Assessment Of Biventricular Function Research Articles

The emerging role of cardiovascular magnetic resonance in the evaluation of cardiac involvement in systemic sclerosis

Abstract Systemic sclerosis (SSc) is an autoimmune rheumatic disease, characterized by vascular, inflammatory and fibrotic alterations. Cardiac involvement is the « fatal tip of the iceberg» in SSc, as it leads to high morbidity/mortality. Cardiovascular imaging modalities play an important role in the early diagnosis and treatment assessment of cardiac involvement. Echocardiography is the corner stone for evaluation of cardiac involvement, providing information about function, wall motion, pulmonary pressure, pericardium and valvular disease. It is a low-cost modality, widely available, without radiation and with great experience among cardiologists. However, it is a window and operator dependent modality and cannot provide tissue characterization information, absolutely necessary for diagnosis and treatment of cardiac involvement in SSc. Cardiovascular magnetic resonance (CMR) can perform myocardial function and tissue characterization in the same examination without radiation, has excellent reproducibility and is window and operator independent. The great advantage of CMR is the capability to assess peri- myo-vascular inflammation, myocardial ischemia and presence of replacement and diffuse myocardial fibrosis in parallel with ventricular function assessment. The modified Lake Louise criteria including T2, native T1 mapping and extracellular volume fraction (ECV) has been recently used to diagnose inflammatory cardiomyopathy. According to expert recommendations, myocardial inflammation should be considered if at least 2 indices, one T2 and one T1 parameter are positive, whereas native T1 mapping and ECV assess diffuse fibrosis or oedema, even in the absence of late gadolinium enhancement (LGE). Moreover, transmural/subendocardial LGE following the distribution of coronary arteries and diffuse subendocardial fibrosis not related with epicardial coronary arteries are indicative of epicardial and micro-vascular coronary artery disease, respectively. To conclude, CMR can overcome the limitations of echocardiography by identifying acute/active or chronic myocardial inflammation/fibrosis, ischemia and myocardial infarction using classic and parametric indices in parallel with biventricular function assessment

AI approach to biventricular function assessment in cine-MRI: an ultra-small training dataset and multivendor study

Objective. It was a great challenge to train an excellent and generalized model on an ultra-small data set composed of multi-orientation cardiac cine magnetic resonance imaging (MRI) images. We try to develop a 3D deep learning method based on an ultra-small training data set from muti-orientation cine MRI images and assess its performance of automated biventricular structure segmentation and function assessment in multivendor. Approach. We completed the training and testing of our deep learning networks using only heart datasets of 150 cases (90 cases for training and 60 cases for testing). This datasets were obtained from three different MRI vendors and each subject included two phases of the cardiac cycle and three cine sequences. A 3D deep learning algorithm combining Transformers and U-Net was trained. The performance of the segmentation was evaluated using the Dice metric and Hausdorff distance (HD). Based on this, the manual and automatic results of cardiac function parameters were compared with Pearson correlation, intraclass correlation coefficient (ICC) and Bland–Altman analysis in multivendor. Main results. The results show that the average Dice of 0.92, 0.92, 0.94 and HD95 of 2.50, 1.36, 1.37 for three sequences. The automatic and manual results of seven parameters were excellently correlated with the lowest r2 value of 0.824 and the highest of 0.983. The ICC (0.908–0.989, P < 0.001) showed that the results were highly consistent. Bland–Altman with a 95% limit of agreement showed there was no significant difference except for the difference in RVESV (P = 0.005) and LVM (P < 0.001). Significance. The model had high accuracy in segmentation and excellent correlation and consistency in function assessment. It provides a fast and effective method for studying cardiac MRI and heart disease.

AI Based CMR Assessment of Biventricular Function: Clinical Significance of Intervendor Variability and Measurement Errors

ObjectivesThe aim of this study was to determine whether left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) and left ventricular mass (LVM) measurements made using 3 fully automated deep learning (DL) algorithms are accurate and interchangeable and can be used to classify ventricular function and risk-stratify patients as accurately as an expert. BackgroundArtificial intelligence is increasingly used to assess cardiac function and LVM from cardiac magnetic resonance images. MethodsTwo hundred patients were identified from a registry of individuals who underwent vasodilator stress cardiac magnetic resonance. LVEF, LVM, and RVEF were determined using 3 fully automated commercial DL algorithms and by a clinical expert (CLIN) using conventional methodology. Additionally, LVEF values were classified according to clinically important ranges: <35%, 35% to 50%, and ≥50%. Both ejection fraction values and classifications made by the DL ejection fraction approaches were compared against CLIN ejection fraction reference. Receiver-operating characteristic curve analysis was performed to evaluate the ability of CLIN and each of the DL classifications to predict major adverse cardiovascular events. ResultsExcellent correlations were seen for each DL-LVEF compared with CLIN-LVEF (r = 0.83-0.93). Good correlations were present between DL-LVM and CLIN-LVM (r = 0.75-0.85). Modest correlations were observed between DL-RVEF and CLIN-RVEF (r = 0.59-0.68). A >10% error between CLIN and DL ejection fraction was present in 5% to 18% of cases for the left ventricle and 23% to 43% for the right ventricle. LVEF classification agreed with CLIN-LVEF classification in 86%, 80%, and 85% cases for the 3 DL-LVEF approaches. There were no differences among the 4 approaches in associations with major adverse cardiovascular events for LVEF, LVM, and RVEF. ConclusionsThis study revealed good agreement between automated and expert-derived LVEF and similarly strong associations with outcomes, compared with an expert. However, the ability of these automated measurements to accurately classify left ventricular function for treatment decision remains limited. DL-LVM showed good agreement with CLIN-LVM. DL-RVEF approaches need further refinements.

