P14893D strain echocardiography in assessing left ventricular diastolic dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H T Ozer ◽  
O Ozer ◽  
C Coteli ◽  
A Kivrak ◽  
M L Sahiner ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Heart Catheterization ◽  
Left Heart ◽  
Left Heart Catheterization ◽  
2D Strain

Abstract Background Diastolic dysfunction is an important factor in the development of heart failure with preserved ejection fraction (HFpEF). As the ejection fraction is preserved in HFpEF, the diagnosis of this disease with non-invasive methods is difficult. Purpose In this study, the relationship of BNP, NT-proBNP, Ghrelin, and echocardiographic 3D strain findings with diastolic dysfunction was investigated in patients undergoing left heart catheterization. Methods Our study is a cross-sectional study and included 78 patients in whom echocardiography was performed, and who underwent left heart catheterization based on relevant indications. The patient data recorded for evaluation included the findings from left heart catheterization, follow-up 3D echocardiography; and the levels of blood NT-proBNP, and Ghrelin. Results The rate of diastolic dysfunction was 42.3%. Longitudinal 2D and 3D mean strain as absolute values were observed to decrease more in patients with diastolic dysfunction. The median levels of BNP, NT-proBNP, and Ghrelin levels were higher in patients with diastolic dysfunction. The independent predictors of diastolic dysfunction were determined to be the left atrial volume index (LAVI) (OR=1.17; p=0.018), longitudinal 3D strain values (OR=1.88; p<0.001), NT-proBNP (OR=1.11; p=0.001), and Ghrelin (OR=1.40; p=0.001), respectively. Relationship Between LV EDP and LV Longitudinal Strain LV EDP 2D Strain 3D Strain r p r p r p BNP, pg/ml 0.429 <0.001* 0.115 0.316 0.178 0.118 NT-proBNP, pg/ml 0.484 <0.001* 0.155 0.177 0.186 0.104 Ghrelin, pg/ml 0.478 <0.001* 0.086 0.455 0.157 0.169 SolV DB – – 0.481 <0.001* 0.591 <0.001* dP/dT −0.389 <0.001* −0.283 0.012* −0.307 0.006* Negative dP/dT −0.747 <0.001* −0.337 0.003* −0.458 <0.001* 2D. % 0.481 <0.001* – – 0.852 <0.001* 3D. % 0.591 <0.001* 0.852 <0.001* – – If p value is less than 0.05 shows statistical significance. Measurement of longitudinal strain Conclusion In conclusion, our study found out that the reduced 3D strain absolute values and increased levels of NT-proBNP and Ghrelin biomarkers predicted diastolic dysfunction. If further large-scale studies prove the efficiency of these practical, they may not only allow for making a diagnosis of HFpEF more readily but may also eliminate the confusion in diagnostic algorithms. Acknowledgement/Funding None

scholarly journals Effects on the left ventricular diastolic dysfunction of a cardiac rehabilitation program in chronic heart failure patients

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Chaveles ◽  
L Karatzanos ◽  
S Nanas
Keyword(s):  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Diastolic Dysfunction ◽  
Left Atrium ◽  
Left Atrial Volume ◽  
Rehabilitation Program ◽  
Left Ventricular ◽  
Volume Index ◽  
Cardiac Rehabilitation Program ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. PURPOSE The aim of the present study is to evaluate the impact of a cardiac rehabilitation program on the diastolic dysfunction, the ejection fraction (EF) of left ventricular and the volume index of the left atrium comparing 2 groups: those with restricted EF (&lt;40%) and those with intermediate and preserved EF (≥ 40%). METHODS In the present study 41 stable CHF patients (N = 41; 56 ±10 years [mean ± SD], 34 males and 7 females) with diastolic dysfunction, participated in an exercise rehabilitation program (3 sessions a week). Only 38 of them completed the rehabilitation program in the form of circuit-interval aerobic training, adjusted according to 70–80% of heart rate reserve, for a period of 3 months. A detailed echocardiogram was performed before and immediately after the rehabilitation program, focusing on the diastolic dysfunction assessment of the left ventricular. RESULTS At the end of the three months rehabilitation program, the diastolic dysfunction stage was significantly decreased (from 1.45+/- 0.72 to 1.08 +/-0.67, p = .000). The LV ejection fraction was significantly increased (from 34.97+/-10.66 to 36.68 +/-10.52, p = .002). In addition, there was a significant decrease in E/E" and RVSP (from 9.37+/-3.54 to 8.47+/-3.34 and from 28.44+/-6.86mmHg to 27.38+/-5.87 mmHg, p =.033 and p =.030, respectively). Finally, the left atrial volume and the average e" had no significant decrease. CONCLUSIONS Circuit training improved both diastolic and systolic dysfunction but had no significant repercussion on the left atrium volume. From this study it was concluded that a rehabilitation cardiac program can have an impact in the improvement in the diastolic dysfunction, especially in the restricted EF group, a mechanism that is essential in the pathophysiology of the CHF. Table 1 PairedDifferences t df Sig. (2-tailed) Mean Std. Deviation Std. ErrorMean 95% Confidence Interval of the Difference Lower Upper Diast.stage b-a 0.368 .589 .096 .175 .562 3.855 37 .000 A b - A a ( m/sec) -.03816 .21084 .03420 -.10746 .03114 -1.116 37 .272 Ε/Α b - Ε/Α a .11039 .44705 .07252 -.03655 .25734 1.522 37 .136 mean e" b - a(cm/sec) .19395 2.56304 .41578 -.64850 1.03640 .466 37 .644 Ε/e "b - Ε/e "a .90026 2.50613 .40655 .07652 1.72401 2.214 37 .033 DTeb -DTe a (msec) 8.500 44.324 7.190 -6.069 23.069 1.182 37 .245 T-Test for the measured diastolic parameters (diastolic stage, E, A, E/A, mean e", E/E", DTe) for all groups (b = before, a = after). Abstract Figure. Linear scatter plot for EF

