Decrease In Left Ventricular Function Research Articles

Hypoxia-Induced Pulmonary Injury-Adrenergic Blockade Attenuates Nitrosative Stress, and Proinflammatory Cytokines but Not Pulmonary Edema.

Hypoxia can induce pulmonary edema (PE) and inflammation. Furthermore, hypoxia depresses left ventricular (LV) inotropy despite sympathetic activation. To study the role of hypoxic sympathetic activation, we investigated the effects of hypoxia with and without adrenergic blockade (AB) on cardiovascular dysfunction and lung injury, i.e., pulmonary edema, congestion, inflammation, and nitrosative stress. Eighty-six female rats were exposed for 72 h to normoxia or normobaric hypoxia and received infusions with NaCl, prazosin, propranolol, or prazosin-propranolol combination. We evaluated hemodynamic function and performed histological and immunohistochemical analyses of the lung. Hypoxia significantly depressed LV but not right ventricular (RV) inotropic and lusitropic functions. AB significantly decreased LV function in both normoxia and hypoxia. AB effects on RV were weaker. Hypoxic rats showed signs of moderate PE and inflammation. This was accompanied by elevated levels of tumor necrosis factor α (TNFα) and nitrotyrosine, a marker of nitrosative stress in the lungs. In hypoxia, all types of AB markedly reduced both TNFα and nitrotyrosine. However, AB did not attenuate PE. The results suggest that hypoxia-induced sympathetic activation contributes to inflammation and nitrosative stress in the lungs but not to PE. We suggest that AB in hypoxia aggravates hypoxia-induced inotropic LV dysfunction and backlog into the pulmonary circulation, thus promoting PE.

Functional features of the myocardium in school-age children with chronic somatic pathology according to echocardiographic examination

The peculiarity of the modern pathology of childhood is the increasing frequency of transition of acute forms of diseases into recurrent and chronic ones and increasing primary chronic pathology. Systematic loads on «endurance» during training determine the necessity to study the possibilities of heart remodelling in school-age children against the background of chronic somatic pathology. Objective: to reveal structural and functional changes of myocardium in schoolchildren with chronic somatic pathology according to echocardiogram examination data. Materials and methods. We analysed 32 echocardiogram results in children aged from 7 to 17 years. The main group (n=16) - children with chronic somatic pathology out of exacerbation, control group (n=16) - children of the 2nd health group. Distribution of chronic somatic pathology in the main group: CNS diseases (n=4), kidney and urinary tract (n=5), GI (n=2), glands of internal secretion (n=3), vascular malformations (n=2). All children underwent echocardiogram examination with analysis of left ventricular ejection fraction systolic and diastolic myocardial function, left ventricular end-diastolic dimension, myocardial wall thickness, valve apparatus, presence/absence of physiological transudate in the pericardial cavity, and presence of small anomalies of cardiac development. Clinical and anamnestic data of the subjects, echocardiogram method and conventional statistical processing of the obtained results using STATISTICA for Windows software system were used to achieve the set goal and solve the research tasks. Results of the study. In the main group left ventricular ejection fraction was 61,8±1,57%, in the control group - 68,25±1,86% (p≤0,05). Left ventricular end-diastolic dimension was normal in both groups (p≥0.05). Concentric myocardial remodelling and increased myocardial wall thickness were found only in the main group in 18.8% (n=3) and 37.5% (n=6) of cases, respectively (p≤0.05). Valve pathology in the main and control groups was 43.8% (n=7) and 18.8% (n=3) of cases. Physiological transudate in the pericardial cavity was noted equally in both groups in 12.5% of cases. Small anomalies of cardiac development were detected in the main and control groups in 31.3% (n=5) and 18.8% (n=2) cases, respectively. Conclusion. Low values of left ventricular ejection fraction and increased myocardial wall thickness indicate a decrease in left ventricular function of the heart and a negative impact of metabolic disorders in children with chronic somatic pathology.

