Increase In Ejection Fraction Research Articles

Prediction of left ventricular ejection fraction changes in heart failure patients using machine learning and electronic health records: a multi-site study

Left ventricular ejection fraction (EF) is a key measure in the diagnosis and treatment of heart failure (HF) and many patients experience changes in EF overtime. Large-scale analysis of longitudinal changes in EF using electronic health records (EHRs) is limited. In a multi-site retrospective study using EHR data from three academic medical centers, we investigated longitudinal changes in EF measurements in patients diagnosed with HF. We observed significant variations in baseline characteristics and longitudinal EF change behavior of the HF cohorts from a previous study that is based on HF registry data. Data gathered from this longitudinal study were used to develop multiple machine learning models to predict changes in ejection fraction measurements in HF patients. Across all three sites, we observed higher performance in predicting EF increase over a 1-year duration, with similarly higher performance predicting an EF increase of 30% from baseline compared to lower percentage increases. In predicting EF decrease we found moderate to high performance with low confidence for various models. Among various machine learning models, XGBoost was the best performing model for predicting EF changes. Across the three sites, the XGBoost model had an F1-score of 87.2, 89.9, and 88.6 and AUC of 0.83, 0.87, and 0.90 in predicting a 30% increase in EF, and had an F1-score of 95.0, 90.6, 90.1 and AUC of 0.54, 0.56, 0.68 in predicting a 30% decrease in EF. Among features that contribute to predicting EF changes, baseline ejection fraction measurement, age, gender, and heart diseases were found to be statistically significant.

PS-C24-10: HAEMODYNAMIC CHARACTERISTICS OF THE HEART BEFORE AND AFTER CRT IN PATIENTS WITH HEART FAILURE

The aim of the study: to evaluate the clinical and hemodynamic effects of resynchronization therapy in patients with congestive heart failure. Materials and Methods: seventy-six consecutive patients underwent echocardiography, NYHA classification, 6-minute walk test before and after cardiac resynchronization therapy. All had complete left bundle branch block, with a QRS complex duration greater than 130 ms. and left ventricular ejection fraction less than 35%. Also, all patients had received optimal medical therapy for at least 3 months before inclusion to the study. Results: we observed significant increase in left ventricular ejection fraction (on 35.4 ± 3.7%, p < 0.001, compared with baseline) and decrease in end-systolic volume of the left ventricle (on 20.2 ± 3.0%, p < 0.001 compared with baseline). Improvement in functional class of congestive heart failure by NYHA classification by more than 1 was observed in 68.4% of individuals, in 26.3% of participants demonstrated no change and 5.3% of patients had worsening of CHF symptoms. Conclusions: the response of patients with congestive heart failure to cardiac resynchronization therapy is heterogeneous. The relationship between left ventricular reverse remodeling and the functional class of the congestive heart failure was not significant.

PS-C13-13: BLOOD PRESSURE REACTIVITY AGAINST PHYSICAL ACTIVITY “ACTISENSITIVITY” EVALUATED BY MULTISENSOR-ABPM CHANGES BEFORE AND AFTER TREATMENT OF HEART FAILURE

Introduction: The pathological significance of blood pressure (BP) variability in patients with heart failure (HF) has not been fully elucidated. We propose the term Actisensitivity to describe such BP reactivity in response to physical activity; this new aspect of BP variability can be evaluated using our recently developed device, a multisensor-ambulatory BP monitoring (ABPM) device (TM-2441, A&D Co., Tokyo) equipped with an actigraph that can detect physical movements. Methods: In the present study, actisensitivity is defined as the slope of the regression line that is calculated from ambulatory systolic BP (SBP) with the log-transformed value corresponding 5-min average of physical activity just before each BP measurement. We prospectively assessed the changes in actisensitivity and ambulatory BP (ABP) parameters between patients with and without improved cardiac function during the treatment of HF. We assessed 20 patients with diagnosed HF (mean ± SD age, 63.3 ± 14.1 years; male, 65%; ischemic heart disease, 15%; atrial fibrillation, 25%) just after initial or adjusted treatments, and reassessed the multisensor-ABPM data at follow-up from 6–12 months after tailored treatment. Second, we divided these patients into an improved (n = 11 patients) and a not-improved (n = 9) cardiac-function group; an increase in echocardiographic left ventricular ejection fraction of ≧ 10%. We then compared the changes in actisensitivity and ABP parameters between the two groups. Results: Parameters of ABP variability, i.e., SD, coefficient of variation, and average real variability of SBP, did not change between baseline and follow-up in either group. However, the actisensitivity value tended to increase from baseline to follow-up in the improved group (1.0 ± 3.5 vs. 4.5 ± 3.5, p = 0.065), but not in the not-improved group. The degree of changes in actisensitivity from baseline to follow-up tended to be higher in the improved group than the not-improved group (3.5 ± 5.6 vs. -1.2 ± 4.8, p = 0.059) (Figure). Moreover, in the overall patient group, the change of actisensitivity from baseline to follow-up was significantly related to the changes of LVEF (r = 0.553, p = 0.011). Conclusion: To our knowledge, this is the first study to prospectively observe the changes of novel BP reactivity against physical activity in HF patients using the new multisensor-ABPM device. Our findings should help to elucidate the relationships between BP variability/hemodynamics during physical activity and cardiac function in patients with HF.

