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Shah AS, Sadayappan S, Urbina EM. Lipids: a Potential Molecular Pathway Towards Diastolic Dysfunction in Youth-Onset Type 2 Diabetes. Curr Atheroscler Rep 2022; 24:109-117. [PMID: 35080716 PMCID: PMC8930525 DOI: 10.1007/s11883-022-00989-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE OF THE REVIEW Obesity and type 2 diabetes (T2D) with onset in youth are emerging public health concerns. Youth with obesity and T2D are at risk for the development of heart failure with preserved ejection fraction (HFpEF) due to diabetes-related cardiomyopathy with evidence of precursor stages, namely diastolic dysfunction, present in youth. We review the literature regarding diastolic dysfunction in youth with obesity and T2D; discuss the potential mechanisms including the role of lipids, contractile proteins and their post-translational modifications, and conclude with studies to guide future treatments. RECENT FINDINGS The diabetes milieu namely hyperglycemia, hyperinsulinemia, and lipotoxicity favor development of diastolic dysfunction and HFpEF. Recent studies show HFpEF is associated with slow left ventricular relaxation and sarcomere stiffness induced by reduced calcium (Ca2+) and β-adrenergic responses. There are currently no effective therapies available for treating HFpEF. Targeting the sarcomere is an area of ongoing research.
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Affiliation(s)
- Amy S. Shah
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, 3333 Burnet Ave ML 7012, Cincinnati, OH, 45229, USA
| | - Sakthivel Sadayappan
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elaine M. Urbina
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, 3333 Burnet Ave ML 7012, Cincinnati, OH, 45229, USA,The Heart Institute, Cincinnati Children’s Hospital, and the University of Cincinnati, Cincinnati, Ohio, USA
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Alsaied T, Niss O, Powell AW, Fleck RJ, Cnota JF, Chin C, Malik P, Quinn CT, Taylor MD. Diastolic dysfunction is associated with exercise impairment in patients with sickle cell anemia. Pediatr Blood Cancer 2018; 65:e27113. [PMID: 29781568 PMCID: PMC6019177 DOI: 10.1002/pbc.27113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Left ventricular diastolic dysfunction (DD) is an independent risk factor for mortality in sickle cell anemia (SCA) and is associated with increased extracellular volume (ECV) on cardiac MRI (CMR). Exercise impairment is common in SCA, but its causes and prognostic value are not well understood. OBJECTIVE To study the effects of DD and ECV on cardiopulmonary exercise test (CPET) in patients with SCA. METHODS AND RESULTS As part of a prospective study to characterize the cardiomyopathy of SCA (NCT02410811), 20 children and adults with SCA underwent CMR, echocardiography, and cycle ergometer CPET (age range 8-43 years). Maximum exercise was reached in 18 patients and 17 (94%) had reduced exercise capacity (%predicted VO2 less than 80%). Six patients had DD and none had systolic dysfunction. Patients with DD had lower exercise capacity compared to patients with normal diastolic function (%predicted VO2 48.2 ± 9.1% vs. 61.2 ± 11.7%; P = 0.01). The z-score of left ventricular lateral E/e' ratio, which is a marker of DD, was negatively associated with %predicted VO2 (r = -0.61, P = 0.01). All patients with moderate-to-severe exercise impairment (%predicted VO2 < 60%) had lateral E/e' z-score > 2. In a multivariate analysis, lateral E/e' z-score was independently associated with %predicted VO2 (P = 0.02). All participants had elevated ECV but the degree of elevation was not associated with exercise parameters. CONCLUSION Left ventricular DD is associated with decreased exercise capacity in SCA. Interventions to prevent or delay DD could improve exercise capacity, quality of life, and long-term outcomes in SCA.
