Echocardiographic Abnormalities Research Articles

#2406 Echocardiographic characteristics of autosomal dominant polycystic kidney disease

Abstract Background and Aims Cardiovascular complications in patients with autosomal dominant polycystic kidney disease (ADPKD) are one of the most frequently investigated extrarenal manifestations. The results are many times contradictory. This is caused by a limited size of studied populations and high inter- and intrafamilial heterogeneity of ADPKD. Expanding knowledge of populations of patients from different regions and cohorts is crucial for improving the understanding and treatment of cardiovascular morbidity and mortality. This study aims to explore the prevalence of cardiovascular abnormalities in echocardiography and to analyze their relationships with clinical characteristics across different stages of CKD progression in patients with ADPKD. Method Sixty-eight patients were included in the study. All patients underwent transthoracic echocardiography with the use of GE Vingmed Ultrasound (GE Norway Health Tech, Oslo, Norway). Information about demography, prior medical history and taking antihypertension drugs was recorded. The results of creatinine, lipids and haemoglobin were collected. To diagnose the rapid progression of CKD, creatinine was sampled twice, in a one-year interval. Results Using different indicators of left ventricular hypertrophy (LVH), we found it in above 40% of ADPKD patients. A single associate of left ventricular mass was eGFR decline after one year of observation. Other highly prevalent findings were asymptomatic left ventricular diastolic dysfunction (ALVDD) (39%), left atrium (LA) enlargement (39%) and mild valvular regurgitations (80%). Ejection fraction, aortic root dimension, tricuspid annular plane systolic excursion (TAPSE) and prevalence of mitral valve prolapse were not importantly increased. Apart from age, the strong determinant of ALVDD diagnosis was the treatment with beta-blockers. Cardiac indices were not different across the eGFR stages. Conclusion LVH, LA enlargement, ALVDD and valvular regurgitations are characteristics of cardiac phenotype in ADPKD. Cardiac indices were not different across different stages of CKD pointing towards the diagnosis of ADPKD being main drive of their occurrence.

#174 Valvulopathies and left ventricular hypertrophy in ADPKD: prevalence and association with genotype and phenotype

Abstract Background and Aims Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited nephropathy due to mutations in PKD1 or PKD2 genes. In addition to kidney involvement, ADPKD is also characterized by extrarenal manifestations including the presence of cysts in other organs, intracranial aneurysms, arterial hypertension, valvulopathies and left ventricular hypertrophy (LVH). Cardiac abnormalities are an important cause of morbidity and mortality in ADPKD patients. Limited data on the association between these cardiovascular manifestations with phenotypic (both renal and systemic) and genotypic features of ADPKD are currently available. In this study we report the prevalence of the main cardiac abnormalities (valvulopathies, with a focus on aortic, mitral, tricuspid valve regurgitation, mitral prolapse, and LVH) observed in a large cohort of ADPKD patients, and investigated their association with renal diameter, renal function, other systemic manifestations such as pancreatic cysts, intracranial cysts, intracranial aneurysm and genotype. Method This retrospective study was conducted at the A. Gemelli Hospital, Rome in a single-center cohort of 129 ADPKD patients, who had previously undergone echocardiogram, abdominal ultrasound, brain MRI, and blood tests, between January 2018 and July 2023. Genetic testing was performed in 58 of the 129 patients. For the statistical analysis the average bilateral renal diameter of each patient was used. An interventricular septum cut-off thickness of 11 mm was used to define left ventricular hypertrophy. Non-parametric (Mann–Whitney and Spearman) and chi-square tests were applied as appropriate. Results In our cohort of 129 patients, the prevalence of valvulopathies was the following: 68% of mitral regurgitation, 22% of mitral prolapse, 20% of aortic regurgitation and 56% of tricuspid regurgitation. Left ventricular hypertrophy was identified in 28% of the entire cohort. We found that in ADPKD patients with aortic regurgitation, renal diameters are larger (p = 0.027) and the eGFR is lower (p < 0.01) than in patients without this echocardiographic abnormality (Fig. 1a,b). In the subset of genotyped ADPKD patients (58), mutations in PKD 1 were associated with mitral prolapse (p = 0.02). Interventricular septal thickness, regardless of the presence of hypertrophy was positively correlated (Fig. 1c) with renal diameter (p = 0.001 r = +0.289) and negatively (Fig. 2a) with eGFR (p < 0.001 r = −0.422). Both correlations, also adjusted for arterial hypertension, remained statistically significant (p = 0.008, coefficient r = +0.235 and p < 0.001, coefficient r = −0.304, respectively). In addition, patients with LVH featured a larger renal diameter (p = 0.03), and a lower eGFR (p < 0.001) (Fig. 2b-c). Moreover LVH was associated with the presence of PKD1 mutations (p = 0.03). Neither valvulopathies nor LVH were associated with other systemic manifestations of the disease. Conclusion We show for the first time an association of LVH with ADPKD genotype (specifically mutations in PKD1) and the association of a specific valvulopathy (aortic regurgitation) with the renal phenotype of ADPKD patients. To date only one study found an association of another valvulopathy, mitral regurgitation, with mutations in PKD1 [1]. Heart valves disease and LVH are risk factors for the subsequent development of further cardiovascular complications therefore understanding the pathogenetic mechanisms responsible for the higher incidence of these abnormalities in ADPKD would be useful to identify high-risk subgroups of patients and tailor personalised interventions.

