Variations in regional strain under different afterload conditions may help to identify ischemic myocardium

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute coronary syndromes are a major health problem worldwide. The Speckle Tracking Imaging has been proposed as adjunctive for diagnosis and prognosis purposes in the context of NSTE-ACS. Purpose We sought to determine the regional myocardial strain in ischemic versus non-ischemic segments in subjects with NSTE-ACS, before and during acute pressure overload. Methods Data from 2D-echocardiography were obtained from 21 patients (mean age, 50 ± 10 years) undergoing cinecoronariography for NSTE-ACS indications. A blinded observer performed an offline analysis to obtain the Systolic Positive Peak (P), Systolic Peak Strain (S), Peak Strain (G) and Time to Peak Strain (TTP) of each segment acquired before and during pressure overload-induced by left hand-grip (42± 8 Kg) combined with simultaneous pneumatic constriction of the right arm and both lower limbs. Moreover, LVEF and GLS were also calculated. A second blinded observer labelled the ischemic regions according to AHA-16 Bull’s eye using data from cinecoronariography. Results The handgrip manuever caused mild reductions in the median LVEF (56 %; IQR 48 -58% vs 54%; IQR 51-56%) as well as the median GLS (-17%; IQR-19%-15% vs -16%; IQR -19-15%). For the analysis of regional myocardial function, we obtained 360 segments (29% labelled as ischemic) with optimal tracking quality. Mean regional strain changes during pressure overload were significantly different in ischemic vs non-ischemic segments for Peak S ( 1,07% x -0.5%; p-value <0,01) and Peak G (0.85% x -0.65%; p-value < 0.01)(Table). Notably, however, we found marked increases in the systolic deformation, restricted to the apical ischemic segments during pressure overload (Figure). Conclusions Our data point to a distinct increase in the systolic deformation of the apical segments in contrast to the overall reductions in the GLS and EF in the ischemic left ventricle. Non- Ischemic segments N = 256 Ischemic segments N = 104 Baseline Handgrip Variation (%) Baseline Handgrip Variation (%) p-value* Peak P 0.33(0.57) 0.36(0.7) 0.03(0.7) 0.50(0.7) 0.57(0.8) 0.07(0.8) 0.32 Peak S -17.9(4.4) -16.8(5.3) 1.07(4.1) -16.6 (5.2) -17.2(5.6) -0.5(4.8) 0.0006 Peak G -18.5 (4.2) -17.68 (4.6) 0.85 (3.7) -17.3 (4.5) -18 (4.6) -0.65(4.2) 0.0005 TTP 377(62) 384(66) 6.5(52) 387(65_ 388(62) 1.15(46) 0.17 * t- test comparing the variations baseline-handgrip between the two groups (ischemic versus non-ischemic. Peak P= positive systolic peak; Peak S= systolic peak; Peak G= peak strain; TTP= time to peak Abstract Figure

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P1385 Mechanical dispersion of the right atrium in dilated cardiomyopathy: does the etiology matter?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.818 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A E Vijiiac ◽

S Iancovici ◽

S Onciul ◽

I Petre ◽

D Zamfir ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Myocardial Strain ◽

