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PubMed2001

[Biventricular impairment of diastolic function in acromegaly].

AIM: Left ventricle impairment is very common in acromegaly. Concentric hypertrophy and diastolic dysfunction are observed at an early stage. Late left ventricle dilatation with systolic dysfunction may appear. Few reports have studied right ventricle diastolic function. METHODS: Twenty-seven acromegalic patients were included. Biventricular diastolic function was assessed using Doppler-echocardiography. Possible associations with hormonal activity, evolution time of illness, hypertension, left ventricular hypertrophy and systolic impairment on echocardiography were studied. RESULTS: Fifteen patients showed left ventricular diastolic dysfunction, whereas thirteen patients showed right ventricular diastolic dysfunction. A good correlation was observed between E/A relation of both ventricles (r = 0.70; p < 0.01) and isovolumetric relaxation time (r = -0.60; p < 0.01). The right ventricular E/A relation correlated with left ventricular mass index and significance was almost achieved with the presence of hypertension. There was no statistical correlations between the right ventricular E/A relation and hormone values or evolution time of illness. The left ventricular E/A relation showed a significant association with left ventricular mass index, isovolumetric time index and evolution time of illness. There were no statistical association with hormone values. CONCLUSIONS: The high prevalence of right ventricular diastolic dysfunction observed in acromegaly suggests the presence of acromegalic myocardiopathy.

Acromegaly↗
PubMed2000

Atrioventricular filling dynamics, diastolic function and dysfunction.

Left ventricular diastolic dysfunction is associated with slowing of LV relaxation and a decrease in LV chamber compliance. This impairment of function leads to changes in filling velocities as measured by pulsed wave Doppler echocardiography in the pulmonary veins and across the mitral valve, and in intraventricular flow propagation velocity as measured by color M-mode Doppler. This paper explores some of the physiology of LV filling in a clinical context.

Aortic Valve↗
PubMed2001

Effect of the Valsalva manoeuver on diastolic filling indices in patients with essential hypertension.

In some hypertensive patients, echocardiographic examination does not reveal any pathologic finding in spite of a documented blood pressure elevation. In our study, we investigated the effect of preload reduction with Valsalva manoeuver on transmitral flow velocities in hypertensive patients with normal mitral flow pattern and compared the results with a healthy control group. Sixty-eight patients without evidence of coronary artery disease or heart failure (28 female, 40 male, age 50 +/- 7) were divided in two groups according to their E/A ratio as those with diastolic dysfunction (n = 36) and without diastolic dysfunction (DD(-): n = 32). DD(-) patients and the control group (n = 20) performed Valsalva manoeuver and their pulsed-Doppler mitral flow measurements were repeated at the strain phase. During Valsalva manoeuver, E wave velocity decreased in all subjects. In the controls, peak A velocity showed a similar decline and E/A ratio remained over 1.0. However, in 72% of DD(-) patients A velocity did not change or increased and their E/A ratio fell below 1.0. In 47% of the patients with an E/A ratio reversal after Valsalva manoeuver, myocardial perfusion scintigraphy revealed reversible defects whereas none of the patients whose E/A ratio remained over 1.0 had perfusion defects. It is concluded that: (1) in hypertensive patients with normal E/A ratio Valsalva manoeuver should be performed in order to unmask a probable false normal finding, (2) an important percent of hypertensive individuals have left ventricular relaxation abnormalities, and (3) diastolic dysfunction develops together with a decrease in coronary reserve.

Adult↗
PubMed2005

Reverse remodeling of the left cardiac chambers after catheter ablation after 1 year in a series of patients with isolated atrial fibrillation.

