Early Diastolic Myocardial Velocity Research Articles

Speckle tracking echocardiography for evaluation of myocardial functions before and after mitral valvuloplasty in dogs

BackgroundMyxomatous mitral valve disease (MMVD) is the most common acquired heart disease in dogs. Mitral valvuloplasty (MVP) addresses regurgitation, but the pre- and postoperative changes in myocardial function remain uncertain.ObjectivesThis study evaluated myocardial motion before and after MVP using two-dimensional speckle-tracking echocardiography (2D-STE).AnimalsEight client-owned dogs undergoing MVP for MMVD.MethodsMyocardial deformation was assessed by 2D-STE before surgery and at 1- and 3-months post-surgery. Measurements included left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), cardiac twist, and right ventricular free wall GLS (RVFW-GLS).ResultsPostoperative decreases were observed in left ventricular internal dimensions, left atrial size, and early diastolic myocardial velocity, with an increase in peak late diastolic velocity. LV-GLS decreased at 1 month (−14.4%) and 3 months (−16.3%) compared to preoperative values (−24.4%) (p = 0.0078, p = 0.015). GCS decreased at 1 month (−12.9%) and 3 months (−14.8%) compared to preoperative values (−21.7%) (p = 0.0078). GRS decreased at 1 month (27.7%) and 3 months (32.0%) compared to preoperative values (67.7%) (p = 0.0078). No significant changes were observed in RVFW-GLS. Peak systolic twist increased at 3 months (9.1° vs. 4.9°, p = 0.039). Peak systolic apical rotation showed an upward trend at 3 months (p = 0.109). Left ventricular twist was mildly affected by LVIDd, LVIDDN, and sphericity index (R2 = 0.187, p = 0.034; R2 = 0.33, p = 0.0029; R2 = 0.22, p = 0.019).Conclusions and clinical importancePostoperative myocardial motion approached reference values, indicating significant improvement, particularly in left ventricular twisting motion. These findings highlight the positive impact of surgery on cardiac function in dogs with MMVD.

Changes of cardiac structure and function in pregnant women with different types of hypertensive disorders in pregnancy and their influencing factors

Objective: To analyze the changes in cardiac structure and function in women with different types of hypertensive disorders in pregnancy (HDP) and explore their influencing factors. Methods: A total of 1 967 pregnant women diagnosed with HDP who delivered at Peking University Third Hospital from January 1, 2014 to April 15, 2022 were included in the study. They were categorized into four groups based on specific HDP diagnoses: gestational hypertension (506 cases, 25.7%), pre-eclampsia (589 cases, 29.9%), pregnancy complicated with chronic hypertension (332 cases, 16.9%) and chronic hypertension with pre-eclampsia (540 cases, 27.5%). Differences in cardiac structure and function among four groups were retrospectively analyzed. Cardiac structure indicators included left atrial diameter (LAD), left atrial area (LAA), right atrial area (RAA), left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), systolic function indicators included left ventricular ejection fraction (LVEF), lateral systolic mitral annular velocity (Sm), diastolic function indicators included peak early diastolic mitral in flow velocity (E)/peak late diastolic mitral in flow velocity (A), and E/peak early diastolic myocardial velocity of the lateral mitral annulus early diastolic velocity (Em). Influencing factors on cardiac structure and function were analyzed using generalized linear regression. Influencing factors were assessed by generalized linear regression. Results: (1) General clinical data: the differences in age, gestational week at delivery, blood pressure, proportion of diabetes, and length of hospital stay were statistically significant among four different HDP types (all P<0.05). (2) Compared with pregnant women with pregnancy complicated with chronic hypertension, pre-eclampsia, and gestational hypertension, those with chronic hypertension with pre-eclampsia had larger LAD, LAA, RAA and LVEDD (all P<0.001), thicker IVST and LVPWT (all P<0.001), and reduced left ventricular diastolic function (E/A, lateral Em, E/Em) and systolic function (lateral Sm; all P<0.001). Pregnant women with gestational hypertension had the least changes in cardiac structure and function. Compared with pregnant women with pre-eclampsia, those with pregnancy complicated with chronic hypertension had smaller RAA (P<0.001) and lower E/A (P<0.001), with no significant difference in other indicators (all P>0.05). (3) Chronic hypertension with pre-eclampsia, pregnancy complicated with chronic hypertension, and pre-eclampsia were associated with larger LAD, LAA, and LVEDD, and lower lateral Em (all P<0.05). Conclusions: Different types of HDP are associated with distinct changes in cardiac structure and function. Chronic hypertension with pre-eclampsia demonstrates the most pronounced alterations, followed by pre-eclampsia and pregnancy complicated with chronic hypertension, and gestational hypertension showed the least changes.

Assessment of right ventricular diastolic function in pediatric patients with repaired tetralogy of Fallot by cardiovascular magnetic resonance and echocardiography.

