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PubMed2001

T wave positivity in resting electrocardiogram predicts preserved systolic thickening in chronic anterior Q wave myocardial infarction: an echocardiographic study.

AIM: After ST elevation myocardial infarction, ST segment and T wave changes generally resolve, but in some patients T waves keep their negative components for a long time. The aim of this study is to evaluate the pathophysiological implications of persistent negative T waves and restored positive T waves in the chronic stage of Q wave myocardial infarction. METHODS: We studied 30 patients with a previous anterior wall ST elevation myocardial infarction (more than one year follow-up) and presenting Q waves in at least three consecutive precordial leads in the standard 12-lead electrocardiogram at rest. Patients were divided into two groups according to the T wave pattern in leads with Q waves: positive T group consisting of patients in whom all T wave components showed an upright configuration; and a negative T group consisting of patients in whom T waves were are least partly inverted. We used echocardiography to measure systolic thickening of the interventricular septum within the infarction area. Systolic thickening was considered significant when end-systolic thickness was greater than end-diastolic thickness by > 25% in proportion and > 1 mm in absolute value. RESULTS: Significant systolic thickening was demonstrated in 14 (74%) of the 19 positive T patients and in one (9%) of the 11 negative T patients (odds ratio 8.1; 95% CI, 1.2 to 53.5; p = 0.002). CONCLUSION: In the chronic stage of a myocardial infarction, restored T wave positivity predicts preserved systolic thickening, suggesting the presence of viable and normally contracting myocytes within the infarction area. Further studies are needed to establish the prognostic value of T wave characteristics in patients with a past history of myocardial infarction.

Chronic Disease↗
PubMed2002

A 2D Echo color-Doppler study of the extracranial carotid arteries in borderline arterial isolated systolic hypertension.

BACKGROUND: The aim of this study was to evaluate the prevalence of atherosclerotic carotid lesions in isolated systolic borderline arterial hypertension by 2D echo color-Doppler and effect of night-time pressure fall by ambulatory blood pressure monitoring. METHODS: Outpatients from January 1992 to December 1998 were examined. One hundred and twenty normotensive control subjects and 99 isolated systolic borderline untreated hypertensives were studied, based on blood pressure fall were divided into dippers, with nocturnal systolic and/or diastolic blood pressure fall of >10%, and non dippers. Subjects with ischemic heart disease, valvulopathies, heart failure, renal insufficiency, cerebrovasculopathies, hypercholesterolemia (total cholesterol >200 mg/dl) and diabetes. Normotensives and hypertensives were homogenous for cardiovascular risk factors. A thickness of =/> 0.95 mm, calculated as a mean of 5 measurements of the common carotid artery, 2-3 cm from the carotid bifurcation, was considered a sign of myointimal thickening, and the plaque as a focal thickening of =/> 2 mm, based on echogenic characteristics and site. RESULTS: Compared to normotensives, isolated systolic borderline hypertensives, showed carotid arteries with an intima-media thickening (p=0.002) with one or more plaques (p=0.0001) much more frequently, while normal carotid arteries (p=0.0001) were less frequent. In normotensives, like in hypertensives, the prevalence of vasal lesions was not significantly different in dippers compared with non dippers. Plaques were most often localized at level of the common carotid and lesions were hard. CONCLUSIONS: The conclusions is drawn that isolated systolic hypertension is the sign of major vascular atherosclerotic lesions. The night-time pressure fall does not affect the importance of the lesions.

Adult↗
PubMed2002

[Left ventricular peak systolic pressure/end-systolic volume ratio change after dobutamine infusion for predicting left ventricular contractile reserve: comparison with Emax].

