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PubMed2005

Prevalence, pathophysiology, and clinical significance of post-heart transplant atrial fibrillation and atrial flutter.

BACKGROUND: Atrial rhythm disturbances, in particular atrial fibrillation (AF) and flutter (AFL), are common in the denervated transplanted heart. However, there is a relative paucity of data in the prevalence, mechanism of arrhythmia, and long-term significance. OBJECTIVES: (1) Determine the prevalence of AF and AFL in heart transplant patients, (2) define the echo/Doppler features associated with arrhythmia, and (3) evaluate the impact of arrhythmia on long-term survival. METHODS: All patients who received an orthotopic heart transplant at the Mayo Clinic, Rochester, Minnesota, between 1988 and 2000 were included. Analysis of serial electrocardiograms and Holter monitor records provided evidence of AF or AFL development. Variables including general patient demographics, histology-proven rejection numbers and grades, results of serial coronary angiography, endomyocardial biopsy specimens, and echocardiographic studies performed at 6 weeks and 3 years after transplant were obtained to determine variables predictive of arrhythmia development. RESULTS: There were 167 heart transplant recipients, of which 16 (9.5%) developed AF and another 25 (15.0%) developed AFL over 6.5 +/- 3.4 years. Patients who developed AF or AFL had lower left ventricular (LV) ejection fractions (56.6% +/- 1.6% vs 62.5% +/- 1.5%, p < 0.05), higher LV end-systolic dimensions (LVESD) (33.6 +/- 1.12 mm vs 29.7 +/- 0.97 mm, p < 0.01), higher right atrial volume indexes (43.2 +/- 12.3 ml vs 35 +/- 5.3 ml, p < 0.03), lower mitral deceleration time (145 +/- 8 msec vs 160 +/- 12 msec, p < 0.05), and lower late mitral annulus tissue a' velocities (0.06 +/- 0.005 cm/sec vs 0.08 +/- 0.01 cm/sec, p < 0.02) compared with an age- and gender-matched Sinus Rhythm Group. Grade 3 rejection was a time-dependent covariate predictor of AFL risk (hazard ratio [HR], 2.95; 95% confidence interval [CI], 1.3-6.6, p < 0.008) but not AF (HR, 2.264; 95% CI, 0.72-7.1; p = 0.10). Thirty-nine of 167 patients died: 13 in the arrhythmia group and 26 in the normal sinus rhythm group. Development of atrial dysrhythmia adversely affected the outcome in the first 5 years (p < 0.001) compared with normal sinus rhythm. Predictors of long-term mortality included AF/AFL (HR, 2.88; 95% CI, 1.38-5.96; p < 0.004), age at transplant (HR, 1.04; 95% CI, 1.00-1.07, p < 0.03), coronary artery disease (HR, 2.655; 95% CI, 1.25-5.64; p = 0.01), pre-transplant cardiac amyloidosis (HR, 5.02; 95% CI 2.37-10.62; p < 0.001), right atrial volume index (HR, 1.03; 95% CI, 1.00-10.7; p = 0.03), mitral deceleration time <160 msec (p < 0.01), and LVESD >30 mm (p < 0.04). CONCLUSION: Development of AF/AFL post-heart transplantation is not uncommon and is associated with decreased long-term survival. Cumulative effects of repeated moderate-to-severe (grade 3 or more) rejections that result in increased cardiac fibrosis are associated with the development of AFL, but not AF. Similarly advanced restrictive diastolic dysfunction caused by fibrosis from repeated moderate-to-severe (grade 3 or more) rejections was predominant in the patients with arrhythmia and was a marker of poor long-term outcome.

Adult↗
PubMedDate not supplied

Constrictive pericarditis versus restrictive cardiomyopathy: challenges in diagnosis and management.

