Doppler Echocardiographic Examination Research Articles

#1073 Changes in endothelial function in patients with impaired central and renal hemodynamics respiratory pathology

Abstract Background and Aims To determine the degree of influence of endothelial dysfunction on the hemodynamics of renal and central vessels in respiratory pathology, as well as to determine the effectiveness of complex therapy regimens with carvedilol. Method Studies were conducted in 26 patients with chronic obstructive pulmonary disease (COPD) of II- III severity (group 1, in whom the level of glomerular filtration rate of the kidneys eGFR CKD-EPI ≥6 ml/min/1.73 m2 was determined) and 32 patients with COPD of IV severity (group 2, they were determined e GFR CKD-EPI ≥60 ml/min/1.73 m2). Patients received one course of ten-day standard therapy (GOLD, 2020) in combination with a beta–blocker drug, T. carvedilol 5 mg (Vertex). Doppler echocardiographic examination of peripheral vessels, heart and renal vessels of patients was performed. Stable metabolites of nitric oxide (Cm NO) in blood plasma, ventilation and perfusion state of the lungs were determined. Results A significant decrease in the functional state of the respiratory system was parallel with a decrease in Cm NO synthesis, which was clearly reflected in the second group (by 11%) compared with the first group (by 7%). Pronounced structural changes with remodeling of the right parts of the heart, as well as a pronounced degree of pancreatic hypertrophy in the second group were accompanied by a sharp change in renal filtration function (eGFR ≤60 ml/min/1.73 m2). When measuring the state of diastolic dysfunction of the right parts of the heart, a decrease in E/As well as an increase in the circulatory vascular resistance index and mean blood pressure were significantly higher in the first group of patients (where еGFR ≥6 ml/min/1.73 m2). After a course of treatment with t. carvedilol, based on basic treatment, normalization of endothelial function was determined, reflected in an increase in the concentration of stable metabolites of nitric oxide by 1.05 and 1.5 times (p<0.05) in the biological fluid, respectively, in the first and second groups. In the dynamics of the course of therapy in groups of patients with 75% and 35% decrease in lung ventilation capacity, mean pulmonary arterial pressure decreased by 18.1 and 14.3%, respectively, and the hemodynamic resistance index decreased by 7.9% and 5.7% in parallel (p<0.05). Conclusion When monitoring the functional state of central and renal hemodynamics and ventilation-perfusion function of the bronchopulmonary system after complex treatment with carvedilol, a long-term hypotensive effect, a decrease in endothelial dysfunction, respectively, and an improvement in central and renal hemodynamics were determined.

Maternal supplementation with docosahexaenoic acid does not cause constriction of fetal ductus arteriosus: randomized controlled trial.

Docosahexaenoic acid (DHA) is recommended routinely in pregnancy to promote fetal development. DHA has anti-inflammatory activity, but its effects on the fetal heart and circulation are unknown. This study aimed to investigate whether maternal DHA supplementation in the third trimester affects maternal prostaglandin levels and fetal ductus arteriosus flow dynamics. This was a double-blind randomized controlled trial with parallel groups conducted between 2018 and 2021. Pregnant women aged over 18 years with a normal fetus at 27-28 weeks' gestation showing no cardiac/extracardiac anomalies or ductal constriction were eligible for the trial. Women consuming substances with a known inhibitory effect on prostaglandin metabolism, such as non-steroidal anti-inflammatory drugs and polyphenol-rich foods, were excluded. The intervention group received oral supplementation of omega-3 with 450 mg/day of DHA for 8 weeks and the placebo group received capsules of soy lecithin for 8 weeks. Anthropometric measurements, assessment of polyphenol and omega-3 consumption, fetal morphological ultrasound examination, fetal Doppler echocardiographic examination and blood sample collection were performed at the start of the study and the latter two were repeated at follow-up. Prostaglandin E2 (PGE2) level and echocardiographic parameters were compared between the intervention and placebo groups and between baseline and follow-up. A total of 24 participants were included in each group. After 8 weeks, there were no significant differences between the intervention and placebo groups in maternal serum PGE2 level or Doppler echocardiographic parameters of ductal flow. No case of ductus arteriosus constriction was observed. The expected intragroup changes in cardiac morphology, as a result of advancing gestation, were present. Maternal DHA supplementation in the third trimester at a clinically recommended dose did not result in inhibition of PGE2 or constriction of the ductus arteriosus. These findings should be confirmed in postmarket surveillance studies with larger patient numbers in order to test the full safety profile of DHA and provide robust clinical reassurance. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

The impact of coronary revascularization on coronary flow capacity assessed by serial transthoracic echocardiographic findings in patients with chronic coronary syndrome

