scholarly journals Diastolic Dysfunction Is a Predictor of Poor Survival in Patients with Decompensated Cirrhosis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Manas Kumar Behera ◽  
Surendra Nath Swain ◽  
Manoj Kumar Sahu ◽  
Gaurav Kumar Behera ◽  
Debakanta Mishra ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Diastolic Dysfunction ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Decompensated Cirrhosis ◽  
Predictors Of Mortality ◽  
2D Echocardiography ◽  
Advanced Cirrhosis ◽  
Cirrhotic Patients

Background. Left ventricular diastolic dysfunction (LVDD) appears to be the earliest cardiac disturbance in cirrhosis patients. There are many previous reports reporting the significance of severity of LVDD on the outcome of liver transplantation or TIPS insertion, a few Indian studies have addressed the role of LVDD on survival in decompensated cirrhosis. The objective of this study is to assess the effect of LVDD on the survival of decompensated cirrhotic patients. Methods. We prospectively evaluated 92 decompensated cirrhotic patients from April 2015 to March 2017 at IMS and SUM Hospital, Bhubaneswar, India. 2D echocardiography with tissue Doppler imaging was used to evaluate cardiac function, as per the American society of echocardiography guidelines. The primary endpoint was to evaluate the effect of LVDD on overall mortality. Results. Ninety-two decompensated cirrhotic patients were evaluated in this prospective cohort study. Twenty-eight out of 92 patients (30%) died due to liver-related complications after a follow-up of 24 months. The decompensated cirrhotic patients with MELD   score ≥ 15 had a significantly higher E / e ′ ratio ( 11.94 ± 4.24 vs. 8.74 ± 3.32 , p < 0.001 ) suggesting severe LV dysfunction in advanced cirrhosis. Patients with E / e ′   ratio > 10 had significantly higher MELD score and Child-Pugh score ( 19.88 ± 7.72 vs. 14.31 ± 5.83 ; 10.25 ± 1.74 vs. 9.02 ± 1.74 , p < 0.01 , respectively) as compared to the E / e ′   ratio < 10 group. In Cox proportional hazard multivariate analysis, E / e ′ ≥ 10 (HR 2.72, 95% CI 1.07-6.9, p = 0.03 ) and serum albumin (HR 0.32, 95% CI 0.14-0.7, p < 0.01 ) were found to be independent predictors of mortality in decompensated cirrhotic patients. Conclusion: The presence of LVDD and low serum albumin were independent predictors of mortality in decompensated cirrhotic patients. Hence, LVDD is an indicator of advanced cirrhosis and mortality.

scholarly journals Assessment of left ventricular systolic and diastolic functions in severely malnourished children

2019 ◽  
Vol 67 (1) ◽  
Author(s):  
Gihan M. Bebars ◽  
Hany T. Askalany
Keyword(s):  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Control Group ◽  
Nutritional Rehabilitation ◽  
Malnourished Children ◽  
Grade Ii ◽  
Diastolic Functions

Abstract Background Malnourished children endure many changes in body composition and lose heart and skeletal muscle mass. Diastolic dysfunction is one of the major causes of heart failure with preserved ejection fraction. Aim To assess left ventricular systolic and diastolic functions in children with severe acute malnutrition using tissue Doppler imaging technique and to evaluate the effect of nutritional rehabilitation. Patients and Methods A follow-up case-control study conducted on 60 severely malnourished children (WHZ < -3SD) and 120 age and sex-matched healthy children as a control group. Tissue Doppler imaging (TDI) was done for all included malnourished children at admission and for control to measure left ventricular systolic and diastolic functions. Nutritional rehabilitation was done according to WHO protocol and tissue doppler was repeated after rehabilitation when (WHZ > -2SD) to detect any changes in systolic or diastolic functions. Results Systolic function was normal in malnourished children and control. Grade I diastolic dysfunction was detected in 40% and grade II in 30% of severely malnourished children in comparison to 100% normal diastolic function in control group. No correlations between diastolic dysfunction and either anthropometric measurements, electrolyte disturbances or Hb% in malnourished children before nutritional rehabilitation. Mortality from sepsis with associated ventricular dysfunction grade II documented in 3.3% of malnourished children. After nutritional rehabilitation diastolic function improved significantly as 65.6% of children attained normal diastolic function, 31% grade1 and 3.4% grade II. Positive correlations between diastolic function and WAZ, HAZ, WHZ and MUAC after rehabilitation. Conclusion Severe acute malnutrition affects diastolic function in children which is reversible in most of these cases with rehabilitation. TDI is an easy and practical method for detection and follow-up of ventricular function in malnourished children.

