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Sepsis is a systemic inflammatory response syndrome of suspected or confirmed infectious origin, which frequently culminates in multiorgan failure, including cardiac involvement. Septic cardiomyopathy (SCM) remains a poorly defined clinical entity, lacking a formal or consensus definition and representing a significant knowledge gap in critical care medicine. It is an often-underdiagnosed complication of sepsis. The only widely accepted aspect of its definition is that SCM is a transient myocardial dysfunction occurring in patients with sepsis, which cannot be attributed to ischemia or pre-existing cardiac disease. The pathogenesis of SCM appears to be multifactorial, involving inflammatory cytokines, overproduction of nitric oxide, mitochondrial dysfunction, calcium homeostasis dysregulation, autonomic imbalance, and myocardial edema. Diagnosis primarily relies on echocardiography, with advanced tools such as tissue Doppler imaging (TDI) and global longitudinal strain (GLS) providing greater sensitivity for detecting subclinical dysfunction and guiding therapeutic decisions. Traditional echocardiographic findings, such as left ventricular ejection fraction measured by 2D echocardiography, often reflect systemic vasoplegia rather than intrinsic myocardial dysfunction, complicating accurate diagnosis. Right ventricular (RV) dysfunction, identified as a critical component of SCM in many studies, has multifactorial pathophysiology. Factors including septic cardiomyopathy itself, mechanical ventilation, hypoxemia, and hypercapnia—particularly in cases complicated by acute respiratory distress syndrome (ARDS)—increase RV afterload and exacerbate RV dysfunction. The prognostic value of cardiac biomarkers, such as troponins and natriuretic peptides, remains uncertain, as these markers primarily reflect illness severity rather than being specific to SCM. Treatment focuses on the early recognition of sepsis, hemodynamic optimization, and etiological interventions, as no targeted therapies currently exist. Emerging therapies, such as levosimendan and VA-ECMO, show potential in severe SCM cases, though further validation is needed. The lack of standardized diagnostic criteria, combined with the heterogeneity of sepsis presentations, poses significant challenges to the effective management of SCM. Future research should focus on developing cluster-based classification systems for septic shock patients by integrating biomarkers, echocardiographic findings, and clinical parameters. These advancements could clarify the underlying pathophysiology and enable tailored therapeutic strategies to improve outcomes for SCM patients. [ABSTRACT FROM AUTHOR]

Background: Recent large clinical trials have revealed that sodium–glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular outcomes not only in patients with heart failure with reduced ejection fraction, but also in patients with heart failure with mildly reduced or preserved ejection fraction (HFpEF). However, the effect of SGLT2 inhibitors on left ventricular (LV) diastolic function is still controversial. Methods and Results: The TOP-HFPEF trial (Efficacy of Tofogliflozin on Left Ventricular Diastolic Dysfunction in Patients with Heart Failure with Preserved Ejection Fraction and Type 2 Diabetes Mellitus) is a multicenter, double-arm, open-label, confirmatory, investigator-initiated clinical study to investigate the effect of SGLT2 inhibitor on LV diastolic function in patients with HFpEF and type 2 diabetes mellitus. The participants are randomly assigned (1:1) to the tofogliflozin group (20 mg once daily) or the control group (administration or continuation of antidiabetic drugs other than SGLT2 inhibitors). The estimated number of patients to be enrolled in this trial is 90 in total (45 in each group). The participants are followed up for 52 weeks with tofogliflozin or control drugs. The primary endpoint is the change in E/e′ assessed by echocardiography from the baseline to the end of this study (52 weeks). This trial will also evaluate the effects of tofogliflozin on cardiovascular events, biomarkers, other echocardiographic parameters, the occurrence of atrial fibrillation, and renal function. Conclusions: The TOP-HFPEF trial will clarify the efficacy of an SGLT2 inhibitor, tofogliflozin, on LV diastolic function in patients with HFpEF and type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Aim To explore the effect of age on myocardial remodeling after percutaneous coronary intervention (PCI) in patients with acute anterior myocardial infarction. Methods This study was a cross-sectional study analyzing clinical data of regular follow-up at 1, 3, 6 and 12 months after PCI for acute anterior myocardial infarction. According to the age of the patients, they were divided into a low age group (<65 years old) and a high age group (≥65 years old). The differences in baseline data, biochemical indexes, coronary angiography, inflammatory factor levels, and cardiac ultrasound indexes between the two groups were analyzed, and the correlation analysis between age and inflammatory factors and the multivariate linear regression analysis of diastolic function were performed. Results A total of 87 patients with acute anterior myocardial infarction were selected, aged (62 ±13) years, including 67 males (77. 0%), 43 in the low age group and 44 in the high age group. Compared with the low age group, the levels of inflammatory factors such as C-reactive protein, interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) increased in the high age group, while ultrasound indicators such as mitral valve annulus septal e′, mitral valve flow velocity E/A, and mitral valve annulus sidewall e′ decreased (P<0. 05). Older age was an independent risk factor for a decrease in mitral valve flow velocity E/A, mitral valve annulus sidewall e′ and mitral valve annulus septal e′ in patients with acute anterior myocardial infarction 6 months after PCI (P<0. 05). Conclusion Age is an independent risk factor for reduced diastolic function after PCI in acute anterior myocardial infarction, inflammatory factor such as IL-1β, IL-6 and TNF-α may play a role in the impaired diastolic function after PCI in age-related acute anterior myocardial infarction. [ABSTRACT FROM AUTHOR]

Background/Objectives: Solid organ transplant recipients (OTR) have been recently involved in exercise prescription programs in order to reduce the high prevalence of cardiovascular diseases. The normal systolic and diastolic cardiac function is fundamental to personalizing the prescription. Diastolic dysfunction can be associated to a higher risk of cardiovascular events and left atrial (LA) strain is an emerging parameter in the evaluation of diastolic compromising, especially in subjects with preserved ejection fraction. Left atrial (LA) strain has never been explored in this category. The study aimed to evaluate the contribution of the LA strain in the assessment of diastolic function of OTR and its potential contribution in the exercise program. Methods: 54 solid OTR (liver and kidney transplants) regularly trained for at least 12 months in a home-based, partially supervised model at moderate intensity estimated by cardiopulmonary exercise test, underwent a complete echocardiographic analysis. The measured variables included left ventricle systolic function (ejection fraction, EF), diastolic function (E/A and E/E'), LA indexed volumes, LA peak atrial longitudinal strain (PALS) and LA peak atrial contraction strain (PACS). The data were compared to those of 44 healthy subjects (HS). Results: The OTR showed an overweight condition (BMI: 25.79 ± 2.92 vs. 22.25 ± 2.95; p < 0.01). Both groups showed a preserved systolic function (EF: OTR 63.1 ± 3.5% vs. HS 66.9 ± 6.1; p < 0.001), while diastolic standard parameters were significantly different (E/A, 1.01 ± 0.4 vs. 1.96 ± 0.74; p < 0.001; E/E', 9.2 ± 2.7 vs. 6.9 ± 1.3; p < 0.001, in OTR and HS respectively) despite being normal. LA strain was significantly lower in OTR vs. HS (4C PALS, 33.7 ± 9.7 vs. 45.4 ± 14.19; p < 0.001; 4C PACS, 15.9 ± 6.7 vs. 11.6 ± 7.5; p = 0.006; 2C PALS, 35.3 ± 11.1 vs. 47.6 ± 14.9; p < 0.001; 2C PALS, 17.4 ± 4.9 vs. 13.2 ± 14.97; p = 0.001; in OTR and HS respectively). A specific correlation of two- and four-chamber PACs and PALs with BMI has been observed (R for 4C PALS −0.406 ** and 2C PALS −0.276 *). Conclusions: These findings suggest that the coexistence of increased bodyweight in asymptomatic OTR patients can exacerbate the impairment of LA strains. LA strain detection could be useful in the development of a personalized exercise program for OTRs, especially for asymptomatic subjects and those with elevated cardiovascular risk profile, to potentially manage the exercise program in the long term. Larger studies will confirm the role via an eventual structured clinical score index. [ABSTRACT FROM AUTHOR]