Utility of single-shot compressed sensing cardiac magnetic resonance cine imaging for assessment of biventricular function in free-breathing and arrhythmic pediatric patients

BackgroundThis study aimed to explore the feasibility and accuracy of single-shot compressed-sensing (CS) cardiac magnetic resonance cine technology for the assessment of biventricular function and morphology in free-breathing (FB) pediatrics, especially those with arrhythmia. MethodsSeventy consecutive pediatric participants (6.27 ± 3.8 years, range:0.5–14 years) were enrolled between August 2019 and July 2020. Single-shot CS and conventional balanced steady-state free-precession (bSSFP) cine were obtained. The total scanning time, image quality and biventricular function parameters were compared for both sequences. ResultsSingle-shot CS cine had shorter acquisition time compared with the conventional bSSFP cine (all P < 0.001). The single-shot CS cine also had fewer artifacts than conventional bSSFP cine (breath-hold (BH): 4.6 ± 0.6 vs. 4.3 ± 0.6; FB without ongoing arrhythmia: 4.5 ± 0.6 vs. 3.6 ± 0.9; FB with ongoing arrhythmia: 4.7 ± 0.5 vs. 2.6 ± 1.1; all P < 0.05). No statistical difference of left ventricular parameters and right ventricular end-systolic volume/ejection fraction were found between the single-shot CS and conventional bSSFP cine in both BH and FB without ongoing arrhythmia group. There was an excellent correlation (R2 = 0.60–0.98, all P < 0.001) and good intra-(range: R2 = 0.57–0.99, P < 0.001)/inter-observer agreements (range: R2 = 0.76–1, P < 0.001) for single-shot CS cine images in terms of biventricular function parameters. ConclusionsThe single-shot CS cine can significantly reduce the image acquisition time, offering reliable quantification of biventricular function in free breathing condition for arrhythmic patients.

Assessment of biventricular function in patients with hepatopulmonary syndrome.

Cardiac function impairment in the setting of hepatopulmonary syndrome (HPS) in patients with end stage liver disease remains an issue of debate. The current study evaluated possible correlations between HPS and biventricular systolic function in patients with decompensated cirrhosis. Consecutive liver transplantation candidates with stable decompensated cirrhosis were prospectively evaluated. HPS was defined as the presence of an elevated alveolar-arterial oxygen gradient and intrapulmonary vasodilatation, detected by contrast enhanced echocardiography. HPS severity was determined based on arterial blood oxygen pressure values, while shunt size was assessed with a semi-quantitative method. Demographic, clinical and laboratory parameters were also prospectively collected. In total, 130 patients (mean age 56.5, M/F: 94/36, MELD score 14.6 ± 5.6) were enrolled, of whom 45 (34.6%) fulfilled the criteria for HPS diagnosis (mild: 57.7%, moderate: 33.3%, severe 4.4% and very severe 4.4%). Significantly lower absolute left ventricular (LV) global longitudinal strain (GLS) values (- 21.6 ± 2.3 vs. - 22.6 ± 2.5%, p = 0.041) were measured in patients with HPS compared to cirrhotic patients without HPS, while there was no statistically significant difference regarding right ventricular GLS (- 22.1 ± 3.3 vs. - 23.2 ± 3.5%, p = 0.061) between the two groups. Lower LV ejection fraction values were also recorded in the HPS group (53.9 ± 3.5 vs. 56.3 ± 4.5%, p < 0.01). No other echocardiographic parameter was correlated to HPS. Intrapulmonary shunt grading was correlated to HPS classification (χ2 = 19.8, p < 0.01), with lower arterial oxygen values being recorded in higher stages of intrapulmonary shunt. In patients with cirrhosis, the presence of HPS is associated with worse LV contractile performance.