#2814 Characterization of cardiological manifestations in patients with sodium-wasting tubulopathies

Abstract Background and Aims Bartter (BS) and Gitelman (GS) syndromes are rare tubulopathies caused by mutations affecting renal NaCl transporters, resulting in similar symptoms like muscle weakness, cramps, and electrolyte imbalances, with GS also presenting with hypomagnesemia. Treatment focuses on electrolyte and fluid balance, using supplements and drugs to inhibit prostaglandin production and RAAS activation. Electrolyte deficits in these conditions can extend the QT interval and increase the risk of potentially fatal cardiac arrhythmias. This study aims to profile BS and GS patients followed at our hospital, focusing on cardiological phenotyping. We assessed diagnostic, clinical, and lab data, particularly examining the link between electrolyte imbalances (like hypokalemia or hypomagnesemia) and electrocardiographic changes or cardiac symptoms during follow-up. Method We screened all BS and GS patients for study inclusion, requiring a genetic diagnosis with disease-causing mutations and comprehensive clinical and electrocardiographic data. We excluded cases lacking sufficient data. We gathered demographic and health information retrospectively, categorizing patients based on electrocardiographic results into groups: 1) persistent long QT interval, 2) transient long QT interval, and 3) no long QT interval. Data were summarized with medians, interquartile ranges, and frequencies. Results A total of 27 patients were enrolled in the study, 16 with Bartter Syndrome (BS) and 11 with Gitelman Syndrome (GS); median length of follow-up was 6 years (range 3-19). Only one patient was classified in group 1, with a constant QTc prolongation (446.3 ms); 8 patients (34.8%) fell into group 2 with median QTc values of 420 ms, all exhibiting hypokalemia and hypomagnesemia. The majority (14/23, 61%) were in group 3, with a median QTc of 399.2 ms and 79% displaying hypokalemia and hypomagnesemia. All 9 patients who experienced cardiac-related symptoms were adults, with 8 presenting these symptoms during intercurrent episodes. The study also compared clinical differences between BS and GS patients, noting a higher frequency of hypokalemia and hypomagnesemia in GS, whereas BS patients had more electrocardiographic alterations, although not statistically significant. No echocardiographic abnormalities were detected from the available data, and there were no recorded incidents of malignant arrhythmias or sudden death. Conclusion Electrocardiographic abnormalities in BS and GS patients fluctuate, often related to episodic events, with QT prolongation in one-third of cases but no severe cardiac complications, indicating a generally positive prognosis.

#482 Implementation of trans-esophageal echocardiography in pre-transplant recipient's basic preparation

Abstract Background and Aims Kidney transplantation is the module of choice to reduce mortality in comparison with dialysis [1]. Many patients on transplant waiting list undergoing haemodialysis via central venous catheters [2]. Cardiovascular morbidity control is one of the pillars of successful transplantation outcome [3]. Tans-thoracic echocardiographic abnormalities can be used to identify renal transplant recipients at high risk of cardiovascular disease [4]. Trans-oesophageal echocardiography is superior to trans-thoracic echocardiography in detecting vegetations. Endocarditis complicating central venous catheters often involves right-sided structures, with catheter tips in or near the right atrium, frequently requires Trans-oesophageal echocardiography for diagnosis [5]. Three-dimensional trans-oesophageal echocardiography is considered the missed module for clear vegetations visualization [6]. Method Evaluation of Transoesophageal echocardiography results in 377 haemodialysis patients with central venous dialysis access planned for kidney transplantation. All patients were examined by transthoracic echocardiography and stated absent vegetations from our registry. Candidates were re-evaluated by real time trans-oesophageal procedure to diagnose possibility of silent vegetations. Informed consent was obtained. Results Among 377 patients undergoing haemodialysis via central venous access and recorded in transplantation waiting list. All of them were having absent vegetations stated by transthoracic echocardiography. Our patients were subjected to transoesophageal echocardiography. Results showed 13 patients with variable sized right sided 4-6 mm vegetations (3.4%). Among our positive group of patients six patients were founded with 6 mm vegetation (1.6%), four patients with 5 mm (0.5%) and finally three patients with 4 mm vegetations (0.7%). Conclusion Trans-oesophageal echocardiography may be implemented in renal transplant recipient basic preparation checklist for evaluation of silent vegetations associated with central access of dialysis.