To study the relationship between myocardial infarction size (IS), myocardial edema, and diastolic dysfunction after acute myocardial infarction (MI) both in the acute phase, and in the development of diastolic dysfunction in the follow-up setting. A further purpose is to study diastolic function using a mechanistic model as well as conventional parameters. Patients underwent cardiovascular magnetic resonance (CMR) imaging and echocardiography including mechanistic analysis using the parameterized diastolic filling method within 4–7 days (acute) and 6 months after a first acute anterior MI (n = 74). Linear regression modeling of echocardiographic diastolic parameters using CMR IS with and without inclusion of the myocardium at risk (MAR) and model comparisons with likelihood ratio tests were performed. Diastolic parameters at 6 months follow-up were modelled using final IS. For most parameters there was no association with acute IS, except for deceleration time (R2 = 0.24, p < 0.001), left atrial volume index (R2 = 0.13, p = 0.01) and the mechanistic stiffness parameter (R2 = 0.21, p < 0.001). Adding MAR improved only the e′ model (adjusted R2 increase: 0.08, p = 0.02). At 6 months follow-up, final IS was only associated with viscoelastic energy loss (R2 = 0.22, p = 0.001). In acute MI, both IS and MAR are related to diastolic function but only to a limited extent. At 6 months after infarction, increasing IS is related to less viscoelastic energy loss, albeit also to a limited extent. The relationship between IS and diastolic dysfunction seems to be mediated by mechanisms beyond simply the spatial extent of ischemia or infarction. [ABSTRACT FROM AUTHOR]

The orphan nuclear receptor Nr4a1 has complex biological functions and has been implicated in numerous diseases, including cardiovascular disease. While protective in atherosclerosis and myocardial ischemia, Nr4a1 has been shown to cause cardiac fibrosis in non-ischemic adverse remodeling of the heart. However, mechanisms underlying these actions are still poorly understood. Accordingly, we sought to: (1) understand the contribution of Nr4a1 to the inflammatory environment including macrophage phenotype; and (2) determine the contribution of Nr4a1 to cardiac fibroblast phenotype in the fibrotic heart. Wild type and Nr4a1−/− mice were infused with angiotensin II (1500 ng/kg/min) to induce cardiac fibrosis and diastolic dysfunction. Nr4a1 deletion prevented cardiac fibrosis and maintained normal diastolic function. We determined that macrophages lacking Nr4a1 had distinctly different phenotypes to wild type macrophages, with Nr4a1 deletion preventing the induction of a pro-inflammatory macrophage phenotype, instead promoting an anti-inflammatory phenotype. This had functional consequences in that macrophages lacking Nr4a1 showed a reduced ability to induce cardiac fibroblast migration. Interestingly, deletion of Nr4a1 in isolated cardiac fibroblasts also had profound effects on their phenotype and function, with these cells not able to produce excess extracellular matrix proteins, convert to a myofibroblast phenotype, or respond to macrophage stimuli. Nr4a1 causes cardiac fibrosis and subsequent diastolic dysfunction by inducing a pro-inflammatory phenotype in macrophages and by pushing cardiac fibroblasts towards a pro-fibrotic phenotype in response to pro-fibrotic stimuli. Nr4a1 is also critical for macrophage/fibroblast interactions. [ABSTRACT FROM AUTHOR]

In the absence of left-sided cardiac/pulmonary disease, functional tricuspid regurgitation (FTR) is referred to as isolated or idiopathic. Relationships between left ventricular diastolic dysfunction (DD) and FTR remain unknown. The purpose of this study was to investigate the prevalence, incidence, and outcome of DD in patients with idiopathic FTR. Adults without structural heart disease were identified. Severe DD was defined by ≥3 of 4 abnormal DD parameters (medial e′, medial E/e′, TR velocity, left atrial volume index) and ≥ moderate DD by ≥2. Propensity-score matching was performed (3:1) between each less-than-severe TR group and severe TR based on age, sex, body mass index, and comorbidities. Among 30,428 patients, FTR was absent in 73%, mild in 22%, moderate in 4%, and severe in 0.4%. In the propensity-matched sample, severe DD was present in 2%, 6%, 9%, and 13% patients, and ≥ moderate DD in 11%, 18%, 28%, and 48%, respectively (P < 0.001). The probability of heart failure with preserved ejection fraction using the H 2 FPEF score increased with increasing FTR (median 29.7%, 45.5%, 61.4%, and 88.7%, respectively), as did the prevalence of impaired left atrial strain <24% (35%, 48%, and 69% in mild, moderate, and severe TR). Incident severe and ≥ moderate DD developed more frequently with increasing FTR (HR: 8.45 [95% CI: 2.60-27.50] and HR: 2.82 [95% CI: 1.40-5.69], respectively for ≥ moderate vs no FTR) over a median of 3.0 years. Findings were confirmed in patients without lung disease or right ventricular enlargement. Over a median of 5.0 years, patients with ≥ moderate FTR and DD had the greatest risk of worse outcomes (multivariable P < 0.001). The association between TR and adverse outcomes was significantly diminished in the absence of DD. Diastolic dysfunction, increased heart failure with preserved ejection fraction probability, and impaired left atrial strain are commonly present in patients with idiopathic FTR, suggesting that the latter may not be truly isolated. Patients with FTR without DD or heart failure are at increased risk of incident DD. Patients with FTR and DD display worse outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract Current guideline for evaluating diastolic function requires multiple parameters to identify patients with elevated left ventricular end-diastolic pressure (LVEDP). However, the intermediate result still exists and may cause LVEDP undetermined. Previous studies have shown intraventricular pressure difference (IVPDs) are required for normal LV filling, but the relationship between IVPDs and LVEDP is unknown. In this study, we analyzed the relationship between IVPDs and LVEDP in 54 patients with coronary artery disease (CAD). LVEDP was prospectively measured at the time of coronary intervention and LVEDP > 15 mmHg was considered as elevated LV filling pressure. Simultaneous echocardiographic data was collected prior to the intervention. The relative intraventricular pressure was calculated using the vector flow mapping method. The IVPD was defined as the pressure difference from the apex to the base of LV. From 54 patients presenting with CAD, elevated LVEDP occurred in 30(55.6%). To analyze the changing trend of IVPD with LVEDP, CAD patients were further divided into group I with normal LVEDP (12.7 ± 3.1 mmHg) and group II with elevated LVEDP (26.0 ± 7.2 mmHg). In early diastole, both isovolumic relaxation period and rapid filling period showed decreased IVPD in CAD patients, but only the reduction in isovolumic relaxation period (IVPD-IVR) was statistical different between patients with elevated LVEDP and normal LVEDP (1.03 ± 0.42 mmHg vs. 2.25 ± 1.21 mmHg, p

