Final Left Ventricular Ejection Fraction Research Articles

Prognosis After Withdrawal of Cardioprotective Therapy in Patients With Improved Cancer Therapeutics–Related Cardiac Dysfunction

BackgroundThe long-term prognosis after the discontinuation of cardioprotective therapy (CPT) in patients with cancer therapeutics–related cardiac dysfunction (CTRCD) that has shown improvement remains unclear. ObjectivesThis study aims to assess the prognosis after CPT withdrawal in patients exhibiting improved CTRCD. MethodsIn this retrospective analysis of a single-center prospective cohort study, patients with improved CTRCD, defined as an increase in left ventricular ejection fraction (LVEF) ≥10 percentage points from the time of CTRCD diagnosis, were included. We analyzed their clinical outcomes, which included hospitalization for heart failure or a decrease in LVEF ≥10 percentage points within 2 years after CTRCD improvement, alongside echocardiographic changes. ResultsThe cohort comprised 134 patients with improved CTRCD. The median follow-up duration after CTRCD diagnosis was 368.3 days (Q1-Q3: 160-536 days). After improvement, 90 patients continued CPT (continued group [CG]) and 44 withdrew CPT (withdrawn group [WG]). Among patients whose baseline LVEF at CTRCD diagnosis ranged from 45% to 55%, the final mean LVEF was comparable between both groups (CG: 64.9% ± 4.4% vs WG: 62.9% ± 4.2%; P = 0.059). However, for patients with a baseline LVEF <45%, the final mean LVEF was significantly lower in the WG (CG: 53.3% ± 6.4% vs WG: 48.2% ± 6.9%; P < 0.001). The occurrence of composite major clinical events was notably higher in the WG (HR: 3.06; 95% CI: 1.51-7.73; P = 0.002). ConclusionsPatients who withdrew CPT after demonstrating improvement in CTRCD experienced worse clinical outcomes. Notably, a significant decrease in LVEF was observed after CPT withdrawal in patients with a baseline LVEF <45%.

Development of automated neural network prediction for echocardiographic left ventricular ejection fraction.

The echocardiographic measurement of left ventricular ejection fraction (LVEF) is fundamental to the diagnosis and classification of patients with heart failure (HF). This paper aimed to quantify LVEF automatically and accurately with the proposed pipeline method based on deep neural networks and ensemble learning. Within the pipeline, an Atrous Convolutional Neural Network (ACNN) was first trained to segment the left ventricle (LV), before employing the area-length formulation based on the ellipsoid single-plane model to calculate LVEF values. This formulation required inputs of LV area, derived from segmentation using an improved Jeffrey's method, as well as LV length, derived from a novel ensemble learning model. To further improve the pipeline's accuracy, an automated peak detection algorithm was used to identify end-diastolic and end-systolic frames, avoiding issues with human error. Subsequently, single-beat LVEF values were averaged across all cardiac cycles to obtain the final LVEF. This method was developed and internally validated in an open-source dataset containing 10,030 echocardiograms. The Pearson's correlation coefficient was 0.83 for LVEF prediction compared to expert human analysis (p < 0.001), with a subsequent area under the receiver operator curve (AUROC) of 0.98 (95% confidence interval 0.97 to 0.99) for categorisation of HF with reduced ejection (HFrEF; LVEF<40%). In an external dataset with 200 echocardiograms, this method achieved an AUC of 0.90 (95% confidence interval 0.88 to 0.91) for HFrEF assessment. The automated neural network-based calculation of LVEF is comparable to expert clinicians performing time-consuming, frame-by-frame manual evaluations of cardiac systolic function.

Modelo de predicción para cuantificar la fracción de eyección recuperada del ventrículo izquierdo en taquimiocardiopatía

Introduction and objectivesTachycardiomyopathy is a frequent cause of reversible ventricular dysfunction, whose predictors of recovery are not properly identified. Their individual estimate would be useful to carry out the corresponding invasive procedures. MethodsThis is an observational, retrospective and unicentral study. Cases diagnosed with tachycardiomyopathy were collected between September 2015 and January 2023. The sample was split into 2 study groups: the first one was used for the construction of the linear regression model by performing a multivariate analysis based on evaluating all possible equations (sample 1, 70%); whereas the second one was intended for the validation of the model (sample 2, 30%). ResultsA total of 134 patients were gathered and left ventricular ejection fraction (LVEF) at recovery (the difference between final and original LVEF) was calculated in all of them. Within sample 1, setting parameters of 16,383 models were estimated. The model selected, based on Mallows’ Cp index, was the composed of the following variables: sex, arterial hypertension (HT), LVEF at diagnosis, achievement of rhythm control, and ablation. The selected model explains about half of the individual variability of the recovered LVEF (R2 0.493). Afterwards, individual LVEF at recovery predicted by the model was compared with the observed LVEF in sample 2. No overall significant differences were observed in the R2 coefficient of determination. ConclusionsSex, arterial hypertension, LVEF at diagnosis, achievement of rhythm control, and ablation were considered as predictors of recovered LVEF in patients with tachycardiomyopathy. This has made possible a quantitative estimate when integrating them within the model.

