Search

Diabetes mellitus is associated with left-sided myocardial remodeling in heart failure with preserved ejection fraction (HFpEF). Little is known about the impact of diabetes mellitus on right ventricular (RV) function in HFpEF. We therefore studied the relation between diabetes mellitus and RV dysfunction in HFpEF. We have examined patients with HFpEF who underwent simultaneous right-sided cardiac catheterization and echocardiography. RV systolic function was assessed using multiple established echocardiographic parameters, and systolic dysfunction was present if ≥2 parameters were outside the normal range. RV diastolic function was assessed using the peak diastolic tissue velocity of the lateral tricuspid annulus (RV e') and was present if <8.0 cm/s. Diabetes mellitus was defined as a documented history of diabetes, a fasting glucose level of ≥7.0 mmol/L, a positive glucose intolerance test result, or a glycated hemoglobin level of ≥6.5%. A total of 91 patients were studied (mean age 74 ± 9 years, 69% women). A total of 37% had RV systolic dysfunction and 23% RV diastolic dysfunction. Thirty-seven percent of the patients had type 2 diabetes mellitus. These patients had higher pulmonary artery pressure (34 mm Hg vs 29 mm Hg, p = 0.004), more RV systolic dysfunction (57% vs 29%, p = 0.009), more RV diastolic dysfunction (46% vs 12%, p = 0.001), and lower RV e' (8.7 cm/s vs 11.5 cm/s, p = 0.006). The presence of diabetes mellitus was independently associated with RV systolic dysfunction (odds ratio 2.84, 95% confidence interval 1.09 to 7.40, p = 0.03) and with RV diastolic dysfunction (odds ratio 4.33, 95% confidence interval 1.25 to 15.07, p = 0.02), after adjustment for age, gender, and pulmonary pressures. In conclusion, diabetes mellitus is strongly associated with RV systolic and diastolic dysfunctions in patients with HFpEF, independent of RV afterload., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The unique, unphysiological Fontan circulation is associated with an impaired functional status of the patients that is suggested to deteriorate over time. Unfortunately, previous studies did not integrate both pulmonary and cardiac determinants of functional status. In addition, a comparison with the natural decrease in exercise capacity in healthy subjects (in both children and adults) is lacking. This single-center study aims to investigate the functional status in a cohort of Fontan patients in relation to time since Fontan completion and to identify its determinants, including cardiac characteristics and pulmonary characteristics. Eighty-five consecutive Fontan patients ≥10 years who performed adequate cardiopulmonary exercise testing (respiratory exchange ratio >1.01) were included. Mean time since Fontan completion was 15 ± 9 years (range 2 to 37 years). New York Heart Association functional class was I in 36 patients (42%), II in 41 patients (48%), and III in 8 patients (9%). Peak oxygen uptake during exercise (VO 2 index) was 25.7 ± 7.9 ml/min/m 2 (58 ± 14% of predicted). New York Heart Association functional class and peak VO 2 index both correlated with time since the Fontan operation; however, peak VO 2 as percentage of predicted (VO 2 (pred)) did not. In multivariate analyses, peak VO 2 (pred) was independently associated with maximum heart rate, oxygen pulse at peak exercise, and forced expiratory volume in 1 second (R 2  = 0.579) but not with cardiac output in rest. In conclusion, the present data suggest that functional status in Fontan patients is impaired already shortly after Fontan completion, whereas its subsequent deterioration seems to follow the natural decline of aging. Furthermore, functional status in Fontan patients correlates with pulmonary function and cardiac functional parameters during exercise but not with conventional cardiac measurements at rest., (Copyright © 2017. Published by Elsevier Inc.)

Right ventricular (RV) dysfunction is a powerful risk marker after acute myocardial infarction (MI). Primary percutaneous coronary intervention (PCI) has markedly reduced myocardial damage of the left ventricle, but reliable data on RV damage using cardiac magnetic resonance imaging (MRI) are scarce. In a recent trial of patients with acute MI treated with primary PCI, in which the primary end point was left ventricular (LV) ejection fraction after 4 months measured with MRI, we conducted a prospectively defined substudy in which we examined RV function. RV ejection fraction (RVEF) and RV scar size were measured with MRI at 4 months. Tricuspid annular plane systolic excursion (TAPSE) and RV free wall longitudinal strain (FWLS) were assessed using echocardiography before discharge and at 4 months. We studied 258 patients without diabetes mellitus; their mean age was 58 ± 11 years, 79% men and mean LV ejection fraction was 54 ± 8%. Before discharge, 5.2% of patients had TAPSE <17 mm, 32% had FWLS > -20% and 11% had FWLS > -15%. During 4 months, TAPSE increased from 22.8 ± 3.6 to 25.1 ± 3.9 mm (p <0.001) and FWLS increased from -22.6 ± 5.8 to -25.9 ± 4.7% (p <0.001). After 4 months, mean RVEF on MRI was 64.1 ± 5.2% and RV scar was detected in 5 patients (2%). There was no correlation between LV scar size and RVEF (p = 0.9), TAPSE (p = 0.1), or RV FWLS (p = 0.9). In conclusion, RV dysfunction is reversible in most patients and permanent RV ischemic injury is very uncommon 4 months after acute MI treated with primary PCI., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Patients with tetralogy of Fallot and combined right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation (PR) have a less dilated right ventricular (RV) and better RV function compared with patients without RVOTO. It is not known whether RVOTO is associated with improved exercise capacity. We compared cardiac magnetic resonance imaging, echocardiography, and exercise tests in 12 patients with RVOTO (Doppler peak RVOT gradient ≥30 mm Hg) and 30 patients without RVOTO. RV end-systolic and end-diastolic volumes were smaller in patients with RVOTO compared with patients without RVOTO (50 ± 16 vs 64 ± 18 ml/m(2) and 117 ± 24 vs 135 ± 28 ml/m(2), respectively) and patients with RVOTO had a higher RV mass (52 ± 14 vs 42 ± 11 ml/m(2)), p <0.05. RV ejection fraction was marginally significantly different between both groups (58 ± 8% vs 53 ± 7%), p = 0.051. Degree of PR, left ventricular volumes, and function did not differ significantly between both groups. Peak oxygen uptake in patients with RVOTO was significantly lower (25 ± 3 vs 32 ± 8 ml/kg/min) than in patients without RVOTO, as was the percentage of predicted peak oxygen uptake (63 ± 7% vs 79 ± 14%), p <0.001. Multivariate analysis showed that the peak RVOT gradient was the only independent predictor of exercise capacity. In conclusion, exercise capacity is lower in patients with RVOTO compared with those without RVOTO despite a less dilated RV and comparable degree of PR. Therefore, exercise capacity may be of importance and should additionally be taken in consideration to RV volumes and function in patients with tetralogy of Fallot and PR., (Copyright © 2014 Elsevier Inc. All rights reserved.)