Disease activity is associated with reduced left ventricular systolic myocardial function in patients with rheumatoid arthritis

2016 ◽  
Vol 76 (2) ◽  
pp. 371-376 ◽  
Author(s):  
Helga Midtbø ◽  
Anne Grete Semb ◽  
Knut Matre ◽  
Tore K Kvien ◽  
Eva Gerdts
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Ejection Fraction ◽  
Disease Activity ◽  
Cardiovascular Risk Factors ◽  
Myocardial Function ◽  
Systolic Function ◽  
Left Ventricular ◽  
Lv Ejection Fraction ◽  
Lv Systolic Function

ObjectivesDisease activity has emerged as a new, independent risk factor for cardiovascular disease in patients with rheumatoid arthritis (RA). We tested if disease activity in RA was associated with lower left ventricular (LV) systolic function independent of traditional cardiovascular risk factors.MethodsEchocardiographic assessment was performed in 78 patients with RA having low, moderate or high disease activity (Simplified Disease Activity Index (SDAI) >3.3), 41 patients in remission (SDAI ≤3.3) and 46 controls, all without known cardiac disease. LV systolic function was assessed by biplane Simpson ejection fraction, stress-corrected midwall shortening (scMWS) and global longitudinal strain (GLS).ResultsPatients with active RA had higher prevalence of hypertension and diabetes compared with patients in remission and controls (both p<0.05). LV ejection fraction (endocardial function) was normal in all three groups, while mean scMWS and GLS (myocardial function) were reduced in patients with RA with active disease compared with patients with RA in remission (95±18% vs 105±17% and −18.9±3.1% vs −20.6±3.5%, respectively, both p<0.01). Patients with RA in remission had similar scMWS and GLS as the controls. In multivariable analyses, having active RA was associated with lower GLS (β=0.21) and scMWS (β=−0.22, both p<0.05), both reflecting lower LV systolic myocardial function, independent of cardiovascular risk factors and LV ejection fraction. Classification of RA disease activity by other disease activity composite scores yielded similar results.ConclusionsActive RA is associated with lower LV systolic myocardial function despite normal ejection fraction and independent of traditional cardiovascular risk factors.

scholarly journals Non-Invasive Assessment of Left Ventricle Ejection Fraction: Where Do We Stand?

2021 ◽  
Vol 11 (11) ◽  
pp. 1153
Author(s):  
Alessandra Scatteia ◽  
Angelo Silverio ◽  
Roberto Padalino ◽  
Francesco De Stefano ◽  
Raffaella America ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Ejection Fraction ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricle Ejection Fraction ◽  
Advantages And Disadvantages ◽  
Non Invasive ◽  
Lv Ejection Fraction ◽  
Lv Systolic Function ◽  
Invasive Evaluation

The left ventricular (LV) ejection fraction (EF) is the preferred parameter applied for the non-invasive evaluation of LV systolic function in clinical practice. It has a well-recognized and extensive role in the clinical management of numerous cardiac conditions. Many imaging modalities are currently available for the non-invasive assessment of LVEF. The aim of this review is to describe their relative advantages and disadvantages, proposing a hierarchical application of the different imaging tests available for LVEF evaluation based on the level of accuracy/reproducibility clinically required.

scholarly journals The effect of left ventricular remodeling on the longitudinal myocardial kinetics of both heart ventricles in patients with arterial hypertension and cardiovascular risk factors

2019 ◽  
Vol 26 (3) ◽  
pp. 27-34
Author(s):  
O. S. Barabash ◽  
Yu. A. Ivaniv ◽  
I. M. Tumak ◽  
Y. R. Barabash
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Systolic Function ◽  
Left Ventricular ◽  
Concentric Hypertrophy ◽  
Diastolic Velocity ◽  
Eccentric Hypertrophy ◽  
The Right ◽  
Kinetics Of

