Increase In End-diastolic Volume Research Articles

Speckle-Tracking Echocardiography Predicts Adverse Left Ventricular Remodeling After Valve Replacement in Rheumatic Mitral Stenosis.

Rheumatic mitral stenosis(RMS) may leads to left ventricular remodeling (LVR), which can persist even after valve surgery. Identifying markers for early structure and function in patients with rheumatic heart disease who are at risk for adverse LVR after surgery can help determine the optimal timing of intervention. This study aimed to investigate whether preoperative parameters of global left ventricular long-axis strain (LVGLS) and mechanical discretization (MD) could predict postoperative adverse LVR. A total of 109 adult patients withRMS and 50 healthy controls were enrolled in this study. Baseline clinical features, conventional echocardiography results, LVGLS, and MD were compared between the two groups. Pre- and post-surgery echocardiography measurements were collected, and adverse LVR was defined as a>15% increase in left ventricular end-diastolic volume or >10% decrease in left ventricular ejection fraction. Binary regression analysis was used to determine independent predictors of poor left ventricular remodeling. The variables associated with adverse LVR in this study were LVGLS (P<0.001, odds ratio: 1.996, 95% CI: 1.394-2.856) and MD (P=0.011, odds ratio: 1.031, 95% CI: 1.007-1.055). The poorly reconstructed group had lower absolute values of LVGLS and higher MD than the healthy control group and the non-poorly reconstructed group. A LVGLS cutoff of -15.0% was the best predictor for patients with poorly reconstructed LVR (sensitivity: 75.7%; specificity: 100.0%; AUC: 0.93), and a MD cutoff of 63.8ms was the best predictor (sensitivity: 63.8%; specificity: 98.6%; AUC: 0.88). Speckle tracking echocardiography has potential value for predicting the progression of adverse LVR and for identifying non-responders among patients with RMS undergoing surgery.

Dosiahnennia kardiolohii u vyvchenni predyktoriv prohnozuvannia hostroi livoshlunochkovoi ta kryteriiv narostannia tiazhkosty khronichnoi sertsevoi nedostatnosty pid chas khvorob sertsia (ohliad literatury; rezultaty vlasnykh doslidzhen)

Introduction. Few works have been published in the literature on the prediction of predictors of acute and chronic heart failure. The aim of the study. Аnalyze the achievements of cardiology in the field of studying the predictors of predicting acute left ventricular failure and the criteria for the progression of CHF with various CVD. Materials and methods. Vikoristani 51 published an article and presented the results of public research in the field of predicting acute respiratory failure and progression of CHF in heart disease. Results. In most patients, the term after the transferred MI is associated with an increase in end-diastolic volume and end-systolic volume, which are prognostically unfavorable signs. In these cases, the development of LV remodeling is of great importance, as well as accepting the same name as MI, stroke, and HF. Predictors of unfavorable cardiovascular diseases dynamics: changes in EDV, ESV and left ventricular ejection fraction. It should be noted that GLS and diastolic dysfunction are important predictors of cardiovascular complications and SCD. The apparent mitral regurgitation increased the risk of death for 5 years of birth. On the basis of our research, we proved for the first time in 1991 that 4 pathogenetically related mechanisms play a leading role in the development of the initial stage of HF in SCD: central, regional pulmonary hemodynamics, microcirculation, and tissue exchange with the development of arteriolar hypoxemia, venous hyperoxia, reduction of ABB by O2 and utilization of oxygen by tissues, reduction of aerobic processes occurring in the H. A. Krebs cycle and replenishment of energy deficit due to increased glycolysis and pentose phosphate shunt (activities of succinate dehydrogenase and cytochrome oxidase). Conclusions. Based on the given data and own results of the study, predictors of predicting acute CHF and progression are: AMI, UA severe form, stable angina pectoris 3-4 FC, cardiac aneurysm, SBP more than 180 mm Hg. and is less than 100 mm Hg, age 70 years and older, AF, TP, VE of 3-5 gradations, “pirouette”-type VT, significant increase in EDV, ESV and decrease in LVEF. The study of predictors of acute progression and criteria for predicting CHF is of primary importance. Key words: predictor of acute left ventricular insufficiency, chronic heart failure

