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Gel stretch method: a new method to measure constitutive properties of cardiac muscle cells.

Diastolic dysfunction is an important cause of congestive heart failure; however, the basic mechanisms causing diastolic congestive heart failure are not fully understood, especially the role of the cardiac muscle cell, or cardiocyte, in this process. Before the role of the cardiocyte in this pathophysiology can be defined, methods for measuring cardiocyte constitutive properties must be developed and validated. Thus this study was designed to evaluate a new method to characterize cardiocyte constitutive properties, the gel stretch method. Cardiocytes were isolated enzymatically from normal feline hearts and embedded in a 2% agarose gel containing HEPES-Krebs buffer and laminin. This gel was cast in a shape that allowed it to be placed in a stretching device. The ends of the gel were held between a movable roller and fixed plates that acted as mandibles. Distance between the right and left mandibles was increased using a stepper motor system. The force applied to the gel was measured by a force transducer. The resultant cardiocyte strain was determined by imaging the cells with a microscope, capturing the images with a CCD camera, and measuring cardiocyte and sarcomere length changes. Cardiocyte stress was characterized with a finite-element method. These measurements of cardiocyte stress and strain were used to determine cardiocyte stiffness. Two variables affecting cardiocyte stiffness were measured, the passive elastic spring and viscous damping. The passive spring was assessed by increasing the force on the gel at 1 g/min, modeling the resultant stress vs. strain relationship as an exponential [sigma = A/k(ekepsilon - 1)]. In normal cardiocytes, A = 23.0 kN/m2 and k = 16. Viscous damping was assessed by examining the loop area between the stress vs. strain relationship during 1 g/min increases and decreases in force. Normal cardiocytes had a finite loop area = 1.39 kN/m2, indicating the presence of viscous damping. Thus the gel stretch method provided accurate measurements of cardiocyte constitutive properties. These measurements have allowed the first quantitative assessment of passive elastic spring properties and viscous damping in normal mammalian cardiocytes.

Animals↗

Ultrafiltration in patients with hypervolemia and congestive heart failure.

Fluid overload may occur in patients with myocardial dysfunction and different clinical problems. Myocoardial dysfunction may be a consequence of heart dilatation with reduced contractility, ventricular stiffness with diastolic dysfunction or the consequence of myocardial injury or circulating myocardial depressant factors as seen in sepsis. In all cases, cardiac support can be achieved by the optimization of fluid balance, the reduction in organ edema and the restoration of desirable levels of pre- and afterload. Several reports have shown that myocardial elastance can improve after hemofiltration with restoration of adequate fluid balance. In such conditions, continuous extracorporeal therapy may result in remarkable cardiovascular stability with maintenance of hemodynamic parameters, including mean arterial pressure, heart rate and systemic vascular resistance. Such stability, which is achieved through the slow continuous ultrafiltration and continuous refilling of the intravascular volume from the interstitium, enables the stability of the circulating blood volume and the preservation of organ perfusion. This is also crucial for renal recovery during acute renal failure.

Blood Volume↗

[Postoperative changes in diastolic function of the left ventricle in patients with aortic valve stenosis].