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Affiliation(s)
- Tarek Alsaied
- Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Division of Cardiac Imaging, Boston Children’s Hospital
| | - Omar Niss
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Adam W. Powell
- Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Robert J. Fleck
- Department of Radiology at Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - James F. Cnota
- Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Clifford Chin
- Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Punam Malik
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Division of Experimental Hematology and Cancer Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Charles T. Quinn
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael D. Taylor
- Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Shimron M, Williams L, Hazanov Y, Ghanim D, Kinany W, Amir O, Carasso S. Clinical and echocardiographic characteristics of patients in sinus rhythm, normal left ventricular function, and indeterminate diastolic function. Echocardiography 2018; 35:792-797. [PMID: 29457270 DOI: 10.1111/echo.13838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Diastolic dysfunction (DDFx) is the major underlying mechanism of heart failure with preserved left ventricular ejection fraction (EF). Yet, the echocardiographic diagnosis of DDFx in patients in sinus rhythm is challenging and up to 25% of studies have discrepant measures making assessment of DDFx indeterminate. We aimed to describe the clinical and echocardiographic characteristics of patients with indeterminate diastolic function compared to patients with definite normal and abnormal diastolic function. METHODS One thousand six hundred seventy-four patients were identified from the echocardiography database in sinus rhythm, EF ≥ 45% without wall-motion abnormalities, valvular, congenital heart diseases, cardiomyopathies or pulmonary disease. Patients were divided according to their lateral mitral E/E' ratio and left atrial systolic diameter: normal diastolic function (DFx) (left atrial systolic diameter [LASd] <40 mm, E/E' < 10), DDFx (LASd ≥ 40 mm, E/E' ≥ 10) and indeterminate DFx (discrepant LASd diameter and E/E' ratio). RESULTS Clinical and echocardiographic characteristics of the 3 groups, DDFx (n = 186), indeterminate diastolic function (IndtDFx) (n = 207), and normal diastolic function (NDFx) (n = 1281) were significantly different. IndtDFx demonstrated intermediate parameter abnormalities, largely overlapping with DDFx. LASd and E/E' were similarly associated with the inability to determine diastolic function. Age, female gender, renal failure, E/E' and pulmonary pressure were found to be independent predictors of heart failure symptoms (RR = 1.02, 1.5, 2.5, 1.1, 1.1, respectively, P < .0001, r = .35). CONCLUSION Clinically and echocardiographically patients with IndtDFx are more closely related to DDfx than to NDFx. Although LAd was abnormal in IndtDFx it was not predictive of heart failure symptoms. Further study is suggested to establish whether LA function rather than its maximal size can provide additional information.
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Affiliation(s)
- Matan Shimron
- Department of Cardiology, B Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel
| | - Lynne Williams
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Yevgeni Hazanov
- Department of Cardiology, B Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel
| | - Diab Ghanim
- Department of Cardiology, B Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel
| | - Wadia Kinany
- Department of Cardiology, B Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel
| | - Offer Amir
- Department of Cardiology, B Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel
| | - Shemy Carasso
- Department of Cardiology, B Padeh Medical Center, Poriya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel
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Rafique AM, Zarrini P, Singh N, Beigel R, Tadwalkar R, Chonde M, Slipczuk L, Cercek B, Kar S, Siegel RJ. Echo-Doppler determinants of outcomes in patients with unoperated significant mitral regurgitation in current era. Open Heart 2016; 3:e000378. [PMID: 27547425 PMCID: PMC4975870 DOI: 10.1136/openhrt-2015-000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 04/19/2016] [Accepted: 06/07/2016] [Indexed: 11/09/2022] Open
Abstract
Objective One-half of patients with severe symptomatic mitral regurgitation (MR) do not undergo surgery due to comorbidities. We evaluated prognosticators of outcomes in patients with unoperated significant MR. Methods In this observational study, we retrospectively evaluated medical records of 75 consecutive patients with unoperated significant MR. Results All-cause mortality was 39% at 5 years. Non-survivors (n=29) versus survivors (n=46) were: older (77±9.8 vs 68±14, p=0.006), had higher New York Heart Association (NYHA) class (2.7±0.8 vs 2.3±0.8, p=0.037), higher brain natriuretic peptide (1157±717 vs 427±502 pg/mL, p=0.024, n=18), more coronary artery disease (61% vs 35%, p=0.031), more frequent left ventricular ejection fraction <50% (20.7% vs 4.3%, p=0.026), more functional MR (41% vs 22%, p=0.069), higher mitral E/E′ (12.7±4.6 vs 9.8±4, p=0.008), higher pulmonary artery systolic pressure (PASP; 52.6±18.7 vs 36.7±14, p <0.001), more ≥3+ tricuspid regurgitation (28% vs 4%, p=0.005) and more right ventricular dysfunction (26% vs 6%, p=0.035). Significant predictors of 5-year mortality were PASP (p=0.001) and E/E′ (p=0.011) using multivariate regression analysis. Conclusions Patients with unoperated significant MR have high mortality. Elevated PASP and mitral E/E′ were the most significant predictors of 5-year survival in patients with unoperated significant MR. Current American College of Cardiology (ACC)/American Heart Association (AHA) guidelines provide a limited incorporation of echo-Doppler parameters in the preoperative risk stratification of patients with severe MR.
