Browsing by Author "Celic, Vera (57132602400)"

OBJECTIVE: The aim of our study was to define the relationship between the metabolic syndrome (MS), nondipping pattern, and their interaction on right ventricular (RV) structural and functional changes in untreated hypertensive patients. METHODS: This cross-sectional study included 318 recently diagnosed hypertensive patients. MS was defined by the presence of at least 3 National Cholesterol Education Program's Adult Treatment Panel III criteria. All patients underwent 24-h ambulatory blood pressure monitoring and a complete two-dimensional echocardiography examination. RESULTS: MS was found in 144 (45%) hypertensive patients and the nondipping pattern was detected in 147 (46%) patients. Hypertensive patients with MS had higher 24-h and night-time blood pressure levels in comparison with non-MS patients with the same nocturnal blood pressure pattern. RV wall thickness was significantly increased and RV diastolic function was significantly deteriorated in nondippers (with and without MS), but still more impaired in MS patients. MS, nondipping pattern, and their interaction had a huge impact on RV wall thickness, parameters of RV diastolic function (E/At, E/e′t, e′/a′t), as well as RV global function estimated by the myocardial performance index. Among the MS criteria, only fasting glucose level and abdominal obesity were associated independently with RV hypertrophy, diastolic, and global dysfunction. CONCLUSION: MS, nondipping pattern, and their interaction significantly impact RV structure, diastolic, and global function. Fasting glucose level and abdominal obesity are the most important MS criteria for RV remodeling in arterial hypertension. Copyright © Lippincott Williams & Wilkins.

OBJECTIVE: The aim of our study was to define the relationship between the metabolic syndrome (MS), nondipping pattern, and their interaction on right ventricular (RV) structural and functional changes in untreated hypertensive patients. METHODS: This cross-sectional study included 318 recently diagnosed hypertensive patients. MS was defined by the presence of at least 3 National Cholesterol Education Program's Adult Treatment Panel III criteria. All patients underwent 24-h ambulatory blood pressure monitoring and a complete two-dimensional echocardiography examination. RESULTS: MS was found in 144 (45%) hypertensive patients and the nondipping pattern was detected in 147 (46%) patients. Hypertensive patients with MS had higher 24-h and night-time blood pressure levels in comparison with non-MS patients with the same nocturnal blood pressure pattern. RV wall thickness was significantly increased and RV diastolic function was significantly deteriorated in nondippers (with and without MS), but still more impaired in MS patients. MS, nondipping pattern, and their interaction had a huge impact on RV wall thickness, parameters of RV diastolic function (E/At, E/e′t, e′/a′t), as well as RV global function estimated by the myocardial performance index. Among the MS criteria, only fasting glucose level and abdominal obesity were associated independently with RV hypertrophy, diastolic, and global dysfunction. CONCLUSION: MS, nondipping pattern, and their interaction significantly impact RV structure, diastolic, and global function. Fasting glucose level and abdominal obesity are the most important MS criteria for RV remodeling in arterial hypertension. Copyright © Lippincott Williams & Wilkins.

We aimed to determine left ventricular (LV) and right ventricular (RV) structure, function and mechanics, as well as heart rate variability (HRV), and their relationship, in patients with systemic sclerosis (SSc). The study included 41 SSc patients and 30 age-matched healthy volunteers. All the patients underwent clinical examination, serological tests, pulmonary function testing, 24-h Holter monitoring and complete two-dimensional echocardiography including strain analysis. The parameters of LV structure (interventricular septum thickness and LV mass index) and RV structure (RV wall thickness) were significantly higher in SSc patients. LV and RV diastolic function (estimated by mitral and tricuspid E/e′ ratio) was significantly impaired in SSc group comparing with the healthy controls. LV and RV longitudinal function was significantly deteriorated in SSc patients. LV circumferential strain was also significantly lower in SSc group, whereas LV radial strain was similar between the observed groups. All parameters of time and frequency domain of HRV were decreased in SSc patients. LV and RV cardiac remodeling parameters, particularly diastolic function and longitudinal strain, were associated with HRV indices without regard to the main demographic or the clinical and echocardiographic characteristics. Rodnan Skin Score was also independently associated with biventricular cardiac remodeling in SSc patients. LV and RV structure, function and mechanics, as well as autonomic nervous function, were significantly impaired in SSc patients. There is the significant association between biventricular cardiac remodeling and autonomic function in these patients, which could be useful for their everyday clinical assessment. © 2016, Springer-Verlag Berlin Heidelberg.