Modified Glasgow Prognostıc Score May Be Useful to Predict Major Adverse Cardiac Events in Heart Failure Patients Undergone Cardiac Resynchronization Treatment.

Whether modified Glasgow prognostic score predicts prognosis in patients with cardiac resynchronization therapy with defibrillation is unknown. Our aim was to investigate the association of modified Glasgow prognostic score with death and hospitalization in cardiac resynchronization therapy with defibrillation patients. A total of 306 heart failure with reduced ejection fraction patients who underwent cardiac resynchronization therapy with defibrillation implantation were categorized into 3 groups based on their modified Glasgow prognostic score categorical levels. C-reactive protein >10 mg/L or albumin <35 g/L was assigned 1 point each and the patients were classified into 0, 1, and 2 points, respectively. Remodeling was determined according to the clinical event and myocardial remodeling criteria. Major adverse cardiac events were defined as mortality and/or hospitalization for heart failure. Age, New York Heart Association functional class, modified Glasgow prognostic score prior to cardiac resynchronization therapy with defibrillation, sodium levels, and left atrial diameter were higher in the major adverse cardiac events(+) group. Age, left atrial diameter, and higher modified Glasgow prognostic score were found to be predictors of heart failure hospitalization/death in multivariable penalized Cox regression analysis. Besides, patients with lower modified Glasgow prognostic score showed better reverse left ventricular remodeling demonstrated by increase in left ventricle ejection fraction and decline in left ventricle end systolic volume. Modified Glasgow prognostic score prior to cardiac resynchronization therapy with defibrillation can be used as a predictor of long-term heart failure hospitalization and death in addition to age and left atrial diameter. These results can guide the patient selection for cardiac resynchronization therapy with defibrillation therapy and highlight the importance of nutritional status.

ЭМПАГЛИФЛОЗИН В ЛЕЧЕНИИ ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ, ЕГО ВЛИЯНИЕ НА ЖЕЛУДОЧКОВЫЕ НАРУШЕНИЯ РИТМА

The study aims to assess empagliflozin affecting ventricular dysrhythmia and late potential of ventricles in patients with chronic heart failure with low etiology ejection fraction. The study included 35 male patients (61.7 ± 11.2 years old) who received standard therapy, followed by 10 mg empagliflozin in 6 months. The examination included echocardioscopy, 12-leads electrocardiography, signal-averaged electrocardiography, and daily electrocardiography monitoring. 10 mg empagliflozin added to the standard therapy provided for a statistically significant decrease in the number of single premature heart beats by 67.7 % (p = 0.001), in the episodes of unstable ventricular tachycardia by 74.5 % (p = 0.001), in the frequency of late ventricular potential by 31 % (Chisquare = 5.51; р = 0.019), and for a statistically insignificant trend to ejection fraction increase (p &gt; 0.05).

Impact of residual coronary artery disease on left ventricular function after percutaneous coronary intervention: atwo-dimensional strain echocardiography study.

The aim of this study was to investigate the relationship between the residual SYNTAX score (rSS) and recovery of left ventricular function after percutaneous coronary intervention (PCI) in stable symptomatic patients. Overall, 81patients (mean age: 62.3 ± 9.1years, 72.8% male) were included in the study. Echocardiographic parameters were measured before PCI (baseline) and 3months after PCI (follow-up). The patients were divided into two groups based on rSS: complete revascularized group (CR) with rSS = 0(n =32; 39.5%) and incomplete revascularized group (iCR) with rSS > 0 (n = 49; 60.5%). The median (25th-75th percentile) SYNTAX score (SS) and rSS values were8 (5-11) and2 (0-3), respectively. The difference between basal and follow-up global longitudinal strain (GLS) values (∆GLS) was significantly higher in the CR group (1.25% ± 1.52 vs. 0.11% ± 1.66% p = 0.003). At the follow-up, there was asignificant increase in left ventricular ejection fraction (58.41 ± 6.91% vs. 61.74 ± 5.76%, p < 0.001), asignificant decrease in Tei index (0.46 ± 0.18 vs. 0.35 ± 0.16%, p < 0.001), and asignificant increase in GLS (14.92 ± 2.76% vs. -15.49 ± 2.66%, p = 0.004). In the linear regression analysis, the only variable related to ∆GLS was rSS (β = -0.113, 95% CI: -0.217--0.010; p = 0.033). Increased residual coronary artery disease burden has anegative impact on recovery of left ventricular function after PCI.

