Interventricular Septum Diameter Research Articles

Predictive value of Doppler echocardiography parameters for cardiovascular events in patients with systemic lupus erythematosus.

This study aimed to assess the utility of Doppler echocardiography in evaluating left ventricular diastolic function, and prognosis in patients with systemic lupus erythematosus (SLE). A total of 286 SLE patients were selected along with 100 age- and gender-matched healthy individuals who underwent physical examinations. Clinical baseline characteristics were collected. Various Doppler echocardiographic parameters were measured and analyzed, including left ventricular posterior wall thickness (LVPWT), interventricular septal diameter (IVSD), left ventricular mass (LVM), LVM index (LVMI), and others. Compared to the control group, SLE patients exhibited significantly higher levels of C-reactive protein and lower levels of complement (C) 3 and C4 (p < .001). Doppler echocardiographic parameters showed significant differences between SLE patients and healthy controls, including increased LVPWT, IVSD, LVM, LVMI, peak A, PWI + Tei, E/e', TDI-Tei, and decreased e' and E/A (p < .001). Subgroup analyses indicated more severe ventricular diastolic dysfunction in patients with higher SLE activity and those who experienced cardiovascular events. Correlation analysis revealed positive associations of PWI + Tei, TDI-Tei, and GLS with SLE activity and cardiovascular events (p < .01). Multivariate logistic regression analysis identified LVMI, PWI + Tei, TDI-Tei, and GLS as significant predictors of cardiovascular events (p < .05). Doppler echocardiography is a valuable tool for the early diagnosis of left ventricular diastolic dysfunction in SLE patients. Key echocardiographic parameters, including LVMI, PWI + Tei, TDI-Tei, and GLS, are effective in predicting cardiovascular events, underscoring the importance of comprehensive cardiac function assessments in these patients.

Normal M-mode, Pulsed Wave and Tissue Doppler Echocardiographic Studies in Healthy Working Police Dogs

Background: Physical activity alters the cardiovascular system of dogs depending on the exercise characteristics and the animal’s physical conditioning. Little is known about the cardiovascular changes in working police dogs. This study evaluated the cardiovascular responses of working Labradors to regular exercise and various workload. Methods: Twelve working Labradors of Tamil Nadu police department that were regularly trained and exercised 30 minutes morning and evening and twelve normal household pet Labradors brought for regular checkup to Madras Veterinary College Teaching hospital were taken for the study. All the animals were subjected to physical, clinical, hematobiochemical, electrocardiographic examinations and cardiac auscultation before performing echocardiography. Those animals which showed normal recordings in all the above tests were further subjected to M-mode, Pulsed wave and Tissue Doppler echocardiography. In this study, the resting heart rate values of working groups were lesser than that of normal pet dogs. Result: The results of echocardiography showed significant increase in Interventricular septal diameter during diastole, left atrial diameter, aortic artery diameter and the left atrium to aortic diameter ratio without impairing systolic and diastolic cardiac functions in working dogs. The present study indicated that there were few changes in the echocardiographic parameters which might be a response to physiological adaptation and regular exercise.

Impact of Chronic Consumption of Herbal Rooibos on Cardiovascular Function in Adults with Cardiovascular Risk.

The prevalence of cardiovascular disease (CVD) has increased in South Africa, emphasizing the importance of prevention strategies. This study used echocardiography to investigate the impact of Rooibos on cardiovascular function in those at risk of CVD. This research aims to contribute to understanding its effects on reducing cardiovascular risk factors. The study design involved a 12-week randomized, parallel, double-blinded, placebo-controlled dietary intervention trial using capsules containing standardized water-soluble extracts of green and traditional fermented Rooibos alongside a placebo control. Echocardiography was incorporated as a diagnostic imaging tool to assess cardiac function in the participant cohort. Aorta (AO) dimensions showed no significant change in any intervention group. Left atrium (LA) reduced in size from 3.832 ± 0.071 cm to 3.675 ± 0.067 cm (P = 0.01). There was no significant change in LA/AO ratio in any intervention group. Interventricular septum diameter in the placebo group decreased from 1.334 ± 0.030 cm to 1.250 ± 0.025 cm (P = 0.002), with no significance in fermented Rooibos, while green Rooibos resulted in a decrease from 1.282 ± 0.036 cm to 1.186 ± 0.029 cm (P = 0.002). Left ventricle posterior wall (LVPW) showed no significant changesin any of the intervention group. The left ventricle mass in the placebo and green Rooibos groups demonstrated no significance changes, while fermented Rooibos caused a decrease from 204.102 ± 7.102 g to 191.394 ± 6.707 g (P = 0.015). The phytochemical bioactive components, such as the polyphenolic antioxidants present in green and fermented Rooibos, improved cardiovascular function. This study confirms the effectiveness of echocardiography as imaging tool for assessing cardiac function in this particular population. Regular Rooibos consumption may offer promising therapeutic benefits for preventing and managing CVD risk.

Effects of NEAT1 levels on cardiovascular events and prognosis in diabetic nephropathy patients undergoing peritoneal dialysis.

