Functional Echocardiographic Parameters Research Articles

Sex-related differences in left atrial and right ventricular remodelling and function in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Abstract Background Sex-specific differences in aortic stenosis(AS) regarding the underlying pathophysiological mechanisms affecting the valve and left ventricular(LV) response to pressure overload are well recognised. Data on differences in left atrial(LA) and right heart remodelling and function between men and women with AS are scarce. Purpose To investigate sex-related differences in LA and right ventricular(RV) remodelling and function echocardiographic parameters in AS patients(pts) and their association with long term all-cause mortality after TAVI. Methods Fifty-seven women and 57 men with severe AS undergoing TAVI, matched to be similar with respect to age(77±6 vs 78±6 yrs,p=0.67) and LV ejection fraction(55±10 vs 54±8%,p=0.22) were enrolled and examined before and 30 days after TAVI. All pts underwent a comprehensive echocardiogram, including speckle tracking echocardiography (STE) for deformation analysis. Peak values of global longitudinal LA strain(LAε), LA systolic strain rate(SSr, reservoir function) and early diastolic strain rate(ESr, conduit function) were measured in all. Contractile LA function(late diastolic strain rate, ASr) was assessed in pts in sinus rhythm(89 pts). Results At baseline, the degree of LA dilation in female pts was higher(indexed LA volume(LAVi): 54.1±12.4 vs 47.9±16.7 ml,p=0.028), global longitudinal LA strain(12.6±6.2 vs 13.7±7.1%), SSr(0.6±0.3 vs 0.7±0.3) and ESr(-0.4±0.3 vs -0.5±0.3) were similar in men and women(all p values >0.05), while women had worse contractile LA function(ASr: -0.9±0.5 vs -1.2±0.6,p=0.034). Women also had a less dilated RV(32±5 vs 35±5mm,p=0.012) and better RV global systolic function(fractional area change, FAC: 44±8 vs 40±6%,p=0.012). A significant improvement in LA volumes, global LA strain, SSr and ESr 30 days after TAVI was observed in both men and women, while the contractile LA function improved only in men. The RV parameters that significantly improved after TAVI were the RV-free wall S wave in both men(p<0.001) and women(p=0.003) and the 6-segments RVLS in women(p=0.037)(Figure 1). During follow-up(4.2±0.7yrs), death occurred in 27 pts(23.7%). Although 1-year and 3-year survival rates were higher in women, 5-year survival rate was similar in both groups(Figure 2). In female pts, the predictors for all-cause mortality were baseline RV-free wall S wave(p=0.045) and LAVi(p=0.036), and after-TAVI LAVi(p=0.023), while in male pts the only predictors were global longitudinal LA strain at baseline(p=0.036) and after-TAVI(p=0.016). Conclusions AS is associated with significant differences in LA and RV response between men and women, with women exhibiting a more significant LA dilatation, poorer LA contractile function, less dilated RV and better RV global systolic function. TAVI is associated with a significant recovery of LA dimensions and function in both men and women, suggesting reverse remodelling, although men show a more significant improvement in LA contractile function. Figure 1 Figure 2

Reverse structural and functional left atrial remodeling after successful catheter ablation for paroxysmal atrial fibrillation.

Abstract Background Catheter ablation is considered the most effective method for restoring sinus rhythm in patients with atrial fibrillation (AF). However, data on the reverse structural and functional remodeling of the left atrium (LA) after a successful procedure are still inconclusive, especially in patients with sinus rhythm during catheter ablation. The aim of the present study was to investigate echocardiographic parameters indicating the presence of reverse LA remodeling, following a successful procedure and long-term follow-up of sinus rhythm maintenance. Methods Of the 106 patients who had undergone successful catheter ablation (between January 2021 and May 2023) for paroxysmal AF (with sinus rhythm on echocardiography during ablation), 49 patients were included in the study up to now. The absence of AF recurrence was assessed during a follow-up consisting of outpatient visits/televisits and 7-day Holter monitoring (at 6 and 12 months after ablation). All patients underwent conventional and 2D speckle tracking echocardiography on the day of ablation and after the long-term of follow-up period of maintanance of sinus rhythm. Results A total of 48 patients were included in the study. The mean age of the study population was 60±11 years, of which 62.5% were male. The follow-up period was 17 ± 4month. A significant increase in LA reservoir strain (LASr) (median 23 vs. 25%, p<0.001) and e’ average (median 7.5 vs. 8.5 cm/s, p=0.02) was noted from baseline to follow-up. LA stiffness index (defined as E/e’average/LASr ratio) (median 0.33 vs. 0.28, p=0.001), LA area (median 23.8 vs. 22.1cm2, p=0.003) and LA volume index (median 35.9 vs. 32.9ml/m2, p<0.001) showed significant reduction over the same time period. In addition, left ventricular (LV) end-diastolic diameter, indexed LV mass index and right atrial area, decreased significantly (51 vs. 49 mm, p<0.001; 123 vs. 109g/m2, p<0.001, 17.2 vs. 15.5cm2, p=0.02, respectively). Left ventricular function parameters, such as LV ejection fraction or global LV longitudinal strain, remained unchanged. Conclusions During the long-term follow-up period after restoration and maintenance of sinus rhythm following catheter ablation for AF, both structural and functional echocardiographic parameters of the LA improved. Our preliminary results also suggest the possibility of reverse structural LV and RA remodeling after successful AF treatment.

