Subclinical impact of diabetes and hypertention on left ventricular function

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Maaroufi ◽  
S Abouradi ◽  
H Zahidi ◽  
H Choukrani ◽  
R Habbal
Keyword(s):  
Sex Ratio ◽  
Systolic Function ◽  
Mitral Annulus ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Lv Function ◽  
Diabetic Patients ◽  
Systolic Performance ◽  
The Mean ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Assessment of longitudinal left ventricular (LV) function has a major clinical significance for the early detection of contractile LV dysfonction. The measurement of the MAPSE (Mitral annular plane systolic excursion) and the systolic peak velocity of the edge of the mitral ring (Sm) allow an accurate assessment of longitudinal systolic performance Objective The aim of this study was to compare the impact of isolated type 2 diabetes and the coexistence of hypertension and diabetes on LV longitudinal systolic performance. Patients and Methods The study included 170 diabetic patients, of whom 85 had both hypertension and diabetes, and 50 controls. The systolic mitral annulus (Sm) velocity by tissue Doppler and the Mitral annular plane systolic excursion (MAPSE) by M mode were measured in all subjects. Results The mean age was 52.8 ± 15 years with a sex ratio M / F 0.23 in diabetic patients, and a mean age 60.8 ± 8 years with a sex ratio M / F 0.45 in control subjects. The mean MAPSE value was reduced in diabetics (11.5 ± 2.6 mm) and even more in hypertensive diabetics (10.5 ± 3.0 mm) compared to controls (16.1 ± 2.4 mm ) (p = 0.02). Similar results were found for Sm (controls, 12.4 ± 2.5 cm / s; diabetics, 9.0 ± "3.3 cm / s; diabetic hypertensive, 7.3 ± 2.0 cm) (p = 0.04). Conclusions diabetics present a depression of the LV longitudinal systolic indices compared to healthy controls; the coexistence of diabetes and hypertension results in further impairment of LV longitudinal systolic function in an additive manner.

scholarly journals B-Lines on Chest Ultrasound Predicts Elevated Left Ventricular Diastolic Pressures

2017 ◽  
pp. 1-7
Author(s):  
Maadarani O ◽  
Bitar Z ◽  
Almeri K
Keyword(s):  
Pulmonary Edema ◽  
Predictive Value ◽  
Lung Ultrasound ◽  
Systolic Function ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Acute Pulmonary Edema ◽  
Chest Ultrasound ◽  
Highly Sensitive ◽  
The Mean

Background: Echocardiography and lung ultrasound are important tests for assessing left ventricular function in patients presented to the emergency department with acute pulmonary edema. Chest ultrasound is becoming an important tool in diagnosing acute pulmonary edema. Aim: To investigate the relationship between the B profile on ultrasound chest and Spectral tissue Doppler echocardiography (E/e’ ratio) in patients presented with the suspicion of acute pulmonary edema. Methods: This paper reports a prospective observational study of 61 consecutive patients, which was presented with symptoms and signs of pulmonary edema and B - profile detected by echocardiography with a 5 MHz curvilinear probe. Critical care physicians trained in ultrasound examination performed echocardiography and chest ultrasounds. Results: Sixty-one participants were included in the study. Forty-seven of the 61 patients had a B-profile and 14 patients had an A profile. The mean E/e’ level in the patients with B-profile was 20.8, compared with the mean level in the patients with an A-profile of 8.2 (CI = 0.33-0.82). The distribution in the two groups differed significantly (p=0.003). Based on the value of E/e’, the sensitivity and specificity were determined; the sensitivity of B profile on ultrasound was 92% (95% confidence interval (CI) = 0.812-0.968), and the specificity was 91% (CI =0.623-0.98). The positive predictive value of the B-profile was 97% (CI=0.889-0.996), and the negative predictive value was 71% (CI=0.454-0.883). The systolic function in the subjects with a B-profile was below 50% in 74.3% of the subjects and normal in 25.7% of the subjects. All the subjects with B profile and systolic function > 50% had elevated ProBNP and E/e’ > 15. An A-profile subjects had systolic function > 55%. Conclusions: Detecting the B-profile in lung ultrasound is highly sensitive and specific for elevated left ventricular diastolic pressures regardless of the systolic function of the left ventricle which may help in diagnosing pulmonary edema.