Cardiovascular magnetic resonance (CMR) imaging is routinely performed for assessing right ventricular (RV) systolic but not diastolic function. We aimed to investigate CMR-based assessment of RV diastolic function in pediatric patients with repaired tetralogy of Fallot (rTOF), compared to transthoracic echocardiography (TTE) measurements. A total of 130 consecutive pediatric patients with rTOF who underwent clinically indicated CMR and same-day TTE were included. Forty-three controls were recruited. Phase-contrast images were used to measure trans-tricuspid valve flow velocities during early (E) and late diastolic (A) phases (measured in cm/s). Feature tracking of the tricuspid annulus was performed to derive early (e') and late diastolic (a') myocardial velocities (measured in cm/s). RV diastolic function was evaluated by E/A ratio, E/e' ratio, and E-wave deceleration time (measured in milliseconds). Regression analyses were utilized to identify potential variables associated with RV diastolic dysfunction (DD). The performance of CMR-derived parameters in diagnosing RV DD was assessed using receiver-operating characteristic analyses. Good agreement was found between CMR and TTE measurements (ICC 0.70-0.89). Patients with RV DD (n = 67) showed significantly different CMR-derived parameters including E and e' velocities, and E/A and E/e' ratio, compared to patients without DD (n = 63) (all p < 0.05). CMR-derived E and e' velocities and E/e' ratio were independent predictors of RV DD. E/e' of 5.8 demonstrated the highest discrimination of RV DD (AUC 0.76, sensitivity 70%, specificity 86%). CMR-derived parameters showed good agreement with TTE parameters in determining RV DD. CMR-derived E/e' was proved to be the most effective in identifying RV DD. This study demonstrated the feasibility and efficacy of CMR in assessing diastolic function in pediatric patients. RV DD was presented in over half of patients according to current TTE guidelines, highlighting the need for assessing RV diastolic function during follow-up. • Routinely acquired cine and phase-contrast cardiovascular magnetic resonance (CMR) images yielded right ventricular (RV) diastolic parameters which demonstrated good agreement with transthoracic echocardiography (TTE) measurements. • There was a high prevalence of RV diastolic function impairment in pediatric patients with repaired tetralogy of Fallot (rTOF). • CMR is a reliable complementary modality of TTE for RV diastolic function evaluation.

Initial establishment and validation of a predictive model for preeclampsia in twin pregnancies based on maternal characteristics and echocardiographic parameters.

The primary objective of this study was to evaluate the association between maternal echocardiographic changes and the occurrence of preeclampsia (PE) in twin pregnancies. Additionally, we established and validated a prediction model for PE in twin pregnancies. The first part of this study was retrospective and included data from 854 twin pregnancies that received antenatal care at Peking University Third Hospital from April 2017 to April 2021 (training cohort). Overall, 159 women who underwent transthoracic echocardiography were included in the analysis. To build a predictive model, cardiac findings were compared between normotensive women and those with PE. The model was then validated in a prospective longitudinal cohort (test cohort) that included 109 women with twin pregnancies who underwent two consecutive transthoracic echocardiography examinations during the second and third trimesters. Fifty-four normotensive women and 105 women with PE were analyzed in the retrospective cohort that was used to build the model in which later preeclampsia was associated with higher left ventricular mass index (>61 g/m2 ), interventricular septal thickness (>7.87 mm), left atrial anteroposterior diameter (>33.5 mm), mitral inflow late diastolic velocity (A) (>0.685 m/s), ratio of early diastolic velocity (E) and peak early diastolic myocardial velocity of the lateral mitral annulus (>6.5), and lower peak early diastolic myocardial velocity (<13.1 cm/s). The optimized PE prediction model based on the interventricular septal thickness, left atrial anteroposterior diameter, A, peak early diastolic myocardial velocity and pre-pregnancy bodyweight index was then established (area under the curve [AUC] = 0.840, 95% CI 0.778-0.903, P < 0.001). The model was tested in the prospective cohort including 87 normotensive women and 22 women with PE; the validation test showed that the prediction model in the second (AUC = 0.801) and third (AUC = 0.811) trimesters had high discriminative ability and calibration. Maternal echocardiographic changes in twin pregnancies are associated with the development of preeclampsia. The model constructed, based on the echocardiographic parameters and body mass index, provides novel ideas for the prediction of PE.

Peripheral Blood Mononuclear Cells Mitochondrial Respiration and Superoxide Anion after Heart Transplantation.

