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PubMed2000

[Evaluation of early cardiovascular involvement in patients with systemic sclerosis].

UNLABELLED: The aim of the study was to evaluate cardiac function in patients with systemic sclerosis by means of noninvasive methods in order to detect early dysfunction of cardiovascular system. MATERIAL AND METHODS: We studied a group of 19 patients (15 women, 4 men, aged 17-74 yrs, av. 51 +/- 11) with systemic sclerosis comparing the results with a group of 23 healthy volunteers (17 women, 6 men aged 21-69 yrs, av 53 +/- 15). All the patients with SSc were taking corticosteroids, immunosuppressants or vasodilators at the time of the study. In all the patients we performed 24-hour Holter monitoring for the evaluation of arrhythmias, conduction disturbances, ischaemia, heart rate variability (HRV) and late potentials (LP). The following parameters of HRV in time domain were analyzed: SDNN, SDANN, SDNNI, rMSSD, pNN50. Standard ECG was performed to assess QT interval (QT, QTc, QTd). In all the patients the echocardiography examination was performed (M-Mode, 2-D, Doppler echocardiography). The morphology of heart structures and haemodynamic function were analyzed. RESULTS: In patients with SSc Holter monitoring revealed tendency to tachycardia. The mean heart rate was 81 +/- 11 vs. 71 +/- 9 in controls. Conduction disturbances were observed in 3 pts. In 6 pts we found significant ventricular arrhythmia. Silent ischaemia episodes were detected in 6 pts. Concerning HRV analysis the significantly lower values were detected in pts with SSc vs. controls: SDNN 123 vs 170; SDNNI 51 vs 76; SDANN 110 vs 152; rMSSD 29.6 vs 54; pNN50 6.1 vs 21. Late potentials were present in one patient with SSc vs none in the control group. The mean values QT-371, QTc-419, QTd-40- did not exceed the ranges of normal values. No signs of systolic cardiac dysfunction were detected, while in 6 pts we recognized left ventricle diastolic dysfunction. Valvular lesions were observed in 8 pts, but only in 2 pts they were hemodynamically important. CONCLUSIONS: 24-hour Holter monitoring and ECHO examination are valuable methods, which allow to detect early dysfunction of cardiovascular system in patients with systemic scleroderma presenting no apparent cardiac impairment symptoms.

Adolescent↗
PubMed1994

[Transesophageal coronary flowmetry and ventricular diastolic properties in surgically treated aortic insufficiency].

In patients with aortic valve regurgitation anginal pain without coronary artery disease is a consequence of both impairment of coronary flow (CF) reserve and reduction of diastolic CF (D) due to a diminished coronary perfusion pressure (CPP). Aim of this study was to evaluate with transesophageal multiplane echocardiography CF pattern in 15 patients with severe aortic regurgitation (AR) in the operative room before and after aortic valve replacement and to correlate it with hemodynamic parameters of left ventricular systolic (echocardiographic fractional shortening area) and diastolic (Doppler E/A ratio of mitral flow and X/Y ratio of pulmonary venous flow; pulmonary wedge pressure) function. Patients were compared to a control group (C) of 10 subjects. Coronary flow was divided into systolic (S), protodiastolic (PD) and end-diastolic (ED) components. In AR we observed a reduction in D/S ratio (2.6 +/- 1.3 versus 3.5 +/- 0.8, NS) and an increase in PD/ED ratio (2.24 +/- 2.8 versus 1.05 +/- 0.15, p < 0.001). A positive correlation was observed between PD/ED ratio and left ventricular diastolic impairment (E/A ratio: r = 0.71, p < 0.001; wedge pressure: r = 0.70, p < 0.001) and a negative correlation with CPP (r = -0.6, p < 0.02). Forty-five min after aortic valve replacement diastolic function improvement and CPP increase were associated with a normalization of CF pattern (D/S = 4.35 +/- 1.9/PD/ED = 1.06 +/- 0.16). In conclusion in AR diastolic dysfunction and abnormal CPP are strictly related to the reduction in diastolic CF; valve replacement normalizes the former two parameters and redistributes CF in late diastole.

Aortic Valve↗
PubMedDate not supplied

[Doppler evaluation of diastolic function in hypertrophic cardiomyopathy].