Prognostic role of left atrial morpho-functional parameters in left ventricular remodeling following acute st-elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite prompt reperfusion and optimal medical therapy of acute ST-elevation myocardial infarction (STEMI), patients may undergo left ventricular (LV) remodeling (REM), which may lead to systolic and/or diastolic heart failure. Little is known regarding factors and mechanisms leading to LV REM, and this knowledge gap hinders potential strategies to prevent this complication. Left atrium (LA) functional and dimensional parameters are emerging as independent prognostic markers in ischemic heart disease. Purpose The present study aims at exploring the potential role of LA morpho-functional parameters by CMR-FT in predicting LV REM following STEMI. Methods This study derives from a sub-analysis of the prospective and multicenter "VavirimS" trial. All patients were assessed through 2 consecutive CMR scans, at 1 and 6 months after STEMI. CMR-FT was applied to both LA and LV. The endpoint was to evaluate the association between LA volumes and phasic functions with LV REM at 6-month follow up, defined as: i) LV REMEDV: ≥10% increase in LV end diastolic volume (EDV); ii) LV REMEDV-ESV: ≥12% increase in LV EDV and ≥6% LV end systolic volume (ESV). Results Out of 193 patients included in the VavirimS trial, 149 were enrolled and 44 have been excluded either for inadequate image quality for CMR-FT analysis or for the presence of factors impacting on LA morphology and function (i.e. mitral regurgitation and atrial fibrillation). LV REMEDV occurred in 34 patients (23%), who showed worse LA strain parameters (reservoir, conduit and booster function), LV global radial strain (GRS) and LV global circumferential epicardial strain [Fig. 1]. At multivariate analysis, LA reservoir and LV global radial strain (GRS) were confirmed as independent predictors of LV-REMEDV [Fig. 1]. The best cut-off for LA reservoir and LV GRS were 20% (sensitivity 97%; specificity 45%) and 56% (sensitivity 67%; specificity 69%), respectively. LV REMEDV-ESV occurred in 17 patients (11%), who showed reduced LA strain and LV GRS [Fig. 1]. The only independent predictor of LV remodeling in this group was LA reservoir [Fig. 1]. A subgroup analysis has been performed on two groups, according to EF: i) p-EF: preserved ejection fraction, ii) r-EF: reduced ejection fraction. In the p-EF group both LA reservoir and LV GRS were confirmed to be associated with LV REM [Fig. 1], while in the r-EF group the only independent predictor of LV REM was LV GRS [Fig. 1]. Conclusions CMR-derived LA reservoir and LV GRS are independent predictors of LV remodeling following STEMI. In patients with preserved EF LA reservoir is confirmed as independent predictor of LV remodeling, hinting at early and subclinical impairment of left chambers compliance. LA functional parameters following STEMI may help physicians in identifying patients at higher risk of LV remodeling.

Stroke volume response during prolonged exercise depends on left ventricular filling: Evidence from a beta-blockade study.

Prolonged moderate intensity exercise leads to a progressive upward drift in heart rate (HR) that may compromise stroke volume (SV). Alternatively, the HR drift may be related to abated SV due to impaired ventricular function. The aim of this study was to examine the effects of cardiovascular drift on left ventricular volumes and in turn SV. Thirteen healthy young males completed two 60-minute cycling bouts on a semi-recumbent cycle ergometer at 57%VO2max either under placebo condition (CON) or after ingesting a small dose of β1-blockers (BB). Measurements of HR, end-diastolic volume (EDV), and end-systolic volume were obtained by echocardiography and used to calculate SV. Other variables such as ear temperature, skin temperature, blood pressure, and blood volume were measured to assess potential changes in thermoregulatory needs and loading conditions. HR drift was successfully prevented when using BB from min10 to min60 (128±9 to 126±8bpm, p=0.29) but not in CON (134±10 to 148±10bpm, p<0.01). Conversely, during the same time, SV increased by 13% when using BB (103±9 to 116±7mL, p<0.01) while it was unchanged in CON (99±7 to 101±9mL, p=0.37). The SV behavior was mediated by a 4% increase in EDV in the BB condition (164±18 to 170±18mL, p<0.01), while no change was observed in the CON condition (162±18 to 160±18mL, p=0.23). In conclusion, blocking HR drift enhances EDV and SV during prolonged exercise. These findings suggest that SV behavior is tightly related to filling time and loading conditions of the left ventricle.