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Affiliation(s)
| | - Parham Zarrini
- Cedars-Sinai Heart Institute , Los Angeles, California , USA
| | | | - Roy Beigel
- Sheba-Tel Hashomer Hospital , Ramat Gan , Israel
| | | | - Meshe Chonde
- UPMC Presbyterian , Pittsburgh, Pennsylvania , USA
| | | | - Bojan Cercek
- Cedars-Sinai Heart Institute , Los Angeles, California , USA
| | - Saibal Kar
- Cedars-Sinai Heart Institute , Los Angeles, California , USA
| | - Robert J Siegel
- Cedars-Sinai Heart Institute , Los Angeles, California , USA
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5
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Saponaro F, Sonaglioni A, Rossi A, Montefusco L, Lombardo M, Adda G, Arosio M. Improved diastolic function in type 2 diabetes after a six month liraglutide treatment. Diabetes Res Clin Pract 2016; 118:21-8. [PMID: 27485853 DOI: 10.1016/j.diabres.2016.04.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 03/23/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022]
Abstract
AIMS To investigate whether liraglutide improves diastolic function in type 2 diabetes. METHODS Thirty-seven patients with type 2 diabetes who began liraglutide therapy between June 2013 and May 2014 were enrolled in this observational, prospective study. 26 patients received liraglutide therapy for at least 6months. The remaining 11 patients withdrew from liraglutide therapy during the first month, were started on other hypoglycaemic therapies and formed the control group. Anthropometric, metabolic and echocardiographic parameters including pulsed wave tissue Doppler imaging were evaluated at baseline and at 6months. RESULTS In the liraglutide group the early diastolic mitral annulus velocity on the lateral (e-lat) and medial (e-med) sides of the mitral annulus increased from 9.2±3.4 to 11.6±4.7cm/s (p<0.001) and from 6.9±1.7 to 8.4±2.6cm/s (p<0.003), respectively. The ratio of early-to-late velocities on the lateral and medial sides of the mitral annulus increased from 0.7±0.3 to 0.9±0.4 (p<0.001) and from 0.5±0.1 to 0.6±0.1 (p<0.02), respectively. The ratio of early diastolic mitral inflow velocity to early diastolic myocardial relaxation velocity decreased from 10.7±4.3 to 8.5±2.5 (p<0.005). No improvements in diastolic function was detected in the control group. Glucose control improved similarly in both groups: HA1bc -1.5% (-17mmol/mol) vs -1.3% (-14mmol/mol), p=0.67. CONCLUSIONS In patients with type 2 diabetes, 6months liraglutide treatment was associated with a significant improvement in diastolic function.
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Affiliation(s)
- Fabio Saponaro
- Unit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Multimedica IRCCS, Milan, Italy
| | - Andrea Sonaglioni
- Unit of Cardiology, San Giuseppe Hospital, Multimedica IRCCS, Milan, Italy
| | - Antonio Rossi
- Unit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Multimedica IRCCS, Milan, Italy
| | - Laura Montefusco
- Unit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Multimedica IRCCS, Milan, Italy
| | - Michele Lombardo
- Unit of Cardiology, San Giuseppe Hospital, Multimedica IRCCS, Milan, Italy
| | - Guido Adda
- Unit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Multimedica IRCCS, Milan, Italy
| | - Maura Arosio
- Unit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Multimedica IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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Yao GH, Zhang M, Yin LX, Zhang C, Xu MJ, Deng Y, Liu Y, Deng YB, Ren WD, Li ZA, Tang H, Zhang QB, Mu YM, Fang LG, Zhang Y. Doppler Echocardiographic Measurements in Normal Chinese Adults (EMINCA): a prospective, nationwide, and multicentre study. Eur Heart J Cardiovasc Imaging 2015; 17:512-22. [DOI: 10.1093/ehjci/jev330] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/19/2015] [Indexed: 11/13/2022] Open
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The Short-Term Effects of Ketogenic Diet on Cardiac Ventricular Functions in Epileptic Children. Pediatr Neurol 2015; 53:233-237.e1. [PMID: 26302701 DOI: 10.1016/j.pediatrneurol.2015.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/15/2015] [Accepted: 06/11/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Our primary aim was to determine the short-term effects of a ketogenic diet on cardiac ventricular function in patients with refractory epilepsy. METHODS Thirty-eight drug-resistant epileptic patients who were treated with a ketogenic diet were enrolled in this prospective study. Echocardiography was performed on all patients before beginning the ketogenic diet and after the sixth month of therapy. Two-dimensional, M-mode, color flow, spectral Doppler, and pulsed-wave tissue Doppler imaging measurements were performed on all patients. RESULTS The median age of the 32 patients was 45.5 months, and 22 (57.8%) of them were male. Body weight, height, and body mass index increased significantly at the sixth month of therapy when compared with baseline values (P < 0.05). Baseline variables assessed by conventional M-mode echocardiography showed no significant difference at month 6 (P > 0.05). Doppler flow indices of mitral annulus and tricuspid annulus velocity of patients at baseline and month 6 showed no significant differences (P > 0.05). Tricuspid annular E/A ratio was lower at month 6 (P < 0.05). Although mitral annulus tissue Doppler imaging studies showed no significant difference (P > 0.05), there was a decrease in Ea velocity and Ea/Aa ratio gathered from tricuspid annulus at month 6 compared with baseline (P < 0.05). CONCLUSION A 6-month duration ketogenic diet does not impair left ventricular functions in children with refractory epilepsy; however, it may be associated with a right ventricular diastolic dysfunction.
