EA Ratio Research Articles

Diastolic function assessment with four-dimensional flow cardiovascular magnetic resonance using automatic deep learning E/A ratio analysis

BackgroundDiastolic left ventricular dysfunction is a powerful contributor to the symptoms and prognosis of patients with heart failure. In patients with depressed left ventricular systolic function the EA ratio is the first step to defining the grade of diastolic dysfunction. Doppler echocardiography is the preferred imaging technique for diastolic function assessment, while CMR is less established as a method. Previous 4D Flow-based studies have looked at the EA ratio proximally to the mitral valve, requiring manual interaction. In this study we compare an automated, deep learning-based, and two semiautomated approaches for 4D Flow CMR-based EA ratio assessment to conventional, gold standard echo-based methods. MethodsNinety-seven subjects with chronic ischemic heart disease underwent a cardiac echo followed by an MRI investigation. 4D Flow-based EA ratio values were computed using three different approaches; two semi-automated, assessing the EA ratio by measuring the inflow velocity (MVvel) and the inflow volume (MVflow) at the mitral valve plane, and one fully automated, creating a full LV segmentation using a deep learning-based method within which the EA ratio could be assessed without constraint to the mitral plane (LVvel). ResultsMVvel, MVflow, and LVvel EA ratios were strongly associated with Echo EA ratio (R2= 0.60, 0.58, 0.72). LVvel peak E and A showed moderate association to Echo peak E and A, while MVvel values were weakly associated. MVvel and MVflow EA ratios were very strongly associated with LVvel (R2= 0.84, 0.86). MVvel peak E was moderately associated with LVvel, while peak A showed strong association (R2= 0.26, 0.57). Discussion and ConclusionPeak E, peak A and EA ratio are integral to the assessment of diastolic dysfunction and may expand the utility of CMR studies in patients with cardiovascular disease. While underestimation of absolute peak E and A velocities was noted, the EA ratio measured with all three 4D Flow methods was strongly associated with the gold standard Doppler echocardiography. The automatic, deep learning-based method performed best, with the most favorable runtime of ~40seconds. As both semiautomatic methods associated very strongly to LVvel, they could be employed as an alternative for estimation of EA ratio.

Kiosk 4R-TA-07 - Diastolic Function Assessment with 4D Flow CMR Using Automatic Deep Learning EA Ratio Analysis

Kiosk 4R-TA-07 - Diastolic Function Assessment with 4D Flow CMR Using Automatic Deep Learning EA Ratio Analysis

Associations between occupational physical activity and left ventricular structure and function over 25 years in CARDIA.

Leisure time physical activity (LTPA) confers cardiovascular health benefits, while occupational physical activity (OPA) may have paradoxically negative health associations. This study tested the explanatory hypothesis that unfavourable cardiac remodelling may result from chronic OPA-induced cardiovascular strain. Longitudinal associations of OPA and left ventricular (LV) structure and function were examined in 1462 participants {50.0% female, 56.4% White, aged 30.4 ± 3.4 years at baseline [Year 5 exam (1990-91)]} from the Coronary Artery Risk Development in Young Adults study. Left ventricular structure and function were measured as LV mass (LVMi), end-diastolic volume (LVEDVi), end-systolic volume (LVESVi), ejection fraction (LVEF), stroke volume (LVSVi), and e/a-wave ratio (EA ratio) via echocardiography at baseline and 25 years later. Occupational physical activity was reported at seven exams during the study period as months/year with 'vigorous job activities such as lifting, carrying, or digging' for ≥5 h/week. The 25-year OPA patterns were categorized into three trajectories: no OPA (n = 770), medium OPA (n = 410), and high OPA (n = 282). Linear regression estimated associations between OPA trajectories and echocardiogram variables at follow-up after adjusting for baseline values, individual demographic/health characteristics, and LTPA. Twenty-five-year OPA exposure was not significantly associated with LVMi, LVEDVi, LVSVi, or EA ratio (P > 0.05). However, higher LVESVi (β = 1.84, P < 0.05) and lower LVEF (β = -1.94, P < 0.05) were observed at follow-up among those in the high- vs. no-OPA trajectories. The paradoxically adverse association of OPA with cardiovascular health was partially supported by null or adverse associations between high OPA and echocardiogram outcomes. Confirmation is needed using more precise OPA measures.

The Study of the Banking Industries in Haiti

The main objective of this study is to find out and examine the determinants of banks’ profitability in Haiti. The sample is a data set of the eight banks operating in Haiti for the period 2017 to 2021. The results prove that, among the independent variables that impact banks profitability in Haiti significantly and positively, Equity-tototal assets (EA ratio), which is used to proxy capital adequacy in this study, is the strongest. In addition, diversification is the second most influential independent variable in terms of positive effect. Average yield on loans does not show any significant impact on ROA and ROE. In contrast, the efficiency ratio, which is used to proxy management efficiency, has a significant negative effect on banks’ profitability in Haiti. Likewise, Nonperforming loans (NPL), which is the measure of asset quality, and Liquid Assets -to-Deposit (LAD), a proxy for liquidity, show a negative influence on banks’ profitability. The macroeconomic variables do not have any effect on banks’ profitability in Haiti. The private banks are more profitable than the public one. And there are significant differences between those two groups.