We aimed to determine left ventricular (LV) and right ventricular (RV) structure, function and mechanics, as well as heart rate variability (HRV), and their relationship, in patients with systemic sclerosis (SSc). The study included 41 SSc patients and 30 age-matched healthy volunteers. All the patients underwent clinical examination, serological tests, pulmonary function testing, 24-h Holter monitoring and complete two-dimensional echocardiography including strain analysis. The parameters of LV structure (interventricular septum thickness and LV mass index) and RV structure (RV wall thickness) were significantly higher in SSc patients. LV and RV diastolic function (estimated by mitral and tricuspid E/e′ ratio) was significantly impaired in SSc group comparing with the healthy controls. LV and RV longitudinal function was significantly deteriorated in SSc patients. LV circumferential strain was also significantly lower in SSc group, whereas LV radial strain was similar between the observed groups. All parameters of time and frequency domain of HRV were decreased in SSc patients. LV and RV cardiac remodeling parameters, particularly diastolic function and longitudinal strain, were associated with HRV indices without regard to the main demographic or the clinical and echocardiographic characteristics. Rodnan Skin Score was also independently associated with biventricular cardiac remodeling in SSc patients. LV and RV structure, function and mechanics, as well as autonomic nervous function, were significantly impaired in SSc patients. There is the significant association between biventricular cardiac remodeling and autonomic function in these patients, which could be useful for their everyday clinical assessment. © 2016, Springer-Verlag Berlin Heidelberg.

The aim of this study was to investigate the impact of nondipping arterial blood pressure pattern and the metabolic syndrome (MS), as well as their interaction, on left ventricular (LV) structural and function remodeling. The study included 352 never-treated hypertensive patients with and without MS. Nondipping pattern and MS, separately, as well as their interaction, significantly impacted LV structure, LV geometry pattern, systolic, diastolic and global function in hypertensive patients. Abdominal obesity was the only MS criterion which was simultaneously associated with LV hypertrophy, LV diastolic dysfunction and, LV global dysfunction. © Informa Healthcare USA, Inc.

The aim of this study was to investigate the impact of nondipping arterial blood pressure pattern and the metabolic syndrome (MS), as well as their interaction, on left ventricular (LV) structural and function remodeling. The study included 352 never-treated hypertensive patients with and without MS. Nondipping pattern and MS, separately, as well as their interaction, significantly impacted LV structure, LV geometry pattern, systolic, diastolic and global function in hypertensive patients. Abdominal obesity was the only MS criterion which was simultaneously associated with LV hypertrophy, LV diastolic dysfunction and, LV global dysfunction. © Informa Healthcare USA, Inc.

Objective: The aim of the study was to evaluate right atrial (RA) phasic function in hypertensive patients with different left ventricular (LV) geometric patterns by using two-dimensional (2DE) and three-dimensional (3DE) echocardiography. Methods: This cross-sectional study involved 177 hypertensive patients who underwent 2DE and 3DE examination. The updated criteria of LV geometry that included LV mass index, LV end-diastolic diameter, and relative wall thickness were applied. Using this classification, patients were separated into six groups: normal geometry, concentric remodeling, eccentric nondilated LV hypertrophy (LVH), concentric LVH, dilated LVH, and concentric–dilated LVH. Results: Two-dimensional echocardiography and 3DE RA volumes were significantly higher in concentric and dilated LVH than in other LV geometric types. RA reservoir function, estimated by total 2DE and 3DE RA emptying fraction (EF), was decreased in subjects with dilated LVH compared with normal geometric and concentric LV remodeling patterns. RA conduit function assessed with 2DE and 3DE RA passive EF, gradually reduced from normal LV geometry to dilated LVH. RA pump function was increased in patients with concentric and dilated LVH than in subjects with normal LV geometry and concentric remodeling. 2DE strain analysis confirmed these findings about RA phasic function. Concentric LVH and dilated LVH were associated with RA enlargement and dysfunction irrespectively of main demographic and clinical parameters. Conclusion: Left ventricular geometric patterns have significant impact on RA phasic function in hypertensive patients. Concentric and dilated LVH patterns have the most prominent negative effect on RA morphological and functional remodeling. © 2016, Wiley Periodicals, Inc.

