scholarly journals 4 Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Maria Maiello ◽  
Annagrazia Cecere ◽  
Marco Matteo Ciccone ◽  
Pasquale Palmiero
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Early Diagnosis ◽  
Diastolic Dysfunction ◽  
Postmenopausal Women ◽  
Doppler Echocardiography ◽  
Odds Ratio ◽  
Left Ventricular ◽  
Control Group ◽  
Chi Squared

Abstract Aims The most frequent cause of death among patients affected by rheumatoid arthritis (RA) is heart failure, its high prevalence is independent by cardiovascular risk factors. An early diagnosis of heart failure risk may be done assessing left ventricular diastolic dysfunction (LVDD) by Doppler echocardiography. Our study aimed to estimate the LV diastolic function in RA patients. Methods and results We enrolled 207 consecutive postmenopausal women (PMW) with normal electrocardiography, physical examination, and confirmed diagnosis of RA for over a year and 200 PMW free from RA as control group (CG). All women underwent to M-mode, two-dimensional Doppler echocardiography. Seventy-two women were affected by LVDD among 207 women with RA (34.8%), 46 among 200 women on CG (23%), Chi-squared 6.8, odds ratio 1.8, confidence interval (CI) 95%, P < 0.0088. In our population of PMW the chance to be affected by LVDD is almost one and a half times. There were 70 women affected by LVDD among 72 hypertensive women with RA (97.2%), 32 women were affected by LVDD among 98 hypertensive women on CG (32.7%), Chi-squared 72.1, odds ratio 7.2, CI 95%, P < 0.0088, Table II. Among hypertensive PMW of our population the chance to be affected by LVDD is more than triple. All LVDD subjects had abnormal diastole for all different degrees of severity. Conclusions We assess that PMW affected by RA have a significantly high incidence of LV diastolic dysfunction without clinical evidence of heart disease, the incidence is even higher if they are hypertensive, so we recommend a Doppler echocardiography examination for all women with a diagnosis of RA.

scholarly journals Accelerated diastolic dysfunction in premenopausal women with rheumatoid arthritis

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Gee Hee Kim ◽  
Yune-Jung Park
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Diastolic Dysfunction ◽  
Age Of Onset ◽  
Systolic Heart Failure ◽  
Premenopausal Women ◽  
Incidence Rates ◽  
Left Ventricular ◽  
Control Group ◽  
Early Screening

Abstract Background Disturbances of diastolic function precede systolic heart failure and, although clinically silent, represent the earliest sign of cardiac involvement. Diastolic dysfunction (DD) is associated with age, gender (female), and hypertension. However, little is known about the age-specific incidence rates and risk factors for DD in patients with rheumatoid arthritis (RA). Methods We used standard two-dimensional/Doppler echocardiography to screen for the presence of diastolic dysfunction in 61 patients with RA and 107 healthy subjects. All participants were premenopausal women with no history of hypertension. DD includes an impaired relaxation with or without increased left ventricular (LV) filling pressures, pseudonormal filling, and restrictive filling based on parameters measured using echocardiography. Results The two groups were similar with respect to age (P=0.269). Patients with RA had significantly higher LV mass index, LV filling pressure, and lower E/A velocity than controls. All patients had preserved ejection fraction (EF ≥50%). DD was more common in patients with RA at 47% compared to 26% in the controls (P=0.004). Women with RA in the 30- to 49-year age range were over 3.5 times more likely to have DD than those of similar age in the control group (OR=3.54; 95% CI 1.27 to 9.85). Among patients with RA, high CRP levels were independently associated with DD even after adjustment for cardiovascular risk factors (P=0.009). Conclusions In premenopausal women with RA, DD is much more common and the age of onset is reduced. Early screening of myocardial function may provide an opportunity for preventing future cardiovascular disease.

