Baseline Left Ventricular Function Research Articles

The Effect of Cardiac Resynchronization Therapy on Right Ventricular Function: A Systematic Review and Meta-Analysis.

Background: Right ventricular (RV) failure is an important predicting factor regarding overall and event-free survival regardless of baseline left ventricular (LV) function in patients with severe heart failure (HF). Previous studies have indicated that cardiac resynchronization therapy (CRT) improves LV and RV reverse remodeling in patients with systolic dyssynchrony within the left ventricle. However, there is conflicting evidence regarding the role of CRT in RV function. The aim of this systematic review and meta-analysis was to examine the implications of CRT on RV function indices. Methods: A systematic literature search was conducted using the MedLine and EMBASE databases and the Cochrane Library from their inception until 18 March 2024. Eligible were studies providing information on RV function indices, both at baseline and after CRT. Evidence was summarized using random-effects meta-analytic models. Results: In total, 30 studies were deemed eligible. CRT resulted in a significant improvement in right ventricular fractional area change (mean difference (MD) 5.11%, 95% confidence interval (CI) 2.83 to 7.39), tricuspid annular plane systolic excursion (TAPSE, MD 1.63 mm, 95% CI 1.10 to 2.16), and myocardial systolic excursion velocity (MD 1.85 cm/s, 95% CI 1.24 to 2.47) as well as a significant decrease in pulmonary artery systolic pressure (MD -6.24 mmHg, 95% CI -8.32 to -4.16). A non-significant effect was observed on TAPSE to PASP ratio and right ventricular global longitudinal strain. Conclusions: Our meta-analysis demonstrates that CRT is associated with a significant improvement in echocardiographic parameters of RV function. Further investigation is necessary to elucidate how these changes, both independently and in conjunction with LV improvement, impact patients' long-term prognosis, and to identify the specific patient populations expected to derive the greatest benefit.

Differential Stroke Volume between Left and Right Ventricles as a Predictor of Clinical Outcomes: The MESA Study.

Background Valvular heart disease and intracardiac shunts can disrupt the balance between left ventricular (LV) and right ventricular (RV) stroke volumes. However, the prognostic value of such imbalances has not been established among asymptomatic individuals. Purpose To assess the association between differential ventricular stroke volumes quantified using cardiac MRI and clinical outcomes in individuals without cardiovascular disease. Materials and Methods This secondary analysis of a prospective study included participants without cardiovascular disease at enrollment (July 2000 to July 2002) who underwent cardiac MRI. Differences in stroke volume were calculated as LV stroke volume minus RV stroke volume, and participants were categorized as having balanced (greater than or equal to -30 mL to ≤30 mL), negative (less than -30 mL), or positive (>30 mL) differential stroke volumes. Multivariable Cox proportional hazard regression models were used to test the association between differences in stroke volume and adverse outcomes. Results A cohort of 4058 participants (mean age, 61.4 years ± 10 [SD]; 2120 female) were included and followed up for a median of 18.4 years (IQR, 18.3-18.5 years). During follow-up, 1006 participants died, 235 participants developed heart failure, and 764 participants developed atrial fibrillation. Compared with participants who had a balanced differential stroke volume, those with an increased differential stroke volume showed a higher risk of mortality (hazard ratio [HR], 1.73 [95% CI: 1.12, 2.67]; P = .01), heart failure (HR, 2.40 [95% CI: 1.11, 5.20]; P = .03), and atrial fibrillation (HR, 1.89 [95% CI: 1.16, 3.08]; P = .01) in adjusted models. Participants in the negative group, with a decreased differential stroke volume, showed an increased risk of heart failure compared with those in the balanced group (HR, 2.09 [95% CI: 1.09, 3.99]; P = .03); however, this was no longer observed after adjusting for baseline LV function (P = .34). Conclusion Participants without cardiovascular disease at the time of study enrollment who had an LV stroke volume exceeding the RV stroke volume by greater than 30 mL had an increased risk of mortality, heart failure, and atrial fibrillation compared with those with balanced stroke volumes. ClinicalTrials.gov Identifier: NCT00005487 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Almeida in this issue.

