Diastolic Dimension Research Articles

Cardiac deformation imaging in differentiation between patients with ischemic versus non-ischemic dilated cardiomyopathy presented with Left bundle branch block

Abstract Funding Acknowledgements Type of funding sources: None. Background Differentiation between ischemic (IDCM) and non-ischemic(NIDCM) cardiomyopathy using non-invasive image modalities is a clinical dilemma. Left bundle branch block (LBBB) imparts additional challenges into the etiologic diagnosis of DCM. This study employed 2D-strain imaging to characterize myocardial deformation and extent of mechanical discoordination in IDCM and NIDCM in presence of LBBB and their possible value for etiologic diagnosis. Methods We examined myocardial longitudinal& circumferential strain at segmental & global levels and LV twist [derived from basal and apical rotation] and electromechanical dyssynchrony in 36 DCM patients with LBBB. Of these patients, 16 were diagnosed with IDCM and 20 with NIDCM using coronary angiography, they were compared to 30 healthy controls. Results NIDCM were younger in age (45.7 ± 14 versus 61.5 ± 7.5, P<.0001) had larger LV end systolic (P<.03), end diastolic (P<.02) dimensions, LAV (P<.003), more mitral regurgitation(P<.02) and lower EF (31% vs 39%, P<.04). Compared with IDCM, patients with NIDCM had lower longitudinal strain of septal, lateral, inferior walls and global longitudinal strain (GLS), P<.001 and lower LV twist (1.64 ± 1.4º vs. 3.25 ± 2.1º, p< 0.01). IDCM had prevalent typical contraction activation (38% versus 5%) and higher electromechanical delay compared with NIDCM (P<.01). However, there was no significant difference in circumferential strain between LBBB groups. Using ROC analysis value of GLS <3.4% predicted NIDCM with 87.5% sensitivity and 78.9% specificity, area under curve is 0.836 and p < 0.001. Conclusion In dilated cardiomyopathy with LBBB, deformation imaging is offering newer mechanistic insights and enables detailed characterization of ischemic and non-ischemic etiologies in heart failure patients.

A four year experience of peripartum cardiomyopathy in a rural public hospital in south india

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Peripartum cardiomyopathy (PPCM), as defined by the study group on PPCM of Heart Failure Association of the European Society of Cardiology (ESC), is an idiopathic Cardiomyopathy with systolic heart failure occurring towards the end of pregnancy or in the months following delivery, in previously healthy women. The current diagnostic criteria are: - heart failure in the last month of pregnancy or in the first 5 postpartum months - absence of other causes of heart failure - absence of known heart disease predating the development of heart failure. - reduced Left Ventricular Ejection Faction (LVEF) of < 45% or Fractional Shortening < 30% The global incidence of PPCM is variable, the least reported in Japan and the most in Nigeria. The estimates of the incidence in India need more scrutiny because of the difficulties in diagnosing the condition. The current incidence in literature is 1 in 1374 live births. We conducted the study to characterize PPCM among women delivered at a resource-limited setting in South India. Aim To estimate the incidence of PPCM To describe the risk factors and Feto-maternal outcomes and associated mortality To estimate the recovery of cardiac function at the end of one year. Materials and Methods This was a prospective longitudinal study conducted in a rural public hospital in South India, from 2017 to 2020. PPCM was diagnosed in pregnant and puerperal women, in concurrence with global standards. Data included were Age, Parity, Gestational age, Risk factors, Medical Management, Pregnancy outcome and Echocardiography data on diagnosis and at 1-year follow-up. Results - 32 out of 14505 women in the 4-year study period were diagnosed with PPCM. - The incidence of PPCM was 1 in 453 live births. - The mean age was 23.2 years. - 46.8% were primigravidae. - 21.8% had pre-eclampsia. - 100% had breathlessness at presentation (62.5% were in New York Heart Association – Class III). - The mean LVEF on diagnosis was 24.5%. - The Fractional Shortening was 16%. - The Left Ventricular End Diastolic Dimension was 5.8cm. - 18.75% of women were diagnosed antenatally, 75% in the early puerperium and 6.25% in the late puerperium. - 81.3% were delivered by caesarean section. - At 1-year follow up, complete recovery of cardiac function was observed in 65.6% of the women. - There was no maternal mortality or adverse perinatal outcomes. Conclusion Although rare, PPCM is an important cause for Maternal Mortality. Being a diagnosis of exclusion, a high index of suspicion and involvement of a multi-disciplinary team will aid to optimize the Feto-maternal outcomes. Setting up a National PPCM registry will help in establishing the clinical epidemiology, risk factor assessment, screening strategies, diagnostic criteria and management options for mothers suffering from the condition.

Efficacy and safety of sacubitril valsartan in treating heart failure with midrange ejection fraction after acute myocardial infarction in diabetic patients.