Abstract 19340: Advanced Peripheral Endothelial Dysfunction Correlates with Left Ventricular Diastolic Dysfunction and Heart Failure with Preserved Left Ventricular Ejection Fraction in Hypertensive Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Eiichi Akiyama ◽  
Seigo Sugiyama ◽  
Yasushi Matsuzawa ◽  
Hiroyuki Suzuki ◽  
Masaaki Konishi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Endothelial Dysfunction ◽  
Confidence Interval ◽  
Ejection Fraction ◽  
Endothelial Function ◽  
Diastolic Dysfunction ◽  
Odds Ratio ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Hypertensive Patients

Background: Left ventricular (LV) diastolic dysfunction (DD) and vascular functions including peripheral endothelial function play an important role in the pathogenesis of heart failure (HF) with preserved LV ejection fraction (EF) (HFPEF). Hypertension is the most important risk factor in HFPEF and the increased workload caused by hypertension results in LV pathological hypertrophy and LVDD. However, the importance of endothelial function in hypertensive patients with LVDD or HFPEF remains yet undetermined. We investigated the association between peripheral endothelial function, LVDD, and HFPEF in hypertensive patients. Methods and Results: We evaluated cardiac function by echocardiography measuring the ratio of early transmitral flow velocity to tissue Doppler early diastolic mitral annular velocity (E/e’) and LVEF. We also noninvasively assessed peripheral endothelial function by reactive hyperemia-peripheral arterial tonometry (RH-PAT) as the RH-PAT index(RHI) in 405 hypertensive patients with preserved LVEF (LVEF>50%), comprising 180 HFPEF and 225 non-HF patients (LVDD; E/e’>15, non-HF with LVDD; n=98, non-HF without LVDD; n=127). RHI negatively correlated with E/e’ (r=-0.24, P<0.001) and B-type natriuretic peptide (r=-0.19, P<0.001). RHI was significantly lower in hypertensive patients with HFPEF than in non-HF hypertensive patients (0.49±0.17 vs. 0.62±0.20, P<0.001). Furthermore, RHI was significantly lower in non-HF hypertensive patients with LVDD than those without LVDD (0.58±0.19 vs. 0.65±0.21, P=0.01). Multivariate logistic regression analysis identified that lower RHI independently correlated with the presence of HFPEF in hypertensive patients with preserved LVEF (odds ratio: 0.65, 95% confidence interval: 0.55-0.77, P<0.001) and with the presence of LVDD in non-HF hypertensive patients (odds ratio: 0.65, 95% confidence interval: 0.71-0.95, P=0.01). Conclusions: RHI was independently associated with the presence of HFPEF and LVDD in hypertensive patients with preserved LVEF. Endothelial dysfunction in microcirculation could play a crucial role in the pathogenesis of LVDD and HFPEF in hypertensive patients.

scholarly journals Importance of NT-pro BNP in the Prevention of Heart Failure, Left Ventricular Systolic Dysfunction and Cardiovascular Events

2021 ◽  
Vol 28 (2) ◽  
pp. 167-173
Author(s):  
Irina CUCIUREANU ◽  
◽  
Cristian Alexandru ION ◽  
Anamaria-Georgiana AVRAM ◽  
Maria Suzana GUBERNA ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Cardiovascular Events ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Intervention Group ◽  
Left Ventricular ◽  
Control Group ◽  
Ventricular Systolic Dysfunction ◽  
Cardiovascular Pathology

Objective: The importance of the NT-proBNP value in detecting patients at risk of developing heart failure (HF) and its importance in guiding medical management to prevent the development of HF. Material and methods: The study is a prospective study and includes 314 patients who was presented at the Bagdasar-Arseni Emergency Hospital for cardiology consultation, by appointment, for a period of 3 years. The inclusion criteria were as follows: essential hypertension (diagnosed more than 5 years before), diabetes mellitus (insulin-deficient or under treatment with oral ant diabetics diagnosed more than 5 years before), ischemic heart disease, mild or moderate valvulopathy (mild or moderate mitral regurgitation and large or moderate aortic stenosis) and permanent or paroxysmal atrial fibrillation. Exclusion criteria were as follows: a previous diagnosis of heart failure or left ventricular systolic dysfunction, and the presence of signs or symptoms of heart failure at the time of enrollment in the study. Patients were randomized into 2 groups, a control group and a intervention group. Patients in the intervention group were managed according to the NT-proBNP value, and patients in the control group received the conventional intervention. Patients were monitored for 3 years and the following objectives were pursued: new diagnosis of heart failure, systolic or diastolic dysfunction of the left ventricle and hospitalization for cardiovascular pathology. Results: After 3 years, in the control group there were 40 patients (25.5%) who developed HF, compared to 28 patients (17.8%) in the intervention group. In the control group, 60 patients (38.2%) were diagnosed with left ventricular systolic dysfunction, compared to 43 patients (27.4%) in the intervention group. Regarding left ventricular diastolic dysfunction, in the control group there were 98 patients (62.4%), and in the intervention group there were 80 patients (51.0%). Also, the rate of hospitalizations for cardiovascular pathology was higher in the control group, 56 patients (35.7%), compared to 33 patients (21.0%) in the intervention group. Discussions: The incidence of heart failure, left ventricular systolic or diastolic dysfunction, or hospitalizations for cardiovascular events, was lower in the intervention group, in which patients were managed according to the NT-proBNP value, compared to patients in the control group who received conventional intervention. Conclusions: The NT-proBNP biomarker may be useful in the medical management of patients for the prevention of heart failure.