Prognostic Significance ◽

Right Atrial ◽

P Value ◽

Supraventricular Arrhythmias ◽

Time To Peak ◽

Mechanical Dispersion ◽

Group I ◽

Significant Difference

Abstract Funding Acknowledgements This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF Background Mechanical dispersion assessed by myocardial strain reflects a susceptibility for arrhythmia development. While the contractile heterogeneity of both ventricles has been assessed in different clinical settings, the incidence and significance of right atrial (RA) dyssynchrony in dilated cardiomyopathy (DCM) are unknown. Methods 50 consecutive patients with DCM were divided in 2 groups according to the etiology: group I had 26 patients with ischemic DCM (68 ± 10 years, 23 men), group N had 24 patients with non-ischemic DCM (52 ± 12 years, 18 men). We assessed the RA strain by 2D speckle-tracking analysis, and we calculated RA mechanical dispersion as the standard deviation of the time-to-peak contraction strain in 6 RA segments. 20 healthy individuals served as controls. Data were compared between groups with one-way analysis of variance and using a post-hoc Bonferroni correction. Results The RA strain was reduced in DCM patients, both in group I and in group N. All three components of the RA strain were most reduced in group I (p < 0.001 for reservoir and conduit strain, p = 0.001 for contraction strain) (Table). The RA mechanical dispersion was highest in group I (56.8 ± 21.6 ms), followed by group N (39.9 ± 15.3 ms) and controls (23.8 ± 7.7 ms)(p < 0.001). Patients with DCM and documented supraventricular arrhythmias (either atrial fibrillation, atrial flutter or premature atrial contractions) had higher RA mechanical dispersion (57.5 ± 19.7 ms) than DCM patients with no documented atrial rhythm disturbances (44.9 ± 19.9 ms, p = 0.04). Conclusion Mechanical dispersion of the RA is pronounced in patients with DCM and it is higher in patients with documented supraventricular arrhythmias. Patients with ischemic DCM have a more pronounced mechanical dispersion of the RA than patients with non-ischemic DCM, reflecting a more heterogenous RA contraction in ischemic heart disease when compared to other forms of DCM. The prognostic significance of RA dyssynchrony in a disease primarily involving the left heart warrants further studies. Group I Group N Controls P value Reservoir RA strain (%) 12.9 ± 7.4§ 17.6 ± 12.9§ 30.1 ± 9.9 <0.001 Conduit RA strain (%) -6 ± 5.5§ -8 ± 8.9§ -15.2 ± 6.4 <0.001 Contraction RA strain (%) 6.9 ± 6§ 9.6 ± 8.1 14.9 ± 6.1 0.001 RA mechanical dispersion (ms) 56.8 ± 21.6§ 39.±15.3§* 23.8 ± 7.7 <0.001 § significant difference with controls; * significant difference with group I

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Quantitative Evaluation On Cardiac Remodeling Mechanism After Intensive Exercise: A Preliminary Study of Non-enhanced Cardiac Cine MRI

10.21203/rs.3.rs-710342/v1 ◽

2021 ◽

Author(s):

hongqin Liang ◽

Liqiang Zhu ◽

Bing Ji ◽

Yongning Shang ◽

xiaoyue Zhou ◽

...

Keyword(s):

Cardiac Function ◽

Myocardial Strain ◽

Strain Analysis ◽

Exercise Group ◽

Left Ventricular ◽

Cine Mri ◽

Control Group ◽

Peak Strain ◽

Functional Parameters ◽

Time To Peak

Abstract Purpose: High intensity and longtime aerobic exercise may lead to the remodeling of both left and right ventricles with increased myocardial mass and cavity dilatation,which is mainly reflected in the changes of traditional cardiac function parameters.Feature tracking myocardial strain allows quantitative strain analysis of myocardial functionThe purpose was to quantitatively evaluate traditional cardiac function and feature tracking myocardial strain of exercise-induced ,andMaterials and methods: The study included 67 healthy volunteers (21 ± 2 years of age). The exercise group (n=43) who fulfilled our defined exercise criteria. The control group (n=23) who maintained a basic daily life .Noncontrast enhancement CMR scanning were performed on all the subjects using a 3T MRI scanner .Cvi42 software was used for post-processing . Left ventricular cardiac function and overall globle stress were measured.Results: Cardiac function parameters in the exercise group were significantly higher than those of the control group except for the ejection fractions (EFs) and heart rates (HRs). The GRS peak strain and GLS peak diastolic strain rates of both groups were significantly different (P＜0.05).The GRS peak strains and EFs were partly correlated (R=0.61). The GRS peak diastolic strains and cardiac Indices (CIs) were significantly correlated (R=0.68). The GCS and GRS Peak Strains showed highly negative correlations (R=–0.96). The GCS and GRS time to peak values were also highly correlated (R= 0.87). Conclusion:The initial results showed that Changes in the functional parameters were more obvious than in the myocardial strain parameters, and some strain indices were correlated with the cardiac functional parameters,when the remodeling of the heart occurs.This is a new attempt to quantitatively assessment of Cardiac function and strain by Non-contrast-enhanced magnetic resonance.