Renin-angiotensin System Antagonists and Beta-blockers in Prevention of Anthracycline Cardiotoxicity: a Systematic Review and Meta-analysis.

The evidence supporting the use of renin-angiotensin-aldosterone system (RAAS) inhibitors and beta-blockers for the prevention of anthracycline-induced cardiomyopathy is controversial. We performed a meta-analysis to assess the effectiveness of these drugs in preventing cardiotoxicity. The meta-analysis included prospective, randomized studies in adults receiving anthracycline chemotherapy and compared the use of RAAS inhibitors or beta-blockers versus placebo with a follow-up of 6 to 18 months. The primary outcome was change in left ventricular ejection fraction (LVEF) during chemotherapy. Secondary outcomes were the incidence of heart failure, all-cause mortality, and changes in end-diastolic measurement. Heterogeneity was assessed by stratification and meta-regression. A significance level of p < 0.05 was adopted. The search resulted in 17 studies, totaling 1,530 patients. The variation (delta) in LVEF was evaluated in 14 studies. Neurohormonal therapy was associated with a lower delta in pre- versus post-therapy LVEF (weighted mean difference 4.42 [95% confidence interval 2.3 to 6.6]) and higher final LVEF (p < 0.001). Treatment resulted in a lower incidence of heart failure (risk ratio 0.45 [95% confidence interval 0.3 to 0.7]). There was no effect on mortality (p = 0.3). For analysis of LVEF, substantial heterogeneity was documented, which was not explained by the variables explored in the study. The use of RAAS inhibitors and beta-blockers to prevent anthracycline-induced cardiotoxicity was associated with less pronounced reduction in LVEF, higher final LVEF, and lower incidence of heart failure. No changes in mortality were observed. (CRD PROSPERO 42019133615).

Alcoholic cardiomyopathy- characterization and outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Alcoholic cardiomyopathy is a severe consequence of chronic alcohol abuse and causes gradual changes in the structure and function of the heart, being a form of dilated cardiomyopathy. Purpose To characterize the population of patients (pts) with alcoholic cardiomyopathy (AC) in terms of baseline characteristics, echocardiographic parameters, alcohol consumption, medication and outcomes. We also intended to evaluate the impact of alcohol reduction/cessation. Methods We performed a retrospective study of the group of pts with the diagnosis of AC, established after exclusion of other aetiologies, followed in the heart failure consultation between 2018 and 2022. We divided the population into patients who maintained (2), reduced (1) (to an average of 2 drinks in men and 1 in women) or discontinued consumption (0). Results A total of 39 pts with a mean age of 68.13 ± 11 years were included. Of these, 35 were males (89.7%). In terms of cardiovascular risk factors, 64.1% had hypertension, 33.3% had diabetes, 53.5% dyslipidaemia, 10.3% had chronic hepatic disease, 30.8% were smokers and 10.3% ex-smokers. The prevalence of atrial fibrillation (AF) was 46.2%, with a median heart rate of 72.50 ± 20.99 bpm. At the beginning of follow-up, this population had a mean left ventricular ejection fraction (LVEF) of 30.46% ± 9.99, a mean indexed LA volume of 58.5 ml/m2 ± 32.63 and a mean indexed LV volume 87.44% ± 27.73. Concerning the alcohol consumption, during the follow-up, 43.6% of the patients stopped drinking alcohol, 10.3% reduced the habits and 20.5% maintained the consumption. Regarding the medication, at the end of follow-up 24.4% were medicated with sacubitril/valsartan, 51.1% with angiotensin-converting enzyme inhibitors, 71.1% with beta blockers, 51.1% with mineralocorticoid receptor antagonists and 35.6% with SGLT2 inhibitors. In a mean follow-up of 26.62± 11.11 months, there was a significant improvement of the ejection fraction (mean of 9.59% ± 12.97, p&amp;lt; 0.001), with a mean LVEF of 40.59% ± 12.78 at the end of follow-up. In fact, in 17.8% of the patients the final LVEF was more than 50%. Regarding indexed LV volume, there was a significant reduction during follow-up (102.250 ± 43.46 ml/m2, p= 0.018). Concerning alcohol consumption, pts who quit drinking had a mean improvement of LVEF of 13,73% ± 15.83 (p= 0.003), pts who reduced alcohol consumption 8.6% ± 5.81 (p=0.03) and pts that kept the consumption 2.67% ± 3.01 (p= 0.82). The variation of LVEF was statistically significant between the groups (p=0.03). These three groups had no statistically significant differences in medical history of hypertension (p=0.37), diabetes (p=0.22), dyslipidaemia (p=0.17), AF (p=0.70) and medication. Conclusion Pts with alcoholic cardiomyopathy had a high prevalence of atrial fibrillation and cardiovascular risk factors. Improvement and even recovery of cardiac function depends on reduction/extinction of alcohol consumption.

