Recovery Of Ejection Fraction Research Articles

The Recovery of Left Ventricular Function in Cases of Primary Angioplasty for Acute Myocardial Infarction

Background: This study is to investigate the recovery in left ventricular ejection fraction in the first 3 months after acute myocardial infarction treated with primary angioplasty. Left ventricular function (LVF) is the main predictor of long term prognosis in cases of survival after acute myocardial infarction. Study aims to investigate successful improvement in left ventricular ejection fraction after primary angioplasty.
 Methodology: A cross sectional study was conducted at Chaudhary Pervaiz Ellahi Institute of Cardiology, Multan from 1stSeptember 2019 to 30thSeptember 2020. Left ventricular ejection fraction was evaluated in 100 patients treated with primary angioplasty. Primary angioplasty is a very 1st treatment to re-open the locked artery after acute myocardial infarction. Ejection fraction was measured with Echocardiography Simpson’s biplane method at 3rd day and 3 months after angioplasty. Collected data was analyzed by using SPSS version 23. Chi square test was applied to see association among variables.
 Results: One hundred patients were included this study. The mean age and BMI of the patients was 59.45±6.01 years and 24.76±8.02 kg/m2, respectively. Male 70 (70%) and female 30 (30%) ratio was 7:3. LVEF at 3rd month was observed in ≤40% in 223 (23.0%) patients and >40% in 77 (77%) patients. Male patients were greater in number that’s why LVEF is also observed in greater in male gender (p<0.001). Increase in age also have no impact on procedure success (p>0.050).
 Conclusion: Results of this study reveal that primary angioplasty is successful treatment plan in patients with acute myocardial infarction. A significant recovery of left ventricular function during 3 months after primary angioplasty in acute Myocardial infarction (MI) patients was observed.

Native T1 high region and left ventricular ejection fraction recovery in patients with dilated cardiomyopathy.

Native T1 mapping is used to assess myocardial tissue characteristics without gadolinium contrast agents. The focal T1 high-intensity region can indicate myocardial alterations. This study aimed to identify the association between the native T1 mapping including the native T1 high region and left ventricular ejection fraction (LVEF) recovery in patients with dilated cardiomyopathy (DCM). Patients with newly diagnosed DCM (LVEF of < 45%) who underwent cardiac magnetic resonance imaging with native T1 mapping were included in the analysis. Native T1 high region was defined as a signal intensity of > 5 SD in the remote myocardium. Recovered EF was defined as a follow-up LVEF of ≥ 45% and an LVEF increase of ≥ 10% after 2 years from baseline. Seventy-one patients met the inclusion criteria for this study. Forty-four patients (61.9%) achieved recovered EF. Logistic regression analysis showed that the native T1 value (OR: 0.98; 95% CI: 0.96-0.99; P = 0.014) and the native T1 high region (OR: 0.17; 95% CI: 0.05-0.55; P = 0.002), but not late gadolinium enhancement, were independent predictors of recovered EF. Compared with native T1 value alone, combined native T1 high region and native T1 value improved the area under the curve from 0.703 to 0.788 for predicting recovered EF. Myocardial damage, which was quantified using native T1 mapping and the native T1 high region were independently associated with recovered EF in patients with newly diagnosed DCM.

Early improvement of strain imaging parameters predicts long-term response to sacubitril/valsartan in patients with heart failure with reduced ejection fraction: An observational prospective study

BackgroundManagement of patients affected by heart failure with reduced ejection fraction (HFrEF) has deeply changed thanks to novel pharmacological therapies, such as Sacubitril/Valsartan, which assured morbidity and mortality advantages in this population. These effects may be mediated by both left atrial (LA) and ventricular reverse remodeling, although left ventricular ejection fraction (LVEF) recovery still represents the main parameter of treatment response. MethodsIn this prospective, observational study, 66 patients with HFrEF and naïve from Sacubitril/Valsartan were enrolled. All patients were evaluated at baseline, at 3 months and 12 months from therapy initiation. Echocardiographic parameters, including speckle tracking analysis, LA functional and structural metrics, were collected at three timepoints. The endpoints of our study were: (1) to evaluate the effects of Sacubitril/Valsartan on echo measurements; (2) to assess the predictive role of early modifications of these parameters (expressed as ∆ 3–0 months) on long-term LVEF significant recovery, defined as >15% improvement from baseline. ResultsThe majority of echocardiographic parameters evaluated progressively improved during the observation period, including LVEF, ventricular volumes and LA metrics. ∆(3–0 months) of LV Global Longitudinal Strain (LVGLS) and LA Reservoir Strain (LARS) were associated with significant LVEF improvement at 12 months (p < 0.001 and p = 0.019 respectively). A cut-off of ∆(3–0 months) LVGLS of 3% and of ∆(3–0 months) LARS of 2% could predict LVEF recovery with satisfactory sensitivity and specificity. ConclusionsLV and LA strain analysis may identify patients who adequately respond to HFrEF medical treatment and should be routinely used in the evaluation of these patients.

