ABSTRACT
Background: Cirrhosis is a long-term inflammatory process of hepatic tissue condition that mainly affects people aged 50 to 60. This study aims to assess Left ventricular diastolic dysfunction (LVDD) in cases with cirrhotic liver by conventional, tissue Doppler and two-dimensional speckle tracking echocardiography to clarify the correlation between the severity of cirrhotic liver and LVDD. Methods: A prospective case-control research involved 100 adult cases with confirmed HCV and HBV. Cases were divided into 4 equal group: Group A: Child A cases, group B: Child B cases, group C: Child C cases and group D (Controls): healthy non-hepatic subjects of the same age and sex who have normal blood pressure, nonsmoking participants with no further concomitant problems. Results: Number of cases with LVDD had a statistical noticeable increase in Child A, B, and C (p =0.004, <0.001, and <0.001 respectively. LAVi had a statistical noticeable increase in Child C / B (p =0.013 and p =0.014). Conclusion: Left atrial volume index (LAVi) had a statistical noticeable increase in Child C / B in comparison to the controls but E m, E l were statistical noticeable lower in Child C / B. /E had a statistical noticeable increase in Child C group, LVSRe had a statistical noticeable decrease in Child C group but it was insignificantly different across Child A / B/ C and controls and across Child B / C and controls.
ABSTRACT
ObjectiveTo study the possible correlation between serum osteoprotegerin （OPG）/soluble receptor activator of the nuclear factor κB ligand （sRANKL） levels and the left ventricular diastolic dysfunction （LADD） in patients with type 2 diabetes mellitus （T2DM）. MethodsTotally 68 T2DM patients and 37 healthy controls were selected. Serum OPG and sRANKL were determined by solid-phase enzyme-linked immunosorbent assay （ELISA）. The left ventricular diastolic function of T2DM patients was measured by transthoracic echocardiography， where E/A < 1 were regarded as LVDD. T2DM patients were further divided into two subgroups according to E/A ratio （E/A≥1.0 and E/A<1）. Spearman correlation analysis， logistic regression and ROC curves were used to assess the possible correlation between serum OPG/sRANKL and LADD in T2DM patients. ResultsCompared with the healthy controls， serum OPG level in T2DM patients was higher with statistically significant difference （P <0.01）， while serum sRANKL level was lower without statistically significant difference （P =0.32）. T2DM patients with E/A<1 had significantly higher OPG level and lower sRANKL level than those with E/A≥1（P <0.01） in subgroup analysis. Spearman correlation analysis showed serum OPG level was negatively correlated with E/A ratio， while sRANKL was positively related with E/A ratio. In single factor logistic regression analyses， serum OPG ［OR （95% CI）=1.068 （1.031， 1.106）， P<0.001］ and sRANKL ［OR （95% CI）=0.976 （0.959， 0.992）， P=0.003］ were significant correlation with LVDD in T2DM patients. ROC curve analysis showed that the sensitivity and specificity of combined OPG and sRANKL in diagnosing T2DM patients LADD were 78.13% and 88.3%， respectively （area under the curve： 0.857； 95% CI=（0.768， 0.946）； P<0.001）. ConclusionsThe elevated OPG and decreased sRANKL levels may be associated with LADD in T2DM patients.
ABSTRACT
Introduction: Chronic renal failure, regardless of the cause, is the presence of kidney damage or a reduced level of kidney function for three months or longer. It is a group of signs and symptoms brought on by slow and long-term renal damage. The most frequent cardiovascular finding in people on dialysis is LVH. Objective: The study was conducted to estimate the prevalence of left ventricular hypertrophy and left ventricular diastolic dysfunction by echocardiography in patients with chronic renal failure. Method: This was an observational cross-sectional study at the Department of General Medicine among IPD patients, Tertiary Care Hospital, Surat. Result: Left ventricular hypertrophy out of 34 cases 22 (64.71%) cases were show left ventricular hypertrophy with an odd ratio of 3.208 (1.049, 9.81) and a p-value 0.0378 which was statically significant. prevalence of diastolic dysfunction was 79%. comparison of renal function test and echocardiographic change of chronic renal failure. In the renal function test serum, creatinine and EGFR were show a p-value < 0.001 which was statistically significant. Conclusion: Cardiac dysfunction and LVH are frequently noted in individuals with chronic renal failure at the time of commencement of dialysis. cardiovascular abnormalities in the form of LVH and diastolic dysfunction which antedate severe systolic dysfunction are frequently observed in milder degrees of chronic renal failure
ABSTRACT
Resumo Fundamento vários estudos avaliam alterações ecocardiográficas como preditores de risco cardiovascular; entretanto, nenhum associa risco cardiovascular global com alterações ecocardiográficas em brasileiros. Objetivo Este estudo avalia a associação entre risco cardiovascular global (ASCVD) e achados ecocardiográficos como hipertrofia ventricular esquerda (HVE), disfunção diastólica (DDVE) e aumento do volume do átrio esquerdo (AE). Métodos A população foi composta por participantes do ELSA-Brasil que realizaram ecocardiografia entre 2008 e 2010 (n = 2.973). Eram assintomáticos e não tinham história de doença cardiovascular (DCV). O escore ASCVD foi calculado em dois períodos: 2008-2010 e 2012-2014. Razões de prevalência (RP) foram estimadas com intervalos de confiança (IC) de 95%. Resultados Evidenciou-se associação entre alterações ecocardiográficas e alto risco cardiovascular global (escore ASCVD ≥ 7,5) nos dois períodos do estudo, separadamente. O risco global combinado (baixo risco no primeiro período e alto risco no segundo período) teve associação significativa apenas com DDVE (RP = 3,68; IC 95%: 2,63-5,15) e HVE (RP = 2,20; IC 95%: 1,62-3,00). Conclusão Alterações ecocardiográficas (DDVE, HVE e aumento do volume do AE) são preditores independentes de risco cardiovascular em adultos brasileiros sem DCV prévias.
