Hypokinetic Segments Research Articles

Contemporary early left ventricular thrombus resolution by echocardiography: insight from a longitudinal multicenter registry

Abstract Funding Acknowledgements Type of funding sources: None. Background Multicenter longitudinal data are lacking regarding the incidence and the time needed for total left ventricular thrombus (LVT) regression obtained with contemporary antithrombotic regimens diagnosed with modern echocardiographic technology. Purpose To quantify the effect of antithrombotic therapy on LVT evolution using sequential up-to-date echocardiography in a large cohort of patients with LVT. Methods Ten centers were involved in this observational prospective multicenter study. LVT was defined as an echo-dense mass adjacent to a hypokinetic or akinetic myocardial segment. To be distinguishable from the underlying myocardium, a clear thrombus–blood interface was required and the LVT had to be visible on at least 2 views during the cardiac cycle. Initial follow-up echocardiograph was scheduled at 14±7 days (T0) and 42±7 days (T1). The early resolution was defined when LVT was no longer detected at T1. The use of different anticoagulant regimens and ultrasound contrast was left at the discretion of attending physicians, according to good clinical practice. Results From October 2020 to November 2022, 99 patients with LVT (mean age 66 ± 11 years, 80% men) were identified with echocardiography, in 53% ultrasound contrast was used. Early resolution of LVT was observed in 42%. Echocardiographic characteristics by early resolution of LVT are shown in Table. The independent correlates of early LVT regression were smaller baseline LVT area, higher LVEF, and mobile LVT (p<0.05). Conclusions In this large and well-characterized present-day cohort of patients with LVT, early regression by echocardiography was achieved in less than half of the patients and was mostly related to the size of the LVT and heart function rather than treatment despite a high proportion of antithrombotic therapy. The next step will be to assess the impact of LVT persistence on subsequent clinical outcomes.

Left ventricular function and volumes from gated [13N]-ammonia positron emission tomography myocardial perfusion imaging: A prospective head-to-head comparison against CMR using a hybrid PET/MR device

BackgroundPositron emission tomography (PET) myocardial perfusion imaging (MPI) can be used to evaluate left ventricular (LV) volumes and function. We performed a head-to-head comparison of LV function and volumes obtained simultaneously using [13N]-ammonia-PET and cardiac magnetic resonance (CMR), with the latter serving as the reference standard. Methods and ResultsIn this prospective study, 51 patients underwent [13N]-ammonia-PET MPI and CMR using a hybrid PET/MR device. Left ventricular end-systolic volumes (LVESV), end-diastolic volumes (LVEDV), stroke volumes (LVSV), ejection fractions (LVEF), and segmental wall motion were analyzed for both methods and were compared using correlational and Bland-Altman (BA) analysis; segmental wall motion was compared using ANOVA. The agreement between [13N]-ammonia-PET and CMR for LVEF was good, with minimal bias (− .6%) and narrow BA limits of agreement (− 7.9% to 6.8%), but [13N]-ammonia-PET systematically underestimated LV volumes, with high bias in LVESV (− 11.2 ml), LVEDV (− 28.9 ml), and LVSV (− 17.5 ml). Mean segmental wall motion in [13N]-ammonia-PET differed significantly among the corresponding normokinetic (6.6 ± 2 mm), hypokinetic (5.1 ± 2 mm), and akinetic (3.3 ± 2 mm) segments in CMR (P < .01). ConclusionLVEF and LV wall motion can be accurately assessed using [13N]-ammonia-PET MPI, although LV volumes are significantly underestimated compared to CMR.

Thin and hypokinetic myocardial segments in cats with cardiomyopathy

Introduction/objectivesThin and hypokinetic myocardial segments (THyMS) represent adverse ventricular (LV) remodeling in human hypertrophic cardiomyopathy. We describe the echocardiographic features and outcome in cats with THyMS, and in a subpopulation, the echocardiographic phenotype before LV wall thinning was detected (pre-THyMS). AnimalsEighty client-owned cats. Materials and methodsRetrospective multicenter study. Clinical records were searched for cats with THyMS, defined as LV segment(s) with end-diastolic wall thickness (LVWT) <3 mm and hypokinesis in the presence of ≥one LV segment(s) with LVWT >4 mm and normal wall motion. When available, echocardiograms pre-THyMS were assessed. Survival time was defined as time from first presentation with THyMS to death. ResultsMean thickest LV wall segment (MaxLVWT) was 6.1 mm (95% CI 5.8–6.4 mm) and thinnest (MinLVWT) was 1.7 mm (95% CI 1.6–1.9 mm). The LV free wall was affected in 74%, apex in 13% and septum in 5%. Most cats (85%) presented with heart failure and/or arterial thromboembolism. Median circulating troponin I concentration was 1.4 ng/mL ([range 0.07–180 ng/mL]). Prior echocardiography results were available for 13/80 cats, a mean of 2.5 years pre-THyMS. In segments subsequently undergoing thinning, initial MaxLVWT measured 6.7 mm (95% CI 5.8–7.7 mm) vs. 1.9 mm (95% CI 1.5–2.4 mm) at last echocardiogram (P<0.0001). Survival data were available for 56/80 cats, median survival time after diagnosing THyMS was 153 days (95% CI 83–223 days). Cardiac histopathology in one cat revealed that THyMS was associated with severe transmural scarring. ConclusionsCats with THyMS had advanced cardiomyopathy and a poor prognosis.