The aim – to study the longitudinal kinetics of the left, right ventricles and interventricular septum (IVS), depending on the type of left ventricular (LV) remodeling in patients with arterial hypertension (AH) in combination with additional cardiovascular risk factors with preserved LV contractility, as well as to determine the correlation of changes in the right ventricular systolic and diastolic parameters estimated with the tissue pulsed-wave Doppler imaging (TDI) with the same indices of the LV and IVS. Materials and methods. The study included 71 patients (average age – 54) with essential AH (68 % men) with a normal LV ejection fraction. The patients had the obese stage 1, combined hyperlipidemia, 29.6 % of patients had type II diabetes, 33.8 % were smokers. The patients were distributed into 4 groups depending on the types of remodeling: 1 – normal geometry (12.7 %); 2 – concentric remodeling (47.9 %); 3 – concentric hypertrophy (35.2 %); 4 – eccentric hypertrophy (4.2 %). TDI of the left and right ventricles and IVS was performed, systolic and diastolic TDI indices were determined, and the index of isovolumic myocardial acceleration (IVA) was calculated for the right ventricle (RV). Results and discussion. The type of LV concentric hypertrophy negatively affects the longitudinal myocardial kinetics of LV and IVS in the study group. The early diastolic velocity Em and the systolic velocity Sm were significantly decreased for the LV and IVS, the late diastolic velocity Am was decreased for the IVS and the E/Em for LV ratio was notably increased. Among the diastolic RV TDI indices only the deceleration time DTEm was significantly longer in LV concentric remodeling and concentric hypertrophy, than in its normal geometry. The IVA index was decreased in changing the type of LV geometry from normal to eccentric hypertrophy, indicating worsening of the RV longitudinal myocardial systolic function. There was a close correlation between diastolic and systolic TDI indices of the RV and IVS, which potentially indicated the importance of IVS in the mechanism of interventricular interaction and its effect on the RV function. The reliable dependence of systolic and diastolic RV TDI indices on the LV contractility was established. Conclusions. The type of LV remodeling, especially concentric hypertrophy, negatively affects the longitudinal myocardial kinetics of both ventricles in patients with AH in combination with additional cardiovascular risk factors. IVA can be a sensitive diagnostic criterion in the detection of early myocardial disorders of the RV systolic function with the changes of the LV geometry in this category of patients. Indices of RV longitudinal myocardial kinetics are closely dependent on changes in the function of IVS, which has a leading role in the formation of interventricular interaction.

Lack of association of a 9 bp insertion/deletion polymorphism within the bradykinin 2 receptor gene with myocardial infarction

2004 ◽  
Vol 107 (5) ◽  
pp. 505-511 ◽  
Author(s):  
Marcus FISCHER ◽  
Wolfgang LIEB ◽  
Daniel MAROLD ◽  
Matthias BERTHOLD ◽  
Andrea BAESSLER ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Left Ventricular Function ◽  
Cardiovascular Risk Factors ◽  
Ventricular Function ◽  
Systolic Function ◽  
Receptor Gene ◽  
Left Ventricular ◽  
Deletion Polymorphism

The BK (bradykinin) B2 receptor is the major cellular mediator of the effects of BK. A 9 bp deletion in the promoter of the receptor gene represents an allelic variant that is associated with enhanced mRNA expression levels. We tested whether this polymorphism is associated with the prevalence of MI (myocardial infarction) or with echocardiographically determined left ventricular function in post-MI patients. Patients with documented MI (n=484), matched controls and controls without evidence of coronary heart disease (n=1363) constituted cases and controls. MI patients and controls were carefully matched for age, gender and cardiovascular risk factors. Genotype distributions of the 9 bp insertion/deletion polymorphism were similar across the groups: −9/−9, −9/+9 and +9/+9 were 22.1, 49.5 and 28.5% in MI patients, and 23.0, 44.6 and 32.5% in matched control subjects respectively. The lack of association was also observed in selected subgroups, stratified by age, gender and cardiovascular risk factors. Furthermore, there was no relation between this polymorphism and left ventricular systolic function in post-MI patients. These findings indicate that the 9 bp insertion/deletion polymorphism of the BK B2 receptor gene is neither related to the prevalence of MI nor to left ventricular function after MI.

scholarly journals Non-invasive Myocardial Work Index Contributes to Early Identification of Impaired Left Ventricular Myocardial Function in Uremic Patients With Preserved Left Ventricular Ejection Fraction

2021 ◽  
Author(s):  
Huizhen Zhu ◽  
Yanan Li ◽  
Cunying Cui ◽  
Danqing Huang ◽  
Yuanyuan Liu ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Sensitivity And Specificity ◽  
Myocardial Function ◽  
Systolic Function ◽  
Left Ventricular ◽  
Non Invasive ◽  
Work Index ◽  
Uremic Patients ◽  
Global Work ◽  
Lv Systolic Function