Abstract 16508: Use of Ultrasound Enhancing Agents in Echocardiography for Stroke Across Yale New Haven Health System

Background: Transthoracic echocardiography (TTE) is routinely performed for evaluation of stroke. We examined patterns of ultrasound enhancing agent (UEA) use for stroke across Yale New Haven Health System (YNHHS) Hypothesis: Prevalence of left ventricular (LV) thrombus depends on LV function, wall motion and UEA use. Methods: 15209 TTE studies with indication of cerebrovascular accident or transient ischemic attack were performed from January 2019 to December 2022 across YNHHS. UEA was used in 7578 studies (49.8%). We compared the prevalence of LV thrombus and frequency of UEA use stratified by location (community hospitals, university hospitals, and outpatient sites) and by LV function. Chi square was used to compare rates of LV thrombus as well as frequency of UEA use stratified by LV function and location. Results: UEA use varied from 2.6% in community outpatient sites, 23.3 % in community hospitals to 77% in a university hospital. LV thrombus was detected in 56 of 7578 UEA studies (0.74%). Increasing prevalence of LV thrombus was associated with decreasing LV function (p<0.0001). LV thrombus was detected only in 1/3716 UEA studies (0.027%) with normal LV function and normal wall motion. Increased frequency of contrast use in university hospital compared with community hospitals did not lead to overall higher rate of thrombus detection.When stratified by LV function, only subgroup with normal function had marginally higher rate of LV thrombus, but prevalence of LV thrombus in this subgroup was very low. Conclusion: Significant variability of UEA in TTE exists for evaluation of stroke across YNHHS with low prevalence of thrombus in hyperdynamic to normal LV function without wall motion abnormalities. Increased use of UEA was not associated with increased rate of LV thrombus detection, except group with normal function. Value of increased detection in this group with low prevalence of thrombus should be balanced against cost and risk of adverse reactions.

E-Point Septal Separation: A Bedside Tool for Emergency Physician Assessment of Left Ventricular Ejection Fraction

Introduction: Rapid assessment of left ventricular ejection fraction (LVEF) may be critical among emergency department (ED) patients. This study examined the predictive relationship between bedside mitral-valve E-point septal separation (EPSS) measurements to the quantitative calculated LVEF. Objective: The aim of this study was to investigate the ability of a new index, namely the mitral valve E-Point Septal Separation (EPSS ) to predict the left ventricular (LV) systolic function. Methods: A prospective observational study was conducted on a sequential convenience sample of patients, receiving comprehensive Transthoracic Echocardiography (TTE). The current study recruited 100 patients who presented to the Cardiology Clinic of Lab Aid Cardiac Hospital. Echocardiographic examinations were performed to obtain 2D guided M-mode measurements of the EPSS in addition to calculation of conventional, quantitative LVEF. All the measurements were done in the Para-sternal long-axis view. A linear regression analysis was conducted to examine the relation of EPSS to the calculated LVEF from the comprehensive TTE. Results: Total 100 patients were enrolled in the study. It was found that there was a very significant negative correlation of EPSS with Calculated LVEF (r=--.766, p<0.001). An EPSS ≥ 7 mm was evidence of reduced LVEF <40%, ( p<0.01). Of note an EPSS ≥ 12 mm correlates with severely decreased LV function, with an estimated LVEF of ≤ 30% (p<0.01). As was shown by the results of the linear regression analysis, EPSS was a significant determinant of calculated LVEF (R=.766, p<0.001). The results of the linear regression analysis indicated that the EPSS was an independent predictor of the LVEF. Conclusions: Measurements of EPSS were significantly associated with the calculated measurements of LVEF from comprehensive TTE. An EPSS measurement of >7 mm was uniformly sensitive at identifying patients with reduced LVEF & >12 mm was uniformly sensitive at identifying patients with severely reduced LVEF. EPSS may allow certain clinicians, especially beginners and emergency department physicians, to assess the LVEF when other methods are not available or questionable. Bangladesh Crit Care J September 2023; 11 (2): 90-94

Decrease of left ventricular function measured by speckle-tracking echocardiography based on systemic lupus erythematosus severity in children.

Systemic lupus erythematosus in children generally manifests more severely with a more aggressive disease course. Cardiac involvement in systemic lupus erythematosus often does not show specific signs and symptoms, but speckle-tracking echocardiography can detect cardiac dysfunction. This study aimed to determine the differences in left ventricular function as measured by speckle-tracking echocardiography in children with various severity of systemic lupus erythematosus activity. A cross-sectional study of 49 children diagnosed with systemic lupus erythematosus are currently undergoing outpatient or inpatient care at Dr Hasan Sadikin General Hospital, Bandung, from May 2023 to June 2023. Disease activity was assessed by Mexican Version of the Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) with a score of 2-5 classified as mild activity, 6-9 as moderate, and ≥10 as severe. Each subject underwent conventional echocardiography and speckle-tracking echocardiography with a Philips EPIQ machine performed by a Pediatric Cardiologist Consultant 10 days after inclusion. Fifteen (30.6%) subjects had mild disease activity, and 34 (69.4%) subjects had moderate disease activity. Most subjects (81.96%) were female with an average age of 15 years. The mean ejection fraction and fractional shortening as well as the median E/A ratio in the mild and moderate disease activity groups were not significantly different (65.76 versus 67.38%, 35.73 versus 37.11%, 1.6 versus 1.5%, respectively, p > 0.005). The global longitudinal strain in the moderate activity group was reduced more significantly than in the mild activity group (-16.58 versus -19.65, p = 0.008). Left ventricular function as measured by speckle-tracking echocardiography was lower in children with moderate systemic lupus erythematosus activity than those with mild disease activity.