Prognostic Role of Simultaneous Assessment of Biventricular Function Using Left Ventricular Stroke Work Index and Right Ventricular Stroke Work Index

<h3>Purpose</h3> We hypothesized that simultaneous assessment of biventricular function could predict clinical outcomes. <h3>Methods</h3> We reviewed 180 patients undergoing a milrinone drug study and right heart catheterization at our center from January 2013 to January 2019. Left ventricular stroke work index (LVSWI) was calculated as 0.0136 * ((cardiac index/heart rate) * 1000) * (mean arterial pressure - pulmonary capillary wedge pressure), and right ventricular stroke work index (RVSWI) was calculated as 0.0136 * ((cardiac index/heart rate) * 1000) * (mean pulmonary arterial pressure - right atrial pressure). Cutpoints were determined by ROC analysis. Patients were stratified as: (1) High LVSWI, High RVSWI; (2) High LVSWI, Low RVSWI; (3) Low LVSWI, High RVSWI; and (4) Low LVSWI, Low RVSWI. Univariate and multivariate logistic regression analyses were performed to determine association with escalation of therapy, defined as left ventricular assist device implantation, heart transplantation, or death. <h3>Results</h3> Cutpoints of 18.3 and 10 were determined for LVSWI and RVSWI, respectively. Low LVSWI, High RVSWI was associated with escalation of therapy or death at 30 days (OR 4, 95% CI 1.05 - 15.59, p = 0.041). All of the following statuses were associated with a negative outcome at one year: Low LVSWI, High RVSWI (OR 14, 95% CI 2.44 - 265.8, p = 0.015), Low LVSWI, Low RVSWI (OR 4.85, 95% CI 2.25 - 10.85, p <0.0001), and High LVSWI, High RVSWI (OR 2.45, 95% CI 1.06 - 5.87, p = 0.039). In multivariate analysis, Low LVSWI, High RVSWI and Low LVSWI, Low RVSWI were predictors of escalation of therapy or death at one year (OR 14.76, 95% CI 2.56-281.3, p = 0.013; OR 5.74, 95% CI 2.43 - 14.3, p <0.001, respectively). <h3>Conclusion</h3> Simultaneous assessment of biventricular function using LVSWI and RVSWI is associated with clinical outcomes and may be useful for risk stratification.

Assessment of Biventricular Function by Echocardiography in Patients with Right Ventricular Apical Pacing

Introduction: Artificial cardiac pacing is a consolidated, safe, and effective treatment strategy that has been evolving for 60 years. In a normal heart, the left ventricle (LV) contracts in a fast and synchronized manner. Stimulation anywhere in the right ventricle (RV) alters the natural pattern of activation and as a consequence the ventricular contraction. This may lead to the induction of asynchrony with potential risk for the development of ventricular dysfunction. The majority of studies have looked into left ventricular dysfunction, while effects on the RV have not been studied. Furthermore, there are little data on the chronology of events that occur in pacemaker patients. We, therefore, aimed to evaluate diastolic and systolic functions of LV and RV in consecutive patients undergoing Ventricle is paced, sensed, and the pulse generator inhibits pacing output in response to a sensed ventricular event (VVI) permanent pacemaker implantation over 6 months using trans-thoracic echocardiography. Materials and Methods: This was a hospital-based observational study from October 2017 to April 2019. Conclusion: Diastolic abnormalities are first to appear which are followed by appearance of systolic abnormalities of the respective ventricles. The right ventricular dysfunction (tricuspid annular plane systolic excursion &lt;17 mm) developed in 28% at 1 month and in 62% at the end of 6 months. The left ventricular dysfunction (ejection fraction&lt; 50%) occurs later, LV dysfunction developed in 14%, and worsening of LV function developed in 16% of the study population at the end of study, that is, 6 months.

Assessment of biventricular function with speckle tracking echocardiography in newly-diagnosed adult-onset asthma

Objective There is limited number of studies on the effect of asthma disease on cardiac functions. The aim of this study was to investigate if there was any association between adult onset asthma and cardiac dysfunction. Methods Total of 83 nonsmoking adult onset asthma patients aged between 18 and 65, and 83 control subjects with comparable age and sex distribution were included in the study.None of the subjects had any chronic cardiovascular or systemic diseases.Two-dimensional, M-mode and tissue Doppler examinations were performed. STE analysis was obtained using the QLAB software. Complete blood count and high-sensitive C-reactive protein (hsCRP) levels were measured. Results There was no difference between two groups in terms of standard echocardiography and Doppler parameters. While tricuspid annular plane systolic excursion (TAPSE) was observed to be lower in asthmatics (24.9 ± 2.0 vs. 25.5 ± 2.1, p = 0.043), right ventricular myocardial performance index (RV MPI) was higher (0.36 ± 0.07 vs 0.32 ± 0.06, p˂0.001). There was no significant difference between the groups in terms of left ventricular STE parameters. Measurements of right ventricular global longitudinal strain (RVGLS) and right ventricular free wall strain (RVfree) were observed to be lower in the asthma group (-20.3 ± 2.9 vs −21.5 ± 2.9, p = 0.007; −24.0 ± 3.0 vs 25.1 ± 2.9, p = 0.009, respectively). Conclusion -We demonstrated that while adult onset mild-stage asthma patients have normal parameters in standard echocardiography, they have reduced right ventricular functions by STE.