MYOCARDIAL AND PERICARDIAL DISEASES INCIDENCE IN COVID

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), also referred to as COVID–19, was declared a pandemic by the World Health Organization in March 2020. The manifestations of COVID–19 are widely variable and range from asymptomatic infection to multi–organ failure and death. Like other viral illnesses, acute myocarditis and/or pericarditis has been reported to be associated with COVID–19 infection. The guidelines for the diagnosis of COVID–19 introduced the echocardiogram for diagnosis of carditis in these patients. Purpose In our study we investigated the incidences of myocarditis and/or pericarditis in a consecutive series of 1540 Athletes undergo to agonostic certification that performed echocardiogram, and subdivided the incidence of carditis depend on the period and the possible subtype of the covid (alpha, beta, gamma, delta, epsilon). Methods From March 2020 to October 2022 we enrolled in this epidemiological evaluation 1540 patients that was affected by COVID. Every patients was admitted to ambulatory of sport medicine of 2 Italian centres on the major islands to perform a return to play agonist certificate. Overall, 69% males and 31%. females were enrolled with a mean age of 24.3 years (12–67 years). None presented a risk factor of a cardiac disease. Results The incidence of Echocardiographic abnormality was 3,2% in our population The kind and the incidence of alteration was showed in table 1, and consist in dilated cardiomiopathy (0,4%), regional cinetic dysfunction (0,4%), pericardial effusion (1,9%), aspecific alterations (0,2%). Based on the period we evaluated the incidence of the echocardiographic alterations during the seasons and in corralation of variant of COVID . The results was showed in figure 1. Conclusions Based on our evalution the incidence of echocardiographic findings in COVID was 3,2% in all period, with a progressive reduction long the time, from alpha variant to epsilon variant.

Association of echocardiographic parameters with all-cause and cardiovascular mortality in patients with type 2 diabetes

BackgroundThis study aimed to evaluate associations between echocardiography markers and mortality in patients with type 2 diabetes mellitus (T2DM). MethodsDiabetes Care Management Program database of a medical center was used, including 5612 patients with T2DM aged 30 years and older and who underwent echocardiography assessment between 2001 and 2021. Cox proportional hazard regression models were used to evaluate associations of echocardiography abnormalities with all-cause and expanded cardiovascular disease (CVD) mortality. ResultsDuring a mean follow-up of 5.8 years, 1273 patients died. Hazard ratios (95% confidence intervals) of all-cause mortality for each standard deviation increase were presented for the cardiac systolic function indicator of left ventricular ejection fraction (0.77, 0.73–0.81), cardiac structural parameters of left ventricular mass index (1.25, 1.19–1.31) and left atrial volume index (1.31, 1.25–1.37), and cardiac diastolic function of E/A ratio (1.10, 1.07–1.13), E/e’ ratio (1.37, 1.30–1.45), and TR velocity (1.25, 1.18–1.32); meanwhile, the values of expanded CVD mortality included left ventricular ejection fraction (0.67, 0.62–0.72), left ventricular mass index (1.35, 1.25–1.45), left atrial volume index (1.40, 1.31–1.50), E/A ratio (1.12, 1.08–1.16), E/e’ ratio (1.57, 1.46–1.69), and TR velocity (1.29, 1.19–1.39), respectively. ConclusionsCardiac systolic function indicator of left ventricular ejection fraction, cardiac structural parameters of left ventricular mass index and left atrial volume index, and cardiac diastolic function indicators of E/A ratio, E/e’ ratio, and TR velocity are associated with all-cause and expanded CVD mortality in patients with T2DM.

Regional wall motion abnormalities in transthoracic echocardiography in patients with significant coronary artery disease and coronary collateral circulation in adults

BackgroundCoronary collateral circulation is a common finding in patients with chronic total occlusions (CTOs) resulting from chronic coronary artery disease (CAD). Regional wall motion abnormalities (RWMA) on transthoracic echocardiography (TTE) can be used for the diagnosis of CAD. However, little work has been done to investigate the impact of collateral vessels on the diagnostic accuracy of resting TTE for CAD. MethodsA retrospective chart review was conducted of adults seen by the Temple Baylor Scott & White echocardiography laboratory who received a resting TTE and cardiac catheterization within 30 days over a 4-year period. Exclusion criteria included catheterization without coronary angiography and prior history of CAD, percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG). We analyzed RWMA on TTE in patients with CAD and coronary collateral circulation on cardiac catheterization to assess for correlation. ResultsOf the 753 patients were included in this study, 453 had CAD, 272 had both CAD and RWMA, 111 had collateral circulation, and 73 had collateral circulation and RWMA. There was no significant difference in RWMA in patients with CAD with and without collateral circulation. There was no significant difference in the sensitivity (60.0 % vs 59.2 %) and specificity (78.4 % vs 73.9 %) after collateral-adjusted interpretation of RWMA and CAD (p = 0.3). DiscussionOur results suggest the average coronary collateral system is of insufficient clinical significance to prevent the development of RWMA on resting TTE.

Frequency, characteristics and risk assessment of pulmonary arterial hypertension with a left heart disease phenotype.