Background: The benefits of exercise for primary and secondary prevention of cardiovascular events have been reported in patients with type 2 diabetes mellitus (T2DM). However, the effects of exercise on cardiac structure and function require clarification. Methods: A literature search for clinical studies reporting on the effects of exercise on cardiac structure, cardiac function, and VO2peak in T2DM patients was conducted. PubMed, Embase, EBSCO, Web of Science, and China National Knowledge Infrastructure were systematically searched for original articles published from January 2000 to July 2023. The effect size was expressed as the mean difference (MD) or standardized mean difference (SMD) and its 95% confidence interval (CI). Subgroup analyses were performed by exercise mode (high-intensity interval training [HIIT] or moderate-intensity continuous training [MICT]) and intervention duration (>6 or ≤6 months). Results: Compared to usual care, both HIIT and MICT significantly affected left ventricular end-diastolic volume (MD: 19.44, 95% CI: 13.72 to 25.17, p < 0.00001; I2 = 42%; MD: 13.90, 95% CI: 7.64 to 20.16, p < 0.0001; I2 = 0%), but only HIIT significantly affected left ventricular mass (MD: 17.04 g, 95% CI: 5.45 to 28.62, p = 0.004; I2 = 0%). HIIT significantly improved left ventricular ejection fraction (MD: 5.52, 95% CI: 2.31 to 8.73, p = 0.0008; I2 = 0%), as did MICT in the ≤6 months subgroup (MD: 1.36, 95% CI: 0.61 to 2.10, p = 0.0004; I2 = 0%). Neither significantly affected systolic tissue velocity. HIIT significantly improved VO2peak (MD: 8.04, 95% CI: 6.26 to 9.83, p < 0.00001; I2 = 0%), as did MICT in the ≤6 months subgroup (MD: 3.33, 95% CI: 2.39 to 4.27, p < 0.00001; I2 = 0%). Conclusion: Exercise significantly improved cardiac structure, systolic function, and VO2peak, but did not significantly affect diastolic function in T2DM patients. HIIT seemed to be superior to MICT at improving VO2peak and left ventricular ejection fraction in T2DM patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, PROSPERO registration no.: CRD4242018087376 [ABSTRACT FROM AUTHOR]

Simple Summary: In recent years, intraventricular pressure gradient (IVPG) measured using color M-mode, which is excellent for evaluating diastolic function, has gained attention. In this study, the IVPG of cats with hypertrophic cardiomyopathy (HCM) was evaluated. The results showed that in non-obstructive HCM (HNCM), there were no changes in IVPG, whereas in hypertrophic obstructive cardiomyopathy (HOCM), IVPG increased despite a suspected decline in diastolic function. The fact that a significant difference was observed only with IVPG suggests the existence of pathophysiological differences that can only be detected by IVPG. By using IVPG for the evaluation of HOCM, it is expected that more accurate assessment of the condition, improvement of treatment methods, and new prognostic indicators, which were previously unattainable, will become possible. Hypertrophic cardiomyopathy (HCM) is a common form of cardiomyopathy in cats, and heart failure occurs as diastolic dysfunction progresses. HCM in cats is broadly classified as non-obstructive and obstructive hypertrophic cardiomyopathy, depending on the presence or absence of outflow tract obstruction. Measurement of the intraventricular pressure differences (IVPD) using color M-mode (CMM) has attracted attention as a reliable diastolic index as it correlates with catheterization, the gold standard for the assessment of diastolic performance. Because IVPD is affected by the size of the heart, the intraventricular pressure gradient (IVPG) index, which is unaffected by heart size, is by calculated by dividing IVPD by LV length. In the present study, CMM IVPG was used to non-invasively assess diastolic impairment in cats with obstructive hypertrophic cardiomyopathy. This study was conducted on 10 control cats and 18 cats in the HCM group. Although no severe left atrial enlargement was observed in the HCM group, the basal IVPG was significantly increased in the HOCM group compared to the control group. Although IVPD typically suggests impaired diastolic function and reduced ventricular compliance, the significant increase observed in the HOCM group compared to controls may suggest an indirect elevation in left atrial pressure, likely secondary to left ventricular outflow tract obstruction. The increase in IVPG in HOCM, as shown in this study, is a pathological effect of left ventricular outflow tract obstruction that cannot be detected by conventional echocardiographic indices, and evaluating IVPG is useful to evaluate cardiac function from a perspective that differs from conventional methods. [ABSTRACT FROM AUTHOR]

Current guideline for evaluating diastolic function requires multiple parameters to identify patients with elevated left ventricular end-diastolic pressure (LVEDP). However, the intermediate result still exists and may cause LVEDP undetermined. Previous studies have shown intraventricular pressure difference (IVPDs) are required for normal LV filling, but the relationship between IVPDs and LVEDP is unknown. In this study, we analyzed the relationship between IVPDs and LVEDP in 54 patients with coronary artery disease (CAD). LVEDP was prospectively measured at the time of coronary intervention and LVEDP > 15 mmHg was considered as elevated LV filling pressure. Simultaneous echocardiographic data was collected prior to the intervention. The relative intraventricular pressure was calculated using the vector flow mapping method. The IVPD was defined as the pressure difference from the apex to the base of LV. From 54 patients presenting with CAD, elevated LVEDP occurred in 30(55.6%). To analyze the changing trend of IVPD with LVEDP, CAD patients were further divided into group I with normal LVEDP (12.7 ± 3.1 mmHg) and group II with elevated LVEDP (26.0 ± 7.2 mmHg). In early diastole, both isovolumic relaxation period and rapid filling period showed decreased IVPD in CAD patients, but only the reduction in isovolumic relaxation period (IVPD-IVR) was statistical different between patients with elevated LVEDP and normal LVEDP (1.03 ± 0.42 mmHg vs. 2.25 ± 1.21 mmHg, p < 0.01). IVPD-IVR had the best correlation with LVEDP (r=-0.499, p < 0.01) among IVPDs. Lower IVPD-IVR was associated with higher risk of elevated LVEDP. Evaluating IVPD-IVR might improve the diagnostic algorithm for predicting elevated LVEDP. [ABSTRACT FROM AUTHOR]