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Changes in left ventricular electromechanical relations during targeted hypothermia

Intensive Care Medicine Experimental ◽

10.1186/s40635-020-00363-7 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Kristin Wisløff-Aase ◽

Viesturs Kerans ◽

Kristina Haugaa ◽

Per Steinar Halvorsen ◽

Helge Skulstad ◽

...

Keyword(s):

Heart Rate ◽

Qt Interval ◽

Clinical Importance ◽

Left Ventricular ◽

Peak Strain ◽

Time To Peak ◽

Mechanical Dispersion ◽

Dispersion Of Repolarization ◽

Aortic Valve Closure ◽

Prolonged Qt Interval

Abstract Background Targeted hypothermia, as used after cardiac arrest, increases electrical and mechanical systolic duration. Differences in duration of electrical and mechanical systole are correlated to ventricular arrhythmias. The electromechanical window (EMW) becomes negative when the electrical systole outlasts the mechanical systole. Prolonged electrical systole corresponds to prolonged QT interval, and is associated with increased dispersion of repolarization and mechanical dispersion. These three factors predispose for arrhythmias. The electromechanical relations during targeted hypothermia are unknown. We wanted to explore the electromechanical relations during hypothermia at 33 °C. We hypothesized that targeted hypothermia would increase electrical and mechanical systolic duration without more profound EMW negativity, nor an increase in dispersion of repolarization and mechanical dispersion. Methods In a porcine model (n = 14), we registered electrocardiogram (ECG) and echocardiographic recordings during 38 °C and 33 °C, at spontaneous and atrial paced heart rate 100 beats/min. EMW was calculated by subtracting electrical systole; QT interval, from the corresponding mechanical systole; QRS onset to aortic valve closure. Dispersion of repolarization was measured as time from peak to end of the ECG T wave. Mechanical dispersion was calculated by strain echocardiography as standard deviation of time to peak strain. Results Electrical systole increased during hypothermia at spontaneous heart rate (p < 0.001) and heart rate 100 beats/min (p = 0.005). Mechanical systolic duration was prolonged and outlasted electrical systole independently of heart rate (p < 0.001). EMW changed from negative to positive value (− 20 ± 19 to 27 ± 34 ms, p = 0.001). The positivity was even more pronounced at heart rate 100 beats/min (− 25 ± 26 to 41 ± 18 ms, p < 0.001). Dispersion of repolarization decreased (p = 0.027 and p = 0.003), while mechanical dispersion did not differ (p = 0.078 and p = 0.297). Conclusion Targeted hypothermia increased electrical and mechanical systolic duration, the electromechanical window became positive, dispersion of repolarization was slightly reduced and mechanical dispersion was unchanged. These alterations may have clinical importance. Further clinical studies are required to clarify whether corresponding electromechanical alterations are accommodating in humans.

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Impact of type 2 diabetes mellitus on left ventricular diastolic function in patients with essential hypertension: evaluation by volume-time curve of cardiac magnetic resonance

Cardiovascular Diabetology ◽

10.1186/s12933-021-01262-1 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Wei-feng Yan ◽

Yue Gao ◽

Yi Zhang ◽

Ying-kun Guo ◽

Jin Wang ◽

...

Keyword(s):