Comparison of Functional Echocardiographic Markers in Septic and Non-Septic Neonate

Background: Neonatal sepsis accounts for significant morbidity and mortality and its hemodynamics is complex. Functional echocardiography is emerging at a rapid pace and currently it is considered as a key tool for providing real time information on cardiovascular performance. Objective: To assess and compare functional Echocardiographic markers in septic and non-septic neonate. Methodology: This cross-sectional comparative study was conducted in the Department of Neonatology, BSMMU over an Eighteen-month period from March 2022 to August 2023. 25 neonates including term baby and preterm ≥ 34 weeks with early or late-onset sepsis satisfying the inclusion criteria were enrolled for the study and compared with same gestational age matched healthy control. Result: Comparison of functional echocardiographic parameters between two groups were statistically significant in respect to right and left ventricular output and tricuspid annular plane systolic excursion. Cardiac output was increased (rt. ventricular output 277.4 ± 74.2 Vs 209 ± 70, lt. ventricular output 339.5 ± 43.2 Vs 276 ± 74.9, p-values were 0.002 and 0.001 respectively) and tricuspid annular plane systolic excursion (0.49 ± 0.13 Vs 0.74 ± 0.34, p value 0.001) was decreased in septic neonate compared to healthy counterpart. The result was also statistically significant result in respect to right and left ventricular output and tricuspid annular plane systolic excursion (p-values were 0.039, 0.004 and 0.01) respectively in comparison between preterm septic and non-septic newborn. When compared between the term neonates (37 weeks to 40 weeks) of both groups, there were also statistically significant result in respect to right ventricular output, left ventricular output and tricuspid annular plane systolic excursion (p- values were 0.006,0.03 and 0.025) respectively. Conclusion: Significant cardiovascular changes like cardiac output and right ventricular systolic dysfunction evidenced by Functional Echocardiography, were common association of neonatal sepsis in comparison to non-septic neonate.

Atrial cardiomyopathy in postmenopausal female healthcare professionals- a single-center study

Abstract Background Atrial cardiomyopathy (ACM) is a new clinical entity with significant importance, because of its potential to be a determinant of heart failure, atrial fibrillation and thromboembolic complications¹. Defining different atrial phenotypes is challenging, because of the lack of consensus for the diagnosis of ACM²'³. Menopausal transition is associated with adverse changes in women’s health such as obesity and hypertension, both known risk factors for ACM⁴. Aim To investigate left atrial (LA) structural and functional echocardiographic parameters in postmenopausal female healthcare professionals and to define atrial phenotype in this population. Methods Consecutive asymptomatic, postmenopausal, middle-age women (n=105), healthcare professionals from our hospital, were separated in 3 groups according to co-morbidities : with obesity (n=50), obesity and hypertension (n=24), healthy control (n=31). All patients underwent 2D echocardiographic examination with volumetric and speckle tracking analysis of LA. Results There were significant differences in LA structural and functional indices between 3 groups- table 1. Higher body mass index was associated with increased LA volume index (p<0.001, r= 0.56), reduced LA total emptying fraction- LATEF (p<0.001, r= -0.62), Peak atrial longitudinal strain-PALS (p<0.001, r= -0.59 ) and Peak atrial contractile strain- PACS (p<0.001, r= 0.56 ). ROC analysis was performed for identifying atrial phenotype of obese women with hypertension: LAVi 16.5ml/m2,(sensitivity 0.833, specificity 0.839, AUC 0.875), PALS 46.55% (sensitivity 0.903, specificity 0.875, AUC 0.951), PACS -20.75% (sensitivity 0.806, specificity 0.708, AUC 0.855), LATEF 69% (sensitivity 0.903, specificity 0.792, AUC 0.920)- figure 1. Conclusion Postmenopausal women with obesity and hypertension are at risk for asymptomatic ACM. Further investigations are needed to confirm this concept.

The role of cardiopulmonary rehabilitation in the recovery of right ventricular function and right ventricular-pulmonary artery coupling in convalescent COVID-19 patients

