scholarly journals Effect of different ranges of systolic blood pressure on left ventricular structure and diastolic function in a Chinese population: a cross-sectional population-based Shunyi study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028398
Author(s):  
Liu Yongtai ◽  
Lai Jinzhi ◽  
Zhou Lixin ◽  
Zhai Feifei ◽  
Zhang Dingding ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Function ◽  
Chinese Population ◽  
Reference Group ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Cross Sectional ◽  
Group 1

ObjectivesTo evaluate the effect of different ranges of systolic blood pressure (SBP) on left ventricular (LV) geometry and diastolic function in Chinese population.DesignCross-sectional study.SettingPeking Union Medical College Hospital in Beijing, China.ParticipantsAll inhabitants aged 35 years or older, living in five villages of Shunyi were invited. Exclusion criteria included individuals who declined participation, presence of moderate to severe valvular heart disease, persistent atrial fibrillation and suboptimal echocardiograms.InterventionsThe baseline data of 1051 participants were analysed. The relationship between SBP and LV geometric and diastolic function assessed by echocardiography was analysed after adjusting for conventional cardiac risk factors.ResultsThe adjusted value of SBP was independently associated with LV hypertrophy (LVH) and LV diastolic dysfunction (LVDDF) (all p<0.01). Setting individuals with SBP <120 mm Hg as the reference group (group 1), those with SBP between 120 mm Hg and 140 mm Hg (group 2) had higher risk odds of LVH and those with SBP ≥140 mm Hg (group 3) had higher risk odds of LVH and LVDDF (all p<0.01). With the increase of SBP, LV mass index (LVMI) and E/e′ stepwise increased and e′ stepwise decreased significantly from group 1 to 3 (all p<0.05). In the whole population, SBP was independently correlated with LVMI, LVEDD, Left Atrial Volume Index, e′, and E/e′ (all p<0.01).ConclusionsSBP was independently related to LVH and LVDDF, SBP between 120 and 140 mm Hg was independently related to worse LV remodelling and diastolic function, these findings indicated the potential benefit of intensive SBP control.

scholarly journals Presence of Microvascular Dysfunction and CHA2DS2-VASc Score in Patients with ST-Segment Myocardial Infarction after Primary Percutaneous Coronary Intervention

Pulse ◽  
2021 ◽  
pp. 1-8
Author(s):  
Ragab A. Mahfouz ◽  
Marwa M. Gad ◽  
Mohamed Arab ◽  
Moei-E. deen Abulfotouh
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Left Atrial Volume ◽  
Microvascular Dysfunction ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
St Segment ◽  
Stent Diameter

<b><i>Objective:</i></b> We aimed to investigate the relation between CHA<sub>2</sub>DS<sub>2</sub>-VASc score and microvascular dysfunction (MVD) assessed by the index of microvascular resistance (IMR) immediately after primary percutaneous intervention (PPCI) for patients with ST-segment elevation myocardial infarction (STEMI). <b><i>Subjects and Methods:</i></b> The study included 115 consecutive patients with STEMI who underwent successful PPCI. Angiographic results of reperfusion were inspected to evaluate the association of high CHA<sub>2</sub>DS<sub>2</sub>-VASc score and IMR. Also, we assessed echocardiographic changes with respect to CHA<sub>2</sub>DS<sub>2</sub>-VASc score. <b><i>Results:</i></b> Subjects were stratified into 2 groups based on IMR &#x3c;/≥ 40 U; 72 patients (62.6) with IMR &#x3c;40 U and 43 patients (37.4) with IMR ≥40 U. Patients with IMR ≥40 U had higher CHA<sub>2</sub>DS<sub>2</sub>-VASc score (<i>p</i> &#x3c; 0.001). CHA<sub>2</sub>DS<sub>2</sub>-VASc score was significantly correlated with increased left atrial volume index, diastolic dysfunction, wall motion score index, and inversely correlated left ventricular ejection. Moreover, CHA<sub>2</sub>DS<sub>2</sub>-VASc score was strongly correlated with IMR (<i>p</i> &#x3c; 0.001). At multivariate analysis, low systolic blood pressure, stent diameter, and CHA<sub>2</sub>DS<sub>2</sub>-VASc score were associated with MVD. Besides, CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥4 was the optimal value in predicting MVD (IMR ≥40) in STEMI patients. <b><i>Conclusions:</i></b> The data of the current study point out that increased CHA<sub>2</sub>DS<sub>2</sub>-VASc score, lower systolic blood pressure &#x3c;90 mm Hg, and stent diameter are associated with increased incidence of MVD (increased IMR) after PPCI of STEMI. We suggest that the CHA<sub>2</sub>DS<sub>2</sub>-VASc score may be a simple, inexpensive useful risk score for the prediction of MVD risk after PPCI for STEMI patients.