The Novel Cardiac Myosin Activator Danicamtiv Improves Cardiac Systolic Function at the Expense of Diastolic Dysfunction In Vitro and In Vivo: Implications for Clinical Applications.

Recent cardiotropic drug developments have focused on cardiac myofilaments. Danicamtiv, the second direct myosin activator, has achieved encouraging results in preclinical and clinical studies, thus implicating its potential applicability in the treatment of heart failure with reduced ejection fraction (HFrEF). Here, we analyzed the inotropic effects of danicamtiv in detail. To this end, changes in sarcomere length and intracellular Ca2+ levels were monitored in parallel, in enzymatically isolated canine cardiomyocytes, and detailed echocardiographic examinations were performed in anesthetized rats in the absence or presence of danicamtiv. The systolic and diastolic sarcomere lengths decreased; contraction and relaxation kinetics slowed down with increasing danicamtiv concentrations without changes in intracellular Ca2+ transients in vitro. Danicamtiv evoked remarkable increases in left ventricular ejection fraction and fractional shortening, also reflected by changes in systolic strain. Nevertheless, the systolic ejection time was significantly prolonged, the ratio of diastolic to systolic duration was reduced, and signs of diastolic dysfunction were also observed upon danicamtiv treatment in vivo. Taken together, danicamtiv improves cardiac systolic function, but it can also limit diastolic performance, especially at high drug concentrations.

500 HEMODYNAMIC FORCES AS PREDICTORS OF CARDIAC REMODELING AND OUTCOME IN PATIENTS WTH HEART FAILURE WITH REDUCED EJECTION FRACTION TREATED WITH SACUBITRIL/VALSARTAN

Abstract Aims To evaluate the predictive value of echo-derived hemodynamic forces (HDF) compared to other echocardiographic, biohumoral and cardiopulmonary parameters on: a) angiotensin receptor-neprilysin inhibition (ARNI) response to 6-months treatment; b) cardiovascular events at follow-up. Methods Eighty-nine consecutive patients with heart failure with reduced ejection fraction (HFrEF) performed clinical, laboratory, ultrasound, and cardiopulmonary exercise testing. Patients experiencing no adverse events and showing ≥50% reduction in plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and/or ≥10% increase in left ventricle ejection fraction over 6 months were considered responders to ARNI. We conducted a clinical follow-up for the composite endpoint of HF-related hospitalization, new-onset atrial fibrillation and cardiovascular death. Results Out of 89 patients, 45 (51%) were ARNI-responders. Among several variables evaluated at baseline, only the whole cardiac cycle left ventricle strength (wLVS) calculated from HDF was found to be higher in responders (4.4±1.3 vs 3.6±1.2; p=0.01) and the only independent predictor of ARNI-response at multivariate logistic regression analysis (odds ratio 1.36; 95% confidence interval 1.10–1.67; p=0.004), with good accuracy at receiver operating characteristic (ROC) analysis (optimal cut-off ≥3.7%; area under the curve [AUC]=0.736, 0.607–0.840; p&amp;lt;0.0001). During a median follow-up of 33 months (interquartile range 23-41), 6-month wLVS increase (ΔwLVS) showed a high discrimination ability at time-dependent ROC analysis (optimal cut-off ≥0.5%; AUC=0.811, 0.69–0.90; p&amp;lt;0.0001), stratified prognosis (log-rank p&amp;lt;0.0001) and remained an independent prognostic predictor for the composite endpoint (hazard ratio 0.76, 0.61–0.95; p&amp;lt;0.01), after adjusting for all clinical, functional and conventional echocardiographic parameters (Figure). Conclusions HDF analysis helps in predicting ARNI-response and optimizing follow-up and medical/device decision-making in patients with HFrEF.