Left Ventricular Recovery after Transapical Transcatheter Aortic Valve Implantation Compared with Conventional Aortic Valve Replacement in Patients with Aortic Regurgitation and Reduced Ejection Fraction

Background and Aim of the Study. To evaluate differences in left ventricular recovery after transapical transcatheter aortic valve implantation and conventional aortic valve replacement in patients with aortic regurgitation and reduced left ventricular ejection fraction. Methods. All patients with reduced left ventricular ejection fraction who underwent aortic valve surgery for AR at our institution between January 2015 and November 2021 were retrospectively reviewed. Generalized estimating equations were used to compare left ventricular recovery and remodeling outcomes between the patient groups. Results. A total of 87 cases were included in this study, 36 patients for TA-TAVI and 51 patients for C-AVR. Transapical transcatheter aortic valve implantation was associated with better and faster recovery of left ventricular ejection fraction and left ventricular end-diastolic dimension (adjusted β = 0.002, 95% CI: 0.000 to 0.003, and p = 0.046 ; adjusted β = 0.330, 95% CI: 0.185 to 0.474, and p &lt; 0.001 , respectively) within the first 3 months postoperatively compared with left ventricular ejection fraction, with the same improvement in New York Heart Association function class (adjusted β = 0.381, 95% CI: −0.349 to 1.111, and p = 0.306 ). Conclusions. This study highlights patients who underwent transapical transcatheter aortic valve implantation for aortic regurgitation with reduced left ventricular ejection fraction. However, future randomized controlled prospective clinical trials with longer follow-up durations are required.

Response to cardiac resynchronization therapy and treatment with ARNi and iSGLT2

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure with reduced ejection fraction (HFrEF) is associated in about one third of patients with abnormal conduction of the cardiac electrical impulse, resulting in asynchronous activation of the ventricles and worsening of cardiac pump function. Cardiac resynchronization therapy via biventricular pacing (CRT) has demonstrated improvement in cardiac mechanical function. The pharmacological treatment of HFrEF with sacubitril/valsartan (ARNi) and glyphozines (iSGLT2) have been shown to significantly reduce mortality. Purpose The objective of our study was 1) to evaluate the effect of therapy with ARNi and iSGLT2 on the recovery of left ventricular ejection fraction (LVEF %) in a population affected by HFrEF and with CRT 2) to evaluate whether there are any differences in terms of improvement in LVEF among patients who introduced these drugs into therapy before CRT implantation and those who introduced them after. Methods This single-center retrospective study analyzed patients with HFrEF and CRTD. These patients in our center undergo regular follow-up with cardiology visit, ECG and echocardiography every 6 months. We analyzed clinical features, drug therapy, and echocardiographic data including LVEF. Patients were considered responders they had an increase in LVEF ≥ 5% or a decrease in end-systolic volume of 15% at 6 months. The data analysis was performed with the R software. Results 258 patients were included, 202 males (78%) with a mean age of 69.4 years, and 67.4% of them with ischemic HFrEF. Diabetes mellitus (68%), dyslipidemia (87%) and arterial hypertension (73%) were the most frequent comorbidities. Fifty-two percent of patients (133) were CRT responders and there was no difference in the proportion of responders between patients receiving ARNi and/or iSGLT2 therapy and those without (55% vs 47%; p=ns). The mean increase of LVEF was also similar between the two groups (+7.7% vs +10.3%; p=ns). In the group of patients taking ARNi or iSGLT2, no significant differences were found between patients taking these drugs already before CRT compared to those who started after. Conclusions In this population, HFrEF patients with CRT, therapy with ARNi or iSGLT2 does not affect the response to CRT.

Impact of in-Hospital Left Ventricular Ejection Fraction Recovery on Long-Term Outcomes in Patients Who Underwent Impella Support for HR PCI or Cardiogenic Shock: A Sub-Analysis from the IMP-IT Registry.

