SAT0415 Diastolic Left Ventricular Dysfunction in Ankylosing Spondylitis Improves during Tumor Necrosis Factor Alpha Blocking Therapy

Risk Factors for Acute Renal Insufficiency Induced by Diuretics in Patients With Congestive Heart Failure

Treatment of Diabetes in People with Heart Failure

Concomitant systolic and diastolic alterations during chronic hypertension in pig

Influence of Left Ventricular Dysfunction (Diastolic Versus Systolic) on Long-Term Prognosis in Patients With Versus Without Diabetes Mellitus Having Elective Peripheral Arterial Surgery

Introduction: Diabetes Mellitus (DM) is a global health problem and India is the capital of it. It leads to acute metabolic and long-term complications with high morbidity and mortality. Cardiovascular (CV) disease is the major cause of mortality. Microalbuminuria (MAU) has been associated with generalised vasculopathy in major organ systems. Left Ventricular (LV) dysfunction and premature onset of CV disease is predicted by MAU. Aim: To evaluate the correlation of degree of microalbuminuria in Type 2 Diabetes Mellitus (Type2DM) as a predictor of LV dysfunction. Materials and Methods: This was a cohort study conducted in the Outpatient Department (OPD) of Medicine on 251 patients clinically diagnosed with Type2DM. Subjects were selected as per American Diabetic Association (ADA) criteria and cases having hypertension Ischaemic Heart Disease (IHD), valvular heart disease, Chronic Kidney Disease (CKD), Urinary Tract Infection (UTI), Chronic Liver Disease (CLD) were excluded from the study. MAU was assessed as having persistent albuminuria in two out of three urine samples as (30-300 mg/day or 20- 200 microgram per mg or an albumin creatinine ratio of 30- 300 microgram per mg creatinine). Echocardiogram to assess LV function were done in the Department of Cardiology using dual mode real time, 213/M-Mode, colour doppler, pulsed web doppler, continuous web doppler, considering criteria of American Society of Echocardiography and Mayo Clinic criteria. Data was analysed by Unpaired t-test for normal data, Chi-square test for dichotomous data and values were correlated using Pearson’s correlation coefficient. Results: Out of 251 study subjects, 148 were males and 103 were females with male to female ratio of 1.43:1. MAU was positive in 24.7% cases out of 251 cases. Echocardiogram revealed 77.4%% of study population have LV dysfunction and 46.8% of cases having diastolic dysfunction. With increased level of MAU, the incidence of LV diastolic dysfunction and LV systolic dysfunction also increased. In LV systolic dysfunction, severity of MAU was negatively correlated with Ejection fraction (EF), Fractional Shortening (FS), Cardiac Output (CO) and positively correlated with E Point Septal Separation (EPSS). In LV diastolic dysfunction, all parameters were positively correlated with severity of MAU. Severity of MAU and LV dysfunction were correlated and was found statistically significant (p<0.05). Conclusion: Severity of MAU was found to have significant correlation with parameters of LV systolic and diastolic function with significant p-value. LV dysfunction has also a strong correlation with poor glycaemic control and duration of DM.

Left ventricular (LV) diastolic dysfunction is associated with heart failure with preserved ejection fraction, and metabolic syndrome (MetS) is a risk factor. However, there is limited knowledge regarding the metabolic factors that contribute to LV dysfunction in postmenopausal women without comorbidities. This study aimed to analyze the relationship between LV diastolic dysfunction and MetS, as well as other cardiovascular risk factors, and to determine risks for LV diastolic dysfunction. Postmenopausal women without hypertension, diabetes mellitus, LV systolic dysfunction, or other heart diseases underwent physical examinations, including echocardiography. The study participants were diagnosed with LV diastolic dysfunction based on several echocardiographic parameters. Logistic regression analyses of LV diastolic dysfunction and cardiovascular risk factors were performed. Of the 269 postmenopausal women examined, 29 (10.7%) and 40 (14.9%) had MetS and LV diastolic dysfunction, respectively. Abnormal diastolic blood pressure (odds ratio, 3.6; 95% confidence interval, 1.16-10.9; P < 0.05) and age (odds ratio, 1.1; 95% confidence interval, 1.07-1.19; P < 0.01) were predictors of LV diastolic dysfunction. In healthy postmenopausal women, high-normal diastolic blood pressure was the only independent risk factor for LV diastolic dysfunction, and it thus may be a useful predictor of diastolic heart failure during routine physical examinations.

