Abstract P150: Association Of Leisure Time Physical Activity (LTPA) With Left Atrial Function In Older Adults: The Atherosclerosis Risk In Communities (ARIC) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Romil Parikh ◽  
Riccardo M Inciardi ◽  
Wendy Wang ◽  
Sheila M Hegde ◽  
Faye L Norby ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Diastolic Function ◽  
Left Atrial ◽  
Contractile Function ◽  
Left Ventricular ◽  
Volume Index ◽  
Aric Study ◽  
Lv Diastolic Function ◽  
Conduit Function

Introduction: Prior research indicates that higher LTPA is associated with better left ventricular (LV) diastolic function, but not with left atrial volume index (LAVI). Left atrial (LA) strain is a more sensitive marker of LA pathology. Hence, we evaluated association of LTPA with LA strain in the ARIC study, a community-based cohort study. Hypothesis: Higher LTPA is associated with better LA reservoir, conduit and contractile function. Methods: We included 4005 participants (mean age 75 years, 63% female, 21% black) with 2D echocardiographic (2DE) LA % strain data, LTPA data, and without prevalent coronary heart disease, valvular heart disease, heart failure, atrial fibrillation, and stroke at Visit 5 (V5, 2011-13). We estimated LTPA as metabolic equivalent-minutes per week from validated Baecke questionnaire and categorized it as poor, intermediate, or ideal as per AHA recommendation. We categorized change in LTPA from V3 (1993-95) to V5 as persistently poor (referent), decreasing, increasing, or persistently active. LA reservoir, conduit, and contractile % strain were measured from speckle-tracking 2DE. Linear regression was used to evaluate association of LTPA with LA function. We modeled LTPA (1) cross-sectionally at V5 as a continuous variable and (2) change from V3 to V5, as continuous and categorical variables (referent- persistently poor). Results: Higher LTPA at V5 (Table) and persistently high (vs poor) LTPA from V3 to 5 (β estimate -0.89, 95% CI -1.40, -0.38) were significantly associated with better LA conduit function after adjusting for CV risk factors, LV function, and LAVI. The same associations with LA reservoir function were no longer significant after adjusting for CV risk factors. LTPA was not associated with LA contractile function (Table). Conclusions: Consistent with LTPA’s salutary effect on LV diastolic function, higher LTPA is associated with better LA conduit function. Maintaining high LTPA from midlife to late-life may be beneficial in mitigating age-related changes in cardiac function.

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 P1273 Effects of surgical septal myectomy on left ventricular function in patients with hypertrophic obstructive cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Furugen ◽  
H D Doi ◽  
M H Hashimoto ◽  
R K Koshima ◽  
K M Mitsube
Keyword(s):  
Mitral Valve ◽  
Diastolic Function ◽  
Longitudinal Strain ◽  
Function Analysis ◽  
Left Ventricular ◽  
Volume Index ◽  
Lv Function ◽  
Septal Myectomy ◽  
Concomitant Procedure ◽  
Lv Diastolic Function

Abstract Introduction and Purpose Surgical left ventricular (LV) septal myectomy in patients with obstructive hypertrophic cardiomyopathyhas been shown to reduce left ventricular outflow tract (LVOT) gradient and improve symptoms. We investigated changes in strain analysis, LA volume and LV systolic and diastolic function in patients with HOCM after surgical septal myectomy. Methods We enrolled consecutive 30 patients (age 63.7 ± 11.0 years, 47% Female), who underwent surgical LV septal myectomy for HOCM from 2012 to 2019. We evaluated LV dimension, LVOTG, LV-stroke volume, LV in flow pattern (E wave, A wave, Dct), e’(septal and lateral), LA volume, mitral regurgitation (MR), systolic anterior motion of mitral valve (SAM) and Global longitudinal strain. These parameters were evaluated at baseline and after LV myectomy at medium term (at least 6 months after surgery). Results They are followed for a mean of 3.4± 1.9 years after surgery. Eight patients underwent concomitant procedure; mitral valve repair and annuloplasty in 3 patients (10%), Maze surgery in 1 patient, LV aneurysmectomy in 2 patients and aortic valve replacement in 3 patients (10%). Patients with concomitant procedure were excluded from LV function analysis. Postoperative LVOTG were controlled in 10mmHg or less.Global longitudinal strain (GLS) improved but no significant change. Otherwise LA volume index decreased (from 52.5 ± 16.7 to 32.9 ± 14.6 ml/m2, p = 0.01) and LV diastolic function improved with an increase in lateral e" velocity (from 4.5 ± 2.8 to 9.2 ± 3.4 cm/sec, p = 0.001) and improved E/e’ (from 18.9 ± 5.6 to 10.6 ± 5.2, p &lt;0.05). Symptoms of dyspnea, chest oppression and heart failure improved with reduction in the New York Heart Association functional class. Conclusion Excellent relief of LVOT obstruction in HOCM by surgical LV septal myectomy results in decreased LA volume and LV diastolic function with improved symptoms.

