Assessment of diastolic dysfunction in elderly hypertensive patients using integrated Doppler echocardiography

Dénes, Mónika; Kiss, István; Lengyel, M

doi:10.1080/08037050903013899

Cited by 7 publications

(5 citation statements)

References 36 publications

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“…If BP can be decreased effectively, the left ventricle relaxing and filling can be improved by reducing the left atrial and end-diastolic pressure. 6 LCZ696 reduced the BP better than valsartan; however, regression results of the BP changes showed that the benefits for NT-proBNP and left atrial size reduction were independent of the lowered BP. 5…”

Section: Introductionmentioning

confidence: 84%

The Effects of LCZ696 in Patients With Hypertension Compared With Angiotensin Receptor Blockers

Zhao

et al. 2017

J Cardiovasc Pharmacol Ther

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LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor, has been demonstrated to have greater advantages in the treatment of heart failure compared with angiotensin-converting enzyme inhibitors, enalapril, or angiotensin receptor blockers (ARBs). However, studies that compared the efficacy and safety of LCZ696 against valsartan in patients with hypertension are limited. To provide further evidence for the benefits of LCZ696 and to make this assessment, a meta-analysis of randomized controlled trials (RCTs) was performed. The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, PubMed, and ClinicalTrials.gov were searched for RCTs. Twelve studies involving 3816 patients were eligible for inclusion. Seven studies compared LCZ696 with valsartan, and 5 studies compared LCZ696 with olmesartan. LCZ696 showed a significantly greater reduction in systolic blood pressure (BP; mean difference [MD] = -5.43 mm Hg; 95% confidence interval [CI]: -6.36 to -4.49 mm Hg; P < .001), diastolic BP (MD = -2.34 mm Hg; 95% CI: -2.67 to -2.01 mm Hg; P < .001), 24-hour ambulatory systolic BP (MD = -3.57 mm Hg, 95% CI: -4.29 to -2.85 mm Hg; P < .001), and 24-hour ambulatory diastolic BP (MD = -1.32 mm Hg, 95% CI: -1.77 to -0.78 mm Hg; P < .001) from the baseline than ARBs. LCZ696 was more effective in reducing BP (odds ratio [OR] = 5.34; 95% CI: 4.49-6.36; P < .01) and had a higher rate of BP control compared with ARBs (OR = 1.52; 95% CI: 1.37-1.69; P < .01). LCZ696 had no difference in the incidence of adverse events (OR = 1.05; 95% CI: 0.94-1.18; P = .38) or serious adverse events (OR = 0.80; 95% CI: 0.51-1.24; P = .31) compared to ARBs. This meta-analysis revealed that LCZ696 has a greater antihypertensive efficacy and an equal tolerability profile.

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Section: Introductionmentioning

confidence: 84%

The Effects of LCZ696 in Patients With Hypertension Compared With Angiotensin Receptor Blockers

Zhao

et al. 2017

J Cardiovasc Pharmacol Ther

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“…First degree (mild) diastolic dysfunction (DD) is defined as: E/A < 0.8, E/Ea < 8, DT > 200 msec and second degree (medium) DD as: 0.8 < E/A < 1.5, 8 < E/Ea < 13 and the DT is 160-200 msec. The criteria for third degree (severe) DD are: E/A > 2, E/Ea > 13, DT < 160 msec [67,68]. The diastolic dysfunction in cirrhosis is most pronounced in patients with ascites [28,53].…”