Abstract Background Coronary flow capacity (CFC) integrates quantitative hyperaemic myocardial blood flow and coronary flow reserve (CFR) to comprehensively assess physiological severity of coronary artery disease. This study evaluated the effects of revascularization (PCI) on CFC assessed by serial transthoracic doppler echocardiography (TDE) examinations before and after elective PCI. Methods A total of 177 patients with chronic coronary syndrome underwent stress TDE examinations of left anterior descending arteries (LAD) before and after PCI to assess changes in CFC. Resting and hyperemic diastolic peak velocity (hDPV) was used to calculate CFR. Using previously reported thresholds for ischemia and normal perfusion, vessels were stratified in four CFC categories: severely reduced, moderately reduced, minimally reduced CFC, and normal flow. The association between CFC increase and pre-procedural TDE parameters was studied. Results After PCI, fractional flow reserve (FFR) values improved in all cases (0.70, (0.62 - 0.74), P < 0.001), although 74 cases (41.8%) showed CFC decrease. Pre-PCI lower FFR, lower resting Pd/Pa, lower CFR, and lower hDPV were significant predictors for CFC increase after PCI. Lower baseline CFC, particularly in ischemic CFC defined as a composite of moderately, and severely reduced CFC was a predictor of CFC increase (P < 0.01). On multivariable analysis, pre-PCI lower hDPV, and pre-PCI ischemic CFC were independent factors predicting CFC-improvement, while pre-PCI wire-based physiological data including FFR were not significantly associated with CFC improvement. Conclusions About a half of successful LAD PCI resulted in an increase in CFC. Preprocedural TDE-derived parameters including hDPV and CFC may help identification of lesions that benefit from revascularization with respect to an increase in coronary flow capacity. Further studies are needed to elucidate the effect of CFC improvement on prognosis.Effect of preprocedural CFC after PCI

#5221 PULMONARY HYPERTENSION: AN IMPORTANT RISK FACTOR IN CARDIOVASCULAR MORTALITY IN DIALYSIS PATIENTS

Abstract Background and Aims It is widely known that chronic dialysis patients experience significantly higher cardiovascular (CV) death rates than the overall population. Among other CV risk factors, recent research has shown pulmonary hypertension (PH) as a consequence of chronic kidney disease and end-stage renal failure. The present study aimed to determine the risk factors that impact survival in chronic haemodialysis and peritoneal dialysis patients and to analyse the correlation of these factors with pulmonary hypertension. Method We studied 125 stable haemodialysis and peritoneal patients (females 40%, mean age 52.42 ±11.88 years) on RRT for more than three months with a two-year follow-up. Demographic information, clinical characteristics, blood tests, and a thorough echocardiographic evaluation were collected at the optimal dry weight. After conventional echocardiographic examination, a tissue Doppler echocardiographic (TDE) examination was performed to evaluate the global and regional myocardial systolic and diastolic functions and pulmonary hypertension. Systolic pulmonary artery pressure (sPAP) of 35 mmHg was used to define PH. Results The cardiovascular mortality rate was 15.5%. In ROC analysis for CV mortality, the area under the curve (AUC) for PH and CRP was found 0.8; for LVM-I, E/E', and PP, the AUC was 0.76, 0.75, 0.72, respectively, while the inverse relationship was found with MASa and TASa with AUC = 0.66 and 0.95 respectively. According to the echocardiographic findings, PH was found in 28% (35 patients) of all patients. The mean PH was 33.46±5.38 mmHg. The higher level of higher parathormone (PTH), C-reactive protein (CRP), and E/E’ average, the lower left ventricular ejection fraction (EF), the peak systolic velocity at the lateral mitral annulus (MASa), and the peak systolic velocity at the lateral tricuspid annulus (TASa) were found to be predictors of PH. Patients evaluated with PH have a significantly lower cardiovascular survival rate [Long Rank (Mantel-Cox) p = 0.0001. Conclusion Our research demonstrates that cardiovascular morbidity and death in dialysis patients are mainly attributed to pulmonary hypertension, inflammation, vascular stiffness, and left ventricular hypertrophy. PH is common among dialysis patients. Inflammation, CKD-MBD biomarkers linked to systolic and diastolic left and right ventricular dysfunction, and inflammation all influence it. These conditions are all connected. Cardiovascular imaging is simple to use, offers a favourable viewpoint in the early identification of cardiac abnormalities and quick treatment of this disease, and is thus strongly advised in the dialysis population.

Strain Rate Changes during Stress Echocardiography Are the Most Accurate Predictors of Significant Coronary Artery Disease in Patients with Previously Treated Acute Coronary Syndrome.

Dobutamine stress echocardiography (DSE) is a well-established non-invasive investigation for the detection of ischemic myocardial dysfunction. The aim of this study was to evaluate the accuracy of myocardial deformation parameters measured by speckle tracking echocardiography (STE) in predicting culprit coronary artery lesions in patients with prior revascularization and acute coronary syndrome (ACS). We prospectively studied 33 patients with ischemic heart disease, a history of at least one episode of ACS and prior revascularization. All patients underwent a complete stress Doppler echocardiographic examination, including the myocardial deformation parameters of peak systolic strain (PSS), peak systolic strain rate (SR) and wall motion score index (WMSI). The regional PSS and SR were analyzed for different culprit lesions. The mean age of patients was 59 ± 11 years and 72.7% were males. At peak dobutamine stress, the change in regional PSS and SR in territories supplied by the LAD showed smaller increases compared to those in patients without culprit LAD lesions (p < 0.05 for all). Likewise, the regional parameters of myocardial deformation were reduced in patients with culprit LCx lesions compared to those with non-culprit LCx lesions and in patients with culprit RCA legions compared to those with non-culprit RCA lesions (p < 0.05 for all). In the multivariate analysis, the △ regional PSS (1.134 (CI = 1.059-3.315, p = 0.02)) and the △ regional SR (1.566 (CI = 1.191-9.013, p = 0.001)) for LAD territories predicted the presence of LAD lesions. Similarly, in a multivariable analysis, the △ regional PSS and the △SR predicted LCx culprit lesions and RCA culprit lesions (p < 0.05 for all). In an ROC analysis, the PSS and SR had higher accuracies compared to the regional WMSI in predicting culprit lesions. A △ regional SR of -0.24 for the LAD territories was 88% sensitive and 76% specific (AUC = 0.75; p < 0.001), a △ regional PSS of -1.20 was 78% sensitive and 71% specific (AUC = 0.76, p < 0.001) and a △ WMSI of -0.35 was 67% sensitive and 68% specific (AUC = 0.68, p = 0.02) in predicting LAD culprit lesions. Similarly, the △ SR for LCx and RCA territories had higher accuracies in predicting LCx and RCA culprit lesions. The myocardial deformation parameters, particularly the change in regional strain rate, are the most powerful predictors of culprit lesions. These findings strengthen the role of myocardial deformation in increasing the accuracy of DSE analyses in patients with prior cardiac events and revascularization.

