Ventricular twist in isolated left ventricular noncompaction

The study aimed at assessing the rotational motion of the left ventricle around the long axis in patients affected by isolated left ventricular noncompaction (LVNC) and comparing their results with those of healthy volunteers.Patients and methodsThe study comprised eight patients with LVNC confirmed by echocardiography and magnetic resonance imaging (mean age 41 ± 19 years; four males; left ventricular ejection fraction [LVEF] 45 ± 25%). The patients were divided into Group A with an LVEF above 50% (four patients; one male) and Group B with an LVEF below 50% (four patients; three males). For both groups, age- and sex-matched volunteers were found. The focus was on myocardial twist, rotation of the LV apex and base, times to reach maximal apical and maximal basal rotation and myocardial twist, as well as correlations between systolic function, rotation of individual planes and LV twist.ResultsWhen comparing LVNC patients with healthy volunteers, there were statistically significantly decreased systolic function (p = 0.004), larger diastolic dimension (p = 0.045) and decreased apical rotation (p = 0.01). Left ventricular twist was significantly decreased in the group of patients with LVNC and systolic dysfunction (p = 0.04). A statistically significant correlation was found between systolic function and LV apical rotation.ConclusionThe study showed a significant decrease in apical rotation and twist mechanism of the LV as measured using two-dimensional speckle tracking in patients with LVNC and decreased LV systolic function. Measuring these parameters could contribute to more accurate diagnosis and risk stratification of patients affected by this condition.     

Comparison between left atrial features in well-controlled hypertensive patients and normal subjects assessed by three-dimensional speckle tracking echocardiography

BackgroundThree-dimensional speckle tracking echocardiography (3D-STE) has a major advantage in the improvement of accuracy in the evaluation of cardiac chamber volume without any geometrical assumption. Thus, the aim of this study was to use 3D-STE to elucidate the features of left atrial (LA) volume and function that are altered by hypertension (HTN) by comparing well-controlled HTN patients with normal subjects.MethodsConventional echocardiographic parameters and LA phasic volume and function were measured from apical view by 3D-STE in 40 patients with well-controlled HTN [systolic blood pressure (BP) <140 and diastolic BP <90 mmHg for more than one year] and 40 normotensive subjects.ResultsThe passive LA emptying function (EF) in the patients with well-controlled HTN significantly decreased (16 ± 7% vs. 22 ± 8%, p = 0.0013) and the active LAEF in patients with well-controlled HTN significantly increased (35 ± 10% vs. 30 ± 9%, p = 0.029) compared with the values in normotensive subjects. Multivariate logistic regression analysis revealed that E/e′ was an independent determinant of well-controlled HTN. The maximum LA volume index was correlated with elevated E/e′ (r = 0.30, p = 0.0064), whereas the maximum LA volume index was not correlated with LV mass index or systolic BP. This change was independent of age.ConclusionsThese results suggest that LV diastolic dysfunction occurs before structural changes of left atrium and left ventricle even in patients with well-controlled HTN.     

Evaluation of left ventricular performance in hypertensive patients by speckle tracking echocardiography: Correlation with brain natriuretic peptide

BackgroundHypertension results in hemodynamic changes ranging from maladaptive left ventricular hypertrophy (LVH) to heart failure. Two-dimensional speckle tracking echocardiography (2D-STE) allows rapid and accurate analysis of regional and global left ventricular (LV) systolic and diastolic functions.ObjectiveAssessments of LV function in hypertensive patients with apparently preserved LV systolic function using 2D-STE in correlation with plasma brain natriuretic peptide (BNP) levels.Patients and MethodsEighty hypertensive patients were enrolled, they were classified into LVH group (group III) and non-LVH group (group II). Twenty sex and age-matched healthy individuals were recruited as controls (group I). 2D-STE was done to all subjects to assess LV longitudinal strain, and strain rate (SR). Plasma BNP levels were measured in all subjects.ResultsGlobal longitudinal systolic strain was significantly reduced in group III compared with group II (P = 0.037) and group I (P = 0.000). Furthermore, group III showed significantly reduced global LV longitudinal systolic SR and early diastolic strain rate compared with group II (P = 0.023 and 0.008 respectively), and group I (P = 0.01 and 0.0001 respectively). On the other hand, the mean values of global SRa s⁻¹ were significantly higher in both group II and group III compared to group I (P = 0.0001). A negative correlation was found between BNP level and global peak systolic strain, global systolic strain rate, early diastolic strain rate and late diastolic strain rate in hypertensive patients (groups II & III) in whom BNP level was significantly higher than controls (group I) (P = 0.000).ConclusionA substantial impairment of LV systolic and diastolic functions is detected in hypertensive patients with apparently preserved LV systolic function, especially if associated with LVH, as evidenced by two-dimensional speckle tracking echocardiography. Plasma BNP level is elevated in hypertensive patients and shows a significant negative correlation with strain and strain rate values.     