(1) Background: Percutaneous left ventricle assist devices (pLVADs) demonstrated an improvement in mid-term clinical outcomes in selected patients with severely depressed left ventricular ejection fraction (LVEF) undergoing percutaneous coronary interventions. However, the prognostic impact of in-hospital LVEF recovery is unclear. Accordingly, the present sub-analysis aims to evaluate the impact of LVEF recovery in both cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR PCI) supported with pLVADs in the IMP-IT registry. (2) Methods: A total of 279 patients (116 patients in CS and 163 patients in HR PCI) treated with Impella 2.5 or CP in the IMP-IT registry were included in this analysis, after excluding those who died while in the hospital or with missing data on LVEF recovery. The primary study objective was a composite of all-cause death, rehospitalisation for heart failure, left ventricle assist device (LVAD) implantation, or heart transplantation (HT), overall referred to as the major adverse cardiac events (MACE) at 1 year. The study aimed to evaluate the impact of in-hospital LVEF recovery on the primary study objective in patients treated with Impella for HR PCI and CS, respectively. (3) Results: The mean in-hospital change in LVEF was 10 ± 1% (p < 0.001) in the CS cohort and 3 ± 7% (p < 0.001) in the HR PCI group, achieved by 44% and 40% of patients, respectively. In the CS group, patients with less than 10% in-hospital LVEF recovery experienced higher rates of MACE at 1 year of follow-up (FU) (51% vs. 21%, HR 3.8, CI 1.7-8.4, p < 0.01). After multivariate analysis, LVEF recovery was the main independent protective factor for MACE at FU (HR 0.23, CI 0.08-0.64, p = 0.02). In the HR PCI group, LVEF recovery (>3%) was not associated with lower MACE at multivariable analysis (HR 0.73, CI 0.31-1.72, p = 0.17). Conversely, the completeness of revascularisation was found to be a protective factor for MACE (HR 0.11, CI 0.02-0.62, p = 0.02) (4) Conclusions: Significant LVEF recovery was associated with improved outcomes in CS patients treated with PCI during mechanical circulatory support with Impella, whereas complete revascularisation showed a significant clinical relevance in HR PCI.

Incidence, Risk Factors, Maternal and Neonatal Outcomes of Peripartum Cardiomyopathy (PPCM) in Oman.

Peripartum cardiomyopathy (PPCM) is an idiopathic life-threatening condition occurring towards the end of pregnancy or in the first few months following delivery that might affect the maternal and neonatal outcomes. To assess the incidence and to evaluate the antenatal risk factors and the maternal and neonatal outcomes in Omani women diagnosed with PPCM. A retrospective cohort study was conducted at two tertiary institutions in Oman between the 1st of January 2010 to the 31st of December 2018. All cases fitting the standard definition of PPCM were included in the analysis. Patients with pre-existing dilated cardiomyopathy, chronic obstructive pulmonary disease and significant valvular heart disease have been excluded. A total of 113,104 deliveries were screened during the study period. PPCM was confirmed in 116 cases with an incidence of 1.02 per 1000 deliveries. Independent predictors for the development of PPCM were age; especially women at the mid reproductive age (26-35 years), singleton pregnancy and gestational hypertension. In general, maternal outcomes were favorable, with full recovery of left ventricular ejection fraction in 56.0%, recurrence of 9.2%, and an overall mortality rate of 3.4%. The most common maternal complication was pulmonary edema (16.3%). The neonatal mortality rate was 4.3% and the preterm birth rate was 35.7%. Neonatal outcomes included 94.3% live births, out of which 64.3% were term with Apgar scores of more than 7 at five minutes in 91.5% of the neonates. Our study resulted in an overall incidence of PCCM in Oman of 1.02 in 1000 deliveries. Given the significance of maternal and neonatal complications, establishing a national PPCM database and local practice guidelines, and emphasizing their implementations in all regional hospitals, are fundamental for early recognition of the disease, timely referral, and application of therapy. Future studies, with a clearly defined control group, are highly recommended to appraise the significance of antenatal comorbidities in PPCM compared to non-PPCM cases.

