Ejection Fraction In Group Research Articles

Relationships between 18-month kinetics and functional capacity and left ventricular remodeling and cardiac fibrosis in dilated cardiomyopathy

Abstract Introduction Myocardial fibrosis is a primary pathogenetic process in dilated cardiomyopathy (DCM) that is responsible for progressive cardiac remodeling and functional capacity impairment. We sought to verify whether there were differences between 18-month kinetics of functional capacity and left ventricular remodeling in DCM patients with different types and advancement of fibrosis who were up-titrated with guideline directed pharmacotherapy (GDMT). Methods Between May 2019 and September 2020, 99 DCM patients (88 male, mean age 45.2 ± 11.8 years, mean EF 29.7 ± 10%) underwent cardiac magnetic resonance with assessment of replacement fibrosis via late gadolinium enhancement (LGE) and interstitial fibrosis via extracellular volume (ECV). Each patient had serial (baseline, 6-, 12-, 18 month) functional assessment: NYHA class and 6- minute walking test (6-MWT) and follow-up echocardiography, including measurement of left ventricular end-diastolic volume (LVEDvol) and ejection fraction (EF). Patients were divided into LGE-negative and LGE-positive groups, whereas based on median ECV – they were divided into those with ECV below and above median values. Results Overall, LGE was identified in 44 (44%) of patients, whereas median ECV was 27.7%. NYHA class was significantly worse in patients with LGE (1.5±0.5 vs. 1.9±0.6) and with higher ECV (1.93±0.6 vs. 1.6±0.5) in comparison to those without LGE and lower ECV. However, NYHA class improved during observational period in all groups. There were no differences in 6-MWT distance in LGE positive and negative groups at all time points. Baseline 6-MWT distance in LGE positive group was 494.2±88.2 vs. 453.9±98.8 meters in LGE negative group. Baseline 6-MWT distance in upper median ECV group was (408.8±103.5 vs. 492.4±92.9 meter) was significantly lower ECV group (p=0.03). During 18 months 6-MWT distance increased only in LGE negative group but in both ECV groups (Figure 1 A-D). There were no differences in EF between patients with and without LGE and also with higher and lower ECV. Baseline EF in LGE positive group was 27.4±11.2% and 31.7±10.6% in LGE negative. Baseline indexed LVEDvol in LGE positive group was 107.7±40.7 vs. 91.8±37.8 ml/m2 (p=0.09) in LGE negative group. EF increased significantly in both groups, whereas indexed LVEDvol decreased only in LGE negative group (Figure 2 A-D). Conclusions Regardless of the presence of replacement and to some extent of interstitial fibrosis, functional and cardiac morphological improvement was observed during 18 months observation in DCM patients on GDMT. The greatest improvement occurred during the first 3 (occasionally 6) months which was associated with the greatest escalation of GDMT. Further dose escalation was not associated with a significant improvement in both functional and morphological parameters.

Prevalence and associations of asymptomatic left ventricular systolic dysfunction in Lebanese patients with type 2 diabetes mellitus.

Diabetes Mellitus is a prevalent disease with a growing impact on individuals worldwide. Evaluating the prevalence of subclinical left ventricular dysfunction and understanding its associations with microvascular complications, uncontrolled glycemia, diabetes duration, and patient age is crucial. Our aim is to determine the utility of screening for this condition. We conducted a retrospective cohort study involving 159 asymptomatic individuals with type 2 diabetes. Bivariate analysis was employed to assess potential factors and their associations with subclinical left ventricular dysfunction. Patients with a history of cardiac disease or interventions were excluded. The average age of our sample was 61.5 years. Almost half of the patients exhibited an HbA1c exceeding 7% (50.3%), and approximately half had an ejection fraction (EF) of less than 55% (50.9%). In the bivariate analysis, a notable difference in microvascular diabetic complications was observed among different EF groups. Specifically, nephropathy (62%), neuropathy (57.5%), and retinopathy (74.4%) were significantly more prevalent among patients with an EF < 55%. We also identified a significant age difference between groups, with a higher mean diabetes duration (14.1 ± 7.7 years) in the lower EF group. Notably, 63.7% of patients with an HbA1c exceeding 7% exhibited an EF < 55%. Older patients were associated with a lower EF, with an adjusted odds ratio (aOR) of 0.94. An HbA1c of 7% or less was linked to a higher likelihood of an EF > 55%. We established a correlation between subclinical left ventricular systolic dysfunction and microvascular complications. However, further extensive prospective research is necessary to deepen our understanding of these associations and their clinical implications.

Effect of Coronary Collateral Supply on Left Ventricular Global Longitudinal Strain after Recanalization of Chronic Total Occlusion.