Early Detection of Cardiac Systolic Functional Impairment and Correlation with NT-ProBNP Change in AL Amyloidosis by Cardiac Lateral Wall Tissue Doppler S Wave.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2814-2814
Author(s):  
Marna de Cruz ◽  
Babita Pawarova ◽  
Helen Lachmann ◽  
Julian Gillmore ◽  
Simon Gibbs ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Systolic Function ◽  
Prognostic Significance ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
S Wave ◽  
International Consensus ◽  
2D Strain ◽  
The Mean ◽  
Significant Change

Abstract Abstract 2814 Poster Board II-790 N-terminal fragment of brain natriuretic peptide is a cardiac biomarker that has prognostic significance in amyloidosis and NT-ProBNP can rapidly change after completion of chemotherapy. We and others who have previously reported such changes in NT-ProBNP to be of prognostic significance but there was no cardiac “progression” or “improvement” according to the international amyloidosis consensus criteria (Gertz et al 2005) in the majority - making this finding difficult to explain. We now report subtle changes in left ventricular systolic function using lateral wall tissue Doppler as a new robust and reproducible parameter correlating well with such changes in NT-ProBNP. Patients with cardiac amyloidosis as defined by the international consensus criteria who had good renal function (creatinine clearance >30ml/min), received chemotherapy and had a significant change in NT-ProBNP after chemotherapy were identified from the database of the UK National Amyloidosis Centre. A significant change in NT-ProBNP was defined as minimum rise or fall of 30% over the baseline pre-treatment value. Ninty seven patients with identified. All analysis was repeated on stored off line data on EchoPAC” in accordance with British Society of Echocardiography guidelines with special focus on ejection fraction (EF) (Biplane Simpson's method), longitudinal 2D strain, lateral TDI S wave (Tissue Doppler Imaging) and mean left ventricular wall thickness. At baseline the mean EF was 59%, mean LV wall thickness 13mm and mean TDI S wave velocity 0.07m/sec. 76/97 (78%) patients showed a significant increase in the NT-proBNP levels and 21/97 (22%) showed a significant a decrease. There was a significant correlation between the free light chain (FLC) level and NT-ProBNP at diagnosis (correlation coefficient 0.322; p <0.001). NT-ProBNP decreased from median 444 to 144 pMol/L (p=0.021) among patients who had a complete FLC response. There was also good correlation between the NT-ProBNP level with interventricular septal and left ventricular posterior wall thickness (spearman correlation coefficient 0.55, significance 0.01) at baseline. None of the patients had cardiac progression or improvement by echocardiography according to the international consensus criteria . In both groups of patients (increase or decrease in NT-ProBNP), there was no significant change in the LV wall thickness. In patients with a decrease in the NT-proBNP, there was no significant increase in the ejection fraction or longitudinal 2-D strain in the evaluable cases. But there was a significant improvement in the mean lateral TDI S wave (a marker of longitudinal LV systolic function) from 0.07 m/s to 0.08m/s (p=0.02) suggesting improvement in systolic function. In patients with an increase in the NT-ProBNP, there was a significant decrease in the mean EF from 60% to 56% (p=0.032). The longitudinal 2D strain also decreased significantly by mean of 10% (-13.9% to -12.6%; p=0.009) and the lateral TDI S wave also showed significant worsening with a decline from 0.09m/sec to 0.07m/sec (p <0.001). NT-ProBNP changes after chemotherapy have remained difficult to explain. The international consensus criteria for cardiac progression or improvement by echocardiography - a 2 mm change in the LV wall thickness or 20% change in EF - are relatively insensitive and the clinical criteria (change in NYHA class by 2) are not robust or reproducible to detect cardiac improvement or progression. Lateral TDI S wave is a robust and reproducible parameter that correlates well with both an increase and decrease drop in NT-ProBNP levels. This suggests that there are subtle changes to the left ventricular systolic function which correlate well with change in NT-ProBNP and are of prognostic significance. These changes in systolic function occur well before any substantial diastolic functional change or change in wall thickness. This interesting finding needs further validation in larger groups and if confirmed should be considered for incorporation in the consensus criteria for cardiac progression or improvement. Disclosures: No relevant conflicts of interest to declare.

