Abstract 18141: Is There Systolic Myocardial Mechanical Dysfunction in Patients With Different Degrees of Diastolic Dysfunction and Normal Ejection Fraction?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sergio Barros-Gomes ◽  
Patricia A Pellikka ◽  
Angela Dispenzieri ◽  
Hector R Villarraga

Introduction: Diastolic dysfunction has been characterized in relation to the relaxation and compliance properties of the left ventricle; limited information exists regarding its relationship to systolic function as assessed by deformation imaging. Objectives: To determine if there is left ventricular systolic dysfunction detected by global longitudinal strain (GLS) measured by two dimensional speckle tracking echocardiography in patients with immunoglobulin light chain (AL) amyloidosis with different degrees of diastolic dysfunction and normal ejection fraction (EF). Methods: Consecutive biopsy-proven AL patients with preserved EF (≥ 55%) who had a comprehensive echocardiogram performed and strain analysis were included. Cohort was divided into 5 groups according to the different grades of diastolic dysfunction: Group 0: normal filling pressures; Group 1: abnormal relaxation; Group 2: pseudo-normal pattern; Group 3: reversible restrictive; Group 4: fixed restrictive. Images were acquired and performed on a Vivid 9 from the 3 apical views, and analyzed on vendor-specific software (Echo-PAC, GE). GLS was averaged from the 16 segments, and their means compared by ANOVA and each pair with Student’s t test. Results: A total of 858 patients were included, mean age was 63.7 years ± 10.1, and 61.5% were male. From those, 205 (24%) were in group 0; 299 (35%) in group 1; 255 (30%) in group 2; 65 (7%) in group 3; and 34 in group 4 (4%). GLS means measurements were -18.95 ± 2.4, -16.86 ± 3.4, -15.60 ± 3.9, -12.31 ± 3.0, and -10.48 ± 3.3, respectively (P<0.0001). All individual GLS values were significantly different statistically when compared between each group (P<0.01 for all pairs; figure). Conclusions: Longitudinal systolic mechanical function is progressively impaired in AL amyloid patients as diastolic dysfunction progresses, despite normal EF. This systolic dysfunction provides insights into the intrinsic relationship between the components of the cardiac cycle.

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Cristina Chimenti ◽  
Romina Verardo ◽  
Andrea Frustaci

Abstract Aim To investigate the contribution of unaffected cardiomyocytes in Fabry disease cardiomyopathy. Findings Left ventricular (LV) endomyocardial biopsies from twenty-four females (mean age 53 ± 11 ys) with Fabry disease cardiomyopathy were studied. Diagnosis of FD was based on the presence of pathogenic GLA mutation, Patients were divided in four groups according with LV maximal wall thickness (MWT): group 1 MWT ≤ 10.5 mm, group 2 MWT 10.5–15 mm, group 3 MWT 16–20 mm, group 4 MWT > 20 mm. At histology mosaic of affected and unaffected cardiomyocytes was documented. Unaffected myocytes’ size ranged from normal to severe hypertrophy. Hypertrophy of unaffected cardiomyocytes correlated with severity of MWT (p < 0.0001, Sperman r 0,95). Hypertrophy of unaffected myocytes appear to concur to progression and severity of FDCM. It is likely a paracrine role from neighboring affected myocytes.


2020 ◽  
Vol 7 ◽  
Author(s):  
Daisuke Harada ◽  
Hidetsugu Asanoi ◽  
Takahisa Noto ◽  
Junya Takagawa