The mitochondrial function of circulating peripheral blood mononuclear cells (PBMCs) is an interesting new approach to cardiac diseases. Thus, PBMC's mitochondrial respiration decreases in relation to heart failure severity. However, no data are available on heart-transplanted patients (Htx). We determined PBMCs mitochondrial respiration by high-resolution respirometry (Oroboros Instruments) and superoxide anion production using electron paramagnetic resonance (Bruker-Biospin) in 20 healthy subjects and 20 matched Htx and investigated clinical, biological, echocardiographic, coronarography and biopsy characteristics. PBMCs mitochondrial respiratory chain complex II respiration was decreased in Htx (4.69 ± 0.84 vs. 7.69 ± 1.00 pmol/s/million cell in controls and Htx patients, respectively; p = 0.007) and complex IV respiration was increased (24.58 ± 2.57 vs. 15.68 ± 1.67 pmol/s/million cell; p = 0.0035). Superoxide anion production was also increased in Htx (1.47 ± 0.10 vs. 1.15 ± 0.10 µmol/min; p = 0.041). The leucocyte-to-lymphocyte ratio was increased in Htx, whom complex II correlated with leucocyte number (r = 0.51, p = 0.02) and with the left ventricular posterior wall peak early diastolic myocardial velocity (r = -0.62, p = 0.005). Complex IV was increased in the two patients with acute rejection and correlated negatively with Htx's isovolumetric relation time (r = -0.45, p = 0.045). Although presenting with normal systolic function, Htx demonstrated abnormal PBMC's mitochondrial respiration. Unlike immunosuppressive therapies, subclinical diastolic dysfunction might be involved in these changes. Additionally, lymphopenia might reduce complex II, and acute rejection enhances complex IV respirations. PBMC's mitochondrial respiration appears modified in Htx, potentially linked to cellular shift, mild diastolic dysfunction and/or acute rejection.

Effect of spironolactone on vascular stiffness in hemodialysis patients: a randomized crossover trial.

BackgroundThe role of spironolactone treatment in hemodialysis patients is debated, but a survival benefit is suggested. Mineralocorticoids and chronic kidney disease have been linked to cardiovascular fibrosis. Therefore, we hypothesized that spironolactone would affect vascular stiffness, cardiac systolic, and diastolic function in hemodialysis patients.MethodsThis was a randomized crossover study in hemodialysis patients supplemented with an echocardiographic case series. All outcomes reported here were secondary in the trial and were assessed without blinding. Block randomization and allocation determined treatment order. Participants received 50 mg spironolactone daily for 12 weeks and untreated observation for another 12 weeks. Pulse wave velocity (PWV) was measured before and after treatment and observation. Doppler-echocardiography was conducted before and after treatment. Systemic arterial compliance indexed to body surface area (SACi), left ventricular ejection fraction (LVEF), the peak early diastolic mitral inflow velocity (E), the peak late diastolic mitral inflow velocity (A), and the peak early diastolic myocardial lengthening velocity (E’) were measured. E/A and E/E’ were then calculated. Statistical analyses were conducted per protocol. A generalized linear mixed model with random participant effects was used for PWV. The Wilcoxon signed-rank test was used for echocardiographic variables.ResultsThirty participants were recruited, 18 completed follow-up, and 17 were included in PWV-analyses. Spironolactone treatment showed a tendency toward an increase in PWV of 1.34 (95% confidence interval: −0.11 to 2.78) m/s, which was not statistically significant (P = 0.07). There were no significant changes in any of the other variables (LVEF, E/A, E/Eʹ, or SACi).ConclusionsWe found no evidence supporting an effect of 12-week administration of spironolactone 50 mg daily on vascular stiffness, cardiac systolic, or diastolic function in hemodialysis patients.

Abstract 10130: Immediate Changes of Transesophageal Echocardiographic Findings in Percutaneous Closure of Atrial Septal Defects

Introduction: Atrial septal defects (ASD) are treated with percutaneous closures that subsequently increase the left ventricular volume load. This retrospective study aimed to assess the change in transesophageal ultrasound indices and to determine the search associated post-closure left diastolic index. Subjects: We enrolled 62 patients who underwent percutaneous closure of ASD in our hospital between January 2018 and November 2020. Method: Percutaneous ASD closure was performed under general anesthesia. We measured left ventricular inflow (early diastolic flow velocity, E; atrial contraction flow velocity, A; E-wave deceleration time, DT), mitral annulus velocity by tissue doppler imaging at lateral annulus (early diastolic myocardial velocity, E'; atrial contraction velocity, A'), and pulmonary venous blood flow velocity (peak systolic velocity, S; diastolic velocity, D; atrial systolic regurgitation velocity, AR; atrial systolic regurgitation time, AD) using transesophageal echocardiography (TEE). The ratio of E and E' (E/E') was calculated for and compared between before (pre) and after (post) ASD closure. Statistical analysis was performed using the EZR software. Wilcoxon's code order test was used for comparison, and multivariate correlation analysis was performed with post-occlusion E/E' as the objective variable. Statistical significance was set at p&lt;0.05. Results: Significant changes were seen in A', E', E, S, D, AD, and E/E'. Multivariate correlation analyses revealed a significant association of post E/E’ with the pre E/E’ and pre AR. Conclusion: In this study, the pulmonary venous flow velocity was found to decrease during systole and diastole following ASD closure. The DT did not change; thus, there was no change in the stiffness of the left ventricle. We concluded that the increased left ventricular volume load caused the increase in the left end-diastolic pressure.