Abstract Background Several studies have evaluated echocardiographic abnormalities as predictors of cardiovascular risk; however, none have associated the global cardiovascular risk with echocardiographic abnormalities in the Brazilian population. Objective This study evaluates the association between the global cardiovascular risk (ASCVD score) and three echocardiographic abnormalities: left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and increased left atrium (LA) volume. Methods The study population was composed of participants from ELSA-Brasil who underwent echocardiography between 2008 and 2010 (n = 2973). They were asymptomatic and had no history of cardiovascular disease. The ASCVD score was calculated in two periods: 2008-2010 and 2012-2014. Prevalence ratios (PR) were estimated with 95% confidence intervals (CI). Results There is an association between echocardiographic abnormalities and high global cardiovascular risk (ASCVD score ≥ 7.5) in both study periods, separately. The combined global risk (low risk in the first period and high risk in the second period) was significantly associated only with LVDD (PR = 3.68, CI 95% 2.63-5.15) and LVH (PR = 2.20, 95% CI 1.62-3.00). Conclusion Echocardiographic abnormalities (LVDD, LVH, and increased LA volume) are independent predictors of cardiovascular risk in Brazilian adults.
ABSTRACT
Objective:To evaluate the effect of positive end-expiratory pressure (PEEP) ventilation on cardiac function in patients with early left ventricular (LV) diastolic dysfunction undergoing laparoscopic radical gastrectomy.Methods:Patients who underwent laparoscopic radical gastrectomy under elective general anesthesia from July 2021 to February 2022 at the Subei People's Hospital were enrolled [age 60-75 years old, American Society of Anesthesiologists (ASA) grade Ⅰ-Ⅱ, and left ventricular ejection fraction (LVEF) > 0.50]. Transthoracic echocardiography (TTE) was performed before operation, and the peak early diastolic velocity (E peak) and peak late diastolic velocity (A peak) at the mitral ostium were recorded and the E/A and E peak deceleration time (DT) were calculated. Then isovolumic relaxation time (IVRT) and early peak mitral annular diastolic velocity (e') were recorded and left ventricular E/e' (LVE/e') was calculated. According to the E/A, mitral e', LVE/e', DT, and IVRT, the patients were divided into early LV diastolic dysfunction group (E/A < 1, mitral e' < 7 cm/s, LVE/e' > 14, DT > 200 ms, and IVRT > 100 ms) and normal cardiac function group (1 < E/A < 2, 160 ms < DT < 240 ms, and 70 ms < IVRT < 90 ms), with 35 patients in each group. Both groups were received fixed 5 cmH 2O (1 cmH 2O≈0.098 kPa) PEEP 5 minutes after the beginning of the pneumoperitoneum until the end of the procedure. A volume controlled ventilation was used with a tidal volume (VT) of 7 ml/kg, an inspired oxygen concentration of 0.60, and an inspiratory to expiratory ratio of 1∶2. Left and right myocardial systolic and diastolic function related parameters, including LVEF, LV global longitudinal strain (LVGLS), tricuspid annulus plane systolic migration (TAPSE), the peak early diastolic velocity (E peak) at the mitral and tricuspid valve ostia and the peak early diastolic velocity (e') at the corresponding annulus were measured by transesophageal echocardiography (TEE) before tracheal intubation (T 0), 5 minutes after the pneumoperitoneum (T 1), 5 minutes after PEEP ventilation (T 2), 30 minutes after PEEP ventilation (T 3), and 5 minutes after the end of pneumoperitoneum (T 4), respectively. The left and right ventricular myocardial performance index (LVMPI/RVMPI) was calculated. Results:Finally, 60 patients were included in the analysis, including 28 patients in the early LV diastolic dysfunction group and 32 patients in the normal cardiac function group. Compared with those at T 0, mean arterial pressure (MAP), LVEF, mitral e', LVGLS, tricuspid e' and TAPSE were significantly lower in the normal cardiac function group at T 1, and the early LV diastolic dysfunction group at T 1, T 2, and T 3, and LVMPI, LVE/e', RVE/e', and RVMPI were significantly higher. At T 4, the LVE/e' and the RVE/e' were significantly higher in the early LV diastolic dysfunction group than those at T 0 (LVE/e': 16.52±1.26 vs. 14.32±1.09, and RVE/e': 18.71±1.74 vs. 16.51±1.93, respectively, both P < 0.05), Mitral e' and tricuspid e' were significantly lower than those at T 0 [mitral e' (m/s): 0.07±0.01 vs. 0.09±0.01, tricuspid e' (m/s): 0.06±0.01 vs. 0.08±0.01, both P < 0.05]. Compared with the normal cardiac function group, MAP, LVEF, mitral e', LVGLS, tricuspid e', and TAPSE at T 1, T 2, and T 3 were significantly lower in the early LV diastolic dysfunction group, while LVMPI, LVE/e', RVE/e', and RVMPI were significantly higher. At T 4, the LVE/e' and the RVE/e' were significantly higher in the early LV diastolic dysfunction group than those in the normal cardiac function group (LVE/e': 16.52±1.26 vs. 9.87±1.25, RVE/e': 18.71±1.74 vs. 10.97±1.70, both P < 0.05). Mitral e' and tricuspid e' were significantly lower in the normal cardiac function group [mitral e' (m/s): 0.07±0.01 vs. 0.11±0.02, tricuspid e' (m/s): 0.06±0.01 vs. 0.10±0.02, both P < 0.05]. Conclusions:In early LV diastolic dysfunction patients, compared with patients with normal cardiac function, 5 cmH 2O PEEP can further exacerbate left and right myocardial systolic and diastolic function in patients during pneumoperitoneum; when the pneumoperitoneum was ended, 5 cmH 2O PEEP only worsen left and right myocardial diastolic function in patients, and did not affect left and right myocardial systolic function.