963 PRELIMINARY OBSERVANIONAL STUDY ON CARDIAC REMODELING IN PATIENTS UNDERGOING EDGE-TO-EDGE TRANS-CATHETER MITRAL VALVE REPAIR WITH MITRA CLIP DEVICE

Abstract Preliminary Observational Study on Cardiac Remodeling in Patients Undergoing Edge-to-Edge Trans-catheter Mitral Valve Repair with MitraClip Device Considering the current interest to the new trans-catheter mitral valve repair, it has been our aim to investigate the remodeling of left ventricular (LV), left atrium (LA) and right ventricular (RV) in a cohort of 24 patients with severe organic (13 cases) or functional (11 cases) mitral regurgitation (MR), on a 6 months follow-up. Their mean age was 78,54 ± 7,64 years, and STS score 4,69 ± 2,39 and EuroSCORE II of 5,10 ± 3,28%, and a corresponding ASA score of 3, due to age, co-morbidity and impaired cardiac function (NHIA III/IV). In our study we used advanced techniques of 3D- echocardiography, for the advantage of images independent from the cutting sections, probe angles, and operators skills: this method accuracy is comparable to that of cardiac magnetic resonance imaging. In detail, all enrolled patients underwent transthoracic 3D, spackle tracking imaging, to assess valve anatomy, and suitability for MitraClip treatment according to the EVEREST anatomic eligibility criteria. They were on optimized medications and, when necessary, previously treated with percutaneous angioplasty and stent implantation. Our results, in both functional and organic cases of MV regurgitation, can be summarized in a statically significant improvement of the NHYA class, reduction in the degree of MV and tricuspid valve insufficiency, decrease in LV end-diastolic diameter and diastolic volume, and mainly in a corrected direction of LV outflow towards the high pressure aortic system: so we explain the unchanged left ventricular ejection fraction. The LA remodeling was present with a significant reduction in LA volume only in patients without atrial fibrillation, while in its function there was a reduced peak strain. Regard the indicative parameters of afterload on the right heart chambers, the derived systolic pulmonary arterial pressure decreased, and in case of tricuspid regurgitation, a significant decrease in the maximal velocity of the blood flow was observed. There was also a statistically significant reduction in the right atrial area, and in RV size, both correlated with a reduced back flow in the RA. About the RV volumetric remodeling there was no statistically significant improvement in the end-diastolic RV volume, most probably of its better compliance towards a low pressure inflow. An improvement in RV systolic function parameters was obtained in terms of increased ejection fraction, decreased free wall strain, and decreased velocity at the tricuspid annular. In Conclusion, the clinical improvement observed after Mitral Clip repair consist in decreased overload to the left chambers, facilitating their reverse remodeling, and in the LV function. In perspective, we are planning to perform pre-operative models of MV repair, where we can calculate the reduced volume of regurgitated blood and the increase in the LVEF physiological outflow, in order to better tailor the indications to this procedure.

Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial

With modern treatments for heart failure with reduced ejection fraction (EF), indicative of impaired cardiac systolic function, patients may exhibit an increase in EF. Limited data are available regarding the clinical management of this growing population, categorized as heart failure with improved EF (HFimpEF), which has a high event rate and has been excluded from virtually all prior heart failure outcomes trials. In a prespecified analysis of the DELIVER trial (NCT03619213), of a total of 6,263 participants with symptomatic heart failure and a left ventricular EF >40%, 1,151 (18%) had HFimpEF, defined as patients whose EF improved from ≤40% to >40%. Participants were randomized to 10 mg dapagliflozin or placebo daily and the primary outcome of the trial was a composite of cardiovascular death or worsening heart failure (heart failure hospitalization or an urgent heart failure visit). Participants with HFimpEF had similar event rates to those with an EF consistently >40%. In participants with HFimpEF, dapagliflozin reduced the primary composite outcome (hazard ratio (HR) = 0.74, 95% confidence interval (CI) = 0.56–0.97), first worsening heart failure events (HR = 0.84, 95% CI = 0.61–1.14), cardiovascular death (HR = 0.62, 95% CI = 0.41–0.96) and total worsening heart failure events (rate ratio = 0.68, 95% CI = 0.50–0.94) to a similar extent as for individuals with an EF consistently >40%. These data suggest that patients with HFimpEF who are symptomatic may benefit from the addition of a sodium/glucose cotransporter 2 inhibitor to previously instituted guideline-directed medical therapy to further reduce morbidity and mortality.

Subclinical hypothyroidism and its relationship with therapy failure in patients underwent cardiac resynchronization therapy.