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Echocardiographic Evaluation of Left Atrial Mechanics: Function, History, Novel Techniques, Advantages, and Pitfalls. BIOMED RESEARCH INTERNATIONAL 2015; 2015:765921. [PMID: 26236735 PMCID: PMC4508385 DOI: 10.1155/2015/765921] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 01/24/2015] [Accepted: 02/08/2015] [Indexed: 01/04/2023]
Abstract
Left atrial (LA) functional analysis has an established role in assessing left ventricular diastolic function. The current standard echocardiographic parameters used to study left ventricular diastolic function include pulsed-wave Doppler mitral inflow analysis, tissue Doppler imaging measurements, and LA dimension estimation. However, the above-mentioned parameters do not directly quantify LA performance. Deformation studies using strain and strain-rate imaging to assess LA function were validated in previous research, but this technique is not currently used in routine clinical practice. This review discusses the history, importance, and pitfalls of strain technology for the analysis of LA mechanics.
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9
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Effect of increasing age on the haemodynamic response to thoracic epidural anaesthesia. Eur J Anaesthesiol 2014; 31:597-605. [DOI: 10.1097/eja.0000000000000125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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10
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Predictors of improvement in diastolic function after transcatheter aortic valve implantation. J Echocardiogr 2014; 12:17-23. [PMID: 27278912 DOI: 10.1007/s12574-013-0195-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/21/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Aortic stenosis is associated with concentric left ventricle (LV) hypertrophy or remodeling resulting in impaired diastolic function and elevated left-sided filling pressure. We investigated the changes in LV geometry and LV filling hemodynamics, giving emphasis to parameters associated with changes in diastolic function after transcatheter aortic valve implantation (TAVI). METHODS Comprehensive diastolic assessment was performed before and six months after TAVI in 70 patients with severe aortic stenosis. Patients with any degree of mitral stenosis or >mild left-sided valvular regurgitation were excluded. RESULTS In the entire cohort six months after TAVI, LV end-diastolic diameter increased (44.1 ± 6 versus 45 ± 6 mm, P = 0.02), whereas LV mass and relative wall thickness (RWT) decreased (270.1 ± 76 versus 245.1 ± 75 g and 0.53 ± 0.15 versus 0.46 ± 0.1, respectively; P < 0.0001 for both). Lateral e' increased (5.8 ± 2 versus 6.6 ± 3 cm/s, P = 0.03) and left atrium (LA) volume, E/e' ratio, and systolic pulmonary pressure decreased (88.1 ± 30 versus 80 ± 28 cc, 18 ± 7.8 versus 16.3 ± 5.5, and 42.7 ± 14.9 versus 38.7 ± 12 mmHg, respectively; P < 0.05 for all), suggesting reduction in LA pressure. The improvement in LA volume and E/e' was almost exclusively seen in patients with LV hypertrophy before TAVI (P < 0.05 both), as opposed to patients with concentric remodeling. CONCLUSIONS In our preliminary study, TAVI resulted in LV and LA reverse remodeling, and improved LV relaxation and LA filling pressure in patients with severe aortic stenosis and concentric hypertrophy. Patients with concentric remodeling at baseline seem to have limited improvement in LV diastolic function and filling pressure following TAVI, but larger clinical trials would be required to conclude if they have no improvement at all.
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Kim HL, Zo JH, Seo JB, Chung WY, Kim YJ, Kim SH, Kim MA, Sohn DW. Additional value of lateral tissue Doppler imaging in the assessment of diastolic dysfunction among subjects with pseudonormal pattern of mitral inflow. Cardiovasc Ultrasound 2013; 11:31. [PMID: 23961879 PMCID: PMC3751783 DOI: 10.1186/1476-7120-11-31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/19/2013] [Indexed: 01/19/2023] Open
Abstract
Background There has been a lack of research on further stratification of subjects who have pseudonormal pattern of mitral inflow. The study aim was to clarify 2 different groups with different diastolic function grades among these subjects using lateral tissue Doppler imaging (TDI). Methods A total of 122 consecutive subjects showing pseudonormal pattern of mitral inflow (E/A ≥ 1 and septal e’/a’ < 1) without structural abnormality were prospectively recruited. TDI measurements were performed from both septal and lateral mitral annuli. Results Study subjects were stratified according to lateral TDI pattern (e’/a’ < 1 [n = 50] versus e’/a’ ≥ 1 [n = 72]). Subjects with lateral e’/a’ < 1 had higher values of left atrial volume index (LAVI) and E/e’ compared to those for lateral e’/a’ ≥ 1 (p < 0.001 for each). Among subjects with lateral e’/a’ ≥ 1, only 9.3% of subjects had grade II diastolic dysfunction, whereas among subjects with lateral e’/a’ < 1, majority of subjects (64.1%) had grade II diastolic dysfunction (p < 0.001). Multiple linear regression analysis showed that lateral e’/a’ was independently associated with LAVI (β = −0.484, p < 0.001), even after adjusting for potential confounders including age, sex, body mass index, hypertension and diabetes. Conclusions In subjects without structural abnormality showing E/A ≥ 1 and septal e’/a’ < 1, lateral TDI measurement is useful in the assessment of diastolic dysfunction. Lateral e’/a’ ≥ 1 is a valuable indicator of early diastolic dysfunction but not of advanced diastolic dysfunction in this population.