Our aim was to compare left ventricular (LV) deformation in subjects with masked hypertension (MH) to normotensive and sustained hypertensive patients. This cross-sectional study included 185 untreated subjects who underwent 24-hour ambulatory blood pressure (BP) monitoring and complete two-dimensional echocardiographic (2DE) examination including multilayer strain analysis. MH was diagnosed if clinic BP was normal (<140/90 mm Hg), and 24-hour BP was increased (≥130/80 mm Hg). 2DE LV longitudinal and circumferential strains gradually and significantly decreased from normotensive controls across MH individuals to sustained hypertensive patients. 2DE radial strain was not different between groups. 2DE longitudinal and circumferential endocardial and midmyocardial layer strains progressively decreased from normotensive control to sustained hypertensive individuals. Longitudinal and circumferential epicardial layer strains were lower in sustained hypertensive patients than in normotensive controls. Clinic and 24-hour systolic BP were associated with 2DE LV longitudinal endocardial strain, midmyocardial strain, and 2DE circumferential endocardial strain in the whole-study population independent of LV structure and diastolic function. MH significantly affect LV deformation assessed by 2DE traditional strain and 2DE multilayer strain. Clinic and 24-hour systolic BP were associated with LV mechanics evaluated with comprehensive 2DE strain analysis independent of LV structure and diastolic function. © 2016 American Society of Hypertension

Background: We sought to investigate right ventricular (RV) and right atrial (RA) deformation obtained using 3-dimensional echocardiography (3DE) and 2-dimensional (2DE) strain in subjects with the metabolic syndrome (MS). Methods: This cross-sectional study included 108 untreated subjects with the MS and 75 control subjects similar according to sex and age. The MS was defined by the presence ® 3 American Heart Association/National Heart, Lung, and Blood Institute criteria. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. Results: 2DE global longitudinal strain of the RV was significantly decreased in the MS group compared with the control subjects (-24 ± 5 vs-27 ± 5%; P < 0.001). Similar results were obtained for the RA longitudinal strain (40 ± 5 vs 44 ± 7%; P < 0.001). Systolic and early diastolic RV and RA strain rates were decreased, whereas late diastolic strain rates were increased among the MS participants compared with the control subjects. 3DE RV ejection fraction was significantly decreased in the MS subjects (55 ± 4 vs 58 ± 4%; P < 0.001). The multivariate analysis of MS criteria showed that systolic blood pressure, waist circumference, and fasting glucose were independently associated with RV and/or RA myocardial function and deformation. Conclusions: RV mechanics and RA mechanics, assessed using 3DE and 2DE strain, were significantly deteriorated in the MS subjects. Among all MS risk factors, systolic blood pressure, abdominal circumference, and fasting glucose were the most responsible for the right heart remodelling. © 2014 Canadian Cardiovascular Society.

