Diastolic Parameters Research Articles

Layer myocardial strain is the most heritable echocardiographic trait.

Myocardial deformation assessed by strain analysis represents a significant advancement in our assessment of cardiac mechanics. However, whether this variable is genetically heritable or whether all/most of its variability is related to environmental factors is currently unknown.We sought to determine the heritability of echocardiographically determined cardiac mechanics indices in a population setting. A total of 1357 initially healthy subjects (women 51.6%; 48.2 ± 14.1 years) were included in this study from 20 years follow-up after the 4th visit of the longitudinal familial STANISLAS cohort (Lorraine, France). Data were acquired using state-of-the-art cardiac ultrasound equipment, using acquisition and measurement protocols recommended by the EACVI/ASE/Industry Task Force. Layer-specific global longitudinal strain (GLS) and global circumferential strain (GCS) (full-wall, subendocardial and subepicardial) and conventional structural and functional cardiac parameters and their potential heritability were assessed using restricted maximum likelihood analysis, with genetic relatedness matrix calculated from genome-wide association data. Indices of longitudinal/circumferential myocardial function and left ventricular (LV) ejection fraction had low heritability (ranging from 10 to 20%). Diastolic and standard LV function parameters had moderate heritability (ranging from 20 to 30%) except for end-systolic and end-diastolic volumes (respectively 30 and 45%). In contrast, GLSEndo/GLSEpi ratio had a high level of heritability (65%). Except for GLSendo/GLSepi ratio, a large percentage of variance remained unexplained (greater than 50%). In our population cohort, GLSendo/GLSepi ratio had a high level of heritability whereas other classical and mechanical LV function parameters did not. Given the increasing recognition of GLSendo/GLSepi ratio as an early/sensitive imaging biomarker of systolic dysfunction, our results suggest the possible existence of individual genetic predispositions to myocardial decline.

Assessing the impact of transcatheter aortic valve replacement on myocardial work indices and left ventricular diastolic function in aortic valve stenosis patients.

Aortic valve stenosis (AS) is the most common valvular heart disease worldwide. When timely intervention is performed, aortic valve replacement can improve patients' quality and duration of life. Load-independent left ventricular (LV) functional assessments, such as myocardial work indices (MWIs) and LV diastolic function parameters, could help clinicians decide on the optimal timing of intervention. To evaluate the reliability of MWI in AS patients and the changes in MWI and LV diastolic function after transcatheter aortic valve replacement (TAVR). We enrolled 53 consecutive patients with severe AS undergoing TAVR admitted between March 2021 and November 2021. MWIs and LV diastolic function were assessed before and after TAVR for each patient. All MWIs and LV diastolic function indices improved after TAVR. The degree of MWIs improvement was higher in patients with lower prior-TAVR MWI values, while the more severe the impairment of diastolic function, the greater the post-TAVR benefit. The introduction of myocardial work parameters into the routine assessment of patients with AS could improve our understanding of cardiac performance and aid in identifying the optimal timing for surgical or percutaneous treatment.

Characterization of left ventricular diastolic parameters of gated-single-photon emission computed tomography myocardial perfusion imaging in patients with diabetes and normal myocardial perfusion and systolic function.

Diabetic cardiomyopathy is defined as an independent entity with a specified pathological progression from diastolic dysfunction with preserved ejection fraction to overt heart failure. Myocardial perfusion imaging (MPI) with gated-single-photon emission computed tomography (G-SPECT) has been introduced as a feasible tool to evaluate left ventricular (LV) diastolic function. The aim of this study was to investigate the characteristics of diastolic parameters derived from G-SPECT MPI in diabetic patients compared to patients at very low risk of coronary artery disease (CAD) and with no other CAD risk factors. This cross-sectional study was performed on patients referred to the nuclear medicine department for G-SPECT MPI. Demographic and clinical data, as well as medical history, were extracted from a digital registry system including 4447 patients. Then, two matched groups of patients with only diabetes as cardiac risk factor ( n = 126) and those without any identifiable CAD risk factors ( n = 126) were selected. Diastolic parameters of MPI, including peak filling rate, time to peak filling rate, mean filling rate at the first third of diastole and second peak filling rate, were derived using quantitative software for eligible cases. The mean age of the diabetic and nondiabetic groups was 57.1 ± 14.9 and 56.7 ± 10.6 years, respectively ( P = 0.823). Comparison of quantitative SPECT MPI parameters between the two groups showed a statistically significant difference only in total perfusion deficit scores, whereas none of the functional parameters, including diastolic and dyssynchrony indices and the shape index, were significantly different. There were also no significant differences in diastolic function parameters between diabetes and nondiabetes patients in the age and gender subgroups. Based on the G-SPECT MPI findings, there is a comparable prevalence of diastolic dysfunction in patients with only diabetes as a cardiovascular risk factor and low-risk patients with no cardiovascular risk factors in the setting of normal myocardial perfusion and systolic function.