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Affiliation(s)
- Hack-Lyoung Kim
- Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul, Korea.
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Okada K, Mikami T, Kaga S, Onozuka H, Inoue M, Yokoyama S, Nishino H, Nishida M, Matsuno K, Iwano H, Yamada S, Tsutsui H. Early diastolic mitral annular velocity at the interventricular septal annulus correctly reflects left ventricular longitudinal myocardial relaxation. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:917-23. [DOI: 10.1093/ejechocard/jer154] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kim TS, Youn HJ. Role of echocardiography in atrial fibrillation. J Cardiovasc Ultrasound 2011; 19:51-61. [PMID: 21860717 PMCID: PMC3150696 DOI: 10.4250/jcu.2011.19.2.51] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/07/2011] [Accepted: 05/25/2011] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation (AF) is most common arrhythmia and its prevalence appears to be increasing as the population ages. Echocardiography can play a key role in risk stratification and management of patients with AF. Transthoracic echocardiography allows rapid and comprehensive assessment of cardiac anatomical structure and function. Pulmonary vein flow monitoring using echocardiography has the potential to an increasing role in the evaluation of cardiac function and AF ablation procedures. Transesophageal echocardiography also provides accurate information about the presence of a thrombus in the atria and thromboembolic risk. The novel technique of intracardiac echocardiography has emerged as a popular and useful tool in the everyday practice of interventional electrophysiology. Other imaging modalities, such as computed tomography and magnetic resonance imaging have complementary roles in risk stratification and assessment of patients with AF. Echocardiography continues to be the foundation of clinical evaluation and management of AF.
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Affiliation(s)
- Tae-Seok Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Luo C, Ramachandran D, Ware DL, Ma TS, Clark JW. Modeling left ventricular diastolic dysfunction: classification and key indicators. Theor Biol Med Model 2011; 8:14. [PMID: 21554684 PMCID: PMC3117805 DOI: 10.1186/1742-4682-8-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 05/09/2011] [Indexed: 01/07/2023] Open
Abstract
Background Mathematical modeling can be employed to overcome the practical difficulty of isolating the mechanisms responsible for clinical heart failure in the setting of normal left ventricular ejection fraction (HFNEF). In a human cardiovascular respiratory system (H-CRS) model we introduce three cases of left ventricular diastolic dysfunction (LVDD): (1) impaired left ventricular active relaxation (IR-type); (2) increased passive stiffness (restrictive or R-type); and (3) the combination of both (pseudo-normal or PN-type), to produce HFNEF. The effects of increasing systolic contractility are also considered. Model results showing ensuing heart failure and mechanisms involved are reported. Methods We employ our previously described H-CRS model with modified pulmonary compliances to better mimic normal pulmonary blood distribution. IR-type is modeled by changing the activation function of the left ventricle (LV), and R-type by increasing diastolic stiffness of the LV wall and septum. A 5th-order Cash-Karp Runge-Kutta numerical integration method solves the model differential equations. Results IR-type and R-type decrease LV stroke volume, cardiac output, ejection fraction (EF), and mean systemic arterial pressure. Heart rate, pulmonary pressures, pulmonary volumes, and pulmonary and systemic arterial-venous O2 and CO2 differences increase. IR-type decreases, but R-type increases the mitral E/A ratio. PN-type produces the well-described, pseudo-normal mitral inflow pattern. All three types of LVDD reduce right ventricular (RV) and LV EF, but the latter remains normal or near normal. Simulations show reduced EF is partly restored by an accompanying increase in systolic stiffness, a compensatory mechanism that may lead clinicians to miss the presence of HF if they only consider LVEF and other indices of LV function. Simulations using the H-CRS model indicate that changes in RV function might well be diagnostic. This study also highlights the importance of septal mechanics in LVDD. Conclusion The model demonstrates that abnormal LV diastolic performance alone can result in decreased LV and RV systolic performance, not previously appreciated, and contribute to the clinical syndrome of HF. Furthermore, alterations of RV diastolic performance are present and may be a hallmark of LV diastolic parameter changes that can be used for better clinical recognition of LV diastolic heart disease.