BACKGROUND: Isolated atrial fibrillation (AF) is associated with mild enlargement of the left atrium (LA) and left ventricular (LV) diastolic dysfunction. The impact of ablation of isolated AF on left chamber size and function is unclear, and whether diastolic dysfunction is the cause or the consequence of AF remains unknown. The objective of this prospective study was to evaluate the impact of sinus rhythm restoration by catheter ablation on LV diastolic dysfunction, LA morphology, and mechanical function. METHODS AND RESULTS: Forty-eight patients with isolated AF were studied by serial echocardiographic studies at baseline and at 1-, 3-, 6-, 9-, and 12-month intervals after radiofrequency ablation. LA dimensions and mechanical function and LV systolic and diastolic functions were evaluated at each time interval. Diastolic function was assessed with conventional Doppler parameters and new indexes such as tissue Doppler imaging, mitral flow propagation velocity, and combined criteria. LV diastolic dysfunction was present in paroxysmal and chronic AF patients with a reduction of tissue Doppler imaging lateral early diastolic peak velocity in 37% (P<0.001) and 48% (P<0.01), respectively, compared with healthy control subjects. At the end of the follow-up, LA area decreased significantly by 18% (P<0.001) in paroxysmal and 23% (P<0.05) in chronic AF patients. Diastolic function improved significantly with an increase in lateral early diastolic peak velocity of 29% (P<0.001) in paroxysmal AF and 46% (P<0.05) in chronic AF patients. A significant increase in LV ejection fraction was also noted for both groups: 7.7% and 18.8%, respectively. CONCLUSIONS: This study demonstrates reverse morphological remodeling of the LA and improvement of LV diastolic and systolic functions after restoration of sinus rhythm by ablation for isolated AF. Because patients with isolated AF have none of the traditional causes of LV diastolic dysfunction, our findings suggest that AF may be partly the cause rather than the consequence of diastolic dysfunction.

Adult↗
PubMed2001

Acute effect of clonidine on left ventricular pressure-volume relation in hypertensive patients with diastolic heart dysfunction.

We sought to assess the haemodynamic effects of clonidine on left ventricular (LV) pressure-volume relation in patients with diastolic heart dysfunction due to essential hypertension. Towards this end, simultaneous recordings of LV volume (acoustic quantification) and LV pressure (micromanometer) were obtained in 10 such patients before and after drug administration and compared to baseline findings on 10 matched normal controls. The following measurements and calculations were obtained: maximal positive and negative first derivative of LV pressure (peak +dP/dt and peak -dP/dt, respectively), LV minimal and end-diastolic pressure, peak systolic blood pressure, time constant of relaxation (TAU), LV stroke work and LV stiffness constant. The two invasive indexes, LV stiffness constant and TAU classified 10/10 patients as having abnormal LV diastolic function compared with 7/10 patients so classified by Doppler studies. Central sympathetic suppression by a single oral dose of clonidine 0.125 mg in these patients resulted within 60 min in a decrease of heart rate and mean arterial pressure as well as a significant improvement of LV diastolic function indexes. Specifically, the LV stiffness constant (ml(-1)), in normal subjects was 0.0028 vs 0.0152 (P < 0.001) in hypertensive subjects at baseline, vs 0.0053 in hypertensive after clonidine (P < 0.001 vs baseline). Likewise, the E/A ratio, was 1.08 in normal subjects vs 0.88 (P < 0.0001) in hypertensives at baseline, vs 1.28 in hypertensives after clonidine (P < 0.0001 vs baseline). With clonidine the diastolic portion of the pressure-volume curve was displaced downward. In conclusion, clonidine can improve diastolic dysfunction without depressing systolic LV performance. The improvement may be attributable in part to withdrawal of direct sympathetic influence on the myocardium and in part to the indirect effect of systemic, pulmonary and coronary artery relaxation.

Aged↗
PubMed2002

Cardiac dysfunction in hypertrophic cardiomyopathy mutant tropomyosin mice is transgene-dependent, hypertrophy-independent, and improved by beta-blockade.

Familial hypertrophic cardiomyopathy (FHC) has been linked to mutations in proteins of the cardiac contractile apparatus, including alpha-tropomyosin (Tm). Mice expressing alphaTm in the heart were developed to determine the effects of FHC mutant Tm on cardiac structure and function from single cardiac myocytes to whole organ function in vivo. Expression of E180G mutant Tm did not produce cardiac hypertrophy or detectable changes in cardiac muscle morphology. However, E180G mutant Tm expression increased the Ca2+ sensitivity of force production in single cardiac myocytes in a transgene expression-dependent manner. Contractile dysfunction in single myocytes manifested organ level dysfunction, as conductance-micromanometry showed E180G Tm mice had significantly slowed relaxation (diastolic dysfunction) under physiological conditions. The diastolic dysfunction in E180G Tm mice was no longer evident during beta-blockade because propranolol eliminated the effect of E180G Tm to slow myocardial relaxation. Cellular and organ level dysfunction were evident in E180G Tm mice in the absence of significant cardiac structural abnormalities normally associated with FHC. These findings therefore suggest that diastolic dysfunction in FHC may be a direct consequence of FHC mutant protein expression. In addition, because diastolic dysfunction in E180G Tm mice is dependent on inotropic status, cardiovascular stress may play an important role in FHC pathogenesis.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

From left ventricular hypertrophy to congestive heart failure: management of hypertensive heart disease.