Diastolic function may play a significant role in patients affected by hypertrophic cardiomyopathy, because abnormalities in diastolic function, even in presence of a normal systolic function, may determine the clinical features of the disease. Doppler ecocardiography, using a non-invasive and not highly expensive method, easily allows to analize the indexes of diastolic function, as soon as some morpho-functional parameters, represented by extent and localization of the myocardial hypertrophy and presence or absence of obstruction in the left ventricular outflow, which have always been considered relevant in the prognosis together with the typical arrhythmic abnormalities of the disease. The aim of this study was to investigate the behaviour of Doppler ecocardiographic parameters of diastolic function in 38 patients with hypertrophic cardiomyopathy and to analize whether they might be correlated with the morpho-functional patterns and clinical features of the disease, represented by the NYHA functional class and occurrence of ventricular tachycardia during 48 hour ambulatory electrocardiographic monitoring. Diastolic function abnormalities, although occurring in most patients, do not seem to be related with clinical conditions and/or with the typical morpho-functional patterns of the disease; however, an increase in the left atrial size together with a specific increase in the rate of deceleration of flow velocity in early diastole that were detected in patients with ventricular tachycardia, by suggesting a relation between diastolic dysfunction and arrhythmogenic substrate, remarks the importance of the analysis of diastolic function for a better prognostic evaluation of the hypertrophic cardiomyopathy.

Adolescent↗
PubMed2004

Subclinical cardiac involvement in myotonic dystrophy manifesting as decreased myocardial Doppler velocities.

To assess subendocardial (long-axis) and mid-wall (short-axis) left ventricular (LV) function in patients with type 1 myotonic dystrophy (MD1), with no symptoms or clinical signs of heart disease, to investigate if they have subclinical cardiac involvement, 28 subjects (14 with MD1, and 14 age- and sex-matched normals) had conventional and tissue Doppler echocardiography. Myocardial velocities and timings to peak systolic contractions were measured. LV wall thickness, diameters, and ejection fraction were not different between the groups. 4/14 of the MD1 patients (29%) had global diastolic dysfunction. Both long-axis and short-axis systolic and early diastolic myocardial velocities were lower in patients with MD1, whereas time-to-peak myocardial contraction was longer; mean longitudinal systolic velocity was 5.5+/-1.7 cm/s in patients with MD1, compared with 7.8+/-1.3 cm/s in normal subjects (P<0.001) 10/14 of the patients (71%) had reduced longitudinal systolic function. Longitudinal systolic and diastolic velocities were inversely related to the duration of the QRS complex ( r=-0.86 and r=-0.63 respectively, both P<0.01), but they did not correlate with the CTG-repeat size. Patients with MD1 have subclinical cardiac impairment revealed by measurement of myocardial velocities using tissue Doppler echocardiography.

Adult↗
PubMed2000

Coronary reserve and arteriolosclerosis in hypertensive heart disease.

Hypertensive heart disease leads to left ventricular hypertrophy, structural and functional alterations of the myocardium, and to wall thickening and sclerosis of intramural coronary arteries and arterioles, called arteriolosclerosis, that increase myocardial stiffness and cause diastolic dysfunction right from the beginning. Especially, increased content of collagen in the periarteriolar region contributes to impaired coronary reserve that predisposes to myocardial ischemia even in the absence of coronary artery disease and may be an important factor for diastolic and finally systolic dysfunction. Antihypertensive therapy should additionally aim at inducing repair of myocardial and vascular structure.

Animals↗
PubMed1997

Where are all the women with heart failure?

In recent clinical trials of medical therapy for heart failure, only approximately 20% of patients enrolled were women. The reasons for the low enrollment of women have not been clear. Although the incidence of heart failure is higher in men than in women, the prevalence is equal. When men and women with heart failure and a low left ventricular ejection fraction are compared, the women are more symptomatic and have a similarly poor outcome. Because mortality is worse in men than in women in large populations of patients with heart failure, there may be important pathophysiologic differences. Substantial data suggest that women may have diastolic dysfunction more often than men. This difference would explain differences in mortality and the difficulty in enrolling women in studies of medical therapy for heart failure with underlying systolic dysfunction.

Diastole↗
PubMed2005

Dynamic changes in right ventricular pressures during haemodialysis recorded with an implantable haemodynamic monitor.