Percutaneous coronary intervention (PCI) to chronic total occlusion (CTO) is still a subject of debate. The primary goal of revascularization is to provide symptomatic relief and enhance left ventricular (LV) functions. Global longitudinal strain (GLS) is proven to be more sensitive than the ejection fraction (EF), especially for subtle ischemic changes. The purpose of this study was to investigate the improvement in LV GLS after revascularization of symptomatic stable coronary patients with single-vessel CTO, categorized according to their collateral supply grades. Sixty-nine patients with successful CTO-PCI were grouped, according to their collateral supply grades, as well-developed (WD) and poor collateral groups and followed-up for 3 months. Basal characteristics were similar for both groups, except for a lower EF (p = 0.04) and impaired GLS (p < 0.0001) in the poor collateral group. At the end of 3 months follow-up, symptomatic relief was similar in both groups (p = 0.101). GLS improvement reached statistical significance only for the poor collateral, not for the WD group (p < 0.0001 and p = 0.054, respectively). The EF did not change significantly in both groups. Poorly collateralized CTO lesions may not only result in baseline LV dysfunction, but also appear to carry potential for recovery after revascularization. This may not be the case for WD collaterals.

Long-Term Risk of Cardiovascular Death in Patients With Mildly Reduced Ejection Fraction After Acute Myocardial Infarction: A Multicenter, Prospective Registry Study.

The prognostic implication of mildly reduced ejection fraction (mrEF) after acute myocardial infarction has not been clearly demonstrated. We investigated the long-term risk of cardiovascular death and its predictors in patients with mrEF following acute myocardial infarction. A total of 18 668 patients who presented with acute myocardial infarction were included in 2 prospective, multicenter registries. The incidence of adverse cardiovascular events according to the left ventricular ejection fraction (EF) strata at index admission were evaluated. A score system consisting of clinical variables were developed to predict long-term cardiovascular death in the mrEF group. There were 2548 patients with reduced EF (EF ≤40%), 4266 patients with mrEF (EF 41%-49%), and 11 854 patients with preserved EF (EF ≥50%). During a median follow-up period of 37.9 months, the cardiovascular death rate was 22.3% in the reduced EF group, 10.3% in the mrEF group, and 7.3% in the preserved EF group (P<0.001). In the mrEF group, age>65 years, hypertension, stroke, severe renal insufficiency, and Killip class ≥3 were independent predictors for cardiovascular death. Presence of >2 predictors best discriminated the high-risk patients for cardiovascular death with an area under the curve of 0.746. Incidence of cardiovascular death in the high-risk mrEF group was comparable with the rEF group, while it was lower in the low-risk mrEF group than in the pEF group. Patients with mrEF after acute myocardial infarction had a modest risk of cardiovascular death. Clinical predictors could help discriminate a high-risk subpopulation with cardiovascular death risks comparable with those in the reduced EF group.

Association of QRS Duration with Echocardiographic Left Ventricular Dimensions

Background: QRS duration (QRSd) is used to diagnose left bundle branch block (LBBB) and is important for determining cardiac resynchronization therapy eligibility. Others have reported associations of left bundle branch block (LBBB) and interventricular conduction delay with left ventricular (LV) systolic and diastolic dysfunction in patients without clinical HF. Individualized QRSd thresholds may improve diagnosis and intervention strategies. The goal of this study was to assess the relations of QRS duration to echocardiographic left ventricular (LV) dimensions in individuals. Methods: This was a hospital-based cross-sectional analytical study. A total of 134 purposively selected respondents were included in the study from the patients attending the outpatient or inpatient department of cardiology, Dhaka Medical College Hospital, advised for an echocardiogram. They were divided into two groups depending on their QRS complex duration (Group I≤100 ms and Group II&gt;100 ms). After taking informed written consent, a case record form was filled and Echo measurements were taken following standard procedure with confidentiality. Results: Among the respondents, the mean age was found 52.68 ± 14.24 years. The majority were male (68%), and around 1/3rd of the respondents were overweight or obese. Males were found to have less QRS duration than females (p&lt;0.001) but there was no difference in age (p=0.814) between the groups. All the risk factors considering obesity, diabetes mellitus, hypertension, family history, smoking status, and dyslipidemia were found in similar proportions in both groups (p&gt;0.05). The study found that the interventricular septum thickness and inferolateral wall thickness were higher among those having a QRS duration of more than 100 ms (Group II), but this difference was not significant (p &gt; 0.05). On the other hand, left ventricular diastolic dimension, systolic dimension, and left ventricular mass were found to be increased significantly (p&lt;0.05) with a reduction in ejection fraction in Group II (p&lt;0.05). Conclusion: Left ventricular diastolic and systolic dimensions along with left ventricular mass significantly increase according to QRS duration among the patients. Meanwhile, a reduction in ejection fraction was also evident. (Bangladesh Heart Journal 2024; 39(2): 144-150

A new animal model of cardiorenal syndrome could be established by inducing heart failure through coronary artery ligation in spontaneously hypertensive rats