Abstract Introduction Coronavirus disease-19 (COVID-19) is predominantly a respiratory disease, but simultaneous cardiovascular impairment has been documented, even in the post-acute phase. Subclinical right ventricular (RV) dysfunction is often described and mainly attributed to parenchymal lung damage (ARDS) or pulmonary vascular complications such as pulmonary embolism. Cardiopulmonary rehabilitation programs play an integral part in the long-term management of chronic cardiovascular and pulmonary diseases and lately have been proven useful in managing post-COVID-19 sequelae. Purpose The aim of this study is to assess the impact of a post-COVID-19 rehabilitation program in the recovery of right ventricular function and right ventricular-pulmonary artery coupling in convalescent COVID-19 patients. Methods 40 convalescent COVID-19 patients were evaluated one and three months after the acute phase of the disease. 30 subjects participated in a 3-month cardiopulmonary rehabilitation program (study group) and 10 did not (control group). Right ventricular function echocardiographic parameters (right ventricular global longitudinal strain (RVGLS) and pulmonary artery systolic pressure (PASP)) were evaluated and right ventricular-arterial coupling (RVAC) was estimated via the RVGLS/PASP ratio. Results A total of 40 patients were included in this study, of whom 30 underwent cardiopulmonary rehabilitation. There were no major differences in the prevalence of cardiovascular risk factors between the two groups. When examining right ventricular parameters at baseline, RVGLS (Rehabilitation: -23.1 (4.1) % vs. No rehabilitation: -23.0 (4.7) %, p=0.94) and PASP (Rehabilitation: 28 (6) mmHg vs. No rehabilitation: 25 (4) mmHg, p=0.08) did not differ statistically between the two groups. RVAC was also similar at baseline (Rehabilitation: -0.96 (0.28) %/mmHg vs. No rehabilitation: -0.86 (0.27) %/mmHg, p=0.30). At follow-up, patients who underwent cardiopulmonary rehabilitation exhibited a significant improvement in RVGLS (from Τ0: -23.1 (4.2) % to T1: -24.3 (4) %, p<0.001), PASP (from T0: 28 (6) mmHg to T1: 27 (5) mmHg, p=0.016), and RVAC (from T0: -0.86 (0.27) %/mmHg to T1: -0.93 (0.26) %/mmHg, p<0.001). In the no rehabilitation group, RVGLS (from T0: -23.0 (4.7) % to T1: -23.2 (4.4) %, p=0.19), PASP (from T0: 25 (4) mmHg to T1: 25 (4) mmHg, p=0.17), and RVAC (from T0: -0.96 (0.28) %/mmHg to T1: -0.96 (0.27) %/mmHg, p=0.60) were not significantly altered at follow-up. We detected a statistically significant interaction of intervention with RVGLS (p=0.024) and RVAC (p=0.012) (Figure 1). Conclusion Subclinical right ventricular dysfunction is present in convalescent COVID-19 patients. Cardiopulmonary rehabilitation can accelerate the improvement of RVAC by mediating both the RV afterload reduction (PASP) and improving RV function.Figure 1

Right ventricular free wall longitudinal strain as a predictor of myocardial recovery in patients with advanced cardiogenic shock supported with the Impella device

Abstract Background Right ventricular (RV) dysfunction is a known independent factor influencing the outcome of patients in cardiogenic shock (CS). The aim of this monocentric retrospective study was to investigate the impact of left ventricular (LV) unloading on the right heart function and its predictive role regarding weaning following Impella device implantation in patients with profound CS due to LV failure. Methods We performed a retrospective analysis of 41 patients admitted to intensive care unit over a period of 3 years with CS due to LV dysfunction requiring support with Impella. Clinical and echocardiographic data were collected and correlated with weaning success. Finally, a multivariate analysis to identify independent predictors of weaning success was performed. Results After Impella implantation, the following was observed: right ventricular fractional area change (RVFAC) increased from a mean value of 28% to 38% (p=0.01), the tricuspid annular systolic velocity (TASV) increased from 9 cm/s to 10 cm/s (p=0.01), the velocity time integral right ventricular outflow tract (VTI RVOT) increased from 10 to 13 cm3/stroke (p=0.01), the right ventricular free wall longitudinal strain (RVFWLS) increased from -12% to -21% (p< 0.001). However, following LV unloading, a decrease in both RVFAC from 38% to 30% (p 0.01) and in VTI RVOT from 13 to 11 cm3/stroke (p<0.01) was observed. Moreover, there was a significant decrease in RVFWLS from -21% to -14% (p < 0.001). Notably, the percentage of change in RVFWLS between maximum and minimum (Δ%RVFWLSPmax-Pmin) support with Impella during the weaning process was significantly lower in weanable patients (34.5% in weaned vs 86% in non-weaned; p=0.038). Investigating the predicting ability of these parameters, Δ%RVFWLSPmax-Pmin emerged showing an AUC of 0.826 (0.690-0.962) in identifying non-weaned patients with a cut-off value of 38%. According to the multivariate analysis, Δ%RVFWLSPmax-Pmin in non-weaned patients remained the only significant parameter even considering possible confounders. Conclusions LV unloading with Impella in advanced CS patients improved RV function echocardiographic parameters. RVFWLS increased significantly after Impella implantation and its percentage of change between maximum and minimum support was significantly lower in weanable compared to non-weanable patients. Our findings suggest that RVFWLS could be used as a predictor of myocardial recovery allowing to identify weanable patients with adequate accuracy.

Assessment of Specific Biomarkers' Profile and Structural, Functional Parameters of the Left Ventricle in Patients With Lymphomas Undergoing Antitumor Therapy.