MATERNAL LEFT VENTRICULAR ADAPTATION IN TWIN PREGNANCY

Objective: During pregnancy, a maternal left ventricular (LV) remodeling occurs to face significant hemodynamic changes. Although twin pregnancy can require greater modifications than in singleton, limited data are currently available. The aim of the study was to longitudinally investigate maternal changes of LV function and compliance in twin pregnancy. Design and method: 35 uncomplicated twin pregnancy women underwent transthoracic echocardiography at first (T1, 10-15 weeks) and third trimester (T3, 30-35 weeks) of gestation. Left atrial (LA) and LV dimensions, LV volumes, systolic and diastolic function were measured, LV mass was calculated. Speckle-tracking imaging was used to evaluate global longitudinal strain (GLS). Non-invasive pressure-volume curves (PV loops) were reconstructed using a dedicated software. Results: Maternal LA and LV dimensions, LV volumes and mass increased from T1 to T3. Ejection fraction and GLS showed no changes between visits. Assessment of diastolic function (at pulsed wave Doppler and tissue Doppler) showed no changes in E/A ratio, while E/e’ ratio was higher at T3. At PV loops analysis, ventricular-arterial coupling (VAC) was stable due to the reduction of both LV end-systolic elastance (Ees) and arterial elastance (Ea). An increase in stroke work was observed. The increase in LV end-diastolic volumes from T1 to T3 with no changes in LV end-diastolic filling pressure suggested enhanced LV cavity compliance (rightward shift of the end-diastolic pressure-volume relationship, EDPVR). Conclusions: Maternal heart in uncomplicated twin pregnancy adapts to the increased hemodynamic load with an increase in stroke work and enhancement of LV volumes without altering ventricular filling pressure.

Assessment of right ventricular structure and systolic function in amateur marathon runners using three-dimensional speckle tracking echocardiography.

Prolonged high-intensity endurance exercise has been reported to have adverse effects on the heart, which are further correlated with exercise dose. However, its effect on the right ventricle (RV) of amateur runners is unknown. This study aimed was to evaluate the early right ventricular structure and systolic function of amateur marathon runners by three-dimensional speckle tracking echocardiography (3D-STE), and to further analyze the correlation between relevant parameters and the amount of training. A total of 30 amateur marathon runners (marathon group) and 27 healthy volunteers (control group) were enrolled. Conventional echocardiography combined with 3D-STE was performed in all subjects, and the marathon group was screened by echocardiography a week before a marathon (V1), within 1h post-marathon (V2), and 4days post-marathon (V3). RV global longitudinal strain (GLS) and RV end-diastolic volume (EDV) increased significantly in the marathon group compared to the control group (P < 0.05). RV GLS was significantly decreased in the marathon group within 1h post-marathon (V1: -26.2 ± 2.5% vs V2: -23.0 ± 1.6% vs V3: -25.6 ± 2.6%, P < 0.001). However, there was no significant difference in RV ejection fraction (RVEF) (P > 0.05). The results of the correlation analysis showed that RV EDV and RV end-systolic volume (ESV) were positively correlated with the average training volume (P < 0.001). Multivariate linear regression analysis showed that average training volume was an independent predictor of RV EDV in amateur marathoners (β = 0.642, P < 0.001). The systolic function of the RV was enhanced in amateur marathon runners in the early stage, manifested by an increase in RV EDV. After a long period of high-intensity endurance exercise, RV systolic function will temporarily be reduced. 3D-STE can identify this subclinical change with high sensitivity and provide valuable information to assess the structure and function of RV in amateur marathon runners.

Endovascular aortic repair impact on myocardial contractility: A prospective study.

This study aimed to estimate if the altered sphygmic wave transmission may affect the left ventricular (LV) contractile function in patients undergoing endovascular aortic repair (EVAR). A prospective single-centre study was carried out on consecutive patients undergoing EVAR for abdominal aortic aneurysm. A preoperative and 6-month single photon emission computed tomography (SPECT) with arterial stiffness measurement were performed to evaluate variations in pressure wave curve and myocardial perfusion parameters. From 2018 to 2020 a total of 16 patients were included in the study. Among the parameters evaluated, we found a measurable reduction of the reflected wave transit time from pre- to postoperative period, for both stress (115.13 ± 7.2 ms-111.1 ± 7.0 ms, p = .08) and rest SPECT acquisitions (115.3 ± 6.2 ms-112.2 ± 5.6 ms, p = .1). Unidirectional increase of both LV end-systolic volume (34 ± 9 mL-39 ± 8 mL, p = .02) and end-diastolic volume (85 ± 34 mL-89 ± 29 mL, p = .6) was also observed. Lastly, the ratio between the end-systolic pressure and the end-systolic volume (maximal systolic myocardial stiffness) decreased from 3.6 ± 1.5 mmHg/mL to 2.66 ± .74 mmHg/mL (p = .03). Our data showed that EVAR induced an altered transmission of the sphygmic wave associated with an early LV contractile impairment.

Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during Infancy.

Surgical closure of an atrial septal defect (ASD) is infrequently indicated during infancy. We evaluated the clinical characteristics and outcomes of patients who underwent surgical ASD closure during infancy. A single-center retrospective review was performed for 39 patients (19 males) who underwent surgical ASD closure during infancy between 1993 and 2020. The median body weight percentile at the time of operation was 9.3. During a median follow-up of 60.9 months, 4 late deaths occurred due to chronic respiratory failure. A preoperative history of bronchopulmonary dysplasia (BPD) was the only risk factor for late mortality identified in Cox regression (hazard ratio, 3.54; 95% confidence interval [CI], 1.75-163.04; p=0.015). The 5-year survival rate was significantly lower in patients with preoperative history of BPD (97.0% vs. 50.0%, p<0.001) and preoperative ventilatory support (97.1% vs. 40.4%, p<0.001). There were significant postoperative increases in left ventricular end-diastolic (p=0.017), end-systolic (p=0.014), and stroke volume (p=0.013) indices. A generalized estimated equation model showed significantly better postoperative improvement in body weight percentiles in patients with lower weight percentiles at the time of operation (<10th percentile, p=0.01) and larger indexed ASD diameter (≥45 mm/m2, p=0.025). Patients with ASD necessitating surgical closure during infancy are extremely small preoperatively and remain small even after surgical closure. However, postoperative somatic growth was more prominent in smaller patients with larger defects, which may be attributable to an increase in postoperative cardiac output due to changes in ventricular septal configuration. The benefits of ASD closure in patients with BPD are undetermined.

Myocardial strain parameters and autonomic balance in various variants of the postinfarction course in patients receiving high-dose atorvastatin therapy

Aim. To study parameters of left ventricular (LV) strain and heart rate variability (HRV) in patients with ST-segment elevation myocardial infarction (STEMI) in various variants of postinfarction receiving high-dose atorvastatin therapy.Material and methods. The study included 96 patients with STEMI. All patients underwent two-dimensional speckle tracking echocardiography and 24-hour electrocardiographic monitoring with HRV analysis. The included individuals were divided into groups without pathological LV remodeling (R (-), n=57) and with pathological post-infarction LV remodeling (R (+), n=39), the criterion for which was an increase in end-diastolic and/or end-systolic volume &gt;20% and &gt;15%, respectively. Further, depending on the achievement of target low-density lipoprotein cholesterol (LDL-C) (1,5 mmol/l and/or a decrease of more than 50%), the following subgroups were identified: 17 (43,6%) people, who reached target LDL-C levels (group 1), 22 (56,4%) patients, who did not reach target LDL-C levels (group 2). Similar subgroups were identified in the R (-) group as follows: 28 (49,1%) people, who reached target LDL-C levels (group 3) and 29 (50,9%) people, who did not reach target LDL-C levels (group 4).Results. Starting from the 12th week of follow-up, worsening of global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain (p&lt;0,01) was registered in group 2. In group 1, worsening of these parameters was registered only by the 48th week (p&lt;0,01). In group 3, an increase in GLS was revealed by the 48th week (p=0,001), GCS and GRS — by the 12th week (p&lt;0,05). In group 4, favorable changes were observed only in GLS and GCS by the 48th week (p&lt;0,01). A significant change in HRV parameters was observed in group 3. By the 48th week, there was an increase in temporal indicators (SDNN, SDNNi, SDANN, RMSSD, pNN50) (p&lt;0,0001) and total spectrum power (p=0,0001) due to an increase in all frequency indicators (p&lt;0,001), while the index of autonomic balance L/H decreased by 33% (p=0,002). In group 4, only SDNN, SDANN and pNN50 (p&lt;0,05), as well as the total spectrum power (p=0,001) increased, but no change in frequencies. According to intergroup analysis in the acute period of STEMI, group 4 patients had higher HRV than in group 3 (p&lt;0,05).Conclusion. High-dose atorvastatin therapy improves LV strain characteristics and autonomic balance during the rehabilitation period after STEMI.

