Evaluation Of Cardiac Function Research Articles

Diagnosis of Acute Myocarditis Using Texture-Based Cardiac Magnetic Resonance, with CINE Imaging as a Novel Tissue Characterization Technique.

Cardiac magnetic resonance (CMR) has emerged as a useful tool in the diagnostic work-up of patients with clinically suspected acute myocarditis (AM), yet the diagnosis remains challenging. The purpose of this proof-of-concept study was to evaluate if data-driven texture analysis has the feasibility to automatically distinguish between patients with and without CMR-verified AM using T2-weighted, late gadolinium enhancement, and CINE imaging. In particular, the present study investigated if functional CINE imaging could be used as a novel tissue characterization technique. Twenty patients with clinically suspected AM, separated into CMR-verified (n = 10) and non CMR-verified (n = 10) AM according to the Lake Louise criteria, were retrospectively included. Texture features were extracted from the images, compared on a group level, and correlated to the diagnostic outcome (CMR-verified versus non CMR-verified AM). Several features showed good to excellent reproducibility with very large differences between the groups, and moderate to strong correlation with the diagnostic outcome, suggesting that CMR texture analysis is a promising diagnostic tool for patients with clinically suspected AM. Furthermore, findings indicate that CINE imaging, which is currently used for the evaluation of cardiac function, might be a useful non-contrast-based technique for tissue characterization in patients with clinically suspected AM.

1098 CHARACTERIZATION OF DIFFERENT TYPES OF LV REMODELING USING QUANTITATIVE INTRACARDIAC FLUID-DYNAMICS

Abstract Background Hyperdoppler is a novel advanced echocardiographic technique for the quantitative assessment of intracardiac fluid-dynamics. Recently, its use has been proven useful to complement traditional echocardiographic evaluation of cardiac function in Heart Failure. However, no specific data are available on its application to differentiate between different types of LV remodeling. Thus, our aim was to investigate whether quantitative changes in fluid dynamics might be able to characterize patients with different ventricular geometry. Methods We enrolled 100 consecutive patients with one of the following: LV concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodeling, normal LV geometry (CTRL). They underwent a complete echocardiographic examination with intracardiac fluid-dynamic analysis by Color Vector Flow Mapping (Hyperdoppler, Esaote, Genova, Italy). The following parameters were obtained: vortex area (VA); vortex length (VL); vortex depth (VD). Bland Altman Plot has been used to assess intra and inter-observer variability. Results Mean Vortex Depth was significantly higher in CR (p=0.011), CH (p=0.001) and EH (p=0.025) compared to CTRL (p=0.013, p=0.001 and p=0.022, respectively). In addition, CH had significantly higher Vortex Length (p= 0.008) and larger VA (p=0.012) compared to CTRL. No significative differences in vortices parameters have been observed between CH and EH. Conclusion(s) Quantitative fluid-dynamic assessment was feasible and reliable in the whole population and is a promising tool to complement standard echocardiography for the early characterization of different types of LV remodeling.

Relationship between haemodynamic indicators and haemogram in patients with heart failure.

Pulmonary congestion, reduced cardiac output, neurohumoral factor activation, and decreased renal function associated with decreased cardiac function may have various effects on haemograms. The relationship between these factors and haemograms in patients with heart failure has not been sufficiently investigated. Recently, it was suggested that the lungs are an important site for platelet (Plt) biosynthesis and that it is necessary to study the relationship between pulmonary congestion and Plt count in heart failure in detail. In this study, we examined the relationship between various haemodynamic indicators and haemograms in detail using statistical analyses. A total of 345 patients who underwent cardiac catheterization for the evaluation of cardiac function between 1 January 2015 and 31 December 2020 were included in the study. Haemodynamic indices, including left ventricular end-diastolic pressure (LVEDP) and cardiac index (CI), were measured. Plasma noradrenaline (Nor) concentration, estimated glomerular filtration rate (eGFR), white blood cell (WBC) count, haemoglobin (Hb) level, and Plt count were measured using blood samples collected at the same time. Structural equation modelling (SEM) was used to examine the relationship between LVEDP, CI, plasma Nor concentration, eGFR, WBC count, Hb level, and Plt count. Bayesian inference using SEM was performed for Plt count. A total of 345 patients (mean age: 66.0±13.2years) were included in this study, and 251 (73%) patients were men. After simple and multiple regression analyses, path diagrams were drawn and analysed using SEM. LVEDP showed a significant negative relationship with Plt count (standardized estimate: -0.129, P=0.015), and CI showed a significant negative relationship with Hb level (standardized estimate: -0.263, P<0.001). Plasma Nor concentration showed a significant positive relationship with WBC count (standardized estimate: 0.165, P=0.003) and Plt count (standardized estimate: 0.198, P<0.001). The eGFR had a significant positive relationship with Hb level (standardized estimate: 0.274, P<0.001). Bayesian inference using SEM revealed no relationship between LVEDP and Hb level or WBC count but a significant negative relationship between LVEDP and Plt count. LVEDP, CI, plasma Nor concentration, and eGFR were related to WBC count, Hb level, and Plt count in patients with heart failure. There was a strong relationship between elevated LVEDP and decreased Plt count, suggesting that pressure overload on the lungs may interfere with the function of the lung as a site of Plt biosynthesis.