Background: Stratified medicine may enable the development of effective treatments for particular groups of patients with heart failure with preserved ejection fraction (HFpEF); however, the heterogeneity of this syndrome makes it difficult to group patients together by common disease features. The aim of the present study was to find new subgroups of HFpEF using machine learning.Methods: K-means clustering was used to stratify patients with HFpEF. We retrospectively enrolled 350 outpatients with HFpEF. Their clinical characteristics, blood sample test results and hemodynamic parameters assessed by echocardiography, electrocardiography and jugular venous pulse, and clinical outcomes were applied to k-means clustering. The optimal k was detected using Hartigan's rule.Results: HFpEF was stratified into four groups. The characteristic feature in group 1 was left ventricular relaxation abnormality. Compared with group 1, patients in groups 2, 3, and 4 had a high mean mitral E/e′ ratio. The estimated glomerular filtration rate was lower in group 2 than in group 3 (median 51 ml/min/1.73 m2 vs. 63 ml/min/1.73 m2p &lt; 0.05). The prevalence of less-distensible right ventricle and atrial fibrillation was higher, and the deceleration time of mitral inflow was shorter in group 3 than in group 2 (93 vs. 22% p &lt; 0.05, 95 vs. 1% p &lt; 0.05, and median 167 vs. 223 ms p &lt; 0.05, respectively). Group 4 was characterized by older age (median 85 years) and had a high systolic pulmonary arterial pressure (median 37 mmHg), less-distensible right ventricle (89%) and renal dysfunction (median 54 ml/min/1.73 m2). Compared with group 1, group 4 exhibited the highest risk of the cardiac events (hazard ratio [HR]: 19; 95% confidence interval [CI] 8.9–41); group 2 and 3 demonstrated similar rates of cardiac events (group 2 HR: 5.1; 95% CI 2.2–12; group 3 HR: 3.7; 95%CI, 1.3–10). The event-free rates were the lowest in group 4 (p for trend &lt; 0.001).Conclusions: K-means clustering divided HFpEF into 4 groups. Older patients with HFpEF may suffer from complication of RV afterload mismatch and renal dysfunction. Our study may be useful for stratified medicine for HFpEF.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Godet ◽  
O Raitiere ◽  
H Chopra ◽  
P Guignant ◽  
C Fauvel ◽  
...  

Abstract Background Treatment by sacubitril/valsartan decreases mortality, improves KCCQ score and ejection fraction in patients with heart failure with reduced ejection fraction (HF REF), but there is currently no data to predict response to treatment. Purpose The purpose of our work was to assess whether unbiased clustering analysis, using dense phenotypic data, could identify phenotypically distinct HF-REF subtypes with good or no response after 6 months of sacubitril/valsartan administration. Methods A total of 78 patients in NYHA functional class 2–3 and treated by ACE inhibitor or AAR2, were prospectively assigned to equimolar sacubitril/valsartan replacement. We collected demographic, clinical, biological and imaging continuous variables. Phenotypic domains were imputed with 5 eigenvectors for missing value, then filtered if the Pearson correlation coefficient was >0.6 and standardized to mean±SD of 0±1. Thereafter, we used agglomerative hierarchical clustering for grouping phenotypic variables and patients, then generate a heat map (figure 1). Subsequently, participants were categorized using Penalized Model-Based Clustering. P<0,05 was considered significant. Results Mean age was 60.4±13.4 yo and 79.0% patients were males. Mean ejection fraction was 29.3±7.0%. Overall, 16 phenotypic domains were isolated (figure 1) and 3 phenogroups were identified (Table 1). Phenogroup 1 was remarkable by isolated left ventricular involvement (LVTDD 64.3±5.9mm vs 73.9±8.7 in group 2 and 63.8±5.7 in group3, p<0.001) with moderate diastolic dysfunction (DD), no mitral regurgitation (MR) and no pulmonary hypertension (PH). Phenogroups 2 and 3 corresponded to patients with severe PH (TRMV: 2.93±0.47m/s in group 2 and 3.15±0.61m/s in groupe 3 vs 2.16±0.32m/s in group 1), related to severe DD (phenogroup 2) or MR (phenogroup 3). In both phenogroups, the left atrium was significantly enlarged and the right ventricle was remodeled, compared with phenogroup 1. Despite more severe remodeling and more compromised hemodynamic in phenogroups 2 and 3, the echocardiographic response to sacubitril/valsartan was comparable in all groups with similar improvement of EF and reduction of cardiac chambers dimensions (response of treatment, defined by improvement of FE +15% and/or decreased of indexed left ventricule diastolic volume −15% = group 2: 22 (76%); group 3: 18 (60%); group 1: 9 (50%); p=0.17; OR group 2 vs 1: OR=3.14; IC95% [0.9–11.03]; p=0.074; OR group 3 vs 1: OR=1.5; IC95% [0.46–4.87]; p=0.5)). The clinical response was even better in phenogroups 2 and 3 (Group 2: 19 (66%); group 3: 21 (78%) vs group 1: 9 (50%); p=0.05). Heat map Conclusion HF-REF patients with severe diastolic dysfunction, significant mitral regurgitation and elevated pulmonary hypertension by echocardiographic had similar reverse remodeling but better clinical improvement than patients with isolated left ventricular systolic dysfunction.