Left ventricular (LV) diastolic dysfunction, atrial fibrillation (AF), and heart failure with preserved ejection fraction (HFpEF) share common risk factors and are closely related to one another and to adverse cardiovascular events. Exertional dyspnoea in patients with AF should trigger a comprehensive LV diastolic function evaluation since AF frequently precedes incident HFpEF. An echocardiographic assessment of LV diastolic function in patients with AF is challenging, mainly because of variability in cycle length, the absence of atrial contraction, and the frequent occurrence of left atrial enlargement regardless of LV filling pressures (LVFPs). The algorithm of the 2016 recommendations for the evaluation of LV diastolic function cannot be directly applied in this setting. This review discusses the modalities available for diastolic function assessment and HFpEF diagnosis in patients with AF. Based on currently available data, a reasonable clinical target of diastolic function evaluation in AF would be to reach a binary conclusion: LVFP elevated or not. Recently, a two-step algorithm that combined several echocardiographic parameters plus the inclusion of body mass index has been proposed to differentiate normal from elevated LVFP in patients with AF. The echocardiographic evaluation must be complemented by a thorough clinical evaluation along with natriuretic peptides and cardiac catheterization in selected cases. If a diagnosis of HFpEF cannot be ascertained, a close follow-up for timely identification of diastolic dysfunction markers, along with monitoring and correction of modifiable risk factors, is recommended. [ABSTRACT FROM AUTHOR]

This article reviews and discusses non-myocardial disorders that represent diagnostic challenges when evaluating patients for suspected heart failure with preserved left ventricular ejection fraction. This includes pre-capillary pulmonary hypertension, which is important to differentiate from post-capillary hypertension caused by left-sided heart disease. The impact of electrical disorders on LV diastolic function is also reviewed, and includes a discussion of left bundle branch, which has both a direct effect on LV diastolic function, as well as a long-term effect due to remodelling. Furthermore, evaluation of diastolic function in patients with atrial fibrillation is discussed. Pericardial diseases are reviewed as well as effects of a normal pericardium on diastolic function in failing hearts. Finally, the article reviews how valvular diseases impact LV diastolic function. [ABSTRACT FROM AUTHOR]

Heart failure with preserved ejection fraction (HFpEF) is a major healthcare problem that is raising in prevalence. There has been a shift in HpEF management towards early diagnosis and phenotype-specific targeted treatment. However, the diagnosis of HFpEF remains a challenge due to the lack of universal criteria and patient heterogeneity. This review aims to provide a comprehensive assessment of the diagnostic workup of HFpEF, highlighting the role of echocardiography in HFpEF phenotyping. [ABSTRACT FROM AUTHOR]

Obesity is associated with important changes in cardiac energetics and function, and an increased risk of adverse cardiovascular outcomes. Multi‐nuclear MRS and MRI techniques have the potential to provide a comprehensive non‐invasive assessment of cardiac metabolic perturbation in obesity. A rat model of obesity was created by high‐fat diet feeding. This model was characterized using in vivo hyperpolarized [1‐13C]pyruvate and [2‐13C]pyruvate MRS, echocardiography and perfused heart 31P MRS. Two groups of obese rats were subsequently treated with either caloric restriction or the glucagon‐like peptide‐1 analogue/agonist liraglutide, prior to reassessment. The model recapitulated cardiovascular consequences of human obesity, including mild left ventricular hypertrophy, and diastolic, but not systolic, dysfunction. Hyperpolarized 13C and 31P MRS demonstrated that obesity was associated with reduced myocardial pyruvate dehydrogenase flux, altered cardiac tricarboxylic acid (TCA) cycle metabolism, and impaired myocardial energetic status (lower phosphocreatine to adenosine triphosphate ratio and impaired cardiac ΔG~ATP). Both caloric restriction and liraglutide treatment were associated with normalization of metabolic changes, alongside improvement in cardiac diastolic function. In this model of obesity, hyperpolarized 13C and 31P MRS demonstrated abnormalities in cardiac metabolism at multiple levels, including myocardial substrate selection, TCA cycle, and high‐energy phosphorus metabolism. Metabolic changes were linked with impairment of diastolic function and were reversed in concert following either caloric restriction or liraglutide treatment. With hyperpolarized 13C and 31P techniques now available for human use, the findings support a role for multi‐nuclear MRS in the development of new therapies for obesity. [ABSTRACT FROM AUTHOR]

To assess the hemodynamics of twin-to-twin transfusion syndrome (TTTS), we measured the intraventricular pressure difference (IVPD), a sensitive marker of myocardial diastolic function, using fetal echocardiography. We included 28 monochorionic diamniotic (MD) twins diagnosed with TTTS who underwent fetoscopic laser photocoagulation (FLP) between 2018 and 2022. Color M-mode Doppler images of both cardiac ventricles were obtained before and after FLP. According to this evaluation, the IVPDs were divided into three groups; those with total, basal, and mid-apical IVPD. Of the 28 twins, 21 were available for analysis (including eight, eight, three, and two cases in stages Quintero Ⅰ, Ⅱ, Ⅲd, and Ⅲr, respectively). Comparing the pre and postFLP results, significant increases in total and mid-apical IVPD in the left ventricle (LV) of recipient twins were noted (total and mid-apical IVPD: p=0.026 and 0.013, respectively). In the LV of the donor twins, all IVPDs were significantly increased after FLP (total, basal, and mid-apical IVPD: p=0.003, 0.001, and 0.022, respectively). In addition, comparisons between the donor and recipient groups did not show significant differences in either ventricle before FLP. IVPD detected subtle hemodynamics changes, such as volume overload and diastolic dysfunction in TTTS before and after FLP. Therefore, IVPD may be a useful marker for monitoring myocardial diastolic function in TTTS. [ABSTRACT FROM AUTHOR]