OBJECTIVES: Genuine left ventricular contractile function is difficult to assess in the clinical setting. Left ventricular peak systolic pressure/end-systolic volume (Pps/Ves) ratio may be misleading because this index takes no account of the left ventricular end-systolic point and V0 intercept in the pressure-volume relation geographic curve. End-systolic pressure-volume relation and maximum chamber elastance derived from left ventricular pressure-volume loops can provide reliable estimates of contractile function. However, the feasibility of this technique for clinical purposes is limited, because it requires instantaneous measurement of left ventricular pressure and volume. This study assessed the feasibility of using Pps/Ves ratio for predicting the left ventricular contractile reserve by direct comparison with maximum elastance (Emax) derived from left ventricular pressure-volume loops. METHODS: Studies were undertaken in 18 consecutive patients aged 60 +/- 9 years who underwent cardiac catheterization. On-line instantaneous left ventricular volume was derived from the acoustic quantification method by transthoracic echocardiography. Pps was determined by pressure manometer tipped wire and Ves was measured automatically from acoustic quantification software in an ultrasound system. Pps/Ves was compared with Emax derived from each simultaneous pressure-volume loop during inferior vena caval occlusion before and after dobutamine infusion. Emax was determined as the slope of end-systolic points for each loop with the use of an automated iterative linear regression technique. Left ventricular contractile reserve was assessed by evaluating its functional response to 10 micrograms/kg/min of dobutamine infusion. RESULTS: Pps/Ves showed significant correlation with Emax in all patients (r = 0.70, p < 0.0001). However, scattered distribution of V0 value differences were noted. Contractile reserve (Pps/Ves) showed strong correlation with contractile reserve (Emax) despite V0 value differences (r = 0.927, p < 0.0001). CONCLUSIONS: Pps/Ves change after dobutamine infusion may minimize individual V0 distribution. This simple index could be used to evaluate left ventricular systolic performance without requiring the left ventricular pressure-volume relationship and volume unloading maneuver.

Aged↗
PubMed2001

[Value of tissue Doppler imaging in the determination of the right ventricular systolic function].

OBJECTIVE: Since there is a difficulty in the assessment of right ventricular systolic function by 2D echocardiography, a noninvasive, practical and, cost effective method is desirable. Tissue Doppler technique enables to visualize systolic and diastolic velocities of the tissue through sample volume replacement. In this study, we aimed to evaluate the relationship between tricuspid annular tissue Doppler velocities and right ventricular systolic functions. METHODS: For this purpose, tricuspid annular systolic (S), early diastolic (E) and, late diastolic (A) velocities were obtained from 38 patients (23 with dilated cardiomyopathy, 15 with mitral stenosis, all of them in sinus rhythm) and 15 healthy control subjects by placing the pulsed wave sample volume at the junction of right ventricular free wall and tricuspid annulus. The time velocity integral (TVI) of S, peak velocity of S and isovolumic contraction time (IVCT) were compared with right ventricular ejection fraction (RVEF) determined by 2D echocardiographic hemi-elliptic shell model, peak velocity of tricuspid regurgitation and dP/dt calculated from the spectral trace of this regurgitation. RESULTS: A significant correlation was determined between RVEF and peak S velocity, S TVI and IVCT (r: 0.76, p < 0.001, r: 0.82, p < 0.0001 and r: -0.85, p < 0.0001 respectively). The peak S velocity < 12 cm/sec, S TVI < 2 cm and IVCT > 75 msec yielded 76%, 84%, 92% sensitivity and 84%, 84%, 80% specificity for predicting the patients with right ventricular ejection fraction < 40%, respectively. A significant and powerful correlation was determined between the peak S velocities and dP/dt in 19 patients whose tricuspid regurgitation could be clearly recorded (r: 0.88, p < 0.0001). CONCLUSIONS: The analysis of tricuspid annular velocities obtained by tissue Doppler technique is a practical method of the assessment of right ventricular systolic functions.

Adult↗
PubMed2002

[Role of left ventricular systolic and diastolic dysfunction in clinical manifestations of chronic heart failure in patients with prior myocardial infarction].