Objective to evaluate the clinical efficacy and safety of sacubitril valsartan in the treatment of heart failure (HF) with midrange ejection fraction after acute myocardial infarction (AMI) in diabetic patients. From January 2015 to July 2020, HF patients with diabetes mellitus complicated with AMI were retrospectively analyzed. According to the medication, they were divided into 2 groups, that is, sacubitril valsartan group (84 cases) and valsartan group (86 cases). Valsartan group took valsartan capsule (80 mg/capsule, Beijing Novartis Pharmaceutical Co., Ltd) 80 mg, qd, on the basis of routine treatment. On the basis of routine treatment, the sacubitril valsartan group took sacubitril valsartan sodium tablets (50 mg/tablet, Beijing Novartis Pharmaceutical Co., Ltd), the initial dose was 25 mg, bid, and gradually increased to the target dose according to the patient's blood pressure. After 12 months of treatment, the independent sample t test showed that the left ventricular end diastolic dimension in the sacubitril valsartan group was lower than that in the valsartan group [(47.26 ± 4.71) mm vs (50.05 ± 5.62) mm, P < .001]. The left ventricular ejection fraction in the sacubitril valsartan group was higher than that in the valsartan group [(54.76 ± 4.24)% vs (49.28 ± 3.74)%, P < .001]. χ2 inspection showed that the readmission rate in the sacubitril valsartan group was lower than that in the valsartan group (7.14% vs 18.60%, P < .05). Sacubitril valsartan has good safety and tolerability in patients with diabetes mellitus complicated with AMI who have HF with midrange ejection fraction. Compared with valsartan, sacubitril valsartan can improve the left ventricular function better and reduce the readmission rate due to HF in these patients.

Variability of echocardiographic parameters in systemic right ventricle

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In transposition of the great arteries after atrial switch repair (TGA-AS), systemic circulation is supported by morphological RV. Initial remodeling of this systemic RV (sRV) is inevitably followed by ventricular enlargement and dysfunction. The evaluation of sRV size and function is therefore essential in the follow-up of TGA-AS patients. Although magnetic resonance imaging is considered the gold standard for sRV evaluation, transthoracic echocardiography (TTE) remains the most commonly used in everyday clinical practice. Comprehensive evaluation of sRV size and function is challenging even for experienced TTE operators. Furthermore, due to the lack of specific and standardized recommendations, TTE examinations also vary between operators and centres. Purpose We sought to determine interobserver variability in echocardiographic parameters for assessment of sRV size and function in patients with TGA-AS. Methods We retrospectively analysed echocardiographic recordings of all patients with TGA-AS from two national centres for adults with congenital heart disease (Centre 1: University Medical Centre Ljubljana, Slovenia and Centre 2: University Hospital Centre Zagreb, Croatia). Three congenital cardiologists (1 from Centre 1 and 2 from Centre 2), skilled in echocardiography and blinded for patients’ clinical data, reviewed offline TTE images on EchoPac (GE Vingmed Ultrasound). According to the recommendations, we obtained the following parameters of RV size and function: a) quantitative parameters: RV end diastolic dimension (RVEDD), RV hypertrophy (RVH), RV ejection fraction estimated in percentage (RV EF %), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid annulus S wave velocity (TDI S"), fractional area change (FAC), RV global longitudinal strain (RV GLS) and b) qualitative parameters: RV enlargement, RVEF by eyeballing and tricuspid regurgitation (TR). Qualitative parameters were classified into four categories: no/normal, mild, moderate, severe. Intraclass correlation coefficients (ICC) were calculated to evaluate interobserver variability, and values were classified into five reliability categories: &amp;lt;0.50 (poor), between 0.50 and 0.75 (moderate), between 0.75 and 0.90 (good), and above 0.90 (excellent interobserver agreement). Results In total, we identified 35 patients with TGA-AS (Centre 1: 15 patients, Centre 2: 20 patients). One patient was excluded from the analysis due to insufficient imaging data. In the remaining 34 patients, we showed excellent interobserver agreement in 5 parameters (TAPSE, RVEF eyeballing and RVEF %, RV GLS, TR) and good interobserver agreement in 4 parameters (RVEDD, RV enlargement, TDI S’, FAC). Only RVH showed moderate agreement (Table). Conclusion Echocardiographic parameters in sRV show good to excellent agreement between skilled investigators. According to our results, echocardiography performed by experienced operators is a reliable imaging method in sRV. Abstract Table

Echocardiographic assessment of ventricular function in chronic HCV patients receiving direct antiviral therapy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Hepatitis C virus (HCV) infection is still a major public health burden in many parts of the world (1). Globally, an estimated 58 million people have chronic hepatitis C virus infection, with about 1.5 million new infections occurring per year (2). Treatment for chronic HCV infection has evolved from interferon (IFN)-based therapy to direct-acting antivirals (DAAs) (3,4). With the development of DAA, treatment of HCV became better-tolerated and highly effective (5,6). Several studies have attempted to explore their cardiac side effects, especially their impact of left ventricular (LV) function; however, these studies were limited by their design and the methods of assessment (7-10). Aim In this prospective study we aimed at evaluating the short effects of DAAs on left ventricular functions using 3D Echocardiography. Methods Patients with HCV infection planned to receive combination therapy of Sofosbuvir 400 mg daily plus Daclatasvir 60 mg daily for 12 weeks were assessed by echocardiography before starting and after 3 months after completion of treatment. Patients with other systemic or cardiac conditions or structural heart disease were excluded. Assessment of LV volume and EF was performed by 3D quantification and global longitudinal strain (GLS). Right ventricle size was assessed by 2D and systolic function was evaluated by TAPSE, S` and FAC. Results In 102 patients who were followed up at 3 months after DAA therapy, We found an increase in increase in both LV end diastolic dimensions and volumes (p∼0.02 &amp; p∼0.045 respectively) as well as end systolic volumes (p∼0.005). There was no significant difference in neither LV systolic function as assessed by EF and GLS (62.25 ± 5.15 vs. 62.35 ± 5.77, p∼0.850, -22.97 ± 2.93 vs. -22.83 ± 2.59, p∼0.546 respectively), nor in diastolic function (p∼0.546). However, subgroup analyses revealed a significant negative correlation between age and GLS (P∼0.022) as well as the number of cardiovascular risk factors (P∼0.039). Hypertension was found to be the only predictor of the decrease in GLS in the regression analysis of risk factors (p∼0.001). There was no significant change in RV size and systolic function at follow up. Conclusions There was no significant change in LV systolic or diastolic function before and after DAA therapy as measured by EF and GLS. Nonetheless, subgroup analysis suggests a drop in GLS in older patients and those with more cardiovascular risk factors. An increase in LV size was also noted while no significant effect was noted with regards to RV size and function.