Амплитудные показатели ЭКГ у мужчин разного возраста при субмаксимальной физической нагрузке (на примере жителей Европейского Севера России)

The purpose of this study was to investigate the effect of submaximal physical activity (PWC170 test) on electrocardiogram (ECG) amplitude parameters in men of different ages. Materials and methods. The research involved apparently healthy men aged 20–29 (n = 27) and 40–49 (n = 27) years living in the European North of Russia. They performed a bicycle ergometer PWC170 test with incrementally increasing 3-minute loads (50, 100 and 150 W) and ECG recording in the Nehb leads. Results. A and D leads showed the most informative dynamics of ECG parameters in the subjects during the exercise test. It was mainly expressed in an increase in P wave amplitude, a decrease in T wave amplitude, a deepening of the S wave, and ST segment depression. The group of 40–49-year-old men, compared to 20–29-year-olds, was characterized by less pronounced T wave (lead D) amplitude changes at the beginning of the test, a less deep S wave (lead I), no shift in the ST segment (lead D) as well as a smaller number of parameters that showed statistically significant changes in the exercise test. ST segment (lead A) depression during the final load was twice as common in the older group of men (13 % in 20–29-year-olds and 25 % in 40–49-year-olds). Heart rate (HR) at all stages of the test, except for the last one, was lower in 40–49-year-olds; however, its more significant increase by the end of the test eliminated the statistical differences in HR at the final stage and in physical work capacity (PWC170) between the groups. The revealed differences in ECG and HR parameters may be associated with morphological changes occurring in the cardiovascular system with age, in particular, with the decrease in left ventricular function. Submaximal physical activity in men of the older age group involves a greater expenditure of myocardial reserves.

Infant Alstrom syndrome diagnosed by a new gene mutation: a case report.

Alstrom syndrome is a rare autosomal recessive disorder resulting from an ALMS1 gene mutation. Here, we present the clinical data of a case of an infant diagnosed with Alstrom syndrome through whole-exome sequencing. A 2-month-old male infant was admitted to Sichuan Provincial Maternity and Child Health Care Hospital on 30 May 2019 after "coughing for half a day and dyspnea for 2 hours". He was diagnosed with severe pneumonia, acute congestive heart failure, Grade III cardiac function, acute respiratory failure, and myocarditis. After treatment, he was discharged with a prescription for oral medication. After a 4-month follow-up, the patient's left ventricle exhibited spherical enlargement and a decrease in left ventricular function. The infant's whole-exome sequencing results revealed compound heterozygous mutations in the ALMS1 gene: c.2179dup (p. Y727Lfs*12), a frameshift mutation, that was heterozygous and originated from the mother, while c.11140C>T (p. Q3714*) was a heterozygous nonsense mutation that originated from the father. Both mutations are classified as "category 1-pathogenic mutations" according to the American College of Medical Genetics and Genomics (ACMG) assessment. A novel ALMS1 mutation was identified in this case report, highlighting the importance of genetic testing for the early diagnosis of Alstrom syndrome.

Comparison of Biosimilar Trastuzumab ABP 980 with Reference Trastuzumab in Neoadjuvant Therapy for HER2-positive Breast Cancer - an Analysis of a Large University Breast Cancer Centre.

