Association of Sugar-Sweetened Carbonated Beverage with the Alteration in Left Ventricular Structure and Diastolic Function.

BACKGROUND: High consumption of sugar-sweetened carbonated beverage (SSCB) has been associated with multiple metabolic risk factors for cardiovascular disease. However, published data is scarce regarding the influence of SSCB consumption on left ventricular (LV) structure and diastolic function. The present study is to investigate the association of SSCB consumption with alteration in LV structure and diastolic function. METHOD: Study subjects were 46,417 Koreans who received echocardiography as an item of health checkup. They were categorized into 4 groups by SSCB consumption based on one serving dose (200 ml) with never/almost never, <1 serving/week, 1 ≤ serving/week <3 and ≥3 serving/week. Multivariate logistic regression analysis was used in calculating adjusted odd ratio (OR) and 95% confidence interval (CI) (adjusted OR [95% CI]) for left ventricular hypertrophy, increased relative wall thickness (IRWT) and impaired LV relaxation with each group (reference: never/almost never consumption). Subgroup analysis was conducted by age of ≥40 and <40. RESULT: Compared with never/almost never consumption, SSCB consumption ≥3 serving/week had the higher mean levels in body mass index, blood pressure and triglyceride despite of younger age. In fully adjusted analysis, SSCB consumption ≥3 serving/week was associated with IRWT (1.14 [1.02-1.27]) and impaired LV relaxation (1.23 [1.08-1.41]). This association was reinforced in age subgroup ≥40 years, but not statistically significant in age subgroup <40 years. CONCLUSION: SSCB consumption ≥3 serving/week was associated with the increased probability of IRWT and impaired LV relaxation.

Left ventricular diastolic function assessment using time differences between mitral annular velocities and transmitral inflow velocities in patients with heart failure.

BACKGROUND: Evaluation of left ventricular (LV) diastolic function is important in clinical echocardiography. The relationship between mitral annular velocities and transmitral inflow velocities provide additional information about LV filling and diastolic function. This study evaluates the relationships of time intervals between peaks E of mitral inflow velocities and E' of mitral annular velocities, and peaks A and A' in patients with heart failure (HF). METHODS: Eighty patients with HF and 50 age- and gender-matched normal healthy subjects were prospectively recruited and underwent full echocardiograms. The following time intervals were measured: (1) from the onset of R-wave on the ECG to the peak of E-wave on the transmitral flow (TMF) (R-pE); (2) from R to peak of E'-wave on the LV lateral wall of tissue Doppler imaging (TDI) (R-pE'); (3) from onset of P-wave to peak of A-wave on the TMF (P-pA); and (4) from onset of P-wave to peak of A'-wave (P-pA') of TDI. Early-diastolic temporal discordance (EDTD) and late-diastolic temporal discordance (LDTD) were calculated as the difference between the time intervals (R-E) and (R-E'), (P-pA) and (P-p A'). RESULTS: EDTD significantly decreased in patients with HF compared with normal subjects (18.0±54.1ms vs. 28.0±33.5ms, P<0.05). There was also a significant decrease in LDTD in HF patients compared with normal subjects (19.6±23.5ms vs. 34.8±20.6; P<0.05). CONCLUSIONS: EDTD and LDTD decreased in patients with heart failure, and they may be useful tools in identifying abnormal LV relaxation and left atrial contraction for LV diastolic function.

Efficacy of His Bundle Pacing on LV Relaxation and Clinical Improvement in HF and LBBB.