CI-452766-3 LEFT BUNDLE BRANCH AREA PACING IN PATIENTS WITH SEVERELY REDUCED LEFT VENTRICULAR EJECTION FRACTION

Left bundle branch area pacing (LBBAP) has been used as an alternative to biventricular pacing (BiVp) to achieve cardiac resynchronization therapy (CRT). However, its use in patients with severely reduced left ventricular ejection fraction (LVEF) has not been described. To evaluate the outcomes of LBBAP compared to BiVp in patients with an LVEF ≦20%. In this multicenter study, consecutive adult patients with ischemic and non-ischemic cardiomyopathy and an LVEF <35% undergoing CRT were included. LBBAP was offered as a first line treatment strategy after thorough discussion with patients; the last consecutive patients in whom BiVp was performed were used as controls. Patients were analyzed according to their LVEF (≤20% vs. 21-35%) and the pacing strategy used (LBBAP vs BiVp). The primary outcome was a composite of HF-related hospitalization and all-cause mortality. Secondary outcomes included individual components of the primary outcome, procedural and fluoroscopy times, paced QRS duration, change in LVEF, final LVEF, and change in HF-related symptoms. A total of 342 patients (mean age 69.7±11.2, female 30.1%; 117 with LVEF ≤20%) were included. No significant differences in the primary outcome or HF-related hospitalization were found in patients with LVEF ≤20% compared to patients with an LVEF 21-35%, but patients with a baseline LVEF ≤20% had a higher all-cause mortality (OR: 2.35; 95%CI 1.018-5.436, p=0.047). There were no differences in the primary outcome in patients with LVEF ≤20% treated with LBBAP vs. BiVp. However, patients with an LVEF ≤20% treated with LBBAP had significantly lower fluoroscopy times (17.5±10.3 vs. 23.1±15.4 mins., p=0.03), shorter paced QRS durations (124.6±18.7 vs. 151.1±34.3 msec, p<0.001), greater improvements in LVEF (8.1±11.2 vs. 3±5.7%, p=0.011), higher final LVEF (26.7±12.9 vs. 21.1±7.2%, p=0.018) and were less symptomatic (NYHA class 1.83±0.93 vs. 2.27±0.88, p=0.018) than patients treated with BiVp, respectively. A baseline LVEF ≤20% was associated with significantly longer procedural and fluoroscopy times in patients undergoing LBBAP compared to a baseline LVEF 21-35%. Patients with a baseline LVEF ≤20% have a higher all-cause mortality than patients with an LVEF 21-35%. Patients with an LVEF ≤20% treated with LBBAP have lower fluoroscopy time, shorter paced QRS duration, significantly less HF related symtpoms, greater changes and higher final LVEF than patients treated with BiVp.

Association of Soluble IL-1 Receptor Type 2 with Recovery of Left Ventricular Function and Clinical Outcomes in Acute Myocardial Infarction.

The role of soluble interleukin-1 receptor type 2 (sIL-1R2) in acute myocardial infarction (AMI) remains undocumented. In the present study, we aimed to evaluate the possible associations of sIL-1R2 with left ventricular (LV) function, remodeling and future clinical events in the setting of AMI. Circulating sIL-1R2 levels were quantified after percutaneous coronary intervention (PCI) on day 1 of hospital admission for 204 AMI patients, and upon enrollment of 204 healthy controls. Echocardiography was conducted in the acute phase and at 12-month follow-up. Adverse clinical events were registered after 12 months. Circulating sIL-1R2 levels were significantly higher in AMI patients than in healthy controls (medians respectively 6652.81 pg/mL, 3799.13 pg/mL, p 0.0001). AMI patients with sIL-1R2 levels less than the median had a larger proportion of worsened LV ejection fraction [a decrease in LV ejection fraction (LVEF) of more than 10% units] and reduced LVEF (a final LVEF 50%). After multivariate adjustment, sIL-1R2 levels less than the median were associated with an increased risk of worsened LVEF [odds ratio (OR): 3.7, 95% confidence interval (CI): 1.6-8.5, p = 0.002] and reduced LVEF at 12 months (OR: 2.1, 95% CI: 1.1-4.3, p = 0.035). Moreover, low sIL-1R2 levels were associated with an increased risk of having an adverse clinical event during the first 12 months after AMI [hazard ratio (HR): 2.5, 95% CI: 1.0-6.1, p = 0.039]. Low levels of circulating sIL-1R2 were associated with impaired recovery of LV function and adverse clinical outcomes in AMI patients. These findings might contribute to understanding the important role of sIL-1R2 in postinfarction inflammation.