Real-world outcomes for tricuspid edge-to-edge repair: initial echocardiographic results from the TriClip bRIGHT study

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Abbott Background Tricuspid regurgitation (TR) is a frequent disease with a graded increase in mortality as disease severity increases. The TriClip tricuspid valve repair system (TVRS) recently gained CE mark approval in March 2020 as a transcatheter treatment option for severe TR. The bRIGHT study was initiated to evaluate real-world safety and efficacy in patients treated with the TriClip TVRS and gather data to better understand these patients and this disease. Purpose To report real-world, core lab adjudicated changes in TR severity and echocardiographic parameters from baseline through 30-day follow-up in subjects treated with tricuspid transcatheter edge-to-edge repair (TEER). Methods bRIGHT is a prospective, multi-center, single arm post-market study evaluating the safety and effectiveness of the TriClip device in symptomatic patients with severe TR. Detailed echocardiographic assessment was performed on all available echo data for the first 175 enrolled subjects by an independent echo core lab. TR was categorized using a 5-grade scale, with the traditional "severe" grade further characterized as severe, massive and torrential. Results At baseline, TR was "severe" in 98% (143/146) of subjects, which further stratifies to severe in 9% (13/146), massive in 63% (92/146) and torrential in 26% (38/146) of subjects using the 5-grade scale. At 30 days, TR was reduced by ≥1 grade in 81% of subjects, with 70% of subjects at moderate or less residual TR compared to only 1% at baseline (p &amp;lt; 0.0001, Figure 1). Vena contracta width decreased from 0.79 ± 0.56 mm at baseline to 0.41 ± 0.37 mm at 30 days. Effective regurgitant orifice (EROA) area decreased from 0.87 ± 0.57 cm2 at baseline to 0.38 ± 0.25 cm2 at 30-days. Similarly, regurgitant volume, PISA radius and jet area showed significant reductions (Table 1). RV end diastolic dimension decreased from 4.70 ± 0.85 cm at baseline to 4.22 ± 0.83 cm at 30 days. No changes were observed in right atrial volume or right ventricular function. Subjects were treated with 1.9 ± 0.7 clips on average, with less than a 1 mmHg increase in mean tricuspid valve gradient; average gradient was 1.12 ± 0.65, 1.92 ± 1.15 and 1.97 ± 1.81mm Hg at baseline, discharge and 30 days respectively. Tricuspid annular diameter was significantly higher in subjects with torrential TR at baseline compared to subjects with severe or massive TR (p &amp;lt; 0.001). Conclusions Tricuspid TEER with the TriClip device showed significant reduction in TR severity in a real-world setting. Significant reduction were seen in vena contracta width, PISA radius, EROA, regurgitant volume and jet area among others. The majority of patients had massive TR at baseline. Future studies in larger cohorts are needed to investigate the relationship between the extent of TR reduction and clinical outcomes. Abstract Figure 1 Abstract Table 1

POS-272 Roxadustat versus erythropoietin: comparison of efficacy in reversing ventricular remodeling in dialysis patients with anemia

Renal anemia has been identified as an important independent risk factor for left ventricular hypertrophy and progression of heart failure, as well as adverse cardiovascular outcomes. Recent studies suggest that hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) Roxadustat may represent a novel pharmacological treatment for renal anemia. This study aimed to compare the role of Roxadustat and erythropoietin in reversing ventricular remodeling in dialysis patients with anemia. This was a retrospective cohort study compared the treatment of Roxadustat and erythropoietin in dialysis patients for at least 24 weeks from January 2016 to August 2021. A total of 181 participants underwent echocardiography at least twice every 6 months. Baseline and follow-up examinations focused on the change of cardiac structure and function (doppler echocardiography), clinical and biochemical parameters and blood pressure. Participants were treated with oral iron supplements and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and controlled blood pressure (target value≤130 / 80 mmHg). There were no significant difference in age, sex and body mass index between two groups. However, left ventricular mass index (LVMI) and LV end diastolic dimension (LVDd) significantly decreased from 137.81±36.88 to 129.79±35.33 g/m2 (P=0.003), and from 5.19±0.68 to 5.02±0.69 cm (P=0.001) in Roxadustat-treated dialysis patients, respectively. In addition, Roxadustat increased hemoglobin and serum albumin level and reduced the level of diastolic blood pressure, low density lipoprotein, and lipoprotein(a). Interestingly, there was no obvious effect on LVMI or any other parameters of LV remodeling in erythropoietin-treated dialysis patients although the level of hemoglobin and serum albumin was increased and lipoprotein(a) level was decreased. In addition to the efficacy in the treatment of renal anemia, Roxadustat was found to be closely associated with improvement of LV diastolic function in dialysis patients. Our findings may provide new insights into anemia management in dialysis patients. Prospective clinical trials are necessary to further evaluate the role of Roxadustat or other HIF-PHIs in reversing ventricular remodeling.