Cardiac resynchronization therapy (CRT) is used in patients with heart failure (HF), an important problem in cardiology practice, with reduced left ventricular systolic dysfunctions and left ventricular dyssynchrony to improve morbidity and mortality. Thyroid diseases have undeniable effects on cardiac functions. So, we aimed to evaluate the effect of subclinical hypothyroidism on CRT response in HF patients in this study. After the exclusion, 386 consecutive patients who received first-time CRT-defibrillator (CRT-D) or CRT-pacemaker (CRT-P) were retrospectively included. Known overt hypothyroidism or hyperthyroidism patients were excluded. The response of CRT was defined as a relative increase (≥15%) or absolute increase (≥10%) in left ventricular ejection fraction (LVEF) from implantation to one-year after follow-up. Diabetes mellitus, atrial fibrillation and coronary artery disease ratios were similar between responder vs. non-responder groups. Thyroid stimulating hormone (TSH) levels were higher (p <0.005) in non-responder group. Responder group had higher baseline LVEF (p <0.001), and follow-up LVEF (p <0.001) and longer baseline QRS interval (p =0.004), but similar post-implant QRS interval duration (p >0.005) with non-responder group. Baseline QRS interval (p =0.002), baseline LVEF (p <0.001) and the presence of subclinical hypothyroidism (SCH) (p =0.001) were independent predictors of CRT response. Adding SCH as a risk factor to our baseline risk modelling has an independent prognostic impact to predict non-responder patients (p =0.01). Presence of the SCH may be an important predictor of non-response in patients undergoing CRT. Evaluating the risk factors associated with non-response to CRT may be logical in identifying patients who obtain maximum benefit from CRT treatment.

«BRIDGE» TO HEART TRANSPLANTATION: HEMOSORPTION, VENTRICULAR REMODELING OR LVAD? ABSTRACT

Background. Heart failure (HF) is a global public health problem worldwide [2]. The most frequent cause of severe HF is dilated cardiomyopathy (DCM) [6]. The morbidity and mortality rate are constantly growing, which indicates the presence of unresolved issues in the therapy of this nosology [3]. Aim. To determine the efficacy of alternative methods of treatment in patients with severe HF caused by DCM. Materials and methods. A retrospective analysis of the treatment results in 86 patients with severe HF on the background of DCM during the period from 2005 to 2021. All patients were divided into three groups depending on the type of treatment: in group 1 (n=59) – the standard protocol of conservative therapy was supplemented with a course of hemosorption (HS); in group 2.1 (n=21) – left ventricular remodeling surgery was performed; in group 2.2 (n=6) – left ventricular assist device (LVAD) was implanted. During the study we analyzed patients’ clinical condition, the results of transthoracic echocardiography, complications and mortality: before treatment, by the end of in-hospital treatment and in the long-term period (12 months later). Statistical evaluation was performed using Student’s test and Pearson’s χ2 test (significance level p&lt;0.05). Results. After the therapy, all groups showed improvement of clinical condition of the patients by one NYHA class (p&lt;0.05). There was an increase of left ventricular ejection fraction (LVEF) from 21.1±4.66 % to 34±2.59 % in group 1 and from 22.4±2.27 % to 35.65±5.25 % in group 2.1 (p&lt;0.05). We also observed inverse LV remodeling with marked decrease of LV end-diastolic volume (LV EDV) and LV end-systolic volume (LV ESV) to 242.16±26.11 ml and 148.6±21.3 ml ( p&lt;0.05) in group 1, to 228.75±20.5 ml and 141.5±17.5 ml (p&lt;0.05) in group 2. 1 and a significant decrease in these indices in group 2.2 to 261, 2±103.56 ml (by 29.15%) and to 193±92.27 ml (by 36.23%) (p&lt;0.05), respectively. Conclusion. Extracorporeal and surgical methods of treatment of patients with severe HF against DCM background reliably improve their clinical condition and can be used in addition to the protocol of conservative therapy.

Cardiac MRI in the Diagnosis and Prognosis of patients with Hypertrophic Cardiomyopathy (HCM) - A Case Report

Hypertrophic cardiomyopathy (HCM) is a condition of genetic mutation in the cardiac sarcomere that is defined by cardiac hypertrophy, a non-dilated left ventricle, and a normal or increased ejection fraction. It presents with a heterogeneous clinical picture which continues to challenge clinicians to diagnose it clinically. Cardiac magnetic resonance (CMR) - a non-invasive imaging technique is an essential diagnostic tool that reliably confirms the diagnosis, differentiates hypertrophic cardiomyopathy from other etiologies of left ventricular hypertrophy as well as identifies the individuals who are most at risk of sudden cardiovascular events. We present a case of 15 years old female patient with complaints of left-sided chest pain, dyspnea, palpitations, and orthopnea with a history of several episodes of syncopal attacks in the past. Following echocardiography, cardiac magnetic resonance imaging was done for the proper interpretation of the presenting clinical manifestations.