scholarly journals Decreased hydraulic forces are incrementally associated with survival beyond conventional measures of diastolic dysfunction

2021 ◽  
Author(s):  
Dhnanjay Soundappan ◽  
Angus Seen Yeung Fung ◽  
Daniel E Loewenstein ◽  
David Playford ◽  
Geoff Strange ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Cross Sectional ◽  
Left Atrial Volume Index ◽  
C Statistic ◽  
Area Difference

BACKGROUND: Decreased hydraulic forces during diastole contribute to reduced left ventricular (LV) filling and heart failure with preserved ejection fraction. OBJECTIVES: To determine the association between diastolic hydraulic forces, estimated by atrioventricular area difference (AVAD), and both diastolic function and survival. We hypothesized that decreased diastolic hydraulic forces, estimated as AVAD, would associate with survival independent of conventional diastolic dysfunction measures. METHODS: Patients (n=11,734, median [interquartile range] 3.9 [2.4-5.0] years follow-up, 1,213 events) were selected from the National Echo Database Australia based on the presence of relevant transthoracic echocardiographic measures, LV ejection fraction (LVEF) ≥ 50%, heart rate 50-100 beats/minute, the absence of moderate or severe valvular disease, and no prior cardiac surgery. AVAD was calculated as the cross-sectional area difference between the LV and left atrium. LV diastolic dysfunction was graded according to 2016 guidelines. RESULTS: AVAD was weakly associated with E/e prime, left atrial volume index, and LVEF (multivariable global R2=0.15, p<0.001), and not associated with e prime and peak tricuspid regurgitation velocity. Decreased AVAD was independently associated with poorer survival, and demonstrated improved model discrimination after adjustment for diastolic function grading (C-statistic 0.645 vs 0.607) and E/e prime (C-statistic 0.639 vs 0.621), respectively. CONCLUSIONS: Decreased hydraulic forces, estimated by AVAD, are weakly associated with diastolic dysfunction and provide an incremental prognostic association with survival beyond conventional measures used to grade diastolic dysfunction.

scholarly journals Features of the relationship between the parameters of left ventricular mechanics and the level of biomarkers of heart failure in patients with epicardial obesity

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
O Gritsenko ◽  
GA Chumakova
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Speckle Tracking ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Serum Biomarker ◽  
Volume Index ◽  
Time To Peak ◽  
Ventricular Mechanics ◽  
The Relationship