In rats with unilateral nephrectomy and cardiac dysfunction, renal function deteriorates at an accelerated rate, as evidenced by increased proteinuria. Whether myocardial infarct-induced heart failure (HF) exacerbates renal injury in hypertensive rats with mild renal injury has not been reported. Rats underwent either coronary ligation or sham surgery. Thirty spontaneously hypertensive rats (SHRs) aged 8 weeks were randomly divided into two groups. Group 1 was the sham group, in which the rats underwent thoracotomy without ligation of the coronary artery. Group 2 underwent coronary artery ligation. The rats in group 2 underwent coronary artery ligation on week 0. The experiment lasted 12 weeks. Urine was collected in metabolic cages over a 24-h period. Urine was collected from the rats 2 days before the end of the experiment, and the ratio of urinary protein to urinary creatinine was measured in the clinical laboratory. All rats were examined by echocardiogram one day before the end of the experiment. On the last day of the experiment, blood was collected and sent to the laboratory for analysis. Hematoxylin–eosin (HE) and periodic acid-Schiff (PAS) staining were performed on heart and kidney sections. The ejection fraction in group 2 was lower than that in group 1 (P < 0.001). The urinary albumin to creatinine ratio in group 2 was greater than that in group 1 (P < 0.001). The urea and creatinine levels in group 1 were significantly lower than those in group 2 (P < 0.01). The levels of brain natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C were greater in the second group than in the first group (P < 0.05). The interleukin-1β (IL-1β) and interleukin-6 (IL-6) levels in group 2 were significantly greater than those in group 1 (P < 0.001). The malondialdehyde (MDA) levels in Group 2 were greater than those in Group 1 (P < 0.01). The glutathione peroxidase (GSH-Px) levels in Group 2 were lower than those in Group 1 (P < 0.05). The level of angiotensin II (AT-II) in group 1 was lower than that in group 2 (P < 0.001). Cardiac dysfunction secondary to myocardial infarction could induce cardiorenal interactions in SHRs. It could be interpreted by the activation of oxidative stress, changes in inflammation and alteration of renin–angiotensin–aldosterone system.

Prognostic value of growth differentiation factor-15 in heart failure among whole ejection fraction phenotypes.

The utility of growth differentiation factor-15 (GDF-15) in predicting long-term adverse outcomes in heart failure (HF) patients is not well established. This study explored the relationship between GDF-15 levels and adverse outcomes in HF patients across various ejection fraction (EF) phenotypes associated with coronary heart disease (CHD) and evaluated the added prognostic value of incorporating GDF-15 into the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score-based model. This single-centre cohort study included 823 HF patients, categorized into 230 (27.9%) reduced EF (HFrEF), 271 (32.9%) mid-range EF (HFmrEF), and 322 (39.1%) preserved EF (HFpEF) groups. The median age was 68.0years (range: 56.0-77.0), and 245 (29.8%) were females. Compared with the HFrEF and HFmrEF groups, the HFpEF group had a higher GDF-15 concentration (P=0.002) and a higher MAGGIC risk score (P<0.001). We examined the associations between GDF-15 levels and the risks of all-cause mortality and HF rehospitalization using Cox regression models. The C-index, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) metrics were employed to assess the incremental prognostic value. During the 9.4year follow-up period, 425 patients died, and 484 were rehospitalized due to HF. Multivariate Cox regression analysis revealed that elevated GDF-15 levels were significantly associated with an increased risk of all-cause mortality [hazard ratio (HR)=1.36, 95% confidence interval (CI): 1.20-1.54; P<0.001] and HF rehospitalization (HR=1.75, 95% CI: 1.57-1.95; P<0.001) across all HF phenotypes. This association remained significant when GDF-15 was treated as a categorical variable (high GDF-15 group: all-cause death: HR=1.73, 95% CI: 1.40-2.14; P<0.001; HF rehospitalization: HR=3.37, 95% CI: 2.73-4.15; P<0.001). Inclusion of GDF-15 in the MAGGIC risk score-based model provided additional prognostic value for all HF patients (Δ C-index=0.021, 95% CI: 0.002-0.041; IDI=0.011, 95% CI: 0.001-0.025; continuous NRI=0.489, 95% CI: 0.174-0.629) and HF rehospitalization (Δ C-index=0.034, 95% CI: 0.005-0.063; IDI=0.021, 95% CI: 0.007-0.032; continuous NRI=0.307, 95% CI: 0.147-0.548), particularly in the HFpEF subgroup. GDF-15 is identified as an independent risk factor for adverse outcomes in HF patients across the entire EF spectrum in the context of CHD. Integrating GDF-15 into the MAGGIC risk score-based model enhances its prognostic capability for adverse outcomes in the general HF population. This incremental prognostic effect was observed specifically in the HFpEF subgroup and not in other subgroups.

Cause-Specific Health Care Costs Following Hospitalization for Heart Failure and Cost Offset With SGLT2i Therapy