Background ABP980 is a biosimilar antibody to reference trastuzumab (RTZ). Aim of the following study is to confirm the similarity of ABP980 and RTZ in terms of clinical efficacy and safety in patients with HER2-positive early breast cancer (EBC) undergoing neoadjuvant trastuzumab-containing chemotherapy in a clinical real-world situation that also includes patients receiving pertuzumab. Methods Patients with HER2-positive EBC, who were treated from 12/2010 to 03/2020 at the Department of Women's Health at Tuebingen University Hospital, Germany, with at least four cycles of neoadjuvant chemotherapy (+/- pertuzumab) in combination with ABP980 or RTZ were included in a retrospective analysis. For efficacy analysis patients achieving a pathologic complete remission (pCR = no invasive tumor in breast and lymph nodes) were compared. Safety was evaluated by comparing the number of patients with a decrease in left ventricular function (LVEF) of >10%. Results 124 patients were included of whom 46 (37.1%) have received ABP980 and 77 (62.9%) were treated with RTZ. A pCR was found in 77 patients (62.1%). For patients treated with ABP980 as compared to RTZ, there was no significant difference regarding efficacy (pCR-rates of 60.9% versus 62.8%, p=0.829) or cardiac safety (LVEF decline in 6.5% versus 2.6%, p=0.274). Conclusion Similarity of ABP980 as compared to RTZ was confirmed in a real-world situation, including a large proportion of patients that have also received pertuzumab treatment.

Contractile Force of Transplanted Cardiomyocytes Actively Supports Heart Function After Injury.

Background:Transplantation of pluripotent stem cell–derived cardiomyocytes represents a promising therapeutic strategy for cardiac regeneration, and the first clinical studies in patients with heart failure have commenced. Yet, little is known about the mechanism of action underlying graft-induced benefits. Here, we explored whether transplanted cardiomyocytes actively contribute to heart function.Methods:We injected cardiomyocytes with an optogenetic off-on switch in a guinea pig cardiac injury model.Results:Light-induced inhibition of engrafted cardiomyocyte contractility resulted in a rapid decrease of left ventricular function in ≈50% (7/13) animals that was fully reversible with the offset of photostimulation.Conclusions:Our optogenetic approach demonstrates that transplanted cardiomyocytes can actively participate in heart function, supporting the hypothesis that the delivery of new force-generating myocardium can serve as a regenerative therapeutic strategy.

LGG-23. Cardiac function in children and young adults treated with MEK inhibitors: a single institution retrospecive cohort study

INTRODUCTION: MEK inhibitors (MEKi) have shown efficacy in pediatric low-grade glioma, among other tumors, but have been associated with acute cardiac dysfunction in adults. Cardiac consequences in children are unknown. MATERIAL AND METHODS: We performed a single center retrospective cohort study evaluating cardiac function by echocardiography (echo) in children and young adults <21 years old receiving MEKi at Children’s Hospital Los Angeles between October 2013 and May 2018. Blinded assessment of left ventricular function by fractional shortening (FS) and ejection fraction (EF) was performed on all available echocardiograms obtained before, during, and following therapy, as well as after re-initiation of therapy. RESULTS: Twenty-six patients underwent MEKi therapy with echo follow-up during the study period. Twenty-four of these had complete echo data. Median follow-up was 12 months. Borderline EF (EF 53-57.9%) occurred in 12 (50%) patients; and 3 (12.5%) progressed to abnormal EF (EF <53%). Cardiac dysfunction, when it occurred, was mild (lowest documented EF was 45%, and lowest FS was 24.4%). EF abnormalities typically fluctuated during therapy, resolved off therapy, and recurred with MEKi re-initiation. No clinical or demographic differences were detected between those who maintained normal cardiac function and those who developed borderline or overt cardiac dysfunction. Symptomatic heart failure did not occur. CONCLUSION: In this cohort of children and young adults, MEKi use was associated with a relatively high incidence of borderline decrease in left ventricular function, often of uncertain clinical significance. There was no evidence of permanent cardiac dysfunction. Further evaluation in larger prospective trials is needed.

Cardiac remodeling in acute myocardial infarction: Prospective insights from multimodality ultrasound imaging.

The severity of MI declined markedly in the last decade, and contemporary patterns of cardiac remodeling after MI are not defined. We prospectively enrolled community patients with first MI and performed comprehensive two- and three-dimensional echocardiography. Remodeling was defined as left ventricular (LV) end-systolic volume index (ESVI) above American Society of Echocardiography normal values. Remodeling patterns were characterized as an increase in LVESVI or LV end-diastolic volume index (LVEDVI), or both. Between 2014 and 2016, 213 patients (63±13 years; 34% women) were enrolled within 3 days after MI (77% non-ST-elevation MI). Acute remodeling was present in 51% of patients. Higher troponin and wall motion score index were associated with greater remodeling (p<0.001). Atrial annular area, leaflet tenting and papillary muscle areas increased with greater remodeling (p<0.001). The greater the cardiac remodeling, the lower the LV ejection fraction and global longitudinal strain (p<0.001). This decrease in LV function was accompanied by stroke volume augmentation and maintenance of cardiac index at the expense of increased LVEDVI. Different remodeling patterns were identified. Cases showing increased LVEDVI and normal LVESVI had smallest infarct size and better hemodynamics compared to cases with augmented LVESVI and normal LVEDVI. Acute remodeling occurs in more than half of first MI cases and exhibits different patterns defined by cavity size and hemodynamic profile. Acute remodeling is a global phenomenon, which also involves the left atrium and the mitral apparatus.

