Average LVEF Research Articles

Is Manually Measured Global Longitudinal Strain a Reliable Alternative to Speckle Tracking Global Longitudinal Strain?

To determine if manually measured global longitudinal strain (MM-GLS) can be a reliable alternative to speckle tracking global longitudinal strain (ST-GLS). We undertook an analysis of Princess Alexandra Hospital’s echocardiography database and looked at all patients who underwent a transthoracic echocardiogram, both inpatient and outpatient, in the monthly of June 2020. Both ST-GLS and MM-GLS were calculated and compared using Pearson’s correlation coefficient. Descriptive statistics were analysed using Student’s T test. In the month of June 2020, there were 154 patients who underwent an echocardiogram at Princess Alexandra Hospital. 64% of them were males and the mean age was 61.7+/-14.75 years. The average LVEF was 51.32+/-11.3% and the average ST-GLS calculated was 16.72+/-3.75. Pearson’s coefficient between MM-GLS and ST-GLS was 0.982 (p<0.001). In the event that ST-GLS is unavailable or cannot be accurately assessed, MM-GLS can be a reliable alternative.

Echocardiographic markers of mortality at 60 days in patients with COVID-19 in the intensive care unit

Abstract Introduction Coronavirus disease (COVID)-19 predominantly produces its effects through lung damage, but an important component of multi-organ dysfunction is cardiac involvement. We have few reports that inform about the behavior of echocardiographic images of patients with the most severe forms of the disease. Purpose The present work aims to identify prognostic markers for 60-day mortality in patients hospitalized in intensive care based on echocardiographic findings. Methodology A single-center retrospective cohort was conducted. Hospitalized patients were included in one of the nine intensive care units for COVID-19 confirmed by RT-PCR from May to October 2020. Patients with previous conditions that determined a limitation of the therapeutic effort, those who died before 24 hours and pregnant women were excluded. Portable echocardiograms were performed by two expert cardiologists following the recommendations for isolation and personal protection. The time to death was evaluated as outcome. A Cox proportional hazards model was constructed, HR and 95% confidence intervals with their p values. The study was approved by the institutional ethics committee. Results Of 326 patients included, 153 patients had an echocardiogram. The mean age was 60.7 years, 47 (30.7%) were female and 67 (44.7%) had positive troponin. 91 patients (59.5%) not survive, the mean long of stay was 8.4 (SD: 4.2) days. 111 (72.5%) had shock, 128 (83.7%) severe ARDS (PaO2 / FiO2 &amp;lt;100 mmHg), 142 (92.8%) required invasive ventilatory support, and 86 (56.2%) acute kidney injury. 27 (17.6%) patients had acute pulmonary embolism, 16 (10.4%) acute myocardial infarction and 9 (5.9%) myocarditis. The mean right ventricular ejection fraction was 37%, TAPSE was decreased in 16 cases (10.4%). 41 cases (26.8%) had right diastolic dysfunction. 34/48 (71%) cases had pulmonary hypertension. The average LVEF was 59.3% and 74 (48.4%) had some left ventricular diastolic dysfunction. 12 (7.8%) had left ventricular segmental wall motion abnormality and 16 (10.4%) had pericardial effusion. Univariate analysis identified TAPSE, PSAP, acute cor pulmonale and right ventricular dilatation as variables related to the outcome of mortality. The multivariate Cox model (Table 2) documented that acute cor pulmonale with a HR of 12.8 (95% CI 3.51 - 46.63, p&amp;lt;0.001) and right ventricular dilation with a HR of 4, 87 (95% CI 1.36–17.46, P 0.016) were associated with mortality. Conclusions In patients hospitalized in the intensive care unit for COVID-19, acute cor pulmonale and right ventricular dilatation behaved as independent predictors of in-hospital death. Funding Acknowledgement Type of funding sources: None. Table 1. Baselines characteristicsTable 2. Multivariate analisys

SAFETY AND FEASIBILITY OF LEFT BUNDLE BRANCH AREA PACING FOLLOWING VALVULAR INTERVENTIONS: MULTI-CENTER STUDY

<h3>BACKGROUND</h3> Left bundle branch area pacing (LBBAP) has emerged as a promising pacing modality for physiologic pacing. Atrioventricular heart block is a common complication after a valvular intervention but there are limited data on the performance of LBBAP in this population. The aim of this study is to evaluate the safety and feasibility of LBBAP in patients with valvular interventions. <h3>METHODS AND RESULTS</h3> Seventy-nine patients were included in this study. All patients underwent surgical or percutaneous valvular interventions. LBBAP was attempted in all patients. Implant success rates, peri- and post procedure ECG, pacing parameters, and complications were assessed at implant, and during follow-up. LBBAP implantation was successful in 75/79 (95 %) patients. Mean age was 70.9 ± 13.8 years and 65 % patients were male. Prior interventions included TAVR (25), SAVR (34), combined surgical AVR plus MVR (6), MVR (8), TVR (1), and PVR (1). Average LVEF was 52.6 ± 10.7 %. Total procedure duration was 74.3 ± 37.3 min and fluoroscopic duration was 9.8 ± 7.0 min. Pacing parameters were stable during follow up period of 8.1 ± 4.9 months. Pacing QRS duration was significantly narrower than baseline QRS duration (130.5 ± 30.6 ms vs. 113.9 ± 14.0 ms, p < 0.001, respectively). No acute complications were observed. However, during follow-up period there were 3 complications (two superficial infections and one infective endocarditis) and 2 patients had loss of LBBAP within 1 month of implant. <h3>CONCLUSION</h3> LBBAP is feasible and safe pacing modality in patients with prior interventions for valvular heart disease.