Haemodynamic insights into the effects of ischaemia and cycle length on tissue Doppler-derived mitral annulus diastolic velocities

2004 ◽  
Vol 106 (2) ◽  
pp. 147-154 ◽  
Author(s):  
Sherif F. NAGUEH ◽  
Liyun RAO ◽  
Julia SOTO ◽  
Katherine J. MIDDLETON ◽  
Dirar S. KHOURY
Keyword(s):  
Cycle Length ◽  
Systolic Function ◽  
Vena Cava ◽  
Coronary Artery Occlusion ◽  
Mitral Annulus ◽  
Tissue Doppler ◽  
Artery Occlusion ◽  
Left Ventricular ◽  
Heart Catheterization ◽  
Cycle Lengths

In the present study, we performed simultaneous epicardial echocardiography and left heart catheterization on ten adult dogs to investigate the effects of ischaemia and tachycardia on the mitral annulus early (Ea) and late (Aa) diastolic velocities and the haemodynamic mechanisms involved. Left atrial pressure and left ventricular (LV) volumes and pressures were measured with 5 French Millar catheters. In each dog, inferior vena cava occlusion was used to alter preload and circumflex coronary artery occlusion was applied to induce ischaemia at two different cycle lengths: 450 and 550 ms. At both cycle lengths, ischaemia resulted in a reduction in LV relaxation, LV global and ipsilateral systolic function, transmitral pressure gradient (TMG), Ea and Aa (P<0.05). The shorter cycle length was associated with a shorter tau (time constant of LV relaxation), reduced TMG and reduced septal and lateral Ea (P<0.05 for all variables). Both septal and lateral Aa were significantly increased (P<0.05). Ischaemia influences Ea through changes in LV relaxation, global and regional systolic function and TMG. An increase in heart rate reduces Ea, but increases Aa.

Link between diabetes and diastolic dysfunction and the diagnostic role of echocardiography

2009 ◽  
Vol 150 (45) ◽  
pp. 2060-2067 ◽  
Author(s):  
András Nagy ◽  
Zsuzsanna Cserép
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Systolic Function ◽  
Diastolic Heart Failure ◽  
Systolic Dysfunction ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Doppler Study

Diabetes mellitus, a disease that has been reaching epidemic proportions, is an important risk factor to the development of cardiovascular complication. The left ventricular diastolic dysfunction represents the earliest pre-clinical manifestation of diabetic cardiomyopathy, preceding systolic dysfunction and being able to evolve to symptomatic heart failure. In early stages, these changes appear reversible with tight metabolic control, but as pathologic processes become organized, the changes are irreversible and contribute to an excess risk of heart failure among diabetic patients. Doppler echocardiography provides reliable data in the stages of diastolic function, as well as for systolic function. Combination of pulsed tissue Doppler study of mitral annulus with transmitral inflow may be clinically valuable for obtaining information about left ventricular filling pressure and unmasking Doppler inflow pseudonormal pattern, a hinge point for the progression toward advanced heart failure. Subsequently we give an overview about diabetes and its complications, their clinical relevance and the role of echocardiography in detection of diastolic heart failure in diabetes.

scholarly journals Right and left ventricular adaptation to hypoxia: a tissue Doppler imaging study

2005 ◽  
Vol 289 (4) ◽  
pp. H1391-H1398 ◽  
Author(s):  
Sandrine Huez ◽  
Kathleen Retailleau ◽  
Philippe Unger ◽  
Adriana Pavelescu ◽  
Jean-Luc Vachiéry ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Wave Velocity ◽  
Tissue Doppler Imaging ◽  
Systolic Function ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Lv Function ◽  
Tricuspid Annulus ◽  
Lv Systolic Function