Incident atrial functional mitral regurgitation in atrial fibrillation and sinus rhythm

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial functional mitral regurgitation (AFMR) has been associated with atrial fibrillation (AF) and heart failure with preserved ejection fraction. However, data on its incidence, risk factors, and clinical outcomes are scarce. Objective We aimed to study the incidence, risk factors and clinical significance of AFMR, defined as >mild functional MR in the absence of more than mild left ventricle enlargement or dysfunction, in AF and sinus rhythm (SR). Methods Adults with a new diagnosis of AF between 2010–2021 who had a transthoracic echocardiogram (TTE) were identified (n=57,109). Similarly, adults with no diagnosis of AF who had a TTE between 2010–2021 were identified for comparison (n= 364,767). Patients with >mild MR at baseline, primary mitral valve disease, cardiomyopathy, ≥moderate aortic valve disease, current or previous low ejection fraction, enlarged left ventricle, cardiac devices, previous cardiac surgeries, or with no follow up TTE ≥6 months from baseline were excluded. Furthermore, patients with AF had to have a TTE within 1 month of AF diagnosis. The presence of ≥2 of 4 abnormal diastolic function parameters [mitral septal e’ <0.07 m/sec, mitral septal E/e’ >15 in SR and >11 in AF, TR velocity >2.80 m/sec, left atrial volume index >34 ml/m2] was determined. Cox proportional hazards regression was used to determine risk factors associated with incident AFMR and all-cause death. Patients without the event of interest were censored at last follow up. Patients who developed >mild MR of other types (primary or functional ventricular) were censored at that time. Results Overall, 1,747 (median age 67 years; 34% females) patients with AF and 29,623 (median age 59; 51% females) in SR were included. Incident AFMR occurred in 167 patients with AF over median 3.1 (IQR 1.6–5.1) years [incidence rate of 2.6 per 100-person year] and in 780 patients in SR over median 3.1 (IQR 1.5–5.8) years [incidence rate 0.7 per 100-person year] (Figure 1). AF remained associated with AFMR after adjusting to confounding factors [age ≥65, female sex, ≥2 abnormal diastolic function parameters, and low hemoglobin; adjusted HR 3.23 (2.71–3.85)]. Independent risk factors associated with incident AFMR in AF were age ≥65, female sex, persistent AF, and ≥2 abnormal diastolic function parameters, whereas successful rhythm control without recurrence was a protective factor (Figure 2a). Risk factors for AFMR in SR were age ≥65 years, female sex, presence of ≥2 abnormal diastolic function parameters, and low hemoglobin (Figure 2a). Incident AFMR was independently associated with all-cause death in both AF and SR (Figure 2b). Conclusions AF confers more than 3-fold increase in the risk of AFMR. Diastolic dysfunction, older age, and female sex were independent risk factors for incident AFMR in both SR and AF. Paroxysmal AF and successful rhythm control were protective factors against AFMR in AF. AFMR is universally associated with worse mortality.

Echocardiography identifies geometric and functional cardiac alterations in patients with Familial Partial Lipodystrophy

Abstract Funding Acknowledgements Type of funding sources: None. Lipodystrophy (LPD) is a rare condition characterized by levels of loss of adipose tissue in a generalized or partial form. Cardiovascular disease is a significant cause of morbidity in this population,n but cardiomyopathy associated with LPD is still not well described. We sought to characterize cardiac morphology and left ventricle function in patients with partial LPD with no cardiac symptoms. Methods This is a cross-sectional case-control study. Adult patients with clinical diagnosis of familial partial LPD and Controls were invited to collect echocardiographic images prospectively. Transthoracic echocardiography was performed with conventional bidimensional and Doppler techniques and LV Speckle-tracking technique. Left atrium (LA) dimension and volumes, LV dimension, thickness, mass, and diastolic and systolic function were measured. Data between groups compared with appropriate tests according to variable distribution. Relation between echocardiographic variables and LPD diagnosis were tested with simple and multiple regression models, considering the effect of systolic arterial blood pressure (SBP) as an independent variable. The significance level was set as p <0.05. Results twenty-nine patients with LPD were compared to 17 control. LPD patients and control group did not differ in age (44.58±11.77 vs. 43.84±13.32, p = 0.94), gender, BMI (26.73±4.30 vs. 24.52±5.04 Kg/ml, p = 0.05) or BSA (1.70±0.23 vs. 1.67±0.16, p = 0.9). Patients with LPD had statistically higher SBP (122.7±14.85 vs. 110.9±11.08, p = 0.02). LPD had LA higher dimension (37.27±4.44 vs. 32.12±4.25 mm, p = 0.001) and volume (LAVi)(30.17±7.24 vs. 24.94±9.04 ml/m2, p = 0.02), LV mass_i (79.29±17.38 vs. 67.10±19.36, p = 0.02), and also reduced diastolic LV parameters as mitral tissue Doppler E' lateral (11.07±3.48 vs. 14.94±2.35 cm/s, p = 0.001) and E' septal ( 8.0±2.73 vs. 11.38±2.02 cm/s, p = 0.001, and also E/E' ratio (7.89±2.22 vs. 6.35±1.29, p = 0.02). Parameters of LV systolic function as LVEF (64.70±4.56 vs. 62.15±4.35 %, p = 0.08) or GLS were not statistically different between groups (−17.06±2.70vs. −18.02±1.98%, p = 0.25). There was a positive relation of LA dimension ( β 5.6, p<0.001), wall thickness (β 1.3, p 0.011), tissue Doppler E' lateral (β −3.5, p = 0.002) and E' septal (β −3.2, p<0.001) to LPD diagnosis, even after adjusted for SBP. Conclusion patients with familial partial LPD present early cardiomyopathy with LV hypertrophy, LA enlargement, and LV diastolic dysfunction before LV systolic dysfunction. Echocardiographic parameters are related to LPD diagnosis independent of SBP.