Essential Hypertension ◽

Diastolic Function ◽

Control Group ◽

Peak Strain ◽

Filling Rate ◽

Time Curve ◽

Time To Peak ◽

Peak Ejection Rate ◽

Lv Diastolic Dysfunction

Abstract Background Essential hypertension and type 2 diabetes mellitus (T2DM) are two common chronic diseases that often coexist, and both of these diseases can cause heart damage. However, the additive effects of essential hypertension complicated with T2DM on left ventricle (LV) diastolic function have not been fully illustrated. This study aims to investigate whether T2DM affects the diastolic function of the LV in patients with essential hypertension using the volume-time curve from cardiac magnetic resonance (CMR). Methods A total of 124 essential hypertension patients, including 48 with T2DM [HTN(T2DM +) group] and 76 without T2DM [HTN(T2DM-) group], and 52 normal controls who underwent CMR scans were included in this study. LV volume-time curve parameters, including the peak ejection rate (PER), time to peak ejection rate (PET), peak filling rate (PFR), time to peak filling rate from end-systole (PFT), PER normalized to end-diastolic volume (PER/EDV), and PFR normalized to EDV (PFR/EDV), were measured and compared among the three groups. Multivariate linear regression analyses were performed to determine the effects of T2DM on LV diastolic dysfunction in patients with hypertension. Pearson correlation was used to analyse the correlation between the volume-time curve and myocardial strain parameters. Results PFR and PFR/EDV decreased from the control group, through HTN(T2DM −), to HTN(T2DM +) group. PFT in the HTN(T2DM-) group and HTN(T2DM +) group was significantly longer than that in the control group. The LV remodelling index in the HTN(T2DM −) and HTN(T2DM +) groups was higher than that in the normal control group, but there was no significant difference between the HTN(T2DM −) and HTN(T2DM +) groups. Multiple regression analyses controlling for covariates of systolic blood pressure, age, sex, and heart rate demonstrated that T2DM was independently associated with PFR/EDV (β = 0.252, p < 0.05). The volume-time curve method has good repeatability, and there is a significant correlation between volume-time curve parameters (PER/EDV and PFR/EDV) and myocardial peak strain rate, especially circumferential peak strain rate, which exhibited the highest correlation (r = − 0.756 ~ 0.795). Conclusions T2DM exacerbates LV diastolic dysfunction in patients with essential hypertension. The LV filling model changes reflected by the CMR volume-time curve could provide more information for early clinical intervention.

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Contractile behavior of rat myocardium after reversal of hypertensive hypertrophy

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1982.242.5.h882 ◽

1982 ◽

Vol 242 (5) ◽

pp. H882-H889 ◽

Cited By ~ 3

Author(s):

J. M. Capasso ◽

J. E. Strobeck ◽

A. Malhotra ◽

J. Scheuer ◽

E. H. Sonnenblick

Keyword(s):

Myocardial Hypertrophy ◽

Applied Pressure ◽

Pressure Overload ◽

Heart Weight ◽

Biochemical Alterations ◽

Time To Peak ◽

Velocity Of Shortening ◽

Significant Depression ◽

Contractile Performance ◽

Biochemical Abnormalities

The effects of renovascular hypertension and its reversal on the contractile performance of papillary muscles from rats has been examined. Hypertension of 10 wk duration caused a 48% increase in heart weight and significant prolongations of isometric time to peak tension (TPT), time to half relaxation, and time to peak shortening (TPS). A significant depression in the velocity of shortening was observed in the 10-wk group. However, muscles from hypertensive rats were still able to maintain normal levels of peak isometric developed tension and peak shortening; this may be due to the observed prolongation of TPT and TPS, respectively. In addition, calcium-activated actomyosin ATPase activity was depressed in hearts of hypertensive animals. Reversal of hypertension was studied at 20 wk after the onset of hypertension (10 wk of hypertension followed by 10 wk of normotension). Contractile and biochemical alterations observed in hypertensive animals were reversed in rats undergoing this regime. Thus reversal of a gradually applied pressure overload resulted in the regression of mechanical and biochemical abnormalities associated with the pressure overload myocardial hypertrophy.

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Faktor-Faktor yang Mempengaruhi Terjadinya Anemia pada Remaja Putri

Jurnal Ilmiah Universitas Batanghari Jambi ◽

10.33087/jiubj.v21i1.1116 ◽

2021 ◽

Vol 21 (1) ◽

pp. 331

Author(s):

Yeni Indrawatiningsih ◽

ST Aisjah Hamid ◽

Erma Puspita Sari ◽

Heru Listiono

Keyword(s):