Comparative electrocardiographic study of the Asian freshwater box turtle Cuora flavomarginata and the Asian yellow pond turtle Mauremys mutica using non-invasive methods.

Evaluation of cardiac function is an integral part of clinical examination of chelonians. However, information about electrocardiography (ECG) in turtles and tortoises is limited and fragmentary. Its application is limited due to the lack of ECG reference values. This study aimed to compare specific ECG parameters using non-invasive methods in the Asian box turtle Cuora flavomarginata (CF) and the Asian yellow pond turtle Mauremys mutica (MM). We included 116 clinically healthy and conscious turtles. Two non-invasive methods, using adhesive patches or crocodile clips, for ECG were applied where possible. The ambient temperature was within the preferred optimum temperature zone of both species. We used specific digital ECG monitoring equipment to record the ECG data and analysed the data using specific software. The MM group showed better ECG quality and lower heart rate than the CF group. Comparing both methods, the adhesive patches method yielded higher ECG quality in the CF group, while the crocodile clips method yielded higher ECG quality in the MM group. The study population was selected as presumed healthy turtles; the presence of systemic or cardiac disease could not be excluded completely due to limited investigation. Both ECG methods were clinically potentially useful for obtaining ECG parameters; the ECG quality was influenced by the method used.

Evaluation of foetal tricuspid annular plane systolic excursion with conventional m-mode ultrasound in normal pregnancy

Background: Foetal tricuspid annular plane systolic excursion (fTAPSE) in-utero helps in the evaluation of the right foetal cardiac function, which is key in the early diagnosis of congenital heart defects and abnormalities. Objectives of the study was to assess foetal TAPSE in the second half of normal pregnancy, establish reference ranges for this measurement in our environment, and to determine the relationship of foetal TAPSE with gestational age and estimated foetal weight.Methods: This descriptive cross-sectional study was conducted between March 2022 and August 2022 at the Obstetric Units and Radiology Departments of the two tertiary facilities, one secondary facility and one radiodiagnostic facility in Bayelsa State, Nigeria. Consenting pregnant women presenting to the antenatal clinic during the second half of pregnancy were consecutively included. An obstetric ultrasound scan was performed transabdominally. Data were analysed using SPSS version 25.Results: There was a very strong, positive and significant relationship between fTAPSE and gestational age (ɼ=0.81; p=0.001); and between fTAPSE and estimated foetal weight (ɼ=0.79; p=0.001). The mean fTAPSE and standard deviation from the 20th to the 23rd week of gestation were 2.10±1.11 mm, 2.43±0.95, 2.74±0.84 mm and 2.94±0.70 mm, showing a gradual increase in mean fTAPSE as gestational age increases.Conclusions: Our study revealed that there was a significant relationship between fTAPSE and gestational age; and between fTAPSE and estimated foetal weight, which correlates with published data around the globe.

Abstract 14791: Evaluation of Cardiac Size, Shape and Function in Fetuses With Coarctation of the Aorta by Fetal Heart Quantitative Technique

Introduction: This study aimed to evaluate the size and shape of the four-chamber view (4CV) and right and left ventricles (RV and LV) as well as the function of the RV and LV in fetuses with coarctation of the aorta (CoA) using fetal heart quantitative (Fetal HQ) technique. Methods: A total of 67 CoA fetuses and 67 gestational age-matched controls were included. Fetal HQ technique was used to obtain the 4CV end-diastolic (ED) width, length, area, and global sphericity index (GSI), RV and LV 24-segment ED diameter (EDD), 24-segment sphericity index (SI), area, and the following functional parameters: (1) fractional area change (FAC); (2) global longitudinal strain (GLS); (3) 24-segment transverse fractional shortening (FS); (4) LV ejection fraction (LVEF), LV ED volume (LVEDV), LV stroke volume (LVSV) and LV output (LVO). Results: Compared with normal controls, the Z-score of 4CV ED width was increased ( P &lt; 0.05), while the GSI was decreased ( P &lt; 0.05) in fetuses with CoA. However, there were no significant differences in the Z-scores of 4CV ED length and area between two groups (both P &gt; 0.05) The RV 24-segment EDD Z-scores, RV area Z-score as well as the RV/LV 24-segment EDD were significantly higher in CoA fetuses than in controls (all P &lt; 0.05). In contrast, the LV 24-segment EDD Z-scores and area Z-score were significantly lower in fetuses with CoA ( P &lt; 0.05). The 24-segment SIs of the LV were significantly higher, while the 24-segment SIs of the RV were significantly lower in CoA group (all P &lt; 0.05). CoA fetuses presented lower GLS, FAC and 24-segment FSs for both RV and LV when compared with normal controls (all P &lt; 0.05). In addition, LVEF, LVEDV Z-score, LVSV Z-score and LVO Z-score were all decreased in CoA fetuses (all P &lt; 0.05). Conclusions: In fetuses with CoA, the 4CV was increased in width and spherical in shape. The LV area and width were decreased, while the transverse width and area of RV was increased. Abnormal SIs reflected a flatter LV and a more spherical RV. RV and LV global, longitudinal, and transverse contractility were all depressed. Fetal HQ can be used to quantitatively analyze cardiac size, shape and function in CoA fetuses, which may improve prenatal diagnosis of CoA.