BACKGROUND: Intermittent and chronic volume overload contributes to the development of cardiovascular disease in patients on maintenance haemodialysis (HD). Continuous monitoring of central haemodynamic parameters may provide valuable information to improve volume control, particularly in patients with left ventricular dysfunction. METHODS: Five patients on HD, age 53-76 years, with systolic and/or diastolic dysfunction (EF 20-50%) received an implantable haemodynamic monitor (IHM) (Chronicle model 9520, Medtronic). The IHM consists of a memory device implanted subcutaneously and a transveneous right ventricular (RV) lead carrying a pressure sensor. It continuously records heart rate, RV systolic (RVSP) and diastolic pressures (RVDP), RV dP/dt and an estimate of pulmonary artery diastolic pressure (ePAD). Continuous haemodynamic profiles were recorded in all patients. RESULTS: During dialysis RVSP and ePAD dropped by a mean of 39 and 50%, respectively. RVDP decreased by 6.6 mmHg. The lowest pressures occurred during the first 90 min of dialysis and were partly restored at the end of the procedure. Long-term haemodynamic monitoring unmasked severe volume overload in one patient, when dry weight was kept stable despite a decrease in lean body mass. In another patient with recurrent dyspnea after dialysis, paroxysmal atrial fibrillation, regularly occurring during dialysis, was identified as the cause of symptoms. CONCLUSION: The implanted haemodynamic monitor was a sensitive indicator for changes in volume load. Continuous haemodynamic monitoring may offer a valuable tool to improve volume management in dialysis patients with left ventricular dysfunction.

Aged↗
PubMed1996

Deficient cellular cyclic AMP may cause both cardiac and skeletal muscle dysfunction in heart failure.

Deficient myocardial cyclic AMP concentrations contribute to abnormal Ca2+ handling and systolic and diastolic dysfunction in chronic heart failure (CHF). We tested the hypothesis that decreased cyclic AMP in skeletal muscle of animals with failure may contribute to the weakness and easy fatiguability also common in patients with CHF. We compared intracellular Ca2+ signaling and contractility in skeletal muscle preparations from rats 6 weeks after myocardial infarction-induced CHF versus sham-operated controls. Bundles of 100 to 200 cells were dissected from the extensor digitorum longus (EDL) muscle of control and CHF rats. Muscles from CHF rats exhibited depressed tension development compared with control muscles during twitches. Treatment with 2mM dibutyryl cyclic AMP returned tension and Ca2+ towards normal levels. There was no evidence of cellular atrophy in the CHF rats. In conclusion, EDL skeletal muscle from rats with CHF had intrinsic abnormalities in excitation-contraction coupling that could be reversed with cyclic AMP supplementation as previously reported for the heart. This suggests that deficient cyclic AMP levels may contribute to both cardiac and skeletal muscle dysfunction in CHF.

Animals↗
PubMed1996

Beneficial effects of felodipine on myocardial and coronary function during low-flow ischemia and reperfusion.

An acute coronary occlusion causes severe low-flow ischemia in the occluded region. Calcium antagonists have the potential to reduce the rate of ischemic injury by decreasing myocardial oxygen demand, as well as by other mechanisms, especially when given prior to the onset of ischemia. However, their clinical use may be limited by their negative inotropic effects. The purpose of this study was to assess the effects of felodipine as a potentially protective agent against myocardial ischemia and reperfusion injury, independent of any negative inotropic actions, when given after the onset of low-flow ischemia. Isolated isovolumic (balloon-in-LV), blood-perfused rabbit hearts, paced at a constant heart rate, were subjected to 90 minutes of low-flow ischemia at a coronary perfusion pressure of 10 mmHg, which reduced coronary blood flow to 22-24% of baseline. After 15 minutes of low-flow ischemia, hearts received 2 x 10(-6) M felodipine (n = 7) or no drug (controls, n = 8). Felodipine was given until 15 minutes of reperfusion. During low-flow ischemia both groups of hearts had identical coronary blood flow, heart rate, left ventricular (LV) developed pressure, lactate production, and O2 consumption. However, felodipine markedly protected against ischemic diastolic dysfunction. At the end of low-flow ischemia, LV end-diastolic pressure (LVEDP) had increased from 10 +/- 1 to 28 +/- 5 mmHg in the felodipine group, while in the controls LVEDP increased to 48 +/- 8 mmHg (p < 0.05). During 30 minutes of reperfusion, felodipine had a beneficial effect upon coronary blood flow (initial postischemic hyperemia 245 +/- 38% of baseline in the felodipine group vs. 124 +/- 18% in the controls; p < 0.01) Felodipine markedly improved the recovery of contractile function [LV developed pressure recovered from a baseline of 104 +/- 4 to 75 +/- 6 mmHg (72%) in the felodipine group vs. 34 +/- 10 mmHg (32%) in the control group; p < 0.01], as well as diastolic function (LVEDP = 25 +/- 4 mmHg in the felodipine group vs. 61 +/- 10 mmHg in the controls; p < 0.05), and ATP levels (8.5 +/- 1.4 mumoles/g d.w. in the felodipine group vs. 3.9 +/- 1.4 mumoles/g d.w. in the control group, p < 0.05). Felodipine, given after the onset of low-flow ischemia, protects the myocardium during both ischemia and reperfusion by mechanisms other than reducing myocardial oxygen demand.