CE-452776-3 IS RATE CONTROL EVER ADEQUATE? CATHER ABLATION IN RATE CONTROLLED ATRIAL FIBRILLATION WITH REDUCED EJECTION FRACTION

The optimal rate control target for atrial fibrillation (AF) in the setting of heart failure with reduced ejection fraction (HFrEF) is not defined. Prior clinical trials have demonstrated benefits of AF ablation for patients with HFrEF, including recovery in left ventricular ejection fraction (LVEF). However, it is unknown if degree of rate control prior to ablation affects outcomes. To evaluate whether degree of pre-ablation rate control impacts LVEF recovery following AF ablation in patients with HFrEF. A single center, retrospective cohort study of 75 consecutive patients with LVEF ≤35% who underwent first-time ablation for persistent AF at NYU Langone Health between January 2014 and January 2021. Patients were classified as having a LVEF recovery if their post-ablation LVEF was >35%. Proportion of patients with LVEF recovery were compared between multiple rate control cutoffs: 110 bpm, 90 bpm, and 70 bpm. A binomial logistic regression analysis was then performed examining the relationship of pre-ablation HR on LVEF recovery. The mean pre-ablation HR was 90±25 bpm, baseline LVEF was 27±6%, and 64% (48/75) of patients had at least 3 months of maximal GDMT prior to ablation (Table 1A). Significant improvement in LVEF was observed in all patient subgroups irrespective of rate control status (Figure 1A) and regardless of prior GDMT (Figure 1B). Overall, LVEF recovery to >35% occurred in 59% (44/75) of patients. Compared to patients with pre-ablation HR faster than evaluated rate control cutoffs (Table 1B), there were no differences in frequency of LVEF recovery when using ≤110 bpm (controlled: 58% vs. not controlled: 63%, p=0.73) or ≤90 bpm (controlled: 52% vs. not controlled: 66%, p=0.21). In contrast, patients achieving rate control ≤70 bpm were significantly less likely to have LVEF recovery (41%) compared to those with HR above the cutoff (66%; p=0.04). Binomial logistic regression analysis did not reveal HR as a significant predictor of LVEF recovery (OR=1.01; CI 95%=0.99-1.03; p=0.16). Catheter ablation of persistent in AF in patients with HFrEF frequently resulted in improvement in LVEF, irrespective of achieved rate control. LVEF recovery >35% following catheter ablation was reduced only with rate control of HR 70bpm. Catheter ablation should be considered in HFrEF patients regardless of degree of rate control achieved. Heart rate 70bpm should be evaluated as a goal for adequate rate control in patients with HFrEF in whom rhythm control is not pursued.

A novel caffeic acid derivative prevents angiotensin II-induced cardiac remodeling

Differentiation of cardiac fibroblasts into myofibroblasts is a critical event in the progression of cardiac fibrosis that causes pathological cardiac remodeling. Cardiac fibrosis is a hallmark of heart disease and is associated with a stiff myocardium and heart failure. This study investigated the effect of caffeic acid ethanolamide (CAEA), a novel caffeic acid derivative, on cardiac remodeling. Angiotensin (Ang) II was used to induce cardiac remodeling both in cell and animal studies. Treating cardiac fibroblast with CAEA in Ang II-exposed cell cultures reduced the expression of fibrotic marker α-smooth muscle actin (α-SMA) and collagen and the production of superoxide, indicating that CAEA inhibited the differentiation of fibroblast into myofibroblast after Ang II exposure. CAEA protects against Ang II-induced cardiac fibrosis and dysfunction in vivo, characterized by the alleviation of collagen accumulation and the recovery of ejection fraction. In addition, CAEA decreased Ang II-induced transforming growth factor-β (TGF-β) expression and reduced NOX4 expression and oxidative stress in a SMAD-dependent pathway. CAEA participated in the regulation of Ang II-induced TGF-β/SMAD/NOX4 signaling to prevent the differentiation of fibroblast into myofibroblast and thus exerted a cardioprotective effect. Our data support the administration of CAEA as a viable method for preventing the progression of Ang II-induced cardiac remodeling.

Review of Randomized Controlled Trials in Patients with Peripartum Cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is a rare but potentially lifethreatening disease, defined as idiopathic cardiomyopathy occurring towards the end of pregnancy or in the months following delivery, abortion or miscarriage. We aim to raise awareness of this condition and give an overview of current knowledge as well as an insight and comparison of clinical trials focusing on randomized controlled trials. Systematic literature searches were conducted using PubMed up to December 2021. Studies published involving clinical trials and interventions in women with PPCM after 1970 were selected. Randomized controlled trials have shown that the addition of Bromocriptine to standardized heart failure therapy improves outcome in terms of recovery of Left Ventricular Ejection Fraction (LVEF), symptoms and death. Bromocriptine 2.5 mg twice daily for two weeks followed by 2.5 mg once daily for six weeks had the best trend and outcome. The addition of Levosimendan to standardized heart failure therapy had no effect, whereas the addition of Selenium improved heart failure symptoms but did not reduce risk in terms of unrecovered LVEF or death. One prospective study showed potential usage of TNF-alfa inhibitors, but was never tried in a randomized clinical trial. PPCM is a rare and potentially fatal disease. New insights on pathophysiology, genetics and clinical studies, particularly randomized controlled trials, have shown that the addition of Bromocriptine has a beneficial effect in terms of improved LVEF and death. However, some clinical studies have shown promising results using anti-inflammatory pharmacological agents with an improvement in LVEF. We suggest that targeting an anti-inflammatory route may prove beneficial in patients with PPCM. However, further research is highly warranted.