Left ventricular reverse remodelling as a promising strategy for resolving left ventricular thrombus.

Recent years, several studies have suggested that abnormal baseline left ventricular (LV) function and structure are associated with left ventricular thrombus (LVT) formation. Despite this, most studies have given less attention to the potential role of left ventricular reverse remodelling (LVRR), that is, the improvement of LV function and structure, in resolving LVT. In this study, we aim to investigate the clinical characteristics, prognosis, and LVT resolution in patients with LVRR. This is a retrospective study conducted at The First Affiliated Hospital of Dalian Medical University. Our cohort consists of patients diagnosed with LVT between 1 November 2015 and 31 May 2020. Enrolled patients were categorized into two groups: LVRR and Failure of LVRR. The primary endpoints included LVT resolution and embolic events. A total of 84 patients were included in the study, with 59 patients in the LVRR group and 25 patients in the Failure of LVRR group. In our study, patients in the LVRR group experienced higher incidence of LVT resolution and a lower risk of embolic events. Multivariate logistic analysis revealed that Failure of LVRR was the only independent negative predictor for LVT resolution and positive predictor for embolic events. Patients with LVRR experience higher incidence of LVT resolution and have lower risk of embolic events, highlighting the significance of identifying and mitigating risk factors that contribute to abnormal LV function and structure in management of patients with LVT.

Effects of ipragliflozin on left ventricular diastolic function in patients with type 2 diabetes: A sub-analysis of the PROTECT trial

BackgroundWe hypothesized that the beneficial effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on diastolic function might depend on baseline left ventricular (LV) systolic function. MethodsTo investigate the effects of SGLT2 inhibitors on LV diastolic function in patients with type 2 diabetes mellitus (T2DM), we conducted a post-hoc sub-study of the PROTECT trial, stratifying the data according to LV ejection fraction (LVEF) at baseline. After excluding patients without echocardiographic data at baseline or 24 months into the PROTECT trial, 31 and 38 patients with T2DM from the full analysis dataset of the PROTECT trial who received ipragliflozin or no SGLT2 inhibitor (control), respectively, were included. The primary endpoint was a comparison of the changes in echocardiographic parameters and N-terminal pro-brain natriuretic peptide levels from baseline to 24 months between the two groups stratified according to baseline LVEF. ResultsDifferences in diastolic functional parameters (e' and E/e') were noted between the two groups. Among the subgroups defined according to median LVEF values, those with higher LVEF (≥60 %) who received ipragliflozin appeared to have a higher e' and lower E/e' than did those who received the standard of care with no SGLT2 inhibitor, indicating longitudinal improvements between baseline and follow up (p = 0.001 and 0.016, respectively). ConclusionsIpragliflozin generally improved LV diastolic function in patients with type 2 diabetes, the extent of this improvement might appear to vary with LV systolic function.

USEFULNESS OF BPN LEVELS IN IDENTIFYING DIABETIC HYPERTENSIVES WITH SYSTOLIC-DIASTOLIC LEFT VENTRICULAR DYSFUNCTION. ABILITY OF THE ANGIOTENSIN II INHIBITOR TO CONVERT IT BACK

Objective: We tested the hypothesis that the renin-angiotensin system could convert left ventricular diastolic dysfunction in patients with type 2 diabetes. Design and method: Fifty asymptomatic patients with type 2 diabetes were recruited in this double-blind cross-over trial. Baseline left ventricular diastolic function was assessed with Doppler echocardiography; using velocity ratios of peak flow through the mitral orifice (E/A) and the integral velocity of before end diastolic transmitral flow (VTIE/VTIA). In addition, plasma brain natriuretic peptide (BNP) levels were measured. Patients randomly received either zofenopril (15mg/day), or Olmesartan (10mg/day) or their combination for 3 months and each time after a 2-week washout period. Measurements were repeated at the end of each treatment period. Results: Both E/A and VTIE/VTIA ratios increased (29 and 20% with zofenopril, 25 and 23% with olmesartan, and 36 and 28% with combination treatment, respectively, p < 0.001), while levels plasma BNP levels were significantly reduced with all 3 regimens (9% with zofenopril, 25% with olmesartan, and 36% with combination, p < 0.001). Conclusions: Both olmesartan and zofenopril improve left ventricular diastolic echocardiographic indices and reduce plasma BNP levels in diabetic patients, their combination produces an even better therapeutic effect.