Abstract BackgroundCardiac damage is the leading cause of death in uremic patients. This study aimed to evaluate the application of non-invasive myocardial work index (NIMWI) by echocardiography in assessing the left ventricular (LV) systolic function in uremic patients.MethodsTwenty-six uremic patients and twenty-seven age- and sex-matched healthy volunteers were enrolled in the study. Except for the conventional echocardiographic parameters, the LV myocardial work (MW) parameters including GWI (myocardial global work index), GCW (global constructive work), GWW (global wasted work), and GWE (global work efficiency) were calculated in study participants. Differences in MW parameters between the uremic and normal groups were compared by independent-sample t-test. Receiver operating characteristic (ROC) curves were constructed for MW parameters to detect abnormal LV systolic function in uremic patients.ResultsCompared with the normal group, GWW was significantly increased and GWE decreased in the uremic group (P< 0.05). Area under the curve (AUC) for GWE by the ROC analysis was 0.966. The best threshold, sensitivity and specificity values of GWE to detect abnormality of LV systolic function in uremic patients were 92.5%, 0.89 and 0.96 respectively. ConclusionsNIMWI may be applied to assess the global MW of uremic patients. The presence of reduced GWE can help identify impaired left ventricular myocardial function in uremic patients with preserved LV ejection fraction with a high sensitivity and specificity.

scholarly journals Hemodynamics and Clinical Implications of Occult Left Ventricular Dysfunction in Adults Undergoing Ebstein Anomaly Repair

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Alexander C. Egbe ◽  
William R. Miranda ◽  
Joseph A. Dearani ◽  
Heidi M. Connolly
Keyword(s):  
Ejection Fraction ◽  
Organ Dysfunction ◽  
Tricuspid Valve ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Ebstein Anomaly ◽  
Lv Ejection Fraction ◽  
Lv Systolic Function

Background: Left ventricular global longitudinal strain (LVGLS) can detect early phases of LV systolic dysfunction, but its application has not been studied in Ebstein anomaly. We hypothesized that LVGLS can detect early phases of LV systolic dysfunction and that patients with occult LV systolic dysfunction will have worse hemodynamics, end-organ dysfunction, and suboptimal postoperative LV reverse remodeling after tricuspid valve surgery in comparison to patients with normal LV systolic function. Methods: In this retrospective cohort study, 371 Ebstein patients that underwent tricuspid valve surgery were divided into 3 groups: normal LV systolic function (normal LVGLS and LV ejection fraction; n=244, 77%), occult LV systolic dysfunction (abnormal LVGLS with normal LV ejection fraction; n=44, 14%), and overt LV systolic dysfunction (abnormal LVGLS and LV ejection fraction; n=27, 9%). Results: Compared with the normal LV function group, the occult group had smaller LV volume and cardiac output (2.1±0.4 versus 2.9±0.6 L/min per m 2 , P <0.001), worse end-organ dysfunction (glomerular filtration rate, 78±14 versus 91±18 mL/min per 1.73 m 2 , P =0.01), and suboptimal postoperative LV reverse remodeling. Although both the occult and overt groups had a similar degree of end-organ dysfunction (glomerular filtration rate, 78±14 versus 82±16 mL/min per 1.73 m 2 , P =0.3), the occult group was less likely to be on heart failure therapy (48% versus 96%, P <0.001). Conclusions: Abnormal LVGLS was associated with suboptimal postoperative LV reverse remodeling. These data suggest that LVGLS can potentially be used for risk stratification and provides a foundation for further studies to determine whether optimal heart failure therapy or tricuspid valve intervention can improve outcomes for LV systolic dysfunction in patients with Ebstein anomaly.

scholarly journals P1593 Myocardial work in a cohort of systemic sclerosis patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S L Magda ◽  
E C Popa ◽  
R Rimbas ◽  
A M Gheorghiu ◽  
A C Ciobanu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Systemic Sclerosis ◽  
Cardiovascular Risk Factors ◽  
Systolic Function ◽  
Strain Analysis ◽  
Constructive Work ◽  
Global Work ◽  
Lv Systolic Function ◽  
Mean Time

Abstract Funding Acknowledgements Grants 83/2018 and TE49/2018 Context Myocardial strain analysis provides important information on cardiac performance adding to standard parameters of left ventricular (LV) systolic function. Myocardial work (MW) is emerging as an alternative tool for studying LV systolic function, because it isn’t influenced by changes in afterload that could alterate strain analysis. Systemic sclerosis (SSc) is an autoimmune disease frequently associated with myocardial fibrosis determining diastolic and subclinical systolic dysfunction. Aim to assess parameters of myocardial work in patients with SSc and in age and cardiovascular risk factors matched controls. Methods 60 subjects (51 ± 9 years, 53 women) were studied: 40 patients with SSc (75% limited, 25% generalized form, mean time since onset 5 ± 4 yrs, mean time since treatment start 2.5 ± 0.5 yrs), and 20 age and cardiovascular risk factors matched controls. A comprehensive echocardiographic examination was performed using EACVI recommended protocols. Myocardial work parameters were calculated during mechanical systole and isovolumetric relaxation (IVR), by 2DSTE: global constructive work (GCW), performed during shortening in systole adding negative work during lengthening in IVR; global wasted work (GWW), performed during lengthening in systole adding work performed during shortening in IVR; global work efficiency (GWE), as the constructive work divided by the sum of constructive and wasted work and global work index (GWI), as the GCW added to GWW. Results 2DEF, 2D longitudinal strain, GWW, GWE and GWI were similar in both groups, with values expected for sex and age. GCW was significantly lower in SSc patients (Table). Conclusion Patients with treated SSc have lower myocardial constructive work (GCW) compared to matched controls, probably due to subtle myocardial fibrosis, persisting under adequate treatment. Longer follow up and larger cohorts are needed in order to establish the role of MW analysis in the serial assessment of patients with SSc at risk of developing overt cardiovascular disease. Parameter Systemic sclerosis Controls p GCW (mmHg%) 2124.2 ± 449.5 3102.8 ± 337.5 0.02 GWW (mmHg%) 81.0 ± 51.3 73.5 ± 38.9 NS GWE (mmHg%) 95.0 ± 2.8 95.9 ± 2.1 NS GWI (mmHg%) 1869.9 ± 410.9 2023.2 ± 321.7 NS EF (%) 61.3 ± 6.5 60.4 ± 8.7 NS 2DLS (%) 22.9 ± 3.4 22.4 ± 4.1 NS