Fatal Myocarditis Following Administration of Zoledronic Acid: A Case Report

Myocarditis is a potentially life-threatening condition which occurs due to inflammation of the cardiac muscle. It has a multitude of causes including certain medications. Zoledronic acid is a bisphosphonate given as an intravenous preparation for bone related diseases. Medical literature provides details about only very few cases of Zoledronic acid induced myocarditis and all of them were non-fatal. We report a fatal case of myocarditis due to administration of intravenous Zolendronic acid. A 40-year-old male with a history of multiple joint pain and swelling for one week and right knee joint swelling for three months was administered intravenous Zolendronic acid. One day after administration of Zolendronic acid patient developed dizziness, and eventually became drowsy. His ECG revealed ST depressions in leads I, II, aVF, as well as leads V3 to V5. Highly sensitive Troponin I was elevated to 2195.3 pg/ml (<26.5 pg/ml) and Echocardiogram showed an ejection fraction of 30% with hypokinetic wall segments and regional wall motion abnormalities. He went into cardiogenic shock and was pronounced dead. At the autopsy, macroscopic examination did not reveal any noticeable fatal pathology. however histological examination of the myocardium reveals diffuse infiltration mononuclear cells with myocyte necrosis. This case highlights importance of being vigilant in using this drug.

Admission and follow-up cardiac magnetic resonance imaging findings in BNT162b2 Vaccine-Related myocarditis in adolescents

Background There is limited data on the pattern and severity of myocardial injury in patients with COVID-19 vaccination associated myocarditis. Objective We aimed to define the myocardial damage occurring after BNT162b2 vaccination, raise awareness about adverse reactions developing after vaccination, and determine the patterns and scope of Cardiac magnetic resonance imaging (MRI) findings. Patients/Methods A total of 9 patients diagnosed with vaccine-associated myopericarditis were followed up. Results The mean age of the patient at diagnosis was 15.3 ± 1.0 (range: 14–17) years, and all patients were male. Seven patients presented with myocarditis symptoms after their second vaccine dose, one patient presented with pericarditis symptoms after his first dose, and the other patient presented with myocarditis symptoms after his booster dose. The median time at presenting to the hospital was 3 (range: 2–22) days. Seven (77.7%) patients had abnormal electrocardiography (ECG) findings, and the most prevalent finding was diffuse ST-segment elevation. Initial cardiac MRI results were abnormal in all patients, where 8 (88.8%) patients had late gadolinium enhancement, and 5 (55.5%) had myocardial edoema. Three patients showed local left ventricular wall-motion abnormalities. In their follow-up MRIs 3–6 months later, myocardial edoema was present in 2 (28.5%) patients, while late gadolinium enhancement was present in all patients (7/7, 100%, 2 patients did not have control MRI time). Hypokinetic segments were still present in one of the 3 patients. No negative cardiac events were observed in the short-term follow-up of any patient. Conclusion Further follow-up evaluation and larger multicenter studies are needed to determine the clinical significance of persistent cardiac MRI abnormalities.

Kounis syndrome – a silent killer under the blanket

Allergy angina syndrome or allergic myocardial infarction is an immune-mediated coronary spasm which is also known as Kounis syndrome (KS). It's not uncommon, but it's often underdiagnosed. In a typical case of allergy, a skin reaction may be preceding symptoms and shock status may be a severe accompanying symptom. KS may cause devastating events namely cardiac arrest in some extreme cases. A 40-year-old obese gentleman with underlying intrapapillary mucinous neoplasm of uncinate process of pancreas was electively admitted for pancreaticoduodenectomy. He had a past medical history of hypertension and chronic gout arthritis with no previous history of ischemic heart disease. Intraoperatively was uneventful and he was monitored in the intensive care unit postoperatively. However, due to new onset obstructive jaundice postoperatively, he was subjected to contrast-enhanced computed tomography (CECT) of the abdomen for further evaluation. Following injection of contrast, he was developed generalized skin rashes followed by respiratory distress and cardiac arrest. Intravenous steroid and antihistamine were given immediately. He was resuscitated for 9 min, and ECG post-resuscitation showed new onset ST segment elevation V3-V6. Bedside echocardiography revealed preserved ejection function with no obvious hypokinetic segment. Repeated ECG two hours later noted resolution of the ST elevation with the absence of Q wave, T wave inversion, and return into sinus rhythm. Unfortunately, he was complicated prolonged hospital stay, seizure, hypoxic-ischemic encephalopathy (HIE), persistent abdominal sepsis subsequently succumbed after 27 days of admission. As per the above case, cardiac arrest following contrast agent administered should ring a bell about Kaonis syndrome. Diagnosis made needs the concurrent presence of acute coronary syndrome and an allergic event. Every contrast agent has the potential to cause KS. Therefore it is very crucial to detect and treat promptly as it may also lead to death.

