Henriette Gavallér

Correlations between aortic stiffness and parasympathetic autonomic function in healthy volunteers

Cardiovascular autonomic dysfunction and alterations in vascular elasticity are known complications of several disorders, including diabetes mellitus, hypertension, hypercholesterolemia, aging, and chronic kidney disease. The current study was designed to test whether a relationship existed between pulse wave velocity (PWV), augmentation index (AIx), aortic elastic properties, and cardiovascular autonomic function in healthy volunteers. The study comprised 25 healthy volunteers, whose aortic strain, distensibility, and stiffness index were measured by echocardiography, whereas PWV and AIx were evaluated by Arteriograph (TensioMed, Budapest, Hungary) in all cases. Autonomic function was assessed by means of 5 standard cardiovascular reflex tests. We found that heart rate response to deep breathing, as the most reproducible cardiovascular reflex test to characterize parasympathetic function, showed low to moderate correlations with PWV (r = -0.431, p = 0.032), aortic strain (r = 0.594, p = 0.002), distensibility (r = 0.407, p = 0.043), and stiffness index (r = -0.453, p = 0.023). Valsalva ratio and autonomic neuropathy score (ANS) correlated with PWV (r = -0.557, p = 0.004 and r = -0.421, p = 0.036, respectively) and AIx (r = -0.461, p = 0.020 and r = -0.385, p = 0.057, respectively), while ANS correlated with even aortic stiffness index (r = -0.457, p = 0.022). Cardiovascular reflex tests mainly characterizing sympathetic function had no correlation with aortic stiffness parameters (p = NS for all correlations). Correlations exist between parameters characterizing aortic elasticity and parasympathetic autonomic function, as shown by standard cardiovascular reflex tests in healthy volunteers.

Hypertrophic Cardiomyopathy Is Associated with Abnormal Echocardiographic Aortic Elastic Properties and Arteriograph‐Derived Pulse‐Wave Velocity

Objective: Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease and defined by the presence of unexplained left ventricular hypertrophy (LVH). Vascular alterations are frequently associated with HCM including microvascular and/or peripherial endothelial dysfunction. This study was designed to evaluate echocardiographic ascending aortic elastic properties and arteriograph‐derived pulse‐wave velocity (PWV) and augmentation index (Aix) in HCM. Methods: This study comprised 38 patients with typical features of HCM. Their results were compared to 20 hypertensive patients with LVH and 23 controls. Systolic and diastolic ascending aortic diameters were recorded in M‐mode at a level of 3 cm above the aortic valve from a parasternal long‐axis view. The following echocardiographic aortic elastic properties were measured from aortic data and forearm blood pressure values: aortic strain, distensibility, and stiffness index. Arteriograph‐derived PWV and AIx were also measured. Results: Aortic stiffness index (18.4 ± 17.6 vs. 6.88 ± 3.63, P < 0.05), PWV (9.44 ± 4.08 vs. 7.97 ± 1.20 m/sec, P < 0.05) and Aix (‐24.9 ± 32.6 vs. –41.4 ± 24.3, P < 0.05) were increased, while aortic strain (0.061 ± 0.053 vs. 0.100 ± 0.059, P < 0.05) and aortic distensibility (1.94 ± 1.68 cm2/dynes 10−6 vs. 3.08 ± 1.77 cm2/dynes 10−6, P < 0.05) were decreased in HCM patients compared to controls. Aortic elastic properties of hypertensive patients with LVH showed similar alterations to HCM patients. Conclusions: Abnormal echocardiographic aortic elastic properties and arteriograph‐derived PWV and Aix could be demonstrated in HCM patients compared to matched controls. (Echocardiography 2011;28:848‐852)

Correlations between Arteriograph‐derived pulse wave velocity and aortic elastic properties by echocardiography

Introduction:  There is an increased scientific interest on the evaluation of parameters characterizing aortic elasticity. The current study was designed to compare two characteristics of aortic distensibility: Arteriograph‐derived pulse wave velocity (PWV) and augmentation index standardized to 80 per minutes heart rate (AIx80) and aortic elastic properties by echocardiography.