scholarly journals Left Atrial Strain and Diastolic Function Abnormalities in Obese and Type 2 Diabetic Adolescents and Young Adults.

2020 ◽  
Author(s):  
Jeremy Mark Steele ◽  
Elaine M Urbina ◽  
Wojciech M Mazur ◽  
Philip R Khoury ◽  
Sherif F Nagueh ◽  
...  
Keyword(s):  
Young Adults ◽  
Strain Rate ◽  
Diastolic Function ◽  
Left Atrial ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Normal Weight ◽  
Adolescents And Young Adults ◽  
Lv Diastolic Function

Abstract Background Adults with obesity and type 2 diabetes mellitus (T2DM) related to obesity are at increased risk of heart failure with preserved ejection fraction (HFpEF). Whether left ventricular (LV) diastolic function abnormalities related to obesity and T2DM start in adolescence and early adulthood is unknown. We non-invasively evaluated the differences seen in LV diastolic and left atrial (LA) function in adolescents and young adults with obesity and T2DM. Methods We analyzed echocardiographic measures of LV diastolic function in patients with structurally normal hearts which were divided into 3 groups (normal weight, obese, and T2DM). Spectral and tissue Doppler and 2-D speckle tracking measurements of diastolic function were obtained. Logistic regression was performed to compare the prevalence of abnormalities in diastolic function based on the worst 25th percentile for each measure to determine the prevalence of diastolic and LA function abnormalities in obese and T2DM patients. Results 331 teenagers and young adults (median age 22.1 years) were analyzed (101 normal weight, 114 obese, 116 T2DM). Obese and T2DM group had lower E/A and higher E/e’. Obese and T2DM patients had significantly lower atrial reservoir, conduit, and booster strain and worse reservoir and conduit strain rate compared to normal patients (p < 0.001 for all measures). All patients had normal LA volumes. On multivariable analysis, conduit strain and reservoir and conduit strain rate were independently associated with having below the 25th percentile e’. Conduit strain rate was independently associated with having below the 25th percentile for mitral E/A ratio on multivariable analysis. Conclusions Abnormal indices of LV diastolic function are detected in adolescents and young adults with obesity and T2DM. LA function and strain analysis were able to detect evidence of decreased reservoir, conduit, and booster strain in these patients although LA volume was normal. The use of LA function strain may increase our ability to detect early diastolic function abnormalities in this population.

scholarly journals Global diastolic strain rate for the assessment of left ventricular diastolic dysfunction in young peritoneal dialysis patients: a case control study

2020 ◽  
Author(s):  
Jing Zhu ◽  
Fei Shi ◽  
Tao You ◽  
Chao Tang ◽  
Jianchang Chen
Keyword(s):  
Peritoneal Dialysis ◽  
Strain Rate ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Volume Index ◽  
Diastolic Strain Rate ◽  
Diastolic Velocity ◽  
Lv Diastolic Function