Collateral presence and extent do not predict myocardial viability and ischemia in chronic total occlusions: A stress-CMR study

BackgroundWell-developed collaterals are assumed as a marker of viability and ischemia in chronic total occlusions (CTO). We aim to correlate viability and ischemia with collateral presence and extent in CTO patients by cardiac magnetic resonance (CMR). MethodsMulticentre study of 150 CTO patients undergoing stress-CMR, including adenosine if normal systolic function, high-dose-dobutamine for patients with akinetic/>2 hypokinetic segments and EF ≥35%, otherwise low-dose-dobutamine (LDD); all patients underwent late gadolinium enhancement (LGE) imaging. Viability was defined as mean LGE transmurality ≤50% for adenosine, as functional improvement for dobutamine-stress-test, ischemia as ≥1.5 segments with perfusion defects outside the scar zone. ResultsRentrop 3/CC 2 defined well-developed (WD, n = 74) vs poorly-developed collaterals (PD, n = 76). Viability was equally prevalent in WD vs PD: normo-functional myocardium with ≤50% LGE in 52% vs 58% segments, p = 0.76, functional improvement by LDD in 48% vs 52%, p = 0.12. Segments with none, 1–25%,26–50%,51–75% LGE showed viability by LDD in 90%,84%,81%,61% of cases, whilst in 12% if 76–100% LGE (p < 0.01). There was no difference in WD vs PD for ischemia presence (74% vs 75%, p = 0.99) and extent (2.7 vs 2.8 segments, p = 0.77). ConclusionsIn a large cohort of CTO patients, presence and extent of collaterals did not predict viability and ischemia by stress-CMR. Scar extent up to 75% LGE was still associated with viability, whereas ischemia was undetectable in 25% of patients, suggesting that the assessment of CTO patients with CMR would lead to a more comprehensive evaluation of viability and ischemia to guide revascularization.

P314 WHEN TAKO–TSUBO TRAPS… NOT ONLY OCTOPUSES

Abstract The case we present involves a 75 years–old woman with no cardiological past medical history, who presented to our attention complaining of sudden onset thoracic pain associated with dyspnea, dry cough, nausea and an episode of vomit. She called 911 rapidly coming to our Hospital. In the Emergency room an EKG showed ST segment depression in the inferior leads and in the blood test a remarkable increase in HS–Troponin level was evident. An echocardiogram showed mid and apical left ventricle segments hypokinesia with moderately reduced Ejection Fraction (45%); notably, right ventricle was increased in dimension with moderate tricuspid regurgitation and mild pulmonary hypertension. Because of this last find, D–dimer was checked and a pulmonary angio– CT was performed which excluded active pulmonary embolism. Next day she underwent coronary angiography which showed no coronary lesion able to explain the clinical and echocardiographic presentation; left ventriculography was also performed showing an increase in end–systolic volume with hypokinesia of the anterolateral, apical and diaphragmatic walls and an Ejection Fraction (EF) of 30%. These findings allowed us to make the diagnosis of Tako–Tsubo syndrome, also known as stress–induced cardiomyopathy. Few days later, a cardiac magnetic resonance (CMR) was performed showing whole apical and antero–lateral mid ventricular hypokinesia with compensatory hyperkinesia of basal segments; T2–weighted sequences were positive at the hypokinetic segments with no specific Late Gadolinium Enhanced (LGE) images. What’s more, an atrial septal defect type “ostium secundum” was clearly evident, causing a left–to–right shunt hemodynamically significant (Qp/Qs of about 2,8) with right atrial and right ventricle dilatation. Pulmonary artery and its main branches were dilated too. After these findings, lady underwent right heart cardiac catheterization that reported a Qp/Qs of 3,24 and a shunt flow of 8,78 L/min, with a cardiac index of 2,5 L/min/m2 and normal pulmonary vascular resistance (0,7 Wood Units). Because of these measures the patient was discharged from our Cardiology Unit and referred to the Interventional Cardiology centre of our city for the percutaneous closure of the hemodynamically significant atrial septal defect. This case is curious because it shows how things in Cardiology can be deeply and unpredictably connected.