Severe COVID-19-associated myocarditis with cardiogenic shock – management with assist devices – a case report & review

BackgroundPrimary viral myocarditis associated with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection is a rare diagnosis.Case presentationWe report the case of an unvaccinated, healthy patient with cardiogenic shock in the context of a COVID-19-associated myocarditis and therapy with simultaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and percutaneous left ventricular decompression therapy with an Impella. The aim of this review is to provide an overview of therapeutic options for patients with COVID-19-associated myocarditis.ConclusionsThe majority of patients required a combination of two assist devices to achieve sufficient cardiac output until recovery of left ventricular ejection fraction. Due to the rapid onset of this fulminant cardiogenic shock immediate invasive bridging therapy in a specialized center was lifesaving.

Heart failure with improved ejection fraction: practical guidance for the clinician

Heart failure with improved ejection fraction (HFimpEF) represents a nosological entity that has recently been recognized and has little evidence from the literature. Available data indicate an increasing incidence of this patient group, consistent with the progressive improvement and implementation of medical therapy of heart failure with reduced ejection fraction (HFrEF). Furthermore, it is important to underline that the therapy itself should not be suspended after ejection fraction recovery, to avoid the recurrence of worse systolic dysfunction and patient outcomes. Only recently a randomized clinical study has been published, which enrolled also this patient subgroup, the DELIVER trial. Other data will soon become available, given the interest of the scientific community for this subgroup of patients, whose best management remains controversial. Since many studies suggest that the probability of myocardial recovery in HFrEF patients might be as high as 40%, depending on the case series taken into account, whereas the time to recovery might even be 12 months, the appropriate timing of device implantation, such as the defibrillator, in this setting deserves careful consideration.

Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients With Congenital Heart Disease.

Left ventricular global longitudinal strain (LVGLS) has been shown to improve risk stratification in patients with LV systolic dysfunction and subsequent recovery of LV ejection fraction (LVEF) in the acquired heart disease population. The purpose of this study was to assess the relationship between LVGLS and cardiovascular events (heart failure hospitalization, sustained ventricular tachycardia/appropriate shock, heart transplant, or cardiovascular death) and deterioration in LVEF (absolute decrease in LVEF ≥10% to LVEF <50%) in adults with congenital heart disease. Retrospective cohort study of congenital heart disease patients with previous diagnosis of LV systolic dysfunction (LVEF <50%) and subsequent recovery of LVEF (absolute increase in LVEF of ≥10% to LVEF ≥50%) on subsequent echocardiogram (index echocardiogram). Based on the index echocardiogram, patients were divided into normal LVGLS (absolute LVGLS >18%) versus abnormal LVGLS (absolute LVGLS ≤18%) groups. Of 193 patients with recovered LVEF, 86 (45%) had normalization of LVGLS at index echocardiogram. A higher absolute LVGLS and use of renin angiotensin aldosterone system antagonist was associated with a lower risk of cardiovascular events and subsequent deterioration in LVEF, while hypertension was associated with higher risk of cardiovascular events and deterioration in LVEF. These results suggest that patients with congenital heart disease with recovered LVEF remained at risk for adverse outcomes, and LVGLS can be used to identify patients at risk for adverse outcomes. Medical therapy for heart failure and treatment of hypertension may reduce the risk of adverse outcome, but these findings require empirical validation, hence the need for a clinical trial.