Clinical predictors of improvement in left ventricular ejection fraction in U.S. veterans with heart failure

BackgroundOur understanding of the factors associated with improvement of LVEF and a heart failure with improved EF (HFimpEF) phenotype remains incomplete. MethodsWe conducted a retrospective study using a national database of patients followed in the Veterans Affairs (VA) health system with serial assessment of left ventricular ejection fraction (LVEF) by echocardiography. We identified US veterans with a new diagnosis of heart failure with: (i) LVEF of <40 % in the 12 months prior to diagnosis, and (ii) follow-up LVEF assessment at least 6 months after their diagnosis. We defined HFimpEF as a final LVEF of ≥40 %. ResultsAmong the 106,414 US veterans with an initial LVEF of <40 % in this analysis, 39,994 (37.6 %) had a final EF of >40 % after a median follow up of 5 years. Multivariate regression analysis identified several factors that were independently associated with LVEF improvement including female sex, younger age, higher BMI, and a history of specific comorbid conditions such as hypertension, valve disease, atrial fibrillation, connective tissue disease, liver disease, and malignancy (p < 0.001). Conversely, a history of ischemic heart disease and peripheral arterial disease, as well as specific racial backgrounds (Black and Hispanic) were associated with lower rates of LVEF improvement. The model c-statistic for predicting LVEF improvement was 0.70. ConclusionsThis large, detailed dataset facilitated an analysis of a large number of variables that significantly associated with HFimpEF; however, their combined discriminatory value for LVEF improvement remained modest, underscoring the complexity of the gene-environment-treatment interactions that govern LV function.

Tachycardiomyopathy: linear regression model for left ventricular ejection fraction recovery

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Tachycardiomyopathy is a common cause of reversible left ventricular disfunction, whose predictors are not well-stablished. Its individual estimation would be useful for the decision-making process. Methods Retrospective single-centre, observational study of consecutive patients with diagnosed tachycardiomyopathy between September 2014-2020. Sample was split in 2 parts: first for the construction of the lineal-regression model selected by the all-possible equation’s method (sample 1, 70% of the cohort), second for its validation (sample 2, 30%). Results 113 patients were gathered in this period. Most prevalent arrhythmia was atrial fibrillation (75.2%), followed by atrial flutter (22.1%), ventricular extrasystole (5.3%) and atrial tachycardia (2.65%). Mean left ventricular ejection fraction (LVEF) at diagnosis was 33.7% (±6.48) and mean left ventricular end-diastolic diameter 56.3 mm (±6.97). Rhythm control was achieved in 81.4% of patients, of whom 79.3% underwent an ablation procedure. After a mean of 11.4 months, mean final LVEF was 55.1% (±6.04). Recovered LVEF (final minus initial) was calculated in all patients. Using sample 1 131,071 models were calculated. The best model was selected based on the Mallows index (Picture 1), composed by arterial hypertension, sleep apnea syndrome, atrial fibrillation as the culprit arrythmia, LVEF at diagnosis and rhythm control strategy. The selected model explained nearly half of the individual variability of LVEF (R2 0.476). Subsequently in sample 2, predicted recovered LVEF was compared with the observed one (Picture 2), without significative differences in the determination coefficient r2 (R2 - r2 = -0.0064). Conclusion Arterial hypertension, sleep apnea syndrome, atrial fibrillation as the culprit arrythmia, LVEF at diagnosis and rhythm control strategy predicted LVEF recovery in tachycardiomyopathy patients.

THE HEART OF THE MATTER: ANTHRACYCLINE-INDUCED CARDIOTOXICITY

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cardiotoxicity is a well-known complication of anthracycline chemotherapy. The incidence has been reported as high as 9% in solid cancer patients and up to 18% in acute myeloid leukemia (AML) patients [1].Unfortunately, anthracycline-induced cardiotoxicity (AIC) in AML patients represents a unique and high-risk subset of patients that are largely underrepresented in the literature.We report a case of a patient with AML who was admitted for induction chemotherapy with Cytarabine and Daunorubicin. Two weeks later she developed cardiogenic shock and was transferred to the ICU. A literature review reveals gaps in current research and suggests AML patients are at particularly high risk for developing AIC. CASE PRESENTATION: Ms. D was a 64 year-old female with AML admitted for induction chemotherapy with high dose Cytarabine and Daunorubicin. Eighteen days after receiving treatment she developed hypoxic respiratory failure with pulmonary edema and an echocardiogram showed a newly reduced ejection fraction of 30%. Heart catheterization revealed a depressed cardiac index. She was started on inotropic support with improved lactate clearance and cardiac function; however, given her poor overall prognosis, she was determined to not be a candidate for mechanical circulatory support. Congruent with the patient's wishes, she was placed on comfort measures and died 12 hours later. DISCUSSION: AIC is generally defined as >10% reduction in left ventricular ejection fraction (LVEF) with a final LVEF < 50% [2]. Pathogenesis is multifactorial and involves reactive oxygen species generation and defective mitochondrial biogenesis with a predilection for cardiac myocytes due to their high mitochondrial content [3]. Patient risk factors for AIC include age >65 or <18 years old, female sex, pre-existing cardiac disease and genetic factors [1]. In studies of solid cancer and lymphoma regimens, AIC is dose-dependent [1]. For unclear reasons, AML patients seem to experience unexpectedly high rates of AIC after induction. Medications to reduce the risk of AIC include chelation therapy with dexrazoxane, prolonged infusion times, liposomal preparations and pre-treatment with enalapril and carvedilol [3]. These interventions have failed to show consistent benefit in AML patients [1]. CONCLUSIONS: We present a case of AIC in an AML patient who's only known risk factor was female sex. This case and review of the literature suggests that AML patients are at an increased risk for developing AIC. More research is needed to determine effective preventative strategies for AML patients receiving anthracycline chemotherapy. REFERENCE #1: Neuendorff NR, Loh KP, Mims AS, Christofyllakis K, Soo WK, Bölükbasi B, Oñoro-Algar C, Hundley WG, Klepin HD. Anthracycline-related cardiotoxicity in older patients with acute myeloid leukemia: a Young SIOG review paper. Blood Adv. 2020 Feb 25;4(4):762-775. doi: 10.1182/bloodadvances.2019000955. PMID: 32097461; PMCID: PMC7042993. REFERENCE #2: Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GYH, Lyon AR, Lopez Fernandez T, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM; ESC Scientific Document Group. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016 Sep 21;37(36):2768-2801. doi: 10.1093/eurheartj/ehw211. Epub 2016 Aug 26. Erratum in: Eur Heart J. 2016 Dec 24;: PMID: 27567406. REFERENCE #3: Volkova M, Russell R 3rd. Anthracycline cardiotoxicity: prevalence, pathogenesis and treatment. Curr Cardiol Rev. 2011 Nov;7(4):214-20. doi: DISCLOSURES: No relevant relationships by Robert McLeroy, source=Web Response No relevant relationships by Matthew Middendorf, source=Web Response No relevant relationships by Sarah Schulte, source=Web Response