C81 ROLE OF RESTRICTIVE DIASTOLIC DYSFUNCTION FOR RISK STRATIFICATION OF PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: A BAYESIAN MODEL AVERAGING

Abstract Background Hypertrophic cardiomyopathy (HCM) is characterized by increased left ventricular (LV) stiffness, leading to raised ventricular filling pressures and restrictive diastolic dysfunction (RDD), in itself independently associated with an increased risk of a clinical deterioration. We assessed whether echocardiography evaluation of diastolic function in HCM could yield prognostic value and be useful in HCM risk stratification. Methods We retrospectively reviewed clinical and imaging (echocardiography and cardiovascular magnetic resonance, CMR) data from 361 consecutive patients from two HCM Italian referral centers (Mauriziano Hospital, Turin; University Hospital of Trieste, Trieste). Among them, 28 patients were classified after Doppler echocardiography examination as restrictive (E/A &amp;gt; 1.5, DecT E &amp;lt; 140 ms, E/e’ &amp;gt; 10). The primary endpoint was a large cardiovascular composite consisting of sudden cardiac death (SCD), major ventricular arrythmias (MVAs), heart transplant (HT) and hospitalization for heart failure (HF). Other secondary endpoints were investigated as follows: 1) a secondary arrhythmic endpoint consisting of SCD and MVAs, 2) a key secondary composite of HF, HT, non–SCD. A Bayesian Model Averaging (BMA) was then performed to overcome the bias determined by the limited number of observations. Results Over a mean follow up of 7 ± 3 years, 61 (17%) patients experienced at least one primary composite endpoint event. Of them, 10 were identified with a restrictive diastolic pattern. When BMA was performed, late gadolinium enhancement (LGE) presence at CMR and RDD were significantly associated with the primary composite outcome (respectively, PI = 100, HR = 3.55, pd = 1.00; PI = 74.5, HR = 3.33, pd = 0.99). Left atrium (LA) diameter was not strongly associated with the arrhythmic endpoint, whereas it was significantly associated with the key secondary composite outcome, as well as with increased filling pressures (E/e’) (respectively, PI = 94.5, HR = 1.10, pd = 1.00; PI = 86.8, HR = 1.08, pd = 0.99). Conclusions Restrictive diastolic dysfunction is an independent predictor of poor prognosis in early stages of HCM in absence of systolic dysfunction. In particular, RDD predicted outcomes related to heart failure better then LA diameter and E/e’.

Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis.

Heart failure is the most frequent cause of death among patients affected by rheumatoid arthritis(RA), in which high prevalence is independent of traditional risk factors. An early diagnosis of subclinical heart failure may be made by assessing left ventricular diastolic dysfunction (LVDD) by Doppler Echocardiography. Our study aims to early identify LVDD in RA patients. We enrolled 207 consecutive postmenopausal women (PMW) with normal electrocardiography and physical examination with a confirmed diagnosis of RA, for over one year, 200 PMW free from RA served as the control group (CG). All women underwent M-mode and two-dimensional Doppler echocardiography. A total of 72 women were affected by LVDD among 207 women with RA (34.8%), 46 among 200 women in the CG (23%), chi-squared 6.8, OR 1.8, confidence interval (CI) 95%, p < 0.009. For our RA women, the chance of being affected by LVDD has almost doubled. There were 70 women affected by LVDD among 72 hypertensive women with RA (97.2%). A total of 32 women were affected by LVDD among 98 hypertensive women in the CG (32.7%), chi-squared 72.1, OR 7.2, CI 95%, p < 0.009. Among hypertensive PMW in our population, the chance of being affected by LVDD has more than tripled. All LVDD subjects had abnormal diastolic function for all different degrees. We propose that PMW, affected by RA, have a significantly higher prevalence than CG of LVDD without clinical evidence of heart disease. Since the prevalence is even higher if they are hypertensive, we suggest a Doppler echocardiography examination for all women with a diagnosis of RA.

Assessment of Left Ventricular Functions by Two-Dimensional Speckle Tracking Echocardiography in Patients with Coronary Slow-Flow Phenomenon.

