scholarly journals Cardiac manifestations of GH deficiency after treatment for acromegaly: a comparison to patients with biochemical remission and controls

2008 ◽  
Vol 159 (6) ◽  
pp. 705-712 ◽  
Author(s):  
Agatha A van der Klaauw ◽  
Jeroen J Bax ◽  
Gabe B Bleeker ◽  
Eduard R Holman ◽  
V Delgado ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Gh Deficiency ◽  
Systolic Function ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Healthy Controls ◽  
Cross Sectional ◽  
Diastolic Velocity ◽  
Active Acromegaly ◽  
Biochemical Remission

ObjectiveBoth GH excess and GH deficiency (GHD) lead to specific cardiac pathology. The aim of this study was to evaluate cardiac morphology and function in patients with GHD after treatment for acromegaly.DesignCross-sectional study.Patients and methodsCardiac parameters were studied by conventional two-dimensional echocardiography and tissue Doppler imaging in 53 patients with acromegaly (16 patients with GHD, 20 patients with biochemical remission, and 17 patients with active disease). Patients with GHD were also compared with age- and gender-matched controls.ResultsLeft ventricular (LV) dimensions, wall thickness, and mass did not differ between the three groups, or between the patients with GHD and healthy controls. Systolic function, assessed by LV ejection fraction, tended to be lower in patients with GHD compared with patients with biochemical remission (65.9±7.3% vs 72.4±8.5%, P=0.070), but was higher when compared with active acromegaly (58.8±9.3%, P=0.047). No differences were found with healthy controls. Diastolic function, measured with early diastolic velocity (E′), was lower in patients with GHD when compared with both patients with biochemical remission (6.0±2.1 cm/s vs 8.3±1.5 cm/s, P=0.005) and healthy controls (8.1±1.9 cm/s, P=0.006).ConclusionGHD after acromegaly results in a specific decrease in diastolic function compared with patients with biochemical remission of acromegaly and healthy controls. In addition, systolic function tends to be decreased in patients with GHD compared with patients with biochemical remission, but was higher than that in patients with active acromegaly.

scholarly journals Persistent diastolic dysfunction despite successful long-term octreotide treatment in acromegaly

2005 ◽  
Vol 153 (2) ◽  
pp. 231-238 ◽  
Author(s):  
S W van Thiel ◽  
J J Bax ◽  
N R Biermasz ◽  
E R Holman ◽  
D Poldermans ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Diastolic Function ◽  
Biological Effects ◽  
Hormone Secretion ◽  
Growth Hormone Secretion ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Diastolic Velocity ◽  
Active Acromegaly

Introduction: This study was designed to evaluate potential reversibility of left-ventricular (LV) dysfunction in patients with acromegaly following long-term control of disease. It is unknown whether the cardiac changes induced by acromegaly can be reversed completely by long-term strict control of growth hormone excess by octreotide. Patients and methods: We compared LV systolic and diastolic function in inactive patients with acromegaly (n = 22), who were divided into patients with long-term control by octreotide (n = 14) and patients with long-term cure by surgery/radiotherapy (n = 8). We also assessed these parameters in patients with active acromegaly (n = 17). Results: In patients with active acromegaly, systolic function at rest was decreased by 18% (P < 0.01), LV mass index increased by 40% (P < 0.04) and isovolumetric relaxation time increased by 19% (P < 0.01), compared with patients with inactive acromegaly. These parameters were not different between well-controlled and cured patients. Using tissue Doppler imaging, the ratio between early and late diastolic velocity (E′/A′ ratio) was decreased in active, compared with inactive acromegaly (0.75±0.07 versus 1.24±0.15; P < 0.01). This E′/A′ ratio was considerably higher in cured, compared with octreotide-treated, patients (1.75±0.41 versus 1.05±0.1; P < 0.01). Conclusion: Diastolic function is persistently and significantly more impaired in acromegalic patients with long-term control by octreotide than in surgically cured patients, which points to biological effects of subtle abnormalities in growth hormone secretion. Criteria for strict biochemical control of acromegaly should thus be reconsidered.

scholarly journals Arrest of atherosclerosis progression after interruption of GH replacement in adults with congenital isolated GH deficiency

2012 ◽  
Vol 166 (6) ◽  
pp. 977-982 ◽  
Author(s):  
Vanessa P Araujo ◽  
Manuel H Aguiar-Oliveira ◽  
Joselina L M Oliveira ◽  
Hertaline M N Rocha ◽  
Carla R P Oliveira ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Function ◽  
Gh Deficiency ◽  
Systolic Function ◽  
Receptor Gene ◽  
Intima Media Thickness ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Carotid Imt ◽  
Gh Replacement

