Improves LV Systolic Function Research Articles

The impact of spinal anesthesia on cardiac function in euvolemic vascular surgery patients: insights from echocardiography and biomarkers.

Existing evidence of the effect of spinal anesthesia (SA) on cardiac systolic function is scarce and inconclusive. This study aimed to evaluate the effects induced by a single injection of SA for elective vascular surgery on left (LV) and right (RV) ventricular systolic performance using transthoracic echocardiography (TTE). A prospective study. Single-center study, university hospital. Adult patients undergoing elective vascular surgery with SA. During patients' evaluations fluid administration was targeted using arterial waveform monitoring. All patients underwent TTE studies before and after SA induction for the assessment of indices reflective of LV and RV systolic function. Blood samples were drawn to measure troponin and brain natriuretic peptide (BNP) levels. A total of 62 patients (88.7% males, 71.00 ± 9.42 years) were included in the study. The primary outcome was the difference before and after SA in LV ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE). In total population, LVEF significantly increased after SA 53.07% [16.51]vs 53.86% [13.28]; p < 0.001). End-systolic volume (ESV, 69.50 [51.50] vs. 65.00 [29.50] ml; p < 0.001) decreased while stroke volume (SV) insignificantly increased (70.51 ± 16.70 vs. 73.00 ± 18.76ml; p = 0.131) during SA. TAPSE remained unchanged (2.23 [0.56] vs. 2.25 [0.69] mm; p = 0.558). In patients with impaired compared to those with preserved LV systolic function, the changes evidenced in LVEF (7.49 ± 4.15 vs. 0.59 ± 2.79; p < 0.001), ESV (-18.13 ± 18.20 vs-1.53 ± 9.09; p < 0.001) and SV (8.71 ± 11.96 vs-1.43 ± 11.89; p = 0.002) were greater. This study provides evidence that SA in patients undergoing elective vascular surgery improved LV systolic function, while changes in RV systolic function are minimal.

Changes of Left Ventricular Global Longitudinal Strain and Diastolic Function Parameters in Patients Undergoing Primary Percutaneous Coronary Intervention with TIMI Flow Grade III after Anterior ST Segment Elevation Myocardial Infarction

Abstract Background STEMI is the most serious presentation of atherosclerotic CAD carrying the most hazardous consequences. STEMI is caused by occlusion of a major coronary artery and primary PCI is the recommended reperfusion therapy over fibrinolysis if performed by an experienced team as soon as possible. Myocardial infarction makes significant changes in composition, shape, and contractile function of myocardium. Especially left ventricle which is the major contributor to the contractile function of the heart, so it affects the systolic and diastolic functions of the heart. Objective To study the dynamic changes of left ventricular global longitudinal strain and diastolic function parameters in patients undergoing primary percutaneous coronary intervention with TIMI flow grade III after anterior STEMI Methods This study is a prospective observational study that was conducted at Ain Shams university hospitals, in the time interval from October 2022 till June 2023. A total of 100 Patients with anterior STEMI Results Our study showed significant improvement in LV systolic function, GLS and diastolic function parameters after PCI during the follow-up. Age &amp;gt; 53, DM, Chest pain to door &amp;gt; 7 hours and CK-total &amp;gt; 4356 were associated with no GLS recovery in Univariate analysis. In multivariate analysis, Chest pain to door &amp;gt; 7 hours was independently associated with no GLS recovery at follow-up with a sensitivity 90 % and specificity 95%. Conclusion In the present study we found Our study showed significant improvement in LV systolic function, GLS and diastolic function parameters after PCI during the follow-up. Age &amp;gt; 53, DM, Chest pain to door &amp;gt; 7 hours and CK-total &amp;gt; 4356 were associated with no GLS recovery in Univariate analysis. In multivariate analysis, Chest pain to door &amp;gt; 7 hours was independently associated with no GLS recovery at follow-up with a sensitivity 90 % and specificity 95%.

SCARY ECG IN TAKOTSUBO CARDIOMYOPATHY

Abstract Takotsubo cardiomyopathy (TTC) is characterized by a transient ventricular wall motion abnormality and shares common features with acute coronary syndrome (ACS) with a wide spectrum of triggers, such as both emotional or physical, activating common toxic catecholamines–mediated pathways. TTC might be associated with severe clinical complications. We report a case of a 74–year female patient with circulatory shock with mixed phenotype, distributive due to sepsis and cardiogenic due to TTC. The patient presented to the emergency department with severe hypotension, pathological qSOFA score and clinical and laboratory findings consistent with severe sepsis. ECG showed diffuse lambda ST–segment elevation, also called “shark fin”(fig.1). According to hemodynamically unstable scenario and ECG pattern, emergency coronary angiography was performed, showing absence of coronary artery disease(fig. 2). Echocardiography revealed severe LV systolic disfunction (EF 20–25%) with apical ballooning and severe systolic anterior motion (SAM) of the anterior mitral leaflet eliciting dynamic LVOTO with peak gradient greater than 90 mmHg; fig. 3) and severe MR. Patient was treated with cautious fluid administration, hemotrasfusion and empiric large spectrum antibiotic therapy. According to TTC working diagnosis, even if septic state was thought to contribute to cardiogenic shock, norepinephrine was not administered due to concerns for LVOTO and SAM. After overcoming of dramatic first phase and after hemodynamic steadiness was achieved, beta blockade and ACEi were progressively administered. Seriate transthoracic echocardiogram revealed progressive improvement of LV systolic function, regression of apical ballooning, SAM and LVOTO. ECG monitoring showed regression of ischemic ST elevation. ST elevation has been described in about 56% of TTC cases, however with amplitude tipically lower than in STEMI. Lambda–wave ST elevation has been rarely reported. Vasospasm, local intermittent microvascular constriction, catecholamine–induced metabolic toxicity, transmural systolic wall tension and its the mechano–electric feedback can explain scaring ECG–pattern. Despite its rare prevalence in TTC “shark fin” pattern appears to relate to adverse outcome and it should be used as an early marker of potential further clinical deterioration, suggesting more intensive monitoring to avoid delays in possible therapy escalation.

