Abnormal Left Ventricular Function Research Articles

Cardiac magnetic resonance including parametric mapping in acute Takotsubo syndrome: Preliminary findings

IntroductionT1 and T2 mapping have been shown to be reliable markers of interstitial myocardial fibrosis, edema, and inflammation. The aim of this study was to evaluate myocardial involvement in acute phase Takotsubo syndrome using native and post-contrast T1 mapping, ECV fraction, and T2 mapping. Material and methodsWe investigated 14 patients with acute Takotsubo syndrome and 14 healthy controls. CMR included cine imaging, black-blood STIR imaging, early and late gadolinium enhancement imaging, native and post-contrast T1 mapping, and T2 mapping. Wall motion, T2 ratio, early gadolinium enhancement ratio, extracellular volume fraction, T1 and T2 relaxation times were analyzed. ResultsPatients had significantly impaired left ventricular function (46 ± 10%) and acute wall motion abnormalities compared with controls (62 ± 2%). Native T1 and T2 values, T2 ratio, and ECV fraction were significantly higher in patients compared with controls. In patients, native T1 and T2 values as well as T2 ratio were significantly higher in segments with abnormal wall motion compared with normokinetic segments. Native T1 values, T2 relaxation times, T2 ratio, and ECV fraction were significantly higher, post-contrast T1 relaxation times significantly lower in segments with abnormal wall motion compared with segments of controls; except for T2 ratio and post-contrast T1 relaxation times this also held true for patients’ segments with normal wall motion. ConclusionsNative T1 and T2 mapping, as well as ECV fraction, discriminate between visually affected vs. unaffected segments in patients with acute Takotsubo syndrome and reveal significant T1 and T2 tissue changes even in visually unaffected segments. Thus, mapping may allow for better detection in convalescent stages of disease and additionally may have the potential to serve as a marker of disease progress. These preliminary findings warrant further investigation in a larger patient cohort.

Abstract WP271: A Comparison of Bedside Echocardiography with Point of Care Ultrasound to Standard Transthoracic Echocardiography in the Setting of Acute Stroke and TIA

Background: Transthoracic Echocardiography (TTE) is routinely performed in the setting of acute stroke and transient ischemic attack (TIA) to evaluate for a cardiac source of emboli. Although standard of care, guidelines remain ambiguous on the indications and recommendations for its routine use. Point-of-care ultrasound (POCUS), a quick bedside method of echocardiography using an easily portable, hand-held device, has been studied extensively in the ED, trauma, and ICU settings, but not for acute stroke and TIA. Here, we demonstrate the feasibility of using POCUS for the purpose of screening echocardiography in acute stroke & TIA patients. Additionally, we compare POCUS with TTE in order to evaluate the veracity of the point-of-care method with the gold standard. Methods: A retrospective comparison was made between routine TTE and POCUS results performed by a cardiologist during consultation. 99 patients were included, each admitted for workup of stroke, TIA, or retinal artery occlusions, and had a cardiology consultation for any reason. Parameters compared included left ventricular (LV) function, left atrial (LA) size, mitral valve (MV) and aortic valve (AV) pathology, and the presence of LA or LV thrombi, masses, or aneurysms. Results: All 16 cases with significant abnormalities (LV dysfunction, LV thrombi, or AV/MV vegetations) that were found on TTE were also identified by POCUS. Of the 13 patients with severely abnormal LV function on TTE, 12 were identified as severe on POCUS, and one as mild-moderate. Findings in 9 of these 16 patients led to a change in management, including one case where a large LV thrombus requiring a heparin infusion was identified hours earlier by POCUS. Conclusions: POCUS was comparable and non-inferior to the gold standard TTE for the purpose of screening echocardiography in the workup of acute ischemic stroke & TIA. Significant findings on TTE were all identified by a bedside POCUS (with the only discrepancy in the degree of LV dysfunction in a single case). All TTE findings resulting in management changes were also identified by POCUS. Importantly, POCUS can be used as a quick diagnostic screening tool to help establish an earlier diagnosis of life threatening conditions, and may lead to earlier management and treatment decisions.