Heart Failure Patients with type II diabetes still require more focus

Abstract Funding Acknowledgements Type of funding sources: None. Background A bidirectional relationship exists between heart failure and diabetes; heart failure is a risk factor for type II diabetes and type II diabetes is a risk factor for heart failure. The prevalence of both chronic conditions is on a continuous upward rise. Heart failure has a poorer prognosis than diabetes and therefore heart failure patients with diabetes should be also managed at a heart failure centre. It has been shown that heart failure medication is of benefit to patients with or without diabetes. Purpose With new advances in heart failure medication this retrospective and prospective analysis examines if patients with or without type II diabetes receiving similar care at a heart failure centre will have similar outcomes. Methods A retrospective and prospective cohort analyses was performed on 50 patients attending a single centre heart failure clinic over a 12-month period. LVEF, NT Pro BNP and NYHA was examined pre- and post-receiving similar heart failure care. Results 50 patients were recruited for this study. There were 25 patients in the type II diabetes cohort (10 female: 15 male. Average age 77 years old) and 25 patients in the non-diabetes cohort (7 female:18 male. Average age 79 years old). In the type II diabetes cohort average LVEF pre care 27%: post care 33% (difference 6%), average NT Pro BNP pre care 3558 pg/ml: post care 2564 pg/ml (difference 994 pg/ml), average NYHA pre care II: post care I-II (difference of 0.5). In the non-diabetic cohort average LVEF pre care 26%: post care 37% (difference 11%), average NT Pro BNP pre care 1679 pg/ml: post care 1135 pg/ml (difference 544 pg/ml), average NYHA pre care II: post care I-II (difference 0.5). Conclusion Both cohorts of patients had similar NYHA functional class outcomes. The patients in the type II diabetes cohort had higher NT Pro BNP levels pre care and higher reduction in NT Pro BNP post care than the non-diabetic cohort. Both cohorts had similar LVEF pre care, but the non-diabetic cohort had better improvement post care, with possible avoidance of need for implantable cardiac devices compared to the type II diabetes cohort. This study shows that heart failure nurses should be aware that heart failure patients with type II diabetes carry a higher risk profile and should be actively identified as part of an individualised, person-centred care approach. Heart failure patients with type II diabetes need to have vigilant scrutiny of their care to optimise their outcomes.

Safety and feasibility of left bundle branch area pacing following valvular interventions: Multicenter study.

To evaluate the safety and feasibility of left bundle branch area pacing (LBBAP) in patients with valvular interventions. Eighty-four patients were included in this study. All patients underwent recent surgical or percutaneous valvular interventions. LBBAP was attempted in all patients. Implant success rates, peri- and postprocedure electrocardiogram, pacing parameters, and complications were assessed at implant, and during follow-up. LBBAP implantation was successful in 80/84 (95%) patients. Mean age was 74.1 ± 13.8 years and 56% patients were male. Prior valvular replacements included: percutaneous aortic (26), surgical aortic (36), combined surgical aortic plus mitral (6), MVR (10), tricuspid (1), and pulmonic (1). Average LVEF was 52.6 ± 11%. Majority of patients underwent LBBAP due to atrioventricular block (76%) and sinus node disease (13%). Total procedure duration was 74.1 ± 12.5 min and fluoroscopic duration was 9.7 ± 6.8 min. Pacing parameters were stable during follow-up period of 10.0 ± 6.3 months. Pacing QRS duration was significantly narrower than baseline QRS duration (131.5 ± 31.4 ms vs. 114.3 ± 13.7 ms, p < .001, respectively). No acute complications were observed. Mean follow-up was 10.0 ± 6.3 months (median: 8.4 months, min: 1 and max: 24 months). During follow-up, there were three device infections and two patients had loss of LBBA capture within 1 month of implant. LBBAP is a feasible and safe pacing modality in patients with prior interventions for valvular heart disease.