Purpose: The aim of this study was to investigate the influence of metabolic syndrome (MS) on left ventricular (LV) structure and function depending on gender. Methods: The study included 235 never-treated MS subjects and 138 controls. MS was defined as the presence of three or more National Cholesterol Education Program's Adult Treatment Panel III criteria. All the subjects underwent laboratory blood tests and complete two-dimensional, pulsed, and tissue Doppler echocardiography. Results: LV structure, diastolic function, and global function were significantly impaired in all MS subjects. Multivariate analysis of individual MS factors showed that increased blood pressure (BP) and impaired fasting glucose were independently associated with LV hypertrophy in women, whereas the only independent predictor in men was increased BP. The same analysis revealed that the combination of impaired glucose level, abdominal obesity, and dyslipidemia was associated with LV hypertrophy only in women. Higher BP, impaired fasting glucose, and triglycerides level were independently associated with LV diastolic dysfunction in women, whereas higher BP was the only independent predictor in men. The combination of increased BP, fasting glucose, and dyslipidemia was independently associated with LV diastolic dysfunction only in women. Conclusions: Different MS factors are responsible for LV remodeling in women and men. The metabolic sequence of MS is more important for LV remodeling in women. © 2013 Wiley Periodicals, Inc.

Objectives-Right heart function and mechanics have not been investigated in patients with subclinical hyperthyroidism. Our aim was to investigate right ventricular (RV) and right atrial (RA) function and deformation as evaluated by 3-dimensional echocardiography (3DE) and speckle-tracking 2-dimensional echocardiography (2DE) in these individuals. Methods-We included 39 untreated women with endogenous subclinical hyperthyroidism and 39 healthy women matched by age. All participants underwent laboratory analyses that included thyroid hormone levels and comprehensive 2DE and 3DE examinations. Results-Three-dimensional echocardiographic RV volumes were significantly elevated in the patients with subclinical hyperthyroidism (P < .05), whereas the 3DE RV ejection fraction was reduced in this group, but with borderline significance. Twodimensional echocardiographic longitudinal RV and RA strain were significantly reduced in the patients with subclinical hyperthyroidism. Two-dimensional echocardiographic RV systolic and early diastolic strain rates were reduced, whereas late diastolic strain rates were increased in the patients with subclinical hyperthyroidism. The same changes were detected in RA mechanics among the patients with subclinical hyperthyroidism. The thyrotropin (TSH) level correlated with the left ventricular mass index, transmitral early diastolic peak flow velocity (E)/late diastolic flow velocity (A) ratio, tricuspid E/A ratio, 2DE RV global strain, 2DE RA, strain, and 3DE RV enddiastolic volume. A multivariate regression analysis showed that the mitral E/A ratio, 2DE RV global strain, and 3DE RV end-diastolic volume were independently associated with the TSH level. Conclusions-Right ventricular and RA function as evaluated by 3DE and speckletracking 2DE is significantly impaired in patients with subclinical hyperthyroidism. The TSH level correlated with parameters for RV function and mechanics in the whole study population. © 2016 by the American Institute of Ultrasound in Medicine.

Objectives-Right heart function and mechanics have not been investigated in patients with subclinical hyperthyroidism. Our aim was to investigate right ventricular (RV) and right atrial (RA) function and deformation as evaluated by 3-dimensional echocardiography (3DE) and speckle-tracking 2-dimensional echocardiography (2DE) in these individuals. Methods-We included 39 untreated women with endogenous subclinical hyperthyroidism and 39 healthy women matched by age. All participants underwent laboratory analyses that included thyroid hormone levels and comprehensive 2DE and 3DE examinations. Results-Three-dimensional echocardiographic RV volumes were significantly elevated in the patients with subclinical hyperthyroidism (P < .05), whereas the 3DE RV ejection fraction was reduced in this group, but with borderline significance. Twodimensional echocardiographic longitudinal RV and RA strain were significantly reduced in the patients with subclinical hyperthyroidism. Two-dimensional echocardiographic RV systolic and early diastolic strain rates were reduced, whereas late diastolic strain rates were increased in the patients with subclinical hyperthyroidism. The same changes were detected in RA mechanics among the patients with subclinical hyperthyroidism. The thyrotropin (TSH) level correlated with the left ventricular mass index, transmitral early diastolic peak flow velocity (E)/late diastolic flow velocity (A) ratio, tricuspid E/A ratio, 2DE RV global strain, 2DE RA, strain, and 3DE RV enddiastolic volume. A multivariate regression analysis showed that the mitral E/A ratio, 2DE RV global strain, and 3DE RV end-diastolic volume were independently associated with the TSH level. Conclusions-Right ventricular and RA function as evaluated by 3DE and speckletracking 2DE is significantly impaired in patients with subclinical hyperthyroidism. The TSH level correlated with parameters for RV function and mechanics in the whole study population. © 2016 by the American Institute of Ultrasound in Medicine.