The purpose of this study was to provide observational indicators for clinically predicting cardiovascular events in patients with diabetic nephropathy (DN) undergoing peritoneal dialysis by determining the effects of nuclear enriched abundant transcript 1 (NEAT1) levels on the cardiovascular events and prognosis in DN patients receiving continuous ambulatory peritoneal dialysis (CAPD). A retrospective analysis was conducted on the data of 80 DN patients undergoing CAPD. Patients were assigned to NEAT1 high expression group and NEAT1 low expression group. NEAT1 had a substantially increased expression in the serum of DN patients, and it could serve as a potential biomarker for predicting the development of DN. Patients with highly expressed NEAT1 had an higher level of high-sensitivity C-reactive protein (hs-CRP), larger cardiac structural parameters left ventricular end-diastolic diameter (LVED), left ventricular end-systolic diameter (LVESD), interventricular septal diameter (IVSD) and left ventricular posterior wall diameter (LVPWD), but a notably lower cardiac function evaluation indicator left ventricular ejection fraction (LVEF) than those with lowly expressed NEAT1. The coefficient (r) of correlation between NEAT1 and hs-CRP level was 0.3585 (P=0.0011). The incidence rates of acute myocardial infarction, congestive heart failure and angina in NEAT1 high expression group were higher than those in NEAT1 low expression group. Patients with NEAT1 high expression exhibited a higher mortality rate than NEAT1 low expression group. With the increase in NEAT1 levels, the level of hs-CRP rose in DN patients undergoing CAPD. A higher expression level of NEAT1 indicates poorer cardiac function, higher incidence rates of cardiovascular adverse events and a poorer prognosis in diabetics undergoing CAPD.

Structural and functional cardiac parameters across occupations: a cross-sectional study in differing work environments

Previous investigations have highlighted notable variations in cardiovascular risk indicators associated with various professional categories. However, only a few studies have examined structural and functional cardiac parameters using echocardiography within distinct occupational groups. Hence, this study endeavored to assess cardiac structural and functional parameters in three additional occupations: firefighters (FFs), police officers (POs), and office workers (OWs). This prospective study encompassed 197 male participants (97 FFs, 54 POs, and 46 OWs) from Germany. All participants underwent 2D and Doppler echocardiography in resting conditions; standard parasternal and apical axis views were employed to evaluate structural (diastolic and systolic) and functional (systolic and diastolic function, and strain) cardiac parameters. All three occupational groups exhibited a tendency towards septal hypertrophy. Notably, OWs exhibited the largest diastolic interventricular septum diameter (IVSd), at 1.33 ± 0.25 cm. IVSd significantly varied between POs and OWs (p = 0.000) and between POs and FFs (p = 0.025). Additionally, during diastole a substantially larger left ventricular posterior wall diameter (LVPWd) was observed in OWs compared to FFs (p = 0.001) and POs (p = 0.013). The left ventricular diastolic cavity diameter (LVIDd) and the left ventricular systolic cavity diameter (LVIDs) were significantly higher in POs than they were in FFs (LVIDd: p = 0.001; LVIDs: p = 0.009), and the LVIDd was notably higher in FFs (p = 0.015) and POs compared to OWs (p = 0.000). FFs exhibited significantly better diastolic function, indicated by higher diastolic peak velocity ratios (MV E/A ratio) and E/E’ ratios, compared to POs (E/A ratio: p = 0.025; E/E’ ratio: p = 0.014). No significant difference in diastolic performance was found between OWs and FFs. Significantly higher E’(lateral) values were noted in POs compared to FFs (p = 0.003) and OWs (p = 0.004). Ejection fraction did not significantly differ among FFs, POs, and OWs (p > 0.6). The left ventricular mass (LV Mass) was notably higher in POs than it was in FFs (p = 0.039) and OWs (p = 0.033). Strain parameter differences were notably improved in two- (p = 0.006) and four-chamber (p = 0.018) views for FFs compared to POs. Concentric remodeling was the predominant change observed in all three occupational groups. Significant differences in the presence of various forms of hypertrophy were observed in FFs, POs, and OWs (exact Fisher test p-values: FFs vs. OWs = 0.021, POs vs. OWs = 0.002). OWs demonstrated notably higher rates of concentric remodeling than FFs did (71.77% vs. 47.9%). This study underscores disparities in both functional and structural parameters in diverse occupational groups. Larger prospective studies are warranted to investigate and delineate differences in structural and functional cardiac parameters across occupational groups, and to discern their associated effects and risks on the cardiovascular health of these distinct professional cohorts.