Abstract Background: Left ventricular (LV) myocardial longitudinal diastolic strain rate measured by two-dimensional speckle tracking imaging (2D-STI) was proved to have a better correlation with the LV diastolic function. We aimed to use this sensitive tool to predict LV myocardial diastolic dysfunction in young peritoneal dialysis (PD) patients with preserved LV ejection fraction (LVEF).Methods: We enrolled 30 PD patients aged ≤60 with LVEF ≥54% and classified as normal LV diastolic function by conventional echocardiography, and 30 age- and sex-matched healthy people as the control group. The left atrial maximum volume index (LAVI), LV mass index (LVMI), LVEF, LV posterior wall thickness (LVPWT), interventricular septal thickness (IVST), peak velocity of tricuspid regurgitation (TR), peak early diastolic velocity/late diastolic velocity(by Pulsed Doppler) (E/A) and E/peak velocity of the early diastolic wave (by Pulsed-wave tissue Doppler) (E/e’) were recorded by conventional echocardiographic. Next, the average LV global longitudinal systolic strain (GLS avg) and the average LV global longitudinal diastolic strain rate (DSr avg) during early diastole (DSrE avg), late diastole (DSrA avg) and isovolumic relaxation period (DSrIVR avg) were obtained from 2D-STI. Combined them with E, the new noninvasive indexes (E/DSrE avg, E/DSrA avg and E/DSrIVR avg) were derived.Results: The PD group ’s LVEF, E/e¢, TR and LAVI were in the normal range compared with the controls, and only e¢ (p<0.001) was decreased. The LVMI (p<0.001), LVPWT (p<0.001), IVST (p<0.001) increased while E/A (p<0.001) decreased. The GLS avg (p=0.008) was significantly decreased in PD patients compared with the controls. DSrA avg (p=0.006) and E/DSrE avg (p=0.006) were increased, while DSrE avg (p<0.001), DSrIVR avg (p=0.017) and E/DSrA avg (p<0.001) decreased. After the multivariable regression analysis, the correlation between DSrE and the conventional parameters including LVPWT (p<0.001), E/A (p<0.001) still remained significant. Conclusions: Young PD patients with preserved LVEF already exhibited myocardial diastolic dysfunction. Global diastolic strain rate indexes were valuable parameters to evaluate diastolic dysfunction. Additionally, LVPWT was highly correlated with DSrE, such parameter should be taken into account for predicting the early LV diastolic dysfunction in clinical practice.

scholarly journals The associations of circulating microRNA-133a with parameters of hypertension heart disease in patients with arterial hypertension and obesity

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Yushko ◽  
S Koval ◽  
I Snihurska ◽  
O Mysnychenko
Keyword(s):  
Heart Disease ◽  
Arterial Hypertension ◽  
Diastolic Function ◽  
Comparison Group ◽  
Left Ventricular ◽  
Main Group ◽  
Control Group ◽  
Circulating Microrna ◽  
Plasma Microrna ◽  
Lv Diastolic Function

Abstract Introduction Blood pressure (BP) elevation leads to chronical increasing left ventricular (LV) overload, LV hypertrophy (LVH), impaired LV relaxation, development of LV diastolic dysfunction (DD), left atrial (LA) enlargement, which result in development of hypertension heart disease (HDD), increased risk of atrial fibrillation and heart failure. MicroRNA-133a is one the epigenetics factor, which has cardioprotective properties, but its role in the development of HHD in hypertension patients with obesity is not well understood. Purpose The aim of the study was to investigate the circulating microRNA-133a levels in patients with hypertension and obesity and to define its associations with components of HHD. Methods The study involved 82 patients with arterial hypertension grades 2–3 and obesity (44 men and 38 women) aged 43 to 70. All patients were separate in two groups: 45 patients with HHD (main group) and 37 patients without HHD (comparison group). The control group consisted of 21 practically healthy individuals of comparable gender and age. The HHD was defined as LVH in hypertension patients with/without LV DD. The LVH was determined according to the 2018 ESC/ESH guidelines. The LV DD was determined according to the 2016 ASE/EACVI recommendations. Obesity was diagnosed at body mass index ≥30 kg/m2. Circulating plasma microRNA-133a levels were obtained by polymerase chain reaction using the CFX96 Touch System, “TaqMan microRNA Assay” and “TaqMan® Universal PCR Master Mix” reagent kits. Results The levels of microRNA-133a in main group were significantly lower than in comparison group and control group (0.133 [0.099; 0.184] vs 0.238 [0.155; 0.410], p&lt;0.05 and 0.382 [0.198; 0.474]), p&lt;0.05). In the main group 23 patients had LV DD and 25 patients had normal LV diastolic function. In patients with LV DD the levels of circulating plasma microRNA-133a were significantly lower than in patients with normal LV diastolic function (0.094 [0.067; 0.147] vs 0.152 [0.092; 0.189]), p&lt;0.05). In the main group there was a statistically significant negative correlation between microRNA-133a levels and LV mass index (R=−0.37, p&lt;0.01) and no significant correlation with ejection fraction, LA size or E/e' (averaged) ratio (p&gt;0.05). In patients of the comparison group there were not significant associations of microRNA-133a levels with LV parameters (p&gt;0.05). Conclusion The results of the study indicate a significant role of decreased circulating plasma microRNA-133a levels in patients with arterial hypertension and obesity in the pathogenesis and development of HHD and such its components as LVH and LV DD. Funding Acknowledgement Type of funding source: None

scholarly journals impact of dapagliflozin on left ventricular diastolic function in diabetic patients with heart failure complicating cardiovascular risk factors