Long-term outcomes after coronary artery bypass graft with or without surgical ventricular reconstruction in patients with severe left ventricular dysfunction.

Patients with chronic myocardial infarction (MI) and severe left ventricular (LV) dysfunction have poor clinical outcomes. This study aimed to determine whether coronary artery bypass graft (CABG) with surgical ventricular reconstruction (SVR) leads to further improvement in long-term patient outcomes compared with isolated CABG (I-CABG). From April 2010 to June 2013, 140 consecutive patients with chronic MI and severe LV dysfunction who received contrast-enhanced cardiovascular magnetic resonance imaging (CE-CMR) within 1 month before surgery were enrolled in this study. The cardiovascular events (CVEs) and long-term survival of patients who underwent CABG and SVR were compared with those who met the criteria for SVR but received I-CABG. A total of 140 patients were included in the final analysis, including 70 patients who underwent CABG and SVR and 70 patients who underwent I-CABG. No differences were observed in the baseline characteristics, LV function, and late gadolinium enhancement (LGE) between the two groups. CABG+SVR patients experienced a longer cardiopulmonary bypass (CPB) time (116.0±35.0 vs. 100.2±23.8 minutes, P=0.002) and ventilation time [median (interquartile range): 22.0 (17.0, 37.0) vs. 20.0 (15.0, 24.0) hours, P=0.019] than I-CABG patients. During a mean follow-up of 123.1±12.7 months (range, 102-140 months), the CABG+SVR group had fewer rehospitalizations for congestive heart failure (CHF) (4.3% vs. 19.1%, P=0.007), but no statistical difference in the mortality rate was observed (2.9% vs. 4.4%, P=0.987). The cumulative CVE-free survival rate was significantly higher in CABG+SVR patients (87.0% vs. 67.6%, P=0.007). Our findings indicated that patients with chronic MI and severe LV dysfunction experienced similar perioperative outcomes after CABG+SVR or I-CABG. However, the CABG+SVR group resulted in fewer rehospitalizations for CHF and a higher cumulative CVE-free survival rate.

Biventricular Function is Impaired in Right Ventricular Septal Pacing-A Prospective Study Using Myocardial Strain Imaging.

Left ventricular (LV) dysfunction is known to occur after right ventricular (RV) pacing; the effect on RV function is less well studied. The aim of this study was to assess the impact of RV mid-septal pacing upon RV function using the novel parameters of speckle-tracking derived RV global longitudinal strain (RV GLS) and RV free wall strain (RV FWS), as well as the conventional parameters RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and tricuspid annular systolic velocity (RV S'). Thirty-two (32) consecutive patients with normal baseline LV and RV function requiring permanent pacemaker insertion were prospectively recruited. Echocardiography was performed prior to implantation, at 1 day, 1 month and 1 year after implantation, with 29 patients completing follow-up. After 1 year, three patients (10%) with otherwise normal RV parameters developed abnormal RV strain patterns. Compared to 1 day after implantation, at 1 year significant reductions were observed in mean RV GLS (-24.8 to -21.8%) RV S' (15.1 to 12.2 cm/s), TAPSE (24.2 to 21.9 mm), RV GLS (-24.8 to -21.8%), left ventricular ejection fraction (LVEF) (66.0 to 57.9%), LV GLS (-19.9 to 17.0), all p<0.01. There was a non-significant reduction for RV FWS (-29.0 to -26.7%, p=0.06) and there was no change in RV FAC (49.1 to 46.9%, p=0.24). We report abnormalities of RV strain developing 1 year after pacemaker insertion. Measurement of myocardial strain is emerging as an additional method to detect patients at risk of RV dysfunction in those who have undergone pacemaker implantation.