AIM: To study the impact of systolic and systolic dysfunction of the left ventricle (LV) on the clinical manifestations of chronic heart failure (HF) in patients with prior myocardial infarction (MI). MATERIALS AND METHODS: 102 patients (mean age 47.4 +/- 0.7 years) who had sustained large focal IM at least 6 months before were examined. LV echocardiography was made to define systolic-diastolic relationships in HF. RESULTS: Analyzing the prevalence of primary diastolic HF in patients with its different clinical manifestations, it may be concluded that LV diastolic dysfunction is of the leading pathogenetic value at early stages of ischemic heart dysfunction. A complex relationship between the clinical manifestations of HF and a number of parameters characterizing the systolic and diastolic function of LV was estimated by the multiple regression analysis and presented as a trinomial equation. CONCLUSION: The results of the regression analysis have shown that the clinical manifestation of HF intensifies as relaxation slows down and transmitral blood flow redistributes to the left atrial systole; the severity of HF also increases with the depletion of compensatory mechanisms responsible for LV contractility.

Diastole↗
PubMed2003

Peak systolic and diastolic CSF velocity in the foramen magnum in adult patients with Chiari I malformations and in normal control participants.

BACKGROUND AND PURPOSE: Abnormal flow of CSF through the foramen magnum has been implicated in the pathogenesis of clinical deficits in association with Chiari I malformation. The purpose of this study was to test the hypothesis that peak CSF velocities in the foramen magnum are increased in patients with Chiari I malformations. METHODS: Eight adult patients with symptomatic Chiari I malformations and 10 adult volunteers were studied with cardiac gated, phase-contrast MR imaging in the axial plane at the foramen magnum. The spatial uniformity of flow velocity in the foramen magnum was assessed at 14 time frames within the R-R interval. The velocity in each of the voxels at each of the time frames was calculated, and the peak systolic and diastolic velocities were tabulated for the patients and controls. RESULTS: For the normal volunteers, the CSF velocities in the subarachnoid space were relatively uniform throughout the subarachnoid space at each of the time frames. Peak systolic velocity ranged from 1.2 to 3.3 cm/s, and peak diastolic velocity ranged from 1.6 to 4.5 cm/s. In symptomatic patients with Chiari I, velocities in the foramen magnum did not appear as uniform throughout the subarachnoid space in the phase-contrast images. Peak systolic velocities ranged from 1.8 to 4.8 cm/s, and peak diastolic velocities ranged from 2.5 to 5.3 cm/s. Peak systolic velocity was significantly higher (P =.01) in the patients than in the control volunteers. CONCLUSION: Patients with Chiari I malformations have significant elevations of peak systolic velocity in the CSF in the foramen magnum.

Adult↗
PubMed2003

Echocardiography or auscultation? How to evaluate systolic murmurs.

OBJECTIVE: To compare cardiac physical examination with echocardiography for evaluating systolic murmurs. QUALITY OF EVIDENCE: Three databases were searched for studies comparing echocardiography and auscultation as to sensitivity and diagnostic accuracy: MEDLINE (Ovid Online), EMBASE, and Current Contexts. The quality of reported data is lowered by subjective interpretation of results of both cardiac physical examination and echocardiography, especially Doppler colour flow imaging. MAIN MESSAGE: In adults, functional systolic murmurs can usually be distinguished from organic murmurs. Pathologic murmurs frequently have one or more associated clinical abnormalities. If a clinician determines a murmur is benign, results of echocardiography are very likely to be normal, especially in young and middle-aged adults. According to current guidelines, echocardiography should not be ordered for "innocent" systolic murmurs in patients who are asymptomatic and have otherwise normal findings on examination. If patients with functional systolic murmurs could be identified and not routinely referred for echocardiography, great cost savings could be realized. CONCLUSION: Echocardiography is not required for all patients with systolic murmurs and should not replace cardiac physical examination.

Adult↗
PubMed2003

In vivo adaptive response of the peripheral conduit artery in patients with borderline systolic hypertension.

OBJECTIVE: To investigate elastic changes of the radial artery, a medium-sized muscular peripheral conduit artery, in patients with borderline systolic hypertension. METHODS: Using a non-invasive high-resolution echo-tracking device coupled to a photoplethysmography (Finapres system) allowing simultaneous arterial diameter and finger blood pressure monitoring, we measured radial artery elastic parameters of 20 patients with borderline systolic hypertension and 20 normal subjects according to Langewouters model. RESULTS: The diameter of the radial artery of control subjects and those with borderline systolic hypertension at the isobaric level of 100 mmHg and mean arterial pressure was similar, but the compliance and distensibility at similar conditions in patients with borderline systolic hypertension did not further reduced and even increased. CONCLUSION: In patients with borderline systolic hypertension, the adaptive responses of the radial artery compliance and distensibility to increased pressure were directed to maintain its elasticity, contributing to the homeostasis of the cardiovascular system.

