Average Ejection Fraction Research Articles

Inspiratory muscle training after atrial fibrillation catheter ablation: A pilot study

Atrial fibrillation management is challenging, and traditional cardiac rehabilitation often overlooks respiratory issues. We aimed to evaluate the safety and efficacy of cardiac rehabilitation with inspiratory muscle training to enhance respiratory and cardiac functions after atrial fibrillation catheter ablation. This prospective, single-center observational study, conducted at the University of Tokyo Hospital between February 2019 and January 2020, included 5 men (average age 68.4 ± 2.58 years) who underwent initial ablation for symptomatic paroxysmal (n = 1) or non-paroxysmal (n = 4) atrial fibrillation. The participants underwent inspiratory muscle training alongside standard cardiac rehabilitation (intensity: 20% of the maximal inspiratory pressure, adjusted weekly). The pre- and post-intervention ejection fraction, left atrial volume index, and brain natriuretic peptide levels were evaluated. Inspiratory muscle training integration was associated with improvements in respiratory muscle strength and pulmonary function. The average ejection fraction improved from 62.0% to 64.4%, the left atrial volume index decreased from 39.4 mL/m2 to 27.0 mL/m2, and brain natriuretic peptide levels reduced from 112.28 pg/mL to 20.98 pg/mL. The anaerobic threshold increased from a mean of 12.3 to 14.2, and the mean peak oxygen uptake increased from 16.72 mL/kg/min to 18.12 mL/kg/min. Over a 4-year follow-up, atrial fibrillation recurrence was observed in only 1 of the 5 patients. Inspiratory muscle training, when integrated with cardiac rehabilitation, could potentially improve respiratory and cardiac function in patients with post-atrial fibrillation ablation and may help reduce the likelihood of atrial fibrillation recurrence. This pilot study supports the potential of inspiratory muscle training in enhancing standard rehabilitation protocols, warranting further investigation in larger randomized trials to substantiate these findings and explore long-term benefits.

A Comparison Study of Olmesartan and Valsartan Effects on Myocardial Metabolism in Patients With Dilated Cardiomyopathy: the OVOID Trial.

Myocardial metabolism plays an important role in maintaining cardiac function. Patients with dilated cardiomyopathy exhibit alterations in myocardial metabolism characterized by increased myocardial glucose metabolism. This study aimed to evaluate effects on myocardial metabolism of the angiotensin II receptor blockers olmesartan and valsartan in patients with dilated cardiomyopathy. We hypothesized that olmesartan, owing to its stronger and longer-lasting angiotensin II receptor blockade, would lead to a greater reduction in myocardial glucose metabolism compared with valsartan. OVOID (A Comparison Study of Olmesartan and Valsartan Effects on Myocardial Metabolism in Patients With Dilated Cardiomyopathy) was a multicenter, randomized controlled trial involving 44 patients with New York Heart Association classes II through IV dilated cardiomyopathy. Participants were randomized 1:1 to receive olmesartan (20 mg once daily) or valsartan (160 mg twice daily) for 6 months, in addition to standard care. The primary outcome was myocardial glucose metabolism measured by standardized uptake value ratio at 6 months after treatment. To measure standardized uptake value ratio, 18F-fluoro-2-deoxyglucose cardiac positron emission tomography was performed at baseline and 6 months after receiving the study agent. Baseline clinical characteristics and standardized uptake value ratio were not significantly different between the 2 groups. The average left ventricular ejection fraction was 25.1%±7.8% at baseline, with significant improvement in both groups after 6 months, though with no difference between them. At 6 months, the standardized uptake value ratio value was significantly lower in the olmesartan group than that in the valsartan (3.76±2.00 versus 5.76±3.10; P=0.01). Six months of olmesartan therapy significantly decreased myocardial glucose metabolism in dilated cardiomyopathy patients compared with valsartan therapy for 6 months. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04174456.

Totally Endoscopic Management of Mitral Annular Calcification: A Single-Center Experience.

