Beneficial Effect of Sodium-Glucose Co-transporter 2 Inhibitors on Left Ventricular Function

2021 ◽  
Author(s):  
Fang-Hong Shi ◽  
Hao Li ◽  
Long Shen ◽  
Li Xu ◽  
Heng Ge ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Sglt2 Inhibitor ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Sglt2 Inhibitors ◽  
Volume Index ◽  
Cochrane Library ◽  
Lv Function ◽  
Left Atrial Volume Index ◽  
Reduced Ejection Fraction

Abstract Background Sodium-glucose cotransporter 2 (SGLT2) inhibitors lowered the risk of cardiovascular events in patients with diabetes or heart failure (HF) with reduced ejection fraction, whether they directly promote cardiac function remains unclear. Therefore, we sought to determine whether SGLT2 inhibitors could improve left ventricular (LV) function in these patients. Methods A literature search was conducted using MEDLINE, EMBASE, and Cochrane Library databases from their inception to 9 July 2021. Randomised clinical trials and cohort studies that reported LV function-related variables were included. Results Thirteen studies comprising 1437 patients (830 SGLT2 inhibitor-treated and 607 non-SGLT2 inhibitor-treated patients) and representing seven RCTs with 640 individuals and six cohort studies with 797 individuals were included in this meta-analysis. LV regression (LV mass, LVM), LV ejection fractions (LVEF), LV volumes (LV end-diastolic volumes and -systolic volumes, LVEDV and LVESV), and LV diastolic function (mitral inflow E velocity to tissue Doppler e’ ratio, E/e’ and left atrial volume index, LAVI) were all significantly improved in patients treated with SGLT2 inhibitors (weighted mean differences, 95% confidence interval, LVM: ‒6.319 g, ‒10.850 to ‒1.789; LVEF: 2.458 %, 0.693 to 4.224; LVEDV: ‒9.134 mL, ‒15.808 to ‒2.460; LVESV: ‒8.440 mL, ‒15.093 to ‒1.787; LAVI: ‒2.791 mL/m 2, ‒4.554 to ‒1.027; E/e’: ‒1.567, ‒2.440 to ‒0.698). Subgroup analysis further confirmed the improvement of LV function mainly in patients with HF or those receiving empagliflozin treatment. Conclusions Treatment with SGLT2 inhibitors can significantly improve LV function in patients with or without diabetes (especially those with HF or undergoing empagliflozin treatment).

The Effect of Angiotensin Receptor Inhibitors and Neprilysin on Aortic Stiffness in Patients with Heart Failure and Reduced Ejection Fraction

2021 ◽  
Vol 76 (3) ◽  
pp. 298-306
Author(s):  
Alexey S. Ryazanov ◽  
Evgenia V. Shikh ◽  
Konstantin I. Kapitonov ◽  
Mariya V. Makarovskaya ◽  
Alexey A. Kudryavtsev
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Aortic Stiffness ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Atrial Volume Index ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Background. Compared with enalapril, sacubitril/valsartan reduces mortality from cardiovascular diseases and the number of hospitalizations for heart failure in patients with heart failure and reduced ejection fraction (HFrEF). These benefits may be related to effects on hemodynamics and cardiac remodeling. The aim of the study is to determine the effect of sacubitril/valsartan on aortic stiffness and cardiac remodeling compared with enalapril in HFrEF. Materials and methods. In this long-term outpatient study, 100 patients with HFrEF received sacubitril/valsartan or enalapril. The primary endpoint was the change in arterial impedance (aortic stiffness characteristic) over a 12-month follow-up. Secondary endpoints included changes in N-terminal cerebral natriuretic propeptide (NT-proBNP), ejection fraction, left atrial volume index, E/e index, left ventricular end-systolic and end-diastolic volumes; left ventricular-arterial index (Ea/Ees). Results. During 12 months of follow-up, 100 patients showed significant differences between the groups with respect to changes in arterial impedance, which decreased from 224.0 to 207.9 dynes s/ cm5 in the sacubitrile/valsartan group and increased from 213.5 to 214.1 dyne s/cm5 in the enalapril group (difference between groups: 9.3 dynes s/ cm5; 95% CI: from 16.9 to 12.8 dynes s/cm5; p = 0.69). Also, there were intergroup differences in the change in left ventricular ejection fraction and Ea/Ees index. NT-proBNP level, left ventricular end-diastolic and systolic volume index, left atrial volume index, E/e index were reduced in the sacubitril/valsartan group. Conclusions. Treatment with sacubitril/valsartan compared with enalapril resulted in a significant reduction in aortic stiffness in HFrEF.

scholarly journals Left Atrial Volume Index in Diagnosis of Heart Failure With Preserved Ejection Fraction