Abstract Funding Acknowledgements Type of funding sources: None. Currently, there is no serum biomarker that is a marker of the presence of heart failure (HF) at an early stage. It is also shown that the traditional indicators used for the diagnosis diastolic dysfunction (DD) of left ventricular (LV) using echocardiography (ECG) are not informative enough. Thus, it is currently relevant to study new serum biomarkers of DD, such as sST2, as well as to study the mechanics of LV. Objective to study the relationship between mechanics of LV and the level of sST2 (bioamarker of HF) in patients with epicardial obesity (EO). Materials and methods The study included 110 men with general obesity. According to the results of echocardiography (ECG), patients were divided into 2 groups: EO (+) with epicardial fat thickness (tEAT) ≥7 mm (n = 70); EO (-) with tEAT &lt;7 mm (n = 40) without diastolic dysfunction according to the results of ECG. All patients were assessed for sST2 and NT-pro-BNP levels using enzyme immunoassay. Using speckle-tracking ECG, the mechanics of LV were studied (twist LV, peak twist ratio LV, time to peak twist of LV, peak untwist ratio LV, time to peak untwist of LV). The exclusion criteria were the presence of coronary pathology, arterial hypertension, and type 2 diabetes mellitus. Results In the group patients with EO ( + ) a statistically significant increase in the level of sST2 was revealed in comparison with the group of EO (-) [21,55 ng/ml (26,52; 15,40) and 9.89 ng/ml (11.12; 7.95); p = 0.001, respectively], while the levels of NT-pro-BNP in both groups were not statistically different [211.36 pg / ml (254.0; 156.0) and 204.81 pg / ml (268.0; 157.0), respectively, p = 0.85]. When determining the parameters of DD LV by ECG, there were no statistical differences between the EO (+) and EO (-) groups [e ", cm / sec 0.09 (0.11; 0.09) and 0.09 (0.11; 0.09), respectively, p = 0.63; E/e " , units, 7.80 (8.90; 6.55) in the EO (+) and 8.53 (9.70; 7.20) in the EO group ( - ), p = 0.08; left atrial volume index, ml / sq2, in the EO group (+) 28.39 (31.25; 24.17) and in the EO group(-) 27,82 (30,21; 25,66), p = 0.55; in the EO group ( + ), the maximum speed of tricuspid regurgitation, m / sec, is 2.78 (2.9; 2.58) in the EO group(-) 2,67 (2,87; 2,41), p = 0.13]. According to the results of speckle-tracking ECG in the EO (+) group, an increase peak untwist ratio LV to -128.31 (-142.0; -118.0) deg/s-1 (p = 0.002) and an increase time to peak untwist of LV of 476.44 (510.0; 411.0) msec was determined in comparison with the EO ( - ) group (p = 0.03). A significant relationship between peak untwist ratio LV and sST2 was revealed (r = 0.37; p = 0.02). Conclusion Thus, it can be assumed that patients with EO have DD LV at the preclinical stage, which is not diagnosed using traditional ECG indicators. The serum biomarker sST2 is an early marker of the presence of HF.

Abstract 13798: Influence of Advanced Pulmonary Vascular Remodeling on Accuracy of Echocardiographic Parameters of Left Ventricular Filling Pressure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yasuyuki Chiba ◽  
Hiroyuki Iwano ◽  
Sanae Kaga ◽  
mio shinkawa ◽  
Michito Murayama ◽  
...  
Keyword(s):  
Left Atrial Volume ◽  
Right Heart Catheterization ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Vascular Lesions ◽  
Volume Index ◽  
Control Group ◽  
Heart Catheterization ◽  
Left Atrial Volume Index ◽  
Echocardiographic Parameters

Introduction: Evaluation of left ventricular (LV) filling pressure (FP) plays an important role in the clinical management of pulmonary hypertension (PH). However, the accuracy of echocardiographic parameters for the estimation of LV FP in the presence of pulmonary vascular lesions has not been fully addressed. Methods: We investigated 87 patients diagnosed with PH due to pulmonary vascular lesions (non-cardiac PH; PH NC ) (PH NC group) and 117 patients with ischemic heart disease without reduced LV ejection fraction (<40%) (control group). Mean pulmonary arterial wedge pressure (PAWP) and pulmonary vascular resistance (PVR) were obtained by right heart catheterization. As echocardiographic parameters of LV FP, the ratio of early- (E) to late-diastolic transmitral flow velocity (E/A), ratio of E to early-diastolic mitral annular velocity (E/e'), and left atrial volume index (LAVI) were measured. The PH NC group was subdivided into non-severe and severe groups according to median PVR (5.3 Wood units). Results: PAWP was 12±5 mmHg in controls, 9±4 mmHg in non-severe PH NC , and 8±3 mmHg in severe PH NC . In the control and non-severe PH NC groups, positive correlations were observed between PAWP and E/A (R=0.66 and R=0.41, respectively), E/e' (R=0.36 and R=0.33), and LAVI (R=0.38 and R=0.62). In contrast, in the severe PH NC group, PAWP was only correlated with LAVI (R=0.41, p=0.006). In the control group, PAWP determined E (β=0.45, p<0.001) but PVR did not, whereas both PAWP and PVR were independent determinants of E (β=0.32, p=0.001; and β=-0.35, p<0.001, respectively) in the PH NC group. Conclusions: In the presence of advanced pulmonary vascular lesions, conventional Doppler echocardiographic parameters may not accurately reflect LV FP. Importantly, elevated PVR would lower the E value, even when PAWP is elevated, resulting in blunting of these parameters for the detection of elevated LV FP. LAVI might be a reliable parameter for estimating LV FP in patients with severe non-cardiac PH.

