Impaired Ventricular Systolic Function Research Articles

Quantitative Analysis of Myocardial Work in Gestational Diabetes Mellitus Using Noninvasive Left Ventricular Pressure-Strain Loop Measurement.

Gestational diabetes mellitus (GDM) poses a risk for cardiovascular damage during pregnancy. This study focused on evaluating changes in left ventricular myocardial performance in GDM patients using the left ventricular pressure-strain loop (LV-PSL) method and examining risk factors associated with reduced myocardial function. A prospective, randomized study involving 112 pregnant women diagnosed with GDM was conducted from June 2021 to June 2024. Additionally, 84 healthy pregnant women from the same period served as the control group. Utilizing both conventional echocardiography and two-dimensional speckle tracking echocardiography, left ventricular myocardial work metrics were assessed using LV-PSL technology. GDM patients demonstrated significantly reduced values for global longitudinal strain (GLS), global work index (GWI), global work efficiency (GWE), and global constructive work (GCW) (p < 0.05), while conventional ultrasound measures showed no significant difference between GDM and control groups. GWI, GWE, GCW, and GLS had high predictive value for cardiac function changes in GDM patients, with GWE showing the highest predictive value {Area under curve (AUC)=0.866, cutoff value=95.5%, specificity=0.77, sensitivity=0.87}. GWI, GWE, and GCW were negatively correlated with GLS (r=-0.532, -0.411, -0.425, all p < 0.001), whereas global wasted work (GWW) showed a positive correlation with GLS (r=0.325 and p < 0.001). These parameters were also correlated with HbA1c levels (r=-0.316, -0.256, -0.260, all p < 0.001 for negative correlations, and r=0.172, p < 0.05 for positive correlations). Multivariate logistic regression indicated that 1-h OGTT (mmol/L), 2-h OGTT (mmol/L), and HbA1c (%) were significant predictors of left ventricular systolic function (GWE) in GDM patients. LV-PSL is an effective tool for early detection of left ventricular systolic function impairment in GDM patients.

A multimodality assessment of the protective capacity of statin therapy in a mouse model of radiation cardiotoxicity

PurposeDespite technological advances in radiotherapy (RT), cardiotoxicity remains a common complication in patients with lung, oesophageal and breast cancers. Statin therapy has been shown to have pleiotropic properties beyond its lipid-lowering effects. Previous murine models have shown statin therapy can reduce short-term functional effects of whole-heart irradiation. In this study, we assessed the efficacy of atorvastatin in protecting against the late effects of radiation exposure on systolic function, cardiac conduction, and atrial natriuretic peptide (ANP) following a clinically relevant partial-heart radiation exposure. Materials and MethodsFemale, 12-week old, C57BL/6j mice received an image-guided 16 Gy X-ray field to the base of the heart using a small animal radiotherapy research platform (SARRP), with or without atorvastatin from 1 week prior to irradiation until the end of the experiment. The animals were followed for 50 weeks with longitudinal transthoracic echocardiography (TTE) and electrocardiography (ECG) every 10 weeks, and plasma ANP every 20 weeks. ResultsAt 30–50 weeks, mild left ventricular systolic function impairment observed in the RT control group was less apparent in animals receiving atorvastatin. ECG analysis demonstrated prolongation of components of cardiac conduction related to the heart base at 10 and 30 weeks in the RT control group but not in animals treated with atorvastatin. In contrast to systolic function, conduction disturbances resolved at later time-points with radiation alone. ANP reductions were lower in irradiated animals receiving atorvastatin at 30 and 50 weeks. ConclusionsAtorvastatin prevents left ventricular systolic dysfunction, and the perturbation of cardiac conduction following partial heart irradiation. If confirmed in clinical studies, these data would support the use of statin therapy for cardioprotection during thoracic radiotherapy.

Assessment of Right Ventricular Systolic Function with 3-Dimensional Speckle Tracking Echocardiography in Isolated Mild Mitral Stenosis.