scholarly journals Incidence and predictors of new onset left ventricular diastolic dysfunction in asymptomatic patients with rheumatoid arthritis without overt cardiac disease

2019 ◽  
Vol 89 (3) ◽  
Author(s):  
Elena Costanza Dal Piaz ◽  
Giovanni Cioffi ◽  
Federica Ognibeni ◽  
Andrea Dalbeni ◽  
Alessandro Giollo ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Cardiac Disease ◽  
Multivariate Logistic Regression Analysis ◽  
Left Ventricular ◽  
Transmitral Flow ◽  
Asymptomatic Patients ◽  
New Onset

Rheumatoid arthritis (RA) is associated with higher risk of heart failure. Several studies report that left ventricular (LV) diastolic dysfunction (LVDD), a silent precursor of heart failure, is widely present in RA patients. Very little is known about the factors related to the development of LVDD in this disease. In this study we assessed the incidence and the predictors of new-onset LVDD in RA patients. Two-hundred-ninety-five adults with RA without overt cardiac disease were prospectively analyzed from March 2014 to March 2015 by Doppler echocardiography. Among the 295 subjects evaluated, 217 (73.6%) had normal LV diastolic function and represented the final study population. At 1-year follow-up, 53 of 217 patients (24%) developed LVDD, which was of degree I (mild dysfunction) in all of them. By multivariate logistic regression analysis, lower E/A ratio of transmitral flow (ratio between the peak velocity of early diastolic “E” wave and late diastolic “A” wave of transmitral flow) was independently associated with new-onset LVDD [OR 0.17 (CI 0.09-0.57)], together with older age and higher systolic blood pressure. In a clinical predictive model derived from multivariate analysis, the new-onset LVDD rate event ranged from 0% (patients without any factor) to 75% (patients in whom the three predictors coexisted). A significant portion of patients with RA without overt cardiac disease develop LVDD at 1-year follow-up. This condition can be predicted by a simple clinical model which could improve the clinical management and the prognostic stratification of patients with RA.

Abstract 3076: Effects of Exercise on Ventricular Mechanical Dyssynchrony in Patients with Heart Failure Currently not Recommended for Resynchronization - Results from the Dyssynchrony Induced by Ventricular Exertion in Heart Failure (DIVE-HF) Study.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Yi-Chih Wang ◽  
Chih-Chieh Yu ◽  
Juey-Jen Hwang ◽  
Ling-Ping Lai ◽  
Chia-Ti Tsai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Clinical Features ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Resynchronization Therapy ◽  
Post Exercise ◽  
Ventricular Dyssynchrony ◽  
Bruce Protocol

