scholarly journals Characteristics of Cirrhosis Patients With Left Ventricular Diastolic Dysfunction In China: A Single-Center Retrospective Study.

Author(s):  
Jingjing Hu ◽  
Zhaobin Cai

Abstract Objective: Mounting evidence links cirrhosis patients with left ventricular diastolic dysfunction(LVDD) has a poor prognosis. However, little is known about these particular individuals. Therefore, we conducted this cross-sectional study to assess the prevalence of LVDD and its associated risk factors.Methods: Consecutive cirrhosis patient who were attending Hangzhou Xixi hospital from January 2018 to December 2019 were included in this study. According to the American Society of Echocardiography 2016 criteria, cirrhosis patients were sorted into two group: the left ventricular diastolic dysfunction(LVDD) group and left ventricular diastolic function normal(LVDDn) group. Patients’ demographic data, clinical characteristics, laboratory data were recorded. Furthermore, we conducted a multi-factor analysis.Results: A total of 398cirrhosis patients were included in the study. The incidence of LVDD in this study was 49.7% (198 cases). In this study, the mean age and BMI of the patients were 52.9±8.2 years and 23.0±3.3kg/m2,respectively. Of 398 patients, 255(64.1%) of them were males. With regard to etiology, there were 296 patients (74.4%) with hepatitis B cirrhosis and 59 patients (14.8%) with alcoholic cirrhosis. The LVDD group had higher age, higher BMI, greater frequency of ascites and esophageal varices, prolonged prothrombin time, increased international normalized ratio, increased bilirubin, increased CK and AST, and longer QT interval than the LVDDn group(p<0.05, both). In terms of echocardiography, the LVDD group had larger aortic inner diameter, left atrial inner diameter and left ventricular wall diastolic thickness than LVDDn group(p<0.05, both). The multivariate analysis showed age>55 years, BMI>24kg/m2, hepatic decompensated, QTcB>440ms were independently associated with risk of LVDD.Conclusion: The prevalence of LVDD among cirrhosis patients was 49.8%. Cirrhosis patients with LVDD had worse liver function. Further, age>55 years, BMI>24kg/m2, hepatic decompensated, QTcB>440ms were independent predictors of LVDD.