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Soga ◽  
H Tanaka ◽  
K Tatsumi ◽  
Y Mochizuki ◽  
H Sano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Diastolic Function ◽  
Sglt2 Inhibitor ◽  
Density Lipoprotein ◽  
Left Ventricular ◽  
Lv Diastolic Function

Abstract Funding Acknowledgements Type of funding sources: None. Background Type 2 diabetes mellitus (T2DM) is a well-known risk factor for heart failure (HF), even in patients without a structural heart disease or a symptom of HF. Diabetes-related cardiomyopathy is presented as an left ventricular (LV) diastolic dysfunction, which, like cardiovascular disease, is a contributor of the development of HF in both patients with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). Furthermore, comorbid factors other than T2DM also have been identified as high risk factors for of progression to HF. Dapagliflozin is a sodium glucose cotransporter type 2 (SGLT2) inhibitor, and represents a new class of anti-hyperglycemic agents for T2DM. A result from a recent large clinical trial showed that dapagliflozin reduced risk of worsening HF or death from cardiovascular causes for patients with HFrEF compared to those who received a placebo, regardless of the presence or absence of T2DM. However, the effect of SGLT2 inhibitors on LV diastolic function in T2DM patients with HF who had cardiovascular risk factors other than T2DM remains uncertain. Purpose Our purpose was to investigate the impact of dapagliflozin on LV diastolic function in T2DM patients with stable HF complicating cardiovascular risk factors. Methods We analyzed data from our previous prospective multicenter study, which investigate the effect of dapagliflozin on LV diastolic function of 53 T2DM patients with stable HF at five institutions in Japan. Patients who had been taking at least one antidiabetic drugs other than SGLT2 inhibitor started the administration of dapagliflozin. Cardiovascular risk factors other than T2DM was determined as age, gender, hypertension, dyslipidemia, history of cardiovascular events and overweight. Results E/e′ significantly decreased from 9.3 to 8.5 cm/s 6 months after administration of dapagliflozin (p = 0.020) as previously described. Multivariate logistic regression analysis showed that dyslipidemia was the only independent determinant of an improvement of E/e’ among cardiovascular risk factors. Furthermore, relative changes in E/e’ from baseline to 6 months after administration of dapagliflozin seen in HFpEF patients with dyslipidemia were significantly larger than those in HFpEF patients without dyslipidemia (-15.2% vs. 29.6%, p = 0.014), but such a difference was not observed in non-HFpEF patients. In addition, relative changes in high-density lipoprotein cholesterol (HDL-C) from baseline to 6 months after administration of dapagliflozin had significant correlation with those in E/e’ (r=-0.300, p = 0.038). However, such correlations were not observed in low-density lipoprotein cholesterol (LDL-C) and triglyceride (r = 0.05, p = 0.72 and r = 0.05, p = 0.73). Conclusion: Dapagliflozin was more beneficial effect on LV diastolic function for T2DM patients with stable HF, especially those with complicating dyslipidemia. Our findings may thus offer a new insight into the management of T2DM patients with HF. Abstract Figure.

scholarly journals Validation of evaluating left ventricular diastolic function with estimated left atrial volume from anteroposterior diameter

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yonghuai Wang ◽  
Liang Zhang ◽  
Shuang Liu ◽  
Guangyuan Li ◽  
Fanxin Kong ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Left Atrial ◽  
Large Scale ◽  
Left Atrial Volume ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Summation Method ◽  
Anteroposterior Diameter ◽  
Validation Set ◽  
Lv Diastolic Function