Cardioprotection Using Strain-Guided Management of Potentially Cardiotoxic Cancer Therapy: 3-Year Results of the SUCCOUR Trial

BackgroundGlobal longitudinal strain (GLS) can predict cancer therapeutics–related cardiac dysfunction and guide initiation of cardioprotection (CPT). ObjectivesIn this study, the authors sought to determine whether echocardiography GLS-guided CPT provides less cardiac dysfunction in survivors of potentially cardiotoxic chemotherapy, compared with usual care at 3 years. MethodsIn this international multicenter prospective randomized controlled trial, patients were enrolled from 28 international sites. All patients treated with anthracyclines with another risk factor for heart failure were randomly allocated to GLS-guided (>12% relative reduction in GLS) or ejection fraction (EF)–guided (>10% absolute reduction of EF to <55%) CPT. The primary end point was the change in 3-dimensional (3D) EF (ΔEF) from baseline to 3 years. ResultsAmong 331 patients enrolled, 255 (77%, age 54 ± 12 years, 95% women) completed 3-year follow-up (123 in the EF-guided group and 132 in the GLS-guided group). Most had breast cancer (n = 236; 93%), and anthracycline followed by trastuzumab was the most common chemotherapy regimen (84%). Although 67 (26%) had hypertension and 32 (13%) had diabetes mellitus, left ventricular function was normal at baseline (EF: 59% ± 6%, GLS: 20.7% ± 2.3%). CPT was administered in 18 patients (14.6%) in the EF-guided group and 41 (31%) in the GLS-guided group (P = 0.03). Most patients showed recovery in EF and GLS after chemotherapy; 3-year ΔEF was −0.03% ± 7.9% in the EF-guided group and −0.02% ± 6.5% in the GLS-guided (P = 0.99) group; respective 3-year EFs were 58% ± 6% and 59% ± 5% (P = 0.06). At 3 years, 17 patients (5%) had cancer therapeutics–related cardiac dysfunction (11 in the EF-guided group and 6 in the GLS guided group; P = 0.16); 1 patient in each group was admitted for heart failure. ConclusionsAmong patients taking potentially cardiotoxic chemotherapy for cancer, the 3-year data showed improvement of LV dysfunction compared with 1 year, with no difference in ΔEF between GLS- and EF-guided CPT. (Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes [SUCCOUR]; ACTRN12614000341628)

Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions.

Left ventricular ejection fraction (EF) is an independent predictor of adverse outcomes after myocardial infarction (MI). However, current data on trajectories and determinants of EF are scarce. The present study aimed to describe the epidemiology of EF after MI. Data from a single-center prospectively-designed registry of consecutive patients hospitalized at a large tertiary cardiology center were utilized. Out of 1,593 patients in the registry, 1,065 were hospitalized for MI type I (65.4% STEMI) and had no previous history of heart failure or MI. At discharge, EF < 40% was present in 238 (22.3%), EF 40-50% in 326 (30.6%) and EF > 50% in 501 (47.0%). Patients with EF < 40% were often those who suffered subacute and anterior STEMI, had higher heart rate at admission and higher maximal troponin level, and had more often HF signs requiring intravenous diuretics. Among subjects with EF < 40%, the follow-up EF was available in 166 (80% of eligible). Systolic function recovered to EF > 50% in 39 (23.1%), slightly improved to EF 40-50% in 44 (26.0%) and remained below 40% in 86 (50.9%). Systolic function improvement to EF > 40% was predicted by lower severity of coronary atherosclerosis, lower leukocyte count, and the absence of atrial fibrillation. Despite recent improvements in in-hospital MI care, one in five patients has systolic dysfunction at hospital discharge. Out of these, EF improves in 51%, and full recovery is observed in 23%. The severity of coronary atherosclerosis, inflammatory response to MI, and atrial fibrillation may affect EF recovery.

Abstract 159: Time-course Of Left Ventricular Systolic Dysfunction Recovery After Cardiac Arrest