OBJECTIVES: This study aimed to compare acute hemodynamic improvements and responses to His bundle pacing (HBP) and conventional biventricular pacing (BVP). BACKGROUND: HBP can correct left bundle branch block (LBBB) and may be an alternative cardiac resynchronization therapy (CRT) to BVP. METHODS: Fourteen consecutive patients with heart failure (HF) and typical LBBB who required CRT were enrolled. The acute hemodynamic responses during HBP and BVP were compared using a micromanometer-tipped catheter inserted into the left ventricle (LV) before CRT. Each configuration was compared with AAI mode. A permanent HBP device was implanted when LBBB correction threshold was ≤1.5 V at 1.0 ms, and remaining patients were treated with BVP. Clinical and echocardiographic improvements were assessed during a 12-month follow-up period. RESULTS: The LV contractile index (positive maximal rate of LV pressure rise [dP/dtmax]) increased similarly during HBP and BVP (18.8% ± 6.4% vs 18.0% ± 10.2%; P = 0.810). LV relaxation indices (negative dP/dtmax and tau) were significantly improved during HBP compared with BVP (negative dP/dtmax: 14.3% ± 5.5% vs 3.1% ± 8.1%; P < 0.001; tau: 7.2% ± 4.3% vs -0.8% ± 8.1%; P = 0.001). Nine (64%) patients received permanent HBP devices, while 5 patients were treated with BVP. The New York Heart Association functional class, LV ejection fraction, LV end-systolic volume, and B-type natriuretic peptide level improved in patients treated with HBP and BVP (all P < 0.05 vs baseline). Patients treated with HBP exhibited earlier and greater improvements of the LV ejection fraction and LV end-systolic volume than did those with BVP. CONCLUSIONS: HBP improves systolic function and LV relaxation in patients with HF and LBBB. CRT via HBP produced earlier and greater clinical responses than BVP.

Left ventricular flow propagation velocity measurement: Is it cast in stone?

This study aims to investigate the measurement of left ventricular flow propagation velocity, V p, using phase contrast magnetic resonance imaging and to assess the discrepancies resulting from inflow jet direction and individual left ventricular size. Three V p measuring techniques, namely non-adaptive (NA), adaptive positions (AP) and adaptive vectors (AV) method, were suggested and compared. We performed the comparison on nine healthy volunteers and nine post-infarct patients at four measurement positions, respectively, at one-third, one-half, two-thirds and the conventional 4 cm distances from the mitral valve leaflet into the left ventricle. We found that the V p measurement was affected by both the inflow jet direction and measurement positions. Both NA and AP methods overestimated V p, especially in dilated left ventricles, while the AV method showed the strongest correlation with the isovolumic relaxation myocardial strain rate (r = 0.53, p < 0.05). Using the AV method, notable difference in mean V p was also observed between healthy volunteers and post-infarct patients at positions of: one-half (81 ± 31 vs. 58 ± 25 cm/s), two-thirds (89 ± 32 vs. 45 ± 15 cm/s) and 4 cm (98 ± 23 vs. 47 ± 13 cm/s) distances. The use of AV method and measurement position at one-half distance was found to be the most suitable method for assessing diastolic dysfunction given varying left ventricular sizes and inflow jet directions.

A Test in Context: E/A and E/e' to Assess Diastolic Dysfunction and LV Filling Pressure.

Diastolic dysfunction represents a combination of impaired left ventricular (LV) relaxation, restoration forces, myocyte lengthening load, and atrial function, culminating in increased LV filling pressures. Current Doppler echocardiography guidelines recommend using early to late diastolic transmitral flow velocity (E/A) to assess diastolic function, and E to early diastolic mitral annular tissue velocity (E/e') to estimate LV filling pressures. Although both parameters have important diagnostic and prognostic implications, they should be interpreted in the context of a patient's age and the rest of the echocardiogram to describe diastolic function and guide patient management. This review discusses: 1) the physiological basis for the E/A and E/e' ratios; 2) their roles in diagnosing diastolic dysfunction; 3) prognostic implications of abnormalities in E/A and E/e'; 4) special scenarios of the E/A and E/e' ratios that are either useful or challenging when evaluating diastolic function clinically; and 5) their usefulness in guiding therapeutic decision making.

