Chronic Left Ventricular Dysfunction Research Articles

Relationship between arterial stiffness, left ventricular diastolic function, and renal function in chronic kidney disease

AimIn chronic kidney disease, IgA nephropathy, and left ventricular diastolic dysfunction have prognostic significance as well. However, the relationship between diastolic dysfunction, arterial stiffness, and renal function has not been fully elucidated.Methods79 IgA nephropathy patients (aged 46 ± 11 years) and 50 controls were investigated. Tissue Doppler imaging was used to measure early (Ea) and late (Aa) diastolic velocities. Arterial stiffness was measured by a photoplethysmographic (stiffness index (SI)) and an oscillometric method (aortic pulse wave velocity (PWVao)).ResultsWe compared the IgAN patients to a similar cardiovascular risk group with a preserved eGFR. A strong correlation was found between Ea/Aa and SI (p < 0.001), also with PWVao (p < 0.001), just in IgAN, and with eGFR (p < 0.001) in both groups. IgAN patients were divided into groups CKD1-2 vs. CKD3-5. In the CKD 3–5 group, the incidence of diastolic dysfunction increased significantly: 39% vs. 72% (p = 0.003). Left ventricle rigidity (LVR) was calculated, which showed a close correlation with SI (p = 0.009) and eGFR (p = 0.038). By linear regression analysis, the independent predictors of SI were age, E/A, and E/Ea; SI was the predictor of LVR; and E/A and hypertension were the predictors of eGFR.ConclusionIn chronic kidney disease, increased cardiac rigidity and vascular stiffness coexist with decreased renal function, which is directly connected to diastolic dysfunction and vascular stiffness. On the basis of comparing the CKD group to the control group, vascular alterations in very early CKD can be identified.

Current Role of Myocardial Viability Imaging Using Positron Emission Tomography in Patients with Chronic Ischemic Heart Failure and Left Ventricular Dysfunction

Current Role of Myocardial Viability Imaging Using Positron Emission Tomography in Patients with Chronic Ischemic Heart Failure and Left Ventricular Dysfunction

The Association of Ejection Fraction With Hospital-Associated Cardiac Arrest and Heart Failure Hospitalization Differs According to Baseline Estimated GFR

Chronic kidney disease (CKD) and left ventricular (LV) dysfunction are risk factors for cardiovascular events. We explore whether the association of LV ejection fraction (LVEF) with cardiac arrest, heart failure hospitalization, and all-cause mortality differs across stages of kidney impairment. We performed an observational cohort study of 19,032 patients from 2004 to 2014 with estimated glomerular filtration rate (eGFR)≤90 ml/min per 1.73 m2 and without end-stage kidney disease (ESKD). Cox regression models, incorporating an interaction term for eGFR and LVEF, were fit and adjusted for relevant covariates. Mean age of the patients was 67 ± 14 years, and 51% were male. The mean eGFR was 64 ± 19 ml/min per 1.73 m2 and LVEF was 54 ± 13%. Over a median follow-up of 3.0 (0.7-6.0) years there were 504 cardiac arrests, 4181 heart failure hospitalizations, and 6989 deaths. The association of LVEF with cardiac arrest and heart failure hospitalization differed according to continuous eGFR (P-interaction<0.01 for both outcomes). The association of LVEF with cardiac arrest in the lowest quartile was attenuated (adjusted hazard ration [aHR] per 5% higher LVEF 0.92; 95% confidence interval [CI] 0.88-0.96) compared to the highest eGFR quartile (aHR per 5% higher LVEF 0.85; 95% CI 0.78-0.91). The association of LVEF with heart failure hospitalization was similarly attenuated in the lowest eGFR quartile. There was no effect modification of LVEF by continuous eGFR for all-cause mortality (P-interaction 0.26). Among non-ESKD patients with eGFR≤90 ml/min per 1.73 m2, the association of LVEF with cardiac arrest and heart failure hospitalization is attenuated at lower levels of kidney function. Further research is required to elucidate what factors beyond LVEF drive these observations.

Urinary proteomics combined with home blood pressure telemonitoring for health care reform trial-First progress report.

