End Diastole Research Articles

Personalized evaluation of the passive myocardium in ischemic cardiomyopathy via computational modeling using Bayesian optimization.

Biomechanics-based patient-specific modeling is a promising approach that has proved invaluable for its clinical potential to assess the adversities caused by ischemic heart disease (IHD). In the present study, we propose a framework to find the passive material properties of the myocardium and the unloaded shape of cardiac ventricles simultaneously in patients diagnosed with ischemic cardiomyopathy (ICM). This was achieved by minimizing the difference between the simulated andthe target end-diastolic pressure-volume relationships (EDPVRs) using black-box Bayesian optimization, based on the finite element analysis (FEA). End-diastolic (ED) biventricular geometry and the location of the ischemia were determined from cardiac magnetic resonance (CMR) imaging. We employed our pipeline to model the cardiac ventricles of three patients aged between 57 and 66years, with and without the inclusion of valves. An excellent agreement between the simulated and thetarget EDPVRs has been reached. Our results revealed that the incorporation of valvular springs typically leads to lower hyperelastic parameters for both healthy and ischemic myocardium, as well as a higher fiber Green strain in the viable regions compared to models without valvular stiffness. Furthermore, the addition of valve-related effects did not result in significant changes in myofiber stress after optimization. We concluded that more accurate results could be obtained when cardiac valves were considered in modeling ventricles. The present novel and practical methodology paves the way for developing digital twins of ischemic cardiac ventricles, providing a non-invasive assessment for designing optimal personalized therapies in precision medicine.

Left Ventricular Diastolic Function in Children with Atrial Septal Defects Improves After Closure by Means of Increased Hydraulic Force

AbstractHydraulic force aids diastolic filling of the left ventricle (LV) by facilitating basal movement of the atrioventricular plane. The short-axis atrioventricular area difference (AVAD) determines direction and magnitude of this force. Patients with atrial septal defect (ASD) have reduced LV filling due to the left-to-right shunt across the atrial septum and thus potentially altered hydraulic force. The aims were therefore to use cardiac magnetic resonance images to assess whether AVAD and thus the hydraulic force differ in children with ASD compared to healthy children, and if it improves after ASD closure. Twenty-two children with ASD underwent cardiac magnetic resonance before ASD closure. Of these 22 children, 17 of them repeated their examination also after ASD closure. Twelve controls were included. Left atrial and ventricular areas were delineated in short-axis images, and AVAD was defined as the largest ventricular area minus the largest atrial area at each time frame and normalized to body height (AVADi). At end diastole AVADi was positive in all participants, suggesting a force acting towards the atrium assisting the diastolic movement of the atrioventricular plane; however, lower in children both before (6.3 cm2/m [5.2–8.0]; p < 0.0001) and after ASD closure (8.7 cm2/m [6.6–8.5]; p = 0.0003) compared to controls (12.2 cm2/m [11.3–13.9]). Left ventricular diastolic function improves after ASD closure in children by means of improved hydraulic force assessed by AVAD. Although AVADi improved after ASD closure, it was still lower than in controls, indicating diastolic abnormality even after ASD closure. In patients where AVADi is low, ASD closure may help avoid diastolic function deterioration and improve outcome. This could likely be important also in patients with small shunt volumes, especially if they are younger, who currently do not undergo ASD closure. Changes in clinical routine may be considered pending larger outcome studies.

Atrioventricular Area Difference Aids Diastolic Filling in Patients with Repaired Tetralogy of Fallot.

A hydraulic force aids diastolic filling of the left ventricle (LV) and is proportional to the difference in short-axis area between the left ventricle and atrium; the atrioventricular area difference (AVAD). Patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) have reduced LV filling which could lead to a negative AVAD and a hydraulic force impeding diastolic filling. The aim was to assess AVAD and to determine whether the hydraulic force aids or impedes diastolic filling in patients with rToF and PR, compared to controls. Twelve children with rToF (11.5 [9-13] years), 12 pediatric controls (10.5 [9-13] years), 12 adults with rToF (21.5 [19-27] years) and 12 adult controls (24 [21-29] years) were retrospectively included. Cine short-axis images were acquired using cardiac magnetic resonance imaging. Atrioventricular area difference was calculated as the largest left ventricular short-axis area minus the largest left atrial short-axis area at beginning of diastole and end diastole and indexed to height (AVADi). Children and adults with rToF and PR had higher AVADi (0.3 cm2/m [-1.3 to 0.8] and -0.6 [-1.5 to -0.2]) at beginning of diastole compared to controls (-2.7 cm2/m [-4.9 to -1.7], p = 0.015) and -3.3 cm2/m [-3.8 to -2.8], p = 0.017). At end diastole AVADi did not differ between patients and controls. Children and adults with rToF and pulmonary regurgitation have an atrioventricular area difference that do not differ from controls and thus a net hydraulic force that contributes to left ventricular diastolic filling, despite a small underfilled left ventricle due to pulmonary regurgitation.