2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
R Sharafutdinova ◽  
VI Ruzov ◽  
VA Razin ◽  
RH Gimaev ◽  
LT Nizamova

Abstract Funding Acknowledgements Type of funding sources: None. Aim of study. To study spontaneous platelet aggregation in patients with arterial hypertension with different functional classes (FC) of CHF with preserved systolic function not taking antiplatelet therapy. Material and Methods 51 patients with AH with different types of CHF, mean age 55.4 ± 5.9 years, with preserved left ventricular systolic function according to ECHO-CS were studied. The patients were divided into 4 groups depending on FC of CHF: Group 1 - 0 FC of CHF (n = 11), Group 2 - 1 FC of CHF (n = 13), Group 3 - 2 FC of CHF (n = 14), and Group 4 - 3 FC of CHF (n = 13). Spontaneous platelet aggregation was determined on a KFK-2MP photoelectrocolorimeter (Russia). Results. During the study, the spontaneous platelet aggregation was 1.08 ± 0.31 in patients with CHF class 0 (1 gr), and 1.22 ± 0.25 in patients with CHF class 1, with no statistical difference in comparison with 1 gr (p = 0.233). In group 3 (2FC CHF), spontaneous platelet aggregation was 1.33 ± 0.27, with a statistically significant difference with spontaneous platelet aggregation in patients with type 0 (p = 0.042), but with group 2 (1FC CHF), no statistically significant difference was found (p = 0.281). Spontaneous platelet aggregation in group 4 (3FC CHF) was 1,62 + 0,32, with statistically significant difference in comparison with all groups, so with group 1 - p &lt; 0,001, with group 2 - p = 0,016 and with group 3 - p = 0,017. Conclusion. Patients with arterial hypertension with preserved systolic function showed an increase in spontaneous platelet aggregation with increasing functional class of CHF, and the most significant increase in platelet aggregation was seen in patients with class 3 CHF.


Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sung-Ji Park ◽  
Chinami Miyazaki ◽  
Charles J Bruce ◽  
Diego Bellavia ◽  
Fletcher A Miller ◽  
...  

Backgrounds: Left ventricular torsion (LVtor) is an integral part of systole and untwisting plays an important role in diastole. The aim of this study was to characterize LVtor and untwisting in different grades of diastolic dysfunction. Methods: We studied 135 patients with normal LV EF with various grades of diastolic dysfunction (40 group1:mild,42 group 2:moderate,and 22 group 3:severe dysfunction) and 31 controls with normal diastolic function. Apical and basal short axis rotations were measured by 2D STE. LVtor was defined as net difference between apical and basal rotation. Results: Age, gender, and EF were similar in 3 groups and control. Mitral annulus early diastolic velocity was reduced in all 3 groups (see table ). Peak LVtor was significantly greater in group 1 compared with control, group 2 and group 3. The time from peak LVtor to Mitral valve opening, and to peak early diastolic velocity were significantly delayed in group 1 compared to control (p=0.0030 and 0.0409, respectively). The twisting rate and untwisting rate were found to be highest in group 1. Conclusions: Systolic torsion and diastolic untwisting are significantly increased in patients with mild diastolic dysfunction. In patients with advanced diastolic dysfunction with increased filling pressure, torsion and untwisting are normalized. Hence, vigorous LV torsion appears to be a compensatory mechanism during an early stage of diastolic dysfunction to maintain normal filling in the setting of reduced longitudinal myocardial motion.


2019 ◽  
Vol 95 (1122) ◽  
pp. 205-209 ◽  
Author(s):  
Amar Mistry ◽  
Zakariyya Vali ◽  
Abu Taher ◽  
Bharat Sidhu ◽  
Xin Li ◽  
...  