ABSTRACT
Introduction: Metabolic syndrome is a complex disorderwith high socio-economic cost that is considered aworldwide epidemic. It is very common condition Consistinghyperglycemia,central obesity, hypertension and dyslipidemia(low levels of high density lipoprotein cholesterol(HDL-C)and high levels of triglycerides). Current study was done toassess Left Ventricular Diastolic Dysfunction in patients ofMetabolic Syndrome by 2d- Echocardiography.Material and methods: In this study my aim is to find outthe prevalence of left ventricular diastolic dysfunction inmetabolic syndrome and to highlight the importance ofprimary prevention in metabolic syndrome. The Presentstudy is cross-sectional observational study carried out atCSS Hospital Subharti medical college Meerut UP, consistingof 50 patients having metabolic syndrome according to thecriteria of International Diabetic Federation and to look forthere LVDD via 2d- Echocardiography.Results: The left ventricular diastolic dysfunction grade isassociated with the number of characteristics of metabolicsyndrome. Waist circumference, FBS, E/A, IVRT, Decelerationtime, E/e’ showed a statistically significant association (p value<0.01) with the degree of diastolic dysfunction.Conclusion: The current study showed that, metabolicsyndrome group have an associated abnormal left ventriclediastolic performance So the patients with metabolic syndromeshould receive aggressive therapy to avoid occurrence of heartfailure in the future.
ABSTRACT
Background: Left ventricular diastolic dysfunction (LVD) is very common in chronic obstructive pulmonary disease (COPD) patients. The aim of the present study was to LVD function in COPD patients using echocardiogram and to detect the presence of LVD dysfunction in all stages of COPD.Methods: This was an observational study done at Institute of Internal Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, during the period from March 2015 to August 2015. The study included 100 patients with COPD. All patients were subjected to chest X-ray, electrocardiogram, pulmonary function test (PFT) and echocardiogram.Results: The results showed the prevalence rate of LVD dysfunction in 80% patients with COPD. There was a good significant correlation between age (p<0.001), status of smoking (p<0.05), chest X-ray findings (p<0.001) and stages of COPD (p<0.001) with incidence of LVD in study population.Conclusions: High prevalence of LVD dysfunction was noticed in patients with COPD. Hence patients with COPD should undergo routine examinations timely to prevent the incidence of associated cardiovascular complications.