Feasibility of left ventricular volume measurements by three-dimensional speckle tracking echocardiography depends on image quality and degree of left ventricular enlargement: Validation study with cardiac magnetic resonance imaging

BackgroundNovel 3-dimensional echocardiography with speckle tracking imaging (3D-STE) may have advantages in assessing left ventricular (LV) volume through a cardiac cycle. The feasibility of 3D-STE may be affected by image quality and LV morphology.Methods and resultsWe studied 64 patients (38 men, age 55 ± 12 years) who underwent cardiac magnetic resonance imaging (CMRI) and 3D-STE on the same day. LV end-diastolic volume (EDV) and end-systolic volume (ESV) were measured by both modalities. Imaging qualities were quantified in each of 6 LV segments by an imaging quality score (IQS) of 1–3, and scores were averaged (mean IQS) at end-diastole and end-systole. Compared to CMRI, 3D-STE showed a tendency to underestimate LV volume measurements, but not significantly (EDV: bias = −18 ± 37 ml; ESV: bias = −10 ± 34 ml), and measurements correlated well with those by CMRI (EDV: R = 0.80, ESV: R = 0.86, ejection fraction: R = 0.75, p < 0.001). The absolute differences of LVEDV and ESV between 3D-STE and CMRI correlated significantly with mean IQS (LVEDV, R = −0.35, p = 0.005; LVESV, R = −0.30, p = 0.02). Based on the medium value of LVEDV by CMRI (127 ml), subjects were classified into the small (<127 ml) and large LVEDV (≧127 ml) groups. In the large LVEDV group, mean IQS significantly correlated with the absolute differences of LVEDV (mean IQS, r = −0.45, p = 0.01), despite no significant correlation in the small LVEDV group.Conclusion3D-STE could measure LV volume as well as CMRI, however, its accuracy depends on the quality of the acquired image and particularly on enlargement of the left ventricle.     

Low-dose dobutamine induces left ventricular mechanical dyssynchrony in patients with dilated cardiomyopathy and a narrow QRS: A study using real-time three-dimensional echocardiography

AimsThe effects of inotropic agents on left ventricular (LV) synchrony in heart failure patients are still unknown. The purpose of this study was to investigate the effects of dobutamine on LV mechanical dyssynchrony and LV systolic performance in patients with dilated cardiomyopathy (DCM) and a narrow QRS using real-time three-dimensional echocardiography (RT3DE).Methods and resultsThirty-three patients with idiopathic DCM and a narrow QRS underwent low-dose dobutamine stress echocardiography (LDSE) with RT3DE. A time-global LV volume curve and time-regional LV volume curves were derived from RT3DE. Regional LV stroke volumes were summed in each stage, and the dobutamine-induced increase in the sum of regional LV stroke volumes was considered as the sum of regional contractile reserve. Systolic dyssynchrony index (SDI) was calculated as follows: (standard deviation of time to minimal volume for regional LV segments) × 100/RR duration. Among the 33 patients, low-dose dobutamine increased global LV stroke volume (SV) in 28 (85%), but decreased global LVSV in the remainder (15%). The sum of regional contractile reserve was modestly correlated with the dobutamine-induced increase in global LVSV (R = 0.57, p < 0.001). In contrast, low-dose dobutamine increased SDI in 14 (42%) patients without a significant change in QRS duration, and there was an inverse correlation between the increase in SDI and the increase in global LVSV induced by dobutamine (R = ?0.67, p < 0.001).ConclusionsDobutamine may induce LV mechanical dyssynchrony in a substantial proportion of patients with DCM and a narrow QRS. In such cases, regional LV contractile reserve does not fully contribute to an increase in global LVSV.     