A study on the application of radiomics based on cardiac MR non-enhanced cine sequence in the early diagnosis of hypertensive heart disease

BackgroundThe prevalence of hypertensive heart disease (HHD) is high and there is currently no easy way to detect early HHD. Explore the application of radiomics using cardiac magnetic resonance (CMR) non-enhanced cine sequences in diagnosing HHD and latent cardiac changes caused by hypertension.Methods132 patients who underwent CMR scanning were divided into groups: HHD (42), hypertension with normal cardiac structure and function (HWN) group (46), and normal control (NOR) group (44). Myocardial regions of the end-diastolic (ED) and end-systolic (ES) phases of the CMR short-axis cine sequence images were segmented into regions of interest (ROI). Three feature subsets (ED, ES, and ED combined with ES) were established after radiomic least absolute shrinkage and selection operator feature selection. Nine radiomic models were built using random forest (RF), support vector machine (SVM), and naive Bayes. Model performance was analyzed using receiver operating characteristic curves, and metrics like accuracy, area under the curve (AUC), precision, recall, and specificity.ResultsThe feature subsets included first-order, shape, and texture features. SVM of ED combined with ES achieved the highest accuracy (0.833), with a macro-average AUC of 0.941. AUCs for HHD, HWN, and NOR identification were 0.967, 0.876, and 0.963, respectively. Precisions were 0.972, 0.740, and 0.826; recalls were 0.833, 0.804, and 0.863, respectively; and specificities were 0.989, 0.863, and 0.909, respectively.ConclusionsRadiomics technology using CMR non-enhanced cine sequences can detect early cardiac changes due to hypertension. It holds promise for future use in screening for latent cardiac damage in early HHD.

Increased indexed proximal aortic diameter is a predictor of poor prognosis in maintenance hemodialysis patients

Background: Recent studies have shown that the baseline values of absolute aortic root diameter (ARD) and indexed diameter are associated with all-cause mortality and cardiovascular events in the general population, even in the absence of aneurysmal aortic disease. However, there is limited available data on the association between ARD and prognosis in end-stage renal disease (ESRD) patients receiving maintenance hemodialysis (MHD). Accordingly, the purpose of this study is to investigate the predictive value of ARD for all-cause mortality and cardiovascular events in this specific population.Methods: ARD was measured by echocardiography at the level of the sinuses of Valsalva at end diastole and indexed to body surface area (BSA). The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiovascular events (MACE), including cardiovascular mortality, myocardial infarction and stroke. Cox proportional hazards models were conducted to evaluate the association between baseline ARD/BSA and clinical outcomes.Results: A total of 391 patients were included in this study. The primary endpoint occurred in 95 (24.3%) patients while the secondary endpoint occurred in 71 (18.2%) patients. Multivariate Cox regression analysis showed that ARD/BSA was an independent prognostic factor for all-cause mortality (HR, per 1-SD increase, 1.403; 95% CI, 1.118–1.761; p = 0.003) as well as MACE (HR, per 1-SD increase, 1.356; 95% CI, 1.037–1.772; p = 0.026).Conclusions: Our results show that ARD/BSA is predictive of all-cause mortality and MACE in MHD patients with ESRD and support the view that assessment of ARD/BSA may refine risk stratification and preventive strategies in this population.

Diastolic Filling in Patients After Heart Transplantation Is Impaired Due to an Altered Geometrical Relationship Between the Left Atrium and Ventricle.

The geometrical relationship between atrial and ventricular short-axis cross-sectional area determines the hydraulic forces acting on intracardiac blood. This is important for diastolic filling. In patients undergoing heart transplantation (HTx), the left atrium is often enlarged as a result of the standard surgical technique. We hypothesized that diastolic filling in HTx patients is affected by the surgery altering the geometrical relationship between atrium and ventricle. This retrospective, cross-sectional study included 25 HTx patients (median age, 52 [range, 25-70] years), 15 patients with heart failure with reduced ejection fraction (median age, 63 [range, 52-75] years), 15 patients with heart failure with preserved ejection fraction (median age, 74 [range, 56-82] years), and 15 healthy controls (median age, 64 [range, 58-67] years) who underwent cardiac magnetic resonance imaging. Left ventricular, atrial, and total heart volumes (THV) were obtained. Atrioventricular area difference at end diastole and end systole was calculated as the largest ventricular short-axis area minus the largest atrial short-axis area. Left atrial minimum volume normalized for THV (LAmin/THV) was larger in HTx patients (median, 0.13 [range, 0.07-0.19]) compared with controls (median, 0.05 [range, 0.03-0.08], P <0.001), whereas left ventricular volume normalized for THV (left ventricular end-diastolic volume/THV) was similar between HTx and controls (median, 0.19 [range, 0.12-0.24] and median, 0.22 [range, 0.20-0.25], respectively). At end diastole, when atrioventricular area difference reached its largest positive value in controls, 11 HTx patients (44%) had a negative atrioventricular area difference, indicating impaired diastolic filling. Diastolic filling is impaired in HTx patients due to an altered geometrical relationship between the left atrium and ventricle. When performing cardiac transplantation, a surgical technique that creates a smaller left atrium may improve diastolic filling by aiding hydraulic forces.