Stabilizing Ryanodine Receptors Improves Left Ventricular Function in Juvenile Dogs With Duchenne Muscular Dystrophy

BackgroundDuchenne muscular dystrophy is associated with progressive deterioration in left ventricular (LV) function. The golden retriever muscular dystrophy (GRMD) dog model recapitulates the pathology and clinical manifestations of Duchenne muscular dystrophy. Importantly, they develop progressive LV dysfunction starting at early age. ObjectivesThe authors tested the cardioprotective effect of chronic administration of the ARM036, a small molecule that stabilizes the closed conformation of the cardiac sarcoplasmic reticulum ryanodine receptor/calcium release channel (RyR2) in young GRMD-dogs. MethodsTwo-month-old GRMD-dogs were treated with ARM036 or placebo for 4 months. Healthy-dogs of the same genetic background served as controls. Cardiac function was evaluated by conventional and 2-dimensional speckle-tracking echocardiography. Cardiac cellular and molecular analyses were performed at 6 months old. ResultsConventional echocardiography showed normal LV dimensions and ejection fraction in 6-month-old GRMD dogs. Interestingly, 2-dimensional speckle-tracking echocardiography revealed decreased global longitudinal strain and the presence of hypokinetic segments in placebo-treated GRMD dogs. Single-channel measurements revealed higher RyR2 open probability at low resting Ca2+ in GRMD cardiomyocytes than in controls. ARM036 prevented those in vivo and in vitro dysfunctions in GRMD dogs. Myofilament Ca2+-sensitivity was increased in permeabilized GRMD cardiomyocytes at short sarcomere length. ARM036 had no effect on this parameter. Cross-bridge cycling kinetics were altered in GRMD myocytes and recovered with ARM036 treatment, which coincided with the level of myosin binding protein-C-S glutathionylation. ConclusionsGRMD-dogs exhibit early LV dysfunction associated with altered myofilament contractile properties. These abnormalities were prevented pharmacologically by stabilizing RyR2 with ARM036.

Association between the osmotic fragility of erythrocytes and the course of acute myocardial infarction

Aim. To investigate the relationship between the osmotic fragility of erythrocytes and the course of acute myocardial infarction (MI).Methods. An analysis of the osmotic fragility of erythrocytes was conducted using beta-blocker-based osmotic fragility test in sixty-two patients within the first 6 hours after onset of MI symptoms.Results. The results revealed that the patients with increased erythrocyte osmotic fragility experienced more complications after acute MI, such as left ventricular failure and cardiac arrhythmias (ventricular extrasystoles and ventricular tachycardia) (p = 0.026). Moreover, these patients exhibited greater myocardial injury - the concentration of biomarkers of myocardial necrosis, such as creatine phosphokinase, creatine phosphokinase MB and Troponin I was increased - p = 0.009, p = 0.032 and p = 0.001, respectively. In addition to that, the patients with high osmotic fragility had a larger number of hypokinetic and akinetic segments, high impaired myocardial contractility index, and low ejection fraction. The impaired myocardial contractility index was significantly higher in patients with increased erythrocyte osmotic fragility (1.5 (1.22; 1.75) vs 1.12 (1.0; 1.56), U = 157.5, p = 0.032).Conclusion. Increased erythrocyte osmotic fragility in patients was associated with greater myocardial injury, manifesting through the higher concentration of biomarkers of myocardial necrosis in blood, as well as higher number of hypokinetic segments.

Varfarin Tedavisi Alan Serebrovasküler Hastalığı Olan Hastalarda Terapötik Aralıkta Olma Oranlarının Değerlendirilmesi

Objective: The efficacy of warfarin therapy correlates with the Time in Therapeutic Range (TTR). This study aimed to investigate the efficacy and target achievement rates in patients using warfarin who were followed up in stroke outpatient clinics. Methods: In this study, 103 patients who had been under warfarin treatment were retrospectively evaluated. Duration and indications for warfarin use, thrombotic or hemorrhagic complications were recorded. Target INR value was 3.0-3.5 in patients with mechanical valves and 2.0-3.0 in those using warfarin for other indications. Results: In this study, 103 patients with a mean age of 67.14±14.19, 47 men and 56 women, were included. Indications for warfarin use, respectively, were non-valvular atrial fibrillation (AF) in 61.6% of the patients, akinetic/hypokinetic segment on echocardiography (ECHO) in 12.62%, thrombophilia in 8.74%, metallic prosthetic valve in 3.88%, frequent transient ischemic attacks in 6.79%, a hypokinetic segment on ECHO with atrial fibrillation in 5.82% and vertebral artery dissection in 0.87%. 46.8% of the patients were determined to be in good control, with a mean TTR of 64.09%; also, TTR was 100% in 36.8% of them. Minor/major hemorrhagic event was noted in 10 patients (9.70%), two of whom had an intracerebral hemorrhage. Conclusion: The mean TTR value detected in this study is considerably higher than the rate reported in our country. Findings of this study suggest that close monitoring is paramount of importance and vital in patients with stroke. Regular monitoring of stroke patients using warfarin will be beneficial in terms of informing patients, providing optimal anticoagulation and preventing complications.