Minimally invasive surgery for mitral annular calcification (MAC) has been reported sporadically, but data on endoscopic surgery are scarce. We summarize current surgical understanding of MAC and how it applies to endoscopic surgery through our experience. All patients with severe MAC undergoing endoscopic mitral surgery at a single institution (December 2020 to August 2024) were studied. Twenty-five patients (3 female patients) with an average left ventricular ejection fraction of 52.12% (46.25% to 60%), average age of 69.13 (64 to 75.7) years, average body surface area of 1.92 (1.69 to 2.09) m2, and average Society of Thoracic Surgeons predicted risk of mortality score of 8.30% (2.13% to 8.66%) underwent endoscopic surgery. Twelve patients had regurgitation (48%), 10 had stenosis (48%), and 3 had a combination (12%). Circumferential MAC was found in 4 patients (16%), 80% circumference in 7 (28%), 60% circumference in 7 (28%), and 40% circumference in 7 (28%). Mitral valve replacement was done in 72% (n = 18) with tissue valves (n = 11), mechanical valves (n = 4), or transcatheter balloon-expandable valves (n = 3). Seven patients (28%) had repairs. There were no operative deaths, atrioventricular complications, or strokes. The average duration of surgery was 5 h 40 min (4 h 13 min to 8 h 22 min), with average cardiopulmonary bypass and cross-clamp times of 214 (166 to 241) min and 152 (117 to 193) min, respectively. MAC was debrided in 20 patients with ultrasonic emulsification (n = 13) or mechanical debridement (n = 7). Endoscopic surgery for severe MAC can be safely and successfully performed using a combination of surgical techniques including ultrasonic decalcification, mechanical debridement, annular patching, and direct implantation of balloon-expandable valves.

Value of non-invasive remote monitoring in managing weight, symptoms, and reducing hospitalizations in heart failure patients : An analysis of a French cohort over one year

Value of non-invasive remote monitoring in managing weight, symptoms, and reducing hospitalizations in heart failure patients : An analysis of a French cohort over one year

Evaluation of qt prolongation in patients following conduction system pacing implantation

Evaluation of qt prolongation in patients following conduction system pacing implantation

Determining the optimal electrogram signal annotation method to enhance functional Ventricular Tachycardia substrate identification with decremental evoked potential (DeEP) mapping

Determining the optimal electrogram signal annotation method to enhance functional Ventricular Tachycardia substrate identification with decremental evoked potential (DeEP) mapping

Long-term prognostic value of scar characteristics in cardiac magnetic resonance to predict appropriate therapies in primary prevention

Long-term prognostic value of scar characteristics in cardiac magnetic resonance to predict appropriate therapies in primary prevention

Contemporary outcomes of implantable cardioverter defibrillator patients on amiodarone

Contemporary outcomes of implantable cardioverter defibrillator patients on amiodarone

Impact of SGLT2 inhibitors on endothelial function and echocardiographic parameters in dilated cardiomyopathy.

