Indices Of Left Ventricular Diastolic Function Research Articles

Left atrial reservoir strain as a prognostic indicator for cardiovascular events after mitral valvuloplasty

Abstract Background In patients after mitral valvuloplasty (MVP), assessing valve function and heart failure (HF) is crucial for prognostic predictions. Left ventricular diastolic function assessed by transthoracic echocardiography (TTE) plays an important role in the evaluation of HF in general practice. However, post-mitral valve surgery patients are excluded from the left ventricular diastolic function assessment guidelines proposed by the American Society of Echocardiography in 2016 due to their low correlation with left ventricular diastolic function indices. On the contrary, the left atrial reservoir strain (LARS) before MVP is considered as a prognostic factor, reflecting left atrial dysfunction caused by mitral regurgitation. Nevertheless, there are limited reports on the relationship between LARS and cardiovascular (CV) events after MVP. Purpose The study aims to investigate the utility of LARS in predicting CV events after MVP. Methods The study included 249 patients who underwent TTE between January 2011 and January 2023 after MVP at our hospital. Patient background data, including NYHA classification, medical history, medications, blood tests, and TTE data, were collected at the time of follow-up TTE. LARS, left ventricular global longitudinal strain (LV-GLS), and right ventricular free wall strain (RV-FWSL) analysis were performed using a vender-independent external strain analysis software for all patients in the cohort. The primary endpoints were cardiovascular death and HF rehospitalization. The predictor of cardiovascular events was assessed using the Cox proportional hazards model and Kaplan-Meier curve (KMC). Results The mean age was 61±14 years, and 159 patients (64%) were male. The median time from surgery to TTE was 4.8 (1.0-6.8) years, 32 patients (13%) had events within 8.5 (3.7-10.8) years after TTE. The event groups had higher age, NYHA classification, and NT-pro BNP compared to the non-event group. TTE parameters such as left ventricular mass index, left ventricular end-diastolic volume and end-systolic volume were larger, and LV-GLS and LARS were significantly lower in the event group. In multivariate Cox proportional hazards models showed that LARS was also a prognostic indicator even after adjustment for several variables (Table 1). The KMC showed that LARS was associated with events regardless of left atrial volume index (Log-rank p <0.001, chi-square:31.03) (Figure 1). Conclusion LARS was strongly associated with CV events after MVP. We consider LARS to be a useful prognostic indicator after MVP.

Cardiovascular Adaptation in Fetal Growth Restriction: A Longitudinal Study From Fetuses at Term to the First Year of Life.

To investigate longitudinal trends in fetal and offspring cardiovascular adaptation in fetal growth restriction (FGR). Prospective longitudinal study. Fetal Medicine Unit. Thirty-five FGR pregnancies and 37 healthy controls assessed as term fetuses (mean age 37 ± 1 weeks) and again in infancy (mean age 8 ± 2 months). Conventional echocardiographic techniques, tissue Doppler imaging and speckle tracking echocardiography. Left ventricular (LV) and right ventricular (RV) geometry and function. Echocardiographic parameters were normalised by ventricular size adjusting for differences in body weight between groups. Compared to healthy controls, late FGR fetuses showed significant alterations in cardiac geometry with more globular LV chamber (LV sphericity index, 0.56 vs. 0.52), increase in biventricular global longitudinal systolic contractility (MAPSE, 0.29 vs. 0.25 mm; TAPSE, 0.42 vs. 0.37 mm) and elevated cardiac output (combined CO: 592 vs. 497 mL/min/kg, p < 0.01 for all). Indices of LV diastolic function in FGR fetuses were significantly impaired with myocardial diastolic velocities (LV A', 0.30 vs. 0.26 cm/s; IVS E', 0.19 vs. 0.16 cm/s) and LV torsion (1.2 vs. 3.5 deg./cm, p < 0.01 for all). At postnatal assessment, FGR offspring revealed persistently increased SAPSE (0.27 vs. 0.24 mm), LV longitudinal strain (-19.0 vs. -16.0%), reduced LV torsion (1.6 vs. 2.1 deg./cm) and elevated CO (791 vs. 574 mL/min/kg, p < 0.01 for all). Perinatal cardiac remodelling and myocardial dysfunction in late FGR fetuses is most likely due to chronic placental hypoxaemia. Persistent changes in cardiac geometry and function in FGR offspring may reflect fetal cardiovascular maladaptation that could predispose to long-term cardiovascular complications in later life.

Sixteen-Frame Gated Myocardial Perfusion SPECT as a Surrogate for Equilibrium Radionuclide Angiography in Measurement of Systolic and Diastolic Indices: A Cross-Sectional Study

