scholarly journals Short-Term CPAP Improves Biventricular Function in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 889
Author(s):  
Ioana Mădălina Zota ◽  
Radu Andy Sascău ◽  
Cristian Stătescu ◽  
Grigore Tinică ◽  
Maria Magdalena Leon Constantin ◽  
...  
Keyword(s):  
Patient Adherence ◽  
Systolic Function ◽  
Blood Pressure Monitoring ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Short Term ◽  
Biventricular Function ◽  
Obesity And Diabetes ◽  
Obstructive Sleep ◽  
The Impact

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing, exhibiting an increasing prevalence and several cardiovascular complications. Continuous positive airway pressure (CPAP) is the gold-standard treatment for moderate-severe OSA, but it is associated with poor patient adherence. We performed a prospective study that included 57 patients with newly diagnosed moderate-severe OSA, prior to CPAP initiation. The objective of our study was to assess the impact of short-term CPAP on ventricular function in patients with moderate-severe OSA and cardiometabolic comorbidities. The patients underwent a clinical exam, ambulatory blood pressure monitoring and comprehensive echocardiographic assessment at baseline and after 8 weeks of CPAP. Hypertension, obesity and diabetes were highly prevalent among patients with moderate-severe OSA. Baseline echocardiographic parameters did not significantly differ between patients with moderate and severe OSA. Short-term CPAP improved left ventricular global longitudinal strain (LV-GLS), isovolumetric relaxation time, transmitral E wave amplitude, transmitral E/A ratio, right ventricular (RV) diameter, RV wall thickness, RV systolic excursion velocity (RV S‘) and tricuspid annular plane systolic excursion (TAPSE). Short-term CPAP improves biventricular function, especially the LV-GLS, which is a more sensitive marker of CPAP-induced changes in LV systolic function, compared to LVEF. All these benefits are dependent on CPAP adherence.

scholarly journals P286 Inverse relation between systolic blood pressure variability and global longitudinal strain in patients with Parkinson"s disease and autonomic dysfunction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Caminiti ◽  
V D"antoni ◽  
V Morsella ◽  
M Torti ◽  
P Grassini ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Autonomic Dysfunction ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Blood Pressure Monitoring ◽  
Global Longitudinal Strain ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
S Wave ◽  
Hypertensive Patients

Abstract Background Parkinson"s disease (PD) patients often present cardiac blood pressure (BP) derangement as a result of autonomic dysfunction. However their echocardiography pattern have been poorly investigated yet . Study aim: to evaluate the correlation between indices of left ventricular function ad 24/h blood pressure pattern in patients with PD Methods We evaluated 20 patients with diagnosed PD and autonomic dysfunction and 15 hypertensive age-matched subjects. All patients performed 24/h blood pressure monitoring (ABPM) and echocardiography. Left ventricular systolic function was evaluated through ejection fraction (EF), tissue doppler S wave and global longitudinal strain (GLS). BP variability (BPV) was evaluated through average real variability. Results GLS (17.6 vs 22.8; p = 0.04) was reduced in the PD group compared to hypertensive patients. Conversely EF and S wave was similar between the two groups. Patients with PD had an inverse significant correlation between GLS and 24/h systolic BPV (r= -0.64; p = 0.003) and a trend through significance between S wave and systolic BPV (r= -0.31; p = 0.07). sNocturnal diastolic BP was inversely related to GLS (r= -0.44; p = 0.001) . There were no correlation between GLS and BPV and values in hypertensive patients. Conclusions In PD patients GLS is related to indices of poor BP control. GLS appears to be an early detector of LV dysfunction in patients with PD and autonomic dysfunction.

scholarly journals P1390 Myocardial work indices in the assessment of the systolic function of the left ventricle in amateur half marathon runners

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Dankowski ◽  
A Szalek ◽  
J Tschurl ◽  
W Sacharczuk ◽  
A Baszko ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Training Period ◽  
Loading Conditions ◽  
Myocardial Mechanics ◽  
Constructive Work ◽  
The Impact