Correlation of Left Ventricular Global Longitudinal Strain and Angiographically Derived SYNTAX Score in Patients of Stable Angina Pectoris

Background: The present study aimed to assess the relationship between global longitudinal strain (GLS) by two-dimensional (2D) speckle tracking echocardiography (STE) and SYNTAX score (SS) in patients with stable angina pectoris and normal baseline left ventricular (LV) function. Methods: Fifty patients aged ≥18 years presented with stable angina pectoris with LV ejection fraction ≥60.0% posted for elective coronary angiography were included in the study. All the patients underwent 2D echocardiography, 2D STE, and coronary angiography. GLS and SSs were calculated. The primary objective was to find the correlation between GLS and SS in assessing the severity of coronary artery disease (CAD), whereas the secondary objectives were to find the sensitivity and specificity of GLS to predict critical CAD. Results: A significant negative correlation (−0.862, P = 0.001) was observed between GLS and SSs. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of GLS score 16 were 100.0%, 64.0%, 73.5%, 100.0%, and 82.0, respectively, in predicting higher SS (≥22). The mean GLS values were significantly higher in noncritical CAD (16.4 ± 1.1) as compared to critical CAD (12.4 ± 1.3). Conclusions: GLS is a useful noninvasive tool to detect the severity of CAD.

Predictive value of oxidative, antioxidative, and inflammatory status for left ventricular systolic recovery after percutaneous coronary intervention for ST-segment elevation myocardial infarction.

This study aimed to evaluate the association between left ventricular ejection fraction recovery and the total oxidant status, total antioxidant capacity, and high-sensitivity C-reactive protein levels. A total of 264 ST-elevation myocardial infarction patients were classified into two groups according to baseline and 6-month follow-up left ventricular systolic function: reduced and recovery systolic function. Predictors of the recovery of left ventricular ejection fraction were determined by multivariate regression analyses. Multivariable analysis indicated that oxidative status index, baseline left ventricular ejection fraction and peak creatine-kinase myocardial bundle level, and high-sensitivity C-reactive protein were independently associated with the decreased of left ventricular ejection fraction at 6-month follow-up. Oxidative stress and inflammation parameters were detrimental to the recovery of left ventricular ejection fraction in patients with ST-elevation myocardial infarction.

The Prognostic Role of Mitral Valve Regurgitation Severity and Left Ventricle Function in Acute Heart Failure.

Aims: Data about the prognostic interplay between mitral regurgitation MR and left ventricular (LV) function in the outcome of patients admitted with acute heart failure (AHF) are scarce. We evaluated the prognostic impact of MR severity and LV function on mortality and on recurrent heart failure hospitalization (re-HFH) in patients admitted with AHF. Methods and Results: In total, 6843 patients admitted with AHF were evaluated: 2521 patients with LV ejection fraction (LVEF) ≤ 40% (reduced LVEF), 1238 of them (51%) having ≥moderate MR; and 4322 with LVEF > 40% (preserved LVEF), 1175 of them (27%) having ≥moderate MR. One-year mortality and re-HFH rates were higher in patients with ≥moderate MR unrelated to the baseline LV function (p = 0.028 and p < 0.001, respectively). After multivariable analysis, only reduced LVEF, and not the severity of MR, predicted mortality risk (HR: 1.31 [95% CI: 1.12–1.53] for patients with reduced LV function and ≤mild MR; HR: 1.44 [95% CI: 1.25–1.67] for patients with reduced LV function and ≥moderate MR); p < 0.001 for both. There was an increased risk for re-HFH in each group (HR: 1.35 [95% CI: 1.17–1.52] for patients with preserved LV function and ≥moderate MR; HR: 1.31 [95% CI: 1.15–1.51] for patients with reduced LV function and mild MR; and HR: 1.65 [95% CI: 1.45–1.88] for patients with reduced LV function and ≥moderate MR); p < 0.001 for all. Conclusions: In patients admitted with AHF, the LV function is the main prognostic determinant for mortality after 1 year. Significant (≥moderate) MR is associated with an increased risk of recurrent hospitalization.

