Doppler Mitral Inflow Variables Time Course After Treadmill Stress Echo with and Without Ischemic Response

This study evaluated Doppler mitral inflow variables changes from rest to post-exercise among 104 subjects with and without echocardiographic evidence of ischemic response (IR) to exercise (63.9 ± 11 years, 54% male, 32% with IR) who underwent a clinically indicated treadmill stress echo (TSE) test. The time from exercise cessation to imaging (TIME) was recorded. The changes (after TSE minus baseline values) in the peak E-wave velocity (∆E) [34.2 vs. 24.2, p = 0.024] and E-wave deceleration rate (∆DR) [348.0 vs. 225.7, p = 0.010] were bigger in ischemic than in nonischemic subjects, while the changes in the peak A-wave velocity (∆A) did not differ [7.9 vs. 15.0, p = 0.082]. The correlations between Doppler variables and IR, TIME, and TIME*IR interaction were analyzed. We observed a significant interaction between TIME and IR regarding ∆E and ∆DR. The differences in the regression line slopes of time courses for ∆E and ∆DR based on IR were significant: ∆E (–0.09 vs. –8.17, p = 0.037) and ∆DR (11.23 vs. –82.60, p = 0.022). Main findings: 1. Time courses after exercise of ∆E and ∆DR in subjects with and without IR were different. 2. ∆E and ∆DR did not differ between subjects with and without IR at exercise cessation (TIME = 0). 3. The simple main effect of ischemia on ∆E and ∆DR was significant at TIME of ≥3 min. Divergent time courses of ∆E and ∆DR after exercise might be promising for detecting diastolic dysfunction caused by ischemia.

Treatment of Sleep Apnea with Positive Airway Pressure and Its Association with Diastolic Dysfunction: A Systematic Review and Meta-Analysis

<b><i>Background:</i></b> This meta-analysis assessed the effect of long-term (&#x3e;6 weeks) noninvasive positive airway pressure (PAP) on diastolic function in patients with obstructive sleep apnea (OSA). <b><i>Methods:</i></b> We searched the databases for randomized clinical trials including Ovid MEDLINE, Ovid Embase Scopus, Web of Science, Google Scholar, and EBSCO CINAHL from inception up to December 20, 2019. The search was not restricted to time, publication status, or language. Two independent investigators screened the studies and extracted the data, in duplicate. Risk of bias was assessed using Cochrane collaboration tools. <b><i>Results:</i></b> A total of 2,753 abstracts were resulted from literature search. A total of 9 randomized clinical trials assessing the effect of long-term (&#x3e;6 weeks) PAP on diastolic function in patients with OSA including 833 participants were included. The following echo parameters were found in treated patients: a decrease in deceleration time (−39.49 ms CI [−57.24, −21.74]; <i>p</i> = 0.000), isovolumic relaxation time (−9.32 ms CI [−17.08, −1.57]; <i>p</i> = 0.02), and the ratio of early mitral inflow velocity to mitral annular early diastolic velocity (−1.38 CI [−2.6, −0.16]; <i>p</i> = 0.03). However, changes in left-atrial volume index and the ratio of early to late mitral inflow velocities were not statistically different. The risk of bias was mild to moderate among the studies. <b><i>Conclusion:</i></b> Our results suggest that chronic treatment of moderate to severe OSA with noninvasive PAP is associated with improvement in echocardiographic findings of diastolic dysfunction.

Diastolic Function and Ambulatory Hypertension in Children With Chronic Kidney Disease

Diastolic dysfunction is one of the earliest cardiac abnormalities in patients with chronic kidney disease. We analyzed echocardiographic markers of left ventricular function from 786 children and adolescents (1658 person-visits) enrolled in the CKiD (Chronic Kidney Disease in Children) cohort, a large prospective observational study of children with chronic kidney disease. Primary outcome was early mitral inflow velocity-to-early mitral annular peak velocity (E/e′) ratio as a marker of left ventricular compliance. Abnormal diastolic function was defined as E/e′>8.0. Those with an abnormal E/e′ ratio were younger, had a lower estimated glomerular filtration rate and hemoglobin, and a higher prevalence of hypertension and left ventricular hypertrophy compared to children with a normal E/e′. In adjusted analysis, a higher E/e′ ratio was independently associated with ambulatory (sustained) hypertension (1.66 [95% CI, 1.15–2.42]). Other significant independent predictors were higher left ventricular mass index Z score, increased body mass index Z score, lower hemoglobin, higher phosphorus level, and younger age. Casual blood pressure was not significantly associated with higher E/e′. These data indicate that ambulatory blood pressure might better identify children with chronic kidney disease at risk for subclinical cardiac dysfunction than clinic blood pressure alone.

