scholarly journals Sex-Specific Impact of Diabetes Mellitus on Left Ventricular Systolic Function and Prognosis in Heart Failure

2020 ◽  
Author(s):  
Soongu Kwak ◽  
In-Chang Hwang ◽  
Jin Joo Park ◽  
Jae-Hyeong Park ◽  
Jun-Bean Park ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Structural Equation ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular Systolic Function ◽  
Equation Model ◽  
Sem Analysis ◽  
Left Ventricular ◽  
Main Driver

Abstract Background: Diabetes mellitus (DM) aggravates the clinical features and outcomes of heart failure (HF). However, the sex-specific cardiovascular consequence of DM in HF patients remains unclear. We aimed to investigate the sex differences in associations of DM with echocardiographic phenotypes and clinical outcomes of HF.Methods: We studied 4,180 patients admitted for acute HF between 2009 and 2016 (median follow-up, 31.7 months), whose left ventricular global longitudinal strain (LV-GLS) data were available. Patients were compared by sex and DM. Structural equation model (SEM) analysis was performed to evaluate the moderating effects of two causal paths, via ischemic heart disease (IHD) and LV-GLS, linking DM with mortality by sex. Results: Among 1,431 patients with HF and DM (34.2%), women had more preserved LV systolic function, whereas men had more ischemic etiology. Compared to non-diabetic women, diabetic women had lower LV-GLS (11.3% versus 10.1%, p<0.001), but the difference was attenuated within men (9.7% versus 9.2%, p=0.014). In Cox analyses, DM was an independent predictor for higher mortality in both women and men, with a statistically insignificant but higher relative risk in women than men (adjusted hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.15-1.59 for women versus HR 1.24, 95% CI 1.07-1.44 for men, p for interaction=0.669). Restricted cubic spline curves showed that LV-GLS consistently declined, and mortality increased in women as hyperglycemia became more severe, but these trends were not evident in men. In SEM analysis, the main driver from DM to mortality differed by sex; men had a stronger effect via IHD than LV-GLS, whereas effect mediating LV-GLS was the only predominant path in women.Conclusions: DM increases the mortality risk in HF irrespective of sex. However, the main driver leading to mortality differed by sex, suggesting the importance of sex-specific strategies for HF management.

scholarly journals Sex-specific impact of diabetes mellitus on left ventricular systolic function and prognosis in heart failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Soongu Kwak ◽  
In-Chang Hwang ◽  
Jin Joo Park ◽  
Jae-Hyeong Park ◽  
Jun-Bean Park ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Structural Equation ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular Systolic Function ◽  
Equation Model ◽  
Sem Analysis ◽  
Left Ventricular ◽  
The Difference

AbstractWe aimed to investigate the sex differences in associations of diabetes mellitus (DM) with echocardiographic phenotypes and clinical outcomes of heart failure (HF). We studied 4,180 patients admitted for acute HF between 2009 and 2016 (median follow-up, 31.7 months) whose left ventricular global longitudinal strain (LV-GLS) data were available. Patients were compared by sex and DM. Structural equation model (SEM) analysis was performed to evaluate the moderating effects of two causal paths, via ischemic heart disease (IHD) and LV-GLS, linking DM with mortality. Compared to non-diabetic women, diabetic women had significantly lower LV-GLS (11.3% versus 10.1%, p < 0.001), but the difference was attenuated within men (9.7% versus 9.2%, p = 0.014) (p-for-interaction by sex = 0.018). In Cox analyses, DM was an independent predictor for higher mortality in both sexes (women: adjusted hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.15–1.59 versus men: HR 1.24, 95% CI 1.07–1.44, p-for-interaction by sex = 0.699). Restricted cubic spline curves showed that LV-GLS consistently declined, and mortality increased in women with worsening hyperglycemia, but these trends were not evident in men. In SEM analysis, the main driver from DM to mortality differed by sex; men had a stronger effect via IHD than LV-GLS, whereas LV-GLS was the only predominant path in women.

