scholarly journals Predictors of heart failure in patients with major beta-thalassemia

2020 ◽  
Vol 8 ◽  
pp. 670-684
Author(s):  
Ionut Stanca ◽  
Mihaela Rus ◽  
Alice Albu ◽  
Simona Fica
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Right Ventricle ◽  
Diastolic Function ◽  
Systolic Function ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Beta Thalassemia ◽  
Myocardial Mass ◽  
Systolic And Diastolic Function

Cardiomyopathy by loading the myocardium with iron is the cause of heart failure in patients with major beta-thalassemia. In these patients, cardiac systolic function remains normal for a long time, but when signs of heart failure appear, death may occur in the first year, so it is necessary to identify parameters to predict the patient's progress and prognosis.Materials and methods. We enrolled 62 patients with beta-thalassemia major (30 men and 32 women), mean age 29.9 ± 7.3 years. 32.2% of patients had disorders of carbohydrate metabolism, 12.9% associated hypothyroidism, and the mean ferritin was 1060.9 ± 856.6 ng / ml. Patients were evaluated echocardiographically, using tissue doppler technique to assess systolic and diastolic function. Myocardial mass was calculated using standard formulas and the type of left ventricular remodeling (LV) was thus obtained. Depending on the ferritin level, choosing the threshold value of 1000ng / ml, a group subanalysis of the ultrasound parameters of cardiac systolic and diastolic function was performed.Results. All patients had LV ejection fraction above 50% (LVEF), but longitudinal LV systolic dysfunction was observed in 19.3% of patients. Also in patients with serum ferritin values ​​above 1000ng / ml, the parameters of longitudinal systolic function of LV are affected, paradoxically the average value of LVEF being higher in these patients. About a quarter of patients had diastolic dysfunction, but 40.3% had elevated LV filling pressures. We noticed that the batch with ferritin over 1000 ng / ml associated increased LV filling pressures. The evaluation of the function of the right ventricle by tissue Doppler (S wave at the level of the free wall VD) was statistically significantly correlated with the hemoglobin value and we obtained pathological values ​​(S VD <11.5 cm / s) especially in the group with ferritin over 1000ng / ml. We noticed the presence of morphological abnormalities of LV, by increasing myocardial mass and the appearance of LV remodeling, 31% of patients showed severe forms, especially eccentric remodeling. It was observed that there is a risk of negative remodeling of the left ventricle in the group of those with ferritin above 1000ng / ml.Conclusions. The study proves that the evaluation of the systolic and diastolic function of the left and right ventricle by tissue Doppler ultrasound is much more accurate in the early detection of myocardial dysfunction. Ferritin levels above 1000ng / ml have been associated with impaired cardiac function parameters. Also, the remodeling of the left ventricle observed in this group of patients may be the first sign of heart failure.

scholarly journals Systolic and Diastolic Function in Congestive Heart Failure Pediatric Patients

2016 ◽  
Vol 54 (1) ◽  
pp. 37-46
Author(s):  
Angela Butnariu ◽  
Camelia Zamfir ◽  
Mihaela Iancu ◽  
Daniela Iacob ◽  
G. Samasca ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Healthy Children ◽  
Systolic And Diastolic Function

Background and Aims. Two-dimensional (2D) and Doppler echocardiography are the main methods for the non-invasive evaluation of ventricular function in children. Our study monitored the evaluation of systolic and diastolic function in pediatric patients, using classical echocardiographic parameters and pulsed tissue Doppler parameters, as well as the correlation between these. Methods. The study included 18 healthy children and 9 children diagnosed with congestive heart failure secondary to congenital heart malformations. The parameters of systolic and diastolic function were measured by 2D echocardiography, 2D guided M mode, color and pulsed Doppler, as well as by pulsed tissue Doppler at the level of the mitral and tricuspid annulus. Results. A relaxation alteration pattern or a pseudonormal pattern of E diastolic velocity compared to the A wave was found (E = A; E > A) in the group of subjects with heart failure. E wave deceleration time had significantly increased values in the case of patients with CHF, being correlated with diastolic dysfunction. Left ventricular flow propagation velocity Vp was decreased in patients with heart failure, the E/Vp ratio being maintained relatively constant in subjects with congestive heart failure and healthy subjects, most probably on account of the concomitant change in the E wave. Associations between the severity of systolic dysfunction and the diastolic dysfunction were found in pediatric patients diagnosed with congestive heart failure (Student test, p < 0.05). Conclusions. Tissue Doppler measurements proved to be useful for the evaluation of pediatric patients with altered ventricular geometry secondary to congenital heart disease, systolic-diastolic dysfunction and heart failure.

