scholarly journals Diagnostic Values of P-Wave Dispersion to Detect Diastolic Function in Patient with Hypertension

2018 ◽  
Vol 3 (2) ◽  
pp. 71
Author(s):  
Braghmandaru Adhi Bhaskara ◽  
Rano Irmawan ◽  
Lucia Kris Dinarti ◽  
Hasanah Mumpuni
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Predictive Value ◽  
Blood Pressure Measurement ◽  
Wave Dispersion ◽  
Diagnostic Value ◽  
P Wave ◽  
P Wave Dispersion

Background: Hypertension is one of the main causes of cardiovascular disease. Patients with hypertension have increase risk of heart failure compared to populations with normal blood pressure. Clinical evidence shows diastolic dysfunction (DD) can lead to heart failure. Diagnostic of DD with echocardiography is important but access to echocardiography machines is limited compared to electrocardiography (ECG). ECG research correlates P-wave dispersion (PWD) with DD. The aim of this study is to determine the value of PWD to diagnose DD in patients with hypertension.Methods: A cross sectional study was conducted in patients with hypertension at Dr. Sardjito Hospital. Patients received echocardiography, ECG, blood pressure measurement and data recording. The diastolic dysfunction was determined based on 2016 ASE/EACVI criteria. We conducted ROC analysis to determine the cut-off point of P-wave dispersion and the area under the curve (AUC) value, and bivariate analysis on demographic and clinical factors related to PWD. Multivariate analysis was performed to determine the independent factors affecting PWD.Results: 113 patients met the criteria of the study subjects, with 47 men (37.2%), mean age 58.32±11.17 years. Thirteen (11.5%) subjects had DD and 37 subjects (32.7%) with increased PWD. Results showed increased PWD above 71.4 m.s with AUC 76.2%, sensitivity 75%, specifcity 72.2%, positive predictive value 33.3%, negative predictive value 96%, and accuracy of 72.5% in diagnosing DD.Conclusion: This is the frst study to examine the diagnostic value of PWD to detect diastolic function based on 2016 ASE/EACVI criteria. We found PWD above cut-off point 71.4 m.s has a moderate diagnostic value for detecting DD in patients with hypertension.

scholarly journals Features of heart failure with preserved ejection fraction (HFpEF) in diabetic patients with resistant hypertension

2021 ◽  
Vol 24 (4) ◽  
pp. 304-314
Author(s):  
M. A. Manukyan ◽  
A. Y. Falkovskaya ◽  
V. F. Mordovin ◽  
T. R. Ryabova ◽  
I. V. Zyubanova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Blood Pressure ◽  
Blood Flow ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Resistant Hypertension ◽  
Diabetic Patients ◽  
Preserved Ejection Fraction

BACKGROUND: It is expected that a steady increase in the incidence of diabetes and resistant hypertension (RHTN), along with an increase in life expectancy, will lead to a noticeable increase in the proportion of patients with heart failure with preserved ejection fraction (HFpEF). At the same time, data on the frequency of HFpEF in a selective group of patients with RHTN in combination with diabetes are still lacking, and the pathophysiological and molecular mechanisms of its formation have not been yet studied sufficiently.AIM: To assess the features of the development HFpEF in diabetic and non-diabetic patients with RHTN, as well as to determine the factors associated with HFpEF.MATERIALS AND METHODS: In the study were included 36 patients with RHTN and type 2 diabetes mellitus (DM) (mean age 61.4 ± 6.4 years, 14 men) and 33 patients with RHTN without diabetes, matched by sex, age and level of systolic blood pressure (BP). All patients underwent baseline office and 24-hour BP measurement, echocardiography with assess diastolic function, lab tests (basal glycemia, HbA1c, creatinine, aldosterone, TNF-alpha, hsCRP, brain naturetic peptide, metalloproteinases of types 2, 9 (MMP-2, MMP-9) and tissue inhibitor of MMP type 1 (TIMP-1)). HFpEF was diagnosed according to the 2019 AHA/ESC guidelines.RESULTS: The frequency of HFpEF was significantly higher in patients with RHTN with DM than those without DM (89% and 70%, respectively, p=0.045). This difference was due to a higher frequency of such major functional criterion of HFpEF as E/e’≥15 (p=0.042), as well as a tendency towards a higher frequency of an increase in left atrial volumes (p=0.081) and an increase in BNP (p=0.110). Despite the comparable frequency of diastolic dysfunction in patients with and without diabetes (100% and 97%, respectively), disturbance of the transmitral blood flow in patients with DM were more pronounced than in those without diabetes. Deterioration of transmitral blood flow and pseudo-normalization of diastolic function in diabetic patients with RHTN have relationship not only with signs of carbohydrate metabolism disturbance, but also with level of pulse blood pressure, TNF-alfa, TIMP-1 and TIMP-1 / MMP-2 ratio, which, along with the incidence of atherosclerosis, were higher in patients with DM than in those without diabetes.CONCLUSIONS: Thus, HFpEF occurs in the majority of diabetic patients with RHTN. The frequency of HFpEF in patients with DN is significantly higher than in patients without it, which is associated with more pronounced impairments of diastolic function. The progressive development of diastolic dysfunction in patients with diabetes mellitus is associated not only with metabolic disorders, but also with increased activity of chronic subclinical inflammation, profibrotic state and high severity of vascular changes.