Adaptation, Physiological↗
PubMed2003

[Spectral analysis of systolic blood pressure in atrial fibrillation].

OBJECTIVES: Power spectral analysis was used to analyze fluctuations of systolic blood pressure and heart rate. METHODS: Non-invasive finger plethysmography and electrocardiography were performed in 20 patients with chronic atrial fibrillation and in 10 age-matched healthy subjects with normal sinus rhythm. The impulse train was stored on a personal computer and the power spectrum of R-R interval and systolic blood pressure were obtained by Fourier analysis (0.01-0.03 Hz). The power spectrum (log power vs log frequency) characteristically revealed a linear regression as 1/f beta. RESULTS: The R-R interval spectrum during atrial fibrillation showed a white noise-like flat spectrum when plotted as log power against log frequency, whereas the systolic blood pressure spectrum during atrial fibrillation showed a 1/f noise-like negative slope linear pattern. The spectrum exponent of systolic blood pressure in patients with atrial fibrillation was significantly lower than that in subjects with normal sinus rhythm (2.3 +/- 0.1 vs 1.3 +/- 0.1, p < 0.0001). CONCLUSIONS: Systolic blood pressure fluctuation in patients with atrial fibrillation has a fractal component and is more complex than that of healthy subjects with normal sinus rhythm.

Atrial Fibrillation↗
PubMed1992

[Isolated systolic hypertension in persons older than 60].

Isolated systolic hypertension (ISH) is generally defined as a systolic pressure of 160 mmHg or more, with a diastolic pressure cut-off point below 95 mmHg in some studies and 90 mmHg in others. Its prevalence and incidence vary from 3 to 30% depending on the definition applied, methodology of measurement, as well as the population and the age and sex of the patients. Mechanisms that could lead to the development of isolated systolic hypertension are discussed, especially the role of atherosclerosis and sodium intake. Comparing results from different countries, the Intersalt study showed that the age related rise in systolic pressure was positively related to the mean sodium excretion in that country. A post-hoc analysis of data from 4 Belgian groups could not show such a correlation within our country. The risks of systolic hypertension on mortality and morbidity in the elderly are considered. The need for further studies to quantify the risk and to establish the effect of treatment is emphasized. Three such studies in patients above the age of 60 years with ISH were started. The studies are double-blind, placebo-controlled trials and the main purpose is to examine the influence of treatment on morbidity, mortality, and general well-being. In the American SHEP study the patients of the actively treated group received a diuretic and possibly a beta-blocker or reserpine. The results indicate a significant reduction in non fatal stroke, heart failure and myocardial infarction without a significant reduction in fatal stroke, fatal myocardial infarction, cardiovascular or all cause mortality. Studies in other continents are still in progress, such as the Syst-Chin in China and the Syst-Eur trial in Europe. They may indicate whether the results obtained in the U.S.A. can be extrapolated to other continents and whether the use of other drugs without metabolic disturbances, such as calcium entry blockers and angiotensin converting enzyme inhibitors, produce a similar reduction in events. Additional studies are needed to establish the effect of reducing salt intake in younger age groups on the prevalence of ISH and of the related morbidity and mortality.

Adult↗
PubMed2004

[Systolic and diastolic left ventricular dysfunction--independent types of cardiac failure or two sides of a single process?].

At present disturbances of systolic and diastolic myocardial function are subjected to intensive study. Most researches acknowledge possibility of development of diastolic dysfunction in the absence of systolic dysfunction. Meanwhile disturbances of systolic and diastolic myocardial functions have common pathogenetic and pathomorphological basis representing the essence of cardiac remodeling. Patients with instrumental signs of pure diastolic dysfunction and subjects with combination of disturbances of systolic and diastolic functions have similar clinical symptoms. This literature review deals with problems of relationship between systolic and diastolic dysfunction and expediency of clear delineation of these disturbances.