Функціональний стан лівого шлуночка серця в пацієнтів із гострим інфарктом міокарда без елевації сегмента ST після реваскуляризації міокарда, яка проводилася в різні терміни від початку розвитку симптомів захворювання

Мета роботи – оцінити вплив реваскуляризації міокарда, проведеної хворим із гострим інфарктом міокарда без стійкої елевації сегмента ST (non-ST-segment elevation myocardial infarction, NSTEMI) у різні терміни від початку симптомів, на стан систолічної функції лівого шлуночка (ЛШ), а також на функціональний клас стенокардії через 12 міс спостереження.Матеріали і методи. Пацієнти з NSTEMI, які увійшли в дослідження (n=128), були розподілені за часом проведення реваскуляризації (ургентна або планова реваскуляризація), а також за способом реваскуляризації (коронарне стентування або шунтування) на 5 груп, включаючи групу хворих з NSTEMI, яким стентування не проводили. Групу 1 (n=28) становили пацієнти, яким були виконані ургентні коронаровентрикулографія (КВГ) та стентування ad hoc у перші 72 год від початку симптомів. До групи 2 (n=61) увійшли пацієнти, яким КВГ і стентування проводили планово через 72 год і більше (до кількох місяців від початку розвитку симптоматики). До групи 3 (n=12) увійшли пацієнти, яким у плановому порядку виконували коронарне шунтування. Група 4 (n=27) складалася з пацієнтів, яким після КВГ реваскуляризацію не проводили (контрольна група). До групи 5 (n=101) увійшли пацієнти вищеозначених груп, яким була виконана будь-яка реваскуляризація. Хворим усіх груп була проведена вихідна КВГ, визначено вихідний рівень серцевих тропонінів, проведено ангіографічне та ехокардіографічне дослідження стану ЛШ за стандартними методиками з оцінюванням вихідних показників регіонарної та загальної скоротливості міокарда. За відсутністю протипоказань хворим груп 2 і 3 виконували тести з дозованим фізичним навантаженням для встановлення функціонального класу (ФК) стенокардії. Під час короткострокового (перед виписуванням зі стаціонару, через 1 міс та через 3 міс після виписування) і довгострокового (через 6 місяців та через 1 рік) спостережень хворим повторно визначали фракцію викиду (ФВ) ЛШ, оцінювали регіонарну скоротливість ЛШ та ФК стенокардії.Результати та обговорення. Дані тесту з дозованим фізичним навантаженням показали: якщо до реканалізації стенокардію 0–I ФК не фіксували в жодному випадку, то через 6 міс цей показник становив 70,6 %, а через рік – 73,8 % Кількість випадків тяжкої стенокардії зменшилася з 43,8 % під час першого обстеження до 7,7 % через 12 міс спостереження. Аналіз показників регіонарної та загальної скоротливості ЛШ виявив статистично значуще поліпшення цих показників у пацієнтів з NSTEMI через 12 міс, як у групі ургентного, так і у групі планового стентування. Кількість нормокінетичних сегментів підвищилася на 10 % (з 84,2 до 94,2 %), а гіпокінетичних – зменшилася більш ніж удвічі (з 16,5 до 6,8 %). ФВ ЛШ за 12 міс спостереження, як у групі ургентного, так і у групі планового стентування, статистично значуще поліпшилася. У контрольній групі, як і в групі шунтування, статистично значущих позитивних змін ФВ ЛШ через 12 міс після NSTEMI не спостерігали.Висновки. Коронарне стентування, як ургентне, так і планове, у пацієнтів з NSTEMI, за даними річного спостереження, статистично значуще поліпшує функціональні й об’ємні показники ЛШ. Поліпшення цих показників зумовило статистично значуще зменшення ФК стенокардії в пацієнтів з NSTEMI, що своєю чергою покращило якість життя цих хворих.

Prognosis Innovative Approaches in Relation to Results and Complications of Coronary Remedial Surgical Procedure in Case of Acute Coronary Syndrome

In modern cardio surgery, it has become possible to predict not only the outcome of surgical interferencein order to save life, but also its effectiveness in terms of the quality of life improvement. It is proved thatcoronaro correcting technologies can not only soften the clinical picture of chronic coronary insufficiency,but also increase the contractility of the ischemic myocardium, as well as significantly improve the patient’squality of life, if the myocardial ischemia has the character of hibernation, and not stanning. The ability todetermine which variant of the ischemic syndrome occurs in the patient before surgery helps to predict theinterference effectiveness. The method used for this purpose (radioisotope scintigraphy, positron emissiontomography, MRI, pharmacological stress echotests) are technically or economically inaccessible, difficultto apply in the perioperative period, and sometimes dangerous.The purpose of the research: to offer an informative, accessible and safe method of preoperative identificationof the hibernating myocardium among patients with IHD for successful prediction of the interferenceeffectiveness.Materials and Method: 83 patients with acute and chronic forms of IHD were under study. In the first group(49 people), there was a coronary stenting (CS). In the second group (34 patients), there was a heart bypasssurgery (HB). There was the comparative assessment analysis in regard to variant of ischemic syndromeand the effectiveness of both operations by means of precardial ECG mapping and stress echotest withdipyridamole.Results: In case of IHD acute forms (acute coronary syndrome, acute myocardial infarction) CS and HBoperations had significant positive dynamics in regard to indicators of coronary blood flow within thecourse of ischemia and myocardial contractility in accordance with precordial mapping (area reductionof ischemia - AST and the decrease of the ischemia degree - ?ST) and stress echotest with dipyridamole(increased contractility of EF indicator and a reduction of ESV, increase in the number of eukinetic segmentsof the myocardium and decrease of hypokinetic segments). We observed the same dynamics, but much lesspronounced, in accordance with ECG mapping and stress echotest data after both operations within thegroup with chronic forms of ischemia.Conclusion: The precardial ECG mapping is informative and available for use in regional cardiosurgicalclinics as a method of the hibernating myocardium identification, which is a more perspective variant ofischemia in case of IHD in terms of left ventricular contractility increase.