Abstract 2690: Should We Classify Impaired Relaxation Pattern With Elevated E/e’ As Grade 1 Diastolic Dysfunction?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Un-jung Choi ◽  
Hong-Seok Lim ◽  
Soo-Jin Kang ◽  
Jung-Won Hwang ◽  
Byoung-Joo Choi ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Flow Velocity ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Transmitral Flow ◽  
Venous Flow ◽  
Mitral Annular Velocity ◽  
Echocardiographic Measurement ◽  
Ventricular Filling Pressure

Purpose : Impaired relaxation pattern (grade 1 diastolic dysfunction) by Doppler echocardiography is known to reflect preserved left ventricular filling pressure (LVFP), while increased ratio of early diastolic transmitral flow velocity to mitral annular velocity (E/E’) indicated elevated LVFP. We evaluated the characteristics of impaired relaxation pattern with elevated E/E’ ratio. Methods : Eighty-eight patients (mean age 63 ± 11, 59 males) who had coronary artery disease with impaired relaxation pattern (E/A < 1) were enrolled. Echocardiography including tissue Doppler imaging (TDI) was performed. All patients underwent cardiac catheterization to investigate LV pre-A pressure (LVP pre-A ) within 6 hours after echocardiographic measurement. Patients were divided into subjects with E/E’ < 10 (n = 71) and E/E’ ≥ 10 (n = 17). Results : LVP pre-A was well correlated with echocardiographic Doppler and hemodynamic parameters (E/E’, r = 0.536, p < 0.001; LA volume, r = 0.295, p = 0.008; EF, r = -0.234, p = 0.028). Forty (45% of total) patients had high LVFP, defined as LVP pre-A ≥15 mmHg. Patients with E/E’ ≥10 had a significantly higher incidence of high LVFP, when compared to patients with E/E’ < 10 (88% vs 35%, p < 0.001). LA volume and LVP pre-A were significantly increased and EF was decreased in patients with E/E’ ≥ 10 (table 1 ). However, there were no significant differences of parameters derived from transmitral inflow and transpulmonary venous flow between two groups. Conclusions : In patients with impaired relaxation pattern, elevated E/E’ has related to elevation of LVFP, regardless of transmitral inflow and transpulmonary indices. Therefore, impaired relaxation pattern with elevated ratio of early diastolic transmitral flow velocity to mitral annular velocity (E/E’) may have been considered as another grade of diastolic dysfunction. Table 1

Abstract 15943: Left Ventricular Regional Longitudinal Displacement Assessed by Tissue Doppler Imaging is a Powerful Predictor of All-cause Mortality in Patients With Systolic Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Morten Sengeløv ◽  
Peter Godsk Jørgensen ◽  
Niels Eske Bruun ◽  
Flemming Javier Olsen ◽  
Thomas Fritz Hansen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Tissue Doppler Imaging ◽  
Systolic Heart Failure ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Longitudinal Displacement ◽  
Predictors Of Mortality ◽  
All Cause Mortality ◽  
Echocardiographic Parameters

Objective: Tissue tracking (TT), obtained by tissue Doppler imaging (TDI), can be utilized to assess the mitral annular longitudinal displacement (LD) during systole. However, the prognostic utility of regional LD in patients with heart failure with reduced ejection fraction (HFrEF) is unknown. Methods: Transthoracic echocardiographic examinations from 911 patients with HFrEF were retrieved from a heart failure clinic’s database. The exams were performed from 2005 to 2013. The echocardiographic images were subsequently analyzed obtaining conventional echocardiographic measurements. Regional LD was obtained from the three apical TDI projections with sampling at six mitral annular sites located at the anterior, lateral, posterior, inferior, septal and anteroseptal myocardial walls. Results: During a median follow-up period of 40 months 150 (16.4 %) patients died. Patients that died had significantly lower LVEF (23.3% vs 28.3%, p<0.001) and lower regional LD in all six mitral annular sites (Figure). Many conventional echocardiographic parameters presented as predictors of mortality (LVEF, LVMI, LAVI, E, E/e’, deceleration time and TAPSE). However, only LD at the septal and inferior annular sites remained independent predictors of mortality in cox proportional-hazards models after adjusting for age, gender, BMI, total cholesterol, heart rate, atrial fibrillation, non-independent diabetes mellitus and the aforementioned conventional echocardiographic predictors (Figure). In addition, the septal and the inferior sites had the highest Harrell’s C-statistic of all the echocardiographic predictors (0.70 and 72, respectively). Conclusion: In patients with severe heart failure, septal and inferior LD are independent predictors of all-cause mortality. Furthermore, septal and inferior LD proved to be superior prognosticators when compared to all the conventional echocardiographic parameters.

scholarly journals Cardiac dysfunction in acromegaly: evidence by pulsed wave tissue Doppler imaging

2000 ◽  
pp. 363-369 ◽  
Author(s):  
G Mercuro ◽  
S Zoncu ◽  
P Colonna ◽  
P Cherchi ◽  
S Mariotti ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Tissue Doppler Imaging ◽  
Systolic Function ◽  
Lateral Wall ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Control Group ◽  
Diastolic Velocity ◽  
Acromegalic Cardiomyopathy