Diastole↗
PubMed2004

Precipitating factors for systolic and diastolic heart failure: a four-year follow-up of 192 patients.

OBJECTIVES: To investigate precipitating factors for systolic and diastolic heart failure. DESIGN: Prospective study. PATIENTS AND METHODS: The study population consisted of 192 patients with heart failure treated for 536 episodes of acute decompensation of heart failure from 1998 to 2002. The patients were classified as having systolic or diastolic heart failure, and grouped according to aetiology and precipitating factors. RESULTS: Coronary heart disease was the most common cause of systolic heart failure, whereas rheumatic heart disease was the most frequent cause of diastolic heart failure. The most important precipitating factors in systolic heart failure were infections (38%), arrhythmias (35%), and vascular causes (24%), whereas the precipitating factors in diastolic heart failure were infections (50%), arrhythmias (46%), and uncontrolled hypertension (26%). Avoidable precipitating factors in systolic and diastolic heart failure were noted in 34% and 68% of cases, respectively. CONCLUSIONS: Better patient education and better follow-up of patients by physicians according to the most recent guidelines may decrease the frequency of heart failure events and consequent morbidity and mortality.

Adult↗
PubMed2004

[The effects of propofol on left ventricular systolic and diastolic function during induction of anesthesia--a transthoracic echocardiographic study].

BACKGROUND: The effects of clinical doses of propofol on left ventricular (LV) systolic function remain controversial and LV diastolic function has not been evaluated during induction of anesthesia with propofol. We assessed the effects of propofol on LV systolic and diastolic function during induction of anesthesia in adult patients with transthoracic echocardiography. METHODS: Twenty-three patients, ASA 1-2 and age < 70 y.o., received propofol 2 mg x kg(-1) for induction of anesthesia. LV systolic function was evaluated by fractional shortening (FS), ejection fraction (EF), rate-corrected mean velocity of circumferential fiber shortening (Vcfc) and a contractile index, LV end-systolic wall stress (ESWS) versus Vcfc relation (ESWS-Vcfc relation). LV diastolic functions were assessed by analysis of transmitral flow velocity, peak early diastolic and late diastolic filling velocities (E wave and A wave), E/A ratio and E wave deceleration time (DT). RESULTS: After induction, propofol preserved FS, EF, Vcfc and ESWS-Vcfc relation and caused a significant decrease in E wave and A wave, and a significant increase in E/A ratio and maintained DT. CONCLUSIONS: During induction of anesthesia in adult patients, propofol preserved LV systolic and diastolic functions.

Adult↗
PubMed1992

Experience with twenty-eight cases of systolic anterior motion after mitral valve reconstruction by the Carpentier technique.

Systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction after Carpentier-type mitral reconstruction with ring annuloplasty has led some surgeons to abandon an otherwise successful repair or to avoid use of a rigid ring. To assess the long-term significance of such motion, we studied 439 patients undergoing Carpenter mitral reconstruction at our institution between March 1981 and June 1990. The hospital mortality rate was 4.8% (21/439) overall and 3.7% (9/243) for isolated mitral reconstruction. Systolic anterior motion was found in 6.4% (28/438) after the operation, and 2.3% (10/438) had a coexisting left ventricular outflow tract gradient (mean 53 mm Hg). Of the 28 patients with systolic anterior motion, 27 (96.4%) had leaflet prolapse, 17 (60.7%) had undergone more than a 3 cm resection of the posterior leaflet, and two (7.1%) had preexisting idiopathic hypertrophic subaortic stenosis. All patients were treated medically, 14 with negative inotropic agents. Follow-up echocardiograms at a mean of 32 months demonstrated the disappearance of systolic anterior motion in 13 of 28 patients (46.4%) and resolution of the outflow tract gradient in 10 of 10 (100%). At follow-up only one patient was in New York Heart Association class III or IV and required reoperation for rheumatic mitral insufficiency. These data demonstrate that systolic anterior motion after Carpentier mitral reconstruction with ring annuloplasty is not prevalent and should be managed medically in most cases. Associated left ventricular outflow tract obstruction resolves with medical treatment.