This is the case of a patient who presented with severe right-sided heart failure due to diastolic dysfunction that caused a dilemma of differential diagnosis between restrictive cardiomyopathy and constrictive pericarditis. Restrictive cardiomyopathy was diagnosed based on noninvasive and invasive hemodynamic testing. However, the patient did not respond to therapy and succumbed to worsening heart failure and multiple comorbidities. Clinical features of right heart failure with edema, ascites, jugular venous distention, and tender hepatomegaly are commonly seen in clinical practice. When systolic function is determined to be normal, diastolic causes of heart failure must be ruled out. These include myocardial disorders with a broad range of pathologies leading to restrictive physiology, of which amyloidosis is a prototype. Pericardial disorders leading to diastolic heart failure are usually in the form of constrictive physiology, when pericardial tamponade is ruled out. Differentiation between restrictive and constrictive pathologies is often difficult and requires careful attention to hemodynamic and Doppler echocardiographic features. We report a case of severe right heart failure illustrating some of the complexities in decision-making and the importance of meticulous hemodynamic and ancillary testing in the diagnosis and treatment of this often fatal condition.

Aged↗
PubMed1990

Heart failure with normal ejection fraction. The V-HeFT Study. Veterans Administration Cooperative Study Group.

In patients with clinical heart failure entered into the Veterans Administration Cooperative Study (V-HeFT) trial, 83 of 623 who had a baseline radionuclide measurement of left ventricular ejection fraction exhibited an ejection fraction of at least 0.45. When compared with the patients with an ejection fraction of less than 0.45, these subjects with apparent predominant diastolic dysfunction had a lower incidence of coronary artery disease (26.5% vs. 47.2%, p less than 0.001) and a higher incidence of preexisting hypertension (53.0% vs. 39.4%, p less than 0.02). In the normal ejection fraction group, systolic blood pressure was higher (129.7 vs. 117.7 mm Hg, p = 0.0001), heart rate slower (75.0 vs. 83.2 beats/min, p = 0.0001), cardiothoracic ratio smaller (0.512 vs. 0.536, p = 0.002), echocardiographic left ventricular dimension smaller in diastole (61.7 vs. 69.2 mm, p = 0.0001) and in systole (47.4 vs. 58.1 mm, p = 0.0001), and posterior wall thickness greater (9.0 vs. 7.9 mm, p = 0.004). Exercise tolerance was only slightly better in the normal ejection fraction group (peak oxygen consumption, 15.5 vs. 14.6 ml/kg/min, p = 0.04). Prognosis in the normal ejection fraction patients (annual mortality rate, 8.0%) was significantly better than in the low ejection fraction group (annual mortality rate, 19.0%) (p = 0.0001). Ventricular tachycardia on Holter monitor was a poor prognostic sign in these patients, and severe reduction in exercise tolerance also tended to predict poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Exercise Test↗
PubMed1992

Effects of new intravascular contrast agents on [Ca2+]i transients and contraction in cultured ventricular myocytes.

We examined the effects of four kinds of intravascular contrast agents (amidtrizoic acid, iohexol, iopamidol, and ioxaglic acid) on [Ca2+]i transients (indo-1 fluorescence) and cell contraction (video motion analyzer), using cultured chick embryo ventricular myocytes. Exposure of ventricular myocytes to amidtrizoic acid (a conventional contrast agent) reduced the [Ca2+]i transients and the sensitivity of the contractile elements to [Ca2+]i. Ioxaglic acid (a low osmotic contrast agent) also reduced the [Ca2+]i transients, but did not significantly change the sensitivity of the contractile elements to [Ca2+]i. Neither iohexol nor iopamidol (nonionic contrast agents) reduced the [Ca2+]i transients, but both significantly decreased the sensitivity of the contractile elements to [Ca2+]i. A marked negative inotropic effect of amidtrizoic acid was caused by both calcium binding and hypertonicity. The less marked depression of contractility produced by ioxaglic acid is possibly the result of calcium binding, but is not caused by hypertonicity. The negative inotropism produced by nonionic contrast agents (iohexol and iopamidol) was due to hypertonicity, but not due to alterations in the [Ca2+]i transients. Exposure of ventricular myocytes to nonionic contrast agents (iohexol and iopamidol) slowed decay in the [Ca2+]i transients with increased end-diastolic [Ca2+]i. After washing out the nonionic contrast agents, these parameters returned to control levels. On the other hand, exposure to amidtrizoic acid decreased end-diastolic [Ca2+]i without changing decay time in the [Ca2+]i transients. After washing out amidtrizoic acid, there was a prolongation of half decay time in [Ca2+]i transients with a significant increase in end-diastolic [Ca2+]i and cell position. Diastolic dysfunction just after washout of amidtrizoic acid was possibly caused by an increase in [Na+]i due to sodium influx during exposure to the contrast agent.