Echocardiography algorithms to assess high left atrial pressure and grade diastolic function in preterm infants.

Relaxation, restoring forces, myocardial stiffness and atrial function determine left ventricular (LV) diastolic function. This study aims to provide a comprehensive assessment of diastolic function in preterm infants using conventional echocardiography and speckle tracking imaging and determine the diagnostic accuracy of various algorithms to detect high left atrial pressure (LAP). Preterm infants received an echocardiogram 1week after birth and diastolic reference values were derived from the outer percentiles of stable preterm infants. Impaired relaxation, LV stiffness and high LAP were defined by using algorithms where at least half of the parameters were outside the normal range. Diastolic function was graded using the 2016 American Society of Echocardiography algorithm and expanded with the EA ratio and left atrial strain. The diagnostic accuracy of various algorithms to detect high LAP was determined with sensitivity analysis. We studied 146 infants (59 stable) with a mean of 27(1) weeks gestation. Impaired relaxation, LV stiffness and high LAP were found in 8%, 7%, and 14% of infants. The patent ductus arteriosus was a contributing factor to high LAP and LV stiffness, not impaired relaxation. Diagnostic accuracy improved from 90% to 96% and sensitivity from 40% to 90% by adding left atrial strain to the 2016 algorithm. Various grades of diastolic dysfunction could be appreciated in preterm infants using a multi-parameter approach. Adding left atrial strain improved sensitivity to detect infants with high LAP.

Effect of Liraglutide on Cardiac Function in Individuals With Type 2 Diabetes: A Meta-Analysis.

The aim of this study was to determine the effect of liraglutide on cardiac function in individuals with type 2 diabetes. The present meta-analysis aimed to identify studies testing liraglutide in individuals with type 2 diabetes. We included observational and randomized controlled trials comparing liraglutide with placebo or any other drug alone or in combination with other drugs. A comprehensive search was carried out using online databases including PubMed, Google Scholar, and Cochrane Library to find relevant studies from inception to June 30, 2023, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Key terms used to search for relevant studies included "liraglutide," "cardiac function," and "type 2 diabetes," along with their synonyms and Medical Subject Heading (MeSH) terms. The outcomes assessed in the present meta-analysis included diastolic cardiac function and systolic cardiac function. For diastolic cardiac function, we assessed the E to A (E/A) ratio and the E to Ea (E/Ea) ratio. To assess the impact of liraglutide on systolic function, we assessed stroke volume in mL, left ventricular ejection fraction (LVEF) in %, cardiac output in L/min, and cardiac index in L/min/m². A total of seven studies were included, with a pooled sample size of 307 individuals (160 in the liraglutide group and 147 in the control group). The results indicated that liraglutide significantly reduced the E/A ratio (mean difference [MD]: -0.22, 95% CI: -0.38 to -0.06, p-value: 0.008) and E/Ea ratio (MD: -0.76, 95% confidence interval (CI): -1.39 to -0.12, p-value: 0.02, suggesting a potential clinical benefit on ventricular diastolic function. However, there was no significant impact on LVEF (MD: 0.46, 95% CI: -3.13 to 4.05, p-value: 0.80), cardiac output (MD: 0.05, 95% CI: -0.39 to 0.49), cardiac index (MD: 0.07, 95% CI: -0.18 to 0.32), and stroke volume (MD: -5.34, 95% CI: -14.81 to 4.12), indicating that liraglutide did not improve systolic function.

Combined use of right ventricular coupling and pulmonary arterial elastance as a comprehensive stratification approach for right ventricular function.