INTRODUCTION: Diastolic dysfunction in valvular aortic stenosis frequently precedes systolic dysfunction. The purpose of this study was to examine the changes in left ventricular diastolic function after aortic valve replacement. METHODS: Seventy eight patients with significant isolated valvular aortic stenosis were enrolled in the study. The echocardiographic examination was performed with ACUSON-XP 10 imaging system. Complete M-mode, 2-dimensional and Doppler echocardiographic results were obtained. In 48 patients right and left heart catheterisation was performed. Left ventricular diastolic function was evaluated by pulse Doppler recording of inflow velocity on the tips of the mitral valve leaflets. Forty two underwent aortic valve replacement. They were followed up 6-12 months postoperatively. RESULTS: Abnormal patterns of left ventricular diastolic filling were noticed in almost all patients (Table 1). Most prominent changes were found in subjects with marked and diffuse hypertrophy (Table 2). After aortic valve replacement decrease in left ventricular size, mass, pressures and improvement in systolic Function (Table 3). Twelve months after the operation late diastolic filling velocity was lower (A = 64 +/- 15 cm/s, Avti = 7.1 +/- 1.8 cm), early diastolic filling velocity was higher (E = 83 +/- 14 cm/s, Evti = 10.3 +/- 1.4 cm), deceleration time (DT = 123 +/- 14 ms) and isovolumetric relaxation time (IRT = 66 +/- 6 ms) were longer in patients with preoperative moderate hypertrophy (Table 4). In patients with severe left ventricular hypertrophy changes in diastolic function were slower. We found decrease in early diastolic filling velocity (A = 44 +/- 6 cm/s, Avti = 4.6 +/- 04 cm), increase in late diastolic filling velocity (E = 67 +/- 14 cm/s, Evti = 9.4 +/- 1.7 cm), with prolongation of deceleration (DT = 131 +/- 18 ms) and isovolumetric relaxation time (IRT = 94 +/- 23 ms) (Table 5). DISCUSSION: In adults with significant sympthomatic aortic valve stenosis, aortic valve replacement is therapy of choice. Replacement of the diseased aortic valve with a prosthetic valve yields relief of left ventricular outflow obstruction. Myocardial remodeling with regression of mass transpires as the heart adapts to the new level of afterload. In patients with moderate left ventricular hypertrophy improvement in diastolic function during the first year after aortic valve replacement is visible, while in patients with extreme myocardial hypertrophic changes it was slower.

Adolescent↗

Clinical assessment of ventricular function after surgical treatment of congenital heart defects.

The assessment of ventricular function has contributed to the current surgical evaluation and surgical treatment of congenital heart defects, but many issues remain unresolved. The challenge of assessing ventricular function after surgical repair of congenital heart defects includes not only the general problem of distinguishing adverse loading conditions from myocardial failure but also more unique problems of right heart function and developmental differences in ventricular function. The possibility and significance of diastolic dysfunction are essentially unexplored and contingent upon our better understanding of the determinants of diastolic indices. Many of the technologies and methods are currently available and there is the beginning of a move toward better designed clinical trials and analysis of results. The assessment of ventricular function will become increasingly important as surgical techniques are improved and we are left with the more difficult choices between competing approaches.

Cardiac Output↗

[Left ventricular diastolic function in type I diabetes. A longitudinal echocardiographic study].

The present study was performed to assess the extent of left ventricular diastolic abnormalities and their possible progression with time in patients with type I (insulin dependent) diabetes. Two echocardiographic examinations were performed at an interval of 5 years in 18 study patients. Left ventricular diastolic function was assessed by computer digitized analysis of the M-mode echocardiographic tracings. During the study period all patients remained in satisfactory metabolic control and without retinopathy. Twelve normal subjects, matched for age and sex, were used as control group. Peak rate of left ventricular posterior wall excursion and the peak rate of increase in left ventricular internal dimensions were significantly reduced in patients with diabetes (14.12 +/- 2.5; 16.48 +/- 3.9 cm/sec) compared with controls (17.25 +/- 2.8; 20.41 +/- 3.6 cm/sec) (p less than .005; p less than .01). In addition time to peak rate of increase in left ventricular internal dimensions, isovolumic relaxation index and isovolumic relaxation time were significantly prolonged in patients with diabetes (63.66 +/- 16.5; 23.9 +/- 9; 72.7 +/- 14 msec) compared to controls (46.83 +/- 9.8; 13.4 +/- 4; 61.1 +/- 12 msec) (p less than .005; p less than .001; p less than .05). In the study patients, no relation was found between the extent of diastolic abnormalities and age, duration of the disease and insulin dosage. The extent of left ventricular diastolic dysfunction did not show significant changes during follow-up. Our results indicate that diastolic abnormalities are common in patients with type I diabetes and are not related to the duration of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus, Type 1↗

Left ventricular diastolic filling in elderly hypertensive patients.

