scholarly journals Some Morpho-Functional Changes of the Left Heart in Patients with Viral Liver Cirrhosis

2018 ◽  
Vol 14 (4) ◽  
pp. 537-542
Author(s):  
M V. Chistyakova ◽  
A. V. Govorin ◽  
N. N. Kushnarenko
Keyword(s):  
Diastolic Function ◽  
Left Atrial Volume ◽  
Holter Monitoring ◽  
Nonparametric Test ◽  
Control Group ◽  
Lv Function ◽  
Myocardial Mass ◽  
Functional Changes ◽  
Concentric Hypertrophy ◽  
Lv Dysfunction

Material and methods. 55 patients with VLC class А, B, C according to Сhild-Pugh were examined. The average age of patients 42 years, disease duration – 3,8 years. Depending on the presence of ascites, patients were divided into 2 groups: 28 patients had no ascites (group 1), 27 patients had ascites (group 2), and a control group of 22 healthy people. Echocardiography was performed by the "VIVID E 95" device. All patients were evaluated diastolic function of the LV in accordance with the АSЕ/ЕAЕ-2009 and ASE/EACVI-2016 recommendations. Holter monitoring of ECG was performed. Statistical data processing was carried out using Statistica 6.0 statistical software package and Mann-Whitney nonparametric test. The correlation analysis was performed using the Spearman coefficient.Results. In all patients there was an increase in the index of myocardial mass and relative wall thickness of LV in comparison with the control group, more severe disorders were identified in patients with VLC with ascites, p<0.001. In the study of LV remodeling, concentric hypertrophy was most common in patients with VLC – in 11 (43%) patients of the 1st group and in 19 (70%) patients of the 2nd group. Holter monitoring of ECG revealed supraventricular extrasystoles in 9 (32%) patients of the 1st group and 11 (40%) – 2nd group; paroxysmal form of atrial fibrillation – in 2 (7%) patients and in 5 (18%), respectively. It was found that the maximum index of the left atrial volume was higher in patients with VLC compared to control, and in patients with ascites this disorder was more pronounced (p<0.001). In accordance with the ASE/EACVI-2016 algorithm, normal diastolic LV function was registered almost twice as often as when using the ASE/EAE-2009 algorithm. Undefined result was recorded in 8% of cases due to tricuspid regurgitation.Conclusion. Thus, patients with VLC develop an increase in the LV myocardial mass with the formation of concentric hypertrophy, remodeling of the left atrium with the occurrence of cardiac arrhythmias, diastolic LV dysfunction, and these changes are more pronounced in patients with ascites. In accordance with the new algorithm ASE/EACVI-2016 for detection of diastolic LV dysfunction, normal LV diastolic function was almost 2 times more common in patients with VLC than in accordance with the old ASE/EAE-2009 algorithm.

2139Left atrial dysfunction assessed by strain correlates with symptoms and severity of aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Santoro ◽  
A Pardo ◽  
R Hinojar ◽  
A Garcia ◽  
L Salido ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Speckle Tracking ◽  
Global Longitudinal Strain ◽  
Control Group ◽  
Lv Function ◽  
Functional Changes ◽  
Lv Dysfunction ◽  
Significant Difference ◽  
Atrial Strain ◽  
And Function