Inter-season training effects on cardiovascular health in American-style football players

BackgroundRecent studies on American-style football (ASF) athletes raised questions about the impact of training on the cardiovascular phenotype, particularly among linemen players who engage mostly in static exercise during competition and who exhibit concentric cardiac remodeling, often considered maladaptive. We aimed to examine the cardiovascular adaptation to the inter-season mixed-team training program among ASF players.MethodsA prospective, longitudinal, cohort study was conducted among competitive male ASF players from the University of Montreal before and after an inter-season training, which lasted 7 months. This program includes, for all players, combined dynamic and static exercises. Clinical and echocardiographic examinations were performed at both steps. Left atrial (LA) and ventricular (LV) morphological and functional changes were assessed using a multiparametric echocardiographic approach (2D and 3D-echo, Doppler, and speckle tracking). Two-way ANOVA was performed to analyze the impacts of time and field position (linemen versus non-linemen).ResultsFifty-nine players (20 linemen and 39 non-linemen) were included. At baseline, linemen had higher blood pressure (65% were prehypertensive and 10% were hypertensive), thicker LV walls, lower LV systolic and diastolic functions, lower LA-reservoir and conduit functions than non-linemen. After training, linemen significantly reduced weight (Δ-3.4%, P < 0.001) and systolic blood pressure (Δ-4.5%, P < 0.001), whereas non-linemen maintained their weight and significantly increased their systolic (Δ+4.2%, P = 0.037) and diastolic (Δ+16%, P < 0.001) blood pressure ). Mixed training was associated with significant increases in 2D-LA volume (P < 0.001), 3D-LV end-diastolic volume (P < 0.001), 3D-LV mass (P < 0.001), and an improvement in LV systolic function, independently of the field position. Non-linemen remodeled their LV in a more concentric fashion and showed reductions in LV diastolic and LA reservoir functions.ConclusionsOur study underscored the influence of field position on cardiovascular adaptation among university-level ASF players, and emphasized the potential of inter-season training to modulate cardiovascular risk factors, particularly among linemen.

Improvement in Echocardiographic Indexes of Systolic Heart Failure Post-Kidney Transplantation: A Retrospective Analysis

Introduction: End-stage renal disease is a major risk factor for cardiovascular morbidity and mortality, which can be partially eliminated by kidney transplantation. Systolic heart failure might be considered contraindication for kidney transplant, although some patients demonstrate myocardial recovery post-transplant. We aimed to identify and characterize the phenomenon of reverse myocardial remodeling in kidney transplanted patients. Methods: The study is a retrospective cohort of patients undergoing kidney transplants between 2016 and 2019 (n = 604) at Rabin Medical Center. Patients were assessed according to availability of two echocardiographic examinations: pre- and post-kidney transplant. The change in estimated ejection fraction (EF) and possible predictors of myocardial recovery were examined. Results: Data of 293 patients was available for the final analysis. Eighty-one (28%) patients had a LVEF improvement equal to or above 5%, whereas 36 (12%) patients had a LVEF improvement of 10% or more post-transplantation. Twenty-five patients (8.5%) had moderate or severe systolic heart failure with LVEF reduced to 40% or less at baseline. 13 of them (52%) had a LVEF improvement of ≥5%, and 10 patients (40%) had an improvement of ≥10% in their EF. Cox regression analyses identified female gender as the only independent variable associated with LVEF improvement of at least 10%. Conclusion: Renal transplantation might lead to improved LV systolic function in some patients.

Echocardiography-guided percutaneous intramyocardial alginate hydrogel implants for heart failure: canine models with 6-month outcomes.

Echocardiography-guided percutaneous intramyocardial alginate-hydrogel implantation (PIMAHI) is a novel treatment approach for heart failure (HF). We validated PIMAHI safety and efficacy in canine HF models. Fourteen canines with HF [produced by coronary artery ligation, left ventricular ejection fraction (LVEF) < 35%] were randomised to PIMAHI treatment (n = 8) or controls (n = 6). Echocardiography, two-dimensional speckle tracking echocardiography, and pathological examinations after a 6-month follow-up were performed. Repeated-measures analysis of variance was used for within-group comparisons. At 6-month follow-up, PIMAHI treatment reversed LV dilation and remodelling, increasing LV free wall thickness (LVFW, p = 0.002) and interventricular septum thickness (IVS, p < 0.001) and reducing LV end-diastolic volume (EDV, p = 0.008) and end-systolic volume (ESV, p = 0.004). PIMAHI significantly improved LV systolic function, increasing LVEF (EF, p = 0.004); enhanced LV myocardial contractility, including increased LV global longitudinal strain (GLS, p < 0.001), global circumferential strain (GCS, p = 0.006), and mitral annulus displacement (MAD, p = 0.001). Compared with controls at 6-month, PIMAHI group significantly increased LVFW thickness (8.5 ± 0.3 vs. 6.8 ± 0.2 mm, p = 0.002) and IVS (7.9 ± 0.1 vs. 6.1 ± 0.2 mm, p < 0.001); decreased LVEDV (30.1 ± 1.6 vs. 38.9 ± 4.5 ml, p = 0.049) and ESV (17.3 ± 1.2 vs. 28.7 ± 3.6 ml, p = 0.004); increased LV systolic function (42.7 ± 1.5 vs. 26.7 ± 1.1% in EF, p = 0.001); and enhanced LV myocardial contractility including GLS (13.5 ± 0.8 vs. 8.4 ± 0.6%, p = 0.002), GCS (16.5 ± 1.4 vs. 9.2 ± 0.6%, p = 0.001), and MAD (11.4 ± 3.5vs 4.6 ± 2.5 mm, p = 0.003). During PIMAHI treatment, no sustained arrhythmia, pericardial, or pleural effusion occurred. PIMAHI in canine HF models was safe and effective. It reversed LV dilation and improved LV function.