Abstract 11197: Gender Differences and Temporal Trends in Clinical Characteristics and Use of Myocardial Scintigraphy in Evaluation of Stable CAD

Introduction: Data on temporal and gender differences in referral patterns and clinical characteristics of patients referred for myocardial scintigraphy for suspected coronary artery disease (CAD), is lacking. Furthermore, the differential impact of COVID-19 pandemic on gender differences in referrals and clinical risk profile of referred patients is not known. Methods: This is a cross-sectional observational single center study of patients evaluated across 3 yearly time intervals in 2000, 2010 and 2020. We evaluated 2,615 patients (68% women) with mean age 65.9 years, who were referred for stress/rest myocardial scintigraphy. Trends in clinical characteristics and test results were compared in women and men across these intervals. Results: Men were more likely to be referred for testing than women, however there was a consistent increase in proportion of women referred over time, including the time of COVID pandemic in 2020. Men were more likely to present with typical symptoms, compared to women. Among women, there is a significant increase in prevalence of active smoking and a decrease in age at presentation and hypertension, over time (p&lt;0.05). Among men, there was a significant decrease in history of previous MI, with no change in other risk factors over time. Across time intervals, in both men and women, there was a significant increase in EF (Ejection Fraction) and decrease in presence of ischemic myocardium at risk, identified by semi-quantitative scores including summed rest score (SRS), summed stress score (SSS) at rest (p&lt;0.05). Conclusions: There are gender differences in proportion of men and women who are referred for stress testing, for evaluation of stable CAD. There was a substantial change in risk of inducible myocardial ischemia among male and female patients with known or suspected CAD. Our findings are relevant to understand the implications of gender differences on risk assessment and diagnostic accuracy in known or suspected CAD, over time.

Abstract 12664: Comprehensive Histological Analysis of Endomyocardial Biopsy and T1 Mapping for Predicting Left Ventricular Reverse Remodeling in Patients with Recent-Onset Dilated Cardiomyopathy

Background: Cardiomyocyte injury is a key pathological pathway in the progression of heart failure that predicts a poor prognosis; therefore, combined assessment of myocardial fibrosis and cardiomyocyte DNA damage from endomyocardial biopsy (EMB) samples may be of great importance. Meanwhile, cardiovascular magnetic resonance (CMR) native T1 reflects a composite of both intra- and extracellular compartments in the whole myocardium. We sought to assess the performance of native T1 mapping and EMB results to predict left ventricular reverse remodeling (LVRR) in recent-onset dilated cardiomyopathy (DCM). Methods: A total of 29 patients with DCM underwent cine CMR and triple-slice T1 mapping using the MOLLI sequence at 3T, and EMB before receiving guideline-directed medical therapy. Poly ADP-ribose (PAR) nuclear and sirius-red staining were used for quantification of DNA damage and collagen volume fraction (CVF), respectively. LVRR was defined as an increase in LV ejection fraction of ≥10% to the final value of &gt;35%, accompanied by a decrease in LV end-diastolic volume ≥10% at the follow-up CMR. Results: Fifteen patients (52%) achieved LVRR. The mean native T1, histological CVF, and proportion of PAR-positive nuclei were 1376 ± 55 ms, 0.13 ± 0.05, 25 ± 15%, respectively. Native T1 correlated well with CVF (p=0.004) and trended to be higher in DCM patients with increased DNA damage (p=0.17). There was no significant association between CVF and %PAR-positive nuclei. Native T1 &lt;1400 ms provided 86% sensitivity and 67% specificity, with the C-statistic of 0.82 (95% CI 0.67-0.98) for predicting LVRR. By contrast, C-statistic of %PAR nuclei, CVF, and combined assessment of %PAR nuclei and CVF were 0.59, 0.61 and 0.66, respectively. Conclusion: CMR T1 mapping may be a promising strategy for noninvasive biopsy of the whole heart and provide a better prediction of LVRR in recent-onset DCM than comprehensive histological analysis of EMB.

Smoothelin-like 1 knockout mice display sex-dependent alterations in blood flow and cardiac function.