Abstract Introduction Equilibrium radionuclide angiography (ERNA) has long been assumed as the preferred method to assess cardiac volumes as well as left ventricular systolic and diastolic indices. ERNA was used to diagnose subtle changes in cardiac function during chemotherapy or early stages of heart failure. Gated myocardial perfusion SPECT (GMPS) was introduced as a more feasible and versatile alternative to ERNA, but the precision of GMPS to assess systolic and diastolic indices has not yet been fully reviewed. Method We studied the left ventricular systolic and diastolic functional indices measured by a 16-frame GMPS and compared the results with those of ERNA in 25 patients. All the images were analyzed visually, semi-quantitatively, and quantitatively using quantitative gated SPECT (QGS), quantitative blood pool SPECT (QBS), and planar gated blood pool (PGBP) software. The left ventricular functional indices calculated using QGS compared with those obtained using QBS and PGBP Result Our study found a significant correlation between the left ventricular ejection fraction (LVEF) calculated using the PGBP, QGS, and QBS methods. There was a significant correlation between the LV peak ejection rate (LVPER) calculated by the PGBP and QGS analyses, and there was no significant difference in the LVPER calculated with the QGS and QBS methods. This study also revealed a significant correlation between the LV peak filling rate (LVPFR) calculated by QBS and QGS, with no significant difference between them. We also found a significant correlation between LV end systolic volume (LVESV) calculated using QGS and QBS and between LV end diastolic volume (LVEDV) calculated using QGS and QBS software. This study also revealed a significant correlation between the LV mean filling rate over the first third of diastole (LVMFR/3) calculated using the QGS and QBS software. Conclusion Considering the significant correlation between LVEF, LVPER, LVPFR, LVESV, LVMFR/3, and LVEDV calculated using the QGS and QBS methods in our study, the 16-frame GMPS could be regarded as an acceptable substitute for ERNA in the investigation of systolic and diastolic indices.

Effect of Ciprofol on Left Ventricular Myocardial Strain and Myocardial Work in Children Undergoing Cardiac Surgery: A Single-center Double-blind Randomized Noninferiority Study

ObjectiveTo compare the effect of ciprofol and propofol on left ventricular (LV) systolic function and myocardial work by noninvasive speckle-tracking echocardiography (STE) in children undergoing surgical repair of atrial septal defect (ASD) or ventricular septal defect (VSD). DesignSingle-center double-blind randomized non-inferiority study. SettingAt a tertiary care center affiliated to Shanghai Jiao Tong University, China. ParticipantsOne hundred and twelve children aged 1 month to 16 years old undergoing ASD or VSD surgery with cardiopulmonary bypass. InterventionsOne hundred and twelve children were allocated randomly into receiving ciprofol (n = 67) and propofol (n = 45) in a 1.5:1 ratio. Ciprofol or propofol were IV infused at loading doses of 0.4 mg/kg or 2.0 mg/kg respectively over 30 seconds depending on the physical condition of each patient. When the bispectral index was maintained between 45 - 55 after induction, transthoracic echocardiography including apical two-chamber, three-chamber and four-chamber views were collected at bedside. Measurements and Main ResultsOf total 112 patients enrolled, 104 completed the study. The global longitudinal strain (GLS) of ciprofol and propofol groups after anesthesia was -17.3% (95% CI, -18.0% to -16.6%) and -17.8% (-18.7 to -17.0%) in the full analysis set (FAS) and -17.5% (95% CI, -18.2% to -16.9%) and -17.8% (-18.7% to -17.0%) in the per-protocol set (PPS) respectively. The noninferiority margin was set as 2% and confirmed with a lower limit of two-sided 95% CI for the inter-group difference of 1.58% and 1.34% in the FAS and PPS. There were no significant differences between two groups in LV systolic and diastolic function and myocardial work indices. Postoperative vasoactive-inotropic score, NT-proBNP, duration of mechanical ventilation, length of stay in cardiac intensive care unit and hospital were also comparable between two groups (all p > 0.05). ConclusionsCiprofol did not show different effect from propofol on myocardial function and postoperative outcomes. Furtherly on sensitive cardiac systole marker GLS, ciprofol had noninferiority to propofol. Ciprofol might be alternative solution for cardiac anesthesia in CHD children with mild lesion.

GENDER DIFFERENCES IN THE IMPACT OF VENTRICULAR-ARTERIAL COUPLING ON LEFT VENTRICULAR FUNCTION IN PATIENTS WITH HYPERTENSION

Objective: Increased arterial stiffness elevates aortic load, which can have adverse impacts on left ventricular (LV) function and contribute to the onset of heart failure. This impact is known to be more pronounced in women. Optimal coordination between ventricular contraction and the arterial system is required to maintain efficient cardiac function. This study aimed to investigate gender differences in the impact of ventricular-arterial coupling (VAC) on LV function in patients with hypertension at rest and after handgrip exercise. Design and method: Echocardiographic indexes of LV volumes, systolic function, and diastolic function were obtained in the usual way. Effective arterial elastance (EA) and index (EAI) were calculated from stroke volume measured using LV outflow waveform. Effective LV end-systolic elastance (ELV) and index (ELVI) were obtained using the single-beat method. Central aortic pressure waveform was recorded using the applanation tonometry. Characteristic impedance (Zc) of aortic root and reflection magnitude (RM) was calculated after Fourier transformation of both aortic pressure and flow waveforms. Results: Sixty-four patients (31 women and 33 men) with hypertension were enrolled. Women showed higher ELVI (1.33±0.34 vs. 1.10±0.29 mmHg/ml/m2, P=0.004) and EAI (1.14±0.25 vs. 0.93±0.26 mmHg/ml/m2, P=0.001), but VAC was not different (women: 0.88±0.17 vs. men: 0.85±0.11, P=0.431). Zc and RM were not different between women and men. After handgrip exercise, an increase in ELVI (P=0.021) and a decrease in VAC (P=0.035) were observed specifically in men, with no corresponding changes noted in women. In women, VAC was significantly associated with E’ velocity (beta -0.344, P=0.029) and left ventricular global longitudinal strain (beta 0.470, P=0.012) after adjustment, but in men, no association was found. Conclusions: Hypertensive women demonstrated greater stiffness in both the left ventricle and arterial systems, along with impaired LV contractile reserve in response to handgrip exercise, as compared to men. The ventricular-arterial mismatch had a notable impact on LV diastolic and systolic dysfunction only in women, but not in men.