Burden of Ventricular Arrhythmias in Cardiac Resynchronization Therapy Defibrillation and Implantable Cardioverter-Defibrillator Recipients with Recovered Left Ventricular Ejection Fraction: The Additive Role of Speckle-Tracking Echocardiography

Patients with heart failure undergoing cardiac resynchronization therapy with or without defibrillator function may exhibit recovery of left ventricular ejection fraction (LVEF) during follow-up. Mechanical dispersion (MD; the SD of time to peak longitudinal strain by two-dimensional speckle-tracking echocardiography) is a known predictor of life-threatening ventricular arrhythmias (VAs). Relationships among LVEF recovery, changes in MD, and incidence of VA are still not extensively investigated. In this retrospective study, recipients of cardiac resynchronization therapy defibrillation (n=183) or implantable cardioverter-defibrillators only (n=87) underwent conventional and speckle-tracking echocardiography, both at baseline and after 10 to 12months, and were followed clinically. Both a ≥10% increase in LVEF and a final LVEF > 35% defined echocardiographic response (EchoResp). Reduction in MD ≥10 msec defined MD response (MDResp). Risk for appropriate implantable cardioverter-defibrillator therapy for VAs was assessed using a multivariable Cox hazard model. The prevalence of EchoResp+ and MDResp+ was 39% and 46%, respectively. During follow-up (49.8±33.5months), 74 VA events occurred. The incidence rate (per 100 patient-years) of VAs was lowest in the EchoResp+/MDResp+group (1.66%; 95% CI, 0.69%-3.99%), highest in the EchoResp-/MDResp- group (12.8%; 95% CI, 9.53%-17.2%; P<.0001), and intermediate in the EchoResp-/MDResp+ (5.5%; 95% CI, 3.3%-9.4%) or EchoResp+/MDResp- (5.3%; 95% CI, 3.0%-9.4%) group. Multivariable analysis showed that higher MD at follow-up (>71.4 msec) was associated with VAs independent of whether final LVEF was below or above the guideline-reported cutoff of 35% (P<.05). Among ICD recipients, improvements in both left ventricular function and MD are associated with reduced risk for VAs. In patients whose follow-up LVEFs improved to >35%, risk for VAs, although substantially decreased, remained elevated in the presence of still elevated MD.

Statin Use Can Attenuate the Decline in Left Ventricular Ejection Fraction and the Incidence of Cardiomyopathy in Cardiotoxic Chemotherapy Recipients: A Systematic Review and Meta-Analysis.

There is insufficient evidence about the cardioprotective effects of statins against chemotherapy-induced cardiomyopathy. The MEDLINE and EMBASE databases were searched from inception to March 2021 for studies that reported the mean left ventricular ejection fraction (LVEF) before and after chemotherapy and the incidence of chemotherapy-induced cardiotoxicity in patients who received concurrent statin therapy and those who received chemotherapy alone. A random effects meta-analysis was performed to obtain the pooled weighted mean difference (WMD) and the 95% confidence interval (CI) for the mean final LVEF and the mean LVEF change, and the pooled odds ratio (OR) and the 95% CI of the incidence of chemotherapy-induced cardiomyopathy. Seven studies with 3042 patients were included in this meta-analysis (statin group: 1382 patients received concurrent statin with chemotherapy; control group: 1660 patients received chemotherapy alone). Patients in the control group had a more significant decline in LVEF (WMD = −6.08%, 95% CI: −8.55 to −3.61, p < 0.001) compared to those in the statin group. Additionally, the statin group had a significantly lower incidence of chemotherapy-induced cardiomyopathy compared to the control group (OR = 0.41, 95% CI = 0.28–0.60, p < 0.001). Consequently, our study showed a significant reduction in the incidence of chemotherapy-induced cardiomyopathy and the degree of LVEF decline in patients in the statin group compared to those in the control group.

