SP576IMPACT OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION FOR PREDICTING CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS WITH PRESERVED SYSTOLIC FUNCTION

Background: Left ventricular diastolic dysfunction (LVDD) causes heart failure with a preserved left ventricular ejection fraction (LVEF) in the general population. Objective: To examine the relationships between the LVDD grades of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) recommendations and several arteriosclerotic parameters and major cardiovascular events (MACE) in hemodialysis patients with preserved LVEF. Method: Sixty-three prevalent hemodialysis patients (median age [interquartile range], 69 [64–75] years, 31.7% female) with normal systolic function (LVEF > 50%) were enrolled. LVDD evaluated by echocardiography at baseline was divided into three groups according to ASE/EACVI recommendations (normal diastolic function [ND], n = 24; intermediate, n = 19; diastolic dysfunction [DD], n = 20). All patients underwent analyses of several arteriosclerotic parameters (carotid intima-media thickness [CIMT], plaque score [PS], ankle brachial index [ABI], and brachial-ankle pulse wave velocity [baPWV]). The presence or absence of postdialysis orthostatic hypotension was assessed in each dialysis session. MACE during the 1-year follow-up period was obtained from medical records. Kaplan-Meier and Cox’s regression analyses were used to investigate the relationship between LVDD grades and MACE. Results: Postdialysis orthostatic hypotension and PS, but not CIMT, ABI, or baPWV, increased proportionally with LVDD grades. Eleven patients developed MACE, including 2 cardiovascular deaths. The Kaplan-Meier analysis showed that MACE frequently occurred in the DD grade (p = 0.002 by the log-rank test). Cox’s regression analysis adjusted for potential confounders (age, sex, diabetes, systolic blood pressure, and body mass index) revealed that the DD grade was associated with MACE when the ND grade was set as a reference. Conclusions: In maintenance hemodialysis patients with normal ventricular systolic function, a classification of LVDD by the 2016 ASE/EACVI recommendations may be a useful tool for predicting cardiovascular events.

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Prevalence and renal prognosis of left ventricular diastolic dysfunction in non-dialysis chronic kidney disease patients with preserved systolic function

Journal of Hypertension ◽

10.1097/hjh.0000000000003069 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Silvio Borrelli ◽

Luca De Nicola ◽

Carlo Garofalo ◽

Ernesto Paoletti ◽

Sergio Lucà ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Diastolic Dysfunction ◽

Systolic Function ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Ventricular Diastolic Dysfunction ◽

Renal Prognosis

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Left ventricle diastolic dysfunction in diabetes: an update

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302007000200005 ◽

2007 ◽

Vol 51 (2) ◽

pp. 168-175 ◽

Cited By ~ 11

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.

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Left Ventricular Diastolic Dysfunction in Type 2 Diabetes—Progress and Perspectives

Diagnostics ◽

10.3390/diagnostics9030121 ◽

2019 ◽

Vol 9 (3) ◽

pp. 121 ◽

Cited By ~ 3

Author(s):

Elena-Daniela Grigorescu ◽

Cristina-Mihaela Lacatusu ◽

Mariana Floria ◽

Bogdan-Mircea Mihai ◽

Ioana Cretu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diastolic Dysfunction ◽

Diabetic Cardiomyopathy ◽

Cardiovascular Events ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Diabetic Patients ◽

Screening Programs ◽

Ventricular Diastolic Dysfunction

In-depth understanding of early cardiovascular manifestations in diabetes is high on international research and prevention agendas given that cardiovascular events are the leading cause of death for diabetic patients. Our aim was to review recent developments in the echocardiographic assessment of left ventricular diastolic dysfunction (LVDD) as a telltale pre-clinical disturbance preceding diabetic cardiomyopathy. We analyzed papers in which patients had been comprehensively assessed echocardiographically according to the latest LVDD guidelines (2016), and those affording comparisons with previous, widely used recommendations (2009). We found that the updated algorithm for LVDD is more effective in predicting adverse cardiovascular events in patients with established LVDD, and less specific in grading other patients (labelled “indeterminate”). This may prove instrumental for recruiting “indeterminate” LVDD cases among patients with type 2 diabetes mellitus (T2DM) in future screening programs. As an interesting consideration, the elevated values of the index E/e’ can point to early diastolic impairment, foretelling diabetic cardiomyopathy. Identifying subclinical signs early makes clinical sense, but the complex nature of T2DM calls for further research. Specifically, longitudinal studies on rigorously selected cohorts of diabetic patients are needed to better understand and predict the subtle, slow onset of cardiac manifestations with T2DM as a complicating backdrop.

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Prevalence of left ventricular diastolic dysfunction by cardiac magnetic resonance imaging in thalassemia major patients with normal left ventricular systolic function

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1235-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Benjaporn Chinprateep ◽

Nithima Ratanasit ◽

Yodying Kaolawanich ◽

Khemajira Karaketklang ◽

Pairash Saiviroonporn ◽

...

Keyword(s):

Diastolic Dysfunction ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Thalassemia Major ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Beta Thalassemia ◽

Ventricular Systolic Function ◽

Normal Left Ventricular ◽

Ventricular Diastolic Dysfunction

Abstract Background The leading cause of mortality of thalassemia major patients is iron overload cardiomyopathy. Early diagnosis with searching for left ventricular diastolic dysfunction before the systolic dysfunction ensued might yield better prognosis. This study aimed to define the prevalence of the left ventricular diastolic dysfunction (LVDD) in thalassemia major patients with normal left ventricular systolic function and the associated factors. Methods Adult thalassemia major patients with normal left ventricular systolic function who were referred for cardiac T2* at Siriraj Hospital – Thailand’s largest national tertiary referral center – during the October 2014 to January 2017 study period. Left ventricular diastolic function was defined by mitral valve filling parameters and left atrial volume index using CMR. Patients with moderate to severe valvular heart disease, pericardial disease, or incomplete data were excluded. Baseline characteristics, comorbid diseases, current medication, and laboratory results were recorded and analyzed. Results One hundred and sixteen patients were included, with a mean age of 27.5 ± 13.5 years, 57.8% were female, and 87.9% were transfusion dependent. Proportions of homozygous beta-thalassemia and beta-thalassemia hemoglobin E were 12.1 and 87.9%, respectively. The baseline hematocrit was 26.3 ± 3.3%. The prevalence of LVDD was 20.7% (95% CI: 13.7–29.2%). Cardiac T2* was abnormal in 7.8% (95% CI: 3.6–14.2%). Multivariate analysis revealed age, body surface area, homozygous beta-thalassemia, splenectomy, heart rate, and diastolic blood pressure to be significantly associated with LVDD. Conclusions LVDD already exists from the early stages of the disease before the abnormal heart T2 * is detected. Homozygous beta-thalassemia and splenectomy were strong predictors of LVDD. These data may increase awareness of the disease, especially in the high risk groups.

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