Cardiac MRI viability study and its role in revascularization- Excerpts from a tertiary care cardiac centre

Abstract Funding Acknowledgements Type of funding sources: None. Background Assessment of cardiac viability based revascularization has not convincingly demonstrated, to improve patient outcomes statistically even by large trials like STITCH and PPAR-2 using SPECT and PET analysis. Here we used cardiac viability by cardiac MRI to guide us for revascularization and also found out problems arising in the statistical analysis for the same Methods It is a retrospective observational longitudinal follow up study whereby patients who had ischemic cardiomyopathy (confirmed with coronary angiogram) and who were admitted with features of heart failure or with acute coronary syndrome and who subsequently underwent cardiac MRI viability testing during the period from 1/02/2017 to 31/01/2020 were included. Patients were excluded who had non ischemic cardiomyopathy. Using cardiac MRI- LVEF, RVEF, Wall motion severity Index and Total viability percentage were additionally computed and analyzed. Patients were deemed having viable myocardium on ≤50% LGE in cardiac MRI and final treatment of CABG, PCI or only medical management was analyzed for the Primary end points of CV mortality, non-fatal CVA and non-fatal AMI Results Based on the criteria total of 94 patients were selected for the study, 53 patients kept on only medical management, 19 patients underwent PCI and 22 patients had CABG. The baseline characteristics of the study population were an average age of 60years, male (76%) with Diabetes Mellitus(69%) and Hypertension (41.5%) in them. Coronary Angiogram showed that 10.6% patients had LM involvement, 92% had LAD disease, 72% patients had LCX lesion and 74% had RCA disease. While average Echo LVEF was 35.82%, Cardiac MRI based mean LVEF was 30.78%. It was found that patients who were kept only on medical management had higher Wall motion Severity Index (2.05) over patients who were treated with PCI (1.94) or CABG (1.80) (p = 0.006). Also it was found that the Total viability percentage was less in patients kept only on medical management (74%) vs patients who were treated with PCI (78%) or CABG (77.8%)(p = 0.08) .It was found by cardiac MRI that patients with significant LAD lesions with viable LAD territory, those who underwent CABG or PCI based therapy had lesser mortality(7.69%,10%) over patients kept only on medical management (23%) (p = 0.407). Among patients with significant LAD lesions with non-viable LAD territory, those who underwent CABG or only medical management had lesser mortality (11.5%) than patients who underwent PCI (50%) (p = 0.137). Conclusion(s) Cardiac MRI based viability testing may guide the physician for optimal treatment but it does not reach statistical significance. The reasons maybe different arterial segments having different viability and anatomical hazards acting as cofounding factors. Viability being a continuum process does not follow a strict cut off of 50% LGE and 100% acute occluded vessel may not allow LGE.

Outcomes of a Cardiac Rehabilitation (CRH) Program after phase II: what about our patients almost 4 years later?

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION CRH in patients with ischemic heart disease is recommended by the different clinical practice guidelines with an IA level of evidence, with an important role in reducing cardiovascular mortality and hospital readmissions during follow-up. OBJECTIVE The goal of this study is to show the 4-year clinical results of a population of patients who participated in an CRH program after an Acute Coronary Syndrome (ACS). METHODS Between May/2014 and September/2017, 221 patients who had recently presented an ACS completed the 12 weeks of phase II of the CRH program at our center. In May/2020 we collected epidemiological, clinical and echocardiographic information at the time of the acute cardiovascular event; and we evaluate the current vital status of the patients and the incidence of readmissions for: angina, HF, new ACS, or arrhythmic events. RESULTS Of the 221 patients, 182 were men (82%). The mean age of our population was 58.3 ± 7.8 years. 58% (129 patients) suffered from ST-elevation ACS. The mean time of hospital stay was 6.20 ± 2.9 days. An echocardiogram was performed at discharge, which showed an average LVEF of 56 ± 6%. Eight patients (4%) developed early Ventricular Fibrilation (VF) during the acute phase of ACS. Among the classic CVRF, smoking (79%) was the most prevalent, followed by dyslipidemia (53%) and hypertension (47%). The mean time from hospital discharge to the start of phase II RHC was 42 ± 16 days. The overall incidence of events was 9%: 10 patients suffered reinfarction during follow-up, and 7 were readmitted for unstable angina, all of whom underwent PCI; no patient was admitted for HF; and none of the 8 patients with early VF had a new tachyarrhythmia, registering a single admission for VT during follow-up. None of the patients had sustained ventricular tachyarrhythmias during exercise-training. At the mean 4.5-year follow-up, 218 patients were still alive (98%). CONCLUSION The incidence of CV events in the follow-up of our cohort was low, which can be explained by the fact that it is a young population, with an LVEF at low limits of normality at discharge, which is one of the most important predictors in the prognosis after an ischemic event. As an improvement, we must shorten the time until the start of phase II of the program. CRH shows once again its clinical benefit after an ACS, in consonance with the existing evidence. Abstract Figure. Outcomes of a CRH program.

