Abstract 14264: The Impact of Bariatric Surgery on Echocardiographic Features of Cardiac Remodeling and Diastolic Function

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Raj K Dalsania ◽  
Kaitlyn Ibrahim ◽  
Rohit Soans ◽  
Abdullah Haddad ◽  
Vikram J Eddy ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Cardiac Remodeling ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Pulmonary Artery Systolic Pressure ◽  
Increased Risk ◽  
Lv Mass ◽  
The Impact

Introduction: Candidates for bariatric surgery are at increased risk for cardiovascular disease and often develop adverse cardiac remodeling as a result of obesity. Bariatric surgery can alter cardiac structure and function in these patients; however, this has not been fully investigated. Hypothesis: We hypothesized that patients undergoing bariatric surgery would demonstrate favorable cardiac remodeling and improvement in diastolic parameters according to the American Society of Echocardiography (ASE) guidelines. Methods: All patients undergoing bariatric surgery at our institution from 2014-2018 were reviewed. In patients with pre- and post-operative echocardiograms, the following were measured: left ventricular (LV) size, pulmonary artery systolic pressure (PASP), LV mass, mitral E/A, LV ejection fraction (EF), medial and lateral E/e’, medial e’ and a’, lateral e’ and a’, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVI), degree of LV hypertrophy, and relative wall thickness (RWT). The grade of diastolic dysfunction (DD) was calculated according to ASE guidelines. Results: A total of 69 patients met criteria for inclusion, with 77% (n=53) female, 87% (n=60) non-white, and mean age 49±10.7. Mean decrease in BMI one year post-operatively was 14.6±5.7 kg/m 2 . Median time between bariatric surgery and post-operative echocardiogram was 21.8 months. Post-operatively, there was a mean 17.8 cm/s decrease in TR velocity (p=0.0064) and 4.2 mmHg decrease in PASP (p=0.02). LAVI increased by 3.4 mL/m 2 (p=0.048). There was no significant change in LV size, LV mass, LVEF, LV hypertrophy, or RWT. Out of the 29 patients with pre-existing DD (grade 1, n=20; grade 2, n=8; grade 3, n=1), 45% (n=13) demonstrated improvement in grade of DD. When compared to pre-operative DD, post-operatively, 5 of 20 patients with G1DD had no DD, 2 of 8 patients with G2DD had no DD, 5 of 8 patients with G2DD had G1DD, and 1 patient with G3DD had G1DD. This was driven by a decrease in TR velocity and medial E/e’. Conclusions: In patients undergoing bariatric surgery, TR velocity and PASP improved while LAVI paradoxically increased. Patients with pre-existing DD demonstrated improvement in diastology, driven by changes in TR velocity and medial E/e’.

scholarly journals Heart reHeart remodeling in patients with severe systolic dysfunction due tocancer chemotherapymodeling in patients with severe systolic dysfunction due tocancer chemotherapy.

Kardiologiia ◽  
2020 ◽  
Vol 60 (3) ◽  
pp. 51-58
Author(s):  
E. I. Emelina ◽  
A. A. Ibragimova ◽  
I. I. Ganieva ◽  
G. E. Gendlin ◽  
I. G. Nikitin ◽  
...  
Keyword(s):  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Pulmonary Artery Systolic Pressure ◽  
Ventricular Ejection Fraction ◽  
Men And Women

Objective Comparative analysis of structural and functional specific features of the heart in patients with toxic cardiomyopathy (TCMP) with a low left ventricular ejection fraction (LVEF) and severe, chronic heart failure (CHF) and in patients with idiopathic dilated cardiomyopathy (DCMP) and similar LVEF and CHF severity.Materials and Methods This observational, single-site study included 15 patients with TCMP (12 of them received treatment including anthracycline antibiotics and 3 patients received targeted therapies) and 26 patients with idiopathic DCMP. Data of echocardiography were compared for patients with TCMP and DCMP with comparably low LVEF of <40 %.Results In patients with severe heart damage associated with antitumor therapy with low LVEF, volumetric and linear indexes of left and right ventricles and the left atrium (left atrial volume index (LAVI), 33.7 (21.5–36.9) ml / m2; right ventricular end-diastolic dimension (RVDd), 2.49 (1.77–3.53) cm; and end-diastolic volume index (EDVI), 78.0 (58.7–90.0) ml / m2) were considerably less than in the DCMP group (LAVI, 67.1 (51.1–85.0) ml / m2; RVDd, 4.05 (3.6–4.4) cm; and EDVI, 117.85 (100.6–138.5) ml / m2, p<0.0001). Furthermore, LV wall thickness and pulmonary artery systolic pressure did not differ in these groups. Both in men and women with TCMP, LAVI and EDVI were significantly less than in men and women with DCMP.Conclusion The study showed significant differences in parameters of cardiac remodeling. In TCMP patients as distinct from DCMP patients, despite a pronounced decrease in LVEF, LV dilatation was absent or LV volumetric parameters were moderately increased with a more severe somatic status.

