Background
The effects of left ventricular (LV) loading on myocardial deformation variables are not well-studied in the clinical setting. In the present study, we evaluated the effects of isolated changes in preload, afterload and heart rate on LV longitudinal strain, systolic (SR-S) and early diastolic strain rate (SR-E) in post-cardiac surgery patients.

Methods
Twenty-one patients were studied early after cardiac surgery. Longitudinal myocardial strain and SR were analysed off-line using 2-D speckle echocardiography. The experimental protocol consisted of three consecutive interventions: (1) preload was increased by passive leg elevation, (2) afterload was increased by an infusion of phenylephrine to increase arterial blood pressure by 10–15% and (3) heart rate was increased 10% and 20% by atrial pacing. During both the preload and afterload challenges heart rate was kept constant by atrial pacing. Central venous pressure was kept constant during pacing by infusion of hetastarch/albumin.

Results
The increase in preload increased LV strain, SR-S and SR-E by 20%, 11% and 17%, respectively. The phenylephrine-induced increase in afterload, did not affect LV strain, SR-S or SR-E. LV strain was not affected while SR-S and SR-E increased by pacing-induced heart rate increase.

Conclusion
After cardiac surgery, systolic and early diastolic strain rate are dependent on both preload and heart rate, while neither of these variables was afterload-dependent. LV strain was preload-dependent but not affected by atrial pacing. When evaluating the direct effects of various pharmacological or other interventions on myocardial contractility and relaxation, preload and heart rate must be controlled.

Load-dependence of myocardial deformation variables - a clinical strain-echocardiographic study.

In patients with type 2 diabetes, both supervised exercise and treatment with the glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1RA) liraglutide may improve cardiac function. We evaluated cardiac function before and after 16 weeks of treatment with the GLP-1RA liraglutide or placebo, combined with supervised exercise, in 33 dysregulated patients with type 2 diabetes on diet and/or metformin. Early diastolic myocardial tissue velocity was improved by exercise in the placebo group (mean ± standard deviation [s.d.] -7.1 ± 1.6 to -7.7 ± 1.8 cm/s, P  = .01), but not in the liraglutide group (-7.1 ± 1.4 to -7.0 ± 1.4 cm/s, P  = .60; between groups, P  = .02). Similarly, the mean ± s.d. ratio of early and atrial mitral annular tissue velocities improved in the placebo group (1.0 ± 0.4 to 1.2 ± 0.4, P  = .003), but not in the liraglutide group (1.0 ± 0.3 to 1.0 ± 0.3, P  = .87; between groups, P  = .03). We found no significant differences in heart rate, left ventricular (LV) structure or function within or between the groups. In conclusion, the addition of liraglutide to exercise in sedentary patients with dysregulated type 2 diabetes may blunt the suggested beneficial effect of exercise on LV diastolic function.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/dom.12900

Effect of Exercise Combined With Glucagon-Like peptide-1 Receptor Agonist Treatment on Cardiac Function: A Randomized Double-Blind Placebo-Controlled Clinical Trial

Comparison of Admission Lung Ultrasound and Left Ventricular End-Diastolic Pressure in Patients Undergoing Primary Percutaneous Coronary Intervention.

The prevalence of heart failure with preserved ejection fraction (HFpEF) continues to grow at alarming rates and is predicted to become the most prevalent phenotype of heart failure over the next decade Recent data show a higher non-cardiac comorbidity burden associated with HFpEF, and similar overall hospitalisation rates when compared with patients with heart failure with reduced ejection fraction (HFrEF) Unfortunately, clinicians mainly focus their efforts in diagnosis of HFrEF despite HFpEF accounting for 50% of the cases of heart failure Therefore, this review is intended to create awareness on the pathophysiology, risk factors, diagnosis and management of patients with HFpEF and its core mechanical abnormality left ventricular diastolic dysfunction Clinical distinction between HFpEF and HFrEF should be of particular interest to internal medicine physicians and general practitioners as this distinction is seldom made and early diagnosis can lag if appropriate risk factors are not promptly recognised

https://pmj.bmj.com/content/postgradmedj/92/1088/346.full.pdf

The clinical dilemma of heart failure with preserved ejection fraction: an update on pathophysiology and management for physicians

Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization.

Heart Rate–Dependent Left Ventricular Diastolic Function in Patients With and Without Heart Failure

Heart Rate-Dependent Left Ventricular Diastolic Function in Patients With and Without Heart Failure

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Heart Rate–Dependent Left Ventricular Diastolic Function in Patients With and Without Heart Failure

Heart Rate-Dependent Left Ventricular Diastolic Function in Patients With and Without Heart Failure