Abstract 10933: Artificial Intelligence Enabled Fully Automated Myocardial Strain Quantification for Risk Stratification Following Acute Myocardial Infarction

Introduction: Feasibility of automated volume-derived cardiac functional evaluation has successfully been demonstrated using cardiovascular magnetic resonance (CMR) imaging. Notwithstanding, strain assessment has proven incremental value for cardiovascular risk stratification. Since introduction of deformation imaging to clinical practice has been complicated by time-consuming post-processing, we sought to investigate automation respectively. Methods: CMR data (n=1095 patients) from two prospectively recruited acute myocardial infarction (AMI) populations with ST-elevation (STEMI) (AIDA STEMI n=759) and non-STEMI (TATORT-NSTEMI n=336) were analysed fully automated and manually on conventional cine sequences. LV function assessment included global longitudinal, circumferential, and radial strains (GLS/GCS/GRS). Agreements were assessed between automated and manual strain assessments. The former were assessed for major adverse cardiac event (MACE) prediction within 12 months following AMI. Results: Manual and automated derived GLS showed the best and excellent agreement with an intraclass correlation coefficient (ICC) of 0.81. Agreement was good for GCS and poor for GRS. Amongst automated analyses, GLS (HR 1.12, 95% CI 1.08-1.16, p&lt;0.001) and GCS (HR 1.07, 95% CI 1.05-1.10, p&lt;0.001) best predicted MACE with similar diagnostic accuracy compared to manual analyses; area under the curve (AUC) for GLS (auto 0.691 vs. manual 0.693, p=0.801) and GCS (auto 0.668 vs. manual 0.686, p=0.425). Amongst automated functional analyses, GLS was the only independent predictor of MACE in multivariate analyses (HR 1.10, 95% CI 1.04-1.15, p&lt;0.001). Conclusions: Considering high agreement of automated GLS and equally high accuracy for risk prediction compared to the reference standard of manual analyses, automation may improve efficiency and aid in clinical routine CMR examinations.

Evaluation of Cardiac Function in Uncomplicated COVID-19 Survivors by 2-Dimensional Speckle Tracking Imaging.

COVID-19 is a multi-systemic infectious disease. Nearly 20%-30% of hospitalized patients have evidence of acute myocardial involvement, portending a poorer prognosis. However, information about the long-term effects of the disease on cardiac functions is sparse. As a result, there is a growing concern about the cardiac sequelae of COVID-19 among survivors. This study aimed to investigate the effects of prior mild-moderate COVID-19 infection on cardiac functions, using speckle tracking echocardiography. Patients who have been diagnosed with COVID-19 within the previous 6 months and age-, sex-, and risk factor-matched healthy adults were included. All patients underwent a comprehensive echocardiographic examination. Both conventional and 2-dimensional speckle tracking echocardiographic measurements were performed. Serum cardiac biomarkers were also obtained on the day of the echocardiographic study. Compared with healthy controls, COVID-19 survivors had similar left and right ventricular longitudinal strain values at 6 months. Also, left and right atrial peak systolic strain values did not differ between the groups. Our study is valuable in putting forth the unaffected ventricular and atrial functions on long term in uncomplicated COVID-19 cases and may decrease the survivors' anxiety and the number of unnecessary applications to cardiology clinics.