Superiority of three-dimensional quantitative analysis technique and automatic cardiac motion quantification technique in evaluating left ventricular systolic function in patients with chronic kidney disease

Objective: To investigate the value of three-dimensional quantitative analysis (3DQA) and automatic cardiac motion quantification (aCMQ) in evaluating the left ventricular systolic function in patients with different stages of chronic kidney disease (CKD). Methods: A total of 127 cases of CKD patients between June 2016 and December 2017 who were admitted to Department of Nephrology of Wuxi No.2 People's Hospital were divided into three groups: Group A (44 cases in CKD stage 1 and 2), Group B (38 cases in CKD stage 3) and Group C (45 cases in CKD stage 4 and 5). Another 50 age and sex matched normal controls were selected during the same period. The left ventricular segments and global longitudinal strain (GLS), left ventricular segments and global three-dimensional displacement (3DD) obtained by aCMQ and 3DQA techniques were compared and analyzed. Results: Compared with the control group, as for the longitudinal strain (LS) of each segment of left ventricular 5 (17 in all) segments in Group A, 10 segments in Group B and all segments in Group C decreased (P<0.05). As for the 3DD of each segment of left ventricular, 6 segments in Group A, 12 segments in Group B and all segments in group C decreased (P<0.05). As for the GLS, there was no statistically significant difference in group A, however, absolute value of GLS in group B and C [(19.82±3.62)%, (16.62±5.48)% vs (21.98±4.32)%] decreased statistically significantly (both P<0.05). As for the left ventricular global 3DD, the global 3DD of group A, group B and group C [(6.24±0.51) mm, (5.54±0.29) mm, (4.62±0.55) mm vs (7.11±0.51) mm] decreased (all P<0.05). Conclusions: Three-dimensional quantitative analysis and automatic cardiac motion quantification can detect the abnormality of left ventricular systolic function in patients with chronic kidney disease at an early stage. And the global 3DD of left ventricle of 3DQA is more sensitive than the global longitudinal strain of left ventricle of aCMQ.

Echocardiography assessment of the left ventricular systolic function and regional wall motion abnormalities pre- and post-coronary artery bypass grafting surgery

Background and Objective: Coronary artery disease is a significant global health problem and is a leading cause of disability and death. In this study, the effect of coronary artery bypass graft (CABG) surgery on left ventricular (LV) systolic functions and regional wall motion abnormalities in the 1st week and 3rd month after surgery was evaluated through echocardiographic techniques. Patients and Methods: Fifty patients who underwent elective isolated CABG at Azadi Heart Center were included and studied prospectively from November 2018 to May 2019. Transthoracic two-dimensional echocardiography was used to assess the LV-systolic function (LV ejection fraction [LVEF]) and wall motion score index (WMSI) and abnormalities. Results: Almost all patients had chest pain preoperatively, and 32% and 38% of them were in Canadian Cardiovascular Society (CCS) Class III and IV, respectively. Ninety percent had multivessel disease, and the left anterior descending was the most common vessel affected (86%), complete revascularization was done in all patients using 3–6 grafts, and left internal mammary artery was used in 48 patients (96%). There was no significant improvement in LVEF in the early postoperative period (P = 0.28). On the contrary, there was a highly significant improvement of LVEF lately postoperatively, which was improved from (49.62%–56.92%) at (P ≤ 0.001). As well, there was a substantial improvement of WMSI at lately postoperative (P = 0.026) that changed from (1.204 to 1.12). Conclusions: The present study suggests that CABG has a positive effect on LV systolic functions and regional wall motion abnormalities 3-month post-operatively as confirmed through echocardiographic techniques.

Estrogen deprivation aggravates intracellular calcium dyshomeostasis in the heart of obese-insulin resistant rats.