Aim: Two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE) may overcome many limitations of the conventional 2D echocardiography (2DE) in assessing right ventricular (RV) function. We sought to determine whether characteristics of the right atrium and right ventricle as measured by 2D-STE and 3DE are associated with cardiac mortality in patients with ischemic heart failure, over a 6-year follow-up. Materials and Methods: The inclusion criteria were ischemic cardiomyopathy with left ventricular ejection fraction of <40% diagnosed using standard 2DE, 2D-STE, and 3DE examination. Patients were followed for 6 years, and cardiac mortality was recorded. Results: The study sample comprised a total of 54 participants. During the period of follow-up, 24% (13/54) died. The 2DE models showed that being older, having a higher body mass index (BMI), having higher systolic pulmonary artery pressure (SPAP), and a lower RV global longitudinal strain were associated with cardiac mortality in our cohort after 6-year follow-up. Finally, the 3DE models showed that in addition to being older, having higher BMI, having a higher SPAP baseline, lower baseline 3DE RV stroke volume, and larger 3DE RV end-diastolic volume and 3DE RV end-systolic volume were associated with cardiac mortality over 6-year follow-up. Conclusion: This study provides evidence that RV dysfunction as seen on 2D-STE and 3DE could be associated with increased risk of cardiac-related mortality in patients with heart failure over 6 years. © 2024 Journal of Cardiovascular Echography | Published by Wolters Kluwer - Medknow.

Background Detailed analysis of layer-specific mechanical changes in patients with type 2 diabetes mellitus (DM) might improve insight into left ventricular (LV) remodelling and diabetic cardiomyopathy. Aim We sought to investigate layer-specific LV deformation in patients with DM, with and without hypertension. Methods This cross-sectional study included 146 subjects (44 controls; 48 patients with DM; 54 patients with DM and hypertension) who underwent complete examination by two-dimensional echocardiography (2DE), including multilayer strain analysis. Results 2DE LV longitudinal and circumferential strains deteriorated progressively and significantly from controls, through patients with DM, to patients with DM and hypertension. 2DE radial strain was lower in patients with DM and hypertension than in controls. 2DE longitudinal and circumferential mid-myocardial and epicardial layer strains decreased progressively from controls to patients with DM and hypertension, whereas endocardial layer strain was lower in patients with DM and patients with DM and hypertension than in controls. Variables of DM control (fasting glucose and glycated haemoglobin) were associated with 2DE LV longitudinal and circumferential layer-specific strains, independent of age, body mass index, blood pressure, LV diastolic function and hypertrophy in patients with DM. Conclusion DM and hypertension significantly affect LV deformation assessed by 2DE traditional strain and 2DE multilayer strain. Hypertension showed an additional negative effect on LV deformation in patients with DM. Fasting glucose and glycated haemoglobin were associated with LV mechanics evaluated by comprehensive 2DE strain analysis, independent of LV structure and diastolic function. © 2017 Elsevier Masson SAS

Aims: We evaluated left atrial (LA) phasic function and heart rate variability (HRV) in asymptomatic diabetic patients, and the relationship between HRV indices and LA phasic function assessed by volumes and speckle tracking imaging. Method: This cross-sectional study included 55 asymptomatic patients with type 2 diabetes and 50 healthy controls without cardiovascular risk factors. All study subjects underwent laboratory analyses, complete two-dimensional echocardiography examination (2DE) and 24-h Holter monitoring. Results: Maximum, minimum LA and pre-A LA volumes and volume indexes are significantly higher in diabetic patients. Total and passive LA emptying fractions (EF), representing the LA reservoir and conduit function, are significantly lower in diabetic subjects. Active LA EF, the parameter of the LA booster pump function, is compensatory increased in diabetic patients. Similar results were obtained by 2DE strain analysis. Cardiac autonomic function, assessed by HRV, is significantly deteriorated in diabetic patients. Time and frequency-domain HRV measures are significantly lower in diabetic subjects than in controls. HbA1c, LV mass index and HRV are associated with total LA EF and longitudinal LA strain independently of age, body mass index and LV diastolic function in the whole study population. Conclusions: LA phasic function and cardiac autonomic nervous system assessed by HRV are impacted by diabetes. HbA1c and HRV are independently associated with LA reservoir function evaluated by volumetric and strain methods in the whole study population. This study emphasizes the importance of determination of LA function and HRV as important markers of preclinical cardiac damage and autonomic function impairment in diabetic patients. © 2017, Springer-Verlag Italia.

