Ejection Fraction In Group Research Articles

RE-EVALUATION OF TWO-DIMENSIONAL STRAIN IN THE PATIENTS WITH TYPE 2 DIABETES MELLITUS

ObjectivesBased on the ventricular-arterial coupling, the longitudinal strain (LS) of myocardium in the patients with type 2 diabetes mellitus (DM) were discussed in detail.MethodsEighty patients with DM were divided into...

Outcomes in cardiac surgery in 500 consecutive Jehovah's Witness patients: 21 year Experience

BackgroundRefusal of heterogenic blood products can be for religious reasons as in Jehovah's Witnesses or otherwise or as requested by an increasing number of patients. Furthermore blood reserves are under continuous demand with increasing costs. Therefore, transfusion avoidance strategies are desirable. We describe a historic comparison and current results of blood saving protocols in Jehovah's Witnesses patients.MethodsData on 250 Jehovah's Witness patients operated upon between 1991 and 2003 (group A) were reviewed and compared with a second population of 250 patients treated from 2003 to 2012 (group B).ResultsIn group A, mean age was 51 years of age compared to 68 years in group B. An iterative procedure was performed in 13% of patients in group B. Thirty days mortality was 3% in group A and 1% in group B despite greater operative risk factors, with more redo, and lower ejection fraction in group B. Several factors contributed to the low morbidity-mortality in group B, namely: preoperative erythropoietin to attain a minimal hemoglobin value of 14 g/dl, warm blood cardioplegia, the implementation of the Cornell University protocol and fast track extubation.ConclusionsCardiac surgery without transfusion in high-risk patients such as Jehovah Witnesses can be carried out with results equivalent to those of low risk patients. Recent advances in surgical techniques and blood conservation protocols are main contributing factors.

Study on ventricular-arterial coupling in patients with type 2 diabetes mellitus by ultrasound

Objective To study the ventricular-arterial coupling in the patients with type 2 diabetes mellitus (DM) by ultrasound.Methods Eighty patients with DM were divided into 2 groups:normal left ventricular ejection fraction (EF) group (DMN,EF≥50 ％,n =40) and abnormal EF group (DMA,EF＜50％,n =40).At the same time,42 healthy volunteers were selected as a control group.The left ventricular (LV) relative wall thickness (RWT),mass index (LVMI),stroke volume (SV),stroke works (SW),ratepressure product (RPP),systemic vascular resistance index (SVRI),LV end-systolic elastance (Ees),arterial elastance index (Ea) and ventricular vascular index (VVI) were measured and calculated.Longitudinal strain (LS) of myocardial segment including base(LSBA),papillary muscle (LSPM) and apex (LSAP) were analyzed by two-dimensional speckle tracking imaging.Results (1) Compared with the control,the RWT and LVMI were all increased (P ＜0.01),but the LSBA,LSPM and LSAP were decreased (P ＜ 0.01) in the DMN and DMA groups (P ＜0.01).In DMA group,the RWT,LSBA,LSPM and LSAP were decreased (P ＜0.01).Compared with the DMN group,the LSBA,LSPM and LSAP were decreased in DMN group (P ＜0.01).(2) Compared with the control,the Ea,VVI,RPP and SVRI were increased,but the Ees was decreased (P ＜0.05)in DMA group (P ＜0.01).In the DMN,RPP was increased compared with the control group (P ＜0.01).Compared with the DMN group,the Ea,VVI,RPP and SVRI were increased,but Ees was decreased in the DMA (P ＜0.05).(3)The LSBA,LSPM and LSAP were all positively correlated with VVI(P ＜0.01).Multiple regression analysis showed that the LSAP,RWT,LVMI and SW were independent predictor of VVI (b' =-0.613,-0.290,0.290 and-0.205,P ＜ 0.05).Conclusions The ventricular-arterial coupling is normal in the DMN group,but is abnormal in DNA group.LSAP is independent predictors for ventricular-arterial coupling. Key words: Echocardiography; Diabetes mellitus,type 2; Ventricular function,left; Ventriculararterial coupling

Abstract 330: Relationship Between On-Treatment Decreases in Inappropriate Versus Absolute or Indexed Left Ventricular Mass and Increases in Ejection Fraction in Hypertension