MITRAL ANNULAR PLANE SYSTOLIC EXCURSION-DERIVED FORMULA TO CALCULATE THE EJECTION FRACTION: A SIMPLE, EASY AND RAPID ECHOCARDIOGRAPHY PARAMETER TO ASSES LEFT VENTRICLE SYSTOLIC DYSFUNCTION

Aims &amp; Objectives - MAPSE DERIVED EJECTION FRACTION CAN BE USED AS AN ALTERNATIVE TO THE CONVENTIONAL ECHOCARDIORAPHIC MEASUREMENTS OF EJECION FRACTION IN EVERY DAY CLINICAL PRACTICE WITH PATIENTS WITH LV SYSTOLIC DYSFUNTION &amp; VALIDATION OF MITRAL ANNULAR PLANE SYSTOLIC EXCURSION DERIVED FORMULA TO CALCULATE THE EJECTION FRACTION IN PATIENTS WITH LV SYSTOLIC DYSFUNCTION EF=4.8XMAPSE(mm)+5.8 in adult male &amp; 4.2X MAPSE(mm)+20 in adult female. Our study is Material and Methodobservational, prospective study with cross sectional data collection done in a period of nov 2018 to nov 2019, The study included 151 adult male and female patients with LV systolic dysfunction fullling all inclusion criteria, LVEF measured by average MAPSE and LVEF measured by visual inspection, M–mode, and modied Simpson's rule was statistically correlated to know the validity of MAPSE derived ejection in case of LVsystolic dysfunction. The current study showed a signicant positive correlation Result - between average MAPSE and EF measured by Mmode (r =0.980, P &lt; 0.001), EF measured by Simpson's rule (r =0.968, P &lt; 0.001), and EF measured by visual inspection(r =0.960, P &lt; 0.001). The mean differences in the EF derived by MAPSE formula between the inter-observer was(-0.14 ± 3.18 ). MAPSE-derived EF using Conclusion - the equation EF = 4.8 × MAPSE (mm) + 5.8 for male and EF = 4.2×MAPSE (mm)+20 for female, is a valid echocardiographic parameter in adult males and females with impaired LV systolic function to asses global LV longitudinal function with minimal interobserver variability.

POS-250 HYPERPARATHYROIDISM: A CARDIOVASCULAR RISK FACTOR IN CHRONIC HEMODIALYSIS?

Secondary hyperparathyroidism (SHPT) is an increased secretion of PTH due to parathyroid hyperplasia caused by triggers such as hypocalcemia, hyperphosphatemia, or decreased active vitamin D. It is a common complication in patients with chronic kidney disease (CKD). The aim of our study is to study the relationship between alterations in phosphocalcic metabolism and cardiovascular risk. This is a cross sectional study conducted on 20 chronic hemodialysis patients in our department in which biological parameters were collected: serum calcium, phosphorus, parathyroid hormone (iPTH) as well as echocardiographic parameters: left ventricular ejection fraction % (LVEF%) the presence or not of hypertrophic cardiomyopathy and/or valvulopathy.The iPTH was determined by a commercial kit (reference range 12–64 pg/mL) and the other parameters were determined by a standard autoanalyzer.Patients who had parathyroidectomy or those on steroids, phenytoin, phenobarbitone or other factors that affect the bone biochemical parameters were excluded. Twenty patients were collected with a mean age of 52.5 years (31-73 years) with a male predominance (sex ratio=1.5). The average duration of hemodialysis was 75.8 months (29 – 109 months). The average iPTH was 374.3pg/ml (234 – 1385 pg/ml). 72% of patients had a PTH > 300 pg/ml. Mean blood calcium was 1.88 mmol/l (1.8-2.38 mmol/l). Mean phosphorus was 1.63 mmol/l (0.77-2.67 mmol/l). At echocardiographic The average LVEF was 61% (43 – 70%). Mitral Valvulopathy and aortic valvulopathy were present respectively in 15% and 10% of patients. Hypertensive cardiomyopathy and ischemic cardiomyopathy were present respectively in 20% and 15% of patients. 66% of patients with hypertrophic cardiomyopathy and 75% of patients with valvulopathy had a PTH> 300pg/ml. This study shows that hyperparathyroidism play a key role in the increased cardiovascular mortality and morbidity in chronic hemodialysis. It is one of the non-traditional risk factors. Hence the importance of early and adequate management in these patients.

Intraluminal Esophageal Temperature Monitoring Using the Circa S-Cath™ Temperature Probe to Guide Left Atrial Ablation in Patients with Atrial Fibrillation.