BackgroundLittle is known regarding differences in cause-specific costs between heart failure (HF) with ejection fraction (EF) ≤40% vs >40%, and potential cost implications of sodium glucose co-transporter 2 inhibitor (SGLT2i) therapy. ObjectivesThis study sought to compare cause-specific health care costs following hospitalization for HF with EF ≤40% vs >40% and estimate the cost offset with implementation of SGLT2i therapy. MethodsThis study examined Medicare beneficiaries hospitalized for HF in the Get With The Guidelines–Heart Failure registry from 2016 to 2020. Mean per-patient total (excluding drug costs) and cause-specific costs from discharge through 1-year follow-up were calculated and compared between EF ≤40% vs >40%. Next, risk reductions on total all-cause and HF hospitalizations were estimated in a trial-level meta-analysis of 5 pivotal trials of SGLT2is in HF. Finally, these relative treatment effects were applied to Medicare beneficiaries eligible for SGLT2i therapy to estimate the projected cost offset with implementation of SGLT2i, excluding drug costs. ResultsAmong 146,003 patients, 50,598 (34.7%) had EF ≤40% and 95,405 (65.3%) had EF >40%. Mean total cost through 1 year was $40,557. Total costs were similar between EF groups overall but were higher for EF ≤40% among patients surviving the 1-year follow-up period. Patients with EF >40% had higher costs caused by non-HF and noncardiovascular hospitalizations, and skilled nursing facilities (all P < 0.001). Trial-level meta-analysis of the 5 SGLT2i clinical trials estimated 11% (rate ratio: 0.89; 95% CI: 0.84-0.93; P < 0.001) and 29% (rate ratio: 0.71; 95% CI: 0.66-0.76; P < 0.001) relative reductions in rates of total all-cause and HF hospitalizations, respectively, regardless of EF. Reductions in all-cause and HF hospitalizations were projected to reduce annual costs of readmission by $2,451 to $2,668 per patient with EF ≤40% and $1,439 to $2,410 per patient with EF >40%. ConclusionsIn this large cohort of older U.S. adults hospitalized for HF, cause-specific costs of care differed among patients with EF ≤40% vs >40%. SGLT2i significantly reduced the rate of HF and all-cause hospitalizations irrespective of EF in clinical trials, and implementation of SGLT2i therapy in clinical practice is projected to reduce costs by $1,439 to $2,668 per patient over the 1 year post-discharge, excluding drug costs.

Impact of preprocedural left ventricular systolic function on the safety and durability of percutaneous coronary intervention.

Percutaneous coronary intervention (PCI) is considered less safe in patients with reduced ejection fraction (EF), an impression based on older data. Whether the safety and durability of contemporary PCI are different in patients with reduced EF compared with normal EF patients is unknown. Patients from the BIOFLOW II, IV and V clinical trials were grouped as normal EF (≥50%) and reduced EF (30%-50%). Using multivariable logistic regression and cox proportional hazards regression, we determined relations of EF category with procedural safety (a composite of cardiac death, myocardial infarction, stroke and urgent coronary artery bypass grafting within 30 days of PCI) and target lesion failure (TLF; comprising cardiac death, target vessel myocardial infarction, target vessel revascularization within 1 year of PCI) respectively. In sensitivity analyses, we regrouped patients into EF < 45% and ≥55% and repeated the aforementioned analyses. In 1685 patients with normal EF (mean age 65 years; 27% women; mean EF 61%) and 259 with low EF (mean age 64 years; 17% women; mean EF 41%), 101 safety and 148 TLF events occurred. Compared with patients in the normal EF group, those with reduced EF had neither a statistically significant higher proportion of safety events, nor a higher multivariable-adjusted risk for such events. Similarly, patients with reduced EF and normal EF did not differ in terms of TLF event proportions or multivariable-adjusted risk for TLF. The results were similar in sensitivity analyses with EF groups redefined to create a 10% between-group EF separation. PCI safety and durability outcomes are similar in patients with mild-moderately reduced EF and normal EF.

Off-pump minimally invasive coronary artery bypass grafting in patients with left ventricular dysfunction: the lampang experience.

The minimally invasive cardiac surgery off-pump coronary artery bypass (MICSOPCAB) is technically difficult; therefore, previous studies have indicated that MICSOPCAB should be contraindicated in patients with impaired left ventricular (LV) function. In this study, we investigated the feasibility of MICSOPCAB in patients with impaired LV function. The 226 patients underwent MICSOPCAB between August 2017 and September 2022. Our study defined impaired LV function as ejection fraction (EF) in echocardiography 40% or less. The patients were divided into Low EF group (n = 39) and Normal EF group (n = 187). The Low EF group was in a more critical preoperative condition than Normal EF group (41.0% in the Low EF group vs. 14.4% in the Normal EF group; p < 0.001). For preoperative transthoracic echocardiography, LV end-diastolic diameter (5.5 ± 0.9 cm in the Low EF group vs. 5.0 ± 0.8 cm in the Normal EF group; p < 0.001) and LV end-systolic diameter (4.4 ± 1.0 cm in the Low EF group vs. 3.4 ± 1.0 cm in the Normal EF group; p < 0.001) were significantly larger in the Low EF group. No differences were found in the operative time (180 [160-240] min in the Low EF group vs. 205 [165-253] min in the Normal EF group; p = 0.231) and the median number of distal anastomoses (2 [1-2] in the Low EF group vs. 2 [1-3] in the Normal EF group; p = 0.073). Intensive care unit stay was longer in the Low EF group than in the Normal EF group (2 [1-2] in the Low EF group vs. 1 [1-2] in the Normal EF group; p = 0.010). Perioperative transfusion was more common in the Low EF group than in the Normal EF group (69.7% vs. 49.2%; p = 0.023). There were no differences in major complications, hospital stay, and 30-day mortality. The Kaplan-Meier curve showed no significant difference in postoperative major adverse cardiac or cerebrovascular events rates between the two groups (p = 0.185). In this study, MICSOPCAB can be performed in patients with low EF having short- and mid-term outcomes similar to patients with normal EF. Therefore, low EF should not be contraindicated in MICSOPCAB.

Two-year clinical outcome of patients with mildly reduced ejection fraction after acute myocardial infarction: insights from the prospective KAMIR-NIH Registry.