To obtain real-world evidence about the features and risk stratification of pulmonary arterial hypertension (PAH) with a left heart disease (LHD) phenotype (PAH-LHD). By reviewing the records of consecutive incident PAH patients at 7 tertiary centers from 2001 to 2021, we selected 286 subjects with all parameters needed to determine risk of death at baseline and at first follow-up with COMPERA and COMPERA 2.0 scores. Fifty seven (20%) had PAH-LHD according to the AMBITION definition. Compared with no-LHD ones, they were older, had higher BMI, more cardiovascular comorbidities, higher E/e' ratio and left atrial area, but lower BNP concentrations and better right ventricular function and pulmonary hemodynamics. Survival was comparable between PAH-LHD and no-LHD patients, although the former were less commonly treated with dual PAH therapy. Both COMPERA and COMPERA 2.0 discriminated all-cause mortality risk of PAH-LHD at follow-up, but not at baseline. Risk profile significantly improved during follow-up only when assessed by COMPERA 2.0. At multivariable analysis with low-risk status as reference, intermediate-high and high-risk, but not LHD phenotype, were associated with higher hazard of all-cause mortality. Results were comparable in secondary analyses including patients in the last 10years and atrial fibrillation and echocardiographic abnormalities as additional criteria for PAH-LHD. In real life, PAH-LHD patients are frequent, have less severe disease and are less likely treated with PAH drug combinations than no-LHD. TheCOMPERA 2.0 model may be more appropriate to evaluate their mortality risk during follow-up and how it is modulated by therapy.

The role of cardiac magnetic resonance in sports cardiology: results from a large cohort of athletes.

Cardiac magnetic resonance (CMR) provides information on morpho-functional abnormalities and myocardial tissue characterisation. Appropriate indications for CMR in athletes are uncertain. To analyse the CMR performed at our Institute to evaluate variables associated with pathologic findings in a large cohort of athletes presenting with different clinical conditions. All the CMR performed at our Institute in athletes aged > 14years were recruited. CMR indications were investigated. CMR was categorised as "positive" or "negative" based on the presence of morphological and/or functional abnormalities and/or the presence of late gadolinium enhancement (excluding the right ventricular insertion point), fat infiltration, or oedema. Variables associated with "positive" CMR were explored. A total of 503 CMR were included in the analysis. "Negative" and "positive" CMR were 61% and 39%, respectively. Uncommon ventricular arrhythmias (VAs) were the most frequent indications for CMR, but the proportion of positive results was low (37%), and only polymorphic ventricular patterns were associated with positive CMR (p = 0.006). T-wave inversion at 12-lead ECG, particularly on lateral and inferolateral leads, was associated with positive CMR in 34% of athletes (p = 0.05). Echocardiography abnormalities resulted in a large proportion (58%) of positive CMR, mostly cardiomyopathies. CMR is more efficient in identifying a pathologic cardiac substrate in athletes in case of VAs (i.e., polymorphic beats), abnormal ECG repolarisation (negative T-waves in inferolateral leads), and borderline echocardiographic findings (LV hypertrophy, mildly depressed LV function). On the other hand, CMR is associated with a large proportion of negative results. Therefore, a careful clinical selection is needed to indicate CMR in athletes appropriately.

Exploring sleep heart rate variability: linear, nonlinear, and circadian rhythm perspectives.

Heart rate variability (HRV) is believed to possess the potential for disease detection. However, early identification of heart disease remains challenging, as HRV analysis in dogs primarily reflects the advanced stages of the disease. The aim of this study is to compare 24-h HRV with sleep HRV to assess the potential utility of sleep HRV analysis. Thirty healthy dogs with no echocardiographic abnormalities were included in the study, comprising 23 females and 7 males ranging in age from 2 months to 8 years (mean [standard deviation], 1.4 [1.6]). This study employed a cross-sectional study. 24-h HRV and sleep HRV were measured from 48-h Holter recordings. Both linear analysis, a traditional method of heart rate variability analysis, and nonlinear analysis, a novel approach, were conducted. Additionally, circadian rhythm parameters were assessed. In frequency analysis of linear analysis, the parasympathetic index nHF was significantly higher during sleep compared to the mean 24-h period (mean sleep HRV [standard deviation] vs. mean 24 h [standard deviation], 95% confidence interval, p value, r-family: 0.24 [0.057] vs. 0.23 [0.045], 0.006-0.031, p = 0.005, r = 0.49). Regarding time domain analysis, the parasympathetic indices SDNN and RMSSD were also significantly higher during sleep (SDNN: 179.7 [66.9] vs. 156.6 [53.2], 14.5-31.7, p < 0.001, r = 0.71 RMSSD: 187.0 [74.0] vs. 165.4 [62.2], 13.2-30.0, p < 0.001, r = 0.70). In a geometric method of nonlinear analysis, the parasympathetic indices SD1 and SD2 showed significantly higher values during sleep (SD1: 132.4 [52.4] vs. 117.1 [44.0], 9.3-21.1, p < 0.001, r = 0.70 SD2: 215.0 [80.5] vs. 185.9 [62.0], 17.6-40.6, p < 0.001, r = 0.69). Furthermore, the circadian rhythm items of the parasympathetic indices SDNN, RMSSD, SD1, and SD2 exhibited positive peaks during sleep. The findings suggest that focusing on HRV during sleep can provide a more accurate representation of parasympathetic activity, as it captures the peak circadian rhythm items.