Abstract Background Myocardial work (MW) has been recently introduced as a tool for non-invasive assessment of left ventricular (LV) systolic function. It is based on myocardial strain analysis but incorporates also data regarding loading conditions, which is potential advantage of this technique. Purpose We south to evaluate the impact of a three-month training before the half-marathon on cardiac function using indices of MW. Methods The study included 28 young amateur runners (11 women, mean age 32 years). None of the participants had a prior history of cardiovascular disease. The group was assessed at the beginning of training period, after three month (within 48 hours before half-marathon), and within 72 hours after the run. We collected clinical, laboratory and echocardiographic data. All participants underwent echocardiography to assess myocardial mechanics and MW indices using speckle-tracking technique. Results 23 participants completed the training and all of them finished the race. After the training period we observed significant increase in LV end-diastolic diameter only (49,9 ± 0,94 mm vs 51,6 ± 0,9 mm, p= 0,007) with no significant change after the run. There were no changes in global longitudinal strain (GLS), global work index (GWI) global wasted work (GWW) neither after the training period nor after the run. We observed significant changes suggesting myocardial injury after the race, including slight increase of NT-proBNP and troponin levels, increase in left atrial volume index, and reduction of tissue Doppler lateral e` wave. Global constructive work (GCW) decreased significantly after the training period, with no change after the run (2122,0 ± 299,4 vs 1929,0 ± 227 vs 1986,5 ± 295,7 mmHg%; start of the training vs before the run assessment vs after the run assessment, respectively; p = 0,005). GCW was correlated significantly with systolic blood pressure, which decreased also significantly after the training period. Conclusion Three-months training before the participation in half-marathon run was not associated with significant changes in myocardial work indices except the global constructive work, which could be related to decrease of loading conditions. Despite the signs of myocardial injury there was no deterioration in myocardial mechanics parameters, which may indicate the beneficial effects of training before the half-marathon run.

scholarly journals 1042 Assessment of left ventricular systolic function in obstructive sleep apnea with automatic function imaging and its relation relation with hypoxia

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M A Chenyao ◽  
JOHN Sanderson ◽  
L U Mi ◽  
L I U Hu ◽  
XIAO Lei ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Systolic Function ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Lv Function ◽  
P Value ◽  
2D Echocardiography ◽  
Obstructive Sleep ◽  
The Impact

Abstract Funding Acknowledgements OSA & Subclinical myocardial impairment Background Early detection of left ventricular (LV) systolic dysfunction is crucial for patients with obstructive sleep apnea (OSA) . LV longitudinal strain (GLS), derived from automated function imaging (AFI) based on 2D echocardiography, provides a new tool to detect subclinical impairment of both global and regional myocardium. Its value in OSA remains unclear compared to traditional parameters since obesity is not uncommon in OSA, which may compromise the accuracy of AFI. We aimed to investigate the feasibility of AFI in OSA and further to explore the impact of OSA severity and degree of hypoxia on LV function. Methods Comprehensive transthoracic echocardiography was done in those receiving polysomnography (PSG) suspected as OSA consecutively (n = 322). All subjects were divided into 3 groups by apnea-hyponea index (AHI) by PSG (Control: AHI＜5; mild-to-moderate AHI 5-30; severe: AHI≥30) and GLS and mitral annular plane systolic excursion (MAPSE) were compared among the 3 groups. Results 322 patients with normal LVEF (≥50%) were finally analyzed. Though more segments were measured, inter- and intra- observer variability of GLS were comparable with MAPSE in a Bland-Altman analysis. For group comparison, GLS was reduced compared to the other 2 groups in the severe OSA category (p ≤ 0.001) while MAPSE showed no differences. Further analysis showed the feasibility of AFI was acceptable even in obese patients. In multivariable analysis of GLS, only maximum desaturation was an independent associated factor (p = 0.027). Conclusions Even in OSA patients with obesity, AFI-derived GLS is feasible. GLS is more sensitive than MAPSE or TDI for detection of reduced LV systolic function in OSA. Control(n = 27) Mild-Mod OSA(n = 145) Severe OSA(n = 160) P-value Age(years) 43 ± 13 47 ± 12 46 ± 11 0.218 Males, n(%) 17(63.0%) 118(81.4%) 154(96.3%) ＜0.001 BSA(m2) 1.82 ± 0.18 1.88 ± 0.18 1.97 ± 0.17*† ＜0.001 BMI(kg/ m2) 24.7 ± 4.4 26.8 ± 3.7* 28.6 ± 4.2*† ＜0.001 LVEF(%) 66.5 ± 6.4 67.0 ± 5.0 66.7 ± 4.6 0.813 Sep S’(cm/s) 8.3 ± 1.7 8.4 ± 1.5 8.7 ± 1.9 0.256 Sep E’(cm/s) 9.5 ± 3.0 9.0 ± 2.4 8.2 ± 2.0*† 0.003 E/ E’ 9.2 ± 2.9 9.1 ± 2.9 9.8 ± 2.9 0.145 GLS(%) 19.1 ± 2.7 19.0 ± 2.5 17.9 ± 2.4*† ＜0.001 MAPSE(mm) 15.1 ± 2.5 14.7 ± 2.3 14.3 ± 2.2 0.302 *p＜0.05 compared with mild OSA patients, †p＜0.05 compared with moderate OSA patients Echo Comparison between 3 OSA Groups

scholarly journals Fast Assessment of Left Ventricular Systolic Function in Obstructive Sleep Apnea Patients with Automated Function Imaging: Comparison with Mitral Annular Plane Systolic Excursion

