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PubMed1995

[Ca2+]i transients in hypertensive and postinfarction myocytes.

Changes in intracellular calcium concentration ([Ca2+]i) in paced fura 2-loaded myocytes isolated from Sham, renovascular hypertensive (Hyp), and myocardial-infarcted (MI) rats were examined. Compared with controls, Hyp myocytes paced at physiological rates had similar systolic but elevated diastolic [Ca2+]i. By contrast, systolic [Ca2+]i was significantly lower and diastolic [Ca2+]i higher in MI myocytes. The different patterns of alterations in [Ca2+]i dynamics in Hyp and MI myocytes may partly explain predominantly diastolic dysfunction in hypertensive hearts and systolic dysfunction in hearts surviving MI. In the presence of 1 microM isoproterenol, both Hyp and MI myocytes had much lower systolic [Ca2+]i when compared with their respective controls. Isoproterenol restored the elevated diastolic [Ca2+]i in Hyp myocytes toward normal but had no effect on the intrinsic differences in diastolic [Ca2+]i between Sham and MI myocytes. The observation that isoproterenol lowers diastolic [Ca2+]i in Hyp myocytes toward normal may provide a cellular mechanism for the lack of efficacy of beta-adrenergic blockers to improve diastolic compliance in patients with hypertensive hypertrophic cardiomyopathy.

Adrenergic beta-Agonists↗
PubMedDate not supplied

[Anaerobic threshold detected using "V-slope analysis" in chronic chagasic disease].

Anaerobic threshold (AT) as measured by V-slope, is the best parameter of cardiac reserve in patients with heart failure. A reduction of AT reflects linearly a limited cardiopulmonary reserve in patients with heart disease. We measured the anaerobic threshold from 28 patients (18 men; age 47 +/- 6.7 years) classified into four groups: IA (normal ECG, without heart disease; 9 patients); IB (normal ECG, early left ventricular segmental abnormalities; 5 patients); II (abnormal ECG, advanced myocardial damage, no signs of heart failure, 7 patients); and III (abnormal ECG, end-stage, congestive heart failure; 7 patients). The analysis of variance indicated that the anaerobic threshold from patients of group LA was significantly greater than in groups IB, II and III (p = 0.001). Tukeys multiple comparison test showed no significative differences between mean AT in groups IB, II and III. The present study clearly demonstrates that occurrence of initial left ventricular contraction abnormalities is associated with definite reduction of cardiopulmonary reserve, and that this reduction is progressive and parallels the hemodynamic alterations. The most probable cause of this finding in group IB is diastolic dysfunction as clearly shown in echocardiogram.

Adult↗
PubMed2006

The DAVES (Disfunzione Asintomatica VEntricolare Sinistra) study by the Italian Society of Cardiovascular Echography: rationale and design.

BACKGROUND: Diagnosis of heart failure (HF) is based on clinical signs, instrumental findings and response to treatment. The recent classification of the European Society of Cardiology identifies early stages of ventricular dysfunction not associated with symptoms of HF (Stage A-B). However, only few data are available on the prevalence and prognostic value of asymptomatic left ventricular dysfunction. METHODS: The SIEC (Società Italiana di Ecografia Cardiovascolare - Italian Society of Cardiovascular Echography) has planned a national multicenter observational study aimed to assess: (1) the prevalence of left ventricular (LV) systolic and diastolic dysfunction in asymptomatic subjects without a history of HF (transversal phase); (2) the relationship between cardiovascular risk factors and LV asymptomatic dysfunction; (3) the relationship between comorbidities and LV asymptomatic dysfunction; and (4) the incidence of cardiac events at follow-up (longitudinal phase). Data from 75 echocardiographic laboratories were recorded, merged, and analyzed using a dedicated software. CURRENT STATUS: Recruitment started in June 2003 and closed in February 2004. Overall, 16 099 patients (men, 8496; women, 7603; male: female ratio, 1.11) have been screened and 6679 (men, 3504; women, 3175; male: female ratio, 1.10) were enrolled. The follow-up is currently ongoing.

Cardiac Output, Low↗
PubMed1989

The effect of cilazapril on systolic and diastolic cardiac function in hypertensive patients.