Evaluation of left ventricular mechanical dyssynchrony in chronic heart failure patients by two-dimensional speckle tracking imaging

The purpose of this study was to evaluate left ventricular mechanical dyssynchrony (LVMD) in chronic heart failure (CHF) patients using two-dimensional speckle tracking imaging (2D-STI), and also to compare the usefulness of three patterns of myocardial deformation in mechanical dyssynchrony assessment. Furthermore, the relationships between left ventricular ejection fraction (LVEF), QRS duration (QRSd), and LVMD were explored. In total, 78 patients and 60 healthy individuals (group 3) were enrolled. The patients were classified into two subgroups: LVEF ≤ 35% (group 1), 35% < LVEF < 50% (group 2). All participants underwent two-dimensional echocardiography, and dyssynchrony indices derived from 2D-STI were calculated. According to statistical principles, the cut-off value of LVMD was defined as mean ± 1.645 SD of the normal population. Dyssynchrony rates were calculated in CHF subgroups and compared within each subgroup, respectively. Compared with group 3, all indices in group 1 were remarkably higher (p < 0.05), and some of the indices in group 2 were significantly higher (p < 0.05). A significant difference of dyssynchrony rate was noted within both group 1 and group 2 (χ² = 25.55, p < 0.05 vs. χ² = 23.88, p < 0.05), and the highest value was derived from the longitudinal index in both subgroups. LVEF was related to all three forms of strain/strain rate (p < 0.05), whereas no relationship existed between QRSd and dyssynchrony indices (p > 0.05). CHF patients have different extents of LVMD. Longitudinal deformation shows the best detectability of dyssynchrony motion. Left ventricular systolic function was closely related to mechanical dyssynchrony, whereas QRSd showed no significant correlation.     

Efficacy of ivabradine in idiopathic dilated cardiomyopathy patients with chronic heart failure

BackgroundThe aim of this study was to investigate the effect of ivabradine on symptoms, quality of life, effort tolerance, and echocardiographic parameters in patients with idiopathic dilated cardiomyopathy presenting with New York Heart Association (NYHA) class III or IV heart failure (HF) symptoms.MethodsWe screened 167 patients hospitalized for NYHA class III or IV chronic HF symptoms and left ventricular (LV) ejection fraction <40%. Of these, 53 were randomly assigned to either guidelines-based medical therapy alone (23 patients, control group) or ivabradine as add-on therapy (30 patients) for 3 months with about 1 year follow up.ResultsAfter 3 months’ treatment, adding ivabradine significantly reduced the heart rate from 96 to 72 bpm (p < 0.0001 versus control group), with more improvement in echocardiographic LV dimensions, LV volumes, LV ejection fraction (p = 0.045), NYHA class symptoms (p = 0.004), exercise tolerance (p = 0.03), and quality of life (p = 0.02). The average number of hospitalizations for HF over a mean longer-term follow-up of 13.5 months was 1.0 ± 1.4 in the ivabradine group versus 2.1 ± 1.1 in the control group (p = 0.003). Heart rate reduction was significantly correlated with better exercise tolerance, quality of life, LV ejection fraction, and NYHA class, together with fewer HF hospitalizations. Multivariate analysis showed heart rate reduction to be a stronger predictor for better LV ejection fraction (p = 0.024) and decreased hospitalizations than ivabradine use.ConclusionAdding ivabradine to optimal medical treatment in HF patients improved symptoms, quality of life, effort tolerance, and echocardiographic parameters, and reduced hospitalization. This beneficial ivabradine effect is probably due to its heart rate–reducing properties.     

Three-dimensional echocardiographic evaluation of mechanical dyssynchrony in systolic heart failure with narrow QRS complex

ObjectivesTo investigate the role of three-dimensional echocardiography (3DE) in evaluation of left ventricular mechanical dyssynchrony (LVMD) in heart failure (HF) patients with narrow QRS.Methods143 subjects (70 with HF and narrow QRS, 23 with HF and LBBB and 50 controls) were subjected to 3DE, evaluating global and regional dyssynchrony using systolic dyssynchrony index, maximum segmental dyssynchrony and opposite segment dyssynchrony. Spatial distribution of LVMD was studied in each patient using 3DE derived regional time volume curves. Extent of LVMD in HF patients with narrow QRS was compared to those with left bundle branch block (LBBB).ResultsFrequency of LVMD was similar in HF patients with narrow QRS or LBBB (55.7% vs. 47.8%, p = NS). There was no difference in the severity of LVMD between these two groups (10.7 ± 6.7% vs. 12.1 ± 7.4%, p = NS). Both HF groups had significantly more dyssynchrony than controls. A scattered pattern of distribution of asynchronous segments was seen in narrow QRS patients; 33.96% of them had their earliest contracting segment, instead of delayed segment, located in areas conventionally targeted for LV pacing i.e. anterolateral, inferolateral or inferior segments.Conclusions3DE confirmed significant dyssynchrony in  > 50% HF patients with narrow QRS as demonstrated by other imaging methods. 3D distribution patterns of asynchronous segments indicate possibility of left ventricular mechanics related reasons responsible for lack of CRT responsiveness, an observation that generates hypothesis on possible reasons of CRT non-responsiveness.     

