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PloS One 2019Left ventricular diastolic dysfunction (LVDD) is present in more than 50% of patients suffering from heart failure. LVDD animal models are limited and its underlying...
BACKGROUND
Left ventricular diastolic dysfunction (LVDD) is present in more than 50% of patients suffering from heart failure. LVDD animal models are limited and its underlying mechanisms remain largely unknown. Aortic valve stenosis (AVS) may cause LVDD, and we recently reported LVDD in an AVS rabbit model. Here we aimed to develop a rabbit model of LVDD without AVS.
METHODS
Rabbits were fed with a 0.5% cholesterol-enriched diet (n = 9) or normal diet (n = 8) until they developed LVDD defined by a value of the echocardiographic parameter E/Em ratio higher than the mean at baseline + 2SD. Rabbits were then fed a 0.2% cholesterol-enriched diet for 4 weeks (average total diet duration: 20 weeks). Detailed cardiac structure and function measurements were assessed by echocardiography at baseline, weeks 8, 12 and 14 to 20, when applicable. Histological analyses and RT-qPCR were performed on LV samples.
RESULTS
The hypercholesterolemic diet induced LVDD without systolic dysfunction or AVS, as shown by multiple echocardiographic parameters, including early filling mitral peak velocity and deceleration rate, Em/Am ratio and E/Em ratio (all p<0.05), and by increased cardiac mRNA expression of brain natriuretic peptide (Bnp). Cardiac expression of mRNA for Nox2, Vcam1, Mmp12, Mmp12/Timp1, Il1b and Col1/Col3 ratios was also higher in these rabbits (p<0.05). In contrast, cardiac Sod2 mRNA expression was reduced in hypercholesterolemic rabbits compared to controls.
CONCLUSION
Rabbits fed with a cholesterol-enriched diet develop LVDD with preserved systolic function and evidence of cardiac inflammation and oxidative stress. This rabbit model may be used in future studies to test treatment strategies against LVDD.
Topics: Animals; Cholesterol; Disease Models, Animal; Echocardiography; Heart Failure, Diastolic; Hypercholesterolemia; Inflammation; Oxidative Stress; Rabbits; Ventricular Dysfunction, Left
PubMed: 31393963
DOI: 10.1371/journal.pone.0220707 -
Ultrasound in Obstetrics & Gynecology :... Aug 2021Gestational diabetes mellitus (GDM) is associated with premature cardiovascular disease and adverse cardiovascular outcome in the mother. Subclinical cardiac functional...
OBJECTIVES
Gestational diabetes mellitus (GDM) is associated with premature cardiovascular disease and adverse cardiovascular outcome in the mother. Subclinical cardiac functional changes in the left ventricle have been reported during pregnancy in women with GDM using conventional echocardiography, but results are inconsistent. The aims of the current study were to assess whether GDM is associated with biventricular systolic dysfunction in the mother and whether these cardiac changes can be detected using the novel echocardiographic modalities of strain imaging and three-dimensional (3D) echocardiography.
METHODS
This was a cross-sectional study in women with GDM and controls examined at 26-40 weeks of gestation. All women underwent echocardiography, and 3D volumes of the left and right ventricles and left atrium were collected. Ejection fraction and left ventricular mass were measured using 3D echocardiography. Left ventricular mass was indexed to body surface area. Speckle-tracking echocardiography was used to assess global longitudinal strain of the left and right ventricles and strain of the left atrium.
RESULTS
The study population included 123 women with GDM and 246 controls. Women with GDM, compared to controls, were older (35.1 ± 5.2 vs 32.4 ± 5.5 years; P < 0.001), had higher body mass index (30.6 (interquartile range (IQR), 26.2-35.2) vs 27.5 (IQR, 24.7-30.7) kg/m ; P < 0.001) and had higher systolic blood pressure (119.9 ± 11.2 vs 116.4 ± 12.0 mmHg; P = 0.007). In all women with GDM, there was good glycemic control. In women with GDM, compared to controls, there was lower global longitudinal strain of the left ventricle (-19.3% (IQR, -21.4 to -17.6%) vs -20.1% (IQR, -22.1 to -18.7%); P = 0.002) and right ventricle (-22.2% (IQR, -26.1 to -19.8%) vs -24.1% (IQR, -27.0 to -21.9%); P < 0.001). There was no significant difference between the groups in ejection fraction, left ventricular mass, diastolic function assessed by left atrial strain, or 3D functional indices.
