Reliable measurement methods for the isovolumic relaxation time: comparisons of dual gate Doppler and seven other methods.

PURPOSE: Isovolumic relaxation time (IVRT) is a useful indicator of diastolic dysfunction. However, a measurement method for IVRT has not been established. The Dual Gate Doppler method, which can record two separate pulse-wave Doppler signals simultaneously using two sample gates, may be ideal for measuring IVRT. This study aimed to evaluate the accuracy of IVRT measured using conventional methods versus that measured using the Dual Gate Doppler method. METHODS: A total of 104 patients (mean age 58 ± 21 years, 48 women) were examined using ultrasound equipment with Dual Gate Doppler at our hospital. In addition to Dual Gate Doppler method, IVRTs were measured using seven different methods: pulsed Doppler (PW method), continuous wave Doppler (CW method), and other methods. The IVRT values obtained using the Dual Gate Doppler method were compared with those measured using other methods. RESULTS: All IVRTs measured using conventional methods showed a strong correlation with the that measured using the Dual Gate Doppler method. However, there were slight deifferences among the IVRTs depending on the method. The PW method and the PW time difference method using only the PW showed small statistical bias and were not complicated. The IVRT measured using the CW method was significantly longer than that measured using the Dual Gate Doppler method. CONCLUSIONS: Among the conventional methods, the PW method was the simplest and most practical method for measuring the IVRT in any conditions as arrhythmias. It is important to recognize the characteristics of IVRTs based on the measurement method.

Evaluation of cardiac function in asthmatic children by Tissue Doppler Echocardiography.

BACKGROUND: Bronchial asthma is a global health problem with rising prevalence in developing countries. Children with severe asthma can experience cor pulmonale later in life, but little is known about the cardiac changes that might be present earlier in mild or moderate severity of disease. This study aimed to evaluate biventricular function among children suffering from persistent asthma by Tissue Doppler Echocardiography (TDE). RESULTS: Thirty-five asthmatic children enrolled from Alexandria Children's Hospital between September 2021 to May 2022; they were compared to 35 healthy matched children. Chronic respiratory disease, cardiac disease, or other comorbidities were excluded. The mean age of cases was 8.87 ± 2.03 years with a male/female ratio of 54.3%:45.7%. There were 28.3% mild cases, 45.7% moderate, and 25.7% severe. Conventional echocardiographic variables of cardiac function were normal for both ventricles. The TDE indices of medial mitral annulus (S' velocity and peak E') were significantly reduced (14.55 ± 2.30 and 14.69 ± 2.30) versus controls (15.68 ± 1.96, 15.69 ± 1.76, P; 0.044, P < 0.0045) but with preserved LV function. The lateral tricuspid annulus (S' velocity and peak E') was significantly reduced (11.53 ± 3.24 and 11.56 ± 3.18) versus controls (15.71 ± 0.98, 16.02 ± 1.75, < 0.001*), while E/A and IVRT were significantly increased (1.49 ± 0.06 versus 1.70 ± 0.18 and 102.39 ± 5.37 versus 140.10 ± 34.35, respectively, P < 0.001*) with impaired RV function. Peak expiratory flow rate (PEFR) was negatively correlated with the IVRT of the tricuspid annulus (P = 0.002, r = -0.503*) and to the E'/A' (P = 0.036, r =-0.355*). All TDE variables of lateral tricuspid annulus of severe subgroups were significantly  changed versus moderate or mild subgroups. CONCLUSIONS: Tissue Doppler echocardiography is the recommended modality for early detection of biventricular cardiac dysfunction among children with different levels of asthma severity. Periodic screening is advised through the use of IVRT especially for RV.

Echocardiographic diagnosis of heart failure with preserved ejection fraction in elderly patients with hypertension.