Metabolic manipulation in dilated cardiomyopathy: Assessing the role of trimetazidine

ObjectivesTo study the role of metabolic modulator (trimetazidine: TMZ) in dilated cardiomyopathy (DCM). Optimizing altered substrate metabolism in heart failure (HF) with metabolic modulators allows more efficacious energy production from glucose than from free fatty acids.Methods100 patients of DCM (47.7 years, NYHA class 2.17, LVEF 27.3%) were randomized to TMZ (20 mg tid, n = 50) vs conventional therapy (n = 50). Functional status, BNP and various echocardiographic parameters were assessed at 3–6 months.ResultsAt 3 months, TMZ group had significantly improved NYHA class (2.25 vs 1.85), 6 min walk test (349.7 vs 402 m), LVD-36 score (25.5 vs 21) and BNP (744.7 vs 248.3 pg/ml), all p 0.001. Significant improvement was also seen in LV end-systolic (LVESV, 87.1 ± 27.5 vs 78.5 ± 24.9 ml/m², p 0.001), LV end-diastolic volumes (LVEDV, 117.6 ± 29.3 vs 110.9 ± 27.4 ml/m², p 0.001), LVEF (27 vs 30.9%, p 0.001) and LV wall stress (90.2 ± 18.9 vs 71.1 ± 13.2 dyn/cm², p 0.0001). The % change in LVESV, LVEDV, LVEF and LV wall stress was −9.5%, −5.4%, +8.4% and −21.8%. Other echo parameters also improved after 3 months of TMZ (E/A ratio 1.9 vs 1.2, p = 0.001, E/A VTI 2.7 vs 1.6, p = 0.001, myocardial performance index, MPI 0.8 vs 0.7, p = 0.0001), Tissue Doppler parameters (E/E′ septal (19.7 vs 12.5, p = 0.001) and E/E′ lateral (13.3 vs 9.4, p = 0.0001)). Patients in control group had no change in NYHA class, LVD-36 scores, LV volumes or LVEF at 3 months although BNP and LV wall stress reduced to a slight extent. Patients on TMZ had further improvement in NYHA class, walk test, BNP levels and echocardiographic parameters at 6 months.ConclusionsMetabolic modulators (TMZ) may help in improving LV function in DCM. In this study, benefit was noted by 3 months with further improvement at 6 months.     

Assessment of right ventricular function by myocardial performance index in diabetic patients

BackgroundAssessment of right ventricular (RV) function remains difficult because of the RV complex shape. Data regarding RV performance in patients with diabetes are incomplete The aim of this study was to assess the feasibility of pulsed wave tissue Doppler imaging and myocardial performance index (MPI) for the assessment of right ventricular function in diabetic patients without coronary artery disease.MethodsThe study included 20 diabetic patients, 20 diabetic hypertensive and 20 gender and age matched healthy subjects underwent standard echocardiography with tissue Doppler imaging (TDI) to assess RV function. Patients with myocardial ischemia, impaired left ventricular systolic function, valvular heart disease or other diseases which could alter the right ventricular performance were excluded.ResultsMyocardial performance index was significantly higher in diabetes compared to control group (0.41 ± 0.05 versus 0.27 ± 0.04, p = 0.001). Peak myocardial systolic velocity (Sa), early diastolic myocardial velocity (Ea), and late diastolic myocardial velocity (Aa) were significantly lower in patients with diabetes mellitus (DM) compared to the control group (p = 0.0001). Isovolumetric relaxation time (IVRT) was significantly higher in DM group compared to control group (p = 0.003). MPI was significantly higher in diabetic hypertensive group versus DM alone group (0.46 ± 0.050 versus 0.41 ± 0.05, p = 0.01). There was no correlation between MPI and blood glucose level and duration of diabetes.ConclusionMyocardial performance index is a useful noninvasive tool for the detection of early right ventricular systolic and diastolic dysfunction in diabetic patients, regardless of coexisting hypertension.     