Other than age, left ventricular hypertrophy (LVH) is the most potent predictor of adverse cardiovascular outcomes in the hypertensive population, and is an independent risk factor for coronary heart disease, sudden death, heart failure and stroke. Although directly related to systolic blood pressure, other factors including age, sex, race, body mass index and stimulation of the renin-angiotensin-aldosterone and sympathetic nervous systems play an important role in the pathogenesis of LVH. LVH involves changes in myocardial tissue architecture consisting of perivascular and myocardial fibrosis and medial thickening of intramyocardial coronary arteries, in addition to myocyte hypertrophy. The physiologic alterations which occur as a result of these anatomical changes include disturbances of myocardial blood flow, the development of an arrhythmogenic myocardial substrate and diastolic dysfunction. The latter is directly related to the degree of myocardial fibrosis and is the hemodynamic hallmark of hypertensive heart disease. When diastolic dysfunction is present, left ventricular end-diastolic pressure increases out-of-proportion to volume and may be elevated at rest or with exertion leading to clinical heart failure. At least one third of heart failure patients in the United States can be considered to have heart failure related to diastolic dysfunction. Compared to heart failure patients with systolic dysfunction, diastolic heart failure patients are more likely to be older, female, and to be hypertensive at the time of presentation. Although it has been assumed that LVH may lead to systolic dysfunction, evidence is lacking that LVH resulting from hypertension is a major risk factor for systolic heart failure independent of coronary artery disease. Treatment of hypertension greatly attenuates the development of LVH and significantly decreases the incidence of heart failure. In patients with established LVH, regression is both possible and desirable and results in a significant reduction in adverse clinical endpoints.

Antihypertensive Agents↗
PubMed2000

Left ventricular inflow normal or pseudonormal. A new echocardiographic method: diastolic change of left atrial diameter.

UNLABELLED: Mitral flow Doppler study has been used to evaluate left ventricle (LV) diastolic function. Through its use, greater A wave than E wave, pseudonormal pattern, and restrictive pattern were observed progressively in patients with more LV diastolic dysfunction. Differentiation of normal or pseudonormal mitral flow is very important. In this study, left atrium (LA) diameter change during diastole was used as a new method for the differentiation of normal and pseudonormal mitral flow. METHOD: Sixty-eight patients (30 men, 38 women; mean age 53 +/- 13 years) with echocardiographically determined diastolic dysfunction and 60 healthy volunteers (36 men, 24 women; mean age 49 +/- 12 years) were included in the study. Mitral flow E/A ratio, isovolumetric relaxation time (IVRT), and deceleration time (DT) of E wave were used for determination of the diastolic dysfunction. Thirty of 68 diastolic dysfunction patients had A>E wave, 20 had pseudonormal mitral flow pattern, and 18 had restrictive mitral flow pattern. Left parasternal long-axis echocardiographic window was used for the measurement of LA diameter. Left atrium emptying fraction (LAEF) was defined as ratio of end-diastolic LA diameter to end-systolic diameter. RESULTS: LAEF was found 0.69 +/- 0.01 (mean +/- SE) in the control group, 0.76 +/- 0.01 in the A>E group (P < 0.05, control vs A > E group), 0.83 +/- 0. 05 in the pseudonormal pattern group (P < 0.05, control vs pseudonormal pattern group), and 0.87 +/- 0.01 in the restrictive pattern group (P < 0.001, control vs restrictive pattern group). CONCLUSION: (1) LV diastolic dysfunction reduces the filling of LA content to the LV during diastole; (2) LA diameter changes during diastole as a new and practical method for the differentiation of the normal-pseudonormal mitral flow pattern.

Adult↗
PubMed2002

[Echocardiography diagnosis of diastolic heart failure].