Cardiac Surgical Procedures↗
PubMed2004

[Prognostic value of the parameters of left ventricular systolic function in patients with heart failure].

UNLABELLED: There are several parameters of left ventricular (LV) systolic function assessment. The calculation of the ejection fraction (EF) strongly relates to the preload and afterload conditions. Wall motion score index (WMSI) seems to be to impractical as the semi-quantitative method. Measurement of the LV pressure rise by Doppler evaluation of mitral regurgitation is a reproducible and an accurate method for dP/dt evaluation. As a method for LV systolic function estimation it does not depend on loading conditions. We have compared the prognostic value of these three methods in patients with a broad spectrum of systolic dysfunction. The study group consisted of 75 patients evaluated by all these methods in years 1995-1999 in our echocardiographic laboratory (73%--men, mean 54 +/- 12 years). In 13 patients the coronary artery disease was diagnosed but LV function was apparently normal, in 35--regional dysfunction after myocardial infarction was described, and in 27--global dysfunction due to idiopathic dilated cardiomyopathy. The EF ranged from 11% to 70% (mean 34 +/- 14%), WMSI--from 1 to 3.6 points (mean 2.2 +/- 0.7), and dP/dt from 235 to 4000 mmHg/s (mean 1108 +/- 698 mmHg/s). The closest relationship was noted between EF and dP/dt (R2=0.50). During 38 +/- 19 months of follow-up, 40 patients died (53%). In the multivariate logistic analysis the only significant parameter related to prognosis was EF (p=0.001). WMSI (p=0.12) and dP/dt (p=0.16) were not statistically significant correlated to death. CONCLUSION: The left ventricular ejection fraction still remains the most important parameter for the evaluation of prognosis in patients with depressed systolic function. Left ventricular pressure rise describes the systolic function but does not have impact on the prognostic evaluation.

Adult↗
PubMed1992

Systolic or diastolic notch in uterine artery blood flow velocity waveforms in hypertensive pregnant patients: relationship to outcome.

To identify the relationship between a systolic or diastolic notch in uterine artery flow velocity waveforms and pregnancy outcome, we studied 140 hypertensive pregnant women with transvaginal, image-directed pulsed Doppler ultrasound. The subjects were classified according to the presence or absence of a systolic or diastolic notch. In 14 with a systolic and 25 with a diastolic notch, the resistance indexes in the uterine arteries on both sides of the uterus were significantly higher than in 101 subjects without a notch. Those with notches had significantly higher rates of fetal growth retardation and cesarean delivery because of fetal distress. Significantly more infants born to women with a notch spent longer than 48 hours in the neonatal intensive care unit. Subjects with a systolic notch also had significantly higher rates of abnormal fetal heart rate patterns during labor and low Apgar scores at 5 minutes. Fifty-one women with elevated resistances indexes in both uterine arteries were divided into two groups according to the resistance index in the umbilical artery. Each group was subdivided according to the presence or absence of a systolic or diastolic notch in the uterine artery flow velocity waveforms. In the group with a normal resistance index in the umbilical artery, five women had growth-retarded fetuses when a notch was present (N = 8), compared with none in women without a notch (N = 11) (P less than .005). The respective figures for the group with abnormal umbilical artery resistance indexes were 14 of 19 (73.7%) and two of 13 (15.4%) (P less than .002).(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed2006

Heart failure and diabetes: left ventricular systolic function.