Cardiovascular Complications in Hematopoietic Stem Cell Transplanted Patients

Hematopoietic stem cell transplantation (HSCT) is the only curative treatment for many patients suffering from hematologic malignancies, solid tumors, inborn errors of metabolism or genetic disorders. Despite decades of successful HSCT, clinical outcomes are still far from satisfactory due to treatment-related complications, including graft-versus-host disease (GvHD) and cardiovascular complications (CVC). CVC may affect patients in the acute period post-HSCT; however, the occurrence is far higher among long-term survivors. Induction treatment using cardiotoxic treatments, e.g., anthracyclines and radiotherapy, conditioning regimens containing cyclophosphamide, and post-HSCT comorbidities, including GvHD, are factors contributing to CVC. Cardiac function evaluation prior to and post-transplantation is an important strategy for choosing the proper conditioning regimen, HSCT protocol and post-HSCT supportive care. Cardiac systolic function evaluation by echocardiography, in addition to serum cardiac biomarkers, such as troponins and brain natriuretic peptides, is recommended as a routine follow-up for HSCT patients. Angiotensin-converting enzyme inhibitors, angiotensin-II-receptor blockers, and beta-blockers, which are mostly used for the treatment of chemotherapy-induced cardiotoxicity, might be used as treatments for HSCT-related CVC. In summary, the present review reveals the urgent need for further investigations concerning HSCT-related CVC both at the preclinical and clinical levels due to the lack of knowledge about CVC and its underlying mechanisms.

Echocardiographic Features of Longevity: A Cross-Sectional Study of Centenarians.

Centenarians represent an under-studied population within cardiovascular medicine. This study aimed to describe the echocardiographic characteristics of a cohort of centenarians at a tertiary referral center. The institutional Echocardiography database was retrospectively reviewed and identified 100 consecutive centenarians referred for transthoracic echocardiography between January 2009 and December 2020. Cardiac chamber quantification, diastology, and valvular heart disease were assessed according to the American Society of Echocardiography guidelines. Independent t-tests and Mann-Whitney U-tests compared data between males and females. The mean age was 101.5 ± 1.7 years, 78% were female, and the most common co-morbidities were hypertension (77%), coronary artery disease (46%), and congestive heart failure (42%). The mean left ventricular (LV) ejection fraction measured 56.9 ± 11.3% (females vs males, 58.4 ± 9.8 vs 51.6 ± 14.6%, p = 0.01). Males had larger LV end-diastolic (2.8 ± 0.6 vs 2.5 ± 0.5, p = 0.03) and end-systolic diameter (1.9 ± 0.6 vs 1.6 ± 0.4, p = 0.001) indices; a smaller relative wall thickness (0.54 ± 0.18 vs 0.69 ± 0.36, p = 0.06); and a lower E/e' ratio (13.3 [10.3-19.6] vs 17.3 [13.2-23], p = 0.05), when compared with females. The prevalence of severe valvular lesions was 13.5%, and similar between genders. However, in patients with aortic stenosis, the transaortic pressure gradients were significantly higher in females (mean gradient: 32.0 ± 17.7 vs 18.7 ± 9.2 mmHg, p = 0.04). The present study on centenarians affords a cross-sectional evaluation of cardiac structure and function in a growing population, and highlights important differences between male and female patients.

Laparoscopic hepatectomy for hepatocellular carcinoma in a patient with congenital factor V deficiency: a case report

BackgroundFactor V (FV) deficiency is an extremely rare disease, with an incidence of 1 in 1 million. The bleeding symptoms are mild, and the prognosis is good; however, the safety of surgical treatment is unclear, because there are few available reports. Herein, we report a case of hepatocellular carcinoma with congenital FV deficiency in a patient who safely underwent laparoscopic hepatectomy.Case presentationA 79-year-old man, diagnosed with hepatocellular carcinoma of liver segment 5, with type C cirrhosis and sustained virological response visited our hospital. He had congenital FV deficiency, and blood tests showed coagulation deficiencies with an FV activity of < 2.6%, prothrombin time activity of 11%, and activated partial thromboplastin time of 100.3 s. Surgery and radiofrequency ablation were considered for treatment. Since the tumor was in contact with the Glissonean pedicle 5 + 6, surgery was judged to be superior from the viewpoint of safety and curability. After discussing the safety of the surgery with a hematologist, it was determined that the operation could be performed safely by transfusing sufficient fresh frozen plasma (FFP). Laparoscopic hepatic segment 5 + 6 subsegmental resection was performed with FFP transfusion, fluid restriction, airway pressure control, and central venous pressure reduction to control the bleeding. Bleeding was minimized during the transection of the liver parenchyma and no bleeding tendency was observed. The operative time was 445 min, and the amount of intraoperative bleeding was 171 mL. No complications, such as postoperative bleeding, were observed, and the patient was discharged on the eighth postoperative day.ConclusionsLiver surgery can be performed safely in FV-deficient patients with strict coagulation capacity monitoring and appropriate transfusion of FFP. Preoperative evaluation of cardiac function to determine tolerance to high doses of FFP and ingenuity of surgery and intraoperative management to minimize blood loss are important.

