Lack Of Reverse Remodeling Research Articles

GDF-15 (Growth Differentiation Factor 15) Is Associated With Lack of Ventricular Recovery and Mortality After Transcatheter Aortic Valve Replacement.

Recent data suggest that circulating biomarkers may predict outcome in patients undergoing transcatheter aortic valve replacement (TAVR). We examined the association between inflammatory, myocardial, and renal biomarkers and their role in ventricular recovery and outcome after TAVR. A total of 112 subjects undergoing TAVR were included in the prospective registry. Plasma levels of B-type natriuretic peptide, hs-TnI (high-sensitivity troponin I), CRP (C-reactive protein), GDF-15 (growth differentiation factor 15), GAL-3 (galectin-3), and Cys-C (cystatin-C) were assessed before TAVR and in 100 sex-matched healthy controls. Among echocardiographic parameters, we measured global longitudinal strain, indexed left ventricular mass, and indexed left atrial volume. The TAVR group included 59% male, with an average age of 84 years, and 1-year mortality of 18%. Among biomarkers, we found GDF-15 and CRP to be strongly associated with all-cause mortality (P<0.001). Inclusion of GDF-15 and CRP to the Society of Thoracic Surgeons score significantly improved C index (0.65-0.79; P<0.05) and provided a category-free net reclassification improvement of 106% at 2 years (P=0.01). Among survivors, functional recovery in global longitudinal strain (>15% improvement) and indexed left ventricular mass (>20% decrease) at 1 year occurred in 48% and 22%, respectively. On multivariate logistic regression, lower baseline GDF-15 was associated with improved global longitudinal strain at 1 year (hazard ratio=0.29; P<0.001). Furthermore, improvement in global longitudinal strain at 1 month correlated with lower overall mortality (hazard ratio=0.45; P=0.03). Elevated GDF-15 correlates with lack of reverse remodeling and increased mortality after TAVR and improves risk prediction of mortality when added to the Society of Thoracic Surgeons score.

P1559Hyperuricemia predicts mortality and the lack of reverse remodeling in CRT patients

P1559Hyperuricemia predicts mortality and the lack of reverse remodeling in CRT patients

Reversal of left ventricular dysfunction after ablation of premature ventricular contractions related parameters, paradoxes and exceptions to the rule

BackgroundSuppression of frequent premature ventricular contractions (PVCs) does not systematically lead to an expected reversal of PVC-induced cardiomyopathy and determinants of left ventricular ejection fraction (LVEF) recovery (reverse remodeling) after ablation remain largely unknown. MethodsNinety-six consecutive patients with a suspicion of PVC induced-cardiomyopathy were retrospectively included. Parameters potentially related to reverse remodeling (>10% increase in LVEF) were analyzed in patients w/wo long-term success (decrease in PVC burden >80%). ResultsOver a mean follow-up of 24±21months, long-term ablation success was obtained in 76 patients (79%). In these, reverse remodeling was observed in 63 (83%) (LVEF 39±8 to 56±8%, p<0.0001). In multivariate analysis, only an older age (and marginally a lower PVC QRS amplitude) was independently associated with the lack of reverse remodeling. Only 10 of the 35 patients who initially should have received an ICD for primary prevention remained candidates for implantation after ablation. Lack of reverse remodeling was significantly linked to a higher mortality. ConclusionReverse remodeling was observed in 83% of patients with frequent PVC and unexplained cardiomyopathy undergoing long-term successful ablation of the PVC. A younger age was independently correlated with the occurrence of reverse remodeling.

Does preoperative tethering symmetry affect left ventricular reverse remodeling after restrictive annuloplasty?

Background We hypothesized that a preoperative symmetric pattern with anterior mitral leaflet (AML) tethering predominance is related to lack of LVRR after restrictive annuloplasty. Methods In 300 patients with surgical annuloplasty for chronic ischemic mitral regurgitation the AML and posterior mitral leaflet (PML) tethering angles were quantified and patients were divided on the basis of the preoperative anterior/posterior tethering angle ratio: there were 144 patients with symmetric (Group 1) and 156 with asymmetric (Group 2) preoperative tethering pattern patients underwent echocardiography preoperatively, at discharge and at follow-up appointments (6 months [IQR 5–8 months]; late, 48 months [15–63 months]). Reverse remodeling was defined as a reduction in left ventricular end systolic volume index > 15%. Results LVRR was higher in the asymmetric group at discharge (69.2% vs. 9.7%, p < 0.001), early (70.55% vs. 10.45%, p < 0.001 and late follow up (81.4% vs. 4.8%, p < 0.001). At multivariable regression analysis corrected by significant key factors of LVRR, symmetric leaflet tethering (OR, 4.8 [95% CI 2.9–5.6], p < 0.001), anterior tethering angle α′ < 39.5° (OR, 5.0 [95% CI 2.0–6.6], p < 0.001), coaptation height < 11 mm (OR, 2.5 [95% CI 1.1–3.3], p = 0.006) and coaptation length ≥ 8 mm at the end of procedure (OR, 2.0 [CI 0.8–3.0], p = 0.01) were independent predictors of LVRR. Compared with patients with asymmetric pattern (adjusted OR 0.2 [95% CI 0.03–1.6), those with symmetric pattern had > 4-fold odds for lack of LVRR. Conclusions The preoperative symmetric pattern with AML prevalence was strongly associated with lack of reverse remodeling after annuloplasty. An accurate echocardiographic evaluation of the tethering mechanisms should be incorporated into clinical risk assessment and prediction models.

Abstract 822: Change in Regional Strain after Cardiac Resynchronization Therapy

Background: Cardiac resynchronization therapy (CRT) improves global systolic function in left ventricle. However, the impact of CRT on regional myocardial function is less clear. The aim of this study, therefore, is to evaluate regional changes in myocardial strain after CRT. Methods: Speckle tracking echocardiography (STE) was performed in 91 patients before and 6 month after CRT. Peak longitudinal strain was measured in 18 segments at base, mid and apex in three apical views. Left ventricular end-systolic volume (ESV) was measured by biplane Simpson’s method and reverse remodeling was defined as 10 % reduction in ESV at 6 month after CRT. Results: Peak strain improved in basal and mid segments of medial walls (basal inferoseptal, anteroseptal and inferior segments, p&lt;0.05, mid inferoseptal and inferior segments: p&lt;0.01) in entire group after CRT, with a greater degree of improvement in CRT responders than in nonresponders (Figure ). There was no significant improvement in free wall strain, with significant reduction in basal inferolateral segment after CRT (P=0.047) in entire group. Nonresponders had significant reduction in strain at the mid anterolateral segment (P=0.004) (Figure ). Strain of the apical segments also did not improve. Conclusions: CRT induces reverse remodeling by enhancing regional myocardial function in the septum, but suppresses the function in the free wall. Lack of reverse remodeling after CRT was characterized by the reduced function in lateral segments without improvement in septal function..