Right ventricular (RV)-pulmonary arterial uncoupling is the consequence of increased afterload and/or decreased RV contractility. However, the combination of arterial elastance (Ea) and end-systolic elastance (Ees)/Ea ratio to assess RV function is unclear. We hypothesized that the combination of both could comprehensively assess RV function and refine risk stratification. The median Ees/Ea ratio (0.80) and Ea (0.59mmHg/mL) were used to classify 124 advanced heart failure patients into four groups. RV systolic pressure differential was defined as end-systolic pressure (ESP) minus beginning-systolic pressure (BSP). Patients among different subsets showed dissimilar New York Heart Association functional class (V=0.303, P=0.010), distinct tricuspid annular plane systolic excursion/ pulmonary artery systolic pressure (mm/mmHg) (0.65 vs. 0.44 vs. 0.32 vs. 0.26, P<0.001), and diverse prevalence of pulmonary hypertension (33.3% vs. 35% vs. 90% vs. 97.6%, P<0.001). By multivariate analysis, Ees/Ea ratio (hazard ratio [HR] 0.225, P=0.004) and Ea (HR 2.194, P=0.003) were independently associated with event-free survival. Patients with Ees/Ea ratio >0.80 and Ea <0.59mmHg/mL had better outcomes (P<0.05). In patients with Ees/Ea ratio >0.80, those with Ea ≥0.59mmHg/mL had a higher adverse outcome risk (P<0.05). Ees/Ea ratio ≤0.80 was associated with adverse outcomes, even when Ea was <0.59mmHg/mL (P<0.05). Approximately 86% of patients with ESP-BSP >5mmHg had an Ees/Ea ratio ≤0.80 and/or an Ea ≥0.59mmHg/mL (V=0.336, P=0.001). Combined use of Ees/Ea ratio and Ea could be a comprehensive approach to assessing RV function and predicting outcomes. An exploratory analysis demonstrated that Ees/Ea ratio and Ea might be roughly estimated based on RV systolic pressure differential.

New generation of LCPM and left atrial strain: a promising predictor of atrio-ventricular synchrony in leadless pacemaker pacing

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Leadless cardiac pacemakers (LCPMs) are a new alternative to traditional transvenous pacemaker. They recently have evolved from a single chamber VVI-R pacemaker to devices that can provide atrio-ventricular synchrony (AVS) in patient with sinus rhythm through an 3-axis accelerometer, detecting atrial contractions. To date, Micra AV Transcatheter Pacing System (Medtronic) is the only LCPM on the market that provides AVS. Purpose Many efforts have been made to identify clinical predictors of a good A4 signal amplitude, that determines the ability of the Micra-AV to pace while maintaining AVS (1). Our exploratory study investigates the utility of Left Atrial strain (LAs) for this purpose. Methods Data was extracted from the Cardiac Interventional Registry implemented at our hospital and approved by local ethic committee. Six patients, implanted with Micra-AV (72±13 years), underwent to a complete echocardiography focused on left atrium (LA). Morphological (LA diameters, 2d LA volume and 2d LA area) and functional (EA ratio and LAs study) parameters were assessed. An echocardiography core laboratory studied LAs (Figure A), using a dedicated software (Philips, Epiq 7-Auto Strain Tomtec Application): LA Reservoir Strain (LAsr), LA Conduit Strain (LAscd) and LA Contraction Strain (LAsct) were measured (2). All patients after implantation had a complete electronic control of leadless pacemaker to assess A4 wave amplitude. Results We found that A4 wave amplitude was inversely correlated to 2D-LA volume (Spearman's coefficient rho=-0.96; p=0.003), while it was positively related to LAsr (rho=0.81; p=0.05) and LAsct absolute value (Figure B). In the last years, in addition to the traditional echocardiographic parameters, LA was studied with a new functional parameter, LAs (3). The MARVEL2 study showed that A4 amplitude is fundamental to ensure a high AVS percentage; it was directly related to a parameter defined generically "atrial strain" (4). It is known that LAs is a complex parameter that indicates how the left atrium works overall. Today, thanks to the technological developments of the new echocardiographic software, it can be evaluated more precisely in its components. According to our preliminary data the components that predict A4 amplitude are specifically LAsr and LAsct: we found higher value of A4 in patients that have grater absolute value of these LAs parameters. LAsr is related to the atrial filling and depends on atrial stiffness and fibrosis, LAsct is an indicator of LA ability to empty, thus contributing to the final stage of ventricular diastolic filling. These are simple measurable parameters of LA functional capacity and they seem capable of predicting the possibility of a good AVS in LCPM pacing. Conclusion Patient selection is crucial to obtain good clinical outcomes. In this context, echocardiographic parameters and particularly the LAs study look promising to make a correct choice.