Early postoperative hemodynamic instability after heart transplantation \u2013 incidence and metabolic indicators

BackgroundPrimary graft dysfunction (PGD) is the main cause of death in the first 30 days after heart transplantation (HTX), accounting for approximately 40% of mortality. The study’s primary aim was to assess the incidence of PGD, following the International Society for Heart and Lung Transplantation consensus, and to compare it with the incidence of significant postoperative hypotension despite administration of high-dose inotropes and vasoconstrictors. The secondary aim of the study was to determine changes in biochemical markers that accompany the phenomenon.MethodsForty-five patients who underwent HTX between 2010 and 2015 were enrolled in this study, and detailed hemodynamic and metabolic data from the first 48 postoperative hours were collected and analyzed. Hemodynamic instability was defined as significant postoperative hypotension (mean arterial pressure (MAP) < 60 mmHg) combined with a high inotrope score (> 10). Data for long-term mortality were obtained from the population registration office.ResultsPGD incidence was relatively low (17.8%); however, hemodynamic instability was common (40%). Among unstable patients, MAP was insufficient for end-organ perfusion (51.4 ± 9.5 mmHg) but no decrease in left ventricular function was observed (cardiac index, 2.65 ± 0.6 l/min/m2; left ventricular ejection fraction, 52.9 ± 15.5%). Within this group, mean systemic vascular resistance index (961 ± 288 dyn*s*m2/cm5) was low despite receiving high doses of vasoactive agent (norepinephrine 0.21 (0.06-0.27) μg/kg/min during first 24 h postoperatively and 0.21 (0.01-0.27) μg/kg/min during next 24 h postoperatively). After HTX, serum lactate levels were initially significantly higher in patients with hemodynamic instability (p = 0.002); however, impaired lactate clearance was not observed (p = 0.366), and lactate levels normalized within the first 24 h postoperatively. Postoperative hemodynamic instability altered the long-term outcome and increased 5-year mortality after HTX (p = 0.034).ConclusionsHemodynamic instability is a more common phenomenon than PGD. Only early postoperative serum lactate levels correspond with hemodynamic instability following HTX. Postoperative hemodynamic instability is associated with poor long-term survival among HTX recipients.

Catastrophic antiphospholipid syndrome presented as ruptured papillary muscle during puerperium in a patient with systemic lupus erythematosus

Catastrophic antiphospholipid syndrome (CAPS) is a rare and serious phenomenon that requires prompt recognition and treatment. The authors present the case of a puerperal woman with systemic lupus erythematosus (SLE) admitted to the emergency room with headache, blurred vision, thoracic pain, and purpuric lesions on both ears. Echocardiogram revealed global decrease in left ventricular function while cardiac and inflammatory markers were elevated. Three days after admission she developed cardiogenic shock due to rupture of mitral papillary muscle which required emergent cardiac surgery, with replacement of the mitral valve; treatment with anticoagulation, high-dose glucocorticoids, and intravenous immunoglobulins were initiated. Cardiac and brain MRI revealed signs of ischemic lesions in both organs. Histopathology analysis of the placenta and papillary muscle showed signs of ischemia secondary to microvascular thrombosis. Based on the clinical demonstration of thrombosis in three organs, and the presence of lupus anticoagulant antibodies, a diagnosis of probable CAPS was established. This case highlights the importance of a high level of suspicion of CAPS, particularly in patients with risk factors, and the value of immediate adequate treatment. Moreover, the rupture of a papillary muscle with histologically consistent signs of antiphospholipid syndrome expands the spectrum of involvement of this disease and should be considered as a rare but life-threatening possibility in patients with myocardial injury.