Screening of anti-heart failure active compounds from fangjihuangqi decoction in verapamil-induced zebrafish model by anti-heart failure index approach.

Heart failure is the end stage of various cardiovascular diseases. Fangjihuangqi Decoction (FJHQD) is a famous traditional Chinese medicine (TCM) formula, which is clinically effective in the treatment of chronic heart failure. However, the anti-heart failure ingredients of FJHQD have not been clarified, and the related mechanisms of action are rarely studied. In the present study, through quantification analysis of heart rate and ventricular area changes, a heart failure model and cardiac function evaluation system in cardiomyocytes-labelled Tg (cmlc2: eGFP) transgenic zebrafish larvae were constructed, and the anti-heart failure index (AHFI) that can comprehensively evaluate the cardiac function of zebrafish was proposed. Based on this model, FJHQD, its mainly botanical drugs, components and ingredients were evaluated for the anti-heart failure effects. The results showed that FJHQD and its botanical drugs exhibited potent anti-heart failure activity. Furthermore, total alkaloids from Stephania tetrandra S. Moore, total flavonoids from Astragalus mongholicus Bunge and total flavonoids from Glycyrrhiza uralensis Fisch. ex DC. were identified to be the main components exerting the anti-heart failure activity of FJHQD. Then, we screened the main ingredients of these components, and glycyrrhizic acid, licochalcone A and calycosin were found to exhibit excellent cardioprotective effects. Finally, we found that FJHQD, glycyrrhizic acid, licochalcone A and calycosin may improve cardiac function in zebrafish by regulating oxidative stress, inflammatory response and apoptosis-related pathways. Taken together, our findings offer biological evidences toward the anti-heart failure effect of FJHQD, and provide guidance for the clinical application of FJHQD.

Evaluation of cardiac function and 30-day clinical outcome with synchronized analysis of phonocardiogram and electrocardiogram in patients with acute myocardial infarction

Abstract Background Acute myocardial infarction (AMI) is associated with short-term and long-term mortality. Survivors of AMI suffer from cardiovascular events, among which heart failure (HF) is the most important factor affecting the prognosis. Echocardiography is a traditional method of measuring cardiac function, but it is inconvenient. Previous studies have identified the effectiveness of a new wearable coin-sized phonocardiogram (PCG) and electrocardiogram (ECG) device in HF patients. In our study, we apply this device in the hospitalization monitoring of post-AMI patients. Purpose The purpose of this study was to evaluate the role of the synchronized analysis of PCG and ECG in identifying cardiac functions in hospitalized AMI patients and to forecast adverse events for 30-days post-AMI in general clinical practice. Methods One hundred and sixty-three ST-elevated myocardial infarction (STEMI) patients and sixty-nine non-ST-elevated myocardial infarction (NSTEMI) patients were enrolled. All were admitted to the hospital and diagnosed with AMI. The left ventricular ejection function (LVEF) was determined by echocardiography and synchronized PCG and ECG signals were recorded using the wearable coin-sized PCG and ECG device on the first day of admission. PCG and ECG signals were analyzed to determine electromechanical activation time (EMAT), EMAT/RR (EMAT%), pre-ejection period/RR (PEP%), left ventricular systolic time/RR (LVST%), left ventricular ejection time/RR (LVET%). Primary endpoint was defined as the occurrence of major adverse cardiovascular events (MACE) following AMI in thirty days. Results ROC analysis demonstrated that the sensitivity and specificity of EMAT% &amp;gt;12.1% for the diagnosis of LVEF &amp;lt;50% were 81% and 82%, respectively. Overall, 232 patients were enrolled who were divided into four groups according to the classification of AMI and EMAT%. Patients in STEMI group with EMAT% &amp;gt;12.1% had a lower LVEF% (p&amp;lt;0.001), greater EMAT (p&amp;lt;0.001), PEP% (p&amp;lt;0.001), LVET% (p&amp;lt;0.001), LVST% (p=0.001), LVEDV (p&amp;lt;0.001) and LVESV (p&amp;lt;0.001). The same pattern was observed in NSTEMI patients between EMAT% &amp;gt;12.1% and EMAT≤12.1% group. Twenty-eight STEMI patients (17.28%) and seventeen NSTEMI patients (24.6%) developed a MACE event. Compared with EMAT≤12.1% group, EMAT% &amp;gt;12.1% group showed a higher occurrence of MACE, especially in post-STEMI patients (36.54% vs 8.11%, p&amp;lt;0.001). Conclusion PCG and ECG offer the possibility to assess the systolic parameters associated with left ventricular (LV) function and clinical status that differ between normal and heart failure states in acute AMI patients, with EMAT% &amp;gt;12.1% as a cut-off for deceased LV systolic function. Moreover, EMAT% &amp;gt;12.1% showed strong association with clinical outcome, suggesting EMAT% may be helpful to further improve the risk stratification of post-AMI patients, especially STEMI patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Shanghai Clinical Research Center for Interventional Medicine,Clinical Research Plan of SHDC