Aims: We evaluated left atrial (LA) phasic function and heart rate variability (HRV) in asymptomatic diabetic patients, and the relationship between HRV indices and LA phasic function assessed by volumes and speckle tracking imaging. Method: This cross-sectional study included 55 asymptomatic patients with type 2 diabetes and 50 healthy controls without cardiovascular risk factors. All study subjects underwent laboratory analyses, complete two-dimensional echocardiography examination (2DE) and 24-h Holter monitoring. Results: Maximum, minimum LA and pre-A LA volumes and volume indexes are significantly higher in diabetic patients. Total and passive LA emptying fractions (EF), representing the LA reservoir and conduit function, are significantly lower in diabetic subjects. Active LA EF, the parameter of the LA booster pump function, is compensatory increased in diabetic patients. Similar results were obtained by 2DE strain analysis. Cardiac autonomic function, assessed by HRV, is significantly deteriorated in diabetic patients. Time and frequency-domain HRV measures are significantly lower in diabetic subjects than in controls. HbA1c, LV mass index and HRV are associated with total LA EF and longitudinal LA strain independently of age, body mass index and LV diastolic function in the whole study population. Conclusions: LA phasic function and cardiac autonomic nervous system assessed by HRV are impacted by diabetes. HbA1c and HRV are independently associated with LA reservoir function evaluated by volumetric and strain methods in the whole study population. This study emphasizes the importance of determination of LA function and HRV as important markers of preclinical cardiac damage and autonomic function impairment in diabetic patients. © 2017, Springer-Verlag Italia.

Background: Left atrial (LA) mechanics has been poorly investigated in women with subclinical hypothyroidism (SHT), and the effect of levothyroxine therapy on LA deformation and function is unknown. Aim: To investigate LA phasic function and mechanics assessed by two-dimensional echocardiography (2DE) and speckle tracking in women with SHT, and to estimate the influence of levothyroxine therapy on LA remodeling. Methods: We included 48 untreated women with SHT and 38 healthy control women of the same age. All the SHT patients received levothyroxine therapy and were followed for 1 year after euthyroid status was achieved. All the participants underwent laboratory analyses and complete 2DE examination. Results: Left atrial total emptying fraction was significantly lower in the SHT patients at the baseline in comparison with the controls. LA passive emptying fraction gradually decreased from the controls, throughout the treated SHT patients, to the untreated SHT patients. LA active emptying fraction was lower in the controls than in the untreated and the treated SHT participants. 2DE LA longitudinal strain and systolic strain rate gradually decreased from the controls to the untreated SHT patients, whereas LA early diastolic strain rate signi ficantly increased in the same direction. Late diastolic LA strain was lower in the controls than in the untreated and the treated SHT patients. Conclusion: Subclinical hypothyroidism significantly affects LA mechanics. Reservoir, conduit, and booster pump LA functions are all impacted by SHT. A 1-year levothyroxine therapy significantly improves, but does not completely restore LA phasic function and mechanics in the SHT patients. © 2014, Wiley Periodicals, Inc.