To evaluate the dynamics of specific biomarkers for cardiotoxicity, endothelial dysfunction, fibrosis, systemic inflammation, and morpho-functional alterations in the left ventricular (LV) myocardium in patients with newly diagnosed lymphomas during 6 courses of polychemotherapy (PCT). The study included 30 patients with newly diagnosed lymphomas. All patients were evaluated for laboratory markers of cardiotoxicity at baseline and after 6 courses of chemotherapy (6 months), including N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hsTnI), endothelin-1 (ET-1), circulating cardiac biomarker ST-2, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and LV structural and functional echocardiographic (EchoCG) parameters. The changes in NT-proBNP and hsTnI concentrations during 6 courses of PCT were not statistically significant. Comparison of the baseline values with those after 6 courses of PCT showed increases in the median concentrations of ET-1 (3.38 and 5.5 pg/ml, respectively; p=0.438) and ST-2 (12.21 and 26.75 ng/ml, respectively; p=0.687). Markers of systemic inflammation were significantly decreased after 6 courses of PCT: the median CRP decreased from 15.2 to 0.72 mg/ml (p=0.006), and the median IL-6 decreased from 12.2 to 5.1 pg/ml (p=0.034). EchoCG data revealed a statistically significant impairment of the LV diastolic function parameters (E/A; E/e' lateral; E/e' average; left atrial volume index; isovolumic relaxation time). A moderate direct correlation was found between the ET-1 concentration and the isovolumic relaxation time at baseline and after 6 courses of PCT, respectively (r1 = 0.387, p=0.047 and r2 = 0.391, p=0.035). No changes in the LV systolic function were observed. The study showed that patients with lymphoproliferative diseases had no signs of cardiotoxicity during PCT according to the accepted criteria. This study described and highlighted for the first time the interrelation of endothelial dysfunction, profibrotic status, and LV diastolic dysfunction as manifestations of cardiovascular toxicity in patients with lymphoproliferative diseases. It is advisable to supplement the integrated strategies for the prevention and monitoring of PCT cardiovascular toxicity with a thorough evaluation of instrumental parameters of diastolic dysfunction for timely initiation/correction of cardioprotective therapy.

Assessing subaortic right ventricle function after atrial switch repair through myocardial work analysis

BackgroundThe Mustard and Senning operations for dextro-transposition of the great arteries (D-TGA) establish a biventricular physiology with a subaortic right ventricle (sRV). While prolonged QRS has been associated with worse prognosis in these patients, current echocardiographic tools fall short in adequately assessing the (mal)performance and function decline of the sRV during follow-up. The present study is the first to characterize Myocardial Work (MW) indices of the sRV in D-TGA patients after Mustard/Senning repair. Methods and resultsAll adult D-TGA patients at follow-up in the University Hospital of Leuven between 2018 and 2022 were screened for inclusion. We retrospectively collected the most recent electrocardiogram parameters, 2D echocardiographic images and serum biomarkers’ values. Offline calculations of MW indices were performed. We established correlations between all variables and categorized patients into QRS<120 ms and QRS≥120 ms for further analysis. A total of 51 D-TGA patients were included (13 Mustard, 33 male, 39 ± 6 years). QRS duration increased with age and was correlated with sRV dimensions and serum levels of troponins (R = 0.42, p < 0.01) and NT-proBNP (R = 0.31, p = 0.03). However, no significant correlation was found between QRS duration and intraventricular desynchrony or conventional functional echocardiographic parameters. QRS prolongation was associated with a deterioration in septal, but not lateral, MW parameters. Patients with QRS≥120 ms had significantly larger ventricles and higher levels of troponins and NT-proBNP. ConclusionQRS prolongation after Mustard/Senning repair is linked to ventricular dilatation and worse performance, particularly affecting the septal wall. Global and regional MW analysis may be useful to assess the subclinical deterioration of sRV function.

Myocardial function, mechanics and work by echocardiography in adolescents with severe obesity.

Obesity and its metabolic complications can impact the heart's structure and function in childhood, although demonstrating this impact has been challenging. New echocardiographic parameters such as left atrial strain (LAε) and left ventricular strain (LVε), as well as myocardial work (MW), could reveal subclinical alterations in cardiac function. The aim is to evaluate the feasibility of these parameters in adolescents with severe obesity and explore their associations with body fat, metabolic comorbidities, and physical capacity. This is a cross-sectional study in adolescents with obesity who underwent echocardiography with analysis of LAε, LVε and MW using speckle tracking. Feasibility and association with anthropometry, body fat percentage, comorbidities and cardiopulmonary test were analyzed. Twenty adolescents were recruited, 13 (65%) were males, median age 14.2 (interquartile range: 12.9-14.9) years old. The median Z-score for BMI (zBMI) was +3.03 (2.87-3.14), 14 (70%) had severe obesity (zBMI ≥+3), 12 (60%) body fat ≥95th percentile, 9 (45%) high blood pressure (HBP) and 8 (40%) metabolic syndrome. The analysis of the echocardiographic parameters was feasible in 95% (LAε) and 100% (LVε and MW). LVε was lower in adolescents with vs. without metabolic syndrome: 17.8% (17.5-19.3%) vs. 19.3% (18.3-20.3%), P = 0.046; and with vs. without HBP 17.8% (17.5-18.6%) vs. 19.7% (18.4-20.3%), P = 0.02. Those with body fat ≥95th percentile had lower LAε and MW parameters, without association with cardiopulmonary test. Echocardiographic evaluation of LAε, LVε and MW is feasible in adolescents with severe obesity. A higher proportion of body fat and the presence of comorbidities are associated with alterations in these new echocardiographic functional parameters suggesting myocardial impact of higher metabolic compromise.