Mechanisms of Exercise Capacity Improvement after Cardiac Rehabilitation Following Myocardial Infarction Assessed with Combined Stress Echocardiography and Cardiopulmonary Exercise Testing.

Cardiac rehabilitation (CR) is indicated in all patients after acute myocardial infarction (AMI) to improve prognosis and exercise capacity (EC). Previous studies reported that up to a third of patients did not improve their EC after CR (non-responders). Our aim was to assess the cardiac and peripheral mechanisms of EC improvement after CR using combined exercise echocardiography and cardiopulmonary exercise testing (CPET-SE). The responders included patients with an improved EC assessed as a rise in peak oxygen uptake (VO2) ≥ 1 mL/kg/min. Peripheral oxygen extraction was calculated as arteriovenous oxygen difference (A-VO2Diff). Out of 41 patients (67% male, mean age 57.5 ± 10 years) after AMI with left ventricular ejection fraction (LVEF) ≥ 40%, 73% improved their EC. In responders, peak VO2 improved by 27% from 17.9 ± 5.2 mL/kg/min to 22.7 ± 5.1 mL/kg/min, p < 0.001, while non-responders had a non-significant 5% decrease in peak VO2. In the responder group, the peak exercise heart rate, early diastolic myocardial velocity at peak exercise, LVEF at rest and at peak exercise, and A-VO2Diff at peak exercise increased, the minute ventilation to carbon dioxide production slope decreased, but the stroke volume and cardiac index were unchanged after CR. Non-responders had no changes in assessed parameters. EC improvement after CR of patients with preserved LVEF after AMI is associated with an increased heart rate response and better peripheral oxygen extraction during exercise.

Independent Association of Fatty Liver Index With Left Ventricular Diastolic Dysfunction in Subjects Without Medication

Nonalcoholic fatty liver disease has been reported to be potentially linked to cardiovascular disease. Fatty liver index (FLI) is a noninvasive and simple predictor of nonalcoholic fatty liver disease. However, little is known about the relationship between FLI and cardiac function, especially in a general population. We investigated the relationships of FLI with echocardiographic parameters in 185 subjects (men/women: 79/106) of the Tanno-Sobetsu Study, a population-based cohort, who were not being treated with any medication and who underwent echocardiography. FLI was negatively correlated with high-density lipoprotein cholesterol and peak myocardial velocity during early diastole (e'; r= -0.342, p <0.001), an index of left ventricular (LV) diastolic function, and ratio of peak mitral velocities during early and late diastole (E/A) and was positively correlated with age, systolic and diastolic blood pressures, creatinine, uric acid, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein, ratio of mitral to myocardial early diastolic peak velocity (E/e'), left atrial volume index and LV mass index. No significant correlation was found between FLI and LV ejection fraction. Stepwise multivariable regression analysis showed that FLI was independently and negatively associated with e' after adjustment of age, gender, high-density lipoprotein cholesterol, homeostasis model assessment of insulin resistance, and high-sensitivity C-reactive protein. Conversely, e' was independently and negatively associated with FLI after adjustment of age, gender, systolic blood pressure, and LV ejection fraction. In conclusion, elevated FLI is independently associated with LV diastolic dysfunction in a general population without medication. FLI would be a novel marker of LV diastolic dysfunction as an early sign of myocardial injury.

Early detection of myocardial dysfunction in a cat that gradually progressed to endomyocardial form of restrictive cardiomyopathy

BackgroundRestrictive cardiomyopathy (RCM) is a common myocardial disease in cats, characterized by diastolic dysfunction and atrial enlargement without myocardial hypertrophy. Especially, endomyocardial form of RCM, one of the subtypes in RCM, is characterized by endocardial fibrosis, endocardial scar bridging the interventricular septum and left ventricular (LV) free wall, and deformation and distortion of the LV. However, it is unclear how the myocardial dysfunction and the endocardial scar contribute to the pathophysiology of RCM disease progression.Case presentationA 3 years and 2 months old, intact male, Domestic shorthaired cat was presented for consultation of cardiac murmur. At the first visit (day 0), the notable abnormal finding was echocardiography-derived chordae tendineae-like structure bridging the interventricular septum and the LV free wall, resulting high-speed blood flow in the left ventricle. Electrocardiography, thoracic radiography and noninvasive blood pressure measurements were normal. No left atrial enlargement was observed, and LV inflow velocity showed an abnormal relaxation pattern. Although there was no abnormality in tissue Doppler imaging-derived myocardial velocity, two-dimensional speckle tracking echocardiography (2D-STE) revealed a decrease in the LV longitudinal strain and an increase in endocardial to epicardial ratio of the LV circumferential strain on day 0. On day 468, obvious left atrium enlargement and smoke like echo in the left atrium were observed. The LV inflow velocity was fused, and the tissue Doppler imaging-derived early-diastolic myocardial velocity of the septal mitral annulus decreased. Regarding 2D-STE, LV circumferential strain was further decreased, and right ventricular strain was additionally decreased. Although the general condition was good, we made a clinical diagnosis of endomyocardial RCM based on the above findings. On day 503, the cat showed the radiographic evidence of pulmonary edema and congestive heart failure signs.ConclusionsCats with abnormal LV structure and associated myocardial dysfunction like this case needs careful observation. Additionally, 2D-STE indices may be useful for early detection of myocardial dysfunction in feline RCM.