scholarly journals Echocardiography of right ventricular-arterial coupling predicts survival of elderly patients with heart failure and reduced to mid-range ejection fraction

2020 ◽  
Vol 90 (2) ◽  
Author(s):  
Gian Marco Rosa ◽  
Andreina D'Agostino ◽  
Stefano Giovinazzo ◽  
Giovanni La Malfa ◽  
Paolo Fontanive ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Ace Inhibitor ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
And Gender ◽  
The Impact

Echocardiography of right ventricular (RV)-arterial coupling obtained by the estimation of the ratio of the longitudinal annular systolic excursion of the tricuspid annular plane and pulmonary artery systolic pressure (TAPSE/PASP) has been found to be a remarkable prognostic indicator in patients with HF. Our aim was to evaluate the impact of TAPSE, PASP and their ratio in the prognostic stratification of outpatients with HF aged ≥70 years and reduced to mid-range ejection fraction (EF). A complete echocardiographic examination was performed in 400 outpatients with chronic HF and left ventricular (LV) EF ≤50% who averaged 77 years in age. During a median follow-up period of 25 months (interquartile range: 8-46), there were 135 cardiovascular deaths. Two different Cox regression models were evaluated, one including TAPSE and PASP, separately, and the other with TAPSE/PASP. In the first model, LV end-systolic volume index, age, no angiotensin converting enzyme (ACE) inhibitor use, TAPSE, PASP and gender were found to be independently associated with the outcome after adjustment for demographics, clinical, biochemical, echocardiographic data. In the second model, TAPSE/PASP resulted the most important independent predictor of outcome (hazard ratio [HR]:0.07, p<0.0001) followed by LV end-systolic volume index, no ACE inhibitor use, age and gender. The use of the variable TASPE/PASP improved the predictive value of the new multivariable model (area under the curve [AUC] of 0.74 vs AUC of 0.71; p<0.05). TASPE/PASP improved the net reclassification (NRI = 14.7%; p<0.01) and the integrated discrimination (IDI = 0.04; p<0.01). In conclusion, the study findings showed that assessment of RV-arterial coupling by TAPSE/PASP was of major importance to assess the prognosis of patients with chronic HF and LV EF ≤50% aged ≥70 years.

scholarly journals P290 Differences in cardiac dimensions in mitral valve prolapse with or without Barlow phenotype

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Kamoen ◽  
S Calle ◽  
T De Backer ◽  
F Timmermans
Keyword(s):  
Mitral Valve ◽  
Connective Tissue ◽  
Mitral Valve Prolapse ◽  
Systolic Pressure ◽  
Connective Tissue Diseases ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Atrial Volume Index ◽  
Ventricular Systolic Pressure

Abstract Background Mitral valve prolapse (MVP) is a common cause of chronic mitral regurgitation (MR). Barlow’s disease (BD) and fibro-elastic deficiency (FED) are two major entities of MVP affecting the connective tissue of the mitral valve, but both have a different underlying pathophysiology and phenotype. In some connective tissue diseases (CTD), it has been suggested that ventricular dysfunction occurs despite absence of MR, suggesting that CTD directly involve the myocardium. We therefore investigated whether patients with BD have different cardiac dimensions compared to FED, after correcting for MR severity grade. Methods 134 patients with MVP and chronic MR were prospectively included. MR was graded carefully by echocardiography using a multi-parametric approach. The morphology of the mitral valve prolapse was specified as definite Barlow (n = 45) or non-Barlow (n = 89; FED, flail leaflet or unspecified etiology) by two experienced echocardiographers. Results In our cohort, MR was significantly more severe in the non-Barlow group compared to typical BD group (regurgitant volume (RV) 51 vs 33 ml, p = 0.021; right ventricular systolic pressure, 40 vs 34 mmHg, p= 0.05, left atrial volume index, 51 vs 42 ml/m², p = 0.07, respectively). However, there was a trend towards higher left ventricular end-diastolic diameter index (LVEDDi, 27.7 vs 29 mm, p = 0.07) and a significantly higher end-diastolic volume index (LVEDVi, 62 vs 71 ml/m², p= 0.02) in the Barlow group, despite similar ejection fractions and much less MR in the Barlow group. This resulted in a significantly higher RV/LVEDV ratio in the non-Barlow group compared to the Barlow group (42% vs 23%, p = 0.001). Similarly, the LA volume/LVEDV ratio was significantly lower in the Barlow cohort (63 vs 79%, p= 0.026). There were no significant differences in aortic dimensions between groups. Conclusions We describe for the first time that compared to non-Barlow (mostly FED), patients with MVP due to typical Barlow disease have larger ventricular dimensions and volumes, which are disproportionate to the degree of MR. We therefore hypothesize that the connective tissue alterations in these patients may also involve the myocardium resulting in LV dilation independent of MR. Further investigation and clinical implications of these findings is mandatory.