Dilated cardiomyopathy (DCM) is a common cause of heart failure with reduced ejection fraction (HFrEF) in industrialized countries and a major contributor to morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant benefits in HFrEF management; however, their impact on endothelial function in this patient population remains less explored. This study aims to evaluate the effects of SGLT2i on endothelial function and echocardiographic parameters in patients with DCM. This observational, longitudinal, monocentric study enrolled patients with DCM and HFrEF. Endothelial function was assessed using peripheral arterial tonometry (EndoPAT) at baseline, 6 months, and 12 months following the initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i). The enrollment period spanned from November 2021 to November 2022. The primary endpoint was the change in reactive hyperemia index (RHI) over time. In addition, a subgroup analysis was conducted to compare the effects of different SGLT2i agents (empagliflozin vs. dapagliflozin) and DCM etiology (ischemic vs. idiopathic) on endothelial function. A total of 102 patients were included, predominantly male (72%), with a median age of 75 years and an average baseline left ventricular ejection fraction (LVEF) of 32.9 ± 7.9%. NYHA class II/III was observed in 76% of participants, and ischemic etiology accounted for 53% of DCM cases. The baseline RHI value was 1.15 ± 0.34. At 6 months, it significantly increased to 1.40 ± 0.34 (P < 0.0001), reflecting an absolute change of 0.25 ± 0.03 (ΔRHI baseline - 6 months). Between 6 and 12 months, the RHI showed a further significant increase to 1.69 ± 0.36 (P < 0.0001), with an additional change of 0.29 ± 0.03 (ΔRHI 6 - 12 months). The overall change in RHI from baseline to 12 months (ΔRHI baseline - 12 months) was 0.54 ± 0.04 (P < 0.0001). No significant differences in RHI were observed between patients treated with dapagliflozin and those receiving empagliflozin (P = 0.589), nor between different DCM etiologies (ischemic vs. idiopathic, P = 0.463). The enhancement in RHI was associated with a reduction in the incidence of hospitalization for heart failure (AUC 0.783, P < 0.001). Progressive improvement in left ventricular function was observed through echocardiographic parameters. Although EDV and ESV showed a decreasing trend (EDV: 176.2 ± 64.9 to 167.6 ± 31.1 ml, P = 0.335; ESV: 124.5 ± 52.7 to 116.8 ± 24.6 ml, P = 0.606), these changes were not statistically significant. LVEF improved significantly from 32.9 ± 7.9% at baseline to 36.8 ± 5.5% at 6 months and 37.1 ± 4.9% at 12 months (P < 0.001). The E/A ratio declined from 1.5 ± 0.5 to 1.1 ± 0.3 (P = 0.023) and the E/E' ratio decreased from 18.1 ± 5.1 to 11.1 ± 2.8 (P = 0.027).Left atrial volume significantly decreased from 108 to 100 ml (P = 0.041), and pulmonary artery systolic pressure dropped from 44 to 39 mmHg at 6 months and 35 mmHg at 12 months (P < 0.001). SGLT2i therapy significantly improves endothelial function in patients with DCM suggesting a potential vascular benefit beyond their well established cardioprotective effects.

Anticoagulation of post-operative atrial fibrillation during cardiac rehabilitation

Abstract Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and is associated with increased mortality. Post-operative AF, describing the onset of the arrhythmia during or shortly after a surgical intervention, is particularly prevalent, with an incidence of 30–50%. The evidence supporting anticoagulation therapy in these patients remains limited, reflected by a Class IIa recommendation in current guidelines. The aim of this study was to assess how many patients receive oral anticoagulation (OAC) after postoperative AF and how this treatment strategy changes during cardiac rehabilitation. Methods This retrospective analysis included cardiology and cardiac surgery patients referred to inpatient rehabilitation following external treatment between 2022 and 2024. Post-operative AF diagnosis were extracted from referral letters, included patients with paroxysmal and persistent AF, while those with a prior diagnosis of AF were excluded. Anticoagulation was defined as the use of a non-vitamin K antagonist oral anticoagulant (NOAC) or a vitamin K antagonist (VKA). Results We analyzed 890 patients, 22% of whom were female, with a median age of 65 years (IQR 58;72). The average left ventricular ejection fraction (LV-EF) was 54.0% (IQR 45;60). Post-operative AF was diagnosed in 147 patients (16.5%). Of these, 85 (57.8%) were on anticoagulation at admission to cardiac rehabilitation - 32 (37.7%) on NOACs and 53 (62.4%) on VKAs. During an average rehabilitation stay of 24 days, anticoagulation distribution shifted, with 46 patients (50.0%) on NOACs and 46 (50.0%) on VKAs at discharge. Overall, 92 of 147 patients (62.6%) with postoperative AF were on anticoagulation at discharge. Conclusion In our study, just over half of the patients with newly diagnosed postoperative AF were initiated on OAC, with nearly two-thirds of these on VKAs. Although the distribution shifted in favor of NOACs during rehabilitation, the overall anticoagulation rate remained low at 62.6%, even weeks after the initial therapy. Continuous rhythm monitoring and outcome analyses may help guide individualized therapeutic decisions in the future.Figure 1:OAC in patients with postop AF

Diagnosis first: assessing kidney function in cardiovascular rehabilitation patients