Strain analysis using feature tracking cardiac magnetic resonance (FT-CMR) in the assessment of myocardial viability in chronic ischemic patients.

The purpose of this study is totest the capability of a commercially available feature tracking-cardiac magnetic resonance (FT-CMR) strain analysis software module in differentiating between viable and non-viable myocardium in chronic ischemic patients. Thirty chronic ischemic patients and 10 healthy volunteers were enrolled. Cine images were used for peak circumferential and radial strains quantification using dedicated FT-CMR software. Global strain was compared between patients and controls. In patients, segmental strain was compared in viable and non-viable myocardium determined by late gadolinium enhancement (LGE); and in segments with wall abnormalities. Among 480 myocardial segments analyzed in patients, 76 segments were non-viable on LGE. The mean left ventricular ejection fraction (LVEF) of the patients (87% males, mean age 55 ± 12years) was 40 ± 12% vs. 61 ± 5% for the controls (80% males, mean age 39 ± 11years). Peak global circumferential strain (GCS) and global radial strain (GRS) were significantly impaired in patients compared to controls (-13.89 ± 4.12% vs. -19.84 ± 1.47%), p < 0.001 and (23.11 ± 6.59% vs. 31.72 ± 5.52%), p = 0.001. Segmental circumferential strain (SCS) and segmental radial strain (SRS) were significantly impaired in non-viable compared to viable segments (-9.47 ± 7.26% vs. -14.72 ± 7.5%), p < 0.001 and (15.67 ± 12.11% vs. 24.51 ± 16.22%), p < 0.001. Cut-off points of -9.36% for the SCS (AUC = 0.7, 95% CI = 0.63-0.77) and 19.5% for the SRS (AUC = 0.67, 95%CI = 0.61-0.73) were attained above which the segment is considered viable.SCS was able to discriminate between normokinetic, hypokinetic and akinetic segments (mean = 27.6 ± 17.13%, 18.66 ± 12.88% and 15.24 ± 10.70% respectively, p < 0.001). Circumferential and radial segmental strain analysis by FT-CMR was able to discriminate between viable and non-viable segments of the myocardium defined by LGE and between normokinetic, hypokinetic and akinetic segments, using routinely acquired cine images, and thus can provide a more objective metric for risk stratification in chronic ischemic patients.

Transmural difference in myocardial damage assessed by layer-specific strain analysis in patients with ST elevation myocardial infarction

We performed layer-specific strain analysis with speckle-tracking echocardiography to investigate the transmural difference of myocardial damage as the predicting factor for the viability of damaged myocardium in patients with ST segment elevation myocardial infarction (STEMI). We analysed patients with acute STEMI who had undergone primary percutaneous coronary intervention and echocardiography within 24 h from the intervention and 2 months after the event. Segmental strains of the left ventricular (LV) endocardium, myocardium, epicardium, and strain gradient (SG) between the endocardium and epicardium were evaluated. In 34 patients, 112 akinetic/dyskinetic and 94 hypokinetic segments were observed among 612 segments of the LV at baseline, and 65 akinetic/dyskinetic segments had viability. In our study, layer-specific strains were gradually deteriorated by their wall motion. SG was augmented in the hypokinetic segments where inhomogeneous wall motion impairment was progressed. SG in the akinetic/dyskinetic segments was different between the viable and non-viable myocardium and was maintained in viable segments. We therefore believe that significantly reduced SG is indicative of irreversible transmural damage in the acute stage of STEMI and can be suitably used as a parameter for predicting myocardial viability.

P774Transcoronary transfer of Wharton's jelly mesenchymal pluripotent stem cells in patients with chronic ischaemic heart failure shows safety and unprecedented high-grade myocardial uptake