Left ventricular-only fusion pacing versus cardiac resynchronization therapy in heart failure patients: A randomized controlled trial.

BackgroundIt is unclear whether clinical benefits of cardiac resynchronization can be achieved by pacing only the left ventricle.HypothesisWe aimed to compare the effect of a novel adaptive left ventricular‐only fusion pacing (LVP) on ventricular function with conventional biventricular pacing (BVP) in cardiac resynchronization therapy (CRT) indicated patients.MethodsThis prospective, randomized, multicenter study enrolled CRT‐indicated patients with PR interval ≤ 200 ms who were randomized in the adaptive LVP group (using the AdaptivCRT™ algorithm with intentional non‐capture right ventricular pacing) or the echocardiography‐optimized BVP group. Cardiac function and echocardiography were evaluated at baseline and follow‐ups. CRT super response was defined as two‐fold or more increase of left ventricular ejection fraction (LVEF) or final LVEF >45%, and LV end‐systolic volume (LVESV) decrease >15%, and New York Heart Association (NYHA) class improved by at least one level.ResultsSixty‐three patients were enrolled in the study (LVP = 34 vs. BVP = 29). At 6‐month follow‐up, significant improvements in LVEF, LVESV, and NYHA class were observed in both groups. The CRT super response rate was significantly higher in patients with high‐percentage adaptive LV‐only pacing in LVP group (68.4%) than in BVP group (36.4%, p = .04).ConclusionsAdaptive LV‐only pacing was comparable to BVP in improving cardiac function and clinical condition in CRT‐indicated patients. This finding raises the possibility that an adaptive LVP algorithm with appropriate right ventricular sensing to fuse with intrinsic right ventricular activation in a two‐lead (right atrium and left ventricle) device may provide clinical benefit in a subset of CRT patients with intact atrioventricular conduction.

B-IN01-06 PERSONALIZED APPROACH FOR CARDIAC RESYNCHRONIZATION THERAPY (CRT) IMPLANTATION GUIDED BY REAL-TIME NON-INVASIVE 3D ELECTROCARDIOGRAPHIC MAPPING

The optimal approach for CRT implantation is not established. To evaluate the feasibility of CRT implantation under electrocardiographic mapping guidance. Thirty consecutive patients with left ventricular ejection fraction (LVEF) ≤35% and conduction delay (9 LBBB and 21 non-LBBB) were recruited. A 252-electrode vest (CardioInsight, Medtronic) was worn by the patient during the procedure to measure the total activation time (TAT) when different pacing combinations of biventricular pacing (BVP), His-bundle pacing (HBP) and/or left bundle branch pacing (LBBP) were tested. The combination that resulted in the shortest TAT would be chosen. Clinical response was defined by ≥1 NYHA class improvement and echocardiographic response by LV end-systolic volume reduction ≥15% and/or LVEF improvement ≥10% at 6-months follow-up. Final pacing configurations involved LBBP in 40%, HBP in 33%, BVP in 13% and RV or LV pacing alone in 13% of patients. Mean QRS duration shortened from 164±18ms to 128±18ms and LVEF improved from 26±6% to 39±14% (both p <0.01). Clinical and echocardiographic response rates were 80% and 73%, respectively. Super echocardiographic responder rate (final LVEF >45%) was 33%. Mean TAT (57ms vs. 87ms) was significantly lower and TAT reduction (42% vs. 12%) was significantly greater with final pacing-configuration compared to BVP, respectively (both p<0.01). Personalized approach for CRT implantation using real-time non-invasive electrocardiographic mapping was feasible and associated with better resynchronization results compared to BVP.

B-PO01-100 PERSONALIZED APPROACH FOR CARDIAC RESYNCHRONIZATION THERAPY (CRT) IMPLANTATION GUIDED BY REAL-TIME NON-INVASIVE 3D ELECTROCARDIOGRAPHIC MAPPING