Twenty-year changes in the clinical and echocardiographic characteristics of patients with early postinfarction remodeling after primary ST-segment elevation myocardial infarction

Aim. To compare structural and functional left ventricular (LV) changes in the early period of myocardial infarction (MI) within 20 years on the basis of the Emergency Cardiology Department of the Cardiology Research Institute (Tomsk).Material and methods. The study included two groups of patients who were treated at different periods of time with an interval of 20 years. Group 1 included 83 patients who had ST-segment elevation MI (STEMI) in 1997-1999, while group 2 — 83 patients with STEMI from 2019-2020. Echocardiography was performed during the first 72 hours from hospitalization and on the 7-10th day. Depending on the increase in LV end-diastolic volume (EDV) by &gt;15% by the 7-10th day, the patients were divided into 2 subgroups: with remodeling (LVR+) and without remodeling (LVR-).Results. Patients of the 2nd group were older, with a larger proportion of females and with a high incidence of risk factors for coronary artery disease compared with patients of the 1st group. In the early postinfarction period among patients of the 2nd group, acute LV aneurysm, early postinfarction angina and Dressler syndrome developed less frequently. The proportion of adverse LV remodeling in patients of the 1st group was higher (32,8% vs 17%), and while the percentage of reverse remodeling was lower (10% vs 24%), p&lt;0,05. Comparison of the absolute values of LV EDV, end-systolic volume (ESV) and ejection fraction (EF) at baseline and after 7 days, as well as their increase showed higher intensity of post-infarction remodeling in group 1 patients. In patients of the 1st group, there was a progression of LV remodeling (Me ΔEDV — 12,2%) with a deterioration in LV contractility by the 7th day (Me ΔESV — 14%), while in patients of the 2nd group during the first 7 days of MI, there were more stable LV EDV and ESV (p&gt;0,05) and an increase in LVEF (p=0,03) before discharge.Conclusion. In the present era of primary percutaneous coronary intervention and pharmacological treatment of MI, early adverse LV remodeling develops less frequently and is characterized by less pronounced left heart dilatation.

Non-Contrast Cine Cardiac Magnetic Resonance Derived-Radiomics for the Prediction of Left Ventricular Adverse Remodeling in Patients With ST-Segment Elevation Myocardial Infarction.

To investigate the predictive value of radiomics features based on cardiac magnetic resonance (CMR) cine images for left ventricular adverse remodeling (LVAR) after acute ST-segment elevation myocardial infarction (STEMI). We conducted a retrospective, single-center, cohort study involving 244 patients (random-split into 170 and 74 for training and testing, respectively) having an acute STEMI (88.5% males, 57.0 ± 10.3 years of age) who underwent CMR examination at one week and six months after percutaneous coronary intervention. LVAR was defined as a 20% increase in left ventricular end-diastolic volume 6 months after acute STEMI. Radiomics features were extracted from the one-week CMR cine images using the least absolute shrinkage and selection operator regression (LASSO) analysis. The predictive performance of the selected features was evaluated using receiver operating characteristic curve analysis and the area under the curve (AUC). Nine radiomics features with non-zero coefficients were included in the LASSO regression of the radiomics score (RAD score). Infarct size (odds ratio [OR]: 1.04 (1.00-1.07); P = 0.031) and RAD score (OR: 3.43 (2.34-5.28); P < 0.001) were independent predictors of LVAR. The RAD score predicted LVAR, with an AUC (95% confidence interval [CI]) of 0.82 (0.75-0.89) in the training set and 0.75 (0.62-0.89) in the testing set. Combining the RAD score with infarct size yielded favorable performance in predicting LVAR, with an AUC of 0.84 (0.72-0.95). Moreover, the addition of the RAD score to the left ventricular ejection fraction (LVEF) significantly increased the AUC from 0.68 (0.52-0.84) to 0.82 (0.70-0.93) (P = 0.018), which was also comparable to the prediction provided by the combined microvascular obstruction, infarct size, and LVEF with an AUC of 0.79 (0.65-0.94) (P = 0.727). Radiomics analysis using non-contrast cine CMR can predict LVAR after STEMI independently and incrementally to LVEF and may provide an alternative to traditional CMR parameters.