Adenosine Triphosphate↗
PubMed1995

Hemodynamic and antiischemic effects of intravenous elgodipine, a new dihydropyridine calcium channel blocker, in patients with chronic stable angina.

Elgodipine is a new second-generation dihydropyridine calcium antagonist. Its hemodynamic and antiischemic properties were evaluated in a single-blind, placebo-controlled trial in 22 males with chronic stable angina. Coronary artery disease was angiographically confirmed. Measurements were performed with a Swan-Ganz thermodilution catheter during a 30-minute period of rest and before the end of a 4-minute bicycle exercise test at maximum individual workload, both with placebo (IV infusion of 5 ml saline over 30 minutes) and elgodipine (10 micrograms/kg/2 min bolus IV, then IV infusion of 1 micrograms/kg/min for 28 minutes. Elgodipine caused very similar hemodynamic changes at rest and during exercise. Its major hemodynamic modification was the marked decrease in systemic vascular resistance, which was accompanied by an increase in cardiac index and stroke volume. Mean arterial blood pressure was slightly reduced, whereas the opposite small increase in heart rate meant that the double product remained unchanged. Contrary to resting conditions, pulmonary capillary wedge pressure, pulmonary artery pressures, pulmonary vascular resistance, and mean right atrial pressure remained normal or increased to a lesser extent during exercise after elgodipine. After elgodipine ischemic ST depression during exercise was diminished, and 11 of 16 assessable patients remained free from angina pectoris. We conclude that elgodipine is an efficacious antianginal drug. Its major mechanism of action is lowering of systemic vascular resistance. Thus elgodipine improves systolic cardiac function in patients with chronic stable angina and may delay the onset of ischemic diastolic dysfunction during exercise, as indicated by a normal left ventricular end-diastolic pressure (LVEDP). The data also suggest an improvement in coronary blood flow during exercise.

Adult↗
PubMed1998

Use of color kinesis for evaluation of left ventricular filling in patients with dilated cardiomyopathy and mitral regurgitation.

OBJECTIVES: We tested the feasibility of using analysis of color kinesis images to objectively assess global and regional left ventricular (LV) diastolic function in patients with dilated cardiomyopathy (DCM). In addition, the ability of this technique to track drug-induced changes on LV diastolic properties was studied. BACKGROUND: Diastolic dysfunction contributes to symptomatology in patients with DCM. The assessment of LV diastolic function using conventional Doppler echocardiography is indirect and is confounded by multiple variables. Moreover, the noninvasive evaluation of regional diastolic properties is difficult. In contrast, color kinesis directly tracks and color-encodes regional diastolic endocardial motion. METHODS: We studied 24 patients with DCM and mitral regurgitation (MR) and 24 age-matched normal subjects. Transmitral and pulmonary vein flow velocities were measured using pulsed Doppler echocardiography. Diastolic color kinesis images were used to calculate indexes of magnitude and timing of global and regional diastolic function. Diastolic asynchrony was evaluated in different subgroups of patients with DCM. The effects of drug infusions (nitroprusside and dobutamine) were also studied. RESULTS: Color kinesis indexes of global diastolic function showed significant differences between patients with DCM and normal subjects. Compared with Doppler indexes, color kinesis was less confounded by MR and was capable of differentiating between drug-induced lusitropic and vasodilator effects. Diastolic asynchrony was increased in patients with DCM and severe MR. CONCLUSIONS: Quantitative analysis of global and regional LV diastolic function in patients with DCM using color kinesis is feasible.