Abstract Introduction A decline in kidney function potentially leading to chronic kidney disease (CKD) is a key driver of cardiovascular disease (CVD) and is associated with increased mortality. With the advent of sodium-glucose co-transporter-2 inhibitors (SGLT2i), a novel therapeutic option has emerged especially for these patients. However, the detection of CKD among cardiovascular patients is often underestimated and remains challenging due to a high proportion of acute kidney injury in this population. This study aimed to investigate: 1) the proportion of cardiovascular rehabilitation patients diagnosed with CKD upon admission, 2) the actual kidney function and potential prevalence of CKD when calculated at baseline with admission creatinine measurement and 3) changes in eGFR during the inpatient rehabilitation stay. Methods This retrospective analysis included cardiology and cardiac surgery patients referred to inpatient rehabilitation between 2019 and 2023. CKD diagnosis was extracted from referral letters. The glomerular filtration rate (GFR) was calculated using the CKD-EPI formula for creatinine and categorized based on KDIGO criteria. Creatinine levels were assessed at admission and immediately before discharge. Results We analyzed 890 patients. Among them, 22% were female, with a median age of 65 years (IQR 58–72). The average left ventricular ejection fraction (LV-EF) was 54.0% (IQR 45–60). At baseline, 79 of 890 patients (8.8%) presented with CKD as a documented diagnosis. Based on measured creatinine levels, the median eGFR was 53.6 ml/min/1.73m² (IQR 44–63). According to KDIGO classification, 64.01% met the criteria for CKD (37.3% in stage G3a, 19.2% in stage G3b, 6.6% in stage G4, and 1.0% in stage G5). At discharge, after an average stay of 24 days, the median eGFR was 52.96 ml/min/1.73m² (IQR 44–62), which was comparable to admission levels. 66.67% still fulfilled the criteria for CKD. Notably, 30% of the 890 patients were discharged with a prescription for an SGLT2 inhibitor. Conclusion The documented prevalence of CKD at admission was low, with only 8.8% of all patients diagnosed. However, the actual kidney function and CKD rate, based on creatinine-measured kidney function, might be significantly higher at 64.0%. Interestingly, eGFR values showed no improvement during rehabilitation and the potential CKD proportion remained stable at 66.7%. Thus, progression from potential acute kidney disease to CKD poses as a real risk for this population. These findings highlight the importance of routine screening of kidney function and awareness of potential (de novo) CKD in cardiovascular patients. Only a correct diagnosis ensures timely access to effective treatments and the prevention of disease progression for our patients including but not limited to SGLT2 inhibitors.Figure 1:prevalence of CKD

ECG HOLTER TO DETECT ATRIAL FIBRILLATION IN PATIENT WITH ISCHEMIC STROKE: IS STILL USEFUL ?

Abstract Background Atrial fibrillation (AF) related strokes account for 20% of all ischemic stroke and 10% of cryptogenetic stroke, furthermore AF has been found also in lacunar and atherothrombotic stroke. AF detection is important for secondary prevention. Many studies demonstrated that longer ECG monitoring leads to a higher detection of paroxysmal AF, and it’s recommended in selected patients. Holter ECG is still used in order to detect AF, but there are still some open questions as limited diagnostic yield. The aim of the present study is to investigate the usefulness of Holter ECG in patients with neuroimaging suggesting a cardioembolic source of the stroke. Methods We considered 492 consecutive patients, hospitalized in the Neurology Unit with ischemic stroke or transient ischemic attack (TIA) from February 2022 to September 2023, who have been investigated with 24 h or 72 h Holter ECG. We evaluated AF registration, ‹ 30 sec atrial tachycardia (TA) and cerebral lesions. Results 492 stroke patients have been investigated with Holter ECG, mean age was 74,3± 12,41 years, 58% were males and 42% females, the median CHA2DS2VAS was 4,98±3,06. 82% of these patients had hypertension, 20% diabetes, 29% dyslipidemia, 60% a previous stroke, 14% peripheral vascular disease, 14,9% coronary artery disease, 3,2% heart failure, 11% a history of cancer. The average left ventricular ejection fraction (LVEF) was 56,9 %.AF was detected in 4,5%, atrial tachycardia (AT) lasting less than 30 sec in 11,6% patients. We found supraventricular ectopic beats (SVEB) in 91%, repetitive in 18%. We analyzed neuroimaging of acute stroke in 50 patients in order to investigate for embolic pattern (defined as cortical lesions or lesions in multiple region). We didn’t find any significant relationship between AF detection and imaging embolic pattern. Conclusions We found a low diagnostic usefulness of AF detection with 24 – 72 h Holter ECG, but our sample was underpowered. We hope that our dataset, when complete, could give more information about the role of Holter ECG usefulness in patients with neuroimage suggestive for cardioembolic stroke.