scholarly journals Additive prognostic value of exercise echocardiography in symptomatic patients with normal or abnormal left ventricular diastolic function

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J.C Peteiro Vazquez ◽  
A Bouzas-Mosquera ◽  
E Martin-Alvarez ◽  
C Barbeito-Caamano ◽  
J Vazquez-Rodriguez
Keyword(s):  
Diastolic Function ◽  
Systolic Function ◽  
Coronary Revascularization ◽  
Left Ventricular Diastolic Function ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Exercise Echocardiography ◽  
Lv Systolic Function ◽  
Systolic And Diastolic Function

Abstract Background Exercise echocardiography (ExE) may assess left ventricular (LV) systolic and diastolic function. We aimed to assess the value of diastolic parameters at exercise (early LV inflow velocity to early tissue Doppler annulus velocity [E/e']) in patients with normal or abnormal resting diastolic function (DF) referred for a clinically indicated ExE. Methods LV systolic and DF according to EACVI Guidelines-2016, and mitral regurgitation (MR) were evaluated at rest in 773 patients (age 67±12 years) with preserved LVEF (≥50). At peak exercise we assessed regional/global LV systolic function, MR and E/e'. Abnormal ExE was defined as ischemia or fixed wall motion abnormalities and raised E/e'values as &gt;15 at rest and at exercise (e' at the septal level). Patients were grouped as complaining or not of dyspnea. Events were overall mortality, myocardial infarction, admission for unstable angina or cardiac failure, coronary revascularization, pulmonary thromboembolism, and stroke. Results Abnormal resting DF was present in 221 patients (29%), indeterminate in 78 (10%). Percentages were similar among the 431 patients with dyspnea (27%/11%) and the 342 without (31%/ 9%), as they were E/e values &gt;15 at rest and at exercise (16% and 18% with dyspnea; 16% and 21% without). Exercise E/e' &gt;15 was found in 37% of patients with abnormal DF, 21% with undeterminate DF, and 6% with normal DF (p&lt;0.001). Patients with abnormal resting DF had more frequently abnormal ExE (30%) in comparison with indeterminate (18%) or normal DF (17%, p&lt;0.001). Patients with abnormal ExE had more frequently abnormal resting DF than patients with normal ExE (42% vs 25%, p&lt;0.001) and similar indeterminate DF (9% vs 10%). Also, they had raised E/e' values at rest in 29% and at exercise in 25%, in comparison with normal ExE (16% at rest, 13% at exercise, both p&lt;0.001). During median follow-up of 0.9 years (25–75th percentiles 0.4–1.7) there were 109 events. Independent predictors were age (HR=1.03, 95% CI=1.01–1.06, p=0.001), male gender (HR=2.00, 95% CI=1.31–3.07, p=0.001), history of coronary disease (HR=1.63; 95% CI=1.05–2.51, p=0.03), positive clinical or exercise ECG testing (HR=1.92, 95% CI=1.31–2.81, p=0.001), peak exercise LVEF (HR=0.93, 95% CI=0.91–0.94, p&lt;0.001), and exercise E/e'(HR= 1.05, 95% CI=1.01–1.08, p=0.009). Neither resting E/e' values nor resting abnormal DF by EACVI Guidelines-2016 were independent predictors. Annualized event-rates were 38% in patients with (+) ExE plus (+) exercise E/e', 21% in those with (+) ExE and (−) exercise E/e', 11.5% in (−) ExE and (+) exercise E/e', and 3.7% with both variables normal (Figure). Conclusions Diastolic dysfunction results at rest and at exercise were similar between patients with or without dyspnea referred for ExE, but they were associated to abnormal ExE. Exercise E/e' reclassified 21% of patients with indeterminate DF and further predicted outcome on top of ExE results. FUNDunding Acknowledgement Type of funding sources: None.