Comparative analysis of echocardiographic and electrocardiographic data of survivors and deceased patients with COVID-19 (sub-analysis of the international register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors”)

Aim . To carry out comparative analysis of echocardiographic and electrocardiographic (ECG) data of survivors and deceased patients with COVID-19 (sub-analysis of the international register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors”). Material and methods. The study presents the results of a sub-analysis of the international AKTIV registry, which was called AKTIV CARDIO. Data were collected from 9 medical centers in the Russian Federation. AKTIV CARDIO included 973 hospitalized patients, of which 50 patients died during hospitalization. Results . Comparative analysis of echocardiographic parameters revealed that 4 parameters differed in deceased patients compared to survivors: left ventricular ejection fraction (LVEF), right ventricular end diastolic dimension (RV EDD), right atrial (RA) short axis diameter and pulmonary artery systolic pressure (PASP). RA short axis diameter was higher in deceased patients compared with survivors (38,0 [36,0; 39,0] versus 35,0 [33,0; 38,0] mm, p=0,011). RV EDD was higher in deceased patients than in survivors (3,0 [29,0; 33,0] vs 28,0 [27,0; 32,0] mm, p=0,019). LVEF was lower in deceased patients compared with survivors (55 [52; 55] vs 60 [56; 65]%, p&lt;0,001). PASP was higher in deceased patients compared with survivors (25 [21; 35] vs 20 [19; 25] mm Hg, p=0,006). Correlation analysis found that the largest number of correlations with markers of the infection severity was observed for RA short axis diameter and RV EDD. A comparative analysis of ECG data revealed that in deceased patients, compared with survivors, atrial fibrillation (AF) (21,4% vs 6,06%, p=0,001) and supraventricular premature beats (14,3% vs 3,36%, р=0,004) occurred more often. In addition, deceased patients had longer QTc interval (440 [416; 450] vs 400 [380; 430] ms, p&lt;0,001). Conclusion . Comparative analysis of echocardiographic data showed that deceased patients have more pronounced right heart remodeling, higher PASP and lower LVEF. Patient survival was related to RV and RA sizes. Right heart enlargement was associated with markers of infection severity. Echocardiographic parameters characterizing the right heart side can probably be independent prognostic factors in the acute COVID-19 period.

Heart failure presentation thirty years after tricuspid valvectomy for infective endocarditis

Heart failure presentation thirty years after tricuspid valvectomy for infective endocarditis

Brain Natriuretic Peptide Levels in Hypertensive Heart Failure Patients with and without Diabetes Mellitus: A Cross-sectional Study

Introduction: Heart Failure (HF) is a major disorder causing mortality and morbidity in the elderly population. Brain Natriuretic Peptide (BNP) is considered as the gold standard biomarker for diagnosis of HF. Aim: To find the association of plasma BNP levels with heart failure in hypertensive patients with and without diabetes mellitus. Materials and Methods: This cross-sectional study consisted of 35 hypertensive heart failure patients who attended the Outpatient General Medicine Department at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, between March 2020 to December 2020. The patients who belonged to class IV heart failure of the New York heart association were included. Total 35 HF patients were divided into two groups. Group 1 included 10 patients with hypertensive heart failure without diabetes mellitus. Group 2 included 25 patients with hypertensive heart failure with diabetes mellitus. Parameters such as Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), waist to hip ratio, Body Mass Index (BMI), Ejection Fraction (EF), transmitral filling velocities (E/A ratio), Left Ventricular Posterior Wall Thickness (LVPW), Left Ventricular Internal Dimension in diastole (LVIDd) and BNP level, random plasma glucose and HbA1c % were assessed in all the patients. Student’s t-test and Mann-Whitney U test were used to statistically analyze the data and p-value ≤ 0.05 was considered statistically significant. Results: Mean age of patients were 65.80±12.72 years in group 1 and 66.56±11.72 years in group 2. All patients in group 1 and most of the patients in group 2 (15,42%) were males. All the patients were in the obese category (BMI&gt;27 kg/m2 ). Serum BNP level was 1365 (243-3680) ng/L in group 1 and 691 (44.7-4261) ng/L in group 2, but this difference was not statistically significant (p-value=0.23). Echocardiography showed significant differences in left ventricular internal dimension in diastole, left ventricular posterior wall thickness and E/A ratio-integrated between hypertensives and hypertensives with diabetes mellitus. Serum BNP had a significant positive correlation with systolic blood pressure (r=0.33, p-value=0.05). There were highly significant differences in random plasma glucose and glycated haemoglobin between the groups. Conclusion: Plasma BNP levels were associated with systolic blood pressure in heart failure patients with hypertension. The significance of association is the same in hypertensives with diabetes mellitus. Thus, BNP as a biomarker plays a major role in the prediction of heart failure. But BNP could not differentiate whether the heart failure was due to hypertension alone or due to associated metabolic conditions.