Systolic and diastolic function in patients with systemic sclerosis

BackgroundClinical and epidemiological findings indicate that symptomatic heart disease in patients with systemic sclerosis (SSc) predicts poor prognosis, but cardiac involvement may occur years before clinical manifestation. The aim of this study was to evaluate the cardiac function in patients with SSc and to correlate the echocardiographic parameters with others that quantify the diseases' severity.MethodsTwenty consecutive patients with SSc were investigated with transthoracic echocardiography (TTE). Two dimensional, pulsed Doppler and pulsed tissue Doppler imaging (TDI) techniques were used, in all the patients, to assess the systolic and diastolic function for left ventricle (LV). Correlations were made between echocardiographic measurements and some clinical and serological features of the patients.ResultsNone of the patients had any clinical signs of cardiac involvement, nor ECG or TTE systolic function impairment; there are significant differences between systemic sclerosis patients and control group for peak A velocity (0.75 ± 0.22 vs 0.57 ± 0.32, P = 0.05), E/A ratio (1.14 ± 0.22 vs 1.48 ± 0.26, P = 0.01), E/Ea ratio (8.25 ± 1.57 vs 7 ± 2.2, P = 0.05), which account for filling impairment of LV. There are also significant correlations between some other parameters, like the mean duration of Raynaud's phenomenon and E/Ea ratio (r = 0.48, P < 0.05).ConclusionsThe analysis of SSc heart disease, mainly at a preclinical level, is important in all the cases as an asymptomatic patient may have diastolic dysfunction which can be treated and should be closely observed.     

Speckle tracking echocardiography in systemic sclerosis: A useful method for detection of myocardial involvement

BackgroundSystemic sclerosis is a multisystem disorder characterized by tissue fibrosis and organ damage. Heart involvement is one of the main factors shortening survival, which may be underestimated by conventional echocardiography measurements. Two-dimensional speckle-tracking echocardiography is a powerful novel modality to assess subclinical myocardial dysfunction.AimThe aim of this study is to investigate heart involvement in systemic sclerosis patients, and to determine the usefulness of ventricular longitudinal deformation using the Two-dimensional speckle tracking technology for an early detection of ventricular dysfunction.Patients and methodsBetween May 2016 and September 2016, 25 patients with systemic sclerosis and 25 healthy subjects underwent echocardiography to assess heart abnormalities and the strain of the two ventricles using two dimensions’ speckle tracking echography.ResultsThe two groups were comparable in age and gender. Despite comparable left ventricle systolic function (left ventricular ejection fraction patients 64.58 ± 8.87 vs. in healthy 68.2 ± 7.41, P = 0.19), patients presented altered longitudinal peak systolic strain values (global longitudinal strain: patients −17.42 ± 1.62 vs. healthy −19.24 ± 8.85, P < 0.0001). Despite comparable pulmonary artery systolic pressure, there was a significant alteration in right ventricular systolic and diastolic function assessed by standard measurement. Longitudinal peak systolic strain of the right ventricle was significantly lower in patients compared with controls (P < 0.01).ConclusionVentricular deformation analysis by two dimensions’ speckle tracking echocardiography appears to be a sensitive method to detect early ventricular impairment in patients with systemic sclerosis.     

Hypocalcemia is related to left ventricular diastolic dysfunction in patients with chronic kidney disease

BackgroundLeft ventricular (LV) diastolic dysfunction in patients with chronic kidney disease (CKD) is of a complex nature and is the predominant cause of congestive heart failure in this group of patients. This work aimed to evaluate the potential effect of disturbances in calcium-phosphorus (Ca-P) metabolism in patients with CKD on LV diastolic function as assessed by echocardiography.Materials and methodsThe study group consisted of 81 ambulatory patients with CKD, stages 2–5, with preserved LV systolic function–LV ejection fraction >50% and with sinus rhythm. Standard echocardiography was performed in all patients with tissue Doppler echocardiography for the evaluation of the systolic velocity and both diastolic velocities of LV (EmLV and AmLV). The following laboratory parameters were measured: serum creatinine concentration, estimated glomerular filtration rate, and the levels of urea, P, Ca, parathormone, platelet count, hemoglobin level, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Patients were divided into two groups according to the results of EmLV: group with LV diastolic dysfunction (EmLV < 8 cm/s) DF (+) and group with normal LV diastolic function DF (−), when EmLV was ≥8 cm/s.ResultsPatients in DF (+) group, as compared to DF (−) patients, manifested a lower serum Ca level and an elevated NT-proBNP level [9.03 ± 0.76 mg/dL vs 9.44 ± 0.78 mg/dL, p = 0.02, and 257.9 (32.6–12,633) pg/ml vs 149 (11.7–966) pg/ml, p = 0.035, respectively]. The area under the receiver operating characteristics (ROC) curve of Ca for diastolic dysfunction was 0.627, 95% CI (0.511–0.734), p = 0.04, whereas ROC derived Ca value of ≤9.82 mg/dL was characterized by a sensitivity of 91.8% and specificity of 38.1% for diagnosing LV diastolic dysfunction. The only independent variable predicting LV diastolic dysfunction as measured by a multivariate logistic regression analysis was Ca level ≤ 9.82 mg/dL with odds ratio = 8.81 (95% CI 1.49–51.82), p = 0.014.ConclusionsHypocalcemia is an independent predictive factor for LV diastolic dysfunction in patients with CKD.     