638: COPEPTIN AND CARDIOVASCULAR FUNCTION CORRELATION IN CHILDREN WITH MULTISYSTEM INFLAMMATION SYNDROME

Introduction: Children exposed to COVID-19 can develop Multisystem Inflammation Syndrome in Children (MIS-C). Literature has shown that 80% of affected children have cardiovascular involvement. Copeptin, a provasopressin protein, has been shown to correlate with myocardial injury and failure. Copeptin is a stable biomarker with minimal variation in a healthy population. We hypothesize that copeptin levels will correlate with troponin and Brain Natriuretic Peptide (BNP) levels and echocardiogram findings of left ventricular dysfunction in MIS-C. Methods: We conducted a prospective study with subjects admitted to the Pediatric Intensive Care Unit who met WHO criteria for MIS-C between 2021-2022. Within 24 hours of initiating therapy, consent and a whole blood sample was obtained. The plasma was evaluated by enzyme-linked immunosorbent assay for a copeptin level. Troponin and BNP were drawn as standard of care. Echocardiograms obtained within 24 hours of the copeptin sample were evaluated for dysfunction. Comparisons between copeptin and troponin, BNP, and Ejection Fraction (EF) were evaluated using Wilcoxon Signed Rank Test. Comparisons of copeptin across echocardiogram markers of diastolic dysfunction (EE’ ratio, EA ratio) and diastolic dimensions (LV diastolic dimeter index (LVDd), septal diastolic diameter index (LVSDd), and posterior wall diastolic diameter index (LVPWDd)) were evaluated using Friedman’s Test. Kruskal-Wallis test was used to compare copeptin levels in patients on vasopressor support. Results: Ten patients with a clinical diagnosis of MIS-C were recruited. While copeptin levels (normal range 4-45pg/ml, subjects range 19.5-963pg/ml) were not significantly different between patients who received vasopressors (p=0.088), LVSDd (p=< 0.001) and LVPWDd (< 0.001) did differ. Significant differences were found between copeptin and EA ratio (p=0.006) but not with EE’ ratio (p=0.495). Differences between copeptin and EF were statistically significant (p=0.007). Comparisons of copeptin with troponin (p=0.007) and BNP (p=0.005) were also significant. Conclusions: Copeptin is a biomarker that has the potential to indicate cardiac dysfunction in the MIS-C population. Elevated copeptin levels correlated with echocardiogram findings of systolic dysfunction and diastolic dysfunction in children with MIS-C.

Evaluation of right ventricular function in patients with pulmonary arterial hypertension by different right ventricular-pulmonary artery coupling methods.

To compare the accuracy of end-systolic elasticity (Ees)/arterial elasticity (Ea) ratio measured by single beat estimation, pressure–volume loop and cardiac magnetic resonance (CMR) combined volume method in patients with pulmonary artery hypertension, and to find a feasible and reliable method to quantitatively evaluate the function of right ventricle in patients with pulmonary artery hypertension. Forty-nine pulmonary artery hypertension patients enrolled between May 2017 and May 2018 in our hospital were retrospectively analyzed. Firstly, measure Ees/Ea ratio by single beat estimation, pressure–volume loop and CMR combined volume method, then, compare Ees/Ea ratio with New York Heart Association (NYHA) classification and NT-proBNP value respectively to evaluate the accuracy of the 3 methods. Ees/Ea ratio measured by single beat estimation is 2.07 ± 1.01, correlation analysis is not statistically significant when compare with NYHA classification and NT-proBNP value (P > .05). Ees/Ea ratio measured by pressure–volume loop is 2.64 ± 1.48, correlation analysis is not statistically significant when compare with NYHA classification and NT-proBNP value (P > .05). Ees/Ea ratio measured by CMR combined volume method is 0.72 ± 0.43, correlation analysis is statistically significant when compare with NYHA classification and NT-proBNP with negative correlation (P < .05). Ees/Ea ratio decrease according to the increase of NT-proBNP value and the NYHA classification. There is linear regression equation between Ees/Ea ratio measured by CMR combined volume method and log (NT-proBNP) value: Y = –0.257X + 1.45, and the linear regression equation is statistically significant (P = .001). Ees/Ea ratio measured by CMR combined volume method is a feasible and reliable method to quantitatively evaluate the function of right ventricule in patients with pulmonary artery hypertension, which might be further verified in a larger patient population.

Endurance Versus Non-endurance Athletes: A Descriptive Discriminant Analysis Based On Echocardiography

PURPOSE: To discriminate between endurance and non-endurance athletes according to echocardiographic measures. METHODS: Echocardiographic exams carried out in 201 male and female athletes of diverse sports were studied (Age = 21.7 ± 5.4 years; mean ± SD). A set of fifteen measures was considered: Left ventricular diastolic diameter (LVDD), Left ventricular diastolic diameter index (LVDDI), Interventricular septum thickness (IST), Left ventricular posterior wall thickness (LVPWT), Relative wall thickness (RWT), Left ventricular mass (LVM), Left ventricular mass index (LVMI), Left auricular diameter (LAD), Aortic root diameter (ARD), Inferior vena cava diameter (IVCD), E-wave velocity (EV), A-wave velocity (AV), E/A ratio (EAR), E/e′ ratio (Ee′R) and Right ventricular systolic velocity (RVS). The athletes were categorized in two groups based on the characteristics of their sport discipline: “Endurance” (cardiorespiratory endurance) and “Other” (Non-Endurance). Gender-stratified analyses were performed. MANOVA was firstly implemented to evaluate for a significance difference between endurance and non-endurance athletes. Post-hoc analysis was done by means of Descriptive discriminant analysis; in order to obtain a more reduced set of variables, Stepwise variable selection method was previously performed using the Wilk’s Lambda criterion. Statistical significance was fixed at the 0.05 level. RESULTS: MANOVA was statistically significant in men (Wilk's λ = 0.78, F = 1.81, p = 0.04) and in women (Wilk's λ = 0.63, F = 2.82, p = 0.002). The Stepwise procedure selected two variables in the male (IST and LVDDI) and female (LVMI and LVDDI) strata. The discriminant function was highly significant in both cases (males: Wilk's λ = 0.86, F = 8.59, p < 0.001; females: Wilk's λ = 0.77, F = 13.21, p < 0.001). In men, the standardized discriminant coefficient and the structure coefficient were higher for IST (0.96 and 0.81) than for LVDDI (0.60 and 0.36). And in women, the coefficients corresponding to LVMI (0.62 and 0.84) were similar to the ones of LVDDI (0.59 and 0.81). CONCLUSIONS: In the male athletes, IST showed a more important contribution for distinguishing between the endurance and non-endurance groups than LVDDI. And in the female athletes, LVMI and LVDDI had a comparable contribution.