OBJECTIVE: To verify whether the accuracy of data on myocardial function provided by pulsed-wave tissue Doppler imaging (PWTDI), a new echocardiographic application that allows quantitative measurements of myocardial wall velocities, could help towards a better understanding of the natural history of acromegalic cardiomyopathy. DESIGN: Eighteen patients with active acromegaly (ten men and eight women; mean age 48.0+/-15.0 years) with no other detectable cause of heart disease underwent PWTDI. Thirteen healthy individuals matched for age and body mass index acted as a control group. METHODS: Ejection fraction (EF), transmitral early/late diastolic velocity (E/A) ratio and isovolumic relaxation time (IVRT) were measured by conventional echocardiography; systolic peak (Sv) and early (Ev) and late (Av) diastolic peak velocities, Ev/Av ratio and regional IVRT (IVRTs) were obtained by PWTDI. RESULTS: All patients showed appreciably abnormal left ventricular global diastolic function represented by prolongation of the IVRT (P<0.001). Using PWTDI we found a prolongation of IVRTs and inversion of the Ev/Av ratio. In addition, the Ev/Av ratio proved to be significantly negatively correlated with IVRT; this correlation was not present in the case of the E/A ratio. Furthermore, a decrease in Sv was detected in the basal segment of the lateral wall (P<0.01), which had the greatest degree of diastolic dysfunction. CONCLUSIONS: PWTDI confirmed the acknowledged diastolic dysfunction that accompanies acromegalic cardiomyopathy and highlighted the greater sensitivity of regional PWTDI with respect to global Doppler diastolic indexes. Furthermore, by revealing an impairment of regional systolic function in presence of a normal EF, the findings with PWTDI contradicted the largely accepted theory that systolic function remains normal for several years in patients affected by acromegalic cardiomyopathy.

scholarly journals Cardioprotective effect of Trimetazidine in patients with early breast cancer receiving anthracycline-based chemotherapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.G Delle Donne ◽  
A Iannielli ◽  
P Capozza ◽  
R De Caterina ◽  
M Marzilli
Keyword(s):  
Breast Cancer ◽  
Diastolic Dysfunction ◽  
Speckle Tracking ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Doppler Imaging ◽  
Control Group ◽  
Speckle Tracking Imaging ◽  
Lv Diastolic Dysfunction

Abstract Background Anthracyclines, alone or in combination with other drugs, are among the most effective chemotherapeutic agents to treat breast cancer both in the adjuvant and neoadjuvant settings. Unfortunately, anthracycline-associated dose-dependent cardiotoxicity is a limiting factor in clinical use. Extensive efforts have been devoted to identifying strategies to prevent anthracycline-induced cardiotoxicity. However, most cardioprotective agents have shown little efficacy in clinical trials. We hypothesized that myocardial damage by anthracyclines could be rationally prevented by using trimetazidine (TMZ), previously reported to interfere with anthracycline- and trastuzumab-induced cardiotoxicity. Therefore, we planned a randomized, controlled, open trial to determine whether TMZ may prevent the development of left ventricular (LV) dysfunction in patients receiving standard treatment for breast cancer. Methods The trial included 73 patients (41.2±8.1 years) undergoing surgery for breast cancer, who were scheduled for adjuvant epirubicin-containing chemotherapy and, if indicated, trastuzumab. Patients were randomly allocated in a 1:1 ratio to receive TMZ or baseline therapy only (control group). The main study endpoint was a reduction in the deterioration of left ventricular ejection fraction (LVEF), as evaluated by serial echocardiography performed at randomization and then every 3 months after the start of chemotherapy and for 1 year after its completion. Secondary outcome measures included echocardiographic indices of LV diastolic dysfunction, structural myocardial alterations, as assessed by speckle tracking echocardiography, and changes in cardiac biomarkers (troponin and brain natriuretic peptide). Results We found no significant differences between the two groups regarding baseline clinical and echocardiographic parameters. The two groups reached a similar cumulative dose of doxorubicin. No patient died during the study and no patients withdrew from chemotherapy. Three months after the start of chemotherapy, nonsignificant changes were observed in LVEF, shortening fraction, and LV diameters. No significant changes in cardiac biomarkers were observed in either group. Tissue Doppler imaging detected a significant decrease in myocardial velocities (P=0.001) in the control group, indicating LV diastolic dysfunction. In the same group, speckle tracking imaging revealed a statistically significant alteration in ventricular deformation (P=0.01), which means a decrease in LV systolic function. In the TMZ group, no significant alterations in LV diastolic function were observed. Conclusions Tissue Doppler imaging and speckle tracking imaging are more sensitive than conventional echocardiograms in the early diagnosis of cardiac dysfunction and TMZ seems to have an important role in the prevention of cardiotoxicity. Funding Acknowledgement Type of funding source: None

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