Background. Resynchronization therapy has been proven to improve exercise tolerance only in heart failure (HF) patients (pts) with profoundly impaired left ventricular ejection fraction (LVEF). Whether it could be useful to other spectrum of HF pts may depend on the existence of ventricular dyssynchrony, either at rest or exercise-induced. Methods. We studied clinical features, ECG, and echocardiography coupled with tissue Doppler imaging (TDI) in 70 pts (38 men and 32 women, mean age 62±13 years). Among them, 60 pts with compensated HF (functional class II–III) for at least 3 months were grouped into systolic HF (SHF; EF=35–50 %, N=30) and diastolic HF (DHF; EF=50 % plus diastolic dysfunction, N=30) groups. The other 10 pts had no systolic or diastolic dysfunction are the control group. Six-minutes (stage 2) treadmill exercise tests were performed for SHF pts by modified Bruce protocol and for DHF and control pts by Bruce protocol. Dyssynchrony index (DI) represented by standard deviation of electromechanical delays of 12 LV segments was measured before and immediately after exercise. Results. Except for diverse clinical features and conventional echo-parameters as expected, the QRS duration was similar (mean: 93±16 ms) between the 3 groups. TDI studies showed that baseline synchronized LV contraction remained unchanged after exercise (DI: 12.4±3.6 vs. 11.8±2.9 ms, p =ns) in control group. With regard to the DHF group, the preexisting ventricular dyssynchrony got significantly exacerbated (DI: 52.4±10.0 vs. 62.4±12.8 ms, p< 0.001) including 21 pts (70%) with a ≥ 10% increase of DI after exercise provocation. With a more complex response to exercise, the DI in SHF pts didn’t worsen significantly (27.0±19.2 vs. 32.8±20.6 ms, p< 0.06). However, the proportion of DI>33 ms, considered as presence of dyssynchrony, increased from 37% at baseline to 50% after exercise, including 6 pts (20%) with post-exercise new development and 2 pts (7%) with post-exercise disappearance of ventricular dyssynchrony. Conclusions. Exercise-exacerbated ventricular dyssynchrony in DHF pts, and a 50% incidence of post-exercise dyssynchrony in SHF pts with LVEF between 35 to 50% may support the potential utility of resynchronization therapy to these non-indicated HF groups.

Cardiac damage in liver cirrhosis in alcohol abusers

2016 ◽  
Vol 88 (8) ◽  
pp. 99-104
Author(s):  
V A Romanova ◽  
A S Goncharov ◽  
N N Terebilina ◽  
V S Moiseev
Keyword(s):  
Heart Failure ◽  
Liver Cirrhosis ◽  
Diastolic Dysfunction ◽  
Heart Diseases ◽  
Left Ventricular ◽  
Control Group ◽  
Qtc Interval ◽  
Alcohol Abusers ◽  
History Of ◽  
Lv Diastolic Dysfunction

Aim. To estimate the contribution of liver cirrhosis (LC) to the development of heart diseases in alcohol abusers. Subjects and methods. The investigation included 80 patients with alcoholic LC without a history of cardiovascular and respiratory diseases and, as a control group, 32 alcohol abusers without a history of chronic diseases of the liver and cardiovascular and respiratory systems; 45 patients with alcoholic cardiomyopathy (ACM) and congestive heart failure without a history of coronary heart disease and valvular diseases, among whom 11 patients were found to have LC. In addition to standard clinical examination, all the patients underwent electrocardiography, by estimating the corrected QT interval (QTc), standard echocardiography; and those without ACM underwent estimation of left ventricular (LV) kinetics using speckle-tracking echocardiography. Results. The patients with alcoholic LC were found to have a higher LV ejection fraction and a more obvious impairment of LV global longitudinal deformity, and more commonly LV diastolic dysfunction. 16 of the 80 patients with LC were observed to have moderate pulmonary hypertension while the mean pulmonary artery pressure (MPAP) was within the normal range in all the patients without LC. A prolonged QTc interval was revealed in the patients with LC. The duration of QTc was directly correlated with the MELD severity of LC. The patients with chronic heart failure in the presence of ACM and CL showed a more obvious LV diastolic dysfunction, as estimated by E/E’, a greater LV mass index, and a higher MPAP than those with ACM without LC. Conclusion. The LC patients both with ACM and without a history of diseases of the heart were noted to have its more evident disorders as diastolic dysfunction and elevated MPAP. Those without ACM were observed to have impaired LV global deformity and a prolonged QTc interval.

Abstract 3199: Diastolic Dysfunction in Chronic Heart Failure and Aging - Effects of Exercise Training

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Marcus Sandri ◽  
Stephan Gielen ◽  
Norman Mangner ◽  
Robert Höllriegel ◽  
Sandra Erbs ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Control Group ◽  
Aging Effects ◽  
Training Effects ◽  
Diastolic Left Ventricular Dysfunction

