Effect of revascularizing viable myocardium on left ventricular diastolic function in patients with ischaemic cardiomyopathy

Carluccio, Erberto; Biagioli, Paolo; Alunni, Gianfranco; Murrone, Adriano; Leonelli, Valeria; Pantano, Paola; Vincenti, Gabriella; Giombolini, Claudio; Ragni, Temistocle; Reboldi, Gianpaolo; Gentile, Federico; Ambrosio, Giuseppe

doi:10.1093/eurheartj/ehp125

Cited by 37 publications

(32 citation statements)

References 43 publications

(21 reference statements)

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“…In contrast to the highly significant reduction in left atrial early diastolic strain rate after sleep deprivation, there were no significant changes in left atrial systolic strain, systolic strain rate, and late diastolic strain rate. This fits very well to the isolated, small but significant increase in left ventricular relaxation and isovolemic relaxation time, possibly indicating that acute sleep deprivation affected primarily early left ventricular diastole, i.e., the energy-consuming process of diastole, which for example is also affected by myocardial ischemia [13] or changes in afterload [14]. The only finding which does not fit into the picture is the lack of change (not even a trend) in the early diastolic mitral annular velocity (e′), which is currently regarded as one of the best if not the best non-invasive measures of left ventricular relaxation [15].…”

supporting

confidence: 75%

Reduced left atrial early strain rate following acute sleep deprivation: chance finding or chance to find out more on the conundrum of sleep and cardiovascular disease?

Maeder

2012

Sleep Breath

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There is now a large and robust body of evidence showing that the presence of severe obstructive sleep apnea (OSA) is associated with an increased risk of hypertension, atrial fibrillation, heart failure, and death [1]. In addition, epidemiological studies have also revealed associations between self-reported short sleep duration in the absence of known OSA and several cardiovascular risk factors including hypertension [2] and diabetes [3]. In this context, a number of small mechanistic studies using acute sleep deprivation models have been undertaken in healthy humans to test the hypothesis that sleep deprivation per se, i.e., in the absence of OSA, may adversely affect the cardiovascular system. In these studies, acute sleep deprivation has been shown to increase heart rate [4]; to adversely affect heart rate variability [4][5][6]; to increase atrial electromechanical delay [7], P wave dispersion [8], and QT dispersion [9]; to increase plasma norepinephrine [5]; and to impair vascular function [4,5]. To date, there are very little data on the impact of sleep deprivation on cardiac function as assessed by echocardiography, however.In their current paper in Sleep and Breathing, Acar et al.[10] present the results of an innovative study investigating the effects of acute sleep deprivation on left heart function, in particular left atrial function. The authors performed comprehensive transthoracic echocardiography in a cohort of 27 normal subjects both after a night of regular sleep and after a night of sleep deprivation. Sleep deprivation was induced by night work (one night with partial sleep deprivation), and the intervention (normal sleep versus sleep deprivation) was not randomized. The authors assessed left atrial function not only by standard volumetric parameters but also measurement of tissue Doppler-derived left atrial strain and strain rate. Strain reflects intrinsic myocardial deformation, and strain rate represents its change over time [11,12]. Both measurements have the advantage to be relatively load-independent. Although measurement of strain and strain rate on the atrial level is not currently in routine clinical use, a number of studies have demonstrated their applicability in different populations [11,12]. After a night of sleep deprivation (sleeping time 2.3 h versus 7.8 h during regular sleep), no significant effects on blood pressure, heart rate, left ventricular dimensions, left atrial dimensions, and volumetric measurements of left atrial function were found in the present study. However, the authors observed a significant reduction in left atrial early diastolic strain rate (a measure of left atrial conduit function) after sleep deprivation, and there was a moderate correlation between lower left atrial early diastolic strain rate and shorter sleep duration (r 2 00.31). In contrast, there was no significant change in left atrial systolic strain, systolic strain rate, and late diastolic strain rate. There was also a small but significant increase in deceleration time and isovolemic relaxati...

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supporting

confidence: 75%

Reduced left atrial early strain rate following acute sleep deprivation: chance finding or chance to find out more on the conundrum of sleep and cardiovascular disease?