An altered plasma lipidome-phenome network characterizes heart failure with preserved ejection fraction.

Heart failure with preserved ejection fraction (HFpEF) is a multifactorial, multisystemic syndrome that involves alterations in lipid metabolism. This study aimed to test whether distinct plasma lipid profiles or lipid entities or both are associated with clinical and functional echocardiographic parameters in HFpEF. We examined the human plasma lipidome in HFpEF patients (n=18) with left ventricular ejection fraction ≥50% and N-terminal pro-brain natriuretic peptide (NT-proBNP) >125pg/mL and control subjects (n=12) using mass spectrometry-based shotgun lipidomics. The cohort included 8 women and 22 men with average age of 67.8±8.6 SD. The control and disease groups were not significantly different with respect to age, body mass index, systolic and diastolic blood pressure, and waist-to-hip ratio. The disease group experienced more fatigue (P<0.001), had more often coronary artery disease (P=0.04), and received more medications (beta-blockers, P<0.001). The disease group had significantly different levels of HFpEF-relevant parameters, including NT-proBNP (P<0.001), left ventricular mass index (P=0.005), left atrial volume index (P=0.001), and left ventricular filling index (P<0.001), and lower left ventricular end-diastolic diameter (P=0.014), with no difference in left ventricular ejection fraction. Significant differences in lipid profiles between HFpEF patients and controls could not be detected, including no significant differences in abundance of circulating lipids binned by carbon chain length or by double bonds, nor at the level of individual lipid species. However, there was a striking correlation between selected lipids with smoking status that was independent of disease status, as well as between specific lipids and hyperlipidaemia [with corresponding significance of either false discovery rate (FDR) <0.1 or FDR<0.01]. In an exploratory network analysis of correlations, we observed significantly stronger correlations within the HFpEF group between individual lipids from the cholesterol ester and phosphatidylcholine (PC) classes and clinical/echocardiographic parameters such as left atrial volume index, left ventricular end-diastolic diameters, and heart rate (FDR<0.1). In contrast, the control group showed significantly stronger negative correlations (FDR<0.1) between individual species from the PC and sphingomyelin classes and left ventricular mass index or systolic blood pressure. We did not find significant direct associations between plasma lipidomic parameters and HFpEF and therefore could not conclude that any specific lipids are biomarkers of HFpEF. The validation in larger cohort is needed to confidently conclude the absence of first-order associations.

Cardiac dimensions and hemodynamics in healthy juvenile Landrace swine

BackgroundSwine are frequently used as animal model for cardiovascular research, especially in terms of representativity of human anatomy and physiology. Reference values for the most common species used in research are important for planning and execution of animal testing. Transesophageal echocardiography is the gold standard for intraoperative imaging, but can be technically challenging in swine. Its predecessor, epicardial echocardiography (EE), is a simple and fast intraoperative imaging technique, which allows comprehensive and goal-directed assessment. However, there are few echocardiographic studies describing echocardiographic parameters in juvenile swine, none of them using EE. Therefore, in this study, we provide a comprehensive dataset on multiple geometric and functional echocardiographic parameters, as well as basic hemodynamic parameters in swine using EE.MethodsThe data collection was performed during animal testing in ten female swine (German Landrace, 104.4 ± 13.0 kg) before left ventricular assist device implantation. Hemodynamic data was recorded continuously, before and during EE. The herein described echocardiographic measurements were acquired according to a standardized protocol, encompassing apical, left ventricular short axis and long axis as well as epiaortic windows. In total, 50 echocardiographic parameters and 10 hemodynamic parameters were assessed.ResultsEpicardial echocardiography was successfully performed in all animals, with a median screening time of 14 min (interquartile range 11–18 min). Referring to left ventricular function, ejection fraction was 51.6 ± 5.9% and 51.2 ± 6.2% using the Teichholz and Simpson methods, respectively. Calculated ventricular mass was 301.1 ± 64.0 g, as the left ventricular end-systolic and end-diastolic diameters were 35.3 ± 2.5 mm and 48.2 ± 3.5 mm, respectively. The mean heart rate was 103 ± 28 bpm, mean arterial pressure was 101 ± 20 mmHg and mean flow at the common carotid artery was 627 ± 203 mL/min.ConclusionEpicardial echocardiography allows comprehensive assessment of most common echocardiographic parameters. Compared to humans, there are important differences in swine with respect to ventricular mass, size and wall thickness, especially in the right heart. Most hemodynamic parameters were comparable between swine and humans. This data supports study planning, animal and device selection, reinforcing the three R principles in animal research.Graphical

The impact of the right heart cavities echocardiographic features on atrial-high rate episodes.