Although in cross-sectional studies left ventricular mass (LVM) which exceeds that predicted by work load (inappropriate LVM [LVM inappr ]), but not absolute LVM or LVM index, is inversely related to LV ejection fraction (EF), whether LVM inappr (%observed/predicted LVM) accounts for decreases in EF is unclear. In 168 mild-to-moderate hypertensives treated for 4 months, using echocardiography, we assessed whether on-treatment decreases in absolute LVM, LVM index (LVMI) or LVM inappr are associated with on-treatment changes in EF. Although in patients with an LVMI>51g/m 2.7 (n=112)(change in LVMI=-13.7±1.2g/m 2.7 , p<0.0001), but not in patients with an LVMI≤51g/m 2.7 (n=56)(change in LVMI=1.3±1.7g/m 2.7 ) LVMI decreased with treatment; treatment failed to increase EF in either group (1.2±1.0% and 2.7±1.4% respectively). In contrast, in patients with inappropriate LV hypertrophy (LVH) (LVM inappr >150%, n=33) LVM inappr decreased (-32±4%, p<0.0001) and EF increased (5.0±1.8%, p<0.0001) after treatment, whilst in patients with a LVM inappr ≤150% (n=135), neither LVM inappr (-0.5±2%), nor EF (0.9±0.9%) changed with therapy. With adjustments for LV wall stress and other confounders, whilst on-treatment decreases in LVM or LVMI were weakly related to an attenuated EF (partial r=0.17, p<0.05), on-treatment decreases in LVM inappr were strongly related to increases in EF (partial r=-0.38, p<0.0001)(p<0.0001, comparison of partial r values) even after further adjustments for LVM or LVMI. In conclusion, decreases in LVM inappr but not LVM or LVMI are strongly related to on-treatment increases in EF. LVH can therefore be viewed as a compensatory change that preserves EF, but when in excess of that predicted by stroke work, as a pathophysiological process accounting for a reduced EF.

Relationship Between On-Treatment Decreases in Inappropriate Versus Absolute or Indexed Left Ventricular Mass and Increases in Ejection Fraction in Hypertension

Although in cross-sectional studies left ventricular mass (LVM), which exceeds that predicted by workload (inappropriate LVM [LVM(inappr)]) but not absolute LVM or LVM index (LVMI), is inversely related to LV ejection fraction (EF), whether on-treatment decreases in LVM(inappr) (%observed/predicted LVM) account for increases in EF beyond LVM or LVMI is unclear. Echocardiography was performed in 168 mild-to-moderate hypertensives treated for 4 months. Although in patients with an LVMI >51 g/m(2.7) (n=112; change in LVMI, -13.7±14.0 g/m(2.7); P<0.0001) but not in patients with an LVMI ≤51 g/m(2.7) (n=56; change in LVMI, 1.3±9.3 g/m(2.7)) LVMI decreased with treatment, treatment failed to increase EF in either group (1.2±10.8% and 2.7±10.7%, respectively). In contrast, in patients with inappropriate LV hypertrophy (LVM(inappr) >150%; n=33) LVM(inappr) decreased (-32±27%; P<0.0001) and EF increased (5.0±10.3%; P<0.05) after treatment, whereas in patients with an LVM(inappr) ≤150% (n=135), neither LVM(inappr) (-0.5±23%) nor EF (0.9±10.3%) changed with therapy. With adjustments for circumferential LV wall stress and other confounders, whereas on-treatment decreases in LVM or LVMI were weakly related to an attenuated EF (partial r=0.17; P<0.05), on-treatment decreases in LVM(inappr) were strongly related to increases in EF even after further adjustments for LVM or LVMI (partial r=-0.63 [CI, -0.71 to -0.52]; P<0.0001). In conclusion, decreases in LVM(inappr) are strongly related to on-treatment increases in EF beyond changes in LVM and LVMI. LV hypertrophy can, therefore, be viewed as a compensatory change that preserves EF, but when in excess of that predicted by stroke work, it can be viewed as a pathophysiological process accounting for a reduced EF.