Diastolic function may be impaired in hypertensives even before alterations occur in systolic function. We studied the effect of a single dose of cilazapril, 5 mg orally, on systolic and diastolic cardiac function in 20 hypertensive patients using a double-blind crossover placebo controlled design. All patients had mild to moderate concentric left ventricular hypertrophy, preserved systolic function and long standing hypertension (for a period of 11.9 +/- 9.0 years). Radionuclide scintigraphy was performed with cilazapril and placebo, given one week apart. A two-week washout period of all cardioactive drugs preceded the study. Within one hour of oral administration of cilazapril blood pressure was significantly lowered. The absolute time to peak filling rate of the left ventricle, as well as the time to peak filling rate expressed as a percentage of diastole, were reduced from 176 +/- 34 to 158 +/- 33 msec (P less than 0.01) and from 46 +/- 10% to 37 +/- 8% (P less than 0.02) (reduction by 9% and 18.4%, respectively). Heart rate, left and right ventricular ejection fraction and peak filling rate was not significantly altered. Placebo had no significant effect. The effect of cilazapril is most probably related to afterload reduction. In conclusion; cilazapril seems to improve diastolic cardiac function in hypertensive patients. Long-term therapy may result in improvement of other, less sensitive indices of diastolic dysfunction.

Administration, Oral↗
PubMed1996

Effects of antihypertensive therapy on left atrial function.

OBJECTIVES: To investigate left atrial (LA) function as a reservoir, as a conduit and as a booster pump in essential hypertension (EH). LA volumes were echocardiographically measured in 28 untreated hypertensive patients and in 20 control subjects. BACKGROUND: LA makes a large contribution in left ventricular filling, especially in patients with impaired diastolic function. LA function is fundamental in left ventricular filling in hypertensive patients as hypertension results in left ventricular diastolic dysfunction. METHODS: Diagnosis of EH (blood pressure > 140/90 mm Hg) was based on three repeated readings of blood pressure (BP). Patients with myocardial infarction, cardiomyopathy, valvular or congenital heart disease were excluded. Doppler diastolic early (E) and late (A) velocity of mitral inflow were measured. The following indexes were calculated: left ventricular mass index (LVMI) using the Penn convention; left ventricular stroke volume (LVSV); LA reservoir volume (LARV = LA maximal volume at mitral valve opening minus minimal volume); LA conduit volume (LACV = LVSV-LARV). Atrial systolic function was assessed by calculating the active emptying fraction (volume at onset of atrial systole minus minimal volume/volume at onset of atrial systole, the E/A ratio and the LA ejection force (0.5 rho A2 MOA, where rho = the density of blood, MOA = mitral orifice area from the parasternal short axis view). Measurements were obtained in all hypertensive patients before and after 16 weeks administration of either enalapril (10 or 20 mg) or enalapril +/- chlorthalidone (20/25 mg) once a day. RESULTS: After 16 weeks of treatment, BP was reduced significantly (from 172/110 to 137/86 mm Hg, P < 0.001). LVMI decreased significantly as well (from 141 to 123 g/m2) although it was higher compared to controls (94 g/m2, P < 0.001). LARV decreased significantly (from 35.4 to 29.3 cm3, P < 0.05) while LACV increased significantly (from 43.8 to 51.3 cm3, P < 0.05), LA active emptying fraction and E/A ratio did not change. LA ejection force decreased significantly (from 20.9 to 18.1 kdynes, P < 0.05) but it was greater than controls (16.7 kdynes, P < 0.01). There was a positive relationship of LVMI to LARV (P < 0.01) in controls (r = 0.77) which held true in hypertensive patients, before (r = 0.72) and after treatment (r = 0.69). There was a negative relationship of LVMI to LACV (P < 0.01) in controls (r = -0.65), and in hypertensive patients untreated (r = -0.74) and after treatment (r = -0.72). CONCLUSIONS: Our results showed that in hypertensive patients, LA reservoir function increases and LA conduit function decreases, while LA ejection force increases. Antihypertensive treatment with enalapril and/or thiazide, induces normalisation of the LA function in parallel to left ventricular hypertrophy regression.

Adolescent↗
PubMed2005

[Characteristics of hypertensive cardiomyopathy in a population of hypertensive patients never treated].