2021 ◽  
Author(s):  
ChenYao Ma ◽  
John Sanderson ◽  
Qi Chen ◽  
Zhe Liang ◽  
XiaoJun Zhan ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular Systolic Function ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Repeated Measurements ◽  
Obese Patients ◽  
Obstructive Sleep

Background: Early cardiovascular impairment in obstructive sleep apnea (OSA) patients is often overlooked, leading to irreversible outcome. Left ventricular (LV) global longitudinal strain (GLS) derived from automated function imaging (AFI) echocardiography provides a fast tool to assess global longitudinal function. We therefore aimed to compare the feasibility and reproducibility of AFI with mitral annulus plane systolic excursion (MAPSE) as obesity is common in OSA. Methods: A comprehensive echocardiographic examination was done in 186 consecutive patients having polysomnography for suspected OSA in this prospective study. MAPSE was measured by using M-mode. AFI was derived by offline analysis of three long-axis views that semi-automatically detects LV endocardial boundary, which is adjusted manually as necessary. Variability of AFI and MAPSE were compared among the different subgroups and further tested in BMI subgroups. Results: Despite a relatively high obesity rate (42.9%), AFI was feasible in 94% (175/186) patients and MAPSE could be recorded in all patients. Although more segments were measured with AFI it showed excellent correlation (r=0.882) superior to MAPSE (r=0.819) between the expert and beginner. Intra- and inter- observer variability of AFI were comparable with MAPSE in Bland-Altman analysis, 5.5% and 6.5% for AFI, 6.2% and 8.8% for MAPSE, respectively. In repeated measurements, AFI showed higher intra-class correlation (ICC=0.95) than MAPSE (ICC=0.87). Furthermore, analysis showed that AFI was feasible even in more obese patients (BMI≥28kg/m2). Conclusions: Even in obese patients with OSA, AFI-GLS is feasible and more reliable for less expert operators than MAPSE for detecting LV longitudinal dysfunction.

scholarly journals Associations of the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet with cardiac remodelling in the community: the Framingham Heart Study

2021 ◽  
pp. 1-9
Author(s):  
Maura E. Walker ◽  
Adrienne A. O’Donnell ◽  
Jayandra J. Himali ◽  
Iniya Rajendran ◽  
Debora Melo van Lent ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Root Diameter ◽  
Left Ventricular ◽  
Cardiac Remodelling ◽  
Lv Function ◽  
The Mediterranean ◽  
Diet Score ◽  
Mind Diet

Abstract Normal cardiac function is directly associated with the maintenance of cerebrovascular health. Whether the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet, designed for the maintenance of neurocognitive health, is associated with cardiac remodelling is unknown. We evaluated 2512 Framingham Offspring Cohort participants who attended the eighth examination cycle and had available dietary and echocardiographic data (mean age 66 years; 55 % women). Using multivariable regression, we related the cumulative MIND diet score (independent variable) to left ventricular (LV) ejection fraction, left atrial emptying fraction, LV mass (LVM), E/e’ ratio (dependent variables; primary), global longitudinal strain, global circumferential strain (GCS), mitral annular plane systolic excursion, longitudinal segmental synchrony, LV hypertrophy and aortic root diameter (secondary). Adjusting for age, sex and energy intake, higher cumulative MIND diet scores were associated with lower values of indices of LV diastolic (E/e’ ratio: logβ = −0·03) and systolic function (GCS: β = −0·04) and with higher values of LVM (logβ = 0·02), all P ≤ 0·01. We observed effect modification by age in the association between the cumulative MIND diet score and GCS. When we further adjusted for clinical risk factors, the associations of the cumulative MIND diet score with GCS in participants ≥66 years (β = −0·06, P = 0·005) and LVM remained significant. In our community-based sample, relations between the cumulative MIND diet score and cardiac remodelling differ among indices of LV structure and function. Our results suggest that favourable associations between a higher cumulative MIND diet score and indices of LV function may be influenced by cardiometabolic and lifestyle risk factors.