WEARABLE CARDIOVERTER DEFIBRILLATOR: ADHERENCE AND IMPACT ON PERCEIVED HEALTH STATUS IN A SINGLE CENTRE EXPERIENCE

Abstract Background Nowadays a wearable cardioverter defibrillator (WCD) is reccomended in current guidelines in patients with transient risk of sudden cardiac death (SCD). A crucial factor for the effectiveness of the WCD is adequate patient compliance. In literature patients wore WCD with different wearing time between first randomized trial and registries. Methods We evaluated the adherence to WCD in consecutively patients discharged from our cardiology department for potentially transient high risk of SCD, that wore the WCD from August 2017 to June 2024 after a systematic education session lasting 30 – 45 minutes. They were followed through remote monitoring. Furthermore we have retrospectively administered a questionnaire of perceived health status used in France Wearit II registry. Results Out of 116 patients recruited, with average age 65,8 ±11,1 years old and baseline average left ventricular ejection fraction (LVEF) 29,9±8,9,76,7% were males and 61% of these patients wore WCD for severe systolic disfunction in ischemic cardiac disease, 4% after removal of an infected ICD, 35% after newly diagnosed cardiomyopathy. The median daily WCD wear time was 60,5 days ±42,5 and 22,9±2,6 hours daily. No sex difference were found both in days (males 60±39 vs females 60±39 , p=0,5 ) than in hours (m 23±1,5 vs f 22,45±4,9). Few patients (only 4%) wore the WCD for ‹ 20 h per day. In univariate analysis age was lower but not significativly(median Age ‹ 20 h 53,2±14,2 vs › 20 h 66,3±10,7, p=0,05). Regarding questionnaire the two items that patients most agreed with were: ”the WCD gives me pace of mind “and“ I follow lifestyle modification reccomandation fraom physicians with respectively 71% and 70% patients responding“. “Strongly agree“ or “agree”. Conclusions In our experience after adequate training the patient adherence in wearing WCD is almost optimal as in European registries. Furthermore the use of WCD was generally positively associated with health and lifestyle benefits.

PANCREATITIS–ASSOCIATED MYOCARDITIS: SYSTEMATIC REVIEW AND META–ANALYSIS OF A DEADLY DUO

Abstract Background Myocardial injury is a recognized complication of acute pancreatitis, whereas myocarditis has only been occasionally reported and has not been systematically evaluated. Methods We systematically reviewed PubMed literature published up to January 2024 for studies including both “myocarditis“ and “pancreatitis“ as keywords. Relevant data regarding patient characteristics and outcomes were collected and analyzed. Results A total of 31 patients from 31 independent studies were included. The etiology of pancreatitis was viral in 52%, bacterial in 20%, toxic in 16%, autoimmune in 9%, and idiopathic in 3%. 23% of patients were immunocompromised. Median high sensitivity–cardiac troponin T was 342 (IQR 73–890) ng/L and N–terminus–pro–brain natriuretic peptide was 11053 pg/mL (IQR 1397–26150). The average left ventricular ejection fraction was 33±13%. Fulminant myocarditis, presenting with cardiogenic shock and/or malignant ventricular arrhythmias occurred in 48% of patients, more frequently in men than in women (p=0.026). Severe myocarditis occurred in 42% of edematous and 60% of necrotizing pancreatitis (p=0.56). No association was found between the severity of myocarditis and plasma levels of amylase (p=0.98) and lipase (p=0.83). The relative frequency of severe myocarditis was 80% in pancreatitis due to Leptospirosis, and 40% in pancreatitis due to viral infections. The mortality rate was 22%: 13% died during hospitalization and 9% after. Conclusions Myocarditis is a potentially lethal complication of pancreatitis and is more frequently associated with viral etiology in immunocompromised individuals. Based on such findings, cardiac troponin measurements and an electrocardiogram are advisable to exclude myocardial involvement in selected patients. Confirmatory diagnosis and prognostic assessments should be based on cardiac magnetic resonance imaging (Figures 1-2-3).Figure 1 Figure 2 Figure 3