Radiofrequency catheter ablation is a common treatment for atrial fibrillation (AF), during which thermal esophageal injury may rarely occur and lead to an atrio-esophageal fistula. Therefore, we studied the utility of the Circa S-Cath™ multi-sensor luminal esophageal temperature (LET) probe to prevent esophageal thermal injury. Thirty-six patients, enrolled prospectively, underwent circumferential or segmental pulmonary vein isolation for treatment of AF. A maximum ablation electrode temperature of 42ºC was programmed for automatic power delivery cutoff. In addition, energy delivery was manually discontinued when the maximum LET on any sensor of the probe rose abruptly (i.e. ˃0.2ºC) or exceeded 39º C. Esophagoscopy was performed immediately after ablation in 18 patients (with the temperature probe still in place) and at approximately 24 hours after ablation in 18 patients. Esophageal lesions were classified as likely traumatic or thermally related. Of the 36 patients enrolled in the study, 21 had persistent and 15 had paroxysmal AF, average LVEF 57±16% and CHA2DS2VASc score 1.6±1.2 (range 0-4). Average maximum LET was 37.8±1.4ºC, power delivery 31.1±8 watts and ablation electrode temperature 36.4±4.1ºC. Average maximum contact force was 44.5±20.5 grams where measured. Only 1 patient (<3%) had an esophageal lesion that could potentially represent thermal injury and 4 patients (11.1%) had minor traumatic mechanical injury. LET guided titration of power and duration of energy application, using an insulated multi-sensor esophageal temperature probe, is associated with a low risk of esophageal thermal injury during AF ablation. In only rare cases, LET monitoring resulted in the need to manipulate the esophagus to avoid unacceptable temperature rises, that could not be achieved by adjustment of power and duration of energy application.

Myocardial Recovery in Dilated Cardiomyopathy with Goal Directed Medical Therapy

Background Dilated cardiomyopathy (DCM) is a common cause of heart failure (HF). Goal Directed Medical Therapy (GDMT) for HF has been shown to improve mortality and morbidity but rate of myocardial recovery is not well known. Methods In this retrospective study, 325 patients with newly diagnosed systolic heart failure (LVEF 10% and maintained >6 months. At baseline, all patients underwent echocardiogram; additionally, 22% underwent cardiac MRI, 7% cardiopulmonary stress test and 14% right heart catherization. GDMT was initiated inpatient and titrated weekly the first month, biweekly for the second month and monthly thereafter in our HF clinic. At discharge, 25% of the patients were sent home with wearable cardioverter-defibrillator (WCD). Results Of the 325 patients, 148 patients (45.5%) had myocardial recovery. In the recovery group, average age was 55.0 years, 58.8% were males, 64.9% Caucasians and 30.0% African Americans. At baseline, average LVEF was 27.3% and NYHA class 2.3. Average time for myocardial recovery was four months post initiation of GDMT. At one-year follow-up, average LVEF was 48.6% and NYHA class 1.7. In the recovery group, 84.0% were on ACEI/ARB/ARNI, 95.3% BB, 59.5% MRA, 4.7% Hydralazine, 2.7% Nitrates and 13.4% on Digoxin. No malignant arrhythmias were noted in patients discharged with WCD. The 30-day HF readmission rate in the myocardial recovery group was Conclusion GDMT for HF is well established and with aggressive medication titration in newly diagnosed systolic HF due to DCM and NICM, myocardial recovery is possible with rates as high as 45.5% at one-year.

Long-Term Cardiac Remodeling after LVAD Deactivation for Myocardial Recovery

Left ventricular assist devices (LVADs) through mechanical unloading can lead to reverse remodeling and in select individuals culminate in myocardial recovery permitting deactivation of LVAD support. Data on the sustainability of reverse remodeling as measured by myocardial structure (left ventricular internal diastolic diameter, LVIDD) and function (left ventricular ejection fraction, LVEF) after LVAD deactivation is poorly characterized in the literature. This is a single-center analysis from December 2011 to November 2018 of 14 patients who had LVAD deactivation in the setting of myocardial recovery. Patients were followed with serial echocardiography for up to 2 years post-LVAD deactivation. The mean age of patients was 41.8 ± 13.4 years, 42% were females, and all but one had a non-ischemic cardiomyopathy. Prior to LVAD deactivation, wedge pressure was 14 ± 6.7mmHg, cardiac index 2.8 ± 1.1L/m2, and peak VO2 19.5 ± 5.2mL/kg/min. Median LVAD support prior to deactivation was 18.0 months (range 3.3 to 104.4). 10 patients (71%) had the LVAD left in-situ with the outflow graft ligated and driveline divided and 4 (29%) had a full LVAD explant. Mean LVEF was 54.7 ± 7.2% prior to deactivation and LVIDD was 4.6 ± 0.7 cm. At 24 months, average LVEF had fallen to 36% while average LVIDD had increased to 5.6 cm (Table). Two patients (14%) had recurrent heart failure within a year and required cardiac transplantation. The remaining 12 patients (86%) are NYHA functional Class I or II and are alive without a heart failure hospitalization or need for LVAD or transplant at 2 years. LVAD deactivation following evidence of myocardial recovery is associated with a change in LV structure and function. Importantly, despite these changes, 86% of patients remained NYHA I or II without need for hospitalization, VAD, or transplant due to worsening of their cardiomyopathy at 2 years. These data show the promise of LVAD induced myocardial remodeling and warrant further investigation in a multi-center cohort.

Percutaneous left atrial appendage closure, a safe alternative to anticoagulation for patients with nonvalvular atrial fibrillation and end-stage renal disease on hemodialysis: A single center experience.