The incidence of cardiovascular disease and metabolic syndrome increases after the onset of menopause, giving evidence for the vital role of estrogen. Intracellular calcium [Ca2+ ]i regulation plays an important role in the maintenance of left ventricular (LV) contractile function. Although either estrogen deprivation or obesity has been shown to strongly affect the metabolic status and LV function, the effects of estrogen deprivation on the cardiometabolic status and cardiac [Ca 2+ ]i regulation in the obese-insulin resistant condition have never been investigated. Our hypothesis was that estrogen deprivation aggravates LV dysfunction through the increased impairment of [Ca 2+ ]i homeostasis in obese-insulin resistant rats. Female rats were fed on either a high-fat (HFD, 59.28% fat) or normal (ND, 19.77% fat) diet for 13 weeks. Then, rats were divided into sham (HFS and NDS) operated or ovariectomized (HFO and NDO) groups. Six weeks after surgery, metabolic status, LV function and incidence of [Ca 2+ ]i transients were determined. NDO, HFS, and HFO rats had evidence of obese-insulin resistance indicated by increased body weight with hyperinsulinemia and euglycemia. Although NDO, HFS, and HFO rats had markedly reduced %LV fractional shortening, E/A ratio and decreased [Ca 2+ ]i transient amplitude and decay rate, HFO rats had the most severe impairments. These findings indicate that estrogen deprivation had a strong impact on abnormal LV function through [Ca 2+ ]i regulation. In addition, evidence was found that in obese-insulin resistant rats, estrogen deprivation severely aggravates LV dysfunction via increased impairment of [Ca 2+ ]i homeostasis.

Abstract 16682: Abnormal Left Ventricular Deformation in Mitral Valve Prolapse

Background: Mitral valve (MV) prolapse (MVP) is usually considered a primary valvular abnormality. We hypothesized that there are concomitant abnormalities in regional left ventricular (LV) function in this syndrome. Objective: To characterize LV global and regional strain in MVP with and without significant mitral regurgitation (MR), defined as regurgitant fraction &gt;15%, in comparison with controls using cardiac magnetic resonance (CMR). Methods: A total of 109 MVP patients (median age 51 years, 40% males) with normal LV ejection fraction, and a control group of 45 patients (47 years, 53% males) without structural heart disease by CMR were retrospectively included. From standard cine images we quantified LV volumes and ejection fraction and, using feature tracking, global and segmental longitudinal and circumferential peak systolic strains. Results: Significant MR was found in 49 (44%) of MVP patients. Compared with controls, MVP patients had significantly higher LV end-diastolic and end-systolic volumes without differences in ejection fraction (Table). While there were no differences in global strains, regional longitudinal and circumferential peak systolic strains were increased in the basal anterior and anterolateral segments, and reduced in the mid inferior segment (Table). When comparing only patients without significant MR with controls, these differences remained significant (Table). Conclusions: In patients with MVP and normal LV ejection fraction there is LV dilatation and increased basal anterior and anterolateral deformation in comparison with controls, even in the absence of significant MR. These findings suggest that MVP may be a disease not only of the MV but also of the adjacent myocardium.

Impact of Exercise Training on Cardiac Function Among Patients With Type 2 Diabetes: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Type 2 diabetes (T2D) is associated with subclinical abnormalities in left ventricular function and an increased downstream risk for heart failure. Exercise training has been associated with significant improvement in cardiorespiratory fitness among these patients. However, its impact on cardiac function is not well established. We conducted a meta-analysis including all randomized and nonrandomized trials that evaluated effects of exercise training on cardiac function among patients with T2D. Primary outcomes were measures of left ventricular systolic (global longitudinal strain) and diastolic (early diastolic velocity [é]) function. The effects of exercise training on peak oxygen uptake; other markers of diastolic dysfunction: mitral peak early-to-late diastolic filling velocity (E/A), mitral inflow to annular ratio (E/é), and deceleration time (DT); and systolic velocity were also assessed. Our study included 441 patients enrolled in 6 trials. Exercise training significantly improved early diastolic velocity (standardized mean difference [SMD], 0.58; 95% CI, 0.09-1.07), global longitudinal strain (SMD, 0.62; 95% CI, 0.04-1.21), and peak oxygen uptake (SMD, 1.43; 95% CI, 0.51-2.35) as compared with control group. However, no significant changes were observed in other markers of diastolic function (E/A, E/é and DT) and systolic velocity. Exercise training in patients with T2D is associated with a significant improvement in some echocardiographic indicators of systolic and diastolic function and cardiorespiratory fitness. These findings suggest that exercise training may improve subclinical systolic and diastolic dysfunction in patients at risk for clinical heart failure.