Prevalence of cardiac amyloidosis in patients undergoing carpal tunnel release with amyloid deposition in removed tenosynovium

Abstract Background Carpal tunnel syndrome (CTS) is an early symptom and important clinical indicator for the diagnosis of cardiac amyloidosis. Amyloid deposition in removed tenosynovium during carpal tunnel release (CTR) is often confirmed; however, the prevalence of concomitant cardiac amyloidosis is not yet understood. Purpose This study aimed to evaluate the prevalence of amyloid deposition in removed tenosynovium in patients who underwent CTR and to clarify the prevalence of concomitant cardiac amyloidosis in patients who had amyloid deposition in removed tenosynovium. Methods Overall, 669 patients who underwent CTR were prospectively examined and evaluated for amyloid deposition after tenosynovium removal. Invitation and proposal letters for cardiac screening were sent to patients with amyloid deposition. Electrocardiography, echocardiography, and biomarkers were evaluated to assess the likelihood of cardiac amyloidosis. Results Amyloid deposition was observed in 261 (39%) patients, who were significantly older and predominantly male (p&amp;lt;0.05). Among them, 111 patients (mean age; 70.8 ± 7.3 years old; men: 55%) agreed to cardiac screening. 99mTc-labeled pyrophosphate (99mTc-PYP) scintigraphy was performed in 12 patients who met the following criteria: 1) interventricular septum diameter (IVSd) ≥14 mm or 2) 12 mm ≤ IVSd &amp;lt;14 mm with above-normal limits in high-sensitivity cardiac troponin T (hs-cTnT; &amp;gt;0.014 ng/mL). Six patients (50%) had positive findings on 99mTc-PYP scintigraphy and were diagnosed with wild-type transthyretin cardiac amyloidosis with Mayo prognostic stage I. The prevalence of concomitant cardiac amyloidosis was observed in 6/111 (5.4%) CTR patients with amyloid deposition and 50% (6/12) in patients with left ventricular hypertrophy (≥12 mm) with increased hs-cTnT levels. Conclusion Amyloid deposition in removed tenosynovium was frequently observed in elderly men with CTS. Cardiac screening may be useful for the early diagnosis of cardiac amyloidosis in patients undergoing CTR with amyloid deposition. This knowledge should be shared with orthopedic surgeons and cardiologists for the early diagnosis of cardiac amyloidosis.Flowchart of participant selectionGraphical Abstract

Left atrial strain measurement to predict new-onset atrial fibrillation in ST-elevation myocardial infarction patients

Abstract Background/Introduction ST-elevation myocardial infarction (STEMI) remains a healthcare burden not only through increased mortality risk, but also development of chronic cardiac pathologies like atrial fibrillation (AF). Left atrial (LA) reservoir strain is a known predictor of incident AF in the general population. Purpose Our aim was to explore the additional prognostic value of LA reservoir strain measured by transthoracic echocardiography (TTE) in STEMI patients for new-onset atrial fibrillation (NOAF). Methods Data were analyzed retrospectively from an ongoing STEMI registry. Patients with previous myocardial infarction, AF, known history of heart failure, severe valvular pathology, suboptimal image quality, AF during TTE or missing follow-up were excluded. TTE was performed within 48 hours of hospitalization. LA reservoir strain was measured in apical 4-chamber view. LA strain &amp;lt;23% was used as cut-off value for impaired LA function as previously established. The endpoint was NOAF. Follow-up was censored at last patient visit or at 5 years. Results In total 1238 patients (mean age 60±12 years; 930 (75%) men) were included. After median follow-up of 22 months (IQR 12; 60) 106 (8.6%) patients developed NOAF, most events (71 (67%)) taking place within the first year after STEMI. Mean LA reservoir strain was more impaired in patients who developed NOAF as compared to those who did not (19.3 ± 8.1% versus 24.3 ± 8.8% respectively (p&amp;lt;0.001). Clinical and echocardiographical characteristics are shown in the table. Cumulative event-free survival rates at 1, 3 and 5 years in patients with preserved versus decreased LA strain were 97%, 95% and 93% versus 91%, 89% and 83% respectively (Log-rank X2 = 21.1; p&amp;lt;0.001; Figure). Factors significant on univariable Cox regression analysis (age, presence of chronic obstructive pulmonary disease, troponin levels, left ventricular end-diastolic diameter, interventricular septum diameter, left ventricular global longitudinal strain, LA volume index, LA reservoir strain, E/E’ ratio and right ventricular fractional area change) were included in multivariable model, where LA reservoir strain remained significantly associated with NOAF (HR 0.96 (0.93 – 0.99); p=0.015). Addition of LA strain provided incremental prognostic value over baseline clinical risk factors, traditional TTE parameters and left ventricular global longitudinal strain (X2 84.5 vs 88.8; p=0.013). Conclusion LA reservoir strain was associated with new-onset atrial fibrillation in STEMI patients after adjusting for relevant clinical and echocardiographic risk factors.TableFigure

Aromatase Inhibitors May Increase the Risk of Cardiometabolic Complications in Adolescent Boys.