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 The effect of spironolactone on diastolic function in haemodialysis patients

2021 ◽  
Author(s):  
T. Hauser ◽  
◽  
V. Dornberger ◽  
U. Malzahn ◽  
S. J. Grebe ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Function ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Left Atrial Volume Index ◽  
Maintenance Haemodialysis ◽  
Significant Difference

AbstractHeart failure with preserved ejection fraction (HFpEF) is highly prevalent in patients on maintenance haemodialysis (HD) and lacks effective treatment. We investigated the effect of spironolactone on cardiac structure and function with a specific focus on diastolic function parameters. The MiREnDa trial examined the effect of 50 mg spironolactone once daily versus placebo on left ventricular mass index (LVMi) among 97 HD patients during 40 weeks of treatment. In this echocardiographic substudy, diastolic function was assessed using predefined structural and functional parameters including E/e’. Changes in the frequency of HFpEF were analysed using the comprehensive ‘HFA-PEFF score’. Complete echocardiographic assessment was available in 65 individuals (59.5 ± 13.0 years, 21.5% female) with preserved left ventricular ejection fraction (LVEF > 50%). At baseline, mean E/e’ was 15.2 ± 7.8 and 37 (56.9%) patients fulfilled the criteria of HFpEF according to the HFA-PEFF score. There was no significant difference in mean change of E/e’ between the spironolactone group and the placebo group (+ 0.93 ± 5.39 vs. + 1.52 ± 5.94, p = 0.68) or in mean change of left atrial volume index (LAVi) (1.9 ± 12.3 ml/m2 vs. 1.7 ± 14.1 ml/m2, p = 0.89). Furthermore, spironolactone had no significant effect on mean change in LVMi (+ 0.8 ± 14.2 g/m2 vs. + 2.7 ± 15.9 g/m2; p = 0.72) or NT-proBNP (p = 0.96). Treatment with spironolactone did not alter HFA-PEFF score class compared with placebo (p = 0.63). Treatment with 50 mg of spironolactone for 40 weeks had no significant effect on diastolic function parameters in HD patients.The trial has been registered at clinicaltrials.gov (NCT01691053; first posted Sep. 24, 2012).

Abstract 14622: Longitudinal Changes in Left Ventricular Diastolic Function in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Li Zhao ◽  
Brian Claggett ◽  
Kunihiro Matsushita ◽  
Dalane W Kitzman ◽  
Aaron R Folsom ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Diastolic Function ◽  
Left Atrial Volume ◽  
Late Life ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Atrial Volume Index ◽  
Longitudinal Changes ◽  
Aric Study

Introduction: Diastolic dysfunction is a potent risk factor for heart failure (HF). However, there is limited data regarding longitudinal changes of diastolic function in the very old, who are at the highest risk for HF. Methods: We studied 2,559 community-based elderly participants in the prospective ARIC study who underwent protocol echocardiography, were in sinus rhythm at study Visits 5 (2011-2013) and 7 (2018-2019), and did not have an interval myocardial infarction. The primary diastolic measures were Tissue Doppler e’, E/e’ ratio, and left atrial volume index (LAVi). Results: Mean age at Visit 5 was 74±4 years, 59% were women, and 25% black. At Visit 5, mean e’ was 5.8±1.4 cm/s, E/e’ 11.8±3.6, and LAVi 24.3±6.7 ml/m 2 . Over a mean of 6.5±3.1 years, e’ decreased by 0.6±1.4 cm/s, E/e’ increased by 3.1±4.5, and LAVi increased by 1.4±7.7 ml/m 2 . Using validated ARIC-based cut-points, there was significant increase in the proportion of participants with abnormal e’ (18% at Visit 5 to 34 % at Visit 7), E/e’ (20% vs 46%), LAVi (17% vs 25%; all p<0.01), and in the number of abnormal diastolic measures ( Figure ). Compared to participants free of cardiovascular (CV) risk factors or CV diseases (n=237), those with CV risk factors or diseases at Visit 5 (n=2,210) demonstrated greater increases in E/e’ (2.3±3.9 vs 3.1±4.5 respectively; p=0.006) and LAVi (0.0±7.0 vs 1.5±7.7 ml/m 2 ; p=0.008) while increases in E/e’ (5.0±5.1; p<0.001) and LAVi (4.6±8.7 ml/m 2 ; p<0.001) were the most prominent in those who developed HF between Visits 5 and 7 (n=60). Conclusions: Diastolic function progressively worsens over 6.5 years in late life, particularly among persons with CV risk factors. Further studies are necessary to determine if risk factor prevention or control will mitigate these changes.