The optimal approach for CRT implantation is not established. To evaluate the feasibility of CRT implantation under electrocardiographic mapping guidance. Thirty consecutive patients with left ventricular ejection fraction (LVEF) ≤35% and conduction delay (9 LBBB and 21 non-LBBB) were recruited. A 252-electrode vest (CardioInsight, Medtronic) was worn by the patient during the procedure to measure the total activation time (TAT) when different pacing combinations of biventricular pacing (BVP), His-bundle pacing (HBP) and/or left bundle branch pacing (LBBP) were tested. The combination that resulted in the shortest TAT would be chosen. Clinical response was defined by ≥1 NYHA class improvement and echocardiographic response by LV end-systolic volume reduction ≥15% and/or LVEF improvement ≥10% at 6-months follow-up. Final pacing configurations involved LBBP in 40%, HBP in 33%, BVP in 13% and RV or LV pacing alone in 13% of patients. Mean QRS duration shortened from 164±18ms to 128±18ms and LVEF improved from 26±6% to 39±14% (both p <0.01). Clinical and echocardiographic response rates were 80% and 73%, respectively. Super echocardiographic responder rate (final LVEF >45%) was 33%. Mean TAT (57ms vs. 87ms) was significantly lower and TAT reduction (42% vs. 12%) was significantly greater with final pacing-configuration compared to BVP, respectively (both p<0.01). Personalized approach for CRT implantation using real-time non-invasive electrocardiographic mapping was feasible and associated with better resynchronization results compared to BVP.

Change in ejection fraction and long-term mortality in adults referred for echocardiography.

We investigated long-term mortality associated with changes in left ventricular ejection fraction (LVEF) in a large, real-world patient cohort. A total of 117 275 adults (63 ± 16 years, 46% women) had LVEF quantified by the same method ≥6months apart. This included 17 343 cases (66 ± 15 years, 48% women) being initially investigated for heart failure (HF). During 3.3 [interquartile range (IQR) 1.7-6.0] years from first to last echocardiogram, median change in LVEF was -1 (IQR -8 to +5) units from a baseline of 62% (IQR 54-69%). During subsequent 7.6 (IQR 4.3-10.1) years of follow-up, 11 397 (9.7%) and 34 101 (29.1%) cases died from cardiovascular disease and all causes, respectively. Actual 5-year, all-cause mortality increased from 12% to 29% among those with the smallest to the largest decrease in LVEF (from <5units to >30 units); the adjusted risk of cardiovascular-related mortality increased two- to eightfold beyond a >10-unit decline in LVEF (vs. minimal change; P< 0.001 for all comparisons). Among those initially investigated for HF (32% with initial LVEF <50%), the adjusted hazard ratio for cardiovascular-related mortality ranged from 0.35 [95% confidence interval (CI) 0.28-0.49] to 4.21 (95% CI 3.30-5.22) for a >30-unit increase to >30-unit decline in LVEF (vs. minimal change; P< 0.001 for both comparisons). A distinctive, bi-directional plateau of improved vs. worsening mortality was evident around a final LVEF of 50% to 55%. These data, derived from a large, heterogeneous cohort of adults being followed up with echocardiography, suggest that modest LVEF changes (particularly around an LVEF of 50-55%) may be of clinical significance.

Impact of age on reperfusion success and long-term prognosis in ST-segment elevation myocardial infarction - A cardiac magnetic resonance imaging study.

BackgroundCoronary collateral circulation and conditioning from remote ischemic coronary territories may protect culprit myocardium in the elderly, and younger STEMI patients could suffer from larger infarcts. We evaluated the impact of age on myocardial salvage and long-term prognosis in a contemporary STEMI cohort.MethodsOf 1603 included STEMI patients 807 underwent cardiac magnetic resonance. To assess the impact of age on infarct size and left ventricular ejection fraction (LVEF) as well as the composite endpoint of death and re-hospitalization for heart failure we stratified the patients by an age cut-off of 60 years.ResultsYounger STEMI patients had smaller final infarcts (10% vs. 12%, P = 0.012) and higher final LVEF (60% vs. 58%, P = 0.042). After adjusting for multiple potential confounders age did not remain significantly associated with infarct size and LVEF. During 4-year follow-up, the composite endpoint occurred less often in the young (3.2% vs. 17.2%; P < 0.001) with a univariate hazard ratio of 5.77 (95% CI, 3.75–8.89; p < 0.001). Event estimates of 4 subgroups (young vs. elderly and infarct size beyond vs. below median) showed a gradual increase in the occurrence of the composite endpoint depending on both age and acute infarct size (log-rank p < 0.001).ConclusionHaving a STEMI after entering the seventh decade of life more than quadrupled the risk of future death or re-hospitalization for heart failure. Risk of death and re-hospitalization depended on both advanced age and infarct size, albeit no substantial difference was found in infarct size, LVEF and salvage potential between younger and elderly patients with STEMI.

Probiotics Supplementation on Cardiac Remodeling Following Myocardial Infarction: a Single-Center Double-Blind Clinical Study