Trends in Patients Hospitalized With Heart Failure and Preserved Left Ventricular Ejection Fraction

Background— Heart failure with preserved ejection fraction (EF) is a common syndrome, but trends in treatments and outcomes are lacking. Methods and Results— We analyzed data from 275 hospitals in Get With the Guidelines–Heart Failure from January 2005 to October 2010. Patients were stratified by EF as reduced EF (EF &lt;40% [HF–reduced EF]), borderline EF (40%≤EF&lt;50% [HF–borderline EF]), or preserved (EF ≥50% [HF–preserved EF]). Using multivariable models, we examined trends in therapies and outcomes. Among 110 621 patients, 50% (55 083) had HF–reduced EF, 14% (15 184) had HF–borderline EF, and 36% (40 354) had HF–preserved EF. From 2005 to 2010, the proportion of hospitalizations for HF–preserved EF increased from 33% to 39% ( P &lt;0.0001). In multivariable analyses, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at discharge decreased in all EF groups, and β-blocker use increased. Patients with HF–preserved EF less frequently achieved blood pressure control (adjusted odds ratio, 0.44 versus HF–reduced EF; P &lt;0.001) and were more likely discharged to skilled nursing (adjusted odds ratio, 1.16 versus HF–reduced EF; P &lt;0.001). In-hospital mortality for HF–preserved EF decreased from 3.32% in 2005 to 2.35% in 2010 (adjusted odds ratio, 0.89 per year; P =0.01) but was stable for patients with HF–reduced EF (3.03%–2.83%; adjusted odds ratio, 0.93 per year; P =0.10). Conclusions— Hospitalization for HF–preserved EF is increasing relative to HF–reduced EF. Although in-hospital mortality for patients with HF–preserved EF declined over the study period, an important opportunity remains for identifying evidence-based therapies in patients with HF–preserved EF.

057 A randomised controlled trial of catheter ablation vs medical treatment of atrial fibrillation in heart failure (the CAMTAF trial)

IntroductionAlthough atrial fibrillation (AF) has deleterious effects in patients with heart failure (HF), rhythm control using medication has limited efficacy. Catheter ablation (CA) of AF is effective in restoring sinus...

Natural course of sleep-disordered breathing after acute myocardial infarction

The aim of this study was to test whether an improvement of left ventricular ejection fraction (EF) in the early phase after acute myocardial infarction is associated with a reduction of the severity of central and obstructive sleep apnoea. 40 consecutive patients with acute myocardial infarction underwent polysomnography and cardiovascular magnetic resonance imaging within 5 days and 12 weeks after the event to assess sleep apnoea and cardiac function. We stratified the sample in patients who improved their left ventricular EF within 12 weeks by ≥ 5% (improved EF group, ΔEF 9 ± 1%, n=16) and in those who did not (unchanged EF group, ΔEF -1 ± 1%, n=24). Prevalence of sleep apnoea (≥ 15 apnoea and hypopnoea events·h(-1)) within ≤ 5 days after myocardial infarction was 55%. Apnoea and hypopnoea events·h(-1) were significantly more reduced in the improved EF group compared with the unchanged EF group (-10 ± 3 versus 1 ± 3 events·h(-1); p=0.036). This reduction was based on a significant alleviation of obstructive events (-7 ± 2 versus 4 ± 3 events·h(-1); p=0.009), while the reduction of central events was similar between groups (p=0.906). An improvement of cardiac function early after myocardial infarction is associated with an alleviation of sleep apnoea. This finding suggests that re-evaluation of treatment indication for sleep apnoea is needed when a change in cardiac function occurs.

Assessment of left ventricular systolic function in fetuses without myocardial hypertrophy of gestational diabetes mellitus mothers using velocity vector imaging

The aim of this study was to quantifiably assess left ventricular systolic function by velocity vector imaging (VVI) in fetuses without myocardial hypertrophy born to gestational diabetes mellitus (GDM) mothers. Ventricular images (4-chamber) from 60 normal fetuses and 32 GDM fetuses were selected. Myocardial global and segmental peak strain and systolic strain rates were obtained from VVI offline software. Ejection fraction (EF) was also measured to assess fetal cardiac function. EF of normal fetuses and GDM group were 65.55 ± 4.64% and 65.72 ± 4.92%. No difference was found in EF between the control group and GDM group. Global strain and strain rate of GDM groups were –13.74 ± 3.19% and –1.41 ± 0.54 s−1, respectively and were found to be lower than the normal group (p < 0.05). Six different segmental peak strains and peak systolic strain rates had identical adjacent segments not only in the control group, but also in GDM fetuses. It was concluded that VVI could reflect fetal cardiac function sensitivity. Global strain and strain rate may be useful parameters for assessing the fetal myocardial systolic function in diabetic mothers.