CONCLUSIONS
Women with GDM, compared to women with uncomplicated pregnancy, have lower left and right ventricular myocardial deformation. Volumetric assessment using 3D echocardiography does not provide additional information about maternal cardiac function. Strain imaging is a sensitive echocardiographic modality to detect early cardiac functional changes in women with GDM. Further studies are needed to assess the pattern of deterioration of cardiac function with advancing age in women with a history of GDM. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Adult; Cardiomyopathies; Cross-Sectional Studies; Diabetes, Gestational; Echocardiography, Three-Dimensional; Female; Humans; Pregnancy; Ultrasonography, Prenatal; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 33949740
DOI: 10.1002/uog.23666 -
Clinics in Chest Medicine Mar 2021The right ventricle is coupled to the low-pressure pulmonary circulation. In pulmonary vascular diseases, right ventricular (RV) adaptation is key to maintain... (Review)
Review
The right ventricle is coupled to the low-pressure pulmonary circulation. In pulmonary vascular diseases, right ventricular (RV) adaptation is key to maintain ventriculoarterial coupling. RV hypertrophy is the first adaptation to diminish RV wall tension, increase contractility, and protect cardiac output. Unfortunately, RV hypertrophy cannot be sustained and progresses toward a maladaptive phenotype, characterized by dilation and ventriculoarterial uncoupling. The mechanisms behind the transition from RV adaptation to RV maladaptation and right heart failure are unraveled. Therefore, in this article, we explain the main traits of each phenotype, and how some early beneficial adaptations become prejudicial in the long-term.
Topics: Animals; Heart Ventricles; Humans; Hypertrophy, Right Ventricular; Mice; Rats; Ventricular Dysfunction, Right
PubMed: 33541611
DOI: 10.1016/j.ccm.2020.11.010 -
Pediatric Cardiology Jan 2021Infants with aortic coarctation may present with left ventricular (LV) dysfunction which may complicate the postoperative course and lead to increased healthcare costs....
Infants with aortic coarctation may present with left ventricular (LV) dysfunction which may complicate the postoperative course and lead to increased healthcare costs. We aimed to define the prevalence of moderate to severe left ventricular (LV) systolic dysfunction, evaluate time to recovery, and compare health care costs. Single-center retrospective cohort study at a tertiary care hospital was conducted. Infants < 6 months old at diagnosis with aortic coarctation were identified using surgical codes for coarctation repair between January 2010 and May 2018. Moderate to severe dysfunction was defined as ejection fraction (EF) < 40%. Of 160 infants studied, 18 (11%) had moderate to severe LV dysfunction at presentation. Compared to those with better LV function, infants with moderate to severe LV dysfunction were older at presentation (12 vs. 6 days, p = 0.004), had more postoperative cardiac intensive care unit (ICU) days (5 vs. 3, p < 0.001), and more ventilator days (3.5 vs. 1, p < 0.001). The median time to normal LV EF (≥ 55%) was 6 days postoperatively (range 1-230 days). Infants presenting with moderate to severe LV dysfunction had higher index hospitalization costs ($90,560 vs. $59,968, p = 0.02), but no difference in cost of medical follow-up for the first year following discharge ($3,078 vs. $2,568, p = 0.46). In the current era, > 10% of infants with coarctation present with moderate to severe LV dysfunction that typically recovers. Those with moderate to severe dysfunction had longer duration of mechanical ventilation and postoperative cardiac ICU stays, likely driving higher costs of index hospitalization.
Topics: Aortic Coarctation; Female; Hospitalization; Humans; Infant; Intensive Care Units; Male; Postoperative Complications; Prevalence; Respiration, Artificial; Retrospective Studies; Stroke Volume; Time Factors; Vascular Surgical Procedures; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 33005984
DOI: 10.1007/s00246-020-02455-3 -
Circulation Journal : Official Journal... May 2022Chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) are characterized by elevated pulmonary arterial pressure resulting in...