The relation between tissue doppler imaging and the severity of coronary artery stenosis in patients undergoing coronary angiography

Objectives: Early detection of local dysfunction in patients suspected of coronary artery disease (CAD) is usually performed using Tissue Doppler Imaging (TDI). The present study investigated the relationship between TDI and the severity of coronary artery stenosis in hospitalized patients with suspected CAD.&#x0D; Methods: The present study is a descriptive-analytical study. The research population was 200 patients hospitalized in Seyyed al-Shohada Hospital, Urmia University of Medical Sciences, undergoing coronary angiography between 2013 and 2018. The patients were divided into three groups- mild, moderate, and severe. All patients underwent echocardiography and color TD. Myocardial performance index (TIE index) was evaluated using Doppler echo. Logistic regression analysis was used to investigate the effect of tissue Doppler indices on the degree of coronary artery involvement. SPSS version 22 software was used for statistical analysis.&#x0D; Results: A total of 200 patients, 113 (56.5%) males, were investigated. The age range of participants was between 25 to 78 years. Left ventricular systolic and diastolic function indices and mean velocity E in the three groups were 0.73 ± 0.158, 0.68 ± 0.134, and 0.64 ± 0.145, respectively (P = 0.025). The average velocity A, the average ratio E/A, the MP index, the average velocity e, and the average ratio E/e had significant differences in all the three groups.&#x0D; Conclusions: Due to the significant correlation between numerous left ventricular functional indices, TDI can be used as a non-invasive tool in evaluating coronary arteries.

Left atrial strain as an independent predictor of sinus rhythm maintenance after catheter ablation for paroxysmal atrial fibrillation in HFpEF patients

Abstract Background The early AF treatment by radio-frequency catheter ablation (CA) is very important for improving clinical outcome in patients with history of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Left atrial (LA) strain showed to be a useful index to monitor atrial function in AF and HFpEF states. However, the accuracy of LA strain to predict the long-term maintenance of sinus rhythm (SR) in HFpEF patients with paroxysmal AF undergoing CA is still under debate. Aims To define the best echocardiography derived parameters to predict the long-term maintenance of SR in paroxysmal AF patients with high probability of HFpEF undergoing CA. Methods We prospectively enrolled 200 consecutive patients (62 ± 10 years, 58% males) with dyspnea (NYHA≥II), paroxysmal AF and preserved LV ejection fraction (≥50%). All patients had a H2FPEF score suggesting high probability of HFpEF. During sinus rhythm, all patients underwent comprehensive transthoracic echocardiography at baseline, including assessment of left ventricular (LV) global longitudinal strain (GLS), left atrial (LA) reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) using two-dimensional speckle tracking in apical views. Results After 42+/-8 months follow-up, a total of 34 (17%) patients had a documented recurrence of AF. Patients with AF recurrence had lower LASr (22.2% vs. 28.3%, p &amp;lt; 0.001) and LASct (10.9% vs. 13.2%, p &amp;lt; 0.01) compared to patients who keep on SR. Among speckle tracking derived LA phasic strain indices, LASr showed the largest area under the curve (AUC = 0.8, p &amp;lt; 0.001) and the strongest independent predictive value (LASr &amp;gt; 22%) of long-term maintenance of SR with sensitivity of 80% and specificity of 66% (Figure 1). Other parameters of LA function, LA diameter, maximum or minimum LA volume index, LV GLS or ejection fraction, and indices of LV diastolic function had lower area under the curve. Using multivariable logistic regression, only LASr (OR 0.89, 95% CI 0.81-0.97, p=0.013) was independently associated with long-term SR maintenance while other LA size and function indices were not. Conclusion In HFpEF patients with paroxysmal AF undergoing CA, LASr is more accurate predictor of SR maintenance than other standard echocardiographic parameters in long-term follow-up.