Left ventricular ejection fraction (LVEF) is a crucial prognostic indicator of acute myocardial infarction (AMI). However, there is a lack of studies on the clinical characteristics and prognosis of patients with mildly reduced ejection fraction (EF) after AMI. We categorized 6,553 patients with AMI from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) between November 2011 and December 2015 into three groups based on their EF, as assessed by echocardiography during index hospitalization: reduced EF (LVEF ≤40%), mildly reduced EF (LVEF 41%-49%), and preserved EF (LVEF ≥50%). The primary outcome was all-cause death within 2 years. The secondary outcomes included myocardial infarction (MI), revascularization, and patient-oriented composite endpoint (POCE), which was defined as a composite of all-cause death, any MI, or revascularization. Of the total 6,553 patients, 884 (13.5%) were classified into the reduced EF group, 1,749 (26.7%) into the mildly reduced EF group, and 3,920 (59.8%) into the preserved EF group. Patients with mildly reduced EF exhibited intermediate mortality (reduced EF, 24.7%; mildly reduced EF, 8.3%; preserved EF, 4.6%; p < 0.0001), MI (3.9% vs. 2.7% vs. 2.6%; p < 0.0046), and POCE (33.0% vs. 15.6% vs. 12.4%; p < 0.0001) rates, albeit closer to those of the preserved EF. After adjustment for demographics, risk factors, admission status, and discharge medications, patients with mildly reduced EF showed a lower risk of all-cause death than those with reduced EF (mildly reduced EF group as a reference: HR, 1.74; 95% CI, 1.40-2.18; p < 0.001), but it did not differ significantly from those with preserved EF (HR, 0.94; 95% CI, 0.75-1.18; p = 0.999). Over a 2-year follow-up period, patients with AMI and mildly reduced EF demonstrated better prognoses than those with reduced EF, but did not differ significantly from those with preserved EF. cris.nih.go.kr, identifier: KCT-0000863.

Discussion on the Treatment Methods and Value of the No-Reflow Phenomenon During Percutaneous Coronary Intervention

Objective: To explore the treatment methods and value of the no-reflow phenomenon during percutaneous coronary intervention (PCI). Methods: 180 patients with acute myocardial infarction (AMI) who underwent PCI treatment at the First Hospital of Hebei Medical University from November 2020 to December 2022 were selected and divided into Group A, Group B, and Group C by random number table extraction method, each group included 60 cases. Group A received intracoronary injection of recombinant human urokinase and Group B received intracoronary injection of diltiazem. Group C adopted a targeted drug administration strategy of “front and back pinch method,” where targeted thrombolysis was performed in the target vessel before the stent was released to quickly dissolve the residual thrombus near the lesion and the small distal thrombus; recombinant human urokinase was subsequently injected in the targeted vessel. The incidence of cardiovascular events, cardiac function, and quality of life of the three groups were analyzed. Results: After the intervention, the incidence rates of angina pectoris, heart failure, and recurrent myocardial infarction in Group C were lower than those in Group B (P &lt; 0.05); the overall incidence rate was the lowest in Group C, followed by Group A and Group B; after intervention, left ventricular end-diastolic diameter, end-systolic diameter, and ejection fraction in Groups A and C were all better than those of group B (P &lt; 0.05), and Group C was better than Group A; after intervention, the scores of different dimensions of quality of life in Groups A and C were higher than those of Group B (P &lt; 0.05). Conclusion: AMI patients are prone to the no-reflow phenomenon after PCI treatment. Using recombinant human urokinase to complete the “front and back pinch method” can effectively improve the no-reflow phenomenon, reduce the incidence of cardiovascular events, optimize cardiac function, and improve the patient’s quality of life and survival rate.

Abstract 14826: Effect of Torsemide vs Furosemide After Discharge for Acute Heart Failure Across the Spectrum of Left Ventricular Ejection Fraction: Observations From Transform-HF

Introduction: TRANSFORM-HF trial showed no significant difference in mortality or hospitalization outcomes in patients randomized to torsemide (T) versus furosemide (F) following a heart failure (HF) hospitalization (HFH). However, outcomes and responses to some therapies differ across ejection fraction (EF) subgroups. Methods: We compared baseline patient characteristics and described treatment effects for various endpoints in TRANSFORM-HF stratified by EF: HF with reduced (EF≤40%;HFrEF) vs mildly reduced (41-49%;HFmrEF) vs preserved (≥50%;HFpEF) EFs. We also evaluated the prognostic association between EF and outcomes. Study endpoints were all-cause mortality and hospitalization at 30 days and 12 months (separately and as composites), and total hospitalizations. Results: Our analysis included 2635 patients with EF data. Participants with HFpEF were older (72 [62-79] years) with lower eGFR (52 [36-72] ml/min/1.73m 2 ) compared to the other EF cohorts, while patients with HFrEF had lower systolic blood pressure (112 [101-125] mmHg) and higher NT-proBNP levels (4554 [2368-9620] pg/ml). The neutral treatment effect for all studied endpoints did not differ across EF groups (all interaction p-values&gt;0.05, Figure 1A). There was no significant difference in the rates of mortality and/or hospitalization at 12 months between patients in the three EF groups (HFrEF 59.2, HFmrEF 61, HFpEF 63 events/100 patient-years, p=0.24, Figure 1B). Even after adjusting for covariates the relative risk or rate ratio for all endpoints did not differ across EF groups. Conclusions: Despite baseline differences between EF cohorts in TRANSFORM-HF, there were no significant differences in the study endpoints with T versus F across the EF spectrum. In contrast to previous observations, the adjusted risk ratios for all study endpoints did not differ by baseline EF. Following a HFH, there is substantial risk for all-cause mortality and subsequent hospitalization independent of EF.