Background: Coronary slow flow phenomenon (CSFP) is a medical challenge, especially regarding its diagnosis. The use of speckle tracking seems to provide a clue for diagnosis. However, its role is not well addressed.&#x0D; Aim of the work: To assess the value of the left ventricle's global longitudinal strain by 2D speckle tracking to detect subclinical left ventricular systolic dysfunction in patients with the slow coronary flow.&#x0D; Patients and methods: This study was performed between May and September 2020 at the cardiology department, Al-Azhar University Hospital (New Damietta). Thirty patients are known to have slow coronary flow based on a previous coronary angiographic examination, and 30 healthy participants with the same demographic match (age and sex) as a control group were included. Patients were classified into two groups: Group (A): Included 30 patients with a coronary slow flow. Group (B): Included 30 normal healthy adult persons served as a control group. All were assessed clinically and by radiological investigations. In addition, speckle tracking echocardiography was done for all patients.&#x0D; Results: In Doppler flow measures, E wave and E/A ratio showed significantly lower values in CSFP when compared with the control group (p= 0.02, 0.003 respectively). According to tissue velocity imaging (TVI), there is a similarity between both groups without any significant difference. Speckle tracking measurements demonstrate significantly lower value in patients with CSFP than the control group (p=0.003).&#x0D; Conclusion: In patients with CSF, LV systolic function detected during both conventional and tissue Doppler echocardiographic examinations was not affected, but 2D longitudinal strain demonstrated that LV systolic function was impaired. CSFP could impair LV diastolic function.

Comparison of echocardiographic measurements and cardiac biomarkers in healthy dogs eating nontraditional or traditional diets.

There has been a recent association between nontraditional diets and development of diet-associated dilated cardiomyopathy (DCM) in dogs. To compare echocardiographic measurements and cardiac biomarkers between healthy dogs eating nontraditional vs traditional diets. We hypothesized that dogs eating nontraditional diets would have lower measures of systolic myocardial performance compared to dogs eating traditional diets. Forty-six healthy dogs: 23 eating nontraditional diets and 23 eating traditional diets. Prospective, cross-sectional study. Dogs were divided into groups based on diet ingredients. Dogs underwent 2-dimensional (2D), 3-dimensional (3D), and Doppler echocardiographic examinations and analysis of plasma N-terminal prohormone of B-type natriuretic peptide, serum cardiac troponin I, and whole blood and plasma taurine concentrations. Mean 2D ejection fraction (EF) was lower for dogs eating nontraditional diets (48.65 ± 7.42%) vs dogs eating traditional diets (56.65 ± 4.63%; P < .001; mean difference 8.0% [4.0%-12.0%] 95% confidence interval [CI]). Mean 3D EF was lower for dogs eating nontraditional diets (45.38 ± 7.35%) vs dogs eating traditional diets (57.58 ± 4.84%; P < .001; 12.0% [8.0%-16.0%] 95% CI). Mean 2D left ventricular end-systolic volumes, indexed to body weight, were significantly higher in dogs eating nontraditional diets (1.46 ± 0.08 mL/kg) vs dogs eating traditional diets (1.06 ± 0.08 mL/kg; P=.002; 0.4mL/kg [0.18-0.62 mL/kg] 95% CI). Healthy dogs eating nontraditional diets had lower indices of systolic function and larger left ventricular volumes compared to dogs eating traditional diets. Screening of apparently healthy dogs eating nontraditional diets might allow for early detection of diet-associated DCM.

PECULIARITIES OF THE POST-INFARCTION PERIOD CLINICAL COURSE IN PATIENTS WITH DIABETES MELLITUS TYPE II AFTER PERCUTANEOUS CORONARY INTERVENTION

Aim – to define the parameters’ dynamics of carbohydrate, lipid, energy and adipokinemetabolism and the structural and functional state of the left ventricle (LV) myocardiumin patients with post-infarction cardiosclerosis and type 2 diabetes mellitus (DM).Materials and methods. 74 type 2 DM patients, who underwent myocardial infarction,were examined. The first subgroup comprised 20 patients, who received medicinaltherapy, and the second subgroup was composed of 50 patients who underwentpercutaneous coronary intervention (PCI). Serum levels of insulin, adropin, irisin, fattyacid binding protein 4 (FABP4) and C1q/tumor necrosis factor- related protein (CTRP3)were determined by enzyme- linked immunosorbent assay. Doppler echocardiographicexamination was performed using a Radmir ULTIMA Pro30 ultrasound scanner. Theresults were statistically analyzed using IBM SPPS software (version 27.0). A level ofp&lt;0.05 was set for determining statistical significance.Results. Following parameters: end-diastolic volume (17,19% and 7,42% respectively),end-systolic volume (30,71% and 10,24% respectively), stroke volume (32,58% and10,61% respectively), iricin (37,57% and 79,89% respectively) increased and such indicesas insulin (46,70% and 58,03% respectively), glucose (35,24 and 39,81% respectively)decreased in patients with post-infarction cardiosclerosis and type 2 DM under conditionsof medicinal therapy in comparison with values of these indices in patients before thetreatment respectively (p&lt;0,05). Following the treatment only with medicinal therapy,in patients with post-infarction cardiosclerosis and type 2 DM higher values of suchindicators as EDS 4.90%, LV PWT 16.67%, LA 18.42%, LVMM 7.77%, LVMMI 19.24%,have been determined, reliably lower value of diastolic arterial pressure – 16,19%,lipoproteins of low density – 5,90%, triglycerides – 13,30%, atherogenic coefficient –16,09%, adropin – 41.43%, FABP4-27.71%, CTRP3-32.91% were established underconditions of only PCI treatment in comparison with the values of those biochemicalparameters before the treatment, respectively, (p&lt;0.05).Conclusions. 1. An increase of echocardiographic indicators, imbalance in energetic andadipokine metabolism have been found in patients with post-infarction cardiosclerosisand type 2 DM. 2. In patients under conditions of PCI structural- functional changes of LVmyocardium delay in comparison with those receiving only medicinal therapy.

Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis.

Background and Aim: Dobutamine stress echocardiography (DSE) is a well-established noninvasive investigation for significant coronary artery disease (CAD). The aim of this study was to evaluate the accuracy of cardiac Doppler parameters in predicting CAD. Methods: We prospectively studied 103 consecutive patients with suspected CAD based on typical symptoms; 59 proved to have CAD, and 44 patients proved to have no-CAD (n = 44). All patients underwent a complete stress Doppler echocardiographic examination. Total isovolumic time (T-IVT) as a marker of cavity dyssynchrony and wall motion score index (WMSI) were also calculated. Results: At peak dobutamine stress, the compromised LV longitudinal excursion (MAPSE), systolic septal and lateral velocities (s’), and diastolic indices were more pronounced in the CAD patients compared with those without CAD, but LV dimension did not differ between groups (p > 0.05). The WMSI was higher and t-IVT more prolonged in patients with CAD (p < 0.01 for both). Similarly, the changes were more pronounced in patients with significant CAD compared with insignificant CAD. On multivariate model, Δ mean s’, OR 2.016 (1.610 to 3.190; p < 0.001), Δ E velocity OR 2.502 (1.179 to 1.108; p < 0.001), Δ t-IVT 2.206 (1.180 to 2.780; p < 0.001) and Δ WMSI OR 1.911 (1.401 to 3.001; p = 0.001) were the most powerful independent predictors of the presence of CAD, particularly when significant (>75%). Δ mean s’ < 5.0 was 85% sensitive, 89% specific with AUC 0.92. Respective values for Δ E velocity <6.0 cm/s were 82%, 90% and 0.91; for Δ t-IVT > 4.5, 78%, 77% and 0.81 and for Δ FT ≥ 150 ms, 76%, 78% and 0.84 in predicating significant CAD. WMSI ≥ 0.7 was 75% sensitive, 77% specific with AUC of 0.81 in predicting significant CAD. The accuracy of DSE was higher in significant CAD compared to insignificant CAD (80% vs. 74%; p = 0.03). Conclusions: Compromised LV longitudinal systolic function, lower delta E wave, prolonged t-IVT, and increased WMSI were the most powerful independent predictors of the presence and significance of CAD. These finding strengthen the role of comprehensive DSE analysis in diagnosing ischemic disturbances secondary to significant CAD.

Left ventricular myocardial and cavity velocity disturbances are stronger predictors of stress induced ischaemia in patients with significant coronary artery disease

Abstract Background and aim Dobutamine stress echocardiography (DSE) is a well-established non-invasive investigation for significant coronary artery disease (CAD). The aim of this study was to evaluate the accuracy of cardiac Doppler parameters in predecting CAD. Methods We prospectively studied 103 consecutive patients with suspected CAD based on typical symptoms, 59 proved to have CAD and 44 patients proved to have no-CAD (n=44). All patients underwent a complete stress Doppler echocardiographic examination, including tissue Doppler, long axis velocities and total isovolumic time (T-IVT) as a marker of cavity dyssynchrony, determined as [60 − (total ejection time (ET) + total filling time (FT))]. The wall motion score index (WMSI) was also calculated. Results CAD patients were older, had less females, less prevalent cardiac risk factors and higher CT calcium score compared to patients with no-CAD (p&amp;lt;0.05, for all). At peak dobutamine stress the compromised LV longitudinal excursion (MAPSE), systolic septal and lateral velocities (s'), TAPSE and diastolic indices were more pronounced in the CAD patients compared to those without CAD, but LV dimension did not differ between groups (p&amp;gt;0.05). The WMSI was higher and t-IVT more prolonged in patients with CAD (p&amp;lt;0.01, for both). Similarly, the changes were more pronounced in patients with significant CAD compared to insignificant CAD. On multivariate model, delta mean s' OR 2.016 (1.610–3.490, p&amp;lt;0.001), delta E velocity OR 1.822 (1.179–2.360, p&amp;lt;0.001), delta t-IVT OR 1.406 (1.180–2.180, p&amp;lt;0.001), and delta FT OR 1.911 (1.401–2.710, p=0.001), were the most powerful independent predictors of the presence of CAD, particularly when significant (&amp;gt;50%). Delta mean s' &amp;lt;5.0 was 85% sensitive, 89% specific with AUC 0.92. Respective values for delta E velocity &amp;lt;6.0 cm/s were 82%, 90% and 0.91; for delta t-IVT &amp;gt;4.5, 78%, 77% and 0.81 and for delta FT ≥150ms, 76%, 78% and 0.84 in predicating significant CAD. WMSI≥0.7 was 75% sensitive, 77% specific with AUC of 0.81 in predicting significant CAD. The accuracy of DSE was higher in significant CAD compared to insignificant CAD (80% vs 74%; p=0.03). Conclusions Compromised LV longitudinal systolic function, lower delta E wave, prolonged t-IVT and increased WMSI were the most powerful independent predictors of the presence and significance of CAD. These finding strengthen the role of comprehensive DSE analysis in diagnosing ischaemic disturbances secondary to significant CAD. Funding Acknowledgement Type of funding sources: None.

Tricuspid Annular Abnormalities in Isolated Left Ventricular Non-compaction-Insights From the Three-dimensional Speckle-Tracking Echocardiographic MAGYAR-Path Study.

