfunction progressed over 5 years. Radial compensation was reversed. Prevention of subclinical myocardial dysfunction in diabetes might require more intensive control of net cardiovascular risk.     

三维应变参数评价肝硬化左心室心肌力学功能

目的应用三维应变参数评价早期肝硬化患者左心室心肌力学功能状态,探讨超声诊断肝硬化性心肌病的有效指标。方法健康对照组为28名健康志愿者,肝硬化组为25例早期肝硬化患者。应用三维斑点追踪技术(3D-STI)分析两组左心室整体三维峰值应变(G3DS)、整体纵向峰值应变(GLS)、心肌不同步指数(ASDI),常规超声测量左室射血分数(LVEF),左室舒张末期容积(LVEDV),二尖瓣口血流E/A比值。结果 B组左心室整体G3DS、GLS较A组减低(P0.05)、ASDI较A组增加(P0.05),LVEDV、LVEF较A组差异无统计学意义,B组二尖瓣口血流E/A比值较A组减低,差异有统计学意义(P0.05)。结论超声三维应变参数可有效评价早期肝硬化引起的左心室心肌收缩功能障碍。     

Relationship between fragmented QRS complexes and left ventricular systolic and diastolic functions

Background

Fragmented QRS complexes (fQRS) have been associated with increased morbidity and mortality, sudden cardiac death, and recurrent cardiovascular events. The association between left ventricular systolic and diastolic functions and presence of fragmented QRS has not been comprehensively studied to date. We tested the hypothesis that the presence of fragmented QRS is associated with left ventricular systolic and diastolic dysfunction.

Methods

The study included 259 patients who were consecutively admitted to our outpatient clinic for cardiovascular risk factor management. Extensive echocardiographic parameters were obtained from all patients and these were compared with the presence and number of fQRS.

Results

Patients with fQRS were of older age (58?±?12 vs. 55?±?13 years, p?=?0.03) and had prolonged QRS time (105?±?12 vs. 93?±?10 ms, p?<?0.001) and a higher rate of Q waves on ECG (36% vs. 11%, p?<?0.001). In addition, they had worse systolic (lower LVEF%, 44?±?17 vs. 61?±?12, p?<?0.001) and diastolic functions (DT, 177?±?77 vs. 211?±?59 ms, p?<?0.001; IVRT, 81?±?27 vs. 92?±?22 ms, p?=?0.001; E_m, 9?±?4 vs. 10?±?4 cm/s, p?=?0.008; E/E_m ratio, 11?±?5 vs. 8?±?4, p?<?0.001) in comparison to patients with nonfragmented QRS. There was a significant negative correlation between the number of fQRS and left ventricle systolic functions (for LVEF%, r?=???0.595, p?<?0.001). After adjustment for age and gender, the number of fQRS remained significantly negatively associated with left ventricular systolic and diastolic functions.

Conclusion

We found that fQRS is related to left ventricular systolic dysfunction and diastolic dysfunction. fQRS, which may be the result of myocardial ischemia or scar on myocardial electrical parameters at the cellular level, may represent inadequate systolic and diastolic functions.     

Hemodialysis improves myocardial interstitial edema and left ventricular diastolic function in patients with end-stage renal disease: noninvasive assessment by ultrasonic tissue characterization

Congestive heart failure is the most common cause of mortality in patients with end-stage renal disease (ESRD). Ultrasonic tissue characterization with integrated backscatter offers a promising method for the noninvasive assessment of regional myocardial contractile performance and fibrosis. The aim of this study was to investigate the effect of hemodialysis (HD) on myocardial tissue characterization and left ventricular function in ESRD patients. We examined 26 patients with ESRD undergoing routine HD (age 63 ± 12 years, duration of HD 9.2 ± 3.2 years) and 30 patients with essential hypertension (HT; 60 ± 10 years). Routine echocardiographic parameters and the cyclic variation of ultrasonic integrated backscatter of the ventricular septum (CV-IBS) were measured. Left ventricular mass index was significantly larger in patients with ESRD than in those with HT (217 ± 56 vs 146 ± 45 g/m², P < 0.05). The indices for left ventricular diastolic function (E/A, the ratio of left ventricular peak early to late diastolic filling velocity; DT, the deceleration time of the early diastolic filling) and CV-IBS had deteriorated significantly in patients with ESRD before HD compared with those with HT (E/A, 0.6 ± 0.2 vs 0.9 ± 0.3, P < 0.05; DT, 228 ± 23 vs 184 ± 19 ms, P < 0.05; CV-IBS, 9.0 ± 1.3 vs 12.4 ± 0.9 dB, P < 0.05), possibly reflecting interstitial fibrosis. In patients with ESRD, HD reduced calculated left ventricular mass index by 19% (before HD, 217 ± 56 vs immediately after HD, 176 ± 45 g/m², P < 0.05) and CV-IBS by 19% (9.0 ± 1.3 vs 7.3 ± 1.1 dB, P < 0.05), that possibly reflected improvement of interstitial edema. HD also significantly improved indices for left ventricular diastolic function (E/A, 0.6 ± 0.2 vs 0.9 ± 0.2, P < 0.05; DT, 228 ± 23 vs 188 ± 21 ms, P < 0.05). HD improves myocardial interstitial edema and left ventricular diastolic function in patients with ESRD. Noninvasive assessment of ultrasonic tissue characterization is useful in defining the pathophysiological changes of ventricular myocardium in patients with ESRD. Received: December 17, 2001 / Accepted: April 19, 2002 Correspondence to O. Hirono     