PurposeImplantable cardioverter defibrillator (ICD) implantation rates remain variable despite established guideline recommendations. This study aims to assess whether being managed by a cardiologist has an impact on whether patients are considered for an ICD for primary prevention of sudden cardiac death.Design/MethodsSingle-centre, retrospective, observational study of patients identified to have severe left ventricular systolic dysfunction (LVSD) on echocardiography (n = 129) between 1 and 30 June 2016 with cross-sectional assessment at 1 year. An assessment of ICD consideration at 1 year following the echocardiogram was documented, in addition to the specialty of the managing physician (group 1—electrophysiologist/heart failure specialist; group 2—all other cardiologists; group 3—non-cardiologist).Results129/1173 (11%) transthoracic echocardiographies (s) were identified to have severe LVSD. 52 (40%), 37 (29%) and 40 (31%) were managed by group 1, group 2 and group 3, respectively. Mean age was 74.7 (±12.6) years with a predominance of male gender (70.5%). An ICD was not considered in 47.3%. Those managed by a cardiologist were more likely to be considered for an ICD than a non-cardiologist (63.9% vs 30.0%; OR 4.0, 95% CI 1.8 to 8.8, p = 0.001) with a greater survival at 1 year (89.9% vs 52.5%, OR 8.1 95% CI 3.2 to 20.4, p < 0.001). Group 1 were more likely to consider ICD than group 2 cardiologists (75.0% vs 45.9%; OR 3.5; 95% CI 1.4 to 8.7, p = 0.005).ConclusionThere is significant variation between cardiologists and non-cardiologists, as well as within different cardiology subspecialists, when considering the option of ICD therapy for primary prevention.


Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 830
Author(s):  
Ruxandra Nicoleta Horodinschi ◽  
Camelia Cristina Diaconu

Background: Heart failure (HF) and atrial fibrillation (AF) commonly coexist and patients with both diseases have a worse prognosis than those with HF or AF alone. The objective of our study was to identify the factors associated with one-year mortality in patients with HF and AF, depending on the left ventricular ejection fraction (LVEF). Methods: We included 727 patients with HF and AF consecutively admitted in a clinical emergency hospital between January 2018 and December 2019. The inclusion criteria were age of more than 18 years, diagnosis of chronic HF and AF (paroxysmal, persistent, permanent), and signed informed consent. The exclusion criteria were the absence of echocardiographic data, a suboptimal ultrasound view, and other cardiac rhythms than AF. The patients were divided into 3 groups: group 1 (337 patients with AF and HF with reduced ejection fraction (HFrEF)), group 2 (112 patients with AF and HF with mid-range ejection fraction (HFmrEF)), and group 3 (278 patients with AF and HF with preserved ejection fraction (HFpEF)). Results: The one-year mortality rates were 36.49% in group 1, 27.67% in group 2, and 27.69% in group 3. The factors that increased one-year mortality were chronic kidney disease (OR 2.35, 95% CI 1.45–3.83), coronary artery disease (OR 1.67, 95% CI 1.06–2.62), and diabetes (OR 1.66, 95% CI 1.05–2.67) in patients with HFrEF; and hypertension in patients with HFpEF (OR 2.45, 95% CI 1.36–4.39). Conclusions: One-year mortality in patients with HF and AF is influenced by different factors, depending on the LVEF.