Abstract 14648: Interleukin-18 Blockade Prevents Diastolic Dysfunction in a Mouse Model of Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jessica A Regan ◽  
Adolofo G Mauro ◽  
Salvatore Carbone ◽  
Carlo Marchetti ◽  
Eleonora Mezzaroma ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Mouse Model ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Low Dose ◽  
Preserved Ejection Fraction ◽  
Interleukin 18 ◽  
Lv Diastolic Function

Background: Heart failure with preserved ejection fraction (HFpEF) is characterized by elevated left ventricular (LV) filling pressures due to impaired LV diastolic function. Low-dose infusion of angiotensin 2 (AT2) in the mouse induces a HFpEF phenotype without increasing blood pressure. AT2 infusion induces expression of Interleukin-18 (IL-18) in the heart. We therefore tested whether IL-18 mediated AT2-induced LV diastolic dysfunction in this model. Methods: We infused subcutaneously AT2 (0.2 mg/Kg/day) or a matching volume of vehicle via osmotic pumps surgically implanted in the interscapular space in adult wild-type (WT) male mice and IL-18 knock-out mice (IL-18KO). We also treated WT mice with daily intraperitoneal injections of recombinant murine IL-18 binding protein (IL-18bp, a naturally occurring IL-18 blocker) at 3 different doses (0.1, 0.3 and 1.0 mg/kg) or vehicle for 25 days starting on day 3. We performed a Doppler-echocardiography study before implantation and at 28 days to measure LV dimensions, mass, and systolic and diastolic function in all mice. LV catheterization was performed prior to sacrifice to measure LV end-diastolic pressure (LVEDP) using a Millar catheter. Results: AT2 induces a significant increase in isovolumetric relaxation time (IRT) and myocardial performance index (MPI) at Doppler echocardiography and elevation of LVEDP at catheterization, indicative of impaired LV diastolic function, in absence of any measurable effects on systolic blood pressure nor LV dimensions, mass, or systolic function. Mice with genetic deletion of IL-18 (IL-18 KO) or WT mice treated with IL-18bp had no significant increase in IRT, MPI or LVEDP with AT2 infusion. Conclusion: Genetic or pharmacologic IL-18 blockade prevent diastolic dysfunction in a mouse model of HFpEF induced by low dose AT2 infusion, suggesting a critical role of IL-18 in the pathophysiology of HFpEF.

How valuable is P-wave dispersion in the determination of carboxyhemoglobin levels?

2013 ◽  
Vol 33 (5) ◽  
pp. 466-472
Author(s):  
MT Sener ◽  
Y Anci ◽  
K Kalkan ◽  
MZ Kir ◽  
M Emet
Keyword(s):  
Roc Curve ◽  
Predictive Value ◽  
Complete Blood Count ◽  
Wave Dispersion ◽  
P Wave ◽  
Control Group ◽  
Co Poisoning ◽  
P Wave Dispersion ◽  
Cohb Level ◽  
Positive Correlations