Association between C-reactive protein level and echocardiography assessed left ventricular function in first ST-segment elevation myocardial infarction patients who underwent primary coronary intervention

BackgroundAn elevated C-reactive protein (CRP) level is associated with adverse outcomes in patients with acute myocardial infarction (AMI). Although CRP levels have been shown to be associated with left ventricular (LV) systolic function and remodeling in AMI, little is known about their relation to early LV diastolic function.MethodsWe retrospectively studied 173 consecutive patients <75 years of age with first ST-segment elevation MI (STEMI) that was treated by primary percutaneous coronary intervention (PPCI). They had presented within 24 h of chest pain onset and their CRP levels were determined within 6 h of hospital admission. They all underwent echocardiography within 3 days of admission and were stratified by CRP tertiles.ResultsThe cut-off points for the CRP tertiles were <2.6 mg/L, 2.6–7.9 mg/L, and >7.9 mg/L. Patients with higher CRP levels had a significantly higher mean mitral inflow E wave velocity (68 ± 16 cm/s vs 77 ± 19 cm/s vs 76 ± 17 cm/s; p = 0.02), a higher E/average e′ (8.9 ± 1.9 vs 9.8 ± 2.8 vs 10.4 ± 3.2; p = 0.02), and a higher systolic pulmonary artery pressure (27 ± 6 mmHg vs 30 ± 8 mmHg vs 32 ± 10 mmHg; p = 0.04). Elevated CRP levels were associated with more advanced diastolic dysfunction than normal CRP levels (p = 0.04). The admission CRP level was an independent predictor of average E/e′ ratio (multivariate analysis).ConclusionAdmission CRP levels are associated with echocardiographic parameters of elevated LV filling pressure in patients with STEMI treated with PPCI.     

Short term statin treatment in idiopathic dilated cardiomyopathy

BackgroundStatins may provide additional benefits in patients with cardiac failure due to their pleiotropic effects besides their cholesterol-lowering actions. In this study, we aimed to evaluate the impact of 12-week 40 mg atorvastatin therapy on the inflammatory markers, endothelium dependent vasodilatation and the ventricular performance markers in patients with heart failure (HF).Methods and resultsThirty chronic symptomatic heart failure patients, all with idiopathic dilated cardiomyopathy (DCM) were included to this open label and prospective study. Thirty patients were subdivided into two groups: group I – 15 patients who were given 40 mg of atorvastatin and group II – 15 patients who were given a placebo. After a 12-week treatment with atorvastatin 40 mg/day; clinical functional capacity, echocardiographic indices of cardiac performance and inflammatory markers were evaluated. After the treatment, even though the left ventricular ejection fraction (LV EF) did not improve significantly in the group receiving statins (29.2 ± 6.18 to 29.73 ± 6.27 in the statin group and 28.13 ± 5.81 to 27.93 ± 5.56 in the control group), both the 6 min walk test and Minnesota living with heart failure questionnaire improved significantly (p = 0.000 and 0.022, respectively). The flow mediated dilatation in the brachial arteries also showed improvement in the statin receiving group (8.9–13.8 in the statin group p = 0.0001, and 9.5–10.2 in the control group p = 0.055). In addition, the statin receiving group showed significantly lower levels of highly sensitive C-reactive protein (hs-CRP) levels at follow up (4.6–1.93 in statin group p = 0.005, and 7.2–4.97 in the control group p = 0.176).ConclusionShort term atorvastatin treatment improved functional capacity and the clinical symptoms in HF patients with idiopathic dilated cardiomyopathy. This positive effect of atorvastatin might be secondary to inflammatory modulation and improvement of endothelial function. Statins in HF deserve special attention by means of further large-scale trials.     

