scholarly journals Arterial stiffness as a factor of structural and functional cardiac remodeling in obesity

2020 ◽  
Vol 25 (5) ◽  
pp. 3756
Author(s):  
M. A. Druzhilov ◽  
T. Yu. Kuznetsova
Keyword(s):  
Blood Pressure ◽  
Waist Circumference ◽  
Arterial Stiffness ◽  
Diastolic Dysfunction ◽  
Abdominal Obesity ◽  
Cardiac Remodeling ◽  
Left Atrial ◽  
Left Ventricular ◽  
Obese Patients ◽  
Lv Diastolic Dysfunction

Aim. To analyze the association of parameters characterizing the degree of arterial stiffness and echocardiographic criteria for cardiac remodeling in patients with abdominal obesity.Material and methods. The study included 194 patients (men aged 46 to 55 years (49,0±2,3 years)), without hypertension (24-hour average blood pressure (BP) 117,5±5,5/73,0±4,1 mmHg), diabetes and cardiovascular diseases, with abdominal obesity (waist circumference >94 cm, body mass index 31,3±3,5 kg/m2). Lipids and glucose concentrations were evaluated, and glomerular filtration rate was estimated using the CKD-EPI equation. We conducted 24-hour monitoring of blood pressure and arterial stiffness parameters (aortic pulse wave velocity (PWV), augmentation index (AIx) and systolic BP in the aorta), and echocardiography.Results. Left ventricular (LV) hypertrophy was detected in 14 (7,2%) patients, LV diastolic dysfunction — in 36 (18,6%) patients. The correlation of the average aortic PWV and the AIx with the LV mass index and the left atrial volume was shown. Patients with a high aortic PWV exceeding the 75th percentile of distribution (8,2 m/s) were characterized by a higher incidence of hypertrophy (18,8% vs 4,9%,p<0,01) and LV diastolic dysfunction (50,0% vs 12,3%, p<0,001). Patients with/with-out LV hypertrophy and diastolic dysfunction were characterized by higher values of average 24-hour aortic PWV, AIx and systolic BP in the aorta. According to the regression analysis, the predictors of LV diastolic dysfunction were age, waist circumference, aortic PWV, and AIx.Conclusion. The relationship of parameters characterizing the degree of arterial stiffness, primarily, aortic PWV and echocardiographic parameters of the structural and functional cardiac remodeling in obese patients was revealed. Patients with a high aortic PWV (>8,2 m/s for men aged 46-55 years) are characterized by a higher prevalence of LV hypertrophy and diastolic dysfunction, as well as left atrial dilatation. This association is probably a reflection of one of the many pathogenesis links of HF and supraventricular cardiac arrhythmias in obese patients.

Abstract 608: Uric Acid Potentially Interacts With Parathyroid Hormone To Promote Left Ventricular Diastolic Dysfunction In Mice Fed A Western Diet

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Guanghong Jia ◽  
Brian P Bostick ◽  
Javad Habibi ◽  
Annayya R. Aroor ◽  
Vincent G. DeMarco ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Weight ◽  
Uric Acid ◽  
Parathyroid Hormone ◽  
Diastolic Dysfunction ◽  
Cardiac Mri ◽  
Left Ventricular ◽  
Western Diet ◽  
P Value ◽  
Lv Diastolic Dysfunction