Evaluation of the diastolic functions of the heart in patients with heart failure after Cardiac Resynchronization Therapy (CRT)

Improvement in systolic functions after CRThas been well-established, but the effect on Left Ventricular (LV) diastolic functions is variable and not well established. The aim of this study is to analyze the improvement in diastolic functions of the heart after CRT. Total 67 cases of Heart Failure (HF) eligible for CRT (mean age, 62.5 ± 11.73 years; 54 males and 13 females) with Left Ventricular Ejection Fraction (LVEF) ≤35% or New York Heart Association (NYHA) Class II, III / Ambulatory IV (IVA) were included in the study. LVEF, pulsed-wave Doppler (PWD) derived transmitral filling indices (E and A wave velocities, E/A ratio), and peak early diastolic longitudinal myocardial velocity (E´) wave by tissue doppler were measured pre and post CRT and were compared. Left Ventricular Ejection Fraction (LVEF) increased &amp;#62;5% (responders) in 42 of 67 patients (62.6%) which was also associated with a reduction in pulsed-wave Doppler (PWD) derived indices that is E velocity, E/A ratio and E/E’ ratio while in non-responders (LVEF&amp;#60;5%) the E velocity, E/A ratio, E’ did not show significant change but E/E’ reduced significantly after CRT. Left Ventricular Diastolic functions improved significantly after CRT in responders but not in non responders.

RELATIONSHIPS BETWEEN SHORT-TERM BLOOD PRESSURE VARIABILITY AND LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN HYPERTENSIVE PATIENTS

Objective: Although an accurate assessment of fast blood pressure (BP) fluctuations occurring within the 24 hours, ideally requires continuous beat-to-beat recording, its assessment is also possible through non-invasive, intermittent 24 h ambulatory BP monitoring (ABPM) Short-term BP variability (SBPV) seems to be relevant to the pathophysiology of target organ damage and to the incidence of clinical events. Our study was aimed to assess in hypertensive patients the relationships between some echocardiographic indices of DD and SBPV. Design and method: We enrolled 289 hypertensive subjects (age: 54 ± 16 years) recruited from those consecutively attending our Hypertension Centre. All the patients underwent: a 24-h ambulatory BP monitoring (ABPM) and an echocardiogram. We calculated the following indices of SBPV: standard deviation and average real variability (ARV) of diurnal and nocturnal systolic (SBP) and diastolic BP (DBP), 24 h weighted SD and ARV of SBP and DBP. Diastolic function was assessed by measuring from the mitral inflow profile, the E-wave (E) and A-wave (A) peak velocities, E/A ratio and E-deceleration time. Isovolumic relaxation time was calculated between aortic valve closure and the start of E-wave. Tissue Doppler imaging of the mitral annulus was obtained placing the sample volume in the lateral mitral valve annulus to evaluate: systolic peak velocity (Sm), early (Em) and late (Am) diastolic myocardial velocities. The E/em ratio was also calculated. Results: All the indices of systolic SBPV examined showed significant correlations with A-wave and with Em (p &lt; 0.01). The correlations with the greatest strenght were those between Em and ARV of 24 h SBP (r = -0.273; p &lt; 0.001) and between Em and weighted SD of 24 h SBP (r = -0.307; p &lt; 0.001). These associations held even after adjustment in multiple regression models for confounders such as age, sex, average 24 h systolic BP and heart rate (p &lt; 0.01). Conclusions: Our findings, showing an independent association between SBPV and some indices of diastolic dysfunction able to predict the development of heart failure, corroborate the concept that an increased short-term systolic BP variability may not be an innocuous phenomenon.

Left Ventricular Impaired Relaxation and Interstitial Myocarditis Identified in Sepsis-Associated Cardiac Dysfunction: Use of a Rodent Model.

