Elisa Giacomin

Acute effects of caffeine and cigarette smoking on ventricular long-axis function in healthy subjects

BackgroundFew data exist regarding the direct effects of caffeine and smoking on cardiac function. We sought to explore the acute effects of caffeine assumption, cigarette smoking, or both on left ventricular (LV) and right ventricular (RV) function in a population of young normal subjects.MethodsForty-five healthy subjects aged 25 ± 2 years underwent echocardiography. Fifteen of them were non-smokers and habitual coffee consumers (group 1), 15 were smokers and not habitual coffee consumers (group 2), and 15 were smokers and habitual coffee consumers (group 3). Peak systolic (Sa), early diastolic Ea, and late diastolic (Aa) velocity of mitral annulus were measured by pulsed Tissue Doppler, and left atrioventricular plane displacement was determined by M-mode. Tricuspid annular velocities and systolic excursion (TAPSE) were also determined. Measurements were performed at baseline and after oral assumption of caffeine 100 mg in group 1, one cigarette smoking in group 2, and both in group 3.ResultsNo changes in ventricular function were observed in group 1 after caffeine administration. In group 2, cigarette smoking yielded an acute increase in mitral Aa (+12.1%, p = 0.0026), tricuspid Sa (+9.8%, p = 0.012) and TAPSE (+7.9%, p = 0.017), and a decrease in the mitral Ea/Aa ratio (-8.5%, p = 0.0084). Sequential caffeine assumption and cigarette smoking in group 3 was associated with an acute increase in mitral Aa (+13.0%, p = 0.015) and tricuspid Aa (+11.6%, p < 0.0001) and a reduction in mitral Ea/Aa ratio (-8.5%, p = 0.0084) tricuspid Ea (-6.6%, p = 0.048) and tricuspid Ea/Aa ratio (-9.6%, p = 0.0003). In a two-way ANOVA model controlling for hemodynamic confounding factors, changes in the overall population remained significant for mitral Aa and Ea/Aa ratio, and for tricuspid Aa and Ea/Aa ratio.ConclusionIn young healthy subjects, one cigarette smoking is associated to an acute impairment in LV diastolic function and a hyperdynamic RV systolic response. Caffeine assumption alone does not exert any acute effect on ventricular long-axis function, but potentiates the negative effect of cigarette smoking by abolishing RV supernormal response and leading to a simultaneous impairment in both LV and RV diastolic function.

Left ventricular twisting as determinant of diastolic function: a speckle tracking study in patients with cardiac hypertrophy.

Purpose: Left ventricular hypertrophy (LVH) can develop in response to training with morphological changes in the heart and to pathological increase in afterload such as in essential hypertension. Deformation analysis using two‐dimensional (2D) strain echocardiography can detect early systolic function abnormalities in patients with LVH. The aim of this study was to characterize left ventricular twisting (LVT) modifications, in professional athletes, compared with control subjects and with patients with hypertensive cardiopathy. Methods: Seventy‐six patients were enrolled: 37 professional athletes with cardiac hypertrophy (group A), 22 patients with early hypertensive cardiopathy (group B) cross‐matched for LV mass index, and 17 healthy controls (group C), with no evidence of cardiac hypertrophy. All patients had no concomitant cardiac disease. All patients were investigated at rest using transthoracic echocardiography. LVT was obtained with speckle tracking analysis, using dedicated software. Results: LVT was reduced in group A compared to group B and C (group A: 8.0°± 2.4°; group C: 10.3°± 2.3°; group B: 16.0°± 4.2°; P < 0.01). In overall population, LVT showed a significant correlation with transmitral flow pattern (r =–0.58, P < 0.01) and with age (r =–0.57, P < 0.01). LVT showed the best predictive value to diagnose diastolic dysfunction (AUC: 0.86, P < 0.0001). Conclusions: 2D strain can identify specific patterns of myocardial deformation in professional athletes, controls, and patients with early hypertensive cardiopathy. In our study LVT showed a parallel trend with modifications of diastolic function and could represent a promising tool to differentiate functional cardiac hypertrophy from hypertensive cardiac hypertrophy. (Echocardiography 2011;28:892‐898)

Impact of diabetes and hypertension on left ventricular longitudinal systolic function