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Affiliation(s)
- Chuan Luo
- Dept, Electrical and Computer Engineering, Rice University, Houston, TX 77005, USA
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Shah AS, Khoury PR, Dolan LM, Ippisch HM, Urbina EM, Daniels SR, Kimball TR. The effects of obesity and type 2 diabetes mellitus on cardiac structure and function in adolescents and young adults. Diabetologia 2011; 54:722-30. [PMID: 21085926 PMCID: PMC4341988 DOI: 10.1007/s00125-010-1974-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 10/22/2010] [Indexed: 01/19/2023]
Abstract
AIMS/HYPOTHESIS We sought to evaluate the effects of obesity and obesity-related type 2 diabetes mellitus on cardiac geometry (remodelling) and systolic and diastolic function in adolescents and young adults. METHODS Cardiac structure and function were compared by echocardiography in participants who were lean, obese or obese with type 2 diabetes (obese diabetic), in a cross sectional study. Group differences were assessed using ANOVA. Independent determinants of cardiac outcome measures were evaluated with general linear models. RESULTS Adolescents with obesity and obesity-related type 2 diabetes were found to have abnormal cardiac geometry compared with lean controls (16% and 20% vs <1%, p < 0.05). These two groups also had increased systolic function. Diastolic function decreased from the lean to obese to obese diabetic groups with the lowest diastolic function observed in the obese diabetic group (p < 0.05). Regression analysis showed that group, BMI z score (BMIz), group × BMIz interaction and systolic BP z score (BPz) were significant determinants of cardiac structure, while group, BMIz, systolic BPz, age and fasting glucose were significant determinants of the diastolic function (all p < 0.05). CONCLUSIONS/INTERPRETATION Adolescents with obesity and obesity-related type 2 diabetes demonstrate changes in cardiac geometry consistent with cardiac remodelling. These two groups also demonstrate decreased diastolic function compared with lean controls, with the greatest decrease observed in those with type 2 diabetes. Adults with diastolic dysfunction are known to be at increased risk of progressing to heart failure. Therefore, our findings suggest that adolescents with obesity-related type 2 diabetes may be at increased risk of progressing to early heart failure compared with their obese and lean counterparts.
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Affiliation(s)
- A S Shah
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7012, Cincinnati, OH 45229, USA.
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Biner S, Rafique AM, Goykhman P, Morrissey RP, Naghi J, Siegel RJ. Prognostic Value of E/E′ Ratio in Patients With Unoperated Severe Aortic Stenosis. JACC Cardiovasc Imaging 2010; 3:899-907. [DOI: 10.1016/j.jcmg.2010.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 07/13/2010] [Accepted: 07/15/2010] [Indexed: 11/16/2022]
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Diastology 2010: clinical approach to diastolic heart failure. J Echocardiogr 2010; 8:65-79. [PMID: 27278797 DOI: 10.1007/s12574-010-0055-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 06/09/2010] [Accepted: 06/09/2010] [Indexed: 10/19/2022]
Abstract
The role of echocardiography in the evaluation of left ventricular diastolic function is increasingly important in both systolic and diastolic heart failure. In routine clinical practice, the diastolic dysfunction associated with diastolic heart failure can mainly be evaluated by Doppler echocardiography. In order to use echocardiographic techniques for this purpose, one should recognize the definition, terminology, epidemiology, and pathophysiology of diastolic dysfunction and diastolic heart failure. There are various echocardiographic parameters for this purpose, including transmitral flow velocity, pulmonary venous flow velocity, mitral annular velocity, flow propagation velocity, left atrial size, strain, strain rate, twist, and so on. However, no single Doppler echocardiographic index has yielded a robust criterion for diastolic dysfunction and elevated left ventricular filling pressure. Thus, multiple indices are required to increase the sensitivity of the diagnosis. Clinicians who take care of heart failure patients should continue to make critical use of a current Doppler echocardiographic evaluation and utilize this information to improve survival and quality of life in these patients.
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Zeybek C, Celebi A, Aktuglu-Zeybek C, Onal H, Yalcin Y, Erdem A, Akdeniz C, Imanov E, Altay S, Aydin A. The effect of low-carbohydrate diet on left ventricular diastolic function in obese children. Pediatr Int 2010; 52:218-23. [PMID: 19674355 DOI: 10.1111/j.1442-200x.2009.02940.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study was conducted to evaluate left ventricle (LV) functions using conventional and tissue Doppler imaging in childhood obesity and to identify the effects of diet on LV diastolic functions. METHODS Conventional and tissue Doppler echocardiographic measurements were compared in 34 obese children and 24 age- and gender-matched lean controls. Fasting plasma glucose, insulin and homeostatic model assessment of insulin resistance levels were also obtained. Thirty-one of the obese children were subjected to a low-carbohydrate diet and their follow-up measurements were obtained after 6 months. RESULTS Left atrial diameter, LV mass and LV mass index were higher in obese children than in lean controls. Lateral mitral myocardial early diastolic (E(m)) and peak E(m)/myocardial late diastolic (A(m)) were lower, and mitral E/E(m) and lateral mitral myocardial isovolumetric relaxation time were higher in obese subjects than in lean controls. Insulin and homeostatic model assessment of insulin resistance levels were higher in obese patients and decreased significantly after diet. After diet therapy, lateral mitral E(m) and peak E(m)/A(m), were increased, mitral E/E(m) and myocardial isovolumetric relaxation time were decreased. CONCLUSIONS Obesity predisposes children to increased preload reserve, left ventricular subclinical diastolic dysfunction and deterioration in diastolic filling. Weight reduction with a low-carbohydrate diet seems to be associated with significant improvement in LV diastolic function and a decrease in diastolic filling, as well as causing reversal in insulin resistance seen in obese children.