Atrial high-rate episodes (AHRE) defined as atrial tachy-arrhythmias, detected through continuous monitoring with a cardiac implantable electronic device (CIED). AHRE's have been associated with increased risks of developing clinically manifested atrial fibrillation, thromboembolism, cardiovascular events, and mortality. Several variables have been researched and identified to predict AHRE existence. The present study evaluated the association between right-heart structural and functional echocardiographic parameters and AHRE in patients with CIEDs and impaired LVEF.This prospective design study included 194 patients with CIED's. The study population was divided into two groups according to presence of AHRE and analyzed the echocardiographic variables which may able to be a predictor of AHRE.Patients was divided into two groups: patients with AHRE (+) and without AHRE (-). The distribution of patients' characteristics according to presence of AHRE was analyzed. The multivariate analysis revealed Age, LAVI, E/Em tricuspid (HR: 1.106, 1.015-1.205% 95 CI;p = 0.022) and RAVI (HR: 1.035, 1.003-1.069 95% CI;p = 0.033) as independent predictors of AHREs. ROC curve analysis indicated that an E/Em tricuspid (AUC: 0.611, 95% CI 0.538-0.680 p: 0.009) and RAVI (AUC = AUC: 0.707, 95% CI 0.637-0.770 p < 0.001) predicted AHREs with a cut-off value of 6.28 and a sensitivity of 53.2% and specificity of 66.7% and a cut-off value of 29.5 mL/m2 with a sensitivity of 72.7% and a specificity of 65.9%, respectively.The main finding of this study was "RAVI" and "E/Emtricuspid ratio" is associated with AHRE. Additionally, "RAVI" and "E/Emtricuspid ratio" is an independent predictor of AHRE existence.

(1131) Comparison of Functional Echocardiographic Parameters for Detection of Coronary Artery Vasculopathy in Pediatric Patients Following Heart Transplant: A Single-Center Retrospective Study

(1131) Comparison of Functional Echocardiographic Parameters for Detection of Coronary Artery Vasculopathy in Pediatric Patients Following Heart Transplant: A Single-Center Retrospective Study

235 COMPARISON OF THE PROGNOSTIC RELEVANCE OF DIFFERENT ECHOCARDIOGRAPHIC PARAMETERS OF RIGHT VENTRICULAR SYSTOLIC FUNCTION IN CHRONIC HEART FAILURE

Abstract Background Right ventricular (RV) systolic function is an important predictor of prognosis in heart failure (HF). Several RV echocardiographic functional parameters have been described as sensitive prognostic markers. Aim To compare the predictive value of different RV systolic echocardiographic parameters in patients with HF. Methods One hundred and sixty patients with stable HF and left ventricular ejection fraction (LV EF) &amp;lt;45% were assessed for the following: (1) tricuspid annular plane systolic excursion (TAPSE), (2) RV fractional area (RVFA), (3) tissue Doppler-derived RV peak systolic velocity (PSVtdi), (4) RV free wall longitudinal 2D-strain (RVFWS); and (5) 3D-RVEF. The primary endpoint was death and/or HF-hospitalization. Results During a mean follow-up of 16.9±10 months, 35 patients reached the primary endpoint. Each of the RV echocardiographic parameters was significantly associated with outcome at univariable analysis. After adjusting for age, eGFR, logNTproBNP, LVEF, restrictive filling pattern, pulmonary artery systolic pressure, and RV end-diastolic volume, by Lasso Cox multivariable analysis, RVFWS (HR 1.09, 95%CI: 1.02-1.18, P=0.0093) and 3D-RVEF (HR 0.95, 95%CI: 0.91-0.99, P=0.0076) remained the only parameters independently associated with outcome with a cut-off of -18.6% and 43.6% respectively, without any difference in C-statistic between the two models (0.826 versus 0.812, p=0.3255). Conclusions RVFWS and 3D-RVEF are strong independent predictors of outcome in HF and appear to be superior to other standard RV systolic echocardiographic parameters.

Echocardiographic Assessment of Right Ventricular Function in COVID-19 Recovered Patients at a Tertiary Care Hospital

Objective: To detect residual RV dysfunction on a right ventricle focused Transthoracic Echocardiography (TTE) in COVID-19 infection survivors with lung involvement.&#x0D; Study Design: Analytical Cross sectional study design.&#x0D; Place and Duration of Study: Combined Military Hospital Abbottabad Pakistan, Feb 2022 to Apr 2022.&#x0D; Methodology: 87 patients who had suffered from and survived COVID-19 infection with definite involvement on CT scans of the chest were studied after discharge. Echocardiography was done to determine the RV anatomical and functional parameters to determine the relationship between extent of lung involvement and transthoracic echocardiographic parameters.Data was entered in Microsoft excel and exported to SPSS v 23 for analysis. &#x0D; Results: The initial sample size was of 87 patients. Due to suboptimal ECHO studies 7 cases were excluded. Males represented 62.5% (n=50) and females 37.5% (n=30). The ages ranged from 27 to 80 years, mean 53.08±12.77 years. Based on the CT severity score severe infections were 61.3 %(n=49) and mild 38.8% (n=31). The CTSS ranged from 6 to 30 with a mean of (17.74±7.13). In our study we found that on TTE, there was a statistically significant difference in 2 of the anatomical parameters; RVOT PLAX (RVOT diameter in Parasternal long axis view) [27.4 vs 28.3; p=0.02], RVOT-Dis (Distal RVOT dia) [22.8 vs 24; p=0.01]. In addition, there was a statistically significant difference in all the functional parameters of RV function TDI S vel (Systolic Tissue Doppler Velocity of the Tricuspid Annulus by Tissue doppler imaging) [7 vs4.9; p&lt;0.0001], RIMPPW (Right Ventricular Index of Myocardial Performance by Pulse wave doppler) [0.46 vs0.38; p&lt;0.0001], RIMP-TDI (Right Ventricular Index of Myocardial Performance by Tissue doppler imaging) [0.57 vs 0.48; p&lt;0.0001]. RV-FAC (RV-Fractional Area Change) was statistically insignificant. [42.8% vs 43.2%; p=0.6].&#x0D; Conclusion: Our study showed that in patients with definite lung involvement on chest CT scans, functional echocardiographic parameters of Right ventricular function were affected in line with the severity of lung involvement.