Paradoxical increase in E/e' during severe central hypovolemia in healthy humans

Abstract Introduction The ratio of mitral blood inflow to mitral annular tissue velocity in early diastole (E/e') is widely used as an index of left ventricular (LV) diastolic dysfunction. Theoretically, it is considered that e’ can correct the effect of LV relaxation on E, and thus E/e’ can be applied for the prediction of LV filling pressures in patients with cardiac diseases. However, recent guidelines indicate that E/e’ may not provide a reliable estimate of filling pressures in healthy subjects. Indeed, previous studies have reported that E/e' did not decrease during acute central hypovolemia because both E and e’ are similarly reduced by low preload condtions. However, it is possible that E/e' did not decrease since central hypovolemia are not critical in the previous studies. Purpose The purpose of the present study was to clarify the change of E/e’ during severe central ypovolemia induced by lower body negative pressure. Methods Twelve healthy men (25±5 years old) underwent 2D Doppler and 3D echocardiography during graded lower body negative pressure (LBNP) up to presyncope. We measured LV diastolic function indices by 2D echocardiography including septal and lateral mitral annular early diastolic velocities (e’), and early (E) and late (A) mitral inflow velocities. In addition, we measured LV function indices by 3D echocardiography including end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), global longitudinal strain (GLS), global circumferential strain (GCS), twist and peak untwisting rate. We compared echocardiography indices before LBNP (Baseline) with those at maximal LBNP (LBNPmax) and at half of the maximal LBNP (LBNP1/2max). Results E/e’ (Baseline: 5.8±0.8, LBNP1/2max: 5.4±1.0, LBNPmax: 7.8±2.3, mean±SD, p&amp;lt;0.01, ANOVA) did not change at the LBNP1/2max but increased only at the LBNPmax. E (80±11, 59±10, 62±12 cm/sec, p&amp;lt;0.01) and E/A (2.2±0.8, 1.5±0.5, 1.0±0.3, p&amp;lt;0.01) decreased at the LBNP1/2max as compared to baseline but did not change from LBNP1/2max to LBNPmax. e’ (14.1±2.0, 11.1±1.5, 8.2±2.2 cm/sec, p&amp;lt;0.01) decreased in response to LBNP. LV EF (62±3, 55±5, 43±9 %, p&amp;lt;0.01), LV GLS (-20.5±2.8, -17.6±2.7, -13.6±4.7 %, p&amp;lt;0.01), and LV GCS (-31.2±3.7, -26.8±3.3, -19.4±5.3 %, p&amp;lt;0.01) decreased in response to LBNP. LV twist (15.2±5.1, 14.5±5.4, 20.9±7.7 °, p&amp;lt;0.01) and LV peak untwisting rate (-138±42, -164±50, -245±88 °/cm, p&amp;lt;0.01) increased only at the LBNPmax. Conclusion The present study for the first time showed that E/e’ paradoxically increased during acute severe hypovolemia in healthy humans. This paradox was likely caused by well-preserved E, while e’ decreased in response to acute severe central hypovolemia. The present finding also showed that peak untwisting rate was increased only at severe central hypovolemia, suggesting that the well-preserved E may be caused by high pressure gradient from left atrium to LV induced by enhanced LV untwisting suction function.Key results of this study①Key results of this study②

Echocardiography protocol and cardiometabolic phenotyping in Indian birth cohorts-the IndEcho study.

Asian Indians are at higher risk of cardiometabolic disease compared to other ethnic groups, and the age of onset is typically younger. Cardiac structure and function are poorly characterized in this ethnic group. In this study, we describe image-acquisition methods and the reproducibility of measurements and detailed echocardiography characteristics in two large Indian population-based cohorts (the New Delhi and Vellore Birth Cohorts) from India. The IndEcho study captured transthoracic echocardiographic measurements of cardiac structure and function from 2,322 men and women aged 43-50 years. M-mode measurements in the parasternal long axis (PLAX) and 2-dimensional (2D) short axis recordings at the mitral valve, mid-papillary and apical level were recorded. Apical 2D recordings of two- three- and four-chamber (2C, 3C and 4C) views and Doppler images (colour, pulsed and continuous) were recorded in cine-loop format. Left ventricular (LV) mass, LV hypertrophy, and indices of LV systolic and diastolic function were derived. Echocardiographic measurements showed good/excellent technical reproducibility. Hetero-geneity across sites, sex and rural/urban differences in cardiac structure and function were observed. Overall, this cohort of South Asian Indians had smaller LV mass and normal systolic and diastolic function when compared with published data on other Asian Indians and the West, (LV mass indexed for body surface area: Delhi men: 68 g/m2, women 63.9; Vellore men: 65.8, women 61.6) but were within ethnic-specific reference ranges. The higher prevalence of obesity, diabetes and hypertension is reflected by the higher proportion of LV remodelling and lesser hypertrophy. Our study adds to scarce population-based echocardiographic data for mid-life Asian Indians. Compared to published literature on other ethnic groups, the Asian Indian heart is characterised by smaller cardiac dimensions and normal range systolic and diastolic function on a background of a high prevalence of hypertension, diabetes and cardiac disease at a relatively young age. This data will form the basis for further analyses of lifecourse, metabolic and body composition predictors of cardiac structure and function, and echocardiographic predictors of future mortality. 13432279.

Correlation between left atrial strain and left ventricular diastolic function in hypertensive patients.

Early detection of asymptomatic diastolic dysfunction is essential to prevent the development of heart failure in hypertensive patients. Current studies suggest that left atrial strain contributes to the evaluation of left ventricular diastolic function, but there are fewer studies on the correlation between left atrial strain and diastolic function in hypertensive patients. In this study, we applied a two-dimensional speckle tracking technique to evaluate the changes in left atrial strain in hypertensive patients, and to investigate the relationship between left atrial strain and left ventricular diastolic function. A total of 82 hypertensive patients who were visited the Department of Cardiology at the Third Xiangya Hospital of Central South University from July 2021 to January 2022, were enrolled for this study, and 59 healthy subjects served as a control group. According to the number of left ventricular diastolic function indexes recommended by the 2016 American Society of Echocardiography Diastolic Function Guidelines (mitral annular e´ velocity: Septal e´<7 cm/s, lateral e´<10 cm/s, E/e´ ratio>14, left atrial volume index>34 mL/m2, peak tricuspid regurgitation velocity>2.8 m/s), the hypertensive patients were divided into 3 groups: Group Ⅰ (0 index, n=36 ), Group Ⅱ (1 index, n=39), and Group Ⅲ (2 indexes, n=7). Two-dimensional speckle tracking technique was used to measure left atrial reservoir strain (LASr), conduit strain, and contraction strain, and to analyze the correlation between left atrial strain and left ventricular diastolic function in hypertensive patients. The LASr, left atrial conduit strain (LAScd), and LASr/(E/septal e´) of the hypertension group were lower than those of the control group, and E/LASr was higher than that of the control group. There was no significant difference in left atrium volume index between the 2 groups (P>0.05). Compared with Group Ⅰ, LASr, LAScd, and LASr/(E/septal e´) were decreased in Group Ⅱ and Group Ⅲ, LASr/(E/septal e´) was also decreased in Group Ⅲ compared with Group Ⅱ (all P<0.05). Compared with Group Ⅰ, E/LASr was increased in Group Ⅲ. LASr was positively correlated with septal e´, lateral e´, E, and E/A, and negatively correlated with E/septal e´. The changes of left atrial function in patients with early hypertension are earlier than those of left atrial structure. Left atrial strain and its combination with conventional ultrasonographic indices [LASr/(E/septal e´)] of diastolic function are potentially useful in assessing left ventricular diastolic function in hypertensive patients.

