Pathophysiology and Echocardiographic Diagnosis of Left Ventricular Diastolic Dysfunction

Silbiger, Jeffrey J.

doi:10.1016/j.echo.2018.11.011

Cited by 91 publications

(73 citation statements)

References 84 publications

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“…In the present study, we found that hypertensive participants with LVH had a lower E/A ratio and a longer deceleration time that indicated abnormalities in relaxation [41,42,64] associated with normal LVFP, as evidenced by a normal E/e' ratio ( 8) [43] with almost normal LAA. The presence of an isolated relaxation abnormality without an impact on lling pressures is believed to be due to the relatively short duration of HTN (5 years and 4 years in participants with LVH and patients without LVH, respectively).…”

Section: Discussionsupporting

confidence: 49%

Association between insulin resistance and left ventricular hypertrophy in asymptomatic Black sub-Saharan African hypertensive patients: A case-control study

Phanzu

Aliocha

Eleuthère

et al. 2020

Preprint

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Background: Conflicting information exists regarding the association between insulin resistance (IR) and left ventricular hypertrophy (LVH). Here, we described the associations between parameters of obesity, fasting insulinaemia, homeostasis model assessment of insulin resistance (HOMA-IR) and LVH in Black patients with essential hypertension. Methods: A case-control study was conducted at the Centre Médical de Kinshasa (CMK), the Democratic Republic of the Congo, between January and December 2019. Cases and controls were hypertensive patients with and without LVH, respectively. The relationships between obesity indices, physical inactivity, parameters of glucose metabolism and lipid disorders and LVH were assessed using linear and logistic regression analyses in simple and univariate exploratory analyses, respectively. When differences were observed between LVH and the independent variables, the effect of potential confounders was studied by adjustment in multiple linear regression and conditional logistic regression in multivariate analysis. The coefficients of determination (R2), the adjusted ORs and their 95% CIs were calculated to determine the association between LVH and the independent variables. Results: Eighty-eight cases (52 men) were compared to 132 controls (81 men). Nineteen percent (19%) of left ventricular mass (LVM) variation was predicted by age; 31.3%, by the duration of hypertension; 44.4%, by body mass index (BMI); 42.5%, by waist circumference (WC); 20%, by glycaemia; 44.8%, by insulinaemia; and 43.7%, by HOMA-IR. In multiple linear regression analysis, duration of hypertension, BMI, insulinaemia and HOMA-IR explained 68.3% of the variability in the increase in LVM. In the logistic model, obesity multiplied the risk of LVH by 3 (aOR: 2.8, 95% CI (1.06-7.4), p = 0.038) and IR by 8 (aOR: 8.4, 95: (3.7-15.7), p <0.001). Conclusions: Obesity and IR appear to be the main predictors of LVH in Black sub-Saharan African hypertensive patients. The comprehensive management of cardiovascular risk factors should be emphasized with particular attention to obesity and IR. A prospective Black sub-Saharan population-based study with serial imaging remains essential to better understand subclinical LV deterioration over time and to confirm the role of IR in Black sub-Saharan individuals with hypertension.

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Section: Discussionsupporting

confidence: 49%

Association between insulin resistance and left ventricular hypertrophy in asymptomatic Black sub-Saharan African hypertensive patients: A case-control study

Phanzu

Aliocha

Eleuthère

et al. 2020

Preprint

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“…In the present study we found that hypertensive subjects with LVH had a lower E/A ratio and a longer deceleration time that indicate abnormality in relaxation [52,54]. The diastolic dysfunction is a consequence of both IR [69,70] and left ventricular hypertrophy, and underlying myocardial brosis [54,[71][72][73][74].…”

Section: Discussionmentioning

confidence: 72%

“…Normal LVM was de ned as ≤115 g/m2 or ≤ 48 g/m2.7 for males and ≤ 95 g/m2 or ≤44 g/m2.7 for females ; LVH was de ned as LVM exceeding these values in males and female patients respectively. Four LV geometric patterns were de ned as follows [51,52] : normal geometry (normal LVM and RWT ≤ 0.42), concentric remodeling (normal LVM and RWT > 0.42), eccentric hypertrophy (LVH and RWT ≤ 0.42) and concentric hypertrophy (LVH and RWT > 0.42).…”

Section: Echographic Datamentioning

confidence: 99%

Association between insulin resistance and left ventricular hypertrophy in sub-saharan hypertensive black patients with preserved ejection fraction: A case control study