AIM: Heart failure is the main cause of mortality and morbidity in general population, annual mortality rate is 20%, in spite of pharmacological treatments or other therapies. Cardio-vascular events and diabetes tight correlation is well known, while it is less evaluated diabetes and heart failure correlation is less studied, heart failure as left ventricular systolic function impairment. Cardiovascular disease rate is decreasing, systolic heart failure rate is raising. Our study goal is to evaluate which role diabetes plays in determining systolic heart failure, diagnosed by echocardiographical examination. METHODS: Four hundred and fifty consecutive patients, systolic heart failure prone, diagnosed by left ventricular ejection fraction less than 40%, were included. Exclusion criteria were rheumatic or congenital valve diseases. Mean age was 78.3 years (53-93 years), 286 were women and 164 men. Statistical analysis were performed by parametric t-Student test and not parametric chi2 test. High significant difference was assessed for P<0.05. RESULTS: Seventy six (16.9%) patients were diabetes prone (D), 374 (83.1%) were diabetes free, so not diabetic (ND). Forty three men were D (56.5%), 131 ND (35%). Diabetic mean age was 74.7 years (52-88), not diabetic was 79.3 (53-93). Six D (7.8%) and 21 ND patients (5.6%) were hypercholesterolemia prone. Eight D (10.5%) and 18 ND (10.1%) patients were smokers. Twenty eight D (36.8%) and 107 ND patients (28.6%) were hypertensive. Thirty three D (43.4%) and 88 ND (26.4%) patients were coronary artery disease prone, 3 of 33 (3.9%) D and 28 of 88 (7.4%) ND ischemic patients were myocardial infarction prone. Twenty one D (27.6%) and 106 ND (28.3%) patients were atrial fibrillation prone. There were not statistical significant difference among D and ND patients for following variables: sex, smoke, total cholesterolemia, hypertension and atrial fibrillation. We found an high significant difference for mean age (P<0.005) and coronary artery disease prone patients (P<0.007), but not for myocardial infarction prone subjects (P<0.1). CONCLUSIONS: Diabetes, not depending by other common cardiovascular risk factors, causes systolic heart failure, in prone patients, on an younger age, and in the same time an higher coronary artery disease rate, but not an higher myocardial infarction rate, because the coronary artery disease is often a microvascular one, and it leads to heart failure rather than myocardial necrosis.

Aged↗
PubMed2006

Assessment of left ventricular systolic synchronicity by real-time three-dimensional echocardiography in patients with dilated cardiomyopathy.

BACKGROUND: Recent advances in real-time three-dimensional echocardiography (RT3DE) offer the potential to assess the left ventricular (LV) dyssynchrony simultaneously by analyzing the 17 segments time-volume curves. The purpose of this study was to test the feasibility and accuracy of RT3DE for quantitative evaluation of left ventricular systolic synchronicity. METHODS: Twenty-four patients with dilated cardiomyopathy (DCM) and twenty-five healthy volunteers were enrolled in this study. Full volume RT3DE was performed by using Philips IE33 with X3-1 probe. The global and 17-segmental time-volume curves were obtained by the on-line Qlab software (version 4.2). The time to minimal systolic volume in each segment (T(msv)) was taken to derive the following indexes of systolic asynchrony: T(msv) 16-SD, T(msv) 16-Dif, T(msv) 12-SD, T(msv) 12-Dif, T(msv) 6-SD and T(msv) 6-Dif, which meant the standard deviation or the maximal difference of T(msv) among the 16, 12 and 6 segments of the left ventricle respectively. The software also provided with each of the above parameters as a percentage of the cardiac cycle. RESULTS: T(msv) 16-SD, T(msv) 12-SD and T(msv) 6-SD were all significantly larger in the DCM group than those of the control group [T(msv) 16-SD: (52.9 +/- 40.6) ms vs (8.8 +/- 6.2) ms; T(msv) 12-SD: (29.5 +/- 30.8) ms vs (6.9 +/- 4.0) ms; T(msv) 6-SD: (28.9 +/- 34.6) ms vs (7.0 +/- 4.7) ms, all P < or = 0.001]. T(msv) 16-Dif, T(msv) 12-Dif and T(msv) 6-Dif were also significantly larger in the DCM group. There were close negative relations between the LVEF determined by RT3DE and each of the indexes of systolic asynchrony, among which the indexes of T(msv)-16-SD% and T(msv)-16-Dif% correlated most closely (r = -0.703 and r = -0.701, respectively). The DCM patients had significantly larger EDV and ESV, with significantly reduced LVEF compared with the healthy subjects. CONCLUSION: RT3DE provides a simple, useful and unique approach to assess the systolic synchronicity of all the left ventricular segments simultaneously.

Adult↗