Abstract Background Chronic ischaemic heart failure (CIHF) remains an important health problem on the patient/family- and society level. In animal models, Wharton's jelly (umbilical cord matrix) multipotent stem cells (WJMSCs) effectively promote angiogenesis, can differentiate to cardiomyocytes, and drive functional myocardial regeneration. Effective uptake of regenerative cells in ischaemic-impaired tissue is fundamental for any therapeutic effect. Purpose To evaluate safety and myocardial uptake of WJMSCs transcoronary transfer in CIHF applied as a novel myocardial regeneration strategy employing allogenic yet hypo-immunogenic, off-the-shelf “unlimited” source of therapeutic cells (NCT03418233 pilot cohort). Material and methods In ten consecutive patients (age 62.6±2.5), with stable CIHF and no current need for revascularization (LVEF 29.3±3% by echo and 26.3±6% by SPECT; NT-proBNP 1746±329pg/mL; myocardial scar tissue 39.9±3.9% by SPECT) and patency of at least two major native coronary arteries or by-pass graft(s), the CardioCell Investigational Medical Product, based on 30x106 WJMSCs, was administered to viable yet hypokinetic segments using a novel algorithm including a dedicated catheter for transcoronary delivery of cellular therapies. The cells were labeled with 99mTc-extametazime to routinely evaluate their myocardial uptake magnitude. Results No symptoms or signs of novel myocardial ischaemia occurred with cell delivery and no patient showed any adverse periprocedural events. One hour after administration, myocardial WJMSCs uptake (SPECT) was 40.3±6%; see Fig for a typical raw data image. By 6 months there were no adverse events in the study cohort. Figure 1 Conclusions This work indicates safety and unprecedented high-grade myocardial uptake of WJMSCs in CIHF patients. Together with animal data, this provides basis for continued assessment of this strategy in an endpoint-powered randomized controlled clinical trial employing CardioCell as an “unlimited” off-the-shelf cellular therapy strategy. Acknowledgement/Funding K/ZDS/005644 and 265761 (National Centre for Research and Development STRATEGMED)

P749Dynamic of cardiac magnetic resonance imaging parameters in patients with non-ischemic cardiomyopathies after endomyocardial stem cell transplantation

Abstract Background Autologous mesenchymal stem cell (MSC) transplantation can be considered as an alternative method of end-staged chronical heart failure treatment in patients with Non-ischemic Cardiomyopathies (NICMP). About 2/3 NICMP are determined by previous myocarditis, transformed in inflammatory cardiomyopathy (ICM), while only 1/3 of NICMP cases are associated with idiopathic dilated cardiomyopathy (DCM). Application of MSC therapy in different groups of NICMP patients is not sufficiently studied. Purpose The purpose of the study was to compare cardiac magnetic resonance imaging (cMRI) parameters in the left ventricle (LV) segments of myocardium in patients with DCM and ICM before and after autologous MSC transplantation. Methods The study covered 15 patients with DCM (mean age 45.8±3.1 years; 4 females, 11 males; LV ejection fraction (EF) &lt;40%) and 15 patients with ICM (mean age 46.0±3.6 years; 5 females, 10 males; LV EF &lt;40%). All patients underwent cMRI, endomyocardial injections of 0.2 ml autologous MSC culture (CD105+, CD90+, CD73+ cells) into akinetic and hypokinetic myocardial segments. In total we have analysed 228 segments of NICMP patients. Results In patients with ICM we found significant decrease in extracellular volume (ECV) within 6 months after primary examination (from 32 [28; 36]% to 27 [25; 30]%, p=0,007). As a result, ICM patients had lower ECV than DCM patients 6 months after MSC transplantation 27 [26; 29] % and 31 [29; 32]% respectively (p=0,001). Patients with ICM demonstrated an increase in LV systolic myocardial segment thickness (SMST) 6 months after MSC injections (5.91 [5.74; 6.15] mm – baseline vs. 6.67 [6.60; 6.82] mm – 6 months later, p≤0,010) with a bigger increase 12 months after MSC injection (9.58 [9.47; 9.73] mm, p≤0,010). In ICM patients LV SMST was significantly higher than in DCM patients 12 months after MSC transplantation (9.58 [9.47; 9.73] mm vs. 7.38 [7.29; 7.61] mm, p=0.032). ICM patients showed an increase in LV ejection fraction (EF) within 6 months after MSC therapy (from 20 [17; 24]% to 27 [17; 32]%, p=0.043). Conclusions Endomyocardial MSC transplantation showed better results in ICM patients compared to DCM patients. It led to a significant decrease in ECV within 12 months in contrast to DCM patients. ICM patients also demonstrated significant increase of LV SMST and LV EF within 6 months after MSC therapy.

THIS TOO SHALL PASS (UNTIL IT DOESN'T): A RARE CASE OF TAKOTSUBO CARDIOMYOPATHY WITH PERSISTENT LEFT VENTRICULAR DYSFUNCTION