Assessment of disturbed functions in patients with chronic heart failure using International classification of functioning ICF categories

BACKGROUND: The evaluation of impaired functions in patients with cardiac diseases is traditionally based on the clinical signs of the disease and instrumental hemodynamic parameters, without affecting all other disorders that occur with this pathology. The International classification of functioning is based on the functioning of the patient in his/her environment; therefore, a consistent assessment of the entire complex of impaired functions of the patient is appropriate, allowing for a more accurate formulation of the goals of rehabilitation and controlling the main stages of rehabilitation.&#x0D; AIM: To evaluate the International classification of functioning for assessing all impaired functions in patients with chronic heart failure.&#x0D; MATERIALS AND METHODS: The study included 68 patients with decompensated chronic heart failure. The analyzed sample included patients with chronic heart failure stages 2B and 3 (NYHA classes IIIIV). The average patient age was 63.9 years, and the average disease duration was approximately 7 years. The sample was predominantly men (66.5%). The etiology of chronic heart failure was represented by uncontrolled arterial hypertension (92%), post-infarction cardiosclerosis (74%), ischemic cardiomyopathy (25%), and chronic obstructive pulmonary disease (12%). Radiation diagnostic methods were used to confirm the severity of cardiac decompensation. The study assessed impaired functions in accordance with the domains of the International classification of functioning, mainly in functions of the cardiovascular system.&#x0D; RESULTS: In this study, 68 patients had decompensated chronic heart failure stages 2B and 3 (NYHA classes IIIIV). Group 1 included 40 patients, and group 2 included 28 patients. The instrumental examination revealed a more pronounced decrease in left-ventricular ejection fraction in group 1 compared with group 2 (42.84.4 and 49.25.6, respectively), showing a significant difference (p 0.05). Other hemodynamic parameters did not differ significantly in the groups. In the analysis of a basic set of the International classification of functioning domains for patients with chronic heart failure, the following domains turned out to be the most significant: heart function (b410), forced myocardial contraction (b4102); heart rate (b4100); blood supply to the heart (b4103); blood pressure functions (b420): increase (b4200), decrease (b4201), maintenance (b4202); functions of the respiratory system (b440) including the respiratory rate (b4400); additional functions and sensations from the cardiovascular and respiratory systems (b450-469); exercise tolerance functions (b455); water balance (b5450), including water retention (b45500), characterizing the presence of edematous syndrome; and muscle strength functions (b730). The indicated domains were also supplemented with Section d (activity and participation) walking long distances (d4501) and doing housework (d640); and Domain e (environmental factors), i.e., help from the next of kin (e310).&#x0D; CONCLUSIONS: A set of domains of the International classification of functioning for patients with decompensated heart failure has been developed and proposed, which makes it possible to more effectively identify the key problems of people with disability and more objectively form a plan for complex rehabilitation, which largely determines the prognosis in these patients.

Three-dimensional Echocardiography for the Early Detection of Cardiac Dysfunction in Patients with Rheumatoid Arthritis

Abstract Background Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease. Left atrial (LA) dysfunction is strongly linked to cardiovascular diseases, and the early detection of LA function in patients with RA is vital. Real-time three-dimensional echocardiography (RT-3DE) offers a noninvasive method to assess the structure and function of the LA. Aim of the study To assess LA volumes and phasic function in patients with RA using 3D transthoracic echocardiography. Materials and Methods This prospective case-control study included 162 subjects classified into two groups: Group 1 included 82 patients with RA, subdivided into an active RA group (n = 40) and an inactive RA group (n = 42), and Group 2 included 80 healthy matched controls. All study participants were examined using 2D and 3D transthoracic echo-cardiography. Results Diastolic dysfunction was significantly greater in patients with moderate and severe disease activity than in patients with mild disease activity. RT-3DE analysis of RA groups showed significantly higher maximum, minimum, and pre-atrial LA volumes compared to controls (p &lt;0.01), and these volumes were significantly higher in the active RA group than in the inactive RA group (p &lt;0.01). We also found significantly lower LA passive ejection fraction (EF) and active EF in both RA groups than the control group (p &lt;0.01), and significantly lower total EF in the active RA group than the inactive RA group (p &lt;0.01). Conclusion Patients with RA had increased 3D LA volumes and impaired mechanical function, especially in active RA. RT-3DE provides an accurate measurement of LA volumes and function, being a feasible and reproducible method in clinical applications.