BACKGROUND
Chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH) are characterized by elevated pulmonary arterial pressure resulting in right heart failure. Right ventricular (RV) dyssynchrony may be associated with early-stage RV dysfunction; however, the differences in RV dyssynchrony between CTEPH and PAH and the factors contributing to RV dyssynchrony remain unclear.Methods and Results: Forty-four patients (CTEPH, 26; PAH, 18) were enrolled in this study. RV dyssynchrony was assessed by determining the standard deviation of the intervals from the peak QRS to peak systolic strain for 6 segments of the RV free and septal wall by using 2-dimensional speckle-tracking echocardiography (RV-6SD). The RV-6SD, pulmonary hemodynamics, echocardiographic findings, and patient demographics in CTEPH and PAH patients were compared and their correlations with RV-6SD were investigated. CTEPH patients were older and had significantly higher pulse pressure of the pulmonary artery (PP), tricuspid valve regurgitation pressure gradient, and RV-6SD, and lower pulmonary arterial compliance (PAC), despite showing comparable pulmonary arterial pressures. Age-adjusted multiple logistic analysis showed that RV-6SD and PAC were predictors of CTEPH rather than PAH. RV-SD6 was positively correlated with PP and RV dimension and negatively correlated with PAC.
CONCLUSIONS
CTEPH patients showed more evident RV dyssynchrony than PAH patients. Low PAC and a widened PP may delay RV free wall motion and cause RV dyssynchrony.
Topics: Familial Primary Pulmonary Hypertension; Heart Ventricles; Humans; Hypertension, Pulmonary; Pulmonary Arterial Hypertension; Pulmonary Artery; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 35283366
DOI: 10.1253/circj.CJ-21-0849 -
Clinical Research in Cardiology :... Oct 2023Fibroblast growth factor 23 (FGF-23) has been associated with left ventricular hypertrophy (LVH) and heart failure. However, its role in right ventricular (RV)... (Observational Study)
Observational Study
BACKGROUND
Fibroblast growth factor 23 (FGF-23) has been associated with left ventricular hypertrophy (LVH) and heart failure. However, its role in right ventricular (RV) remodeling and RV failure is unknown. This study analyzed the utility of FGF-23 as a biomarker of RV function in patients with pulmonary hypertension (PH).
METHODS
In this observational study, FGF-23 was measured in the plasma of patients with PH (n = 627), dilated cardiomyopathy (DCM, n = 59), or LVH with severe aortic stenosis (n = 35). Participants without LV or RV abnormalities served as controls (n = 36).
RESULTS
Median FGF-23 plasma levels were higher in PH patients than in healthy controls (p < 0.001). There were no significant differences between PH, DCM, and LVH patients. Analysis across tertiles of FGF-23 levels in PH patients revealed an association between higher FGF-23 levels and higher levels of NT-proBNP and worse renal function. Furthermore, patients in the high-FGF-23 tertile had a higher pulmonary vascular resistance (PVR), mean pulmonary artery pressure, and right atrial pressure and a lower cardiac index (CI) than patients in the low tertile (p < 0.001 for all comparisons). Higher FGF-23 levels were associated with higher RV end-diastolic diameter and lower tricuspid annular plane systolic excursions (TAPSE) and TAPSE/PASP. Receiver operating characteristic analysis revealed FGF-23 as a good predictor of RV maladaptation, defined as TAPSE < 17 mm and CI < 2.5 L/min/m. Association of FGF-23 with parameters of RV function was independent of the glomerular filtration rate in regression analysis.
CONCLUSION
FGF-23 may serve as a biomarker for maladaptive RV remodeling in patients with PH.
Topics: Humans; Hypertension, Pulmonary; Ventricular Dysfunction, Right; Fibroblast Growth Factor-23; Biomarkers; Heart Failure; Ventricular Function, Right
PubMed: 36790465
DOI: 10.1007/s00392-023-02162-y -
Reviews in Cardiovascular Medicine Dec 2020To investigate the right heart function in coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome (ARDS), a retrospective analysis of 49...