BackgroundSepsis is a serious clinical problem that results from the systemic response of the body to infection. Left ventricular (LV) diastolic dysfunction is increasingly appreciated as a contributor to morbidity and mortality in sepsis. Animal models may offer a method of studying diastolic dysfunction while controlling for many potential clinical confounders, such as sepsis duration, premorbid condition, and therapeutic interventions. This study sought to evaluate an endotoxemia (LPS) rodent model of sepsis, with regard to echocardiographic evidence, including tissue Doppler, of LV diastolic dysfunction and histopathology findings.Material/MethodsFourteen male Sprague-Dawley rats were randomly allocated (1: 1) to LPS or saline (control). Mean arterial blood pressure (MAP) was measured through cannulation of the carotid artery. After a 30-min stabilization, baseline assessment with echocardiography and blood collection was performed. Rats were administered 0.9% saline or LPS (10 mg/mL). Follow-up echocardiography and blood collection were performed after 2 h. Hearts were removed post-mortem and pathology studied using histology and immunohistochemistry.ResultsLPS was associated with hypotension (MAP 81.86±31.67 mmHg; 124.29±20.16; p=0.02) and LV impaired relaxation (myocardial early diastolic velocity [e′] 0.06±0.02 m/s; 0.09±0.02; P=0.008). Histopathology and immunohistochemistry demonstrated evidence of interstitial myocarditis (hydropic changes and inflammation).ConclusionsLPS was associated with both diastolic dysfunction (impaired relaxation) and interstitial myocarditis. These features may offer a link between the structural and functional changes that have previously been described separately in clinical sepsis. This may facilitate further studies focused upon the mechanism and potential benefit treatment of sepsis-associated cardiac dysfunction.

Tissue Doppler velocities for ruling out rejection in heart transplant recipients in the daily routine of the echocardiography laboratory: a feasibility study

Abstract Funding Acknowledgements Type of funding sources: None. Background The sum of systolic and early diastolic myocardial velocities at lateral mitral annulus, evaluated by tissue Doppler (in absolute values, s’+e’) in the apical four chambers view is a parameter whose value for ruling out acute cellular rejection (ACR) in heart transplant (HTx) recipients has been acknowledged by the European and Brazilian recommendations for the use of imaging in HTx. A recent study has shown its independent association with ACR in the context of classical and myocardial deformation variables, with a negative predictive value (NPV) of 98% for treatment requiring ACR (TR-ACR, grade ≥ 2R) for a cut-off point of ≥23 cm/s. This work was performed under experimental conditions (only one expert echocardiographer, only one high-end equipment). Purpose Our objective was to study the diagnostic utility of this parameter for ruling out rejection in HTx recipients in the daily routine of the echocardiography laboratory. Methods From October 2017 to May 2020, serial echocardiograms were performed to 33 consecutive HTx recipients, in the 3 hours after the routine surveillance endomyocardial biopsies (EMB), in the first year after HTx. Three sonographers, seven cardiology residents and six expert echocardiographers participated in the acquisition and interpretation of the images, with seven different echocardiographic machines in only one centre. We analysed the association of s’+e’ with the presence of ACR, and the NPV of s’+e’ ≥23 cm/s for ruling out TR-ACR was investigated. Results A total of 176 pairs of EMB and echocardiogram were obtained. The value of s’+e’ was significantly lower with higher severity of rejection: 25.6 ± 5.5 cm/s, 23.8 ± 5.1 cm/s and 21.6 ± 3.5 cm/s for ACR grade 0R (n = 91, 52%), 1R (n = 67, 38%) and ≥2R (n = 18, 10%), respectively, p = 0.005. It was also lower when comparing studies with (≥1R) and without rejection (23.4 ± 4.9 cm/s versus 25.6 ± 5.5 cm/s, p = 0.005), or TR-ACR versus the rest of series (21.6 ± 3.5 cm/s versus 24.8 ± 5.3 cm/s, p = 0.01). The area under curve for the detection of TR-ACR was 0.67 (CI95% 0.56-0.78), p = 0.02. A cut-off point of ≥23 cm/s, present in 57% of the studies, showed a NPV of 95% for TR-ACR. Conclusion Lateral mitral annulus velocities showed an excellent NPV of 95% for TR-ACR detection in HTx recipients when evaluated in the daily routine of an echocardiography laboratory with a wide variety of operators and echocardiographic equipment. This finding could be useful for reducing the number of EMB in selected cases.