BACKGROUND The assessment of the longitudinal component of left ventricular (LV) function is of major clinical importance for the early detection of LV contractile impairment. The aim of this study was to compare the impact of isolated type-2 diabetes, isolated hypertension, and co-existence of both on LV longitudinal systolic performance, with particular focus on their potential interaction effect. METHODS The study population included 163 consecutive patients: 84 patients with hypertension, 36 with diabetes, and 43 who have both hypertension and diabetes; 70 healthy controls were also recruited. Systolic mitral annulus velocity (S(m)) by Tissue Doppler and left atrioventricular plane displacement (AVPD) by M-mode were measured in all subjects. RESULTS AVPD was similarly reduced in hypertensives (13.2±2.2mm) and diabetics (13.5±2.3mm) when compared with the controls (15.1±2.4mm), and further depressed in diabetic hypertensives (11.5±3.0mm). Similar results were found for S(m). General linear model analysis revealed no significant interaction terms between diabetes and hypertension. CONCLUSIONS Normotensive diabetics and nondiabetic hypertensives show comparable depression in LV longitudinal systolic indices when compared with age- and gender-matched healthy controls; the co-existence of diabetes and hypertension leads to further impairment in LV longitudinal systolic function in an additive manner.

Impact of obesity on left ventricular systolic function in hypertensive subjects with normal ejection fraction

We sought to investigate the potential impact of obesity on left ventricular (LV) systolic function in patients with hypertension and normal ejection fraction (EF). In 112 hypertensive subjects with echocardiographic evidence of normal EF, M-mode left atrio-ventricular plane displacement, and Tissue Doppler-derived peak systolic velocity of the mitral annulus were measured and used as sensitive indices of longitudinal LV systolic dysfunction. The midwall stress-shortening relation was considered as a sensitive load-independent measure of circumferential LV myocardial contractility. There were no differences in either atrio-ventricular plane displacement or peak systolic velocity between normal weight, overweight, and obese subjects. In contrast, circumferential myocardial contractility tended to be reduced in overweight (90.3+/-14.4%) and was significantly depressed in obese (85.9+/-14.3%) as compared to normal weight individuals (95.3+/-14.8%; P=0.042). Multivariate analysis confirmed an independent negative association between body mass index (BMI) and myocardial contractility. The impact of BMI category on circumferential function did not differ between the study population and age- and gender-matched controls, suggesting additive interaction, rather than synergistic, between overweight-obesity and hypertension.

Assessment of left ventricular diastolic events interrelations: An integrated approach

BACKGROUND Left ventricular (LV) diastolic function represents a complex performance that involves long axis displacement, myocardial lengthening velocities as well as cavity filling. The aim of this study was to assess the various diastolic event interrelations in a group of patients with different degrees of diastolic dysfunction. METHODS 128 consecutive subjects with various degrees of diastolic impairment were studied by Doppler echocardiography. The amplitude of early diastolic (El) and late diastolic (Al) long axis lengthening was measured by M-mode and corresponding myocardial velocities (Ea and Aa) by Tissue Doppler. LV filling velocities were also acquired by spectral pulsed wave Doppler. RESULTS Early diastolic long axis amplitudes and velocities correlated (r=0.73, P<0.0001) as did late diastolic ones (r=0.67, P<0.0001). El of ≤5.6 mm was 80.6% sensitive and 70.5% specific in predicting Ea of <8.0 cm/s, a feature of LV impaired relaxation. El/Al correlated with Ea/Aa (r=0.78, P<0.0001), as did E/El with E/Ea ratios (r=0.74, P<0.0001). An E/El ratio>17.3 cm/s/mm had 94.1% sensitivity and 87.4% specificity for predicting an E/Ea ratio>15, a marker for raised LV filling pressures. El≤6.8 mm, total amplitude of diastolic motion (El+Al)≤11.5 mm, and E/El>14.2 cm/s/mm were the best criteria to discriminate between normal diastolic function and pseudonormal/restrictive LV filling. CONCLUSION Diastolic LV components of motion, amplitude and velocities are not independent, neither from each other nor from filling pressures. An integrated approach towards using them all in assessing diastolic function, particularly in patients with raised filling pressure should be of great clinical value.