Nutritional Status ◽

Adolescent Girls ◽

Young Women ◽

Significant Relationship ◽

Healthy Lifestyle ◽

Community Health Center ◽

Multivariate Logistic Regression Analysis ◽

P Value ◽

Cross Sectional ◽

Major Health Problem

Anemia is a major health problem for people in the world, especially in developing countries, about 50-80% of anemia is caused by iron deficiency. The purpose of this study was to determine the factors that influence the occurrence of young women. This research is an analytical survey with a cross sectional research design, the study was conducted in May - June 2020 in the village of Sidomakmur, Gumawang Community Health Center, East OKU Regency, the population in this study were all young women recorded by village midwives in Sidomakmur Village, totaling 212 people. and the sample is some of the young women who take part in the Posyandu Youth in Sidomakmur Village, amounting to 98 people, through Proportional Random Sampling, univariate (proportion), bivariate (chi square test) and multivariate (logistic regression) analysis. The results of the analysis showed that adolescent education (p value: 0,000), parents' income (p value: 0.012) and adolescent nutritional status (p vaue: 0,000) had a significant relationship with the incidence of anemia in adolescent girls, while adolescent age (p value: 0.224). ) does not have a significant relationship with the incidence of anemia in adolescent girls, while the age of adolescents. Based on the final model of multivariate analysis, the variable that had the greatest influence on anemia status was the variable nutritional status. It is necessary to provide counseling to young women and improve the way of delivering information when young women conduct examinations on how to prevent anemia, both in the form of a good healthy lifestyle and how to maintain health for the growth and development of young women themselves.

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P1752 Prognostic role of Multilayer Strain Speckle Tracking Echocardiography in patients with severe aortic stenosis treated with Transcatheter Aortic Valve Implantation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1111 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Cimino ◽

V Maestrini ◽

S Monosilio ◽

F Luongo ◽

M Neccia ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Transcatheter Aortic Valve Implantation ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Lv Function ◽

P Value ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Myocardial Strain evaluation helps to assess the efficacy of therapeutic interventions and to predict the prognosis and clinical outcomes. The aim of the present study was to assess whether Multilayer Global longitudinal Strain (GLS) can be useful in estimation of left ventricle (LV) function in patients with severe symptomatic aortic stenosis (AS) who have undergone transcatheter aortic valve implantation (TAVI). Methods 35 patients with severe AS who successfully underwent TAVI, were enrolled in the study. GLS was measured from the endocardial layer (Endo-LS), epicardial layer (Epi-LS) and full thickness of myocardium before the procedure. Analysis included other parameters such as age, sex, LV volumes and ejection fraction (LVEF), type of prosthesis implanted, right ventricular (RV) dimension and function. Occurrence of cardiovascular (CV) events (rehospitalization for HF or CV death) were collected after 24 months follow-up.Results: CV events occurred in 7 patients (20%). Patients were divided in two groups accordingly with CV events occurrence. No differences in baseline, demographic, echocardiographic and procedural characteristics were found. Patients who developed CV events had a more impaired pre-procedural GLS (-10.2 ± 2.4% vs -12.6 ± 2.2%, p = 0.029), mostly due to his subendocardial layer (Endo-LS -10.8 ± 2 vs -13.9 ± 2, p = 0.003). Moreover, by ROC curve analysis, a cut-off value of -12.4% of endo LS was associated with CV events (sensitivity of 83% and specificity of 65 %, AUC 0.8, p = 0.024), with a log-rank p value assessed by survival analysis of 0.044. Conclusion Multilayer GLS analysis could provide additional information for prognosis stratification in patients with severe symptomatic AS before TAVI, above and beyond assessment of LVEF alone. Parameter Event-group (7/35 pz= 20%) Non-event group (28/35 pz= 80%) p Age (y.o) 86 ± 4 80 ± 7 NS LVEDV (ml) 112 ± 34 94 ± 32 NS LVESV (ml) 51.2 ± 6 56.9 ± 6 NS LVEF(%) 55.7 ± 6 56.9 ± 6 NS AVA (cm2) 0.77 ± 0.2 0.73 ± 0.2 NS GLS (%) -10.2 ± 2.4 -12.6 ± 2.2 0.029 Endo-LS (%) -10.8 ± 2 -13.9 ± 2 0.003 Epi-LS (%) -10.2 ± 2 -11.9 ± 2 NS Abstract P1752 Figure.