The evidence about the effectiveness and safety of oral anticoagulation in patients on hemodialysis is conflicting and scarce. Percutaneous left atrial appendage occlusion (LAAO) has demonstrated to be a valid alternative therapeutic option for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). The aim of this study is to present the outcomes of percutaneous LAAO in patients with end-stage renal disease (ESRD) on hemodialysis and NVAF in our center. We conducteda retrospective review of clinical records, demographics, LAAO procedure, complications, and outcomes of patients with NVAF and ESRD on hemodialysis who underwent a percutaneous LAAO in our center between January 2017 and January 2019. In the period of the study, eight patients with ESRD on hemodialysis underwent a percutaneous LAAO in our center. The overall mean age was 67.5years (range 56-81; SD±7.2). All patients had permanent NVAF. The total mean dialysis duration was 8.49years (range 0.83-14.8; SD±6.2). The mean CHA2DS2-VASc and HAS-BLED scores were high (4.75 [SD±1.16] and 4.62 [SD±0.91], respectively). All patients had history of a major hemorrhagic event (BARC Score ≥3). Most patients (n=6) showed left ventricular hypertrophy, and the average LVEF was 54% (SD±6.5). All devices were implanted successfully. Postprocedural antithrombotic regimen prescribed was based on antiplatelet therapy. No deaths, cardioembolic events, or major bleeding (according to the BARC scale) were reported during a mean follow-up of 14.24months (SD±9.44). Percutaneous LAAO could be of particular interest in patients with NVAF and CKD in hemodialysis. Further studies will be necessary to confirm this hypothesis.

Study of clinical profile and outcomes of Percutaneous Coronary Intervention in ST Elevation Myocardial Infraction

Background and Aims: Percutaneous Coronary Intervention (PCI) is the preferred method of revascularization in Acute ST Elevation Myocardial Infarction (STEMI). Our aim was to study the clinical profile and outcomes of patients who underwent PCI for STEMI at tertiary cardiac centre of Nepal.&#x0D; Methods: It is a retrospective, single centre study, performed at Tribhuvan University, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal. All patients who underwent PCI for STEMI from November 2015 to July 2018 were enrolled in this study. All the data were collected from hospital registry and cath lab records.&#x0D; Results: The Study showed that out of 232 patients who presented with STEMI, 74.5% were male with average age of 57.39 years. The mean time of presentation after onset of symptom/s was 17.5 hours. About 66% patients presented in less than 12 hours of symptoms onset, 21% presented at 12-24 hours of symptoms onset and 13% patients presented late. Primary PCI was done in 87% of patients. Almost all patients (98.2%) underwent coronary artery stenting with drug eluting stents. Multivessel PCI during index procedure was done in 7 patients. TIMI III flow following PCI was achieved in 97% cases. Average LVEF at discharge was 44.73%. There were 8 deaths, all after Primary PCI. In-hospital mortality rates for patients presenting with and without cardiogenic shock were 38.46% and 1.59% respectively. The overall mortality rate was 3.98%.&#x0D; Conclusion: This study has reemphasized that PCI is effective in the management of STEMI cases in Nepal with improving mortality rates and decreasing complications. Minimizing the delayed presentation after the onset of symptoms should be one of the prime focuses for effective management of STEMI.

P5745The Impact Of Brain Atrophy In The Young Patientwith Severe Heart Failure

Abstract Background Recently, several reports recognized the heart failure (HF) effected the brain impairment by impaired vascular blood flow and brain atrophy. However, there are no report mentioned the relationship brain atrophy and the mortality in young patient with severe HF. Methods A total 368 patients with severe HF form 2009 to 2014. We analyzed 117 patients aged under 55 years old without past history of cerebral artery disease. We evaluated the brain atrophy using head CT data by AZE VitualPlace and compared their clinical background, cardiac function, and the mortality. Results The mean age was 41±10 years (male 80%) and the average LVEF was 39±8%. The median follow-up period was 1.264 days. During the observations, we observed a total of 12 all cause death. The ROC analysis revealed that 10.2% of atrophy area was cut-off and the sensitivity was 80%, specificity was 69.5% and the area under the curve was 0.71. In univariate analysis, severe NYHA class, low LVEF, large brain atrophy (&gt;10%) were significant factors as predictor of mortality (P&lt;0.05). Interestingly, as a result of multiple analysis, only the large brain atrophy was independent predictor of mortality. Kaplan-Meier analysis resulted that the patients with the large brain atrophy as over 10% were statistically significant worse mortality than the other patients (P=0.02). Conclusion This is a first report to evaluate the brain atrophy area by CT in young severe HF patients. HF patients with ≥10% of brain atrophy have higher mortality.