A0188 Epidemiologic observations informing clinical application of a urinary peptidomic marker of diastolic left ventricular dysfunction

Objectives: Hypertension, obesity and older age are major risk factors for left ventricular (LV) dysfunction (LVDD), but easily applicable screening tools in people at risk are lacking. We investigated whether HF1, a urinary biomarker consisting of 85 peptides, can predict over a 5 year time span mildly impaired diastolic LV function as assessed by echocardiography. Methods: In 645 White Flemish (50.5% women; 50.9 years [mean]), we measured HF1 by capillary electrophoresis coupled with mass spectrometry in 2002–2010. We measured early (E) and late (A) peak velocities of the transmitral blood flow and early (e’) and late (a¢) mitral annular peak velocities and their ratios in 2009–2013. Results: In multivariable-adjusted analyses, per 1-SD increment in HF1, e¢ was − 0.193 cm/s lower (95% confidence interval [CI]: −0.352 to −0.033; P = 0.018) and E/e¢ 0.174 units higher (0.005 to 0.342; P = 0.043). Of 645 participants, 179 (27.8%) had LVDD at follow-up, based on impaired relaxation in 69 patients (38.5%) or an elevated filling pressure in the presence of a normal (74 [43.8%]) or low (36 [20.1%]) age-specific E/A ratio. For a 1-SD increment in HF1, the adjusted odds ratio was 1.37 (CI, 1.07 to 1.76; P = 0.013). The integrated discrimination (+1.14%) and net reclassification (+31.7%) improvement of the optimized HF1 threshold (−0.350) in discriminating normal from abnormal diastolic LV function at follow-up over and beyond other risk factors was significant (P ≤ 0.024). Conclusion: In conclusion, HF1 allows screening for LVDD over a 5 year horizon in asymptomatic people.

A10827 Assessment of left ventricular structure and functional abnormality and association with cardiovascular risks in an Older Community-Dwelling Chinese Population

Objectives: To make the clinical determination of abnormal left ventricular structure and function in older Chinese community population. Methods: Shanghai Elderly Cardiovascular Health Study (SHECHS) recruited 3891 elderly residents aged 65 years and over with 593 very elderly age over 80 years. Demographic, laboratory echocardiography and tissue Doppler data were obtained and follow-up 3 years for mortality. Results: We defined a subset of low risk participants free of prevalent cardiovascular disease or risk factors referred to as the ‘low risk reference subgroup’ and use quantile regression to calculate 10th, 50th, and 90th percentile limits with associated 95% confidence limits in the low risk reference subgroup overall and stratified by sex with the resulting 10th and 90th percentile limits considered as reference limits for these measures in the overall SHECHS subjects. Therefore, the reference limit and guideline cutoff value in men and women of LVM, LVM index to BSA, LVEDD, LVEDD index to BSA, LAD, LAD index to BSA, e’, E/e’, EF were determined. And the prevalence of LV hypertrophy, LV enlargement, LA enlargement, abnormal EF and E/e’ were determined according to the SHECHS reference limit. Further multivariate logistic regression analysis shows significance of LAD and E/e’ adjusted by age, sex, BMI, SBP, hemoglobin, fast glucose, LDL-C, homocysteine, UA, creatinine, CK, hsCRP and AF (see Table). Conclusion: Our finding suggested that the use of age-based SHECHS reference limit in Older Community-Dwelling Chinese Population improves the accuracy for identify the subjects with LV structural and functional abnormality. LAD and E/e’ might be more associated with age, sex and cardiovascular risks by multivariate logistic regression analysis, while LV enlargement might be not.