Phanzu

Aliocha

Eleuthère

et al. 2020

Preprint

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Background:Conflicting information exists regarding the association between insulin resistance (IR) and left ventricular hypertrophy (LVH).We described the associations between parameters of obesity, fasting insulinemia, HOMAIR with LVH in black patients with essential hypertension.Materials and Methods:A case-control study was conducted at the Centre Médical de Kinshasa (CMK), the Democratic Republic of the Congo, between January and December 2019. Cases and controls were hypertensive patients with and without LVH, respectively. The relationship between obesity indices, physical inactivity, parameters of glucose metabolisme and lipid disorders and LVH were assessed using linear and logistic regression analyses in simple and univariate exploratory analysis, respectively. When differences were observed between LVH and the independent variables, the effect of potential confounders was studied by adjustment in multiple linear regression and in conditional logistic regression in multivariate analysis. The coefficients of determinations (R2), the adjusted ORs and their 95% CI were calculated to determine the association between the LVH and the independent variablesResults:Eighty-eight cases (52 men) were compared to 132 controls (81 men). Nineteen percent of left ventricular mass (LVM) variation (19%) was predicted by age, 31.3% by the duration of hypertension, 44.4% by BMI, 42.5% by WC, 20% by glycemia, 44.8% by insulinemia and 43.7% by HOMAIR. In multiple linear regression analysis, duration of hypertension, Body Mass Index (BMI), insulinemia and HOMAIR explained 68.3% of the variability in the increase in LVM. In the logisitic model obesity multiplied the risk of LVH by 3 (aOR: 2.8, 95% CI (1.06-7.4), p = 0.038), IR by 8 (aOR: 8.4, 95: (3.7-15.7), p <0.001).Conclusion:Obesity and IR appear to be the main predictors of LVH. The comprehensive management of cardiovascular risk factors should be emphasized with particular attention to obesity and insulin resistance. A prospective black sub-saharan population based study with serial imaging remain essential to better understand subclinical LV deterioration over time and to confirm the role of insulin resistance in black sub-saharan hypertensives.

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“…A wide range of diastolic patterns can be seen between the abnormal relaxation and restrictive filling patterns, but all could be described in one category based on the following measurements: LA volume, E/A, IVRT, and DT 22 …”

Section: Introductionmentioning

confidence: 99%

Diastolic function assessment by echocardiography: A practical manual for clinical use and future applications

Henein

Lindqvist

2020

Echocardiography

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Diastole is an important component of the cardiac cycle, during which time optimum filling of the ventricle determines physiological stroke volume ejected in the succeeding systole. Many factors contribute to optimum ventricular filling including venous return, left atrial filling from the pulmonary circulation, and emptying into the left ventricle. Left ventricular filling is also impacted by the cavity emptying function and also its synchronous function which may suppress early diastolic filling in severe cases of dyssynchrony. Sub‐optimum LA emptying increases cavity pressure, causes enlarged left atrium, unstable myocardial function, and hence atrial arrhythmia, even atrial fibrillation. Patients with clear signs of raised left atrial pressure are usually symptomatic with exertional breathlessness. Doppler echocardiography is an ideal noninvasive investigation for diagnosing raised left atrial pressure as well as following treatment for heart failure. Spectral Doppler based increased E/A, shortened E‐wave deceleration time, increased E/e’, and prolonged atrial flow reversal in the pulmonary veins are all signs of raised left atrial pressure. Left atrial reduced myocardial strain is another correlate of raised cavity pressure (>15 mm Hg). In patients with inconclusive signs of raised left atrial pressure at rest, exercise/stress echocardiography or simply passive leg lifting should identify those with stiff left ventricular which suffers raised filling pressures with increased venous return.

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Pathophysiology and Echocardiographic Diagnosis of Left Ventricular Diastolic Dysfunction

Cited by 91 publications

References 84 publications

Association between insulin resistance and left ventricular hypertrophy in asymptomatic Black sub-Saharan African hypertensive patients: A case-control study

Association between insulin resistance and left ventricular hypertrophy in asymptomatic Black sub-Saharan African hypertensive patients: A case-control study

Association between insulin resistance and left ventricular hypertrophy in sub-saharan hypertensive black patients with preserved ejection fraction: A case control study

Diastolic function assessment by echocardiography: A practical manual for clinical use and future applications

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