Hypoxia has been reported to alter left ventricular (LV) diastolic function, but associated changes in right ventricular (RV) systolic and diastolic function remain incompletely documented. We used echocardiography and tissue Doppler imaging to investigate the effects on RV and LV function of 90 min of hypoxic breathing (fraction of inspired O2 of 0.12) compared with those of dobutamine to reproduce the same heart rate effects without change in pulmonary vascular tone in 25 healthy volunteers. Hypoxia and dobutamine increased cardiac output and tricuspid regurgitation velocity. Hypoxia and dobutamine increased LV ejection fraction, isovolumic contraction wave velocity (ICV), acceleration (ICA), and systolic ejection wave velocity (S) at the mitral annulus, indicating increased LV systolic function. Dobutamine had similar effects on RV indexes of systolic function. Hypoxia did not change RV area shortening fraction, tricuspid annular plane systolic excursion, ICV, ICA, and S at the tricuspid annulus. Regional longitudinal wall motion analysis revealed that S, systolic strain, and strain rate were not affected by hypoxia and increased by dobutamine on the RV free wall and interventricular septum but increased by both dobutamine and hypoxia on the LV lateral wall. Hypoxia increased the isovolumic relaxation time related to RR interval (IRT/RR) at both annuli, delayed the onset of the E wave at the tricuspid annulus, and decreased the mitral and tricuspid inflow and annuli E/A ratio. We conclude that hypoxia in normal subjects is associated with altered diastolic function of both ventricles, improved LV systolic function, and preserved RV systolic function.

Abstract 36: Acute Inhibition Of O-GlcNAc Signaling Rescues Inotropic Responsiveness In Type 1 Diabetic Rat Hearts

2014 ◽  
Vol 115 (suppl_1) ◽  
Author(s):  
Chengxue Qin ◽  
Rochelle S S Sleaby ◽  
Lea M Delbridge ◽  
Amy J Davidoff ◽  
John C Chatham ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Male Rats ◽  
Diabetic Heart ◽  
Diabetic Rat ◽  
Lv Function ◽  
Diabetic Patients ◽  
Cardiac Phenotype ◽  
Rat Hearts ◽  
The Impact

Metabolism of excess glucose is an important component of the aetiology of type 1 diabetes. The cardiac phenotype includes left ventricular (LV) remodelling and LV dysfunction. Increased hexosamine biosythesis (HBP) and downstream upregulation of protein O-GlcNAcylation has been linked to diabetic complications in many organs. Its impact on LV contractile responsiveness is however not well understood. This study aimed to test the hypothesis that acute inhibition of O-GlcNAc signaling protects inotropic responsiveness in type 1 diabetic heart. Hearts isolated from adult Sprague-Dawley male rats were Langendorff-perfused (constant flow, 10ml/min). Baseline and phenylephrine-stimulated (PE, 10μmol/L) LV function was determined in diabetic (8wks post-streptozotocin diabetes, 55mg/kg i.v.) versus non-diabetic sham rats in the presence of pharmacological inhibitors of HBP/O-GlcNAc including 6-diazo-5-oxo-L-norleucine (DON, 20μM) and alloxan (5mM). Diabetic rats exhibited a marked reduction in inotropic responsiveness to PE (Table, mean±SEM, one-way ANOVA, #P<0.05 vs non-diabetic vehicle rats, *P<0.05 vs diabetic vehicle, at 40 mins). Acute interruption of cardiac HBP/O-GlcNAc by DON and Alloxan significantly rescued LV responsiveness to PE in type 1 diabetic rat hearts. These results support further assessment of the impact of upregulated protein O-GlcNAcylation on LV function, particularly in the diabetic heart. Treatment strategies that target HBP may provide significant benefits alone or in combination with current standard treatments, to reduce progression of heart failure and death in type 1 diabetic patients.

Abstract P089: Diabetes Worsens Length Of Stay In Patients With Reduced Ejection Fraction Admitted With Nstemi

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Ebenezer Oni ◽  
Zach Port ◽  
Olayinka Afolabi Brown ◽  
Behnam Bozorgnia ◽  
Aman M Amanullah
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Length Of Stay ◽  
Ejection Fraction ◽  
Systolic Function ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Ventricular Ejection Fraction ◽  
The Impact