The influence of the cardiac cycle on the halo sign and its impact on the ultrasound diagnosis of giant cell arteritis.

To investigate whether hypoechoic wall thickness is influenced by the systole or diastole moment in the cardiac cycle and if this can influence ultrasound (US) assessments of giant cell arteritis (GCA). US videos of 100 consecutive patients (50 with GCA, 50 without) performed between January 2021 and June 2023 were reviewed. Intima-media thickness (IMT) of temporal (including common trunk, frontal and parietal branches), axillary and subclavian arteries were measured at two different time points, at systolic peak (SP) and at the end-diastole (ED). Differences between SP IMT and ED IMT, as well as in the halo count (HC) and in the OMERACT GCA Ultrasonography Score (OGUS) between these two times, were analyzed. IMT was significantly higher (4.8-5%) at ED in all arteries, in both GCA and non-GCA groups. HC and OGUS were also higher in ED in both groups. In 4 non-GCA patients (8%), the HC was positive in ED and negative in SP; in all of them the HC in ED was 1. In the GCA group, the timing of the cardiac cycle did not influence the final US diagnosis; however, it did modify the HC in 14 patients (28%). IMT can fluctuate during the cardiac cycle, with higher measurements occurring at ED. This variability could potentially impact the accuracy of US diagnoses and assessments of GCA. If further research corroborates these findings, it may be imperative to revise the guidelines for employing US in diagnosing GCA in order to incorporate these nuanced aspects.

A RARE CASE OF INTERVENTRICULAR SEPTUM DUPLICATION

Abstract Case Report A 62–year–old man, history of hypertension. In 2015, there was suspicion of non–compaction cardiomyopathy, and he underwent cardiac MRI at another facility (report not available). The patient reported palpitations and dyspnea with exertion, leading to a follow–up visit. EKG showed sinus rhythm 90/min, nonspecific intraventricular conduction delay and isolated monomorphic ventricular ectopic beats. Echo revealed a mildly dilated left ventricle (end–diastolic volume 88 ml/m), systolic function at the lower limits of normal (EF 53%), and prominent muscular structures near the posterior interventricular septum (SIV), likely related to anomalies of the papillary muscles (prominent and possibly duplicated posterior–medial papillary muscle). There was apical trabecular protrusion, which did not meet the criteria for non–compaction (NC/C ratio in systole approximately 1), with no other significant findings. The cardiac MRI, performed to assess dilated cardiomyopathy, revealed a conspicuous structural abnormality in the septo–papillary region, located medio–apically and paraseptal–endocardial in the left ventricle. This anomaly lacked evident chordae tendineae with the mitral valve leaflets and exhibited synchronous systo–diastolic motion with the left ventricular wall, suggesting septal duplication. The septal thickness was slightly reduced, particularly in the medio–apical region. Additionally, there was hypertrabeculation of the posterior and lateral walls of the left ventricle, exceeding the threshold for non–compaction (NC/C ratio in end–diastole: 2.6 – normal range: &amp;lt;2.3). Left ventricular mass was normal (mass: 173.52 g; mass/body surface area (BSA): 86.58 g/m). Basal septum, medio–apical septum and medio–apical lateral wallshowed hypokinetic contractility. The left ventricle was dilated (end–diastolic diameter: 55.0 mm; end–systolic diameter: 45.3 mm – end–diastolic volume: 230 ml; stroke volume/BSA: 57.6 ml/m² – EF: 51%). Areas of late gadolinium enhancement (LGE) were observed in the anterior medio–basal septum and at the site of the described structural muscular anomaly, both displaying an intramural non–ischemic pattern. Conclusions The described findings suggest a picture of dilated cardiomyopathy and an associated structural septo–papillary anomaly of uncertain diagnostic interpretation (septum duplication with associated non–compacted myocardium? duplicated posterior–medial papillary muscle with associated non–compacted myocardium?).