scholarly journals Implication of Current ASE/EACVI Left Ventricular Diastolic Function Classification in Predicting 2-Year MACE in Asymptomatic Patients with Diabetes and Hypertension

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Foo ◽  
K H Lam ◽  
M Igo ◽  
M N A Sulaiman ◽  
M Y Ku ◽  
...  
Keyword(s):  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Diabetic Patients ◽  
Prognostic Impact ◽  
Left Atrial Volume Index ◽  
Asymptomatic Patients ◽  
Number Of Patients ◽  
Increased Risk ◽  
Patients With Diabetes

Abstract Background Left ventricular diastolic dysfunction (LVDD) has been shown to be more prevalent in patients with diabetes, and once progress to overt heart failure, carry worse clinical outcomes. Substantial number of patients were classified as indeterminate DF based on the current ASE/EACVI guidelines. The implication of current DF classification in predicting MACE among diabetic patients is not well established. Purpose To assess prognostic impact of current guidelines-based DF classification, and determine predictors of 2-year MACE based on individual LVDD parameters. Methods A total of 111 patients with diabetes and hypertension who attended diabetic clinic follow-up at the primary healthcare settings were enrolled. All patients had no prior cardiovascular events, had preserved left ventricular (LV) ejection fraction on echocardiography and sinus rhythm on ECG at screening. Echocardiography was performed to obtain parameters of LV dimensions, LV volumes and LVDD. The 2016 ASE/EACVI guidelines were applied to classify DF. All patients were followed up until 2 years to assess MACE. Results There were 65 (58.6%) female patients. Mean age was 59.86 (7.45); mean duration of DM was 10.5 (5.41). 80 (72.1%) patients were classified as having normal DF (nDF); 24 (21.6%) patients were classified as indeterminate DF (iDF); 7 patients (6.3%) were classified as LVDD. Patients with LVDD had significantly higher LV mass index (LVMI) (mean 121.72±23.28g/m2 vs 116.62±24.66g/m2 in iDF vs 102.50±22.89g/m2 in nDF); higher left atrial volume index (LAVI) (mean 41.24±10.28ml/m2 vs 30.55±10.07ml/m2 in iDF vs 25.75±6.30ml/m2 in nDF); lower lateral e' velocity (mean 6.35±2.05cm/s vs 7.37±1.73cm/s in iDF vs 8.59±2.13cm/s in nDF); higher septal E/e' ratio (mean 14.89±3.29 vs 12.16±3.99 in iDF vs 9.99±2.35 in nDF); higher average septal-lateral E/e' ratio (mean 14.22±3.77 vs 11.34±3.74 in iDF vs 9.04±2.10 in nDF). Among these 111 patients, 10 patients (9%) reported MACE at 2 years. The risk of 2-year MACE is elevated in both iDF [odds ratio (OR) 3.80, 95% CI 0.87–16.54, p=0.075] and LVDD [OR 7.60, 95% CI 1.11–52.02, p=0.039]. LVMI (OR 1.027, 95% CI 1.004– 1.051, p=0.023), LAVI (OR 1.092, 95% CI 1.017–1.172), and average septal-lateral E/e' ratio (OR 1.276, 95% CI 1.047–1.557, p=0.016) significantly correlated with 2-year MACE. Conclusions LVDD is correlated with increased MACE at 2 years. LVMI, LAVI and average septal-lateral E/e' ratio were predictors of increased risk of MACE at 2 years. Further investigation with larger sample size is warranted. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health Malaysia

scholarly journals Ventricular-arterial coupling parameters and its prognostic value in patients with decompensated heart failure