A8055 Hypertension is associated with abnormal left ventricular diastolic function independent of left ventricular mass

A8055 Hypertension is associated with abnormal left ventricular diastolic function independent of left ventricular mass

Evaluation of Fetal Left Ventricular Size and Function Using Speckle‐Tracking and the Simpson Rule

This study was conducted to evaluate left ventricular (LV) size and function in healthy fetuses and to test a cohort of fetuses at risk for abnormal function using speckle-tracking software. Two hundred control fetuses were examined between 20 and 40 weeks' gestation. With the use of offline speckle-tracking software, the end-diastolic and end-systolic volumes were measured and the following computed: stroke volume (SV), SV per kilogram, cardiac output (CO), CO per kilogram, and ejection fraction. These were regressed against 7 independent variables related to the size, weight, and age of the fetuses. Five fetuses with risk factors for LV dysfunction were examined to sample the validity of the data from the control group. The R2 values for measurements of the end-diastolic volume, SV, and CO correlated with the 7 independent variables of fetal size and age (0.7-0.78), whereas the SV/kg, CO/kg, and ejection fraction had lower R2 values (0.02-0.1). The measurements were normally distributed (Shapiro-Wilke > 0.5). The 5 fetuses at risk for abnormal LV function had measurements of LV size and function that were consistent with the expected pathologic condition. Speckle tracking can provide a comprehensive evaluation of the size and function of the fetal LV.

Anticancer Drug-Related Nonvalvular Atrial Fibrillation: Challenges in Management and Antithrombotic Strategies.

Cancer patients may experience nonvalvular atrial fibrillation (AF) as a manifestation of cardiotoxicity. AF may be a direct effect of a neoplasm or, more often, appear as a postsurgical complication, especially after thoracic surgery. AF may also develop as a consequence of anticancer therapy (chemotherapy or radiotherapy), a condition probably underestimated. Cancer patients with AF require a multidisciplinary approach involving oncologists/hematologists, cardiologists, and coagulation experts. An echocardiogram should be performed to detect possible abnormalities of left ventricular systolic and diastolic function, as well as left atrial dilation and the existence of valvular heart disease, to determine pretest probability of sinus rhythm restoration, and identify the best treatment. The choice of antiarrhythmic treatment in cancer patients may be difficult because scanty information is available on the interactions between anticancer agents and antiarrhythmic drugs. A careful evaluation of the antithrombotic strategy with the best efficacy/safety ratio is always needed. The use of vitamin K antagonists (VKAs) may be problematic because of the unpredictable therapeutic response and high bleeding risk in patients with active cancer who are undergoing chemotherapy and who may experience thrombocytopenia and changes in renal or hepatic function. Low molecular weight heparins (in particular for short and intermediate periods) and non-VKA oral anticoagulants (NOACs) should be preferred. However, the possible pharmacological interactions of NOACs with both anticancer and antiarrhythmic drugs should be considered. Based on all these considerations, antiarrhythmic and anticoagulant therapy for AF should be tailored individually for each patient.