Animals↗
PubMed2001

Strain rate imaging in normal and reduced diastolic function: comparison with pulsed Doppler tissue imaging of the mitral annulus.

OBJECTIVES: The pixel velocity values obtained by color Doppler tissue imaging (DTI) can be processed to velocity gradients as a measure of longitudinal strain rate with a technique termed strain rate imaging (SRI). Color mapping of strain rate does show the spatial-temporal relations of the diastolic phases. The phases of early filling and late filling during atrial systole can be seen to consist of a stretch wave in the myocardium, propagating from the base to the apex. Diastolic function is characterized by both peak strain rate and propagation velocity of this wave. The goals of this study were to establish normal values for these measurements and to study the changes with minimal diastolic dysfunction. METHODS: Twenty-eight healthy control subjects and 26 patients with hypertension and normal systolic function were studied. The patients had normal blood pressure on treatment, normal ejection fraction, minimal hypertrophy, and moderately prolonged deceleration and isovolumic relaxation times. Real-time SRI color cineloops, ordinary echocardiography and Doppler recordings, and pulsed wave DTI from the mitral ring were acquired and processed. RESULTS: Patients showed a reduction of systolic and early diastolic tissue velocities and strain rates and no significant increase in late diastolic tissue velocity and strain rate. Propagation velocity of diastolic strain during both early and late filling phases was reduced in the patients. The combination of changes in peak strain rate and propagation velocity of strain rate corresponded with changes in DTI. CONCLUSION: Diastolic deformation of the ventricle can be shown as a complex series of events, with temporal sequences in the ventricle. The peak strain rate and the propagation velocities of strain rate can describe the two main diastolic events: early and late filling. In reduced diastolic function, both are reduced during early filling. The velocities of the mitral ring are the result of this combination. This adds information about the physiology and pathophysiology of diastole.

Adult↗
PubMedDate not supplied

Congestive heart failure clinical outcomes study in a private community medical group.

BACKGROUND: Although angiotensin-converting enzyme (ACE) inhibitor therapy has been shown to improve clinical outcomes of patients with systolic dysfunction, it has been underused or prescribed in inadequate dosages by physicians in the treatment of congestive heart failure. Our goal was to evaluate whether integration of a clinical guideline within a continuous quality improvement program would improve care for patients with congestive heart failure caused by systolic dysfunction. METHODS: All patients of a private community medical group who were admitted to the hospital with congestive heart failure were studied prospectively for 21 months. An internally developed congestive heart failure practice guideline was presented to the group's physicians. The guidelines were available in the hospital computer system and were reinforced at monthly quality improvement meetings. Performance data were reviewed quarterly with the physicians. RESULTS: Rates of classifying systolic vs diastolic dysfunction remained unchanged during the study. Use of ACE inhibitor therapy at the time of discharge improved substantially for patients with systolic dysfunction. Quarterly admissions of patients with systolic dysfunction declined 49% throughout the study period. No improvement was noted in the documentation of specific discharge instructions. CONCLUSIONS: Use of a disease management guideline, ongoing physician education, and feedback of peer performance data to physicians significantly improved the quality and efficiency of care provided to patients with congestive heart failure in an independent, primary care medical group.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1999

Quality of life in older patients with systolic and diastolic heart failure.

AIMS: To get insight into the quality of life of a clinical practice sample of patients with heart failure that are admitted to the hospital. Secondly to determine differences between patients with systolic and diastolic dysfunction and finally to describe factors relating to quality of life. METHODS: Three dimensions of quality of life (functional capabilities, symptoms and psychosocial adjustment to illness) were assessed during interviews of 186 patients with chronic heart failure. In addition, data on demographic, clinical and self-care characteristics were collected and patients completed a 6-min walk. RESULTS: On average patients walked 172 m in 6 min and reported functioning in daily life at a mean level of 4.5 MET. Patients experienced four different symptoms of heart failure. Most of them described dyspnea, fatigue, sleep disturbance and ankle oedema. Problems with psychosocial adaptation occurred mostly in social and vocational domains. Overall well-being of patients was rated as 6.4 on a 10-point scale. In regard to quality of life, the only differences between patients with systolic and diastolic heart failure was the occurrence of ankle oedema and health-care orientation. The variance in components of quality of life were partly explained by demographics and clinical characteristics. All three dimensions of quality of life were related to ability for self-care. CONCLUSION: Patients with heart failure seen in clinical practice are often not comparable to patients described in major clinical trials or patients that are admitted for transplant evaluation. Their functional capabilities are more compromised, but they may have fewer problems with psychosocial adjustment. Patients with normal systolic dysfunction also report a low quality of life. It could be important to enhance self-care abilities of patients to improve psychosocial adaptation to illness.