Артериальная гипертензия при метаболическом синдроме у женщин репродуктивного возраста

Introduction. The number of overweight and obese people worldwide is steadily increasing. Metabolic disorders caused by excessive accumulation of body fat significantly affect the development and course of functional changes in the body, in particular arterial hypertension (AH). Aim. Determination and evaluation of the levels of carbohydrates, lipids and sex hormones in women of reproductive age with АН and associated metabolic syndrome (MS). Materials and methods. The study included 2 groups of women of reproductive age: the main group consisted of 30 patients with AH grade 1 and MS who were treated at the Aktobe Medical Center (Aktobe, Kazakhstan); control one consisted of 20 apparently healthy women who were examined at the Family Medicine Clinic of the West Kazakhstan Marat Ospanov Medical University. The groups were comparable in age (35–49 years). Along with the blood pressure and body measurements, some biochemical parameters were determined in all patients, and the heart performance indicators were also assessed (using echocardiography). Results. Changes of intracardiac hemodynamics in patients of the main group were revealed: an increase in left ventricle end-diastolic and end-systolic volume, as well as stroke volume. A biochemical analysis revealed an increase in glucose and triglyceride values in the main group, as well as an increase in the level of low-density lipoproteins and a decrease in the level of high-density lipoproteins in the main group compared to the control one. Conclusion. The development and progression of MS has a significant impact on the overall health status of patients and increases the risk of development and progression of АН.

Systemic hemodynamic and cardiac biomechanics changes induced by peripheral ECLS in a total closed chest cardiogenic shock sheep model

Veno-arterial ExtraCorporeal Life Support (VA-ECLS) is proposed as an efficient device to treat refractory cardiogenic shock (CS). If VA-ECLS restores systemic hemodynamics and thus end-organ perfusion, its consequences on native failing myocardium remain more questionable. Besides an increase in left ventricular (LV) afterload induced by retrograde blood flow, an increase in LV preload, LV wall stress, myocardial working as well as a decrease in coronary blood flow have been reported. Most of these cardiac biomechanics changes have been identified as triggers of myocardial remodeling pathways in a myocardial infarction model. Test the hypothesis that VA-ECLS during CS restores systemic hemodynamics but also provokes significant changes in cardiac biomechanics, which could initiate cardiac remodeling processes. A CS sheep model induced by percutaneous intra-coronary alcohol infusion was instrumented to assess cardiac biomechanics (conductance and Swan-Ganz catheter) and systemic hemodynamics. After a one-hour period of stability, a VA-ECLS was implanted through femoral access and blood flow was increased from 25% to 100% of baseline cardiac output by 30 min. Data are mean ± SEM and one-way ANOVA was used to assess the effects of ECLS on different parameters (vs. CS state). CS was characterized by a significant decrease in mean arterial pressure (−32 ±3%), cardiac index (−44 ±4%), and an increase in LVEDP (+86 ±24%). ECLS induced a significant and flow-dependent increase in MAP, carotid blood flow, and venous oxygen saturation. ECLS from 75% to 100% induced a significant decrease in central venous and mean pulmonary arterial pressures while a substantial increase in LV end-diastolic and end-systolic volumes, and arterial elastance was observed. Only ECLS 25 and 50% induced a significant decrease in pressure-volume area, stroke work, potential energy, and maximal elastance. At the high level of supply, all these parameters did not significantly differ from the CS state (Fig. 1). The ECLS restores systemic hemodynamics but also provokes significant changes in cardiac biomechanics. Whether such changes may be triggers of ventricular remodeling remains to be demonstrated by further experiments.

THE ROLE OF BIOMARKER MACROPHAGE MIGRATION INHIBITORY FACTOR IN CARDIAC REMODELING PREDICTION IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION.

The aim: To estimate the role of macrophage migration inhibitory factor and soluble ST2 in predicting the left ventricle remodeling six months after ST-segment elevation myocardial infarction. Materials and methods: The study involved 134 ST-segment elevation myocardial infarction patients. Occurrence of post-percutaneous coronary (PCI) intervention epicardial blood flow of TIMI <3 or myocardial blush grade 0-1 along with ST resolution <70% within 2 hours after PCI was qualified as the no-reflow condition. Left ventricle remodeling was defined after 6-months as an increase in left ventricle end-diastolic volume and/or end-systolic volume by more than 10%. Results: A logistic regression formula was evaluated. Included biomarkers were macrophage migration inhibitory factor and sST2, left ventricle ejection fraction: Y=exp(-39.06+0.82EF+0.096ST2+0.0028MIF) / (1+exp(-39.06+0.82EF+0.096ST2+0.0028MIF)). The estimated range is from 0 to 1 point. Less than 0.5 determines an adverse outcome, and more than 0.5 is a good prognosis. This equation, with sensitivity of 77 % and specificity of 85%, could predict the development of adverse left ventricle remodeling six months after a coronary event (AUC=0.864, CI 0.673 to 0.966, p<0.05). Conclusions: A combination of biomarkers gives a significant predicting result in the formation of adverse left ventricular remodeling after ST-segment elevation myocardial infarction.