2021 ◽  
Author(s):  
Xingxue Pang ◽  
Ruoyi Liu ◽  
Li Xu ◽  
Xin Tao ◽  
Xuezeng Hao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Pressure ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Control Group ◽  
Preserved Ejection Fraction ◽  
Left Atrial Volume Index ◽  
Reduced Ejection Fraction

Abstract Objective To assess the value of left atrium volume index（LAVI）for diagnosing heart failure with preserved ejection fraction (HFpEF) based on the invasive determination of left ventricular end-diastolic pressure (LVEDP).Methods A total of 710 cases of patients with dyspnea (LVEF≥50%) were enrolled in this retrospective study. Left ventricular end-diastolic pressure (LVEDP) was measured through selective coronary angiography. According to the value of LVEDP, cases were divided into the HFpEF group ( LVEDP≥15mmHg) and the control group (LVEDP<15mmHg). LAVI was calculated based on cardiac compartment diameter, as measured by echocardiography, and body surface area (BSA). Differences of LAVI between the HFpEF group and the control group, and between subgroups in the HFpEF group were analyzed.Results The difference in LAVI between the control group and the HFpEF group was statistically significant (41.35±2.28vs.46.78±2.63ml/m2, p=0.008). LVEDP was positively correlated with LAVI (Pearson: r=0.787, P＜0.001). When LAVI took the best cutoff value of 43.7 mm/m2, the sensitivity and specificity of diagnosis of HFpEF were 92.0% and 88.9%. When the boundary value of LAVI was from 41.7 to 45.7 mm/m2, the sensitivity of the diagnosis of ejection fraction retention heart failure was from 97.4% to 64.4% and the specificity was from 51.2.0% to 92.2%.Conclusion In patients with dyspnea after exclusion of heart failure with reduced ejection fraction (HFrEF), LAVI is positively correlated with LVEDP. LAVI can be used to diagnose HFpEF when HFrEF is excluded.

scholarly journals Diastolic left ventricular function in relation to the retinal microvascular fractal dimension in a Flemish population

2021 ◽  
Author(s):  
Fang-Fei Wei ◽  
Lutgarde Thijs ◽  
Jesus D. Melgarejo ◽  
Nicholas Cauwenberghs ◽  
Zhen-Yu Zhang ◽  
...  
Keyword(s):  
Fractal Dimension ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Lv Function ◽  
Vascular Networks ◽  
Left Atrial Volume Index ◽  
Lv Dysfunction ◽  
Diastolic Left Ventricular Function ◽  
Box Counting Method

AbstractFractal analysis provides a global assessment of vascular networks (e.g., geometric complexity). We examined the association of diastolic left ventricular (LV) function with the retinal microvascular fractal dimension. A lower fractal dimension signifies a sparser retinal microvascular network. In 628 randomly recruited Flemish individuals (51.3% women; mean age, 50.8 years), we measured diastolic LV function by echocardiography and the retinal microvascular fractal dimension by the box-counting method (Singapore I Vessel Assessment software, version 3.6). The left atrial volume index (LAVI), e′, E/e′ and retinal microvascular fractal dimension averaged (±SD) 24.3 ± 6.2 mL/m2, 10.9 ± 3.6 cm/s, 6.96 ± 2.2, and 1.39 ± 0.05, respectively. The LAVI, E, e′ and E/e′ were associated (P < 0.001) with the retinal microvascular fractal dimension with association sizes (per 1 SD), amounting to −1.49 mL/m2 (95% confidence interval, −1.98 to −1.01), 2.57 cm/s (1.31–3.84), 1.34 cm/s (1.07–1.60), and −0.74 (−0.91 to −0.57), respectively. With adjustments applied for potential covariables, the associations of E peak and E/e′ with the retinal microvascular fractal dimension remained significant (P ≤ 0.020). Over a median follow-up of 5.3 years, 18 deaths occurred. The crude and adjusted hazard ratios expressing the risk of all-cause mortality associated with a 1-SD increment in the retinal microvascular fractal dimension were 0.36 (0.23–0.57; P < 0.001) and 0.57 (0.34–0.96; P = 0.035), respectively. In the general population, a lower retinal microvascular fractal dimension was associated with greater E/e′, a measure of LV filling pressure. These observations can potentially be translated into new strategies for the prevention of diastolic LV dysfunction.