Natural history of echocardiographic abnormalities in mucopolysaccharidosis III

BackgroundMucopolysaccharidosis (MPS) type III, Sanfilippo Syndrome, is an autosomal recessive lysosomal storage disorder. MPS I and II patients often develop cardiac involvement leading to early mortality, however there are limited data in MPS III. The objective of this study is to describe cardiac abnormalities in a large group of MPS III patients followed in a longitudinal natural history study designed to determine outcome measures for gene transfer trials. MethodsA single center study of MPS III patients who were enrolled in the Nationwide Children's Hospital natural history study in 2014. Two cardiologists reviewed all patient echocardiograms for anatomic, valvular, and functional abnormalities. Valve abnormalities were defined as abnormal morphology, trivial mitral regurgitation (MR) with abnormal morphology or at least mild MR, and any aortic regurgitation (AR). Abnormal left ventricular (LV) function was defined as ejection fraction < 50%. Group comparisons were assessed using two-sample t-tests or Wilcoxon rank sum tests for continuous variables and chi-square or Fisher's exact tests for categorical variables. ResultsTwenty-five patients, 15 Type A and 10 Type B MPS III, underwent 45 echocardiograms. Fifteen patients (60%) demonstrated an abnormal echocardiographic finding with age at first abnormal echocardiogram within the study being 6.8 ± 2.8 years. Left-sided valve abnormalities were common over time: 7 mitral valve thickening, 2 mitral valve prolapse, 16 MR (8 mild, 8 trivial), 3 aortic valve thickening, and 9 AR (7 mild, 2 trivial). Two patients had asymmetric LV septal hypertrophy. No valvular stenosis or ventricular function abnormalities were noted. Incidental findings included: mild aortic root dilation (2), bicommissural aortic valve (1), and mild tricuspid regurgitation (3). ConclusionsIndividuals with Sanfilippo A and B demonstrate a natural history of cardiac involvement with valvular abnormalities most common. In short-term follow up, patients demonstrated only mild progression of abnormalities, none requiring intervention. Valvular disease prevalence is similar to MPS I and II, but appears less severe. These findings raise no specific concerns for gene transfer trials in patients in this age range.

Epidemiologic observations guiding clinical application of a urinary peptidomic marker of diastolic left ventricular dysfunction

Hypertension, obesity, and old age are major risk factors for left ventricular (LV) diastolic dysfunction (LVDD), but easily applicable screening tools for people at risk are lacking. We investigated whether HF1, a urinary biomarker consisting of 85 peptides, can predict over a 5-year time span mildly impaired diastolic LV function as assessed by echocardiography. In 645 white Flemish (50.5% women; 50.9 years [mean]), we measured HF1 by capillary electrophoresis coupled with mass spectrometry in 2005–2010. We measured early (E) and late (A) peak velocities of the transmitral blood flow and early (e') and late (a') mitral annular peak velocities and their ratios in 2009–2013. In multivariable-adjusted analyses, per 1-standard deviation increment in HF1, e' was −0.193 cm/s lower (95% confidence interval: −0.352 to −0.033; P = .018) and E/e' 0.174 units higher (0.005–0.342; P = .043). Of 645 participants, 179 (27.8%) had LVDD at follow-up, based on impaired relaxation in 69 patients (38.5%) or an elevated filling pressure in the presence of a normal (74 [43.8%]) or low (36 [20.1%]) age-specific E/A ratio. For a 1-standard deviation increment in HF1, the adjusted odds ratio was 1.37 (confidence interval, 1.07–1.76; P = .013). The integrated discrimination (+1.14%) and net reclassification (+31.7%) improvement of the optimized HF1 threshold (−0.350) in discriminating normal from abnormal diastolic LV function at follow-up over and beyond other risk factors was significant (P ≤ .024). In conclusion, HF1 may allow screening for LVDD over a 5-year horizon in asymptomatic people.

Menarche, menopause, and pregnancy data in untreated females and females treated with agalsidase alfa in the Fabry Outcome Survey