Asymptomatic left ventricular systolic dysfunction in hypertensive patients with disturbed ventriculo arterial coupling

Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular (LV) ejection fraction (LVEF) is most commonly used validated echocardiographic parameter of systolic function estimation, but left ventricular (LV) global longitudinal strain (GLS) is an early indicator of subclinical cardiac dysfunction, even when LVEF is normal. Purpose To investigate ventriculo – arterial coupling (VAC) and LV function in asymptomatic hypertensive patients without target organ damage to compare different echocardiographic parameters for systolic function. Methods A total 110 patients (56 ± 14 years) with hypertension, were separated in two groups: 32(men, ( 59 %)) patients with normal AE/Ees ratio (Arterial elastance (AE) and ventricular elastance (Ees)) and 78 (men, ( 64%)) hypertensive patients with decrease AE/Ees ratio, marker for ventriculo – arterial coupling. All patients underwent standard two – dimentional echocardiography with Speckle tracking analysis for LV - GLS. End – systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and – systolic pressure/stroke volume and end – systolic pressure/end – systolic volume. Results Patients with disturbed VAC had concentric hypertrophy whereas patients with normal VAC had concentric remodeling. There were no significant differences in EF, but GLS in all patients was reduced. There were no statistically significant differences in LV diastolic function parameters. Statistically significant differences in echocardiographic parameters were found in patients with normal VAC in comparison with disturbed VAC (TABL. 1), There are negative correlation between LV - GLS and AE/Ees (r = -0.327, p = 0.001) and positive with Ees (r=0.250, p = 0.015). Conclusion LV - GLS is a more sensitive parameter of LV systolic function than LVEF, when LV concentric hypertrophy is present in hypertensive patients. Further investigation are needed to confirm the superiority of GLS over LVEF in LV systolic function estimation and its implementation in clinical practice.

The relation between left atrial and left ventricular size in a healthy population

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The project was funded by grants from The Liaison Committee for Education, Research and Innovation in Central Norway, St. Olavs University Hospital (Trondheim, Norway), Nord-Trøndelag Hospital Trust (Levanger, Norway), and Simon Fougner Hartmann's Family Fund (Copenhagen, Denmark). Background The left atrium (LA) and ventricle (LV) are closely linked and adapt to meet metabolic demands. Reduced LV end-diastolic volume (LVEDV) and increased LA end-systolic volume (LAESV) is common in patients with diastolic dysfunction and with higher age. The remodeling of LA and LV in response to endurance exercise is thought to be balanced, and thus, the LA:LV ratio could help discriminate pathologic from physiologic LA enlargement. Purpose We aimed to describe the relative LA and LV chamber remodeling associated with the clinical characteristics age, sex, maximal oxygen consumption (VO2peak), HbA1C, body mass index, systolic blood pressure, and diastolic dysfunction. Methods Healthy participants included in a large longitudinal population study underwent clinical evaluation and cardiopulmonary exercise testing (CPET) in 2006–2008, followed by comprehensive echocardiography and CPET in 2017–18. Exclusion criteria were: 1) submaximal performance during CPET, 2) atrial fibrillation, or 3) presence of heart failure or a history of myocardial infarction. All examinations were performed by highly experienced personnel. All echocardiographic exams and analyses were performed by personnel affiliated a European Association of Cardiovascular Imaging accredited echo-laboratory. Results In total, 1,349 participants were included. Mean (SD) age was 58 (12) years, and 52% were women. The LA:LV ratio was higher with higher age due to lower LVEDV and stable LAESV (Figure 1). Age alone explained 12% (p<0.001) of variance for the LA:LV ratio and men had higher LA:LV ratios than women (0.55 vs. 0.50, p <0.001). All examined clinical characteristics showed significant associations with LA:LV ratios in univariate regression analyses. In adjusted analyses, increased VO2peak was significantly associated with increased LA:LV ratio, but with a small effect-size without clinical significance. In the subsample with indexed LAESV >34mL/m2, increased VO2peak was significantly associated with increased LA:LV-ratio in adjusted analyses (p <0.001). Ten-year change in VO2peak was not significantly associated with LA:LV ratio in adjusted models for the total population, nor in the subgroup with indexed LAESV >34 mL (p = 0.181). Multiple logistic regression showed that higher LA:LV ratio was associated with increased risk of diastolic dysfunction with an OR (95% CI) of 2.4 (1.5, 4.0) per SD increase in LA:LV-ratio, adjusted for age, sex, systolic blood pressure, HbA1c, and BMI (p < 0.001). LA strain measures, E/e’ ratio, and TR velocity were significantly associated with the LA:LV ratio, while other diastolic function parameters were not. Conclusion The LA:LV ratio increases with higher age due to reduced LVEDV and stable LAESV. VO2peak was not a robust predictor of LA:LV ratio in this population. Future studies should evaluate the relative remodeling of LA and LV with repeated measurements of echocardiographic indices and CPET to better define the role of this ratio.