RIGHT VENTRICULAR - PULMONARY VASCULAR COUPLING DURING EXERCISE IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION OR PULMONARY HYPERTENSION DUE TO LEFT HEART DISEASE

<h3>BACKGROUND</h3> Pulmonary hypertension (PH) is a state of high afterload to the right ventricle (RV), which is described as afterload sensitive. The purpose of this study was to examine the effect of exercise on the relationship between RV systolic performance [measured as end-systolic elastance (Ees)], and RV afterload [measured as pulmonary arterial (PA) elastance (Ea)] between 2 groups of patients with pulmonary arterial hypertension (PAH) or PH due to left heart disease (PH-LHD). <h3>METHODS AND RESULTS</h3> Patients with suspected PH underwent right heart catheterization with cycle-ergometry and classified by their exercise hemodynamic responses: 1) Normal 2) PAH and 3) PH-LHD. RV, right atrium (RA), and PA pressures were recorded continuously and analyzed offline. As our lab previously reported, RV Ees and PA Ea were calculated using the single-beat method, and Ees:Ea ratio expresses RV-PA coupling. Ees:Ea is defined as uncoupled if < 0.8. Results were analyzed at semi-upright rest and exercise. Data is presented as Mean ± SD or Median [25th – 75th Percentiles]. We included 40 patients (35%Female; 58±15 years); exercise hemodynamic classification comprised 18 Normal, 11 PAH, and 11 PH-LHD. At rest Ea and Ees were significantly elevated in PAH (0.45[0.38-0.98], p=0.002 and 0.85[0.65-1.20], p=0.003) and PH-LHD (0.51[0.32-0.67], p=0.001 and 0.74[0.39-1.20], p=0.017) vs. Normal (0.22[0.17-0.27] and 0.41[0.29-0.54]). Ea increased significantly with exercise in PAH (0.60[0.51-1.36], p=0.003) and PH-LHD (0.59[0.37-0.91], p=0.002) compared to Normal (0.29[0.21-0.36]). Exercise was associated with a significant decline in Ees:Ea ratio in PH-LHD (∆-0.23±0.72, p=0.022). Ees:Ea ratio was uncoupled at rest/exercise in 6% of the Normal group, 55% of the PAH group and 36% of the PH-LHD group. Figure 1 illustrates the trend to Ees:Ea uncoupling if Ea increased by more than 0.2mmHg/mL. Compared to patients with preserved Ees:Ea coupling, patients with PH and Ees:Ea uncoupling with exercise demonstrated significantly higher increases in RA pressures (∆9±5mmHg vs ∆4±3mmHg, p=0.012) and more impaired stroke volume indexed to body surface area (∆3±9mL/m2 vs ∆12±8mL/m2 p=0.032). <h3>CONCLUSION</h3> During exercise, RV afterload increases in patients with PAH and PH-LHD. In both PH groups, the proportion of patients with Ees:Ea uncoupling was high, and the decline in Ees:Ea ratio reached statistical significance in PH-LHD. Uncoupling of the Ees:Ea ratio occurred with larger increases in Ea and was associated with evidence of impaired RV systolic and diastolic function with exercise. Limiting the increase in Ea with exercise and/or preservation of Ees:Ea coupling may optimize RV function in PH patients.

Preparation and Evaluation of Imatinib Loaded Transfersomal gel for the Treatment of Rheumatoid Arthritis.