Hyperuricemia is frequently observed in obese people and rising obesity rates parallel increased consumption of a high-fat/high-fructose western diet (WD). Epidemiologic and clinical data suggest that serum uric acid (UA) is positively associated with serum parathyroid hormone (PTH) and may be linked with left ventricular (LV) hypertrophy and LV diastolic dysfunction. Accordingly, we hypothesized that allopurinol, a potent xanthine oxidase (XO) inhibitor, would prevent development of LV diastolic dysfunction, independent of blood pressure, by reducing the levels of UA and PTH. Four week-old C57BL6/J male mice were fed a WD and water with 125mg/L allopurinol. After 16 weeks, we assessed levels of UA, XO activity, PTH, as well as diastolic function by cardiac MRI and cardiac ultrastructure by transmission electron microscopy (TEM). Body weight and fat composition were obtained along with HOMA -IR testing for insulin resistance. Allopurinol has been show to exert no effect on blood pressure. High resolution cardiac MRI revealed diastolic dysfunction with WD feeding that was prevented by allopurinol (LV diastolic relaxation time 35.3 ms for WD, 25.4 ms for CD and 27.7 ms for WD+ allopurinol, p value <0.01; Initial filling rate 0. 28 μl/ms for WD, 0.43 μl/ms for CD and 0.42 μl/ms for WD+ allopurinol, p value <0.05). Body weight, fat mass, and HOMA-IR were increased by WD feeding but not significantly improved by allopurinol. However, allopurinol markedly decreased the WD-induced increase in heart weight associated with activation of translational S6 kinase. TEM examination of myocardial ultrastructure revealed that WD induced remodeling changes with large mitochondria with disordered cristae and increased lysosomes. The ultrastructural changes were improved with treatment by allopurinol. Furthermore, allopurinol significantly inhibited both of plasma and urine UA levels and cardiac XO activity caused by WD. Interestingly , WD increased PTH levels which were decreased in parallel with reductions in uric acid with allopurinol. These findings support the notion that increased plasma levels of UA, in concert with elevated PTH, may play a key role in LV hypertrophy and associated LV diastolic dysfunction that result from consuming a WD high in fructose and fat.

scholarly journals P1387 Correlations between left atrial strain parameters and left ventricular function in young patients presenting with acute ST elevation myocardial infarction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A I Scarlatescu ◽  
M M Micheu ◽  
M Stoian ◽  
D Zamfir ◽  
I Petre ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Young Patients ◽  
Left Ventricular ◽  
Systolic Strain ◽  
Left Atrial Strain ◽  
Peak Systolic Strain ◽  
Atrial Strain ◽  
Lv Diastolic Dysfunction

Abstract Funding Acknowledgements This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF Background Previous studies demonstrated the role of left atrial (LA) deformation parameters in characterisation of left ventricular (LV) diastolic dysfunction. It is a marker of the severity of diastolic dysfunction; LA remodelling also proved to be a predictor of clinical outcome, therefore a prognostic marker in acute coronary syndromes. Purpose In this study we aimed to investigate the correlations between left atrial strain and conventional systolic and diastolic dysfunction parameters in a cohort of young patients with acute ST elevation myocardial infarction (STEMI) treated by primary PCI. Material and methods We included 56 consecutive patients in this study: 46 patients under 50 years of age with STEMI and 10 healthy age and sex matched controls. We performed conventional transthoracic echocardiography for all included patients. In addition to conventional echocardiographic parameters, LA strain curves were obtained for each patient using two-dimensional speckle tracking imaging with measurement LA deformation parameters. Results LV ejection fraction, LV global strain and peak LA systolic strain (PALS) were significantly reduced in STEMI patients compared to controls. PALS had significant correlation with 2D LVEF (p = 0.00), LV global longitudinal strain (p = 0.03), E wave (p &lt; 0.05), E/e’ (p &lt; 0.05), left atrial volume and the type of diastolic dysfunction (p = 0.06). PALS also had inversre correlation with the presence of an occluded coronary artery at angiography. PALS was higher in control group than in STEMI group ( 34.6 vs 20.4, p &lt; 0.05). PALS values progressively decreased with worsening of LV diastolic dysfunction showing significant differences between all diastolic dysfunction grades. Using ROC (Receiver operating Characteristics) analysis we identified a cut off value of 25.9 (Sensibility 88%, Specificity 74%, AUC 0.94, CI 95%, p &lt; 0.05) to discriminate between diastolic dysfunction and normal diastolic function. Moreover, PALS was significantly different in patients with normal vs high LV filling pressures. Using ROC analysis we determined a cut off value of 14.5 for LA peak systolic strain to discriminate between the two subgroups, with excellent discrimination power, AUC 0.935, CI 95%, p = 0.045, Sensibility 100%, Specificity 91%. Therefore LA peak systolic strain could be considered a surrogate estimate of LV filling pressures. Conclusion LA peak systolic strain correlated significantly with LV systolic and diastolic function in young patients with acute myocardial infarction treated with primary PCI. Peak LA strain may be helpful as a complementary method to evaluate diastolic dysfunction in this patient population and may also improve the detection of elevated LV filling pressures.