Cardiovascular changes in patients with adult-onset growth hormone deficiency assessed by CMR

Summary The study investigated cardiovascular changes in adultonset growth hormone deficiency (GHD) and showed that patients with adult-onset GHD have a left ventricular mass index (LVMi) at or below the lower limit of normal, which improves with one year of growth hormone replacement. Background GHD causes cardiovascular problems, with loss of cardiac response to exercise and increased cardiac mortality, however the underlying processes are poorly understood. Methods Ten patients with adult-onset GHD and age- and sexmatched controls (n=10) underwent CMR. Patients underwent scans before disease treatment and at twelve months after treatment. Cardiac parameters were calculated and indexed to body surface area (BSA). The comparison between groups was done using Mann-UWhitney test and within the group using Wilcoxon test. The data are presented as median values. Results Patients with GHD did not have significantly different left ventricle (LV) mass or volumetric parameters from controls: LV mass index (LVMi) 55.0 vs. 56.6 g/m 2 , p=0.315; end diastolic volume index (EDVi) 69.2 vs. 76.3 ml/m 2 , p=0.1655; end systolic volume index (ESVi) 24.8 vs. 28.3 ml/m 2 , p=0.3527 and ejection fraction (EF) 64 vs. 63 %, p=0.8197. However, patients had an LVMi beneath the lower limit of normal when compared to published normal ranges (55.4 - 74.0 g/m 2 ). There were no differences between right ventricular (RV) EDVi (68.0 vs. 80.8 ml/m 2 , p=0.393), ESVi (26.2 vs. 27.5, p=0.7394) and EF (63 vs. 61 %, p=0.9696) in the GHD group and controls. Patients with GHD on GH treatment for 1 year showed an increase in median insulin-like growth factor I (IGF-I) SDS from -1.83 to +0.40 (p=0.0068). There was no correlation between LVMi and IGF-I SDS (r=0.164, p=0.657). At one year the median LVMi moved into the previously published normal range (55.0 to 63.0 g/m 2 , normal range 55.4 - 74.0) achieving statistical significance compared to pre-treatment values (p=0.0156). Conclusions Patients with adult-onset GHD have an LVMi at or below the lower limit of normal, which improves with one year of growth hormone replacement.

Serum Glutathione S-Transferase P1 1 in Prediction of Cardiac Function

BackgroundGlutathione S-transferase P1 1 (GSTP1) belongs to the multigene isozyme family involved in cellular response to oxidative stress and apoptosis. Our initial retrospective proteomic analysis suggested that GSTP1 is associated with heart failure (HF). Although pro–B-type natriuretic peptide (proBNP) serves currently as a surrogate diagnostic and prognostic parameter in HF patients, its specificity remains uncertain. We hypothesized that GSTP1 might be a useful serum marker in the monitoring of HF patients. Methods and ResultsSerum GSTP1 and proBNP were prospectively measured in 193 patients subdivided based on their ejection fraction (EF) either in equal-sized quintiles or predefined EF groups >52%, 43%–52%, 33%–42%, 23%–32% and ≤22%. At a cutoff of ≥231 ng/mL, GSTP1 identified HF patients with EF ≤22% with 81% sensitivity and 83% specificity, and at a cutoff of ≥655 pg/mL, proBNP identified the same patient group with 84% sensitivity and 22% specificity. GSTP1 at a ≥126 ng/mL cutoff identified EF ≤42% with 90% sensitivity and 95% specificity, or proBNP at a ≥396 pg/mL cutoff had 97% sensitivity and 20% specificity. In regression analyses, GSTP1, but not proBNP, discriminated between EF ≤42% and EF >42% in HF patients. ConclusionsThese results suggest that GSTP1 is strongly associated with HF and could serve as a sensitive and specific marker to predict the ventricular function in HF patients.

Cardiac surgery for carcinoid heart disease in 12 cases

Cardiac involvement is now a major source of morbidity and mortality in patients with carcinoid tumors. We reviewed patients with carcinoid heart disease who underwent valvular surgery in our center. Twelve patients with carcinoid heart diseases underwent cardiac surgery between 2000 and 2008. Patients were divided into two groups: group A (n = 6) comprised patients who survived more than 6 months after cardiac surgery, and group D (n = 6) comprised those who died within 6 months. Preoperative factors were compared between the groups. All the 12 patients with carcinoid heart disease underwent tricuspid valve surgery (3 had tricuspid repair and 9 had tricuspid replacement with a bioprosthetic valve). Postoperative 30-day mortality was 16.7% and 2-year actuarial survival was 50.0%. Median survival after the first diagnosis of carcinoid disease was 4.4 years that from first diagnosis of carcinoid heart disease was 2.7 years. Preoperative median left ventricular ejection fraction in group D (52.5%) was significantly lower than that in group A (67.2%, P < 0.05). There were no statistically significant differences between the groups in other parameters. Postoperative prognosis may be worse when preoperative left ventricular ejection fraction is borderline, even if it is within the normal limits. Cardiac evaluation is needed in all patients with carcinoid disease from the earliest time of medical and oncological therapy to improve patient outcome.