Cirrhotic cardiomyopathy: Isn't stress evaluation always required for the diagnosis?

AIM: To describe the proportion of patients with cirrhotic cardiomyopathy (CCM) evaluated by stress echocardiography and investigating its association with the severity of liver disease.METHODS: A cross-sectional study was conducted. Cirrhotic patients without risk factors for cardiovascular disease were included. Data regarding etiology and severity of liver disease (Child-Pugh score and model for end-stage liver disease), presence of ascites and gastroesophageal varices, pro-brain natriuretic peptide (pro-BNP) and corrected QT (QTc) interval were collected. Dobutamine stress echocardiography (conventional and tissue Doppler imaging) was performed. CCM was considered present when diastolic and/or systolic dysfunction was diagnosed at rest or after pharmacological stress. Therapy interfering with cardiovascular system was suspended 24 h before the examination.RESULTS: Twenty-six patients were analyzed, 17 (65.4%) Child-Pugh A, mean model for end-stage liver disease (MELD) score of 8.7. The global proportion of patients with CCM was 61.5%. At rest, only 2 (7.7%) patients had diastolic dysfunction and none of the patients had systolic dysfunction. Dobutamine stress echocardiography revealed the presence of diastolic dysfunction in more 6 (23.1%) patients and of systolic dysfunction in 10 (38.5%) patients. QTc interval prolongation was observed in 68.8% of the patients and increased pro-BNP levels in 31.2% of them. There was no association between the presence of CCM and liver impairment assessed by Child-Pugh score or MELD (P = 0.775, P = 0.532, respectively). Patients with QTc interval prolongation had a significant higher rate of gastroesophageal varices comparing with those without QTc interval prolongation (95.0% vs 50.0%, P = 0.028).CONCLUSION: CCM is a frequent complication of cirrhosis that is independent of liver impairment. Stress evaluation should always be performed, otherwise it will remain an underdiagnosed condition.     

Systolic and diastolic heart function in SLE patients

Cardiovascular pathology is frequent in systemic lupus erythematosus (SLE). Left ventricular (LV) diastolic dysfunction is its common findings. The aim of the study was to assess the systolic and diastolic function of the left ventricle (LV) in SLE patients without clinically evident cardiovascular disease, using pulsed Doppler echocardiography. Another purpose was to estimate whether there is a correlation between the duration and severity of SLE and the degree of LV diastolic dysfunction. A comparison of the average values of echocardiographic measurements was made between the SLE group and control group, which constituted healthy volunteers. No statistically significant differences in systolic heart function between groups were observed, except for lower values of the fractional shortening (SF 35.9 ± 1.2 and 37.1 ± 0.9, P = 0.01) in SLE patients, particularly in long (more than 10 years) disease duration (34.9 ± 0.6 vs. 37.0 ± 0.8, P < 0.005) and the value of SLE Disease Activity Index (SLEDAI) higher than six points (35 ± 0.9 vs. 37.1 ± 0.5, P < 0.01) Left atrial end-systolic diameter (LA) was greater (3.69 ± 0.37 vs. 3.5 ± 0.28, P < 0.05) and the ejection fraction (EF) was lower (64.6 ± 1.5 vs. 66.3 ± 1.3, P < 0.05) in SLE subjects of long disease duration than in the controls. SLE patients demonstrated significantly higher late diastolic velocity (A’) and lower E’/A’ ratio than the control group. No differences were observed in A’ values between SLE subset of short disease duration and the controls. Isovolumetric relaxation time in turn was significantly longer and E/A ratio as well as E’/A’ ratio lower in SLE of long disease duration versus the short one. In older patients, peak velocity at the time of atrial contraction (A) and A’ values were higher and peak early velocity wave (E), early diastolic velocity (E’), E/A ratio and E’/A’ ratio lower than in the younger subset. Increased the value of SLEDAI correlated with increased A’ and decreased E, E/A ratio and E’/A’ ratio in SLE subjects. Further analysis concerning the strong connection of these parameters with patients’ age, however, revealed no statistically significant correlation between SLEDAI values and LV diastolic function parameters. In long (>10 years) disease duration LV diastolic properties were worse.