WEARABLE CARDIOVERTER DEFIBRILLATOR IN PATIENT WITH TRANSIENT RISK OF SUDDEN CARDIAC DEATH: SINGLE CENTRE EXPERIENCE

Abstract Background Worldwide sudden cardiac death (SCD) remains a major cause of death, despite the recent progress in prevention and interventions of cardiac disease. Implantable cardioverter defibrillator (ICD) is an effective weapon for SCD prevention in high risk patients with reasonable expectation of survival. However in case of transient risk of SCD, the use of a wearable cardioverter defibrillator(WCD) is considered in current guidelines. The purpose of this study was to investigate the safety and the adherence to WCD in a real world population; moreover we reviewed the rate of ICD implantation after WCD use. Methods We considered consecutively 116 patients discharged from Piacenza cardiology department for potentially transient high risk of SCD, weared a WCD from August 2017 to June 2024. The patients were discharged in high risk mode of SCD with WCD protection and followed through remote monitoring or outpatient. A clinical and echocardiographic evalutation was performed at baseline and at the end of the WCD use period. Results Out of 116 patients, with average age 65,8 ±11,1 years old and baseline average left ventricular ejection fraction (LVEF) 29,9±8,9, 76,7% were males, 71,6% suffered from arterial hypertension, 26% diabetes mellitus 16,3% chronic renal failure , 5,2% previous stroke.61% of these patients weared WCD for severe systolic disfunction in ischemic cardiac disease after recent myocardial infarction, after percutaneous coronary intervention or coronary artery bypass graft , 4% after removal of an infected ICD, 35% after newly diagnosed cardiomyopathy. The average wearing time of WCD was 22,9±2,6 hours daily. We received these events: 1 sustained ventricular tachicardia, 2 non sustained ventricular tachicardia, 5 atrial fibrillation with 3 T wave oversensing. One patient received inappropriate shock. Eight death was detected due advanced haeart failure. After 60±42,9 days of average wearing time 48% of patients were scheduled for ICD implantation. Considering sex difference we observed in females a better baseline LVEF ( f 34,6±9,8 vs m 28,6±8,1 p=0,008) and a significant lower ICD implantation rate at the end of WCD use [f 8(31%) vs m 48(53%)]. Conclusions In our experience we may consider that WCD use is effective, safe and with a good adherence in all patients. The WCD allows saving resources preventing inapprpriate ICD implantation in patient with transient SCD risk. Females presented a lower ICD implantation rate.

PREDICTING ADVERSE OUTCOMES IN HYPERTROPHIC CARDIOMYOPATHY:THE PIVOTAL ROLE OF CARDIOPULMONARY EXERCISE TESTING

Abstract Introduction Hypertrophic cardiomyopathy (HCM) is a genetically driven myocardial disorder characterized by significant variability in clinical presentation and functional capacity (measured by peak oxygen consumption, pVO2). This study investigates the relationship between functional capacity and adverse events, focusing on rehospitalizations and progression to end–stage HCM. Methods 413 HCM patients (46% obstructive; 63% male;mean age 48 years) were evaluated with CPET combined with concomitant transthoracic stress echocardiography at the cardiomyopathy unit of San Camillo Forlanini Hospital (Rome) Clinical outcomes included sudden cardiac death (SCD), progression to end–stage HCM, rehospitalization, myectomy, and implantable cardioverter–defibrillator (ICD) implantation. Results The mean pVO² for the cohort was 19.5 ml/kg/min, with 16% of patients demonstrating values below 50% of predicted levels. The mean pVO²% was 68%, and the mean VE/VCO2 slope was 27. Echocardiographic findings showed an average ejection fraction (EF) of 66%, maximal left ventricular wall thickness of 20.5 mm, and peak LVOT gradients of 46 mmHg. Pulmonary artery systolic pressure was 20 mmHg at rest, rising to 36 mmHg during exercise. Mean filling pressure was higher than normal range (mean E/e’septal13.6; lateral: 9.2). During a mean follow–up of 8.7 years, 2.4% of patients progressed to end–stage HCM, and 8.2% underwent invasive interventions (e.g. myectomy or alcohol septal ablation). Device–based therapies (e.g. ICDs) were utilized in 8.2%, and aborted sudden cardiac death was reported in 0.7%. Disease progression to advanced NYHA classes occurred in 18.5% of patients, while rehospitalization in 10.7%. Rehospitalized patients exhibited significantly lower pVO² values (16.7 vs 19.9 ml/kg/min, pVO²% 62 vs 68%, p ‹ 0.05) (Figure 1), higher VE/VCO2 slopes (29 vs 27, p ‹ 0.05), higher filling pressures (E/e’ 17.5 vs 13.2 p ‹ 0.05), compared to those without rehospitalizations. Similarly, patients progressing to end–stage HCM (11.1%) showed reduced functional capacity (pVO² 17.0 vs 19.9 ml/kg/min, pVO²% 58.8 vs 78%, p‹0.05) (Figure 2), higher filling pressures (E/e’ 17 vs 13, p ‹ 0.05), compared to the others. Conclusions This study highlights the pivotal role of reduced functional capacity in predicting adverse outcomes in HCM. Patients with lower pVO2 are at significantly higher risk of rehospitalizations and progression to end–stage disease, spotting the light on this important clinical information.Figure 1 Figure 2