Objective: To determine whether or not wave/interval dispersions in electrocardiography (ECG) are increased, and to define whether wave and interval dispersions are correlated with carboxyhemoglobin (COHb) levels. Methods: ECG, complete blood count, and biochemical parameters were taken from 87 patients with carbon monoxide (CO) poisoning as well as 90 control patients with similar age, gender, and body mass index distribution. COHb levels were recorded in CO-poisoning patients. The COHb levels and the relationships with ECG parameters were studied. Results: Pmax, Pmin, Pd, PRmax, PRmin, PRd, QTmax, QTmin, QTd, cQTmax, cQTmin, cQTd, Tmax, Tmin, and Td in ECG were higher in intoxicated patients than the control group ( p < 0.05 for all). Pearson’s correlation analyses showed moderately significant positive correlations between COHb level and Pmax ( r = 0.224; p = 0.037) and Pd ( r = 0.222; p = 0.039). The receiver–operator characteristic (ROC) curve showed that a Pd value of 38 ms determined by ECG separates patients with a COHb ≥ 20% with area under the ROC curve of 0.78 (95%CI = 0.71–0.83), a sensitivity of 67.9% (95%CI = 59.4–75.6), a specificity of 95% (95%CI = 83.0–99.2], a positive predictive value of 97.9% (95%CI = 92.5–99.7), and a negative predictive value of 46.3% (95%CI = 35.3–57.7.) Conclusion: A significant increase in wave/interval dispersions in the ECG of CO-poisoning patients compared with controls may show that not only a part is affected but both atrium and the ventricles as a whole are affected by hypoxic ischemia. When COHb levels of the patients are unavailable, P dispersion on ECG may show CO poisoning level of the patient.

The effect of the glucose-insulin-potassium solution on the p-wave dispersion of the heart failure patients

2012 ◽  
Vol 18 (2) ◽  
pp. 85
Author(s):  
Suleyman Ercan ◽  
Muhammed Oylumlu ◽  
Mustafa Oylumlu ◽  
Serdar Soydinc ◽  
Vedat Davutoglu
Keyword(s):  
Heart Failure ◽  
Wave Dispersion ◽  
P Wave ◽  
P Wave Dispersion ◽  
Heart Failure Patients

The effect of rapid blood pressure control on P-wave dispersion in hypertensive urgency

2008 ◽  
Vol 25 (12) ◽  
pp. 1303-1314 ◽  
Author(s):  
Ilgin Karaca ◽  
Polat Durukan ◽  
Necati Dagli ◽  
Mustafa Yavuzkir ◽  
İbrahim Ikizceli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Wave Dispersion ◽  
Pressure Control ◽  
P Wave ◽  
Hypertensive Urgency ◽  
P Wave Dispersion

Relationship between P Wave Dispersion and Left Ventricular Diastolic Dysfunction in Hypertensive and Ischemic Heart Disease Patients

2015 ◽  
Vol 8 (1) ◽  
pp. 13-18
Author(s):  
Asif Zaman Tushar ◽  
AAS Majumder ◽  
STM Abu Azam ◽  
Mohammad Ullah ◽  
Rashid Ahmed ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Wave Dispersion ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
P Wave ◽  
P Wave Dispersion ◽  
Wave Duration ◽  
P Wave Duration ◽  
Ventricular Diastolic Dysfunction ◽  
Surface Electrocardiogram

Background: There is growing recognition that congestive heart failure caused by a predominant abnormality in left ventricular diastolic function is common and causes significant morbidity and mortality. Diastolic function usually declines before systolic function, and this precedes clinical signs. 12-lead electrocardiogram is a commonly used tool to assess left atrial enlargement, which is a marker of left ventricular diastolic dysfunction. We investigated the relationship between P wave dispersion, which is easily measured on the surface electrocardiogram and left ventricular diastolic function.Methods: There were 100 patients: 50 with diastolic dysfunction and 50 without. P wave dispersions were calculated by measuring minimum and maximum P wave duration values on the surface electrocardiogram. The relationships between P wave dispersion and echocardiographic measurements of diastolic dysfunction were assessed.Results: Maximum P wave duration was observed significantly (p=0.001) in patients with left ventricular diastolic dysfunction (119.60±8.2 ms vs 114.0±6.4 ms). Minimum P wave duration was observed significantly (p=0.001) higher in patients without diastolic dysfunction (72.6±7.5 ms vs 62.70±7.4 ms). P wave dispersion was observed significantly (p=0.001) higher in patients with left ventricular diastolic dysfunction (56.6±6.3 ms vs 41.5±5.2 ms). When patients were grouped according to grades of diastolic dysfunction, P wave dispersion was observed sequentially increased among 3 grades of left ventricular diastolic dysfunction (55.8±5.2 ms vs 55.9±7.0 ms vs 61.4±4.7) but the differences were not statistically significant (p=0.09).Conclusion: We conclude that P wave dispersion increases in diastolic dysfunction of LV. When clinical and echocardiographic variables are taken into account, there is a weak but significant correlation between P wave dispersion and left ventricular ejection fraction.Cardiovasc. j. 2015; 8(1): 13-18

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