Masked hypertension (MH) is a clinical condition that indicates normal values of clinic blood pressure (BP) but elevated 24-hour BP. The purpose of this study was to investigate the relationship between MH and left atrial (LA) phasic function evaluated by both the volumetric and speckle tracking method. This cross-sectional study included 49 normotensive individuals, 50 patients with MH, and 70 untreated sustained hypertensive patients adjusted by age and sex. MH was diagnosed if clinic BP was normal and 24-hour BP was increased. LA reservoir function was lower in patients with MH and those with sustained hypertension compared with the normotensive group. LA conduit function gradually decreased, while LA booster pump function progressively increased, from normotension to sustained hypertension. Similar results were obtained by two-dimensional echocardiographic strain analysis. Independently of main clinic and echocardiographic characteristics, 24-hour systolic BP was associated with LA passive ejection fraction, LA total longitudinal strain, LA positive longitudinal strain, and LA stiffness index. In conclusion, MH is associated with impairment of LA phasic function and stiffness, and 24-hour systolic BP increment was closely related with LA remodeling. ©2016 Wiley Periodicals, Inc.

Background: Metabolic syndrome (MS) is a clustering of cardiovascular risk factors responsible for the development of target organ damage. The aim of this study was to determine the effect of the increasing number of MS risk factors on left ventricular function assessed by noninvasive methods. Material/Methods: The study included 204 subjects with MS and 76 controls with no MS risk factors. MS was defined by the presence of 3 or more of ATP-NCEP III criteria. MS subjects were grouped according to the number of criteria they fulfilled: 3 criteria (n=91), 4 criteria (n=65) and 5 criteria (n=48). All subjects underwent laboratory blood tests, complete 2-dimensional, pulse and tissue Doppler echocardiography. Echocardiography was used to assess systolic (LVEF, sseptal), diastolic function, by pulse-wave Doppler (E/A ratio) and tissue Doppler imaging (E/e'average), and global left ventricular function (Tei index). Appropriate time intervals for the estimation of the Tei index were obtained by tissue Doppler. Results: Transmitral E/A ratio decreased significantly and progressively from the 3 criteria to the 5 criteria group (0.82±0.25 vs. 0.79±0.24 vs. 0.67±0.14, p<0.001). The transmitral E/E'average ratio was significantly and gradually increased from the 3 criteria to the 5 criteria group (7.76±1.81 vs. 9.44±2.35 vs. 10.82±2.56, p<0.001). The left ventricle Tei index progressively increased from the 3 criteria to the 5 criteria group (0.43±0.11 vs. 0.48±0.10 vs. 0.54±0.12, p<0.001). Conclusions: The increasing number of MS criteria is associated with cardiac diastolic dysfunction. © Med Sci Monit, 2012.

Aims: In heart failure, a holistic approach incorporating the patient's perspective is vital for prognosis and treatment. Self-rated health has strong associations with adverse events and short-term mortality risk, but long-term data are limited. We investigated the predictive value of two consecutive self-rated health assessments with regard to long-term mortality in a large, well characterised sample of elderly patients with stable chronic heart failure. Methods and results: We measured self-rated health by asking 'In general, would you say your health is: 1, excellent; 2, very good; 3, good; 4, fair; 5, poor?' twice: at baseline and the end of a 12-week beta-blocker up-titration period in the CIBIS-ELD trial. Mortality was assessed in an observational follow-up after 2-4 years. A total of 720 patients (mean left ventricular ejection fraction 45±12%, mean age 73±5 years, 36% women) rated their health at both time points. During long-term follow-up, 144 patients died (all-cause mortality 20%). Fair/poor self-rated health in at least one of the two reports was associated with increased mortality (hazard ratio 1.42 per level; 95% confidence interval 1.16-1.75; P<0.001). It remained independently significant in multiple Cox regression analysis, adjusted for N-terminal pro B-type natriuretic peptide (NTproBNP), heart rate and other risk prediction covariates. Self-rated health by one level worse was as predictive for mortality as a 1.9-fold increase in NTproBNP. Conclusion: Poor self-rated health predicts mortality in our long-term follow-up of patients with stable chronic heart failure, even after adjustment for established risk predictors. We encourage clinicians to capture patient-reported self-rated health routinely as an easy to assess, clinically meaningful measure and pay extra attention when self-rated health is poor. © The European Society of Cardiology 2015.