Impact of Sacubitril/Valsartan Combination on Prevalence of Arrhythmia in Heart Failure Patients with Reduced Ejection Fraction

Abstract Aim and Objectives The aim of this study was to assess the effect of Sacubitril/Valsartan combination on prevalence of arrhythmias in HFrEF patients and compare it with patients on ACEI or ARBs only in addition to echo parameters follow up. Patients and Methods This study was conducted at Ain Shams university and Nasr city insurance hospitals and our target population was heart failure patients with reduced ejection fraction on either Sacubitril\Valsartan combination therapy (Group A) or on ACEI or ARBs (Group B) for at least 3 months, it was an observational study to follow up the burden of arrhythmia among heart failure patients by 48 hours holter monitoring at 3 and 6 months besides Echo parameters follow up. Results Our study included 2 groups. Group A (30 patients on Sacubitril/Valsartan combination therapy and mean age was 58.23 ± 4.80 years, 73.3% of patients were males and 26.7% females). Group B (30 patients on ACEIs or ARBs with mean age 56.37 ± 4.49 years, 80.0% of patients were males and 6 % females). There was no significant difference regarding the medical history, risk factors and NYHA classification of heart failure. The patients were classified into ischemic and non-ischemic cardiomyopathy patients and there was no significant difference between both groups. Group A was characterized by significant decrease in QTc values which reached the lowest values after 6 months, in the opposite side; group B was associated with increasing QTc values through the follow up period. As regards echocardiographic parameters we have found that left ventricle ejection fraction was improving to reach the highest values after six months in group A but we did not find significant improvement of left ventricle ejection fraction in group B. Other echocardiography parameters in group A including LA, LVIDd, RVSP and SWMA were improved by the end of the study but we have found that LA diameter was increasing in group B. In group A, burden of ventricular ectopics was found to be decreasing through the follow up period but there was no significant change of ventricular ectopics incidence in group B by the end of the study. Conclusion Sacubitril/Valsartan combination therapy was superior to ACEIs in reducing ventricular ectopics which means that this drug plays a role in preventing SCD. Ejection fraction in Sacubitril/Valsartan combination group was improving through the follow up period. Echocardiographic parameters were improving in Sacubitril/Valsartan group as regard LA, LVIDd and RVSP. Functional capacity in Sacubitril/Valsartan combinations group was improving through follow up period which means this drug reduces hospitalization.

Assessing the Accuracy of Algorithms That Predict Ejection Fraction for Research in a Cohort of Patients With Heart Failure

Left ventricular ejection fraction (EF) is required to differentiate heart failure (HF) phenotypes but is not collected in national datasets in Aotearoa/New Zealand. This study assessed the accuracy of models derived from the SWEDE-HF registry for predicting HF phenotypes in patients with HF. Six SWEDE-HF models were applied to the PEOPLE study: three predicted EF <50% vs ≥50% and three predicted <40% vs ≥40%. For each EF threshold, Model A used all predictors (age, sex, ischaemic heart disease, anaemia, atrial fibrillation, chronic obstructive pulmonary disease, diabetes, hypertension, valve disease, cancer, device therapy, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta blockers, mineralocorticoid receptor antagonists, digoxin, diuretics, New York Heart Association, mean arterial pressure, heart rate, body mass index, estimated glomerular filtration rate, and N-terminal pro B-type natriuretic peptide [NT-proBNP]); Model B excluded NT-proBNP; Model C excluded clinical measurements (last six in list). Agreement between actual and predicted EF categories was assessed using Cohen’s kappa, which assesses the degree of agreement beyond that expected by chance. Of 941 people with HF (mean age 69 years, 30% women), 610 (65%) had EF <50% and 476 (51%) had EF <40%. Model A predicting EF <40%/≥40% resulted in the greatest agreement between predicted and actual EF category beyond chance (kappa 22.9%). Removing NT-proBNP (Model B) or clinical predictors (Model C) reduced kappa to 17.2% and 19.7%, respectively. For models predicting EF <50%/≥50%, kappa for each model was 9.3%, 4.9%, and 12.5%, respectively. Models that predict EF <40% classify NZ patients into the correct EF group up to 23% better than chance. This is unlikely to be an acceptable degree of accuracy for determining EF phenotype when assessing administrative datasets involving patients with HF in NZ.

P187 INCREASING ROLE OF REMOTE CONTROL AND OPTIMIZATION IN CARDIAC RESYNCHRONIZATION THERAPY

Abstract Background Patients (pts) with heart failure and reduced ejection fraction (HFrEF) treated with resynchronization therapy (with or without defibrillator: CRT–D or CRT–P) require echocardiographic or device algorithms optimization for better clinical results. With remote control is further possible improve follow–up of these pts. Methods From 01/01/2019 42 pts treated with CRT (33 men and 9 women 30 CRT–D and 12 CRT–P) were split in 3 groups: 14 pts underwent optimization and remote control, 14 underwent optimization without remote control, 14 underwent remote control only with implant parameters. Results In the first group ejection fraction (EF) improved from 28 to 43% (p 0.0001)(median age 78.2 years) (y), 3 pts died (2 m and 1 w, for heart failure, neoplastic cause and pneumonia). In the second group (median age 83.3 y) EF improved from 29 to 45% (p 0.0001) 4 pts died (3 m, 1 w, all CRT–D 3 for heart failure and 1 for unknown causes). In the third group (median age 79.2 y) EF improved from 32 to 40% (p 0.012), 2 pts died (1 m and 1 w with heart failure). There weren’t relevant differences for device interventionts in the 3 groups (1 appropriate shock and 1 inappropriate shock for atrial fibrillation in the 1st group, 1 appropriate shock in the 2nd group, 1 appropriate shock in the 3rd group). In the groups with remote control a severe malfunction that needed immediate replacement of CRT and optimal elective replacement timing for 3 device were found. Conclusions Biventricular stimolation optimization with echocardiography and with device algorythm should be always utilized after CRT implant. In our work, although the number of pts is little, a better EF is obtained in the groups with optimization compared to the group only in remote control. In the COVID19 era early recognition of arrhytmias and malfunctions of device and of suboptimal biventricular stimolation is possible with remote control and could improve pts clinical conditions, hospitalization and survival. Further data need to evaluate if remote control can improve prognosis of pts with CRT–D and CRT–P.