scholarly journals Management of Diastolic Heart Failure

2015 ◽  
pp. 50-8
Author(s):  
Starry H. Rampengan
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Systolic Function ◽  
Diastolic Heart Failure ◽  
Angiotensin Receptor Blockers ◽  
Venous Pressure ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Elderly Age

The diastolic heart failure also referred to as heart failure with preserved left ventricular systolic function (preserved ejection fraction). The difference between systolic and diastolic HFs is a pathophysiological one and isolated forms of left ventricular dysfunction are rarely observed. In diastolic HF left ventricular systolic function is normal or only slightly impaired, and the typical manifestations of HF result from increased filling pressure caused by impaired relaxation and compliance of the left ventricle. The management should include antihypertensive treatment, maintenanceof the sinus rhythm, prevention of tachycardia, venous pressure reduction, prevention of myocardial ischemia and prevention of diabetes mellitus. Treatment of diastolic HF is aimed to stop the progression of the disease, relieve its symptoms, eliminate exacerbations and reduce the mortality. The predisposing factors for diastolic dysfunction include elderly age, female sex, obesity, coronary artery disease, hypertension and diabetes mellitus. The European Society of Cardiology specifies the type of therapy in diastolic HF based on: angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, non dihydropyridine calcium channel blockers, diuretics.

Abstract 3356: Does Severe Obesity Cause Progressive Impairment of Left Ventricular Systolic Function?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Theophilus Owan ◽  
Kimberly Morley ◽  
Travis G Ault ◽  
Ronny Jiji ◽  
Nathaniel Hall ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Entire Group ◽  
Obese Patients ◽  
Cross Sectional ◽  
Increased Risk ◽  
Severely Obese ◽  
The Mean

Background: Obesity is associated with an increased risk of developing heart failure. Based on cross sectional studies, it has been hypothesized that the duration of obesity is the key factor leading to impaired cardiac function. However, longitudinal data to confirm this hypothesis are not available. Methods: We prospectively studied 62 severely obese patients at baseline, 2 and 5 years after randomization to nonsurgical therapy (NonSurg, n = 25) or Rouxen-Y gastric bypass surgery (GBS, n = 37). Echocardiography was used to measure left ventricular (LV) size and ejection fraction (EF). Results: At enrollment, the mean BMI was 46±9 and the mean age was 47±11 years (range 25– 66). GBS subjects lost 96± 26 vs. 6±18 lbs at 2 years and 78±42 vs. 17±42 lbs at 5 years compared to NonSurg (p<0.0001 for both). At baseline LVEF was not different between GBS and nonsurg (67±9 vs. 64±8%) and it did not change at 2 years (64±9 vs. 63±9%) or 5 years (63±9 vs. 63±10%). LV diastolic dimension did not change over time in control (4.3±1.0 vs. 4.2±0.6 vs. 4.5±0.3) or GBS patients (4.4±0.6 vs. 4.3±0.7 vs. 4.4±0.4). Stratifying the entire group by quartiles of age or duration of obesity (quartile 1 avg duration = 16 years, quartile 4 average duration = 56 years), we found no evidence of time-dependent changes in LV size or function. Conclusion: In this, prospective study of severely obese patients we found no evidence of progressive changes in LV size or EF over a period of 5 years. Moreover, we find no relationship between age or duration of obesity and LV size or LVEF. These data argue strongly that other factors such as the development of coronary disease are the most likely causes of heart failure in obese patients.

scholarly journals P334 Heart model method: could it be a new echocardiographic gold-standard for the assessment of the left ventricular systolic function in a population under chemotherapy treatment?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Molinero ◽  
P Cabeza ◽  
N Hernandez ◽  
E Silva ◽  
W Delgado
Keyword(s):  
Gold Standard ◽  
Quantitative Methods ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Chemotherapy Treatment ◽  
Heart Model ◽  
Ventricular Systolic Function ◽  
Significant Difference