BACKGROUND: Diastolic left ventricular dysfunction may occur in both physiologic aging and chronic heart failure (CHF). It has, however, never been assessed, whether the degree of diastolic impairment in CHF is influenced by age and if the previously observed beneficial effects of exercise (ET) on left ventricular filling are diminished in old age. METHODS: In this study we randomised 53 pts. with stable CHF(LVEF 27.3±2.1%) and 51 healthy subjects (HS) (LVEF 61.5±2.7%) to a training (T) or a control group (C). To detect possible aging effects we included subjects <55 (young) and >65 years (old). Subjects in the T-group exercised 4 times daily at 60 to 70% of VO 2 max for 4 weeks under supervision. At baseline and after the intervention E/A ratio and lateral E/E′ ratio were determined by echocardiography and with tissue Doppler imaging. RESULTS: As compared to young HS, old HS showed at baseline a reduced E/A ratio and an increased E/È ratio (young: E/A 1.2±0.2; E/È 7.3±0.1 old: E/A 0.7±0.1; E/È 13.5±0.3; p<0.05). In CHF pts., diastolic function was impaired (young E/A 0.8±0.2; E/È 12.9±0.5 old: E/A 0.8±0.1; E/È 13.7±0.4). No difference of these baseline parameters between the age groups was observed (p=0.72). As a result of ET, E/A ratio improved from 0.7±0.1 to 1.2±0.2 and E/È ratio improved from 13.7±0.3 to 9.3±0.4 in old HS (p<0.05), while it remained unchanged in young training HS and C. In young and old pts. with CHF four weeks of ET resulted in a significant change in E/A ratio (young: from 0.8±0.1 to 1.2±0.1; p<0.05; old: from 0.7±0.1 to 1.1±0.2 p<0.05) and E/È ratio (young: from 13.1±0.3 to 10.1±0.2; p<0,05; old: from 14.1±0.3 to 11.2±0.3; p<0.05). In C no effect was detectable. CONCLUSIONS: The present trial provides new insight into chronobiology of cardiovascular training effects: Among HS aging is associated with the development of significant left ventricular diastolic dysfunction. In CHF both young and old pts. exhibit a similar degree of LV-dysfunction. Four weeks of ET are effective in improving diastolic function in old HS and in young and old CHF pts. The lusitropic training effects were not significantly diminished among older pts. underlining the potentials of rehabilitation interventions in this patient group.

The Pattern of Ventricular Remodeling Influences the Level of Oxidative Stress in Heart Failure Patients

2017 ◽  
Vol 68 (7) ◽  
pp. 1506-1511
Author(s):  
Cerasela Mihaela Goidescu ◽  
Anca Daniela Farcas ◽  
Florin Petru Anton ◽  
Luminita Animarie Vida Simiti
Keyword(s):  
Oxidative Stress ◽  
Heart Failure ◽  
Ventricular Remodeling ◽  
Clinical Laboratory ◽  
Left Ventricular ◽  
Control Group ◽  
Reactive Protein ◽  
Lv Mass ◽  
Few Data

Oxidative stress (OS) is increased in chronic diseases, including cardiovascular (CV), but there are few data on its effects on the heart and vessels. The isoprostanes (IsoP) are bioactive compounds, with 8-iso-PGF25a being the most representative in vivo marker of OS. They correlate with the severity of heart failure (HF), but because data regarding OS levels in different types of HF are scarce, our study was aimed to evaluate it by assessing the urinary levels of 8-iso-PGF2aand its correlations with various biomarkers and parameters. Our prospective study included 53 consecutive patients with HF secondary to ischemic heart disease or dilative cardiomyopathy, divided according to the type of HF (acute, chronic decompensated or chronic compensated HF). The control group included 13 hypertensive patients, effectively treated. They underwent clinical, laboratory - serum NT-proBNP, creatinine, uric acid, lipids, C reactive protein (CRP) and urinary 8-iso-PGF2a and echocardiographic assessment. HF patients, regardless the type of HF, had higher 8-iso-PGF2a than controls (267.32pg/�mol vs. 19.82pg/�mol, p[0.001). The IsoP level was directly correlated with ejection fraction (EF) (r=-0.31, p=0.01) and NT-proBNP level (r=0.29, p=0.019). The relative wall thickness (RWT) was negatively correlated with IsoP (r=-0.55, p[0.001). Also 8-iso-PGF25a was higher by 213.59pg/�mol in the eccentric left ventricular (LV) hypertrophy subgroup comparing with the concentric subgroup (p=0.014), and the subgroups with severe mitral regurgitation (MR) and moderate/severe pulmonary hypertension (PAH) had the highest 8-iso-PGF2a levels. Male sex, severe MR, moderate/severe PAH, high LV mass and low RWT values were predictive for high OS level in HF patients.Eccentric cardiac remodeling, MR severity and PAH severity are independent predictors of OS in HF patients.

Sign in / Sign up

Export Citation Format

Share Document