Mucopolysaccharidosis (MPS) type III, Sanfilippo Syndrome, is an autosomal recessive lysosomal storage disorder. MPS I and II patients often develop cardiac involvement leading to early mortality, however there are limited data in MPS III. The objective of this study is to describe cardiac abnormalities in a large group of MPS III patients followed in a longitudinal natural history study designed to determine outcome measures for gene transfer trials.A single center study of MPS III patients who were enrolled in the Nationwide Children's Hospital natural history study in 2014. Two cardiologists reviewed all patient echocardiograms for anatomic, valvular, and functional abnormalities. Valve abnormalities were defined as abnormal morphology, trivial mitral regurgitation (MR) with abnormal morphology or at least mild MR, and any aortic regurgitation (AR). Abnormal left ventricular (LV) function was defined as ejection fraction < 50%. Group comparisons were assessed using two-sample t-tests or Wilcoxon rank sum tests for continuous variables and chi-square or Fisher's exact tests for categorical variables.Twenty-five patients, 15 Type A and 10 Type B MPS III, underwent 45 echocardiograms. Fifteen patients (60%) demonstrated an abnormal echocardiographic finding with age at first abnormal echocardiogram within the study being 6.8 ± 2.8 years. Left-sided valve abnormalities were common over time: 7 mitral valve thickening, 2 mitral valve prolapse, 16 MR (8 mild, 8 trivial), 3 aortic valve thickening, and 9 AR (7 mild, 2 trivial). Two patients had asymmetric LV septal hypertrophy. No valvular stenosis or ventricular function abnormalities were noted. Incidental findings included: mild aortic root dilation (2), bicommissural aortic valve (1), and mild tricuspid regurgitation (3).Individuals with Sanfilippo A and B demonstrate a natural history of cardiac involvement with valvular abnormalities most common. In short-term follow up, patients demonstrated only mild progression of abnormalities, none requiring intervention. Valvular disease prevalence is similar to MPS I and II, but appears less severe. These findings raise no specific concerns for gene transfer trials in patients in this age range.

Nonalcoholic Fatty Liver Is Associated With Further Left Ventricular Abnormalities in Patients With Type 2 Diabetes Mellitus: A 3-Dimensional Speckle-Tracking Study.

The aim of this study was to detect left ventricular (LV) structure and function abnormalities in patients with type 2 diabetes mellitus with or without nonalcoholic fatty liver (NAFL) using 3-dimensional speckle-tracking echocardiography. Eighty patients with type 2 diabetes and a normal LV ejection fraction (≥55%), including 40 with coexistent NAFL, and 40 age- and sex-matched control participants were recruited. Conventional echocardiography and 3-dimensional speckle-tracking echocardiography were performed, and global longitudinal strain, global circumferential strain, global area strain, and global radial strain values were measured. Significant differences in 2-dimensional LV functional patterns were found among the 3 groups (P = .031), and LV hypertrophy was the most prevalent in patients with diabetes and NAFL. The patients with diabetes only had significantly lower global longitudinal strain, global circumferential strain, and global radial strain than the controls (all P < .05). The patients with diabetes and NAFL had severely lower global longitudinal strain, global circumferential strain, global area strain, and global radial strain than the controls (all P < .001), and they also had severely lower global longitudinal strain, global area strain, and global radial strain than the patients with diabetes only (all P < 0.001). The hemoglobin A1c level and NAFL were independently associated with strain values in all patients with diabetes. The strain values in multiple directions (≥2 of global longitudinal, global circumferential, global area, and global radial strain) decreased significantly in the patients with diabetes and moderate and severe NAFL compared to those with mild NAFL (all P < .05). Nonalcoholic fatty liver could aggravate LV hypertrophy and dysfunction in patients with type 2 diabetes. The combined application of conventional and 3-dimensional speckle-tracking echocardiography could detect these asymptomatic preclinical abnormalities.

Duration of Diabetes and Prediabetes During Adulthood and Subclinical Atherosclerosis and Cardiac Dysfunction in Middle Age: The CARDIA Study.

To determine whether the duration of diabetes and duration of prediabetes estimated during a 25-year period in early adulthood are each independently associated with coronary artery calcified plaque (CAC) and abnormalities in left ventricular structure and function later in life. Participants were 3,628 white and black adults aged 18-30 years without diabetes or prediabetes at baseline (1985-1986) in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Durations of diabetes and prediabetes were estimated based on their identification at examinations 7, 10, 15, 20, and 25 years later. CAC was identified by computed tomography at years 15, 20, and 25. Left ventricular structure and function were measured via echocardiogram at year 25. Of the 3,628 individuals, 12.7% and 53.8% developed diabetes and prediabetes, respectively; average (SD) duration was 10.7 (10.7) years and 9.5 (5.4) years. After adjustment for sociodemographic characteristics and other cardiovascular risk factors, and mutual adjustment for each other, the hazard ratio for the presence of CAC was 1.15 (95% CI 1.06, 1.25) and 1.07 (1.01, 1.13) times higher for each 5-year-longer duration of diabetes and prediabetes, respectively. Diabetes and prediabetes duration were associated with worse subclinical systolic function (longitudinal strain [Ptrend < 0.001 for both]) and early diastolic relaxation (e' [Ptrend 0.004 and 0.002, respectively]). Duration of diabetes was also associated with a higher diastolic filling pressure (E-to-e' ratio [Ptrend 0.001]). Durations of diabetes and prediabetes during adulthood are both independently associated with subclinical atherosclerosis and left ventricular systolic and diastolic dysfunction in middle age.