In rheumatic severe mitral stenosis, right ventricular mechanics deteriorate with the increasing severity of mitral stenosis. Therefore, we aimed to investigate right ventricular mechanics in patients with mild mitral stenosis using 3-dimensional speckle tracking echocardiography. In total, 40 patients with mild mitral stenosis and 36 age- and gender-matched healthy controls were included. Conventional echocardiographic examination was performed and 3-dimensional data sets were acquired for strain analysis. Besides conventional echocardiographic parameters, right ventricular volume and function and 3-dimensional speckle tracking echocardiography-derived right ventricular free wall longitudinal strain were compared between patients with mild mitral stenosis and healthy controls. Although 3-dimensional right ventricular volumes and ejection fraction were similar between the groups, 3-dimensional speckle tracking echocardiography-derived right ventricular free wall longitudinal strain was significantly lower in patients with mild mitral stenosis than in controls (25.57 ± 4.39% vs. 27.90 ± 4.71%, P =.028). Significant correlations were observed between right ventricular free wall longitudinal strain and mitral valve area and estimated systolic pulmonary artery pressure (r = 0.597, P <.001; r = -0.508, P =.003, respectively). Another significant positive correlation was observed between planimetric mitral valve area and 3-dimensional speckle tracking echocardiography-derived right ventricular free wall longitudinal strain (r = 0.597, P <.001). The degree of severity of mild mitral stenosis in terms of mitral valve area can help in the early detection of subclinical right ventricular systolic function impairment which can be easily detected by 3-dimensional speckle tracking echocardiography. Right ventricular contractile performance could decrease even in mild mitral stenosis.

Cardiomyopathy Associated with Right Ventricular Apical Pacing-Systematic Review and Meta-Analysis

Bradyarrhythmias are potentially life-threatening medical conditions. The most widespread treatment for slow rhythms is artificial ventricular pacing. From the inception of the idea of artificial pacing, ventricular leads were located in the apex of the right ventricle. Right ventricular apical pacing (RVAP) was thought to have a deteriorating effect on left ventricular systolic function. The aim of this study was to systematically assess results of randomized controlled trials to determine the effects of right ventricular apical pacing on left ventricular ejection fraction (LVEF). we systematically searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for studies evaluating the influence of RVAP on LVEF. Pooled mean difference (MD) with a 95% confidence interval (CI) was estimated using a random effect model. 14 randomized controlled trials (RCTs) comprising 885 patients were included. In our meta-analysis, RVAP was associated with statistically significant left ventricular systolic function impairment as measured by LVEF. The mean difference between LVEF at baseline and after intervention amounted to 3.35% (95% CI: 1.80-4.91). our meta-analysis confirms that right ventricular apical pacing is associated with progressive deterioration of left ventricular systolic function.

Dynamic Change of Left Ventricular Mechanics in Patients with Acute Myocarditis with Preserved Left Ventricular Systolic Function: A 2-Year Follow-up Study.

Acute myocarditis mimics acute coronary syndrome due to its clinical course and presentation. This study aimed to evaluate left ventricular longitudinal and circumferential functions during the acute phase and late phase of acute myocarditis with preserved left ventricular ejection fraction using 2-dimensional speckle tracking echocardiography. Forty-one consecutive acute myocarditis patients with preserved left ventricular ejection fraction confirmed by cardiac magnetic resonance imaging underwent 2-dimensional speckle tracking echocardiography within the first week of hospital admission. Findings were compared with age and sex-matched 40 healthy controls. Left ventricular mechanics of the study group were reevaluated by 2-dimensional speckle tracking echocardiography during follow- up (23.85 ± 6.65 months later). Myocardial lesions with late gadolinium enhancement on cardiac magnetic resonance imaging were mostly localized in the subepicardial layer (91.40%) and commonly observed in the inferolateral wall (42.94%). Consistent with the cardiac magnetic resonance imaging findings, 2-dimensional speckle tracking echocardiography showed the localization of the involved myocardial segments with prominent impairment in global longitudinal peak systolic strain and global circumferential strain of the inferolateral wall of the left ventricle. In the acute phase, global longitudinal peak systolic strain (-17.32 ± 2.02 vs -20.59 ± 2.38) and global circumferential strain (-22.33 ± 2.27 vs -24.85 ± 3.19) were found to be lower in patients with acute myocarditis compared to healthy controls (both P &lt; .001). While global circumferential strain was improved in the late phase compared with the acute phase (from -22.28 ± 2.32 to -22.90 ± 2.65; P = .003). Global longitudinal peak systolic strain was not significantly changed during follow-up (from -17.30 ± 2.09 to -17.62 ± 2.19; P = .072). Subtle left ventricular systolic function impairment can be detected by the 2-dimensional speckle tracking echocardiography technique in patients with acute myocarditis with preserved left ventricular ejection fraction and improvement in circumferential function could be observed during follow-up.

