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

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.

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

Acta Endocrinologica ◽

10.1530/eje.0.1430363 ◽

2000 ◽

pp. 363-369 ◽

Cited By ~ 21

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.

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Diastolic function in Steinert’s disease

Neurology International ◽

10.4081/ni.2014.5140 ◽

2014 ◽

Vol 6 (1) ◽

Cited By ~ 2

Author(s):

Abdallah Fayssoil ◽

Olivier Nardi ◽

Djillali Annane ◽

David Orlikowski

Keyword(s):

Diastolic Function ◽

Tissue Doppler ◽

Left Ventricular ◽

Doppler Imaging ◽

Control Group ◽

Diastolic Velocity ◽

Echocardiography Doppler ◽

Steinert's Disease ◽

Steinert’S Disease ◽

Deceleration Time

Myotonic dystrophy type 1 (MD) is the most common autosomal dominant muscular dystrophy in adults. Cardiac involvement is mainly characterized by conduction abnormalities and arrhythmias. We sought to assess diastolic function in MD patients. Echocardiography-Doppler was performed in Steinert’s patients and in a control group completed by tissue Doppler imaging (TDI). Twenty-six patients with Steinert’s disease were included in the study and were compared to a control group. Mean age was similar in the 2 groups (45.1 years ±10.9 in Steinert’s patients vs 42.1 years ±11 in control group P 0.4). 6 /26 patients with Steinert’s disease disclosed a left ventricular (LV) ejection fraction <50%. Mean left atrial (LA) diameter was statistically different between Steinert‘s patients and patients in group control (27.8 mm ±8.5 vs 19.7 mm ±4; P=0.0018). Mean peak E/A mitral ratio was 1.29±0.45 in Steinert’s patients vs 1.36±0.4 in control group (P=0.6). We found an increase of the mitral E deceleration time in Steinert’s patients in comparison with patients in control group (219 ms ±53 vs 176 ms ±29; P=0.013). Mean peak lateral early diastolic velocity Ea was similar in the 2 groups (12.3 cm/s ±3 vs 13.1 cm/s ±3.8; P=0.50). Mean peak septal early diastolic velocity was sim- ilar in the 2 groups (11.2 cm/s ±2 vs 10.4±2; P=0.51). We found an increase of the LA diameter and an increase of the mitral deceleration time in Steinert’s patients that suggest diastolic abnormalities.

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.0880 ◽

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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Assessment of Left Ventricular Diastolic Function in Children Undegoing Hemodialysis. A Mini Review

10.20944/preprints201811.0435.v2 ◽

2019 ◽

Author(s):

Ljiljana Sulovic ◽

Vladimir Sulovic ◽

Zorica Zivkovic ◽

Maja Vasic ◽

Nenad Sulovic ◽

...

Keyword(s):

Cardiovascular System ◽

Diastolic Function ◽

Tissue Doppler ◽

Left Ventricular ◽

Chronic Hemodialysis ◽

The State ◽

Doppler Imaging ◽

Control Group ◽

Functional Changes ◽

Ventricular Filling

Assessment of cardiac function is the leading parameter when evaluating the state of the cardiovascular system of patients undergoing chronic hemodialysis. The aim of the paper: to assess the state of the cardiovascular system of these patients using new sensitive echocardiography and Doppler techniques and thus advance the prevention of cardiovascular disease.Method: Twenty children with end-stage renal insufficiency on chronic hemodialysis and twenty healthy controls underwent echocardiographic monitoring using standard Doppler and tissue Doppler imaging. Structural and functional changes in the left ventricle were evaluated.Results: Patients on hemodialysis had significantly greater left ventricular mass indices compared to the controls (p<0.001). The patients on hemodialysis had preserved systolic function – their fractional shortening, ejection fraction and Sm (systolic myocardial velocity) did not differ significantly compared to the controls (p>0.05). Early diastolic function in children on hemodialysis was also preserved: the E/A and Em/Am ratio did not differ significantly from the control group (p>0.05). Children on hemodialysis exhibited impaired late diastolic function (compliance index), that is, considerably higher E/Em compared to controls (p<0.00). Myocardial Performance Index values showed statistically significant elevation in children on hemodialysis compared to the control group (p<0.001).Conclusion: Tissue Doppler in tandem with conventional Pulsed Doppler can provide additional information on left ventricular filling pressures (E/Em) in children on hemodialysis. It is therefore recommended to perform routine measuring of Em waves and the E/Em ratio, not only in order to evaluate myocardial relaxation and ventricular filling pressures, but primarily to stratify risk and provide a prognosis.