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Affiliation(s)
- Cenap Zeybek
- Pediatric Cardiology Clinic, Siyami Ersek Cardiovascular Training and Research Hospital, Istanbul, Turkey.
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Ejection time-corrected systolic velocity improves accuracy in the evaluation of myocardial dysfunction: a study in piglets. Pediatr Cardiol 2010; 31:1070-8. [PMID: 20721662 PMCID: PMC2948161 DOI: 10.1007/s00246-010-9767-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 07/26/2010] [Indexed: 10/31/2022]
Abstract
This study aimed to assess the effect of correcting for the impact of heart rate (HR) or ejection time (ET) on myocardial velocities in the long axis in piglets undergoing hypoxia. The ability to eject a higher volume at a fixed ET is a characteristic of contractility in the heart. Systolic velocity of the atrioventricular annulus displacement is directly related to volume changes of the ventricle. Both ET and systolic velocity may be measured in a single heartbeat. In 29 neonatal pigs, systolic velocity and ET were measured with tissue Doppler techniques in the mitral valve annulus, the tricuspid valve annulus, and the septum. All ejection time corrected velocities (S((ET)), mean ± SEM, cm/s) decreased significantly during hypoxia (S(mva(ET)) 15.5 ± 0.2 to 13.2 ± 0.3 (p < 0.001), S(septal(ET)) 9.9 ± 0.1 to 7.8 ± 0.2 (p < 0.001), S(tva(ET)) 12.1 ± 0.2 to 9.8 ± 0.3 (p < 0.001)). The magnitude of change from baseline to hypoxia was greater for ejection time corrected systolic velocities than for RR-interval corrected velocities (mean ± SEM, cm/s); ΔS(mva(ET)) 2.3 ± 2.0 vs. ΔS(mva(RR)) 1.6 ± 1.1 (p = 0.02), ΔS(septal(ET)) 2.1 ± 1.0 vs. ΔS(septal(RR)) 1.6 ± 1.0 (p < 0.01), ΔS(tva(ET)) 2.3 ± 1.1 vs. ΔS(tva(RR)) 1.8 ± 1.3 (p = 0.04). The receiver operator characteristic (ROC) showed superior performance of S((ET)) compared with uncorrected velocities. The decrease in S((ET)) during hypoxia was not influenced by important hemodynamic determinants. ET-corrected systolic velocity improves accuracy and decreases variability in the evaluation of systolic longitudinal function and contractility during global hypoxia in neonatal pigs compared with systolic velocity alone. It is robust toward hemodynamic changes. This novel method has the potential of becoming a useful tool in clinical practice.
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Gul K, Celebi AS, Kacmaz F, Ozcan OC, Ustun I, Berker D, Aydin Y, Delibasi T, Guler S, Barazi AO. Tissue Doppler imaging must be performed to detect early left ventricular dysfunction in patients with type 1 diabetes mellitus. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:841-6. [DOI: 10.1093/ejechocard/jep086] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Gabriel RS, Klein AL. Modern evaluation of left ventricular diastolic function using Doppler echocardiography. Curr Cardiol Rep 2009; 11:231-8. [DOI: 10.1007/s11886-009-0033-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Costanzo P, Prastaro M, Perrino C, Caiazzo G, Monda C, Guerra G, Iorio A, Gargiulo P, Chiariello M, Perrone-Filardi P. Differences in Echocardiographic Assessment with Standard Doppler and Tissue Doppler Imaging of Left Ventricular Filling Pressure in Idiopathic and Ischemic Dilated Cardiomyopathy. Echocardiography 2008; 25:683-91. [DOI: 10.1111/j.1540-8175.2008.00687.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Al-Omari MA, Finstuen J, Appleton CP, Barnes ME, Tsang TS. Echocardiographic assessment of left ventricular diastolic function and filling pressure in atrial fibrillation. Am J Cardiol 2008; 101:1759-65. [PMID: 18549855 DOI: 10.1016/j.amjcard.2008.02.067] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 02/13/2008] [Accepted: 02/13/2008] [Indexed: 10/22/2022]
Abstract
Diastolic dysfunction has been linked to 2 epidemics: atrial fibrillation (AF) and heart failure. The presence and severity of diastolic dysfunction are associated with an increased risk for first AF and first heart failure in patients with sinus rhythm. Furthermore, the risk for heart failure is markedly increased once AF develops. The evaluation of diastolic function once AF has developed remains a clinical challenge. The conventional use of Doppler echocardiography for the assessment and grading of diastolic dysfunction relies heavily on evaluating the relation of ventricular and atrial flow characteristics. The mechanical impairment of the left atrium and the variable cycle lengths in AF render the evaluation of diastolic function difficult. A few Doppler echocardiographic methods have been proved clinically useful for the estimation of diastolic left ventricular filling pressures in AF, but these appear to be underutilized. Several innovative methods are emerging that promise to provide greater precision in diastolic function assessment, but their clinical utility in AF remains to be established. In conclusion, this review provides an up-to-date discussion of the evaluation of diastolic function assessment in AF and how it may be important in the clinical management of patients with AF.