Cardiomyopathy associated with right ventricular apical pacing – systematic review and meta-analysis

Abstract Aims Bradyarrhythmias are potentially life threatening medical conditions. The most widespread type of treatment of slow rhythms is artificial ventricular pacing. From the inception of the idea of artificial pacing, ventricular lead was located in the apex of the right ventricle. Right ventricular pacing (RVP) was thought to have deteriorating effect on left ventricular systolic function. The aim of this study was to systematically assess results of randomized controlled trials of the right ventricular pacing on left ventricular ejection fraction (LVEF). Methods We systematically searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for studies evaluating the influence of the RVP on the LVEF. Pooled mean difference (MD) with a 95% confidence interval (CI) was estimated using a random effect model. Results 15 randomized controlled trials (RCTs) comprising 951 patients were included. The mean follow-up in the included studies ranged between 6 to 24 months. In our meta-analysis, RV pacing was associated with statistically significant (MD 2.91; 95% confidence interval (CI): 1.07–4.75) left ventricular systolic function impairment measured by LVEF. Conclusion Our meta-analysis confirms, that the right ventricular pacing is associated with progressive deterioration of the left ventricular systolic function. Funding Acknowledgement Type of funding sources: None.

Myocardial Involvement in Systemic Lupus Erythematosus: Not only A Problem of Epicardial Coronary Artery

42-year-old woman, active smoker, with an history of arterial hypertension and SLE, treated with Prednisone and Hydroxychloroquine, was admitted to the Emergency Department (ED) complaining of severe chest pain. Electrocardiogram revealed normofrequent sinus rhythm with negative/diphasic T waves in Infero-lateral leads. Bedside Transthoracic Echocardiogram (TTE) showed mild impairment of ventricular systolic function (EF 50%) in presence of hypokinesia of the anterior wall in mid- basal segment. Cardiac biomarkers were elevated and a diagnosis of acute coronary syndrome without persistent ST Elevation Myocardial Infarction (ASC N-STEMI) was performed. The patient underwent for coronary angiography that revealed coronary arteries free from significant atherosclerotic lesions. Moreover, Cardiac Magnetic Resonance (CMR) showed signs of hypertrophic cardiomyopathy along with T2 hyperintensity and mesocardial Late Gadolinium Enhancement (LGE) in the basal segment of postero- lateral wall consistent with acute myocarditis.

Galectin-3 as a Marker of Cardiorenal Syndrome in Patients with Chronic Heart Failure