Abstract Background Aortic stenosis (AS) results in high pressure afterload causing detrimental effect especially on the left chambers. Structural and functional changes of the left ventricle (LV) usually corresponds to concomitant remodelling of the left atrium (LA). However, how this pressure afterload specifically affects LA function and whether the study of LA function could help in stratifying patients with different degree of AS it is not known. Purpose We aim to evaluate the differences in LA and LV function according different degree of AS by standard and speckle tracking echocardiographic. Methods From January 2016 to May 2018 we recruited 135 patients referring to our echo-lab with diagnosis of AS (mean age 79.5±4.4; 60/55% female). We divided this population according to AS severity in patients with moderate AS, severe asymptomatic and severe symptomatic AS and matched with 35 control group with no aortic stenosis (n=45, mean age: 77.6±4.5). All patients underwent standard and 2-dimensional speckle tracking echocardiography computing global longitudinal strain (GLS) of LV and peak atrial strain of LA (PALS). Results In all patients PALS was a good predictor of E/e' ratio after correction for LV EF and age (p<0.001, β: −0.48). LVEF and GLS progressively decreased together with worsening of AS degree, as well as parameters of geometry and function of LA (Table1). By excluding patients with LV dysfunction the reduction gradient of parameters of LA geometry and function was still present. However, when severe symptomatic with asymptomatic severe AS are compared, no difference in E/e' ratio was found while both GLS and PALS were significantly reduced (both p<0.0001). Variables Overall population (180) Control (45) Moderate AS (45) Severe asympt AS (45) Severe sympt. AS (45) p LVEF 65.0±11.1 67.7±5.6 69.4±8.5 66.1±10.7 59.5±13.5 0.0001 GLS −20.4±4.1 −23.1±2.4 −21.5±2.9 −21.4±3.2 −17.1±4.3 0.0001 LA vol index 41.6±21.5 28.2±10.4 40.1±19.7 39.8±16.7 52.3±24.9 0.0001 LA strain 23.6±10.9 30.8±10.3 27.8±9.2 24.4±9.7 15.2±7.1 0.0001 LA reservoir 46.4±15.9 51.9±11.5 53.0±15.0 48.3±14.1 37.2±16.1 0.0001 Ee' ratio 14.8±7.0 9.6±2.7 13.7±6.3 15.4±6.2 19.3±7.2 0.0001 Conclusions LA function seems to progressively decrease according to the degree of AS, independently from LV function. Significant difference was found between parameters of LA remodelling and dysfunction between symptomatic and asymptomatic AS patients. The assessment of LA function by strain may help stratify the patients with AS, identifying those who need intensive medical/surgical treatment.

P5655Efficacy of new-generation atrial antitachycardia pacing for atrial tachyarrhythmias in patients with left ventricular dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kamakura ◽  
K Nakajima ◽  
N Kataoka ◽  
M Wada ◽  
K Yamagata ◽  
...  
Keyword(s):  
Success Rate ◽  
Left Atrium ◽  
Persistent Atrial Fibrillation ◽  
Left Ventricular ◽  
Control Group ◽  
Lv Function ◽  
Antitachycardia Pacing ◽  
Atrial Tachyarrhythmias ◽  
Lv Dysfunction ◽  
New Generation

Abstract Background The progression to persistent atrial fibrillation (AF) is associated with a worse clinical outcome in patients with previous atrial tachyarrhythmias. New-generation atrial antitachycardia pacing (ATP) (Reactive ATP) reduced the progression to persistent AF in patients with pacemaker and preserved left ventricular (LV) function. However, little is known about the efficacy of Reactive ATP in patients with cardiac implantable electronic devices (CIED) and LV dysfunction. Purpose We aimed to investigate the efficacy of Reactive ATP for atrial tachyarrhythmias in patients with LV dysfunction (LV ejection fraction [LVEF] <40%). Methods This study included 423 patients with CIED and previous atrial tachyarrthythmias. Reactive ATP was programmed in 284 patients (ATP group) and 139 were implanted with a dual-chamber device without ATP function (control group). The differences in the success rate of ATP and incidence of progression to persistent AF (≥7 days) between the ATP and control groups were evaluated in 108 patients with LVEF <40% (reduced LVEF) and 315 with LVEF ≥40% (preserved LVEF). Patients with persistent AF were excluded from this study. Results During 710±337 days of follow-up period, 16 patients (15%) with reduced LVEF and 51 (16%) with preserved LVEF progressed to persistent AF (p=0.88). The mean ATP success rate was lower in patients with reduced LVEF than in those with preserved LVEF, although not statistically significant (reduced LVEF: 27.2±19.4% and preserved LVEF: 35.1±29.2%, p=0.12). The incidence of progression to persistent AF was significantly lower in the ATP group than in the control group both in patients with reduced and preserved LVEF (log-rank, reduced LVEF: p=0.0070 and preserved LVEF: p<0.0001) (Figure). Multivariate analysis showed that use of Reactive ATP and smaller left atrium were associated with lower incidences of persistent AF, while LVEF was not predictive of progression to persistent AF (Reactive ATP: hazard ratio [HR] 0.28, 95% confidence interval [CI] 0.17–0.46, p<0.0001, left atrium diameter: HR 1.03, 95% CI 1.00–1.07, p=0.030). Figure 1 Conclusions Reactive ATP was effective in preventing AF progression in patients with LV dysfunction.