Short-term beat-to-beat variability of the QT interval is increased and correlates with parameters of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy

Stratification models for the prediction of sudden cardiac death (SCD) are inappropriate in patients with hypertrophic cardiomyopathy (HCM). We investigated conventional electrocardiogram (ECG) repolarization parameters and the beat-to-beat short-term QT interval variability (QT-STV), a new parameter of proarrhythmic risk, in 37 patients with HCM (21 males, average age 48 ± 15 years). Resting ECGs were recorded for 5 min and the frequency corrected QT interval (QTc), QT dispersion (QTd), beat-to-beat short-term variability of QT interval (QT-STV), and the duration of terminal part of T waves (Tpeak-Tend) were calculated. While all repolarization parameters were significantly increased in patients with HCM compared with the controls (QTc, 488 ± 61 vs. 434 ± 23 ms, p < 0.0001; QT-STV, 4.5 ± 2 vs. 3.2 ± 1 ms, p = 0.0002; Tpeak-Tend duration, 107 ± 27 vs. 91 ± 10 ms, p = 0.0015; QTd, 47 ± 17 vs. 34 ± 9 ms, p = 0.0002), QT-STV had the highest relative increase (+41%). QT-STV also showed the best correlation with indices of left ventricular (LV) hypertrophy, i.e., maximal LV wall thickness normalized for body surface area (BSA; r = 0.461, p = 0.004) or LV mass (determined by cardiac magnetic resonance imaging) normalized for BSA (r = 0.455, p = 0.015). In summary, beat-to-beat QT-STV showed the most marked increase in patients with HCM and may represent a novel marker that merits further testing for increased SCD risk in HCM.

Right atrial deformation analysis in isolated left ventricular noncompaction – insights from the three-dimensional speckle tracking echocardiographic MAGYAR-Path Study

OBJECTIVE Isolated left ventricular noncompaction (ILVNC) is a rare cardiomyopathy characterized by a prominent trabecular meshwork and deep intertrabecular recesses. The present study aimed to examine right atrial (RA) volumes, volume-based functional properties and strains by three-dimensional speckle-tracking echocardiography (3DSTE) in ILVNC patients. METHODS The study group consisted of 13 patients with ILVNC (mean age: 54.6±14.1 years, six male) and 23 healthy age- and gender-matched volunteers (mean age: 50.4±12.4 years, 10 male), who served as normal controls. Complete two-dimensional Doppler echocardiography and 3DSTE were performed in all cases. RESULTS Increased systolic maximum (58.2±15.3 ml vs. 40.5±11.8 ml, p=0.0004) and diastolic pre-atrial contraction (39.6±16.1 ml vs. 28.2±9.2 ml, p=0.01) and minimum (46.2±17.5 ml vs. 34.6±11.6 ml, p=0.02) RA volumes were detected in ILVNC patients. Only total (18.6±8.5 ml vs. 12.2±5.9 ml, p=0.01) and passive (12.0±13.3 vs. 5.9±3.7 ml, p=0.05) RA stroke volumes, representing features of RA reservoir and conduit phases, were increased in ILVNC; active RA stroke volume and all emptying fractions did not differ between ILVNC patients and matched controls. Moreover, global, mean segmental and regional peak strains and strains at atrial contraction showed no differences between ILVNC patients and controls. CONCLUSIONS 3DSTE-derived volumetric analysis confirmed increased cyclic RA volumes in ILVNC. Only mild RA functional alterations were demonstrated in ILVNC.

Increased short-term beat-to-beat variability of QT interval in patients with acromegaly