Meta-Analysis of Relation Between Left Ventricular Dysfunction and Outcomes After Transcatheter Mitral Edge-to-Edge Repair

Randomized controlled trials (RCTs) and observational studies provided conflicting results regarding the role of left ventricular (LV) function on outcomes after transcatheter edge-to-edge repair (TEER). The study aimed to provide a comprehensive assessment of the interplay between severe LV dysfunction and TEER outcomes. Multiple electronic databases, including PubMed, EMBASE, Scopus, Web of Science, and CENTRAL, were searched to identify studies on TEER for secondary mitral regurgitation reporting outcomes stratified for LV ejection fraction <30% and ≥30%. The prespecified primary end points were the composite of all-cause death or heart failure (HF) hospitalization and New York Heart Association (NYHA) class III/IV. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by random-effects models. Multiple sensitivity analyses accounting for baseline characteristics and study design were applied. A total of 6 studies (1,957 patients) with 1 year or 2 years of follow-up were available. Severe LV dysfunction was associated with an increased risk of death or HF hospitalization (OR 1.71, 95% CI 1.14 to 2.57). Conversely, comparable rates of NYHA class III/IV (OR 1.06, 95% CI 0.82 to 1.38) or secondary end points (reinterventions, recurrence of significant secondary mitral regurgitation) were found regardless of the baseline LV function. Subgroup meta-analysis found no difference in the composite primary end point between patients with LV ejection fraction <30% and ≥30% enrolled in RCTs. In conclusion, TEER seems to be associated with higher mortality or HF hospitalization rates in patients with severe LV dysfunction. However, RCTs found no differences between groups. No impact of LV function was found on the risk of NYHA class III/IV or other clinical outcomes.

Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI

The volume of contrast to creatinine clearance ratio (CV/CrCl) is a useful indicator of the risk of acute kidney injury (AKI) in patients undergoing percutaneous interventional procedures. Association between CV/CrCl and adverse outcome after transcatheter aortic valve implantation (TAVI) was suggested but it is not well established. A large retrospective multicenter cohort of 1381 patients treated with TAVI was analyzed to assess the association between CV/CrCl and the risk of AKI and mortality at 90 days and 1 year after TAVI. Patients receiving renal replacement therapy at the time of TAVI were excluded. CV/CrCl ≥ 2.2 was associated with the risk of AKI and 90 days mortality after TAVI after adjustment for age, sex, diabetes, baseline left ventricular function, baseline chronic kidney disease (CKD), previous myocardial infarction and peripheral vascular disease (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.09–1.22, p < 0.0001). Importantly, CV/CrCl was associated with the adverse outcome independently from the presence of baseline CKD (p for interaction = 0.22). CV/CrCl was independently associated with the individual components of the composite primary outcome including AKI (odds ratio: 1.18, 95% CI: 1.08–1.28, p < 0.0001) and 90 days mortality (HR: 1.90, 95% CI: 1.01–3.60, p = 0.047) after TAVI. AKI (HR: 1.94, 95% CI: 1.21–3.11, p = 0.006) but not CV/CrCl was associated with the risk of 1‐year mortality after TAVI. CV/CrCl is associated with excess renal damage and early mortality after TAVI. Procedural strategies to minimize the CV/CrCl during TAVI may improve early clinical outcomes in patients undergoing TAVI.