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ASYMPTOMATIC DIABETICS

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.11.1765 ◽

2016 ◽

Vol 23 (11) ◽

pp. 1373-1376

Author(s):

Liaqat Ali ◽

Naeem Asghar ◽

Imran Khan

Keyword(s):

Diabetes Mellitus ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Pulmonary Veins ◽

Tissue Doppler ◽

Cardiovascular Complications ◽

Left Ventricular ◽

Doppler Imaging ◽

Cross Sectional ◽

Color Flow

Background: Diabetes mellitus (DM) is not only a significant independent riskfactor for developing of atherosclerotic ischemic heart disease or ventricular hypertrophy but itis also able to trigger a diabetic cardiomyopathy due to dysmetabolic processes resulting heartfailure. Cardiovascular complications are known to be the main cause of death and morbidity indiabetic patients. Objectives: How frequent is the diastolic dysfunction in asymptomatic diabetic?Study Design: Descriptive cross sectional. Setting: Echocardiography department FaisalabadInstitute of Cardiology Faisalabad. Patients were recruited from outpatient department ofFaisalabad institute of cardiology Faisalabad. Duration of Study: Six months from: 28-06-2015to 28-12-2015. Methodology: 200 patients were included in the study. Patient’s bio data wasrecorded and informed consent was taken. All echocardiographic studies were performed withVIVID-07 echo machine by the same operator. Detailed assessment of left ventricular systolicand diastolic function by using standard 2-dimensional, color flow Doppler and tissue Dopplerimaging (TDI) was done. Images were obtained in all patients. Each patient underwent leftventricular (LV) diastolic function assessment by conventional Doppler, tissue Doppler imaging(TDI). LV ejection fraction was calculated using conventional method. Blood flow velocities atmitral valve leaflets and pulmonary veins were recorded with averaged from 3 end-expiratorycycles at a sweep of 100 mm/s. This information was collected through a specially designedproforma by the author. Results: In our study, out of 200 cases, 52%(n=104) were between 50-55 years of age while 48%(n=96) were between 56-60 years of age, mean+sd was calculatedas 55.54+2.59 years, 49%(n=98) were male while 51%(n=102) were females, frequency ofdiastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus wasrecorded as 45.5%(n=91) while 54.5%(n=109) had no findings of the morbidity. Conclusion:We conclude that the frequency of diastolic dysfunction is quite high (45.5%) in asymptomaticdiabetics.

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Prognostic importance of tissue Doppler imaging of systolic and diastolic functions in dogs with severe sepsis and septic shock

Acta Veterinaria Hungarica ◽

10.1556/004.2019.051 ◽

2019 ◽

Vol 67 (4) ◽

pp. 517-528

Author(s):

Mehmet Ege Ince ◽

Kursad Turgut ◽

Aybars Akar ◽

Amir Naseri ◽

Ismail Sen ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Diastolic Dysfunction ◽