BACKGROUND AND OBJECTIVE: Although impaired diastolic function is frequently found in systemic hypertension, the diagnosis of hypertensive heart disease (HHD) is based on the demonstration of left ventricular (LV) growth. The aim of the current work was to investigate the potential interactions between diastolic function and LV growth in patients with arterial hypertension. PATIENTS AND METHOD: One hundred and sixteen never-treated asymptomatic hypertensives underwent an echocardiographic evaluation. Classification of diastolic dysfunction (DD) was based on alterations in parameters assessing transmitral inflow, Doppler tissue imaging of mitral annular motion, and color M-mode propagation velocity. Classification of LV growth was based on alterations in left ventricular mass index and/or relative will thickness. RESULTS: Ninety-four patients (81%) exhibited DD and 22 (19%) exhibited normal diastolic function. Amongst patients with DD, 79 (84%) exhibited a pattern of impaired relaxation and 15 (16%) a pseudonormal pattern. The presence of LV growth was documented in 41% of patients without DD and 75% of patients with DD (p < 0.05). None of the studied patients exhibited echocardiographic signs of systolic dysfunction. CONCLUSIONS: These findings indicate that DD is an early and highly frequent cardiac alteration in arterial hypertension. In addition, our data show that one fifth of hypertensive patients have DD in the absence of LV growth. It is thus suggested that the diagnosis of HHD can not be further based exclusively on morphologic criteria and should include also the evaluation of alterations in LV filling.

Adult↗
PubMed2004

Evaluating preload dependence of a novel Doppler application in assessment of left ventricular diastolic function during hemodialysis.

BACKGROUND: Left ventricular (LV) diastolic dysfunction, commonly found in hemodialysis (HD) patients, is a major cause of intradialytic hypotension. Conventional Doppler interrogation of mitral flow velocities typically is load dependent. Tissue Doppler imaging (TDI) recently was proposed as a new and relatively load-independent approach to assess diastolic function. The aim of this study is to determine whether HD-related volume reduction affects mitral annular velocities in a large number of patients. METHODS: One hundred twenty-eight uremic patients underwent Doppler echocardiography 1 hour before and after HD. Two-dimensional and M-mode echocardiography were used to analyze LV size, volume, mass, systolic function, and the inferior vena cava. Doppler signals were obtained from the mitral inflow and TDI of the mitral annulus to measure variations in hemodynamics and LV diastolic filling parameters. RESULTS: After HD, LV size, volume, mass, stroke volume, and cardiac output were significantly decreased (all P < 0.001). Peak early (E) and late diastolic velocities (A) and E/A ratio decreased significantly after HD (all P < 0.001). Mitral annulus E' velocity and E'/A' ratio also changed significantly (both P < 0.001), whereas A' did not. Consequently, changes in E and A significantly differed with respect to the varying amount of ultrafiltration (both P < 0.05). CONCLUSION: Our larger cohort study shows that the proposed technique of TDI is still volume dependent. Therefore, LV diastolic function in HD patients must be assessed carefully in a timely manner, even when the new Doppler application is used.

Adolescent↗
PubMed2005

Strain rate analysis allows detection of differences in diastolic function between viable and nonviable myocardial segments.

Analysis of diastolic function for assessment of myocardial viability has not been evaluated. Strain rate (SR) analysis allows quantitative segmental analysis of myocardial function and has been used during dobutamine stimulation for assessment of systolic functional reserve. In 37 patients with ischemic left ventricular dysfunction diastolic function was evaluated at rest and during low-dose dobutamine stimulation (10 mug/kg/min) using SR imaging and related to F18-fluorodeoxyglucose positron emission tomography. Analysis of peak early (E waves) and late (A waves) diastolic myocardial SR was performed using apical views. In all, 317 segments had normal function at rest by 2-dimensional echocardiography. A total of 192 segments with dyssynergy at rest were classified by positron emission tomography as viable in 94 cases and nonviable in 98 cases. Dys-synergic segments had lower E and A waves SR compared with normal contracting segments. There were no significant differences in peak E and A waves SR at rest between dys-synergic viable and nonviable segments. With dobutamine stimulation peak E waves SR increased significantly for viable segments (0.89 +/- 0.51-1.06 +/- 0.51 L/s, P < .01) whereas it was unchanged for nonviable segments (0.77 +/- 0.49-0.78 +/- 0.48 L/s, P = .835). Peak A waves SR increased for viable (0.71 +/- 0.55-1.00 +/- 0.56 L/s, P < .01) and nonviable (0.57 +/- 0.47-0.71 +/- 0.58 L/s, P = .023) segments. However, during dobutamine stimulation peak A waves SR was larger ( P < .001) for viable than for nonviable segments. In conclusion, normal contracting segments at rest have higher E and A waves SR compared with dys-synergic segments. Dys-synergic viable myocardial segments demonstrate an increase in E and A waves SR with dobutamine stimulation whereas nonviable segments are less responsive to dobutamine.