Author(s):  
Viktoriia V. Kundina ◽  
Tetiana M. Babkina

Background. Coronary artery disease (CAD) is one of the main causes of cardiovascular death. The severity of CAD is determined by the left ventricular (LV) dysfunction which is caused by coronary atherosclerosis. The possibility of restoring functional capacity of the heart (ejection fraction (EF)) depends on hibernating volume of the myocardium which is a pitfall in revascularization. The aim. To assess the correlation between the score of the viable myocardium (VM) and EF with systolic dysfunction and preserved LVEF in patients after coronary artery bypass grafting (CABG). Material and methods. To implement the set clinical tasks, 62 patients with CAD with preserved systolic function and systolic dysfunction were examined, 35 (56%) patients had heart failure with an EF of 49% (group 2) and less. Twenty-seven (44%) patients had preserved ventricular function of 50% or more (group 1). The mean age of the subjects was 59.6 ± 8.2 years. Five (8.0%) patients denied myocardial infarction. Myocardial scintigraphy was performed on Infinia Hawkeye all purpose imaging system (GE, USA) with integrated CT. The studies were performed in SPECT and SPECT/CT with ECG synchronization (gated SPECT) modes. 99mTc-MIBI with an activity of 555–740 MBq was used. Myocardial scintigraphy was performed in the course of treatment (before CABG and after CABG) according to the One Day Rest protocol. A total of 124 scintigraphic studies were performed. Results and discussion. Samples of the studied patients “before” and “after” treatment were compared using Wilcoxon matched-pairs test. In group 1 in patients with EF ≥ 50% the score of VM increased after CABG with values from 81.7 CI 95% [78.5; 84.9] to 86.9 CI 95% [84.4; 89.3]. However, the EF itself before and after treatment remained the same or slightly decreased amounting to 54.9 CI 95% [50.8; 59.1] and 52.5 CI 95% [48.6; 56.3]. In group 2 in patients with EF ≤ 49% the amount of VM increased after CABG with values from 59.9 CI 95% [54.9; 64.8] to 65.9 CI 95% [60.2; 71.6] (p = 0.00005). However, the EF itself before and after treatment remained the same, amounting to 28.9 CI 95% [24.8; 32.9] and 31.1 CI 95% [26.8; 35.5] (p = 0.19). Conclusions. Myocardial viability in both study groups significantly improved, given the high statistical reliability of the results, although LVEF either remained unchanged or changed slightly. Improvement of static parameters (wall perfusion) also confirms positive effect of revascularization with constant dynamic parameters (EF, end-diastolic volume) or statistically insignificant changes thereof. There is no direct correlation between VM and EF.


2017 ◽  
Vol 9 (2) ◽  
pp. 147-154
Author(s):  
Rezwana Siddique ◽  
Tuhin Haque ◽  
Md Kabiruzzaman ◽  
Sohel Reza Chowdhury ◽  
Fazila Tun Nesa Malik ◽  
...  

Background: Hypertension is an emerging risk factor for developing heart failure with preserved ejection fraction (HFpEF). Diastolic dysfunction most frequently associated with a subclinical impairment of systolic function in patients with HFpEF. The aim of this study was to detect early impairment of left ventricular function in hypertensive patients with preserved ejection fraction using Tissue Doppler Imaging (TDI).Methods: This cross-sectional study included a total 105 subjects who were divided into three groups (group-1: 35 healthy control; group-2: 35 hypertensive patients without concentric left ventricular hypertrophy, and group-3: 35 hypertensive patients with concentric left ventricular hypertrophy having left ventricular ejection fraction (LVEF)>50% on 2D echocardiography). They underwent TDI to measure systolic dysfunction by systolic annular velocity during systole (S´) and diastolic dysfunction by diastolic filling pressure (E/E´).Results: The results were obtained in 105 subjects: group-1 (40.63±5.0years; 34.4% male); group-2 (49.57±9.7years; 34.4% male) and group-3 (55.17±8.5years; 31.2% male). LVMI and RWT were significantly higher (p<0.001) in both hypertensive groups. The presence of systolic dysfunction by TDI as evidence by systolic annular velocity (S´) was significantly reduced (p<0.001) in both hypertensive groups compared to controls (0.08±0.11 vs.06±0.01 vs. 0.05±0.01).The presence of diastolic dysfunction by TDI as evidence by diastolic filling pressure (E/E´) were significantly higher (p<0.001) in both groups of hypertensive patients. There was significant correlation between E/E´ and S´(r = -593; p= <0.001).Conclusion: TDI provided a new insight into impaired systolic function by detecting lower values of S´ and impaired diastolic function by detecting higher values of E/E´ in hypertensive patients. This study was a clear reflection of early impairment of LV function in hypertensive patients (with or without C-LVH) and it might be helpful for identifying hypertensive patients who are at high risk for heart failure.Cardiovasc. j. 2017; 9(2): 147-154


VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.


Sign in / Sign up

Export Citation Format

Share Document