Assessment of biventricular function using advanced echocardiography in patients with Ebstein's anomaly pre and post-tricuspid valve surgery

Abstract Background Ebstein's anomaly (EA) is a right ventricular myopathy with failure of tricuspid valve (TV) delamination. While conventional echocardiographic measurements of ventricular function such as tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging RV systolic velocity (s'), fractional area change (FAC) and left ventricle ejection fraction (LV EF) are load dependent measures of systolic function and may not reflect true myocardial function, speckle tracking echocardiography (STE) evaluates more subtle myocardial deformation on a regional level. However, the role of STE for the biventricular assessments in an adult cohort of EA before and after tricuspid valve repair/replacement (TVR) is not fully elucidated. Purposes To assess biventricular function by conventional echocardiographic parameters and global and regional longitudinal strain (GLS, RLS) using speckle tracking echocardiography in adult patients with EA pre- and post-TVR. Methods 47 patients with EA (57% women, age at operation 37±16 years) who had TV repair/replacement (17/30) between 2005 and 2019 were retrospectively identified from Echo database. 2D conventional echocardiographic parameters (TAPSE, s', FAC and LV EF) and biventricular GLS and RLS were assessed pre-TVR, at 1-, 2- and 5-year post-TVR. RV and LV segments were visually graded for STE feasibility assessment (Figure 1). Results TAPSE and s' declined after TVR with no further changes over 5 years (both p&amp;lt;0.0001); FAC decreased after TVR (p=0.005) with some amelioration but remaining impaired at 5 years. RV GLS deteriorated at 1 year post-TVR with improvements at 2 and 5 years (p&amp;lt;0.0001, Table 1). LV EF remained preserved (p=0.2), however, LV GLS was low pre-TVR and decreased at 1 year with improvements at 2 and 5 years (p=0.004). Least feasible segments were RV mid (pre-TVR and 1y and 5y post-TVR) and apical free wall (both pre- and post-operative) and LV apical lateral (pre-TVR and 2y post-TVR) all with median score of 1. Conclusions Despite the TV regurgitation reduction, TV surgeries have led to RV dysfunction with only some amelioration of RV longitudinal strain and all conventional echocardiographic parameters after 5 years. The segmental analysis showed that the basal septal segment was the most negatively affected. LV strain was reduced before and after surgery despite preserved ejection fraction. Hence, speckle tracking echocardiography is a feasible and a sensitive method in detecting myocardial dysfunction in patients with Ebstein's anomaly. Feasibility assessment Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Royal Brompton Hospital; Imperial College

Assessment of biventricular function by three-dimensional speckle-tracking echocardiography in clinically well pediatric heart transplantation patients.

The biventricular function plays an important role in the prognosis of pediatric heart transplantation (HTx) patients. Therefore, in this study, we aimed to evaluate the biventricular function of pediatric HTx patients by three-dimensional (3D) speckle-tracking echocardiography (3D-STE). We enrolled 30 clinically well pediatric HTx patients and 30 healthy controls with a similar distribution of sex and age to the HTx. All participants underwent comprehensive two-dimensional (2D) and 3D echocardiography. Left ventricular (LV) global longitudinal strain (GLS), global circumferential strain (GCS), left and right ventricular ejection fraction (LVEF and RVEF, respectively), and right ventricular free wall longitudinal strain (RV FWLS) were acquired by 3D-STE. Moreover, the correlations between strains and clinical data were explored. Compared with controls, LV GLS was decreased in pediatric HTx patients (P<.05), while LV GCS and LVEF showed no difference. LV GLS showed a weak correlation with cold ischemic time in HTx group (r=0.396, P<.05). Meanwhile, RVEF and RV FWLS were significantly lower in the HTx group (P<.05). In the HTx group, RV FWLS showed a weak correlation with the preoperative mean pulmonary artery pressure (r=0.420, P<.05) and postoperative pulmonary artery systolic pressure (r=0.465, P<.05). The 3D-biventricular mechanical functions were decreased in clinically well pediatric HTx patients. The provided characteristics and appropriate normal values of biventricular mechanical functions can be the basis in subsequent studies in the pediatric HTx patients.