Left ventricular (LV) hypertrophy and diastolic dysfunction are commonly observed in hypertensive patients, and have been demonstrated to be risk factors of chronic heart failure due to LV diastolic dysfunction. Recently, reduced bone mineral density has been found in hypertensive patients compared with healthy controls. However, relationships between bone mineral density and LV hypertrophy and diastolic dysfunction have not been fully assessed. We examined relationships between bone mineral density and both LV hypertrophy and diastolic dysfunction in 38 hypertensive patients (23 males, 15 females; mean age 71 ± 8 y) who had been treated with antihypertensive drugs for at least 1 year. The bone mineral density of the calcaneus was measured with a quantitative ultrasound measurement device (A-1000 EXPRESS/InSight, GE Healthcare, Horten, Norway), and the stiffness index was determined as a parameter of bone mineral density. Echocardiography was performed to measure the left ventricular mass index as a parameter of LV hypertrophy. Left ventricular diastolic dysfunction was also assessed by early diastolic mitral annular velocity (e′), and the ratio of early transmitral flow velocity (E) to e′ (E/e′). The bone mineral density did not correlate with left ventricular mass index, but did correlate with e′ (r = 0.453, P < .01) and E/e′ (r = −0.359, P < .05). Thus, reduced bone mineral density in hypertensive patients is not associated with LV hypertrophy but with LV diastolic dysfunction. Hypertensive patients with reduced bone mineral density may have a high risk of chronic heart failure due to LV diastolic dysfunction as well as bone fractures due to osteoporosis.

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BackgroundGlycosylated hemoglobin (HbA1c) has a detrimental impact on the myocardium with left ventricular (LV) diastolic dysfunction. Obesity is a risk factor of type 2 diabetes. To understand the relationships between HbA1c, body mass index (BMI) and LV diastolic dysfunction, we performed this interaction analysis in patients with type 2 diabetes.MethodsTotal 925 type 2 diabetes patients were selected from the patients who were diagnosed and treated at the First Affiliated Hospital of Shenzhen University. Patients’ BMI levels were defined as normal (BMI < 24 kg/m2) and overweight /obese (BMI ≥ 24 kg/m2). Patients’ HbA1c levels were grouped as HbA1c ≥ 9%、7% ≤ HbA1c < 9% and HbA1c < 7%. Logistic regression, stratified, interaction analysis, multivariate Cox regression and curve fitting analysis were performed to investigate the correlations and interactions between HbA1c and BMI with LV diastolic dysfunction.ResultsThe BMI levels were significantly associated with LV diastolic dysfunction in the patients with type 2 diabetes [adjusted model: 1.12 (1.05, 1.20), P = 0.001]. While HbA1c levels had association with LV diastolic dysfunction only in normal BMI group patients [adjusted model: 1.14 (1.01, 1.30), P = 0.0394] and curve correlation was observed. There was a significant interaction between BMI and HbA1c to affect LV diastolic dysfunction (P = 0.0335). Cox regression model analysis showed that the risk of LV diastolic dysfunction was a U type correlation with HbA1c levels in the normal weight group and the turning point was HbA1c at 10%. HbA1c level was not found to have a significant association with LV diastolic dysfunction in overweight/obese group.ConclusionsIn patients with type 2 diabetes, correlation between LV diastolic dysfunction and HbA1c was interactively affected by BMI. Glycemic control is beneficial to the heart function in normal body weight patients. For overweight/obese patients, the risk of LV diastolic dysfunction was not determined by the HbA1c level, indicating it may be affected by other confounding factors.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NWO-ZonMw Background The relative impact of left ventricular (LV) diastolic dysfunction (LVDD) and impaired left atrial (LA) function on cardiac exercise performance (CEP) in heart failure with preserved ejection fraction (HFpEF) remains largely unknown Purpose To elucidate the relative effects of LVDD and impaired LA function on hemodynamics at rest and on cardiac performance during exercise by performing virtual HFpEF patient simulations. Methods Using a well-validated cardiovascular system model (CircAdapt), impaired LV relaxation was simulated by increasing the rate of myocardial relaxation (tau) from 35 to 65 ms. To study the effect of moderate and sever LV myocardial stiffness increase, LV end-diastolic elastance was increased from 0.15 mmHg/ml to 0.60 mmHg/ml and 2.00 mmHg/ml, respectively. In each simulation, LV diastolic function at rest (cardiac output (CO) and heart rate (HR) of 5.1 l/min and 70 bpm, respectively) was assessed using LV ejection fraction (LVEF), mitral E/A ratio, maximum LA volume (LAV), and mean left atrial (LA) pressure (mLAP). To investigate the relative effect of these cardiac abnormalities on exercise capacity, CO and HR were gradually increased using a fixed CO-HR relationship until mLAP exceeded a threshold pressure of 35 mmHg, which was assumed to be a physiological limit of exercise intensity. Results Simulations showed that regardless of the modelled LV and LA function, LVEF was preserved (&amp;gt;50%). Impaired LV relaxation function was associated with decreased E/A-ratio and a small increase in mLAP at rest, regardless of LA function. Increased LV passive stiffness resulted in increased E/A-ratio, LA dilation and markedly elevated mLAP at rest, regardless of LA function (Figure: top-left). Impaired LA function resulted in reduced A-peak velocity, and increased E/A–ratio, LAV and mLAP at rest regardless of LV function (Figure: top-right) Exercise simulations showed that increased LV passive stiffness exerts a stronger exercise-limiting effect than impaired LV relaxation function, in particular when LA function is impaired (Figure: bottom). Conclusions Through simple and well-controlled variations in LV and LA function, we were able to simulate virtual HFpEF patients with a wide range of LVDD severities at rest, preserved LVEF, and reduced cardiac exercise performance. In general, our simulations suggest that increased LV passive stiffness, rather than impaired LV relaxation function, reduces exercise tolerance, especially in the presence of LA dysfunction. Abstract Figure. Simulating rest &amp; exercise hemodynamics