Factors associated with cardiac allograft vasculopathy after heart transplantation.

Cardiac allograft vasculopathy (CAV) is a major threat to long-term survival after heart transplantation (HT). To determine factors associated with CAV detection in patients after HT. We analyzed 299 consecutive patients after HT who underwent routine visits at our institution between 2016 and 2018. Human interleukin 33 (IL-33) and suppression of tumorigenicity 2 (ST2) were measured by sandwich enzyme-linked immunosorbent assay with a commercially available kit (Human ST-2 and IL-33 ELISA, SunRedBio Technology Co, Ltd, Shanghai, China). The patients' median age was 59.00 years, and 74.2% were men. The frequency of CAV was 47.5%. Multivariable logistic regression analysis showed that IL-33 (odds ratio (OR) = 1.044 (1.029-1.059), p < 0.001) and ST2 (OR = 1.061 (1.040-1.083), p < 0.001) serum concentrations, donor age (OR = 1.046 (1.009-1.085), p = 0.015), left ventricular diastolic dimension (LVDD) (OR = 1.081 (1.016-1.149), p = 0.013), and time from HT to blood collection (OR = 1.256 (1.151-1.371), p < 0.001) were independent risk factors for CAV. The area under the receiver operating characteristics curve (AUC) indicated good prognostic power of IL-33 and ST2 concentrations (AUC = 0.779 and AUC = 0.784, respectively) and excellent prognostic power of the IL-33/ST2 score (AUC = 0.863). Lower IL-33 and higher ST2 serum concentrations, as well as older donor age, larger LVDD and longer time from HT to blood collection, are independently associated with CAV. IL-33 and ST2 have good discriminatory power and the IL-33/ST2 score has excellent strength for detecting CAV.

Predictors of cardiovascular complications in patients with arterial hypertension and comorbid pathology

Aim. To study the relationship between central arterial pressure (BP) and cystatin C in patients with arterial hypertension and comorbid pathology, depending on gender differences.&#x0D; Materials and methods. The study involved 162 patients aged 39 to 82 years, suffering from hypertension and comorbid pathology. The average age of the surveyed was 58.610.3 years. The following nosological forms were revealed: coronary heart disease 40.7% of the examined, overweight 33.9%, 1st degree obesity 30.8%, type 2 diabetes mellitus 29.0%, chronic obstructive disease lungs 16.6%, cerebrovascular diseases 13.5%. All participants underwent general clinical examinations. The concentration of the lipid spectrum was investigated: the levels of total cholesterol, triglycerides, cholesterol high density lipoproteins (HDL cholesterol) and low density lipoprotein cholesterol (LDL cholesterol) and plasma cystatin C. Glomerular filtration rate (GFR) was calculated according to F. Hoek's formula (80.35/cystatin C 4.32=GFR). Study of central aortic pressure (CAP), mm Hg Art., was carried out using the device "AngioScan". Echocardiography was performed on a "Vivid q" apparatus (USA, 2014) according to the generally accepted technique. All examined patients were divided into 2 subgroups. The 1st subgroup includes women, the 2nd men.&#x0D; Results. In patients with hypertension and comorbid pathology, the most common abnormalities were an increased level of LDL cholesterol (58%), a decreased level of HDL cholesterol (51.8%), hypercholesterolemia (54.3%), hypertriglyceridemia (43.8%) and tachycardia (40.7%). In 51.8% of the surveyed, and more among males, the achievement of the target blood pressure level was detected. In women, the indicators of average age, body mass index, the content of total cholesterol, LDL cholesterol and HDL cholesterol were significantly higher. In male patients, the indicators of the diameter of the aortic outflow tract, end systolic and diastolic dimensions of the left ventricle (LV) significantly exceeded those of women, and the ejection fraction of the LV was significantly lower. The prevalence of LV hypertrophy (LVH) was 37% in the total sample, and it was higher in women than in men (45.9 and 26.6%, respectively, p=0.012). At the same time, the frequencies of concentric and eccentric types of LVH in both subgroups were similar. The incidence of LV concentric remodeling in women and men was 5.7 and 13.3%, respectively (p=0.001). In both subgroups, a negative correlation was found between the LV myocardial mass index and the calculated GFR. A positive correlation was noted between the levels of systolic blood pressure and CAP, the concentrations of cystatin C and plasma triglycerides.&#x0D; Conclusion. In hypertension, the structure of comorbid pathology is dominated by coronary heart disease, obesity and type 2 diabetes mellitus, when hyper- and dyslipidemia were often detected. The incidence of LVH in the general group of subjects was 37.0%, and in women this indicator was higher. In the subgroup of men, cases of LV concentric remodeling were significantly more frequent. An increase in the level of CAP and systolic blood pressure, as well as the concentration of cystatin C, was associated with an increase in the LV myocardial mass index, especially in the subgroup of women.

Body Mass Index: An Effective Predictor of Ejection Fraction Improvement in Heart Failure.