ObjectiveGH replacement therapy (GHRT) in adult-onset GH deficiency (AOGHD) reduces carotid intima-media thickness (IMT) and increases myocardial mass, with improvement of systolic and diastolic function. These observations have reinforced the use of GHRT on AOGHD. Conversely, we have previously reported that in adults with lifetime congenital and severe isolated GH deficiency (IGHD) due to a mutation in GHRH receptor gene (GHRHR), a 6-month treatment with depot GH increased carotid IMT, caused the development of atherosclerotic plaques, and an increase in left ventricular mass index (LVMI), posterior wall, and septal thickness and ejection fraction. Such effects persisted 12 months after treatment (12-month washout – 12mo).MethodsWe have studied the cardiovascular status (by echocardiography and carotid ultrasonography) of these subjects 60 months after completion of therapy (60-month washout – 60mo).ResultsCarotid IMT reduced significantly from 12 to 60mo, returning to baseline (pre-therapy) value. The number of individuals with plaques was similar at 12 and 60mo, remaining higher than pre-therapy. LVMI, relative posterior wall thickness, and septum thickness did not change between 12 and 60mo, but absolute posterior wall increased from 12 to 60mo. Systolic function, evaluated by ejection fraction and shortening fraction, was reduced at 60mo in comparison with 12mo returning to baseline levels. The E/A wave ratio (expression of diastolic function) decreased at 60mo compared with both 12mo and baseline.ConclusionsIn adults with lifetime congenital IGHD, the increase in carotid IMT elicited by GHRT was transitory and returned to baseline 5 years after therapy discontinuation. Despite this, the number of subjects with plaques remained stable at 60mo and higher than at baseline.

scholarly journals Highly active antiretroviral therapy and left ventricular diastolic function in children with human immunodeficiency virus infection

2019 ◽  
Vol 59 (3) ◽  
pp. 139-43
Author(s):  
Ni Made Ayu Agustini ◽  
Eka Gunawijaya ◽  
Ni Putu Venny Kartika Yantie ◽  
Ketut Dewi Kumara Wati ◽  
Komang Ayu Witarini ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Highly Active Antiretroviral Therapy ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Cross Sectional ◽  
Ventricular Diastolic Function ◽  
Highly Active

Background In the past, cardiovascular involvement did not seem to be a common complication of HIV, but in recent years it has been described more frequently. With the advent of highly active antiretroviral therapy (HAART), the symptoms of cardiac disease has changed, as the number of HIV-infected patients with abnormal diastolic parameters has increased significantly, often presenting as symptomatic rather than asymptomatic. Objective To analyze for a possible correlation between HAART duration and left ventricular diastolic function in HIV-infected children. Methods This cross-sectional study was conducted from December 2016 to December 2017 at the Cardiology and Allergy-Immunology Division/Department of Child Health, Universitas Udayana Medical School/Sanglah Hospital, Denpasar, Bali. Subjects with HAART were collected using a consecutive sampling method. The following data were recorded for each subject: age, sex, current stage of HIV, CD4+ level, as well as HAART regimen and duration of use. Transthoracic echocardiography was performed for tissue doppler imaging (TDI) of diastolic function. Spearman’s test was used to analyze the strength of correlation based on normality test results. Results This study involved 53 subjects, 21 of whom had impaired diastolic function. There was no correlation between HAART duration and diastolic function in children with HIV infection (r= -0.03; P=0.82). Conclusion Diastolic dysfunction is found in children under HAART treatment, but there is no correlation between HAART treatment duration and diastolic dysfunction.

scholarly journals P282 Left ventricular diastolic dysfunction in asymptomatic type 2 diabetes mellitus with preserved systolic function

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Mouadili ◽  
M Sebani ◽  
C Mbauchy ◽  
M El Hattaoui ◽  
S El Karimi
Keyword(s):  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Systolic Function ◽  
Stress Test ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Type Ii ◽  
Cross Sectional ◽  
Glucose Levels