Aged↗
PubMed1992

Analysis of pulmonary venous flow velocity patterns in hypertensive hearts: its complementary value in the interpretation of mitral flow velocity patterns.

Although the Doppler mitral flow velocity pattern changes in accordance with the degree of left ventricular diastolic dysfunction, it is "normalized" in the presence of heart failure. In this study the pulmonary venous flow velocity pattern was characterized in 43 hypertensive patients with and without heart failure to clarify whether analysis of the pulmonary venous flow velocity pattern provides complementary information in the interpretation of the mitral flow velocity pattern. The mitral flow velocity pattern in 32 hypertensive patients without heart failure was characterized by decreases in the peak early diastolic filling velocity (E) and the ratio of E to peak filling velocity at atrial contraction. The mitral flow velocity pattern was "normalized" in 11 patients with heart failure, with no differences in any mitral flow velocity pattern indexes as compared with 24 normal subjects. The pulmonary venous flow velocity pattern in hypertensive patients without heart failure was characterized by a decreased peak diastolic forward flow velocity (D) and an increased ratio of peak systolic forward flow velocity (S) to D (S/D ratio). In patients with heart failure, D was higher and the S/D ratio was lower compared with hypertensive patients without heart failure (p less than 0.01, p less than 0.01) and normal subjects (p less than 0.01, p less than 0.01). Thus the pulmonary venous flow velocity pattern appeared to be more reliable than the mitral flow velocity pattern in differentiating subgroups of patients with hypertension. Analysis of the pulmonary venous flow velocity pattern in conjunction with the mitral flow velocity pattern provides important and complementary information in the interpretation of the mitral flow velocity pattern in hypertensive patients with and without heart failure.

Blood Flow Velocity↗
PubMed1998

Hypertension and the development of heart failure.

Hypertension is a well-known risk factor that predisposes to the development of left ventricular hypertrophy, coronary flow abnormalities, and systolic and diastolic dysfunction. This complex of abnormalities is known as hypertensive heart disease and eventually leads to heart failure. Structural lesions underlying this process include excess deposition of collagens and cellular infiltration, with an increase in the size of cardiac myocytes (remodeling). The occurrence of arteriolar lesions may lead to impediments of flow. Clinically, hypertensive heart disease manifests itself by anginal complaints and sometimes by silent ischemia, arrhythmias, and sudden death. Alterations in systolic and/or diastolic function may be associated with symptoms of heart failure. Although successful treatment of hypertension can probably retard the process of cardiac impairment, there is as yet no evidence that heart failure can be prevented.

Antihypertensive Agents↗
PubMed1996

[Left ventricular diastolic function assessment by transthoracic Doppler echocardiography].

Left ventricular diastolic dysfunction is currently recognized in patients with different heart diseases. Three abnormal filling patterns of the left ventricle detected by pulsed-Doppler echocardiography are observed in patients with heart disease. Each filling pattern is characterised by different symptoms, and by differences in function and dimension of the left atrium and filling pressures. Mitral and pulmonary venous flow velocities and durations obtained by pulsed Doppler technique can be used to evaluate left ventricular diastolic function in patients with different heart diseases. However, several factors affect the transmitral and pulmonary venous flow such as age, heart rate, positioning of the sample volume and aortic- and mitral valve insufficiency. These factors must be taken into consideration when the diastolic function is evaluated by pulsed Doppler technique.

Diastole↗
PubMed2001

Cardiac involvement in autosomal-dominant polycystic kidney disease: a hypertensive heart disease.