In the present study, imatinib-loaded transfersomal gel (imatinib-TFS-Gel) was developed to minimize the oral dosing frequency and side effects during rheumatoid arthritis (RA) therapy. Imatinib-loaded transfersomes (imatinib-TFS) were prepared by the film-hydration method. The effects of lecithin content, lecithin/ EA ratio, and the type of EA on the characteristics of the imatinib-TFS were studied using a D-optimal design. Morphology of imatinib-TFS was investigated using scanning electron microscopy. The optimized imatinib-TFS formulation was used to prepare imatinib-TFS-Gel with the aid of Carbopol 940 as the gelling agent. The Optimized imatinib-TFS had a spherical shape with the particle size of 140.53 ± 0.87 nm, polydispersity index of 0.44 ± 0.01, the zeta potential of -17.63 ± 0.65 mV, encapsulation efficiency of 98.70 ± 0.38%, and release efficiency of 81.26 ± 0.70 %. Ex-vivo skin permeation studies through the rat skin showed that the cumulative amount of imatinib permeated from imatinib-TFS-Gel was significantly higher than that from imatinib-Gel. The RA rat model indicated a substantial reduction in paw edema during the 14 days study following the application of imatinib-TFS-Gel as compared with imatinib-Gel. Therefore, imatinib-TFS-Gel can be considered as a promising drug delivery system for the treatment of RA.

Abstract 14229: Hepatobiliary Markers in Minority Heart Failure Patients; Echocardiography and Clinical Outcomes

Introduction: AHA sponsored guidelines and studies have focused on cardiac disease and particular heart failure (HF) profiles among minorities like African, Hispanic, and Asian Americans. Previous studies on liver function tests (LFT) in HF patients, like aspartate and alanine aminotransferase (AST, ALT), alkaline phosphatase (ALP), and bilirubin (Bili), have underrepresented minority groups in study cohorts. We investigated the relationship between LFT levels with echocardiographic (ECHO) findings and readmission outcomes among minority patients at the Heart Health Center (HHC) of NYC Health + Hospitals, Kings County, in Brooklyn, New York. Hypothesis: In minority HF patients, LFT levels are associated with ECHO parameters, and LFT abnormalities are associated with increased risk of admission. Methods: Retrospective review was performed of patients in the HF clinic at the HHC, and during acute HF exacerbation admission from November 2017 - November 2018, with hospitalization monitored through November 2019. Baseline and admission LFT levels were obtained. While abnormal AST, ALP, and Bili levels were classified by the hospital’s laboratory range, abnormal ALT levels were classified based on national gastroenterology guidelines. Regression analysis was used to examine the relationship between LFT levels during acute HF exacerbation and ECHO parameters. Odds ratio (OR) and confidence interval (CI) were used for analysis of readmission outcomes. Results: Among 586 HF patients, there was an increased risk of hospitalization with baseline elevations in AST (OR 2.30, CI 1.24 - 4.25, p = 0.008) and ALP (OR 1.99, CI 1.10 - 3.64, p = 0.023). In those hospitalized with acute HF (n = 147), Bili was positively correlated with mitral valve (MV) EA ratio (r = 0.28, p = 0.002) and tricuspid regurgitation max velocity (r = 0.21, p = 0.004). ALT positively correlated with mean MV e’ velocity (r = 0.23, p = 0.009) and negatively correlated with aortic valve (AV) mean velocity (r = -0.24, p = 0.001). Conclusions: Understanding the association of ECHO findings and risk of hospitalization in minority patients with baseline and acute HF LFT levels has crucial implications for the identification of high risk patients and for the development of patient centered HF care strategies.

Significance of left ventricular global longitudinal strain assessment in patients with preserved ejection fraction after acute myocardial infarction

Abstract Background Depression of left ventricular function is common phenomenon after acute myocardial infarction and it's often associated with poor prognosis. However, substantial portion of patients with acute myocardial infarction had normal left ventricular function by assessment of left ventricular ejection fraction. Purpose In this study, we examined role of left ventricular global longitudinal strain assessment in patients who had normal ejection fraction after acute myocardial infarction. Methods We choose patients with acute myocardial infarction who were successfully treated with primary percutaneous coronary intervention (PCI). All of those patients had normal ejection fraction (EF≥55%) in routine echocardiographic examination within 3 days after acute myocardial infarction. Two dimensional speckle tracking echocardiography was used to assess left ventricular global longitudinal strain. Based on existence of newly onset clinical signs (pulmonary edema, lung crackles, peripherial edema etc.) of heart failure patients divided into case and control group. Patients who had other etiology or previous heart failure were excluded. Results A total of 153 patients with AMI were selected and newly onset heart failure is occurred in 20 patients. Left ventricular global strain was significantly different between patients with clinical heart failure and patients without clinical heart failure (−11.1±1.85% vs. −16.6±3.38%, p&amp;lt;0.001). After adjustment of possible predictors of impaired left ventricular function such as, age, gender, hypertension, diabetes, previous coronary artery disease, cardiac troponin, mitral inflow EA ratio, deceleration time, left ventricular end diastolic volume, ejection fraction, mitral annulus EE' ratio and wall motion score index, global longitudinal strain was independent predictor of clinical heart failure (odds ratio 1.79, 95% CI 1.22–2.65, p=0.003). Adding global longitudinal strain into above mentioned predictors of clinical heart failure after acute myocardial infarction is associated with significantly increased c-statistic (0.93, 95% CI 0.87–0.99 vs. 0.97, 95% CI 0.94–0.99, p&amp;lt;0.001). Conclusion Left ventricular global longitudinal strain is independently associated with clinical heart failure in patients with preserved ejection fraction after acute myocardial infarction. Adding global longitudinal strain parameter into screening model may increase rate of precise determination of clinical heart failure after acute myocardial infarction. Funding Acknowledgement Type of funding source: None