Sensitivity And Specificity ◽

Mitral Annulus ◽

Tissue Doppler ◽

Left Ventricular ◽

Doppler Imaging ◽

Control Group ◽

Sepsis And Septic Shock

The goal of this study was to determine the distribution of left ventricular (LV) systolic and diastolic dysfunctions and their prognostic value in canine parvovirus-infected dogs suffering from severe sepsis and septic shock (SS/SS). Twenty dogs with SS/SS (experimental group) and 18 healthy dogs (control group) were used in the study. Systolic and diastolic dysfunction was present in three (15%) and 14 (70%) diseased dogs, respectively, with both types of dysfunction present in two (10%) of the patients. These dogs were split into two groups: survivors (Sv, n = 14) and non-survivors (non-Sv, n = 6). The pulsed wave tissue Doppler (PW-TDI) septal mitral annulus systolic velocity (LVS'), an index of systolic dysfunction, had a high sensitivity and specificity to differentiate Sv and non-Sv animals, with values of 83.3% (95% CI: 41.6–98.4) and 83.3% (95% CI: 59.8–94.8), respectively, at an optimum cut-off point of ≥ 9.90. The PW-TDI septal early mitral annulus early-diastolic peak velocity (E'), an index of diastolic dysfunction, had the best sensitivity and specificity to differentiate Sv and non-Sv dogs, with values of 100% (95% CI: 55.2–100) and 100% (95% CI: 78.9–100), respectively, at an optimum cut-off point of ≤ 6.50. Therefore, diastolic dysfunction determined by E' is a good independent outcome predictor.

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Detection and evaluation of left ventricular diastolic dysfunction in asymptomatic type 2 diabetic patients by conventional and tissue doppler imaging

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20194224 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1589

Author(s):

Ekanthalingam S. ◽

Sharavanan T. K. V. ◽

Kannan I. ◽

Premalatha E. ◽

Prasanna K. B.

Keyword(s):

Diastolic Dysfunction ◽

Tissue Doppler Imaging ◽

Tissue Doppler ◽

Left Ventricular ◽

Doppler Imaging ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Semiquantitative Assessment ◽

Grade Ii

Background: Diabetic cardiomyopathy is characterised predominantly by diastolic dysfunction. While the traditional echocardiography provides only semiquantitative assessment of diastolic dysfunction, tissue Doppler imaging proved to be an effective technique for the quantification of subclinical diastolic dysfunction.Methods: The current cross-sectional study was conducted in out-patient department of General Medicine, Tagore Medical College and Hospital for a period of 6 months. The study population comprised of 100 patients with type 2 diabetes mellitus including 39 male and 61 females. Echocardiography (using Siemens – Acuson NX3 Elite - system with TDI technology) was performed to all subjects in the left lateral position and 2D, M- mode, Doppler techniques were used. The early E wave corresponding to early ventricular filling and A wave which reflect a trial contraction were typically measured to assess the transmitral flow pattern. Systolic S' (Sa), early diastolic E (Ea) and the late diastolic velocities A' (Aa) were measured by tissue Doppler imaging.Results: The E/A ratio ranged from 0.5 to 2 and E/Ea ratio ranged from 1.59 to 14.67. Around 23 patients and 54 patients were abnormal by E/A and E/Ea ratios respectively. Around 29 patients showed grade II diastolic dysfunction by tissue Doppler imagingConclusions: Prompt diagnosis of diastolic dysfunction help us to identify high risk patients who are likely to be benefitted by early therapeutic intervention. Tissue Doppler imaging may be a better tool in the identification of diastolic dysfunction especially grade II in comparison with the conventional echocardiography.

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Assessment of Left Ventricular Diastolic Function in Children Undegoing Hemodialysis Using Various Doppler Techniques

10.20944/preprints201811.0435.v1 ◽

2018 ◽

Author(s):

Ljiljana Sulovic ◽

Vladimir Sulovic ◽

Zorica Zivkovic ◽

Jovan Zivkovic ◽

Maja Vasic ◽

...

Keyword(s):