Pacing-induced cardiomyopathy in patients with permanent right ventricular pacing and preserved left ventricle systolic function: characteristics, methods of treatment and prevention

The aim – to determine the frequency of occurrence and describe the characteristics of pacing-induced cardiomyopathy (PICM) in patients with permanent right ventricular pacing (at least 90 %) and preserved left ventricular ejection fraction (LVEF) (≥ 50 %).Materials and methods. The study included 34 patients with indications for permanent ventricular pacing who had pacemaker implantation from 2012 to 2022 (mean follow-up period was 44.97±28.45 months). PICM was defined as a decrease in LVEF &lt; 45 % during follow-up.Results and discussion. The incidence of PICM in this study was 26 %. The average value of LVEF and EDI at the time of the control follow-up was significantly different in the PICM group and non-PICM group: 38.6±5.9 vs. 53.5±5.7 % (p&lt;0.001) and 97.90±20.75 vs. 60.90±19.32 ml/m2 (p&lt;0.001). All patients from the study group during follow-up went through protocol echocardiography, at which intraventricular and interventricular asynchrony were examined, the number of left ventricular segments with reduced deformation were fixed, and the global longitudinal deformation of the left ventricle (GLS) was calculated. The values of these parameters differed significantly in the PICM group and non-PICM group: intraventricular asynchrony was 261.1±61.0 vs. 146.1±62.8 ms (p&lt;0.001), interventricular asynchrony 91.0±36.4 vs. 54.2±22.2 ms (p=0.014), the number of segments with reduced deformation 8.1±2.6 vs. 3.91±2.30 (p&lt;0.001), GLS -9.7±2.6 vs. -14.9±3.4 (p&lt;0.001). At the time of the follow-up examination, sensitivity on ventricular lead in the PICM group was significantly reduced compared to patients with preserved LVEF (6.26±4.02 vs. 11.56±3.86 mV; p=0.045). The paced QRS width in the PICM group was significantly greater (163.0±22.7 vs. 150.8±14.5; p=0.046) and there were more patients with rate-adapted cardiac pacing in the PICM group (4 (40 %) vs. 2 (8 %)), p=0.0305).Conclusions. According to the obtained data, cardiomyopathy due to right ventricular pacing develops rather instantaneously in the first years after PM implantation, rather than slowly progressing over time, although a multivariate regression analysis of risk factors for the development of PICM has yet to be performed on the obtained clinical data. Biventri­­­cular paicng effectively eliminates the consequences of non-physiological right ventricular myocardial paicng, improves LV systolic function. Conduction system pacing may potentially reduce the risk of right ventricular pacing-induced cardiomyopathy in patients with preserved LVEF.

The Impact of Dapagliflozin on Cardiac LV Systolic Function in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention Who Developed Post MI LV Dysfunction

Abstract Aim and objectives To study the impact of dapagliflozin on LV systolic function in patients with ST Elevation Myocardial Infarction undergoing primary percutaneous Coronary Intervention who developed post MI LV dysfunction. Patients and Methods The study included 80 patient who presented with ST-segment elevation myocardial infarction and underwent primary PCI at the catheterization lab unit, Cardiology department, Ain Shams University. The patients were divided into 2 groups. The standard treatment was given to all patients according to the ESC guidelines including: ACEI or ARNi, a beta-blocker, and an MRA[1] uptitrated according to the clinical state of the patient. The study medication was 10 mg of dapagliflozin[1] given once daily in the morning to the case group and a placebo medication to the control group. LVEF was assessed in both groups post primary PCI and at follow-up after 3 months by the same Echo machine GE VIVED S5 after the procedure since first of June 2021 till end of January 2022. Results There were no statistically significant difference between both groups regarding gender distribution, mean age, and the incidence of different risk factors of CAD (smoking, Diabetes and hypertension). Regarding pain to door (PTD) time, there was no statistically significant difference between case and control groups (P-value = 0.695), and anterior STEMI was the most common presentation in both groups (90% in the case group and 77.5% in the control group in the control group). Subsequently, there was no statistically significant difference between case and control groups regarding TIMI flow, and post-MI EF with mean range 34.88% ± 3.55% in the case group and 34.58% ± 3.65% in the control group (P = 0.711). On the other hand, there was statistically significant improvement in follow-up EF in the case group which showed a mean range of 45.36% ± 7.13% in comparison with the control group which showed a mean range of 41.80% ± 6.93% (P = 0.027). Conclusion Dapagliflozin administration in the early phase after STEMI results in significant improvement in LV systolic function in comparison with the placebo. Abbreviations ACE-I: Angiotensin-converting enzyme inhibitor; ACS: Acute coronary syndrome; ARNI: Angiotensin receptor-neprilysin inhibitor; CBC: Complete blood picture; DM: Diabetes Mellitus; ECG: Electrocardiogram; FH: Family History; GLS: Global longitudinal strain; HF: Heart Failure; HFrEF: Heart Failure reduced Ejection Fraction; HTN: Hypertension IV: Intravenous; LV: Left ventricle; LVEF: Left ventricular ejection fraction; MI: Myocardial Infarction; MRA: Mineralocorticoid receptor antagonists; PCI: Primary percutaneous coronary intervention; SD: Standard deviation; SGLT-2: Sodium-glucose cotransporter-2 inhibitors; SPSS: Statistical Package for the Social Science; STEMI: ST-segment elevation myocardial infarction; T2D: Type 2 Diabetes Mellitus