scholarly journals Impact of Diabetes on Cardiac Function in Patients with High Blood Pressure

2021 ◽  
Vol 18 (12) ◽  
pp. 6553
Author(s):  
Nabila Soufi Taleb Bendiab ◽  
Souhila Ouabdesselam ◽  
Latefa Henaoui ◽  
Marilucy Lopez-Sublet ◽  
Jean-Jacques Monsuez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Lv Function ◽  
Hypertensive Patients ◽  
Concentric Hypertrophy ◽  
Lv Dysfunction ◽  
The Impact

Background: Although the combination of high blood pressure (HBP) and type 2 diabetes (T2DM) increases the risk of left ventricular (LV) dysfunction, the impact of T2DM on LV geometry and subclinical dysfunction in hypertensive patients and normal ejection fraction (EF) has been infrequently evaluated. Methods: Hypertensive patients with or without T2DM underwent cardiac echocardiography coupled with LV global longitudinal strain (GLS) assessment. Results: Among 200 patients with HBP (mean age 61.7 ± 9.7 years) and EF > 55%, 93 had associated T2DM. Patients with T2DM had a higher body mass index (29.9 ± 5.1 kg/m2 vs. 29.3 ± 4.7 kg/m2, p = 0.025), higher BP levels (158 ± 23/95 ± 13 vs. 142 ± 33/87 ± 12 mmHg, p = 0.003), a higher LV mass index (115.8 ± 32.4 vs. 112.0 ± 24.7 g/m2, p = 0.004), and higher relative wall thickness (0.51 ± 0.16 vs. 0.46 ± 0.12, p = 0.0001). They had more frequently concentric remodeling (20.4% vs. 16.8%, p < 0.001), concentric hypertrophy (53.7% vs. 48.6%, p < 0.001), elevated filling pressures (25.8 vs. 12.1%, p = 0.0001), indexed left atrial volumes greater than 28 mL/m2 (17.2 vs. 11.2%, p = 0.001), and a reduced GLS less than −18% (74.2 vs. 47.7%, p < 0.0001). After adjustment for BP and BMI, T2DM remains an independent determinant factor for GLS decline (OR = 2.26, 95% CI 1.11–4.61, p = 0.023). Conclusions: Left ventricular geometry and subclinical LV function as assessed with GLS are more impaired in hypertensive patients with than without T2DM. Preventive approaches to control BMI and risk of T2DM in hypertensive patients should be emphasized.

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

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&lt;0.001). The patients on hemodialysis had preserved systolic function &ndash; their fractional shortening, ejection fraction and Sm (systolic myocardial velocity) did not differ significantly compared to the controls (p&gt;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&gt;0.05). Children on hemodialysis exhibited impaired late diastolic function (compliance index), that is, considerably higher E/Em compared to controls (p&lt;0.00). Myocardial Performance Index values showed statistically significant elevation in children on hemodialysis compared to the control group (p&lt;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.