ASSOCIATION OF ARTERIAL STIFFNESS WITH LEFT VENTRICULAR FUNCTION AND THE IMPACT OF CARDIAC REHABILITATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: Arterial stiffness has an important role in the pathophysiology of coronary artery disease and heart failure. The association of arterial stiffness with left ventricular (LV) function and the impact of cardiac rehabilitation in patients with acute myocardial infarction (AMI) were investigated in this study. Design and method: Echocardiographic indexes of LV volumes, systolic function, and diastolic function were measured in the usual way. Effective arterial elastance (EA) and index (EAI) was calculated from stroke volume measured using LV outflow waveform. The exercise-based, outpatient cardiac rehabilitation (CR) program, which was composed of 8 to 12 visits during 4 weeks to 6 months, was provided, and the follow-up (F/U) echocardiographic study was done after 6 months. Results: Twenty-nine patients (age 58.7+/-10.2 years) with AMI were enrolled, but 8 patients denied CR program. At baseline, EAI was significantly associated with E’ (beta -0.379, P = 0.035) and LV global longitudinal strain (GLS) (beta 0.458, P = 0.014). F/U echocardiographic data showed decreased EAI (from 0.95+/-0.24 to 0.85+/-0.28 mmHg/ml/m2, P = 0.039), increased E’ (from 6.34+/-2.34 to 7.40+/-2.86 cm/sec, P = 0.032), and improved LV GLS (from -13.7+/-2.8 to -16.6+/-3.0%, P &lt;0.001) in patients with CR program, but not in patients without CR program. Changes of EAI was significantly associated with changes of E’ (beta -0.396, P = 0.048). Conclusions: Arterial stiffness was associated with LV dysfunction in AMI patients. The CR improved the arterial stiffness and LV dysfunction.

Left atrial strain as an independent predictor of sinus rhythm maintenance after catheter ablation for paroxysmal atrial fibrillation in HFpEF patients

Abstract Funding Acknowledgements Type of funding sources: None. Background The early AF treatment by radio-frequency catheter ablation is very important for improving clinical outcome in patients with history of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Left atrial (LA) strain showed to be a useful index to monitor atrial function in AF and HFpEF states. However, the accuracy of LA strain to predict the long-term maintenance of sinus rhythm (SR) in HFpEF patients with paroxysmal AF undergoing catheter ablation is still under debate. Aims To define the best echocardiography derived parameters to predict the long-term maintenance of SR in paroxysmal AF patients with high probability of HFpEF undergoing catheter ablation. Methods We prospectively enrolled (between September 2017 and May 2019) 200 consecutive patients (62 ± 10 years, 58% males) with dyspnea (NYHA≥II), paroxysmal AF and preserved LV ejection fraction (≥50%). All patients had a H2FPEF score suggesting high probability of HFpEF. During sinus rhythm, all patients underwent comprehensive transthoracic echocardiography at baseline, including assessment of left ventricular (LV) global longitudinal strain (GLS), left atrial (LA) reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) using two-dimensional speckle tracking in apical views. Results After 42+/-8 months follow-up, a total of 34 (17%) patients had a documented recurrence of AF. Patients with AF recurrence had lower LASr (22.2% vs. 28.3%, p &amp;lt; 0.001) and LASct (10.9% vs. 13.2%, p &amp;lt; 0.01) compared to patients who keep on SR. Among speckle tracking derived LA phasic strain indices, LASr showed the largest area under the curve (AUC = 0.8, p &amp;lt; 0.001) and the strongest independent predictive value (LASr &amp;gt; 22%) of long-term maintenance of SR with sensitivity of 80% and specificity of 66% (Figure 1). Other parameters of LA function, LA diameter, maximum or minimum LA volume index, LV GLS or ejection fraction, and indices of LV diastolic function had lower area under the curve. Using multivariable logistic regression, only LASr (OR 0.89, 95% CI 0.81-0.97, p=0.013) was independently associated with long-term SR maintenance while other LA size and function indices were not. Conclusion In HFpEF patients with paroxysmal AF undergoing catheter ablation, LASr is more accurate predictor of SR maintenance than other standard echocardiographic parameters in long-term follow-up. Figure 1: Receiver-operating characteristic curves of left atrial reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct), LA emptying fraction (LAEF), LA expansion index (LAEI), LA end-systolic (LAES) and end-diastolic (LAED) volume index (VI) to predict long-term maintenance of sinus rhythm.