Smoothelin-like 1 (SMTNL1) modulates the contractile performance of smooth muscle and thus has a key role in vascular homeostasis. Elevated vascular tone, recognized as a contributor to the development of progressive cardiac dysfunction, was previously found with SMTNL1 deletion. In this study, we assessed cardiac morphology and function of male and female, wild-type (Smtnl1+/+) and global SMTNL1 knockout (Smtnl1-/-) mice at 10 weeks of age. Gross dissection revealed distinct cardiac morphology only in males; Smtnl1-/- hearts were significantly smaller than Smtnl1+/+, but the left ventricle (LV) proportion of heart mass was greater. Male Smtnl1-/- mice also displayed increased ejection fraction and fractional shortening, as well as elevated aortic and pulmonary flow velocities. The impact of cardiac stress with pressure overload by transverse aortic constriction (TAC) was examined in male mice. With TAC banding, systolic function was preserved, but the LV filling pressure was selectively elevated due to relaxation impairment. Smtnl1-/- mice displayed higher early/passive filling velocity of LV/early mitral annulus velocity ratio (E/E' ratio) and myocardial performance index along with a prolonged isovolumetric relaxation time. Taken together, the findings support a novel, sex-dimorphic role for SMTNL1 in modulating cardiac structure and function of mice.

Trajectories of Cardiac Function Following Treatment With an Impella Device in Patients With Acute Anterior ST-Elevation Myocardial Infarction

BackgroundLeft ventricular (LV) unloading via the percutaneous micro-axial Impella pump is increasingly used in patients with anterior ST-segment elevation myocardial infarction (STEMI) and overt cardiogenic shock. In this context, the evolution of cardiac function and dimensions beyond hospital discharge remains uncertain. We aimed to characterize echocardiographic changes over time in patients with acute anterior STEMI treated with an Impella device. MethodsFrom an ongoing prospective registry, consecutive patients with acute anterior STEMI managed with an Impella device were extracted. Transthoracic echocardiography was performed at index hospitalization and at first outpatient follow-up. Predictors of response, defined as a ≥ 10% absolute increase in left ventricular ejection fraction (LVEF) at follow-up, were sought. ResultsA total of 66 patients (89.4% male, aged 64.3 ± 11.6 years) with anterior STEMI were treated with an Impella device in the first 24 hours of hospitalization, from 2014 to 2022. In-hospital mortality was 24%. Major bleeding and vascular complications requiring surgery occurred in 24% and 11% of patients, respectively. At baseline, mean LVEF was 34% ±12%. At follow-up, survivors showed a significant increase in LVEF (P < 0.0001), whereas LV dimensions, diastolic parameters, and measures of right ventricular dimension and function remained stable. Overall, 28 patients had a ≥ 10% absolute increase in LVEF at follow-up. Baseline creatinine was the only significant predictor of response at univariate analysis. ConclusionsAmong patients with anterior STEMI requiring mechanical hemodynamic support with an Impella device, the majority of survivors showed a sustained increase in LV function, without evidence of adverse remodelling. This signal warrants further investigation in dedicated trials.

Anemia, erythrocytosis and iron deficiency as prognostic markers of chronic heart failure development

In guidelines of the European Society of Cardiology (ESC) for the diagnosis and treatment of chronic and acute heart failure 2021 authors have written necessity of regular checkup of all patients with chronic heart failure (CHF) to identify anemia or iron deficiency. The prevalence of anemia in patients with CHF varies significantly depending on the clinical characteristics of the studied population and the criteria for the diagnosis of anemia from 4 to 75%. Frequency of iron deficiency without anemia, according to various studies, achieve 55% of cases. In the literature, data are increasingly appearing that even mild anemia and iron deficiency are associated with worsening symptoms, decreased exercise tolerance. They can provoke increasing of numbers of hospitalizations of patients with CHF, and decreasing of their quality of life and increasing rate of mortality. In this paper a number of factors determining iron deficiency in patients with CHF are analyzed. The article also assesses the current state of the problem of the dependence of the presence of anemic syndrome and the gender-age characteristics of patients with CHF, observed in a number of studies, which remains quite contradictory to date. The results of the study of the mechanisms of development of secondary erythrocytosis and the course of CHF against the background of anemic syndrome, iron deficiency conditions, relative erythrocytosis are presented, promising directions of drug correction are reflected. Data from randomized controlled trials (RCTs) on the possibility of using iron supplementation as part of the management of patients with CHF and iron deficiency status are presented. It was noted that using of an injectable form of iron carboxymaltosate in patients with CHF and low EF improves the functional class of CHF according to NYHA, quality of life, tolerance to physical activity, as well as contributes to an increase in the left ventricular ejection fraction and its final systolic volume.

The Effects of Device-Based Cardiac Contractility Modulation Therapy on Left Ventricle Global Longitudinal Strain and Myocardial Mechano-Energetic Efficiency in Patients with Heart Failure with Reduced Ejection Fraction.