The Combination of Left Ventricular Assist Device and Laparoscopic Sleeve Gastrectomy May Promote Myocardial Recovery in Obese Advanced Chronic Heart Failure Patients

Purpose Laparoscopic sleeve gastrectomy (LSG) has been associated with efficient and durable weight loss in obese patients with advanced heart failure (AHF) who undergo LVAD support. However, the effects of this combinatory approach on myocardial recovery remain undefined. Thus, we sought to evaluate the potential association between the combination therapy (LVAD support and LSG) and myocardial recovery in this patient cohort. Methods We retrospectively analyzed patients who underwent simultaneous LVAD implantation and LSG at our center from January 2013-August 2017. Demographic, biochemical, LVAD-related and transplant data were reviewed. Data from patients' outpatient follow-up appointments were gathered for 12 months. Echos were performed at baseline and 12 months. Myocardial recovery was defined as an improvement of LVEF ≥ 10%. Results 20 patients were included in this study. The average patient age was 47±13 years; 11 (56%) of the patients were male and the average BMI was 44±5 kg/m2. Ischemic heart disease was the underlying cause of heart failure in 7 (35%) of the patients. Three (15%) patients received a HeartWare device and 17 (85%) patients received a HeartMate II LVAD. The average pre-implant INTERMACS score was 2.7±0.6. Regarding the cardioprotective therapy, 9 (45%) of patients received ACEI/ARB, 11 (54%) beta blockers and 6 (27%) MRA. The average baseline LVEF was 21±5%; LVEF significantly improved to 32±14% at 12 months (p=0.001). Myocardial recovery was observed in 6 (30%) of the patients; two of these patients' LVEF improved to over 40% and had their LVAD explanted. Interestingly, the average HbA1c also significantly decreased at 12-month follow-up timepoint (6.6±1.5% vs. 5.1±0.5%, p=0.007). There were no deaths during the 12-month follow-up period. Conclusion The combined LVAD and LSG approach may represent a safe and feasible novel treatment strategy to promote myocardial recovery in obese patients with AHF. Although underlying mechanisms remain to be identified, a decrease in insulin resistance, as previously reported, achieved through a combined approach, may represent a significant contributing factor to myocardial recovery in this patient cohort.

5-Year Outcome of Photopheresis in Heart-Transplantation with Refractory/Persistent Rejection

Purpose Extracorporeal photopheresis (ECP) is an apheresis and photodynamic therapy that uses 8-methoxy-psolaren and ultraviolet light to modulate T-cell activity. Research has shown that ECP is an effective treatment for patients (pts) with recurrent acute cellular rejection (ACR) and antibody-mediated rejection (AMR) post-heart transplantation (HTx). We sought to assess the long-term outcome of pts placed on ECP at our single center. Methods Between 2010-2012, we assessed 235 HTx pts, 10 of which were initiated on ECP. ECP was administered for 2 days, weekly x 4 and once monthly x 5 for 6 months total therapy. Endpoints included subsequent 5-year survival, 5-year freedom from cardiac allograft vasculopathy (CAV) as defined by stenosis ≥ 30% by angiography, 5-year freedom from non-fatal major adverse cardiac events (NF-MACE: defined as myocardial infarction, congestive heart failure, percutaneous cardiac intervention, placement of pacemaker/defibrillator, stroke), 5-year freedom from any-treated rejection (ATR), ACR, and AMR. A control group that was not treated with ECP (n=225) was included. Results The average time to ECP initiation was 1.6 years post-transplant. The ECP group had an average LVEF of 40% (range 23% to 63%) pre-treatment. 8/10 patients were sensitized with a PRA ≥ 10% (range 13% to 90%). The ECP group compared to the control group had a significantly lower subsequent 5-year survival (40.0% vs 79.0%, p=0.001). 6 out of 10 pts on ECP died within 5 years. There was no difference in subsequent 5-year freedom from CAV, NF-MACE, ATR, ACR, and AMR between the groups (see table). Conclusion Heart transplant pts treated with ECP due to high risk factors have reduced long-term survival. It is not clear how much ECP benefited these pts or whether earlier treatment may have been of more benefit. The selection of pts for ECP may be key to improved outcome. Further studies are needed.