ABSTRACT
Introduction: The hemodynamic consequences of hyperinflation and emphysema are produced by cardiac compression due to high intrathoracic pressures, which could produce subclinical left ventricular diastolic dysfunction. Our purpose is to correlate the percentage of emphysema with lung function parameters and cardiac chamber sizes, the global ventricular systolic function and the left ventricular diastolic function, in cases of chronic obstructive pulmonary disease. Materials and Methods: The participants were patients with moderate and severe chronic obstructive pulmonary disease treated in the Pulmonology Service of the Hospital Privado Centro Médico de Córdoba from January 1st to October 13th, 2014. We quantified the volume and percentage of emphysema by high resolution computed tomography and carried out a spirometry, a Six Minute Walk Test, measurement of pulmonary volumes and color Doppler echocardiography. Results: We found a significant negative correlation between the percentage of emphysema and the percentage of the post-bronchodilator FEV1 theoretical value (p = 0.005) and the post-bronchodilator FEV1/FVC (Forced Expiratory Volume in First Second/Forced Vital Capacity) quotient (p = 0.004), and, also, between the post-bronchodilator FEV1/FVC quotient and the emphysema volume in cm3 (p = 0.000). Out of a sub-group of 20 patients, seven patients (35%) were diagnosed with grade I left ventricular diastolic dysfunction. We found negative, but not significant correlations between the percentage of emphysema and global ventricular systolic function and cardiac chamber sizes. Conclusions: We should emphasize the usefulness of the echocardiography in reducing sub-diagnoses of left ventricular diastolic dysfunction. We should also stress on the importance hyperinflation and emphysema would have in the impairment of the left ventricular diastolic filling pattern and in the decrease in cardiac chamber sizes, with a decrease in exercise tolerance.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Emphysema , Heart Failure, DiastolicABSTRACT
Objective@#To observe the relationship between impaired myocardial untwisting and left ventricular diastolic dysfunction in patients with autoimmune diseases (AD).@*Methods@#In this retrospective study, 95 AD patients (27 males, (38.6±14.2) years old) were enrolled as AD group and 71 gender and age matched healthy subjects (24 males, (37.6±12.2) years old) were enrolled as control group, all underwent transthoracic echocardiography and two-dimensional speckle-tracking echocardiography (STE) in our hospital between January 2014 and June 2018. Left ventricular untwisting and diastolic function parameters were measured. Multiple logistic regression analysis was used to identify related factors of left ventricular diastolic dysfunction in AD patients. Receiver operating characteristic (ROC) curve was used to identify the diagnosis value of untwisting parameters for left ventricular diastolic dysfunction in AD patients.@*Results@#Compared with control group, left ventricular ejection fraction was lower (58(47, 66)% vs. 67 (62, 71) %, P<0.001), E/e′ was higher (10.78 (7.28, 13.65) vs. 6.30 (5.55, 7.25) , P<0.001), isovolumic relaxation time was longer (73.5 (56.5, 88.0) ms vs. 62.0 (58.0, 68.5) ms, P<0.001),and untwist slope during isovolumic relaxation period (USIR) was lower (31.92 (14.09, 54.92) °/s vs. 59.90 (40.09, 87.18) °/s, P<0.001) in AD group than in control group. Multiple logistic regression analysis showed heart rate (OR=0.885, 95%CI 0.840-0.931, P<0.001), E/e′ (OR=0.655, 95%CI 0.537-0.798, P<0.001) and USIR (OR=0.986, 95%CI 0.974-0.998, P=0.020) were independently related with left ventricular diastolic dysfunction in AD patients. ROC curve showed that area under the curve (AUC) was 0.919 (P<0.001), sensitivity was 87.6%, and specificity was 88.7%, when combining the heart rate, E/e′, and USIR as assessment parameters for the diagnosis of left ventricular diastolic dysfunction in AD patients at a cutoff of 0.51.@*Conclusions@#Impairment of myocardial untwisting indicates the presence of early stage left ventricular diastolic dysfunction in AD patients. USIR may be a sensitive parameter to evaluate early stage left ventricular diastolic dysfunction in AD patients.
ABSTRACT
Objective To investigate the predictive value of serum N-terminal pro brain natriuretic peptide NT-proBNP in left ventricular diastolic dysfunction(LVDD) in septic shock patients.Methods According to retrospective analysis of clinical data 96 patients with septic shock were divided into LVDD group and non-LVDD group.General clinical data,APACHE scores,NT-proBNP,Troponin I(TNI),creatinine,procalcitonin,D-dimer and lactic acid within the first 24 hours after admission were recorded,and multi-factors logistic regression analysis was conducted to find independent risk factors for left ventricular diastolic dysfunction in septic shock patients Receiver operating characteristic curve ROC was constructed to indicate the predictive value.Results There were no significant differences in general clinical data,procalcitonin,D-dimer and lactic acid between two groups.Compared with non-LVDD group the levels of NT-proBNP [lgNT-proBNP (3.66±0.38) vs.(3.03±0.59),P =0.000],TNI [lgTNI(-1.45±0.86)vs.(-2.36±0.82),P ＜ 0.01] and creatinine [(186.12±124.24)vs.(101.16±57.01),P ＜ 0.01] in LVDD group were significantly higher.It was shown by multi-factors logistic regression analysis that NT-proBNP (OR=8.731,95％CI;1.541-49.466,P=0.014) was an independent risk factor for left ventricular diastolic dysfunction in septic shock patients.The area under the curve AUC of NT-proBNP was 0.813 with the cut-off value of 1 725 pg/μL,sensibility =88.6％,specificity =62.1％.Conclusion NT-proBNP was avaluable indicator in predicting left ventricular diastolic dysfunction in septic shock patients.
ABSTRACT
Background: Chronic kidney disease is a major public health problem worldwide with continuously increasing incidence and prevalence. Diabetes and hypertension are the leading causes of chronic kidney disease worldwide, whereas hypertension is a cause as well as effect of chronic kidney disease. Objectives: To evaluate and analyze the echocardiographic changes in the end stage renal disease patients on maintenance haemodialysis by the help of 2-D echocardiography. Materials and methods: End stage renal disease (ESRD) patients who were on maintenance haemodialysis for at least 3 months, in MG hospital were included in the study. We performed 2- Dechocardiography in 50 ESRD patients during inter-dialytic period. Patients with clinical evidence of coronary artery disease, previous history of hypertension, valvular heart disease, congenital heart disease and pericardial effusion were excluded from this study. Results: out of 50 chronic kidney disease patients, echocardiography revealed LVH in 29 (58%) patients, LVDD in 25(50%) patients, pericardial effusion in 10 (20%) patients, pulmonary hypertension in 23(46%) patients, dilated left atrium in 14(28%) patients, dilated left ventricle in 4 (8%) patients and regional wall motion abnormalities in 3 (6%) patients. Hypertension was present in Saxena N, Dhamija JP, Saxena S. Role of 2-D echocardiography in detecting cardiovascular abnormalities in chronic kidney disease patients: Case series of 50 chronic kidney disease patients. IAIM, 2017; 4(1): 122-126. Page 123 46 (92%) out of 50 CKD patients out of which LVH was in 29 patients. Severe Anaemia was present in 10 (20%) patients. Conclusion: LV diastolic dysfunction and left ventricular hypertrophy were the most common and significant echocardiographic findings among 50 CKD patients. There was statistically significant correlation between anaemia and the presence of left ventricular hypertrophy and positive correlation between presence of hypertension and left ventricular hypertrophy.