High blood pressure (BP) and type-2 diabetes (T2DM) are forerunners of chronic kidney disease and left ventricular dysfunction. Home BP telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling risk stratification and personalized prevention. UPRIGHT-HTM (NCT04299529) is an investigator-initiated, multicenter, open-label, randomized trial with blinded endpoint evaluation designed to assess the efficacy of HTM plus UPP (experimental group) over HTM alone (control group) in guiding treatment in asymptomatic patients, aged 55-75 years, with ≥5 cardiovascular risk factors. From screening onwards, HTM data can be freely accessed by all patients and their caregivers; UPP results are communicated early during follow-up to patients and caregivers in the intervention group, but at trial closure in the control group. From May 2021 until January 2023, 235 patients were screened, of whom 53 were still progressing through the run-in period and 144 were randomized. Both groups had similar characteristics, including average age (62.0 years) and the proportions of African Blacks (81.9%), White Europeans (16.7%), women 56.2%, home (31.2%), and office (50.0%) hypertension, T2DM (36.4%), micro-albuminuria (29.4%), and ECG (9.7%) and echocardiographic (11.5%) left ventricular hypertrophy. Home and office BP were 128.8/79.2mmHg and 137.1/82.7mmHg, respectively, resulting in a prevalence of white-coat, masked and sustained hypertension of 40.3%, 11.1%, and 25.7%. HTM persisted after randomization (48 681 readings up to 15 January 2023). In conclusion, results predominantly from low-resource sub-Saharan centers proved the feasibility of this multi-ethnic trial. The COVID-19 pandemic caused delays and differential recruitment rates across centers.

Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function Literature Review

The poor early and mid-term prognosis of secondary mitral regurgitation (MR) with impaired left ventricular function after restrictive annuloplasty with cardioplegic arrest has opened the way for transcatheter repair. The indication for surgery is only incontestable when concomitant coronary revascularization is required. Beating heart mitral valve surgery without aortic clamping has been promoted as an alternative to the technique of cardioplegic arrest. Its potential advantage is the elimination of ischemic reperfusion injury and its impact on myocardial function. On the other hand a randomized study confirmed that for ischemic MR, mitral valve replacement (MVR) reduces the rate of MR recurrence and re-hospitalization compared to restrictive annuloplasty. We performed a review of the literature to assess the strength of the evidence supporting the efficacy of beating heart MVR without aortic clamping compared to the conventional technique for secondary MR with poor left ventricular function. In a randomized study of patients with chronic severe mitral regurgitation and left ventricular dysfunction, beating heart MVR was associated with better LV function, reduction of cardiac enzymes early postoperatively, reduced duration of mechanical ventilation, and ICU than MVR using warm blood cardioplegic arrest. This together with the absence of related perioperative mortality and the major complications suggests that this technique is safe and beneficial to LV function. This finding has been verified by a multitude of other observational studies which have shown that the benefit of this technique is more palpable in cases of redo mitral surgery or in cases of MR with poor left ventricular function.

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.

Coronary artery bypass graft plus surgical ventricular reconstruction for a patient with chronic myocardial infarction and severe left ventricular dysfunction.

Coronary artery bypass graft plus surgical ventricular reconstruction for a patient with chronic myocardial infarction and severe left ventricular dysfunction.

Linkage of Left Atrial Function to Heart Failure with Preserved Ejection Fraction.

In heart failure with preserved ejection fraction (HFpEF), left atrial enlargement is a surrogate marker reflecting chronic left ventricular diastolic dysfunction. As a result, the left atrial volume is often evaluated in daily clinical practice to determine the presence of left ventricular diastolic dysfunction. However, recent studies have shown that left atrial dysfunction is an important factor contributing to the pathogenesis of HFpEF, and it is expected to become one of the therapeutic targets of HFpEF, rather than just a surrogate marker. Echocardiography plays a central role in the identification of left atrial dysfunction and remodeling in HFpEF. In this review, we describe an approach to the evaluation of left atrial function in HFpEF using echocardiography.