Author(s):  
Quang Tuan Pham

TÓM TẮT Mục tiêu: Khảo sát chức năng tâm trương thất trái theo khuyến cáo ASE/EACVI 2016 ở bệnh nhân bệnh cơ tim giãn bằng siêu âm tim. Tìm hiểu mối liên quan giữa chức năng tâm trương thất trái với tình trạng giãn thất trái, độ suy tim NYHA, phân suất tống máu thất trái, phân suất co cơ thất trái. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang trên 56 bệnh nhân bệnh cơ tim giãn nguyên phát được nhập viện và điều trị tại bệnh viện Trung ương Huế từ tháng 4/2018 đến tháng 8/2020. Kết quả: Đường kính thất trái cuối tâm trương và cuối tâm thu trung bình là 66,11 ± 7,3 mm và 57,7 ± 8,02 mm. Đường kính nhĩ trái trung bình là 40,61 ± 7,65 mm. Phân suất tống máu thất trái trung bình là 24,68 ± 5,97 %. Phân suất co cơ thất trái trung bình là 12,91 ± 4,55 %. Tất cả các bệnh nhân nhóm nghiên cứu đều có rối loạn chức năng tâm trương thất trái. Chiếm tỷ lệ cao nhất là rối loạn chức năng tâm trương độ II (44,6%), tiếp sau là rối loạn chức năng tâm trương độ III (35,8%) và rối loạn chức năng tâm trương độ I là 19,6%. Không có sự liên quan có ý nghĩa thống kê giữa mức độ rối loạn tâm trương thất trái với đường kính thất trái cuối thì tâm thu và tâm trương (p > 0,05). Có mối liên quan giữa rối loạn chức năng tâm trương thất trái với các thông số phân suất tống máu EF và phân suất co cơ FS (p < 0,005). Có sự tương quan thuận mức độ vừa giữa phân độ rối loạn chức năng tâm trương thất trái với phân độ suy tim theo NYHA với r = 0,445, sự tương quan đó có ý nghĩa thống kê (p < 0,001). Kết luận: Tất cả các bệnh nhân bệnh cơ tim giãn trong nhóm nghiên cứu đều có rối loạn chức năng tâm trương thất trái, chủ yếu là rối loạn chức năng tâm trương nặng độ II - III. Sự rối loạn này thể hiện rõ qua sự biến đổi các thông số đánh giá chức năng tâm trương thất trái trên siêu âm tim theo khuyến cáo ASE/ EACVI 2016, một khuyến cáo mới đưa ra nhằm tiếp cận đánh giá chức năng tâm trương một cách thuận tiện và dễ dàng hơn. Từ khóa: Bệnh cơ tim giãn, rối loạn chức năng tâm trương thất trái, khuyến cáo ASE/EACVI 2016 ABSTRACT EVALUATION OF LEFT DYSTOLIC FUNCTION ACCORDING TO THE RECOMMENDATION ASE/EACVI 2016 INPATIENTS WITH DILATED CARDIOMYPAHTIES Background: Dilated cardiomyopathy is a disease of the heart muscle, characterized by dilatation of the heart chamber and a dysfunction of the left or both ventricles. It often leads to progressive heart failure, and is the leading cause of heart transplant among all cardiomyopathy. The annual rate of sudden cardiac death in dilated cardiomyopathy is 2 - 4%, with sudden death accounting for half of all deaths [9]. Echocardiography is an evaluation of a patient with dilated cardiomyopathy. There have been many studies on dilated cardiomyopathy in the world. However, there are still few studies evaluating diastolic function in patients with dilated cardiomyopathy using cardiac Doppler echocardiography. Experts around the world have made many recommendations in assessing left ventricular diastolic function, most recently is the recommendation ASE/EACVI 2016. Comparing with the 2009 EAE/ASE recommendation, the recommendation ASE/EACVI 2016 for assessment of left ventricular diastolic function has fewer parameters, so it is easier to implement and more convenient in clinical practice. Objective: Surveying left ventricular diastolic function according to the recommendation ASE/EACVI 2016 in patients with dilated cardiomyopathy by echocardiography and investigating the relationship between left ventricular diastolic function with left ventricular dilatation, heart failure NYHA, left ventricular ejection fraction, left ventricle fractional shortening. Methods: Research was designed as a cross - sectional descriptive study. Studied on 56 patients with primary dilated cardiomyopathy were hospitalized and treated at Hue Central Hospital. Results: The results showed: The mean end - diastolic and end - systolic left ventricular diameters were 66,11 ± 7,3 mm and 57,7 ± 8,02 mm. The mean left atrial diameter was 40,61 ± 7,65 mm. The mean left ventricular ejection fraction was 24,68 ± 5,97%. The mean fractional shortening of left ventricular contraction was 12,91 ± 4,55%. All patients in the study group had left ventricular diastolic dysfunction. The highest proportion is diastolic dysfunction grade II (44,6%), followed by diastolic dysfunction grade III (35,8%) and diastolic dysfunction grade I is 19,6%. There was no statistically significant relationship between the classification of left ventricular diastolic dysfunction and left ventricular systolic and diastolic diameter (p > 0.05). There is a relationship between left ventricular diastolic dysfunction and parameters of ejection fraction EF and contraction fraction FS (p < 0.005). There is a moderate positive correlation between the classification of left ventricular diastolic dysfunction and the heart failure rating according to NYHA (r = 0,445, p < 0,001). Conclusion: All patients in the study group had left ventricular diastolic dysfunction, mostly grade II and grade III diastolic dysfunction. This disorder is clearly demonstrated by the change in the parameters of the left ventricular diastolic function assessment on echocardiography according to the 2016 ASE/ EACVI recommendations, a new recommendation introduced to approach the assessment of diastolic functionmore convenient and easier way. Key words: Dilated cardiomyopathy, left ventricular diastolic dysfunction, the recommendation ASE / EACVI 2016.