scholarly journals Improved Left Ventricular Diastolic Function with Exercise Training in Hypertension: A Doppler Imaging Study

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Huan Zheng ◽  
Ming Luo ◽  
Yi Shen ◽  
Hong Fang
Keyword(s):  
Exercise Training ◽  
Diastolic Function ◽  
Anaerobic Threshold ◽  
Interventricular Septum ◽  
Left Atrial Volume ◽  
Exercise Group ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Volume Index ◽  
Hypertensive Patients

Objective.To study the effects of 6 months’ exercise training on ventricular function in hypertensive patients.Methods.Both groups received routine anti-hypertensive pharmacological therapy and one received a 6 months’ exercise program in addition. All patients underwent incremental cardiopulmonary exercise test and echocardiography in baseline and after 6 months.Results.(1) In 6 months’ follow-up, PeakVO2, Powermax(max workload), AT (anaerobic threshold), VO2AT(VO2at anaerobic threshold), tAT(time from beginning to anaerobic threshold) (), were increased in the exercise group. HRrest(Heart rate at rest) was decreased (). LAVI (left atrial volume index), peak mitral filling velocities during early (E) and late (A) diastole E/A ratio, DT(deceleration time of the mitral E wave), IVST(Interventricular septum thickness in diastole), tissue Doppler indice Mean Ea/Aa ratio () were also improved. (2) Correlation analysis: 4 variates had significant effect on change of PeakVO2in the exercise group: age (), change of HRrest(), change of E/A (), change of Mean Ea/Aa (); Through analyzing 2 groups patients’ baseline values, their age (), VO2AT(), HRrest(), LAVI (), E/A () were found to be independent predictors of MeanEa/Aa. -value under .05 was considered statistically significant.Conclusion.6 months’ exercise could enhance hypertensive patients’ aerobic exercise level and diastolic function to a certain extent.

Association of central blood pressure with left atrial structural and functional abnormalities in hypertensive patients: Implications for atrial fibrillation prevention

2019 ◽  
Vol 26 (10) ◽  
pp. 1018-1027 ◽  
Author(s):  
Monika Przewłocka-Kosmala ◽  
Ewelina Jasic-Szpak ◽  
Aleksandra Rojek ◽  
Maciej Kabaj ◽  
James E Sharman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Left Atrium ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Volume Index ◽  
Central Blood Pressure ◽  
Special Focus ◽  
Cross Sectional ◽  
Uncomplicated Hypertension

AimsFunctional and structural abnormalities of the left atrium have been demonstrated to be clinically and prognostically significant in a range of cardiovascular disorders, increasing the risk of atrial fibrillation. Among the potential contributors to these aberrations, central arterial factors remain insufficiently defined. Accordingly, we sought to investigate the determinants of left atrium abnormalities in hypertension, with special focus on central haemodynamics.MethodsIn this retrospective, cross-sectional study, 263 patients (age 63.8 ± 8.0 years) with uncomplicated hypertension underwent echocardiography including left atrium strain (LAS) and volume analysis, and central haemodynamics assessment using radial tonometry.ResultsPatients were grouped depending on LAS and left atrium volume index (LAVI), using externally validated cutpoints (34.1% for LAS and 34 ml/m2for LAVI). The subset with lower LAS ( n = 124) demonstrated higher central (cPP) and brachial pulse pressure (bPP), ventricular- arterial coupling, left ventricular mass index (LVMI) and LAVI, and lower global left ventricular longitudinal strain and early diastolic tissue velocity (e′). Patients with higher LAVI ( n = 119) presented higher systolic blood pressure, cPP, bPP, central augmentation pressure, LVMI and E/e′ ratio and lower LAS. In multivariable analysis, cPP was independently associated with both LAS ( β = –0.22; p = 0.002) and LAVI ( β = 0.21; p = 0.003). No independent associations with left atrium parameters were shown for bPP.ConclusionHigher cPP is detrimentally associated with left atrium structural and functional characteristics, thus providing a possible pathophysiological link with the development of substrate for atrial fibrillation. Prophylaxis of atrial fibrillation might be another argument for consideration in the treatment strategy in hypertension targeted measures addressing central blood pressure.