To investigate the right heart function in coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome (ARDS), a retrospective analysis of 49 COVID-19 patients with ARDS was performed. Patients were divided into severe group and critically-severe group according to the severity of illness. Age-matched healthy volunteers were recruited as a control group. The cardiac cavity diameters, tricuspid annular plane systolic excursion (TAPSE), tricuspid valve regurgitation pressure gradient biggest (TRPG), pulmonary arterial systolic pressure (PASP), maximum inferior vena cava diameter (IVCmax) and minimum diameter (IVCmin), and inferior vena cava collapse index (ICV-CI) were measured using echocardiography. We found that the TAPSE was significantly decreased in pneumonia patients compared to healthy subjects (P < 0.0001), and it was significantly lower in critically-severe patients (P = 0.0068). The TAPSE was less than 17 mm in three (8.6%) severe and five (35.7%) critically-severe patients. In addition, the TAPSE was significantly decreased in severe ARDS patients than in mild ARDS patients. The IVCmax and IVCmin were significantly increased in critically-severe patients compared to healthy subjects and severe patients (P < 0.01), whereas the ICV-CI was significantly decreased (P < 0.05). COVID-19 patients had significantly larger right atrium and ventricle than healthy controls (P < 0.01). The left ventricular ejection fraction (LVEF) in critically-severe patients was significantly lower than that in severe patients and healthy controls (P < 0.05). Right ventricular function was impaired in critically-severe COVID-19 patients. The assessment and protection of the right heart function in COVID-19 patients should be strengthened.
Topics: COVID-19; Echocardiography, Doppler; Female; Follow-Up Studies; Heart Ventricles; Humans; Male; Middle Aged; Pandemics; Retrospective Studies; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 33388009
DOI: 10.31083/j.rcm.2020.04.159 -
Journal of the American Heart... May 2024Coronary microvascular dysfunction (CMD) is a common complication of ST-segment-elevation myocardial infarction (STEMI) and can lead to adverse cardiovascular events.... (Observational Study)
Observational Study
BACKGROUND
Coronary microvascular dysfunction (CMD) is a common complication of ST-segment-elevation myocardial infarction (STEMI) and can lead to adverse cardiovascular events. Whether CMD after STEMI is associated with functional left ventricular remodeling (FLVR) and diastolic dysfunction, has not been investigated.
METHODS AND RESULTS
This is a nonrandomized, observational, prospective study of patients with STEMI with multivessel disease. Coronary flow reserve and index of microcirculatory resistance of the culprit vessel were measured at 3 months post-STEMI. CMD was defined as index of microcirculatory resistance ≥25 or coronary flow reserve <2.0 with a normal fractional flow reserve. We examined the association between CMD, LV diastolic dysfunction, FLVR, and major adverse cardiac events at 12-month follow-up. A total of 210 patients were enrolled; 59.5% were men, with a median age of 65 (interquartile range, 58-76) years. At 3-month follow-up, 57 patients (27.14%) exhibited CMD. After 12 months, when compared with patients without CMD, patients with CMD had poorer LV systolic function recovery (-10.00% versus 8.00%; <0.001), higher prevalence of grade 2 LV diastolic dysfunction (73.08% versus 1.32%; <0.001), higher prevalence of group 3 or 4 FLVR (11.32% versus 7.28% and 22.64% versus 1.99%, respectively; <0.001), and higher incidence of major adverse cardiac events (50.9% versus 9.8%; <0.001). Index of microcirculatory resistance was independently associated with LV diastolic dysfunction and adverse FLVR.
CONCLUSIONS
CMD is present in ≈1 of 4 patients with STEMI during follow-up. Patients with CMD have a higher prevalence of LV diastolic dysfunction, adverse FLVR, and major adverse cardiac events at 12 months compared with those without CMD.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique Identifier: NCT05406297.
Topics: Humans; Male; Female; Middle Aged; Ventricular Remodeling; Ventricular Dysfunction, Left; Aged; Microcirculation; Prospective Studies; Diastole; ST Elevation Myocardial Infarction; Ventricular Function, Left; Coronary Circulation; Fractional Flow Reserve, Myocardial
PubMed: 38686863
DOI: 10.1161/JAHA.123.033596 -
Annals of Noninvasive Electrocardiology... Nov 2022Since the last century, the electrocardiogram (ECG) remains the non-invasive test, that is, most easily accessible, feasible, and inexpensive for cardiology assessment.... (Review)
Review
Subtle QRS changes are associated with reduced ejection fraction, diastolic dysfunction, and heart failure development and therapy responsiveness: Applications for artificial intelligence to ECG.
BACKGROUND
Since the last century, the electrocardiogram (ECG) remains the non-invasive test, that is, most easily accessible, feasible, and inexpensive for cardiology assessment. In past years, many novel ECG indexes and patterns have been published that allow for a more advanced evaluation of what is currently being done, especially based on subtle QRS changes and patterns.