PO-03-019 ECHOCARDIOGRAPHIC OUTCOMES OF HIS BUNDLE AND LEFT BUNDLE BRANCH AREA PACING: A SINGLE CENTER EXPERIENCE

Traditional right ventricular apical pacing is associated with risk of pacing induced cardiomyopathy (PICM), atrial fibrillation, and heart failure. Conduction system pacing (CSP) via the His or left bundle branch area (HBP, LBBAP) may mitigate or even prevent the development of these complications. To evaluate the effects of CSP on cardiac function as measured by standard 2D-echocardiography. Consecutive patients undergoing HBP or LBBAP implantation between Feb 2014 and July 2022 at Virginia Commonwealth University were analyzed. Ejection fraction (EF), left ventricular diastolic dimension (LVIDd), left ventricular systolic dimension (LVIDs), tricuspid regurgitation severity, and mitral regurgitation severity were compared pre- and post- CSP. Only patients with echo data at 90 days or greater from time of implant were included. A total of 340 patients with CSP had echocardiographic data available. Mean clinical follow up time was 810 days from implant, and median time until post-implant EF was 483 days (IQR 324-763). 77 had reduced EF (<50%) at baseline. Pacing burden exceeded 20% across the cohort. The mean pre- and post- CSP implantation EF in the overall group was 53.8% ±10.9% vs 54.7% ±9.1% (p=0.08). Mean pre- and post- CSP implant LVIDd was 4.59±0.73cm vs 4.37 ±0.72 cm (p<0.001). Mean pre- and post- CSP implant LVIDs was 3.23± 0.79cm vs 3.05± 0.76cm (p<0.001). TR and MR severity were unchanged after pacemaker implantation. In the subset of patients with reduced EF, mean pre-implant EF was 37% ±9.4% and post-implant EF was 47% ±11.6% (p<0.001). Mean pre-implant LVIDd was 5.02cm ±0.86cm and post-implant LVIDd was 4.60cm ±0.75cm (p<0.001). Mean pre-implant LVIDs was 4.05cm ±1.0cm and post-implant this dropped to 3.44cm ±0.96 (p<0.001). CSP via HBP or LBBAP is not associated with PICM in patients requiring high ventricular pacing burdens. In patients with a reduced EF, it may significantly improve systolic function along with positive structural remodeling.

Contraction Patterns of Post-Fontan Single Right Ventricle Versus Normal Left and Right Ventricles in Children: Insights From Principal Strain Analysis

Principal strain (PS) analysis quantifies three-dimensional myocardial deformation using three-dimensional speckle-tracking echocardiography. It defines both the amplitude and direction of the principal myocardial contraction, expressed as PS, and a perpendicular secondary strain of lower intensity. The aims of this study were to apply PS analysis to describe the contractile pattern in the single right ventricle (SRV) functioning as a systemic chamber in hypoplastic left heart syndrome, compared with the normal left ventricle (LV) and right ventricle (RV), and to compare SRV function using conventional echocardiographic evaluations. Fifty-four post-Fontan patients with hypoplastic left heart syndrome and age-matched control subjects (normal LV, n=64; normal RV, n=48) underwent computation of PS lines, ejection fraction (EF), end-diastolic volume indexed to body surface area, PS, secondary strain, circumferential strain, and longitudinal strain. The PS lines were compared between groups. Linear regressions with coefficient determination (R2) of strains, fractional area change, and tricuspid annular plane systolic excursion with EF and end-diastolic volume index were assessed in SRV. Additionally, the hypoplastic left heart syndrome cohort was equally divided into two groups with higher and lower EFs, followed by comparison of all parameters. The pattern of PS lines demonstrated a left-handed direction in the anterior free wall, a right-handed direction in the posterior free wall, and a circumferential direction in the medial wall in SRV. In contrast, in the normal LV, the principal contraction is in the circumferential direction, whereas in the normal RV, it is predominantly longitudinal. The R2 values for PS, secondary strain, and circumferential strain on EF were high (0.88, 0.72, and 0.90, respectively), whereas the R2 value for longitudinal strain was comparable with that for fractional area change (0.56 and 0.55). All parameters were independent of end-diastolic volume index. PS lines in the higher EF group showed a more circumferential orientation than in the lower EF group in SRV. PS analysis provides a unique functional map of SRV contraction. This map differs from corresponding maps of the normal LV and RV. This may be helpful in understanding the mechanisms of SRV function, although future longitudinal studies are needed.