BACKGROUND: There is little information regarding the occurrence and distribution of cardiovascular abnormalities during the course of autosomal-dominant polycystic kidney disease (ADPKD). We conducted a cross-sectional study in three different groups of ADPKD patients to determine the profile and prevalence of cardiac involvement in this population. METHODS: Doppler color echocardiography was performed in 130 ADPKD patients. Patients were divided into normotensive (Group I, n=60), hypertensive (Group II, n=32) and those undergoing hemodialysis (Group III, n=38). RESULTS: There was a progressive increase in left ventricular mass (LVM) index (88.6+/-19.7, 127.6+/-40.4 and 150.5+/-56.5 g/m2, p < 0.0001) and in the prevalence of left ventricular hypertrophy (LVH) (3%, 43%, 62%, p < 0.0001) in Groups I, II and III, respectively. E/A ratio < 1 was found in 2% of normotensives, 46% of hypertensives and 62% of hemodialysis patients (p < 0.0001). Prevalence ofmitral valve prolapse and aortic and/or mitral regurgitation was 4.3% and 8.6%, respectively, in non-dialysis patients. The majority of valvular abnormalities occurred in dialysis patients, and were generally related to annular mitral calcification (28%) or aortic valve calcification (38%). Age, sex, systolic blood pressure (BP) and hemoglobin were independent predictors of LVM index in the entire population, systolic BP and creatinine in non-dialysis patients and systolic BP in dialysis patients. Age, heart rate and diastolic BP in the entire group, and age, heart rate and LVM index in non-dialysis patients remained as independent predictors of abnormal diastolic function. CONCLUSIONS: Cardiac involvement in ADPKD patients is a continuous process that evolves during the course of this disease. It is characterized by a low prevalence of specific valvular abnormalities, a progressive increase in LVM, LVH, and diastolic dysfunction, which are greatest in the latter stages of the disease. This study confirms the major influence of BP on cardiovascular abnormalities of ADPKD patients.

Adult↗
PubMed2000

Secondary and Infiltrative Cardiomyopathies.

Secondary and infiltrative cardiomyopathies are the least common forms of cardiomyopathy and often are the most difficult to treat. In all cases, efforts should be made to establish a specific diagnosis because the removal or avoidance of the causative agent (eg, alcohol, cocaine, persistent tachycardia) holds the best promise for reversal of ventricular dysfunction. Patients who present with a dilated cardiomyopathy (DCM) should be treated with standard heart failure therapy. However, the "standard" is changing and clinicians need to take heed of results of recent trials establishing the role of beta-blockers, aldosterone, and angiotensin receptor antagonists in addition to the regimen of digoxin, diuretics and angiotensin-converting enzyme (ACE) inhibitors. In contrast, patients who present with a more infiltrative clinical picture often manifest more diastolic dysfunction and need strict volume control to maintain euvolemia. For patients with biopsy-proven myocarditis, immunosuppressive therapy generally should be considered in an effort to maintain and potentially improve ventricular function. Patients with sarcoid heart disease have shown the greatest response to high-dose corticosteroids. Patients with hemochromatosis related cardiomyopathy should be treated with iron chelation therapy and phlebotomy. The role of cardiac transplantation is limited, as most of the secondary and infiltrative causes of cardiomyopathy are associated with an adverse posttransplant outcome. Other surgical options, such as left ventricular assist devices, may offer hope to patients who would otherwise be ineligible for cardiac transplantation. On the horizon, biventricular pacing and treatments targeted at cytokines and hormonal receptors hold the promise of improving symptoms and prolonging survival by counteracting the deleterious effects of these secondary mediators.

Journal Article↗
PubMedDate not supplied

Role of gender in heart failure with normal left ventricular ejection fraction.

Heart failure with normal ejection fraction (HF-NEF) is frequently believed to be more common in women than in men. However, the interaction of gender and age has rarely been analyzed in detail, and knowledge of the distinction between pre- and postmenopausal women is lacking. Some of the studies that have described a higher prevalence of HF-NEF in women relied on clinical diagnoses of HF together with normal systolic function and did not measure diastolic function. This applies to the analysis of patients hospitalized for HF and some epidemiological investigations that agree on the greater prevalence of HF-NEF in women. Population-based studies with echocardiographic determination of diastolic function have suggested equal or greater prevalence of diastolic dysfunction in men. Major risk factors for HF-NEF include hypertension, aging, obesity, diabetes, and ischemia. Hypertension is more frequent in women and can contribute to left ventricular and arterial stiffening in a gender-specific way. Aging, obesity, and diabetes affect myocardial and vascular stiffness differently and lead to different forms of myocardial hypertrophy in women and men. In contrast, ischemia may play a greater role in men. Gender differences in ventricular diastolic distensibility, in vascular stiffness and ventricular/vascular coupling, in skeletal muscle adaptation to HF, and in the perception of symptoms may contribute to a greater rate of HF-NEF in women. The underlying molecular mechanisms include gender differences in calcium handling, in the NO system, and in natriuretic peptides. Estrogen affects collagen synthesis and degradation and inhibits the renin-angiotensin system. Effects of estrogen may provide benefit to premenopausal women, and the loss of its protective mechanisms may render the heart of postmenopausal women more vulnerable. Thus, a number of molecular mechanisms can contribute to the gender differences in HF-NEF.