OBJECTIVE: To evaluate the effects of mild to moderate hypertension and of LVH on diastolic filling and other Doppler indices in the elderly. DESIGN: Survey with a control group. SUBJECTS: Seventy-one hypertensives (34 men, 37 women) referred for echocardiograms and 32 age- and sex-matched normotensive volunteers. Thirty-six of the hypertensives had LVH; 34 did not. SETTING: Echocardiographic laboratory. MEASUREMENTS: M-mode, two-dimensional, and pulsed Doppler echocardiograms. A wide variety of Doppler-derived indices of diastolic function were assessed. RESULTS: All Doppler derived indices of left ventricular diastolic filling (peak E, peak A, their ratio, EF slope, time-velocity integrals, atrial filling fraction, and isovolumic relaxation time) were similar among the three groups. CONCLUSION: Elderly mild to moderate hypertensives with or without LVH have LV diastolic filling that is normal for age. The identification of pathological diastolic dysfunction requires comparison to age-matched controls, since aging, a major factor influencing diastolic filling, can mask the effect of hypertension.

Age Factors↗

Acromegaly: evidence for a direct relation between disease activity and cardiac dysfunction in patients without ventricular hypertrophy.

BACKGROUND AND AIMS: Cardiac abnormalities, such as cardiomegaly and congestive heart failure, occur frequently in advanced acromegaly. Abnormalities of systolic and diastolic function, mostly associated with left ventricular (LV) hypertrophy, have been reported. The impact of disease activity on LV performance in patients with normal or slightly elevated LV muscle mass has not been demonstrated. PATIENTS AND METHODS: Conventional two-dimensional/Doppler echocardiography and tissue Doppler imaging (TDI) of the mitral annulus were performed in 13 patients with active acromegaly (AA) and normal or slightly elevated LV muscle mass (< 140 g/m2) and in 19 cured/well-controlled patients (CA). A group of 21 volunteers without symptoms or signs of cardiac disease served as controls (CON). The combined myocardial performance index (Tei-Index) was determined in all patients and controls. RESULTS: Muscle mass index of the left ventricle, ejection fraction, fractional shorting, E/ET-ratio, systolic (ST) and late diastolic (AT) annular velocities did not differ significantly between the three groups. In the AA group, the early diastolic annular velocity ET[7.13 +/- 2.11 (AA); 9.83 +/- 3.29 (CA); 10.10 +/- 1.70 m/s (CON); P < 0.05 AA vs. CA, P < 0.005 AA vs. CON] and the ET/AT-ratio [0.71 +/- 0.26 (AA); 0.95 +/- 0.33 (CA); 1.00 +/- 0.15 m/s (CON); P < 0.05 AA vs. CA, P < 0.005 AA vs. CON] were significantly reduced. Patients with AA had a longer deceleration time [209 +/- 19 (AA); 179 +/- 22 (CA); 185 +/- 26 ms (CON); P < 0.05]. The Tei-Index was significantly higher in AA in comparison with CON [0.50 +/- 0.15 (AA); 0.48 +/- 0.12 (CA); 0.41 +/- 0.10 (CON); P < 0.05 AA vs. CON]. Subjects with CA did not differ significantly from controls with respect to 2-D/Doppler echo- and TDI-derived parameters. CONCLUSION: The data demonstrate that diastolic dysfunction can be verified by tissue Doppler imaging in patients with active acromegaly with normal or slightly elevated muscle mass of the left ventricle and seems to be related to disease activity. The Tei-Index as a sensitive combined myocardial performance index can be used to complete the assessment of systolic and diastolic LV performance in acromegalic patients.

Acromegaly↗

[Morphologic and functional abnormalities of the cardiovascular system in patients with hepatic cirrhosis].