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Arteaga RB, Hreybe H, Patel D, Landolfo C. Derivation and validation of a diagnostic model for the evaluation of left ventricular filling pressures and diastolic function using mitral annulus tissue Doppler imaging. Am Heart J 2008; 155:924-9. [PMID: 18440343 DOI: 10.1016/j.ahj.2007.11.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 11/30/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Several modalities to diagnose diastolic dysfunction by transthoracic echocardiography (TTE) exist. We compared the ratio of early mitral filling velocity (E) to early diastolic velocity by tissue Doppler imaging at the medial (E/E'm) and the lateral (E/E'l) mitral annulus and developed a model to diagnose elevated left ventricular end-diastolic pressure (LVEDP). METHODS Sixty patients underwent same-day cardiac catheterization and TTE. Left ventricular end-diastolic pressure was recorded in addition to TTE data, including left atrial area (LAA), E/E'm, and E/E'l. An LVEDP >15 mm Hg was considered to be elevated and diagnostic of diastolic dysfunction. RESULTS E/E'm had a significantly higher correlation (r = 0.68, P < .001) than did E/E'l (r = 0.46, P < .001). By univariate analysis, LAA >18.75 cm(2), E/E'l >11.2, and E/E'm >15.75 were found to be significant predictors of high LV filling pressure. By multivariate binary logistic regression model analysis, only E/E'm and LAA were independent predictors of LVEDP >15 mm Hg. The presence of 1 variable had a sensitivity of 95% and a specificity of 43.4%, whereas the presence of 2 variables had a sensitivity of 76.2% and a specificity of 100%. CONCLUSIONS Use of a diagnostic model based on easily derived measurements such as E/E'm and LAA was a powerful noninvasive diagnostic modality for elevated LVEDP. Measurement of the mitral annulus velocity by tissue Doppler imaging at the medial aspect of the mitral valve appeared to be superior to that at the lateral aspect.
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Kim H, Cho YK, Jun DH, Nam CW, Han SW, Hur SH, Kim YN, Kim KB. Prognostic Implications of the NT-ProBNP Level and Left Atrial Size in Non-Ischemic Dilated Cardiomyopathy. Circ J 2008; 72:1658-65. [DOI: 10.1253/circj.cj-07-1087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Dong-Hwan Jun
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Seong-Wook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Yoon-Nyun Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Kwon-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
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Park HS, Naik SD, Aronow WS, Ahn CW, McClung JA, Belkin RN. Age- and Sex-Related Differences in the Tissue Doppler Imaging Parameters of Left Ventricular Diastolic Dysfunction. Echocardiography 2007; 24:567-71. [PMID: 17584195 DOI: 10.1111/j.1540-8175.2007.00434.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The effect of age and gender on tissue Doppler imaging measurements comparing the septal and mitral annulus needs to be investigated. METHODS We investigated in 276 outpatients in a university cardiology practice the relationship of age and gender to left atrial (LA) size, LA volume, mitral pulse-wave Doppler E/A ratio, E/Ea ratios by tissue Doppler image of mitral annular velocity (TDI), and left ventricular diastolic dysfunction (LVDD) by TDI. RESULTS Mitral E/A inflow was statistically decreased with age. E/Ea ratios of the lateral and mean of both lateral and septal annulus showed a statistical increase with age, while the E/Ea ratio of the septal annulus did not correlate with age. When comparing men and women of all ages, the mean LA volume for men was 59.2 cm3 +/- 24.36 cm3 versus 48.54 cm3 +/- 16.14 cm3 (P-value < 0.0001) and the mean LA size was 4.0 + 0.51 cm for men and 3.65 + 0.47 for women (P-value < 0.0001). There was no statistical difference between men and women when looking at mitral E/A inflow ratio, deceleration time, E/Ea ratio of the septal annulus, E/Ea ratio of the lateral annulus, E/Ea ratio of the mean of both septal and lateral annulus, and grades of LVDD. CONCLUSION In patients 70 years of age or older, the mean diastolic grade was mild-to-moderate LVDD when using lateral or mean of septal and lateral annular measurements. When only the septal annular measurements were used to determine diastolic grade, all four age groups showed a mean of mildly to moderately impaired LVDD and showed no correlation with age. There were no differences in tissue Doppler imaging measurements between men and women.
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Affiliation(s)
- Hyeun S Park
- Department of Medicine, Cardiology Division, New York Medical College, Valhalla, New York 10595, USA
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