2020 ◽  
Vol 6 (2) ◽  
pp. 97-103
Author(s):  
Bambang Arie Hidayat Dalimunthe ◽  
Nizam Akbar ◽  
Refli Hasan ◽  
Harris Hasan ◽  
Andika Sitepu ◽  
...  

Background: Patients diagnosed with hypertension will deteriorate into hypertensive heart disease which is characterized by diastolic dysfunction first followed by systolic dysfunction later in the course of the disease. Diastolic dysfunction of the left ventricle causes an increase in LVEDP as well as in the dimension of the left atrium. P-Wave Terminal Force V1 (PTFV1) which is derived from 12 lead ECG could help diagnose diastolic dysfunction in centers where echocardiography is not available. The purpose of this study was to determine the correlation of PTFV1 on the 12-lead Electrocardiography with diastolic dysfunction in patients diagnosed with hypertension in the outpatient clinic of Cardiac Center Adam Malik General Hospital in Medan. Methods: This is a cross-sectional study conducted from March 2019 until August 2019. Patients with hypertension who met the inclusion criteria were examined electrocardiographically to obtain PTFV1 value. Then echocardiography examination was then performed to assess the grades of diastolic dysfunction and other parameters. Analysis of correlation between PTFV1 values and diastolic dysfunction was then conducted. Results: From the clinical characteristics, there is no difference regarding age, sex , and risk factorsbetween the three diastolic dysfunction groups, while echocardiography characteristic shows more reduced EF in grade III diastolic dysfunction (36.5±7.7). Significant differences in PTFV1 are found among diastolic dysfunction groups. Grade I diastolic dysfunction has PTFV1 value of 23.8 mm.ms, grade II diastolic dysfunction has PTFV1 value of 34.1 mm.ms, and grade III diastolic dysfunction has PTFV1 value of 52.1 mm.ms, Significance of  p value is <0.001. There is a strong correlation between PTFV1 and diastolic dysfunction grade (r = 0.63 (P <0.001)). Cut off point of PTFV1 > 29.8 mm.ms can discriminate patients who have increased LAP with a sensitivity of 84% and specificity of 71%. Conclusions: PTFV1 is a simple screening tool which is widely available and correlate well with left ventricular diastolic dysfunction in patients with hypertension, which makes it a good alternative tool especially in areas where echocardiography is not readily available.


2021 ◽  
Author(s):  
Boniface Amanee Elias Lumori ◽  
Edwin Nuwagira ◽  
Fardous Charles Abeya ◽  
Abdirahman Ali Araye ◽  
Godfrey Masete ◽  
...  

Abstract Background: Left ventricular diastolic dysfunction (LVDD) is a recognized complication of diabetes mellitus which precedes and is a risk factor for heart failure. We aimed to determine the prevalence of LVDD and its association with body mass index (BMI) in ambulatory adults with diabetes mellitus. Methods: We conducted a cross-sectional study of 195 ambulatory Ugandan adults living with diabetes mellitus for at least five years from the time of diagnosis at Mbarara Regional Referral Hospital (MRRH). We collected demographic, clinical data and measured body mass index. Laboratory tests included glycated hemoglobin (HbA1c), low-density lipoprotein (LDL), and urine microalbumin. Echocardiography was done to determine LVDD by assessing the mitral inflow E/A ratio, E/è ratio, TR jet peak velocity, and left atrium maximum volume index. Logistic regression was used to establish associations of body mass index and other covariates with LVDD. Results: Overall, 195 participants were enrolled and 141(72.3%) were females. The mean age was 62 [standard deviation (SD), 11.5] years and median duration of diabetes diagnosis was 10 [Interquartile range (IQR), 7,15] years. LVDD was prevalent at 86% and majority, 127(65.13%) had grade-1 diastolic dysfunction. BMI ≥25kg/m2 [adjusted Odds Ratio (aOR)=2.8, (95% confidence interval (CI)=1-7.6), p=0.038], age 50 year or more [aOR= 4.9, (95%CI=1.5-16.2), p=0.010], and history of hypertension [aOR= 3.0, (95% CI= 1.1-8.1), p=0.031] were associated with LVDD.Conclusion: The prevalence of LVDD was high during the study period. We recommend early and periodic echocardiographic screening for diabetes patients with high body mass index.