ABSTRACT
Objective To investigate the predictive value of left ventricular diastolic function on mechanical ventilation weaning in patients with left ventricular ejection fraction (LVEF) > 0.50.Methods A retrospective case control study was conducted. Sixty-five patients with LVEF > 0.50 undergoing mechanical ventilation for more than 48 hours admitted to surgery intensive care unit (ICU) of China-Japan Friendship Hospital from June 2014 to December 2016 were enrolled. The clinical data and parameters of echocardiography before spontaneous breathing trial (SBT) were collected. The possible relationship between left ventricular diastolic function and the results of weaning was analyzed according to analysis of blood flow filling parameters of mitral valve orifice. According to the grading standard of left ventricular diastolic function, the patients were divided into normal, mild (level 1) and moderate to severe (level 2-3) groups, and the outcomes of weaning were compared among the groups. Then patients were also divided into two groups of weaning successfully and weaning failure, and the clinical data and left ventricular diastolic function parameters of patients were compared between the two groups. The predictive value of left ventricular diastolic function on results of weaning was evaluated with receiver operating characteristic curve (ROC).Results Sixty-five patients were enrolled and 28 patients (43.1%) failed weaning, 22 patients failed the first SBT and 6 required reintubation within 48 hours, 31 of the patients presented normal left ventricular diastolic function, 9 of patients presented mild diastolic dysfunction, and 25 of them presented moderate to severe diastolic dysfunction. So with the gradual increase of the severity of diastolic dysfunction, the rate of weaning failure was gradually increased, which was 16.1%, 44.6% and 76.0% respectively (χ2 = 20.240,P = 0.001). Patients who failed weaning presented evidence of increased left ventricular filling pressures at pre-SBT, by demonstrating decreased deceleration time of E (DTE, s: 180.4±5.1vs. 196.8±4.0,t = 2.567,P = 0.013), increased left ventricular mitral valve diastolic early and late filling velocity ratio (E/A: 1.47±0.08 vs. 1.14±0.05, t = 3.827,P = 0.000), increased lateral, septal and averaged left ventricular mitral valve diastolic early velocity and maximal velocity of mitral annulus in early diastolic velocity ratio (E/Em: 10.26±0.52 vs. 7.28±0.41,t = 4.535, P = 0.000; 10.08±0.58 vs. 8.16±0.40,t = 2.797,P = 0.007; 10.17±0.48比7.72±0.35,t = 4.231,P = 0.000), and the rapid shallow breathing index (RSBI) was also increased significantly (61.7±3.6 vs. 50.6±2.7,t = 2.507, P = 0.015). It was shown by ROC curve analysis that the basic left ventricular diastolic function at pre-SBT had the diagnostic performance in predicting the outcome of weaning from mechanical ventilation, especially E/A and lateral E/Em. Pre-SBT values of E/A greater than 1.2 and lateral E/Em greater than 7.9 predicted weaning failure with an area under the ROC curve (AUC), sensitivity, and specificity of 0.81±0.06 and 0.85±0.06, 82.6% and 91.3%, 81.4% and 80.7%, respectively, and the AUC was higher than RSBI (0.70±0.07). The AUC of combination of E/A > 1.2 and lateral E/Em > 7.9predicting weaning failure was 0.86±0.05 with a sensitivity of 78.3% and a specificity of 93.6%.Conclusions The results suggest that left ventricular diastolic dysfunction is significantly associated with weaning outcome in critical patients with LVEF > 0.50. The combination of E/A ratio greater than 1.2 and E/Em ratio greater than 7.9 may identify patients at high risk of weaning failure.