Adverse prognostic value of supernormal left ventricular force noninvasively assessed by resting transthoracic echocardiography in hypertrophic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Stress Echo 2030 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI). Background The excessive cross-bridging of cardiac myosin and actin, resulting in increased left ventricular (LV) force development, is one of the biomechanical abormalities inhypertrophic cardiomyopathy (HCM). Purpose To assess the prognostic value of increased LV force development at rest in patients with HCM Methods We enrolled 918 HCM patients (age 48 ± 16 years, 502 males, New York Heart Association I or II, Class III in 48 patients, 6% and with LVOTG &amp;gt;30 mmHg in 211patients, 23%) with ejection fraction (EF) ≥50%, referred for rest transthoracic echocardiography (TTE) in 10 quality-controlled labs from 7 countries (Belgium, Hungary, Italy, Portugal, Serbia, Spain, Brazil). The maximal wall thickness was 21 ± 5 mm. TTE assessment included left ventricular outflow tract gradient (LVOTG, mmHg), EF (%), and LV force (systolic arterial pressure + LVOTG/LV endsystolic volume assessed with 2-D, mmHg/mL). All patients were followed-up. An age- and gender matched control group of 95 healthy subjects was also evaluated. Results. Compared to normals, HCM showed higher values of EF (68 ± 8 vs 65 ± 5%, p &amp;lt; 0.001) and force (7.2 ± 5.5 vs 4.0 ± 1.8 mmHg/mL, p &amp;lt; 0.001). At a median follow-up of 94 months [interquartile range 40-140 months], 95 all-cause deaths occurred. Mortality was significantly increased in the force highest quartile compared to other quartiles (see figure). At multivariable Cox analysis, increased Force (highest quartile &amp;gt;8.5 mmHg/mL hazard ratio= 2.189 95% CI = 1.095-4.377, p = 0.027 and the intermediate quartile: Force 5.7-8.5 mmHg/mL hazard ratio= 2.525 95% CI = 1.2205.228, p = 0.013) were independent predictors of mortality with age (hazard ratio= 1.065 95% CI = 1.047-1.084, p &amp;lt; 0.001) and maximal wall thickness (hazard ratio= 1.094, 95% CI = 1.055-1.135, p &amp;lt; 0.001). At univariate analysis neither LVOTG (hazard ratio= 1.430, 95% CI = 0.920-2.222, p = 0.112) nor quartiles of EF (hazard ratio= 1.497, 95% CI = 0.868-2.582, p = 0.147) were significant. Conclusion HCM patients with preserved baseline LV function and higher values of resting LV force ("too good to be normal") show a worse survival, highlighting the dark prognostic side of an excess of force. The hypercontractile phenotype possibly indicates an increased activity of myosin resulting in increased force production at the sarcomere and cellular levels that propagates at the whole-organ level with unfavorable long-term effects on outcome. Figure Mortality rate based on quartiles of resting LV Force in HCM. Abstract Figure. Mortality rate

374 Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI

Abstract Aims The volume of contrast to creatinine clearance ratio (CV/CrCl) is a useful indicator of the risk of acute kidney injury (AKI) in patients undergoing percutaneous interventional procedures. Association between CV/CrCl and adverse outcome after transcatheter aortic valve implantation (TAVI) was suggested but it is not well established. Methods and results A large retrospective multicentre cohort of 1381 patients treated with TAVI was analysed to assess the association between CV/CrCl and the risk of AKI and mortality at 90 days and one year after TAVI. Patients receiving renal replacement therapy at the time of TAVI were excluded. CV/CrCl was associated with the risk of AKI and 90 days mortality after TAVI after adjustment for age, sex, diabetes, baseline left ventricular function, baseline chronic kidney disease (CKD), previous myocardial infarction and peripheral vascular disease (HR: 1.16, 95% CI: 1.09–1.22, P &amp;lt; 0.0001). Importantly, CV/CrCl was associated with the adverse outcome independently from the presence of baseline CKD (p for interaction = 0.22). CV/CrCl was independently associated with the individual components of the composite primary outcome including AKI (OR: 1.18, 95% CI: 1.08–1.28, P &amp;lt; 0.0001) and 90 days mortality (HR: 1.90, 95% CI: 1.01–3.60, P = 0.047) after TAVI. AKI (HR: 1.94, 95% CI: 1.21–3.11, P = 0.006) but not CV/CrCl was associated with the risk of 1-year mortality after TAVI. Conclusions CV/CrCl is associated with excess renal damage and early mortality after TAVI. Procedural strategies to minimize the CV/CrCl during TAVI may improve early clinical outcomes in patients undergoing TAVI.