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Myocardial mechanical alterations during gradual onset long-term hypertension in rats

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1981.241.3.h435 ◽

1981 ◽

Vol 241 (3) ◽

pp. H435-H441 ◽

Cited By ~ 2

Author(s):

J. M. Capasso ◽

J. E. Strobeck ◽

E. H. Sonnenblick

Keyword(s):

Blood Pressure ◽

Pressure Overload ◽

Left Ventricular ◽

Isometric Tension ◽

Left Renal Artery ◽

Ventricular Performance ◽

Time To Peak ◽

Gradual Onset ◽

Significant Depression ◽

Female Wistar Rats

Although a suddenly produced load leads to depressed myocardial contractility, the effects of a slowly induced physiological overload have not been defined. Therefore, a more gradual pressure overload was produced in female Wistar rats by hypertension due to constriction of the left renal artery. Hypertension (systolic blood pressure greater than or equal to 150 mmHg) developed within 3 wk, and blood pressure continued to increase for the next 5 wk. Heart weights in hypertensive animals were elevated by 34% after the onset of hypertension. Isometric and isotonic contractions from left ventricular papillary muscles were recorded at 5, 10, 20, and 30 wk after the onset of hypertension. Total and actively developed isometric tension at all initial muscle lengths were significantly greater in hypertensive animals throughout the 30-wk period. Time to peak tension and time to half relaxation were significantly prolonged. Force-velocity curves demonstrated a significant depression in velocity of shortening at all relative loads in hypertensive muscles that progressed with the duration of hypertension. These studies suggest that myocardial hypertrophy may impart the ability to maintain ventricular performance in terms of force development while speed of shortening decays.

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P934 Left atrial strain association with left ventricular diastolic function

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.567 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I Rodriguez Sanchez ◽

A Anton ◽

J J Onaindia ◽

S Velasco ◽

J Florido ◽

...

Keyword(s):

Ejection Fraction ◽

Diastolic Function ◽

Left Atrial ◽

Normal Function ◽

Left Ventricular ◽

P Value ◽

Peak Strain ◽

Progressive Decrease ◽

Significant Group ◽

Global Peak

Abstract Objectives to evaluate the relationship between left atrial (LA) peak strain and left ventricular (LV) diastolic function and determine whether LA strain could be used to detect elevated filling pressures in a population of patients with preserved LV ejection fraction (LVpEF). Background the assessment of diastolic function is complex and multiparameter. 2016 ASE and EACVI algorithm has simplified this approach, but there are still patients with discrepant values leading to an indeterminate diagnosis, specially in patients with preserved ejection fraction. Methods we prospectively included 129 patients in our cohort. Inclusion criteria were LVEF > 50% and sinus rhythm. Patients with atrial fibrillation, significant mitral valvulopathy or poor quality imaging were excluded. Two-dimensional speckle tracking was used to measure peak LA strain in all LA segments (using apical 4 chamber, 2 chamber and 3 chamber views). We evaluated the association of LA global peak strain and LA 4 chamber peak strain with the different categories of diastolic function according to the 2016 ASE and EACVI algorithm. Results Both LA global peak strain and 4 chamber LA peak strain showed a progressive decrease with worsening diastolic dysfunction (DD) severity (Table 1). A global LA peak strain cutoff value of 28,35% was very accurate to differentiate normal from elevated filling pressures (normal function or grade 1 DD from grades 2 and 3 DD). Diagnostic accuracy: 80.20%; area under the curve: 0,80 (0,72-0,88); A significant group of patients (21,1%) could not be categorized using 2016 algorithm. Conclusions Both LA global peak strain and 4 chamber LA peak strain demonstrated a progressive decrease with worsening DD severity. Global LA peak strain value of 28,35% was an accurate cutoff to differenciate patients with normal vs elevated filling pressures. LA strain values and diastolic function Total LA global peak STRAIN LA 4C STRAIN N (%) p-value p-value Total 129 30.90 %(11.77) 30.43 (12.36) Diastole <0.0001 <0.0001 Normal function 36 (28.13) 39.72% (9.59) 39.98 (10.59) Indeterminate Diastolic Function 23 (17.97) 31.07% (7.97) 30.19 (7.50) Indeterminate DD 4 (3.13) 30.68 % (6.72) 29.75 (7.31) grade 1 DD 22 (17.19) 32.69 % (12.54) 32.98 (14.46) grade 2 DD 36 (28.13) 23.90 % (9.32) 23.53 (9.49) grade 3 DD 7 (5.47) 15.43 % (5.72) 15.85 (7.32)

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