Abstract The involvement of diabetes in the occurrence of an alteration of the diastolic function of LV is well established. The objective of our study was to evaluate the prevalence of diastolic dysfunction in Type II diabetic patients in light of the latest 2016 recommendations of the American Society of Echocardiography and to identify its associated factors. It was a cross-sectional observational study with a descriptive and analytic focus spread over a 6-month period from July to December 2017.The study included 66 asymptomatic type II diabetic patients, with a normal ECG and a negative stress test ischemia. All hypertensive subjects with an ejection fraction &lt;50%, or those with myocardial, valvular or rhythm disorder, were excluded. The mean age of our patients, was 42 years ± 9 years with extremes ranging from 39 to 84 years, we noted a female predominance (68%) with a sex ratio of 2.14. The prevalence of diastolic dysfunction was 27%. Factors associated with this change in diastolic function were advanced age (p &lt;0.0001), age of diabetes&gt; 10 years (p &lt;0.0001), glycemic imbalance with HbA1c&gt; 7% (p &lt;0) , 0001) and elevated fasting glucose levels (p = 0.039), obesity (p &lt;0.0001), dyslipidemia (p &lt;0.0001) and menopause (p = 0.002). Diastolic dysfunction affects a significant percentage of patients with type II diabetes. Therefore, we propose strict glycemic control in these patients, an early cardiographic echo screening in at-risk subjects, in order to improve their management, and to limit their progression to more serious complications.

scholarly journals Right and left ventricular adaptation to hypoxia: a tissue Doppler imaging study

2005 ◽  
Vol 289 (4) ◽  
pp. H1391-H1398 ◽  
Author(s):  
Sandrine Huez ◽  
Kathleen Retailleau ◽  
Philippe Unger ◽  
Adriana Pavelescu ◽  
Jean-Luc Vachiéry ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Wave Velocity ◽  
Tissue Doppler Imaging ◽  
Systolic Function ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Lv Function ◽  
Tricuspid Annulus ◽  
Lv Systolic Function

Hypoxia has been reported to alter left ventricular (LV) diastolic function, but associated changes in right ventricular (RV) systolic and diastolic function remain incompletely documented. We used echocardiography and tissue Doppler imaging to investigate the effects on RV and LV function of 90 min of hypoxic breathing (fraction of inspired O2 of 0.12) compared with those of dobutamine to reproduce the same heart rate effects without change in pulmonary vascular tone in 25 healthy volunteers. Hypoxia and dobutamine increased cardiac output and tricuspid regurgitation velocity. Hypoxia and dobutamine increased LV ejection fraction, isovolumic contraction wave velocity (ICV), acceleration (ICA), and systolic ejection wave velocity (S) at the mitral annulus, indicating increased LV systolic function. Dobutamine had similar effects on RV indexes of systolic function. Hypoxia did not change RV area shortening fraction, tricuspid annular plane systolic excursion, ICV, ICA, and S at the tricuspid annulus. Regional longitudinal wall motion analysis revealed that S, systolic strain, and strain rate were not affected by hypoxia and increased by dobutamine on the RV free wall and interventricular septum but increased by both dobutamine and hypoxia on the LV lateral wall. Hypoxia increased the isovolumic relaxation time related to RR interval (IRT/RR) at both annuli, delayed the onset of the E wave at the tricuspid annulus, and decreased the mitral and tricuspid inflow and annuli E/A ratio. We conclude that hypoxia in normal subjects is associated with altered diastolic function of both ventricles, improved LV systolic function, and preserved RV systolic function.

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

2000 ◽  
pp. 363-369 ◽  
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.

scholarly journals Diastolic function in Steinert’s disease

2014 ◽  
Vol 6 (1) ◽  
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 <em>vs</em> 42.1 years ±11 in control group P 0.4). 6 /26 patients with Steinert’s disease disclosed a left ventricular (LV) ejection fraction &lt;50%. Mean left atrial (LA) diameter was statistically different between Steinert‘s patients and patients in group control (27.8 mm ±8.5 <em>vs</em> 19.7 mm ±4; P=0.0018). Mean peak E/A mitral ratio was 1.29±0.45 in Steinert’s patients <em>vs</em> 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 <em>vs</em> 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 <em>vs</em> 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.

scholarly journals ASYMPTOMATIC DIABETICS

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.

scholarly journals Left ventricular global dyssynchrony is exaggerated with age

2015 ◽  
Vol 1 (1) ◽  
pp. 47 ◽  
Author(s):  
Gani Bajraktari ◽  
Per Lindqvist ◽  
Michael Henein
Keyword(s):  
Diastolic Function ◽  
Systolic Function ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Tei Index ◽  
Ejection Time ◽  
Upper Limit ◽  
Lv Dyssynchrony ◽  
Filling Time ◽  
Effect Of Age