Cardiovascular System ◽

Diastolic Function ◽

Tissue Doppler ◽

Left Ventricular ◽

Chronic Hemodialysis ◽

The State ◽

Doppler Imaging ◽

Control Group ◽

Doppler Techniques ◽

Ventricular Filling

Assessment of cardiac function is the leading parameter when evaluating the state of the cardiovascular system of patients undergoing chronic hemodialysis. The aim of the paper: to assess the state of the cardiovascular system of these patients using new sensitive echocardiography and Doppler techniques and thus advance the prevention of cardiovascular disease. Method: Twenty children with end-stage renal insufficiency on chronic hemodialysis and twenty healthy controls underwent echocardiographic monitoring using standard Doppler  and tissue Doppler imaging. Structural and functional changes in the left ventricle were evaluated. Results: Patients on hemodialysis had significantly greater left ventricular mass indices compared to the controls (p < 0.001). The patients on hemodialysis had preserved systolic function—their fractional shortening, ejection fraction and Sm (systolic myocardial velocity) did not differ significantly compared to the controls (p > 0.05). Early diastolic function in children on hemodialysis was also preserved: the E/A and Em/Am ratio did not differ significantly from the control group (p > 0.05). Children on hemodialysis exhibited impaired late diastolic function (compliance index), that is, considerably higher E/Em compared to controls (p < 0.00). Myocardial Performance Index values showed statistically significant elevation in children on hemodialysis compared to the control group (p < 0.001). Conclusion: Tissue Doppler in tandem with conventional Pulsed Doppler can provide additional information on left ventricular filling pressures (E/Em) in children on hemodialysis. It is therefore recommended to perform routine measuring of Em waves and the E/Em ratio, not only in order to evaluate myocardial relaxation and ventricular filling pressures, but primarily to stratify risk and provide a prognosis.

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Abstract 3199: Diastolic Dysfunction in Chronic Heart Failure and Aging - Effects of Exercise Training

Circulation ◽

10.1161/circ.118.suppl_18.s_1111-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Marcus Sandri ◽

Stephan Gielen ◽

Norman Mangner ◽

Robert Höllriegel ◽

Sandra Erbs ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Left Ventricular ◽

Doppler Imaging ◽

Control Group ◽

Aging Effects ◽

Training Effects ◽

Diastolic Left Ventricular Dysfunction

BACKGROUND: Diastolic left ventricular dysfunction may occur in both physiologic aging and chronic heart failure (CHF). It has, however, never been assessed, whether the degree of diastolic impairment in CHF is influenced by age and if the previously observed beneficial effects of exercise (ET) on left ventricular filling are diminished in old age. METHODS: In this study we randomised 53 pts. with stable CHF(LVEF 27.3±2.1%) and 51 healthy subjects (HS) (LVEF 61.5±2.7%) to a training (T) or a control group (C). To detect possible aging effects we included subjects <55 (young) and >65 years (old). Subjects in the T-group exercised 4 times daily at 60 to 70% of VO 2 max for 4 weeks under supervision. At baseline and after the intervention E/A ratio and lateral E/E′ ratio were determined by echocardiography and with tissue Doppler imaging. RESULTS: As compared to young HS, old HS showed at baseline a reduced E/A ratio and an increased E/È ratio (young: E/A 1.2±0.2; E/È 7.3±0.1 old: E/A 0.7±0.1; E/È 13.5±0.3; p<0.05). In CHF pts., diastolic function was impaired (young E/A 0.8±0.2; E/È 12.9±0.5 old: E/A 0.8±0.1; E/È 13.7±0.4). No difference of these baseline parameters between the age groups was observed (p=0.72). As a result of ET, E/A ratio improved from 0.7±0.1 to 1.2±0.2 and E/È ratio improved from 13.7±0.3 to 9.3±0.4 in old HS (p<0.05), while it remained unchanged in young training HS and C. In young and old pts. with CHF four weeks of ET resulted in a significant change in E/A ratio (young: from 0.8±0.1 to 1.2±0.1; p<0.05; old: from 0.7±0.1 to 1.1±0.2 p<0.05) and E/È ratio (young: from 13.1±0.3 to 10.1±0.2; p<0,05; old: from 14.1±0.3 to 11.2±0.3; p<0.05). In C no effect was detectable. CONCLUSIONS: The present trial provides new insight into chronobiology of cardiovascular training effects: Among HS aging is associated with the development of significant left ventricular diastolic dysfunction. In CHF both young and old pts. exhibit a similar degree of LV-dysfunction. Four weeks of ET are effective in improving diastolic function in old HS and in young and old CHF pts. The lusitropic training effects were not significantly diminished among older pts. underlining the potentials of rehabilitation interventions in this patient group.

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