scholarly journals Left ventricular mechanical dispersion in a general population: Data from the Akershus Cardiac Examination 1950 study

2019 ◽  
Author(s):  
Erika N Aagaard ◽  
Brede Kvisvik ◽  
Mohammad O Pervez ◽  
Magnus N Lyngbakken ◽  
Trygve Berge ◽  
...  
Keyword(s):  
General Population ◽  
Global Longitudinal Strain ◽  
Population Data ◽  
Left Ventricular ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Clinical Model ◽  
Mechanical Dispersion ◽  
Obesity And Diabetes ◽  
Increased Risk

Abstract Aims Increased left ventricular mechanical dispersion by 2D speckle tracking echocardiography predicts ventricular arrhythmias in ischaemic heart disease and heart failure. However, little is known about mechanical dispersion in the general population. We aimed to study mechanical dispersion in the general population and in diseases associated with increased risk of cardiovascular disease. Methods and results The present cross-sectional study consists of 2529 subjects born in 1950 included in the Akershus Cardiac Examination (ACE) 1950 study. Global longitudinal strain (GLS) was assessed from 17 strain segments, and mechanical dispersion calculated as the standard deviation of contraction duration of all segments. The cohort was divided according to the median value of mechanical dispersion, and multivariable linear regression models were performed with mechanical dispersion as the dependent variable. The prevalence of coronary artery disease (CAD), hypertension, obesity, and diabetes (P < 0.01 for all) was significantly higher in subjects with supra-median mechanical dispersion. In a multivariable clinical model, CAD (B = 7.05), hypertension (B = 4.15; both P < 0.001), diabetes (B = 3.39), and obesity (B = 1.89; both P < 0.05) were independently associated with increasing mechanical dispersion. When echocardiographic indices were added to the multivariable model, CAD (B = 4.38; P < 0.01) and hypertension (B = 2.86; P < 0.001) remained significant in addition to peak early diastolic tissue velocity e’ (B = −2.00), GLS (B = 1.68), and ejection fraction (B = 0.22; P < 0.001 for all). Conclusion In a general middle-aged population, prevalent CAD and hypertension were associated with increasing mechanical dispersion, possibly indicating elevated risk of fatal arrhythmias and sudden cardiac death. Albeit weaker, systolic and diastolic dysfunction, were also associated with increasing mechanical dispersion.

Abstract 14432: Myocardial Work in Stage I and II Hypertensive Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Akshar Jaglan ◽  
Sarah Roemer ◽  
Ana C Perez Moreno ◽  
Bijoy K Khandheria
Keyword(s):  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Deformation Analysis ◽  
Hypertensive Patients ◽  
Reduced Ejection Fraction ◽  
Work Index ◽  
Significant Difference ◽  
Global Work ◽  
Lv Systolic Function

Introduction: Myocardial work is a novel parameter that can be used in a clinic setting to assess left ventricular (LV) pressures and deformation. This study sought to distinguish patterns of global myocardial work index in hypertensive vs. non-hypertensive patients. Methods: Fifty (25 male, mean age 60±14 years) hypertensive patients and 15 (7 male, mean age 38±12 years) control patients underwent transthoracic echocardiography at rest. Hypertensive patients were divided into stage 1 (26 patients) and stage 2 (24 patients) based on the 2017 American College of Cardiology guidelines. We excluded patients with suboptimal image quality for myocardial deformation analysis, reduced ejection fraction (EF), valvular heart disease, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were estimated from LV pressure strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using a noninvasive brachial artery cuff. Results: Global longitudinal strain (GLS) and EF were preserved between the two groups with no statistically significant difference whereas there was a statistically significant difference in the GWI (p<0.01), GCW (p=0.03), GWW (p<0.01), and GWE (p=0.03) (Figure and Table). Conclusions: Myocardial work gives us a closer look at the relationship between LV pressure and contractility in settings of increased load dependency whereas LVEF and GLS cannot. We show how myocardial work is an advanced assessment of LV systolic function in hypertensive patients.

