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PubMed1987

Evaluation of left ventricular systolic and diastolic dysfunction during transient myocardial ischemia produced by angioplasty.

Acute myocardial ischemia is known to cause impairment of both left ventricular systolic and diastolic function. To further investigate these changes as well as their relation to common clinical variables (electrocardiographic [ECG] changes and chest pain), 32 patients were evaluated with Doppler echocardiography during coronary angioplasty. Doppler indexes of left ventricular diastolic function included the ratios of peak early to late and peak early to mean diastolic velocities as well as the ratios of early to late and first third to total velocity integral (one-third filling fraction). All diastolic indexes showed significant impairment by 15 seconds after coronary occlusion (ratio peak early to late filling velocity: 1.11 versus 0.96, p less than 0.01; ratio peak early to mean filling velocity: 1.9 versus 1.7, p less than 0.01; ratio early to late velocity integral: 1.58 versus 1.25, p less than 0.01; one-third filling fraction: 41.2 versus 37.7, p less than 0.01). Left ventricular systolic function was evaluated during coronary occlusion both qualitatively, as assessed by the appearance of a new wall motion abnormality on two-dimensional echocardiography (mean 28.8 seconds), and quantitatively by measurement of systolic percent area change on the two-dimensional short-axis view as well as the Doppler echocardiographic stroke integral index. Systolic indexes did not show significant change until 30 seconds after balloon inflation (percent area change: 42.8 versus 29.2, p less than 0.01; stroke integral index: 11.04 versus 9.36, p less than 0.01). ECGs were performed at 15 second intervals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Impact of ambulatory blood pressure on left ventricular diastolic dysfunction in uncomplicated arterial systemic hypertension.

To determine the relations of 24-hour blood pressure (BP) and its different phases with left ventricular (LV) diastolic filling, 125 subjects (mean age 46 years) not taking cardiac drugs were studied by Doppler echocardiography and ambulatory BP recording. Subjects (excluding those with coronary artery or valvular heart disease, heart failure, or diabetes) were classified into 2 groups according to the level of Doppler-derived ratio of peak early to atrial velocity (E/A ratio): 59 had E/A >1 (normal diastole), 62 had E/A <1 (impaired diastole), and 4 had E/A = 1. Patients with E/A <1 were older and had higher LV mass indexed for height, average 24-hour BP, average nighttime BP, and lower day-night BP decrease, whereas average daytime BP did not differ significantly between the 2 groups. Negative correlations of E/A were found with age, heart rate, office, average 24-hour and average nighttime systolic and diastolic BP, and LV mass index. In a multivariate model that included potentially confounding factors, only age (standardized beta coefficient = -0.52, p<0.00001), nighttime BP (beta = -0.28, p<0.0001), and heart rate (beta = -0.22, p<0.001) were independent predictors of E/A in the pooled population. In conclusion, LV diastolic function is more closely related to ambulatory, rather than to clinic, BP measurements, and high average nocturnal diastolic BP is a powerful marker of LV filling impairment.

Adult↗
PubMed2006

Growth hormone replacement attenuates diastolic dysfunction and cardiac angiotensin II expression in senescent rats.

We tested the hypothesis that long-term growth hormone (GH) replacement in aged rats would preserve diastolic function and attenuate left ventricular remodeling associated with normal aging. Male Brown Norway x F344 rats were randomized to receive twice daily injections of porcine GH (200 microg/injection, subcutaneous) or saline from 24 to 30 months of age. Adult rats (6- to 9-months old) received saline injections throughout the study. Thirty-month-old, saline-treated rats exhibited low levels of insulin-like growth factor 1 (IGF-1), impaired diastolic left ventricular filling (Doppler), increased cardiac angiotensin II (Ang II), reduced plasma Ang II, and increased cardiac collagen. GH administration in old rats restored IGF-1 and diastolic indices to values comparable to those of adults. These effects were associated with reduced cardiac Ang II and attenuations in cardiac collagen. Age-related decreases in GH and IGF-1 may contribute to the decline in diastolic function of aging, in part through alterations in renin-angiotensin system-mediated ventricular remodeling.

Aging↗
PubMed1993

Reversal of diastolic dysfunction in borderline hypertension by long-term medical treatment. Longitudinal evaluation by pulsed Doppler echocardiography.

This study aimed to assess the left ventricular diastolic function of borderline hypertensive patients (BHT) and to determine the effect of long-term blood pressure control by an angiotensin converting enzyme inhibitor on the left ventricular filling profile. Pulsed Doppler echocardiograms were obtained from 18 BHT (14 men, 4 women; mean age: 55 years) and 20 age-sex matched normotensive controls. Studies were done at rest and immediately after exercise on a supine ergometer bicycle. Of the 18 patients, 11 were treated with delapril (30 mg/day) and followed up with longitudinal studies for 24 weeks. At baseline, BHT had a normal left ventricular structure. They showed a decreased peak velocity of early filling (E) (43 +/- 7 v 56 +/- 13 cm/sec, P < .01) and E/A ratio (0.83 +/- 0.2 v 1.08 +/- 0.3, P < .01), whereas peak velocity of late filling (A) and deceleration time (Dec T) were similar in the two groups. Exercise-enhanced filling indices were observed in both groups. Following blood pressure control, no change was observed in the left ventricular morphology. In contrast, progressive improvement of resting and after exercise peak velocity of early filling and E/A ratio were achieved. This indicates that long-term angiotensin converting enzyme inhibition ameliorates cardiac function in borderline hypertension.

Adult↗
PubMed1989

Focus on diastolic dysfunction: a new approach to heart failure therapy.