Echocardiographic findings in apparently healthy Czechoslovakian wolfdogs

IntroductionTo echocardiographically evaluate a large number of apparently healthy Czechoslovakian wolfdogs (CWDs) to identify possible subclinical cardiac abnormalities and to generate reference intervals. AnimalsOne-hundred and seventeen apparently healthy client-owned CWDs. Materials and methodsStandard two-dimensional, M-mode, and Doppler echocardiographic measurements were obtained on non-sedated, manually restrained standing dogs. Animals with no relevant echocardiographic abnormalities were used to generate reference intervals. Echocardiographic variables were compared between males and females and between dogs with and without mitral regurgitation (MR). Results and discussionAmong the 117 CWDs, 103 dogs were used to generate reference intervals. The 14 dogs with abnormalities had more than trivial MR (12 dogs), subaortic stenosis (one dog), and equivocal subaortic stenosis (one dog). The 44 males were heavier than 59 females (P<0.001) and had a larger maximum left atrial dimension (P=0.015), left ventricular internal dimension at end-diastole (P<0.001) and systole (P<0.001), and thicker interventricular septum thickness at end-diastole (P=0.016). A positive linear correlation was identified between bodyweight and aortic root and left atrial diameters and left ventricular dimensions and between age and aortic root and left atrial diameter and peak late transmitral flow velocity. A negative linear correlation was identified between age and peak early transmitral flow velocity and the ratio between peak early and late transmitral flow velocities. No differences in echocardiographic-derived cardiac dimensions were detected between healthy dogs and dogs with more than trivial MR. ConclusionsIn this population of CWDs, subclinical cardiac abnormalities were uncommon, and they were mainly classified as MR.

Myocardial injury in dogs: a retrospective analysis on etiological, echocardiographic, electrocardiographic, therapeutic, and outcome findings in 102 cases

IntroductionIn dogs, myocardial injury (MI) is a poorly characterized clinical entity; therefore, this study aimed to provide a detailed description of dogs affected by this condition. Animals, materials, and methodsDogs diagnosed with MI according to the concentration of cardiac troponin I (cTnI) were retrospectively searched. Signalment, diagnostic, therapeutic, and outcome data were retrieved. Dogs were divided into six echocardiographic (dilated cardiomyopathy phenotype; hypertrophic cardiomyopathy phenotype; hypertrophic cardiomyopathy phenotype with systolic dysfunction; abnormal echogenicity only; endocarditis; and no echocardiographic abnormalities suggestive of MI), four electrocardiographic (abnormalities of impulse formation; abnormalities of impulse conduction; abnormalities of ventricular repolarization; and no electrocardiographic abnormalities suggestive of MI), and nine etiological (infective; inflammatory; neoplastic; metabolic; toxic; nutritional; immune-mediated; traumatic/mechanical; and unknown) categories. Statistical analysis was performed to compare cTnI values among different categories and analyze survival. ResultsOne hundred two dogs were included. The median cTnI value was 3.71 ng/mL (0.2–180 ng/mL). Echocardiographic and electrocardiographic abnormalities were documented in 86 of 102 and 89 of 102 dogs, respectively. Among echocardiographic and electrocardiographic categories, the dilated cardiomyopathy phenotype (n = 52) and abnormalities of impulse formation (n = 67) were overrepresented, respectively. Among dogs in which a suspected etiological trigger was identified (68/102), the infective category was overrepresented (n = 20). Among dogs belonging to different echocardiographic, electrocardiographic, and etiological categories, cTnI did not differ significantly. The median survival time was 603 days; only eight of 102 dogs died due to MI. ConclusionsDogs with MI often have an identifiable suspected trigger, show various echocardiographic and electrocardiographic abnormalities, and frequently survive to MI-related complications.

Should we be afraid of long-term cardiac consequences in children with multisystem inflammatory syndrome? Experience from subsequent waves of COVID-19.