Predicting left ventricular functional recovery in ischaemic cardiomyopathy: needs and challenges.

Left ventricular (LV) systolic function is an essential parameter for the evaluation of patients with ischaemic heart disease, and therapeutic choices are significantly driven by LV ejection fraction (LVEF) in the early stage of the disease and during follow-up. After an acute coronary syndrome, ventricular dysfunction may be reversible when caused by transient myocardial stunning. Therefore, the identification of clinical, laboratory, and instrumental predictors of improvement in LV systolic function (in addition to LVEF) is essential for an adequate prognostic stratification. In the setting of chronic ischaemic heart disease, there is no evidence that an improvement in LV systolic function is invariably associated with a better prognosis and LVEF is only one of many parameters that should be considered for the risk stratification. This state-of-the-art review will critically analyse the scientific evidence regarding known predictors of LVEF recovery, trying to elucidate their pathophysiological principles and clinical value.

Abstract 15038: Collateral Flow From the Right Coronary Artery Alone is Not Sufficient for Adult Alcapa: Clinical Case Report

Introduction: Myocardial ischemia in adult ALCAPA (Anomalous left coronary artery from the pulmonary artery) may lead to sudden death as the first clinical presentation. Cardiac blood supply from the right coronary artery alone is not sufficient for an adult ALCAPA. The aim of the present study was to describe a clinical case of severe myocardial ischemia in an adult female with ALCAPA supplied by the right coronary artery alone. Patient and Clinical data: 45-year-old female patient admitted to our hospital due to recurrent palpitation with tachypnoea after physical exertion for 2 years. Resting ECG on admission with ST-T changes and frequent premature ventricular contractions (PVC) indicated significant myocardial ischemia. Transthoracic echocardiography (TTE) showed dilated left ventricle (LVDd 64mm) with regional systolic dysfunction anterolateral and posterolateral with EF of 44% and dilated right coronary artery. An ALCAPA was observed with dilated caliber of 9 mm at ostium (Panel A) which was confirmed by computed tomographic angiography of the coronary artery and coronary angiography. Well-developed collateral vessels between peripheral right posterior descending (RPD) and distal left anterior descending (LAD) were demonstrated (Panel F). No collateral vessel was found between bronchial artery and ALCAPA. The bronchial arteries were visualized in normal size. The left coronary ostium was not found in the aortic root at aortography. The patient underwent anatomical reconstruction of left main coronary artery by using autologous pulmonary flap and recovered well postoperatively. Results: Postoperative ECG showed that the preoperative ST-T changes and PVC disappeared completely. Cardiac magnetic resonance imaging and TTE one month and 6 months postoperatively demonstrated continuously improved LV systolic function and myocardial perfusion posterolaterally and anterolaterally. Conclusion: Collateral flow from the right coronary artery alone is not sufficient for adult ALCAPA and completely surgical correction is necessary.

P311 TAKOTSUBO CARDIOMYOPATHY RELATED TO MRNA SARS–COV2 VACCINE

Abstract 54–year–old woman with a family history of systemic sclerosis, with no significant cardiological history. She underwent anti–Covid vaccination in February and March 2021 with Spikevax (Moderna) and a booster dose (Spikevax) on 09/12/21. A few hours after this last administration, the patient presented with palpitations, asthenia, and intermittent chest tightness. In the following days, because of dyspnea for mild exertion, she went to the emergency department. ECG showed low QRS voltages in the peripheral leads, poor septal r wave growth and negative T waves in inferior leads and from V3 to V6. Echocardiography showed akinesia of apical and middle segments, LVEF 40%, mitral obstructive systolic anterior motion, moderate mitral regurgitation and mild pericardial effusion. In blood tests: increase in myocardiospecific enzymes and NTproBNP, modest increase in indices of inflammation. The patient was admitted to Cardiology Unit, where coronary angiography showed coronary arteries free from stenosing lesions and Takotsubo–like appearance on ventriculography. Cardiac MRI confirmed alterations in parietal kinetics, hyperintensity in the STIR sequences referable to apical and middle segments edema compatible with Takotsubo cardiomyopathy (CMT). Capillaroscopy excluded scleroderma pattern. The patient presented a progressive reduction of troponins and, the echocardiogram before discharge showed improved LV systolic function, regression of mitral obstructive systolic anterior motion with reduction of mitral regurgitation. Rare case reports of CMT after influenza vaccination [1] and a similar case to the one we described after Spikevax vaccine [2] and ChAdOx1 nCov–19 (AstraZeneca) [3] have been presented in the literature. The underlying pathophysiological mechanism appears to be related to a stress–induced systemic reaction with a predominantly adrenergic sympatho–vagal imbalance [4]. In this clinical setting, cardiac MRI can offer added value in the diagnostic process, especially to exclude post–vaccine myocarditis, which in our case seemed unlikely given the immediate onset of symptoms.