Abstract 18850: A Report on Cardiomyopathy and Arrhythmia Incidence in a Duchenne Muscular Dystrophy Cohort

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mohammed I Aslam ◽  
William R Thompson ◽  
Daniel P Judge ◽  
Saman Nazarian
Keyword(s):  
Duchenne Muscular Dystrophy ◽  
Muscular Dystrophy ◽  
Cardiac Involvement ◽  
Enzyme Inhibitor ◽  
Pulseless Electrical Activity ◽  
Holter Monitoring ◽  
Left Ventricular ◽  
Beta Blockade ◽  
Lv Function ◽  
Lv Dysfunction

Background: With improved respiratory care and the increasing lifespan of patients with Duchenne Muscular Dystrophy (DMD), morbidity and mortality due to cardiac involvement and sudden cardiac death (SCD) have increased. Nevertheless, data regarding incidence of SCD and the appropriate management of cardiac involvement are sparse; evidence-based guidelines for arrhythmia management in DMD do not exist. We sought to define the characteristics of electrocardiography, cardiac imaging abnormalities, association of therapeutic practices with cardiomyopathy and arrhythmia in a cohort with DMD. Methods and Results: A retrospective review of our current institutional electronic medical records (EMR) identified 125 DMD patients aged 10 or older. Electrocardiography was performed at least every 3 years or as prompted by symptoms. Symptom-prompted and baseline echocardiography, cardiac magnetic resonance (CMR) and Holter monitor data were extracted. Cardiac medical therapy primarily consisted of an angiotensin-converting-enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB; 98.4%) and beta-blockade (44.2%). As of May 2015, 115 of the 125 patients were living as determined by EMR. Left ventricular (LV) dysfunction was present in 52% of patients by age 18.7±5.9 years. Of 16 patients with LV dysfunction that underwent CMR, 13/16 had late gadolinium enhancement (LGE). Importantly, myocardial LGE was noted in 9 of 14 patients with normal LV function. The predominant ECG abnormality was tall R waves in V1, and Q waves in lateral precordial leads. Of 43 patients with Holter monitoring, 5 patients had non-sustained ventricular tachycardia and 5 had supraventricular tachycardia. Of 8 patients with an implantable cardioverter defibrillator (ICD), 1 died due to pulseless electrical activity. ICD placement was pursued in those with NSVT, persistently low EF or FS when patient preference allowed. Conclusions: ACEi or ARB use was universal in our DMD cohort. Evidence of LGE on CMR was noted in DMD patients with and without LV dysfunction. ECG characteristics did not appear to have a clinical impact. Future studies to examine the association of LGE and other clinical variables with SCD are warranted.

Acute transient coronary sinus hypertension impairs left ventricular function and induces myocardial edema

1996 ◽  
Vol 271 (3) ◽  
pp. H834-H841 ◽  
Author(s):  
J. W. Pratt ◽  
E. R. Schertel ◽  
S. L. Schaefer ◽  
K. E. Esham ◽  
D. E. McClure ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Coronary Sinus ◽  
Diastolic Pressure ◽  
Myocardial Edema ◽  
Dry Weight ◽  
Cholinergic Receptor ◽  
Left Ventricular ◽  
Control Group ◽  
Lv Function ◽  
Stroke Work

This study was performed to evaluate the direct and indirect effects of acute coronary sinus hypertension (CSH) on systolic and diastolic left ventricular (LV) function. Coronary sinus pressure was elevated to 25 mmHg for 3 h in eight pentobarbital-anesthetized dogs and then relieved. LV contractility was assessed by preload recruitable stroke work (PRSW) and end-systolic elastance (Ees). Diastolic function was assessed by the time constant of isovolumic relaxation (tau) and the end-diastolic pressure volume relationship (EDPVR). PRSW and Ees decreased progressively, and tau and the slope of the EDPVR increased progressively with CSH. These changes persisted after relief of CSH. beta-Adrenergic and cholinergic receptor blockade, performed in six dogs, did not alter the effects of CSH on systolic or diastolic function. The LV wet-to-dry weight ratios of the groups with CSH were significantly greater than those of a control group without CSH. We conclude that CSH results in changes in the left ventricle that depress contractility, prolong active relaxation, and increase diastolic stiffness. The dysfunction was not the direct effect of CSH or autonomic reflex activation, but may have been induced by fluid accumulation within the interstitium.

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.