P5466Exaggerated exercise blood pressure response is accompanied by increased sympathetic activity and arterial stiffness in subjects with high normal blood pressure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kalos ◽  
C Tsioufis ◽  
K Dimitriadis ◽  
N Vogiatzakis ◽  
A Kasiakogias ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Waist Circumference ◽  
Arterial Stiffness ◽  
Sympathetic Nerve ◽  
Muscle Sympathetic Nerve Activity ◽  
Left Ventricular ◽  
Normal Blood ◽  
Peak Exercise ◽  
Normal Blood Pressure ◽  
Arterial Stiffening

Abstract Background/Introduction The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity and arterial stiffening are linked with adverse cardiovascular prognosis. Purpose The aim of this study was to assess the relation of HRE with sympathetic drive as assessed by muscle sympathetic nerve activity (MSNA) and arterial stiffness in subjects with high normal BP. Methods 42 subjects with high normal office BP [defined as office systolic BP=130–139 mmHg and office diastolic BP=85–89 mmHg (age: 53±9 years, 29 males, office BP: 134/84 mmHg, 24-hour BP: 114/72 mmHg)] with a negative treadmill exercise test (Bruce protocol) were divided into those with HRE (n=12) (peak exercise systolic BP ≥210mmHg in men and ≥190 mmHg in women) and those without HRE (n=30). Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV) values. In all participants sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography). Results Subjects with a HRE compared to those without exhibited higher waist circumference (108.2±5.3 vs 94.7±9.2 cm, p=0.001) and were characterized by greater levels of carotid to femoral PWV (8.5±0.8 vs 7.0±0.9 m/sec, p<0.001) and sympathetic nerve traffic as reflected by MSNA levels (41.1±1.5 vs 32.1±1.9 bursts per 100 heart beats, p<0.001), while did not differ regarding metabolic profile and left ventricular mass index (p=NS). In the total population, peak exercise systolic BP was related to 24-h systolic BP (r=0.229, p<0.05), PWV (r=0.218, p=0.002), and MSNA (r=0.214, p<0.05). Moreover, MSNA was related to waist circumference (r=0.33, p=0.004) and office systolic BP levels (r=0.31, p<0.05) but there was no association with PWV values (p=NS). Conclusion In subjects with high normal BP, a HRE identifies a state of arterial stiffening and sympathetic overdrive, as reflected by increased PWV and MSNA levels respectively. These finding suggest that exercise testing provides additional clinical information regarding the vascular status and modulation of sympathetic tone in this setting.

Abstract 14069: Subclinical Impairment of Left Ventricular Function in Stage A Subjects in a Community-based Population

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Takuya Hasegawa ◽  
Masanori Asakura ◽  
Hideaki Kanzaki ◽  
Hiroshi Asanuma ◽  
Seiji Takashio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Dysfunction ◽  
Left Ventricular ◽  
Community Dwelling ◽  
Lv Function ◽  
Mitral Annular Velocity ◽  
Lv Mass ◽  
Lv Diastolic Dysfunction

Introduction: Stage A heart failure (HF) is defined as an asymptomatic state with HF risk factors of hypertension, diabetes, obesity, metabolic syndrome, and atherosclerotic disease in the absence of obvious left ventricular (LV) structural changes including LV hypertrophy (LVH). ACC/AHA guidelines recommend us to treat these risk factors of Stage A HF patients to prevent the progression of HF, hinting us to investigate the prevalence of subclinical impairment of LV function in Stage A subjects in general populations. Methods: We studied 1162 community-dwelling subjects without obvious heart diseases (mean age, 63±11 years; 448 men, 714 women, 63% with hypertension and 11% with diabetes) in the annual health checkup in a rural community, Arita-cho, Saga, Japan. The population was divided into 3 groups; the subjects without either LVH or the HF risk factors ("Stage 0"), the subjects with the HF risk factors in the absence of LVH (Stage A) , and the subjects in the presence of LVH (Stage B). LV systolic and diastolic function were estimated by mitral annular velocity in systole (s'), and the waves of transmitral flow (E) and mitral annular velocity (e'), respectively. LVH was defined as the top quintile of LV mass index. Results: The subjects in Stage A had the lower and higher values of s' and E/e', respectively, and the higher prevalence of LV diastolic dysfunction than those in Stage 0, while 45% of Stages A subjects showed LV diastolic dysfunction (Table). In multivariate logistic analyses, age, systolic blood pressure and LV mass were independent determinants of s', whereas either overlapped or different risk factors, such as age, sex, systolic blood pressure, and body mass index emerged as the determinants for E/e'. Conclusions: Even without obvious LV remodeling, subclinical LV systolic and diastolic impairment was observed in Stage A subjects. The disparity of the risk factors between LV systolic and diastolic dysfunction may indicate their pathophysiological differences.