Impact of Pre-Existing Left Ventricular Dysfunction on Kidney Transplantation Outcomes: Implications for Patient Selection

Background End-stage kidney disease patients with decreased left ventricular ejection fraction (EF) are often denied kidney transplantation (KT) for fear of poor graft and patient survival. Methods We retrospectively studied all patients who underwent KT at our center between 2001 and 2005 to determine the impact of low EF on outcomes post KT. Low EF was defined as <50% EF by noninvasive cardiac imaging. Follow-up was for 1 year post KT. Outcomes assessed included hospitalization for congestive heart failure (CHF), cardiac events, and renal allograft and patient survival. Results Among 254 patients, 37 had low EF (study group) and 217 had normal EF (≥50%; control group). Post KT, the low EF group had a significantly higher rate of hospitalization for CHF. No significant difference was noted in the rate of cardiac events, graft loss, GFR, and all cause death at 12 months post KT. Conclusion Patients with low EF should not be excluded from transplantation, given favorable outcomes.

Abstract 8446: Human Fetal Cardiac Ejection Fraction in Normal and Diabetic Pregnancy Assessed by Matrix 3D/4D Echocardiography

Background: Diabetic pregnancy carries higher risk of fetal development abnormality compared to normal pregnancy. Therefore, fetal growth should be monitored during diabetic pregnancy. We used a 4D matrix method to evaluate whether maternal diabetes could affect fetal heart function. Methods: 24 women 18.0-33.1 weeks gestational age (mean 23.6 ± 4.5 weeks) were included: 12 insulin-dependent diabetic pregnant patients and 12 healthy pregnant women with the same gestational ages. A Philips iE33 ultrasound system with an X7-2 matrix array transducer was used. 4D volumes were acquired from the fetuses with an external heart rate simulator. 4D data was analyzed by QLab 6.2 software (Philips). End-systolic and end-diastolic volumes of left and right ventricles (LV, RV) and ejection fraction (EF) derived for each individual were calculated semi-automatically, and maternal blood HbA1C were recorded. Results: Blood HbA1C levels of the diabetic group were 6.99±1.10%, which was higher than the normal level (5.0%). LV EF of the fetuses with diabetic mothers ranged from 52.4% to 85.9% (mean 70.2 ± 11.2%), and 52.3% to 83.3% (mean 71.5 ± 10.5%) for the control group. No significant difference was shown between LV EFs (P = 0.4029). However, RV EF was 55.3% to 85.1% (mean 66.8 ± 9.9%) in the diabetic group, compared to 64.9% to 87.1%(mean 77.2 ± 7.3%) for the control group (P = 0.0108). Conclusions: LV EF of human fetuses of diabetic mothers was normal, but RV EF of the diabetic pregnancy group was lower.

Comparison of effects of early and late bone marrow mononuclear cells transplantation on left ventricular remodeling after acute myocardial infarction in swines

Objective To compare the effects on left ventricular remodeling of bone marrow mononuclear cells transplantation one week and three months after acute myocardial infarction.Methods Acute myocardial infarction models were successfully established in 15 swine,which were randomly divided into three groups:placebo group,early transplantation group and late trasplantation group.One week after model had been established,early transplantation group underwent bone marrow mononuclear cells transplantation,and then so did the late trasplantation group three months after acute myocardial infarction.B-ultrasound and single photon emission computed tomography (SPECT) examinations were performed to assess the left ventricular end diastolic dimension( LVd),left ventricular end diastolic volume(EDV) and left ventricular ejection fraction(EF) before and one week,three months,six months after acute myocardial infarction.Results The LVd of late transplantation group [ (54.20:t:3.70) mm] was lower than placebo group [ (63.20 ±5.63)mm],but higher than early transplantation group [ (47.40 ± 1.14)mm].The EDV of late transplantation group [ ( 163.00 ±6.96)ml] was lower than placebo group [ (209.40 ± 18.69)ml],but higher than early transplantation group [ ( 135.40 ± 4.93 ) ml ].The EF of late transplantation group (0.25 ±0.02) was higher than placebo group (0.19 ±0.02),but lower than early transplantation group (0.37 ±0.02).Conclusions Bone marrow mononuclear cells transplantation can alleviate progressing ventricular remodeling,even it is performed three month after acute myocardial infarction,but its therapeutic effects are inferior to early transplantation's. Key words: Bone marrow transplantation ; Monocytes/TR; Myocardial infarction/SU/PP; Ventricular remodeling