Immediate and short-term biventricular function assessment post-atrial septal defect surgical versus device closure: A comparative two-dimensional speckle tracking study

BackgroundQuantitative assessment of biventricular function in atrial septal defect (ASD) patients before and after closure remains debatable. This study aimed to assess the global biventricular strain in ASD patients before and 24 h and one month after transcatheter and surgical closure. MethodsStandard Two-Dimensional (2D)-echocardiography and strain imaging were done for sixty ASD patients before, and 24 h and one month after correction by surgery or transcatheter intervention. Also, all echocardiographic and strain parameters for twenty age-matched controls were included. 2D- Strain (S) imaging was measured by speckle tracking analysis. ResultsRight ventricle global longitudinal systolic strain (RV GLSS) was significantly reduced after 24 h of ASD closure in both device and surgical groups. The reduction in RV GLSS was greater in the surgical group (8.00 ± 1.76% vs 2.60 ± 0.72%, P = 0.004). Left ventricle global longitudinal systolic strain (LV GLSS) showed a statistically significant decline after 24 h of device closure (from −24.47 ± 0.57% to −23.14 ± 0.65%, p = 0.048) followed by a significant increase in LV GLSS (from-23.14 ± 0.65% to −24.15 ± 0.75%, p = 0.038) after 1 month. ConclusionsThe ASD closure had a rapid impact on geometric and functional changes of both ventricles regardless of the way of closure. Interestingly, the rate of improvement in LV-GLSS was higher after device closure than a surgical one within one month follows.

Reduced Exercise Capacity in Diabetes Mellitus Is Not Associated with Impaired Deformation or Twist

Exercise capacity is frequently reduced in people with diabetes mellitus (DM) and may be due to subclinical cardiac dysfunction. Speckle-tracking echocardiography is now widely available; however, the clinical utility and significance of left ventricular (LV) strain and twist parameters remain uncertain. We hypothesized that LV strain and twist would be reduced in DM subjects during exercise. Adults with type 1 or type 2 DM and age- and sex-matched controls performed cardiopulmonary exercise testing (VO2 peak) and supine bicycle exercise echocardiography. Detailed echocardiographic assessment of biventricular function was performed at baseline and repeated during incremental exercise to maximal intensity. Of the 60 participants completing the study protocol, 51 (34 DM, 17 controls; mean age, 42±13years; 69% male; DM duration, 16±10years) had sufficient image quality to assess LV deformation and twist mechanics at rest. Of these, 38 (25 DM, 13 controls) were able to be assessed immediately after exercise. Baseline LV systolic and diastolic function using standard echocardiography measurements were similar between groups. Resting LV global longitudinal strain, twist, twist rate and untwist rate, and the corresponding peak exercise and reserve measures did not differ significantly. As compared with the control subjects, exercise capacity was reduced in the DM cohort (VO2 peak 33±10 vs 41±12mL/minute/kg; P=.02); however, no correlation was observed between VO2 peak and LV twist reserve (R=0.28, P=.09), LV twist rate reserve (R=0.14, P=.39), or LV untwist rate reserve (R=0.24, P=.14). Despite reduced VO2 peak, LV twist mechanics at rest and after maximal intensity exercise did not differ significantly in a cohort of asymptomatic DM subjects with normal resting LV systolic and diastolic function compared with age- and sex-matched controls. This would suggest that exercise capacity can be reduced in the absence of subclinical cardiac dysfunction and that noncardiac factors should be considered as alternative explanations.

Assessment of Biventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Adolescents and Young Adults with Human Immunodeficiency Virus Infection: A Pilot Study

Background: The purpose of the study was to assess biventricular parameters of wall deformation with three-dimensional speckle tracking echocardiography (3DSTE) in adolescents and young adults with human immunodeficiency virus (HIV) infection on antiretroviral therapy in order to detect a possible subclinical myocardial dysfunction. Methods: Twenty-one patients aged 12–39 years with HIV, 21 normal controls of the same age and sex, and 21 patients with idiopathic nonischemic dilated cardiomyopathy (DCM) were studied with 3DSTE. All HIV patients were stable in terms of HIV infection, with no history of heart disease or other chronic systemic disease except HIV infection, and were on highly active antiretroviral therapy with good immunological control. Standard echocardiographic measures of left ventricular (LV)-right ventricular (RV) function were assessed. 3D LV global longitudinal strain (GLS), circumferential strain, radial strain, and LV twist were calculated. Global area strain (GAS) was calculated by 3DSTE as percentage variation in surface area defined by the longitudinal and circumferential strain vectors. 3D RV global and free-wall longitudinal strain (FWLS) were obtained. Results: LV GLS and GAS were lower in HIV patients compared to normal controls (p = 0.002, and p = 0.01, respectively). There were no significant differences in LV ejection fractions between the groups. There was a weak positive correlation between LV GLS and age (r = 0.215, p = 0.034) and a weak negative correlation between LV GLS and nadir-CD4 T-cells count (r = 0.198, p = 0.043). DCM patients had more marked and widespread reduction in LV GLS and GAS compared to controls (p < 0.001), whereas in HIV patients LV strain impairment (p < 0.05) was more localized in basal and apical regions. RV FWLS was significantly reduced in HIV patients when compared with the control group (p = 0.03). No patient had pulmonary systolic pressure higher than 35 mm Hg. Conclusions: 3DSTE may help to identify HIV patients at high cardiovascular risk allowing early detection of biventricular dysfunction in the presence of normal LV ejection fraction and in the absence of pulmonary hypertension. LV strain impairment in HIV patients is less prominent and widespread compared to DCM patients.