Maeder

2012

Sleep Breath

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“…21,22 In line with these observations, the present trial documented an improvement in myocardial perfusion and a reduction in myocardial ischemia after intramyocardial bone marrow cell injection. 2 In patients undergoing coronary artery bypass grafting, improvements in myocardial relaxation and filling pressures were reported by Carluccio et al 23 Accordingly, it may be hypothesized that the observed improvements in myocardial relaxation and, subsequently, filling pressures, are secondary to enhanced myocardial perfusion. From a mechanistic point of view, the current data support this hypothesis because the enhanced myocardial perfusion would be expected to improve active processes such as myocardial relaxation rather than altering myocardial structure and ventricular compliance.…”

Section: Discussionmentioning

confidence: 92%

Intramyocardial Bone Marrow–Derived Mononuclear Cell Injection for Chronic Myocardial Ischemia

Ramshorst

Antoni²,

Beeres³

et al. 2011

Circ: Cardiovascular Imaging

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Background— The present substudy of a recently published randomized trial aimed to investigate the effect of intramyocardial bone marrow cell injection on diastolic function in patients with chronic myocardial ischemia. Methods and Results— In a total of 50 patients, diastolic function was evaluated before and 3 months after bone marrow cell injection using standard echocardiography and strain analysis. In addition, MRI-derived transmitral flow measurements were obtained in a subset of 36 patients. Left ventricular ejection fraction increased from 50±5% to 54±7% in the bone marrow cell group, which was a significant improvement as compared with the placebo group (52±5% versus 51±7%, P =0.001). Filling pressure estimate E/E′ ratio improved from 14±5 at baseline to 12±4 at 3 months in the bone marrow cell group, whereas no improvement was observed in the placebo group (13±4 versus 13±5). The improvement in E/E′ ratio was significantly larger in the bone marrow cell group ( P =0.008). Furthermore, the E/A peak flow ratio as assessed by MRI showed a significant increase in the bone marrow cell group as compared with the placebo group (+0.16±0.25 versus −0.04±0.21, P =0.01), which was mainly related to an increase in the early (E) peak flow rate in the bone marrow cell group (from 407±96 mL/s to 468±110 mL/s, P =0.009 as compared with the placebo group). Conclusions— The current study demonstrates that intramyocardial bone marrow cell injection is associated with a beneficial effect on myocardial relaxation and filling pressures in patients with chronic myocardial ischemia. Clinical Trial Registration— URL: http://www.trialregister.nl . Unique identifier: NTR400/ISRCTN58194927.

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“…The FAs are the main source of energy for the heart, and L -carnitine transfers the FA across mitochondrial membranes to produce energy [1]. In the literature, it is well established that CABG surgery produces an increase up to 10% in the LVEF value, with improvement of the left ventricular systolic function [23,24]. …”

Section: Discussionmentioning

confidence: 99%

Effect of <smlcap>L</smlcap>-Carnitine Supplementation on Reverse Remodeling in Patients with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A Randomized, Placebo-Controlled Trial

Guimarães

Cruz

Silva³

et al. 2017

Ann Nutr Metab

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During cardiac failure, cardiomyocytes have difficulty in using the substrates to produce energy. L-carnitine is a necessary nutrient for the transport of fatty acids that are required for generating energy. Coronary artery graft surgery reduces the plasma levels of L-carnitine and increases the oxidative stress. This study demonstrates the effect of L-carnitine supplementation on the reverse remodeling of patients undergoing coronary artery bypass graft. Patients with ischemic heart failure who underwent coronary graft surgery were randomized to group A - supplemented with L-carnitine or group B controls. Left ventricular ejection fraction, left ventricular systolic and diastolic diameters were assessed preoperatively, 60 and 180 days after surgery. Our study included 28 patients (26 [93.0%] males) with a mean age ± SD of 58.1 ± 10.5 years. The parameters for the evaluation of reverse remodeling did not improve after 60 and 180 days of coronary artery bypass grafting in comparison between groups (p > 0.05). Evaluation within the L-carnitine group showed a 37.1% increase in left ventricle ejection fraction (p = 0.002) and 14.3% (p = 0.006) and 3.3% (p > 0.05) reduction in systolic and diastolic diameters, respectively. L-carnitine supplementation at a dose of 50 mg/kg combined with artery bypass surgery did not demonstrate any additional benefit in reverse remodeling. However, evaluation within the L-carnitine group may indicate a clinical benefit of L-carnitine supplementation.

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Effect of revascularizing viable myocardium on left ventricular diastolic function in patients with ischaemic cardiomyopathy

Abstract: In patients with ischaemic cardiomyopathy, LV diastolic filling may largely improve after revascularization. Improvement of diastolic dysfunction is related to the amount of viable tissue and it may represent an additional advantage of revascularizing dyssinergic but viable myocardium.

Cited by 37 publications

References 43 publications

Reduced left atrial early strain rate following acute sleep deprivation: chance finding or chance to find out more on the conundrum of sleep and cardiovascular disease?

Reduced left atrial early strain rate following acute sleep deprivation: chance finding or chance to find out more on the conundrum of sleep and cardiovascular disease?

Intramyocardial Bone Marrow–Derived Mononuclear Cell Injection for Chronic Myocardial Ischemia

Effect of <smlcap>L</smlcap>-Carnitine Supplementation on Reverse Remodeling in Patients with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A Randomized, Placebo-Controlled Trial

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