POSTER PRESENTATIONS

POSTER PRESENTATIONS

Relationship Between Acute Improvement in Left Ventricular Function to 6-Month Outcomes After Cardiac Resynchronization Therapy in Patients With Chronic Heart Failure

The long-term impact of cardiac resynchronization therapy (CRT)-induced acute improvement in left ventricular (LV) function is largely unknown. The goal of this study was to evaluate the significance of acute improvement in LV function resulting from CRT in patients with chronic heart failure (HF). The authors compared 6-month clinical composite score (CCS) and LV end-systolic (ESV) reduction (≥15% from baseline) response rates of CRT-treated patients enrolled in the Predictors of Response to CRT (PROSPECT) trial who showed an acute increase (≥15% from baseline) in LV ejection fraction (EF) vs those who did not show a similar change in EF. Of the 396 patients who had pre-implant and post-implant EF measurements, 78 (19.7%) had an increase in EF and 318 (80.3%) did not. Acute reduction of mitral regurgitation by at least one grade occurred in 26% and 23% of patients with and without an acute increase in EF, respectively. Patients with an acute increase in EF had significantly lower baseline EF and smaller LV volumes but otherwise similar characteristics. At 6 months, LVEF and LV volumes were significantly higher and lower in the increased EF group, respectively; however, CCS improvement (70.5% vs 69.5%) and LVESV reduction (57.1% vs 54.9%) response rates were comparable in the two groups. An acute ≥15% increase in LVEF with CRT does not predict 6-month effects of CRT on patient outcomes or LV reverse remodeling. That such findings occur in patients with smaller LV volumes, however, may provide additional insight into the mechanisms responsible for CRT-induced long-term improvement in LV function and clinical benefit.

115 Relation between global longitudinal strain in patients with aortic stenosis: relation with severity and symptoms

Patient with aortic stenosis (AS) and reduced ejection fraction (EF) should be promptly operated on. Global longitudinal strain (GLS) has been proposed as a subtle subclinical marker of left ventricular (LV) systolic dysfunction and a potential prognostic factor in asymptomatic patients with AS. However, the relation between GLS, AS severity and symptoms has not been fully evaluated. Eighty-six patients (74 ± 11 years, 35% female) with at least mild AS were prospectively enrolled. Clinical evaluation included the assessment of symptoms (angina, syncope, and dyspnea) and a physical examination. All patients had a comprehensive transthoracic echocardiography (TTE). GLS was measured offline using a dedicated station and software (EchoPac, General Electric) blinded of any clinical and TTE information. Forty-three patients (43%) were asymptomatic. AS range was wide with a mean aortic valve area (AVA) of 1.06 ± 0.42 cm 2 [0.33–2.3] and 55 patients (64%) had a severe AS (AVA<1 cm 2 ). Mean EF was 63 ± 6 and 8 patients (9%) and a reduced EF (<60%). We divided our population into 4 subgroups, asymptomatic non-severe AS (group 1), asymptomatic severe AS and normal EF (group 2), symptomatic severe AS and normal EF (group 3) and symptomatic severe AS and reduced EF (group 4). Overall GLS decreased from group 1 to 4 (p < 0.0001) (Table) and a correlation between AS severity and GLS was observed (r = −0.40, p = 0.0002). However, GLS was not significantly different between patients with symptomatic and asymptomatic severe AS (group 2 and 3, p = 0.32). In the present study we show that GLS was significantly correlated to AS severity and reduced in patients impaired EF. However, GLS was not different between patients with symptomatic and asymptomatic severe AS. These preliminary data deserve further confirmation but raise caution regarding the potential prognostic value of GLS in patients with asymptomatic AS. Group 1 (n = 31) Group 2 (n = 12) Group 3 (n = 35) Group 4 (n = 8) P between groups GLS −19,1 ± 2.9 −18,7 ± 4.6 −17.5 ± 3.2 −12.5 ± 4.0 <0.0001