Abstract 8898: Biventricular Function is Impaired in RV Septal Pacing - A Prospective Study Using Myocardial Strain Imaging

Introduction: Left ventricular (LV) dysfunction is observed after right ventricular (RV) pacing from both apical and septal positions. Hypothesis: The primary aim of this study was to assess the impact of RV mid-septal pacing upon RV function using the novel parameter of speckle-tracking derived RV global longitudinal strain (RVGLS), as well as the conventional parameters RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (RV S’). Secondary aims included assessing the impact on LV function and the correlation of pacing burden with echocardiographic parameters. Methods: Thirty-two consecutive patients (mean age 75 ± 10 years) with normal baseline LV and RV function requiring permanent pacemaker insertion were prospectively recruited at a tertiary hospital in Melbourne, Australia. 3 patients were excluded due to poor image quality. Echocardiography was performed prior to implantation, at 1-day, 1-month and 1-year post-implantation, with 29 patients completing follow-up. Results: Compared to 1-day post-implantation, at 1-year a significant decline was noted in mean RV S’ (15.1 to 12.2cm/s), TAPSE (24.2 to 21.9mm), RV GLS (-24.8 to -21.8%), LVEF (66.0 to 57.9%), LV GLS (-19.9 to 17.0), all p &lt;0.01. There was no change in RV FAC (49.1 to 46.9%). Fourteen patients (44%) required a high proportion of ventricular pacing, defined as ≥10% at 1 year. These patients had a greater deterioration in RVGLS (5.0 vs 1.0%) and LVGLS (4.6 vs 0.68%), p &lt;0.05. Changes in RV S’ (3.1 vs 2.7cm/s), TAPSE (1.5 vs 3.1mm), RV FAC (1.9 vs 5.64%) and LVEF (9.5 vs 5.6%) were not significantly different from those in patients with &lt;10% ventricular pacing. Conclusions: RV and LV systolic function declined in all patients after 1 year of RV septal pacing. Further, patients with a high burden of ventricular pacing had a larger deterioration in RVGLS and LVGLS. Myocardial strain may be more useful than conventional echo parameters in detecting RV and LV dysfunction associated with RV septal pacing.

Extent and determinants of left ventricular reverse remodeling in patients with secondary mitral regurgitation undergoing MitraClip implantation.

BackgroundIn secondary MR, data on left ventricular (LV) remodeling after MitraClip procedure are rare, even this information may impact patient selection. This study investigated changes in LV structure and function by cardiovascular magnetic resonance (CMR) following MitraClip implantation for secondary mitral regurgitation (MR) in order to assess extent and predictors of LV reverse remodeling (LVRR).Methods and ResultsTwenty-nine patients underwent CMR imaging prior to and six months after MitraClip procedure. LVRR was defined by a decrease of LV end-diastolic volume index (LVEDVi) > 15% compared to baseline. According to the definition of LVRR, 34% of patients displayed LVRR at follow-up CMR. Baseline LV stroke volume index (LVSVi), LV ejection fraction (LVEF), LV circumferential strain and MR volume at baseline were predictors of LVRR at follow-up. At second CMR, we detected an improvement in hemodynamic status as illustrated by an increase in effective LVSVi (28 ± 8 ml/m2 vs. 33 ± 8 ml/m2; p = 0.053) and cardiac index (2.0 ± 0.5 vs. 2.3 ± 0.5 l/min; p = 0.016), while LVEF and LV strain parameters did not change (p > 0.05). Improvements in effective LVSVi were associated with the decrease of MR volume (r = 0.509; p = 0.018) and MR fraction (r = 0.629; p = 0.002) by MitraClip.ConclusionsTogether, MitraClip implantation is associated with LVRR in one third of patients. Baseline LV function and magnitude of MR are important predictors of LVRR. Improvement of hemodynamic status may be assessed by effective stroke volume index and correlates with the reduction of MR by MitraClip implantation, rather than an increase in LV contractility.

Intensive care unit management of percutaneous mechanical circulatory supported patients: the role of imaging.