Delayed aortic regurgitation after TEVAR procedure: a case report

BackgroundAcute aortic regurgitation (AR) is uncommon condition and usually results in an emergent situation because the left ventricle does not adapt quickly due to a sudden increase in end-diastolic volume caused by the regurgitant flow. Thoracic endovascular aortic repair (TEVAR) is a procedure that places a stent-graft on the lesion of thoracic aorta through a minimally invasive approach.Case presentationHere we report that a catheter-induced aortic valve injury associated with TEVAR can cause delayed AR, exemplified by the case of a patient who developed acute AR 42 months after TEVAR. For this, aortic valve replacement was performed and the patient was discharged without complications.ConclusionOur results demonstrate that when a catheter-related procedure is performed around the aortic valve, slight injury of the valve can cause aortic insufficiency even 3 years after surgery. Consequently, when performing a catheter-related procedure around the aortic valve, special attention is always required.

Combined effects of sepsis and extracorporeal membrane oxygenation on left ventricular performance in a murine model

Extracorporeal membrane oxygenation (ECMO) may be a viable salvage therapy in selected patients with septic shock. As ECMO use increases, we studied left ventricular (LV) performance during sepsis with and without ECMO using a pressure–volume (PV) loop in a murine model and aimed to understand LV hemodynamics in septic shock with ECMO. The rats were divided into Group 1 (ECMO applied to healthy rats), Group 2 (ECMO for septic rats), Group 3 (Controls, n = 20) and Group 4 (Sepsis induction only, n = 20). The cardiac parameters include end-diastolic volume (EDV), end-systolic volume (ESV), end-diastolic pressure (EDP), and end-systolic pressure (ESP), ejection fraction (EF), end-systolic elastance (Ees), diastolic time constant (Tau) index, arterial elastance (Ea), pressure–volume area (PVA), stroke work (SW), and potential energy (PE). We compared the changes of parameters in all groups. A total of 74 rats were included in the analyses. After 2 h on ECMO, Group 2 was associated with significant increases in ESP, EDV, ESV, PVA, PE, and SW. The difference ratio of PE and PVA was significantly higher in Group 2 compared to Group 1 (P < 0.01). In conclusion, myocardial oxygen consumption was higher in septic shock with ECMO than in controls.

Impact of Mineralocorticoid Receptor Gene NR3C2 on the Prediction of Functional Classification of Left Ventricular Remodeling and Arrhythmia after Acute Myocardial Infarction.

Background: The NR3C2 gene encodes the mineralocorticoid receptor, which is present on cardiomyocytes. Prior studies reported an association between the presence of NR3C2 single-nucleotide polymorphisms (SNPs) and an increased cortisol production during a stress response such as acute myocardial infarction (AMI), which may lead to adverse cardiac remodeling. Objective: To study the impact of the NR3C2 rs2070950, rs4635799 and rs5522 gene polymorphisms on left ventricular (LV) remodeling, rhythm and conduction disorders in AMI patients. Methods: A cohort of 301 AMI patients who underwent revascularization was included. SNPs of the NR3C2 gene (rs2070950, rs4635799 and rs5522) were evaluated. A total of 127 AMI patients underwent transthoracic echocardiography follow-up after 72 h and 6 months. Results: The rs2070950 GG genotype and rs4635799 TT genotype were most common in patients who had LV end-diastolic volume increase < 20% and the same or increased LV ejection fraction, indicating a possible protective effect of these SNPs. The rs5522 TT genotype was associated with a higher frequency of arrhythmias, while the presence of at least one rs5522 C allele was associated with a lower risk of arrhythmias. Conclusion: SNPs of the NR3C2 gene appear to correlate with better ventricular remodeling and a reduced rate of arrhythmias post-AMI, possibly by limiting the deleterious effects of cortisol on cardiomyocytes.

Predictive Value of Cardiac Magnetic Resonance for Left Ventricular Remodeling of Patients with Acute Anterior Myocardial Infarction.