The effect of percutaneous coronary revascularization on plasma N-terminal pro-B-type natriuretic peptide levels in stable coronary artery disease

BackgroundThis study was conducted to assess the effect of percutaneous coronary revascularization (PCR) on plasma NT-proBNP concentration in patients with chronic stable angina (CSA).MethodsThis prospective open label interventional study included 22 patients with moderate to severe CSA, normal left ventricular (LV) systolic functions and critical (>90%) proximal stenosis in one of the three major epicardial coronary arteries. After stabilization of medications for 8 weeks, resting supine plasma NT-proBNP levels were measured and patients underwent PCR of the involved vessels. Eight weeks later, with medications unaltered; plasma NT-proBNP levels were repeated and compared with the baseline levels. LV systolic and diastolic functions were assessed before and after PCR.ResultsThe mean age of the patients was 61.27 ± 8.87 years. Out of 22 patients, 20 were male and 2 were female. PCR was performed on left anterior descending coronary artery (LAD) in 12 patients and in a non-LAD vessel in 10 patients. After 8 weeks of successful PCR, there was a significant overall reduction in mean plasma NT-proBNP levels (from 244.36 ± 218.99 to 168.68 ± 161.61 pg/mL, p = 0.016). The patients who underwent PCR of LAD demonstrated significantly reduced NT-pro-BNP levels after PCR (p = 0.009). In the non-LAD group, NT-proBNP levels also decreased, albeit insignificantly (p = 0.432). Reduction in NT-proBNP was independent of change in LV systolic functions.ConclusionSuccessful PCR, by relieving myocardial ischemia, significantly reduced plasma NT-proBNP levels in majority of the patients with chronic stable angina secondary to critical epicardial coronary artery stenosis.     

Effects of sustained-release trimetazidine on chronically dysfunctional myocardium of ischemic dilated cardiomyopathy – Six months follow-up result

BackgroundIschemic cardiomyopathy is a growing burden in third world countries. So far, benefits of trimetazidine in this group of patients have been suggested by clinical trials mainly conducted in Europe. We evaluated the effect of trimetazidine on ischemic dilated cardiomyopathy in our population.Methods and results98 patients (aged 58.5 ± 9.2 years), admitted with decompensated heart failure with previous history of MI and/or documentation of significant CAD with previous CAG, were chosen for the study. Patients were randomized into two groups – one provided with trimetazidine 35 mg sustained released tablet, twice daily and the other with a placebo, along with other conventional medications. Patients were included if they had dilated LV (LVIDd > 57 mm) and left ventricular ejection fraction (LVEF) ≤40%. After 6 months, significantly higher number of patients in trimetazidine group were in NYHA class I (22% vs. 8%, p = 0.03) and class II (56% vs. 34%, p = 0.01); higher number of patients in placebo group were in NYHA class III class IV. Anginal episodes and use of sublingual nitrate per week were significantly lower in the trimetazidine group. Left ventricular diastolic dimension (59.7 ± 5.2 vs. 65.1 ± 6.1, p = 0.001) was significantly different in the two groups as was the increase of LVEF (11% vs. 5.6%, p = 0.001). Hospitalization for worsening heart failure was significantly lower in trimetazidine group (13 vs. 22, p = 0.047).ConclusionTrimetazidine seems to be beneficial in patients with ischemic dilated cardiomyopathy in South Asian population and larger scale study with extended follow-up is needed.     

Predictors of mortality in medically treated patients with congestive heart failure of nonrheumatic etiology and reduced systolic function