Aim. To assess the effect of renal dysfunction on the galectin-3 level in patients with chronic heart failure (HF) with preserved, intermediate and reduced left ventricular ejection fraction (EF).Material and methods. Along with a clinical examination, 69 patients with HF (NYHA class II-IV) underwent tests for the level of NT-proBNP and galectin-3 in serum using enzyme immunoassay.Results. Study participants were divided into 3 groups: 23 patients with preserved EF (HFpEF), 26 patients with midrange EF (HFmrEF), 20 patients with reduced EF (HFrEF). There was a trend to increase the concentration of galectin-3 with increase in NT-proBNP level. Correlation analysis showed significant feedback (r=−0.41, p&lt;0.05) between galectin-3 and EF only in patients with preserved systolic function. In the same group of HFpEF patients, the maximum serum galectin-3 level was 10.5 [6.5; 14.5] ng/ml. Serum galectin-3 level showed negative correlated with the GFR in patients with CHF (r=−0.513, p&lt;0.05). In patients with HF and glomerular filtration rate (GFR) &lt;60 ml/min/1.73 m2 it was higher than in patients with GFR&gt;60 ml/min/1.72 m2 (9 [5.3; 12.6] ng/mL vs 11.8 [6.2; 15.3] ng/mL, p&lt;0.05). According to the ROC-analysis data, galectin-3 level &gt;10.3 ng/ml indicates a high risk of chronic kidney disease stage 3-4 stage development (sensitivity 60%, specificity 75%) and can be considered as a risk factor for development of cardiorenal syndrome in HF patients.Conclusion. Galectin-3 level in patients with HF is more influenced by the degree of reduction in GFR rather than the left ventricular systolic function impairment.

Distribution of Left Ventricular Thrombus among Patients with Significantly Impaired Systolic Function

Background: The prevalence of Left Ventricular (LV) thrombus as well as the distribution among patients with a variable degree of left ventricular systolic function impairment due to various etiologies is not well known. Objectives: To describe the distribution of left ventricular thrombus in relation to the underlying pathology, i.e., ischemic versus non-ischemic cardiomyopathy with Ejection Fraction (EF) below 45%. Methods: All echocardiography studies performed between January 2013 and September 2017 were reviewed, and only those with confirmed LV thrombus were included. The patient’s demographic, clinical characteristics, cardiac history, and echocardiographic parameters were obtained. The cohort was divided into 4 subgroups: 22 patients with EF of 36 - 45% (A), 114 with 26% - 35% (B), 99 with 16 - 25% (C) and 48 with 15% or less (D). Results: A total of 63,732 echocardiography study results were reviewed. Only 282 patients were proved to have LV thrombus with EF less than 45%. 217 (77%) patients had previous myocardial infarction, of which 212 (97.7%) were presented with anterior regional wall motion abnormality. 90 (32.7%) patients were found to have dilated left ventricle, and 41 (14.5%) with dilated cardiomyopathy (DCM). 37 (13.2%) patients had moderately severe to severe mitral regurgitation. It was observed that the highest distribution of LV thrombus was seen in group B (40.3%). Conclusion: The majority of LV thrombus distribution was seen in patients with EF between 26% to 35% due to ischemic cardiomyopathy. Conversely, in the cohort of non-ischemic cardiomyopathy, the majority were observed in those with severely impaired LV function.

Left ventricular systolic function impairment in children after balloon valvuloplasty for congenital aortic stenosis assessed by 2D speckle tracking echocardiography.

The aim of the study was to evaluate left ventricular (LV) remodeling and systolic function using two-dimensional speckle tracking echocardiographic (2D STE) imaging in children at a long-term (more than 36 months, 107.5±57.8 months) after balloon valvuloplasty for aortic stenosis (BAV). 40 patients (mean age 9,68 years, 75% male) after BAV and 62 control subjects matched to the age and heart rate were prospectively evaluated. The 2D STE assessment of LV longitudinal and circumferential strain and strain rate was performed. Left ventricular eccentric hypertrophy (LVEH) was diagnosed in 75% of patients in the study group. Left ventricular ejection fraction (LVEF) was normal in all patients. In study group, global longitudinal strain (GLS), global longitudinal strain rate (GLSr) were significantly lower compared with the controls: GLS (-19.7±2.22% vs. -22.3±1.5%, P< 0.001), GLSr (-0.89±0.15/s vs. -1.04 ±0.12/s, P < 0.001). Regional (basal, middle and apical segments) strain and strain rate were also lower compared with control group. Global circumferential strain (GCS), global circumferential strain rate (GCSr) as well as regional (basal, middle and apical segments) strain and strain rate were normal. Multivariable logistic regression analysis included: instantaneous peak systolic Doppler gradient across aortic valve (PGmax), grade of aortic regurgitation (AR), left ventricular mass index (LVMI), left ventricular relative wall thickness (LVRWT), left ventricular end-diastolic diameter (LVEDd), peak systolic mitral annular velocity of the septal and lateral corner (S'spt, S'lat), LVEF before BAV and time after BAV and showed that the only predictor of reduced GLS was LV eccentric hypertrophy [odds ratio 6.9; (95% CI: 1.37-12.5), P = 0.045]. Patients at long-term observation after BAV present the subclinical LV systolic impairment, which is associated with the presence of its remodeling. Longitudinal deformation is the most sensitive marker of LV systolic impairment in this group of patients.