Value of functional echocardiographic parameters in predicting refractory septic shock in neonates

To study the value of functional echocardiographic parameters in predicting refractory septic shock in neonates. A total of 72 neonates with septic shock were enrolled. According to the highest value of septic shock score, they were divided into two groups: refractory (n=30) and non-refractory (n=42). The two groups were compared in terms of clinical data, laboratory findings, and functional echocardiographic parameters. The receiver operating characteristic (ROC) curve was used to evaluate the performance of functional echocardiographic parameters in predicting refractory septic shock. Compared with the non-refractory group, the refractory group had significantly lower cardiac output and cardiac index (CI) and a significantly higher mean arterial pressure (MAP)/CI ratio (P<0.05). CI had a cut-off value of 2.6 L/(min·m2), a sensitivity of 79%, a specificity of 83%, and an area under the ROC curve (AUC) of 0.841 in predicting septic shock-related death (P<0.05), and MAP/CI ratio had a cut-off value of 11.4, a sensitivity of 83%, a specificity of 73%, and an AUC of 0.769 (P<0.05). CI had a cut-off value of 2.9 L/(min·m2), a sensitivity of 69%, a specificity of 69%, and an AUC of 0.717 in predicting all-cause death within 28 days (P<0.05). CI and MAP/CI ratio can be useful for early prediction of septic shock-related death in neonates.

Fetal aortic coarctation: A combination of third-trimester echocardiographic parameters to improve the prediction of postnatal outcome.

ObjectivesThis study aims to determine a combination of third-trimester echocardiographic parameters for improving the prenatal prediction of coarctation of the aorta (CoA) after birth.MethodsWe included all cases of suspected CoA during fetal echocardiography performed in the second and/or third trimester of pregnancy at Gaslini Children's Hospital between January 2010 and December 2020. The last prenatal ultrasound evaluation was reviewed considering most of the echocardiographic criteria were already published for prenatal CoA diagnosis. Associated minor cardiac anomalies, such as a ventricular septal defect, persistent left superior vena cava (PLSCV), and redundant foramen ovale (FO) membrane, as well as postnatal outcomes, were reported. Initial perinatal management was defined based on the risk stratification of CoA during prenatal echocardiography. Neonates were divided into two groups depending on the presence or absence of CoA after birth.ResultsA total of 91 fetuses with CoA suspicion were selected, of which 27 (30%) were confirmed with CoA after birth and underwent surgical repair. All cardiac parameters except redundant FO membrane and PLSCV showed a significant correlation with CoA. Statistical analysis confirmed that cardiovascular disproportion with right predominance carries an increased risk for occurrence of CoA, especially if already evident during the ultrasound evaluation in the second trimester. Aortic valve (AV) z-score and distal transverse aortic arch (TAA) z-score resulted as the best predictors of CoA after birth. The best cutoff point for CoA discrimination with ROC analysis was an AV z-score of −1.25 and a distal TAA z-score of −0.37. A total of 46% of those without CoA were diagnosed with a cardiac defect, which was not diagnosed in utero, pulmonary hypertension, or a genetic syndrome.ConclusionThe current criteria for diagnosing CoA in utero allow accurate diagnosis of most severe cases but the rate of false positives remains relatively high for milder cases. A combination of anatomic and functional echocardiographic parameters might be used in stratifying the risk of CoA. We proposed the AV and the TAA diameter z-scores as the best predictors of CoA after birth. In addition, neonates without CoA deserve proper monitoring at birth because prenatal evidence of a significant cardiovascular discrepancy between the right and left cardiac structures has an inherent risk for additional morbidity postnatally.