2019 ◽  
Vol 40 (2) ◽  
Author(s):  
Nur Zamiatun Qomara ◽  
Nani Hersunarti B ◽  
Anwar Santoso

Association between Grade of Normoalbuminuria and Left Ventricular Diastolic Dysfunction (LVDD) in Hypertensive Population of Gunungsari Village, Pamijahan-Bogor, Indonesia Nur Z Qomara MD, Nani Hersunarti MD, Anwar Santoso MDDepartement of Cardiology and Vascular Medicine Faculty of Universitas Indonesia  ABSTRACT  Background: Albuminuria has been considered an important diagnostic marker of decreasing renal function, but lately albuminuria has also been linked to cardiovascular and peripheral vascular disease. Many studies have analyzed the association between micro- or macroalbuminuria and the increased risk of cardiovascular disease, but only few examined the association between normoalbuminuria and cardiovascular disease.Objective: To analyze the association between the degree of normoalbuminuria and the occurrence of left ventricular diastolic dysfunction in hypertensive patients.Method: This is cross-sectional analysis in hypertensive patients. Normoalbuminuric subjects are divided into three tertiles based on the cutoff of Urine-Albumin-Creatinine Ratio (UACR). To evaluate left ventricular function, all subjects undergo echocardiography examination. Left ventricular diastolic dysfunction is positive if more than fifty percent of positive findings are present from the fourth parameters stated in the 2016 American Society of Echocardiography criterias.Results: No significant difference in the occurrence of LVDD was found between the two groups according to age, sex, smoking, dyslipidemia, physical activity, BMI, hypertension therapy and HbA1c, but a significant difference was seen in the UACR tertile of the two group. This study showed that upper-limit normoalbuminuria (third tertile) was associated with the occurrence of LVDD (OR 15.57, 95% CI: 2.88-84.25).Conclusion: This study showed that normoalbuminuria in hypertensive population is associated with left ventricular diastolic dysfunction. Keywords: hypertension, normoalbuminuria, left ventricular diastolic dysfunctio


Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tadafuni Sugimoto ◽  
Kaoru Dohi ◽  
Katsuya Onishi ◽  
Masahide Horiguchi ◽  
Takeshi Takamura ◽  
...  

Introduction: Endothelial dysfunction plays a central role in the pathogenesis of diabetic vascular disease. Hypothesis: Although resultant left ventricular diastolic dysfunction is hypothesized to reduce exercise capacity, limited data exist on the relation between endothelial function, left ventricular diastolic function and exercise capacity in patients with type 2 diabetes. Methods: We recruited 231 subjects with type 2 diabetes, a preserved ejection fraction, a negative stress test and a sodium-restricted diet. All subjects underwent a brachial artery flow-mediated dilation (FMD) measurement, a transthoracic echocardiography and a standard submaximal Bruce protocol treadmill exercise test during the hospitalization period for diabetes education program. Results: Impaired FMD (%FMD 8) were found in 193 subjects (84%) and 174 subjects (75%), respectively, of which 11 (5%) had diastolic dysfunction (E/E’ >15). Mean E/E’ by quartile (Q) were: Q1 6.9, Q2 8.9, Q3 10.4, and Q4 14.0. E/E’ was inversely correlated with %FMD (2.9 ± 4.3%, r = -0.19, p = 0.003) and exercise duration (460 ± 150 sec, r = -0.30, p <0.001). Compared with subjects in Q4, those in Q1, Q2 and Q3 had longer exercise duration (Q1 500 ± 150 sec, Q2 510 ± 140 sec, Q3 460 ± 140 sec and Q4 390 ± 140 sec, p <0.001). After adjustment for potential confounders including age, gender, smoking, body mass index, medication for hypertension, diabetes duration of more than 5 years, HbA1c and systolic blood pressure, %FMD and exercise duration were significantly associated with E/E’ (β = -0.17 and -0.18, p = 0.006 and 0.014) in all subjects. Conclusions: Diabetes patients with impaired endothelial function have impaired left ventricular diastolic function potentially leading to exercise intolerance.


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