Spectrum of intracardiac thrombi in different clinical scenarios at a tertiary care center

Cardiologists frequently encounter intracardiac thrombi in the course of their work. Along with tumor and vegetation, it is one of the most frequent differential diagnoses for intracardiac masses. Cardioembolic stroke patients frequently have intracardiac thrombi in the left ventricle. Although the potential for cerebral emboli persists in a large population of patients with chronic left ventricular (LV) dysfunction, the risk of LV thrombus formation is highest during the first 3 months after acute myocardial infarction. The main risk factors for the development of left atrial thrombi are rheumatic valvular disease, especially mitral stenosis and atrial fibrillation. Right heart chamber thrombi may develop in situ or occur when peripheral venous clots that are on their way to the lungs become stuck, leading to acute pulmonary embolism, and their incidence ranges from 4% to 18%. We are presenting five cases that represent a broad range of clinical circumstances involving intracardiac thrombus. When performed during systole and diastole, echocardiography can detect thrombus as a discrete, echo-dense mass with clearly defined borders that is separate from the endocardium. Since dimensions, shape, regularity or irregularity, and homogeneity are all characteristic features that define the embolic risk and therapeutic management, the morphology and structure of thrombi should be carefully assessed.

PS-C29-5: PULMONARY HYPERTENSION AND RIGHT VENTRICULAR REMODELING IN OBSTRUCTIVE SLEEP APNEA

Background and Objective: Acute pulmonary artery (PA) pressure changes during sleep have been extensively reported in obstructive sleep apnea (OSA). However, the role of OSA as an independent risk factor for the day-time pulmonary hypertension (PH) is not well known. The present study was conducted to examine whether OSA is associated with PH and right ventricular (RV) remodeling. Methods: 423 OSA patients without chronic obstructive pulmonary disease or left ventricular dysfunction {age: 55 ± 13 years old, mean apnea-hypopnea index (AHI): 41 ± 22 /h} were enrolled in this study. All patients were performed polysomnography, echocardiography and spirometry. Pulmonary artery systolic pressure (PASP) was determined by continuous-wave Doppler using the simplified Bernoulli equation. For this study, PH was defined as an estimated PASP of greater than 30 mmHg. Patients were divided into two groups: mild-moderate OSA group (n = 153) (AHI = 5–30 /h) and severe OSA group (n = 270)(AHI over 30/h). Results: The prevalence of PH among all OSA patients was 19%. No significant differences were found in PASP, tricuspid annular velocity and tricuspid annular plane systolic excursion (TAPSE) between mild-moderate OSA group and severe OSA group. However, RV diastolic diameter (28.7 ± 3.4 vs 27.7 ± 3.0 mm, respectively, P &lt; 0.01) and main PA diameter (26.2 ± 3.7 vs 24.8 ± 3.9 mm, respectively, P &lt; 0.05) were significantly higher in severe OSA group than those in mild-moderate OSA group. Conclusions: The severity of OSA was significantly associated with RV and PA diameters independently PASP. These results suggested that OSA may directly affects RV and PA remodeling independently PH.

Novel Approach for Assessing Postinfarct Myocardial Injury and Inflammation Using Hybrid Somatostatin Receptor Positron Emission Tomography/Magnetic Resonance Imaging.

Novel Approach for Assessing Postinfarct Myocardial Injury and Inflammation Using Hybrid Somatostatin Receptor Positron Emission Tomography/Magnetic Resonance Imaging.

Speckle-tracking echocardiography for predicting improvement of myocardial contractile function after revascularization: a meta-analysis of prospective trials

Some studies have indicated that the use of 2D-Speckle tracking echocardiography (2DSTE) aids in predicting recovery of myocardial contractile function after revascularization in patients with chronic ischemic left ventricular (LV) dysfunction or acute myocardial infarction (MI). The purpose of this meta-analysis was to evaluate the diagnostic accuracy of 2DSTE strain in the detection of myocardial viability at rest and during low-dose dobutamine (LDD) stress. A systematic review for all prospective trials using 2DSTE to assess myocardial viability until January 2019 was done. Using a standard approach of meta-analysis for diagnostic tests. Overall, nine studies including 525 patients with either chronic ischemic heart disease or acute MI fulfilled the inclusion criteria. Seven studies used longitudinal strain (LS) at rest, nine studies used circumferential strain (CS) at rest, four studies used LS during LDD stress, and four studies used CS during LDD stress. LS and CS during LDD stress showed equally high sensitivity (81.5% and 81.5% respectively) and specificity (81.3% and 81.4% respectively) for detecting reversible dysfunction. At rest, LS and CS showed equally lower sensitivity (67.1%, p < 0.0001 vs. LDD stress and 68.7%, p < 0.0001, vs. LDD stress, respectively) and specificity (64%, p < 0.0001 vs. LDD stress and 65.7%, p = 0.0008 vs. LDD stress, respectively) as compared with LDD stress. LS and CS by 2DSTE during LDD stress accurately identify reversible ischemic myocardial dysfunction in patients with chronic ischemic LV dysfunction or after MI. The use of LDD stress can be recommended over resting strain measures in this setting.