Transthoracic echocardiography parameters as predictors of 30-day readmission after admission for new-onset heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Background In an aging population. heart failure (HF) is one of the biggest challenges facing healthcare systems in the coming years. Hospital readmissions after discharge continue to be one of the main problems for both patients and health systems as they represent costs and work overload for staff. The aim of this study is to re-visit the prognostic value of transthoracic echo parameters (TTE) in readmissions after a new-onset HF episode. Methods Consecutive patients admitted with a first episode of HF were prospectively included into a registry. All patients underwent transthoracic echocardiography based on current guidelines for chamber quantification within 24hrs after admission. Conventional systolic and diastolic function parameters were obtained. In addition. longitudinal strain and ventricular-arterial coupling of both ventricles were evaluated. Results 218 consecutive patients were included. Clinical and imaging characteristics are described in Table 1. 32 patients (14.7%) had readmission within 30-days. Mean age of the cohort was 73.4±13.4 years; mean LV ejection fraction (LVEF) was 42.3±14.2% and mean LV global longitudinal strain (LV-GLS) was −9.2±3.4%. Patients with 30-day readmissions had lower LVEF (37.8±3.1 vs 42.7±1.5%. p = 0.255) and significantly lower LV-GLS (−7.4±2.4 vs −9.5±3.4%. p = 0.042). Regarding diastolic function, patients with 30-day readmissions had a slightly higher E/e’ ratio (15.1±10.3 vs 14.3±7.2, p = 0.747) and a significantly larger left atrium volume index (57.2ml/m2 vs 45.5ml/m2). Right ventricular-arterial coupling (RVAc) was significantly lower in patients with readmissions (0.43±0.11 vs 0.69±0.9, p = 0.031). As for clinicals variables; only obesity was significantly associated with 30-day readmissions (Table 1). A model to predict 30-days readmissions that included LVEF, LV-GLS, LAVI and RVAc had an area under the ROC curve of 0.831. CI (0.72–0.95). Figure 1. Conclusions Several clinical scores have been proposed. however. cardiac function parameters are barely taken into account in most scores. Simple and feasible TTE parameters can accurately predict readmissions after a first episode of heart failure and might be included in clinical scores for better risk stratification of patients with new-onset HF.

#6067 GUT MICROBE-DERIVED UREMIC TOXIN TRIMETHYLAMINE N-OXIDE CONTRIBUTES TO CARDIAC REMODELING IN PATIENTS ON HEMODIALYSIS

Abstract Background and Aims It is well established that cardiovascular pathology is the leading cause of increased morbidity and mortality in chronic kidney disease patients, especially in the terminal stage. This is explained by high prevalence of both traditional and non-traditional cardiovascular risk factors, among which inflammation, intestinal dysbiosis and microbe-derived uremic toxins such as indoxyl sulfate, p-cresyl sulfate, trimethylamine-N-oxide (TMAO) are recently considered the most significant. However, the potential underlying mechanisms of these findings have not been fully elucidated. Here we aimed to investigate the association of serum TMAO with echocardiographic parameters of cardiac remodeling in patients receiving hemodialysis treatment. Method One hundred and forty (85M, 55F) clinically stable patients on dialysis were studied. The median (interquartile range) age was 56,5 (46,2-60,5) years, median duration of dialysis treatment – 48 (14,5-97) months, 39 (27,9%) were diabetic, 109 (77,9%) had high blood pressure, 39 (27,9%) – previous history of ischemic heart disease, including 8 (5,7%) suffered a myocardial infarction. All patients underwent transthoracic echocardiography (General Electric Vivid E95 device) with the registration of standard parameters. The determination of TMAO in serum was performed by LC/MS using a Shimadzu-8060 system combined with a Shimadzu LC-20AD liquid chromatograph. Statistical analysis was performed with STATISTICA 14.0 program. Non-parametric Spearman's rank correlation method was used to evaluate the associations between serum TMAO level and echocardiographic parameters. Value of p<0.05 was considered statistically significant in all analyses. Results Median serum TMAO was 5244 (3588-8701) ng/ml. Echocardiography data: end-systolic left ventricular (LV) size is 38,2±0,6 mm, end-systolic LV volume – 62,0±4,4 ml, end-diastolic LV size – 55,8 ±1,3 mm, end-diastolic LV volume – 111,5±19,7 ml, ejection fraction (according to Simpson method) – 53,2±7,2%, shortening fraction – 28,9±4,4%, inter-ventricular septum thickness – 11,6±0,2 mm, posterior wall thickness – 11,9 ± 0,1 mm, LV mass index – 142,8±4,6 g/m2, LV mass – 298,6±8,8 g, relative wall thickness – 0,43±0,3, number of patients with LV remodeling or hypertrophy – 98 (70%). LV diastolic function parameters (n = 113): E – 0,69±0,2 m/s, A – 0,79±0,2 m/s, E/A (early (E) to late (A) ventricular filling ratio) – 0,89±0,2, deceleration time (DT) – 211±52 ms, number of patients with diastolic disfunction – 104 (74,3%). Statistically significant correlation was fount between TMAO concentration and end-diastolic LV volume (r = 0,315; р = 0,028), LV mass (r = 0,409; р = 0,011) and DT (r = 0,272; р = 0,041). TMAO levels in individuals with LV myocardial hypertrophy and diastolic dysfunction was significantly higher than without these abnormalities (Mann–Whitney U-test р = 0,037 and р = 0,043, correspondingly). Conclusion Our results suggest that elevated TMAO may contribute to cardiac remodeling in hemodialysis patients through the myocardial fibrosis and hypertrophy. The pathophysiological mechanisms of TMAO must be investigated further for a better understanding of its role in cardiovascular disease progression and to develop therapeutic interventions against uremic toxicity.