Cardiovascular Adaptations During the Hormonal Transition of a Male-to-Female Transgender Athlete

PURPOSE: Cardiovascular consequences of female sex hormone exposure on human male biology are currently unknown. This level of investigation is critical given potential adverse outcomes reported in rodent models. This case study aimed to comprehensively assess cardiovascular phenotypes before and during estrogen treatment for gender reassignment METHODS:This is the case of a biologically male, distance runner (28 yr) undergoing male-to-female gender reassignment. Two baseline assessments were made prior to initiation of hormone treatment. Testing following initiation of estrogen treatment took place at 4-8 week intervals depending on subject’s availability. Testing included resting echocardiography for assessment of biventricular function, dual energy x-ray absorptiometry (DXA), and central vascular blood pressures and stiffness assessments. Treadmill-based VO2 peak and running economy, as well as non-invasive cardiac output and a-vO2 difference at rest and at peak exercise were quantified at each visit RESULTS: Throughout the first 12 months of treatment, stroke volume decreased (136 to 80 ml/beat) with an initial reduction in peak heart rate (ranged 188-180 bpm). Consequently, peak cardiac output declined (28.4 L/min to 15.5 L/min) while a-vO2 difference increased (11.6 to 19.9 ml O2/100 ml blood). This resulted in only a minor decrease in absolute VO2 peak (3.3 to 3.1 L/min). Ejection fraction (calculated using modified Simpson’s method via echocardiogram) decreased (61% to 57%) along with left ventricular diastology (mitral valve E/e 6.0 to 4.1). Right Ventricular Fractional Area change was unaffected (53% to 53%), while measures of right heart diastology increased (tricuspid valve E/e 3.9 to 4.6). Both right ventricular (RV) and left ventricular (LV) strain initially improved with the addition of estrogen, before worsening over the course of hormone treatment (RV strain ranged from -36 to -31.5%; LV strain ranged from -23.5 to -19%) CONCLUSIONS: Therapeutic estrogen administration and testosterone blockade may adversely affect cardiopulmonary fitness via reduction in myocardial performance at peak exercise. This may be associated with a worsening of LV and RV strain at rest. More research is needed to examine the long-term effects of gender reassignment therapy on cardiovascular function

Echocardiographic Assessment of Biventricular Function in 249 Patients During the Peri-Extracorporeal Membrane Oxygenation Period

At a quaternary care center that regularly performs and cares for patients undergoing extracorporeal membrane oxygenation (ECMO), a database of all adult patients since 2009 was assembled with echocardiographic parameters of left (LV) and right (RV) ventricular function. From the database, 175 venoarterial (VA) and 74 venovenous (VV) ECMO patients were analyzed to compare the decannulation echocardiographic assessments of biventricular function before, during, and after ECMO in survivors and nonsurvivors. Retrospective chart review-based study. A single quaternary care center. All adult patients who received ECMO from 2009 to 2017 with both survival data and echographic studies were included in this retrospective study. When indicated, transthoracic and transesophageal echocardiograms were performed for ECMO patients. The results of these echocardiograms were reviewed retrospectively, and differences between survivors and nonsurvivors were examined. A retrospective chart review of before, during cannulation, and after decannulation echocardiographic assessments of biventricular function was performed. On average, VA ECMO survivors had better post-decannulation LV function than did nonsurvivors by a full clinical grade-mild impairment versus moderate impairment (p < 0.001). RV function comparison was similar-mild impairment in survivors versus moderate impairment in nonsurvivors (p = 0.007). LV and RV function before and during ECMO in survivors was not different from that of nonsurvivors. The change in biventricular function from before to after cannulation and during cannulation to post-cannulation was approximately a full clinical grade better in survivors than nonsurvivors (p < 0.01 in all cases). In VV ECMO patients, post-decannulation RV function was significantly worse in nonsurvivors (moderate dysfunction vs borderline normal function) (p = 0.013). Retrospective chart review of 249 patients suggests that echocardiographic assessment of biventricular function before ECMO cannulation is not prognostic in VA or VV ECMO patients. Post-decannulation assessment of biventricular function may aid in triaging more "at risk" patients because nonsurvivors have significantly worse biventricular function after decannulation. The failure to improve biventricular function from the before to after ECMO phases and the during to after ECMO phases is concerning for a poor prognosis.

SAT-210 - Assessment of biventricular function in patients with decompensated cirrhosis and hepatopulmonary syndrome

SAT-210 - Assessment of biventricular function in patients with decompensated cirrhosis and hepatopulmonary syndrome

Multimodality imaging evaluation of Chagas disease: an expert consensus of Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI).