BACKGROUND: Left ventricular diastolic dysfunction can be diagnosed if clinical signs of heart failure and normal ejection fraction are found. Beside clinical signs of heart failure and criteria from catheterization studies like abnormal left ventricular relaxation, filling and/or compliance echocardiography provides valuable parameters for the assessment of diastolic dysfunction. ECHOCARDIOGRAPHIC DEGREES OF SEVERITY: By the use of various parameters diastolic dysfunction can be differentiated into four degrees of severity, which are of great prognostic importance. If more than one echocardiographic parameter is used, sensitivity for the assessment of diastolic dysfunction becomes nearly 100%. Conventional parameters include isovolumetric relaxation time (IVRT) measured by pulsed Doppler, the ratio of rapid filling and atrial filling velocity (E/A), deceleration time of rapid mitral inflow as well as the ratio of systolic and diastolic pulmonary venous flow velocities. In patients with signs of diastolic heart failure and a normal E/A ratio pulmonary venous flow pattern can help to unmask "pseudonormalization" as the transition from abnormal relaxation to restriction. These parameters, however, are preload-dependent and do not provide intrinsic left ventricular properties. Even in atrial fibrillation, left ventricular filling pressure can be assessed. NEW METHODS: Two novel approaches, color Doppler M-mode of left ventricular inflow and tissue Doppler of the mitral annulus, are relatively preload-independent and allow direct estimation of relaxation and filling pressure. By the means of real-time 3-D echocardiography we developed a new method for the non-invasive assessment of rapid filling rate (PFR), thereby completing the echocardiographic approaches to determine diastolic dysfunction. CONCLUSION: The broad spectrum of approaches available today makes echocardiography the first choice for the assessment of diastolic dysfunction.

Echocardiography↗
PubMedDate not supplied

Prognosis in diastolic heart failure.

Diastolic dysfunction and the clinical syndrome of diastolic heart failure have become well recognized as contributors to the overall burden of congestive heart failure. This increasing awareness has led to several recent investigations into the impact of diastolic abnormalities on morbidity and mortality. This article reviews the current state of knowledge regarding the prognosis of patient populations with diastolic dysfunction and diastolic heart failure.

Aged↗
PubMed2004

Role of diastole in left ventricular function, II: diagnosis and treatment.

Left ventricular diastolic dysfunction plays an important role in congestive heart failure. Although once thought to be lower, the mortality of diastolic heart failure may be as high as that of systolic heart failure. Diastolic heart failure is a clinical syndrome characterized by signs and symptoms of heart failure with preserved ejection fraction (0.50) and abnormal diastolic function. One of the earliest indications of diastolic heart failure is exercise intolerance followed by fatigue and, possibly, chest pain. Other clinical signs may include distended neck veins, atrial arrhythmias, and the presence of third and fourth heart sounds. Diastolic dysfunction is difficult to differentiate from systolic dysfunction on the basis of history, physical examination, and electrocardiographic and chest radiographic findings. Therefore, objective diagnostic testing with cardiac catheterization, Doppler echocardiography, and possibly measurement of serum levels of B-type natriuretic peptide is often required. Three stages of diastolic dysfunction are recognized. Stage I is characterized by reduced left ventricular filling in early diastole with normal left ventricular and left atrial pressures and normal compliance. Stage II or pseudonormalization is characterized by a normal Doppler echocardiographic transmitral flow pattern because of an opposing increase in left atrial pressures. This normalization pattern is a concern because marked diastolic dysfunction can easily be missed. Stage III, the final, most severe stage, is characterized by severe restrictive diastolic filling with a marked decrease in left ventricular compliance. Pharmacological therapy is tailored to the cause and type of diastolic dysfunction.

Diastole↗
PubMed2002

[Tissue Doppler echocardiography: a new technique to assess diastolic function].