Comparison of Alcohol Septal Ablation With Mavacamten in Obstructive Hypertrophic Cardiomyopathy.

Comparison of Alcohol Septal Ablation With Mavacamten in Obstructive Hypertrophic Cardiomyopathy.

The relationships between non-invasive myocardial work indices, myocardial blood flow and viability determined by PET

Abstract Backgrounds Myocardial work (MW) indices are new echocardiography parameters of left ventricular (LV) performance that consider afterload and global longitudinal strain analysis. However, the relationships between MW indices, myocardial perfusion and viability remain unclear after acute myocardial infarction (AMI). Aims To evaluate relationships between echocardiographic MW indices, myocardial blood flow and viability based on positron emission tomography (PET) in patients with AMI. Methods Thirty prospectively recruited patients (64±9 years, 90% males) underwent PET scans 7.7±3.8 days after primary percutaneous coronary intervention (PCI) for ST-elevation AMI. Global and segmental absolute myocardial blood flow (MBF) and perfusable tissue fraction (PTF) at rest were assessed using 15O-water PET. Myocardial segments were graded as viable or non-viable using the previously defined PTF cut-off value of 0.69 per segment (reference). LV function was evaluated by transthoracic echocardiography on the day of the PET scan (baseline) and at 6 months follow-up. MW index (MWI), constructive MW (CMW), MW efficiency (MWE), and myocardial wasted work (MWW) were measured. The myocardial area at risk (AAR) is based on the culprit coronary arterial segment, determined from the invasive coronary angiography. Two segments remote from the AAR were considered as the remote area. Results At baseline, resting global MBF was 0.84±0.19 ml/g/min, global MWI 1327± 334.9 mm Hg %, global MWE 87% [IQR 83- 92], global CMW 1649.8±415.9 mm Hg %, and global MWW 210.9±133.7 mm Hg %. There was a positive correlation between global MBF and CMW (r=0.42, p=0.02), whereas MWI, MWE, and MWW were not correlated with MBF. However, none of the MW indices correlated with MBF corrected for rate pressure product. In the AAR, MWI and MWE correlated with regional MBF (r= 0.53, p= 0.003, and r= 0.59, p&amp;lt;0.001) and PTF (r= 0.41, p = 0.03, and r= 0.65, p&amp;lt;0.001. Figure 1). The average ejection fraction was similar at baseline and after 6 months (55.8±66.9 vs. 57.5±67.3 %, p=0.2). Of the 156 segments in the AAR, 114 were viable and 42 were non-viable based on based on PTF. There was no difference in MW indices between viable and non-viable segments in the AAR at baseline. However, viable segments in the AAR showed improved MWI, MWE, CMW, and MWW at 6 months compared to baseline (P&amp;lt;0.001, P=0.02, P&amp;lt;0.001, and P&amp;lt;0.001, respectively), whereas there was no change in non-viable segments (Table 1). Moreover, MWI in the remote area increased at 6-month follow-up (p &amp;lt;0.001). Conclusions Although echocardiographic MWE was not associated with global MBF, it correlated with residual myocardial blood flow and PTF in the AAR after reperfused AM. Furthermore, echocardiographic MW indices improved in viable segments of the AAR at the 6-month follow-up. Our results provide evidence that myocardial viability is an important determinant of MWE measured by echocardiography.