Abstract Background Echocardiographic assessment of the left ventricular systolic function is essential in diagnosis and during the follow up of cardiovascular diseases. Although subjective visual approach method is easily applied, quantitative systems give more objective information about systolic function analyses. The purpose of this study is to evaluate the different quantitative methods of estimating systolic function basal in non-invasive techniques Methods We used a group of 40 patients, prospectively collected, under chemotherapy treatment with preserved systolic function. Same echocardiography device (Philips EPIQ-7) has been used in all studies (acquiring apical 4 and 2 chambers and 3 D of apical volume by an experimented operator). We compare three standard methods with impact in the literature (Speckle tracking and 3D Heartmodel system) to the echocardiographic gold-standard (Simpson’s biplane method). The Bland-Altman method has been used for the graphic comparison of the values of the resulting measures while the statistical comparison was made by a T-student method. Results Three quantitative methods were used to compare left ventricular systolic function assessment (Heart Model 3D (60.4% ± 5.2%), Strain (60.50% ± 7.1%), global longitudinal strain (-19.7 ± 3.15%) to Simpson’s biplane (mean 62.10% ± 5.75%). Values of differential means (2.73 with Heart model 3D and 2.08 with Strain) compared to Simpson’s biplane were translated to a Bland-Altman plot and means were compared with a T-student method. A statistically significant difference was found in case of the Heartmodel method compared with Simpson’s biplane (p &lt; 0.05), though it does not imply any clinical difference. Less time consuming and better segmentation of the cardiac cavities in just one beat with the 3D-Heart Model technique was a magnificent point compared to the Strain method that needed a postprocessing modification Conclusions Heartmodel method is probably the most time-saving and with a good accuracy of left ventricular systolic function assesment and it is not inferior compared to the echocardiographic gold-standard Simpson’s biplane method. Abstract P334 Figure 1. Bland-Altman analysis

4933Comparison of left ventricular global longitudinal strain measurements using contrast-enhanced and non-contrast echocardiographic images

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Liang
Keyword(s):  
Image Quality ◽  
Contrast Agents ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Contrast Enhanced ◽  
Contrast Enhanced Echocardiography

Abstract Background Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are two important index for the quantification of left ventricular systolic function. With the help of ultrasound contrast agents, we can improve the definition of endocardial borders and allow the quantification of LVEF in patients with poor image quality. However, the feasibility of GLS measurements in contrast-enhanced images is still controversial. Purpose Our study aimed to explore the feasibility of GLS measured by velocity vector imaging (VVI) in contrast-enhanced images, compare the difference of measurements in contrast-enhanced and non-contrast images, and analyze the relation between LVEF and GLS in both conditions. Methods A total of 133 patients with cancer, who were registered for transthoracic echocardiography as well as contrast-enhanced echocardiography were studied. LVEF was measured using the biplane modified Simpson's rule and GLS was measured with offline VVI analysis of the three standard apical views in non-contrast and contrast-enhanced images respectively. Linear regression was performed to derive correlation coefficients between LVEF and GLS both in non-contrast and contrast-enhanced images. Results GLS measurements in non-contrast images were discarded in 2/133 patients (1.5%), while in contrast-enhanced images were obtained in all patients. LVEF (64.12±7.47% vs. 66.25±8.61%, respectively; P<0.01) and GLS (−20.99±4.67% vs. −23.40±4.58%, respectively; P<0.01) were both significantly higher in the presence of contrast agents. A linear regression between LVEF and GLS in non-contrast images (r=0.627, P<0.001) was observed, as well as in contrast-enhanced images (r=0.649, P<0.001). Conclusions GLS measured by VVI in contrast-enhanced echocardiography is a feasible and reliable index for the quantification of left ventricular systolic function, even in patients with poor image quality. Compared with the measurements in non-contrast images, both LVEF and GLS measurements are higher in the presence of contrast agents.

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