DIASTOLIC DYSFUNCTION EVALUATION IN CARDIAC AMYLOIDOSIS: BEYOND TRADITIONAL PARAMETERS TO DISCRIMINATE BETWEEN TRUE HEART FAILURE WITH PRESERVED EJECTION FRACTION AND MIMICS

Abstract Background Diastolic dysfunction in cardiac amyloidosis (CA), according to current guidelines, can be classified using mitral flow velocities, mitral annular e’ velocity, E/e’ ratio, tricuspid regurgitation jet and left atrial (LA) maximal volume. However, LA minimal volume and the ratio between LA and left ventricular (LV) volumes at end–diastole, known as left atrio–ventricular coupling index (LACI), have recently been proposed to refine prognosis and peak atrial longitudinal strain (PALS) has been demonstrated to better stratify diastolic dysfunction. Aim of the Study To evaluate, in patients with CA: 1) the role of LACI as marker of LV diastolic dysfunction; 2) whether LACI could discriminate cardiomyopathy from normal cardiac function; 3) whether LACI and/or PALS could help discriminate between true heart failure with preserved ejection fraction (HFpEF) and amyloidotic cardiomyopathy (HFpEF–mimic). Methods We retrospectively analyzed 63 patients with CA and compared them with 80 true HFpEF patients and 70 healthy people; echocardiography was performed at the time of the diagnosis and diastolic function was characterized according to current guidelines. Results In patients with CA, LACI significantly increased as diastolic dysfunction worsened (P for trend &amp;lt; 0.0001) and significantly correlated with LV filling pressures estimated by E/e’ ratio (beta = 0.65, P &amp;lt; 0.0001) and pulmonary artery systolic pressure (beta = 0.63, P &amp;lt; 0.0001). LACI, after adjustment for age, gender and body mass index (BMI), was significantly higher in CA [0.62 (95%CI 0.52–0.70)] and in HFpEF [0.61 (95%CI 0.55–0.68)] than in controls [0.29 (95%CI 0.19–0.39)], while the difference between the two diseased populations was not statistically significant; a cut–off value of 0.45 was able to discriminate between controls and diseased patients (sensitivity = 95%, specificity = 94%, area under ROC curve = 0.98). PALS, after adjustment for age, gender and BMI, was significantly lower in CA [11.1 (95%CI 8.4–13.8%) and 8.4 (95%CI 3.5–13.3%) respectively in ATTR and AL] than in HFpEF [17.4 (95%CI 15.6–19.3%)], and a cut–off value of 9.9% was able to discriminate between them (sensitivity = 89%, specificity = 73%, area under ROC curve = 0.86). Conclusions LACI is a novel index able to discriminate between normal and diseased patients. In CA, it shows good correlation with diastolic dysfunction and LV filling pressures. PALS can be used to discriminate between true HFpEF and CA.

Evaluation of deep learning estimation of whole heart anatomy from automated cardiovascular magnetic resonance short- and long-axis analyses in UK Biobank.

Standard methods of heart chamber volume estimation in cardiovascular magnetic resonance (CMR) typically utilize simple geometric formulae based on a limited number of slices. We aimed to evaluate whether an automated deep learning neural network prediction of 3D anatomy of all four chambers would show stronger associations with cardiovascular risk factors and disease than standard volume estimation methods in the UK Biobank. A deep learning network was adapted to predict 3D segmentations of left and right ventricles (LV, RV) and atria (LA, RA) at ∼1 mm isotropic resolution from CMR short- and long-axis 2D segmentations obtained from a fully automated machine learning pipeline in 4723 individuals with cardiovascular disease (CVD) and 5733 without in the UK Biobank. Relationships between volumes at end-diastole (ED) and end-systole (ES) and risk/disease factors were quantified using univariate, multivariate, and logistic regression analyses. Strength of association between deep learning volumes and standard volumes was compared using the area under the receiving operator characteristic curve (AUC). Univariate and multivariate associations between deep learning volumes and most risk and disease factors were stronger than for standard volumes (higher R2 and more significant P-values), particularly for sex, age, and body mass index. AUCs for all logistic regressions were higher for deep learning volumes than standard volumes (P < 0.001 for all four chambers at ED and ES). Neural network reconstructions of whole heart volumes had significantly stronger associations with CVD and risk factors than standard volume estimation methods in an automatic processing pipeline.

HFSCCD: A Hybrid Neural Network for Fetal Standard Cardiac Cycle Detection in Ultrasound Videos.