Abstract Background Left atrial (LA) volume (LAV) is one of the recommended key variables for evaluating left ventricular (LV) diastolic function. However, only LA anteroposterior diameter (LAAP) is available in numerous large-scale existing databases. Therefore, this study aimed to validate whether LV diastolic function could be evaluated with estimated LAV from LAAP. Methods A total of 552 inpatients with sinus rhythm were consecutively enrolled. LAV was measured by biplane Simpson’s disk summation method. LV diastolic function was evaluated according to the 2016 proposed recommendations. Best-fitting regression models of LAAP index (LAAPI)–LAV index (LAVI) were developed and equations with the highest F-value were chosen in the first 276 subjects (derivation set), and concordance for evaluating LV diastolic function between using estimated and observed LAVI was verified in the remaining 276 subjects (validation set). Results In the derivation set, the linear model has the highest F-value in all subjects and in the subjects with normal or depressed LV ejection fraction. In the validation set, using the linear equation (LAVI = 2.05 × LAAPI − 13.86), the higher area under curve and narrower range of difference were shown between estimated LAVI and observed LAVI, respectively. Further, concordance for diagnosis (overall proportion of agreement, 88.4%; κ = 0.79) and grading (overall proportion of agreement, 84.8%; κ = 0.74) of LV diastolic dysfunction was substantial between using estimated and observed LAVI. Conclusions LV diastolic function can be evaluated with estimated LAVI from LAAPI, which might provide a surrogate method when the direct measurement of LAV is not available.

scholarly journals Left Atrial Strain and Diastolic Function Abnormalities in Obese and Type 2 Diabetic Adolescents and Young Adults.

2020 ◽  
Author(s):  
Jeremy Mark Steele ◽  
Elaine M Urbina ◽  
Wojciech M Mazur ◽  
Philip R Khoury ◽  
Sherif F Nagueh ◽  
...  
Keyword(s):  
Young Adults ◽  
Strain Rate ◽  
Diastolic Function ◽  
Left Atrial ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Normal Weight ◽  
Adolescents And Young Adults ◽  
Lv Diastolic Function

Abstract Background: Adults with obesity and type 2 diabetes mellitus (T2DM) related to obesity are at increased risk of heart failure with preserved ejection fraction (HFpEF). Whether left ventricular (LV) diastolic function abnormalities related to obesity and T2DM start in adolescence and early adulthood is unknown. We non-invasively evaluated the differences seen in LV diastolic and left atrial (LA) function in adolescents and young adults with obesity and T2DM. Methods: We analyzed echocardiographic measures of LV diastolic function in patients with structurally normal hearts which were divided into 3 groups (normal weight, obese, and T2DM). Spectral and tissue Doppler and 2-D speckle tracking measurements of diastolic function were obtained. Logistic regression was performed to compare the prevalence of abnormalities in diastolic function based on the worst 25th percentile for each measure to determine the prevalence of diastolic and LA function abnormalities in obese and T2DM patients. Results: 331 teenagers and young adults (median age 22.1 years) were analyzed (101 normal weight, 114 obese, 116 T2DM). Obese and T2DM group had lower E/A and higher E/e’. Obese and T2DM patients had significantly lower atrial reservoir, conduit, and booster strain and worse reservoir and conduit strain rate compared to normal patients (p<0.001 for all measures). All patients had normal LA volumes. On multivariable analysis, conduit strain and reservoir and conduit strain rate were independently associated with having below the 25th percentile e’. Conduit strain rate was independently associated with having below the 25th percentile for mitral E/A ratio on multivariable analysis.Conclusions: Abnormal indices of LV diastolic function are detected in adolescents and young adults with obesity and T2DM. LA function and strain analysis were able to detect evidence of decreased reservoir, conduit, and booster strain in these patients although LA volume was normal. The use of LA function strain may increase our ability to detect early diastolic function abnormalities in this population.

scholarly journals Direct cardiac versus systemic effects of inorganic nitrite on human left ventricular function

2021 ◽  
Author(s):  
Kevin O'Gallagher ◽  
Ana R Cabaco ◽  
Matthew Ryan ◽  
Ali Roomi ◽  
Haotian Gu ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Sodium Nitrite ◽  
Diastolic Pressure ◽  
Contractile Function ◽  
Systolic Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Cardiac Contractile Function ◽  
Lv Systolic Function ◽  
Lv Diastolic Function