Evaluation of morphology and biventricular cardiac function in children with congenital zika syndrome

Abstract Introduction The infection caused by the Zika virus during pregnancy causes microcephaly and brain damage in fetus, and the systemic involvement with diffuse muscle impairment, high frequency of arthrogryposis and microphthalmia, characterizes congenital Zika syndrome (CZS). The cardiac impairment in CZS was rarely evaluated. Purpose To evaluate the morphology and biventricular cardiac function in children affected by CZS, using electrocardiogram (EKG), echocardiogram and biomarkers dosage. Methods This is a cross-sectional study conducted with 52 children with CZS (GZ) compared with 25 healthy children (CG). Clinical evaluation, EKG, and echocardiogram were performed in all of them. Also, troponin I and natriuretic peptide type B (BNP) dosages were performed in GZ. Results The median age of the studied population was 5 years in groups, GZ (3 to 6 years), CG (3 to 8 years), 40.4% (GZ) and 60% (CG) of female gender. The most prevalent electrocardiographic alteration was sinus arrhythmia, GZ: 9 (17.3%) and CG: 4 (16%). The echocardiographic evaluation showed the morphological parameters adjusted for the Z score: left ventricular (LV) end-diastolic diameter in GZ: −2.36 [−5.10, 2.63] vs CG: −1.07 [−3.43, 0.61], p&amp;lt;0.001; LV end-systolic diameter in GZ: −1.02 [−4.49, 0.62] vs CG: −0.06 [−1.98, 2.28], p&amp;lt;0.01; ascending aorta in GZ: −0.09 [−2.08, 1.60] vs CG: 0.43 [−1.47, 2.2], p: 0.021; basal diameter of the right ventricle (RV) in GZ: −2.34 [−4.90, 0.97] vs CG: −0.96 [−2.21, 0.40], p&amp;lt;0.01; pulmonary artery dimension in GZ: −2.13 [−5.99, 0.98] vs CG: −0.24 [−2.53, 0.59], p&amp;lt;0.01. The left atrium volume index (ml/m2) was in GZ: 13.15 [6.80, 18.00] vs CG: 18.80 [5.90, 25.30], p&amp;lt;0.01; right atrium volume index (ml/m2) in GZ: 10.10 [4.90, 15.30] vs CG: 15.80 [4.10, 24.80], p&amp;lt;0.01. The septum systolic excursion of the mitral annular plane (MAPSE, cm) was in GZ: 0.98 [0.78, 1.66] vs CG: 1.25 [1.07, 1.56], p&amp;lt;0.01; and lateral annulus: 1.25 [0.81, 1.86] vs CG: 1.46 [1.07, 1.83], p&amp;lt;0.001; tricuspid annular plane systolic excursion (cm) in GZ: 1.52 [1.13, 2.34] vs CG: 1.90 [1.62, 2.35], p&amp;lt;0.01; S' of the RV (cm/s) was in GZ: 10.60 [6.49, 21.00] vs CG: 12.80 [9.19, 16.20], p&amp;lt;0.01. The peak of late mitral inflow (A wave, cm/s) was in GZ: 64 [24, 134] vs CG: 52 [26, 94], p=0.02; peak of late diastolic mitral annular wave (e') of septum (cm/s) was GZ: 15 [7, 23] vs CG: 17 [12, 27], p&amp;lt;0.01; peak of e' lateral (cm/s) was in GZ: 11 [7, 19], CG: 12 [9, 15], p&amp;lt;0,016; E/e' ratio was GZ: 7.52 [4.57, 10.78] vs CG: 6.41 [4.75, 12.64], p&amp;lt;0.01. The LV longitudinal and circumferential and RV longitudinal strain measurements showed no difference between the groups. Conclusion A reduction in cardiac dimensions and biventricular dysfunction was found in CZS, showing an early cardiac impairment, which will enable to establishment early therapies, avoiding severe heart failure. Funding Acknowledgement Type of funding sources: None.