ABSTRACT
Background: Diabetes is a metabolic disease which affects various organs of the body like heart, eye, kidney, skin and peripheral nerves. Diabetic cardiomyopathy is defined as the appearance of the symptoms of Congestive heart failure in diabetic patient in the absence of hypertension and any structural or congenital heart disease. The aim of the study is to find the relation between type 2 diabetes mellitus and cardiomyopathy, highlighting the variation in incidence according to age, sex and severity on basis of Doppler echocardiographic diagnosis. Methods: The prospective study was conducted for the duration of one year on 100 newly diagnosed Type 2 Diabetes patients aged between 30-60 years. Doppler echocardiography and HbA1c level of the patients was done. The study was conducted on the basis of grading of diastolic dysfunction on echocardiography. Quantitative data was analysed with the help of ‘t’ test and qualitative data with the Chi- Square and Fisher Exact Test. Statistical significance was taken as P < 0.05. Results: In this study, 39% of the newly diagnosed type 2 diabetes mellitus patients developed diabetic cardiomyopathy. In females, the disease was statistically absent in more patients (35) as compared to males (26) (<0.05). The commonest age group affected by grade 1 disease was 41-50 years. The incidence of grade 2 disease was more in age group 51-60 years. The grade 1 diabetic cardiomyopathy was statistically more common in males as compared to females (<0.05). The grade 2 diabetic cardiomyopathy was more common in females, but was statistically insignificant. Patients with HbA1c <8 have 16% chances to get LVDD with significant P value of 0.02. Patients with HbA1c between 8 to 10 have 30% chances to get LVDD with significant P value of 0.01. Conclusion: Diabetic cardiomyopathy is an important complication of type 2 diabetes mellitus patient. HbA1c level and Doppler echocardiography plays an important role in estimating the prevalence and severity of diabetic cardiomyopathy.
ABSTRACT
Background: Metabolic syndrome foretells several cardiovascular complications, including heart failure (HF). Left ventricular (LV) dysfunction accompanies the MS. Although metformin improves LV function in diabetics with HF, there is no evidence of its effect on LV dysfunction in MS patients. We studied the effect of metformin on LV dysfunction in MS patients using tissue Doppler myocardial imaging and two-dimensional speckle tracking. Aims: To evaluate the effects of metformin on metabolic syndrome (MS) induced left ventricular dysfunction. Material and methods: Patients with MS were randomly allocated into two groups (n = 20 each) receiving, an antagonist of angiotensin 2 receptors and; statins, fibrates or both. One group received 850 mg of metformin daily. LV mass, relative wall thickness (RWT), ejection fraction, E/A and E/E' relationship, systolic tissue Doppler velocity (Sm), mean peak systolic strain (SS), and peak early diastolic strain rate (SR-LVe) echocardiographic measurements, at baseline and six months were obtained. Results: All patients had LH concentric hypertrophy or remodeling. Metformin reduced LV mass and RWT. There were LV systolic and diastolic alterations in both groups that metformin improved significantly. SR-LVe increased nearly 2-fold with metformin. Diastolic function improvement was not related to regression of hypertrophy. Conclusions: Patients with MS experienced subtle alterations of systolic and diastolic functions, which improved significantly with a small dosage of metformin over a treatment period of six months.
Antecedentes: El síndrome metabólico (SM) predice varias complicaciones cardiovasculares, como la insuficiencia cardiaca (IC). La disfunción ventricular izquierda (DVI) acompaña al síndrome metabólico. Aunque la metformina mejora la función del ventrículo izquierdo en pacientes diabéticos con insuficiencia cardiaca, no hay evidencia de su efecto sobre la disfunción ventricular izquierda en pacientes con síndrome metabólico. Se estudió el efecto de la metformina sobre la disfunción ventricular izquierda en pacientes con síndrome metabólico utilizando imágenes Doppler de tejido miocárdico y rastreo de manchas bidimensional. Objetivos: Evaluar los efectos de la metformina sobre la disfunción ventricular izquierda inducida por el SM. Material y métodos: Los pacientes con SM fueron asignados al azar en dos grupos (n = 20 cada uno) que recibieron, un antagonista de la angiotensina 2 y receptores; estatinas, fibratos o ambos. Un grupo recibió 850 mg de metformina diaria. La masa del VI, el espesor relativo de la pared (ERP), fracción de eyección, E/A y relación E/E', la velocidad Doppler tisular sistólica (Sm), el promedio de pico de tensión sistólica (SS), y la velocidad de deformación diastólica precoz pico (VDDPP) se obtuvieron por mediciones ecocardiográficas al inicio del estudio y a los seis meses. Resultados: Todos los pacientes presentaban hipertrofia concéntrica o remodelado. La metformina reduce la masa del VI y el ERP. Había alteraciones del ventrículo izquierdo sistólica y diastólica, alteraciones en ambos grupos que la metformina mejoró significativamente. VDDPP aumentó casi al doble con metformina. La mejoría de la función diastólica no se relacionó con regresión de la hipertrofia. Conclusiones: Los pacientes con SM experimentaron alteraciones sutiles de las funciones sistólica y diastólica, lo que mejoró significativamente con una pequeña dosis de metformina en un periodo de tratamiento de seis meses.
ABSTRACT
BACKGROUND: Obesity is associated with a variety of diseases and increases cardiovascular morbidity and mortality. The purpose of this study is to examine the relationship between the obesity index and diastolic function parameters of the left ventricle. We use body mass index (BMI) and waist circumference (WC) as the obesity index. METHODS: From January 2010 to December 2012, 390 cases (283 men, 109 women) were enrolled in this study. The blood pressure, height, weight, blood test, personal habits questionnaire, and echocardiographic indices were obtained. We analyzed the echocardiographic indices of left ventricular diastolic function with BMI and WC. RESULTS: The left ventricle (LV) mass index (P=0.007), LV dimension (P<0.01), A (P<0.01), A' (P=0.030), and E/E' (P=0.006) were higher, and E (P=0.003), E' (P<0.01), E/A (P<0.01) were lower in the overweight and obese groups than in the normal group. On multiple linear regression analysis, E/E' correlated positively with age, gender, BMI and systolic blood pressure. In men, E/E' correlated positively with age and BMI or WC. In women, only age had a positive correlation with E/E'. CONCLUSION: In men, increased BMI or waist circumference are associated with an increase in E/E', which surrogates left ventricular diastolic dysfunction. In women, obesity and abdominal obesity have no correlation with E/E'.