During liver cirrhosis many important changes occur in the cardiovascular system and these abnormalities appear more evident as portal hypertension and liver dysfunction progress. The cirrhotic heart develops a series of structural and functional abnormalities consisting in diastolic dysfunction and reduced myocardial reactivity during exercise, likely due to a diminished myocardial beta-adrenergic receptor function. Nevertheless, the peculiarity of the cardiovascular involvement during liver cirrhosis is represented by a progressive development of a hyperdynamic circulation that seems to be due to portal hypertension rather than to liver insufficiency. In fact, it has been hypothesized that this syndrome raise from the venous portal bed and is primarily determined by an increase in blood volume that leads to an enhanced cardiac output. Later, as liver cirrhosis progresses, new important pathogenetic elements occur and lead to a reduction in peripheral vascular resistances and to the full clinical expression of hyperdynamic circulation. The pathogenesis of hyperdynamic circulation is very interesting for scientific research because of the complex and still in part unknown origin. In addition, this syndrome has an important clinical meaning for its severely adverse prognostic value and it represents the pathogenetic background for a number of severe complications of advanced liver cirrhosis.

Blood Circulation↗

Left ventricular diastolic function in physiologic and pathologic hypertrophy.

BACKGROUND: Patients with hypertensive heart disease and left ventricular hypertrophy demonstrate an impaired left ventricular diastolic filling pattern. The aim of this study was to find out whether physiologic left ventricular hypertrophy induced by endurance training causes disturbances in left ventricular systolic and diastolic filling. METHODS: We examined 49 athletes with left ventricular (LV) hypertrophy due to endurance training, 49 patients with LV hypertrophy due to arterial hypertension, and 26 untrained healthy control subjects by conventional echocardiography. Parameters of LV diastolic filling using pulse wave and color flow Doppler were also assessed. RESULTS: All three study groups showed normal fractional shortening and mid-wall fractional shortening. Conventional echocardiography revealed a higher LV muscle mass index in the two study groups compared with the controls (athletes, 99 +/- 10 g; hypertensive patients, 95 +/- 11 g: controls: 52 +/- 7 g; P < .01 for athletes and hypertensive patients). In patients with arterial hypertension, a diastolic dysfunction consisting of a delayed relaxation pattern with a decrease in maximal early velocity of diastolic filling (0.44 +/- 0.1 m/sec) and a compensatory increase of the maximal late velocity of diastolic filling (0.53 +/- 0.1 m/sec) was demonstrated. In athletes with physiologic LV hypertrophy, a normal LV diastolic filling pattern was documented. CONCLUSIONS: Doppler echocardiographic parameters of LV diastolic function can be of diagnostic importance for discrimination between pathologic and physiologic LV hypertrophy.

Adult↗

Alteration of left ventricular diastolic filling in hypertensive patients: effects of nitrendipine and atenolol.

This study was undertaken to determine the chronic effects of a long-acting calcium-channel blocker (nitrendipine) on resting left ventricular filling abnormalities in ten patients with essential hypertension. Radionuclide left ventricular curves of these hypertensive patients were compared with the curves of twelve normal volunteers and of eight asymptomatic older patients. The curves were analyzed for ejection fraction, peak filling rate (normalized for end-diastolic counts and for stroke counts), time to peak filling rate and filling fraction in the first-third of diastole normalized for cycle length. Heart rate and ejection fraction were similar in both control groups and hypertensive patients before and after nitrendipine. Before nitrendipine, diastolic filling parameters were significantly different in the hypertensive patients as compared with the volunteers and with the asymptomatic aged patients: peak filling rate was lower, time to peak filling rate was longer and the first-third filling fraction was smaller. After six weeks of nitrendipine therapy, systolic and diastolic blood pressure decreased significantly. After nitrendipine, the time to peak filling rate decreased and the first-third filling fraction and the peak filling rate (normalized for stroke counts) increased significantly. The acute oral administration of 100 mg atenolol induced a further decrease in systolic blood pressure and a significant decrease in heart rate. The effect of combining nitrendipine and atenolol on diastolic indexes was a preserved effect on time to peak filling rate and on the first-third filling fraction. These results suggest that short-term therapy with nitrendipine improves early diastolic dysfunction in hypertensives: the addition of a beta-blocking agent further improved the early diastolic indexes.