Introduction: Myocardial dysfunction is a well-documented feature of post-cardiac arrest syndrome. The natural history of left ventricular systolic dysfunction (LVSD) remains largely unknown. We sought to characterize the change in left ventricular systolic function after return of spontaneous circulation (ROSC). Methods: This is a retrospective review of cardiac arrest patients at a single tertiary center between 2015 and 2020. We included patients with a transthoracic echocardiogram (TTE) documenting left ventricular ejection fraction (EF) within 1 day of ROSC and at least one follow-up TTE within 6 months after cardiac arrest. LVSD was defined as EF &lt;40% on TTE. Patients with known LVSD preceding cardiac arrest were excluded. Using paired t-test, we compared initial (within 1 day of ROSC) and follow up TTEs, stratified by shockable rhythm status. Recovery of LVSD was defined as improvement in EF to &gt;50%. Results: Of 477 cardiac arrest patients, 89 (18.7%) patients met the inclusion criterion. 28 (31.5%) had a baseline TTE on file; 5 patients had LVSD prior to arrest and were excluded, leaving a cohort of 84 patients. Thirty-one (36.9%) patients had LVSD on TTE after ROSC, of which 16 (51.6%) had recovery of EF on follow up TTE. The figure shows the timeline of EF recovery for the whole cohort. In-hospital follow up TTE (n=84) was done at a median (IQR) of 7 (4,16) days and post-discharge follow up (n=26) at 63 (29, 115) days. In patients with shockable rhythm arrest, EF improved from ROSC to inpatient follow up TTE [mean (SD) 36% (2.6) to 50% (2.5), P &lt;0.001]. Patients with non-shockable rhythm arrest had a higher baseline EF with a non-significant change at follow up [50% (2.6) to 56% (2.5), p=0.072]. Conclusion: Among survivors of cardiac arrest, significant recovery of LVSD was common. Further work is necessary to elucidate predictors of myocardial recovery and to determine optimal timing for repeat echocardiography.

Abstract 14374: Clinical and Echocardiographic Characteristics of Patients Who Develop Post Liver Transplant Non-Ischemic Cardiomyopathy

Background: Non-ischemic cardiomyopathy is a well-known but poorly understood cardiac complication post orthotopic liver transplantation (OLT). Methods: We performed a nested case control study in a cohort of 590 patients who underwent OLT at Loma Linda University between 2013 - 2021. 29 (4.9%) patients developed post-OLT non-ischemic cardiomyopathy. 100 patients who did not develop cardiomyopathy were selected randomly from the cohort to serve as control group. Clinical characteristics of cases and controls were compared and echocardiograms of patients who developed cardiomyopathy reviewed. Results: Patients who developed cardiomyopathy were more likely to be female, less likely to have history of hypertension, had lower baseline hemoglobin and platelets, and higher MELD scores ( Table 1) . Mean pre-transplant ejection fraction (EF) was 69% among patients who developed cardiomyopathy. Cardiomyopathy developed on average 10 days after OLT with mean EF dropping to 26%. 24 (83%) patients had reduced EF (&lt;40%) and 5 (17%) had mid-range EF (40-49%). Wall motion analysis revealed global hypokinesis in 11 (38%) patients, mid-ventricular takotsubo in 11 (38%) patients, apical takotsubo in 5 (17%) patients, and basal takotsubo in 2 (7%) patients (Figure 1) . 24 (83%) patients recovered EF (≥ 50%) on average of 113 days after initial diagnosis of cardiomyopathy. Conclusions: Female sex and higher MELD scores were associated with development of non-ischemic cardiomyopathy post OLT. Global hypokinesis and mid-ventricular takotsubo were the most common patterns of wall motion abnormality. EF recovery was noted in majority of patients indicating operative stress related etiology.

Abstract 12919: Stress Induced Cardiomyopathy After the Covid-19 Vaccine

Introduction: The SARS-CoV-2 virus has potential to cause acute and long-term cardiac effects. The vaccines were developed to prevent severe illness, but there are concerns about vaccine related side effects. Specific to the heart there have been case reports of mRNA vaccine related cardiomyopathies, particularly myocarditis. We present a case of a patient with presumptive stress induced cardiomyopathy in the setting of recent Covid-19 mRNA vaccination. Case Presentation: A 93-year-old female with a past medical history of hypertension presented with worsening shortness of breath and bilateral lower extremity edema. She received her second dose of the Covid-19 mRNA vaccine five days prior to presentation. She had no history of heart disease, was a nonsmoker, and denied alcohol or drug use. In the ED she was noted to be fluid-overloaded, and her CT chest showed minimal coronary calcification and bilateral pleural effusions. She was admitted for heart failure exacerbation and started on IV furosemide. Her transthoracic echocardiogram showed an ejection fraction of 40-45%. The pattern of left ventricular dysfunction was consistent with stress induced cardiomyopathy with apical akinesis and basal sparing of the left ventricular wall segments. Cardiology was consulted and recommended management with diuretics and beta blocker. She had a diuresis of 5 liters during her hospitalization. At clinic follow-up, dyspnea had improved, and her peripheral edema had resolved. Repeat echocardiogram showed recovery of left ventricular ejection fraction to 61% by Simpsons biplane technique with no regional wall motion abnormalities. Further cardiac assessment to evaluate for obstructive coronary artery disease and myocarditis was discussed and offered to the patient but was declined due to her positive response to conservative management. Discussion: The precise etiology of stress induced cardiomyopathy is unknown, but it is thought to be secondary to the sudden release of stress hormones. There are isolated reports of stress induced cardiomyopathy associated with Covid-19 vaccination, but the potential mechanism is unclear. An improved understanding of the potential effects of mRNA vaccines may help guide decisions regarding future booster vaccinations.