IntroductionProminent trabecular left ventricular (LV) meshwork and deep intertrabecular LV recesses are featuring LV non-compaction (LVNC). The aim of this study was to evaluate tricuspid annular (TA) morphological and functional abnormalities by three-dimensional speckle-tracking echocardiography (3DSTE) in patients with LVNC without right ventricular (RV) involvement.Materials and MethodsThis study consisted of 21 patients with isolated LVNC, from which 6 cases were excluded due to inferior image quality. The remaining patient group consisted of 15 subjects with a mean age of 52.1 ± 11.4 years (9 males). LVNC was defined according to the Jenni's criteria. Their results were compared to 21 age- and gender-matched healthy controls (mean age: 52.4 ± 3.9 years, 14 males). Complete routine 2-dimensional Doppler echocardiographic examination was performed in all the patients with isolated LVNC and healthy controls. End-systolic and end-diastolic TA dimensions were assessed on selected planes derived from full-volume 3D echocardiographic datasets during 3DSTE.ResultsPatients with isolated LVNC showed significantly dilated end-systolic and end-diastolic TA diameter and area, which were accompanied with preserved TA functional properties and associated with right atrial (RA) volumes. TA plane systolic excursion (TAPSE) showed mild correlations with TA fractional area change (TAFAC) and TA fractional shortening (TAFS). No correlations could be demonstrated between TAPSE and TA morphological features. Extent of LVNC did not correlate with any echocardiographic parameters.ConclusionTA is dilated with preserved sphincter-like function in patients with isolated LVNC. Longitudinal (TAPSE) and sphincter-like (TAFAC and TAFS) TA movements correlate with each other. TA dilation is associated with an increased RA volumes respecting cardiac cycle.

Results of PRospect trial to Elucidate the utility of EchocarDiography-based Cardiac ouTput in acute heart failure (PREDICT)

BackgroundThe predictive value of echocardiographic parameters for early worsening heart failure (WHF), worsening of symptoms of heart failure requiring intensification of therapy during an admission for acute decompensated heart failure (ADHF), has not been elucidated. MethodsSixteen centers in Japan prospectively enrolled 303 ADHF hospitalized patients who did not receive positive inotropic agents as an initial therapy. Physical and Doppler echocardiographic examinations were performed before the initial therapy and the association of low output findings and occurrence of early WHF were tested. ResultsEarly WHF occurred in 63 patients with a median duration of 6 (IQR: 2–23) hours from the administration of the initial therapy. In patients with left ventricular (LV) ejection fraction <40% (N = 153), echocardiographic stroke volume index, and cardiac index showed greater c-index [95% confidence interval, 0.71 (0.61–0.79) and 0.72 (0.63–0.80), respectively] compared to single low perfusion finding (symptomatic hypotension, reduced pulse pressure, and impaired mentation) other than cool extremities. When physical findings were combined (low perfusion score), the predictive ability improved to the similar levels of echocardiographic LV output parameters [c-index: 0.69 (0.60–0.76)]. However, addition of cardiac index significantly improved the prognostic ability when added to low perfusion score [0.82 (0.74–0.87), p < 0.001]. In contrast, in patients with LV ejection fraction ≥40% (N = 150), low perfusion score, rather than LV output parameters, was predictive of early WHF [c-index: 0.73 (0.56–0.85)]. ConclusionsWe demonstrated the predictive value of echocardiographic LV output indices for early WHF in ADHF patients with LV systolic dysfunction. These data support the motivation for routine use of echocardiography for initial assessment of ADHF.

NATURAL HISTORY OF CONGENITAL ISOLATED MILD AORTIC VALVE AND MILD PULMONARY VALVE STENOSIS: A SINGLE CENTER FOLLOW-UP STUDY

Objective: Most of the available information on the natural history of aortic stenosis (AS) and pulmonary stenosis (PS) in children is based on studies carried out over the past 35-40 years using cardiac catheterization. This study aimed to reveal the natural history of congenital isolated mild valvular AS and PS in children using serial Doppler echocardiographic examinations. Materials and Methods: A total of 125 children, 50 with mild AS and 75 with mild PS, who underwent Doppler echocardiography were included in this study. The prognoses of mild AS and PS were compared according to age, gender, and valvular gradient at the time of initial diagnosis. Results: The mean age of patients was 26.1±37.6 months at diagnosis. The mean follow-up duration was 27.65±21.60 (1- 120) months. There was a significant decrease in the final gradient of the PS group compared to the baseline (23.58±6.97 vs. 19.88±11.21 mmHg, p=0.001). In the AS group, there was an increase in the final gradient, which was more pronounced in patients ≤1-year-old (22.42±6.12 vs. 27.74±14.12 mmHg, p=0.002). Four percent of patients in the PS group and 12% of patients in the AS group progressed to moderate to severe stenosis. All patients who progressed in the PS group were ≤1-year-old and male. Conclusion: The results showed that mild PS had a better prognosis than mild AS and that the risk of progression in AS was higher. Careful follow-up should be performed in mild PS cases ≤1-year-old, especially in boys, since progression may be detected, even if infrequently. Mild AS should also be followed closely, as the disease may show progressive characteristics in all age groups.

Is serum Osteopontin a predictor of carotid atherosclerosis severity among prevalent hemodialysis patients?