UNLABELLED: Diastolic dysfunction and elevated filling pressure have important role in heart failure. Traditional Doppler echocardiography (DE) however is of limited value in the measurement of these variables. The objective of this study was the evaluation of a new technique, the pulsed tissue Doppler echocardiography of the lateral mitral anulus (PTDI) in diastolic function. 96 consecutive patients were included into the study who were in sinus rhythm, mitral valve disease was excluded and ejection fraction was either > or = 50% (50 patients) or < or = 40% (46 patients). DE technique was used to measure mitral E, A velocity, deceleration time (DT). Myocardial early diastolic (Ea), late diastolic (Aa) velocities were measured at the lateral mitral anulus by PTDI, and E/A, Ea/Aa, E/Ea ratios were calculated. Based on accepted DE criteria of diastolic dysfunction there were 19 normal subjects, 18 patients had abnormal relaxation, 8 had pseudonormalization pattern and 12 had restrictive dysfunction, the rest of patients did not fulfill these criteria. RESULTS: PDTI indicated an association of diastolic dysfunction to systolic dysfunction, which could not be shown by DE. Myocardial Ea velocity was age-dependent only in patients with good systolic function, and it was less than 15 cm/s in all types of diastolic dysfunction. E/Ea ratio over 8 indicated elevated filling pressure, but it was related to E/A ratio only in cases of good systolic function. Importantly one third of cases could be classified into diastolic dysfunction patterns only using tissue Doppler. CONCLUSIONS: Myocardial diastolic velocities can be easily measured by pulsed tissue Doppler technique at the lateral mitral anulus. Decreased early diastolic tissue velocity indicates diastolic dysfunction independently of its type, and it is generally associated to systolic dysfunction, independently of age. Pseudonormalization is defined as the combination of normal mitral inflow and decreased tissue diastolic velocity.

Adolescent↗
PubMed1997

Utility of a bedside Doppler in tracking left ventricular dysfunction related to hemorrhagic shock.

Treatment of hemorrhagic shock with fluid resuscitation alone results in diastolic dysfunction as measured by peak systolic pressure/end systolic volume ratio (PSP/ESV). The purpose of this study was to test the ability of a simple Doppler device to track diastolic dysfunction in hemorrhagic shock. In this prospective, controlled crossover study, five adult swine were resuscitated from hemorrhagic shock using fluids. Diastolic dysfunction was confirmed using PSP/ESV ratio. The effect of nitroprusside and dobutamine on this diastolic dysfunction was evaluated. Data (PSP/ESV, Doppler-derived acceleration, and oxygen transport parameters) were collected at each stage of the model. Arterial pressure and oxygen transport parameters corrected to baseline values; however, the PSP/ESV and Doppler-derived acceleration failed to correct with fluid resuscitation alone. Treatment with nitroprusside and dobutamine increased oxygen transport parameters, PSP/ESV ratio, and Doppler-derived acceleration significantly. Doppler-derived acceleration tracks left ventricular dysfunction seen in hemorrhagic shock.

Animals↗
PubMed1997

[Relationship between systolic and diastolic function of the left ventricle in patients with impaired relaxation of the left ventricle without symptoms of heart failure. Attempt at quantitative estimation of diastolic function in the impaired relaxation stage].

UNLABELLED: Diastolic dysfunction of left ventricle appears very often in patients with coronary artery disease (CAD) and hypertension (HT) and is a main cause of heart failure in 30-40% of all cases. Relation between systolic and diastolic function of left ventricle (LV) is commonly known but not documented well enough. Moreover, no quantitative classification of diastolic dysfunction is still available. AIM OF THE STUDY: To find out the relations between the parameters of systolic and diastolic function of LV in patients with CAD or HT with impaired relaxation of LV without symptoms of heart failure and to make up the quantitative classification of diastolic dysfunction in the stage of impaired relaxation of LV. METHODS: Investigations were carried out in 57 patients (mean age 55.5 +/- 11.5) with angiographically proven CAD and in 91 patients (mean age 56.3 +/- 10.6) with HT and angiographically excluded CAD, all without regional myocardial contractility abnormalities and valvular heart diseases. Control group consisted of 54 healthy subjects (mean age 55.4 +/- 11.4). During 2D echocardiography examination left ventricular end-diastolic (LVEDD) and end-systolic diameters (LVESD) and left atrial dimension (LA) were obtained. Using Doppler method transmitral inflow indices: E velocity (E), A velocity (A), E velocity integral (E-VTI), A velocity integral (A-VTI), total velocity integral (T-VTI), E deceleration time (DT), isovolumic relaxation time (IVRT) and aortic flow velocity integral (Ao-VTI) were measured. Only patients with E/A < or = 1 and--to exclude pseudonormalization of mitral inflow--with DT > or = 140 ms were qualified to the study. We proposed diastolic dysfunction ratio (DDR) calculated from formula: DDR = E/A x E-VTI/T-VTI. Using AFVI, LV outflow diameter, heart rate (HR) and body surface area cardiac index (CI) was calculated. RESULTS: In studied group there were significantly higher values of LA, A, IVRT, DT and lower values of E, E/A, E-VTI and DDR compared to controls. There were no significant differences between these groups in HR, LVEDD, LVESD, T-VTI and CI. No significant differences in any of studied parameters were found between subgroups with CAD and HT. Among healthy subjects in subgroup with abnormal mitral inflow pattern (E/A < or = 1) there were significantly higher values of LA, IVRT, DT and lower values of DDR than in sugroup with normal one. Both subgroups did not differ in LVEDD, LVESD, CI. In the studied group there was positive correlation between DDR and CI (r = 0.69, p < 0.001), DDR and IVRT (r = 0.71, p < 0.001), DDR and DT (r = 0.61, p < 0.001), CI and E (r = 0.34, p < 0.01), CI and IVRT (r = 0.52, p < 0.001), CI and DT (r = 0.42, p < 0.001), CI and E/A (r = 0.54, p < 0.001), CI and E-VTI (r = 0.43, p < 0.001). In the control group significant correlation was found only between DDR and IVRT (r = 0.64, p < 0.02) and between DDR and DT (r = 0.52, p < 0.02) but not between DDR and CI. Using DDR DD was divided into 3 classes: class I with DDR > 0.47, class II with 0.47 > or = 0.30, and class III with DDR < 0.30. Applying of such intervals of values of DDR determined the groups which significantly differed between themselves in CI, IVRT and DT. CONCLUSIONS: (1) In patients with CAD or HT with impaired relaxation of LV without symptoms of heart failure there is relation between parameters of systolic and diastolic function of LV: the more advanced diastolic dysfunction, the more impaired systolic function. (2) In healthy subjects there is no relation between parameters of systolic and diastolic function of LV. (3) DDR is a good indicator of quantitative estimation of diastolic dysfunction in the stage of impaired relaxation of LV.