ObjectiveWe investigated the prognostic value of various parameters on the mortality of patients with nonrheumatic chronic heart failure and left ventricular (LV) systolic dysfunction.MethodsThis study included 132 consecutive patients with congestive heart failure and reduced LV systolic function without rheumatic valve disease. The primary outcome was mortality. Mean follow-up was 38 ± 6 months.ResultsDuring the follow-up period there were 47 deaths (35.6%). The age (64.1 ± 13.5 vs. 58.7 ± 11.8 years, P = 0.019), left bundle branch block (44.7% vs. 18.8%, P = 0.002), urea concentration (11.4 ± 5.3 vs. 8.9 ± 4.6 mmol/L, P = 0.006), LV end-diastolic and end-systolic dimensions (6.7 ± 0.8 vs. 6.4 ± 0.8 cm, P = 0.025 and 5.5 ± 0.8 vs. 4.9 ± 0.8 cm, P < 0.001, respectively), grade 3–4 mitral regurgitation (40.4 vs. 22.4%, P < 0.001), fractional shortening (16.7 ± 5.3% vs. 19.8 ± 5.7%, P = 0.002) and LV ejection fraction (32.9 ± 8.5% vs. 38.7 ± 11.3%, P = 0.003) were different between non-survivors and survivors. Multivariate analysis identified severity of mitral regurgitation (OR = 1.99, 95% CI 1.18–3.34; P = 0.009), age (OR = 1.07, 95% CI 1.02–1.12; P = 0.01) and LV end-systolic dimension (OR = 1.09, 95% CI 1.02–1.16; P = 0.014) as independent correlates of mortality.ConclusionsIn medically treated patients with nonrheumatic chronic heart failure and left ventricular systolic dysfunction, severity of mitral regurgitation, age and enlarged LV end-systolic dimension were independently associated with increased risk of death.     

Assessment of left ventricular function and aortic elastic properties in patients with Behçet’s disease using conventional and tissue Doppler echocardiography

BackgroundBehçet disease (BD) is a multisystemic, chronic inflammatory disorder of unknown etiology with diffuse clinical manifestations including the cardiovascular system.Aim of the workTo assess left ventricular (LV) function and thoracic aorta elastic properties in BD patients using Doppler echocardiography and to correlate echocardiographic findings with disease activity.Patients and methodsThe LV functions and thoracic aorta elastic properties were assessed in 30 BD patients and 30 controls using conventional and Tissue Doppler Imaging (TDI) echocardiography. Disease activity was evaluated using Behçet’s disease current activity form (BDCAF). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), cholesterol and triglyceride levels were measured.ResultsIn BD patients, ESR and CRP were significantly elevated while cholesterol and triglycerides were comparable to the levels in the control. In conventional echocardiography, BD patients had significantly higher aortic diastolic diameter (p < 0.05), aortic stiffness index (p < 0.001), isovolumic relaxation time (p < 0.001), flow propagation velocity (FPV) and peak E-wave velocity/FPV (E/FPV) (p < 0.001) than the control group while aortic strain was significantly lower in BD patients (p < 0.05). Lateral mitral TDI echocardiography showed that myocardial performance index was statically higher in BD patients (p < 0.001) while peak myocardial velocity and myocardial acceleration during isovolumic contraction were significantly lower (p < 0.001). The BDCAF showed a significant correlation with different echocardiographic parameters of systolic and diastolic dysfunction.ConclusionsBehçet disease patients have impaired LV systolic and diastolic functions and altered aortic elastic properties that correlate with disease activity. TDI is more sensitive than conventional echocardiography for the detection of early ventricular dysfunction in patients with BD.     

Utility of QRS width and echocardiography parameters in an integrative algorithm for selecting heart failure patients with cardiac dyssynchrony

BackgroundCardiac resynchronization therapy (CRT) is an effective treatment in dilated cardiomyopathy (DCM). However, it has been demonstrated that mechanical dyssynchrony is not related to electrical dyssynchrony. We hypothesized that a new QRS width cutoff could be easier to use as a first step in the selection of patients with inter- and intraventricular dyssynchrony.MethodsWe included 58 patients with DCM. Electrocardiographic (PR interval and QRS width) and echocardiographic (left ventricular dimensions, systolic and diastolic function, dyssynchrony parameters) data were evaluated in all patients.ResultsAccording to QRS width, we divided the study population in two groups: Group 1, 25 patients having a narrow QRS (≤ 120 ms), and Group 2, 33 patients having a wide QRS (> 120 ms). Patients in Group 2 had larger left ventricles, with similar systolic function and more severe diastolic dysfunction than patients with narrow QRS. Interventricular dyssynchrony was more frequent in group 2 (54.5% vs 20%, p = 0.01), while intraventricular dyssynchrony was highly prevalent in both groups (82.1% vs 72%, p = 0.48). A QRS > 140 ms best predicted the presence of interventricular dyssynchrony (sensitivity 78.2% and specificity 63.6%), while a QRS > 150 ms best predicts intraventricular dyssynchrony (sensitivity 48.6% and specificity 80%).ConclusionsIntraventricular dyssynchrony has a high prevalence in patients with DCM, irrespective of the QRS width. Using a higher QRS width cutoff (150 ms) might help in patient selection for CRT. Electrocardiography and echocardiography can be combined into a selection algorithm for patients receiving resynchronization therapy.