Association of cardiovascular magnetic resonance diastolic indices with arrhythmia in repaired Tetralogy of Fallot

BackgroundPatients with repaired Tetralogy of Fallot (rTOF) experience a high burden of long-term morbidity, particularly arrhythmias. Cardiovascular magnetic resonance (CMR) is routinely used to assess ventricular characteristics but the relationship between CMR diastolic function and arrhythmia has not been evaluated. We hypothesized in rTOF, left ventricular (LV) diastolic dysfunction on CMR would correlate with arrhythmias and mortality. MethodsAdolescents and adults with rTOF who underwent CMR were compared to healthy controls (n = 58). Standard ventricular parameters were assessed and manual planimetry was performed to generate filling curves and indices of diastolic function. Chart review was performed to collect outcomes. Univariate and multivariable logistic regression was performed to identify outcome associations. ResultsOne-hundred sixty-seven subjects with rTOF (mean age 32 years) and 58 healthy control subjects underwent CMR. Patients with rTOF had decreased LV volumes and increased right ventricular (RV) volumes, lower RV ejection fraction (RVEF), lower peak ejection rate (PER), peak filling rate (PFR) and PFR indexed to end-diastolic volume (PFR/EDV) compared to healthy controls. Eighty-three subjects with rTOF had arrhythmia (63 atrial, 47 ventricular) and 11 died. Left atrial (LA) volumes, time to peak filling rate (tPFR), and PFR/EDV were associated with arrhythmia on univariate analysis. PER/EDV was associated with ventricular (Odds ratio, OR 0.43 [0.24–0.80], p = 0.007) and total arrhythmia (OR 0.56 [0.37–0.92], p = 0.021) burden. A multivariable predictive model including diastolic covariates showed improved prediction for arrhythmia compared to clinical and conventional CMR measures (area under curve (AUC) 0.749 v. 0.685 for overall arrhythmia). PFR/EDV was decreased and tPFR was increased in rTOF subjects with mortality as compared to those without mortality. ConclusionsSubjects with rTOF have abnormal LV diastolic function compared to healthy controls. Indices of LV diastolic function were associated with arrhythmia and mortality. CMR diastolic indices may be helpful in risk stratification for arrhythmia.

PS-B07-6: L-ARGININE SUPPLEMENTATION SUBSTANTIALLY ATTENUATES HYPERTENSION BUT NOT CARDIAC INJURY IN RATS WITH METABOLIC SYNDROME

Objective: L-arginine is not only a building block for protein but also a physiological substrate for the synthesis of nitric oxide (NO) and plays a regulatory role in signal transduction pathways in cells. Dietary L-arginine supplementation reduced fat mass both in Zucker diabetic fatty rats and in diet-induced obese rats. However, little is known about the effects of L-arginine on cardiac morphology and function in metabolic disorders. We have now examined the effects of L-arginine on cardiac pathology in DahlS.Z-Leprfa/Leprfa (DS/obese) rats, an animal model of metabolic syndrome (MetS). Design and method: DS/obese rats and their homozygous lean (DahlS.Z-Lepr+/Lepr+, or DS/lean) littermate controls were fed a purified control diet and were supplemented with 0.50% L-arginine-HCl or 0.85% L-alanine (isonitrogenous control) in drinking water from 13 to 17 weeks of age. Results: L-arginine supplementation did not affect body weight, visceral and subcutaneous fat mass, insulin resistance, or food and water intake in DS/obese rats, but substantially alleviated hypertension. However, left ventricular (LV) and cardiomyocyte hypertrophy and the upregulation of myocardial fetal-type gene expression, macrophage infiltration in the heart, and increased perivascular and interstitial fibrosis of the LV myocardium and the upregulation of fibrosis-related gene expression were not improved by such intervention. Additionally, L-arginine did not ameliorate impairments of Doppler- or micromanometer-derived indices of LV diastolic function. None of these parameters were influenced by L-arginine supplementation in DS/lean rats. Conclusions: L-arginine supplementation substantially ameliorated hypertension but did not attenuate LV remodeling or diastolic dysfunction in this model of MetS. These data suggest that in addition to its role as a precursor of NO, L-arginine may play a role as a functional amino acid that modulates growth and inflammation.

Immediate change following valve deployment in left ventricular systolic and diastolic functions in transcatheter aortic valve replacement: a retrospective cohort study.