scholarly journals Prevalence and Risk Factors of Left Ventricular Diastolic Dysfunction in Patients With Hyperthyroidism

2021 ◽  
Vol 11 ◽  
Author(s):  
Huan Li ◽  
Renli Zeng ◽  
Yunfei Liao ◽  
Mengfei Fu ◽  
Huan Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Thyroid Hormones ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Left Ventricular ◽  
Obese Patients ◽  
Control Subjects ◽  
Lv Diastolic Dysfunction ◽  
Overt Hyperthyroidism

BackgroundLeft ventricular (LV) diastolic dysfunction has been demonstrated to be an independent predictor of the future heart failure. Heart failure is one of the severe complications caused by overt hyperthyroidism. However, the effects of overt hyperthyroidism on diastolic dysfunction are conflicting, and little is known about the prevalence and risk factors of the diastolic dysfunction in patients with overt hyperthyroidism.MethodsA total of 388 patients with overt hyperthyroidism were included and compared with 388 age- and gender- matched euthyroid control subjects. LV diastolic function was evaluated by traditional and tissue-Doppler echocardiography. Routine clinical medical data and echocardiographic parameters were recorded for analysis.ResultsThe prevalence of LV diastolic dysfunction was 35.1% among hyperthyroid patients and significantly higher than control subjects whose prevalence was 25.5% (P = 0.003), and it increased with age and body mass index (BMI) in patients with overt hyperthyroidism. The possible risk factors for LV diastolic dysfunction, such as hypertension, diabetes, decreased estimated glomerular filtration rate (eGFR), and increased level of thyroid hormones weren’t associated with LV diastolic dysfunction. However, overweight or obese were significantly associated with LV diastolic dysfunction (OR = 3.024, 95% CI = 1.517–6.027, P = 0.002) compared with normal BMI. When compared with age &lt;40 years old group, 40-50 years old group, 50-60 years old group and age ≥60 years old group were significantly associated with LV diastolic dysfunction, with ORs of 2.976 (95% CI = 1.744–5.019), 12.424 (95% CI = 4.934–31.283), 24.966 (95% CI = 5.975–104.321), respectively.ConclusionLV diastolic dysfunction was very common, in particular, in older and overweight or obese patients with overt hyperthyroidism. Additionally, age and BMI were independent risk factors for LV diastolic dysfunction, while the level of thyroid hormones was not. Therefore, besides the LV systolic function, we also need focus on the diastolic function in patients with overt hyperthyroidism in clinical work, especially the older and overweight or obese patients.

scholarly journals Is hepatojugular reflux a good predictor of heart failure with preserved ejection fraction?

2019 ◽  
Vol 65 (5) ◽  
pp. 592-595
Author(s):  
Guilherme Cristianini Baldivia ◽  
João Vitor Moraes Pithon Napoli ◽  
Josiane Motta e Motta ◽  
Normando Gomes Vieira Filho ◽  
Heno Ferreira Lopes
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Diastolic Dysfunction ◽  
Left Ventricular ◽  
Uncontrolled Blood Pressure ◽  
Volume Increase ◽  
Functional Changes ◽  
Left Atrium Volume ◽  
Lv Diastolic Dysfunction ◽  
Symptoms And Signs

SUMMARY Hypertension may occur with left ventricular (LV) diastolic dysfunction, and the consequence may be symptoms and signs of heart failure (HF). Hepatojugular reflux (HJR), described as a sign of regurgitation of the tricuspid valve, may reflect structural and functional changes of the LV in the hypertensive patient. The signal may be present in the presence of HF. Case: male, 49 years old with uncontrolled blood pressure. Physical examination showed jugular turgescence, HJR, and elevated blood pressure. Complementary exams showed signs of atrial and left ventricular overload in the electrocardiogram and, the echocardiogram showed left atrium volume increase, concentric LV hypertrophy and signs of grade I diastolic dysfunction. DISCUSSIO: The HJR present correlates with pulmonary artery pressure and probably reflect the increase in central blood volume.