Added Value of Modified Anderson–Wilkins Acuteness Score in Prognostication of Patients with Acute Myocardial Infarction

BACKGROUND: Electrocardiogram (ECG) signs on admission can serve as a prognostic marker in patients treated for myocardial infarction (MI).&#x0D; AIM: The aim of the study was to determine the predictive role of modified Anderson–Wilkins (MAW) ECG score of acuteness on the extent of myocardial injury, left ventricular (LV) remodeling, and clinical outcome in patients with acute MI.&#x0D; METHODS: Prospective, observational cohort study on patients treated for MI at the University Clinic for Cardiology. Subjects were analyzed for their demographic, clinical, ECG, LV functional, angiographic variables, course of treatment, and in-hospital outcome. MAW score was calculated for each patient. Patients were comparatively analyzed divided in two groups (score &lt;3 and ≥3).&#x0D; RESULTS: One hundred fifty patients (70% males and 30% females), aged 60.9 years were included in the study. Sixty-eight patients had MAW score &lt;3 (mean 1.7), and 82 had score ≥3 (mean 3.5), p&gt;0.001. Patients with ST-segment elevation MI had OR 2.1 (p&gt;0.000), and patients with multiple locations (excluding anterior) had OR 2.1 (p &gt; 0.000) of having MAW score ≥3. They received mechanical reperfusion 1.9 (p = 0.032) times more often. High MAW score was associated with stress hyperglycemia (OR 2.1; p = 0.032); low potassium (OR 2.8; p = 0.032), lower creatinine (p = 0.050), and higher NT-proBNP (OR 2.5; p = 0.050). High MAW score was associated with decreased LV function and increased LV dimensions on the follow-up echocardiography (p = 0.050 and 0.012, respectively).&#x0D; CONCLUSION: ECG is an important prognostic tool in MI patients. ECG-derived MAW score demonstrates a strong correlation with stress hyperglycemia, potassium, creatinine, and natriuretic peptides level and can serve as an early marker of LV remodeling after MI.

Prognostic factors associated with postoperative adverse outcomes in patients with aortic valve prolapse.

Background and aim:Aortic valve (AV) cusp prolapse and subsequent aortic insufficiency (AI) are 2 of factors leading to left ventricular (LV) enlargement and decreased LV function. Aortic valve replacement (AVR) has been the standard surgical procedure for AI. However, few data is available on the prognosis of these patients undergoing AVR procedure, especially in Chinese population. The study aims to evaluate the potential risk factors affecting the mid-term adverse outcomes after AVR.Methods:One hundred thirty-four patients (mean age: 46.7 years old) with AV cusp prolapse and severe AI who all received surgical aortic valve replacement were recruited in our hospital between January 1, 2009 and December 30, 2017. The clinical characteristics, echocardiography parameters, as well as operative parameters were obtained. The primary endpoint included death, heart failure development, and reoperation.Results:There were 14 adverse events altogether with the primary endpoint during a median follow-up of 8.6 (6–10) months. The multivariable Cox regression analysis revealed that baseline LVEDD (hazard rate, HR = 1.08, 95% CI: 1.01–1.15, P = .021), moderate pulmonary hypertension (HR = 9.36, 95% CI: 1.81–48.28, P = .008), and the time of assisted mechanical ventilation (HR = 1.01, 95% CI: 1.00–1.01, P = .022) were independently associated with the primary endpoint. Kaplan–Meier survival curve showed a significant worse survival free of the endpoint for patients with LVEDD≥70 mm, indexed LVEDD≥37.3 mm/m2 (the mean in this study), indexed LVESD≥25 mm/m2 or baseline LVEF <50% (all P<.05).Conclusion:Baseline enlarged LV dimensions, low LV function, moderate pulmonary hypertension, and prolonged assisted mechanical ventilation may predict the poor mid-term postoperative outcomes for AV cusp prolapse patients undergoing AVR procedure.

Implications of Atrial-Level Shunting by Echocardiography in Newborns with Congenital Diaphragmatic Hernia

To determine whether postnatal echocardiographic indices of left ventricular (LV) size and function are associated with atrial-level shunt direction and investigate whether a relationship exists between LV function and LV size in patients with congenital diaphragmatic hernia (CDH). This was a single-center retrospective study of 51 neonates with CDH evaluated at Children's Hospital Colorado. Initial postnatal echocardiograms were analyzed for cardiac dimensions, valvar integrity, cardiac time intervals, and biventricular function. Comparisons were made between neonates with left-to-right vs right-to-left atrial-level shunting, as well as between those with decreased (ejection fraction <55%) vs normal (ejection fraction ≥55%) LV function. The majority (82.4%) of infants with CDH had a left-to-right atrial-level shunt, and 84.3% had systemic or suprasystemic pulmonary artery pressure. Decreased LV function was demonstrated in 37.2% and was associated with smaller LV volumes and worse outcomes, including the need for extracorporeal membrane oxygenation (ECMO) and survival. Left-to-right atrial-level shunting is common in neonates with severe CDH, even in the presence of suprasystemic pulmonary artery pressure. LV dysfunction correlates with decreased LV volumes and is associated with adverse neonatal outcomes, including increased need for ECMO and decreased survival.