2020 ◽  
Vol 25 (1) ◽  
pp. 39-45
Author(s):  
Z. D. Kobalava ◽  
O. I. Lukina ◽  
I. Meray ◽  
S. V. Villevalde
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Systolic Pressure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Arterial Elastance ◽  
Increased Risk ◽  
All Cause Mortality

Aim. To assess ventricular-arterial coupling (VAC) parameters and their prognostic value in patients with decompensated heart failure (HF).Material and methods. VAC parameters were evaluated upon admission using two-dimensional echocardiography in 355 patients hospitalized with decompensated HF. VAC was expressed as the ratio between arterial elastance (Ea) and end-systolic LV elastance (Ees). The optimal VAC range was considered 0,6-1,2. Parameters of left ventricular (LV) efficacy were calculated using the appropriate formulas. Differences were considered significant at p<0,05.Results. The median values of Ea, Ees and VAC were 2,2 (1,7;2,9) mmHg/ml, 1,8 (1,0;3,0) mmHg/ml and 1,32 (0,75;2,21) respectively. In 63% of patients, VAC disorders were detected: 55% of patients had VAC >1,2 (predominantly patients with HF with reduced ejection fraction (HFrEF)-79%), 8% of patients had VAC <0,6 (all patients with HF with preserved ejection fraction (HFpEF)). Normal VAC was observed in 78%, 42%, and 1% of patients with HFpEF, HF with mid-range EF and HFrEF, respectively. There was significant correlation between Ea/Ees ratio and levels of NTproBNP (R=0,35), hematocrit (R=-0,29), hemoglobin (R=-0,26), pulmonary artery systolic pressure (PAPs) (R=0,18), dimensions of left atrium (R=0,32) and right ventricle (RV) (R=0,32). After 6 months, rehospitalization with decompensated HF was recorded in 72 (20,3%) patients, 42 (11,8%) patients died. Ea decrease <2,2 mmHg/ml and PAPs increase >45 mmHg increased the risk of rehospitalization with decompensated HF and all-cause mortality 2,5 and 3,7 times, respectively.Conclusion. Impaired VAC was diagnosed in 63% of patients with decompensated HF. However, the increased risk of all-cause mortality and rehospitalization with decompensated HF over the 6 months was associated with Ea decrease <2,2 mmHg/ml and PAPs increase >45 mmHg.

Abstract 9610: Aortic Stiffness and Increased Left Ventricular Mass Predict Progress From Prehypertension to Hypertension

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yong H Kim ◽  
Seong-Hwan Kim ◽  
Jin-Seok Kim ◽  
Chol Shin ◽  
Seung-Ku Lee
Keyword(s):  
Left Ventricular Mass ◽  
Aortic Stiffness ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Final Visit ◽  
Ventricular Mass ◽  
Lv Mass ◽  
Fast Increase ◽  
High Range

Introduction: Whether aortic stiffness and increased left ventricular (LV) mass can predict progress from prehypertension to hypertension is not well investigated. Hypothesis: The aim of this study was to find predictors of hypertension and evaluate the clinical implications of aortic stiffness and increased LV mass in disease-free prehypertensive population. Methods: 510 prehypertensive subjects in the Korean Genome Epidemiology Study (KoGES) were observed for four years. In addition to clinical information, left ventricular mass index (LVMI), left atrial volume index (LAVI), aortic pulse wave velocity (PWV), carotid intima-media thickness (cIMT) and other cardiovascular characteristics were obtained at baseline. Baseline clinical and cardiovascular characteristics were compared between subjects that developed hypertension and did not, and independent predictors of hypertension were determined. Results: Out of 510 participants, 237 subjects developed hypertension during four years (46%). After multivariate adjustment, high range prehypertension (OR=4.27 [2.63-9.63], p=0.000), 5th quintile of LAVI (OR=3.38 [1.63-7.04], p=0.001), 5th quintile of LVMI (OR=2.982 [1.399-6.359], p=0.005), 4th (OR=2.881 [1.372-6.049], p=0.005) and 5th quintiles of PWV (OR=2.283 [1.067-4.885], p=0.033) predicted development of hypertension. Subjects in low range prehypertension at baseline and hypertension at the final visit (“fast increase in blood pressure (BP)”) had the highest baseline LVMI, while those with high range prehypertension at baseline and not-hypertension at the final visit ("slow increase in BP") had the lowest baseline LVMI (p=0.005 for fast BP increase vs. slow BP increase). Conclusions: In prehypertensive population, presence of aortic stiffness and increased LV mass independently predicted development of hypertension. Further, increased LVMI at baseline was correlated with fast increase in BP in the future. PWV and echocardiography should be performed to recognize subjects at high risk of hypertension, because they possibly benefit from pre-emptive medical treatment.