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Takotsubo cardiomyopathy (TCM) is characterized by acute regional dysfunction of the left ventricle (LV) triggered by emotional or physical stress. There is an absence of angiographic evidence of obstructive coronary artery disease or acute plaque rupture. TCM is usually reversible within a few weeks to months. Here, we present a rare case of TCM in which 6 months post inciting event there was not only a lack in recovery of LV function, but also new onset ventricular arrhythmias requiring AICD placement. CASE PRESENTATION: A 72-year-old male with a past medical history of hypertension, hyperlipidemia, and diabetes, presented with substernal chest pain for the last 10 days. The patient also reported increased work-related stress recently. EKG showed diffuse ST segment elevations and T wave inversions. Transthoracic echocardiogram (TTE) demonstrated a severely hypokinetic LV apical segment with a left ventricular ejection fraction (LVEF) of 45%. There was no significant atherosclerotic occlusion on coronary angiography. On follow up visit 4 months later, EKG showed persistent diffuse Q waves in anteroseptal and inferior leads with resolution of T wave inversions. The patient also developed new-onset paroxysmal atrial fibrillation. 6 months later, the patient presented with a complaint of palpitations, dizziness, and lethargy. TTE at that time showed persistent diminished LVEF to 45% with continued LV apical hypokinesis. The patient underwent an electrophysiology study that showed new-onset inducible ventricular tachycardia and lengthy sinus nodal reentrant tachycardia. He underwent successful left subclavian dual-lead AICD placement, with resolution of symptoms. DISCUSSION: TCM is generally characterized as transient LV dysfunction secondary to a stressor, with regression of wall motion abnormalities and gradual restoration of LVEF until complete recovery is achieved. Here, we describe a unique case, in which more than 6 months after the inciting event, LV function was still impaired. In approximately 20% of cases of TCM, complications may occur, including cardiogenic shock, heart failure, rhythm disorders, LV thrombus formation, free wall rupture, and death. There have been very few cases, as in this case, in which not only did LV function not recover but rhythm disorders developed months after the inciting event. Differences in the evolution of TCM may be attributed to the different pathophysiological mechanisms that have been cited to contribute to the disorder – namely, catecholamine-induced myocardial stunning, transient epicardial vasospasm, coronary microvascular dysfunction, and transient LV obstructions. CONCLUSIONS: TCM is often characterized as transient LV dysfunction. This case demonstrated the need for close monitoring post inciting event, as there is a possibility for persistent LVEF depression, as well as further complications that could significantly increase mortality. Reference #1: Virani, S. S., Khan, A. N., Mendoza, C. E., Ferreira, A. C., & de Marchena, E. (2007). Takotsubo cardiomyopathy, or broken-heart syndrome. Texas Heart Institute journal, 34(1), 76-9. Reference #2: Zalewska-Adamiec, M., Bachorzewska-Gajewska, H., Tomaszuk-Kazberuk, A., Nowak, K., Drozdowski, P., Bychowski, J., Krynicki, R., Musial, W. J., … Dobrzycki, S. (2016). Takotsubo cardiomyopathy: serious early complications and two-year mortality - a 101 case study. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 24(9), 511-9. DISCLOSURES: no disclosure on file for Rakesh Gupta; No relevant relationships by Christina Jee Ah Rhee, source=Web Response No relevant relationships by Sharmila Sarkar, source=Web Response

A chance encounter with a case of hypertrophic cardiomyopathy.

A chance encounter with a case of hypertrophic cardiomyopathy.

MRI assessment of left ventricular volumetrics and ejection fractions in patients with chronic ischemic heart disease in comparison with 2D echocardiography

Background: Ischemic heart disease (IHD) is highly prevalent in developed countries and is the leading cause of death. Diagnostic imaging plays an important role in the proper assessment and management of ischemic heart disease. The new criteria incorporating imaging evidence of ischemic heart disease involve not only established modalities such as echocardiography and radionuclide imaging, but also the newer modalities, cardiovascular magnetic resonance (CMR) and cardiac computed tomography especially in presence of pitfalls and limitations in diagnosis by established modalities. Aim:To assess left ventricular volumes; end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and wall motion abnormalities by MRI in patients with chronic ischemic heart disease in comparison with 2D echocardiography. PatientsandMethods: This prospective study include examination of 50 adult patients known to have chronic ischemic heart disease with or without suspected progression of the disease came for follow up by MRI and 2D echocardiography in Cairo university and Aswan heart center (MYF) radiology and cardiology departments. MRI was done by using 1.5T machine, using SENSE (sensitivity encoding) cardiac coil (6 element phased-array coil, receive only), functional cine images, first pass perfusion images and delayed enhancement images were acquired. Echocardiography was done transthoracic (TTE) by using a 2D ultrasound machine. The left ventricle volumes and ejection fractions obtained by MRI were compared to those obtained by echocardiography and correlated with standard tables of left ventricle volumetrics. Wall motion abnormalities were assessed visually by both modalities. Results:By comparison of the diagnostic performance of MRI versus 2D echo in estimation of left ventricle volumes and ejection fraction there was agreement and strong correlation value (0.97) between both modalities however, we found that the left ventricle volumes were of lower values by echocardiography relative to MRI with statistically significant difference with P value (0.004) and we found that the EFs detected by echocardiography were of higher values relative to MRI with statistically significant difference with P value (<0.001). As regard wall motion abnormalities, both CMR and 2D echo detected the hypokinetic and akinetic left ventricle segments with no statisticaly significant difference. Conclusion: Cardiac MRI can detect the impairment in left ventricle function in patients with ischemic heart disease and is an accurate tool for assessment of left ventricle volumes and ejection fraction and can be considered as a standard reference for these issues. *= radiodiagnosis department, ^=internal medicine department- faculty of medicine-sohag unevirsity.