To develop a document by Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI) to review and summarize the most recent evidences about the non-invasive assessment of patients with Chagas disease, with the intent to set up a framework for standardized cardiovascular imaging to assess cardiovascular morphologic and functional disturbances, as well as to guide the subsequent process of clinical decision-making. Chagas disease remains one of the most prevalent infectious diseases in Latin America, and has become a health problem in non-endemic countries. Dilated cardiomyopathy is the most severe manifestation of Chagas disease, which causes substantial disability and early mortality in the socially most productive population leading to a significant economical burden. Prompt and correct diagnosis of Chagas disease requires specialized clinical expertise to recognize the unique features of this disease. The appropriate and efficient use of cardiac imaging is pivotal for diagnosing the cardiac involvement in Chagas disease, to stage the disease, assess patients' prognosis and address management. Echocardiography is the most common imaging modality used to assess, and follow-up patients with Chagas disease. The presence of echocardiographic abnormalities is of utmost importance, since it allows to stage patients according to disease progression. In early stages of cardiac involvement, echocardiography may demonstrate segmental left ventricuar wall motion abnormalities, mainly in the basal segments of inferior, inferolateral walls, and the apex, which cannot be attributed to obstructive coronary artery arteries. The prevalence of segmental wall motion abnormalities varies according to the stage of the disease, reaching about 50% in patients with left ventricular dilatation and dysfunction. Speckle tracking echocardiography allows a more precise and quantitative measurement of the regional myocardial function. Since segmental wall motion abnormalities are frequent in Chagas disease, speckle tracking echocardiography may have an important clinical application in these patients, particularly in the indeterminate forms when abnormalities are more subtle. Speckle tracking echocardiography can also quantify the heterogeneity of systolic contraction, which is associated with the risk of arrhythmic events. Three-dimensional (3D) echocardiography is superior to conventional two-dimensional (2D) echocardiography for assessing more accurately the left ventricular apex and thus to detect apical aneurysms and thrombus in patients in whom ventricular foreshortening is suspected by 2D echocardiography. In addition, 3D echocardiography is more accurate than 2D Simpson s biplane rule for assessing left ventricular volumes and function in patients with significant wall motion abnormalities, including aneurysms with distorted ventricular geometry. Contrast echocardiography has the advantage to enhancement of left ventricular endocardial border, allowing for more accurate detection of ventricular aneurysms and thrombus in Chagas disease. Diastolic dysfunction is an important hallmark of Chagas disease even in its early phases. In general, left ventricular diastolic and systolic dysfunction coexist and isolated diastolic dysfunction is uncommon but may be present in patients with the indeterminate form. Right ventricular dysfunction may be detected early in the disease course, but in general, the clinical manifestations occur late at advanced stages of Chagas cardiomyopathy. Several echocardiographic parameters have been used to assess right ventricular function in Chagas disease, including qualitative evaluation, myocardial performance index, tissue Doppler imaging, tricuspid annular plane systolic excursion, and speckle tracking strain. Cardiac magnetic resonance (CMR) is useful to assess global and regional left ventricular function in patients with Chagas diseases. Myocardial fibrosis is a striking feature of Chagas cardiomyopathy and late gadolinium enhancement (LGE) is used to detect and quantify the extension of myocardial fibrosis. Myocardial fibrosis might have a role in risk stratification of patients with Chagas disease. Limited data are available regarding right ventricular function assessed by CMR in Chagas disease. Radionuclide ventriculography is used for global biventricular function assessment in patients with suspected or definite cardiac involvement in Chagas disease with suboptimal acoustic window and contraindication to CMR. Myocardial perfusion scintigraphy may improve risk stratification to define cardiac involvement in Chagas disease, especially in the patients with devices who cannot be submitted to CMR and in the clinical setting of Chagas patients whose main complaint is atypical chest pain. Detection of reversible ischemic defects predicts further deterioration of left ventricular systolic function and helps to avoid unnecessary cardiac catheterization and coronary angiography. Cardiac imaging is crucial to detect the cardiac involvement in patients with Chagas disease, stage the disease and stratify patient risk and address management. Unfortunately, most patients live in regions with limited access to imaging methods and point-of-care, simplified protocols, could improve the access of these remote populations to important information that could impact in the clinical management of the disease. Therefore, there are many fields for further research in cardiac imaging in Chagas disease. How to better provide an earlier diagnosis of cardiac involvement and improve patients risk stratification remains to be addressed using different images modalities.

Comprehensive echocardiographic assessment of biventricular function in the rabbit, animal model in cardiovascular research: feasibility and normal values.