scholarly journals A Single Imaging Modality in the Diagnosis, Severity, and Prognosis of Pulmonary Embolism

2014 ◽  
Vol 2014 ◽  
pp. 1-10
Author(s):  
Hadice Selimoglu Sen ◽  
Özlem Abakay ◽  
Mehmet Güli Cetincakmak ◽  
Cengizhan Sezgi ◽  
Süreyya Yilmaz ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Risk Evaluation ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Risk Of Death ◽  
Prediction Of Mortality ◽  
Increased Risk ◽  
Acute Pe

Introduction. This study aimed to investigate the currency of computerized tomography pulmonary angiography-based parameters as pulmonary artery obstruction index (PAOI), as well as right ventricular diameters for pulmonary embolism (PE) risk evaluation and prediction of mortality and intensive care unit (ICU) requirement.Materials and Methods. The study retrospectively enrolled 203 patients hospitalized with acute PE. PAOI was calculated according to Qanadli score.Results. Forty-three patients (23.9%) were hospitalized in the ICU. Nineteen patients (10.6%) died during the 30-day follow-up period. The optimal cutoff value of PAOI for PE 30th day mortality and ICU requirement were found as 36.5% in ROC curve analysis. The pulmonary artery systolic pressure had a significant positive correlation with right/left ventricular diameter ratio (r=0.531,P<0.001), PAOI (r=0.296,P<0.001), and pulmonary artery diameter (r=0.659,P<0.001). The patients with PAOI values higher than 36.5% have a 5.7-times increased risk of death.Conclusion. PAOI is a fast and promising parameter for risk assessment in patients with acute PE. With greater education of clinicians in this radiological scoring, a rapid assessment for diagnosis, clinical risk evaluation, and prognosis may be possible in emergency services without the need for echocardiography.

scholarly journals A Predictive Model for Dilated Cardiomyopathy With Pulmonary Hypertension

2021 ◽  
Author(s):  
Jiahua Liang ◽  
Ruochen Zhu ◽  
Yi Yang ◽  
Rong Li ◽  
Chuangxiong Hong ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Dilated Cardiomyopathy ◽  
Predictive Model ◽  
External Validation ◽  
Systolic Pressure ◽  
Vital Signs ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Chronic Obstructive ◽  
The Impact

Abstract Background: Dilated cardiomyopathy (DCM) is defined as a serious cardiac disorder caused by the presence of left ventricular dilatation and contractile dysfunction in the absence of severe coronary artery disease and abnormal loading conditions. The incidence of cardiac death is markedly higher in patients with DCM with pulmonary hypertension (PH) than in DCM patients without PH. However, no previous studies have constructed a predictive model to predict PH in patients with DCM.Methods: Data from 218 DCM patients were collected. The diagnostic criterion for PH by echocardiography was a pulmonary artery systolic pressure (PASP) ≥ 40 mmHg. Basic information, vital signs, comorbidities and biochemical data of each patient were determined. The impact of each parameter on PH was analysed by univariable and multivariable analyses, the data from which were employed to establish a predictive model. Finally, the discriminability, calibration ability, and clinical efficacy of the model were verified for both the modelling group and the external validation group.Results: We successfully applied a history of chronic obstructive pulmonary disease (COPD) or chronic bronchitis, systolic murmur (SM) at the tricuspid area, SM at the apex and brain natriuretic peptide (BNP) level to establish a model for predicting PH in DCM. The model was proven to have high accuracy and good discriminability, calibration ability, and clinical application value.Conclusions: A model for predicting PH in patients with DCM was successfully established. The new model is reliable for predicting DCM with PH and has good clinical applicability.