The purpose of the study was to assess and compare short- and long-term cardiac complications of the multisystem inflammatory syndrome in children (MIS-C) by predominant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants throughout the pandemic. The analysis of prospectively collected data comparing cardiac complications of MIS-C during and after hospitalization across the original/alpha, delta, and omicron waves. Cardiac complications were defined as cardiac failure with systolic function impairment or hypotension or abnormalities in echocardiographic findings (decrease in LVEF, FS, valvular insufficiency, pericardial effusion, or coronary artery abnormalities). A total of 120 patients with MIS-C admitted to the Children's Hospital of Krakow between November 1, 2020, and May 5, 2023, were included in the study (74 during original/alpha dominance, 31 delta, and 15 omicron). Patients in the omicron group were found to be younger than those in the alpha and delta groups (37 vs. 75 vs. 80months, p = 0.03). The frequency of cardiac failure with systolic function impairment or hypotension was diagnosed more frequently in the original/alpha and delta groups than in the omicron group (44.59% vs. 41.94% vs. 13.33%, p = 0.08) also echocardiographic abnormalities changed, with rates of 60.8%, 35.5%, and 13.3% (p < 0.001) accordingly. The multivariable regression revealed an older age (OR = 1.19, 95% CI = 1.07-1.33, p = 0.002) as the only independent factors of cardiac failure with systolic function impairment or hypotension. In all patients, signs of cardiac failure resolved during the hospitalization. Moreover, in 98.3% of patients, all echocardiagraphic abnormalities resolved completely during the observation period. Conclusion: The cardiac complications of MIS-C appeared to advance less severely in younger children during the Omicron outbreak. In long-term observation, symptoms of cardiac failure resolve completely. Similarly, also echocardiographic abnormalities normalize in the vast majority of patients. What is Known: • Knowledge about the long-term cardiac complications of MIS-C is still evolving and uncertain. • The greatest concern of MIS-C is cardiac complications, including cardiac failure and coronary artery dilatation. What is New: • Long-term observations revealed complete resolution of cardiac complications in the vast majority of patients with MIS-C, irrespective of the dominant variant. • Cardiac complications of MIS-C were less common in younger children during subsequent pandemic waves in our patient population.

Combination of Tele-Cardiology Tools for Cardiovascular Risk Stratification in Primary Care: Data from the PROVAR+ Study.

Tele-cardiology tools are valuable strategies to improve risk stratification. We aimed to evaluate the accuracy of tele-electrocardiography (ECG) to predict abnormalities in screening echocardiography (echo) in primary care (PC). In 17 months, 6 health providers at 16 PC units were trained on simplified handheld echo protocols. Tele-ECGs were recorded for final diagnosis by a cardiologist. Consented patients with major ECG abnormalities by the Minnesota code, and a 1:5 sample of normal individuals underwent clinical questionnaire and screening echo interpreted remotely. Major heart disease was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, or wall-motion abnormalities. Association between major ECG and echo abnormalities was assessed by logistic regression as follows: 1) unadjusted model; 2) model 1 adjusted for age/sex; 3) model 2 plus risk factors (hypertension/diabetes); 4) model 3 plus history of cardiovascular disease (Chagas/rheumatic heart disease/ischemic heart disease/stroke/heart failure). P-values < 0.05 were considered significant. A total 1,411 patients underwent echo; 1,149 (81%) had major ECG abnormalities. Median age was 67 (IQR 60 to 74) years, and 51.4% were male. Major ECG abnormalities were associated with a 2.4-fold chance of major heart disease on echo in bivariate analysis (OR = 2.42 [95% CI 1.76 to 3.39]), and remained significant after adjustments in models (p < 0.001) 2 (OR = 2.57 [95% CI 1.84 to 3.65]), model 3 (OR = 2.52 [95% CI 1.80 to3.58]), and model 4 (OR = 2.23 [95%CI 1.59 to 3.19]). Age, male sex, heart failure, and ischemic heart disease were also independent predictors of major heart disease on echo. Tele-ECG abnormalities increased the likelihood of major heart disease on screening echo, even after adjustments for demographic and clinical variables.

Abstract P436: Pre-Diabetes With and Without Cardiac Dysfunction and the Risk of Heart Failure in Older Adults

Background: Whether pre-diabetes (pre-DM) is independently associated with the risk of heart failure (HF) in the elderly remains inconclusive. Objective: To examine the prevalence of cardiac dysfunction in pre-DM and the prognostic differences of HF in pre-DM with and without cardiac dysfunction in a diverse elderly population. Methods: We included HF-free individuals with euglycemia (n=770) or pre-DM (n=2157) who underwent echocardiography at the Atherosclerosis Risk in Communities (ARIC) Study Visit 5 (baseline). A composite cardiac dysfunction measure included ≥2 echocardiographic abnormalities (Left ventricular hypertrophy [LV mass index ≥115 g/m 2 in men or≥95 g/m 2 in women], left atrial enlargement [LA volume index ≥34 mL/m 2 ], diastolic dysfunction [E/e’ &gt;13, E/A&gt;2, or E-wave deceleration time &gt;240 ms], and systolic dysfunction [ejection fraction&lt;45%]) and high NT pro-BNP (&gt;125 pg/mL in obese or &gt;100 in non-obese). Our outcome was a new diagnosis of definite or probable acute decompensated HF. We assessed the prevalence of the composite cardiac dysfunction in pre-DM (fasting glucose 100-125 mg/dL or HbA1c 5.7-6.4%) and the association between pre-DM and incident HF with and without cardiac dysfunction at baseline adjusting for age, sex, race, center, education, smoking, BMI, systolic blood pressure, total cholesterol, hypertensive medication, lipid-lowering medication, and eGFR (CKD-EPI) in the Cox regression models. Results: 9.5% of elderly individuals with pre-DM had cardiac dysfunction. In a median follow-up of 7 years, compared to euglycemia without cardiac abnormalities, we found a significant risk of HF in pre-DM with cardiac dysfunction (HR 2.6, 95% CI 1.6-4.5) but not in pre-DM without cardiac dysfunction (0.8, 0.5-1.2). The finding was consistent in sex and race groups and sensitivity analyses excluding those with a history of hypertension or obesity. Conclusion: Pre-DM is associated with an increased risk of HF in elderly people, but the risk was only significant among those with cardiac dysfunction.