Objectives. The aim of this study is to evaluate the diagnostic performance of echocardiography for the diagnosis of heart failure with preserved ejection fraction (HFpEF) in the elderly and to validate the Heart Failure Association diagnostic algorithm (HFA-PEFF). Design. A case-control study was conducted in patients with hypertension with or without HFpEF who were matched for age (n = 33; 78.4 ± 5.3 years) and sex. Participants underwent echocardiography including assessment of left atrial (LA) volume index (LAVI), early mitral filling to early diastolic mitral annulus velocity ratio (E/e'), LA reservoir strain (LASr), tissue Doppler LA contraction (a'), right ventricular isovolumic relaxation time (RVIVRT), and a 6-minute walk test (6-MWT). The filling pressure algorithm from the European association of cardiovascular imaging (EACVI) 2021 was applied. The HFA-PEFF score was also applied, using echocardiography parameters and the value of NT pro-BNP, without considering symptomatic status. Results. Echocardiographic parameters identified patients with HFpEF with an area under the curve (AUC) >0.9 for E/e', RVIVRT, LASr, a', and the ratio of LAVI/a'. LASr correlated with 6-MWT (r = 0.59, p = .0003). The EACVI algorithm classified all controls with normal filling pressure and 94% of patients with HFpEF with increased filling pressure. When the HFA-PEFF diagnostic algorithm was validated, a high score (≥5 points) had 100% sensitivity for HFpEF, while 88% of controls had intermediate scores (2-4 points). Conclusion. The EACVI filling pressure algorithm, RVIVRT, LASr, and the ratio LAVI/a' were accurate for diagnosing HFpEF in elderly patients with hypertension. The HFA-PEFF score had high sensitivity but limited ability to exclude HFpEF.

Right Ventricular Diastolic Dysfunction after Marathon Run.

It has been raised that marathon running may significantly impair cardiac performance. However, the post-race diastolic function has not been extensively analyzed. We aimed to assess whether the marathon run causes impairment of the cardiac diastole, which ventricle is mostly affected and whether the septal (IVS) function is altered. The study included 34 male amateur runners, in whom echocardiography was performed two weeks before, at the finish line and two weeks after the marathon. Biventricular diastolic function was assessed not only with conventional Doppler indices but also using the heart rate-adjusted isovolumetric relaxation time (IVRTc). After the run, IVRTc elongated dramatically at the right ventricular (RV) free wall, to a lesser extent at the IVS and remained unchanged at the left ventricular lateral wall. The post-run IVRTc_IVS correlated with IVRTc_RV (r = 0.38, p < 0.05), and IVRTc_RV was longer in subjects with IVS hypertrophy (88 vs. 51 ms; p < 0.05). Participants with measurable IVRT_RV at baseline (38% of runners) had longer post-race IVRTc_IVS (102 vs. 83 ms; p < 0.05). Marathon running influenced predominantly the RV diastolic function, and subjects with measurable IVRT_RV at baseline or those with IVS hypertrophy can experience greater post-race diastolic fatigue.

Changes in Myocardial Microstructure and Mechanics With Progressive Left Ventricular Pressure Overload.

This study assessed the regional changes in myocardial geometry, microstructure, mechanical behavior, and properties that occur in response to progressive left ventricular pressure overload (LVPO) in a large animal model. Using an index of local biomechanical function at early onset of LVPO allowed for prediction of the magnitude of left ventricular chamber stiffness (Kc) and left atrial area at LVPO late timepoints. Our study found that LV myocardial collagen content alone was insufficient to identify mechanisms for LV myocardial stiffness with progression to heart failure with preserved ejection fraction (HFpEF). Serial assessment of regional biomechanical function might hold value in monitoring the natural history and progression of HFpEF, which would allow evaluation of novel therapeutic approaches.

Acute effect of primary PCI on diastolic dysfunction recovery in anterior wall STEMI - A non-invasive evaluation by echocardiography.