Aromatase inhibitors (AIs) are increasingly used in children and adolescents to augment adult height. The aim of this study was to investigate the effects AIs have on cardiac morphology, functions and their relation to several metabolic parameters in adolescent boys. Three groups matched for sex (boys, n = 67), age (median age 13.5 years), weight, height, body mass index, and puberty stages were enrolled: (i) Group 1: 23 patients using AIs (only AI(n = 6) or in combination with growth hormone (GH) (n = 17)) for at least 6 months; (ii) Group 2: 22 patients using only GH, and (iii) Group 3: 22 healthy boys. Two-dimensional, M-mode conventional Doppler and tissue Doppler examinations of the left ventricle (LV) were performed. Bioelectrical bioimpedance analyses was conducted and follicle-stimulating hormone, luteinizing hormone, total testosterone, lipid, and hemogram parameters were obtained. Patients in Group 1 had significantly higher serum total testosterone (p < 0.001) and hemoglobin (p < 0.001) levels, fat free mass (p = 0.005), LV mass (LVM) (p = 0.002), as well as increased LV posterior wall diameter (LVPWD) (p = 0.002), interventricular septum diameter (IVSD) (p = 0.019), and myocardial systolic wave velocity (Sm)(p = 0.020) compared to the two other control groups. No significant differences were observed in terms of diastolic and systolic functions and lipid profiles (p > 0.05). There were positive correlations between total testosterone, hemoglobin levels, LVM, LVPWD and IVSD (p < 0.05). Increased LVM, LVPWD, IVSD and Sm of patients receiving AI therapy in comparison to the control groups, and the significant correlations of these parameters with total testosterone and hemoglobin levels were determined as potential side effects of AIs. These findings emphasize the need of routine cardiac follow-up in patients using AIs.

Prevalence of Cardiac Amyloidosis in Patients Undergoing Carpal Tunnel Release With Amyloid Deposition.

Carpal tunnel syndrome (CTS) is considered an early sign of cardiac amyloidosis (CA) because amyloid deposition is often confirmed in the tenosynovium removed during carpal tunnel release (CTR); however, the prevalence of concomitant CA is unclear.Methods and Results: We prospectively examined 700 patients who underwent CTR and evaluated amyloid deposition after tenosynovium removal. Amyloid deposition was observed in 261 (37%) patients, who were significantly older and predominantly male (P<0.05). Of them, 120 agreed to cardiac screening. We performed 99 mTc-labeled pyrophosphate (99 mTc-PYP) scintigraphy in 12 patients who met either of the following criteria: (1) interventricular septal diameter (IVSd) ≥14 mm or (2) 12 mm ≤ IVSd < 14 mm with above-normal limits in high-sensitivity cardiac troponin T (hs-cTnT). Six patients (50%) had positive findings on 99 mTc-PYP scintigraphy and were diagnosed with wild-type transthyretin CA. Concomitant CA was observed in 6/120 (5%) CTR patients with amyloid deposition and 50% (6/12) in patients with left ventricular hypertrophy (≥12 mm) with increased hs-cTnT levels. Amyloid deposition was frequently observed in the removed tenosynovium of elderly men with CTS. Cardiac screening may be useful for early diagnosis of CA in patients undergoing CTR with amyloid deposition.

The Effect of Elective Ligation of the Arteriovenous Fistula on Cardiac and Renal Functions in Kidney Transplant Recipients.

Kidney transplantation (KTx) is considered as the best kidney replacement therapy and arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. The systematic ligation of a functioning AVF in stable kidney transplant recipients remains debatable. In this prospective study, we investigated the hemodynamic impact of the surgical closure of AVF in KTRs. Forty-three KTRs underwent an ambulatory blood pressure monitoring (24h-ABPM) before surgical closure of AVF (T0) and 12 months later (M12), as well as measurement of serum cardiac biomarkers (i.e., soluble suppression of tumorigenicity 2 (ST2), N-terminal pro b-type natriuretic peptide (NT-proBNP) and Galectin-3). Serum tests were also performed 6 months after AVF closure (M6). An echocardiographic exam was done at each time-point. All serum creatinine values were collected to compare the individual eGFR slopes before versus after AVF closure. The latest measure of the AVF flow (QAVF) prior to KTx was recorded. Diastolic blood pressure (DBP) significantly raised from T0 to M12: + 4.4±7.3 mmHg (p=0.0003) for 24h, + 3.8±7.4 mmHg (p=0.0018) during the day, and + 6.3±9.9 mmHg (p=0.0002) during the night, leading to an increased proportion of KTRs with ESH-defined arterial hypertension after AVF ligation. No change was observed for systolic BP. NT-proBNP significantly dropped between T0 and M6 (345 [190; 553] to 230 [118; 458] pg/mL, p=0.0001) and then remained stable from M6 to M12, while ST2 and Galectin-3 levels did not change from T0 to M12. We observed a significant decrease of left ventricular (LV) end-diastolic volume, LV end-systolic volume, LV mass, interventricular septum diameter, left atrial (LA) volume, and tricuspid annular plane systolic excursion from T0 to M6, and then a stability from M6 to M12. LV ejection fraction and eGFR slope remained stable during the whole study. These observations remained unchanged after adjustment for QAVF. The closure of a patent AVF in KTRs is associated with elevation of DBP, drop of serum NT-proBNP levels, reduction of LV/LA dimensions, and stable eGFR slope.

Effect of insulin resistance on left ventricular remodelling in essential hypertensives: a cross-sectional study.