In the fetal cardiac ultrasound examination, standard cardiac cycle (SCC) recognition is the essential foundation for diagnosing congenital heart disease. Previous studies have mostly focused on the detection of adult CCs, which may not be applicable to the fetus. In clinical practice, localization of SCCs needs to recognize end-systole (ES) and end-diastole (ED) frames accurately, ensuring that every frame in the cycle is a standard view. Most existing methods are not based on the detection of key anatomical structures, which may not recognize irrelevant views and background frames, results containing non-standard frames, or even it does not work in clinical practice. We propose an end-to-end hybrid neural network based on an object detector to detect SCCs from fetal ultrasound videos efficiently, which consists of 3 modules, namely Anatomical Structure Detection (ASD), Cardiac Cycle Localization (CCL), and Standard Plane Recognition (SPR). Specifically, ASD uses an object detector to identify 9 key anatomical structures, 3 cardiac motion phases, and the corresponding confidence scores from fetal ultrasound videos. On this basis, we propose a joint probability method in the CCL to learn the cardiac motion cycle based on the 3 cardiac motion phases. In SPR, to reduce the impact of structure detection errors on the accuracy of the standard plane recognition, we use XGBoost algorithm to learn the relation knowledge of the detected anatomical structures. We evaluate our method on the test fetal ultrasound video datasets and clinical examination cases and achieve remarkable results. This study may pave the way for clinical practices.

Cervical lymphatic vessel dysfunction induced by amyloid-β and in the 5x-FAD mouse model of Alzheimer’s disease

Alzheimer’s dementia is a multifactorial disease characterized by amyloid-β (Aβ) accumulation in the brain. Aβ clearance occurs partially via meningeal lymphatics into cervical lymph nodes through superficial cervical lymphatic vessels (sCLV), which relies on intrinsic contractions of sCLV. Previous studies showed increased Aβ build up in the brain following ablation of meningeal lymphatics; however, whether Aβ alters sCLV function remains unclear. We hypothesize that sCLV contractile function will be reduced by acute Aβ exposure and in the 5x-FAD mouse model of Alzheimer’s disease. Contractile function of freshly isolated sCLV was assessed using pressure myography. Acute Aβ exposure was achieved by intraluminal incubation of pressurized sCLV with Aβ(1-40) (5 μM) or vehicle for 15 minutes prior to the start of the experiment. Repeated end-diastolic (EDD) and end-systolic (ESD) measurements were used to calculate fractional pump flow (FPF), the product of contractile frequency (FREQ) measured as contractions per minute (Hz), and ejection fraction (EF) calculated as (EDD2-ESD2)/EDD2, at incremental intraluminal pressures ranging from 2 to 10 cmH2O. Statistical differences were determined by two-way ANOVA followed by Sidak correction for multiple comparisons. All data are means ± SEM. In sCLV isolated from 5 months-old males and females C57bl/6J mice, acute Aβ exposure significantly decreased FREQ (Vehicle vs Aβ, n=4 / n=7, p&lt;0.01), without changes in EF (Vehicle vs Aβ, n=4 / n=7, p=0.115) or FPF (Vehicle vs Aβ, n=4 / n=7, p= 0.536). In pressurized sCLV isolated from 5x-FAD mice, when compared to wild-type littermates, we observed a significant reduction in FREQ (Wild-type vs 5x-FAD, n=4 / n=5, p&lt;0.01). No differences were observed in EF (Wild-type vs 5x-FAD, n=4 / n=5, p=0.1224) or FPF (Wild-type vs 5x-FAD, n=4 / n=5, p=0.193). Together, these preliminary data suggest that acute exposure to Aβ(1-40) decreases FREQ of isolated sCLV, a similar effect observed in sCLV isolated from 5x-FAD mice, albeit not reaching statistical power for multiple comparison significance. Consequently, a decrease contractile frequency can contribute to impairments in lymphatic pumping, which to some extent, can be compensated by prolonged filling times, thus leading to increased ejection fraction. In conclusion, we predict that in vivo sCLV contractile function is maintained via compensatory increases in ejection fraction in conditions of exacerbated Aβ production and deposition. Funding: National Institutes of Health (R01 AG073230) and the Alzheimer’s Association (AARGD-21-850835). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