Background: Heart failure patients with higher body mass index (BMI) exhibit better clinical outcomes. Therefore, we assessed whether the BMI can predict left ventricular ejection fraction (EF) improvement following heart failure.Methods and Results: We included 184 patients newly diagnosed with dilated cardiomyopathy and reduced EF in our center and who underwent follow-up examination of EF via echocardiography after 6 months. The EF improved at 6 months in 88 participants, who were included in the heart failure with recovered EF (HFrecEF) subgroup. Patients in whom the EF remained reduced were included in the heart failure with persistently reduced EF (persistent HFrEF) subgroup. Our analyses revealed that EF increase correlated with age (r = −0.254, P = 0.001), left ventricular diastolic dimension (LVDD; r = −0.210, P = 0.004), diabetes (P = 0.034), brain natriuretic peptide (r = −0.199, P = 0.007), and BMI grade (P = 0.000). BMI grade was significantly associated with elevated EF after adjustment for other variables (P = 0.001). On multivariable analysis, compared to patients with persistent HFrEF, those with HFrecEF had higher BMI [odds ratio (OR) = 2.342 per one standard deviation increase; P = 0.001] and lower LVDD (OR = 0.466 per one standard deviation increase; P = 0.001). ROC-curve analysis data showed that BMI > 22.66 kg/m2 (sensitivity 84.1%, specificity 59.4%, AUC 0.745, P = 0.000) indicate high probability of EF recovery in 6 months.Conclusions: Our data suggest that higher BMI is strongly correlated with the recovered EF and that BMI is an effective predictor of EF improvement in patients with heart failure and reduced EF.

The paradoxical effect of aldosterone on cardiovascular outcome in maintenance hemodialysis patients.

BackgroundPatients with end-stage kidney disease face increased risk of cardiovascular events, and left ventricular diastolic dysfunction (LVDD) contributes to the high occurrence of cardiovascular mortality (CM). Although a high serum aldosterone (sALD) level is involved in the development of cardiovascular complications in the general population, this association is unclear in patients undergoing hemodialysis. We aimed to determine the impact of sALD on LVDD and CM among hemodialysis patients (HDPs).MethodsWe performed a prospective cohort study of maintenance HDPs without cardiovascular disease. The patients were divided into two groups according to the median level of sALD. All patients underwent baseline echocardiography to evaluate diastolic dysfunction (E/e' ratio > 15). The LVDD and CM rates were compared between the high and low aldosterone groups.ResultsWe enrolled a total of 60 adult patients (mean age, 57.9 ± 12.1 years; males, 30.0%). The low aldosterone group had an increased left ventricular diastolic dimension compared with the high aldosterone group (52.2 ± 8.4 mm vs. 50.3 ± 5.2 mm, respectively; p = 0.03). Low log-aldosterone (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.19–0.86) and large left atrial dimension (OR, 1.31; 95% CI, 1.11–1.54) were independent risk factors for LVDD at baseline. In addition, Cox regression analysis demonstrated that low sALD was an independent predictor of CM in HDPs (hazard ratio, 0.46; 95% CI, 0.25–0.85; p = 0.01) during follow-up.ConclusionLow sALD was not only associated with LVDD but was also an independent predictor of CM among HDPs regardless of their interdialytic weight gain.

Abstract 10723: Fetal Echocardiographic Assessment of Right Ventricular and Tricuspid Valve Function in Hypoplastic Left Heart Syndrome: Correlation with Postnatal Outcomes

Introduction: Hypoplastic left heart syndrome (HLHS) carries significant morbidity and mortality. Transthoracic echocardiogram (echo) assessment of right ventricular (RV) function and tricuspid regurgitation (TR) correlate with HLHS outcomes. There are limited reports on RV function and TR in fetal HLHS and postnatal outcomes. We aim to correlate RV function and TR on fetal-echo (F-echo) with transplant-free survival (survival), hospital length of stay after initial surgery (LOS), and timing of Glenn (BDG) in HLHS patients. Methods: Imaging and clinical data of fetuses diagnosed with HLHS between February 2014 and September 2020 at our institution were retrospectively reviewed. Measurements of RV myocardial performance index (MPI) and fractional area change (FAC) were made on initial F-echo. The RV shortening fraction (SF), presence/degree of TR, and RV size by diastolic short-axis dimension were recorded. Postnatal outcomes included survival, LOS and age at BDG. Early BDG was a repair at &lt;4 months. Mann-Whitney U test correlated F-echo measures and postnatal outcomes. Results: F-echo was available in 69 subjects; 22 excluded for termination/fetal demise, 9 for genetic syndromes, resulting in 38 subjects. Mean age at initial F-echo was 31.4±0.9wks, 11 referred &gt;30 weeks from regional cardiologists (adjusted mean age 23.1±0.4wks). Subject age at time of review ranged from 7 months to 6.5 years. Eight subjects died (median age 2 months) and 3 required transplant (median age 8 months). F-echo RV MPI was significantly higher (0.372±0.09;p=0.005) and RV FAC was significantly lower (43%±6.4%;p=0.016) in HLHS non-survivors versus survivors. Fetal RV size and presence of TR were not significantly different. Subjects with initial LOS &gt;30 days were more likely to have fetal TR (p&lt;0.001) and RV dilation (p=0.019), but no significant RV MPI and FAC difference. No fetal measures correlated with need for an early BDG. Conclusion: F-echo evaluation of RV MPI and FAC in HLHS correlates with transplant-free survival. Presence of fetal TR and RV dilation correlate with a longer LOS. F-echo measures of RV function and TR function may inform prenatal counseling and postnatal outcomes for fetal HLHS.