Left ventricular (LV) hypertrophy and LV diastolic dysfunction are cardiac changes commonly observed in patients with chronic renal failure (CRF) as well as hypertension. Although the impairment of LV diastolic function in patients with diabetes mellitus has been shown, little is known about the specific effect of diabetes on LV diastolic function in patients with CRF. The present study was designed to investigate the impact of diabetic nephropathy on LV diastolic dysfunction, independent of LV hypertrophy, in CRF patients. In 67 patients with non-dialysis CRF as a result of chronic glomerulonephritis (n = 33) or diabetic nephropathy (n = 34), and 134 hypertensive patients with normal renal function, two-dimensional and Doppler echocardiographic examinations were performed, and LV dimension, mass, systolic function, and diastolic function were evaluated. LV mass was increased and LV diastolic dysfunction was advanced in subjects with CRF compared with hypertensive controls. In the comparison of echocardiographic parameters between the two groups of CRF patients, i.e. chronic glomerulonephritis and diabetic nephropathy groups, all indices of LV diastolic function were more deteriorated in the diabetic nephropathy group than in the chronic glomerulonephritis group, although LV structure including hypertrophy and systolic function did not differ between the groups. In a multiple regression analysis, the presence of diabetes (i.e. diabetic nephropathy group) was a significant predictor of LV diastolic dysfunction in CRF subjects, independent of other influencing factors such as age, blood pressure, renal function, anaemia and LV hypertrophy. The present findings suggest that LV diastolic dysfunction, independent of LV hypertrophy, is specifically and markedly progressed in patients with CRF as a result of diabetic nephropathy.

Objectives Erectile dysfunction (ED) is recognized as an early marker for cardiovascular disease yet the specific clinical characteristics that correlate with cardiac dysfunction remain unclear. We aimed to identify risk factors of cardiac dysfunction in men with ED. Methods In this cross-sectional study, men with ED were included from a Urology outpatient clinic, and via invitations sent to randomly selected men &amp;gt;40 years. Echocardiography assessed left ventricular (LV) systolic and diastolic dysfunction. Data on age, body mass index (BMI), blood pressure, lipid profile, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hs-CRP), and cardiovascular comorbidities were analyzed for associations with cardiac dysfunction. Results Among 398 men, the univariable analysis showed that BMI, diastolic blood pressure, and hs-CRP were associated with increased odds of LV systolic dysfunction (OR per 1 kg/m2: 1.08, OR per 1 mmHg: 1.03, OR per 1 mmol/L: 1.28, respectively). In multivariable analysis, BMI, diastolic blood pressure, and HbA1c were independently associated with LV systolic dysfunction, with ORs of 1.08 (95% CI: 1.01-1.15), 1.04 (95% CI: 1.01-1.07), and 1.06 (95% CI: 1.01-1.12), respectively. Additionally, BMI and dyslipidemia were associated with LV diastolic dysfunction (OR: 1.09 [95% CI 1.00-1.19] and OR: 2.54 [95% CI: 1.11-5.72], respectively). Conclusions Cardiometabolic factors contribute to cardiac dysfunction in men with erectile dysfunction. Elevated BMI, diastolic blood pressure, and HbA1c are associated with LV systolic dysfunction, while BMI and dyslipidemia are associated with LV diastolic dysfunction, possibly driven by chronic inflammation. This underscores the need for targeted management of cardiovascular risks in this high-risk population. Conflicts of Interest The authors declare no conflicts of interest.