The relationship between ascending aortic diameter with left atrial functions and left ventricular mass index in a population with normal left ventricular systolic function.

Ascending aortic dilatation is a common clinical issue. In the present study, we aimed to evaluate the relationship between ascending aortic diameter with left ventricular (LV) and left atrial (LA) functions, and LV mass index (LVMI) in a population with normal LV systolic function. A total of 127 healthy participants with normal LV systolic function took part in the study. Echocardiographic measurements were obtained from each subject. The mean age of the participants was 43±14.1 years and 76 (59.8%) were female. The mean aortic diameter of the participants was 32.2±4.7mm. A negative correlation was found between aortic diameter and LV systolic function (LVEF r=-.516, p<.001; Gls r=-.370). In addition, there was a strong positive correlation between aortic diameter with LV wall thicknesses, LVMI (r=.745, p<.001), and systolic and diastolic diameters. The relationship between aortic diameter and diastolic parameters was evaluated, a negative correlation with Mitral E, Em, E/A ratio, and a positive correlation with MPI, Mitral A, Am, E/Em ratio were found. A strong correlation between ascending aortic diameter with LV and LA functions, and LVMI in individuals with normal LV systolic function.

Impact of SGLT2 inhibitors on the mechanisms of myocardial dysfunction in type 2 diabetes: A prospective non-randomized observational study in patients with type 2 diabetes mellitus without overt heart disease

AimsThis prospective observational study evaluated the possible mechanisms of action of SGLT2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM) without overt heart disease. MethodsThe study was designed to verify whether SGLT2i impact biomarkers of: myocardial stress–NT-proBNP, inflammation–high sensitivity C-reactive protein, oxidative stress –myeloperoxidase, functional and structural echocardiographic parameters, in patients with T2DM on metformin (heart failure stages A and B) who needed treatment intensification with a second antidiabetic agent. The patients were divided in two groups – the ones planned to receive SGLT2i or DPP-4 inhibitor (except saxagliptin). At baseline, and after six months of therapy, 64 patients underwent blood analysis, physical and echocardiography examination. ResultsThere were no significant differences between the two groups in terms of biomarkers of myocyte and oxidative stress, inflammation and blood pressure. Body mass index, triglycerides, aspartate aminotransferase, uric acid, E/E′, deceleration time and systolic pressure in the pulmonary artery significantly decreased, while stroke volume, indexed stroke volume, high-density lipoprotein, hematocrit and hemoglobin significantly increased in the group on SGLT2i. ConclusionsAccording to the results, SGLT2i mechanisms of action comprise rapid changes in body composition and metabolic parameters, reduced cardiac load and improvement in diastolic and systolic parameters.

Longitudinal Assessment of Left Ventricular Function in Patients with Myopericarditis After mRNA COVID-19 Vaccination.

Multiple reports have described myopericarditis following mRNA COVID-19 vaccination. However, data on the persistence of subclinical myocardial injury assessed by left ventricular (LV) longitudinal strain (LVLS) is limited. Our aim was to assess LV function longitudinally in our cohort of COVID-19 vaccine-related myopericarditis using ejection fraction (EF), fractional shortening (FS), LVLS, and diastolic parameters. Retrospective, single-center review of demographic, laboratory, and management data was performed on 20 patients meeting diagnostic criteria for myopericarditis after mRNA COVID-19 vaccination. Echocardiographic images were obtained on initial presentation (time 0), at a median of 12 days (7.5, 18.5; time 1), and at a median of 44 days (29.5, 83.5; time 2). FS was calculated by M-mode, EF by 5/6 area-length methods, LVLS by utilization of TOMTEC software, and diastolic function by tissue Doppler. All parameters were compared across pairs of these time points using Wilcoxon signed-rank test. Our cohort consisted predominantly of adolescent males (85%) with mild presentation of myopericarditis. The median EF was 61.6% (54.6, 68.0), 63.8% (60.7, 68.3), 61.4% (60.1, 64.6) at times 0, 1, and 2, respectively. Upon initial presentation, 47% of our cohort had LVLS < -18%. The median LVLS was -18.6% (-16.9, -21.0) at time 0, -21.2% at time 1 (-19.4, -23.5) (p = 0.004) and -20.8% (-18.7, -21.7) at time 2 (p = 0.004, as compared to time 0). Though many of our patients had abnormal strain during acute illness, LVLS improved longitudinally, indicating myocardial recovery. LVLS can be used as marker of subclinical myocardial injury and risk stratification in this population.