Adult↗
PubMed2006

Hepatopulmonary syndrome and right ventricular diastolic functions: an echocardiographic examination.

AIM: Liver functions are affected in the course of cardiac diseases, and similarly, liver diseases affect cardiac functions. Many studies in the literature have shown that left ventricular systolic and/or diastolic dysfunction may develop during chronic liver disease. However, there are limited studies investigating right ventricular functions during chronic liver diseases. METHODS: A total of 84 patients who had no systolic and/or diastolic dysfunction in the left ventricle (LV) were evaluated; 46 patients with liver cirrhosis; 10 (21.74%) cirrhotic patients with hepatopulmonary syndrome (HPS) (group 1), 36 (78.26) cirrhotic patients without HPS (group 2), and 38 healthy individuals were treated as control. RESULTS: Right ventricular diastolic dysfunction was determined in all patients of group 1 (100%), 26 of group 2 (72.22 %), and 4 of the controls (10.52%) (P<0.05). Tricuspid deceleration time (dt) was significantly different between the groups (P<0.05). In addition, right atrium (RA) diameters, right ventricle (RV) diameters, and RV wall thickness were significantly different between the groups (P<0.05). Pulmonary artery pressure (P<0.05) and pulmonary vascular resistance (P<0.05) were also seen to be higher in group 1 than those in group 2 and control group. CONCLUSIONS: Right ventricular diastolic dysfunction rate is high in chronic liver diseases. In the presence of HPS, right ventricular diastolic dysfunction is more remarkable in patients than those without HPS. Right ventricular diastolic dysfunction may result in dilatation and hypertrophy in the right heart.

Adult↗
PubMed1995

An echocardiographic evaluation of patients with idiopathic heart failure.