Abstract 16485: The Nitroxyl Donor 1-Nitrosocyclohexyl Acetate Limits Cardiac Superoxide Upregulation and Diastolic Dysfunction in a Mouse Model of Diabetic Cardiomyopathy

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rebecca H Ritchie ◽  
Nga Cao ◽  
Yung George Wong ◽  
Sarah Rosli ◽  
Helen Kiriazis ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mouse Model ◽  
Diastolic Dysfunction ◽  
Diabetic Cardiomyopathy ◽  
Ex Vivo ◽  
Systolic Function ◽  
Left Ventricular ◽  
Cardiomyocyte Hypertrophy ◽  
Lv Diastolic Dysfunction ◽  
The Impact

Nitroxyl (HNO), a redox congener of NO•, is a novel regulator of cardiovascular function combining vasodilator and positive inotropic properties. Our previous studies have demonstrated these properties occur concomitantly in the intact heart; HNO moreover also exhibits antihypertrophic and superoxide-suppressing actions. HNO donors may thus offer favorable actions in heart failure. The impact of chronic HNO donor administration has however yet to be reported in this context. We tested the hypothesis that the HNO donor 1-nitrosocyclohexyl acetate (1-NCA) limits cardiomyocyte hypertrophy and left ventricular (LV) diastolic dysfunction in a mouse model of diabetic cardiomyopathy in vivo. Male 6 week-old FVB/N mice received either streptozotocin (55 mg/kg/day i.p. for 5 days, n=17), to induce type 1 diabetes, or citrate vehicle (n=16). After 4 weeks of hyperglycemia, mice were allocated to 1-NCA therapy (83mg/kg/day i.p.) or vehicle, and followed for a further 4 weeks. As shown in the table, blood glucose was unaffected by 1-NCA. LV diastolic dysfunction was evident in diabetic mice, measured as echocardiography-derived A wave velocity, deceleration time and E:A ratio; LV systolic function was preserved. Diabetes-induced diastolic dysfunction was accompanied by increased LV cardiomyocyte size, hypertrophic and pro-fibrotic gene expression, and upregulation of LV superoxide. These characteristics of diabetic cardiomyopathy were largely prevented by 1-NCA treatment. Selectivity of 1-NCA as a donor of HNO versus NO• was demonstrated by the sensitivity of the coronary vasodilation response of 1-NCA to the HNO scavenger L-cysteine (4mM), but not to the NO• scavenger hydroxocobalamin (50μM), in the normal rat heart ex vivo (n=3-7). Collectively, our studies provide the first evidence that HNO donors may represent a promising new strategy for the treatment of diabetic cardiomyopathy, and implies their therapeutic efficacy in settings of chronic heart failure.

Abstract 4197: Does Relative Wall Thickness or Left Ventricular Mass Index Best Predict Mortality Risk in Patients With Preserved Systolic Function?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Dharmendrakumar A Patel ◽  
Carl J Lavie ◽  
Sangeeta Shah ◽  
Yvonne Gilliland ◽  
Richard V Milani
Keyword(s):  
Wall Thickness ◽  
Systolic Function ◽  
Age Groups ◽  
Left Ventricular ◽  
Relative Wall Thickness ◽  
Prognostic Impact ◽  
Geometric Patterns ◽  
Lv Mass ◽  
Mortality Table ◽  
The Impact

Background: Several studies have indicated that left ventricular (LV) geometric patterns predict cardiovascular events. However, little data is available that compares the relative prognostic impact of LV mass index (LVMI) and relative wall thickness (RWT) on mortality in a large cohort of patients with preserved systolic function. Methods: The impact of LVMI and RWT on mortality during an average follow-up of 1.7±1.0 years was examined in a sample of 47,701 patients (mean age: 61.6 ± 15.4; females=54.6 %) with preserved ejection fraction(EF), as well as in age groups of <50 yrs(n=10,864; mean age=39.9 ± 8.1; females=58.4 %), 50 –70 yrs (n=20,181; mean age=59.9 ± 5.7; females=52.2 %) and >= 70 yrs (n=16,836; mean age=77.7 ± 5.5; females=55.1 %). Results: With increasing age (<50, 50 –70, >=70 yrs), both LVMI (78.5 ± 23.4, 84.3 ± 25.4, 90.3 ± 27.6; p<0.0001) and RWT (0.37 ± 0.08, 0.41 ± 0.08, 0.43 ± 0.09; p<0.0001) as well as mortality (2.2%, 5.0%, 14.2%; p<0.0001) showed significant linear trends and were independent predictors of mortality (Table , Figure ). Conclusion: Although, both LVMI and RWT were independently associated with increased mortality in all groups, RWT was by far the strongest independent predictor of all-cause mortality, especially in younger patients.

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