BACKGROUND: It is well established fact that acute coronary occlusion leads to diastolic dysfunction, followed by systolic dysfunction when myonecrosis occur. It is also proven that primary percutaneous coronary intervention (PPCI) is an excellent therapy for ST elevation myocardial infarction (STEMI) to improve outcomes. However there is a paucity of information on efficacy of PPCI in improving diastolic function. Evaluation of the role of PPCI in improving diastolic dysfunction is required. METHODS: 61 patients with first anterior wall STEMI who underwent PPCI to left anterior descending artery were included. Echocardiographic evaluation was performed within 24 h of PPCI and then on day 15, 3 months and 6 months after PPCI. We evaluated the prevalence of diastolic dysfunction after PPCI and its recovery during 6 months along with effect of duration of chest pain on diastolic function. RESULTS: 54.1% of patients had diastolic dysfunction after PPCI whereas it was only 21.3% after 6 months (p value < 0.001). Diastolic function indices like deceleration time, isovolumic relaxation time, E wave, A wave, E/A ratio, left atrial volume and index improved statistically from baseline to 6 months except mitral E/e' ratio. As time required to achieve reperfusion increases (chest pain duration and D to B time) the incidence of residual diastolic dysfunction also increases (p value < 0.001). Patients with TIMI flow < III had more diastolic dysfunction (p value < 0.001). CONCLUSIONS: Primary PCI improves diastolic dysfunction in patients with anterior wall STEMI over a period of 6 months. Time to achieve reperfusion and effectiveness of reperfusion have significant effect on diastolic dysfunction.

What Is the Heart? Anatomy, Function, Pathophysiology, and Misconceptions.

Cardiac dynamics are traditionally linked to a left ventricle, right ventricle, and septum morphology, a topography that differs from the heart's five-century-old anatomic description of containing a helix and circumferential wrap architectural configuration. Torrent Guasp's helical ventricular myocardial band (HVMB) defines this anatomy and its structure, and explains why the heart's six dynamic actions of narrowing, shortening, lengthening, widening, twisting, and uncoiling happen. The described structural findings will raise questions about deductions guiding "accepted cardiac mechanics", and their functional aspects will challenge and overturn them. These suppositions include the LV, RV, and septum description, timing of mitral valve opening, isovolumic relaxation period, reasons for torsion/twisting, untwisting, reasons for longitudinal and circumferential strain, echocardiographic sub segmentation, resynchronization, RV function dynamics, diastolic dysfunction's cause, and unrecognized septum impairment. Torrent Guasp's revolutionary contributions may alter future understanding of the diagnosis and treatment of cardiac disease.

Assessment of Diastolic Function Using Ultrasound Elastography.

Shear wave elasticity imaging (SWEI) is a novel ultrasound elastography technique for assessing tissue stiffness. In this study, we investigate the potential of SWEI for providing diastolic functional assessment. In 11 isolated rabbit hearts, pressure-volume (PV) measurements were recorded simultaneously with SWEI recordings from the left ventricle free wall before and after induction of global ischemia. PV-based end diastolic stiffness increased by 100% after ischemia (p <0.05), and SWEI stiffness showed an increase of 103% (p <0.05). The relaxation time constant (τ) before and after ischemia derived from pressure and SWEI curves showed increases of 79% and 76%, respectively (p <0.05). A linear regression between pressure-derived and SWEI-based (τ) showed a slope of 1.164 with R2 = 0.80, indicating the near equivalence of the two assessments. SWEI can be used to derive (τ) values and myocardial end diastolic stiffness. In global conditions, these measurements are consistent with PV measurements of diastolic function.

Early segmental relaxation abnormalities in hypertrophic cardiomyopathy for differential diagnostic of patients with left ventricular hypertrophy.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is characterized by asymmetric left ventricular hypertrophy (LVH). However, clinical signs can be subtle and differentiation from other causes of LVH is challenging. HYPOTHESIS: As diastolic dysfunction (DD) is an early sign in HCM, we aimed to find regional changes in relaxation pattern for differentiation from other entities of LVH. METHODS: In 148 patients (81 HCM, 55 arterial hypertension (AHT), 12 Fabry disease) and 63 healthy controls, relaxation patterns were assessed using regional tissue Doppler imaging. In 42 HCM patients, myocardial mass and fibrosis were quantified by cardiac magnetic resonance imaging and correlated with relaxation parameters. RESULTS: In HCM the septal to lateral isovolumic relaxation time (s/l IVRT) ratio was higher (1.5 ± 0.4) compared with AHT (1.1 ± 0.2), Fabry disease (1.0 ± 0.1), and controls (1.1 ± 0.2; P < 0.001), showing 77% sensitivity and 79% specificity to discriminate HCM-related LVH from other entities. The s/l IVRT ratio was independent of global DD in HCM (HCM with DD: 1.5 ± 0.5, n = 52; HCM without DD: 1.5 ± 0.3, n = 29) and remained significantly different from other entities in a subgroup of HCM patients with maximum wall thickness < 20 mm (s/l ratio: 1.5 ± 0.5, n = 28). Regional IVRT did not correlate with the corresponding segmental myocardial mass or amount of fibrosis in cardiac magnetic resonance imaging. CONCLUSIONS: HCM patients show a prolonged septal IVRT irrespective of the extent of LVH and even before developing global DD. The s/l IVRT ratio is significantly higher in HCM compared with AHT or Fabry disease, thus establishing segmental IVRT analysis as a potential parameter for differential diagnosis in LVH.