Adult↗
PubMed1994

The factor dominating the determination of left ventricular filling varies during the first five days after acute myocardial infarction.

BACKGROUND: Left ventricular diastolic dysfunction may occur after the onset of acute myocardial infarction. Left ventricular diastolic filling dynamics are related to many factors. To evaluate the influence of left ventricular filling pressure on Doppler-derived left ventricular diastolic flow profiles in patients with acute myocardial infarction, we studied serial changes in filling during the first 5 days after the onset of uncomplicated acute myocardial infarction. METHODS: The study population consisted of 14 patients with acute myocardial infarction and 15 normal subjects: Doppler echocardiographic studies (left ventricular transmitral inflow and outflow velocity patterns) were performed on admission, and on the third and fifth days after infarction. Hemodynamic parameters were measured simultaneously using Doppler echocardiography. RESULTS: The E wave was lower, the A wave and A:E ratio were higher, deceleration half time and isometric relaxation time were prolonged, and peak left ventricular ejection flow velocity was lower in myocardial infarction patients than in normal subjects. The E wave and pulmonary capillary wedge pressure were positively correlated on the first and the third day (r = 0.77, P < 0.001, and r = 0.67, P < 0.01, respectively), but not on the fifth day. The E wave and isometric relaxation time were negatively correlated on the fifth day (r = -0.72, P < 0.01), but not on the first and third day. CONCLUSION: Left ventricular filling pressure (preload) was an important mechanism for maintaining left ventricular filling during the first 3 days, but the relaxation of the ventricle began to play a dominant role on the fifth day.

Aged↗
PubMed2006

Development of heart failure in chronic hypertensive Dahl rats: focus on heart failure with preserved ejection fraction.

The impact of hypertension on left ventricular (LV) structure, pump function, and heart failure in Dahl salt-sensitive rats is poorly characterized but hypothesized to yield insights into the pathophysiology of heart failure with normal or preserved ejection fraction. Eighty Dahl salt-sensitive rats were fed either a high-salt (HS) or low-salt (LS, controls) diet starting at age 7 weeks. Ventricular properties were measured by echocardiography, hemodynamics and end-systolic and end-diastolic pressure-volume relationships (ESPVR and EDPVR, respectively). Compared with LS controls, HS rats developed severe hypertension and LV hypertrophy. At week 12, HS rats developed passive diastolic dysfunction (leftward/upward shifted EDPVR, increased chamber stiffness) with reductions in end-diastolic volume. However, the ESPVR also shifted upward (enhanced end-systolic function) so that overall pump function was enhanced compared with LS, and there was no change in end-diastolic pressure (EDP). At 16 and 20 weeks, HS hearts enlarged so that end-diastolic volumes and EDPVRs became similar to the respective age-matched LS controls. Concomitantly, the ESPVRs and overall pump function curves also moved toward controls, and ejection fraction declined. Despite normal or enhanced overall pump function at these times, EDP and wet lung weight increased, indicative of development of heart failure. In the Dahl salt-sensitive rat, which pathophysiologically retains salt and water, the development of heart failure (increased EDP and wet lung weight) is dissociated from changes in passive diastolic and active systolic properties. These observations suggest that a volume overload sate plays an important pathophysiological role in development of heart failure despite preserved overall ventricular pump function in this model of chronic hypertension.

Animals↗
PubMed1991

Diastolic filling abnormality modified by left ventricular asynchrony in essential hypertension.

Left ventricular (LV) asynchrony has been demonstrated to result in diastolic dysfunction. To test the hypothesis that altered LV synchrony interferes with LV diastolic function in essential hypertensive patients (HT), we performed radionuclide ventriculography and echocardiography in 38 HT and 11 normotensive subjects. LV diastolic asynchrony was measured as the sum (total delta t) of the absolute values of the time difference between global peak filling rate (PFR) and regional PFR. Global PFR and time to PFR were significantly reduced in HT. Although total delta t did not differ between two groups, total delta t significantly correlated with PFR (r = -0.44, p less than 0.01) in HT. Moreover, total delta t positively related to LV endsystolic stress and inversely related to LV ejection fraction in HT. Thus, LV asynchrony, in part, plays a role in early diastolic filling abnormality in hypertensive patients.