Background: Length of stay is an important quality metric and outcome measure in the management of hospitalized patients. We evaluated the association of diabetes in patients admitted for Non-ST Elevation myocardial infarction (NSTEMI) on their length of stay. Hypothesis: the impact of diabetes on length of stay in patients admitted for STEMI Methods: Our study population included patients admitted for NSTEMI in a single center between 08/01/2016 and 09/30/2012. Diabetes (DM) was defined by a documented diagnosis or use of diabetic medication. A higher length of stay (LOS) was defined as spending more than 5 days in the hospital. Results: A total of 720 patients were included in this analysis. The mean age was 66 ± 0.6 years, 50% (n-269) were diabetics, 59% had left ventricular ejection fraction (EF) < 50% and the median LOS was 5 days. A higher number of diabetic patients had LOS> 5days (55%). In an unadjusted logistic regression, diabetics had increased odds of higher LOS, odd ratio (OR) 1.54 ( CI 1.10-2.16 ), p=0.012. After adjusting for confounding variables, the relationship remained significant. When stratified by left ventricular systolic function on admission, the impact of diabetes on length of stay only remained significant in patients with EF less than 50%. See Table 1. Conclusion: The presence of diabetes was significantly associated LOS in NSTEMI, especially for patients admitted with a reduced left ventricular ejection fraction. This study emphases the impact of diabetes on health comes in cardiovascular disease.

scholarly journals Left ventricle diastolic dysfunction in diabetes: an update

2007 ◽  
Vol 51 (2) ◽  
pp. 168-175 ◽  
Author(s):  
Cláudia Maria V. Freire ◽  
Ana Luiza M.T. Moura ◽  
Márcia de Melo Barbosa ◽  
Lucas José de C. Machado ◽  
Anelise Impeliziere Nogueira ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Tissue Doppler ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Detailed Evaluation ◽  
Ventricular Diastolic Dysfunction ◽  
And Function

Diabetes mellitus, a disease that has been reaching epidemic proportions, is an important risk factor to the development of cardiovascular complication. Diabetes causes changes within the cardiac structure and function, even in the absence of atherosclerotic disease. The left ventricular diastolic dysfunction (VE) represents the earliest pre-clinical manifestation of diabetic cardiomyopathy, preceding the systolic dysfunction and being able to evolve to symptomatic heart failure. The doppler echocardiography has emerged as an important noninvasive diagnostic tool, providing reliable data in the stages of diastolic function, as well as for systolic function. With the advent of recent echocardiographic techniques, such as tissue Doppler and color M-mode, the accuracy in identifying the moderate diastolic dysfunction, the pseudonormal pattern, has significantly improved. Due to cardiometabolic repercussions of DM, a detailed evaluation of cardiovascular function in diabetic patients is important, and some alterations may be seen even in patients with gestational diabetes.

P935 Association of intracellular iron status with left ventricular systolic function response to exercise in heart failure with preserved ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Przewlocka-Kosmala ◽  
E Jasic-Szpak ◽  
E A Jankowska ◽  
P Ponikowski ◽  
W Kosmala
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Systolic Function ◽  
Iron Status ◽  
Left Ventricular ◽  
Exercise Intolerance ◽  
Lv Function ◽  
Preserved Ejection Fraction ◽  
Intracellular Iron ◽  
The Impact

Abstract The intracellular iron depletion has been recognized to contribute to the dysregulation of cell energetics. The soluble transferrin receptor (sTfR) is regarded as a marker of cellular iron balance, and its elevated level reflects an insufficient iron delivery to target tissues. Despite the strong pathophysiological link, there is a scarcity of data on the impact of intracellular iron status on myocardial performance. Aim To investigate the association between the intracellular iron status, as assessed by sTfR, and left ventricular (LV) function in a well-characterized population with heart failure and preserved ejection fraction (HFpEF). Methods A complete echocardiogram including evaluation of LV global longitudinal deformation by speckle tracking (GLS) was performed at rest and immediately post-exercise in 83 pts (age 66 ± 8 yrs) with symptomatic HFpEF. Results Pts with the highest sTfR concentrations (from the 3rd sTfR tertile) demonstrated significantly lower exertional GLS than their peers from the other 2 tertiles and lower resting GLS vs. the 2nd tertile (Table). Exercise GLS was inversely correlated with sTfR (r=-0.27, p = 0.01), and this association remained significant after adjustment for age, sex, BMI, LV mass, exercise blood pressure, hemoglobin and serum galectin-3 – a marker of fibrosis (beta=-0.24, p = 0.04). Conclusions In HFpEF, higher sTfR reflecting a decreased global intracellular iron content is independently associated with reduced LV longitudinal contractility response to exertion. This might represent another mechanism of exercise intolerance and should be considered in management strategies in this condition. Abstract P935 Figure.

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