The effects of Cyclosporin-A (CYA) on the Ultrastructure of Gingival Mast Cells (GMC) in Behcet's disease (BD)

1990 ◽  
Vol 48 (3) ◽  
pp. 358-359
Author(s):  
Oktay Arda ◽  
Ulkü Noyan ◽  
Selgçk Yilmaz ◽  
Mustafa Taşyürekli ◽  
İsmail Seçkin ◽  
...  
Keyword(s):  
Unknown Etiology ◽  
Control Group ◽  
Target Cells ◽  
Gingival Hyperplasia ◽  
Cellular Activity ◽  
Direct Relation ◽  
Immune Disease ◽  
Genital Ulceration ◽  
Functional Changes ◽  
The Third

Turkish dermatologist, H. Beheet described the disease as recurrent triad of iritis, oral aphthous lesions and genital ulceration. Auto immune disease is the recent focus on the unknown etiology which is still being discussed. Among the other immunosupressive drugs, CyA included in it's treatment newly. One of the important side effects of this drug is gingival hyperplasia which has a direct relation with the presence of teeth and periodontal tissue. We are interested in the ultrastructure of immunocompetent target cells that were affected by CyA in BD.Three groups arranged in each having 5 patients with BD. Control group was the first and didn’t have CyA treatment. Patients who had CyA, but didn’t show gingival hyperplasia assembled the second group. The ones displaying gingival hyperplasia following CyA therapy formed the third group. GMC of control group and their granules are shown in FIG. 1,2,3. GMC of the second group presented initiation of supplementary cellular activity and possible maturing functional changes with the signs of increased number of mitochondria and accumulation of numerous dense cored granules next to few normal ones, FIG. 4,5,6.

Urine Albumin to Creatinine Ratio and Echocardiographic Left Ventricular Structure and Function in Patients with Essential Hypertension

2011 ◽  
Vol 9 (2) ◽  
pp. 90 ◽  
Author(s):  
Rohola Hemmati ◽  
Mojgan Gharipour ◽  
Hasan Shemirani ◽  
Alireza Khosravi ◽  
Elham Khosravi ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Lv Function ◽  
Creatinine Ratio ◽  
Uncomplicated Hypertension ◽  
Urine Albumin ◽  
Lv Dysfunction ◽  
Mitral Annulus Velocity ◽  
Lv Mass

Background:Appearance of microalbuminuria, particularly in patients with hypertension, might be associated with a higher prevalence of left ventricular (LV) dysfunction and geometric abnormalities. This study was undertaken to determine whether high urine albumin to creatinine ratio (UACR) as a sensitive marker for microalbuminuria can be associated with LV hypertrophy (LVH) and systolic and diastolic LV dysfunction.Methods:The study population consisted of 125 consecutive patients with essential uncomplicated hypertension. Urine albumin and creatinine concentration was determined by standard methods. LVH was defined as a LV mass index >100 g/m2 of body surface area in women and >130 g/m2 in men. Echocardiographic LV systolic and diastolic parameters were measured.Results:The prevalence of microalbuminuria in patients with essential hypertension was 5.6 %. UACR was significantly no different in patients with LVH than in patients with normal LV geometry (21.26 ± 31.55 versus 17.80 ± 24.52 mg/mmol). No significant correlation was found between UACR measurement and systolic and diastolic function parameters, including early to late diastolic peak velocity (E/A) ratio (R=-0.192, p=0.038), early diastolic peak velocity to early mitral annulus velocity (E/E') ratio (R=-0.025, p=0.794), LV ejection fraction (R=0.008, p=0.929), and LV mass (R=-0.132, p=0.154). According to the receiver operator characteristic (ROC) curve analysis, UACR measurement was not an acceptable indicator of LVH with areas under the ROC curves 0.514 (95 % confidence interval 0.394–0.634). The optimal cut-off value for UACR for predicting LVH was identified at 9.4, yielding a sensitivity of 51.6 % and a specificity of 48.3 %.Conclusion:In patients with uncomplicated essential hypertension, abnormal systolic and diastolic LV function and geometry cannot be effectively predicted by the appearance of microalbuminuria.

Sign in / Sign up

Export Citation Format

Share Document