Adult↗

Delayed Recovery of Diastolic Function in Patients with Suspected Acute Myocarditis as Assessed with Doppler Echocardiography.

Pulsed-wave Doppler echocardiography was performed repeatedly in two women (24 and 23 years old) who had clinically suspected acute myocarditis. Systolic function recovered earlier than diastolic function in both cases. Although left ventricular diastolic dysfunction has been demonstrated in lymphocytic myocarditis, this difference in the rates of systolic and diastolic function recovery after acute myocarditis has not been previously described. The slower recovery of the diastolic function might be related to the slower resolution of the infiltrated myocardium. We also discuss the contribution of echocardiography to the difference in the rates of cardiac function recovery after acute myocarditis.

Journal Article↗

Approach to patients with heart failure and normal ejection fraction.

Approximately 50% of patients with a firm clinical diagnosis of heart failure (HF) have a normal ejection fraction. Some patients have valvular disease, but most have underlying diastolic dysfunction that leads to pulmonary and systemic congestion and signs and symptoms of HF. Although diastolic HF is clinically and radiographically indistinguishable from HF with depressed left systolic ventricular function, knowledge of which patients are at risk of diastolic HF, the common clinical profiles, and the common echocardiographic findings enhances the clinician's ability to diagnose diastolic HF with confidence. The prognostic implications of a diagnosis of diastolic HF and the therapeutic approach to such patients are reviewed.

Diagnosis, Differential↗

Cardiomyopathies in the elderly.

Cardiomyopathies are an important cause of congestive heart failure in the elderly, and the magnitude of the problem is compounded by changing population demographics and the frequency of congestive heart failure in the elderly. Although the data are far from complete, differences in the clinical presentations and natural history of the cardiomyopathies in older and younger patients are becoming more clearly appreciated. Dilated cardiomyopathy (DCM) is clearly more common than previously appreciated, and elderly patients have a worse prognosis than their younger counterparts with this disease. The medical management of DCM is often more difficult in the elderly, and the problem is compounded by the relatively infrequent use of cardiac transplantation as a therapeutic option. Hypertrophic cardiomyopathy is also more common than previously appreciated, and changes in left ventricular structure often create difficulties in differentiating pathologic states from physiologic. Fortunately, the prognosis for HOCM is more favorable in the elderly than in younger patients and may be partly accounted for by the different structure of the left ventricle. If needed, surgery is an option for elderly patients with medically refractory HOCM, but particular attention must be paid to the presence and severity of associated cardiovascular disease. Restrictive cardiomyopathy with diastolic dysfunction is increasingly recognized as a cause of congestive heart failure. The differentiation from systolic dysfunction is crucial, because the treatments are so markedly different. Age-related changes in diastolic function are becoming more apparent and better characterized, but standardization of age-related "normal" values is still not available. The diagnosis of restrictive heart disease should stimulate a search for an underlying cause, inasmuch as restrictive cardiomyopathy remains a diagnosis of exclusion. Advances in noninvasive imaging have led to a resurgence of interest and have enhanced our knowledge of the cardiomyopathies. Further investigation should proceed in conjunction with studies aimed at defining the characteristics and variables of "normal" aging. For the present, the enigmatic, poorly identified "cardiomyopathies" remain a problem for both young and old.

Age Factors↗

[Exploration of left ventricular relaxation using gamma-angiography in 70 hypertensive subjects. Practical consequences and implications].