SIMULTANEOUS RECORDING OF CENTRAL BP AND ARTERIAL STIFFNESS DURING ECHO CORRELATES BETTER WITH LV DIASTOLIC FUNCTION THAN ROUTINE EXAMINE

Objective: ASE guidelines for the diagnostics of the left ventricle (LV) of diastolic dysfunction in 2016 suggested using the method of non-invasive assessment of central blood pressure (CBP) and the augmentation index (Aix) in order to obtain more detailed information in patients with arterial hypertension (AH). Routine determination of CBP does not allow the procedure to be performed simultaneously with ultrasound, so that can affect the results of the study because hemodynamics can change significantly during this time. The BAT 41-2 device, developed in Ukraine, allows the performing of two studies at the same time. The purpose of this analysis was to determine whether this approach is better than routine research. Design and method: We included 37 patients with AH grade 2. An echocardiographic examination was done according to ASE guidelines for the diagnosis of diastolic dysfunction of the left ventricle in 2016, including evaluation of transmitral E/A and E/e’ ratios, deceleration time (Dt) and isovolumic relaxation time (IVRT). Routine examination of CBP and Aix standardized for heart rate 75 (Aix@75) was measured with Sphygmocor (ArCor, Australia) according to a standardized protocol. Simultaneous measurement of CBP and Aix@75 was done with BAT41-2 device (IKS-Techno, Ukraine). Simultaneous measurement was done during standard echo views were recorded while the routine examination was done 30-90 min after the ultrasound diagnostic was done. To evaluate associations we used Spearman correlation analysis with the IBM SPSS 26.0 software package. Results: In our analysis, we did not find any correlations of E/A with any of the other parameters. Both routine and simultaneous CBP measurement were associated with LV IVRT but for simultaneous CBP measurement, this association was greater (R = 0.197, P = 0.043, and R = 0.340, P = 0.049 respectively). E/e’ significantly correlated with routine Aix@75 and simultaneous Aix@75, but again the last association was more strong (R = 0.495, P = 0.037 and R = 0.504, P = 0.014 respectively). Simultaneous Aix@75 was also more associated with IVRT (R = 0.438, P = 0.010) than routine (R = 0.210, P = 0.038). Conclusions: Simultaneous registration of CBP and AiX during echocardiography is more associated with LV diastolic function parameters than a routine examination.

EFFECTS OF SARS-COV-2 INFECTION ON THE CARDIORESPIRATORY PERFORMANCE BY HYPERTENSION STATUS

Objective: Few data have been published regarding the holistic approach of patients with history of arterial hypertension after Sars-Cov-2 infection. The purpose of our study was to examine the impact of Covid-19 in the cardiopulmonary status of hypertensive patients 3 months after the first day of infection. Design and method: All participants who recovered Covid-19 infection underwent cardiorespiratory exercise test using either Bruce or modified Bruce protocol and transthoracic echocardiogram where all parameters were evaluated. The population was separated into two groups based on history of hypertension. Group I included 62hypertensives and Group II included 134normotensive subjects. Results: A total of 198 patients (51±15 years, 44.4% males, 6.6% history of coronary heart disease) were assessed. Hypertensives had higher BMI (30.47±4.68 vs. 26.20 ±5.36 kg/m2, p&lt;0.001) and BSA (2.03±0.24 vs. 1.91±0.45, p&lt;0.001). They were hospitalized in higher percentage comparing to normotensives(54.8% vs. 35.8%, p&lt;0.01). Out of echocardiographic parameters, diastolic dysfunction parameters including left atrial diameter(40 ±6 vs. 35±5mm, p&lt;0.001) and E/A ratio (0.95±0.34 vs. 1.22±0.43, p&lt;0.001) differed significantly between two groups. LVEF(%) was also significantly impaired (56±10% vs. 58±9%, p:0.04) in hypertensives. This finding was depicted in lower oxygen consumption (VO2 (ml/kg/min)) both maximum (22±4 vs.28±7, p&lt;0.001) and during the 1st minute of recovery (19±18 vs.21±23, p&lt;0.006), metabolic equivalents (METS) at peak, 10±13 vs. 10±3, p&lt;0.001) and HR1st minute recovery (124±23 vs. 138±21 bpm, p&lt; 0.001) comparing to normotensives. Systolic blood pressure(mmHg) at rest (132±13 vs. 125±16, p: 0.002), maximum (189±28 vs. 177±26, p: 0.01) and during the 1st minute of recovery (179±29 vs. 162±25, p: 0.001) was higher while the exercise duration was significantly lower (8±3 vs. 9±3 min, p&lt;0.001) in patients with hypertension. Finally, hypertensive subjects reported higher scores in Borg scale for dyspnea (7±2 vs. 6±2, p:0.02) comparing to normotensives. Conclusions: Current study highlighted the negative impact of Sars-Cov-2 infection in the ability of patients with hypertension to exercise. Therefore, the need for a more comprehensive approach for rehabilitation including the modification of risk factors like hypertension and obesity in post-covid patients is mandatory

Effects of Antihypertensive Treatment on Left and Right Ventricular Global Longitudinal Strain and Diastolic Parameters in Patients with Hypertension and Obstructive Sleep Apnea: Randomized Clinical Trial of Chlorthalidone plus Amiloride vs. Amlodipine.