Left atrial systolic and diastolic function after cessation of pacing in tachycardia-induced heart failure

1997 ◽  
Vol 273 (2) ◽  
pp. H921-H927 ◽  
Author(s):  
B. D. Hoit ◽  
Y. Shao ◽  
M. Gabel ◽  
C. Pawloski-Dahm ◽  
R. A. Walsh
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Left Atrial ◽  
Systolic Function ◽  
Left Ventricular ◽  
Rapid Pacing ◽  
Lv Systolic Function ◽  
Systolic And Diastolic Function ◽  
Lv Diastolic Dysfunction

Studies in the rapid-pacing model of heart failure have shown that left ventricular (LV) systolic function normalizes on cessation of pacing and LV diastolic dysfunction persists, but there is no information regarding atrial function under these conditions. To determine the effects of cessation of pacing on left atrial (LA) systolic and diastolic function, ten dogs with rapid pacing-induced heart failure (250 beats/min for 3-4 wk), six dogs with regression of heart failure (4 wk after cessation of rapid pacing), and seven control dogs were instrumented with LA sonomicrometers and micromanometers. At matched LA pressure, LA ejection (10.2 +/- 3.0 vs. 17.4 +/- 5.5%), reservoir volume fractions (19 +/- 8 vs. 35 +/- 11%), and heart rate-corrected mean normalized systolic ejection rate (1.25 +/- 0.33 vs. 1.60 +/- 0.44 EF/s) were significantly less, and the volume-normalized diastolic stiffness constant (4.9 +/- 0.8 vs. 3.2 +/- 1.1) was significantly greater, in regression versus control dogs; these changes were associated with incomplete regression of LA hypertrophy and a persistent 77.4% increase in beta-myosin heavy chain (beta-MHC) in the LA body. LV systolic function and weight were not significantly different, whereas the time constant of LV relaxation was longer (52.5 +/- 4.4 vs. 40.8 +/- 7.6 ms; P < 0.05) and LV end-diastolic pressure was greater (12.2 +/- 1.8 vs. 7.1 +/- 2.0 mmHg; P < 0.05) in regression compared with control dogs. Thus, unlike the normalization of LV systolic function observed with cessation of rapid pacing, LA systolic function is persistently abnormal, owing in part to persistent LV diastolic dysfunction, residual LA hypertrophy, and MHC isoform switches.

Regulation of K+ and Ca2+ channels in experimental cardiac failure

1991 ◽  
Vol 261 (6) ◽  
pp. H1979-H1987 ◽  
Author(s):  
M. Gopalakrishnan ◽  
D. J. Triggle ◽  
A. Rutledge ◽  
Y. W. Kwon ◽  
J. A. Bauer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Right Ventricle ◽  
Cardiac Failure ◽  
Radioligand Binding ◽  
Weight Ratio ◽  
Left Ventricular ◽  
Coronary Artery Ligation ◽  
Artery Ligation ◽  
The Right

To examine the status of ATP-sensitive K+ (K+ATP) channels and 1,4-dihydropyridine-sensitive Ca2+ (Ca2+DHP) channels during experimental cardiac failure, we have measured the radioligand binding properties of [3H]glyburide and [3H]PN 200 110, respectively, in tissue homogenates from the rat cardiac left ventricle, right ventricle, and brain 4 wk after myocardial infarction induced by left coronary artery ligation. The maximal values (Bmax) for [3H]glyburide and [3H]PN 200 110 binding were reduced by 39 and 40%, respectively, in the left ventricle, and these reductions showed a good correlation with the right ventricle-to-body weight ratio in heart-failure rats. The ligand binding affinities were not altered. In the hypertrophied right ventricle, Bmax values for both the ligands were not significantly different when data were normalized to DNA content or right ventricle weights but showed an apparent reduction when normalized to unit protein or tissue weight. Moderate reductions in channel densities were observed also in whole brain homogenates from heart failure rats. Assessment of muscarinic receptors, beta-adrenoceptors and alpha 1-adrenoceptors by [3H]quinuclidinyl benzilate, [3H]dihydroalprenolol, and [3H]prazosin showed reductions in left ventricular muscarinic and beta-adrenoceptor densities but not in alpha 1-adrenoceptor densities, consistent with earlier observations. It is suggested that these changes may in part contribute to the pathology of cardiac failure.

scholarly journals THE DIAGNOSTIC AND PROGNOSTIC VALUE OF RIGHT VENTRICLE SYSTOLIC AND DIASTOLIC FUNCTION IN INFERIOR MYOCARDIAL INFARCTION

Biomedika ◽  
2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Niniek Purwaningtyas
Keyword(s):  
Myocardial Infarction ◽  
Diastolic Function ◽  
Sensitivity And Specificity ◽  
Systolic Function ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Inferior Myocardial Infarction ◽  
St Segment Elevation ◽  
St Segment ◽  
Systolic And Diastolic Function