IMPROVEMENT OF RENAL HAEMODYNAMICS AND ECHOCARDIOGRAPHIC PARAMETERS IN PHARMACOLOGICAL CONTROLLED HYPERTENSIVES

Objective: A study was carried out to evaluate the influence of blood pressure lowering treatment with combined doses of olmesartan plus amplodipina compared with those of either drug at a single dose level. Design and method: By double-blind, three-way crossover study (balanced Latin square design) in 102 subjects (mean age 51.9 +/- 7.42 years) with essential hypertension we used Olmesartan 40 mg plus Amplodine 5 mg compared with those of either drug at a single and higher dose level (40 or 10 mg daily, respectively). Left ventricular mass and function were evaluated by M-B mode echocardiography, renal function by glomerular filtration rate (GFR) and by serum and 24-h urinary Na+ and K+ during wash-out period and after 24 weeks of treatment. Results: The supine blood pressure for subjects given placebo was 171/103 mmHg. After 24 weeks of treatment, systolic and diastolic supine blood pressure were significantly lower with 40 mg iolmesartan plus 5 mg amplodipine (134/84 mmHg) than with 10 mg amplodipine (137/84 mmHg) or with 40 mg olmesartan (144/85 mmHg). Left ventricular posterior wall and septal thickness were significantly and similarly reduced in all groups. Left ventricular systolic and diastolic end diameters were not significantly changed. Left ventricular mass (LVM) was significantly reduced in Olmesartan plus Amplodipine group and Olmesartan group. GFR was not significantly altered. The 24-h urinary Na+ significantly increased with olmesartan, more so than amplodipine. The combination was tolerated better than either monotherapy. We observed no clinically significant changes in laboratory variables including blood lipoproteins. Conclusions: The combination of olmesartan plus amplodipina reduced blood pressure more effectively and was better tolerated than other drug alone. All three groups showed similar changes in echocardiographic indices and no change in renal function.

Diagnosis and treatment of feline persistent ductus arteriosus: a retrospective evaluation of 17 cats

The objective of this study was to evaluate the signalement, clinical features, and echocardiographic findings of cats diagnosed with patent ductus arteriosus (PDA) as well as short- and medium-term outcome after successful ligation of the PDA. Over a 10-year period 17 cats were diagnosed with PDA by transthoracic echocardiography. Thirteen cats were surgically treated by thoracotomy and ligation of the PDA. In all cats, a heart murmur was detected. In 88.2% of the cases, this presented as grade 4 out of 6 murmur (15/17 cats). A continuous murmur was more common (10/17 cats; 58.9%) than a systolic murmur (7/17 cats; 41.1%). Echocardiography showed that left ventricular internal diameter end diastole (LVIDd) and left ventricular internal diameter end systole (LVIDs) were significantly above reference values in the majority of cats. Mean diameter of the PDA measured at the widest point of the vessel was 3.4 mm (± 1.08 mm) and mean maximum flow velocity amounted to 5,06 m/sec (2,6m/sec-6,4m/sec). Surgery was successfully performed in all cats treated by surgical ligation and all of these patients were discharged after postoperative inpatient therapy. One cat experienced perioperative bleeding from the PDA, which was stopped efficaciously. This cat exhibited a residual shunt directly postoperatively; this could no longer be visualized in a re-check echocardiography 3 months later. Six cats were followed over a longer period of time. The surgical prognosis in this case study is very good with a postoperative survival rate of 100%. Surgical treatment of PDA is curative in animals not displaying advanced cardiac lesions. The auscultation of a heart murmur can provide initial findings indicative of PDA. Therefore, cardiac auscultation is warranted at every first presentation of a kitten. It must however be taken into consideration that not every cat with PDA necessarily has a continuous murmur but may display a systolic heart murmur. Therefore, it is important give utmost attention to the patients' clinical signs.

Impact of birth weight to placental weight ratio and other perinatal risk factors on left ventricular dimensions in newborns: a prospective cohort analysis.

To investigate the association between birth weight to placental weight (BW/PW) ratio, and echocardiographic left ventricle (LV) morphology at birth, while accounting for other relevant perinatal factors. A prospective cohort study was conducted on neonates at NewYork-Presbyterian Brooklyn Methodist Hospital from 2014 to 2018, categorized by their BW/PW percentile. Missing data were imputed with principal component analysis. Chi-squared and one-way analysis of variance were used to compare BW/PW groups and the best regression model was selected using a genetic and backward stepwise algorithm. We analyzed 827 neonates in three BW/PW groups: small (n=16), normal (n=488), and large (n=323). Placental thickness and smallest diameter were positively correlated with several LV parameters, including inter-ventricular septal thickness during diastole (IVSd) (p=0.002, p<0.001) and systole (IVSs) (p=0.001, p<0.001), LV posterior wall thickness at end of diastole (LVPWd) (p=0.003, p<0.001) and systole (LVPWs) (p<0.001, p<0.001), LV mass (p=0.017, p<0.001), and LV mass/volume (p=0.011, p<0.001). The BW/PW ratio correlated with an increased shortening fraction (estimate=0.29, 95 % CI 0.03-0.55, p=0.027). PW correlated with IVSs (p=0.019), while the longest placental diameter was linked to a decrease in LV internal dimension during diastole (LVIDd) (estimate=-0.07, p=0.039), LV mass (estimate=-0.11, p=0.024), and LV mass/volume (estimate=-0.55, p=0.005). This study found that several placental factors, including the BW/PW ratio, can independently affect LV dimension and morphology, highlighting the importance of fetal growth and placental health in the physiological adaptation of the fetal heart. More research is needed to establish causation and inform newborn prevention strategies.