Residential Proximity to Major Roadways Is Not Associated with Cardiac Function in African Americans: Results from the Jackson Heart Study.

Cardiovascular disease (CVD), including heart failure, is a major cause of morbidity and mortality, particularly among African Americans. Exposure to ambient air pollution, such as that produced by vehicular traffic, is believed to be associated with heart failure, possibly by impairing cardiac function. We evaluated the cross-sectional association between residential proximity to major roads, a marker of long-term exposure to traffic-related pollution, and echocardiographic indicators of left and pulmonary vascular function in African Americans enrolled in the Jackson Heart Study (JHS): left ventricular ejection fraction, E-wave velocity, isovolumic relaxation time, left atrial diameter index, and pulmonary artery systolic pressure. We examined these associations using multivariable linear or logistic regression, adjusting for potential confounders. Of 4866 participants at study enrollment, 106 lived <150 m, 159 lived 150-299 m, 1161 lived 300-999 m, and 3440 lived ≥1000 m from a major roadway. We did not observe any associations between residential distance to major roads and these markers of cardiac function. Results were similar with additional adjustment for diabetes and hypertension, when considering varying definitions of major roadways, or when limiting analyses to those free from cardiovascular disease at baseline. Overall, we observed little evidence that residential proximity to major roads was associated with cardiac function among African Americans.

Soy Protein Alleviates Hypertension and Fish Oil Improves Diastolic Heart Function in the Han:SPRD-Cy Rat Model of Cystic Kidney Disease.

Abnormalities in cardiac structure and function are very common among people with chronic kidney disease, in whom cardiovascular disease is the major cause of death. Dietary soy protein and fish oil reduce kidney disease progression in the Han:SPRD-Cy model of cystic renal disease. However, the effects of these dietary interventions in preventing alterations in cardiac structure and function due to kidney disease (reno-cardiac syndrome) in a cystic kidney disease model are not known. Therefore, weanling Han:SPRD-Cy diseased (Cy/+) and normal (+/+) rats were given diets containing either casein or soy protein, and either soy or fish oil in a three-way design for 8 weeks. Diseased rats had larger hearts, augmented left ventricular mass, and higher systolic and mean arterial blood pressure compared to the normal rats. Assessment of cardiac function using two-dimensional guided M-mode and pulse-wave Doppler echocardiography revealed that isovolumic relaxation time was prolonged in the diseased compared to normal rats, reflecting a diastolic heart dysfunction, and fish oil prevented this elevation. Soy protein resulted in a small improvement in systolic and mean arterial pressure but did not improve diastolic heart function, while fish oil prevented diastolic heart dysfunction in this model of cystic kidney disease.

Accuracy of quantitative echocardiographic measures of right ventricular function as compared to cardiovascular magnetic resonance.

BACKGROUND: Many echocardiographic parameters have been proposed to evaluate right ventricular (RV) systolic function. We comprehensively assessed a wide range of quantitative echocardiographic parameters in a single cohort compared with same-day cardiovascular magnetic resonance (CMR). METHODS AND RESULTS: 92 subjects were examined prospectively: Group 1 consisted of 46 healthy controls (21 males, 33.4 ± 11.4 years), Group 2 consisted of 46 patients (20 males, 38.5 ± 18.9 years) undergoing RV functional assessment by CMR (1.5 T). Echocardiography was performed on the same day as CMR; fractional area change (RVFAC), myocardial performance index via spectral Doppler (RVMPI), RVMPI via Doppler tissue imaging (RVMPI-DTI), peak systolic myocardial velocity by DTI (RVSm), tricuspid annular plane systolic excursion (TAPSE), speckle tracking strain, and three dimensional right ventricular ejection fraction (3DE-RV). Linear regression, Bland-Altman and receiver-operator-characteristic (ROC) analyses were performed. At ROC analysis, the most predictive echocardiographic methods were; RVFAC (AUC = 0.892), RVMPI (AUC 0.785), TAPSE (AUC 0.849) and 3DE-RV (AUC 0.909). 3DE-RV appeared the most accurate compared to CMR, although underestimated true RV volumes. CONCLUSION: As compared to CMR; 3DE-RV, RVFAC, TAPSE and RVMPI were the most reliable predictors of RV function. These parameters can be recommended for clinical use.