LVAD, heart failure journey continues

Introduction Heart failure (HF) is a global pandemic affecting at least 26 million people worldwide and is increasing in prevalence (1). Heart transplantation or implantation of durable mechanical circulatory support (MCS) are the sole therapies available for end-stage heart failure. Such patients have severely impaired systolic ventricular function due to end-stage cardiomyopathies but remain symptomatic despite optimal guideline-recommended treatment (2). Acute MCS can be effectively employed as a bridge to long-term MCS devices and heart transplantation. Heart transplantation has been limited by diminishing donor heart availability leading to a greater role of left ventricular assist device (LVAD) support. Methods Retrospective review of adult patients supported with HeartWare™ HVAD™ Pump as a first long term LVAD between January 2017 and February 2020. Results 73 patients received LVADs at our institution in that period. 59 (80%) males, 14 (20%) females, mean age 50. The most common indications were dilated (40%) and ischaemic (34%) cardiomyopathies. 27% of devices were implanted via sternotomy vs 76% via anterolateral thoracotomy. The most frequent complications were driveline infection 26 (36%), pump thrombosis 18 (25%) and ischaemic stroke 16 (22%). Overall, 30 days survival on LVAD was 85% and 1 year survival 65%. 1-year survival in the thoracotomy group was significantly greater compared to the sternotomy group 72% vs 49%, and less red cell transfusion rate (5.2 vs 9.8 units) in thoracotomy approach group was observed. 4 (5.5%) patients received heart transplant. Discussion Despite the excellent long-term survival data for heart transplantation, patients who are denied a transplant or who will not survive the long high-urgency waiting time, benefit more from a permanent LVAD and achieve outpatient status with acceptable quality of life for a reasonable period of time. The minimally invasive surgical approach implemented at our centre is associated with fewer mediastinal adhesions at time of transplant, which greatly facilitates heart implantation and reduces donor organ ischemic time resulting in improved graft performance (3). With new technology focused on limitations of the most common LVAD complications, implanted via thoracotomy, MCS remains valuable treatment tool and it might potentially play more important role in the future of the HF patients.

352 Impaired LV-GLS in Patients With Myocarditis as a Predictor of Recurrence of Chest Pain Requiring Hospitalisation

Myocarditis is an inflammatory disorder characterized by myocardial inflammation leading to variable clinical outcomes, including recurrent chest pain, cardiac failure and death. In myocarditis patients, subclinical impairment of ventricular systolic function can be detected via sensitive echocardiographic measures such as left ventricular global longitudinal strain (LV-GLS) and right ventricular free wall strain (RV-FWS). The aim of our study was to evaluate the association of LV-GLS and RV-FWS in patients with myocarditis without associated clinical cardiac dysfunction with regards to recurrent hospitalisation for chest pain. Patients admitted to our institution with an established diagnosis of myocarditis (2013-2018) based on Dallas criteria and comprehensive transthoracic echocardiogram were included (n=64). Patients with pre-existent cardiac disease, impaired LVEF, RV-FAC, RVS’ and TAPSE were excluded (n=24). Strain analysis of LV and RV was performed using vendor-independent software (TomTec Arena, Germany v4.6). Patients were followed up post-discharge for recurrence of chest pain requiring hospitalisation. Forty patients (44.3±16.7yrs; 40% female) were included with a mean LV-GLS% of -16.4±2.9% and RV-FWS of -22.6±5.1%. On median follow-up of 24 months, recurrence of chest pain requiring hospitalisation occurred in 9 (22.5%) patients. There was an association between recurrence of chest pain requiring hospitalisation and impaired LV-GLS (p=0.026), but not with age (p=0.816), peak troponin level (p=0.873), LVEF (p=0.312), RV-FAC (p=0.464) or RV-FWS (p=0.709). LV-GLS may be a predictor for chest pain recurrence requiring hospitalisation in patients with myocarditis. Patients with impaired LV-GLS on presentation with acute-phase myocarditis may benefit from more aggressive medical therapy and follow-up.