Age Factors↗
PubMed1995

Serial changes in left ventricular diastolic indexes derived from Doppler echocardiography after anterior wall acute myocardial infarction.

Restrictive ventricular filling pattern derived from Doppler echocardiography after anterior wall AMI may serve as an indicator of diastolic dysfunction due to initial myocardial stiffness and complications such as extension of the infarction, Dressler syndrome, septal rupture, or myocardial failure. Later changes, such as prolongation of deceleration time, may indicate remodeling process, healing of the complications of AMI, or improved revascularization.

Aged↗
PubMed1996

[Evaluation of left ventricular diastolic function using gated SPECT with 99mTc-MIBI].

Development of 3 head SPECT system and 99mTc-labeled radiopharmaceuticals enable us to evaluate left ventricular systolic function on the basis of once gated SPECT routine. This study was focused on assessment of left ventricular diastolic function using 99mTc-MIBI gated SPECT data. Twenty nine patients with ischemic heart diseases underwent 99mTc-MIBI gated SPECT and 99mTc-HSAD ventriculographic assessment of left ventricular diastolic function within 1 month. Region of interests (ROI), simultaneously calculating counts per pixel within ROI, were placed over whole myocardium of 16 serial phasic images reconstructed from gated SPECT data, following selection of the central slice within short axial images. Then, 29 patients were classified into 3 patterns of phase count curve (normal, mixed, and delayed relaxation = diastolic dysfunction). Moreover, 1/3 Count Decreasing Fraction (1/3 CDF) was calculated on the same concept as 1/3 FF. The curve pattern showed significant differences between normal and abnormal group divided on the basis of established indices such as 1/3 FF and PFR, and 1/3 CDF has correlations with 1/3 FF (r = 0.61) and PFR (r = 0.58). We concluded that the new parameters drawn from 99mTc-MIBI gated SPECT data might be feasible for evaluation of diastolic function.

Aged↗
PubMed2006

Prognosis in myocardial infarction patients with heart failure and normal or mildly impaired systolic function.

PURPOSE: To assess factors of importance for long term prognosis in patients with acute myocardial infarction (AMI) and heart failure and normal or mildly reduced left ventricular systolic function. SUBJECTS AND METHODS: Seventy-one consecutive AMI-survivors with clinical or radiological signs of heart failure and an echocardiographically determined wall motion score >1.2 (EF >35-40%) were followed during 11 years for mortality, heart failure readmissions and new ischemic events. RESULTS: Seventeen patients died (24%) while the combined endpoint of death or a new ischemic event (MI or hospitalisation for angina pectoris) occurred in 40 (56%) and fatal or non-fatal heart failure in 20 (28%) patients, respectively. A pre-discharge echocardiographic assessment of diastolic function was obtained in 67 patients out of whom 56 (84%) had diastolic dysfunction, most frequently relaxation abnormalities (43%). Wall motion score did not differ between survivors and non-survivors (1.48+/-0.20 vs. 1.44+/-0.18; p=0.46). Adjusting for age, sex and wall motion score N-terminal pro-ANP, prolongation of the isovolumic relaxation time and exercise induced ST-depressions at discharge (global chi2=26.2; p<0.0001) remained as independent mortality predictors while re-admission for heart failure was predicted by wall motion score, N-terminal pro-ANP and previous heart failure (global chi2=23.7; p<0.001). Death or new ischemic events were associated with low Doppler A-wave flow velocity and male sex (global chi2=14.0; p<0.01). CONCLUSIONS: Evaluation of diastolic function and a natriuretic peptide adds prognostically important information in AMI-patients with clinical heart failure and normal or mildly reduced left ventricular systolic function. Isovolumic relaxation time is an independent predictor of long term mortality and N-terminal pro-ANP of mortality and heart failure.