We hypothesized that the beneficial effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on diastolic function might depend on baseline left ventricular (LV) systolic function. To investigate the effects of SGLT2 inhibitors on LV diastolic function in patients with type 2 diabetes mellitus (T2DM), we conducted a post-hoc sub-study of the PROTECT trial, stratifying the data according to LV ejection fraction (LVEF) at baseline. After excluding patients without echocardiographic data at baseline or 24 months into the PROTECT trial, 31 and 38 patients with T2DM from the full analysis dataset of the PROTECT trial who received ipragliflozin or no SGLT2 inhibitor (control), respectively, were included. The primary endpoint was a comparison of the changes in echocardiographic parameters and N-terminal pro-brain natriuretic peptide levels from baseline to 24 months between the two groups stratified according to baseline LVEF. Differences in diastolic functional parameters (e' and E/e') were noted between the two groups. Among the subgroups defined according to median LVEF values, those with higher LVEF (≥60 %) who received ipragliflozin appeared to have a higher e' and lower E/e' than did those who received the standard of care with no SGLT2 inhibitor, indicating longitudinal improvements between baseline and follow up (p = 0.001 and 0.016, respectively). Ipragliflozin generally improved LV diastolic function in patients with type 2 diabetes, the extent of this improvement might appear to vary with LV systolic function. [Display omitted] • Study on sodium-glucose cotransporter-2 inhibitors' impact on diastolic function in type 2 diabetes. • Ipragliflozin improves diastolic function in high left ventricular ejection fraction (LVEF) diabetes patients. • The effect of ipragliflozin on diastolic function varies with baseline LVEF in diabetes. [ABSTRACT FROM AUTHOR]

Aging per se is a major risk factor for cardiovascular diseases and is associated with progressive changes in cardiac structure and function. Rodent models are commonly used to study cardiac aging, but do not closely mirror differences as they occur in humans. Therefore, we performed a 2D echocardiographic study in non-human primates (NHP) to establish age- and sex-associated differences in cardiac function and morphometry in this animal model. M mode and 2D echocardiography and Doppler analyses were performed cross-sectionally in 38 healthy rhesus monkeys (20 females and 18 males), both young (age 7–12 years; n = 20) and old (age 19–30 years; n = 18). The diameters of the cardiac chambers did not differ significantly by age group, but males had larger left ventricular diameters (2.43 vs 2.06 cm in diastole and 1.91 vs 1.49 cm in systole, p = 0.0004 and p = 0.0001, respectively) and left atrial diameter (1.981 vs 1.732 cm; p = 0.0101). Left ventricular mass/body surface area did not vary significantly with age and sex. Ejection fraction did not differ by age and females presented a higher ejection fraction than males (54.0 vs 50.8%, p = 0.0237). Diastolic function, defined by early to late mitral peak flow velocity ratio (E/A), was significantly lower in old rhesus monkeys (2.31 vs 1.43, p = 0.0020) and was lower in females compared to males (1.595 vs 2.230, p = 0.0406). Right ventricular function, evaluated by measuring the Tricuspid Annular Plane Systolic Excursion, did not differ by age or sex, and Right Ventricular Free Wall Longitudinal Strain, did not differ with age but was lower in males than in females (-22.21 vs -17.95%, p = 0.0059). This is the first echocardiographic study to evaluate age- and sex-associated changes of cardiac morphometry and function in young and old NHP. The findings of this work will provide a reference to examine the effect of age and sex on cardiac diseases in NHP. [ABSTRACT FROM AUTHOR]

This study assessed the impact of sweetened alcohol and naringin on cardiac function in Sprague‐Dawley rats. Male (n = 40) and female (n = 40) rats were allocated to control, sweetened alcohol (SOH), naringin (NA), and sweetened alcohol with naringin (SOH + NA) groups. SOH and SOH + NA rats received 10% alcohol + 20% fructose in gelatine; SOH + NA and NA rats received 50 mg/kg naringin in gelatine daily for 10 weeks. Echocardiography was performed to assess left ventricular (LV) function. LV cardiomyocyte diameters and collagen area fraction were determined by H&E and picrosirius‐red staining, respectively. In males, sweetened alcohol and naringin did not affect cardiac function. Female SOH rats had increased LV end‐diastolic posterior wall (p = 0.04), relative wall thicknesses (p = 0.01), and LV cardiomyocyte diameters (p = 0.005) compared with control. Female SOH and SOH + NA had reduced lateral e' and e'/a' and increased E/e' (p < 0.0001). Female SOH (p = 0.01) and SOH + NA (p = 0.04) rats had increased LV collagen area fraction compared with controls. In males, neither sweetened alcohol nor naringin affected cardiac geometry or diastolic function. In females, sweetened alcohol induced concentric remodelling, impaired LV relaxation, and elevated filling pressures. Naringin may have the potential to improve the sweetened alcohol‐induced concentric remodelling; however, it did not ameliorate diastolic dysfunction in females. [ABSTRACT FROM AUTHOR]

Aims: Echocardiographic diastolic parameters are used to diagnose and monitor increased left ventricular filling pressure (LVFP) and we hypothesized that increased loading conditions cause increased E/e′. Our aim was to assess the effect of preload augmentation on diastolic parameters among both healthy subjects and subjects with known cardiac disease. Methods and results: We included 129 subjects merged from two cohorts; one dialysis cohort (n = 47) and one infusion cohort (n = 82). Echocardiography was performed immediately before and after hemodialysis (HD) or saline infusion, under low and high loading conditions. Elevated LVFP was defined as septal E/e′ ≥ 15 and/or lateral E/e′ ≥ 13 at high‐loading conditions. The population was divided according to elevated LVFP (n = 31) and normal LVFP (n = 98). The load difference for the population was 972 ± 460 mL, with no differences in load difference between elevated and normal LVFP (p NS). The subjects with elevated LVFP were older (63 ± 11 vs. 46 ± 16 years, p <.001), and had lower LV ejection fraction (50 ± 14 vs. 59 ± 8.1%, p <.01). After augmented preload, EDV increased in the normal LVFP group (p <.01) but remained unchanged in the elevated LVFP group (p NS). Both E and e′ increased among the subjects with normal LVFP, whereas E/e′ remained unchanged (∆E/e′ +.1 [‐.5–1.2]), p NS). Among the subjects with elevated, LVFP we observed increased E but not e′, resulting in significantly increased E/e′ (∆ average E/e′ +2.4 [0–4.0], p <.01). Conclusion: Augmented preload does not seem to affect E/e′ among subjects with normal LVFP, whereas E/e′ seems to increase significantly among subjects with elevated LVFP. [ABSTRACT FROM AUTHOR]