OBJECTIVE
The objective of the study was to provide an update on the evidence and clinical applications of these ECG subtle QRS changes and patterns associated with heart disease.
METHODS
Through the literature review, we will highlight the subtle QRS changes and patterns associated with heart disease, mainly focusing on QRS duration, voltage, morphology, axis, and QT interval.
RESULTS
Small increases in QRS duration are associated with a reduction in left ventricular ejection fraction (EF), increased cardiac chamber dimensions, and risk for incident heart failure (HF). Moreover, fragmentation of the QRS complex is associated with myocardial fibrosis and is a substrate for developing arrhythmic events. Besides, low amplitude QRS voltage is associated with congestive HF, and an increase in the voltage of the QRS complexes is associated with the effectiveness of diuresis treatment. Furthermore, small increases in QT interval are associated with diastolic dysfunction due to impaired sarcoplasmic reticulum calcium handling as occurs in myocardial ischemia, hypertension, or diabetes. On the other hand, in patients with left ventricular dysfunction, the QRS area is associated with clinical and echocardiographic response to cardiac resynchronization therapy regardless of the type of bundle branch block. In addition, subtle ECG changes and patterns in the left bundle branch block are associated with concomitant right ventricular dilation, mostly based on the QRS axis and voltage. Notwithstanding, to identify these subtle changes in QRS require exact manual measurements that can take time. In this regard, applying artificial intelligence (AI) to the ECG can make a quicker and more complete assessment, as well as provide a low cost when applied to large populations.
CONCLUSION
We provided an update on the evidence and clinical applications of these subtle QRS changes and patterns associated with diastolic dysfunction, reduced EF, and HF development and therapy responsiveness, as well as their applications for AI to ECG.
Topics: Humans; Stroke Volume; Electrocardiography; Ventricular Function, Left; Artificial Intelligence; Heart Failure; Bundle-Branch Block; Ventricular Dysfunction, Left; Arrhythmias, Cardiac
PubMed: 35904538
DOI: 10.1111/anec.12998 -
Clinical Research in Cardiology :... Apr 2022Left ventricular diastolic dysfunction (DD), a common finding in the general population, is considered to be associated with heart failure with preserved ejection...
AIM
Left ventricular diastolic dysfunction (DD), a common finding in the general population, is considered to be associated with heart failure with preserved ejection faction (HFpEF). Here we evaluate the prevalence and correlates of DD in subjects with and without HFpEF in a middle-aged sample of the general population.
METHODS AND RESULTS
From the first 10,000 participants of the population-based Hamburg City Health Study (HCHS), 5913 subjects (mean age 64.4 ± 8.3 years, 51.3% females), qualified for the current analysis. Diastolic dysfunction (DD) was identified in 753 (12.7%) participants. Of those, 11.2% showed DD without HFpEF (ALVDD) while 1.3% suffered from DD with HFpEF (DDwHFpEF). In multivariable regression analysis adjusted for major cardiovascular risk factors, ALVDD was associated with arterial hypertension (OR 2.0, p < 0.001) and HbA1c (OR 1.2, p = 0.007). Associations of both ALVDD and DDwHFpEF were: age (OR 1.7, p < 0.001; OR 2.7, p < 0.001), BMI (OR 1.2, p < 0.001; OR 1.6, p = 0.001), and left ventricular mass index (LVMI). In contrast, female sex (OR 2.5, p = 0.006), atrial fibrillation (OR 2.6, p = 0.024), CAD (OR 7.2, p < 0.001) COPD (OR 3.9, p < 0.001), and QRS duration (OR 1.4, p = 0.005) were strongly associated with DDwHFpEF but not with ALVDD.
CONCLUSION
The prevalence of DD in a sample from the first 10,000 participants of the population-based HCHS was 12.7% of whom 1.3% suffered from HFpEF. DD with and without HFpEF showed significant associations with different major cardiovascular risk factors and comorbidities warranting further research for their possible role in the formation of both ALVDD and DDwHFpEF.
Topics: Aged; Female; Heart Failure; Humans; Male; Middle Aged; Prevalence; Stroke Volume; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 34269862
DOI: 10.1007/s00392-021-01907-x