Serum cystatin C level is associated with left atrial enlargement, left ventricular hypertrophy and impaired left ventricular relaxation in patients with stage 2 or 3 chronic kidney disease.

BACKGROUND: Cystatin C is an endogenous marker of kidney function that overcomes the limitations of serum creatinine. High serum cystatin C levels have been associated with increased cardiovascular mortality and morbidity. In this cross-sectional study, we aimed to determine the associations between serum cystatin C levels and structural and functional cardiac changes in patients with stage 2 or 3 chronic kidney disease (CKD). METHODS AND RESULTS: We enrolled 429 consecutive patients (aged 24-97 years) with CKD stage 2 or 3 and left ventricular (LV) ejection fraction (LVEF)>40%. Echocardiographic parameters, including LV mass index (LVMI), early diastolic mitral annulus velocity (e' velocity), left atrial volume index (LAVI), and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) were measured. Patients were categorized into quartiles according to serum cystatin C levels. Cystatin C was associated with LAVI (p=0.0055), LVEF (p=0.0432), LVMI (p=0.0409), e' (p=0.0051), E/e' (p=0.0027), and log-transformed NT-proBNP (p<0.0001) according to multivariate linear regression analysis, after adjustment for confounding factors including creatinine-based estimated glomerular filtration rate (eGFRcreat) and urinary albumin to creatinine ratio. Incidence of eccentric and concentric hypertrophy increased with increasing cystatin C (Q1, 38%; Q2 49%; Q3, 51%; Q4, 66%, p=0.0008), mainly because of increasing concentric hypertrophy (Q1, 30%; Q2, 39%; Q3, 39%; Q4, 51%, p=0.0187). CONCLUSION: A high serum cystatin C is strongly associated with structural cardiac abnormalities such as LVH and left atrial enlargement, impaired LV relaxation, and an increased NT-proBNP, independently of eGFRcreat in patients with stage 2 or 3 CKD.

Diastolic Function in Normal Sinus Rhythm vs. Chronic Atrial Fibrillation: Comparison by Fractionation of E-wave Deceleration Time into Stiffness and Relaxation Components.

Although the electrophysiologic derangement responsible for atrial fibrillation (AF) has been elucidated, how AF remodels the ventricular chamber and affects diastolic function (DF) has not been fully characterized. The previously validated Parametrized Diastolic Filling (PDF) formalism models suction-initiated filling kinematically and generates error-minimized fits to E-wave contours using unique load (xo), relaxation (c), and stiffness (k) parameters. It predicts that E-wave deceleration time (DT) is a function of both stiffness and relaxation. Ascribing DTs to stiffness and DTr to relaxation such that DT=DTs+DTr is legitimate because of causality and their predicted and observed high correlation (r=0.82 and r=0.94) with simultaneous (diastatic) chamber stiffness (dP/dV) and isovolumic relaxation (tau), respectively. We analyzed simultaneous echocardiography-cardiac catheterization data and compared 16 age matched, chronic AF subjects to 16, normal sinus rhythm (NSR) subjects (650 beats). All subjects had diastatic intervals. Conventional DF parameters (DT, AT, Epeak, Edur, E-VTI, E/E') and E-wave derived PDF parameters (c, k, DTs, DTr) were compared. Total DT and DTs, DTr in AF were shorter than in NSR (p<0.005), chamber stiffness, (k) in AF was higher than in NSR (p<0.001). For NSR, 75% of DT was due to stiffness and 25% was due to relaxation whereas for AF 81% of DT was due to stiffness and 19% was due to relaxation (p<0.005). We conclude that compared to NSR, increased chamber stiffness is one measurable consequence of chamber remodeling in chronic, rate controlled AF. A larger fraction of E-wave DT in AF is due to stiffness compared to NSR. By trending individual subjects, this method can elucidate and characterize the beneficial or adverse long-term effects on chamber remodeling due to alternative therapies in terms of chamber stiffness and relaxation.