Serum uric acid possibly associated with abnormal left ventricular diastolic function in healthy individuals

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.W Liu ◽  
C.M Tu
Keyword(s):  
Uric Acid ◽  
Diastolic Function ◽  
Serum Uric Acid ◽  
Elevated Serum ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Funding Source ◽  
Healthy Individuals ◽  
Left Atrial Volume Index

Abstract Background Elevated serum uric acid (SUA) is reportedly associated with the traditional left ventricular diastolic dysfunction (LVDD). Purpose We aimed to investigate the association between SUA and the contemporarily defined LV diastolic function (LVDF). Methods We prospectively enrolled healthy individuals who underwent echocardiography to evaluate electrocardiographic abnormalities at the health exam between 1st Jan 2018 and 31th Dec 2019. The evaluation for LVDF includes four criteria: (1) septal E' velocity &lt;7 cm/s or lateral E' &lt;10 cm/s. (2) average E/e' ≥14, (3) left atrial volume index (LAVI) &gt;34 ml/m2, (4) tricuspid regurgitation (TR) velocity &gt;2.8 m/s. The study interest were the presence of the LVDF criteria for each or combined. Results The study consisted of 275 healthy individuals (89% male) with the mean age of 32.9±7.6 years and SUA of 6.1±1.3 mg/dl. The hyperuricemic (N=77) vs. normouricemic (N=198) groups had greater ratio of septal e' &lt;7 (18.2% vs. 5.6%, P=0.002), lateral e' &lt;10 (26% vs. 10.8%, P=0.003), the composite of septal e' &lt;7 or lateral e' &lt;10 (31.6% vs. 13.3%, P=0.001), and average E/e' &gt;14 (3.9% vs. 0%, P=0.021). SUA remained significantly associated with septal e' &lt;7 cm/s (adjusted HR: 1.704, 95% CI: 1.093–2.655, P=0.019) and the presence of any LVDF criteria (adjusted HR: 1.342, 95% CI: 1.044–1.724, P=0.022); Trends toward significant association were found between SUA and average E/e' &gt;14 (adjusted HR: 1.330, 95% CI: 0.981–1.804, P=0.066) and between SUA and lateral e' &lt;10cm/s (adjusted HR: 1.342, 95% CI: 0.970–1.857, P=0.076). Conclusions Elevated SUA was associated with abnormal LVDF in the healthy individuals with normal kidney function. Maintaining SUA level within a normal limit may prevent from the development of abnormal LVDF and LVH. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Tri-service General Hospital, Songshan branch

scholarly journals KCNJ5 Somatic Mutations in Aldosterone-Producing Adenoma Are Associated With a Worse Baseline Status and Better Recovery of Left Ventricular Remodeling and Diastolic Function

Hypertension ◽  
2021 ◽  
Vol 77 (1) ◽  
pp. 114-125
Author(s):  
Yi-Yao Chang ◽  
Cheng-Hsuan Tsai ◽  
Shih-Yuan Peng ◽  
Zheng-Wei Chen ◽  
Chin-Chen Chang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Function ◽  
Somatic Mutations ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Mutation Carriers ◽  
Aldosterone Producing Adenoma

Primary aldosteronism is the most common secondary endocrine form of hypertension and causes many cardiovascular injuries. KCNJ5 somatic mutations have recently been identified in aldosterone-producing adenoma. However, their impacts on left ventricular remodeling precluding the interference of age, sex, and blood pressure are still uncertain. We enrolled 184 aldosterone-producing adenoma patients who received adrenalectomy. Clinical, biochemical, and echocardiographic data were analyzed preoperatively and 1 year postoperatively. KCNJ5 gene sequencing of aldosterone-producing adenoma was performed. After propensity score matching for age, sex, body mass index, blood pressure, hypertension duration, and number of hypertensive medications, there were 60 patients in each group with and without KCNJ5 mutations. The mutation carriers had higher left ventricular mass index (LVMI) and inappropriately excessive LVMI (ieLVMI) and lower e′ than the noncarriers. After adrenalectomy, the mutation carriers had greater decreases in LVMI and ieLVMI than the noncarriers. In addition, only mutation carriers had a significant decrease in E/e′ after surgery. In multivariate analysis, baseline LVMI correlated with KCNJ5 mutations, the number of hypertensive medications, and systolic blood pressure. Baseline ieLVMI correlated with KCNJ5 mutations and the number of hypertensive medications. The regression of both LVMI and ieLVMI after surgery was mainly correlated with KCNJ5 mutations and changes in systolic blood pressure. Aldosterone-producing adenoma patients with KCNJ5 mutations had higher LVMI and ieLVMI and a greater regression of LVMI and ieLVMI after adrenalectomy than those without mutations. The patients with KCNJ5 mutations also benefited from adrenalectomy with regard to left ventricular diastolic function, whereas noncarriers did not.

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