‘Lest We Forget’: A Case Report of an Unusual Complication of Standard Treadmill Exercise Stress Test

Ventricular arrhythmia and cardiac arrest are unusual complications of electrocardiogram exercise stress test. This case report presents a 72-year-old gentleman who developed sustained ventricular tachycardia and subsequent cardiac arrest during a standard treadmill exercise stress test on the background of a 2-month history of intermittent atypical thoracic back pain. Interestingly, thoracic back pain recurred with the onset of ventricular tachycardia. Cardiovascular risk factors were significant for being a current smoker and reported ‘impaired glucose tolerance’. Transthoracic echocardiogram showed preserved left ventricular function and multiple regional wall motion abnormalities, which were consistent with multivessel coronary artery disease. Coronary angiography confirmed severe three-vessel disease. He subsequently underwent coronary artery bypass surgery with an uncomplicated recovery. A retrospective review of glucose tests performed 3 years prior was consistent with the diagnosis of diabetes mellitus.

Characterisation of Cardiac Structure and Function in Patients with First Time Acute Coronary Syndromes in NZ: A MENZACS Substudy

Aim: To investigate the changes in cardiac structure and function that occur in patients with first time acute coronary syndromes (ACS) in New Zealand. Method: 324 patients have been enrolled in the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) at Auckland City Hospital. Echocardiographic data for left ventricular (LV) size, LV ejection fraction (LVEF), and diastolic parameters were obtained from the electronic hospital database. Results: Mean age 61 years (range 30-100), 80 (25%) were women, 164 (51%) presented with STEMI and 141 (44%) with NSTEMI. Echocardiograms could be found in the clinical record for 265 (82%) of which 263 (99%) recorded some assessment of LVEF: 185 (70%) were a quantified EF, although only 51 (19%) had LVEF derived from LV volume assessment. For the patients with NSTEMI 76% had normal LVEF, 13% mild and 9% moderate LV impairment; proportions for those with STEMI were 51%, 30% and 23% respectively. Where LV volumes had been quantified, 19% patients had dilated LV when compared with sex-specific reference values. LV regional wall motion was described in 256 (97%), and abnormalities were present among 80% of the patients. Left atrial size and E/e’ were quantified in 233 (89%) of patients and were abnormal in 59 (25%) and 115 (49%) respectively. Conclusion: Among this cohort of patients with first time ACS semi-quantitative assessment of LV size and LVEF were commonly reported, significant abnormalities of LV function were present and these data provide important insights to inform the data required for the MENZACS Study.

Revascularization of a post ICD implanted patient – Closing the stable after the horse has bolted

Patients with significant coronary artery disease with severe left ventricular dysfunction are at risk of sudden cardiac death secondary to ventricular arrhythmias. Whether complete revascularization or implantation of implantable cardioverter-defibrillator (ICD) first is always clinical dilemma. The revascularization strategy in the presence of multivessel disease is not always without risk and not cost effective. We have discussed one such clinical scenario where patient underwent ICD implantation and later had symptoms of transient heart failure and ventricular arrhythmia secondary to ischemia. His symptoms were relieved after successful percutaneous coronary angioplasty. Revascularization is the appropriate therapy for patients with abnormal left ventricular function and residual ischemia. ICD placement makes most sense for patients who are at risk but who lack the ischemic potential that would send them to revascularization.