Clinical evaluation of left ventricular diastolic performance☆

To assess the atrial systolic function and the contribution of atrial contraction to left ventricular (LV) filling in septic shock patients as compared with healthy volunteers.

Twenty-seven septic patients evaluated during first 48 h of ICU admission and compared with 27 healthy volunteers. Left atrial (LA) contraction contribution to LV filling was calculated as the active emptying atrial volume/LV end-diastolic volume. Atrial systolic function was evaluated with the atrial kinetic force [LAKE = 0.5 × blood density × LVV_active × (peak A velocity)²] and atrial ejection force [LASF = 0.5 × blood density × mitral annulus area × (peak A velocity)²].

LV ejection fraction was lower in septic patients than in control group: 51 ± 14%vs 60 ± 6% (p < 0.01). Contribution of LA contraction to LV preload was greater in septic patients than in normal subjects (26.7 ± 11.3% vs 15.9 ± 5.9%, p < 0.001), even if adjusted for age (0.49 ± 0.19 vs 0.35 ± 0.13, p = 0.004). LAKE and LASF were also significantly larger in septic patients than in normal subjects (21.8 ± 9.1 vs 7.3 ± 3 kdynes·cm, p < 0.001; 16.1 ± 11.7 vs 9.8 ± 4.3 kdynes, p = 0.048, respectively), and remained unchanged during the next 48 h.

In septic shock patients, LA systolic function increased and greatly contributed to support LV filling. These results highlight the role of preserving atrial contraction on the hemodynamic resuscitation in early septic shock.

Purpose: Diastolic dysfunction preceding systolic dysfunction is considered an important interaction in cardiomyopathy with poor prognosis. The aim of this study was to compare left ventricular (LV) isovolumic relaxation with the other parameters as a potential prognostic marker for patients with idiopathic dilated cardiomyopathy (IDC) and hypertrophic cardiomyopathy (HC). Methods: A total of 145 patients with IDC and 116 with HC were evaluated for hemodynamic parameters; LV pressure was directly measured by a micromanometer catheter, and relaxation half-time (T_1/2) was used to determine LV isovolumic relaxation. The median follow-up period was 4.7 years. Results: The mean ages of the patients with IDC and HC were 52.0 ± 12.0 and 57.1 ± 12.4 years, respectively. Each patient group was further divided into 2 groups based on the median value of T_1/2: (1) <41.0 ms (D-L group) and ≥41.0 ms (D-H group) (2) <38.5 ms (H-L group) and ≥38.5 ms (H-H group). Kaplan-Meier analysis showed a significantly higher probability of cardiac events in the D-H group than in the D-L group (p = 0.001) and in the H-H group than in the H-L group (p = 0.028). Further, Cox proportional hazard regression analysis revealed that T_1/2 was an independent predictor of cardiac events for patients with IDC (hazard ratio 1.109; p = 0.007) and HC (hazard ratio 1.062; p = 0.041). In conclusion, regardless of the type of cardiomyopathy, T_1/2 as a measure of LV isovolumic relaxation function was found to be associated with the occurrence of cardiac events.

To investigate whether liraglutide improves diastolic function in type 2 diabetes.

Thirty-seven patients with type 2 diabetes who began liraglutide therapy between June 2013 and May 2014 were enrolled in this observational, prospective study. 26 patients received liraglutide therapy for at least 6 months. The remaining 11 patients withdrew from liraglutide therapy during the first month, were started on other hypoglycaemic therapies and formed the control group. Anthropometric, metabolic and echocardiographic parameters including pulsed wave tissue Doppler imaging were evaluated at baseline and at 6 months.

In the liraglutide group the early diastolic mitral annulus velocity on the lateral (e-lat) and medial (e-med) sides of the mitral annulus increased from 9.2 ± 3.4 to 11.6 ± 4.7 cm/s (p < 0.001) and from 6.9 ± 1.7 to 8.4 ± 2.6 cm/s (p < 0.003), respectively. The ratio of early-to-late velocities on the lateral and medial sides of the mitral annulus increased from 0.7 ± 0.3 to 0.9 ± 0.4 (p < 0.001) and from 0.5 ± 0.1 to 0.6 ± 0.1 (p < 0.02), respectively. The ratio of early diastolic mitral inflow velocity to early diastolic myocardial relaxation velocity decreased from 10.7 ± 4.3 to 8.5 ± 2.5 (p < 0.005). No improvements in diastolic function was detected in the control group. Glucose control improved similarly in both groups: HA1bc −1.5% (−17 mmol/mol) vs −1.3% (−14 mmol/mol), p = 0.67.

In patients with type 2 diabetes, 6 months liraglutide treatment was associated with a significant improvement in diastolic function.