High fat diet aggravates atrial and ventricular remodeling of hypertensive heart disease in aging rats.

Left ventricular hypertrophy is a major cause of heart failure in aging population. This study is to determine whether an excess dietary fat is lipotoxic or lipoprotein to the hypertrophic aging heart. At 44-week-old, a normal chow (12% fat) was replaced a high-fat diet (HFD; 45% fat) for randomly selective spontaneously hypertensive rats (SHR+HFD, n=6) and Wistar-Kyoto rats (WKY+HFD, n=6, normotensive control). Others (SHR, n=11; WKY, n=10) were continuously fed with normal diets. After 27 weeks, electrocardiogram, echocardiography, and femoral arterial catheterization were performed before rats being sacrificed for molecular biology analyses. HFD aggravated cardiac atrial, ventricular dilation and hypertrophy in SHR (LV mass: SHR+HFD 2026.0±424.9 vs SHR 1449±461.1mg, unpaired t test P<0.05). HFD caused significant atrial dilatation in both WKY (LA diameter, 5.38±0.36 vs 4.11±0.42mm, P<0.001) and SHR (6.13±0.79 vs 4.69±1.00, P<0.01). Only in SHR, HFD induced significant left ventricular dilatation (LV diameter, 8.87±1.25 vs 7.08±1.00mm, P<0.01) and reduced ejection fraction (LVEF, 62.8±11.6 vs 75.1±9.2mm, P<0.05). The α-myosin heavy chain was significantly upregulated in atria and ventricles of HFD groups. HFD induced significant upregulation of PPARα, ACADM, and TNFα transcripts in atrial tissues (P<0.05). Hypertensive heart disease in aging rats was aggravated by HFD with worse atrial, ventricular remodeling and associated with left ventricular systolic function impairment.

P5556The use of direct heart hypothermia by METcooler reduces microvascular obstruction and left ventricular systolic function impairment in animal experimental model of myocardial infarction

P5556The use of direct heart hypothermia by METcooler reduces microvascular obstruction and left ventricular systolic function impairment in animal experimental model of myocardial infarction

Impact of mode of failure and end-organ dysfunction on the survival of adult Fontan patients undergoing cardiac transplantation.

Adults with failing Fontan circulation (FFC) represent a heterogeneous, high-risk group for cardiac transplantation with poor reported outcomes. We studied the impact of mode of Fontan failure (preserved versus impaired systolic ventricular function) and end-organ dysfunction on early survival in adults undergoing cardiac transplantation for FFC. A single-centre, retrospective study of 26 adults (≥16 years) with FFC undergoing cardiac transplantation between 1990 and 2015. Patients were classified by the presence or absence of preserved systolic ventricular function (PVF). End-organ dysfunction was assessed by serum markers, including albumin, liver ultrasound and the presence of varices, ascites, splenomegaly and thrombocytopaenia (VAST score for portal hypertension). Thirty-day survival rate for the entire cohort was 69.2%, with 76.2% survival for the recent era. One-year Kaplan-Meier survival rate was 65.4%. Actuarial survival was poorer in those with PVF or heterotaxy (P = 0.01; log-rank test). Cox multivariable regression analysis confirmed PVF as an independent predictor for death (odds ratio, OR 5.38; confidence interval, CI 1.08-26.96; P = 0.04). In examining the PVF subset further, these patients had significantly higher VAST and liver ultrasound scores and lower serum albumin, compared with patients with impaired function. Patients with PVF and ≥moderate liver fibrosis on ultrasound or VAST score ≥2 accounted for two-thirds of the total mortality. Favourable cardiac transplantation outcomes can be achieved in adults with failing Fontan circulation. Patients with PVF may represent a distinct subset with more perturbed failing Fontan physiology and higher cardiac transplant mortality. We continue, however, to evolve and refine our strategies and are optimistic concerning future improvement in outcomes even in those with PVF.