Background and aimChronic hemodialysis (HD) patients are among the highest population risk for accelerated atherosclerosis. Osteopontin (OPN) is a multifunctional protein that is increased in chronic kidney disease that may play a role in vascular remodelling and intimal proliferation. AimTo assess the relation between OPN levels and severity of carotid atherosclerosis among prevalent HD patients. MethodsEighty chronic HD patients underwent serum OPN levels assessment and were further classified into 3 subgroups according to the OPN tertiles’ levels; sub-group 1 (lower tertile) subgroup 2 (middle tertile) and sub-group 3 (upper tertile), together with the carotid duplex and Transthoracic Doppler Echocardiography examination. ResultsThe mean carotid intima-media thickness (CIMT) was 0.89±0.14mm. Out of the studied group, 50 (62.5%) patients had atheromatous plaques and 15 patients (18.8%). had significant stenosis. The 3rd group with the upper OPN tertile (78–270ng/dl) had the highest incidence of atherosclerosis. A significant correlation between the OPN levels and the CIMT (r=0.533, p=0.001). OPN values detect atherosclerosis with diagnostic sensitivity of 70%, specificity of 69%, positive predictive value (PPV) 73%, negative predictive value (NPV) 65% with area under the curve (AUC) 0.804 (95% CI: 0.711–0.897). Serum OPN detect carotid stenosis with sensitivity of 66%, specificity of 81%, PPV 45%, NPV 91% with AUC=0.769 and detect the presence of carotid atheroma with sensitivity 70%, specificity 66.67%, PPV 77.8%, NPV 57.1% and AUC=0.767 (p-value<0.001). Moreover, serum levels of OPN were significantly positively correlated with grade of diastolic dysfunction (r=0.312, p=0.005), E/A ratio (r=0.293, p=0.008) and inversely correlated with left ventricular ejection fraction (r=−0.304, p=0.006). ConclusionsSerum Osteopontin is of clinical value as a predictor biomarker of the severity of carotid atherosclerosis, presence of atheroma and carotid stenosis with high diagnostic sensitivity and specificity in chronic hemodialysis patients. Increased Osteopontin level is associated with left ventricular diastolic and systolic dysfunction in those patients.

Is serum Osteopontin a predictor of carotid atherosclerosis severity among prevalent hemodialysis patients?

Background and aimChronic hemodialysis (HD) patients are among the highest population risk for accelerated atherosclerosis. Osteopontin (OPN) is a multifunctional protein that is increased in chronic kidney disease that may play a role in vascular remodelling and intimal proliferation. AimTo assess the relation between OPN levels and severity of carotid atherosclerosis among prevalent HD patients. MethodsEighty chronic HD patients underwent serum OPN levels assessment and were further classified into 3 subgroups according to the OPN tertiles’ levels; sub-group 1 (lower tertile) subgroup 2 (middle tertile) and sub-group 3 (upper tertile), together with the carotid duplex and Transthoracic Doppler Echocardiography examination. ResultsThe mean carotid intima-media thickness (CIMT) was 0.89±0.14mm. Out of the studied group, 50 (62.5%) patients had atheromatous plaques and 15 patients (18.8%). had significant stenosis. The 3rd group with the upper OPN tertile (78–270ng/dl) had the highest incidence of atherosclerosis. A significant correlation between the OPN levels and the CIMT (r=0.533, p=0.001). OPN values detect atherosclerosis with diagnostic sensitivity of 70%, specificity of 69%, positive predictive value (PPV) 73%, negative predictive value (NPV) 65% with area under the curve (AUC) 0.804 (95% CI: 0.711–0.897). Serum OPN detect carotid stenosis with sensitivity of 66%, specificity of 81%, PPV 45%, NPV 91% with AUC=0.769 and detect the presence of carotid atheroma with sensitivity 70%, specificity 66.67%, PPV 77.8%, NPV 57.1% and AUC=0.767 (p-value<0.001). Moreover, serum levels of OPN were significantly positively correlated with grade of diastolic dysfunction (r=0.312, p=0.005), E/A ratio (r=0.293, p=0.008) and inversely correlated with left ventricular ejection fraction (r=−0.304, p=0.006). ConclusionsSerum Osteopontin is of clinical value as a predictor biomarker of the severity of carotid atherosclerosis, presence of atheroma and carotid stenosis with high diagnostic sensitivity and specificity in chronic hemodialysis patients. Increased Osteopontin level is associated with left ventricular diastolic and systolic dysfunction in those patients.

Triglyceride glucose index reflects the unfavorable changes of left ventricular diastolic functions and structure in uncomplicated newly diagnosed hypertensive patients

ABSTRACT Introduction Left ventricular (LV) diastolic dysfunction and structural abnormalities are common cardiac changes in hypertension (HTN), and several factors other than high blood pressure (BP) may play a role in these changes. The aim of this study was to reveal the relationship between triglyceride glucose (TyG) index, a novel parameter for insulin resistance (IR), with LV diastolic function and structure in hypertensive patients. Material and method A total of 119 newly diagnosed, untrated hypertensive patients free of diabetes and/or cardiovascular complications were included in this study. IR was estimated with the TyG index calculated from ln [fasting TG (mg/dL) × fasting blood glucose (mg/dL)/2]. Two-dimensional and Doppler echocardiographic examinations were performed to assess LV diastolic functions and structure. Results Based on median TyG index, 51 patients was assigned as group I (<8.7) and 68 patients as group II (>8.7). In patients with high TyG index, left atrial volume index (LAVi) (p < .001) LV mass index (LVMI) (p = .016), E/e’ ratio (p < .001) increased, and e’ velocity (p < .001) and E/A ratio (p = .028) decreased. There was a statistically significant correlation between TyG index and these parameters (all p > .05). Stepwise multiple regression analysis demonstrated that the relationship of TyG index with LV diastolic function and structure was independent of potential confounders (all p < .001). Conclusion This study suggest that a high TyG index is related to LV diastolic functional impairment and structure abnormality in newly diagnosed hypertensive patients in the absence of diabetes or CVD.