The primary myocardial disease idiopathic dilated cardiomyopathy (IDCM) is not clearly defined in the literature. The description is both morphologic and etiologic. We examined consecutive patients with congestive heart failure (CHF) of unknown cause to identify possible cases of IDCM and to give a detailed description of echocardiographic data and possible diastolic dysfunction in this group. The hospital records of patients aged 16 to 65 years hospitalized due to CHF or IDCM during a 6-year period (N = 2,711) were evaluated in a defined region of western Sweden. Twenty-two percent (584/2,711) of these records contained no plausible cause of CHF or IDCM, and among patients being alive, obvious cause was lacking in 411 of 1,516 (27%). These 411 patients were offered a diagnostic investigation, including echocardiography, and they were compared with a randomly selected control group (n = 103) from the general population. Of 411 patients, 293 accepted investigation. From the control group, we defined the reference level for left ventricular (LV) dilatation to be > 32 mm/m2, and reduced ejection fraction according to Teichholz formula to be < 50%. Applying these borderlines, we identified LV dilatation and systolic dysfunction to be present in 30%, either dilatation or systolic dysfunction in 36%, and neither in 34%. In patients without any signs of systolic dysfunction 44% (26/59) showed signs of diastolic dysfunction. In a multivariate analysis, LV dimension was not independently correlated to disease, although LV dimension was univariately correlated to ejection fraction (EF) (r = -0.59; p < 0.0001). However, EF (p < 0.0001), left atrial dimension (p < 0.0001), and the first third filling fraction (p < 0.0001) were the constellation of parameters that most accurately separated patients from controls. By using these three parameters, a positive and negative predictive accuracy of 98% and 61%, respectively, was achieved. Thus, in a consecutive group of patients with idiopathic CHF recruited from a nonselected group of hospitalized patients with CHF, all grades of ventricular function were found. In this group, 30% were identified as having IDCM. We give reference values for the diagnosis of idiopathic IDCM and a simple tool to identify patients with systolic and diastolic dysfunction.

Adult↗
PubMedDate not supplied

Women and heart failure.

Almost half of the patients affected with congestive heart failure (CHF) in the United States are women. However, past studies have included predominantly men and generalized results to women. Many women with CHF are older, have hypertension, and have higher ejection fractions. Survival differences have been reported previously with conflicting results. Although treatment for left ventricular dysfunction is somewhat standardized, treatment for diastolic dysfunction is less defined. Clinical trials for this group of patients, many of whom are women, have not been performed. In comparison with men, women have several cardiovascular differences as well as differences in electrical properties. In addition, response to medical (pharmacologic) therapy may differ in men and women.Finally, functional status has been shown to be compromised in both men and women with CHF; however, some studies have shown women to experience more exercise intolerance. This may be because more women than men have diastolic dysfunction. Few women have been included in exercise trials. Future trials must address women with CHF, many of whom are older and have normal (or near normal) left ventricular function or diastolic dysfunction.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Evaluation of the systolic and diastolic function of the left ventricle in patients with diabetes mellitus and microalbuminuria].

UNLABELLED: The objective of this study is to reveal the deterioration of the systolic and diastolic function of the left ventricle (LV) in patients with diabetes mellitus (DM), in correlation with type of DM, the edge and the complications of DM and the associated diagnosis. METHODS: The study included 43 patients with DM (29 patients with DM type 1 or 2 insulinodependent--DMID and 14 patients with DM type 2 nonisulinodependent--DMNID). The age of patients was between 21 years and 57 years, with a duration of DM between 1 year and 22 years. The ecocardiographic evaluation have determined 38 parameters (B mod, M mod, CWD, PWD, colour Doppler). From these parameters, 12 was used for the measurement of the systolic function of the LV and 18 was used for the determination of the diastolic function of the left ventricle. The clinical and biological exam have performed: glycaemia, proteinuria, dyslipidemic syndrome, complications of DM and ischaemic heart disease (ECG). RESULTS: The ejection fraction (EF) of the LV was ?60% in 23 patients, between 50% and 60% in 17 patients and between 40% and 50% in 3 patients. The values of MSER (mean systolic ejection rate) was between 221 ml/s şi 515 ml/s and the values of MVCF (mean velocity of circumferential shortening) was between 0.9 circ/s şi 1, 8 circ/s. The ratio of the E and A waves at the mitral valve was > 1 in 22 patients and < 1 in 21 patients. The LV isovolumic relaxation time (IVRT) was < 70 ms in 13 patients, > 100 ms in 14 patients and had normal values in 16 patients. The E wave deceleration time (EDT) was < 150 ms in 24 patients and had normal values in 19 patients. There is no connection between the systolic/diastolic function and the other determined parameters. CONCLUSIONS: The alteration of the LV systolic function was present in 20 patients from 43 patients. The LV diastolic dysfunction through relaxation troubles was present in 14 patients and the LV diastolic dysfunction through compliance trouble was present in 13 patients. A number of 16 patients had preserved (for the moment) a normal LV diastolic function. The number of patients with these two types of LV diastolic dysfunction was equal in our study. Other studies had found a predominance of LV diastolic dysfunction through compliance troubles in DM.

Adult↗