Left ventricular diastolic function in hypertension: a 4 year follow-up study

Smoking is an important cardiovascular risk factor and thereby strongly related to cerebral ischemia and myocardial infarction. Here we evaluated subclinical effects of smoking behaviors on arterial stiffness and left ventricular diastolic function in middle-aged individuals without known cardiovascular disease. Within a gender and age stratified random sample diastolic function was assessed by standardized echocardiography at baseline and again after ten years. Furthermore pulse wave analysis was performed at the follow-up investigation. Within a healthy subgroup aged 25 to 44 years at baseline (n=400) associations between smoking behaviors and LV diastolic function as well as arterial stiffness were assessed by comparison of non-smokers (nonS, consisted of never smokers and individuals who stopped active smoking at least 10 years before follow-up investigation), ex-smokers (exS, individuals who stopped smoking within 10 years of follow-up), and current smokers (curS). Adjusted mean values were calculated by linear regression models. As compared to non-smokers, current smokers as well as ex-smokers presented with worse diastolic function at follow-up. Specifically, they displayed lower e/a-ratios (curS 1.23 95%-CI [1.19, 1.28]; exS 1.23 [1.15, 1.32]) as compared to nonS (1.33 [1.29, 1.36], p-values 0.001 and 0.041, respectively). Additionally, declines of e/a-ratios associated with ageing by 10 years were also significantly different (curS −0.35 [−0.39, −0.31]; exS −0.39 [−0.46, −0.31]; vs. nonS −0.27 [−0.30, −0.24]; each p=0.006). Furthermore, curS presented with increased arterial stiffness as displayed by higher augmentation index (curS 20.1 [18.5, 21.6]; exS 16.7 [13.9, 19.6]; vs. nonS 16.7 [15.5, 17.9], p<0.001 and p=0.995) and shorter time to reflection (curS 141ms [139, 143]; exS 147ms [143, 151]; vs. nonS 145ms [143, 146], p=0.005 and p=0.265). In middle-aged healthy individuals smoking is strongly related to subclinical changes in arterial stiffness and diastolic function. But even after termination of active smoking these changes partly persist. Consequently, interventional programs addressing younger adults are essential to prevent premature cardiovascular ageing.

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Influence of manual thrombus aspiration on left ventricular diastolic function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1602023i ◽

2016 ◽

Vol 144 (1-2) ◽

pp. 23-30 ◽

Cited By ~ 1

Author(s):

Ivan Ilic ◽

Ivan Stankovic ◽

Radosav Vidakovic ◽

Aleksandra Janicijevic ◽

Milivoje Cerovic ◽

...

Keyword(s):

Myocardial Infarction ◽

Diastolic Function ◽

Left Ventricular Diastolic Function ◽

Coronary Intervention ◽

Left Ventricular ◽

Primary Pci ◽

Thrombus Aspiration ◽

Ventricular Diastolic Function ◽

Percutaneous Coronary

Introduction. Data on effects of thrombus aspiration on left ventricular diastolic function in ST-elevation myocardial infarction (STEMI) population are scarce. Objective. We sought to compare echocardiographic indices of the diastolic function and outcomes in STEMI patients treated with and without manual thrombus aspiration, in an academic, high-volume percutaneous coronary intervention (PCI) center. Methods. A total of 433 consecutive patients who underwent primary PCI in 2011-2012 were enrolled in the study. Patients were not eligible for the study if they already suffered a myocardial infarction, had been previously revascularized, received thrombolytics, presented with cardiogenic shock, had significant valvular disease, atrial fibrillation or had previously implanted pacemaker. Comprehensive echocardiogram was performed within 48 hours. During follow-up patients? status was assessed by an office visit or telephone interview. Results. Patients treated with thrombus aspiration (TA+, n=216) had similar baseline characteristics as those without thrombus aspiration (TA-, n=217). Groups had similar total ischemic time (319 ? 276 vs. 333?372 min; p=0.665), but TA+ group had higher maximum values of troponin I (39.5 ? 30.5 vs. 27.6 ? 26.9 ng/ml; p<0.001). The echocardiography revealed similar left ventricular volumes and systolic function, but TA+ group had significantly higher incidence of E/e?>15, as a marker of severe diastolic dysfunction (TA+ 23.1% vs. TA- 15.2%; p=0.050). During average follow-up of 14?}5 months, major adverse cardiac/ cerebral events occurred at the similar rate (log rank p=0.867). Conclusion. Thrombus aspiration is associated with a greater incidence of severe diastolic dysfunction in unselected STEMI patients treated with primary PCI, but it doesn?t influence the incidence of major adverse cardiovascular events.

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