Myocardial performance index derived from pre-ejection period as a novel and useful predictor of cardiovascular events in atrial fibrillation.

PURPOSE: The pre-ejection period-derived myocardial performance index measured from tissue Doppler echocardiography (PEPa-derived MPI) was reported to be associated with left ventricular systolic and diastolic function in atrial fibrillation (AF). However, its relationship with cardiovascular outcomes in AF has never been evaluated. This study sought to examine the ability of PEPa-derived MPI in predicting adverse cardiovascular events in AF patients. METHODS: In 196 persistent AF patients, we performed comprehensive echocardiography with measurement of PEPa-derived MPI using index beat method. The index beat was defined as the beat following the nearly equal preceding (RR1) and pre-preceding (RR2) intervals. The cycle length of index beat and RR1 and RR2 must be >500ms and the difference between RR1 and RR2 must be <60ms. Cardiovascular events were defined as cardiovascular death, nonfatal stroke, and hospitalization for heart failure. RESULTS: In the multivariate analysis, chronic heart failure and increased ratio of transmitral E-wave velocity to early diastolic mitral annulus velocity (E/Ea) and PEPa-derived MPI (per 0.1 increase, hazard ratio, 1.104; 95% confidence interval, 1.032-1.182, p=0.004) were associated with increased cardiovascular events. The addition of PEPa-derived MPI to a Cox model containing chronic heart failure, systolic blood pressure, age, diabetes, prior stroke, left ventricular ejection fraction, and E/Ea provided an additional benefit in prediction of adverse cardiovascular events (p=0.015). CONCLUSIONS: In AF patients, the PEPa-derived MPI was a useful predictor of adverse cardiovascular events and could offer an additional prognostic benefit over conventional clinical and echocardiographic parameters.

Impact of metabolic syndrome on global left ventricular function: As evaluated by the myocardial performance index.

BACKGROUND: Metabolic syndrome is associated with the development of diabetes mellitus and cardiovascular disease. The impact of metabolic syndrome on the progression of atherosclerosis has been well documented. This study was designed to evaluate the impact of metabolic syndrome on global left ventricular function by using left ventricular myocardial performance index (LVMPI). METHODS: The diagnosis of metabolic syndrome was made as per the criteria of the International Diabetes Federation. Echocardiography was performed with a Philips IE33 machine using a 1-5 MHz transthoracic probe. LVMPI was calculated by adding isovolumic contraction time with isovolumic relaxation time and dividing it by ejection time. RESULTS: The mean LVMPI value in metabolic syndrome was 0.64 ± 0.09, while that in controls was 0.48 ± 0.06 (p < 0.001). Metabolic syndrome was seen to have more significant influence on LVMPI. CONCLUSIONS: Metabolic syndrome is a strong predictor of sub-clinical myocardial dysfunction in subjects free of clinically apparent heart disease.

Small and large animal models in cardiac contraction research: advantages and disadvantages.

The mammalian heart is responsible for not only pumping blood throughout the body but also adjusting this pumping activity quickly depending upon sudden changes in the metabolic demands of the body. For the most part, the human heart is capable of performing its duties without complications; however, throughout many decades of use, at some point this system encounters problems. Research into the heart's activities during healthy states and during adverse impacts that occur in disease states is necessary in order to strategize novel treatment options to ultimately prolong and improve patients' lives. Animal models are an important aspect of cardiac research where a variety of cardiac processes and therapeutic targets can be studied. However, there are differences between the heart of a human being and an animal and depending on the specific animal, these differences can become more pronounced and in certain cases limiting. There is no ideal animal model available for cardiac research, the use of each animal model is accompanied with its own set of advantages and disadvantages. In this review, we will discuss these advantages and disadvantages of commonly used laboratory animals including mouse, rat, rabbit, canine, swine, and sheep. Since the goal of cardiac research is to enhance our understanding of human health and disease and help improve clinical outcomes, we will also discuss the role of human cardiac tissue in cardiac research. This review will focus on the cardiac ventricular contractile and relaxation kinetics of humans and animal models in order to illustrate these differences.