Damage to the Cardiovascular System in Patients with SARS-CoV-2 Coronavirus Infection. Part 2: Correction of Myocardial Systolic Dysfunction

Aim. To study changes in myocardial contractile function when prescribing mineralocorticoid receptor antagonists of spironolactone in patients after coronavirus infection SARS-CoV-2 with symptoms of chronic heart failure (CHF).Materials and methods. The study included 90 hospitalized patients with a diagnosis of SARS-CoV-2 coronavirus infection. The inclusion criteria were: age from 18 to 85 years; the presence of CHF with a preserved or mildly reduced left ventricular ejection fraction (LVEF). The patients were randomized into two groups: group I (n=60) included patients who, for 6 months after discharge from the hospital, in addition to standard drug therapy for CHF, took spironolactone at a dose of 25 mg per day; group II (comparison group; n=30) included patients who received standard drug therapy without additional prescription of spironolactone. The study groups were comparable in age, gender, prevalence of hypertension, coronary heart disease, diabetes mellitus, obesity and severity of CHF; the drug therapy given to the patients had no significant differences. Assessment of LV systolic function, exercise tolerance (six-minute walk test, TSW), quality of life (questionnaire EQ-5D-5L) were performed.Results. When repeated echocardiography was performed after 6 months of treatment, there was a significant improvement in LV systolic function in group I patients. In group I, after 6 months of treatment, there was a significant decrease in the proportion of patients with moderately reduced LVEF (from 30 [50%] to 12 [20%]; p&lt;0.001), and a significant increase in the number of patients with preserved LVEF (from 30 [50%] to 48 [80%], p=0.002). In group II, the number of patients with moderately reduced LVEF did not significantly change. After 6 months of treatment, all patients showed an increase in exercise tolerance. During the test with a six-minute walk, group I patients showed an increase in the index from 316.8±63.5 to 432.9±41.3 meters; group II patients from 337.6±42.7 to 407.6±38.9 meters. The values of the six-minute walking test after 6 months of treatment were significantly higher in group I patients when compared with group II patients. When assessing the quality of life using the EQ-5D-5L questionnaire, it was found that at the time of inclusion of patients in the study, all patients noted the presence of any health problems in one or more components. The average indicator of health status, measured by a 100-point visual analog scale, after 6 months was 71.8±9.2 in patients of group I and was significantly higher than the same indicator in group II – 63.7±9.1. There were no adverse events in the study groups during the entire observation period.Conclusion. A significantly more pronounced improvement in systolic and diastolic left ventricle function, as well as quality of life, was found in the group of CHF patients with preserved or moderately reduced LVEF, who received spironolactone for 6 months after the SARS-CoV-2 infection in addition to standard therapy, compared with patients without aldosterone antagonists.

Оптимізація лікування стабільної ішемічної хвороби серця у разі супутнього цукрового діабету 2 типу з використанням кверцетину та емпагліфлозину

The risk of developing cardiovascular complications is the same in people with diabetes mellitus and in patients with coronary artery disease. Diabetes mellitus is usually referred to as cardiovascular pathology and is considered as a pathogenetic link of the most common disorders of the human organism. Comprehensive correction of glycemia, hyperlipidemia and hypertension is the main target of therapy aimed at reducing the risk of progression of stable coronary artery disease (SCAD) in patients with type 2 diabetes mellitus. It remains relevant to study the possibility and feasibility of using drugs with multimodal action, which could effectively affect the many pathogenetic components of combined pathology. Study aim – to evaluate the effectiveness of drug therapy of stable coronary artery disease and concomitant type 2 diabetes mellitus using bioflavonoid quercetin and empagliflozin, considering the impact on modified risk factors and left ventricular remodeling processes. Methods. 96 patients were examined, all of them had SCAD FC II-III and type 2 diabetes mellitus. Depending on the treatment received, patients were divided into four groups: group I (n = 22) – patients who received basic therapy, group II (n = 26) – received quercetin with basic therapy, group III (n = 25) – took empagliflozin, and group IV (n = 23) – patients who received quercetin on the with basic therapy and empagliflozin. Duration of therapy was 12 weeks. Results. The use of quercetin probably helped to reduce angina pain, palpitations, shortness of breath, and empagliflozin helped to eliminate the manifestations of diabetic polyneuropathy, polydipsia and polyuria, and contributed to weight loss. In patients receiving empagliflozin, HbA1c reduction results in optimized carbohydrate metabolism. In addition, empagliflozin is likely to contribute to the normalization of high-density lipoproteins, and quercetin to both low and high-density lipoproteins. The use of empagliflozin has been shown to have a positive effect on intracardiac hemodynamics, which is contributed by the regression of left ventricular hypertrophy and the improvement of diastolic function. Conclusions. 1. The use of quercetin and empagliflozin in patients with coronary artery disease and concomitant type 2 diabetes mellitus contributed to a significant improvement in the general well-being of patients, the elimination of leading symptoms. 2. Patients with SCAD and concomitant type 2 diabetes mellitus have more profound changes in the lipid spectrum of the plasma, which is characterized by dyslipidemia being more atherogenic in nature. Studied therapy enhanced the antiatherogenic effect of statins, helped to reduce the level of total cholesterol and normalized the ratio of its fractions. 3. Additional administration of empagliflozin allowed to improve the components of transmitral diastolic flow: decreased IVRT, increased the E/A ratio. The improvement in LV diastolic function was accompanied by a decrease of LV mass index, a decrease in LV end diastolic diameter, an improvement in LV systolic function.