Adverse cardiac remodeling after myocardial infarction (MI) can lead to the syndrome of heart failure (HF). Recently, changes in gut microbiota composition (dysbiosis) have appeared as a novel candidate that may be linked to the development of CR and HF. The aim of this trial was to evaluate the effects of probiotics administration on attenuating CR in patients with MI. A single-center double-blind placebo-controlled stratified randomized clinical study was conducted in 44 subjects with MI who underwent percutaneous coronary intervention (PCI). Patients were randomly assigned to take, with lunch, either a probiotic capsule containing 1.6 × 109 colony-forming unit (CFU) of bacteria (treatment group) or capsules contained inulin (control group) over 3months. CR biomarkers (including serum procollagen III, transforming growth factor beta (TGF-β), trimethylamine N-oxide (TMAO), and matrix metallopeptidase 9 (MMP-9)) were assessed. Echocardiography results were measured at baseline and after the intervention. Significant decreases were seen in serum TGF-β concentrations (- 8.0 ± 2.1 vs. - 4.01 ± 1.8pg/mL, p = 0.001) and TMAO levels (- 17.43 ± 10.20 vs. - 4.54 ± 8.7mmol/L, p = 0.043), and there were no differences were seen in MMP-9 (- 4.1 ± 0.12 vs. - 4.01 + 0.15nmol/mL, p = 0.443) and procollagen III levels (- 1.35 ± 0.70 vs. 0.01 + 0.3mg/L, p = 0.392) subsequent to probiotics supplementation compared with the placebo group. Improvements in echocardiographic indices were also greater in the probiotics group as compared with that in the control group, but not at a significant level. Regression analysis revealed that baseline left ventricular ejection fraction (LVEF), and changes of procollagen III, predicted 62% of the final LVEF levels. Probiotics administration may have a beneficial effect on the cardiac remodeling process in patients with myocardial infarction. Iranian Registry of Clinical Trials (IRCT): IRCT20121028011288N15.

Circulating troponin and further left ventricular ejection fraction improvement in patients with previously recovered left ventricular ejection fraction.

AimsThe aim of this study is to determine factors associated with long‐term recovery of left ventricular ejection fraction (LVEF) in patients with heart failure with reduced EF (HFrEF) and if further recovery also occurs in this group.Methods and resultsAmong 621 participants enrolled in the Alberta Heart Failure Etiology and Analysis Team (HEART) Study, 316 with Stage C HF underwent comprehensive imaging and biomarker testing at enrolment and at 1‐year follow up. Using pre‐enrolment data, HF with recovered EF (HFrecEF) was defined as an absolute improvement ≥5% in LVEF from the prior lowest LVEF value, with a final LVEF value > 35% at or prior to study baseline. Participants with all LVEF > 40% were included for comparison. Hospitalization‐free survival to 5 years was performed.The median cohort age was 66 years, and time from diagnosis was 4 years; 82% were male patients. Of the 316 patients, 95 (30%) patients had HFrecEF and 56 (18%) patients pHFrEF. On multivariate analysis, only shorter duration of HF was predictive of HFrecEF status. Over 1 year, LVEF increased in the HFrecEF group 4.0% (0.15–7.90, P = 0.042) as compared with persistent HFrEF, who in turn demonstrated higher baseline serum high sensitivity Troponin‐T with further increase at follow up 0.55(0.33–0.86, P = 0.011). No change in any parameter in the HFpEF/HFmrEF group at follow up was observed.ConclusionsPatients with HFrecEF demonstrate evidence of additional late improvement in LVEF and unchanged troponin levels, in contrast to those with persistent HFrEF, where LVEF does not improve and serum troponin rises over time. These data help to inform mechanisms relating to late LV remodelling.

Assessment of Cardiac Function by Advanced Echocardiography in Breast Cancer Patients (HER2 Positive vs HER2 Negative)

Background: Human epidermal growth factor receptor 2(HER2) is a gene that makes proteins in the breast cell. The HER2 gene is present in about 25% - 30% of patients with breast cancers. The most common side effect of drugs is left ventricular dysfunction. Evaluation of left ventricular ejection fraction (LVEF) by 2D echocardiography cannot detect subtle changes in LV systolic function. Objectives: We want to draw a comparison between two groups of breast cancer patients (HER2 positive and negative) by advanced echocardiography. Methods: We have conducted a single center prospective study at Rajaie Cardiovascular Medical and Research Center in 2018 - 2019. Results: This analysis included 58 patients with breast cancer. 15 cases (34%) were HER2 positive. Mean left ventricular ejection fraction (2D LVEF) in HER2 positive patients was 55 % at baseline and in HER2 negative patients was 55 %. In HER2 positive patients we had 10 percent decrease in LVEF during follow-up and the final LVEF was about 45% (P value &lt; 0.05). Mean left ventricular ejection fraction by 3D echocardiography (3D LVEF) in HER positive patients was 57 % and in HER2 negative patients was 55 % at baseline. In HER2 positive patients we had about 20% decrease in 3D LVEF and the final LVEF was 40 % (P value &lt; 0.05). Mean circumferential strain (GCS) in HER2 positive patients was -21 and in HER2 negative patients was -21 at baseline which decreased to -18 in HER positive patients and -17 in HER2 negative patients, showing clinical significance ( P value = 0.008). Conclusions: In our study HER2 positive breast cancers showed about 10% drop in 2DEF, about 20% drop in 3DLVEF and about 5% drop in HMLVEF, which all were significant (P value &lt; 0.05). We found that GCS is more sensitive than GLS in detecting subclinical involvement, and early changes in GCS is a good predictor of subsequent development of drugs (anthracycline-transtuzumab) induced cardiotoxicity.