Purpose: Obesity is associated with subclinical impairments in cardiac function. Aerobic exercise has positive effects on cardiac-related parameters. However, different exercise intensities may elicit distinct acute responses, leading to chronic adaptations. Therefore, we aimed to investigate the acute effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on left ventricle (LV) function in women with uncomplicated obesity. Methods: Fifteen women performed a bout of HIIT (4 × 4-min at 85–95% of HRmax), MICT (41-min at 65–75% of HRmax), and control condition (CO) (30-min sitting at rest). Data were collected immediately before, and five (t5) and 35 (t35) minutes after the performance of each condition. Results: Significant decreases in global longitudinal strain (GLS) (p = 0.010; p = 0.002), LV ejection fraction (LVEF) (p = 0.017; p = 0.010), LV end-diastolic volume (LVEDV) (p = 0.001; p = 0.048), stroke volume (SV) (p < 0.001; p = 0.013), early diastolic inflow velocity (E) (p = 0.001; p = 0.003) and E/A ratio (p = 0.001; p < 0.001) were observed for HIIT at t5 in relation to baseline and CO, respectively. However, GLS, LVEF, LVEDV, and E wave were reestablished near baseline values at t35. LV end-systolic volume decreased after HIIT in comparison to baseline at t5 (p = 0.050). GLS and E/A ratio decreased following HIIT at t5 compared to MICT (p = 0.013 and p = 0.027, respectively). Conclusion: A single bout of HIIT promoted transient reductions in LV function that were almost completely reestablished near baseline values 35 min after exercise cessation, not implying, therefore, any risk to HIIT performance by this population. Trial registration number: RBR-3v3dqf (Registered on 07/05/2019). [ABSTRACT FROM AUTHOR]

BackgroundThe mitral inflow spectral is expressed as two separate waves: early diastolic trans-mitral flow velocity (E) and late diastolic trans-mitral flow velocity (A) waves. When the heart rate (HR) increases and the diastolic time diminishes, the mitral flow pattern changes from EA-separation to EA-fusion. The E wave provides information about preload and diastolic function. Tissue Doppler imaging (TDI) and non-invasive intraventricular pressure gradient (IVPG) based on color-M-mode echocardiography are two techniques established in recent years with good repeatability in cardiac function evaluation, especially diastolic.Hypothesis/objectiveWe hypothesize that IVPG and E/E’ are differentially influenced by mitral inflow patterns.AnimalsA total of 66 hypertensive cardiomyopathy (HTN-CM) induced by abdominal aorta coarctation and 33 sham-operated rats were divided into 6 groups according to trans-mitral flow patterns.MethodsConventional echocardiography, TDI, and IVPG sampling were performed on rats under general anesthesia with 2.5% isoflurane at 3 weeks after the operation. After code EA-separation = 1, EA-half-separation = 2, and EA-fusion = 3, Pearson’s correlation tests were performed.ResultsBoth E and E’ in EA-fusion (1.04 ± 0.13 and 7.65 ± 0.84) are higher than the EA-separation pattern in all rats (0.91 ± 0.10 and 5.51 ± 0.78, p

Background:Systemic hypertension is an expanding health problem and a major cause of cardiovascular morbidity and mortality. Left atrial (LA) strain by speckle tracking is a new echocardiographic modality that can detect impairment in LA function. Objectives:The aim was to analyze the parameters of LA strain in patients with systemic hypertension and compare them to those of normal persons. Materials and Methods:A case–control study was conducted at the echocardiography department of Marjan Medical City in Hillah from February 2023 to June 2023. The study focused on patients with hypertension and compared their 2D echocardiography, Doppler, tissue Doppler, left ventricle global longitudinal strain, and LA strain to those of a control healthy group. Data collection included a questionnaire, echocardiography using the GE Vivid iq machine, and statistical analysis using Statistical Package for the Social Sciences (SPSS) 27 software. Results:In total, 100 persons were enrolled in the study; 50 of them were patients with systemic hypertension, and the other 50 were persons with negative medical history. The two groups were age, gender, and body surface area matched. Echocardiographic parameters were compared, concentrating on LA strain and diastolic function parameters. A strong correlation was found between hypertension and LA strain parameters. Reservoir, conduit, and contractile strain were lower in the hypertensive group, while the LA volume and LA indexed volume were statistically larger in the hypertensive group than the control group, with a P value of less than 0.001 in both. Conclusion:LA strain by speckle tracking is affected in systemic hypertension more and even before the diastolic function affection. Earlier detection and treatment of dysfunction can delay or even prevent complications.

Abstract Background Echocardiography is widely used to evaluate left ventricular (LV) diastolic function in patients suspected of heart failure. For patients in sinus rhythm, a combination of several echocardiographic parameters can differentiate between normal and elevated LV filling pressure with good accuracy. However, there is no established echocardiographic approach for the evaluation of LV filling pressure in patients with atrial fibrillation. The objective of the present study was to determine if a combination of several echocardiographic and clinical parameters may be used to evaluate LV filling pressure in patients with atrial fibrillation. Results In a multicentre study of 148 atrial fibrillation patients, several echocardiographic parameters were tested against invasively measured LV filling pressure as the reference method. No single parameter had sufficiently strong association with LV filling pressure to be recommended for clinical use. Based on univariate regression analysis in the present study, and evidence from existing literature, we developed a two-step algorithm for differentiation between normal and elevated LV filling pressure, defining values ≥ 15 mmHg as elevated. The parameters in the first step included the ratio between mitral early flow velocity and septal mitral annular velocity (septal E/e’), mitral E velocity, deceleration time of E, and peak tricuspid regurgitation velocity. Patients who could not be classified in the first step were tested in a second step by applying supplementary parameters, which included left atrial reservoir strain, pulmonary venous systolic/diastolic velocity ratio, and body mass index. This two-step algorithm classified patients as having either normal or elevated LV filling pressure with 75% accuracy and with 85% feasibility. Accuracy in EF ≥ 50% and EF

Abstract Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/’preserved’ left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258–271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient’s bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59–G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.

Background: Mitral transcatheter edge-to-edge repair (M-TEER) is an effective treatment for mitral regurgitation (MR) patients. Objectives: The aim of this research was to study M-TEER effects on left atrial (LA) and left ventricular (LV) functions. Methods: LV function was evaluated using conductance catheters for pressure volume loops in 22 patients with primary MR and a control group of 17 heart transplant recipients with normal function. LA pressures and LA operating chamber stiffness were obtained using fluid-filled catheters. MR severity was assessed by echocardiography. Results: Compared to the control group, primary MR patients had increased LV volumes, diastolic pressures, tau, and LV chamber stiffness constant (all P ≤ 0.01). After M-TEER, LV and LA volumes and pressures and MR regurgitant volume decreased (all P 0.20). Post-M-TEER, patients with LA V wave pressure ≥20 mm Hg had significantly higher LA operating chamber stiffness, tau, and LV chamber stiffness constant vs patients with V wave pressure

Objective: Understanding ejection fraction (EF) limits are crucial for the evaluation of diastolic function (DF). Therefore, in our study, we aimed to compare the DFs between patients with low-normal and high-normal EFs. Methods: A total of 70 patients who were followed in our clinic were prospectively included in our study. Those with an EF of 55-62% were included in the low-normal EF group, and those with an EF >62% were included in the high-normal EF group. Subsequently, the relationship between DF and EF was analyzed. Results: Both groups exhibited similarities in demographic characteristics, such as age, sex, and additional medical conditions, demonstrating homogeneous distribution among the groups. No statistically significant difference was observed between the groups in terms of diastolic and systolic parameters. Conclusion: No relationship was found between normal EF and DF. Nonetheless, our work can serve as a model for more extensive research on this topic. [ABSTRACT FROM AUTHOR]