In clinical practice, left ventricular hypertrophy (LVH) is defined by physical findings and electrocardiographic criteria, which are useful but imperfect tools, echocardiographic criteria and cardiac magnetic resonance imaging. In echocardiography, LVH is defined not by left ventricular wall thicknesses but by left ventricular mass. The latter is calculated according to Devereux's formula, and is increased by insulin resistance/hyperinsulinaemia. It is however unclear whether insulin resistance, hyperinsulinaemia, or both, is actually causative and what their collective or individual influence is on the components of Devereux's formula and parameters of left ventricular diastolic function. This study evaluated the associations of the homeostatic model assessment for insulin resistance (HOMAIR) and fasting plasma insulin levels with components of Devereux's formula and parameters of left ventricular diastolic function. Relevant clinical data were collected from 220 hypertensive patients recruited between January and December 2019. The associations of components of Devereux's formula and parameters of diastolic function with insulin resistance were tested using binary ordinal, conditional and classical logistic regression models. Thirty-two (14.5%) patients (43.9 ± 9.1 years), 99 (45%) patients (52.4 ± 8.7 years) and 89 (40.5%) patients (53.1 ± 9.8 years) had normal left ventricular geometry, concentric left ventricular remodelling and concentric left ventricular hypertrophy, respectively. In multivariable adjusted analysis, 46.8% of variation in interventricular septum diameter (R² = 0.468; overall p = 0.001) and 30.9% of E-wave deceleration time (R² = 0.309; overall p = 0.003) were explained by insulin level and HOMAIR, 30.1% of variation in left ventricular end-diastolic diameter (R² = 0.301; p = 0.013) by HOMAIR alone, and 46.3% of posterior wall thickness (R² = 0.463; p = 0.002) and 29.4% of relative wall thickness (R² = 0.294; p = 0.007) by insulin level alone. Insulin resistance and hyperinsulinaemia did not have the same influence on the components of Devereux's formula. Insulin resistance appeared to act on left ventricular end-diastolic diameter, while hyperinsulinaemia affected the posterior wall thickness. Both abnormalities acted on the interventricular septum and contributed to diastolic dysfunction via the E-wave deceleration time.

Automated analysis of echocardiograms at diagnosis is able to predict prognosis in ATTR cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is progressive and ultimately fatal cause of heart failure. ATTR-CM often displays characteristic echocardiographic features, and manual measurements of both stroke volume and longitudinal strain are independent predictors of mortality. We sought to investigate whether automated analysis of echocardiographic parameters at the time of diagnosis were able to predict prognosis in this population. Methods We analysed all consecutive patients between 2006–2021 who underwent an echocardiogram at the time of diagnosis, and analysed their echocardiograms using artificial intelligence software that has been developed and validated by Us2.ai. Results We identified 1972 patients with ATTR-CM (age: 75.6±8.7 years, male: 86.9%), comprising of 1329 wild-type ATTR-CM and 643 hereditary ATTR-CM (V142I = 376, T80A = 171, other = 96). Patients with V142I had an increased relative wall thickness (P&amp;lt;0.001) lower stroke volume indexed (P&amp;lt;0.001), and worse longitudinal strain (P&amp;lt;0.001) than patients with wild-type and T80A ATTR-CM. In a multi-variable analysis of echocardiographic parameters selected a priori (interventricular septal diameter, relative wall thickness, left and right atrial area indexed, biplane stroke volume indexed, full thickness longitudinal strain, and E/e’ lateral), left atrial area indexed (HR=1.08, 95%CI[1.02–1.14], P=0.005), biplane stroke volume indexed (HR=0.96, 95%CI[0.94–0.98], P&amp;lt;0.001) and full thickness longitudinal strain (HR=1.04, 95%CI[1.01–1.08], P=0.009) all remained independent predictors of mortality. Conclusions Automated of analysis echocardiograms using artificial intelligence demonstrated that patients with V142I had more advanced cardiac disease at diagnosis. Automated measurements produced by artificial intelligence software are able to predict prognosis and identify the same parameters as those identified using manual analysis as powerful independent predictors of mortality.

Study on the Efficacy of Sacubitril/Valsartan in Patients with Heart Failure with Preserved Ejection Fraction Undergoing Peritoneal Dialysis

Introduction: Cardiovascular disease is the most common cause of death and morbidity in patients with end-stage renal disease. Sacubitril/valsartan (SAC/VAL) can reduce the risk of cardiovascular mortality among patients with heart failure (HF). The present study set out to evaluate the efficacy of SAC/VAL in the treatment of patients with HF with preserved ejection fraction (HFpEF) undergoing peritoneal dialysis (PD) (HFpEF&PD). Methods: A total of 160 patients with HFpEF&PD were enrolled and randomly divided into the control group (N = 80) and SAC/VAL group (N = 80). The cardiac function efficacy, HF scoring efficacy, echocardiographic parameters, serological indicators, and 6-minute walking test were compared before and after treatment. Results: After 6 months of treatment, the total number of patients who responded to treatment in the SAC/VAL group was higher than that of the control group in terms of cardiac function and HF scoring efficacy. After treatment, levels of early diastolic/late diastolic filling velocity and left ventricular ejection fraction were increased in both groups, while the levels of left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, inter-ventricular septal diameter, and left ventricular posterior wall diameter were decreased; the NT-proBNP levels were diminished in both groups, while hemoglobin levels and the 6-minute walk distance were increased; the systolic blood pressure, diastolic blood pressure, and 24-h ultrafiltration volume were lowered in all patients. The changes in these indexes in the SAC/VAL group were more obvious than those in the controls. Conclusion: SAC/VAL can significantly improve cardiac function in patients with HFpEF&PD.

