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At least 703 records · Page 39Linked to original sources
PubMed2003

Evaluation of left ventricular diastolic function by pulsed Doppler tissue imaging in mice.

BACKGROUND: Diastolic left ventricular (LV) function is commonly characterized by transmitral flow pattern in human beings. Recently, Doppler tissue imaging (DTI) was introduced to evaluate diastolic function. The aim of our study was to validate DTI in the evaluation of diastolic function in mice. METHODS: We measured indices of diastolic function using pulsed DTI, and transmitral Doppler and LV pressure and its maximal rate of decrease (LVdP/dt(min)), before and 4 weeks after aortic banding in C57BL/6 mice. RESULTS: Peak early diastolic velocity and ratio of peak early-to-late filling velocities, both measured by DTI, were significantly reduced after banding, thereby indicating diastolic dysfunction. Diastolic dysfunction was confirmed by impaired LV dP/dt(min), decreased transmitral early filling velocity, and transmitral early-to-late filling velocity ratio using transmitral Doppler. CONCLUSION: DTI detects diastolic dysfunction caused by chronic pressure overload in mice after aortic banding. DTI is suggested to be implemented as part of routine mouse echocardiography for evaluation of LV diastolic function.

Animals↗
PubMed2002

Left ventricular long axis function in diastolic heart failure is reduced in both diastole and systole: time for a redefinition?

OBJECTIVE: To test the hypothesis that, when measured in the long axis, left ventricular systolic function is abnormal in patients with diastolic heart failure. DESIGN: A case-control study. SETTING: University teaching hospital (tertiary referral centre). PATIENTS: 68 patients with heart failure, 29 with a left ventricular ejection fraction (LVEF) of > 0.45 and diastolic dysfunction (diastolic heart failure), 39 with an LVEF of </= 0.45 (systolic heart failure), and 105 normal subjects, including 33 age matched controls. METHODS: LVEF was measured by cross sectional Simpson's method, and mitral annular amplitudes and velocities by M mode and tissue Doppler echocardiography, respectively, along with mitral Doppler inflow velocities. Results were compared between the three groups. MAIN OUTCOME MEASURES: Peak systolic mitral annular velocity and amplitude between the different groups. RESULTS: The mitral annular peak mean velocity and amplitude in systole were lower in the patients with diastolic heart failure (mean (SEM), 4.8 (0.2) cm/s) than in the age matched normal controls (6.1 (0.14) cm/s), but higher than those with systolic heart failure (2.8 (0.13) cm/s) (all p < 0.001). Similar changes were seen the mitral annular amplitude during systole. Peak early diastolic velocity and amplitude were also significantly reduced in the group with diastolic heart failure. Left ventricular hypertrophy was evident in over 95% patients in both diastolic and systolic heart failure groups, with a comparable left ventricular mass index. CONCLUSIONS: In patients with diastolic heart failure and evidence of left ventricular hypertrophy, there is systolic left ventricular impairment as measured by myocardial Doppler imaging of the longitudinal axis. Thus subtle abnormalities of systolic function are present in patients with heart failure and a normal left ventricular ejection fraction, and there appears to be a continuum of systolic function between those with truly normal, mildly impaired (labelled diastolic heart failure), and obviously abnormal left ventricular systolic function. Isolated diastolic dysfunction is uncommon.

Adult↗
PubMed1997

[Heart failure in the elderly. Therapeutic strategies].

The different types of cardiac heart failures are examined: chronic failure deriving from systolic dysfunction, diastolic dysfunction failure, refractory heart failure, acute failure. Heart failure in the elderly is not always associated with impaired ventricular contractility with decreased EF and ventricular enlargement, but frequently with diastolic dysfunction of the left ventricle (LV). The echocardiographic examination is very useful to evaluate the type of ventricular dysfunction. Since the aortic baroceptor system is less sensible, diuretics and drugs decreasing after-load must be use carefully because of orthostatic hypotension and deterioration of kidney function. The elderly are most sensible to the action of digitalis because of the pharmacokinetic changes of the drug due to age. Although the current therapy of heart failure can relieve symptoms and prolong life, prognosis is always serious. The most effective therapy is prevention as it aims at the control and, if possible, at the regression of left ventricular dysfunction in the asymptomatic or slightly symptomatic stage.

Aged↗
PubMed2005

[Age related hemodynamic changes in the elderly].

Systolic blood pressure (SBP) increases by aging. In contrast, diastolic blood pressure (DBP) decreases after age 60 because of lowering aortic compliance. Therefore, isolated systolic hypertension (ISH) is common in the elderly. ISH is a risk for cardiovascular complications, and induces a left ventricular hypertrophy combined with diastolic dysfunction. Diastolic heart failure followed by diastolic dysfunction is more common than systolic heart failure in the elderly. Furthermore, changes in neuroendocrine systems by aging may lead orthostatic hypotension, non-dipping status, large blood pressure variability, and reduced heart rate variability. In the management of elderly hypertension, the understanding for these age-related hemodynamic changes is very important.