Benefits of Angiotensin Receptor-Neprilysin Inhibitor in Heart Failure with Reduced Ejection Fraction: A Longitudinal Study

Introduction: Combination of Angiotensin Receptor and Neprilysin Inhibitors (ARNI) has become the mainstay drug in treatment of Heart Failure (HF) with reduced Ejection Fraction (HFrEF). However, there are very few studies to evaluate the extent and spectrum of benefit of ARNI therapy in Indian HFrEF patients. Aim: To observe the benefits of sacubitril/valsartan (ARNI) therapy on left ventricle function, parameters of cardiac remodelling, N terminal pro Brain-natriuretic peptide (NT-proBNP), rate of rehospitalisation for HF and detailed subgroup analysis in symptomatic HFrEF patients who are already receiving optimal medical therapy. Materials and Methods: This longitudinal study was conducted at Cardiology Department of Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from September 2018 to August 2020. Total 200 patients of HFrEF with previous echocardiographic records of past 6 months, who did not show any further improvement in left ventricle dysfunction or cardiac dimensions were included in the study. Patients were started on ARNI initially from 100 mg/day and up titrated to 400 mg/day. At each follow-up (6 weeks, 4 months, 6 months, 9 months and 1 year) clinical examination, New York Heart Association (NYHA) functional class, 2D Echocardiography and NT-ProBNP were done. Echocardiographic parameters of Cardiac Reverse Remodelling (CRR) i.e., Left Ventricular Ejection Fraction (LVEF), Left Ventricular End Diastolic Diameter (LVEDD), Left Ventricle End-Systolic Diameter (LVESD) were recorded at each follow-up. All categorical variables were shown in the form of frequency, mean with standard deviation and percentage. Intergroup comparison between different time periods was done by one-way Analysis of Variance (ANOVA) and paired t-test. A p-value &lt;0.05 was considered statistically significant. Results: Mean age of study population was 58.61±11.95 years, of whom 104 (59.77%) were males, and 70 (40.22%) were females. Mean LVEF increased from 30.42% at baseline to 45.98%, after 1 year (p-value &lt;0.05). There was reduction in mean LVEDD of 4.5 mm (p&lt;0.05) and LVESD of 3.86 mm (p-value &lt;0.05) at 1 year. These benefits of CRR were observed in all the subgroups of study population (including diabetics, hypertensive, tobacco users, age, gender). Reduction in NT-ProBNP from 1097.65±769.7 pg/mL at baseline to 127.28 pg/mL after 1 year with mean reduction of 970.37±731.33 pg/mL (p-value &lt;0.05). Rate of rehospitalisation for HF was 13.2% (N=23). A positive although weak correlation was seen between change in NT-ProBNP level and change in LVEF, LVEDD, LVESD as per spearman’s rank correlation coefficient. Conclusion: ARNI was well tolerated in this Indian population as 72% achieved maximum dose of 400 mg. There was significant improvement in LV systolic function and cardiac dimensions and benefits extended to different subgroups of HFrEF patients along with positive although weak correlation between fall in NT-ProBNP level and improvement in LV function and cardiac dimensions over and above optimal medical therapy.

The assessment of left ventricular myocardial work in patients with chronic heart failure receiving cardiac contractility modulation therapy

Abstract Introduction A new non-invasive technology for the assessment of left ventricular myocardial work (LVMW) is based on speckle-tracking echocardiography and considers LV pressure. Changes in LVMW are described in patients with different cardiovascular diseases. In patients with chronic heart failure (CHF), LVMW is associated with long-term prognosis and favorable response to cardiac resynchronization therapy. Purpose To study echocardiographic parameters, including LVMW, in patients with CHF receiving cardiac contractility modulation therapy. Methods The study included 40 patients (31 men and 7 women) aged 60.5 [55.0; 66.0] years with heart failure with reduced ejection fraction (NYHA class II or III) in combination with atrial fibrillation. Before implantation of cardiac contractility modulation (CCM) device and 2, 6 and 12 months after, the patients underwent transthoracic echocardiography with an assessment of the main structural and functional parameters. Also, initially and after 12 months of CCM therapy, an assessment of global longitudinal strain (GLS) and LVMW was performed (global work index (GWI), global constructive work (GCW), global wasted work, global work efficiency (GWE)). Results Initially, the patients included in the study had enlarged left heart chambers and decreased left ventricular ejection fraction (LVEF). CCM therapy was accompanied by significant increase in LVEF from 30.0 [26.5; 37.0]% before device implantation up to 34.4 [27.0; 40.0]% (p=0.016) after 2 months and up to 38.0 [30.5; 42.0]% (p&amp;lt;0.01) after 6 months of treatment. One year after device implantation, a significant increase in LVEF was maintained as compared with initial data (39 [31; 45]%, p&amp;lt;0.01). We also analyzed the dynamics of echocardiographic parameters depending on etiology of CHF (ischemic and non-ischemic). As in general group of patients regardless of CHF etiology there was a significant increase in LVEF, that reached maximum values after 12 months of therapy (36 [30; 42]% in group with ischemic etiology, p&amp;lt;0.01 and 37 [30; 45]% in group with non-ischemic etiology, p&amp;lt;0.01). The assessment of GLS before and 12 months after device implantation revealed no significant dynamics (−7 [−9; −4]% and −8 [−9; −5]%, p=0.93). However, we observed significant changes in LVMW: an increase in GWI from 429 [332; 744] to 635 [401; 815] mm Hg% (p=0.01) and GWE (from 73 [68; 79] to 74 [70; 87] %, p=0.02) due to an increase in GCW (from 791 [530; 1031] to 836 [708; 1109] mm Hg%, p=0.03). Conclusions A significant increase in LVEF, GWI and GWE in patients with CHF (NYHA class II or III) receiving CCM therapy indicates an improvement in LV systolic function and the effectiveness of CCM therapy. The modern echocardiographic technologies open great opportunities for detailed assessment of the effectiveness of treatment of patients with CHF, including the use of CCM devices. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of Russian Federation