Remodeling Process in the Right and Left Atria and Ventricles Following Percutaneous Closure of the Atrial Septal Defect in Children and Adolescents: A Mid-term Study

Background: Atrial septal defect and its closure can lead to changes in the right and left cardiac cavities' function and size. In this study, Z-scores of the cardiac chambers and the heart function were assessed, and the important complications were mentioned. Methods: This interventional cross-sectional study was done on patients who had atrial septal defect closure aged younger than 18 years. All patients were recruited for transthoracic echocardiography. About half of the patients were randomly selected. The information of angiography and its side effects belong to all patients, but the echocardiographic parameters and Z-scores belong only to the selected group. Results: A total of 370 patients underwent the atrial septal defect closure, of whom 150 patients participated in the study. The patients' average age and weight were 9.25 ± 3.44 years and 15.12 ± 11.83 kg, respectively, and the mean follow-up time was 2.56 years. Z-scores of the interventricular septal dimension in diastole, the left ventricular posterior wall dimension in diastole, the left ventricular internal dimension in systole, and Z-scores of the size of the right atrium, right ventricle, pulmonary valve annulus, and the main pulmonary artery were more than Z-scores of the normal population. Furthermore, Z-scores of the E/A and the Eat/Aat of the tricuspid valve were less than their peers. Besides, the correlation between Z-scores and the atrial septal defect size and weight of the patients was assessed, which was statistically significant, and patients who underwent atrial special defect closure at the age of fewer than three years and less than 15 kg had more normal cardiac Z-scores. Conclusions: Z-scores of the cardiac chambers and pulmonary artery were more than normal after successful closure of the atrial septal defect in the mid-term follow-up.

Three-month cardiac outcomes of survivors of COVID-19 presenting to a district general hospital in West Hertfordshire, UK

Abstract Background COVID-19 is novel entity associated with significant morbidity and mortality. Most patients recover completely, however, a proportion describe persistent symptoms consistent with cardiopulmonary disturbance. The long-term cardiac and respiratory outcomes of COVID-19 are not known. Purpose The aim of this study was to undertake a comprehensive cardiopulmonary assessment of survivors of COVID-19 with post recovery symptoms. The cardiac findings are presented here. Methods Survivors of COVID-19 presenting to a general hospital in West Hertfordshire between 18 March 2020 and 15 May 2020, were reviewed at 3 months using a structured prespecified protocol. Patients with persistent symptoms and those admitted to the intensive care unit (ICU) were invited to attend a clinical assessment comprising an electrocardiogram (ECG), echocardiography, chest x-ray (CXR) and pulmonary function tests. At follow up, patients were categorised according to disease course: 1) monitored via a community based virtual hospital, 2) admitted for supplemental oxygen, 3) requiring non-invasive ventilation and 4) ICU admission. Results 448 eligible patients were evaluated by telephone. 11 patients admitted to ICU and 147 patients with persistent symptoms were invited for further assessment. At presentation, hospitalised patients were older, had higher levels of obesity and increased rates of hypertension than those managed virtually (p&amp;lt;0.05). Among hospitalised patients, the degree of pulmonary infiltration on CXR was higher, ROX index for intubation lower, eGFR lower, C-reactive protein levels higher and lymphocyte counts lower, compared to those managed virtually (p&amp;lt;0.05). The prevalence of known respiratory conditions was higher among patients admitted to hospital, with a trend towards statistical significance (p=0.051). There were no differences in the prevalence of known cardiac disorders and other co-morbidities amongst both patient groups (table 1). At follow up, CXR appearances were improved and similar among patients monitored virtually, those admitted for supplemental oxygen, those requiring non-invasive ventilation and those treated on ICU. There were no differences in heart rhythm and ECG parameters in the four patient groups. Left ventricular systolic and diastolic dimensions, Simpson's biplane ejection fraction, left atrial volume and left ventricular filling pressures were similar in all four patient groups. There were no differences in right ventricular dimensions, right ventricular fractional area change, tricuspid annular plane systolic excursion and pulmonary artery systolic pressures among patients irrespective of disease severity (table 2). Conclusions At 3 months, we identified no differences in ECG indices and echocardiographic parameters of left and right ventricular function among survivors of COVID-19, independent of disease course. The findings of this study argue against significant cardiac sequalae following COVID-19 infection. Funding Acknowledgement Type of funding sources: None.

Short-term amino acid, clinicopathologic, and echocardiographic findings in healthy dogs fed a commercial plant-based diet.