P4372Left atrial strain: a potential marker of early diastolic dysfunction in patients with Marfan syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Garcia-Izquierdo Jaen ◽  
S Mingo Santos ◽  
M Torres Sanabria ◽  
V Monivas Palomero ◽  
S Moreno Casado ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ejection Fraction ◽  
Strain Rate ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Healthy Controls ◽  
Left Atrial Strain ◽  
Strain And Strain Rate ◽  
Atrial Strain

Abstract Background/Introduction Previous studies using conventional echocardiographic measurements have reported subclinical left diastolic dysfunction in patients with Marfan syndrome (MFS). Left atrial strain (LAS) has been shown to be an accurate predictor of left ventricular diastolic dysfunction. However, there is no evidence regarding the use of LAS in MFS. Purpose To assess feasibility of LAS and compare LAS derived measurements along with traditional diastolic parameters in MFS patients vs healthy controls. Methods 46 MFS patients (normal LV ejection fraction, no previous cardiovascular surgery, no significant valvular regurgitation) vs. 20 healthy controls (age and sex-matched). We performed LAS analysis using 2D speckle-tracking (QLAB 10, Philips). LA strain was determined as the average value of the longitudinal deformation (7 segments) in the apical 4-chamber view (RR gating). Results LAS analysis was feasible in 40 MFS patients (87%). All participants had normal diastolic function according to current guidelines (ASE/EACVI 2016). MFS patients showed lower TDI e' velocities and higher average E/e' ratio, but still within normal range. Similarly, LVEF was normal but slightly reduced in MFS patients. LA strain and strain rate parameters during reservoir and conduit phase were significantly impaired in MFS patients compared to controls. MFS vs controls MFS patients (n=40) Controls (n=20) p MFS patients (n=40) Controls (n=20) p Age 33.8±12.4 34.4±8.3 0.846 Septal e' (cm/s) 9.7±2.5 11.7±2.3 0.006 Male (%) 24 (60%) 12 (60%) 1.000 Average E/e' ratio 6.8±1.5 5.5±1.1 0.002 SBP (mmHg) 120.3±12.4 120.1±9.4 0.969 TR velocity (cm/s) 208.6±21.4 201.6±22.9 0.390 DBP (mmHg) 72.0±10.1 67.1±6.2 0.069 LAVi (ml/m2) 23.5±7.1 25.5±4.8 0.260 Aortic root (mm) 40.3±4.6 31.7±3.7 <0.001 LASr (%) 32.6±8.8 43.0±8.3 <0.001 LVEF (%) 60.9±5.6 64.2±4.2 0.022 LAScd (%) −20.1±8.0 −29.4±5.5 <0.001 E-wave (cm/s) 74.6±16.5 76.7±16.5 0.651 LASct (%) −12.8±6.1 −13.6±5.2 0.622 A-wave (cm/s) 55.2±10.9 52.0±12.8 0.327 LASRr 2.02±0.49 2.31±0.43 0.030 E/A ratio 1.4±0.4 1.5±0.4 0.287 LASRcd −2.22±0.61 −3.07±0.68 <0.001 Lateral e' (cm/s) 13.0±3.6 16.3±3.3 0.002 LASRct −2.24±0.90 −2.35±0.75 0.600 SBP: Systolic blood pressure. DBP: Diastolic blood pressure. LVEF: Left ventricular ejection fraction. LAVi: Left atrial volume index. LAS: Left atrial strain. LASR: Left atrial strain rate. (r): Reservoir. (cd): Conduit. (ct): Contraction. Example of LA strain and strain rate Conclusion MFS patients showed a subtle impairment in diastolic function compared to controls. Although further evidence is needed, LAS derived parameters could be early markers of diastolic dysfunction in this group of patients. Acknowledgement/Funding Programa de Actividades de I+D de la Comunidad de Madrid

scholarly journals Prevalence of arterial stiffness and the risk of myocardial diastolic dysfunction in women

2016 ◽  
Vol 36 (5) ◽  
Author(s):  
Ute Seeland ◽  
Anna Brecht ◽  
Ahmad T. Nauman ◽  
Sabine Oertelt-Prigione ◽  
Mirjam Ruecke ◽  
...  
Keyword(s):  
Waist Circumference ◽  
Arterial Stiffness ◽  
Diastolic Dysfunction ◽  
Vascular Function ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Female Population ◽  
Ventricular Diastolic Dysfunction

The present study reports markers of vascular function among a general female population and shows that left ventricular diastolic dysfunction (LVDD) is significantly associated with pathological PWV (⩾9.7 m/s), a waist circumference >80 cm and age.

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