Impact of conduction disturbances on left ventricular mass regression and geometry change following transcatheter aortic valve replacement

Our study aimed to compare the difference of LV mass regression and remodeling in regard of conduction disturbances (CD) following transcatheter aortic valve replacement (TAVR). A prospective analysis of 152 consecutive TAVR patients was performed. 53 patients (34.9%) had CD following TAVR, including 30 (19.7%) permanent pacemaker implantation and 23 (15.2%) new left bundle branch block. In 123 patients with 1-year follow-up, significant improvement of LV ejection fraction (LVEF) (baseline vs 12-month: 65.1 ± 13.2 vs 68.7 ± 9.1, P = 0.017) and reduced LV end-systolic volume (LVESV) (39.8 ± 25.8 vs 34.3 ± 17.1, P = 0.011) was found in non-CD group (N = 85), but not in CD group (N = 38). Both groups had significant decrease in LV mass index (baseline vs 12-month: 148.6 ± 36.9 vs. 136.4 ± 34.7 in CD group, p = 0.023; 153.0 ± 50.5 vs. 125.6 ± 35.1 in non-CD group, p < 0.0001). In 46 patients with 3-year follow-up, only non-CD patients (N = 28) had statistically significant decrease in LV mass index (Baseline vs 36-month: 180.8 ± 58.8 vs 129.8 ± 39.1, p = 0.0001). Our study showed the improvement of LV systolic function, reduced LVESV and LV mass regression at 1 year could be observed in patients without CD after TAVR. Sustained LV mass regression within 3-year was found only in patients without CD.

Early echocardiographic findings for cardiac chambers remodeling after congenital cardiac defects intervention

Abstract : Echocardiography is one of the most significant features in hospital for patients with inherited cardiac illness to assess defects morphology, assessment of associated abnormalities and exclude additional lesions. We aim to assessment the cardiac function before cardiac catheterization and to detect the possible early change after intervention and to investigate the complications early following intervention. The type of study is a prospective study conducted for a period of four months duration from 1 st January 2020 to 1 st May 2020, at Shahid Al- Mihrab cardiac center, at Al-Hilla city and Al-Nasiriya Heart Center at AL-Nasiriya city, Iraq. All patients who undergone transcatheter intervention for congenital heart disease during data collection time were included in this study. Variables such as age, gender, weight and height were recorded. Echocardiography was done for every patient in day before and day after transcatheter intervention; Data was analyzed using SPSS version 23. 39 patients included, for patients with ASD, echocardiography shown improvement of systolic RV function by significant increase in TAPSE (P value =0.001). For VSD patients, echocardiographic study showed a significant increase in TAPSE and EF (P value = 0.050 & 0.0001 respectively). For patients with PDA, echocardiographic study of LA, LV, PAP there were reduction post operation but statistically non-significant. Regarding COA, showed non-significant improvement of LV systolic function evaluated by EF and there were no significant changes in other echocardiographic parameters. In patients with PS, there was significant improvement of RV systolic function by increase in TAPSE (P value=0.004). Regarding AS there was reduction of PG across the AV with improvement of LV systolic function by increment of EF and there was a reduction of PAP . Echocardiography in the peri interventional situation can enable presentation of interference and vital for recurrent follow-up.

Abstract 17275: The SGLT2 Inhibitor Empagliflozin Ameliorates Left Atrial Dilatation in Non-Diabetic Patients With Heart Failure With Reduced Ejection Fraction: A Secondary Analysis of the EMPATROPISM Trial

Background: SGLT2 inhibitors (SGLT2i) improve prognosis in HFrEF patients. We recently demonstrated in a porcine model of non-diabetic HFrEF that empagliflozin (EMPA) ameliorates adverse cardiac remodeling and improves LV systolic function. However, the effect of EMPA on left atrial (LA) dilatation has not yet been studied Hypothesis:: Empagliflozin ameliorates left atrial dilatation in non-diabetic HFrEF patients Methods: The EMPATROPISM clinical trial investigated the efficacy and safety of EMPA in non-diabetic HFrEF patients. 84 patients were randomized to EMPA 10mg daily for 6 months or placebo on top of optimal medical treatment, and were evaluated with cardiac magnetic resonance (CMR). LA Volumes were quantified by CMR using the Simpson method (the number of slices in the usual short axis SSFP cine sequence was increased to cover both LV and the whole of LA. The primary endpoint was change in LVEDV. Prespecified secondary endpoints were changes in maximal and minimal LA volumes (ΔMax LA Vol and ΔMin LA Vol) at the end of 6 months between both arms Results: 80 patients completed the follow up period. There were no differences at baseline in LVEDV (220±75 vs 209±68mL for EMPA vs placebo, p=0.5) or LVEF (36±8 vs 37±8%, p=0.7). There were no differences at baseline in both groups in either maximal or minimal LA volume (Table). In the primary endpoint, EMPA-treated patients showed decrease in LVEDV and increase in LVEF (ΔLVEDV -25±25 vs -1±25mL, p&lt;0.001; and ΔLVEF 6±4 vs 0±4%, p&lt;0.001 for EMPA vs placebo). EMPA-treated patients exhibited a reduction of both maximal LA volume (ΔMax LA Vol -16.2±17.8 vs 11.4±25.9mL for EMPA vs placebo, p&lt;0.001) and minimal LA volume (ΔMin LA Vol -11.3±13.3 vs 6.4±19.3mL for EMPA vs control, p&lt;0.001) Conclusions: In HFrEF patients without diabetes, treatment with empagliflozin ameliorates left atrial dilatation. As LA volume is a surrogate for chronic filling pressures, this reduced LA volume suggest improved diastolic function with EMPA