Abstract P352: Association of General and Exertional Fatigue Subtype With Pre-Clinical Heart Failure Stage in Community Dwelling Older Adults in the Atherosclerosis Risk in Communities Study

Background: General and exertional fatigue are prevalent in heart failure (HF), can co-occur, and are associated with adverse outcomes. However, little is known about general and exertional fatigue in pre-clinical HF stages (stage A or B HF). Methods: In this cross-sectional analysis, we included participants at ARIC study visit 5 with stage A HF (risk factors for HF) or B HF (echocardiographic abnormalities or cardiac biomarker elevations). Using general fatigue (Patient Reported Outcomes Measurement Information System (PROMIS) fatigue scale) and exertional fatigue (Medical Research Council breathlessness scale) scores, we cross-categorized individuals into 4 fatigue subtypes: fatigue-free; high general fatigue only; high exertional fatigue only; high general/high exertional fatigue. The absence of a fatigue type was defined as a score of “none-mild”, and high severity as a score of “moderate-severe”. We examined the independent association of HF stage with fatigue subtype using multinomial logistic regression. Results: Our sample (N=4,269) was 59% female, 80% White, with a mean age of 75 years. Prevalence of any type of fatigue was 28% (n=1,179). Those with stage B had a higher prevalence of all fatigue types compared to stage A: high general fatigue only (10.2% vs 8.1%), high exertional fatigue only (12.6% vs 9.1%) and high general/high exertional fatigue (6.9% vs 4.7%). Compared to those with stage A, those with stage B had higher odds of having high general fatigue only (adjusted Odds Ratio (aOR) = 1.3 (95%CI = 1.0, 1.7)), high exertional fatigue only (aOR = 1.4 (1.1, 1.8)), and high general/high exertional fatigue (aOR = 1.6 (1.1, 2.2)) compared to being fatigue-free. Further adjustment for cardiometabolic risk factors attenuated these associations (Table). Conclusions: General and exertional fatigue are more prevalent in those with subclinical HF and these associations may be linked to cardiometabolic profiles. Prevention and management of risk factors may reduce the burden of fatigue in this population.

Prenatal detection rates for congenital heart disease using abnormal obstetrical screening ultrasound alone as indication for fetal echocardiography.

To determine the live born prenatal detection rate of significant congenital heart disease (CHD) in a large, integrated, multi-center community-based health system using a strategy of referral only of patients with significant cardiac abnormalities on obstetrical screening ultrasound for fetal echocardiography. Detection rates were assessed for screening in both radiology and maternal fetal medicine (MFM). The impact on fetal echocardiography utilization was also assessed. This was a retrospective cohort study using an electronic health record, outside claims databases and chart review to determine all live births between 2016 and 2020 with postnatally confirmed sCHD that were prenatally detectable and resulted in cardiac surgery, intervention, or death within 1year. There were 214,486 pregnancies resulting in live births. Prenatally detectable significant CHD was confirmed in 294 infants. Of those 183 were detected for an overall live-born detection rate of 62%. Detection rates in MFM were 75% and in radiology were 52%. The number of fetal echocardiograms needed to detect (NND) sCHD was 7. A focus on quality and standardization of obstetrical screening ultrasound with referral to fetal echocardiography for cardiac abnormalities alone achieves benchmark targets for live-born detection of significant CHD requiring fewer fetal echocardiograms.

Echocardiographic abnormalities and joint hypermobility in Chinese patients with Osteogenesis imperfecta