Abstract 13798: Influence of Advanced Pulmonary Vascular Remodeling on Accuracy of Echocardiographic Parameters of Left Ventricular Filling Pressure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yasuyuki Chiba ◽  
Hiroyuki Iwano ◽  
Sanae Kaga ◽  
mio shinkawa ◽  
Michito Murayama ◽  
...  
Keyword(s):  
Left Atrial Volume ◽  
Right Heart Catheterization ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Vascular Lesions ◽  
Volume Index ◽  
Control Group ◽  
Heart Catheterization ◽  
Left Atrial Volume Index ◽  
Echocardiographic Parameters

Introduction: Evaluation of left ventricular (LV) filling pressure (FP) plays an important role in the clinical management of pulmonary hypertension (PH). However, the accuracy of echocardiographic parameters for the estimation of LV FP in the presence of pulmonary vascular lesions has not been fully addressed. Methods: We investigated 87 patients diagnosed with PH due to pulmonary vascular lesions (non-cardiac PH; PH NC ) (PH NC group) and 117 patients with ischemic heart disease without reduced LV ejection fraction (<40%) (control group). Mean pulmonary arterial wedge pressure (PAWP) and pulmonary vascular resistance (PVR) were obtained by right heart catheterization. As echocardiographic parameters of LV FP, the ratio of early- (E) to late-diastolic transmitral flow velocity (E/A), ratio of E to early-diastolic mitral annular velocity (E/e'), and left atrial volume index (LAVI) were measured. The PH NC group was subdivided into non-severe and severe groups according to median PVR (5.3 Wood units). Results: PAWP was 12±5 mmHg in controls, 9±4 mmHg in non-severe PH NC , and 8±3 mmHg in severe PH NC . In the control and non-severe PH NC groups, positive correlations were observed between PAWP and E/A (R=0.66 and R=0.41, respectively), E/e' (R=0.36 and R=0.33), and LAVI (R=0.38 and R=0.62). In contrast, in the severe PH NC group, PAWP was only correlated with LAVI (R=0.41, p=0.006). In the control group, PAWP determined E (β=0.45, p<0.001) but PVR did not, whereas both PAWP and PVR were independent determinants of E (β=0.32, p=0.001; and β=-0.35, p<0.001, respectively) in the PH NC group. Conclusions: In the presence of advanced pulmonary vascular lesions, conventional Doppler echocardiographic parameters may not accurately reflect LV FP. Importantly, elevated PVR would lower the E value, even when PAWP is elevated, resulting in blunting of these parameters for the detection of elevated LV FP. LAVI might be a reliable parameter for estimating LV FP in patients with severe non-cardiac PH.

Abstract 4205: Left Atrial Volume Index and Left Ventricular Geometry Independently Predict Mortality in 47,865 Patients with Preserved Ejection Fraction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Dharmendrakumar A Patel ◽  
Carl J Lavie ◽  
Richard V Milani ◽  
Hector O Ventura
Keyword(s):  
Ejection Fraction ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Mortality Prediction ◽  
Volume Index ◽  
Left Ventricular Geometry ◽  
Preserved Ejection Fraction ◽  
Atrial Volume ◽  
Left Atrial Volume Index

Background: LV geometry predicts CV events but it is unknown whether left atrial volume index (LAVi) predicts mortality independent of LV geometry in patients with preserved LVEF. Methods: We evaluated 47,865 patients with preserved EF to determine the impact of LAVi and LV geometry on mortality during an average follow-up of 1.7±1.0 years. Results: Deceased patients (n=3,653) had significantly higher LAVi (35.3 ± 15.9 vs. 29.1 ± 11.9, p<0.0001) and abnormal LV geometry (60% vs. 41%, p<0.0001) than survivors (n=44,212). LAVi was an independent predictor of mortality in all four LV geometry groups [Hazard ratio: N= 1.007 (1.002–1.011), p=0.002; concentric remodeling= 1.008 (1.001–1.012), p<0.0001; eccentric hypertrophy= 1.012 (1.006 –1.018), p<0.0001; concentric hypertrophy=1.017 (1.012–1.022), p<0.0001; Figure ]. Comparison of models with and without LAVi for mortality prediction was significant suggesting increased mortality prediction by addition of LAVi to other independent predictors (Table ). Conclusion: LAVi is higher and LV geometric abnormalities are more prevalent in deceased patients with preserved systolic function and are independently associated with increased mortality. LAVi predicts mortality independent of LV geometry and has synergistic influence on all cause mortality prediction in large cohort of patients with preserved ejection fraction.