<p>Background and Aim: Total isovolumic time (t-IVT) and Tei index both reflect global left ventricular (LV) dyssynchrony. They have been shown to be sensitive in responding to myocardial revascularization and in predicting clinical outcome in heart failure patients. Since most these patients are senior, determining the exact effect of age on such parameters remains mandatory. The aim of this study was to investigate the effect of age on LV t-IVT and Tei index compared with conventional systolic and diastolic parameters in normal individuals.</p><p><span>Methods: </span>We studied 47 healthy individuals, mean age 62+/-12 years (24 female), who were arbitrarily classified into three groups: M (middle age), S (seniors), and E (elderly), using spectral Doppler echocardiography and tissue-Doppler imaging. We studied the interrelation between age, LV systolic and diastolic function parameters as well as t-IV [60 – (total ejection time + total filling time) in s/min], and Tei index (T-IVT/ejection time).</p><p><span>Results: </span>LV ejection fraction was 68+/-6%, E/A ratio 1+/-0.4, filling time 538+/-136ms, ejection time 313+/-26ms, t-IVT 7.7+/-2.6 s/min and Tei index 0.41+/-0.14. Age strongly correlated with t-IVT (r=0.8, p&lt;0.001) and with Tei index (r=0.7, p&lt;0.001) but not with QRS duration. Age also correlated with E/A ratio (r=-0.6, p&lt;0.001), but not with global or segmental systolic function measurements. Mean values for t-IVT were 5.5 (95% CI, 4.6-6.3 s/min) for M, 6.9 (95% CI, 6.0-7.8 s/min) for S and 9.5 (95% CI, 8.4-10.6 s/min) for E groups. The corresponding upper limit of the t-IVT 95% normal CI (calculated as mean +/-2SD) for the three groups was 8.3 s/min, 10.5 s/min and 14.5 s/min, respectively. The upper limit of normal t-IVT 95% CI was significantly shorter in the S compared with the E group (p=0.001). T-IVT correlated with A wave (r=0.66, p&lt;0.001), E/A ratio (r=-0.56, p&lt;0.001), septal e’ (r=-0.49, p=0.001) and septal a’ (r=0.4, p=0.006), but not with QRS.</p><p><span>Conclusion: </span>In normals, age is associated with exaggerated LV global dyssynchrony and diastolic function disturbances, but systolic function remains unaffected. The strong relationship between age and t-IVT supports its potential use as a marker of global LV dyssynchrony. In addition, variations in the upper limit of normal values, particularly in the elderly may have significant clinical applications in patients recommended for CRT treatment.</p>

scholarly journals Left Ventricular Systolic Function Has Strong Independent Genetic Background from Diastolic Function: A Classical Twin Study

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 935
Author(s):  
Andrea Ágnes Molnár ◽  
Márton Kolossváry ◽  
Bálint Lakatos ◽  
Márton Tokodi ◽  
Ádám Domonkos Tárnoki ◽  
...  
Keyword(s):  
Environmental Factors ◽  
Diastolic Function ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Environmental Influence ◽  
Systolic Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Apical Rotation ◽  
Diastolic Velocity

Background and Objectives: No data are available on whether the heritability of left ventricle (LV) systolic and diastolic parameters are independent of each other. Therefore, our aim was to assess the magnitude of common and independent genetic and environmental factors defining LV systolic and diastolic function. Materials and Methods: We analyzed 184 asymptomatic twins (65% female, mean age: 56 ± 9 years). Transthoracic echocardiography was performed to measure LV systolic (global longitudinal and circumferential strain; basal and apical rotation) and diastolic (early diastolic velocity of mitral inflow and lateral mitral annulus tissue; deceleration time and early diastolic strain rate) parameters using conventional and speckle-tracking echocardiography. Genetic structural equation models were evaluated to quantify the proportion of common and specific genetic (Ac, As) and environmental factors (Ec, Es) contributing to the phenotypes. Results: LV systolic parameters had no common genetic or environmental heritability (Ac range: 0–0%; Ec range: 0–0%; As range: 57–77%; Es range: 24–43%). Diastolic LV parameters were mainly determined by common genetic and environmental effects (Ac range: 9–40%; Ec range: 11–49%; As range: 0–29%; Es range: 0–51%). Systolic parameters had no common genetic or environmental factors (Ac = 0%; Ec = 0%) with diastolic metrics. Conclusions: Systolic LV parameters have a strong genetic predisposition to any impact. They share no common genetic or environmental factors with each other or with diastolic parameters, indicating that they may deteriorate specifically to given effects. However, diastolic functional parameters are mainly affected by common environmental influences, suggesting that pathological conditions may deteriorate them equally. Estimation of the genetic and environmental influence and interdependence on systolic and diastolic LV function may help the understanding of the pathomechanism of different heart failure classification types.

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