Coexistence of left ventricular (LV) longitudinal myocardial systolic dysfunction with LV diastolic dysfunction could lead to heart failure with preserved ejection fraction (HFpEF). Diabetes mellitus (DM) is known as a significant factor associated with HFpEF. Although the mechanisms of DM-related LV myocardial injury are complex, it has been postulated that overweight contributes to the development of LV myocardial injury in type 2 diabetes mellitus (T2DM) patients. However, the precise impact of overweight on LV longitudinal myocardial systolic function in T2DM patients remains unclear. We studied 145 asymptomatic T2DM patients with preserved LV ejection fraction (LVEF) without coronary artery disease. LV longitudinal myocardial systolic function was assessed by global longitudinal strain (GLS), which was defined as the average peak strain of 18-segments obtained from standard apical views. Overweight was defined as body mass index (BMI) ≥ 25 kg/m2. Ninety age-, gender- and LVEF-matched healthy volunteers served as controls. GLS of overweight T2DM patients was significantly lower than that of non-overweight patients (17.9 ± 2.4% vs. 18.9 ± 2.6%, p < 0.05), whereas GLS of both overweight and non-overweight controls was similar (19.8 ± 1.3% vs. 20.4 ± 2.1%, p = 0.38). Furthermore, multiple regression analysis revealed that for T2DM patients, BMI was the independent determinant parameters for GLS as well as LV mass index. Overweight has a greater effect on LV longitudinal myocardial systolic function in T2DM patients than on that in non-DM healthy subjects. Our finding further suggests that the strict control of overweight in T2DM patients may be associated with prevention of the development of HFpEF.
Background: Although right ventricular (RV) pacing is the only effective treatment for patients with symptomatic atrioventricular block, it creates left ventricular (LV) mechanical dyssynchrony, which can induce LV dysfunction and heart failure. Current criterion for consideration of cardiac resynchronization therapy (CRT) is LV ejection fraction (LVEF) ≤35%, but indication for CRT in patients required for RV pacing with LVEF >35% remains uncertain. Methods: We studied 35 consecutive patients with LVEF of 51±9% (all≥35%) who had undergone implantable cardioverter-defibrillator implantation (RV pacing <5%). Echocardiography was performed at baseline and during RV pacing. LV dyssynchrony was determined by the anteroseptal-to-posterior wall delay from mid-LV short-axis view using two-dimensional speckle-tracking radial strain (≥130ms as significant). Patients were divided into two groups based on baseline LVEF: preserved LVEF≥50% (n=19) and mildly reduced LVEF of 35-50% (n=16). Results: LV dyssynchrony in patients with mildly reduced LVEF was significantly worsened during RV pacing compared to that in patients with preserved LVEF (from 86.0±103.9ms to 214.6±132.1ms vs. from 21.7±29.0ms to 65.6±90.9ms, p=0.01). Furthermore, the prevalence of significant LV dyssynchrony during RV pacing in patients with mildly reduced LVEF was significantly higher than that in patients with preserved LVEF (68% vs. 16%, p<0.01). LVEF in patients with mildly reduced LVEF was also significantly worsened during RV pacing compared to that in patients with preserved LVEF (from 42.8±4.6% to 37.6±6.8% vs. from 58.3±5.7% to 57.9±6.9%, p<0.01). Conclusions: The amount of RV pacing-induced LV dysfunction may be associated with baseline LV function. Thus, these adverse effects in patients with mildly reduced LVEF of 35-50% and indications for RV pacing owing to bradycardia can be prevented by CRT.
Aim:The aim of this multicentric study was to assess the relationship between HCV infection and some traditional cardiovascular risk factors (CRF) and its predictive value and cardiovascular complications (CC) in thalassemia major (TM) patients.Methods: We considered 827 TM patients (435 F) consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network.At the baseline assessment mean age of the patients, all free of CC, was 29.65±8.89years and a categorization in 4 groups was performed: negative patients (group 0), patients who spontaneously cleared HCV (group 1), patients who eradicated the virus after treatment with antiviral therapy attaining a sustained virological response-SVR (group 2), and patients with chronic HCV infection (group 3).Results: Patients in group 0 were significantly younger than patients in all the other three groups (P<0.0001) and had a significant lower frequency of diabetes than patients in group 3 (3.6%vs 11.0%; P=0.006).Patients were followed-up for 79.53±28.71months and 84 cardiovascular events (42 arrhythmias, 29 heart failure, and 13 vascular diseases) were registered.Table 1 shows the results of the univariate Cox regression analysis.Patients with chronic HCV infection had a significant higher risk of developing CC than negative patients.
Background: The development of right ventricular (RV) dysfunction in patients with pulmonary hypertension (PH) has been associated with adverse outcomes. Right atrial (RA) function could be a prognostic factors as well as RV function, but non-invasive evaluation of RA function is limited. Our objective was thus to test the hypothesis that RA function was associated with hemodynamic parameters of RV performance in PH patients. Methods: Eighty PH patients with mean pulmonary artery pressure (PAP) of 40±11mmHg (all≥25mmHg) were recruited in this study. RA function was assessed by using two-dimensional speckle-tracking strain from RV-focused apical 4-chamber view. RA strain was calculated with the reference point set at the P wave, which enabled the recognition of peak negative (RAneg), positive strain (RAposi), and the sum of those values (RAtotal), corresponding to RA contractile, conduit, and reservoir function, respectively. All patients underwent right-heart catheterization for measurement of mean PAP and pulmonary vascular resistance (PVR). Results: RAneg (r=0.24 and p=0.03), RAposi (r=0.31 and p=0.01) and RAtotal (r=0.35 and p=0.001) were significantly correlated with mean PAP. In addition, RAposi (r=0.41 and p<0.001) and RAtotal (r=0.44 and p<0.001) were also correlated with PVR. Conclusions: Non-invasively assessed RA strains were associated with mean PAP and PVR. RA strain may be of a valuable additive factor for the management of PH patients, and thus have potential clinical applications.
Background: Left ventricular (LV) diastolic dysfunction was identified as the earliest functional alteration in the course of diabetic cardiomyopathy, and also established it as an important prognostic marker in patients with diabetes mellitus (DM). Furthermore, LV longitudinal systolic dysfunction was closely associated with diabetic cardiomyopathy in DM patients with preserved LVEF. This study’ aim was to investigate the impact of LV longitudinal systolic function on LV diastolic function in DM patients with preserved LVEF. Methods: We studied 177 DM patients with preserved LVEF (all ≥50%), and 82 age-, gender- and LVEF-matched healthy volunteers as control. Global longitudinal strain (GLS) was defined as the average peak strain of 18 segments from standard apical views, GLS Results: For DM patients with LVSD (n=74), E/A and E’ were lower, and E/E’ and isovolumic relaxation time (IVRT) were greater than for DM patients without LVSD (n=103) and normal controls. Moreover, these parameters were lower for DM patients without LVSD than for normal controls. Multivariate analysis revealed that GLS was a strong determinative factor for E’ and E/E’ (β=0.30, p Conclusions: In contrast to age-related LV diastolic dysfunction in normal subjects, in DM patients with preserved LVEF, LV diastolic function was associated with LV longitudinal systolic function and LV dispersion independently of age. Our findings have obvious clinical implications for the management of DM patients.