Echocardiographic evaluation of mechanical dyssynchrony in heart failure patients with reduced ejection fraction.

The aim of this study is to observe the differences between mechanical and electrical dyssynchrony in patients with impaired systolic ventricular function and symptomatic heart failure and to highlight the importance of mechanical dyssynchrony besides electrical dyssynchrony in clinical guidelines and clinical practice. Fifty-eight patients with heart failure, who are with the New York Heart Association (NYHA) functional class II-IV and left ventricular ejection fraction (LVEF) under 35%, were enrolled. Patients were divided into two groups, according to the duration of QRS complex (> 120 ms and ≤ 120 ms respectively). Echocardiographic parameters of interventricular (interventricular mechanical delay - IMD) and intraventricular (septal-to-posterior wall motion delay - SPWMD) dyssynchrony were measured in both groups. Results indicate that the duration of the QRS complex (i.e. electrical dyssynchrony) is not a fully reliable indicator of ventricular dyssynchrony; therefore ecocardiographic evaluation of mechanical dyssynchrony should also be recommended for better selection of candidates for cardiac resynchronization therapy (CRT).

Treatment of heart failure in adult congenital heart disease: a position paper of the Working Group of Grown-Up Congenital Heart Disease and the Heart Failure Association of the European Society of Cardiology.

Improved medical care of congenital heart disease patients increased survival into adulthood from 15% in the 1960s to over 85% in the current era. As a consequence, the prevalence of adult congenital heart disease (ACHD) increased rapidly,1 which is estimated to be >1 million ACHD patients in North America and 1.2 million in Europe. The growing number and aging of ACHD patients led to an overall increase in hospitalizations over the last decade and a substantial increase in patients presenting with heart failure (HF) (∼20%).2 The incidence of first HF-admission was 1.2 per 1000 patient-years in the Dutch national ‘CONCOR’ registry. Patients admitted with HF had a five-fold higher risk of death than those not admitted. From the same registry, the mortality was 2.8% during a follow-up period of 24 865 patient-years. Chronic HF (26%) and sudden death (19%) were recorded most frequently. The median age at death from HF was 51.0 years (range: 20.3–91.2 years).3 In another ACHD cohort, sudden death (26%) was the most common cause of death, followed by progressive HF (21%) and perioperative death (18%).4 Although patients with ACHD may not readily report symptoms, clinical HF is documented in 22.2% of patients with a Mustard repair for transposition of the great arteries (TGAs), 32.3% with congenitally corrected transposition of the great arteries (ccTGA), and 40% of patients after Fontan palliation. ### Heart failure with impaired systolic ventricular function The aetiology and triggers of impaired systolic ventricular function in ACHD patients are summarized in Table 1 . View this table: Table 1 Pathophysiology of heart failure with impaired systolic function: triggers (examples) ### Heart failure with preserved systolic ventricular function This occurs less often in ACHD patients, but is associated with specific conditions such as Shone complex and restrictive …

Left and right ventricular systolic function impairment in type 1 diabetic young adults assessed by 2D speckle tracking echocardiography