This study was performed to evaluate the incidence ant the practical consequences of left ventricular diastolic dysfunction in hypertensive. In 70 mild to moderate hypertensive subjects group [systolic 161 +/- 16 and diastolic blood pressure 104 +/- 9 mmHg 18 women, 52 men, 51 +/- 7 years old] and in a 15 normal subjects control group, the peak filling rate (PFR) and the time to peak filling rate (TPFR) were measured with the time/activity curve of the rest equilibrium blood pool scintigraphy. The ejection fraction and the stress test were normal in all patients [EF 0.66 +/- 0.05, ranging from 0.59 to 0.88]. The PFR was not significantly different in the hypertensive group but 59/70 patients [84 p. 100] showed an individual value lower than the theoretical age and heart rate expected value. The TPFR was not significantly different (183 +/- 33 ms-vs 180, p = ns). In a Holter-defined sub-group of patients (n = 22) exhibiting a high prevalence of supra-ventricular premature beats or a paroxysmal atrial fibrillation, the PFR was significantly slower than in the total hypertensive group [1.92 +/- 0.33 EDV/s-1, p = 0.02]. Early indices of diastolic function give some instantaneous information on left ventricular filling. Determining the exact significance of individual values of PFR and TPFR requires a better knowledge of physiologic and pathologic determinants of LV filling.

Adult↗

Analysis of the interaction between segmental relaxation patterns and global diastolic function by strain echocardiography.

BACKGROUND: Strain echocardiography can depict segmental mechanical activity with high temporal and spatial accuracy, and may allow assessment of segmental relaxation not possible with conventional echocardiography. METHODS: Conventional and strain echocardiography were performed in healthy volunteers (young [group 1] and old [group 2]) and patients with normal 2-dimensional and stress echocardiography, with either normal global diastolic function (group 3a) or grade I or II global diastolic dysfunction (DD) (group 3b). Standard echocardiography criteria were used to define global DD. Early to late diastolic strain rate ratio less than 1.1 was defined as altered segmental relaxation. RESULTS: All participants had normal wall motion and ejection fraction. Participants of group 1 had normal segmental and global diastolic function. Participants of groups 2 and 3a demonstrated a wide range of altered segmental relaxation in the absence of global DD. All patients of group 3b had 12 or more segments with altered relaxation and global DD. Age and hypertension were associated with a larger number of altered segments, a lower mean early to late diastolic strain rate ratio, and global DD. CONCLUSIONS: A wide range of altered segmental relaxation can exist in the absence of global DD. Age and hypertension are associated with altered segmental relaxation and global DD. Assessment of segmental relaxation may be beneficial in the elderly and patients with hypertension.

Adult↗

The effect of chronic alcohol consumption on systolic and diastolic left ventricular function.

The study population consisted of 248 patients with at least five-year (mean 8.7+/-4.2 yrs.) history of drinking, mean age (48+/-4.2 years), including 132 subjects with arterial hypertension (mild or moderate according to WHO/ISH guidelines) and 116 normotensives. A group of 48 patients with essential arterial hypertension not consuming alcohol served as controls. Groups of alcoholics with hypertension, alcoholics with normal blood pressure and the controls were compared with respect to differences in standard BP measurements and 24hr blood pressure monitoring, left ventricular mass index, systolic and diastolic left ventricular function by echocardiography. In alcohol-dependent subjects the left ventricular mass index progressed with the increasing declared consumption of ethanol and duration of abuse. The incidence of LVH in drinking hypertensives (28%) did not differ from that in non drinking hypertensives (26%), p>0.05. In hypertensives irrespective of ethanol consumption delayed relaxation was a marker of left ventricular diastolic dysfunction. The present study did not confirm the hypothesis that left ventricular hypertrophy was responsible for diastolic impairment in alcohol abusers. Chronic ethanol consumption significantly deteriorated left ventricular diastolic function irrespective of its effect on blood pressure and left ventricular mass. In patients with the highest level of ethanol consumption and the longest duration of abuse ejection fraction was significantly lower than in patients with the lowest level of alcohol consumption and the shortest duration of abuse (EF 61.8% vs. EF 67.4%, p<0.05). Thus, the deterioration of systolic function is significantly related with the level of alcohol consumption and duration of abuse.

Adult↗

Regional left ventricular motion during early filling phase in patients with right ventricular pressure overload.