Hypertension is highly prevalent in patients with obstructive sleep apnea (OSA), and fluid retention with its nighttime rostral distribution is one potential mechanism. We tested whether or not diuretics differ from amlodipine in their impact on echocardiographic parameters. Patients with moderate OSA and hypertension were randomized to receive diuretics (chlorthalidone plus amiloride) or amlodipine daily for 8 weeks. We compared their effects on left and right ventricular global longitudinal strain (LV-GLS and RV-GLS, respectively), on LV diastolic parameters, and on LV remodeling. In the 55 participants who had echocardiographic images feasible for strain analysis, all echocardiographic parameters were within normal ranges. After 8 weeks, the 24 h blood pressure (BP) reduction values were similar, while most echocardiographic metrics were kept unchanged, except for LV-GLS and LV mass. In conclusion, the use of diuretics or amlodipine had small and similar effects on echocardiographic parameters in patients with moderate OSA and hypertension, suggesting that they do not have important effects on mediating the interaction between OSA and hypertension.

The levels of certain circulating microRNAs in hypertrophic cardiomyopathy are associated with echocardiographic parameters

Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease; it is characterized by left ventricular (LV) hypertrophy that cannot be explained by hemodynamic causes. It is believed that sarcomere dysfunction underlies the pathogenesis of this disease, however, only half of patients with the HCM phenotype have mutations in sarcomere-encoding genes. HCM is distinguished by both high genetic and clinical heterogeneity and therefore more studies are seeking to investigate a regulation of gene expression in HCM and how the abnormalities in this process can affect disease phenotype. One of the levels of regulation of gene expression - a post-transcriptional level - is mediated by short non-coding microRNAs that inhibit protein synthesis. To identify the correlations between levels of circulating microRNAs, previously shown to be associated with HCM, and clinical parameters of HCM patients. Correlation analysis of miR-499a-5p, miR-454 and miR-339-5p plasma levels and clinical parameters of 33 HCM patients, examined from 2019 to 2021, has been performed. Variants in HCM-associated genes were found in 49% of patients. There were no clinical differences between genotype-positive and genotype-negative patients. MiR-499a-5p level correlated with LV ejection fraction, miR-454 level - with LV diastolic function parameters and miR-339-5p level - with left atrium dimension. Levels of certain circulating microRNAs correlate with echocardiographic parameters in HCM patients.

Enhancement of left ventricular compliance in twin pregnancy

Abstract Funding Acknowledgements Type of funding sources: None. Background The knowledge of maternal left ventricular adaptation in twin pregnancies is incomplete. Purpose The objective of this study was to longitudinally investigate maternal changes of left ventricular (LV) function and compliance in twin pregnancies. Methods Thirty-five women (age 35.3±4.8 years) with uncomplicated twin pregnancy were enrolled to undergo transthoracic echocardiography at 10-15 (T1) and 30-38 (T3) week’s gestation. Left atrial (LA) and LV dimensions, LV volumes and mass, diastolic parameters (at pulsed wave Doppler and tissue Doppler), global longitudinal strain (GLS) at speckle-tracking imaging, and non-invasive pressure-volume curves (PV loops) were measured and calculated. Results Maternal LA and LV dimensions, LV volumes and mass had an increasing trend from T1 to T3 (p&amp;lt;0.001 for all). E/A remained stable, while E/e’ ratio slightly increased during gestation. GLS showed no changes between the two visits. At PV loops analysis (Figure 1), LV end-systolic elastance (Ees) and arterial elastance (Ea) both decreased, with no changes in ventricular-arterial coupling (VAC). LV end-diastolic volumes increased from T1 to T3 with no changes in LV end-diastolic filling pressure; the rightward shift of the end-diastolic pressure-volume relationship (EDPVR) suggested enhanced LV cavity compliance (Figure 2). An increase in stroke work was observed. Conclusions During twin pregnancy GLS and VAC were not modified showing functional adaptation to enhanced haemodynamic load. Importantly, stroke work increase was sustained by enhancement in LV end-diastolic volume with unaltered filling pressure.