Evaluation of Left Ventricular Diastolic Function by 2-D Speckle Tracking Echocardiography in Patients with Connective Tissue Disease-Associated Pulmonary Artery Hypertension

The purpose of this study was to evaluate the role of 2-D speckle tracking imaging in assessing left ventricular diastolic function in patients with connective tissue disease (CTD). A total of 98 CTD patients and 32 healthy controls were prospectively recruited. Early (E) and late (A) diastolic velocities of the transmitral flow were measured by pulsed Doppler echocardiography. Peak early diastolic myocardial velocity (E') was calculated on tissue Doppler echocardiography. The longitudinal strain rate (SR) was calculated as the average of three apical views, while circumferential and radial SRs were measured in three short-axis views. Pulmonary arterial hypertension (PAH) was defined as systolic pulmonary arterial pressure (sPAP) >36 mm Hg. Compared with the control group, CTD patients exhibited significant impairment of left ventricular diastolic function, manifested as lower global SR during early diastole (SRe) in the longitudinal deformation and higher E/SRe in both longitudinal and radial deformation. CTD-PAH patients had significantly lower SRe and higher E/SRe values in both the longitudinal and radial deformation compared with the patients with CTD without PAH. Pearson's correlation analysis revealed that sPAP levels correlated positively with E/E′, longitudinal E/SRe, circumferential E/SRe and radial SRe, and it correlated negatively with septal E′ and radial E/SRe. Receiver operating characteristic curve analysis suggested that E/E′, longitudinal E/SRe and radial SRe could be used to predict PAH. The present study indicates that 2-D speckle tracking imaging is a useful method for evaluation of left ventricular diastolic function, and these derived parameters can serve as good predictors of PAH, but it may not be superior to the commonly used E/E′ in CTD patients.

Evaluation of the Effect of Aortic Stenosis and Severity on Left Ventricular Function by Isovolumic Myocardial Acceleration

Aim: Tissue Doppler-derived isovolumic acceleration (IVA) is a parameter that evaluates the systolic function of both ventricles, without being affected by pre-load and post-load. We aimed to detect left ventricular systolic dysfunction at an early stage with IVA in patients with asymptomatic aortic stenosis (AS).&#x0D; Material and Methods: A total of 105 patients were included in the study, 75 of which had isolated AS and 30 were free of any valve disease. Patients with AS were divided into three groups (mild, moderate and severe) according to their aortic valve area (AVA) and aortic peak velocities, as determined by means of a transthoracic echocardiography. Conventional echocardiography, systolic and diastolic Tissue Doppler parameters [peak myocardial velocity during isovolumic contraction (IVV), myocardial velocity during ejection phase (Sm), early diastolic myocardial velocity (e'), late diastolic myocardial velocity (a'), and acceleration time (AT)] were calculated in all patients. IVA was obtained by dividing the IVV flow rate by the AT time.&#x0D; Results: The systolic parameters IVV (p

Echocardiographic Comparison of COVID-19 Patients with or without Prior Biochemical Evidence of Cardiac Injury after Recovery

Echocardiographic Comparison of COVID-19 Patients with or without Prior Biochemical Evidence of Cardiac Injury after Recovery

P1446 Correlation of B-Type natriuretic peptide with LV and RV function assessed by echocardiography in adults congenital heart diseases patients

Abstract Introduction Brain natriuretic peptide (BNP) is a well-established marker for heart failure in the general population however limited data are available on the value of BNP as a diagnostic and prognostic marker in adults with congenital heart disease (ACHD). The purpose of our study is to evaluate the relation between BNP levels and biventricular systolic and diastolic function in patients with ACHD. Methods We evaluated clinically stable ACHD patients who underwent echocardiography from May 2015 until January 2018. We studied the correlation of BNP with the degree of systolic and diastolic dysfunction of the left ventricle. Moreover we also investigate the relation of BNP with the right tricuspid annular plane systolic excursion (TAPSE), the fractional area change (FAC) and the pulmonary arterial systolic pressure (PASP). Results In total, 385 patients were included in our study (median age, 43 ±12 years; 61% male). Of the 385 patients, 193 (50%) had tetralogy of Fallot, 94 (24%) had systemic RV, including patients with transposition of the great arteries (TGA) after atrial switch operation (Mustard or Senning) and congenitally corrected TGA -ccTGA , 43 (11%) had univentricular hearts and Fontan physiology, 55 (14%) had other lesions. BNP levels were 66 ± 26 pg/mL and 93, ±31pg/mL, for patients with EF &amp;gt; 50% and 50%&amp;gt; EF &amp;gt;35% respectively (p = 0.003). BNP levels correlate with parameters reflecting LV filling pressure, including transmitral early diastolic velocity (E) 81 ± 29pg/mL and its ratio to early diastolic annular myocardial tissue velocity (E/Ea) 77 ± 17pg/mL. (r=-0.607, p = 0.003 r=-0.598, p = 0.005, respectively) BNP levels were also significantly higher in patients with impaired tricuspid annular plane systolic excursion 87 ± 21 pg/mL (TAPSE &amp;lt; 14mm; p = 0.002) and decreased RV FAC 81 ± 18 pg/mL (FAC &amp;lt;35% P= 0.004) and in patients with PASP≥35 mmHg (p = 0.003). The ROC curve and logistic regression analysis spotted the role of BNP in identifying systolic and diastolic dysfunction patterns in ACHD patients. Conclusion: In clinical stable ACHD patiens BNP levels correlate well with LV systolic dysfunction as well as with impaired diastolic function. Furthermore patients with impaired RV function and increased PASP have raised BNP levels. Therefore monitoring BNP levels plays an important role in management of clinical stable ACHD patients