Left ventricular diastolic function during pregnancy: insights from conventional and speckle tracking echo parameters

Introduction Profound changes occur in the cardiovascular system during pregnancy, regarding to induce cardiac pumping function. Although LV systolic and diastolic function have been thoroughly studied using conventional indices, speckle tracking parameters of cardiac function are not well described. Purpose The aim of our study was to evaluate the LV diastolic function during an uncomplicated pregnancy using both traditional and newer speckle tracking parameters. Methods We prospectively enrolled 40 consecutive pregnant women in whom serial echocardiographic evaluation was performed in each pregnancy trimester (1st: 8th–12th week, 2nd: 22th–26th week, 3rd: 32–36th week) and 6 months after delivery. Mitral inflow velocities (E, A), mitral annulus TDI velocities (E', A'), ratio E/A and E/E' and untwisting velocity rate were measured after cautious selection of studies with legible images in. Results The peak E transmitral inflow velocity during early diastole decreased significantly during pregnancy especially between 2nd and 3rd trimester and increased again postpartum (p1-2=0.475, p2-3&lt;0.05 p3-4&lt;0.05). The peak A flow velocity during atrial contraction did not change significantly during pregnancy (p1-2=0.333, p2-3=0.952, p3-4=0.989). As a result, E/A ratio was decreasing as pregnancy was advancing (p1-2=0.964, p2-3&lt;0.05, p3-4=0.240). TDI E' early diastolic velocity was decreased especially in the 3rd trimester and recovered postpartum (p1-2=0.138, p2-3&lt;0.01, p3-4&lt;0.01) while E/E' ratio was increased especially in the 2nd trimester (p1-2&lt;0.05, p2-3=0.572, p3-4=0.021, p1-4=0.383) and also recovered postpartum. Peak untwisting velocity rate demontrated a progressive decrease during pregnancy, although not statistically significant. There was a trend towards recovery in the puerperium (p1-2=0.072, p2-3=0.679, p3-4=0.052, p1-4=0.929) (Table 1). Conclusion Our study demonstrated that diastolic function seems to be impaired during an uncomplicated pregnancy. However all the conventional and newer speckle tracking indices of diastolic function remain in normal range. Postpartum appears to be a recovery process in all parameters. FUNDunding Acknowledgement Type of funding sources: None.

Echocardiographic parameters in different age and sex of Sprague-Dawley rats under isoflurane anesthesia

Echocardiography is a useful technique for diagnosing cardiovascular disease that is safe, reproducible and accurate. A comprehensive understanding of echocardiographic parameters in different age and sex is useful for cardiovascular study. Thirty Sprague-Dawley rats of both sexes at different age underwent repetitive echocardiography. The characteristics of early and late diastolic waves through the mitral inflow depend on the heart rate. The rats had fast heart rates, with early and late diastolic Doppler flows commonly fused. Several parameters in male rats were higher than in females except for ejection fraction, fractional shortening, isovolumetric relaxation time, pre-ejection fraction and ejection time that did not differ. Different age, sex, breed and anesthesia protocol can all cause diverse results. Rat echocardiography can be potentially used as a model for human cardiovascular research. Results revealed changes in echocardiographic parameters in different age and sex to better understand normal cardiovascular functions in rat model

Left Ventricular Diastolic Function Studied with Magnetic Resonance Imaging: A Systematic Review of Techniques and Relation to Established Measures of Diastolic Function

Purpose: In recent years, cardiac magnetic resonance (CMR) has been used to assess LV diastolic function. In this systematic review, studies were identified where CMR parameters had been evaluated in healthy and/or patient groups with proven diastolic dysfunction or known to develop heart failure with preserved ejection fraction. We aimed at describing the parameters most often used, thresholds where possible, and correlation to echocardiographic and invasive measurements. Methods and results: A systematic literature review was performed using the databases of PubMed, Embase, and Cochrane. In total, 3808 articles were screened, and 102 studies were included. Four main CMR techniques were identified: tagging; time/volume curves; mitral inflow quantification with velocity-encoded phase-contrast sequences; and feature tracking. Techniques were described and estimates were presented in tables. From published studies, peak change of torsion shear angle versus volume changes in early diastole (−dφ′/dV′) (from tagging analysis), early peak filling rate indexed to LV end-diastolic volume <2.1 s−1 (from LV time-volume curve analysis), enlarged LA maximal volume >52 mL/m2, lowered LA total (<40%), and lowered LA passive emptying fractions (<16%) seem to be reliable measures of LV diastolic dysfunction. Feature tracking, especially of the atrium, shows promise but is still a novel technique. Conclusion: CMR techniques of LV untwisting and early filling and LA measures of poor emptying are promising for the diagnosis of LV filling impairment, but further research in long-term follow-up studies is needed to assess the ability for the parameters to predict patient related outcomes.