Surface and Morphological Investigation of Synthesized Nanostructured Ridges from Electrospun Polyvinyl Alcohol-Albumin Blend—A Taguchi Design of Experiment Approach

We report the synthesis of presumably a “nanoridge” from the electrospinning of a hydrophilic polymer–protein blend. The material exhibits vertical elevation from the substrate, distinct from the morphologies seen in electrospinning. It is hypothesized that the formation of the nanostructured ridges is due to the migration of the charged protein to the apex through a highly polarized electric field in electrospinning conditions. In this study, we assessed the polyvinyl alcohol–egg albumin (PVA–EA) system in a solvent comprising of water, formic and acetic acid, together with the tip-to-collector distance (TCD) and solution flowrate. To quantify the factor effects in the surface properties of the material, a Taguchi design of experiment was used. The ridge heights observed ranged from 84.8–639.9 nm, and the material height is predominantly affected by the PVA–EA ratio and solution flow rate. The root mean square roughness was influenced by the TCD and flow rate, which has values ranging from 11.37–57.56 nm. In evaluating the sharpness of the ridge, we used the radius of curvature, where the TCD highly affects the apex sharpness. The work offers not just a likely new class of morphology, but a new perspective on the surface characterization of an electrospun material which could affect the performance of such a use in biological and physical systems.

Elevated pulmonary arterial elastance and right ventricular uncoupling are associated with greater mortality in advanced heart failure

The objectives of this study were to describe right ventricular-pulmonary arterial elastance coupling hemodynamic phenotypes and their frequency in patients with advanced heart failure and to evaluate the association of elastance-based indices with all-cause mortality, cardiac transplantation, and left ventricular assist device therapy. This study included 175 patients with heart failure undergoing right heart catheterization to evaluate candidacy for advanced therapies and 21 healthy controls. We modified a single-beat approach to elastance to account for the magnitude of pulmonary arterial pressure and estimated right ventricular end-systolic elastance (Ees), pulmonary arterial elastance (Ea), and the Ees:Ea ratio. We defined elevated pulmonary arterial load as an Ea > 0.5 mmHg/ml, and ventriculo-arterial uncoupling as an Ees:Ea < 0.8. We evaluated associations between Ees, Ea, and Ees:Ea with all-cause mortality and composite event-free survival using multivariable Cox proportional-hazard models, adjusted for age and sex. All 21 controls had Ea ≤ 0.5 mmHg/ml and Ees:Ea ≥ 0.8. Of 175 patients with heart failure, 63% had Ea > 0.5 mmHg/ml. Ees:Ea was lower in patients than in controls (p < 0.001), and 47% of the patients demonstrated Ees:Ea < 0.8, including 8% with normal Ea. In median follow-up of 2.2 (0.8-4.6) years, 53 died, 37 received cardiac transplantation, and 33 received a left ventricular assist device. By multivariable analysis, Ea (hazard ratios [HR]: 2.01, 95% CI 1.18-3.41) and Ees:Ea (HR: 0.46, 95% CI: 0.26-0.82) were independently associated with mortality, whereas Ees was not. Right ventricular-pulmonary vascular coupling is frequently impaired in heart failure and associated with greater mortality. Elevated pulmonary arterial elastance is associated with greater mortality even when coupling is preserved.

Considerable scatter in the relationship between left atrial volume and pressure in heart failure with preserved left ventricular ejection fraction

The index for a target that can lead to improved prognoses and more reliable therapy in each heterogeneous patient with heart failure with preserved ejection fraction (HFpEF) remains to be defined. We examined the heterogeneity in the cardiac performance of patients with HFpEF by clarifying the relationship between the indices of left atrial (LA) volume (LAV) overload and pressure overload with echocardiography. We enrolled patients with HFpEF (N = 105) who underwent transthoracic echocardiography during stable sinus rhythm. Relative LAV overload was evaluated using the LAV index or stroke volume (SV)/LAV ratio. Relative LA pressure overload was estimated using E/e’ or the afterload-integrated index of left ventricular (LV) diastolic function: diastolic elastance (Ed)/arterial elastance (Ea) ratio = (E/e’)/(0.9 × systolic blood pressure). The logarithmic value of the N-terminal pro-brain natriuretic peptide was associated with SV/LAV (r = −0.214, p = 0.033). The pulmonary capillary wedge pressure was positively correlated to Ed/Ea (r = 0.403, p = 0.005). SV/LAV was negatively correlated to Ed/Ea (r = −0.292, p = 0.002), with no observed between-sex differences. The correlations between the LAV index and E/e’ and Ed/Ea and between SV/LAV and E/e’ were less prominent than the abovementioned relationships. SV/LAV and Ed/Ea, showing relative LAV and LA pressure respectively, were significantly but modestly correlated in patients with HFpEF. There may be considerable scatter in the relationships between these indices, which could possibly affect the selection of medications or efforts to improve the prognoses of patients with HFpEF.