Adult↗
PubMed1990

Analysis of left ventricular diastolic function by the pressure-volume relation in cases with idiopathic restrictive cardiomyopathy and amyloid restrictive cardiomyopathy.

To assess left ventricular (LV) diastolic function in idiopathic restrictive cardiomyopathy (IRCM) and amyloid restrictive cardiomyopathy (ARCM), we analyzed LV cineangiograms and pressures (tip manometer) in two patients, one with IRCM and the other with ARCM. LV volume and instantaneous rate of change of volume were derived from frame-by-frame analyses of angiograms. LV relaxation was assessed by the time constant of isovolumic pressure decay. LV compliance was evaluated by the pressure-volume relationship. From these analyses, we conclude as follows: (1) In restrictive cardiomyopathy (RCM), LV diastolic dysfunction may be characterized by impaired relaxation and decreased compliance; (2) LV diastolic filling was minimally impaired or normal in both conditions; (3) The ventricular diastolic pressure wave form of "dip and plateau" seemed not to be a characteristic sign in RCM.

Blood Pressure↗
PubMed1990

Sympathetic control of diastolic function in congestive heart failure.

Sympathetic cardiac stimulation is a major extrinsic compensatory mechanism that maintains or augments systolic and diastolic ventricular function during physiological stress or pathological conditions. In particular, catecholamines may selectively improve diastolic function by reducing myofilament calcium sensitivity, accelerating sequestration of calcium into the sarcoplasmic reticulum, and increasing the rate of actin-myosin cross-bridge turnover. These subcellular mechanisms, unique to inotropic agents that increase myocyte cyclic adenosine monophosphate, result in an increased rate and extent of ventricular relaxation and diastolic filling and a decrease in cardiac filling pressures. Despite these potentially favorable biochemical and mechanical actions, a number of limitations and theoretical concerns remain to be addressed before catecholamine therapy is widely administered to patients with congestive heart failure and diastolic dysfunction.

Animals↗
PubMed1997

Power spectrum analysis of circadian oscillations of heart rate variability in patients with left ventricular dysfunction.

OBJECTIVES: The physiological significance of diurnal fluctuations in heart rate variability (HRV) has not been established to a full extent. The aim of our investigation was to assess a new method of power spectrum analysis of circadian oscillations in HRV in patients with left ventricular systolic and diastolic dysfunction. METHODS: Holter ECG monitoring and echocardiography were performed in 101 patients with coronary artery disease and arterial hypertension: 55 patients with systolic left ventricular dysfunction (LVD) and 46 patients with diastolic LVD, and also in 32 subjects of the control group. The original method of HRV assessment was based on spectrum analysis of time series of consecutive 5-minute measures of standard deviations of mean RR intervals. RESULTS: The study revealed oscillations of HRV with a periodicity of 12 hours and 80-120 minutes. Their amplitude was highest in the control group and lowest in patients with systolic LVD. CONCLUSIONS: Power spectrum analysis of circadian oscillations of heart rate variability reveals information about the character of LVD. Regular oscillations of time domain indices of HRV were observed in the patients with LVD and in the control group; their amplitude is highest in the control group and lowest in systolic LVD.

Circadian Rhythm↗
PubMed2000

Noninvasive modalities. Cardiac MR imaging.

As outlined in this article, the strength of MR imaging is that it can provide flow, function, and in some cases metabolic data in a single examination, independent of patient body habitus. Future prospects for real-time imaging and in vivo mapping of fiber orientation promise further advances in our understanding of the structure-function relationship in diastole. Many of the MR imaging methods that have been developed for cardiovascular imaging are now mature and available on state-of-the-art scanners. Although MR imaging can provide detailed characterization of diastolic function, there is a paucity of clinical results which could lead to use guidelines. When more clinicians have access and become familiar with MR imaging, and the type of information that it can provide, clinical trials will be needed to establish the role of MR imaging for evaluation of diastolic function. In the meantime, MR imaging remains an excellent research tool for this application and will help yield further insights into the pathophysiology of diastolic dysfunction.

Diastole↗