Evaluation of foetal mitral annular plane systolic excursion with conventional m-mode ultrasound in normal pregnancy

Background: Foetal mitral annular plane systolic excursion (fMAPSE) helps in the evaluation of the left foetal cardiac function, which is key in the early diagnosis of congenital heart defects and abnormalities.Objectives: To assess foetal MAPSE in the second half of normal pregnancy, to establish reference ranges for this measurement in our environment, and to determine the relationship between foetal MAPSE and gestational age and estimated foetal weight.Materials and Methods: This descriptive cross-sectional study was conducted between March 2022 and August 2022 at the Obstetric Units and Radiology Departments of the two tertiary facilities, one secondary facility and one radiodiagnostic facility in Bayelsa State, Nigeria. Consenting pregnant women presenting to the antenatal clinics of the study centres during the second half of pregnancy were consecutively included. Obstetric ultrasound scans were was transabdominally. Data were analysed using SPSS version 25.Results: The correlation coefficient (ɼ) between fMAPSE and gestational age was 0.21 with a p-value of 0.001, reflecting a significant but weak relationship between fMAPSE and gestational age. There was a positively weak but significant relationship (ɼ = 0.29; p – 0.001) between fMAPSE and estimated foetal weight.Conclusion: Our study revealed that there was a significant relationship between fMAPSE and gestational age, and between fMAPSE and estimated foetal weight, which correlates with published data around the globe.

Tissue doppler echocardiographic evaluation of cardiac functions in children with mucopolysaccharidosis type III disease.

Mucopolysaccharidosis type III (MPS III) is an extremely rare group of diseases among all MPS types. In recent years, there are studies about the presence and importance of cardiac involvement in MPS III patients as in other types of MPS. The aim of our study is to evaluate the cardiac functions of MPS III patients in pediatric age by using the M-mode, 2D, and Tissue Doppler echocardiographic measurements. The study was conducted prospectively between September and December 2020. Fifteen MPS III patients and 15 healthy volunteers were included in the study. The mean Tei indexes of all three regions including left ventricle (LV), right ventricle (RV), and interventricular septum (IVS) were higher in MPS III patients compared to the control group (0.43/0.36 for LV and 0.44/0.37 for RV and 0.41/0.35), respectively. Diastolic function parameters of MPS III Patients were worse than the control group. In MPS III patients, eight (53.3%) patients had valvular dysfunction, three (20%) patients asymmetric septal hypertrophy and four (26.7%) patients LV concentric remodeling pattern. We detected an increase of z score above +2 in aortic valve annulus, sinuses of Valsalva, IVS diastole diameter and also in the LV posterior wall diastole diameter measurements in some MPS III patients. We conclude that cardiac monitoring of MPS III patients is very important in terms of early detection and treatment of cardiac problems that may arise. Cardiac evaluation of larger series of MPS III patients are needed to make a better decision.

Estimation of pulmonary artery systolic pressure in hemodialysis patients and its association with cardiorespiratory fitness and pulmonary function.

To evaluate the estimated pulmonary arterial systolic pressure (PASP) through transthoracic echocardiography in hemodialysis (HD) patients and associate it with cardiorespiratory fitness and pulmonary function. This study was a cross-sectional analysis of HD patients that performed evaluations of cardiac function, cardiorespiratory fitness, and pulmonary function, through transthoracic echocardiography, cardiopulmonary exercise test, spirometry, and manovacuometry, respectively. All patients underwent the evaluations on a non-dialysis day. Thirty-five HD patients were evaluated and separated according to the presence of probable pulmonary hypertension (PH) (estimated PASP ≥ 35mmHg) or not (estimated PASP < 35mmHg). Those HD patients with probable PH had the worst cardiorespiratory fitness, evaluated by the peak oxygen consumption (VO2peak) (17.11 ± 4.40 versus 12.90 ± 2.73mL/kg/min; p = 0.011), and pulmonary function, evaluated by absolute and predicted of forced vital capacity (FVC) (85.52 ± 12.29 versus 71.38 ± 11.63%; p = 0.005) and absolute and predicted of forced expiratory volume in the first second (FEV1) (83.37 ± 14.98 versus 69.21 ± 13.48%; p = 0.017). The secondary analysis showed that estimated PASP was correlated with VO2peak (r = -0.508; p = 0.002), FVC (r = -0.450; p = 0.007), and FEV1 (r = -0.361; p = 0.033). Moreover, the adjusted odds ratio by HD vintage, dry weight and gender showed that increments in VO2peak (OR 1.62; CI 95% 1.04-2.54; p = 0.034), FVC (OR 39.67; CI 95% 1.74-902.80; p = 0.021), and FEV1 (OR 39.54; CI 95% 1.89-826.99; p = 0.018) were associated with 1-fold and 39-fold higher chance, respectively, for not having PH. However, all these associations were lost when age was included in the analysis. The HD patients with probable PH had the worst cardiorespiratory fitness and pulmonary function. Exploratory analyses showed that greater cardiopulmonary fitness was associated with better cardiac function. Moreover, increments in cardiorespiratory fitness and pulmonary function may increase the chance of not having PH.