Subject(s)
Female , Humans , Male , Blood Pressure , Body Mass Index , Echocardiography , Heart Ventricles , Hematologic Tests , Linear Models , Mortality , Obesity , Obesity, Abdominal , Overweight , Waist CircumferenceABSTRACT
BACKGROUND AND PURPOSE: Left ventricular (LV) diastolic dysfunction, developed in relation to myocardial dysfunction and remodeling, is documented in 15%-25% of the population. However, its role in functional recovery and recurrent vascular events after acute ischemic stroke has not been thoroughly investigated. METHODS: In this retrospective observational study, we identified 2,827 ischemic stroke cases with adequate echocardiographic evaluations to assess LV diastolic dysfunction within 1 month after the index stroke. The peak transmitral filling velocity/mean mitral annular velocity during early diastole (E/e') was used to estimate LV diastolic dysfunction. We divided patients into 3 groups according to E/e' as follows: <8, 8-15, and ≥15. Recurrent vascular events and functional recovery were prospectively collected at 3 months and 1 year. RESULTS: Among included patients, E/e' was 10.6±6.4: E/e' <8 in 993 (35%), 8-15 in 1,444 (51%), and ≥15 in 378 (13%) cases. Functional dependency or death (modified Rankin Scale score ≥2) and composite vascular events were documented in 1,298 (46%) and 187 (7%) patients, respectively, at 3 months. In multivariable analyses, ischemic stroke cases with E/e' ≥15 had increased odds of functional dependence or death at 3 months (adjusted OR [95% CI]: 1.73 [1.27-2.35]) or 1 year (1.47 [1.06-2.06]) and vascular events within 1 year (1.65 [1.08-2.51]). Subgroups with normal ejection fraction or sinus rhythm exhibited a similar overall pattern and direction. CONCLUSIONS: LV diastolic dysfunction was associated with poor functional outcomes and composite vascular events up to 1 year.
Subject(s)
Humans , Diastole , Echocardiography , Observational Study , Prospective Studies , Retrospective Studies , StrokeABSTRACT
Introducción: El objetivo de este trabajo fue determinar la prevalencia de disfunción diastólica subclínica del ventrículo izquierdo (DDVI) y su asociación con el descontrol metabólico en adolescentes con diabetes tipo 1. Métodos: Se trató de un estudio en 53 adolescentes con diabetes tipo 1 en dos fases: primero, un estudio transversal descriptivo y, después de realizar un ecocardiograma, un transversal comparativo. Se consideró DDVI cuando tuvieron tres o más datos ecocardiográficos alterados: velocidad de contracción auricular (relación E/A), tiempo de desaceleración (TD), tiempo de relajación volumétrico (TRIVI) y función sistólica mayor de 50%. Además, se les determinaron los niveles de glucosa, de hemoglobina glucosilada y microalbuminuria. Resultados: El 16.98% de los adolescentes diabéticos mostraron datos ecocardiográficos de DDVI, y el 15.10% correspondió al sexo masculino. El patrón pseudonormalizado se observó en 7.54%, en relación con el 5.66% del patrón de alteración de la relajación y del 3.77% del restrictivo. Estos pacientes, además, mostraron mayor tiempo de la enfermedad, obesidad y un aumento en la glucemia, en la hemoglobina glucosilada y de la microalbuminuria. Conclusiones: La DDVI es una complicación frecuente en los adolescentes con diabetes tipo 1. Aquellos con DDVI presentaron con mayor frecuencia obesidad, mayor tiempo de evolución de la enfermedad y un peor control metabólico. Se propone que en estos pacientes se realice un diagnóstico oportuno y sistemático a través de un ecocardiograma.
Background: To determine the prevalence of subclinical left ventricular diastolic dysfunction (LVDD) and its association with metabolic control in adolescents with type 1diabetes. Methods: We carried out a study in 53 adolescents with type 1 diabetes in two phases: cross-sectional and after performing two-dimensional M-mode echocardiogram and color Doppler, a cross-sectional comparison. Subjects were divided into two groups: the first without LVDD and the second with LVDD. LVDD was considered when there were three or more alterations according to echocardiographic data (rate of atrial contraction, time of deceleration, time of volumetric relaxation) accompanied by systolic function >50%. We also determined glucose, hemoglobin, glycosylate, and microalbuminuria. Results: Of the adolescents with diabetes, 16.98% showed echocardiographic data of LVDD; 15.10% were male. Pseudonormalized pattern was observed in 7.54% compared to 5.66% with impaired relaxation pattern and 3.77% with restrictive pattern. Furthermore, there was a longer time of disease evolution, obesity and a significant increase of glycemia, glycosylated hemoglobin and microalbuminuria. Conclusions: LVDD is a frequent complication in adolescents with type 1 diabetes. Those with LVDD had a higher prevalence of obesity, longer time of disease, and poorer metabolic control. Therefore, we propose that a timely and systematic search with echocardiogram is important in patients with type 1 diabetes.