Analysis of Variance↗
PubMed2004

Diastolic heart failure.

Diastolic heart failure is characterized by the presence of heart failure with preserved left ventricular ejection fraction (LVEF): documentation of diastolic dysfunction, usually by Doppler echocardiography, is strongly recommended. Heart failure with preserved LVEF is a heterogeneous and common condition, especially in the elderly, among whom represents up to 50% of all heart failure patients. Mortality is generally lower than in patients with heart failure and low LVEF, and depends on etiology, patient conditions, and comorbidities. Anyway, morbidity is very high. So far, treatment of diastolic heart failure is empirical, and is aimed to maintain cardiac output, reduce filling pressure, control heart rate and rhythm, and antagonize disease progression with diuretics, inhibitors of the renin-angiotensin-aldosterone system, nitrates, and digoxin.

Diastole↗
PubMed2005

Clinical inquiries. Does furosemide decrease morbidity or mortality for patients with diastolic or systolic dysfunction?

No large-scale randomized, placebo-controlled trials evaluate furosemide's effect on mortality and long-term morbidity in diastolic or systolic dysfunction. In short-term studies, furosemide reduces edema, reduces hospitalizations, and improves exercise capacity in the setting of systolic dysfunction (strength of recommendation [SOR]: B, based upon low-quality randomized controlled trials). Furosemide and other diuretics reduce symptomatic volume overload in diastolic and systolic dysfunction (SOR: C, based on expert opinion). There is potential morbidity with the use of high-dose loop diuretics (volume contraction, electrolyte disturbances, and neuroendocrine activation). Use of high-dose loop diuretics for systolic dysfunction is associated with increased mortality, sudden death, and pump failure death (SOR: B, based on retrospective analyses of large-scale randomized controlled trials). However, diuretic resistance or disease severity may explain these latter findings.

Diuretics↗
PubMed1998

Noninvasive evaluation of left ventricular diastolic function in hypertrophic cardiomyopathy.

Diastolic dysfunction is common in hypertrophic cardiomyopathy (HC). Previous studies suggest that Doppler transmitral flow velocity profiles, and the left atrial (LA) M-mode echogram can be used noninvasively to evaluate left ventricular (LV) diastolic function. However, this has not been proved in HC. In this study we determined the relation of Doppler transmitral flow velocity profiles and the LA M-mode echograms to invasive indexes of LV diastolic function in patients with HC. We studied 25 patients with HC, while off drugs, and calculated LA global and active fractional shortening and the slope of both early and late displacement of the posterior aortic wall during LA emptying by M-mode echocardiography. We calculated peak velocity of early (E) and atrial (A) filling, E to A ratio, and E-wave deceleration time by pulsed Doppler echocardiography, and simultaneous radionuclide angiography, LV pressures, time constant of isovolumic relaxation tau, and the constant of chamber stiffness k by cardiac catheterization. The time constant of isovolumic relaxation tau correlated with the slope of early posterior aortic wall displacement (r = 0.59; p <0.01). LV end-diastolic pressure correlated with global LA fractional shortening (r = -0.75; p <0.001); the constant of chamber stiffness k correlated with active LA fractional shortening (r = -0.53; p <0.02). In a subset of 13 patients, in whom echocardiography and cardiac catheterization were performed simultaneously, similar results were found. LA M-mode recordings provide a more reliable noninvasive assessment of diastolic function in HC than mitral Doppler indexes.

Adolescent↗
PubMed1998

Evaluation of cardiac status in iron-loaded thalassaemia patients following bone marrow transplantation: improvement in cardiac function during reduction in body iron burden.

Iron-induced cardiac disease is the primary cause of death in transfused patients with thalassaemia major. The beneficial effects of deferoxamine mesylate on clinical cardiac disease have been well described but the impact of therapy on subclinical cardiac dysfunction is unknown. To assess the reversibility of subclinical cardiac dysfunction we studied the cardiac status during iron depletion treatment (phlebotomy) in iron overloaded patients, cured of thalassaemia by marrow transplantation, without clinical manifestation of heart failure but with alteration in both left ventricular diastolic function and in contractility property. 32 patients were studied and demonstrated a slight but significant impairment in the morphology and function if compared with matched normal controls. 17 of these patients were submitted to sequential echocardiographic evaluations during the phlebotomy programme. Following completion of the programme, normalization of the indices of contractility and normalization of diastolic function were observed. This study indicates that transplanted thalassaemia patients with subclinical left ventricular diastolic dysfunction and impaired left ventricular contractility may reverse these processes with an effective regimen of iron reduction such as phlebotomy.