The significance of volume overload in the development of pulmonary arterial hypertension in continuous ambulatory peritoneal dialysis patients.

The underlying pathophysiology of pulmonary arterial hypertension (PAH) is multifactorial; however, the significance of chronic volume overload and its subsequent effects on cardiac function must be studied thoroughly. The main objective of this study was to determine the predictive parameters of PAH in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) using transthoracic echocardiography (TTE) and bioimpedance analysis (BIA). In this cross-sectional study, 43 eligible CAPD patients were chosen. The patients were examined by TTE and BIA before the morning dialysis session, and baseline patient characteristics, echocardiography, and BIA parameters were recorded. Sixteen (37.2%) patients were diagnosed with PAH. Patients with PAH had significantly greater left atrial diameter (LAD), left ventricular mass index (LVMI), and higher grades of diastolic dysfunction (DDF). Systolic pulmonary artery pressure (sPAP) correlated with LAD (p< 0.001, r= 0.566), interventricular septal diameter (IVSD) (p= 0.004, r= 0.425), LVMI (p= 0.030, r= 0.323), and extracellular water/total body water (ECW/TBW) ratio (p= 0.002, r= 0.458). Two volume status-related parameters including ECW/TBW ratio and inferior vena cava (IVC) expiratory diameter, and cardiac-related TTE findings such as LAD and DDF were predictors of sPAP in CAPD patients.

Evaluation of cardiovascular system and determination of cardiometabolic risk using novel biomarkers in childhood obesity

BackgroundObesity is a metabolic disorder that is defined as excessive increase in body fat tissue. Early recognition of obesity in children is essential to prevent complications that may occur in both childhood and adulthood. ObjectivesThe purpose of this study was to assess cardiometabolic risk and to investigate the association between novel biomarkers and cardiovascular disease in obese children. MethodsThis research was performed between June 2014 and January 2015 in the Pamukkale University Faculty of Medicine. Fifty obese children and, 29 healthy children were included in the study. Fasting levels of serum lipids, glucose and insulin, serum copeptin, BNP, and ADM were measured. Thickness of main CIMT and EAT were assessed with 2D echocardiogram. M-mode echocardiographic measurements, mitral and tricuspid valve measurements with PDE, and tricuspid and interventricular septum measurements with TDE were performed in both groups. Treadmill stress testing was performed in the same patient group. ResultsLevels of total cholesterol and LDL were significantly higher in obese group. Serum BNP and serum ADM levels were significantly lower in obese group. Left ventricular mass index, CIMT and EAT were statistically higher in obese group. Left ventricular end-systolic diameter, left ventricular end-diastolic diameter, interventricular septum diameter, posterior wall thickness were significantly higher in obese group than in control group. Time to reach target heart rate in treadmill stress testing was significantly shorter in obese group than in control group. ConclusionChildhood obesity is associated with significant changes in the myocardial structure based on echocardiography. Thickness of carotid intima-media and epicardial fat tissue can be used as predictive markers of atherosclerosis in obese children. Our study demonstrated that exercise capacity is significantly lower, and hemodynamic response to exercise is defective in obese children.

Two-dimensional speckle tracking echocardiography, a powerful method for the evaluation of anthracyclines induced left ventricular insufficiency.

Anthracyclines have been one of the most important therapeutic methods in breast cancer therapy for decades. However, serious long-term toxicities, especially cardiotoxicity limits the continuous usage of anthracyclines, hence affects long term prognosis. Early detection of myocardial dysfunction during treatment is critical but challenging. Two-dimensional speckle tracking echocardiography (2D-STE) is a non-Doppler technique that can assess deformation and strain by tracking displacement of acoustic markers in the myocardium. This study aims to compare the sensitivity and precision between 2D-STE and traditional echocardiography on monitoring the left ventricular function in patients with breast cancer after anthracyclines therapy, which is the key indicator for evaluating myocardial changes. Thirty-three patients with breast cancer were recruited from February 2019 to December 2019. All patients were treated with 4 cycles anthracycline. 2D-STE and conventional echocardiography were performed on each patient. Two-dimensional echocardiographic examination was used to collect data interventricular septum diameter (IVSD), end-diastolic left ventricular posterior wall diameter (LVPWD), left ventricular end-diastolic diameter (LVEDD) and left ventricular systole on the parasternal left ventricular long axis view. The final diameter (left ventricular end-systolic diameter [LVESD]) and the left ventricular short axis shortening rate (LVFS) was measured by M-type. The two-plane Simpson’s method was used to measure left ventricular end-diastolic volume (LVEDV) and end-systolic volume (left ventricular end-systolic volume [LVESV]) to obtain left ventricular ejection fraction (LVEF). Two-dimensional speckle tracking imaging technical indicator includes left ventricular global longitudinal strain (LVGLS), subendocardial myocardial longitudinal strain (LVGLS-Endo) and epicardial myocardial longitudinal strain (LVGLS-Epi). The correlation between 2-dimensional speckle tracking imaging and conventional ultrasound parameters were analyzed. Compared with baseline (T0), the systolic function parameter LVEF was significantly changed after four cycle chemotherapy (T4) (P < .05). However, the conventional echocardiographic parameters including IVSD, LVPWD, LVEDD, LVESD, LVEDV, and LVESV were not statistically significant (P > .05). Meanwhile, the two-dimensional strain parameters LVGLS, LVGLS-Endo, and LVGLS-Epi were statistically significant after T2 and T4 cycle chemotherapy (P < .01).The two-dimensional strain parameter GLS has higher accuracy and sensitivity for monitoring left ventricular insufficiency caused by anthracycline therapy when compared with traditional echocardiography.