Introduction: Heart failure (HF) affects about 6 million Americans at an annual direct cost of $40 billion. Left ventricular (LV) diastolic dysfunction and stage B HF are predictors of clinical HF and reduction of stage B HF burden may help reduce HF disease burden in the community. In our Adventist Health Study-2 (AHS-2) of 96,000 subjects, a vegetarian compared to a non-vegetarian diet was associated with lower body mass index, and risk of diabetes and hypertension despite similar caloric intake. Hypothesis: We hypothesized that vegetarianism would also lead to a lower risk of LV diastolic dysfunction and stage B HF. Methods: We invited a random sample of 206 subjects from AHS-2 stratified by diet (vegetarians, lacto-ovo vegetarians, pescovegetarians and nonvegetarians), aged &gt;60 years and living within 50 miles of Loma Linda for a clinic visit consisting of a history, anthropometrics, blood pressure measurement, food frequency questionnaire and a full echocardiogram. LV volume, EF, wall motion, diastolic function and mass and left atrial size were assessed based on guidelines of American society of Echocardiography. Results: The mean age was 74 (10) years, 49% were males and subjects were equally distributed in 4 food groups. LV diastolic dysfunction was present in 60%, LV hypertrophy in 10%, LVEF &lt;50% in 5% and increased left atrial volume index in 45% of the subjects. After adjusting for age, gender, race, body surface area, prevalent MI, diabetes and hypertension, a vegan diet (no animal products), compared to non-vegetarian diet, was associated with a lower prevalence of LV diastolic dysfunction (OR 0.42, 95% CI 0.24-0.73) and LV hypertrophy (OR 0.30, 95% CI 0.08-0.86) Vegetarians also had a lower number of stage A risk factors and stage B components (p&lt;0.05). There was a trend towards graded increase in risk of stage B HF with increasing degree of nonvegetarianism. Conclusions: A vegan diet is independently associated with lower risk of LV diastolic dysfunction, LV mass and stage B HF burden.

Background: The study aimed to determine the prevalence of left ventricular (LV) systolic and diastolic dysfunction in apparently healthy pregnant women and if there is relationship with serum selenium, in a society with high prevalence of peripartum cardiomyopathy (PPCM).Methods: This was a prospective longitudinal study carried out in 3 centres in Kano, Nigeria. 108 apparently healthy pregnant women were consecutively recruited between the 28th and 38th weeks of gestation and re-evaluated at the 6th to 8th weeks postpartum. Serum selenium was measured at enrolment during pregnancy. LV systolic dysfunction was defined as LV ejection fraction (LVEF) below 50%. Results: LV systolic dysfunction and diastolic dysfunction were found in 6 subjects (5.6%) and 20 subjects (18.5%) during pregnancy, and in 9 subjects (10.2%) (p=0.340) and 14 (15.9%) (p=0.631) after delivery, respectively. Mean LVEF was 62.2±6.9% and 60.6±8.2% (p=0.108) during pregnancy and after delivery respectively. Selenium deficiency (&lt;70μg/L) was found in only 2.8% of subjects, and serum selenium did not significantly correlate with indices for LV systolic (LVEF) or diastolic (mitral E/e’ ratio) functions both during pregnancy and after delivery. Conclusion: LV systolic and diastolic dysfunction and selenium deficiency were uncommon during apparently healthy pregnancy and early puerperium, and serum selenium did not correlate with indices for LV function, in a population with high prevalence of PPCM.

Prevalence and Prognostic Value of Left Ventricular Diastolic Dysfunction in Idiopathic and Heritable Pulmonary Arterial Hypertension