The clinical management of patients on Impella support requires multimodality monitoring and imaging. Upon intensive care unit admission, echocardiography is essential to ensure correct pump positioning/guide repositioning, to monitor acute myocardial infarction/device-related cardiac complications and to evaluate baseline left and right ventricular function. Over time, the echocardiographic assessment of myocardial viability has become an essential target for guiding mechanical circulatory support escalation and long-term strategies. The recognition and grading of any valvular dysfunction and damage in Impella patients are challenging, as the device interferes with the colour Doppler signal, and the loading conditions of the left ventricle are modified by the pump. Valvular disease in such patients is often secondary, and correct identification is pivotal for future therapeutic strategies. The emerging use of newer techniques, including speckle-tracking echocardiography, is of increasing interest in the imaging of critically ill patients.

Recovery of Left Ventricular Function After Transcatheter Aortic Valve Implantation: Impact of Pre-Procedural Myocardial Work Index

Recovery of impaired left ventricular (LV) function occurs after transcatheter aortic valve implantation (TAVI) in approximately 50% of patients. Baseline LV function and hypertrophy have been shown to predict response, but, to the best of our knowledge, the predictive value of myocardial work index (MWI) has not been examined.

Non-invasive myocardial work: characterising the normal and ischaemic response to exercise

Abstract Background/Introduction Myocardial work and work efficiency are new parameters for assessing left ventricular function. They have been shown to have value in a range of clinical settings but have not previously been applied to exercise stress echocardiography. Purpose We aim to characterize the normal myocardial work and work efficiency response to exercise in a mixed population and determine if myocardial work could be used to identify patients with inducible ischaemia. Methods Patients were retrospectively enrolled from an existing database of exercise stress echocardiography. Inclusion criteria were a clinical indication of possible ischemia and technical suitability to calculate myocardial work. Exclusion criteria were abnormal baseline left ventricular function or inadequate image quality. Echocardiograms positive for ischaemia were defined by independent visual assessment and compared with angiographic findings where available. Myocardial work and work efficiency were calculated using a proprietary algorithm. Results A total of 177 patients met inclusion criteria, 117 were excluded leaving 40 normal and 20 positive tests for analysis. During normal exercise global work increased 54% and efficiency remained at 96%. Segmental work showed a basal to apical gradient which became more prominent at peak exercise. In patients with inducible ischaemia during exercise there was a significant difference in response; work decreased by 1.9% and efficiency dropped to 87%. Receiver operating characteristic curve for myocardial work had an area under the curve of 0.94. Youden's J statistic suggested an optimum cut point of a 25% increase in work to define a normal test. Conclusion During normal exercise myocardial work increased and efficiency remained unchanged, however during exercise induced ischaemia both myocardial work and efficiency decreased. We have demonstrated that myocardial work can be applied to stress echocardiography to identify ischemia but the utility of this remains uncertain. Further research compared to an objective measure of functional ischemia is needed. Response to exercise Funding Acknowledgement Type of funding source: None

Left ventricular speckle tracking echocardiographic evaluation before and after TAVI

Aims: To assess left ventricular (LV) function before and after transcatheter aortic valve implantation (TAVI) using conventional echocardiographic parameters and global longitudinal LV strain (GLS) and compare outcomes between Edwards S3 and Evolut R valves.Methods and results: Data were collected for consecutive patients undergoing TAVI at Hammersmith hospital between 2015 and 2018. Of the 303 patients, those with coronary artery disease and atrial fibrillation were excluded leading to a total of 85 patients, which constituted our study group. The mean follow-up was 49 ± 39 days. In total, 60% of patients were treated with Edwards S3 and 40% Evolut R. TAVI resulted in an early improvement of GLS (−13.96 to −15.25%, P = 0.01) but not ejection fraction (EF) (47.6 to 50.1%, P = 0.09). LV mass also improved, especially in patients with marked baseline LV hypertrophy (P < 0.001). There were no appreciable differences of LV function improvement and overall LV remodelling after TAVI between the two types of valves used (P = 0.14).Conclusions: TAVI results in reverse remodelling and improvement of GLS, especially in patients with impaired baseline LV function. There were no differences in the extent of LV function improvement between Edwards S3 and Evolut R valves but there was a greater incidence of aortic regurgitation with Evolut R.