Right ventricular (RV) involvement increases mortality and morbidity in inferior myocardial infarction (MI). There are sparse data on the usefulness of pulsed tissue Doppler imaging (TDI) in the diagnosis of RV dysfunction in ST segment elevation MI (STEMI). This study evaluate the diagnostic and prognostic significance of RV systolic and diastolic function compared to classical electrocardiographic RVMI diagnostic criteria in this group of patients. Consecutive patients with first, acute, inferior STEMI were prospectively assessed. The RVMI was defined as an ST-segment elevation ≥ 0.1 mV in lead V4R. Echocardiography with TDI was performed within24 h of the onset of symptoms. Out of 31 patients (mean age 56.39 ± 9.02 years), RVMI was found in 18 (37%). Multivariate analysis showed that two variables—RV systolic and diastolic function, were independent predictors of in-hospital prognosis. Sensitivity and specificity the RV systolic function were 94,4% and 69,2%, respectively. While RV diastolic function were 44% and 76,9%, respectively. RV systolic function predict ECG diagnosis of RVMI with relatively high sensitivity and specificity. RV diastolic function predict ECG diagnosis of RVMI with relatively low sensitivity but with high specificity.Keywords: tissue Doppler imaging, RV myocardial infarction, inferior myocardial infarction

Abstract 18506: Relief of Myocardial Edema in Advanced Decompensated Heart Failure is Associated with Improved Left Ventricular Systolic and Diastolic Function

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Frederik H Verbrugge ◽  
Endry Willems ◽  
Philippe B Bertrand ◽  
Ellen Gielen ◽  
Wilfried Mullens ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Index ◽  
Diastolic Function ◽  
T2 Mapping ◽  
Myocardial Edema ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Volume Index ◽  
Systolic And Diastolic Function ◽  
Cmr Imaging

Introduction: Cardiac magnetic resonance (CMR) imaging with quantitative T2-mapping allows identi[[Unable to Display Character: &#64257;]]cation of myocardial edema, improving risk-stratification in acute coronary syndromes and myocarditis. Hypothesis: Global myocardial edema contributes to left ventricular (LV) dysfunction in advanced decompensated heart failure (ADHF). Methods: CMR with quantitative T2-mapping was performed in consecutive ADHF patients (n=17) undergoing right heart catheterization for worsening dyspnea and volume overload. Patients received vasodilators and diuretics to achieve pulmonary capillary wedge pressure (PCWP) ≤18 mmHg and central venous pressure (CVP) ≤10 mmHg, while maintaining mean arterial pressure ≥65 mmHg. After reaching hemodynamic targets, the pulmonary arterial catheter was removed and CMR imaging repeated. Changes in LV T2-values, hemodynamics, and CMR volumetric measurements were compared. Results: Study patients (64±11 years, male 88%, LV ejection fraction 23±8%, ischemic cardiomyopathy 50%) received decongestive treatment during 5±2 days. PCWP and CVP decreased from 25±7 to 17±4 mmHg and 13±6 to 7±3 mmHg, respectively (p<0.001 for both), while cardiac index increased from 2.14±0.60 to 2.58±0.49 L/min/m 2 (p=0.012). LV T2-values dropped consistently from 59.6±4.9 ms to 56.3±5.2 ms after decongestion (p=0.002; Figure). Decreasing LV T2-values correlated well to both decreasing PCWP (r=0.75; p=0.001) and increasing cardiac index (r=0.58; p=0.023). Although LV end-diastolic volume index (142±31 to 135±34 mL/m 2 ; p=0.033) and end-systolic volume index (110±29 to 99±33 mL/m 2 ; p=0.001) both decreased significantly, the extent of these changes were not correlated to changing T2-values (r=0 and 0.11, respectively; p=ns). Conclusions: Global LV myocardial edema is observed in ADHF and reversible with successful decongestive therapy. Relief of myocardial edema strongly correlates with improvements in systolic and diastolic function.

Tissue-Doppler Analysis of Left Ventricular Systolic and Diastolic Function After a Marathon

2004 ◽  
Vol 36 (Supplement) ◽  
pp. S331
Author(s):  
Keith P. George ◽  
David Oxborough ◽  
Jan Forster ◽  
Greg Whyte ◽  
Rob Shave ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Systolic And Diastolic Function ◽  
Doppler Analysis
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