Impact of left ventricular hypertrophy on frequency and complexity of ventricular arrhythmia among hypertensive Egyptian patients

BackgroundLeft ventricular hypertrophy (LVH) is associated with an increased risk of ventricular arrhythmias and cardiovascular mortality. The study objective was to investigate the effect of LVH severity on the complexity and severity of ventricular arrhythmias among a subset of Egyptian hypertensive patients.ResultsThe study cohort consisted of 60 hypertensive patients with LVH as diagnosed by echocardiography. Their mean age was (53.7 ± 12.3) years. 36 males (40%) and 24 females (60%). Diabetes mellitus was found in 26 patients (43%), 41% of these cases were smokers. 48-h Holter monitoring was performed in all cases to assess the frequency of ventricular premature contractions (VPC) and their complexity using the Lown grading. Increasing posterior wall thickness end diastole (PWTd) was an independent predictor of increasing VPC frequency, each 1 mm increase in the PWTd is associated with a 1.26% increase in the VPC% among total heart beats (b = 12.6, p < 0.001). Higher-grade VPCs—defined as grade 4a, 4b, and 5—were seen in 29 patients (48.3%). Interventricular septum thickness end diastole, PWTd, left ventricular mass, and left ventricular mass index (LVMI), were significantly higher among patients with higher Lown grading (p < 0.001). Using logistic regression analysis, female sex and LVMI were independent predictors of more complex VPC (OR = 8.766, p = .014), (OR = 1.096, p < 0.001), respectively. Among females, LVMI of more than 120 g/m2 can differentiate between high- and low-grade VPCs with 71% sensitivity and 80% specificity, while among males, LVMI of more than 129.5 g/m2 can differentiate between high and low-grade VPCs with 86% sensitivity and 66% specificity.ConclusionsThe frequency and complexity of ventricular arrhythmias among hypertensive heart disease are correlated with the severity of ventricular hypertrophy. Female sex and increasing left ventricular mass index are independent predictors of more complex forms of ventricular arrhythmias.

Morphological and dynamic analysis of the normal aortic valve with 4D computed tomography.

To evaluate the precise dimensions of the normal aortic root, especially the true aortic annulus, during the cardiac cycle using an innovative reconstruction method based on Multiphase Cardiac CT (MCCT) and to assess the feasibility and the reproducibility of this method for aortic root analysis. Between January 2019 and June 2021, 30 optimal consecutive ECG-gated MCCT of patients with normal tricuspid aortic valve were analyzed using an in-house software. Aortic annulus border was pinpointed on 9 reconstructed planes and the 3D coordinates of the 18 consecutive points were interpolated into a 3D curve using a cubic spline. Three additional planes were generated at the level of the left ventricular outflow tract, the level of the Valsalva sinus and the level of the sinotubular junction. This procedure was repeated for all the 10 temporal phases of the RR interval. The aortic annulus mean 3D and 2D areas were 7.67 ± 1.51 cm2 and 5.16 ± 1.40 cm2, respectively. Mean 2D diameter was 2.51 ± 0.23 cm. The mean global area expansion was 11.8 ± 3.5% and the mean perimeter expansion of 7.1 ± 2.6%. During the cardiac cycle, the left ventricle outflow tract expands, reaching its maximum surface at the end of diastole, followed by the aortic annulus, the valsalva sinuses and the sinotubular junction. The aorta changes from a clover shaped cone during diastole to more cylindrical shape during systole. Compared to the 3D measurements, the analysis of the virtual basal ring significantly underestimates the annulus area, perimeter, and mean diameter. 4D morphometric analysis enables to have a precise and reproducible evaluation of the aortic annulus. The aortic annulus and root are deformable structures that undergo a unique expansion sequence during the cardiac cycle which should be considered for procedural planning.