Background: Virtually all patients with heart failure with reduced ejection fraction have a reduction of myocardial mechano-energetic efficiency (MEE). Cardiac contractility modulation (CCM) is a novel therapy for the treatment of patients with HFrEF, in whom it improves the quality of life and functional capacity, reduces hospitalizations, and induces biventricular reverse remodeling. However, the effects of CCM on MEE and global longitudinal strain (GLS) are still unknown; therefore, this study aims to evaluate whether CCM therapy can improve the MEE of patients with HFrEF. Methods: We enrolled 25 patients with HFrEF who received an Optimizer Smart implant (the device that develops CCM therapy) between January 2018 and January 2021. Clinical and echocardiographic evaluations were performed in all patients 24 h before and six months after CCM therapy. Results: At six months, follow-up patients who underwent CCM therapy showed an increase of left ventricular ejection fraction (30.8 ± 7.1 vs. 36.1 ± 6.9%; p = 0.032) as well a rise of GLS 10.3 ± 2.7 vs. −12.9 ± 4.2; p = 0.018), of MEE (32.2 ± 10.1 vs. 38.6 ± 7.6 mL/s; p = 0.013) and of MEE index (18.4 ± 6.3 vs. 24.3 ± 6.7 mL/s/g; p = 0.022). Conclusions: CCM therapy increased left ventricular performance, improving left ventricular ejection fraction, GLS, as well as MEE and MEEi.

Analysis of myocardial salvage with cardiac magnetic ressonance and angiography depending on the STEMI revascularization pathway in a PPCI centre

Abstract Background Reperfusion networks have permitted improvements in reperfusion delays in primary percutaneous coronary intervention (PPCI)-treated ST elevation myocardial infarction (STEMI). However, the impact on myocardial salvage (MS) of direct transfer to the catheterization laboratory (cath-lab) to minimize system delay remains unknown. Objective We sought to quantify the myocardial salvage index (MSI) acutely and to assess adverse remodeling at 6 months in PPCI-treated STEMI according to the mode of patient presentation. Methods Between 2005 and 2021 we included 493 patients in a single center registry of first PPCI-treated STEMI who were studied with Late gadolinium enhanced (LGE) cardiac magnetic resonance (CMR) in the acute phase. Among them, 414 (84.0%) underwent a second LGE-CMR at 6 months. Subjects were classified depending on the mode of presentation: those diagnosed out-of-hospital and directly transferred to the cath-lab by the Emergency Medical Services (EMS group, 29.82%); subjects with first medical contact in a PCI-capable hospital (PCI-H group, 41.75%); and patients presenting to a non-PCI-capable center and transferred for PCI (non-PCI-H group, 28.43%). We computed the angiographic area at risk by BARI score, and combined it with the LGE-CMR derived infarct size to compute a validated MSI, expressed as percentage of area at risk. The change in ejection fraction (EF) and indexed left ventricle end-diastolic volume (iLVEDV) from baseline to 6 months was also computed. Results The mean age was 58.9±11.9 years, 84.5% were male and 51.4% had anterior STEMI. Total median ischaemic time was (median (interquartile range)) 126 (105–161) min in the EMS group, 201 (145–321) min in the PCI-H group and 300 (173–592) min in the non-PCI-H group (p&amp;lt;0.01). MSI was 45.28±2.6%, 39.63±2.2% and 35.53±2.7% respectively (p=0.034). In a multiple linear regression model adjusting for relevant covariables, including initial TIMI flow, area at risk, Killip class, age, sex, diabetes, number of vessels and presence of collaterals, a 7.50% (95% CI 0.9 to 14.1%) increase in MSI was observed in the EMS group compared to the PCI-H group, and 11.03% (95% CI 3.9 to 18.2%) compared to the non-PCI-H group (p=0.027 and 0.003 respectively). At 6 months, the mean absolute increase in EF was 5.36±0.6% for the EMS group, 4.03±0.5% for the PCI-H group and 3.52±0.6% for the non-PCI-H group (p&amp;lt;0.05 in the adjusted analysis) and the increase in iLVEDV was 2.37±7.3, 5.51±6.6 and 18.30±7.6 mL/m2 respectively (p=0.28). Conclusions Patients with out-of-hospital diagnostis of STEMI by the EMS who were directly transferred to the cath-lab showed shorter total ischaemic times, resulting in increased myocardial salvage and a trend towards improved indexes of left ventricular function at 6 months. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Grant from La Maratό de TV3 and grant from Fundaciό La Caixa