Quantification of cardiac structure and function is central in cardiovascular research. Rabbits are valuable research models of cardiovascular human disease; however, there is little normal data available. The aim of this study was to investigate feasibility and provide normal values for comprehensive echocardiographic assessment of biventricular function in rabbits. New Zealand white rabbits underwent trans-thoracic echocardiography using a general electric (GE) Vivid 7/E9 system with a 10MHz transducer, under light sedation, to evaluate biventricular function and dimensions. Images for two-dimensional, M-mode, tissue Doppler imaging (TDI) and speckle-tracking strain echocardiography were acquired and analysed. 55 male rabbits (sized matched with a newborn human baby) were studied, mean weight was 2.9 ± 0.23kg. Adequate images were obtained in 90% for the left ventricle (LV) and 80% for the right ventricle (RV). Two-dimensional speckle-tracking strain was feasible in 60%. Average heart rate was 248 ± 36 beats per minute; LV ejection faction 72 ± 8.0; RV fractional area change 45.9 ± 9.0%; RV myocardial performance index 0.39 ± 0.35; tricuspid annular planar systolic excursion 0.60 ± 0.24cm. LV TDI parameters were S' 8.6 ± 3.1cm/s; E' 12.0 ± 4.46cm/s. RV TDI parameters were S' 10.49 ± 3.18; E' 14.95 ± 4.64cm/s. LV and RV global peak systolic longitudinal strain were -17 ± 5 and -22 ± 8%, respectively. Comprehensive investigation of biventricular dimensions and function by echocardiography is feasible in the rabbit. Apical views and strain imaging have lower feasibility. Normal values of LV and RV functional parameters are with comparable values to human children. Animal cardiovascular research is key to develop new goals in clinical practice.

Assessment of Biventricular Function by Three-Dimensional Speckle-Tracking Echocardiography in Secondary Mitral Regurgitation after Repair with the MitraClip System.

The goal of this study was to determine changes in left ventricular (LV) and right ventricular (RV) function with three-dimensional (3D) speckle-tracking echocardiography (STE) after percutaneous mitral valve repair with the MitraClip system in high-risk surgical patients with moderate to severe or severe secondary mitral regurgitation (MR). Thirty-two patients with MR undergoing MitraClip were prospectively included. Patients underwent two-dimensional (2D) and 3D transthoracic echocardiography before clip implantation and after 6-month follow-up. LV and RV longitudinal strain was obtained by 2D STE and 3D STE. LV circumferential, radial, and area strain was calculated by 3D STE. Data analysis was performed offline. At 6-month follow-up, significant improvements were seen in LV 2D global longitudinal strain (P<.005), 3D global longitudinal strain (P=.0002), and 3D area strain (P=.0001). Overall, significant improvements were also seen in 3D RV ejection fraction (P<.05) and 3D RV free-wall longitudinal strain (P<.05). A poor increase in LV strain after clip implantation (P=NS) occurred in patients with pronounced preexisting RV dysfunction. The areas under the receiver operating characteristic curves for LV and RV 3D speckle-tracking echocardiographic parameters showed high discriminative values (range, 0.87-0.91) in predicting unfavorable outcomes with persistent symptoms (New York Heart Association class>II) after the procedure. Three-dimensional STE showed overall LV and RV strain improvement after clip implantation as well as lower postprocedural LV strain values in patients with worse preexisting RV function. These findings could help in guiding MR treatment strategies, suggesting different therapies in the presence of marked RV impairment or anticipating the procedure in case of evolving RV dysfunction.

Comprehensive assessment of biventricular function and aortic stiffness in athletes with different forms of training by three-dimensional echocardiography and strain imaging

Previous studies have shown distinct models of cardiac adaptations to the training in master athletes and different effects of endurance and strength-training on cardiovascular function. We attempted to assess left-ventricular (LV) function, aortic (Ao) function, and right-ventricular (RV) function in athletes with different forms of training by using three-dimensional (3D) echocardiography, tissue Doppler imaging (TDI) and speckle-tracking imaging (STI). We examined 35 male marathon runners (endurance-trained athletes, ETA), 35 powerlifting athletes (strength-trained athletes, STA), 35 martial arts athletes (mixed-trained athletes, MTA), and 35 sedentary untrained healthy men (controls, CTR). Two-dimensional and three-dimensional echocardiography were performed for the assessment of LV and RV systolic/diastolic function. LV and RV longitudinal strain (LS) and LV torsion (LVtor) were determined using STI (EchoPAC BT11, GE-Ultrasound). Maximum velocity of systolic wall expansion peaks (AoSvel) was determined using TDI. ETA experienced LV eccentric hypertrophy with increased 3D LV end-diastolic volume and mass and significant increase in peak systolic apical rotation and LVtor. In all groups of athletes, RV-LS was reduced at rest and improved after exercise. AoSvel was significantly increased in ETA and MTA and significantly decreased in STA compared with CTR. There were good correlations between LV remodelling and aortic stiffness values. Multivariate analysis showed aortic wall velocities to be independently related to LV mass index. In strength-trained, endurance-trained, and mixed-trained athletes, ventricular and vascular response assessed by 3DE, TDI, and STI underlies different adaptations of LV, RV, and aortic indexes.