Echocardiographic assessment of right ventricular function in inferior wall myocardial infarction and angiographic correlation to proximal right coronary artery stenosis.

BACKGROUND: Presence of right ventricular (RV) infarction imposes a higher risk of adverse events in inferior wall myocardial infarction (IWMI). In this study, we attempted to correlate various indices of RV function assessed by echocardiography with presence of a proximal right coronary artery (RCA) stenosis in patients with first episode of acute IWMI. METHODS: In a prospective study, patients with first episode of acute IWMI underwent echocardiographic assessment within 24 h of symptom onset and indices of RV function viz. RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI) and tissue Doppler velocities from RV free wall were measured. Patients who underwent coronary angiogram (CAG) within one month and they were classified into group 1 and group 2 based on the presence or absence, respectively, of a significant proximal RCA stenosis. RESULTS: There were 90 patients with first episode of IWMI of which 67 patients underwent CAG. There was significant difference between group 1 (n = 26) and group 2 (n = 41) in TAPSE (13.5 ± 1.3 vs 21.3 ± 1.7, p < 0.001), MPI by tissue Doppler (0.87 ± 0.1 vs 0.55 ± 0.2, p < 0.001) and in tissue Doppler systolic velocity from RV free wall (S' 9.8 ± 1.1 vs 15.0 ± 1.5, p < 0.001). There was a good interobserver correlation for TAPSE, MPI by TDI, and S' velocity. TAPSE ≤ 16 (sensitivity 93%, specificity 100%), MPI-TDI ≥ 0.69 (sensitivity 94.7%, specificity 93.5%), S ≤ 12.3 (sensitivity 90.3%, specificity 94.3%) were useful in predicting presence of proximal RCA stenosis. CONCLUSION: RV function indices like TAPSE, MPI-TDI and S' velocity are useful in predicting proximal RCA stenosis in first episode of acute IWMI.

Pre- and post-operative diastolic dysfunction in patients with valvular heart disease: diagnosis and therapeutic implications.

Patients with valvular heart disease often have left ventricular diastolic dysfunction. This review summarizes the underlying mechanisms for diastolic dysfunction in patients with mitral and aortic valve disease. In addition to load, intrinsic myocardial abnormalities occur related to changes in sarcomeric proteins, abnormal calcium handling, and fibrosis. Echocardiography is the initial modality for the diagnosis of left ventricular diastolic function. Although there are challenges to conventional Doppler parameters of diastolic function, it is often possible to arrive at a clinically useful assessment of left ventricular filling pressures using a comprehensive approach. When needed, cardiac magnetic resonance and cardiac catheterization can be obtained. Medical therapy can be of value for the treatment of diastolic dysfunction, but there is a paucity of data evaluating its clinical utility. More importantly, diastolic dysfunction usually improves with timely surgical intervention, although surgery does not always lead to normalization of function.

Functional iron deficiency and diastolic function in heart failure with preserved ejection fraction.

BACKGROUND: Functional iron deficiency (FID) is an independent risk factor for poor outcome in advanced heart failure with reduced EF, but its role in heart failure with preserved EF (HFPEF) remains unclear. We aimed to investigate the impact of FID on cardiac performance determined by pressure-volume loop analysis in HFPEF. METHODS: 26 HFPEF patients who showed an increase in LV stiffness by pressure-volume (PV) loop analysis obtained by conductance-catheterization, performed exercise testing, echocardiographic examination including tissue Doppler and determination of iron metabolism: serum iron, ferritin and transferrin saturation. HFPEF patients who provided ferritin <100 µg/l or ferritin of 100-299 µg/l in combination with transferrin saturation <20% were defined as having FID. In 14 patients the expression of transferrin receptor was determined from available endomyocardial biopsies. RESULTS: Fifteen out of 26 HFPEF patients showed FID without anemia. Compared to control subjects and HFPEF patients without FID, HFPEF patients with FID showed an up-regulation of the myocardial transferrin receptor expression (p<0.05). No differences between HFPEF patients with and without iron deficiency were found in heart dimensions, systolic and diastolic function obtained by PV-loop and echocardiography analysis. According to the linear regression analysis, LV stiffness was correlated with peak oxygen uptake (r=-0.636, p<0.001) but not with the ferritin level or transferrin saturation. No relation was found between FID and exercise capacity. The association of LV stiffness with exercise performance was independent from the level of iron deficiency. CONCLUSION: In non-anemic HFPEF patients, cardiac dysfunction and impaired exercise capacity occur independently of FID.