Impact of transcatheter mitral valve repair using MitraClip on right ventricular remodeling.

The potential of the MitraClip to prevent from right heart failure or to restore right ventricular (RV) function is still unclear. The aim of the present study was to analyze the impact of the MitraClip implantation on RV function and its association with clinical outcome. After MitraClip implantation patients underwent echocardiography follow-up scheduled between 3 and 6months after the procedure in the present single-center registry. A total of 93 patients were included. Compared to baseline, RV function declined in 20%, was unchanged in 25% and improved in 55% of the patients. Factors associated with decline in RV performance were atrial fibrillation, decrease in left ventricular function and lack of reduction in pulmonary artery pressure. Patients who experienced worsening in RV function had a significantly lower survival after mean follow-up of 11 ± 7months compared to those with preserved or improved RV function (15% vs. 83% vs. 83%; p log rank = 0.001). Furthermore, changes in TAPSE were found to be an independent predictor for all-cause mortality [HR 0.88 (0.77-0.99); p = 0.04]. The majority of patients suffering from severe MR benefited from MitraClip with respect to RV remodeling. However, 20% of the patients experienced a decline in RV function, which was associated with poor prognosis. Importantly, changes in RV function after MitraClip were identified as independent predictor for survival in contrast to baseline RV function and, therefore, should be implemented in follow-up routine for better outcome prediction.

710 The Effect of Mitral Valve Surgery on Left Ventricular Remodelling and Function in Paediatric Patients With Rheumatic Heart Disease: An Echocardiographic Study

Rheumatic heart disease (RHD) commonly results in mitral regurgitation (MR). The effects of left ventricular (LV) volume loading and alleviation on LV remodelling remains incompletely studied in children. MR in RHD allows investigation of haemodynamic measures without confounding congenital heart disease. We assessed the effects of MR and repair on LV myocardial mechanics, remodelling and function in children with RHD. Paediatric patients who underwent mitral valve repair or replacement for isolated RHD-MR from 2004 to 2019 with adequate echocardiographic studies were retrospectively assessed pre- and postoperatively and compared to matched controls. Eighteen patients underwent mitral valve surgery during the study period. Postoperatively there was a significant reduction in left atrial (LA) (p=0.001) and LV end-diastolic M-mode dimensions (p=0.001) and volumes (p=0.006), with no change in LV end-systolic volumes, yielding a significant reduction in LV functional measures (fractional shortening (34.5 vs 31.5%, p=0.006), four-chamber ejection fraction (62.6 vs 51.7%, p=0.002) and LV longitudinal strain (-24.3 vs -18.2%, p<0.001). Compared to controls, LA and LV dimensions remained increased with a reduction in all functional parameters after repair. There was a moderate negative correlation between preoperative end-diastolic volumes and postoperative longitudinal strain (r2=0.35). Persistent LV and LA remodelling with decreased LV function is observed after repair of RHD-MR. While these results reflect changes to volume loading, the unmasking of decreased LV function and persistent remodelling; and linear relation to preoperative LV size, may suggest that early intervention to alleviate MR could benefit selected patients and warrants further study.

P3120Prevention of heart failure in treatments with trastuzumab and anthracyclines: a meta-analysis