Transcatheter aortic valve replacement (TAVR) is an effective treatment for aortic valve disorder. Several studies have reported improvements in systolic and diastolic function following TAVR. However, few studies have addressed immediate post-deployment changes. Therefore, this study examines left ventricular (LV) systolic and diastolic function changes immediately after valve deployment in TAVR patients, distinguishing between those with normal and impaired LV ejection fraction (LVEF). In this single-center retrospective cohort study, intraoperative changes in LV systolic and diastolic function were analyzed in patients undergoing TAVR from January 2012 to September 2014. Participants were categorized into two groups based on preprocedural LVEF: the low ejection fraction (EF) group (LVEF <50%) and the normal EF group (LVEF ≥50%). LVEF, as an indicator of LV systolic function, along with lateral e' and the E/e' ratio as indicators of LV diastolic function before and immediately after valve deployment were compared in the overall cohort and within each group. Forty-eight TAVR cases were included, comprising 15 in the low EF group and 33 in the normal EF group. Overall, there was a significant improvement in LVEF {51.7% [standard deviation (SD)] 15.0 vs. 58.0% (SD 11.6), P=0.007}, with no significant changes in e' or E/e'. In the low EF group, a significant increase was observed in LVEF [31.8% (SD 8.0) vs. 45.5% (SD 9.9), P=0.006], e' [5.0 cm/s (SD 1.4) vs. 6.2 cm/s (SD 1.0), P=0.004], and a significant decrease was observed in E/e' [22.3 (SD 7.6) vs. 16.1 (SD 3.4), P=0.01]. The normal EF group showed a significant decrease in e' [6.2 cm/s (SD 1.8) vs. 5.9 cm/s (SD 1.6), P=0.04] without significant changes in LVEF and E/e'. This study revealed significant intraoperative improvements in systolic and diastolic functions immediately after valve deployment in TAVR patients with low preprocedural LVEF. These immediate improvements were not observed in patients with normal LVEF.

PS-C05-7: ASSOCIATION OF VENTRICULAR-ARTERIAL COUPLING WITH LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: Ventricular-arterial coupling (VAC) has an important role in the pathophysiology of coronary artery disease and heart failure. The association of VAC with left ventricular (LV) function in patients with acute myocardial infarction (AMI) was investigated in this study. Design and Method: Echocardiographic indexes of LV volumes, systolic function, and diastolic function were measured in the usual way. Effective arterial elastance (Ea) was calculated from stroke volume measured using LV outflow waveform. Effective LV end-systolic elastance (Elv) was obtained using the single-beat method. Central aortic pressure waveform was recorded using the applanation tonometry. Characteristic impedance (Zc) of aortic root was calculated after Fourier transformation of both aortic pressure and flow waveforms. Results: Eight-five patients (age 58.5 ± 10.6 years) with AMI were enrolled. They were grouped as patients with reduced EF (rEF, &lt; 50%; n = 27) and preserved ejection fraction (pEF, ≧ 50%; n = 58). In patients with rEF, Ea (2.14 ± 0.55 vs. 1.84 ± 0.51 mmHg/mL; P = 0.017) and VAC (1.18 ± 0.22 vs. 1.02 ± 0.22; P = 0.002) were increased, but peripheral and central systolic blood pressure, Elv and Zc were not different. In multiple linear regression analysis, VAC was significantly associated with E” velocity (beta -0.36, P = 0.001) and Zc (beta 0.33, P = 0.019), but neither with EF nor left ventricular longitudinal strain. The association between VAC and E” velocity was significant in patients with pEF (beta -2.64, P = 0.011), but not in patients with rEF. Conclusions: VAC was associated with LV diastolic dysfunction in AMI patients with pEF, but not with rEF.

Serum aldosterone effect on left ventricular structure and diastolic function in essential hypertension

Aldosterone has hypertrophic and profibrotic effects on the heart. This study aims to determine the relationship between serum aldosterone concentration (SAC) and aldosterone-to-renin ratio (ARR) with left ventricular (LV) geometry and diastolic function in essential hypertension (EH). We investigated 213 EH patients (50.3±12.6 years; 57.7% male). SAC, ARR measurements, and echocardiographic analysis were performed for participants. Overall, stepwise multiple regression analysis showed significant associations between SAC and interventricular septum, LV posterior wall thickness, LV amass, LV mass index, e' velocity, a' velocity, and E/e' ratio after adjustment of potentially confounding covariates. When patients were divided into three SAC tertiles, multivariate-adjusted analysis of covariance (ANCOVA) demonstrated a significant increase in LV mass (P ˂ 0.001), LV mass index (P ˂ 0.001), relative wall thickness (P=0.003), interventricular septum (P=0.001), LV posterior wall thickness (P=0.001) and E/e' ratio (P ˂ 0.001), but a decrease in e' velocity (P=0.002) from the first to third tertile of SAC. In logistic regression analysis, increased SAC was independently associated with concentric LV hypertrophy [OR: 1.21, 95% CI: 1.11-1.33, P ˂ 0.001]. No significant associations were found between ARR and echocardiographic parameters of LV structure or diastolic function. In conclusion, SAC, but not ARR, is independently associated with echocardiographic indices of LV structure and diastolic function and is also related to concentric LV hypertrophy. Our findings suggest that aldosterone's pro-hypertrophic and myocardial fibrosis effects contribute to alterations in LV structure and diastolic function in EH beyond blood pressure.

SOdium-glucose CO-transporter inhibition in patients with newly detected Glucose Abnormalities and a recent Myocardial Infarction (SOCOGAMI)