4 Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis

Abstract Aims The most frequent cause of death among patients affected by rheumatoid arthritis (RA) is heart failure, its high prevalence is independent by cardiovascular risk factors. An early diagnosis of heart failure risk may be done assessing left ventricular diastolic dysfunction (LVDD) by Doppler echocardiography. Our study aimed to estimate the LV diastolic function in RA patients. Methods and results We enrolled 207 consecutive postmenopausal women (PMW) with normal electrocardiography, physical examination, and confirmed diagnosis of RA for over a year and 200 PMW free from RA as control group (CG). All women underwent to M-mode, two-dimensional Doppler echocardiography. Seventy-two women were affected by LVDD among 207 women with RA (34.8%), 46 among 200 women on CG (23%), Chi-squared 6.8, odds ratio 1.8, confidence interval (CI) 95%, P &amp;lt; 0.0088. In our population of PMW the chance to be affected by LVDD is almost one and a half times. There were 70 women affected by LVDD among 72 hypertensive women with RA (97.2%), 32 women were affected by LVDD among 98 hypertensive women on CG (32.7%), Chi-squared 72.1, odds ratio 7.2, CI 95%, P &amp;lt; 0.0088, Table II. Among hypertensive PMW of our population the chance to be affected by LVDD is more than triple. All LVDD subjects had abnormal diastole for all different degrees of severity. Conclusions We assess that PMW affected by RA have a significantly high incidence of LV diastolic dysfunction without clinical evidence of heart disease, the incidence is even higher if they are hypertensive, so we recommend a Doppler echocardiography examination for all women with a diagnosis of RA.

Tricuspid annular abnormalities in isolated left ventricular noncompaction – a three-dimensional speckle-tracking echocardiographic study

Abstract Introduction Left ventricular (LV) noncompaction (LVNC) is a rare cardiomyopathy due to arrest of the normal maturation process of the myocardium. It is characterized by prominent LV trabecularization with deep intratrabecular recesses. In most of cases LVNC is isolated, but biventricular forms are also known. The tricuspid valve is a complex anatomical structure which incorporates the three-dimensional (3D) saddle-shaped fibrosus annulus (TA). 3D speckle-tracking echocardiography (STE) is a novel non-invasive imaging method with capability of not only measuring volumetric, strain and rotational parameters of heart chambers, but with finding optimal valvular planes in the 3D space evaluation of TA dimensions respecting cardiac cycle is allowed. The present study was designed to assess TA morphological and functional abnormalities by 3DSTE in LVNC patients without right ventricular (RV) involvement. Methods The present study consisted of 15 patients with LVNC (mean age: 52.1±11.4 years, 9 males). LVNC was defined according to the Jenni's criteria. Their results were compared to 21 age- and gender-matched healthy controls (mean age: 52.4±3.9 years, 14 males). Complete routine 2-dimensional Doppler echocardiographic examination with 3DSTE was performed in all LVNC patients and healthy controls. Results Enlarged left atrial and LV dimensions with reduced LV ejection fraction could be seen in LVNC patients. The mean number of noncompacted segments proved to be 6.9±2.0. Grade 1 and 2 mitral regurgitation (MR) could be demonstratred in 5 and 5 LVNC patients, respectively. Higher grade of MR could not be found. Grade 1 and 2 tricuspid regurgitation (TR) could be demonstrated in 4 and 1 LVNC patients, respectively. Only one LVNC patient has grade 4 TR. Tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RV-FAC) proved to be 13.9±3.9 mm and 34.1±2.7%, respectively. LVNC patients showed significantly dilated end-diastolic and end-systolic TA diameter (2.6±0.3 cm vs. 2.2±0.3 cm, p&amp;lt;0.05 and 2.2±0.2 cm vs. 1.8±0.3 cm, p&amp;lt;0.05, respectively), area (8.4±1.7 cm2 vs. 7.0±1.5 cm2, p&amp;lt;0.05 and 6.5±1.7 cm2 vs. 5.3±1.4 cm2, p&amp;lt;0.05, respectively) and tendentiously larger perimeter (11.2±1.4 cm vs. 10.5±1.2 cm, p=ns and 9.8±1.5 cm vs. 8.9±1.0 cm, p=ns, respectively), which was accompanied with tendentiously lower TA functional properties represented by TA fractional area change (TAFAC, 22.2±12.3% vs. 23.7±11.7%, p=ns) and TA fractional shortening (TAFS, 15.9±5.6% vs. 18.8±8.0%, p=ns). TAPSE and RV-FAC showed mild correlations with TAFAC (r=0.39, p=0.05; r=0.36, p=0.05, respectively) and TAFS (r=0.37, p=0.05; r=0.38, p=0.05). Extent of LV noncompaction did not correlate with any echocardiographic parameters. Conclusions TA is dilated in LVNC patients without obvious RV involvement. Longitudinal (TAPSE) and sphincter-like (TAFAC, TAFS) TA motions correlate with each other. Funding Acknowledgement Type of funding sources: None.