Background: It is suggested that myocardial dysfunction in heart failure patients may result from increased oxidative stress-related membrane changes. Thiol/disulfide homeostasis is a new oxidative stress indicator. The aim of this study was to evaluate serum thiol levels and thiol/disulfide homeostasis in patients with heart failure with preserved ejection fraction (HFpEF). Methods: Eighty-four overweight patients who applied to our clinic between November 2016 and February 2018 and diagnosed with hypertension and left ventricule concentric hypertrophy with normal systolic function are included in the study. Forty-two patients who were asymptomatic and had normal N terminal pro-B type natriuretic peptide (NT-proBNP) levels (≤125) were in the control group. Forty-two patients who have cardiac failure symptoms and have high NT-proBNP levels (>125) were in the patient group. Results: Native thiol, total thiol, and disulfide values of the patient group are found to be significantly lower than the control group (P = .001; P < .001; P = .041 respectively). There is a statictically significant negative correlation between native thiol, total thiol values, and NT-proBNP. There is a statictically significant negative correlation between native thiol, total thiol values, and carbohydrate antigen 125 (CA-125) values. Conclusion: As far as we know from literature, this is the first study on HFpEF and thiol/disulfide homeostasis. It is found that native, total thiol, and disulfide values are low in HFpEF patients and that there is a negative correlation between native, total thiol values and NT-proBNP, CA-125 values. It can be said that oxidant/antioxidant balance is impaired in patients with HFpEF and that larger, randomized studies are needed in order to use oxidant/antioxidant balance in diagnosis and treatment of HFpEF. [ABSTRACT FROM AUTHOR]

Background: There is an unmet medical need for the early detection of immune checkpoint inhibitor (ICI)-induced cardiovascular (CV) adverse events due to a lack of adequate biomarkers. This study aimed to provide insights on the incidence of troponin elevations and echocardiographic dynamics during ICI treatment in cancer patients and their role as potential biomarkers for submyocardial damage. In addition, it is the first study to compare hs-TnT and hs-TnI in ICI-treated patients and to evaluate their interchangeability in the context of screening. Results: Among 59 patients, the mean patient age was 68 years, and 76% were men. Overall, 25% of patients received combination therapy. Although 10.6% [95% CI: 5.0–22.5] of the patients developed troponin elevations, none experienced a CV event. No significant changes were found in 3D left ventricular (LV) ejection fraction nor in global longitudinal strain f (56 ± 6% vs. 56 ± 6%, p = 0.903 and −17.8% [−18.5; −14.2] vs. −17.0% [−18.8; −15.1], p = 0.663) at 3 months. There were also no significant changes in diastolic function and right ventricular function. In addition, there was poor agreement between hs-TnT and hs-TnI. Methods: Here, we present a preliminary analysis of the first 59 patients included in our ongoing prospective clinical trial (NCT05699915) during the first three months of treatment. All patients underwent electrocardiography and echocardiography along with blood sampling at standardized time intervals. This study aimed to investigate the incidence of elevated hs-TnT levels within the first three months of ICI treatment. Elevations were defined as hs-TnT above the upper limit of normal (ULN) if the baseline value was normal, or 1.5 ≥ times baseline if the baseline value was above the ULN. Conclusions: Hs-TnT elevations occurred in 10.6% of the patients. However, no significant changes were found on 3D echocardiography, nor did any of the patients develop a CV event. There were also no changes found in NT-proBNP. The study is still ongoing, but these preliminary findings do not show a promising role for cardiac troponins nor for echocardiographic dynamics in the prediction of CV events during the early stages of ICI treatment. [ABSTRACT FROM AUTHOR]

Introduction: No data are available on the diagnostic algorithms recommended by guidelines for the assessment of diastolic dysfunction (DD) in patients with arterial hypertension. Aim: To fill this gap, we evaluated diastolic function in hypertensive patients with and without LVH matched with healthy subjects by applying 2016 American Society of Echocardiography-European Association of Cardiovascular Imaging Guidelines for the evaluation of LV diastolic function. Methods: 717 healthy and hypertensives with normal LV ejection fraction and with and without LV hypertrophy (LVH), matched 1:1:1 from two prospective registries, represented the study population. Results: By applying algorithm A, indeterminate pattern was found in 0.4% of healthy, in 6.3% of hypertensives without LVH, and in 21% with LVH (overall p < 0.05 vs. healthy). DD was absent in healthy, however present in 2 and 8% of hypertensives without and with LVH (p = 0.06 and p = 0.001 vs. healthy, respectively). By applying algorithm B, no cases of indeterminate pattern were found. DD was observed in 2.9% of healthy, 7 and 10.5% of hypertensives without and with LVH (p < 0.05 vs. healthy). Conclusions: The use of algorithm A should be limited only to truly normal subjects, whereas algorithm B should be applied to all patients with hypertension, even without comorbidities and irrespective of LVH. [ABSTRACT FROM AUTHOR]

Introduction: Expanded hemodialysis (HDx) could provide clearance of larger middle‐molecule uremic toxins. We compared the effect of hemodialysis with medium cut‐off membranes and high‐flux (HFHD) membranes regarding changes in inflammation and vascular and left ventricular function. Methods: This was a single‐center, prospective, parallel‐group comparative study. Patients were divided into two groups (HDx: 25 patients and HFHD: 26 patients). All measurements were performed at baseline and 12 weeks. Serum c‐reactive protein, interkelukin‐18, pentraxin‐3, β‐2 microglobulin, and brain natriuretic peptide were measured. We used pulse wave velocity and augmentation index to assess arterial stiffness and echocardiography to evaluate left and right ventricular function. Findings: We enrolled 51 patients. Although serum c‐reactive protein, interkelukin‐18, pentraxin 3, and β‐2 microglobulin were significantly decreased in the HDx group (p = 0.02, p < 0.001, p = 0.002, and p = 0.02, respectively), there was no significant change in HFHD group at 12th week. Serum c‐reactive protein and interkelukin‐18were significantly lower in the HDx group compared to the HFHD group in the 12th week (p = 0.007 and p = 0.03, respectively). We observed a significant decrease in pulse wave velocity in the HDx group at the end of the study (p = 0.03). Although there was no significant change in pulse wave velocity in the HFHD group, pulse wave velocity was similar between the HDx and HFHD groups in the 12th week. We detected a significant decrease in the mean isovolumetric relaxation time in the HDx group (p = 0.006). However, there was no significant difference in isovolumetric relaxation time between the HDx and HFHD groups in the 12th week. Discussion: HDx provides better clearance of middle molecular uremic toxins and inflammatory biomarkers, and it may be associated with better central hemodynamic parameters and diastolic functions. [ABSTRACT FROM AUTHOR]