Background: Heart failure is a serious complication resulting from left ventricular remodeling (LVR), especially in patients experiencing acute anterior myocardial infarction (AAMI). It is crucial to explore the predictive parameters for LVR following primary percutaneous coronary intervention (PPCI) in patients with AAMI. Methods: A total of 128 AAMI patients who were reperfused successfully by PPCI were enrolled sequentially from June 2018 to December 2019. Cardiovascular magnetic resonance (CMR) was performed at the early stage (<7 days) and after the 6-month follow-up. The patients were divided into LVR and non-LVR groups according to the increase of left ventricular end diastolic volume (LVEDV) measured by the second cardiac magnetic resonance examination ≥20% from baseline. (3) Results: The left ventricular ejection fraction (LVEF), the global longitudinal strain (GLS), the peak circumferential strain in infarcted segments, and the infarct size (IS) remained significantly different in the multivariate logistic regression analysis (all p < 0.05). The area under the receiver operating characteristic curve of Model 1, wherein the GLS was added to the LVEF, was 0.832 (95% CI 0.758−0.907, p < 0.001). The C-statistics for Model 2, which included the infarct-related regional parameters (IS and the peak circumferential strain in infarcted segments)was 0.917 (95% CI 0.870−0.965, p < 0.001). Model 2 was statistically superior to Model 1 in predicting LVR (IDI: 0.190, p = 0.002). (4) Conclusions: Both the global and regional CMR parameters were valuable in predicting LVR in patients with AAMI following the PPCI. The local parameters of the infarct zones were superior to those of the global ones.

Computational modelling of multi-temporal ventricular-vascular interactions during the progression of pulmonary arterial hypertension.

A computational framework is developed to consider the concurrent growth and remodelling (G&R) processes occurring in the large pulmonary artery (PA) and right ventricle (RV), as well as ventricular-vascular interactions during the progression of pulmonary arterial hypertension (PAH). This computational framework couples the RV and the proximal PA in a closed-loop circulatory system that operates in a short timescale of a cardiac cycle, and evolves over a long timescale due to G&R processes in the PA and RV. The framework predicts changes in haemodynamics (e.g. 68.2% increase in mean PA pressure), RV geometry (e.g. 38% increase in RV end-diastolic volume) and PA tissue microstructure (e.g. 90% increase in collagen mass) that are consistent with clinical and experimental measurements of PAH. The framework also predicts that a reduction in RV contractility is associated with long-term RV chamber dilation, a common biomarker observed in the late-stage PAH. Sensitivity analyses on the G&R rate constants show that large PA stiffening (both short and long term) is affected by RV remodelling more than the reverse. This framework can serve as a foundation for the future development of a more predictive and comprehensive cardiovascular G&R model with realistic heart and vascular geometries.

Low sCD163/TWEAK Ratio at First Day After Acute Myocardial Infarction Associated with Adverse Cardiac Remodeling in Non-Elderly Patients.

Aim In this study, we aimed to investigate the role of sCD163 / tumor necrosis factor-like weak apoptosis-inducing (TWEAK) ratio in cardiac remodeling in non-elderly patients diagnosed with first acute myocardial infarction (MI).Material and Methods Forty-four patients (age ranges: 40-64 years) diagnosed with first-time acute ST-elevation MI in the emergency department were evaluated with cardiac magnetic resonance (CMR) imaging. Adverse remodeling (AR) was defined the increases of left ventricular end-diastolic volume by ≥12 % by CMR at 6‑month post-MI TWEAK and sCD163 were measured at the first day (baseline), 2 weeks and 6 weeks post-MI.Results The average age of patients included in the study was 53.6±5.1 years. AR was detected in 18 patients at the 6 months post-MI. At the first day post-MI, median sCD163 concentration (116 069 vs 86 394 pg / mL, p=0.040) and median TWEAK concentration (759.4 vs 220.1 pg / mL, p&lt;0.001) were higher in AR group compared to group without AR (the non-AR group), median sCD163 / TWEAK ratio (101.4 vs. 406.8; p&lt;0.001) was lower. At the first day post-MI, concentrations of TWEAK and sCD163 showed a positive correlation in AR group and group without AR s. At 2 weeks post-MI, positive correlation continued in the non-AR group, but no significant correlation was found in the AR group. At the first day post-MI, sCD163 / TWEAK ratio was higher diagnostic performance compared to TWEAK and sCD163.Conclusion In the early phase post-MI, the relationship between sCD163 - TWEAK may have an important role in AR pathogenesis. A lower sCD163 / TWEAK ratio on the first day after MI was associated with an increase in left ventricular end-diastolic volume after 6 months of follow-up.