ABSTRACT
Objective To investigate the relationship between plasma N-terminal pro brain natriuretic peptide(NT-proBNP) level and left ventricular(LV) diastolic dysfunction in hypertensive patients without systolic dysfunction.Methods Forty-four cases of primary hypertensive patients with left ventricular ejection fraction more than 50％ were enrolled,14 cases in normal diastolic function group,30 cases in diastolic dysfunction group(18 cases in delayed relaxation group and 12 cases in pseudo normalization filling group).LV diastolic function was assessed with conventional Doppler by means of mitral inflow and with tissue Doppler echocardiography by means of mitral annulus.The ratio of early diastolic transmitral E wave velocities to tissue Doppler mitral annulus early diastolic E' wave velocities (E/E') was used to detect LV filling pressures.Patients were divided into three groups according to E/E' ratios.Plasma concentrations of NT-proBNP were also measured.All related data were statistically analyzed.Results The levels of NT-proBNP were (115.2 ± 78.9)ng/L in LV diastolic dysfunction group,(34.7 ± 17.5) ng/L in normal filling group and (206.6 ± 75.8) ng/L in pseudonormal filling group.The level of NT-proBNP significantly elevated (F =85.263,P =0.000) along with the severity of lefi ventricular diastolic dysfunction.There was significant difference between each of the two groups among the three groups(all P ＜0.01).According to E/E' ratios,the patients were divided into three groups:E/E' ＜10(n =16),10 ＜ E/E ＜ 15(n =18),E/E' ＞ 15(n =10).The level of NT-proBNP were (39.5 ± 20.1) ng/L,(71.2 ± 26.4) ng/L and (203.7 ± 75.2) ng/L respectively in the three groups.The NT-proBNP blood level was positively correlated significantly with E/E' ratio (r =0.80,P ＜ 0.01).The sensitivity was 87％ and the specificity was 100％ for diagnosis of left ventricular filling pressure (E/E' ＞ 15)according to a NT-proBNP value of 119 ng/L.Conclusion Combining of plasma NT-proBNP and Doppler E/E'have potential value for identification of those patients with hypertension to detect early cardiovascular changes,especially LV diastolic dysfunction.
ABSTRACT
BACKGROUND: Few studies investigated serum uric acid levels in patients with acute ST-elevation myocardial infarction (STEMI). The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction (STEMI). METHODS: Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010. The level of serum lipid, echocardiographic data and in-hospital major adverse cardiovascular events (MACE) in patients with hyperuricemia (n=119) were compared with those in patients without hyperuricemia (n=383). The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed. All data were analyzed with SPSS version 17.0 software for Student's t test, the Chi-square test and Pearson's correlation coefficient analysis. RESULTS: Serum uric acid level was positively correlated with serum triglyceride level. Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients (43.7％ vs. 33.7％, P=0.047), and serum triglyceride level was significantly higher in hyperuricemia patients (2.11±1.24 vs. 1.78±1.38, P=0.014). But no significant association was observed between serum uric acid level and one or more diseased vessels (P>0.05). Left ventricular end-diastolic diameter (LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients (53.52±6.19 vs. 52.18±4.89, P=0.041). The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients (36.4％ vs. 15.1％, P<0.001; 68.2％ vs. 55.8％, P=0.023). Also, hyperuricemia patients were more likely to have in-hospital MACE (P<0.05). CONCLUSIONS: Serum uric acid level is positively correlated with serum triglyceride level, but not with the severity of coronary artery disease. Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE.
ABSTRACT
Objective To assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).Methods A total of 502 consecutive patients with STEMI were enrolled from January 2005 to December 2010 for retrospective study.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE)in patients with hyperuricemia(n =119)were compared with those in patients without hyperuricemia(n =383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software to make t test and x2 test and Pearson correlation analysis.Results Serum uric acid level was positively correlated with serum triglyceride level.Compared with non-hyperuricemia patients,hyperlipidemia was more commonly found among hyperuricemia patients (43.7％ vs.33.7％,P =0.047),and serum triglyceride level was significantly higher in hyperuricemia patients[(2.11 ± 1.24)mmol/L vs.(1.78 ± 1.38)mmol/L,P =0.014].But a significant association between serum uric acid level and one or more diseased vessels was not observed(P ≥ 0.05).Leftventricular end-diastolic diameter(LVEDd)was found to be larger in hyperuricemia patients than non-hyperuricemia patients[(53.52 ±6.19)mm vs.(52.18 ±4.89)mm,P =0.041].Higher incidence in left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4％ vs.15.1％,P ＜0.01; 68.2％ vs.55.8％,P =0.023).Also,hyp-eruricemia patients had more in-hospital MACE(P ＜ 0.05).Conclusions Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients after STEMI tended to have higher incidence in left systolic dysfunction and diastolic dysfunction,and have more in-hospital MACE.