Abstract 15011: Association of Pulmonary Hemodynamics and Right Ventricular Function With Incident Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Romil R Parikh ◽  
Faye L Norby ◽  
Wendy Wang ◽  
Thenappan Thenappan ◽  
Kurt W Prins ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Right Ventricular ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Volume Index ◽  
Pulmonary Artery Systolic Pressure ◽  
Pulmonary Hemodynamics ◽  
Functional Remodeling ◽  
Rv Function

Introduction: Higher pulmonary artery systolic pressure (PASP) and right ventricular (RV) dysfunction are associated with higher risk of heart failure (HF) and mortality. Whether higher PASP and lower RV function are associated with risk of atrial fibrillation (AF) is unclear. Hypothesis: Higher PASP, higher pulmonary vascular resistance (PVR), and lower RV function are associated with incident AF after accounting for left atrial (LA) size and function, and left ventricular (LV) systolic and diastolic function. Methods: ARIC participants free of prevalent coronary heart disease (CHD), HF, AF, and with LA volume index (LAVi) <34ml/m 2 and average E/e’ ratio <14 in 2011-13 were included. We measured PASP, PVR, RV fractional area change (RVFAC), and RV-PA coupling (defined as RVFAC/PASP ratio) from 2D-echocardiograms. Incident AF (through 2018) was ascertained from hospital discharge codes and death certificates. We used Cox proportional hazards regression in our analysis. Results: We included 1915 participants (mean age 75 years, 69% female, 24% black) of whom 176 developed AF over a median follow-up of 6.3 years. PASP, PVR, and RV-PA coupling were significantly associated with incident AF after adjusting for measures of LA and LV structural and functional remodeling. RVFAC was not significantly associated with incident AF. Conclusions: In persons without CHD, HF, and LA enlargement, higher PASP and lower RV-PA coupling are associated with higher risk of AF after accounting for LA and LV structural and functional remodeling. This finding, which suggests a possible etiological role of RV remodeling for AF, needs further confirmation.

scholarly journals Effects on the left ventricular diastolic dysfunction of a cardiac rehabilitation program in chronic heart failure patients

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Chaveles ◽  
L Karatzanos ◽  
S Nanas
Keyword(s):  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Diastolic Dysfunction ◽  
Left Atrium ◽  
Left Atrial Volume ◽  
Rehabilitation Program ◽  
Left Ventricular ◽  
Volume Index ◽  
Cardiac Rehabilitation Program ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. PURPOSE The aim of the present study is to evaluate the impact of a cardiac rehabilitation program on the diastolic dysfunction, the ejection fraction (EF) of left ventricular and the volume index of the left atrium comparing 2 groups: those with restricted EF (&lt;40%) and those with intermediate and preserved EF (≥ 40%). METHODS In the present study 41 stable CHF patients (N = 41; 56 ±10 years [mean ± SD], 34 males and 7 females) with diastolic dysfunction, participated in an exercise rehabilitation program (3 sessions a week). Only 38 of them completed the rehabilitation program in the form of circuit-interval aerobic training, adjusted according to 70–80% of heart rate reserve, for a period of 3 months. A detailed echocardiogram was performed before and immediately after the rehabilitation program, focusing on the diastolic dysfunction assessment of the left ventricular. RESULTS At the end of the three months rehabilitation program, the diastolic dysfunction stage was significantly decreased (from 1.45+/- 0.72 to 1.08 +/-0.67, p = .000). The LV ejection fraction was significantly increased (from 34.97+/-10.66 to 36.68 +/-10.52, p = .002). In addition, there was a significant decrease in E/E" and RVSP (from 9.37+/-3.54 to 8.47+/-3.34 and from 28.44+/-6.86mmHg to 27.38+/-5.87 mmHg, p =.033 and p =.030, respectively). Finally, the left atrial volume and the average e" had no significant decrease. CONCLUSIONS Circuit training improved both diastolic and systolic dysfunction but had no significant repercussion on the left atrium volume. From this study it was concluded that a rehabilitation cardiac program can have an impact in the improvement in the diastolic dysfunction, especially in the restricted EF group, a mechanism that is essential in the pathophysiology of the CHF. Table 1 PairedDifferences t df Sig. (2-tailed) Mean Std. Deviation Std. ErrorMean 95% Confidence Interval of the Difference Lower Upper Diast.stage b-a 0.368 .589 .096 .175 .562 3.855 37 .000 A b - A a ( m/sec) -.03816 .21084 .03420 -.10746 .03114 -1.116 37 .272 Ε/Α b - Ε/Α a .11039 .44705 .07252 -.03655 .25734 1.522 37 .136 mean e" b - a(cm/sec) .19395 2.56304 .41578 -.64850 1.03640 .466 37 .644 Ε/e "b - Ε/e "a .90026 2.50613 .40655 .07652 1.72401 2.214 37 .033 DTeb -DTe a (msec) 8.500 44.324 7.190 -6.069 23.069 1.182 37 .245 T-Test for the measured diastolic parameters (diastolic stage, E, A, E/A, mean e", E/E", DTe) for all groups (b = before, a = after). Abstract Figure. Linear scatter plot for EF

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