Direct oral anticoagulants compared to vitamin K antagonists for the treatment of left ventricular thrombi

Abstract Background Left ventricular thrombus (LVT) complicates around one in six cases of acute and chronic left ventricular systolic dysfunction and is associated with an increased risk of stroke, major systemic embolism and death, believed to be ameliorated by anticoagulation. Off-label use of direct oral anticoagulants (DOACs) for LVT has steadily increased, largely based on favourable outcomes in atrial fibrillation and venous thromboembolism, but the safety and efficacy of DOACs versus vitamin K antagonists (VKA) for LVT remains uncertain. Purpose The main aim of our study was to compare treatment of LVT with VKA to DOAC, focusing on all-cause mortality, stroke, major systemic emboli and major bleeding. Methods We conducted a retrospective observational longitudinal study of patients presenting to two large quaternary centres between 2011 and 2021 with a diagnosis of LVT. Patients were eligible if they had a documented LVT and received anticoagulation with either VKA or DOAC. Baseline data, thrombus characteristics, treatment type and duration, follow up imaging and clinical events were recorded using electronic health care records. Outcome measures included thrombus resolution, stroke and systemic embolism (SSE), major bleeding and mortality. Results A total of 955 patients were identified, of whom 901 received treatment with either a VKA (567 pts, 62.9%) or a DOAC (334 pts, 37.1%) and were included in the analysis. Underlying aetiologies included acute myocardial infarction (AMI) (38.3%), chronic ischaemic cardiomyopathy (38.0%) and non-ischaemic cardiomyopathy (23.7%). Rivaroxaban (43.4%) was the most frequently prescribed DOAC followed by apixaban (35.9%), and the remaining on edoxaban (20.7%). AMI related LVT was more commonly treated with DOAC (53.0%) and chronic ischaemic cardiomyopathy with VKA (72.9%). There was a lower baseline LVEF in the VKA cohort (29.5±13.2 vs 33.1±14.2, p&amp;lt;0.0001). Other demographic features were comparable. Median follow up was 2.5 years (IQR: 1–3.5). There were no differences in follow up duration between the two treatments (p=0.17). Greater rates of thrombus resolution were seen in the DOAC group compared to VKA (1 year: 78.4% vs 51.4%, p&amp;lt;0.0001), with higher rates of persistent thrombus over the follow-up period seen in the VKA group (25.1% vs 12.9%, p&amp;lt;0.0001). Rates of stroke and systemic embolization were similar between the groups (VKA 9.3% vs 9.6% DOAC, p=0.93). Higher rates of bleeding (BARC &amp;gt;3, 8.1% VKA, 3.6% DOAC, p=0.031) (Figure 1A) and mortality (VKA 18.5%, DOAC 10.2%, p=0.001) (Figure 1B) were seen in the VKA group over the follow-up period. Conclusions In a large multi-centre registry of LVT of mixed aetiology, anticoagulation with DOAC was associated with earlier and greater rates of thrombus resolution and consequential reduced adverse events (major bleeding and mortality) during follow up. A funding application to support a multi-centre randomised control trial is underway. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): This work was supported by the British Heart Foundation (Fellowship FS/CRTF/21/24190 to HM) and the National Institute for Health Research (Biomedical Research Centre Award to Guy's and St Thomas' NHS FT and King's College London).

Impact of Clinical and Lesion Features on Outcomes After Percutaneous Coronary Intervention in Bifurcation Lesions.