Gender-disparities in patients undergoing alcohol septal ablation for hypertrophic obstructive cardiomyopathy

Abstract Background Alcohol septal ablation (ASA) improves symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM) but gender-disparities have only rarely been investigated. Purpose To assess gender-disparities regarding outcome and procedure-related aspects in HOCM patients undergoing ASA. Methods and results 1,367 consecutive ASAs between 2002 and 2020 were retrospectively analyzed for sex-differences. Females (47.2%) had more advanced age at the timing of ASA (66.0 years [IQR 55.0–74.0] vs. 54.0 years [IQR 45.0–62.0]; p&amp;lt;0.0001), had more severe symptoms (NYHA class 2.8±0.6 vs. 2.5±0.8 in males; p&amp;lt;0.0001) and shorter distances walked in 6-min-walk-test at baseline (359.0m [IQR 272.3–442.0] vs. 464.4m [IQR 400.0–524.0] in males; p&amp;lt;0.0001). The baseline interventricular septal diameter (IVSD) was higher in males (21.0mm [IQR 19.0–24.0] vs. 20.0mm [IQR 18.0–23.0] in females; p&amp;lt;0.0001). However, the IVSD was higher in females when it was indexed to the body-surface-area (10.9 mm/m2 [IQR 9.7–12.7] vs. 10.2 mm/m2 [IQR 9.0–11.7] in males; p&amp;lt;0.0001). The resting and exercise-induced left ventricular outflow tract gradients (LVOTG) were lower in females when calculated 1–4 days after ASA (resting: 20.0 mmHg [IQR 12.0–37.5] vs. 22.0 mmHg [IQR 13.0–40.0] in males; p=0.0062; exercise-induced: 55.0 mmHg [IQR 30.0–109.0] vs. 71.0 mmHg [IQR 37.0–115.0] in males; p=0.0006). At 6 months follow-up females had lower exercise-induced LVOTG (34.0 mmHg [IQR 21.0–70.0] vs. 43.5 mmHg [IQR 25.0–74.8]; p=0.0072). More females had complete heart block after ASA (20.3% vs. 13.3% in men; p=0.0005) and, hence, more females (17.4%) than males (10.4%; p=0.0002) needed a pacemaker. There were no differences regarding mortality. Conclusion Female HOCM patients had more advanced age, more severe symptoms and a higher IVSD when indexed to BSA at the timing of ASA. However, early hemodynamic response was better in females, but procedure-related complete heart block was more often found in women. Gender-disparities in clinical characteristics and procedural outcome of ASA should be taken into consideration. Funding Acknowledgement Type of funding sources: None.

Change in echocardiography in patients with transthyretin amyloid cardiomyopathy with tafamidis treatment

Abstract Background Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive and infiltrative disease caused by the deposition of insoluble transthyretin (TTR) amyloid fibrils in the myocardium, which leads to cardiomyopathy characterized by increased ventricular wall thickness and diastolic dysfunction. TTR amyloid fibrils are performed by dissociation of the tetrameric TTR into monomers and misfolding and misassemble into insoluble fibrils. Tafamidis stabilizes the tetramers and inhibits the TTR monomerization, leads to inhibit the formation and deposition of TTR fibril. Clinical trials suggested tafamidis could improve prognosis by slowing the progression of amyloidosis. Evaluation of serial measurement echocardiographic findings by tafamidis treatment is important, but these data has not been fully revealed. Purpose The aim of study was to evaluate the change of echocardiographic parameter in patients with ATTR-CM received tafamidis for 12 months. Especially in strain echocardiogram, global longitudinal strain (GLS) has reported to be associated with prognosis, and apical sparing pattern, which longitudinal strain (LS) in the basal and middle segments is more severely impaired than the apical segments, is specific finding in ATTR-CM. Method Echocardiographic findings before and 12 months were compared in 68 patients with ATTR-CM who started a new prescription of tafamidis and 18 tafamidis naïve patients with ATTR-CM patients who underwent echocardiography annually prior to the approval of tafamidis. Result Among tafamidis treatment group, echocardiographic parameters were not significant changes before and after 12 months tafamidis treatment [left ventricular ejection fraction (LVEF): 49.6±10.6% vs. LVEF: 49.9±10.7% (p=0.767), interventricular septum diameter (IVSd):16.0±2.3mm vs 15.7±2.1mm (p=0.241), left ventricular posterior wall diameter (LVPWd):16.1±2.5mm vs 16.1±2.5mm (p=0.964), GLS: −8.4±2.7% vs −8.2±2.8% (p=0.419), LS at base: −4.6±2.6% vs −4.2±2.4% (p=0.291), LS at middle: −6.9±3.6% vs −6.9±2.8% (p=0.922), LS at apical:-12.7±4.2% vs −12.4±4.4% (p=0.615). Among tafamidis naïve group, these parameters remained almost unchanged in 12 months as well, except for GLS and LS at apical. LS at apical showed a significant impairment. [LVEF: 53.8±9.2% vs 51.7±9.3% (p=0.244), IVSd: 15.5±2.3mm vs 16.0±1.8mm (p=0.321), LVPWd: 15.4±2.3mm vs 15.9±2.3mm (p=0.267), GLS: −10.4±2.4% vs −9.0±2.9% (p=0.065), LS at base: −5.0±2.7% vs −5.1±2.9% (p=0.865), LS at middle: −8.9±3.1% vs −8.5±3.5% (p=0.565), LS at apical: −15.4±4.0% vs −12.6±4.4% (p=0.02); Table 1] Conclusion We evaluated changes in echocardiographic findings with tafamidis treatment for 12 months. The echocardiographic parameters did not change over the course of 12 months, but the decrease in LS at apex observed in the tafamidis naïve group.Segmental LS could reflect a slight progression of cardiac amyloidosis and the short-term effects of tafamidis. Funding Acknowledgement Type of funding sources: None.