BackgroundVery little is known about the characteristics of echocardiographic abnormalities and joint hypermobility in Chinese patients with osteogenesis imperfecta (OI). The aim of our study was to investigate the characteristics, prevalence and correlation of echocardiographic abnormalities and joint hypermobility in Chinese patients with OI.MethodsA cross-sectional comparative study was conducted in pediatric and adult OI patients who were matched in age and sex with healthy controls. Transthoracic echocardiography was performed in all patients and controls, and parameters were indexed for body surface area (BSA). The Beighton score was used to evaluate the degree of joint hypermobility.ResultsA total of 48 patients with OI (25 juveniles and 23 adults) and 129 age- and sex-matched healthy controls (79 juveniles and 50 adults) were studied. Four genes (COL1A1, COL1A2, IFITM5, and WNT1) and 39 different mutation loci were identified in our study. Mild valvular regurgitation was the most common cardiac abnormality: mild mitral and tricuspid regurgitation was found in 12% and 36% of pediatric OI patients, respectively; among 23 OI adults, 13% and 17% of patients had mild mitral and tricuspid regurgitation, respectively, and 4% had mild aortic regurgitation. In multiple regression analysis, OI was the key predictor of left atrium diameter (LAD) (β=-3.670, P < 0.001) and fractional shortening (FS) (β = 3.005, P = 0.037) in juveniles, whereas for adults, OI was a significant predictor of LAD (β=-3.621, P < 0.001) and left ventricular mass (LVM) (β = 58.928, P < 0.001). The percentages of generalized joint hypermobility in OI juveniles and adults were 56% and 20%, respectively. Additionally, only in the OI juvenile group did the results of the Mann‒Whitney U test show that the degree of joint hypermobility was significantly different between the echocardiographic normal and abnormal groups (P = 0.004).ConclusionsMild valvular regurgitation was the most common cardiac abnormality in both OI juveniles and adults. Compared with OI adults, OI juveniles had more prevalent and wider joint hypermobility. Echocardiographic abnormalities may imply that the impairment of type I collagen is more serious in OI. Baseline echocardiography should be performed in OI patients as early as possible.

A comprehensive study of pre-eclampsia in IVF and natural conceptions: clinical phenotypes, perinatal outcomes and neonatal echocardiography

Research question: What differences exist in the preeclampsia phenotypes, perinatal outcomes, and neonatal echocardiography between pregnancies conceived naturally and through in vitro fertilization? DesignFrom January 2002 to December 2022, a total of 610 women diagnosed with preeclampsia were included. This research was conducted within the IVF and Maternal-Fetal Medicine Department of Kaohsiung Chang Gung Memorial Hospital. Participants were divided into two groups, one achieved pregnancy through IVF and another, spontaneously. This study reviewed preeclampsia phenotypes, perinatal outcomes, and screening of newborn echocardiography. Results: After conducting propensity score matching, the natural conception group had a higher prevalence of early-onset preeclampsia (53.9% vs. 37.7%, p = 0.04) and exhibited more severe features (89.1% vs. 69.8%, p = 0.01), when compared to the IVF group. Regarding perinatal outcomes, neonates in the IVF group had higher placental weights than those in the natural conception group (580 vs. 480 g, p = 0.031). There were no differences in the prevalence of abnormal newborn echocardiography. Multivariate analysis showed that greater gestational age at delivery reduced the likelihood of abnormal cardiac echo (RR 0.950, p=0.001), while pregestational diabetes increased it (RR 1.451, p=0.044). Septal defects were the most common, occurring in 15.5% of infants. Conclusion: Our study revealed that the impact of IVF conception on the preeclampsia severity is not as expected. Through neonatal echocardiography, a higher occurrence of abnormalities was observed compared to the general population. Furthermore, these issues were not linked to conception method, suggesting undisclosed factors that could influence the clinical features and perinatal outcomes of preeclampsia.

Higher sclerostin is associated with pulmonary hypertension in pre-dialysis end-stage kidney disease patients: a cross-sectional prospective observational cohort study

BackgroundPulmonary hypertension (PH) is a complication of chronic kidney disease (CKD) that contributes to mortality. Sclerostin, a SOST gene product that reduces osteoblastic bone formation by inhibiting Wnt/β-catenin signaling, is involved in arterial stiffness and CKD-bone mineral disease, but scanty evidence to PH. This study explored the relationship between sclerostin and PH in CKD 5, pre-dialysis end-stage kidney disease (ESKD) patients.MethodsThis cross-sectional prospective observational cohort study included 44 pre-dialysis ESKD patients between May 2011 and May 2015. Circulating sclerostin levels were measured using an enzyme-linked immunosorbent assay. PH was defined as an estimated pulmonary artery systolic pressure > 35 mmHg on echocardiography.ResultsPatients with higher sclerostin levels ≥ 218.18pmol/L had echocardiographic structural cardiac abnormalities, especially PH (P < 0.01). On multivariate logistic analysis, sclerostin over 218.19pmol/L was significantly associated with PH (odds ratio [OR], 41.14; 95% confidence interval [CI], 4.53-373.89, P < 0.01), but multivariate Cox regression analysis showed the systemic vascular calcification score over 1 point (Hazard ratio [HR] 11.49 95% CI 2.48–53.14, P = 0.002) and PH ([HR] 5.47, 95% CI 1.30-23.06, P = 0.02) were risk factors for all-cause mortality in pre-dialysis ESKD patients.ConclusionsSerum sclerostin and PH have a positive correlation in predialysis ESKD patients. The higher systemic vascular calcification score and PH have an association to increase all-cause mortality in pre-dialysis ESKD patients.