Experimental study and numerical simulation of explosion resistance of GFRP reinforced concrete beams

Glass fiber reinforced polymer (GFRP) bars have the advantages of corrosion resistance and high tensile bearing capacity. It can be used as longitudinal reinforcement of concrete protective structures instead of steel reinforcement. In order to clarify the anti-explosion performance of GFRP reinforced concrete beam (GRCBs), the explosion experiment, static bending experiment and numerical simulation analysis of GFRP reinforced concrete beam and reinforced concrete beam (SRCBs) are carried out. The results show that, in the four-point bending static experiment, the bearing capacity of GRCBs designed with the same equivalent stiffness is 5.5 times that of SRCBs under the working condition of 3kg-0.65m explosion loading. With the action of near explosion (proportional detonation distance is less than 0.5159 m kg–3), because the GFRP bars are in the elastic stage, the failure forms are mainly crack, flake and collapse of concrete. According to numerical simulation, the increase of the stiffness of FRP bars can reduce the mid-span displacement of GRCBs. The ratio of the maximum mid-span displacement reduction rate to EA ratio is 0.1, which can reduce the crack and damage of GRCBs and enhance the anti-explosion performance of GRCBs. When the proportional detonation distance is less than 0.4095 m kg–3, C50 and above concrete used in GFRP reinforced concrete beams can effectively reduce concrete collapse and spall. The results show that GRCBs have higher blast resistance than SRCBs.

RIGHT VENTRICULAR - PULMONARY ARTERIAL UNCOUPLING PREDICTS MORTALITY IN CANDIDATES FOR ADVANCED HEART FAILURE THERAPIES

Advanced therapies for heart failure with reduced ejection fraction (HFrEF) include cardiac transplantation and mechanical circulatory support. For both therapies, right ventricular (RV) dysfunction and/or pulmonary hypertension portend adverse outcomes, particularly when systolic PA pressure (sPAP) ≥50 mmHg. End-systolic elastance (Ees) quantifies load-independent systolic RV performance, which can be related to the effective PA load (Ea) by their coupling ratio (Ees:Ea). Elastance may be more sensitive than pressures to detect elevated RV afterload and assess RV-PA coupling. We tested the hypothesis that elevated Ea and Ees:Ea uncoupling are associated with worse prognosis in this population. We prospectively enrolled consecutive patients with HFrEF who underwent right heart catheterization as part of their evaluation for advanced therapies into a registry. A sodium nitroprusside challenge was initiated if sPAP ≥50mmHg and either transpulmonary gradient ≥15 mmHg or pulmonary vascular resistance >3 WU. RV and PA pressures were analyzed offline, and Ees and Ea were determined using a single-beat approach. PA Ea >0.5 mmHg/mL was defined as ‘elevated’, and an Ees:Ea ratio < 0.8 was defined as ‘uncoupled’. We retrospectively collected all-cause mortality from electronic patient records, and examined its association with Ees, Ea, and Ees:Ea using Kaplan-Meier analysis and Cox regression adjusted for age and sex. Data are reported as n (%), median [interquartile range], or hazard ratio (HR). We included 175 patients (57 [50-63] years, 77% male) (Table 1). Ea was normal in 65 patients (37%); of these, 14 (22%) demonstrated uncoupled Ees:Ea. Of the 110 (63%) with elevated Ea, 47 had a sPAP ≥50mmHg and 36 (21% overall) met criteria for a vasodilator challenge. For these cases, sodium nitroprusside (0.75 [0.25-1.00] mcg/kg/min) reduced Ea, (0.63 [0.52-0.82] vs. 0.93 [0.83-1.32] mmHg/mL, p < 0.001). Among patients with an elevated Ea, Ees:Ea was uncoupled in 68 (62%) and coupled in 42. Follow-up was available for 164/175 patients. Fifty patients (29%) died over a median follow-up of 2.2 [0.7-4.4] years. Ea (HR = 2.04 (95%CI 1.20-3.48), p = 0.009, χ2 = 6.5) and Ees:Ea (HR = 0.42 (95%CI 0.23-0.76), p = 0.005, χ2 = 13.8) were each associated with mortality, but isolated Ees was not. Mortality was greater in all subgroups compared to patients with normal Ea and coupled Ees:Ea (Figure 1). Elastance measurements identify RV-PA uncoupling, as well as elevated RV afterload in patients with HFrEF even with acceptable PA pressures. Elevated Ea and uncoupled Ees:Ea identify patients with worse prognosis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)