Adolescent↗
PubMed2006

Correlation and prognostic utility of B-type natriuretic peptide and its amino-terminal fragment in patients with chronic kidney disease.

This study compared the correlation and prognostic utility of B-type natriuretic peptide (BNP) and the N-terminal fragment of proBNP (NT-proBNP) in 171 outpatients with renal dysfunction. The NT-proBNP correlated well with BNP in all cases (r = 0.911; P pound .01), regardless of degree of renal impairment or type of left ventricular dysfunction. BNP and NT-proBNP concentrations (P < .005) and their ratios (P pound .01) increased as the glomerular filtration rate (GFR) declined, indicating a greater effect of GFR on NT-proBNP levels. Both natriuretic peptide levels were higher in patients with systolic dysfunction (P < .05) compared with patients with normal echocardiograms. In contrast, BNP and NT-proBNP levels were below the diagnostic cutoffs for congestive heart failure exacerbations in patients with normal heart function or diastolic dysfunction, with no statistical difference between these groups (P = .99). Both peptides are useful prognostic tools for predicting mortality and cardiac hospitalization in renal patients.

Aged↗
PubMed2003

Diastolic function of the left ventricle assessed by echocardiography.

The authors evaluated a value of diastolic indices of the left ventricle assessed by Doppler from transmitral flow in prediction of diastolic dysfunction. They were related to instantaneous pressure decline of the left ventricle, which was considered as a standard of left ventricular relaxation and was evaluated by Doppler. In a group of 38 patients the diastolic function was assessed by measuring the isovolumic relaxation time, peak velocity during the rapid filling phase of the left ventricle, its deceleration time, peak velocity during atrial contraction, its ratio and flow propagation velocity. Polynomial regression revealed significant association of the instantaneous pressure decline of the left ventricle to isovolumic relaxation time and a value of more than 100 ms identifying a high risk group of patients. There was no association to other echocardiographic indices of diastolic function. (Tab. 3, Fig. 2, Ref. 11)

Adult↗
PubMedDate not supplied

[Subclinical disorders of left ventricular function in diabetics detected by echocardiography].

In diabetic patients, without coronary heart disease and hypertension, left ventricular filing dysfunction exist, that is registered by echocardiography. It is manifested as greater peak flow velocity during atrial systole and as shorter time from the aortic second heart sound to the peak of the early diastolic flow velocity curve. The diastolic dysfunction indicates increased left ventricular stiffness and may be the first maker of diabetic cardiomyopathy.

Adult↗
PubMed1993

[Pulsed Doppler echocardiography in the assessment of diastolic function of the left ventricular myocardium in ischemic heart disease].

Pulsed Doppler echocardiography was used to analyse diastolic transmitral blood flow in 2 groups of patients with coronary heart disease, each including 30 persons. The groups differed in the presence or absence of large postinfarct cardiosclerosis. Diastolic dysfunctions of the left ventricular myocardium were marked by the lower maximum rapid filling rate, increased maximum atrial/rapid filling rate ratios, decreased mean slowing in rapid filling rate, and elevated left ventricular end-diastolic pressure. More profound impairments in diastolic blood flow were recorded in patients with postinfarct cardiosclerosis-complicated coronary heart disease. Pulsed Doppler echocardiography is shown to be useful in the assessment of diastolic function of the left ventricular myocardium in coronary heart disease.

Adult↗
PubMed1984

Right ventricular dysfunction after endocardiectomy for right ventricular endomyocardial fibrosis.

Early right ventricular failure following a large endocardiectomy in right endomyocardial fibrosis (EMF) is reported. This diagnosis was confirmed upon echocardiography by the presence of a dilated right ventricle, and hemodynamically (upon postoperative control catheterization) by the presence of right ventricular diastolic dysfunction. The role of the endocardiectomy and of the pericardium in the genesis of this ventricular dysfunction are discussed in the light of this case which was documented by a hemodynamic study and surgically confirmed.

Adolescent↗
PubMed1998

Cardiovascular ageing and heart failure.

Increase in arterial stiffness with age causes elevation of systolic blood pressure, which is the most common antecedent of heart failure in older people. Heart failure results from systolic and diastolic dysfunction; in either case, reducing mechanical load is the basis for preventing and treating heart failure.

Adolescent↗