Consumer demand for commercially prepared plant-based (PB) dog food is increasing, but studies evaluating the short- or long-term effects of PB diets on canine health are lacking. The objective of this study was to assess the short-term amino acid (AA), clinicopathologic, and echocardiographic findings in 34 client-owned dogs fed a commercial extruded plant-based diet (PBD) in which pea protein was the primary protein source and 4 control dogs fed a commercial extruded traditional diet (TD). Plasma AA and whole blood taurine concentrations were measured in dogs at baseline and after 4 weeks on the PBD or the TD. Hematologic, serum biochemical, and echocardiographic testing were performed at baseline and after 12 weeks on the PBD or the TD. Four dogs in the PBD group did not complete the study. All essential AAs, except methionine, were higher in dogs after 4 weeks on the PBD compared to baseline. Taurine (plasma and whole blood) was also higher after 4 weeks on the PBD compared to baseline. A meaningful difference was detected in whole blood taurine between the PBD group and the control group at 4 weeks (P = .026) with the PBD group being higher. Median hematologic and biochemical results for the PBD group were within normal limits at baseline and at 12 weeks. In the PBD group, left ventricular internal diastolic dimension (LVIDd, P = < .001) and normalized LVIDd (P = .031) were higher 12 weeks post-PBD compared to baseline. There were no meaningful differences in left ventricular internal systolic dimension (LVIDs), normalized LVIDs, or fractional shortening 12 weeks post-PBD. There was no statistical evidence of difference between the 2 groups of dogs for any of the echocardiographic parameters at baseline or at 12 weeks. Essential AA or taurine deficiency was not observed in this cohort of dogs fed a commercial extruded PBD. Additionally, clinically relevant hematologic, serum biochemical and echocardiographic alterations were not detected. Further research is required to determine if long-term static feeding of PB diets can meet and maintain AA and other nutrient targets in dogs.

The impact of substrate and trigger ablation for reduction of functional mitral regurgitation in patients with persistent atrial fibrillation

Abstract Background Functional mitral regurgitation (FMR) is not uncommon in atrial fibrillation (AF) patients. Left atrial (LA) substrate remodeling and corresponding mitral valve annulus dilation has been reported as the most possible cause of FMR. Percutaneous catheter ablation (CA) is an effective treatment for AF. Although significant FMR could be improved by sinus restoration, patients with mitral regurgitation were more likely to experience recurrent AF post ablation, especially those with significant mitral regurgitation. There is no information available on the efficacy of CA for persistent AF in patients with FMR. Purpose The purpose of this study is to investigate the predictors of FMR improvement by CA and to determine the efficacy of substrate and trigger CA for persistent AF in patients with FMR. Methods We prospectively studied 512 consecutive patients admitted for persistent AF ablation from the EARNEST-PVI (Prospective Multicenter Randomized Study of Effect of Extensive Ablation on Recurrence in Patients with Persistent Atrial Fibrillation Treated with Pulmonary Vein Isolation) trial. On admission, enrolled patients were randomly assigned in a 1:1 ratio to pulmonary vein isolation (PVI) or PVI-plus additional ablation (linear ablation or/and CFAE ablation). Of the 512 patients, we studied 94 patients with preoperative echocardiography showing moderate or greater baseline FMR. FMR grades were classified into 5 grades (0/1/2/3/4). The FMR improvement group (FMRI(+)) was defined as a case in which the FMR was improved by two or more grades compared the preoperative echocardiography and the one year follow-up examination. Results Of the 94 patients, 42 were in the PVI group and 52 were in the PVI-plus additional ablation group. There were 30 cases in the FMRI(+) group and 64 cases in the FMRI(−) group. There were no significant baseline differences in age, sinus rhythm maintenance, plasma B-type natriuretic peptide (BNP) level, left ventricular diastolic dimension, or left atrium dimension between the FMRI(+) and FMRI(−) groups. AF duration was significantly shorter in the FMRI(+) group than FMRI(−) groups (5.8±9.4 months vs 12.4±15.4 months, p&amp;lt;0.0001). In addition, significantly more additional ablation cases were observed in the FMRI(+) group than in the FMRI(−) group (73.3% vs 46.8%, p=0.016). In multivariate analyses, only additional ablation was an independent predictor of FMRI (odds ratio 0.226 95% CI 0.081–0.626; p=0.004). Conclusions Catheter ablation is a valid option for the treatment of AF in patients with functional MR and additional substrate and trigger ablation were the only independent predictor of FMR improvement. Funding Acknowledgement Type of funding sources: None.

The Changes of Gene Expression and Protein Level of Stretch-Activated Chloride Channel in Atrial Myocardium of Dogs with Atrial Fibrillation.

ICl,stretch have been reported to be involved in the development of atrial fibrillation, so we observed the changes of transcription and translation levels of ICl,stretch in isolated atrial myocardium of heart failure canine models. In the control group (N = 10), five dogs were untreated and the other five received sham operation, while dogs in the heart failure group (N = 10) were implanted with cardiac pacemakers and underwent right ventricular pacing to induce heart failure. Cardiac structure and function were evaluated. The gene expression and protein level of ICl,stretch in the left atrial appendage were detected. The left atrial diameter, right atrial dimension, left ventricular diastolic dimension, and right ventricular diastolic dimension were significantly larger in the heart failure group (P < 0.05). In contrast, the ejection fraction and the left ventricular shorten fraction were higher in the control group (P < 0.05). Both the mRNA and protein expression levels of ICl,stretch in atrial myocardium of the heart failure group were significantly higher compared with the control group. ICl,stretch might play an important role in the vulnerability to atrial fibrillation in dilated atria with heart failure and could be a potential therapeutic target for atrial fibrillation.