A.J. Sun

Association of Renal Biochemical Parameters with Left Ventricular Diastolic Dysfunction in a Community-Based Elderly Population in China: A Cross-Sectional Study

Background Relationship of left ventricular diastolic dysfunction (LVDD) with parameters that could provide more information than hemodynamic renal indexes has not been clarified. We aimed to explore the association of comprehensive renal parameters with LVDD in a community-based elderly population. Methods 1,166 community residents (aged ≥ 65 years, 694 females) participating in the Shanghai Heart Health Study with complete data of renal parameters were investigated. Echocardiography was used to evaluate diastolic function with conventional and tissue Doppler imaging techniques. Serum urea, creatinine, urea-to-creatinine ratio, estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were analyzed on their associations with LVDD. Results The prevalence of LVDD increased in proportion to increasing serum urea, urea-to-creatinine ratio and UACR. These three renal parameters were found negatively correlated to peak early (E) to late (A) diastolic velocities ratio (E/A), and positively to left atrial volume index; UACR also positively correlated with E to peak early (E’) diastolic mitral annular velocity ratio (E/E’). Serum urea, urea-to-creatinine ratio and UACR correlated with LVDD in logistic univariate regression analysis, and urea-to-creatinine ratio remained independently correlated to LVDD [Odds ratio (OR) 2.82, 95% confidence interval (CI) 1.34–5.95] after adjustment. Serum urea (OR 1.18, 95%CI 1.03–1.34), creatinine (OR 6.53, 95%CI 1.70–25.02), eGFR (OR 0.22, 95%CI 0.07–0.65) and UACR (OR 2.15, 95%CI 1.42–3.24) were revealed independent correlates of advanced (moderate and severe) LVDD. Conclusions Biochemical parameters of renal function were closely linked with LVDD. This finding described new cardio-renal relationship in the elderly population.

Olmesartan attenuates cardiac hypertrophy and improves cardiac diastolic function in spontaneously hypertensive rats through inhibition of calcineurin pathway.

Objective: To test whether olmesartan ameliorates cardiac diastolic dysfunction in spontaneously hypertensive rats (SHRs) through calcineurin pathway. Methods: Twenty-four male SHRs of 6 months were divided into saline- (n = 12) and olmesartan-treated (n = 12) groups. Age-matched WKY (n = 12) rats served as controls. Saline (10 mL·kg·d) or the same volume of olmesartan liquor (2.5 mg·kg·d) was administered by gavage for 3 months. Heart rate, systolic blood pressure, cardiac structure, and function and histological studies were determined. Expression of calcineurin and downstream NFAT3 were also detected. Results: Compared with age-matched Wistar Kyoto rats, SHRs of 6 months exhibited evident cardiac hypertrophy and diastolic dysfunction as demonstrated by elevated systolic blood pressure and E/E′, decreased E/A and E′/A′, while F, left ventricular ejection fraction and fractional shortening remained unimpaired. Treatment with olmesartan significantly decreased systolic blood pressure and ventricular hypertrophy, attenuated fibrosis, and improved diastolic function (all P < 0.05). Meanwhile, both calcineurin and NFAT3 expressions were downregulated in olmesartan group compared with the other 2 groups (both P < 0.05). Conclusions: These data suggest the beneficial effect of olmesartan on cardiac structure and diastolic dysfunction, and it may be mediated through calcineurin pathway. This indicates a new therapeutic target for diastolic dysfunction.

Prevalence and correlates of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction in elderly community residents

BACKGROUNDnLeft ventricular diastolic dysfunction (LVDD) is closely related to heart failure with preserved ejection fraction (HFpEF), while the prevalence and correlates of either LVDD or HFpEF in elderly population remain largely unknown.nnnMETHODSnThe study was performed in 1274 community residents (769 women, aged ≥65years) who participated in the Shanghai Heart Health Study. Demographic, laboratory and echocardiographic data were obtained to analyze correlates of LVDD and HFpEF using univariate and multivariate Logistic analysis.nnnRESULTSnLVDD was detected in 31.9% (406/1274) residents and it was significantly higher in women than in men (34.2% vs. 28.3%, P=0.027). HFpEF prevalence was 2.8% (35/1274), and increased with aging in the whole cohort. For residents with left ventricular ejection fraction ≥50% and normal-sized ventricular cavity, female sex (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.24-2.29), heart rate (OR 0.76, 95% CI 0.68-0.86), atrial fibrillation (OR 7.37, 95% CI 3.13-17.36), hypertension (OR 1.32, 95% CI 1.00-1.75), N-terminal pro-B type natriuretic peptide (OR 2.33, 95% CI 1.50-3.61) and high-sensitivity troponin T (hs-TnT) (OR 1.90, 95% CI 1.12-3.23) were independent correlates of asymptomatic LVDD. While age (OR 1.44, 95% CI 1.01-2.06), heart rate (OR 0.66, 95% CI 0.47-0.93) and hs-TnT (OR 4.37, 95% CI 1.46-13.12) were independently related to HFpEF.nnnCONCLUSIONSnLVDD is common in this community elderly population, and HFpEF is also not rare. Different factors played roles in different stages of HFpEF. Future studies are warranted to explore the predictors of LVDD and HFpEF in the community elderly.