Abstract 4205: Left Atrial Volume Index and Left Ventricular Geometry Independently Predict Mortality in 47,865 Patients with Preserved Ejection Fraction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Dharmendrakumar A Patel ◽  
Carl J Lavie ◽  
Richard V Milani ◽  
Hector O Ventura
Keyword(s):  
Ejection Fraction ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Mortality Prediction ◽  
Volume Index ◽  
Left Ventricular Geometry ◽  
Preserved Ejection Fraction ◽  
Atrial Volume ◽  
Left Atrial Volume Index

Background: LV geometry predicts CV events but it is unknown whether left atrial volume index (LAVi) predicts mortality independent of LV geometry in patients with preserved LVEF. Methods: We evaluated 47,865 patients with preserved EF to determine the impact of LAVi and LV geometry on mortality during an average follow-up of 1.7±1.0 years. Results: Deceased patients (n=3,653) had significantly higher LAVi (35.3 ± 15.9 vs. 29.1 ± 11.9, p<0.0001) and abnormal LV geometry (60% vs. 41%, p<0.0001) than survivors (n=44,212). LAVi was an independent predictor of mortality in all four LV geometry groups [Hazard ratio: N= 1.007 (1.002–1.011), p=0.002; concentric remodeling= 1.008 (1.001–1.012), p<0.0001; eccentric hypertrophy= 1.012 (1.006 –1.018), p<0.0001; concentric hypertrophy=1.017 (1.012–1.022), p<0.0001; Figure ]. Comparison of models with and without LAVi for mortality prediction was significant suggesting increased mortality prediction by addition of LAVi to other independent predictors (Table ). Conclusion: LAVi is higher and LV geometric abnormalities are more prevalent in deceased patients with preserved systolic function and are independently associated with increased mortality. LAVi predicts mortality independent of LV geometry and has synergistic influence on all cause mortality prediction in large cohort of patients with preserved ejection fraction.

Abstract 31: Impact of Acculturation on Cardiac Structure and Function Among Latinos in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL): The ECHO-SOL Ancillary Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Lenny Lopez ◽  
Katrina Sweet ◽  
Fátima Rodríguez ◽  
Jorge R Kizer ◽  
Frank J Penedo ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Structure And Function ◽  
Volume Index ◽  
Cardiac Structure ◽  
Length Of Residence ◽  
The Us ◽  
Cardiac Structure And Function ◽  
And Function

Background: Abnormalities of cardiac structure and function are part of the spectrum of heart failure risk and progression. Acculturation is the process whereby an individual adopts the beliefs and practices of a host culture. Increasing acculturation has been associated with increased psychosocial stress and the adoption of deleterious health behaviors. The extent to which acculturation contributes to cardiovascular disease among Latinos is not well defined, and its association with cardiac structure and function in particular has not been studied among Latinos. Hypothesis: We hypothesized that higher acculturation is associated with worse left ventricular structure and function. Methods: The HCHS/SOL cohort included 16,415 Latino adults age 18-74 years from Cuban, Dominican, Mexican, Puerto Rican, Central American, and South American backgrounds. A random subsample of 1350 also underwent detailed echocardiographic assessment for the following primary outcome measures: left atrial volume index (LAVI), left ventricular mass index (LVMI) and LV ejection fraction (LVEF), LV end diastolic volume (LVEDV) and diastolic dysfunction (Grade 0 vs. Grade 1-3). Acculturation was measured by length of residence in the US categorized as (< 5 years, 5-10 years, >10 years). Chi-square and ANOVA were used to assess differences across acculturation level and dependent variables. Separate linear and logistic regression analyses were used with sequential modeling for age and sex followed by models including diabetes, hypertension, body mass index, tobacco use, and estimated glomerular filtration rate. Results: The mean age of the Echocardiographic Cohort was 56 years (S.D. ±0.5). Length of residence among first generation immigrants (n=1239) was as follows: 9.7% ≤ 5 years; 14.8% 5-10 years; and 75.5% ≥10 years. Fully adjusted models demonstrated abnormal cardiac structure was significantly higher with increasing years of US residence: increasing LAVI (1.6 ml/m 2 higher ≥10 years vs. ≤ 5 years), increasing LVEDV (5.6 ml higher ≥10 years vs. ≤ 5 years), and LVMI (4.9g/m 2 higher ≥10 years vs. ≤ 5 years) (p<0.01 each). Increasing length of residence in the US was also associated with higher prevalence of diastolic dysfunction in models adjusted for age and gender (54.2% ≤ 5 years vs. 63.7% ≥10 years; p=0.04), though this became marginally non-significant in our fully adjustment models (p=0.07). There were no significant differences in systolic cardiac function as measured by LVEF. Conclusions: Among a diverse Latino population, higher acculturation defined as greater length of residence in the US, a proxy measure for acculturation, was associated with larger LA volume, larger LV cavity, higher LV mass and a tendency to higher prevalence of diastolic dysfunction independent of traditional risk factors. Acculturation may be a significant process that impacts cardiac structure and function among Latinos.

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