Cardiovascular diseases, including ventricular arrhythmias are responsible for increased mortality in patients with acromegaly. Acromegaly may cause repolarization abnormalities such as QT prolongation and impairment of repolarization reserve enhancing liability to arrhythmia. The aim of this study was to determine the short-term beat-to-beat QT variability in patients with acromegaly. Thirty acromegalic patients (23 women and 7 men, mean age±SD: 55.7±10.4 years) were compared with age- and sex-matched volunteers (mean age 51.3±7.6 years). Cardiac repolarization parameters including frequency corrected QT interval, PQ and QRS intervals, duration of terminal part of T waves (Tpeak-Tend) and short-term variability of QT interval were evaluated. All acromegalic patients and controls underwent transthoracic echocardiographic examination. Autonomic function was assessed by means of five standard cardiovascular reflex tests. Comparison of the two groups revealed no significant differences in the conventional ECG parameters of repolarization (QT: 401.1±30.6 ms vs 389.3±16.5 ms, corrected QT interval: 430.1±18.6 ms vs 425.6±17.3 ms, QT dispersion: 38.2±13.2 ms vs 36.6±10.2 ms; acromegaly vs control, respectively). However, short-term beat-to-beat QT variability was significantly increased in acromegalic patients (4.23±1.03 ms vs 3.02±0.80, P<0.0001). There were significant differences between the two groups in the echocardiographic dimensions (left ventricular end diastolic diameter: 52.6±5.4 mm vs 48.0±3.9 mm, left ventricular end systolic diameter: 32.3±5.2 mm vs 29.1±4.4 mm, interventricular septum: 11.1±2.2 mm vs 8.8±0.7 mm, posterior wall of left ventricle: 10.8±1.4 mm vs 8.9±0.7 mm, P<0.05, respectively). Short-term beat-to-beat QT variability was elevated in patients with acromegaly in spite of unchanged conventional parameters of ventricular repolarization. This enhanced temporal QT variability may be an early indicator of increased liability to arrhythmia.

Increased aortic stiffness in ulcerative colitis

IntroductionUlcerative colitis (UC) is a chronic inflammatory disease of the colon. Currently, there is an increased scientific interest in the evaluation of early functional vascular alterations, especially in inflammatory disorders. The present study was aimed to examine whether UC is associated with abnormalities in aortic elasticity.MethodsThe study was comprised of 11 UC patients (mean age 39 ± 12 years, 7 males), their results were compared to 22 age- and gender-matched controls. All subjects underwent a complete two-dimensional transthoracic Doppler echocardiography including evaluation of aortic elastic properties. The oscillometry-based Arteriograph device was used in all cases to measure aortic pulse-wave velocity (PWV) and augmentation index (Aix).ResultsDespite similar blood pressure values, aortic stiffness index, PWV and Aix were significantly increased, while pulsatile change in aortic diameter, aortic strain and aortic distensibility were significantly decreased in UC patients compared to controls.ConclusionAbnormal echocardiographic aortic elastic properties and Arteriograph-derived pulse-wave velocity could be demonstrated in patients with ulcerative colitis.

Quantification of Changes in Septal Strain after Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy—Cases from the Three-Dimensional Speckle Tracking Echocardiographic MAGYAR-Path Study

Patients with hypertrophic obstructive cardiomyopathy undergoing alcohol septal ablation are presented. Three‐dimensional speckle tracking echocardiography (3DSTE) is a new, noninvasive tool for quantification of myocardial deformation. In both cases, 3DSTE was performed 1 day before and 3 days after alcohol septal ablation to quantify changes in septal strain of ablated area. Results could suggest the possible role of 3DSTE in the quantitative evaluation of the success of alcohol septal ablation.

Prognostic significance of aortic stiffness index in acromegaly-Results from a 4-year follow-up

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Relationship between early myocardial reperfusion assessed by videodensitometry and late left ventricular function. Results following invasive treatment of acute myocardial infarction

INTRODUCTION It is known that there is a relationship between myocardial perfusion and left ventricular function. AIM The aim of the current study was to examine the relationship between myocardial reperfusion as assessed by videodensitometry on coronary angiograms following invasive treatment of ST elevation myocardial infarction and magnetic resonance imaging-derived late left ventricular function. METHOD The study included 25 patients with ST elevation myocardial infarction. A quantitative parameter of myocardial (re)perfusion was calculated by the ratio of maximal density (Gmax) and the time to reach maximum density (Tmax) following invasive treatment. Magnetic resonance imaging was performed 387±262 days after ST elevation myocardial infarction for the evaluation of left ventricular function in all cases. RESULTS Significant correlations were demonstrated between left ventricular ejection fraction and Gmax (r = 0.40, p = 0.05) and Gmax/Tmax (r = 0.41, p = 0.04) following vessel masking. CONCLUSIONS The results demonstrate significant relationship between densitometric Gmax/Tmax and late left ventricular function following ST elevation myocardial infarction. Orv. Hetil., 2014. 155(5), 187-193.