Aged↗
PubMed2006

The Myocardial Performance Index detects chronic cardiac allograft dysfunction sooner than other methods.

AIM: Many noninvasive techniques have been proposed for the early detection of chronic heart graft dysfunction. Diastolic dysfunction may precede systolic dysfunction, and often is prominent; therefore, the aim of the study was to investigate the clinical and prognostic value of a Doppler-derived index of both systolic and diastolic function in heart transplanted patients (Myocardial Performance Index, MPI). METHODS: The MPI was measured in 63 consecutive patients (mean age 55 years, 49 men and 14 women) in sinus rhythm with an orthotopic heart transplantation for at least 1 year (mean 5.3 years) and in 63 age and sex-matched controls. A complete clinical examination was performed at the time of enrollment and was repeated after 3 months. RESULTS: At 3 months, 11 patients (17.5%) presented events (heart failure, hospitalisation or cardiac death). Patients were divided into 2 groups: Group A (52 patients) without events in the follow-up and Group B (11 patients) with events. The values of MPI in Group B (0.55+/-0.19) were significantly higher than values in Group A (0.34+/-0.18, P=0.001). Whereas the values of the index did not differ significantly between Group A and control group (0.34+/-0.18 vs 0.33+/-0.10, P=NS). In the univariate analysis, the population of heart transplanted patients was dichotomised in subgroups by a cut-off MPI of 0.47 and a cut-off ejection fraction (EF) of 50%. Nine patients (41%) with MPI=or>0.47 presented events, while only 2 patients (5%) with MPI<0.47 had any event (P<0.001; c2 12.9). Six patients (85%) with EF<50% had events, while only 5 patients (9%) with EF=or>50% had an event (P<0.001; c2 14). In the multivariate analysis only MPI (chi squared=22.6, P=0.018) and EF (chi squared=20.8, P=0.025) were significant independent predictors of heart failure or cardiac death. By looking at Kaplan-Meyer curves, MPI seems to be better than EF in the earlier detection of graft dysfunction. CONCLUSION: MPI, as a combined systolic and diastolic index, may detect graft dysfunction earlier than EF.

Chronic Disease↗
PubMed2002

[Hemodynamic features in bronchial asthma concurrent with hypertensive disease].

AIM: To study the cardiorespiratory system, central and intracardiac hemodynamics. MATERIALS AND METHODS: 274 patients with bronchial asthma (BA), including 117 patients with this condition concurrent with hypertensive disease (HD) during traditional medical treatment were examined. RESULTS: The impact of concomitant HD on the pattern of performance of the cardiovascular system and the development of the cardiac structure in these patients was evaluated. CONCLUSION: In patient with BA concurrent with HD, external respiratory dysfunction diastolic dysfunction of both ventricle deteriorate, specific peripheral resistance enhances.

Adult↗
PubMed1990

Invasive evaluation of left ventricular diastolic performance.

Diastole can be divided into four phases: 1. isovolumic relaxation; 2. early filling; 3. diastasis; and 4. atrial systole. The amount of left ventricular (LV) filling that occurs during each of these phases depends on: 1. myocardial relaxation; 2. the passive characteristics of the LV; 3. the characteristics of the left atrium, pulmonary veins and mitral valve; and 4. the heart rate. When diastolic function is normal, the net effect of these factors results in LV filling sufficient to produce an adequate cardiac output, while mean pulmonary venous pressure is maintained below 12 mm Hg. Diastolic dysfunction is normally manifest as pulmonary congestion. In the absence of systolic dysfunction, abnormal diastolic performance is usually due to abnormal relaxation and/or changes in the passive LV characteristics, external compression or disease of the mitral valve and left atrium. Invasive studies can quantify the rate of myocardial relaxation from the time course of the fall of LV pressure during isovolumic relaxation and the passive LV properties from the LV diastolic pressure-volume relation. In addition, frame-by-frame analysis of contrast ventriculography and conductance determination of LV volume can quantify the pattern of LV diastolic filling. Normally, at rest, most LV filling occurs early in diastole. Conditions that produce diastolic dysfunction, such as LV hypertrophy and ischemia, are associated with reduced early diastolic filling and an augmented importance of atrial systole. It is important to recognize that such patterns can occur in patients without clinically apparent diastolic dysfunction and in normals if left atrial pressure is sufficiently elevated. Furthermore, a normal pattern can occur in patients with severe diastolic dysfunction. Reduced early diastolic filling in the absence of pulmonary congestion indicates the loss of diastolic reserve, since the left atrium is being used as a booster-pump. This pattern of diastolic filling in a patient with symptoms of pulmonary congestion suggests diastolic dysfunction, even if systolic LV performance is normal.

Atrial Function↗
PubMed1990

Beta, partial agonists to treat heart failure: effects of xamoterol upon cardiac function and clinical status.