Trigger related outcomes of takotsubo syndrome in a cancer population.

Takotsubo syndrome (TTS) occurs more frequently in cancer patients than in the general population, but the effect of specific TTS triggers on outcomes in cancer patients is not well studied. The study sought to determine whether triggering event (chemotherapy, immune-modulators vs. procedural or emotional stress) modifies outcomes in a cancer patient population with TTS. All cancer patients presenting with acute coronary syndrome (ACS) between December 2008 and December 2020 at our institution were enrolled in the catheterization laboratory registry. Demographic and clinical data of the identified patients with TTS were retrospective collected and further classified according to the TTS trigger. The groups were compared with regards to major adverse cardiac events, overall survival and recovery of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) after TTS presentation. Eighty one of the 373 cancer patients who presented with ACS met the Mayo criteria for TTS. The triggering event was determined to be "cancer specific triggers" (use of chemotherapy in 23, immunomodulators use in 7, and radiation in 4), and "traditional triggers" (medical triggers 22, and procedural 18 and emotional stress in 7). Of the 81 patients, 47 died, all from cancer-related causes (no cardiovascular mortality). Median survival was 11.9 months. Immunomodulator (IM) related TTS and radiation related TTS were associated with higher mortality during the follow-up. Patients with medical triggers showed the least recovery in LVEF and GLS while patients with emotional and chemotherapy triggers, showed the most improvement in LVEF and GLS, respectively. Cancer patients presenting with ACS picture have a high prevalence of TTS due to presence of traditional and cancer specific triggers. Survival and improvement in left ventricular systolic function seem to be related to the initial trigger for TTS.

Trajectories and determinants of left ventricular ejection fraction after first myocardial infarction in current era of primary coronary interventions

Abstract Background Left ventricular ejection fraction (EF) is an independent predictor of adverse outcomes after myocardial infarction (MI). However, contemporary data from the PCI era of MI therapy on trajectories and determinants of EF are scarce. Purpose The present study aimed to describe the epidemiology of systolic dysfunction and EF recovery among consecutive patients hospitalized for their first MI. Methods Data from a single-centre prospectively-designed AMBITION registry of consecutive patients hospitalized for MI between years 2017 and 2021 at a large tertiary cardiology centre were utilized. Results Out of 1593 patients in the registry, 1065 were hospitalized for MI type I and had no previous history of heart failure (HF) or coronary artery disease. Revascularisation was performed in 93.5% of patients: 901 (84.6%) underwent PCI, 89 (8.4%) CABG and 6 (0.6%) both. At discharge, EF&amp;lt;40% was present in 238 (22.3%), EF 40–50% in 326 (30.6%) and EF &amp;gt;50% in 501 (47.0%), respectively. Patients with EF&amp;lt;40% were more often those who suffered subacute and anterior STEMI, had higher heart rate at admission and higher maximal troponin level, and more often HF signs requiring intravenous diuretic therapy (Table 1). In the multivariate Cox analysis, EF&amp;lt;40%, together with age, glomerular filtration rate, glycemia level, clinical signs of HF, and atrial fibrillation were associated with increased mortality risk. Among subjects with EF&amp;lt;40%, the control follow-up EF determined on a median 153 days (IQR 101–407) after discharge was available in 166 patients. Among these, systolic function recovered to EF&amp;gt;50% in 38 (22.9%) and improved to EF 40–50% in 45 (27.1%). Improvement in systolic function to EF&amp;gt;40% was predicted by lower severity of coronary artery atherosclerosis (GENSINI score), by higher discharge EF, by the lower leukocyte count, the absence of atrial fibrillation during MI hospitalization and glycemia level (Table 2). Recovery of systolic function was associated with lower mortality risk (log-rank p=0.012). Conclusion In the current era of primary coronary intervention, only 22% of patients after the first MI have EF below 40%. Of them, EF improves in 50%, and full recovery is observed in 23% of patients. Severity or coronary atherosclerosis, inflammatory response to MI, atrial fibrillation and glucose metabolism may all affect EF recovery. These observations provide novel therapeutic targets for EF recovery. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health, Czech Republic