Aged↗
PubMed2004

Abnormal cardiac function in children after renal transplantation.

BACKGROUND: Cardiac hypertrophy frequently is found in children with a renal transplant. In adults with a transplant, left ventricular (LV) mass (LVM) is associated with cardiac dysfunction. However, in children with a transplant, the relationship between LVM and LV function has not been evaluated. METHODS: Twenty-nine children who underwent transplantation and 33 controls had echocardiographic evaluations during rest and peak exercise. LV contractility was determined based on the relation between heart rate-corrected velocity of circumferential fiber shortening and end-systolic wall stress. Contractile reserve was assessed by the difference between contractility at rest and peak exercise. Early diastole was assessed using indices of LV relaxation derived from transmitral and tissue Doppler and reported as maximal early (E wave) and late (A wave) wave ratio (E-A ratio) and septal mitral annular velocities (Em). Late diastole was determined using an index of LV compliance (E-Em ratio). RESULTS: Compared with controls, children with a transplant had a significantly greater LVM index (P < 0.001) and high prevalence of LV hypertrophy (LVH; 55%). Transplant recipients had increased LV contractility (P < 0.001). Contractile reserve was similar to that of controls. Patients with a transplant had a lower E-A ratio and Em (P < 0.01 for both variables) and higher E-Em ratio (P < 0.001) than controls. In children with a transplant, LVM index was a significant independent predictor for both abnormal LV relaxation (Em; P = 0.03) and abnormal LV compliance (E-Em ratio; P = 0.02). CONCLUSION: Results show impaired cardiac structure and diastolic function in pediatric renal allograft recipients. This suggests that LVH may be a risk factor for diastolic dysfunction in these children.

Adolescent↗
PubMed2002

Tissue Doppler imaging assessment of long axis left ventricular function in hypertensive patients with concentric left ventricular hypertrophy: differential diagnosis with hypertrophic cardiomyopathy.

BACKGROUND: The differential diagnosis between hypertrophic cardiomyopathy and hypertensive heart disease has clinical, therapeutic and prognostic implications, but is not always easy with conventional echocardiography. Tissue Doppler imaging of the mitral annulus allows the detailed study of long axis left ventricular function in hypertrophic cardiomyopathy and may be useful in the differential diagnosis. METHODS: 23 patients with non-obstructive hypertrophic cardiomyopathy and 25 hypertensive patients with concentric left ventricular hypertrophy with similar age, body surface and heart rate were studied with pulsed tissue Doppler imaging of the 4 sides of the mitral annulus (septal, lateral, inferior, anterior) in 4 and 2 chamber views. In each wave (systolic-s, rapid filling-e, atrial contraction-a) we analyzed velocities, time intervals and velocity-time integrals, as well as heterogeneity and asynchrony. Data were compared among the different sides in each group, between groups and with conventional Doppler data. RESULTS: In contrast to hypertensive patients, hypertrophic cardiomyopathy patients showed: 1--Systolic function: lower "s" wave velocities and integrals, higher systolic heterogeneity, longer isovolumic relaxation time and higher PEP/LVET (pre ejection period/left ventricular ejection time). 2--Diastolic function: lower "e" and "a" wave, higher "a" and "e/a" heterogeneity index, higher percentage of annular sides with e/a > or = l, longer isovolumic relaxation time and time to peak e, and higher diastolic asynchrony. Some of these abnormalities occurred in annular sides adjacent to non-hypertrophied walls. CONCLUSIONS: This study shows that: 1--Long axis systolic and diastolic left ventricular function are significantly different between hypertrophic cardiomyopathy patients and hypertensive patients with concentric left ventricular hypertrophy. 2--These functional differences occur in the velocity domain (with heterogeneity), in the time domain (with asynchrony) and also in velocity time integrals. 3--Long axis systolic and diastolic dysfunction occur in annular sides contiguous to hypertrophied and non-hypertrophied walls, enhancing the role of tissue Doppler imaging in the differential diagnosis between these diseases.

Aged↗