P1771 Gender differences of the blood pressure effects on early changes of left ventricle mechanics in untreated hypertension

Abstract Background Left ventricular (LV) diastolic dyssynchrony and global and layer-specific strain can be used for evaluation of early myocardial changes in hypertension. We tried to investigate the gender differences in these early changes in untreated uncomplicated hypertension. Methods This study included 43 consecutive patients (mean age 51.3 ±12.5 years, 56% men) with newly diagnosed hypertension from an out-patient clinic. All subjects were free of complications including renal dysfunction, LV hypertrophy, and diabetes. Comprehensive transthoracic echocardiography (E9, GE, USA) was conducted before treatment of hypertension. Diastolic and systolic parameters were measured by two-dimension (2D), Doppler, tissue Doppler imaging and 2D speckle tracking echocardiography (STE). The time-to-peak early diastolic myocardial annulus velocity (Te) at 6 LV segments from apical-4-chamber, apical-2-chamber and apical-3-chamber views were measured with reference to the QRS complex. The time to peak early diastolic strain rate (TDSr), global longitudinal strain (GLS), layer-specific longitudinal strain included sub-epicardial strain (EpiLS) and sub-endocardial strain (EndLS) were measured from 18 LV segments by STE. Diastolic dyssynchrony parameters were defined as the standard deviation (SD) of Te of all LV segments (Te-SD), SD of TDSr of 18 LV segments (TDSr-SD), and the maximal difference between any two TDSr of the 18 LV segments (MaxD-TDSr). Results There were no differences between men (56%) and women (44%) regarding age, initial blood pressure, hypertension duration, LV mass index, LV ejection fraction, and early mitral velocity to average early annulus velocity ratio. Regarding diastolic dyssynchrony parameters, men were significantly higher than women including Te-SD (22.3 ± 13.8 vs. 14.7 ± 4.2 ms; p = 0.016), TDSrSD (46.0 ± 13.3 vs. 35.3 ± 11.4 ±ms; p = 0.008), and MaxD-TDSr (162.0 ± 40.3 vs. 128.1 ± 50.7 ms; p = 0.019). Men also had worse GLS (-17.6 ± 1.9 vs. -19.5 ± 2.5 %; p = 0.007), EpiLS (-15.1 ± 1.7 vs. -17.0 ± 2.3, p = 0.003), and EndLS (-20.5 ± 2.2 vs. -22.4 ± 2.8 %; p = 0.018) than women. After multivariate analysis controlling age, systolic blood pressure, and LV mass index, TeSD (p = 0.039), TDSrSD (p = 0.018), MaxD-TDSr (p = 0.035) were still significantly higher than women. GLS (p = 0.046), and EpiLS (p = 0.025) were still worse in men. Conclusion In the same age, blood pressure, hypertension duration and LV mass index, men have more diastolic dyssynchrony and worse myocardial strain in untreated hypertension.

Difference in the prevalence of subclinical left ventricular impairment among left ventricular geometric pattern in a community-based population

BackgroundLeft ventricular (LV) hypertrophy is reported to cause LV diastolic dysfunction. This study aimed to examine the prevalence of LV diastolic dysfunction in each group categorized by the geometric pattern of LV hypertrophy in a community-based population. MethodsWe studied 1260 community-dwelling subjects who experienced no symptoms of obvious heart disease (461 men, 799 women) and who participated in annual health check-ups in a rural Japanese community. The subjects were divided into 4 groups according to LV mass index and relative wall thickness: normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. We investigated the prevalence of LV diastolic dysfunction in the overall and stratified population by LV geometric pattern. LV diastolic function was determined by 3 echocardiographic parameters of LV diastolic function: early diastolic myocardial velocity, the ratio of early diastolic mitral inflow velocity and myocardial velocity, and indexed left atrial dimension. LV diastolic dysfunction was defined as the presence of abnormal values in more than 2 of 3 echocardiographic parameters. ResultsThe prevalence of LV diastolic dysfunction was higher in the categories with more severe LV hypertrophy. However, LV mass index, rather than relative wall thickness, was a significant determinant of LV diastolic dysfunction, after adjustment for comorbidities. In addition, 71 (10%) out of 740 subjects with normal LV geometric pattern had LV diastolic dysfunction even without obvious LV geometric change. ConclusionsThe prevalence of LV diastolic dysfunction was higher in the subjects with more severe LV hypertrophy in a community-based population. Subclinical LV diastolic dysfunction without obvious LV geometric change should be noted and its clinical impact should be elucidated.