Implantable Sensors for Heart Failure

Heart failure (HF) affects more than 5 million Americans, and acute decompensated heart failure (ADHF) has emerged as the leading cause of hospitalization among people over the age of 65 years.1 Importantly, HF is a leading public health concern, and hospitalization expenses related to management of ADHF impose a substantial financial burden on the health care system. Additionally, readmission rates after hospitalization for ADHF may be as high as 50% at 6 months,2 and insights from the ADHERE registry suggest that a majority of patients admitted with ADHF have a history of heart failure.1 These data demonstrate that the majority of patients admitted with ADHF are known to the medical system and to medical providers, thereby creating an opportunity for upstream strategies that may be capable of detecting early HF destabilization and implementing therapies to restabilize the patient and avert hospitalization. The anticipated changes in the health care system—with a focus on bundled payments for disease management—will necessitate robust disease management programs to optimize therapy and minimize recurrent admissions once patients have been diagnosed with HF. Perhaps even more importantly, averting repeat episodes of ADHF is likely to have a stabilizing effect on the progression of HF and may improve long-term morbidity and mortality. The transition from chronic HF to ADHF involves perturbations in multiple intersecting processes including neurohormonal circuits, inflammatory mediators, cardiorenal interactions, and myocardial performance. Concurrently, derangements in comorbid illnesses such as coronary disease, atrial and ventricular arrhythmias, and hypertension also contribute to the pathophysiology of ADHF.3 Ultimately, these multiple pathways lead to an elevation in ventricular filling pressures and signs of vascular congestion, which, in concert with symptoms from impaired cardiac output, lead to the clinical constellation of ADHF. This pathophysiologic paradigm highlights multiple opportunities for detecting early changes in the processes that …

Cardiac Iron Overload and Heart Function by CMR In Different Phenotypic Groups of Thalassemia Major Patients

AbstractAbstract 4264 Introduction.β-thalassemia major is a genetic disorder characterized by the absence (β°) or reduced output (β+) of the β chains of haemoglobin. This disorder displays a great deal of phenotypic heterogeneity, not fully investigated in terms of cause-effect (Refaldi C et al, Blood Transf 2005; Thein SL, Haematologica 2005). The aim of our study was to detect if different phenotypes could be related to different levels of cardiac impairments, evaluated by cardiovascular magnetic resonance (CMR). Methods.We performed a retrospective review of the CMR results and of clinical data about 328 TM patients (age 29 ± 9 years, 52% females) enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) project (Meloni A et al, Int J Med Inform). In the MIOT network all CMR and thalassemia centers are linked by a web-based network, configured to collect patients' anamnestic, clinical, and diagnostic data. Myocardial iron overload was assessed by using a multislice multiecho T2* approach (Pepe A et al, Eur J Haem 2006). Three short axis views (basal, medium, and apical) of the left ventricle (LV) were acquired and analyzed using a custom-written, previous validated software (HIPPO MIOT®). The myocardium was automatically segmented into a 16-segments standardized LV model and the T2* value on each segment was calculated as well as the global T2* value. Cine sequences were obtained to quantify biventricular morphological and functional parameters. Results.Three groups of patients were identified: heterozygous (N=172), homozygous β+ (N=58), homozygous β° (N=98). No significant differences for sex and age were found among the groups. The homozygous β+ group showed higher global heart T2* values than the heterozygous and homozygous β° group (32 ± 11 ms vs 26 ± 13 ms vs 23 ± 13 ms, P=0.001) (see figure). The homozygous β+ group showed lower left LV mass index than the heterozygous group (54 ± 10 g/m2 vs 60 ± 14 g/m2, P=0.045). The homozygous β+ group showed higher LV ejection fraction (EF) values than the heterozygous group (64 ± 5 % vs 60 ± 7 %, P<0.0001) and higher right ventricular EF values than the heterozygous and homozygous β° group (64 ± 5 % vs 59 ± 8 % vs 60 ± 7 %, P<0.0001). Conclusions.The homozygous β+ TM patients showed less myocardial iron overload and a concordant better global systolic heart function and cardiac remodelling. These data support the knowledge of the different phenotypes in the clinical and instrumental management of the TM patients suggesting stricter monitoring by CMR in homozygous β° TM patients. [Display omitted] Disclosures:No relevant conflicts of interest to declare.