The presence of systolic dysfunction, diastolic dysfunction, or both is an important consideration in selecting the optimal pharmacologic approach to the treatment of congestive heart failure in an individual patient. Cardiac glycosides and arterial vasodilators act only on systolic function, whereas beta 1-adrenoceptor-stimulating agents, such as beta 1 full and partial agonists, have both inotropic and lusitropic activity. Acute and chronic administration of xamoterol, a new beta 1 partial agonist, to patients with congestive heart failure has been shown to improve myocardial contractility, as indicated by increases in the peak rate of rise in left ventricular pressure, left ventricular ejection fraction, and cardiac output. Improvement in ventricular relaxation and filling, reflected by increases in the peak rate of decline in left ventricular pressure, reductions in the time constant of the decrease in isovolumic pressure, improved left ventricular compliance, and increases in the atrial contribution to diastolic filling, are other beneficial effects of xamoterol on diastolic function. Exercise capacity increases in response to xamoterol therapy, while heart rate at maximum exercise declines. Relief of the signs and symptoms of congestive heart failure and improvement in functional status have also been demonstrated in xamoterol-treated patients. The undesirable effects of beta 1 full agonists, such as tachycardia, arrhythmias, increased myocardial oxygen consumption, and effects on the peripheral vasculature, are not seen with xamoterol. The beta 1 partial agonist also causes no beta-adrenoreceptor down-regulation, a finding that may account for its sustained effectiveness with long-term therapy.

Adrenergic beta-Agonists↗
PubMed2005

Serum-free thyroxine and thyrotropin concentrations in euthyroid patients with decompensated congestive heart failure.

We realized a prospective study of 106 consecutive patients hospitalized in an Internal Medicine Service with decompensated CHF. Between the 95 patients with normal serum-free thyroxine and thyrotropin concentrations, patients older than 70 years had a significant higher serum free thyroxine concentration (13.1+/-2.6 vs. 10.1+/-1.5 pmol/l, p=0.006) and a lower, but not significant, serum thyrotropin concentration (1.3+/-1.2 vs. 1.7+/-1.1 mU/l, p=0.11). No correlation was found between the functional class, the echocardiographic ejection fraction or the in-hospital stay and the serum free thyroxine and thyrotropin concentrations. The sex, the presence of systolic dysfunction, diastolic dysfunction, atrial fibrillation or comorbidity did not determine significant differences in the serum-free thyroxine and thyrotropin concentrations.

Adult↗
PubMed2005

Multimodal detection of perioperative myocardial ischemia.

Cardiac anesthesiologists have the responsibility to detect myocardial ischemia in a timely manner, which can be a challenging task in the perioperative environment. Transesophageal echocardiography pulmonary artery catheterization, and electrocardiography are the 3 major methods available for monitoring perioperative ischemia. Echocardiography, the newest and most sophisticated method, has been shown to be highly sensitive for detecting ischemia associated with systolic dysfunction. Echocardiography can detect wall-motion abnormalities before electrocardiographic changes develop in patients who are likely to experience supply-mediated ischemia. Perioperative ischemia that occurs after bypass and is detected using transesophageal echocardiography has been found to be related to an adverse outcome. However, the use of echocardiography has some limitations, including the detection of abnormalities not induced by ischemia and the presence of ischemia in areas not visible in the view selected. Pulmonary artery catheterization can provide information about systolic dysfunction, diastolic dysfunction, and mitral regurgitation, but the sensitivity and safety of catheterization have been questioned. Electrocardiography can be a superb monitoring device as long as clinicians pay adequate attention to lead selection and placement, filter selection, and gain adjustment. The optimal monitoring approach should integrate all 3 available monitoring systems in order to increase the likelihood of detecting both supply- and demand-mediated ischemia.

Anesthesiology↗
PubMed2006

Anesthesia for the elderly: selected topics.

PURPOSE OF REVIEW: With the graying of the Western population, there is a continuous increase in the proportion of elderly patients undergoing surgical procedures. Geriatric anesthesia is emerging from a 'subspecialty' to the mainstream of today's anesthesia and perioperative care. Much has been written on anesthesia for the elderly, but this review will concentrate on selected topics related to elderly care that represent current unresolved and pertinent issues for the care of the elderly surgical patient. RECENT FINDINGS: Postoperative cognitive dysfunction, cardiac diastolic dysfunction and prophylactic perioperative beta-blockade in the process of major noncardiac surgery are three main topics that have recently attracted great interest in clinical practice and research, and have therefore been chosen as the selected topics for this current review. SUMMARY: Although age is a clear risk factor for postoperative cognitive dysfunction, the association of general anesthesia with cognitive dysfunction is less clear, as is the effect of anesthesia per se or surgery on long-term cognitive dysfunction. Cardiac diastolic dysfunction is a relatively new and evolving concept in anesthesia and perioperative medicine, yet clearly diastolic dysfunction even with a normal ejection fraction may have a significant effect on the perioperative outcome and management of elderly patients. Small, but powerful studies have shown significant outcome benefit with prophylactic perioperative beta-blockade in high-risk patients undergoing major noncardiac surgery. Data from other studies, however, are still conflicting and the final verdict awaits larger scale outcome studies.

Adrenergic beta-Antagonists↗