Cardiac function and arterial biophysical properties in small for gestational age infants: postnatal manifestations of fetal programming.

OBJECTIVE: To investigate the differences in cardiac function and arterial biophysical properties between term-born appropriate for gestational age (AGA) infants and small for gestational age (SGA) infants. Our hypothesis was that adaptation to intrauterine growth restriction induces changes in cardiac and arterial indices. STUDY DESIGN: This was a prospective observational echocardiographic evaluation of cardiac and arterial indices in SGA infants and AGA infants. Demographic and echocardiographic data were compared between 20 inborn term SGA infants with birth weight <3rd percentile for gestational age and 20 AGA infants. RESULTS: The Ponderal index was significantly lower and blood pressure was significantly higher in the SGA infants compared with the AGA infants. Left ventricular output was lower in the SGA infants (170 ± 31 mL/kg/min vs 197 ± 39 mL/kg/min). Diastolic dysfunction was greater in the SGA infants (ie, reduced E and A wave velocities, higher E/A ratio [1.08 ± 0.16 vs 0.85 ± 0.07], and prolonged isovolumic relaxation time [73 ± 6.2 ms vs 62.6 ± 3.6 ms]). Aortic intima-media thickness was significantly greater in the SGA infants (822 ± 105 µm vs 694 ± 52 µm), as were arterial wall stiffness index and input impedance. CONCLUSION: Cardiac function and arterial biophysical properties were altered in the SGA infants. The findings complement the information on the association between in utero growth and cardiovascular morbidity in later life.

Effects of prediabetes and diabetes on left ventricular and coronary microvascular functions.

BACKGROUND: Coronary flow reserve (CFR) provides independent prognostic information in diabetic patients with known or suspected coronary artery disease. However, there have been no substantial data to evaluate CFR in prediabetics. Accordingly, we aimed to evaluate CFR in subjects with prediabetes using second harmonic transthoracic Doppler echocardiography. METHODS AND RESULTS: We measured CFR of 65 subjects with prediabetes, 45 patients with overt type 2 diabetes, and 43 sex and age matched normoglycemic healthy subjects with normal glucose tolerance. Ages, gender, existence of hypertension or hypercholesterolemia, smoking status were similar among the groups. CFR was significantly lower in diabetics (2.15 ± 0.39) than in prediabetics (2.39 ± 0.45) and controls (2.75 ± 0.35); in addition, it was significantly lower in prediabetics than controls. Only 2 (5%) of control subjects had abnormal CFR (<2) but 11 (17%) prediabetic subjects and 19 (42%) diabetic patients had abnormal CFR. We found that only age (ß=-0.31, P<0.01) and presence of the diabetes (ß=-0.57, P<0.01) were significant predictors of lower CFR in a multivariable model that adjusted for other variables. CFR was significantly and inversely correlated with age (r=-0.15, P=0.04), fasting glucose level (r=-0.27, P=0.001), postprandial glucose level (r=0.43, P<0.001), hemoglobin A1C level (r=-0.34, P<0.001), LDL cholesterol level (r=0.22, P=0.009), mitral A velocity (r=-0.27, P=0.001) and Tei index (r=-0.19, P=0.02), whereas mitral E/A ratio, mitral Em (r=0.18, P=0.02), mitral Em/Am ratio (r=0.23, P=0.004) were significantly and positively correlated with CFR. CONCLUSION: CFR is impaired in subjects with prediabetics, but this impairment is not as severe as that in diabetics.