Abstract Background Trastuzumab and anthracyclines are conventional chemotherapies used in breast cancer. Unfortunately, they are associated with a decrease in left ventricular function potentially leading to heart failure (HF). In order to prevent this, randomised controlled trials (RCTs) assess the preventive effect of concomitant beta-blocker (BB), angiotensin receptor blocker (ARB) and angiotensin converting enzyme inhibitor (ACEI) therapy during chemotherapy. Purpose To assess the preventive effect of BB, ARB or ACEIs on left ventricular ejection fraction (LVEF) during trastuzumab and anthracycline treatment in patients without HF. Methods Our primary outcomes were the effect of BBs or ARB/ACEIs during 1) trastuzumab and 2) anthracycline treatment. Secondary outcomes were the distinct effects of 1) BBs and 2) ARB/ACEIs in either trastuzumab or anthracycline treatments. Through the search term “(RCTs), prevention, cancer chemotherapy and cardiotoxicity” in PubMed, studies were selected, excluding those without randomising to a BB, ARB/ACEI and a placebo control group during chemotherapy. Means of the LVEF and the standard deviation (SD) post-chemotherapy were applied. Meta-analyses estimated the standardised mean difference (SMD) in the LVEF. Heterogeneity was calculated as the I2. Results A total of 7 studies (Table 1) were included in the analysis. Between 93 and 100% were woman. Age varied from 41 to 51 years. Treatment time varied from 12 to 52 weeks. Concomitant BB or ARB/ACEI therapy during trastuzumab treatment was not associated with the LVEF, significantly (Fig. 1A; p=0.07). Oppositely, in the anthracycline regime the LVEF remained significant higher in the concomitant BB and ARB/ACEI groups as compared to controls (Fig. 1B). BB and ARB/ACEI separation in the analysis showed both to influence the LVEF positively independent of chemotherapy (P=0.03 &amp; p=0.005). Table 1 Study reference Year Chemotherapies Preventive drugs Pituskin et al., “Multidisciplinary Approach to Novel Therapies in Cardio-Oncology Research (MANTICORE 101-Breast): A Randomized Trial for the Prevention of Trastuzumab-Associated Cardiotoxicity.” 2017 Trastuzumab Perindopril. bisoprolol Gulati et al., “Prevention of Cardiac Dysfunction during Adjuvant Breast Cancer Therapy (PRADA).” 2016 Trastuzumab Candesartan, metoprolol Boekhout et al., “Angiotensin II-Receptor Inhibition With Candesartan to Prevent Trastuzumab-Related Cardiotoxic Effects in Patients With Early Breast Cancer: A Randomized Clinical Trial.” 2016 Trastuzumab Candesartan Janbabai et al., “Effect of Enalapril on Preventing Anthracycline-Induced Cardiomyopathy.” 2017 Anthracycline Enalapril Nabati et al., “Cardioprotective Effects of Carvedilol in Inhibiting Doxorubicin-Induced Cardiotoxicity.” 2017 Anthracycline Carvedilol Tashakori Beheshti et al., “Carvedilol Administration Can Prevent Doxorubicin-Induced Cardiotoxicity: A Double-Blind Randomized Trial.” 2016 Anthracycline Carvedilol Kaya et al., “Protective Effects of Nebivolol against Anthracycline-Induced Cardiomyopathy: A Randomized Control Study.” 2013 Anthracycline Nebivolol Figure 1 Conclusions Concomitant BB and ARB/ACEI therapy both favoured maintenance of the LVEF during trastuzumab and anthracyclines regimens as compared to controls.

Heart failure from cancer therapy: can we prevent it?

AimsConventional cytotoxic chemotherapy is still among the most effective treatment options for many types of cancer. However, cardiotoxicity, notably the decrease in left ventricular function under these regimens, can impair prognosis. Thus, prevention and treatment of cardiotoxicity are crucial. The present meta‐analysis aims to assess the efficacy of beta‐blockers or angiotensin‐converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs) for prevention of cardiotoxicity.Methods and resultsWe systematically searched Pubmed, Cochrane, EMBASE, and Web of Science databases for randomized controlled trials published until February 2019. The analysis included randomized studies that reported on left ventricular ejection fraction (LVEF) after 6 months of chemotherapy in cancer patients who received beta‐blockers or ACE inhibitors/ARBs for prevention of cardiotoxicity compared with controls. Studies on combination cardioprotective therapies were excluded from the analysis. The primary endpoint was prevention of a decrease in LVEF as defined by the individual study and as assessed by either transthoracic echocardiography or magnetic resonance imaging. We here show that patients under anthracycline‐based chemotherapy have a moderate yet significant benefit in LVEF from beta‐blockers or ACEs/ARBs. The beta‐blocker analysis included 769 cancer patients, and the ACE inhibitors/ARBs analysis included a total of 581 cancer patients. The mean LVEF difference between the beta‐blocker group and the control group was 2.57% (95% confidence interval 0.63–4.51, P = 0.009). The mean difference for ACE inhibitors/ARBs was 4.71% (95% confidence interval 0.38–9.03, P = 0.03). However, the beneficial effects throughout the studies were variable as documented by significant heterogeneity between the studies.ConclusionsSystematic evidence is needed to solidly found recommendations for cardioprotective prevention during chemotherapy. Likewise, trials on other neurohumoral drugs (spironolactone) and lipid‐lowering approaches are required to improve protection for cardio‐oncology patients.