Determinants of cardiopulmonary exercise test responses in hypertrophic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Exercise capacity and ventilatory efficiency are often altered in hypertrophic cardiomyopathy (HCM) and several factors have been advocated as possible causes. Aim This study investigates the determinants of cardiopulmonary exercise test (CPET) prognostic markers for HCM (VO2Peak, VE/VCO2 Slope and PETCO2 apex), by considering echocardiographic and cardiac magnetic resonance (CMR) parameters. Secondly, it scopes if myocardial fibrosis at CMR leads to clinical and functional differences. Methods 64 patients with HCM underwent a clinical assessment, including maximal CPET, echocardiography, and CMR. Exclusion criteria were the corrective surgery for cardiac hypertrophy and heart failure stage. Results The study included 66% males, age 40±17 years, NYHA class I or II 91%. Mean left ventricle (LV) ejection fraction was 63,8±7,7%, with a mean LV maximal wall thickness (MVT) of 20,2±5,6 mm; LVOT gradient was &amp;gt;30mmHg in 14% of patients. Late gadolinium enhancement (LGE) was described in 70,3% of cases with a mean LGE extension on bullseye plot of 11%. 39% of patients had a VO2 peak &amp;lt;80% of predicted, 35% a reduced PETCO2 apex and 26% an increased VE/VCO2 Slope. At the stepwise multivariate analysis, age (β=-0,33; p=0,00), BMI (β=-0,80; p=0,002), systolic blood pressure increase (β=0,22; p=0,02), left atrial volume (β=-0,15; p=0,02) and BB therapy (β=-0,45; p=0,00) were independently associated with VO2 peak (R2-adjusted index 0,95). Concerning ventilatory efficiency, sex (β=-0,41; p=0,03), left atrial volume (β=0,46; p=0,01) and LGE extension (β=0,33; p=0,01) were independently associated with VE/VCO2 Slope (R2-adjusted index 0,46). Similar data, with reversed correlations, emerged for PETCO2 apex. Patients with LGE had a LV mass index (mean 104,6 vs 82,7 g/m2, p=0,04), MWT (mean 21,8 vs 16,2 mm, p=0,00) and diastolic function (mean E/e’ 13,4 vs 10,0, p=0,01) worse that the counterpart. No differences were found in sex, age, therapy, CPET parameters and arrhythmic burden. BB+ patients were older, had more LV hypertrophy, worse diastolic parameters, and functional capacity while ventilatory efficiency was similar. Conclusions This study supports previous data about VO2 peak determinants. The correlation between the extension of the LGE and ventilatory efficiency in patients with HCM is an original finding. It confirms the pathophysiological explanation of a lung ventilation/perfusion mismatch due to the increased left atrium pressure that is secondary to a more severe LV diastolic disfunction in patients with LGE. The reduced VO2 in BB+ compared to BB- patients is not inferable given the different age and severity of disease. Moreover, the negative chronotropic effect of BB during exercise prolongs the diastolic filling time, thus, improving stroke volume and alleviating the LV filling pressures, thus normalising, in the less advanced stages of pathology, the ventilatory efficiency in HCM patients.

Diastolic function assessment with left atrial strain in long-term survivors of childhood acute lymphoblastic leukemia

Background and objectivesSurvivors of childhood cancer might be at increased risk of diastolic dysfunction at follow-up due to exposure to cardiotoxic treatment. Although assessment of diastolic function is challenging in this relatively young population, left atrial strain might provide a novel insight in this evaluation. Our aim was to examine diastolic function in a cohort of long-term survivors of childhood acute lymphoblastic leukemia by using left atrial strain and conventional echocardiographic parameters. MethodsLong-term survivors who were diagnosed at a single center between 1985 and 2015 and a control group of healthy siblings were recruited. Conventional diastolic function parameters and atrial strain were compared, and the latter was measured during the 3 atrial phases: reservoir (PALS), conduit (LACS) and contraction (PACS). Inverse probability of treatment weighting was used to account for differences between the groups. ResultsWe analyzed 90 survivors (age, 24.6±9.7 years, time since diagnosis 18 [11-26] years) and 58 controls. PALS and LACS were significantly reduced compared with the control group: 46.4±11.2 vs 52.1±11.7; P=.003 and 32.5±8.8 vs 38.2±9.3; P=.003, respectively. Conventional diastolic parameters and PACS were similar between the groups. The reductions in PALS and LACS were associated with exposure to cardiotoxic treatment in age- and sex-adjusted analysis (≥ moderate risk, low risk, controls): 45.4±10.5, 49.5±12.9, 52.1±11.7; Padj=.003, and 31.7±9.0, 35.2±7.5, 38.2±9.3; Padj=.001, respectively. ConclusionsLong-term childhood leukemia survivors showed a subtle impairment of diastolic function that was detected with atrial strain but not with conventional measurements. This impairment was more pronounced in those with higher exposure to cardiotoxic treatment.

Left ventricular diastolic function in the fifth decade of life in women with a history of spontaneous preterm birth

ObjectiveCardiovascular disease (CVD) is the number one cause of death in women and defining its risk factors is necessary to reduce its prevalence. A history of preeclampsia is shown to be associated with hypertension and alterations in left ventricular (LV) diastolic function parameters. Because of overlapping mechanisms between preeclampsia and spontaneous preterm birth (SPTB), our most recent study investigated the association between SPTB and hypertension, and found an almost 2 times higher prevalence of hypertension after SPTB. No previous studies have focused on the association between SPTB and LV diastolic function. The aim of this study is to investigate LV diastolic function as potential early parameter of CVD in women with a history of SPTB. Study designWe included cases with a history of SPTB between 22 and 37 weeks and controls who had a term birth. Women with hypertensive disorders or gestational diabetes in any of their pregnancies, were excluded. Both groups underwent cardiovascular risk assessment and transthoracic echocardiography 9 to 16 years after pregnancy. Echocardiographic measures were adjusted using a linear regression analysis accounting for hypertension and other risk factors known to be associated with CVD. A subgroup analysis was performed based on hypertension at follow-up. ResultsA total of 94 cases and 94 controls were included, on average 13 years after pregnancy. There were no significant differences in LV diastolic function parameters. Women with a history of SPTB and diagnosed hypertension at follow-up, showed significant higher late diastolic mitral flow velocity, lower e’septal velocity and higher E/e’ratio, compared to women with a history of SPTB without hypertension, although within normal ranges. ConclusionsWhen a history of SPTB is accompanied by hypertension at follow-up, significant changes in LV diastolic function were seen. Therefore, hypertension is the central factor in preventive screening methods, and transthoracic echocardiography has no additional value at this follow-up duration.