Aims/hypothesisEstablished dysglycaemia (impaired glucose tolerance [IGT] or type 2 diabetes [T2DM]) is a risk factor for further cardiovascular events in patients with coronary artery disease. Sodium-glucose cotransporter 2 inhibitors reduce this risk. The aim of the present investigation was to test the hypothesis that empagliflozin exerts beneficial effects on myocardial function in patients with a recent acute coronary syndrome and newly detected dysglycaemia. MethodsForty-two patients (mean age 67.5 years, 81 % male) with recent myocardial infarction (n = 36) or unstable angina (n = 6) and newly detected IGT (n = 27) or T2DM (n = 15) were randomised to 25 mg of empagliflozin daily (n = 20) or placebo (n = 22) on top of ongoing therapy. They were investigated with oral glucose tolerance tests, stress-perfusion cardiac magnetic resonance imaging (CMR) and echocardiography at three occasions: before randomisation, after seven months on study drug and three months following cessation of such drug. Primary outcome was a change in left ventricular (LV) end-diastolic volume (LVEDV) and secondary outcomes were a change in a) systolic and diastolic LV function; b) coronary flow reserve; c) myocardial extracellular volume (ECV) in non-infarcted myocardium; d) aortic pulse wave velocity. ResultsEmpagliflozin induced a significant decrease in fasting and post load glucose (p < 0.05) and body weight (p < 0.01). Empagliflozin did not influence LVEDV, LV systolic or mass indexes, coronary flow reserve, ECV or aortic pulse wave velocity. Echocardiographic indices of LV diastolic function (E/e’ and mitral E/A ratio) were not influenced. No safety concerns were identified. Conclusions/interpretationEmpagliflozin had predicted effects on the dysglycaemia but did not influence variables expressing LV function, coronary flow reserve and ECV. An explanation may be that the LV function of the patients was within the normal range.

Assessment of novel echocardiographic indices of myocardial function in patients with significant primary mitral regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Assessment of left ventricular (LV) function in primary mitral regurgitation remains challenging due to ejection fraction preservation, even in late stages of the disease. Global longitudinal strain (GLS) remains a valuable tool for the assessment of systolic function which is affected, like ejection fraction, by loading conditions. Lately, novel methods, such as myocardial work estimated by echocardiography, have been developed in assessment of LV systolic function, along with left atrial strain in assessment of diastolic function. Early identification of systolic or diastolic dysfunction in primary mitral regurgitation is crucial for further management of these patients. PURPOSE In this study we assessed several indices of LV systolic and diastolic function, such as myocardial work, global longitudinal strain and left atrial strain, in patients with significant primary mitral regurgitation, in order to evaluate early myocardial dysfunction. METHODS We retrospectively assessed echocardiograms of 64 patients, referred to an echocardiography laboratory of a tertiary hospital between 2019 and 2021 with the diagnosis of significant primary MR. Measurements included several echocardiographic indices of LV anatomy and function, such as left atrial volume indexed (LAVi), left atrial strain, global longitudinal strain (GLS), pulmonary hypertension and global myocardial work. Finally we correlated various indices of systolic and diastolic function with severity of mitral regurgitation. RESULTS We analyzed echocardiograms of 64 patients (50 men, mean age 60 ± 13,8) with at least moderate organic MR, 75,8% of which had severe MR, and normal ejection fraction (mean EF 63%±4,9). We identified negative correlation between left atrial strain (reservoir) and pulmonary hypertension measurements (correlation coefficient -358, p &amp;lt; 0,05) in patients with at least moderate MR. However, we were not able to find any statistically significant differences in GLS (21,98 vs 22,26) or myocardial work, even though we noticed a difference in myocardial work between patients with moderate and severe MR (Global Work Index 2302mmHg% vs 2262mmHg% with normal values 2209 ± 307mmHg% in STAAB cohort, Global Constructed Work 2540mmHg% vs 2327mmHg%, Global Waste Work 136,89mmHg% vs 136,43mmHg%, Global Work Efficiency 94,22% vs 93,76%). CONCLUSIONS These data suggest that an early assessment of indices of diastolic function, such as left atrial strain linked to pulmonary hypertension, can guide to a more effective evaluation of patients with severe MR and normal systolic function. Additionally, novel indices of LV function less load-dependent, such as myocardial work, are promising tools in the assessment of left ventricle and early recognition of myocardial dysfunction in patients with severe organic MR, but more prospective studies are needed. Abstract Figure. Abstract Figure.

Blood pressure trajectories in early adulthood and myocardial structure and function in later life

AimsThis study sought to investigate the association between blood pressure (BP) trajectories from early to middle adulthood and echocardiographic indices of structure and function in middle age.Methods and resultsThis prospective cohort study included 4717 black and white adults aged 18–30 years at baseline (1985–86) who were followed over 30 years in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Trajectories of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) from the Year 0 examination to Year 30 examination were identified using latent mixture modelling. Echocardiographic indices of myocardial structure, systolic function, and diastolic function were assessed at the Year 30 examination. Five distinct SBP trajectory groups were identified: low‐stable [1110 participants (23.5%)], moderate‐stable [2188 (46.4%)], high‐stable [850 (18.0%)], moderate‐increasing [416 (8.8%)], and high‐increasing [153 (3.2%)]. After adjustment for clinical variables, a significant decreasing trend was observed from the high‐increasing and moderate‐increasing groups through to the low‐stable group for left ventricular (LV) mass index [mean (SE): high‐increasing, 112.3 (3.4); moderate‐increasing, 99.3 (2.6); high‐stable, 88.9 (2.5); moderate‐stable, 86.1 (2.3); low‐stable, 82.1 (2.4), P trend < 0.01], as well as LV end‐diastolic dimension, left atrial volume index, and E/e′, while an increasing trend was apparent for LV longitudinal strain, E/A ratio, and average e′ velocities. Results were generally consistent for trajectories of DBP and PP.ConclusionsHigher BP trajectories from early to middle adulthood were associated with worse indices of myocardial modelling and LV systolic and diastolic function at middle age.