Abstract 17157: The SGLT2 Inhibitor Empagliflozin Ameliorates Interstitial Myocardial Fibrosis and Aortic Stiffness in Non-Diabetic Patients With Heart Failure With Reduced Ejection Fraction: A Secondary Analysis of the EMPATROPISM Trial

Background: SGLT2 inhibitors (SGLT2i) improve prognosis in HFrEF patients. We recently demonstrated in a porcine model of non-diabetic HFrEF that empagliflozin (EMPA) ameliorates adverse cardiac remodeling and improves LV systolic function. However, the effect of EMPA on interstitial myocardial fibrosis (IMF) and aortic stiffness has not yet been studied Hypothesis: Empagliflozin ameliorates IMF and aortic stiffness in non-diabetic HFrEF patients Methods: The EMPATROPISM clinical trial (NCT 03485222) investigated the efficacy and safety of EMPA in non-diabetic HFrEF patients. 84 patients were randomized to EMPA 10mg daily for 6 months or placebo on top of optimal medical treatment, and were evaluated with cardiac magnetic resonance (CMR). IMF was assessed by CMR using extracellular volume (ECV) by T1 mapping. Aortic stiffness was quantified by pulse wave velocity (PWV) by CMR. The primary endpoint was change in LVEDV. Prespecified secondary endpoints were changes in ECV (ΔECV) and PWV (ΔPWV) at 6 months between both arms Results: 80 patients completed the follow up period. There were no differences at baseline in LVEDV (220±75 vs 209±68mL for EMPA vs placebo, p=0.5) or LVEF (36±8 vs 37±8%, p=0.7). There were no differences at baseline in both groups in either ECV or PWV (Table). In the primary endpoint, EMPA-treated patients showed decrease in LVEDV and increase in LVEF (ΔLVEDV -25±25 vs -1±25mL, p&lt;0.001; and ΔLVEF 6±4 vs 0±4%, p&lt;0.001 for EMPA vs placebo). EMPA-treated patients exhibited a reduction in ECV (ΔECV -1.25±1.5 vs 0.3±1.4% for EMPA vs placebo, p&lt;0.001), which demonstrates IMF regression with SGLT2i. EMPA-treated patients exhibited a reduction in PWV (ΔECV -0.6±1 vs 0.6±1.4 m/s for EMPA vs control, p&lt;0.001), which indicates amelioration of aortic stiffness with SGLT2i Conclusions: In HFrEF patients without diabetes, treatment with empagliflozin ameliorates IMF and aortic stiffness. This may explain the benefits of SGLT2i in HFrEF even in the absence of diabetes

Abstract 16640: Neutrophil Expansion is Essential for Adverse Left Ventricular Remodeling and Dysfunction in Chronic Ischemic Heart Failure

Chronic inflammation contributes significantly to disease progression in heart failure (HF), and is characterized by expansion of activated macrophages, dendritic cells, and T cells in the failing heart. Neutrophils play a well-known role as the initial drivers of inflammatory response to myocardial infarction (MI), thereby providing the platform for the subsequent recruitment of macrophages and T cells. However, whether and how neutrophils contribute to inflammation and adverse LV remodeling in chronic HF are unknown. We tested the hypothesis that activated neutrophils are required for tissue remodeling and disease progression in HF. Male C57Bl/6 mice were studied 4 and 8 weeks after left coronary artery ligation during established ischemic HF (sham-operated controls). As assessed by flow cytometry, CD11b + Ly6G + neutrophils were expanded in the peripheral blood (4 w post-MI), and in the bone marrow, spleen, and heart at 8 w post-MI. Immunostaining revealed that in the failing heart, neutrophils were primarily localized to the MI border zone, but also augmented in remote zone myocardium. CXCL1 and CXCL5 chemokine expression was increased in the failing heart, consistent with chemotactic signals for myocardial neutrophil recruitment. Isolated naïve neutrophils also exhibited increased chemotaxis in response to plasma from HF mice (versus plasma from naïve mice), as assessed by time-lapse video microscopy. Moreover, blood neutrophils isolated from HF mice exhibited significantly increased neutrophil extracellular trap (NET) production as compared to control neutrophils, whereas plasma NETs (histone-DNA complexes) were increased in HF mice. Finally, the in vivo role of neutrophils in chronic HF (8 w post-MI) was determined via depletion studies using genetic (Ly6G-diptheria toxin receptor mice) and antibody (1A8) based approaches. In both models, 2 and 4 w of neutrophil depletion, respectively, significantly improved LV systolic function and reduced end systolic volume. 1A8 treated HF mice also exhibited reduced remote zone fibrosis. We conclude: neutrophil expansion and activation are important components of the chronic inflammatory response in HF, and play an obligatory role in the progression of LV remodeling in ischemic cardiomyopathy.