Long-term prognostic value of left atrial longitudinal strain in a low-risk community-based cohort

Abstract Numerous studies established the significant predictive value of left ventricular (LV) global longitudinal strain (GLS) on adverse clinical outcomes in various cardiac diseases. Despite the well-known importance of left atrial (LA) mechanics in diastolic function, data are scarce regarding the prognostic power of LA longitudinal strain and its potential added value in the risk stratification of a low-risk population. Accordingly, our aim was to determine the long-term prognostic importance of 2D speckle-tracking echocardiography-derived peak atrial longitudinal strain (PALS) in a community-based screening sample comprising of low-risk adult individuals. Three hundred fourteen volunteers were retrospectively identified from a population-based screening program (mean age 62±11, 58% female) with a median follow-up of 9.5 years. All subjects who participated in the screening program underwent 2D echocardiography to measure LV volumes and ejection fraction (EF), LV GLS and PALS, as well as low-dose cardiac CT to determine the Agatston score. The primary endpoint was all-cause mortality. Thirty-nine subjects (12.4%) met the primary endpoint. Subjects with adverse outcome had significantly decreased LV GLS (dead vs. alive; −19.2±4.3 vs. −20.6±3.5%, p&amp;lt;0.05) and PALS (32.3±12.0 vs. 41.8±14.2%, p&amp;lt;0.001), whereas LV EF did not show a difference between the two groups (51.1±7.0 vs. 52.1±6.2, %, p=NS). By multivariable Cox regression analysis, PALS (hazard ratio 0.970 [95% CI: 0.943–0.998], p&amp;lt;0.05) and Agatston score were independently associated with all-cause mortality, whereas GLS was not (hazard ratio 1.008 [95% CI, 0.919–1.105], p=NS). Furthermore, we dichotomised the population based on PALS values using a guideline-directed cut-off of 39%. In subjects with lower PALS values, the risk of all-cause mortality was almost 2.5 times higher than in subjects with PALS values above 39% (hazard ratio 2.499 [95% 1.334–4.682], p&amp;lt;0.05) as shown on the Kaplan-Meier curve (Figure 1). Beyond the assessment of LV EF and LV GLS, PALS offers incremental value in cardiovascular risk stratification in a community-based cohort. PALS was found to be the only significant and independent predictor of long-term mortality among other echocardiographic functional parameters. Our results emphasize the importance of a thorough evaluation of LA mechanics even in a low-risk population. Funding Acknowledgement Type of funding sources: None.

Functional and morphometric changes in children after neonatal arterial switch operation for transposition of the great arteries.

The increase in the survival of patients with D-Transposition of the great arteries (TGA) after arterial switch operation (ASO) has now turned our focus to the evaluation of mid and long-term outcomes. Although most patients are followed by conventional echocardiography, the study of cardiac functionality and morphometric parameters in children with TGA after ASO is scarce. The present study aims to describe the functional and morphometric echocardiographic changes in children after ASO. We performed an observational study in patients aged 1-5 years with TGA who underwent neonatal ASO. Morphometric and functional echocardiographic parameters were analyzed in 21 patients and compared with 52 age-matched healthy controls. We found morphological and functional changes, especially in the right ventricle, which is more globular (right ventricle [RV] basal sphericity index 1.5 vs. 1.8, P = 0.016), and with a decreased systolic function compared to healthy controls (fractional area change 51 vs. 58%, P = 0.006; tricuspid annular plane systolic excursion 13 vs. 20 mm, P = 0.001; s' 7 vs. 12 cm/s, P = 0.001). In the speckle-tracking strain imaging, there was a decrease in the longitudinal deformation of the apical septal myocardium (-23% vs. -27%; P = 0.005). Preoperative systemic overload to the right ventricle could be an important factor in the origin of these changes. In patients with TGA after ASO, there are morphometric and functional echocardiographic changes, such as globular form and decreased function, especially in the RV; the effect of these changes on long-term outcomes would require prospective follow-up studies.

Assessment of global longitudinal strain in pediatric survivors of childhood cancer who received cardiotoxic chemotherapy

Cardiotoxicity induced by chemotherapy is the cause of long-term morbidity and mortality, particularly with child exposure. Early detection is essential, as clinical signs are often delayed. In adults, the global longitudinal strain has proven its effectiveness as an early marker of cardiac dysfunction but its place in paediatric management is not yet established. The aim of our study was to analyse the echocardiographic parameters of cardiac function including global longitudinal strain (GLS) in asymptomatic children who received cardiotoxic chemotherapy, at the University Hospital of Amiens, from April to November 2020. The included cases were compared to healthy controls more than one year after their last exposure. We included 22 pediatric childhood cancer survivors and 27 controls with comparable characteristics. The cases had a median age of 11.5 [9.5] years, a median of 3 [1] years from the chemotherapy and a median cumulative anthracycline dose of 234.77 (±105.88) mg/m 2 . Almost a third of our patients were classified as high risk according to CCSS Cardiovascular Risk Calculator score. All myocardial function values were within normal limits. Standard echocardiographic parameters were not different between cases and controls, respectively EF (%) 66.29 (±5.04) vs. 68.14 (±5.37) P < 0.22. As well, Strain 2D values were not significantly different (GLS (%) −20.10 (±2.59) vs. −19.80 (±2.34) P = 0.67). Furthermore, the interobserver reproducibility of GLS was good (intra-class correlation coefficient 0.82 (0.62;0.92) P < 0.01) ( Fig. 1 ). There was no difference of cardiac function echocardiographic parameters, between children who received chemotherapy and controls. There are several limitations, such as the limited number of patients, the monocentric trial and the exclusion of symptomatic patients. The results seem to be in favour of a long free interval between exposure and the onset of altered echocardiographic parameters. Further studies are needed to develop individualised prognostic tools for the follow-up of these patients.