Clinical and Sociodemographic Profile and Pattern of Echocardiographic Diagnosis of Patients Attending Outpatient Echo Department of NICVD

Background: Cardiovascular diseases (CVDs) represent a significant public health burden globally, including in Bangladesh. Echocardiography is a pivotal diagnostic tool in the assessment of cardiac function, structure, and abnormalities in patients with suspected cardiovascular conditions. Objective: This study aimed to evaluate the clinical and sociodemographic characteristics of patients attending the outpatient echocardiography department at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, and to analyze the pattern of echocardiographic findings. Methods: A cross-sectional study was conducted over six months, including [total number] patients referred for echocardiographic evaluation. Sociodemographic data, including age, gender, and clinical history, were collected. Echocardiographic assessments were performed following standard guidelines, with measurements including aortic root diameter (AO), left atrial size (LA), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and ejection fraction (EF). Descriptive statistics were used to analyze the data, and associations between demographic factors and echocardiographic findings were evaluated. Results: The mean age of the study population was 48.02 ± 14.49 years, with a majority (65.63%) aged between 31-60 years. Males constituted 86.22% of the patients, resulting in a male-to-female ratio of 6.21:1. The mean aortic root diameter was 27.81 ± 4.46 mm, and the mean left atrial diameter was 33.28 ± 4.82 mm. The mean LVEDD and LVESD were 45.28 ± 6.02 mm and 29.74 ± 5.13 mm, respectively. The average ejection fraction was 63%, indicating preserved systolic function in the majority of patients. Notably, 35.32% of patients exhibited regional wall motion abnormalities (RWMA), suggestive of ischemic heart disease. Conclusion: The study highlights that middle-aged and elderly adults, particularly males, constitute the majority of patients undergoing ...

Abstract 4143443: Characteristics of patients with left ventricular aneurysms undergoing ventricular tachycardia ablation

Background: Left ventricular aneurysms (LVAs) are associated with a higher risk of occurrence of ventricular tachycardia (VT). Although there have been smaller studies and case-reports published on the role of catheter ablation of VT in patients with LVAs, larger case-series with relatively longer follow up after VT ablation are limited. Purpose: We sought to assess procedural characteristics and clinical outcomes after VT ablation in patients with LVAs. Methods: We performed a retrospective review on consecutive sets of patients with LVAs who had undergone VT ablation between 01/2015 and 10/2023 at our center. The diagnosis and segmental location of LVAs was confirmed by two independent reviewers (AM and KV) upon review of images from either a transthoracic echocardiogram or cardiac magnetic resonance imaging (cMRI). Procedural reports of VT ablation were reviewed for the characteristics of electroanatomical mapping, number and morphological features of VTs induced and ablation parameters. Data on outcomes after VT ablation was collected by using a combination of clinical follow up and data from remote monitoring and in-person device interrogations. Results: A total of 33 patients with LVAs underwent VT ablation at our center between 2015 and 2023. The average age of patients in our study cohort was 65 +/- 15 years and 88% of them were males. The average left ventricular ejection fraction was 34 +/- 12% and the etiology of the LVAs was ischemic in 58% and non-ischemic in 42% of patients. In the non-ischemic subgroup, the most common etiology was hypertrophic cardiomyopathy (27%) followed by other causes such as mycotic aneurysm (3%), congenital aneurysm (3%), aneurysm secondary to dilated cardiomyopathy (3%) and causes that were unclear (6%). The most common segment involved in the LVAs was apical (85%) followed by basal (in 15%) of patients. The median number of distinct VTs induced and ablated during VT ablation procedure was 2 (IQR: 1-3). The average cycle length of the VTs induced was 353 + 85 ms and the predominant morphology was right bundloid (in 77% of VTs induced). Follow up Data: Upon a median follow up of 245 (IQR of 86-898) days, the overall success rate of VT ablation was 68%. Conclusions: Occurrence of VT is quite common in patients with LVAs in the setting of ischemic and non-ischemic etiologies. Our case-series describes the safety and feasibility of catheter ablation for VT in patients with LVAs.