Global left ventricular (LV) diastolic function has been reported to be disturbed under conditions of right ventricular pressure overload (RVPO). However, from the standpoint of regional wall motion, only a little information related to the mechanism of LV diastolic dysfunction is available. Eight patients with RVPO and 7 healthy volunteers were investigated using tagged cine magnetic resonance imaging. Regional diastolic fraction (RDF) was determined in 4 segments (anterior, lateral, inferior, and septal) in the mid-ventricular short axis section and in 2 segments (septal and lateral) in the 4-chamber section. A heterogeneity index was obtained from the RDFs of the short axis section. In the RVPO group, in both short axis and 4-chamber sections, the RDF of the septal segment was depressed, and it showed an inverse correlation with the right-to-left ventricular systolic pressure (RV/LV) ratio (r = -0.74, p < 0.05) in the short axis section. In the 4-chamber section, the RDF was lower in the septal segment than in the lateral segment (p < 0.05). The heterogeneity index in the RVPO group was greater than that in the control group (p < 0.01). The index correlated positively with the RV/LV ratio (r = 0.77, p < 0.05). The altered regional diastolic motion results in increased heterogeneity in regional diastolic motion.

Adolescent↗

Impact of disease activity on left ventricular performance in patients with acromegaly.

BACKGROUND: In patients with acromegaly, abnormalities of systolic and diastolic left ventricular (LV) performance, mostly associated with hypertension or LV hypertrophy, have been reported. We used 2-dimensional/Doppler echocardiographic methods and tissue Doppler imaging (TDI) to elucidate the impact of disease activity on LV function in patients with acromegaly. METHODS: In a prospective study design, 15 patients with active acromegaly (AA group; mean age-adjusted serum insuline-like growth factor-I [IGF-I] level, 420 +/- 170 ng/mL, mean growth hormone nadir during 75-g oral glucose load, 12.3 +/- 30.1 microg/L), 18 patients with cured (n = 14, mean IGF-I level 205 +/- 115 ng/mL, mean growth hormone nadir during glucose load 0.72 +/- 0.34 microg/L) or well-controlled (n = 4, normal age-adjusted ranges of IGF-I levels with medication with somatostatin analogues 354 +/- 88 ng/mL) acromegaly (CA group), and 24 control subjects (control group) underwent 2-dimensional/Doppler echocardiographic measurements, including assessment of the Tei index (isovolumic contraction time and isovolumic relaxation time divided by ejection time). Systolic and diastolic mitral annular velocities (peak systolic velocity, peak early diastolic velocity [E'], peak late diastolic velocity [A'], E'/A' ratio) were derived from pulsed TDI. RESULTS: No significant differences between study groups were observed with respect to muscle mass and systolic parameters, such as ejection fraction, fractional shortening, and peak systolic velocity. In patients with AA, E' and the E'/A' ratio were lower than in control and CA subjects (AA 6.8 +/- 1.7 cm/s, control 10.0 +/- 1.7 cm/s, CA 9.1+/- 3.0 cm/s, P <.01 AA vs control, P <.05 AA versus CA, AA 0.68 +/- 0.22, control 0.98 +/- 0.16, CA 0.89 +/- 0.37, P <.01 AA vs control and CA, respectively). In comparison with control subjects and patients with CA, patients with AA had a reduced mitral peak velocity of early/late filling ratio (AA 0.78 +/- 0.22 m/s, control 1.12 +/- 0.33 m/s, CA 1.11 +/- 0.36 m/s, P <.05 AA vs control and CA) and a prolonged deceleration time (AA 223 +/- 41 ms, control 188 +/- 26 ms, CA 185 +/- 25 ms, P <.05 AA vs control and CA). The Tei index was significantly elevated in patients with AA in comparison with control subjects and patients with CA (AA 0.54 +/- 0.13, control 0.40 +/- 0.09, CA 0.44 +/- 0.10, P <.05 AA vs control and CA). No significant differences were observed between control subjects and patients with CA with respect to mitral flow-derived variables, TDI parameters, and the Tei index. CONCLUSION: Disease activity has a significant impact on LV performance in patients with acromegaly. In subjects with active disease, diastolic dysfunction and beginning impairment of overall LV performance are present. In patients with cured/well-controlled disease, systolic and diastolic function appear normal.

Acromegaly↗