Bifurcation percutaneous coronary intervention (PCI) is associated with higher risk of clinical events. This study aimed to determine clinical and lesion features that predict adverse outcomes, and to evaluate the differential prognostic impact of these features in patients undergoing PCI for bifurcation lesions. We analyzed 5,537 patients from the BIFURCAT (comBined Insights From the Unified RAIN and COBIS bifurcAtion regisTries) registry. The primary outcome was major adverse cardiac events (MACE) at 2-year follow-up; secondary outcomes included hard endpoints (all-cause death, myocardial infarction) and lesion-oriented clinical outcomes (LOCO) (target-vessel myocardial infarction, target lesion revascularization). The least absolute shrinkage andselection operator (LASSO) model was used for feature selection. During the 2-year follow-up period, MACE occurred in 492 patients (8.9%). The LASSO model identified 5clinical features (old age, chronic renal disease, diabetes mellitus, current smoking, and left ventricular dysfunction) and 4 lesion features (left main disease, proximal main branch disease, side branch disease, and a small main branch diameter) as significant features that predict MACE. A combination of all 9 features improved the predictive value for MACE compared with clinical and lesion features (area under the receiver-operating characteristics curve: 0.657 vs 0.636 vs 0.581; P< 0.001). For secondary endpoints, the clinical features had a higher impact than lesion features on hard endpoints, whereas lesion features had a higher impact than clinical features on LOCO. In bifurcation PCI, 9 features were associated with MACE. Clinical features were predominant predictors for hard endpoints, and lesion features were predominant for predicting LOCO. Clinical and lesion features have distinct values, and both should be considered in bifurcation PCI.

Incidence, predictors and clinical implications of new renal impairment following percutaneous coronary intervention

BackgroundRenal impairment post-percutaneous coronary intervention (post-PCI) is a well-described adverse effect following the administration of contrast media. Within a large cohort of registry patients, we aimed to explore the incidence,...

Cardiac micro-RNA and transcriptomic profile of a novel swine model of chronic kidney disease and left ventricular diastolic dysfunction.

Chronic kidney disease (CKD) is an independent risk factor for the development of heart failure, but the underlying mechanisms remain unknown. Using a novel translational swine model of CKD and cardiac dysfunction, we hypothesize that CKD alters the cardiac miRNA and transcriptomic profile that associate with cardiac remodeling and metabolic processes implicated in the development of left ventricular diastolic dysfunction (CKD-LVDD). CKD-LVDD and normal control pigs (n = 6 each) were studied for 14 wk. Renal and cardiac hemodynamics were quantified by multidetector CT and echocardiography. In randomly selected pigs (n = 3/group), cardiac miRNA- and mRNA-sequencing (seq) was performed, validated (qPCR), and followed by confirmatory ex vivo studies. Differential expression analysis identified nine miRNAs and 125 mRNAs upregulated and 17 miRNAs and 172 mRNAs downregulated [fold-change ≥ 2, and false discovery rate (FDR) ≤ 0.05] in CKD-LVDD versus normal controls. Integrated miRNA-/mRNA-seq analysis identified 71 overlappings downregulated mRNA targets of miRNAs upregulated, and 39 overlappings upregulated mRNA targets of miRNAs downregulated in CKD-LVDD versus controls. Functional analysis showed that these genes were primarily implicated in processes associated with cardiac remodeling, including ubiquitination, ATP and fatty acid synthesis, and extracellular matrix remodeling. In agreement, hearts of CKD-LVDD pigs exhibited abnormal diastolic relaxation, mitochondrial injury, moderate LV fibrosis, and myocardial lipid accumulation. Our work comprehensively characterizes the cardiac micro-RNA and transcriptomic profile of a translational model of CKD-LVDD. Our data may set the foundation for new targeted studies to further elucidate LVDD pathophysiology and assist to develop therapeutic interventions.NEW & NOTEWORTHY Chronic kidney disease (CKD) is a progressive disorder in which more than 50% of deaths are attributed to cardiovascular disease. Using a swine model of CKD that develops left ventricular dysfunction (CKD-LVDD), we characterize the cardiac micro-RNA and transcriptomic profile, identifying dysregulated genes associated with cardiac remodeling and fatty acid metabolism that might be post-transcriptionally regulated early in the disease. These findings pinpointed pathological pathways that may open new avenues toward therapeutic research to reduce cardiovascular morbidity in CKD.