Left ventricular (LV) diastolic dysfunction (DD) is an initially asymptomatic condition that can progress to heart failure, either with preserved or reduced ejection fraction. As such, DD is a growing public health problem. Impaired relaxation, the first stage of DD, is associated with altered LV filling. With progression, reducing LV compliance leads to restrictive cardiomyopathy. While cardiac magnetic resonance (CMR) imaging is the reference for LV systolic function assessment, transthoracic echocardiography (TTE) with Doppler flow measurements remains the standard for diastolic function assessment. Rather than simply replicating TTE measurements, CMR should complement and further advance TTE findings. We provide herein a step-by-step review of CMR findings in DD as well as imaging features which may help identify the underlying cause. [ABSTRACT FROM AUTHOR]

Background: Severe tricuspid regurgitation (TR), pulmonic regurgitation (PR), large atrial septal defect (ASD), and large pulmonary embolism (PE) will lead to decreased left ventricular preload, and therefore, might alter left ventricle (LV) filling diastolic parameters. Significant LV preload reduction might preclude LV diastolic function assessment indeterminate. Methods: This is a controlled study where patients with severe TR, PR, ASD, PE, and without significant LV disease were included in the study group. Stroke volume (SV), E-wave velocity, A-wave velocity, E/A, septal e', lateral e', average E/e', deceleration time, and isovolumic relaxation time (IVRT) were captured from the study group and the control group. The difference of mean of the diastolic parameters in both groups was evaluated as well as the correlation between the SV and the diastolic parameters of the pooled data from both groups. Results: E wave velocity, E/A ratio, IVRT, deceleration time, septal and lateral e', and SV were significantly lower in the study group while E/e' was significantly higher in the study group. IVRT showed a strong positive correlation with SV. Lateral and septal e' showed a moderate positive correlation to SV while the average E/e' showed inverse correlation to SV. Conclusion: Standard diastolic parameters should be interpreted with caution in assessing diastolic function in patients with severely decreased preload. However, a significant preload reduction might preclude diastolic function assessment indeterminate. [ABSTRACT FROM AUTHOR]

Diastolic dysfunction (DD) is a prevalent and clinically significant complication after heart transplantation (HTX). We aimed to characterize the diastolic function of HTX recipients with both short-term and long-term follow-ups by applying left atrial (LA) deformation analysis. We consecutively enrolled and followed up with 33 HTX patients. Three assessments were performed one month, 3–5 months, and 3–5 years after surgery. Beyond conventional echocardiographic measurements, apical four-chamber views optimized for speckle tracking analysis were acquired and post-processed by dedicated software solutions (TomTec AutoStrain LA and LV). Left atrial phasic functions were characterized by reservoir, conduit, and contraction strains. We categorized diastolic function according to current guidelines (normal diastolic function, indeterminate, DD). At the first assessment, nine (27%) patients were in the DD category, and eleven (33%) were indeterminate. At the second assessment, only one patient (3%) remained in the DD category and six (18%) were indeterminate. At the third assessment, 100% of patients were categorized as having normal diastolic function. LA reservoir strain gradually increased over time. LA contraction strain significantly improved from the second to the third assessment. We found a correlation between the LA reservoir strain and NT-proBNP (r = 0.40, p < 0.05). DD is prevalent immediately after HTX but rare until the end of the first postoperative quarter. Speckle tracking analysis enables the characterization of LA phasic functions that may reflect both short- and long-term changes in diastolic function and correlate with NT-proBNP. [ABSTRACT FROM AUTHOR]

Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258–271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59–G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables. [ABSTRACT FROM AUTHOR]

Background: Echocardiography is widely used to evaluate left ventricular (LV) diastolic function in patients suspected of heart failure. For patients in sinus rhythm, a combination of several echocardiographic parameters can differentiate between normal and elevated LV filling pressure with good accuracy. However, there is no established echocardiographic approach for the evaluation of LV filling pressure in patients with atrial fibrillation. The objective of the present study was to determine if a combination of several echocardiographic and clinical parameters may be used to evaluate LV filling pressure in patients with atrial fibrillation. Results: In a multicentre study of 148 atrial fibrillation patients, several echocardiographic parameters were tested against invasively measured LV filling pressure as the reference method. No single parameter had sufficiently strong association with LV filling pressure to be recommended for clinical use. Based on univariate regression analysis in the present study, and evidence from existing literature, we developed a two-step algorithm for differentiation between normal and elevated LV filling pressure, defining values ≥ 15 mmHg as elevated. The parameters in the first step included the ratio between mitral early flow velocity and septal mitral annular velocity (septal E/e'), mitral E velocity, deceleration time of E, and peak tricuspid regurgitation velocity. Patients who could not be classified in the first step were tested in a second step by applying supplementary parameters, which included left atrial reservoir strain, pulmonary venous systolic/diastolic velocity ratio, and body mass index. This two-step algorithm classified patients as having either normal or elevated LV filling pressure with 75% accuracy and with 85% feasibility. Accuracy in EF ≥ 50% and EF < 50% was similar (75% and 76%). Conclusions: In patients with atrial fibrillation, no single echocardiographic parameter was sufficiently reliable to be used clinically to identify elevated LV filling pressure. An algorithm that combined several echocardiographic parameters and body mass index, however, was able to classify patients as having normal or elevated LV filling pressure with moderate accuracy and high feasibility. [ABSTRACT FROM AUTHOR]

The frequency of cardiovascular system involvement is increased in rheumatoid arthritis (RA) and may result in serious morbidity and mortality. Early intervention and control of the disease activity may reduce the risk of cardiovascular events. The purpose of this study is to examine the effects of steroids and methotrexate (Mtx) on the heart functions of newly diagnosed RA patients. Our study is a prospective cohort study involving thirty-six newly diagnosed RA patients according to the American Society of Rheumatology classification criteria. Right and left ventricular echocardiography, and Doppler parameters were evaluated in these patients thrice; before treatment, after one month of steroid treatment, and after three months of Mtx treatment, and laboratory/clinical parameters were noted. The mean age of the patients was 52.66 ± 13.66 years. After the treatment, a significant decrease was observed in the values of inflammatory markers (ESR and CRP) and disease activity score (DAS28) [p <.05]. Left ventricular tissue Doppler showed an increase in lateral S, septal S, and mitral S waves compared to baseline (8.37 ± 1.89 vs 10.0 ± 1.8 cm/s p =.001). While there was a decrease in tissue Doppler tricuspid a wave (18.33 ± 4.76 vs 15.63 ± 4.36 p =.016), an increase in Tricuspid E/e' value and Tricuspid tissue Doppler e/a value was detected after treatment (0.76 ± 0.30) vs 0.94 ± 0.53) p <.010). Significant changes were found to be more prominent after the Mtx treatment. In RA patients, steroid and Mtx treatment significantly positively affects left ventricular systolic and right ventricular diastolic functions. [ABSTRACT FROM AUTHOR]