Effectiveness and safety evaluation of sacubitril/valsartan in blood pressure control and clinical outcomes for elderly patients with heart failure and hypertension: A prospective cohort study

AimThis study was conducted to investigate the safety and effectiveness of sacubitril/valsartan (sac/val) for elderly patients with hypertension and heart failure in the real-world setting. MethodsPatients with established hypertension complicated with structural or functional impairment of ventricular fillings [New York Heart Association (NYHA) functional class II–IV)] were enrolled. The effectiveness of sac/val in terms of BP reduction and improvement in frailty and echocardiographic evaluation of cardiac function were examined from baseline to 6-month administration. ResultsOverall, 241 patients were treated with sac/val and 227 with renin angiotensin aldosterone system inhibitor (RAASi) for hypertension control. There were significant difference in the degree of systolic blood pressure reduction between two groups. Echocardiography showed that sac/val significantly improved left ventricular ejection fraction [4.0% (95% CI: 2.0–7.5) vs −1.0 (95% CI: −4.0–2.0), P = 0.001] during the follow-up visits. Significant improvements in NYHA function class and FRAIL scores post sac/val were observed after 3 and 6 month treatment. The rate of primary cardiovascular composite outcome was higher in patients in the RAASi group (26.9%; 95% CI: 19.6–34.0) than in the sac/val group (22.0%; 95% CI: 16.7–27.3). ConclusionsSac/val may be useful not only for reducing BP, but also for improving the structural and functional parameters of echocardiography, eventually resulting in a significant improvement of the overall symptomatic status, a significant reduction in NYHA class, and functional improvement.

The pediatric heart network's study on long-term outcomes of children with HLHS and the impact of Norwood Shunt type in the single ventricle reconstruction trial cohort (SVRIII): Design and adaptations

BackgroundThe Single Ventricle Reconstruction (SVR) Trial was the first randomized clinical trial of a surgical approach for treatment of congenital heart disease. Infants with hypoplastic left heart syndrome (HLHS) and other single right ventricle (RV) anomalies were randomized to a modified Blalock Taussig Thomas shunt (mBTTS) or a right-ventricular-to-pulmonary-artery shunt (RVPAS) at the time of the Norwood procedure. The aim of the Long-term Outcomes of Children with HLHS and the Impact of Norwood Shunt Type (SVR III) study is to compare early adolescent outcomes including measures of cardiac function, transplant-free survival, and neurodevelopment, between those who received a mBTTS and those who received an RVPAS. MethodsTransplant-free survivors of the SVR cohort were enrolled at 10 to 15 years of age for multifaceted in-person evaluation of cardiac function (cardiac magnetic resonance [CMR], echocardiogram and exercise test) and neurodevelopmental evaluation. Right ventricular ejection fraction measured by CMR served as the primary outcome. Development of arrhythmias, protein losing enteropathy, and other comorbidities were assessed through annual medical history interview. Through the course of SVR III, protocol modifications to engage SVR trial participants were designed to enhance recruitment and retention. ConclusionsEvaluation of long-term outcomes will provide important data to inform decisions about the shunt type placed at the Norwood operation and will improve the understanding of cardiovascular and neurodevelopmental outcomes for early adolescents with HLHS.

Effect of Dapagliflozin on Indicators of Myocardial Fibrosis and Levels of Inflammatory Factors in Heart Failure Patients.

Objective To explore the effect of dapagliflozin on the myocardial fibrosis and the levels of inflammatory factors in heart failure patients. Methods 60 patients with T2DM who were diagnosed as acute left heart failure or acute exacerbation of chronic left heart failure in the Department of Cardiology of our hospital from November 1, 2020, to December 31, 2021, during hospitalization were the study subjects. According to the treatment regimen, they were divided into the experimental group (EG) which received dapagliflozin and conventional drugs and the control group (CG) which received conventional drugs, with 30 cases in each group to compare and analyze the clinical indicators such as myocardial fibrosis and inflammatory factors. Results The levels of TNF-α, IL-1β, IL-6, and hs-CRP in the two groups were decreased gradually after treatment, and the levels of TNF-α, IL-1β, IL-6, and hs-CRP in the EG were visibly lower compared with those in the CG at week 4 of treatment (P < 0.05). The cardiac function evaluation of patients showed that the levels of LVEF and LVEDD in both groups were gradually improved after treatment, with a significant difference from the fourth week. In other words, compared with the CG, the LVEF level in the EG was obviously higher (P < 0.05), the LVEDD level was distinctly lower (P < 0.05), and the levels of ST2, BNP, and MCP-1 in the EG were clearly lower at week 4 of treatment (P < 0.05) with a statistical significance in difference. Conclusion Dapagliflozin has a definite curative effect in heart failure patients with type 2 diabetes mellitus, which can effectively reduce the inflammatory response of patients and inhibit the myocardial fibrosis, and has a potential value in improving cardiac function and promoting prognosis.