A novel echocardiographic right ventricular dysfunction score can identify hemodynamic severity profiles in left ventricular dysfunction

PurposeRecognition of congestion and hypoperfusion in patients with chronic left ventricular dysfunction (LVD) has therapeutic and prognostic implications. In the present study we hypothesized that a multiparameter echocardiographic grading of right ventricular dysfunction (RVD) can facilitate the characterization of hemodynamic profiles.MethodsConsecutive patients (n = 105, age 53 ± 14 years, males 77%, LV ejection fraction 28 ± 11%) referred for heart transplant or heart failure work-up, with catheterization and echocardiography within 48 h, were reviewed retrospectively. Three hemodynamic profiles were defined: compensated LVD (cLVD, normal pulmonary capillary wedge pressure (PCWP < 15 mmHg) and normal mixed venous saturation (SvO2 ≥ 60%)); decompensated LVD (dLVD, with increased PCWP) and LV failure (LVF, increased PCWP and reduced SvO2). We established a 5-point RVD score including pulmonary hypertension, reduced tricuspid annular plane systolic excursion, RV dilatation, ≥ moderate tricuspid regurgitation and increased right atrial pressure.ResultsThe RVD score [median (IQR 25%;75%)] showed significant in-between the three groups differences with 1 (0;1), 1 (0.5;2) and 3.0 (2;3.5) in patients with cLVD, dLVD and LVF, respectively. The finding of RVD score ≥ 2 or ≥ 4 increased the likelihood of decompensation or LVF 5.2-fold and 6.7-fold, respectively. On the contrary, RVD score < 1 and < 2 reduced the likelihood 11.1-fold and 25-fold, respectively. The RVD score was more helpful than standard echocardiography regarding identification of hemodynamic profiles.ConclusionsIn this proof of concept study an echocardiographic RVD score identified different hemodynamic severity profiles in patients with chronic LVD and reduced ejection fraction. Further studies are needed to validate its general applicability.Graphical abstract

Mining the Mesenchymal Stromal Cell Secretome in Patients with Chronic Left Ventricular Dysfunction.

Close examination of the initial results of cardiovascular cell therapy clinical trials indicates the importance of patient-specific differences on outcomes and the need to optimize or customize cell therapies. The fields of regenerative medicine and cell therapy have transitioned from using heterogeneous bone marrow mononuclear cells (BMMNCs) to mesenchymal stromal cells (MSCs), which are believed to elicit benefits through paracrine activity. Here, we examined MSCs from the BMMNCs of heart failure patients enrolled in the FOCUS-CCTRN trial. We sought to identify differences in MSCs between patients who improved and those who declined in heart function, regardless of treatment received. Although we did not observe differences in the cell profile of MSCs between groups, we did find significant differences in the MSC secretome profile between patients who improved or declined. We conclude that “mining” the MSC secretome may provide clues to better understand the impact of patient characteristics on outcomes after cell therapy and this knowledge can inform future cell therapy trials.

Severity Of Functional Mitral Regurgitation On Admission For Acute Decompensated Heart Failure Predicts Long-Term Outcomes-A Modifiable Interaction?

<h3>Background</h3> Functional mitral regurgitation (FMR) has emerged as a therapeutic target in patients with chronic heart failure and left ventricular systolic dysfunction (LVSD). The significance of FMR in acute decompensated heart failure (ADHF) remains obscure. We systematically investigated the prevalence and clinical significance of FMR on admission in patients admitted with ADHF and LVSD. <h3>Methods</h3> Single center, retrospective review of patients admitted with ADHF and LVSD between 2012 and 2017. Patients were divided into three groups of FMR: none/mild, moderate and moderate-to-severe/severe FMR. The primary outcome was 1-year post discharge all-cause mortality. We also compared these groups for 6-month heart failure hospitalization (HFH) rates. <h3>Results</h3> Of 2303 patients, 39% (896) were females. Median left ventricular ejection fraction was 25%. Four hundred and fifty three (20%) patients had moderate-to-severe/severe FMR, which was independently associated with 1-year all-cause mortality. Moderate or worse FMR was found in 1210 (53%) patients and was independently associated with 6-month HFH. Female sex was independently associated with higher severity of FMR. <h3>Conclusions</h3> More than half of patients hospitalized with ADHF and LVSD had at least moderate FMR, which was associated with increased readmission rates and mortality. Intensified post discharge follow-up should be undertaken to eliminate FMR amenable to pharmacological therapy and enable timely and appropriate intervention for persistent FMR. Further studies are needed to examine sex-related disparities in FMR.

TCTAP C-087 Revascularization in Patient With Left Main Coronary Artery Chronic Total Occlusion and Left Ventricular Dysfunction

TCTAP C-087 Revascularization in Patient With Left Main Coronary Artery Chronic Total Occlusion and Left Ventricular Dysfunction