MO745CARDIOVASCULAR EFFECTS OF HIGH FLOW ARTERIO-VENOUSE FISTULA CLOSURE IN POST-KIDNEY TRANSPLANTATION PATIENTS

Background and Aims Presently, the dilemma of what to do with a functioning arterio-venous fistula (AVF) in post-kidney transplantation patients is a subject of debate. One of the arguments in favor of AVF closure is symptomatic congestive heart failure (CHF) due to AVF-induced cardiomyopathy. The subject of the study was the evaluation of the dynamics of some morpho-functional cardiac parameters in post-kidney transplantation patients with AVF-induced CHF before and after AVF closure. Method The results of prospective single center study are presented. 13 post transplantation patients with severe AVF-induced CHF (III-IV f.c. NYHA) were enrolled. Echocardiography (Echo), Doppler evaluation of AVF flow (Qa) and calculation of cardiopulmonary recirculation (Qa/CO) were performed simultaneously (split-protocol) at baseline together with estimation of creatinine plasma level. All patients underwent surgical closure of AVF. In 8 weeks after the closure, an assessment of CHF, Echo and creatinine plasma level were carried out in all enrolled patients. Statistical analysis was performed using the STATISTICA 13 software (T-test). Results The average age – 44 ±13 y, males 54%. All patients bore an upper arm proximal AVF. The average flow of AVF (Qa) – 3.4 ±1.4 L/min, average Qa/CO – 49 ±15%, Qa/CO was more than 30% in 92% of patients. The median of AVF vintage was 5 y (IR 3;10). In 8 weeks after AVF closure, complete clinical resolution of CHF, reduction of volumetric heart parameters, decrease of sPAP, improvement of diastolic function were observed. There was no significant difference in the serum creatinine value (1.85 ±0.66 mg/dL vs 1.97 ±0.95 mg/dL, p &gt;0.05). The results of Echo data before and after AVF closure are presented in Table 1. Conclusion The surgical closure oh high flow AVF in post-kidney transplantation patients with AVF-induced CHF was resulted in significant improvement of morpho-functional cardiac parameters. The CHF due to AVF-induced cardiomyopathy should be considered as one of the indications to AVF closure in post-kidney transplantation patients. CO, cardiac output; CI, cardiac index; LV EDVi, left ventricular end-diastolic volume index; LV ESVi, left ventricular end-systolic volume index; LAVi, left atrial volume index; RAVi, right atrial volume index; TAPSE, tricuspid annular plane systolic excursion LVMi, left ventricular mass index; sPAP, systolic pulmonary arterial pressure; LVEF, left ventricular ejection fraction; Е/A ratio, E - peak early mitral inflow wave velocity, A - peak late mitral inflow wave velocity.

Predicting factors of intradialytic hypotension in the last half of hemodialysis therapy

Background Intradialytic hypotension (IDH) is one of the most frequent complications of hemodialysis. IDH alters a patient’s quality of life and has a strong association with mortality. IDH mainly occurs when ultrafiltration during hemodialysis exceeds the pace of the plasma refill. Ultrasonography has been used to evaluate the intravascular volume status. We evaluated the association between IDH and baseline laboratory data or ultrasound findings during IDH during the latter half of a hemodialysis session. Methods Sixty-two patients who underwent hemodialysis were enrolled in this study. The peak early mitral inflow wave velocity (peak E-velocity), the inferior vena cava (IVC) dimensions, and number of B-lines were estimated at two time points (just after the start and at the midpoint of the hemodialysis session). We compared the parameters between the patients without IDH throughout the hemodialysis session (non-IDH group) and patients with IDH only during the latter half of the hemodialysis session (IDH in the latter half group). Results Of the 62 study participants, 28 patients were in non-IDH group, and 16 patients were in IDH in the latter half group. The serum sodium level was significantly lower in the IDH in the latter half group (135 ± 4 mEq/L) than in the non-IDH group (138 ± 4 mEq/L) (P = 0.015). The rate of decrease of the peak E-velocity was significantly higher in the IDH in the latter half group (0.33 ± 0.13) than in the non-IDH group (0.24 ± 0.14) (P = 0.037). The best cutoff point of the serum level of sodium was 137 mEq/L, with a sensitivity of 68.8% and specificity of 64.3%. The area under the receiver operating characteristic (ROC) curve was 0.71. The best cutoff point of the rate of decrease of the peak E-velocity was 0.295, with a sensitivity of 73.3% and a specificity of 71.4%. The area under the ROC curve was 0.71. Conclusions A low serum level of sodium at baseline and an early decrease in the peak E-velocity during hemodialysis may be related to intradialytic hypotension in the latter half of a hemodialysis session. Careful observation may be needed in the hemodialysis patients in whom the serum level of sodium is below 137 mEq/L or the rate of decrease of the peak E-velocity is over 0.295.