Section: Evaluation Of Diastolic Functionmentioning

confidence: 99%

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Páll¹,

Czifra²,

Vitális³

et al. 2014

JGLD

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Hyperdynamic circulation, systolic and diastolic left ventricular dysfunction and certain electrophysiological abnormalities have been associated with cirrhosis and known for a long time. These clinical features have been introduced as cirrhotic cardiomyopathy (CCM), which is characterized by blunted myocardial contractile responsiveness to physical, physiological and pharmacological stress. Importantly, cardiac dysfunction can be reversible and can improve due to effective medical treatment and also after liver transplantation. Echocardiography and electrocardiography are essential tools for recognizing the characteristic changes in the myocardial function and also the alterations in the electrophysiological properties of the heart. Laboratory markers are auxiliary modalities further aiding the establishment of the correct diagnosis. In this review, we aimed to collect the pathophysiological background and clinical characteristics of CCM with the intention of summarizing the current possibilities for the diagnosis establishment and treatment of this cardio-hepatic disorder.Abbreviations: A: late diastolic transmitral peak flow velocity; ACE: angiotensin converting enzyme; ANP: atrial natriuretic peptide; ARB: angiotensin receptor blocker; BNP: brain natriuretic peptide; cAMP: cyclic adenosine monophosphate; CCM: cirrhotic cardiomyopathy; CGRP: calcitonin gene-related peptide; CO: carbon monoxide; DD: diastolic dysfunction; DT: deceleration time; E: early diastolic transmitral peak flow velocity; Ea: early diastolic velocity of the septal mitral annulus; EF: ejection fraction; MUGA: Multi Gated Acquisition Scan; NO: nitric oxide; NSBB: non-selective beta-blocker; pro-BNP: pro-brain natriuretic peptide; QTc: corrected QT interval; RAAS: renin-angiotensin aldosterone system; RALES: Randomized Aldactone Evaluation Study; suPAR: urokinase-type plasminogen activator receptor; TDI: Tissue Doppler Imaging; TIPS: transjugular intrahepatic portosystemic shunt; TNF-alpha: tumor necrosis factor-alpha.

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“…Hypertension treatment is one of the most important factors in treatment of diastolic dysfunction [ 20 ]. Effective decrease of blood pressure reduces the left atrial and left end-diastole pressure, improves the LV relaxation and filling.…”

Section: Treatment Modalitiesmentioning

confidence: 99%

“…Phospodiesterase 5 inhibitors are considered to reduce LV and arterial stiffness, to improve the endothelial function and reduce the pulmonary vascular resistance /RELAX-study/ [ 10 , 26 ]. Alagebrium chloride is a new agent which, in experimental research in animals, was found to improve the ventricular and vascular compliance, to reduce the blood pressure and vascular stiffness [ 20 , 27 ].…”

Section: Treatment Modalitiesmentioning

confidence: 99%

Heart Failure with Preserved Ejection Fraction â€“ Concept, Pathophysiology, Diagnosis and Challenges for Treatment

Miljkovik

Spiroska

2015

Open Access Maced J Med Sci

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Heart failure (HF) with preserved left ventricular (LV) ejection fraction (HFpEF) occurs in 40 to 60% of the patients with HF, with a prognosis which is similar to HF with reduced ejection fraction (HFrEF). HFpEF pathophysiology is different from that of HFrEF, and has been characterized with diastolic dysfunction. Diastolic dysfunction has been defined with elevated left ventricular stiffness, prolonged iso-volumetric LV relaxation, slow LV filing and elevated LV end-diastolic pressure. Arterial hypertension occurs in majority cases with HFpEF worldwide. Patients are mostly older and obese. Diabetes mellitus and atrial fibrillation appear proportionally in a high frequency of patients with HFpEF. The HFpEF diagnosis is based on existence of symptoms and signs of heart failure, normal or approximately normal ejection and diagnosing of LV diastolic dysfunction by means of heart catheterization or Doppler echocardiography and/or elevated concentration of plasma natriuretic peptide. The present recommendations for HFpEF treatment include blood pressure control, heart chamber frequency control when atrial fibrillation exists, in some situations even coronary revascularization and an attempt for sinus rhythm reestablishment. Up to now, it is considered that no medication or a group of medications improve the survival of HFpEF patients. Due to these causes and the bad prognosis of the disorder, rigorous control is recommended of the previously mentioned precipitating factors for this disorder. This paper presents a universal review of the most important parameters which determine this disorder.

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Assessment of diastolic dysfunction in elderly hypertensive patients using integrated Doppler echocardiography

Abstract: One third of elderly hypertensive patients with preserved systolic function had moderate-to-severe asymptomatic DD. More than half of the patients had EFP with normal mitral inflow pattern.

Cited by 7 publications

References 36 publications

The Effects of LCZ696 in Patients With Hypertension Compared With Angiotensin Receptor Blockers

The Effects of LCZ696 in Patients With Hypertension Compared With Angiotensin Receptor Blockers

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Heart Failure with Preserved Ejection Fraction â€“ Concept, Pathophysiology, Diagnosis and Challenges for Treatment

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