Abstract P3061: A Monoclonal Antibody Blocking Interleukin-1 Receptor Accessory Protein Reduces Acute Viral Myocarditis Severity

IL-1, IL-33 and IL-36 have complementary, pro-inflammatory roles during the immune response that promote autoimmune diseases, particularly myocarditis. While antibodies that neutralize circulating cytokines exist, we hypothesized that blockade of their shared co-receptor, IL-1 receptor accessory protein (IL1RAP), would exhibit a more potent and broader anti-inflammatory profile. The CAN10 antibody blocks IL1RAP and is currently under development for treating severe autoimmune and inflammatory diseases. To investigate if IL1RAP blockade is an effective treatment of cardiac inflammation, we induced autoimmune viral myocarditis in 8-week-old Balb/c male mice with Coxsackievirus B3 and treated them with mCAN10, an anti-mouse IL1RAP monoclonal antibody. Mice were euthanized at day 10, the peak of acute inflammation in the heart. IL1RAP blockade reduced the severity of myocarditis at this timepoint when compared to isotype, saline or IL-1 receptor antagonist (IL1RA) treatment (the gold standard in IL-1 receptor blockade), without affecting viral clearance from the heart. Spectral flow cytometry of heart immune populations revealed that mCAN10 significantly reduced the number of infiltrating leukocytes of broad populations, especially effector CD4 + and CD8 + T cells, inflammatory Ly6C + CCR2 + monocytes, neutrophils and eosinophils. We also observed early echocardiographical parameters suggesting improved heart function, including ejection fraction, fractional shortening and interventricular septum diameter. Interestingly, mCAN10-treated mice demonstrated reduced proliferation of bone marrow precursors of inflammatory myeloid and lymphoid lineage leukocytes. Splenic immune cell populations were not affected, indicating that mCAN10 does not cause global immune suppression in these animals. Altogether, our data show that a single monoclonal antibody targeting three inflammatory cytokine systems, IL-1, IL-33 and IL-36, potently reduces acute viral myocarditis severity in a broader fashion that is not recapitulated by IL-1α/β blockade, and shows translational promise for therapeutics of inflammatory disease. Phase I clinical studies of the CAN10 antibody are in preparation.

Cardiac Remodeling in Female Athletes with Relation to Sport Discipline and Exercise Dose – A Cardiac Magnetic Resonance Study

Abstract Purpose: To compare chronic cardiac adaptations to exercise at various intensities and in different sports categories of female athletes. Methods: This was a retrospective study including 30 elite female athletes (members of the National Team), 14 amateur female athletes training 3-6 h per week for several years, and 20 inactive female controls who underwent cardiac magnetic resonance. Results: Left and right ventricular end-diastolic volumes (LVEDVI and RVEDVI) differed between all studied groups. They rose from controls to elite athletes, with amateur athletes in-between (for LVEDVI 73 ± 9 vs. 83 ± 6 vs. 95 ± 13 ml/m2, P&lt; 0.001, for RVEDVI 74 ± 7 vs. 84 ± 6 vs. 97 ± 14 ml/m2, P&lt; 0.001, respectively). Left and right atrial areas (LAA and RAA) were larger in amateur and elite athletes than in controls (P &lt; 0.001), but there was no difference between the two athlete groups. The interventricular septal diameter was mildly higher only in elite female athletes (9 ± 1 mm vs. 8 ± 1 mm, P&lt; 0.001). No difference in the above parameters was found between power and endurance athletes. Three athletes presented with benign myocardial fibrosis in the lower left ventricular (LV)-right ventricle junction point. Conclusions: The hearts of female athletes differed from inactive controls. Part of the changes was related to exercise intensity (LVEDVI and RVEDVI, mild LV muscle thickening), but other changes were not (LAA and RAA). There was no difference in the heart chamber size and LV muscle thickness between studied athletes engaging in power and endurance disciplines. There were also no significant myocardial tissue changes observed in both elite and amateur female athletes.