Abstract 5794: Geometric Changes of Mitral Annulus Assessed by Real-Time 3-Dimensional Transesophageal Echocardiography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yoshiki Matsumura ◽  
Manatomo Toyono ◽  
Neil L Greenberg ◽  
Tetsuhiro Yamano ◽  
Kunitsugu Takasaki ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Real Time ◽  
Left Atrial Volume ◽  
Normal Subjects ◽  
Shape Index ◽  
Left Ventricular ◽  
Volume Index ◽  
Area Index ◽  
Left Atrial Volume Index ◽  
Geometric Changes

Background: The mitral annular (MA) geometric changes have been reported in patients with various cardiac diseases such as atrial fibrillation (Af), mitral regurgitation (MR) and dilated cardiomyopathy (DCM). The advances of real-time 3D transesophageal echocardiography (TEE) enable us to analyze the MA geometry more accurately and reliably than 3D transthoracic echocardiography (TTE). We sought to determine the independent predictors for MA geometric changes in patients with Af, significant MR, and DCM by 3D TEE. Methods: We examined 32 subjects by 3D TEE and 2D TTE; 6 with lone Af, 9 with mitral valve prolapse (MVP), 3 with organic MR, 6 with DCM, and 8 normal subjects. Left ventricular (LV) end-diastolic and end-systolic volume indices (EDVI and ESVI), ejection fraction (EF), left atrial volume index (LAVI), and MR severity were assessed by 2D TTE. We measured MA area index, commissural length, and MA height (Figure 1 ). For the index of the saddle-shaped MA geometry, MA shape index was calculated as the (MA height)/(commissural length). Results: Patients with MVP and those with DCM had larger MA area index and lower MA shape index than normal subjects (all, P <0.05). MA area index was associated with LAVI, MR severity, and LV EDVI (all, P <0.05) (Figure 2 ). MA shape index was associated with LV EF, ESVI, and the presence of Af (all, P <0.05) (Figure 3 ). In multivariate analysis, LAVI, MR severity, and LV EDVI independently predicted for MA area index, and LV EF was independent predictor for MA shape index (all, P <0.05). Conclusion: MA dilatation was independently associated with larger LA and LV volumes and severer MR, not LV EF, while the saddle-shaped MA geometry was associated with LV EF. Figure 1 Figure 2 Figure 3

P1486Semi-automated volume-strain loops: a new tool in TTE to assess diastolic dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Hubert ◽  
V Le Rolle ◽  
E Galli ◽  
A Hernandez ◽  
E Donal
Keyword(s):  
Left Atrial ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Atrial Volume ◽  
Volume Strain ◽  
Left Atrial Volume Index ◽  
Loop Area ◽  
Lv Volume

Abstract Aim This work aims to evaluate a novel semi-automatic tool for the assessment of volume-strain loops by transthoracic echocardiography (TTE). The proposed method was evaluated on a typical model of left ventricular (LV) diastolic dysfunction: the cardiac amyloidosis. Method 18 patients with proved cardiac amyloidosis were compared to 19 controls, from a local database. All TTE were performed using Vivid E9 or E95 ultrasound system. The complete method includes several steps: 1) extraction of LV strain full traces from apical 4 and 2 cavities views, 2) estimation of LV volume from these two traces by spline interpolations, 3) resampling of LV strain curves, determined for the same cardiac beat, (in apical 4-, 2- and 3- cavities views) as a function of pre-defined percentage increments of LV-volume and 4) calculation of the LV volume-strain loop area. (Figure 1, panel B) Results (Table 1): LVEF was similar between both groups whereas global longitudinal strain was significantly lower in amyloidosis group (−14.4 vs −20.5%; p<0.001). Amyloidosis group had a worse diastolic function with a greater left atrial volume index (51 vs 22ml/m2), a faster tricuspid regurgitation (2.7 vs 2.0 m/s), a greater E/e' ratio (17.3 vs 5.9) with a p<0.001 for all these indices. Simultaneously, the global area of volume-strain loop was significantly lower in amyloidosis group (36.5 vs 120.0%.mL). This area was better correlated with mean e' with r=0.734 (p<0.001) than all other indices (Figure 1, panel A). Table 1 Amyloidosis (N=18) Controls (N=19) p Global strain-volume loop area (%.mL) 36.5±21.3 120.0±54.2 <0.001 Global longitudinal strain (%) −14.4±3.8 −20.5±1.8 <0.001 Left ventricular ejection fraction (%) 62±7 65±5 0.08 Left atrial volume index (ml/m2) 51±22 22±5 <0.001 E/A 1.72±0.97 2.07±0.45 0.17 Mean e' 5.5±1.3 14.4±2.8 <0.001 Mean E/e' 17.3±5.4 5.9±1.4 <0.001 Tricuspid regurgitation velocity (m/s) 2.7±3.8 2.0±0.3 <0.001 Figure 1 Conclusion LV volume-strain loop area appears a very promising new tool to assess semi-automatically diastolic function. Future applications will concern the integration of LV volume-strain loop area as novel feature in machine-learning approach.

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