1. Although heart failure is commonly associated with depressed systolic function, there is increasing evidence that impaired diastolic performance is also universally present and might be a key determinant of symptoms, physical capacity and even survival in some subsets of patients. 2. Reduced diastolic distensibility increases cardiac filling pressure not only at rest, but even more during exercise when diastolic filling time is reduced. The increases in filling pressure and diastolic wall stress lead to pulmonary congestion and subendocardial ischaemia, it also triggers myocardial hypertrophy and a detrimental remodelling of the ventricular cavity. Perhaps even more importantly, impaired ventricular distensibility limits the use of the Frank-Starling mechanism, impairing systolic pump function and cardiac output adaptation during exercise. Therapies able to improve the distensibility of the ventricle are, therefore, desirable in heart failure. 3. Nitrates, angiotensin converting enzyme (ACE) inhibitors and diuretics may indirectly increase left ventricular chamber compliance by their effects on the right side of the heart. Cardiac glycosides do not improve myocardial relaxation and may even cause diastolic contracture at toxic doses. The new beta 1-adrenoceptor partial agonist, xamoterol, on the other hand, consistently lowers left ventricular filling pressure at rest and during exercise, and produces an increase in left ventricular dynamic compliance through the direct lusitropic effect of beta 1-adrenoceptor stimulation. These beneficial effects are maintained during prolonged therapy and also appear sufficient to slow the remodelling of the ventricular cavity. The improvement in symptoms and in exercise tolerance observed during xamoterol (Corwin, Carwin, Corwil, Xamtol, ICI 118,587) therapy might, therefore, be related to the improvement in left ventricular diastolic distensibility induced by this drug.

Adrenergic beta-Agonists↗
PubMed1993

Regional myocardial ischaemia and diastolic dysfunction in hypertensive heart disease.

In patients with systemic hypertension there is progressive left ventricular remodelling characterized mainly by left ventricular hypertrophy accompanied by abnormal diastolic ventricular function. Regional ischaemia, secondary to abnormal myocardial perfusion may explain in part the decrease in relaxation and compliance of the hypertrophied left ventricle. Treatment with anti-ischaemia drugs, such as beta-blockers or calcium channel blockers, improve left ventricular diastolic function.

Diastole↗
PubMed1997

Myocardial fibrosis rather than hypertrophy induces diastolic dysfunction in renovascular hypertensive rats.

The aim of the present study was to evaluate the effect of interstitial fibrosis alone or associated with hypertrophy on diastolic myocardial function in renovascular hypertensive rats. Myocardial function was evaluated in isolated papillary muscle from renovascular hypertensive Wistar rats (RHT, n = 14), renovascular hypertensive rats treated with the angiotensin converting enzyme inhibitor (ACEI) ramipril, 20 mg.kg-1.day-1 (RHT RAM, n =14), and age-matched unoperated and untreated Wistar rats (CONT, n = 12). The ACEI treatment for 3 weeks allowed the regression of myocyte mass and the maintenance of interstitial fibrosis. Myocardial passive stiffness was analyzed by the resting tension-length relationship. The myocardial fibrosis was evaluated by measuring myocardial hydroxyproline (Hyp) concentration and by histological studies of the myocardium stained with hematoxylin and eosin or picrosirus red. Left ventricular weight was significantly higher in RHT (0.97 +/- 0.12 g) compared with CONT (0.66 +/- 0.06 g) and RHT RAM (0.69 +/- 0.14 g). The Hyp levels were 2.9 +/- 0.4, 3.4 +/- 0.3, and 3.8 +/- 0.4 micrograms/mg of dry tissue for the CONT, RHT, and RHT RAM, respectively. Perivascular and interstitial fibrosis were observed in RHT and RHT RAM groups. There were lymphononuclear inflammatory exudate and edema around arteries, involving adjacent myocytes in the RHT group. There was an increased passive stiffness in RHT and RHT RAM groups compared with the CONT group. In conclusion, our results indicate that the impaired diastolic function in the renovascular hypertensive rats is related to interstitial fibrosis rather than to myocardial hypertrophy.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

[Diastolic dysfunction, left ventricular hypertrophy, and microalbuminuria in mild to moderate essential arterial hypertension].

INTRODUCTION: It is known, that there is a high prevalence of left ventricular diastolic disfunction, which precedes left ventricular hypertrophy in hypertensive people, but there is little published in literature about the relationship between these findings and the presence of microalbuminuria. OBJECTIVE: In our study, we pretend to evaluate prevalence and eventual relation among microalbuminuria, diastolic disfunction and left ventricular hypertrophy, in young mild to moderate hypertensive patients, non diabetic and without previous treatment. MATERIAL AND METHODS: We studied prospectively 80 untreated hypertensive patients, with normal serum creatinine, and non diabetic (52.5% women and 47.5% men, mean age 41.4 +/- 9.6 years). We evaluated filling indexes by Doppler Echocardiography: Ratio of early to late diastolic peak filling velocity and early filling deceleration time. Left ventricular hypertrophy was defined by Devereux's criteria. Microalbuminuria in twenty four hours was measured by radioimmunoassay in hypertensive patients (microalbuminuria: 30-300 mg/24 hours). RESULTS: Microalbuminuria occurred in 23.7%, left ventricular hypertrophy 40%, and diastolic disfunction 48.8%, no significant correlation existed between the same. Only 29.5% had no cardiac or renal disease. Statistically significant differences were found in ratio of early to late diastolic peak filling velocity and microalbuminuria, between the two study populations, but multiple regression analysis didn't prove such correlation. Ratio of early to late diastolic peak filling velocity was independently related to age and diastolic blood pressure. CONCLUSIONS: There is a high prevalence of cardiac and/or renal disease in mild hypertensive patients, only 29.5% of these patients are free of disease. We don't find relation between lesions in these organs.

Adult↗