Background Inorganic nitrite generates nitric oxide (NO) in vivo and is considered a potential therapy in settings where endogenous NO bioactivity is reduced and left ventricular (LV) function impaired. However, the effects of nitrite on human cardiac contractile function, and the extent to which these are direct or indirect, are unclear. Methods and Results We studied 40 patients undergoing diagnostic cardiac catheterisation who had normal LV systolic function and were not found to have obstructive coronary disease. They received either an intracoronary sodium nitrite infusion (8.7-26 mmol/min, n=20) or an intravenous sodium nitrite infusion (50 mg/kg/min, n=20). LV pressure-volume relations were recorded. The primary end point was LV end-diastolic pressure (LVEDP) while secondary end points included indices of LV systolic and diastolic function. Intracoronary nitrite infusion induced a significant reduction in LVEDP, LV end-diastolic pressure-volume relationship (EDPVR) and the time to LV end-systole (LVEST) but had no significant effect on measures of LV systolic function or systemic haemodynamics. Intravenous nitrite infusion induced greater effects, with significant decreases in LVEDP, EDPVR, LVEST, LV dP/dtmin, tau, and mean arterial pressure. Conclusions These results indicate that inorganic nitrite has modest direct effects on human LV diastolic function, independent of LV loading conditions and without affecting LV systolic properties. The systemic administration of nitrite has larger effects on LV diastolic function which are related to reduction in both preload and afterload. These effects of inorganic nitrite indicate a favourable profile for conditions characterized by LV diastolic dysfunction, e.g. heart failure with preserved ejection fraction.

scholarly journals Global diastolic strain rate for the assessment of left ventricular diastolic dysfunction in young peritoneal dialysis patients: a case control study

2020 ◽  
Author(s):  
Jing Zhu ◽  
Fei Shi ◽  
Tao You ◽  
Chao Tang ◽  
Jianchang Chen
Keyword(s):  
Peritoneal Dialysis ◽  
Strain Rate ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Volume Index ◽  
Diastolic Strain Rate ◽  
Diastolic Velocity ◽  
Lv Diastolic Function

Abstract Background: Left ventricular (LV) myocardial longitudinal diastolic strain rate measured by two-dimensional speckle tracking imaging (2D-STI) was proved to have a better correlation with the LV diastolic function. We aimed to use this sensitive tool to predict LV myocardial diastolic dysfunction in young peritoneal dialysis (PD) patients with preserved LV ejection fraction (LVEF). Methods: We enrolled 30 PD patients aged ≤60 with LVEF ≥54% and classified as normal LV diastolic function by conventional echocardiography, and 30 age- and sex-matched healthy people as the control group. The left atrial maximum volume index (LAVI), LV mass index (LVMI), LVEF, LV posterior wall thickness (LVPWT), interventricular septal thickness (IVST), peak velocity of tricuspid regurgitation (TR), peak early diastolic velocity/late diastolic velocity(by Pulsed Doppler) (E/A) and E/peak velocity of the early diastolic wave (by Pulsed-wave tissue Doppler) (E/e’) were recorded by conventional echocardiographic. Next, the average LV global longitudinal systolic strain (GLS avg) and the average LV global longitudinal diastolic strain rate (DSr avg) during early diastole (DSrE avg), late diastole (DSrA avg) and isovolumic relaxation period (DSrIVR avg) were obtained from 2D-STI. Combined them with E, the new noninvasive indexes (E/DSrE avg, E/DSrA avg and E/DSrIVR avg) were derived. Results: The PD group ’s LVEF, E/e¢, TR and LAVI were in the normal range compared with the controls, and only e¢ (p<0.001) was decreased. The LVMI (p<0.001), LVPWT (p<0.001), IVST (p<0.001) increased while E/A (p<0.001) decreased. The GLS avg (p=0.008) was significantly decreased in PD patients compared with the controls. DSrA avg (p=0.006) and E/DSrE avg (p=0.006) were increased, while DSrE avg (p<0.001), DSrIVR avg (p=0.017) and E/DSrA avg (p<0.001) decreased. After the multivariable regression analysis, the correlation between DSrE and the conventional parameters including LVPWT (p<0.001), E/A (p<0.001) still remained significant. Conclusions: Young PD patients with preserved LVEF already exhibited myocardial diastolic dysfunction. Global diastolic strain rate indexes were valuable parameters to evaluate diastolic dysfunction. Additionally, LVPWT was highly correlated with DSrE, such parameter should be taken into account for predicting the early LV diastolic dysfunction in clinical practice.

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