Abstract P437: Cumulative Effect of Early-Onset Type 2 Diabetes on Left Ventricular Geometry - The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Type 2 diabetes (T2D) is increasingly common in young adults. Increases in left ventricular (LV) mass and wall thickness are early manifestations of myocardial involvement in T2D. The association between the cumulative burden of risk factors (RFs) and LV structural abnormalities in patients with early-onset T2D has not been well characterized. Objective: Investigate how metabolic RFs accumulated in a 25-year period among patients with early-onset T2D relate to LV mass index (LVMI) and relative wall thickness (RWT). Methods: We used data from the Coronary Artery Risk Development in Young Adults study (CARDIA, baseline to year 25). We defined early-onset T2D by self-reported T2D or anti-diabetic medication use, fasting glucose (FG) ≥126 mg/dL, or oral glucose ≥200 mg/dL at or before follow-up year 10 (age&lt;40). LV outcomes were measured by Doppler echocardiography (LVMI by Devereux formula indexed to body surface area; RWT = LV posterior wall thickness at end diastole x 2/LV internal dimension at end-diastole). Hypertrophy was defined by LVMI ≥115 g/m 2 in men or ≥95 g/m 2 in women. We used the area under the growth curve (AUC) that was derived from quadratic random-effects models of ≥4 repeated measures of RFs (BMI, SBP, DBP, LDL-c, HDL-c, triglycerides, fasting glucose, and fasting insulin) to estimate the cumulative burden of T2D through adulthood. We performed linear regressions to examine the associations of the total AUC of each RF with LVMI or RWT, accounting for sex, race, mid-life age, education, smoking, and control for hypertension, lipids, and diabetes. We assessed the associations by sex and race. Results: Among 227 patients with early-onset T2D, 39% had hypertrophy, and 13% had RWT&gt;0.42 at midlife. Each standard deviation (SD) increase in total AUCs of BMI, SBP, DBP, triglycerides, FG, and fasting insulin was significantly associated with increased LVMI (β coefficients =5.9, 11.5, 10, 7, 4.1, and 6.7, respectively), while high total AUC of HDL-c was inversely associated with LVMI (β = -5.1). Increased total AUC of triglycerides was associated with increased RWT (β = 0.2). Significant sex and race differences were shown in the cumulative effect of RFs on outcomes. The positive associations between AUC of RFs and LVMI were significant in both sexes, but the associations were stronger in male patients than in women. The inverse association between AUC of HDL-c and LVMI was only significant in male patients (P-interaction &lt;0.05). Women with early-onset T2D but not men exhibited significantly increased RWT related to the increase in AUCs of SBP, DBP, triglycerides, FG, and insulin (P-interaction &lt;0.05). The positive association between AUC of BMI and LVMI was significant in Whites but not Blacks (P-interaction &lt;0.05). Conclusion: Cumulative RFs alter mid-adulthood LV geometry in patients with early-onset T2D. This cumulative impact of early-onset T2D on LV geometry varies by sex and race.

Identification of Circulating Plasma Proteins as a Mediator of Hypertension-Driven Cardiac Remodeling: A Mediation Mendelian Randomization Study.

This study focused on circulating plasma protein profiles to identify mediators of hypertension-driven myocardial remodeling and heart failure. A Mendelian randomization design was used to investigate the causal impact of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure on 82 cardiac magnetic resonance traits and heart failure risk. Mediation analyses were also conducted to identify potential plasma proteins mediating these effects. Genetically proxied higher SBP, DBP, and pulse pressure were causally associated with increased left ventricular myocardial mass and alterations in global myocardial wall thickness at end diastole. Elevated SBP and DBP were linked to increased regional myocardial radial strain of the left ventricle (basal anterior, mid, and apical walls), while higher SBP was associated with reduced circumferential strain in specific left ventricular segments (apical, mid-anteroseptal, mid-inferoseptal, and mid-inferolateral walls). Specific plasma proteins mediated the impact of blood pressure on cardiac remodeling, with FGF5 (fibroblast growth factor 5) contributing 2.96% (P=0.024) and 4.15% (P=0.046) to the total effect of SBP and DBP on myocardial wall thickness at end diastole in the apical anterior segment and leptin explaining 15.21% (P=0.042) and 23.24% (P=0.022) of the total effect of SBP and DBP on radial strain in the mid-anteroseptal segment. Additionally, FGF5 was the only mediator, explaining 4.19% (P=0.013) and 4.54% (P=0.032) of the total effect of SBP and DBP on heart failure susceptibility. This mediation Mendelian randomization study provides evidence supporting specific circulating plasma proteins as mediators of hypertension-driven cardiac remodeling and heart failure.

DILATED CARDIOMYOPATHY IN SLENDER-TAILED MEERKATS (SURICATA SURICATTA) UNDER HUMAN CARE.

Meerkats (Suricata suricatta) housed at two accredited zoological institutions in the United States were evaluated via echocardiography, thoracic radiography, and blood biomarkers-taurine and feline N-terminal pro-B-type natriuretic peptide-to determine the prevalence and severity of dilated cardiomyopathy (DCM) in both populations. In total, 24 meerkats were evaluated and 7 were diagnosed with DCM based on the following parameters: left ventricular internal diameter at end diastole > 1.30 cm, left ventricular internal diameter at end systole > 1.10 cm, and a fractional shortening of <18%. Echocardiographic parameters were identified and reported for normal and affected meerkats, whereas thoracic radiographs were not useful for screening for DCM. Meerkats with DCM were treated with pimobendan and/or benazepril and furosemide if indicated. Seven meerkats died during the study period, with the majority exhibiting myocardial fibrosis. Of the blood parameters tested, elevated taurine levels were associated with DCM. Further research is necessary to characterize the etiology of DCM in meerkats.