LEFT VENTRICULAR FUNCTION IMPROVES IN HEART FAILURE PATIENTS TREATED WITH SACUBITRIL-VALSARTAN

Sacubitril-valsartan has been shown to improve morbidity and mortality in heart failure patients with reduced left ventricular (LV) ejection fraction (EF). However, there is little data describing the effects of sacubitril-valsartan on LV remodeling or LVEF. In this single center retrospective study, we assessed all patients who were switched to sacubitril-valsartan at our Heart Function Clinic between Dec 4, 2015 and March 31, 2017. Those who had baseline and follow-up echocardiograms were included in this analysis. Changes in LV size and function as well as functional capacity were assessed. During the study period, a total of 129 patients were switched to sacubitril-valsartan. Of those, 43 patients had pre- and post- echocardiograms with an average age of 58.0 ± 12.9years. 11.6% were NYHA I, 69.8% NYHA II, and 18.6% NYHA III. Baseline medical treatment with β-blockers, ACEi/ARB, and MRA were 100%, 98%, and 95%, respectively. The mean percent of target dose of GDMT for β-blockers, ACEi/ARB, and MRA were 96%, 90%, and 86%, respectively. The average starting and attained doses on sacubitril-valsartan were 89.5 mg BID and 192.4 mg BID, respectively. The median time from LV assessment to initiation of sacubitril-valsartan was 177 (IQR 31, 291) days, whereas the median time from initiation of sacubitril-valsartan to LV reassessment was 161 (IQR 119, 248) days. Average LVEF increased from 27.4 ±6.9% to 36.4 ±12.4%, p < 0.001) (Figure 1), whereas LV end-diastolic dimension decreased from 67.6 mm to 65.2 mm (p = 0.01). There was no significant change in NYHA class post initiation of sacubitril-valsartan. (Fig 2) In this single-centre retrospective analysis, switching from ACEi/ARB to sacubitril-valsartan in heart failure patients with reduced LVEF resulted in a significant increase in LVEF of almost 9%. These results, if reproduced, suggests that sacubitril-valsartan is associated with reverse left-ventricular remodeling.

Subcutaneous ICD–A North Queensland Experience

Introduction: Subcutaneous implantable cardioverter defibrillators (S-ICD) are an attractive option over traditional transvenous devices as they avoid vascular complications, use less fluoroscopy, and avoid intra-cardiac leads. Their availability is increasing globally and we present our experience in North Queensland. Methods: We performed a retrospective review of patients who had an S-ICD inserted in Townsville Hospital. Hospital records and implant details were reviewed. Results: 12 patients had S-ICD implantation between January 2015 and February 2017. Mean age of 42(18-66), with 8 males. Indications included hypertrophic cardiomyopathy (3/12), channelopathies (3/12), idiopathic cardiomyopathy (3/12), ischaemic (2/12) and non-compaction cardiomyopathy (1/12). 7/12 were for primary and 5/12 for secondary prevention. All patients had QRS durations <120ms, no documented bradycardia, and an average LVEF of 46%. All procedures were done under GA using a 3-incision technique with 10 patients having satisfactory defibrillator threshold (DFT) testing. In two, DFT were contraindicated from the presence of intra-cardiac thrombus. Mean procedure time was 87mins (95%CI 53-121mins), with an average radiation dose of 20mGr. There were no peri-procedural complications and all were discharged within 48 hours post implantation. At an average of 9 months follow-up, there were no device related events, one traumatic dehiscence requiring pocket revision, one ED presentation with implantation site pain and no deaths. Conclusion: S-ICD is a safe and viable treatment for prophylaxis against sudden cardiac death. Our experience reveals excellent patient outcomes and support current evidence for its increasing use in a variety of cardiac diseases for the North Queensland community.

Predictors of left ventricular systolic function recovery in the setting of sinus tachycardia in patients with cancer.

To identify unique echocardiographic features that could be used to reliably predict LVEF recovery upon resolution of sinus tachycardia in patients with cancer. Sinus tachycardia may be a manifestation of underlying cardiomyopathy or can lead to a reversible form of dilated cardiomyopathy known as tachycardia-mediated cardiomyopathy. While distinguishing the two can be challenging, predicting recovery regardless of cause can be of significant clinical importance in the cancer population. Results of echocardiograms performed were collected. Patients with a repeat echocardiogram within 6months of the initial echocardiogram were included. Patients with structural heart disease, acute coronary syndrome, sepsis, and pericardial disease were excluded. A comparison between baseline echocardiogram and subsequent echocardiogram was made to determine whether specific echocardiographic parameters predicted LVEF recovery. Two groups of patients were defined at the outset of the study. The recovered group was comprised of patients with reduced LVEF in the setting of sinus tachycardia and normal LVEF with resolution of tachycardia to normal sinus rhythm (NSR). The unrecovered group was comprised of subjects with low LVEF in the setting of both sinus tachycardia and NSR. A total of 40 patients were included in the study. LVEF in the recovered group (n=18) was 42.8% with sinus tachycardia and increased to 58.3% with NSR. Average LVEF in the unrecovered group (n=22) was 35.1% with tachycardia and improved to 38.5% with NSR. Medial TDI (E') was significantly greater in the recovered group with both tachycardia (7.95cm/s versus 4.56cm/s, P<.001) and NSR (8.11cm/s versus 5.13cm/s, P<.001). Similarly, lateral TDI (E') was significantly greater in the recovered group than in the unrecovered group during tachycardia (8.97cm/s versus 5.13cm/s, P<.001) and NSR (9.05cm/s versus 5.13cm/s, P<.001). Multivariable logistic regression analysis showed that medial TDI >6.5cm/s (OR=30.9, P=.001) and lateral TDI >7.8cm/s (OR=52.5, P=.002) are positively associated with the probability of LVEF recovery. In conclusion, TDI (medial E'>6.5cm/s; lateral E'>7.8cm/s) appears to predict LVEF recovery in patients with sinus tachycardia upon resolution of the tachycardia in patients with cancer.