Subclinical left ventricular (LV) and right ventricular (RV) systolic dysfunction has been proved in type 2 diabetes mellitus (DM). There is lack of uniform data on systolic myocardial function in type 1 DM. The aim of this study was to evaluate LV and RV function with 2D speckle tracking echocardiography (2D STE) in adult type 1 diabetic patients. Totally, 50 patients with type 1 DM and 50 control subjects in the same range of age were prospectively evaluated. The 2D STE assessment of LV longitudinal, radial, circumferential strain and RV free-wall longitudinal strain was performed. In diabetic group, left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), left ventricular radial strain at basal level (LVRS-basal), and right ventricular free-wall global longitudinal strain (RVGLS) were significantly lower compared with the controls: LVGLS (-20.3 ± 2.0% vs. -22.2 ± 1.8%, P < 0.001), LVGCS (-21.1 ± 2.5% vs. -22.2 ± 2.4%, P < 0.05), LVRS-basal (50.5% ± 11.5 vs. 57.1% ±17.0, P < 0.05), and RVGLS (-30.1% ± 3.5 vs. -32.7% ± 3.9, P < 0.01). Multivariable logistic regression analysis showed that the only independent predictor of reduced LVGLS was low-density lipoprotein cholesterol [odds ratio 3.65 (95% confidence interval: 1.27-10.5), P = 0.014]. Type 1 DM is associated with subclinical LV systolic dysfunction and worse RV systolic function, which can be detected with 2D STE.

Heart failure therapy in diabetic patients- comparison with the recent ESC/EASD guideline

BackgroundTo assess heart failure therapies in diabetic patients with preserved as compared to impaired systolic ventricular function.Methods3304 patients with heart failure from 9 different studies were included (mean age 63 ± 14 years); out of these, 711 subjects had preserved left ventricular ejection fraction (≥ 50%) and 994 patients in the whole cohort suffered from diabetes.ResultsThe majority (>90%) of heart failure patients with reduced ejection fraction (SHF) and diabetes were treated with an ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) or with beta-blockers. By contrast, patients with diabetes and preserved ejection fraction (HFNEF) were less likely to receive these substance classes (p < 0.001) and had a worse blood pressure control (p < 0.001). In comparison to patients without diabetes, the probability to receive these therapies was increased in diabetic HFNEF patients (p < 0.001), but not in diabetic SHF patients. Aldosterone receptor blockers were given more often to diabetic patients with reduced ejection fraction (p < 0.001), and the presence and severity of diabetes decreased the probability to receive this substance class, irrespective of renal function.ConclusionsDiabetic patients with HFNEF received less heart failure medication and showed a poorer control of blood pressure as compared to diabetic patients with SHF. SHF patients with diabetes were less likely to receive aldosterone receptor blocker therapy, irrespective of renal function.

Exercise capacity reflects ventricular function in patients having the Fontan circulation

In this study we sought to determine, first, whether maximal exercise capacity reflects ventricular function, and second, whether the age of the patient, and the age of completion of the Fontan circulation, influence ventricular function and exercise performance. Cardiac magnetic resonance imaging and cardiopulmonary exercise testing were performed in 29 patients at a median time of 6.9 years after completion of the Fontan circulation. We divided the patients into 2 groups, the first 19 having their operation below the age of 18 years, and the second group, of 10 patients, having completion of the Fontan circulation when they were older than 18 years. Parameters for ventricular function and exercise were compared for both groups with controls. Compared to controls, the younger patients had normal end-diastolic ventricular volumes, but significantly impaired ventricular function, lower maximal work load and consumption of oxygen. The older patients had greater end-diastolic ventricular volumes, and significantly poorer ventricular function than both the younger patients and the controls. Maximal work load and consumption of oxygen were significantly lower in the older patients than in the younger ones and the controls. Patients with the Fontan circulation have an impaired systolic ventricular function, which correlates with maximal exercise capacity and uptake of oxygen. Those having completion of the Fontan circulation when younger than 18 years had significantly better ventricular function and exercise performance than those who had completion of the Fontan circulation at an older age. An early creation of the Fontan circulation may preserve cardiac function and exercise capacity.