ECHOCARDIOGRAPHIC FINDINGS IN PATIENTS WITH NORMOCALCEMIC PRIMARY HYPERPARATHYROIDISM COMPARED TO HYPERCALCEMIC PRIMARY HYPERPARATHYROID PATIENTS AND CONTROL SUBJECTS

2020 ◽  
Author(s):  
Jessica Pepe ◽  
Luciano Colangelo ◽  
Chiara Sonato ◽  
Marco Occhiuto ◽  
Carla Ferrara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Ejection Fraction ◽  
Primary Hyperparathyroidism ◽  
Cardiovascular Risk Factors ◽  
Urinary Calcium ◽  
Left Ventricular ◽  
Ionized Calcium ◽  
Echocardiographic Parameters ◽  
Echocardiographic Findings

Objective: There are no data regarding echocardiographic parameters in patients with normocalcemic primary hyperparathyroidism (NCPHPT). Our aim was to compare the echocardiographic findings in postmenopausal women with NCPHPT with those found in patients with hypercalcemic primary hyperparathyroidism (PHPT) and with controls. Methods: Seventeen consecutive Caucasian postmenopausal women with NCPHPT were compared to 20 hypercalcemic PHPT and 20 controls. Obesity, diabetes, kidney failure and previous cardiovascular diseases were considered exclusion criteria. Each patient underwent biochemical evaluation, bone mineral density scan and echocardiographic measurements. Patients with parathyroid disorder underwent kidney ultrasound evaluation. Results: PHPT patients had significantly mean higher total, ionized calcium, 24-hour urinary calcium, PTH and lower phosphorus compared to controls (all p <0.05). The only differences between NCPHPT and PHPT patients were significantly mean lower total, ionized calcium, 24-hour urinary calcium and higher phosphorus in NCPHPT (all p <0.05). The only biochemical difference between NCPHPT and controls was mean higher levels of PTH in patients with NCPHPT. There were no differences in cardiovascular risk factors between NCPHPT, PHPT and controls. Hypertension was the most frequent cardiovascular risk factor, diagnosed in 65% of PHPT patients. This high prevalence was not statistically different compared to that observed in NCPHT (59%) and in controls (30%). Echocardiography parameters were not different between NCPHPT, PHPT and controls subdivided according to the presence of hypertension (ANOVA followed by Bonferroni correction). Conclusions: In a population not at high cardiovascular risk, we found no differences in cardiovascular risk factors and echocardiographic parameters between NCPHPT, PHPT and controls. Abbreviations: NCPHPT = normocalcemic primary hyperparathyroidism, PHPT = hypercalcemic primary hyperparathyroidism, PTH = parathyroid hormone, PTX = parathyroidectomy, CA = total serum calcium, CA++= ionized calcium, P = phosphorus, CR = creatinine, [25(OH)D]= 25-OH-vitamin D, 24-UCa= 24- hour urinary calcium, GFR= glomerular filtration rate, HDL= lower high-density lipoprotein, LVM= left ventricular mass, LVEF= left ventricular ejection fraction LVEDD = left ventricular end-diastolic diameter, IVS= interventricular septum thickness, PWT= posterior wall thickness, LA= transverse diameter of left atrium, EF %= ejection fraction, E/A ratio= early transmitral diastolic flow (E) and flow velocity during atrial contraction (A) ratio, LVMI= left ventricular mass indexed, IVRT= isovolumetric relaxation time, DXA= dual X-ray absorptometry, BMI= body mass index, ANOVA= analysis of variance.

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