Larger Left Ventricle Research Articles

Effects of exercise on dynamic cardiac function and survival after myocardial infarction

Objective To study the effects of exercise after myocardial infarction on the survival rate and the dynamic functioning of the left ventricle (LV). Methods Ninety-six male Sprague-Dawley rats were randomly assigned to a sedentary sham operation group (Sed-Sh), a previous exercise and sham operation group (PreE-Sh), a sedentary myocardial infarction (MI) group (Sed-MI), a previous exercise MI group (PreE-MI), a post exercise MI group (PostE-MI) and a combined exercise MI group (ComE-MI), each of 16.All of the rats underwent either MI induction or a sham MI operation, the PreE groups after exercising for 5 weeks on a treadmill. The Sed groups did not exercise. The Post E-MI group did not exercise before the operation, but performed treadmill exercises for 4 weeks beginning 8 weeks after the operation. The ComE-MI group exercised for 5 weeks before and 4 weeks after the operation. All the exercising rats ran on the treadmill for 60 minutes daily, 5 d/wk. Life situation and spontaneous mortality were recorded, and echocardiographic measurements were performed on the4thday and 2, 4, 8 and 12weeks after the operation. All of the rats were sacrificed at the end of the experiment. Results Compared with the Sed-Sh group, the Sed-MI group had significantly larger average LV dimensions at the end of both the diastol (LVEDd) and the systol (LVEDs, but it had lower average fractional shortening (FS) and a smaller average ejection fraction(EF) at all of the different measuring times. The PreE-MI group had significantly lower average LVEDd and LVEDs, but a significantly higher FS and EF than the Sed-MI group on the 4th day. However, 2 weeks after the intervention the difference in LVEDd between the two groups was no longer significant. Significantly higher FS and EF were observed in the PostE-MI group at 12 weeks compared to the Sed-MI group. The ComE-MI group had significantly lower average LVEDd and LVEDs, but significantly higher FS and EF at all the time points than the Sed-MI group. The ComE-MI group had a significantly lower average LVEDs but a higher average FS and EF than the PreE-MI group at 12 weeks after the intervention. Conclusion Pre-MI exercise improves LV function significantly at the early stage, though the difference is temporary. Post-MI exercise improves LV function in the longer term. Combined exercise improves LV function the most effectively. Key words: Exercise; Myocardial infarction; Left ventricular function; Survival rate

ErbB4 Gene Polymorphism Is Associated With the Risk and Prognosis of Congestive Heart Failure in a Northern Han Chinese Population

BackgroundThere has been no research evaluating the association between human Neuregulin (NRG) 1/ErbB2/ErbB4 gene polymorphisms and heart failure risk. Methods and ResultsGenotyping of 13 single nucleotide polymorphisms (SNPs) in the NRG-1/ErbB2/ErbB4 genes was performed in 569 unrelated heart failure patients and 682 healthy controls from a Northern Han Chinese population with the use of iPlex SNP Genotyping analysis on a Sequenom Massarray System. In the ErbB4 gene, the variants rs10932374 and rs1595064 were associated with reduced risk of heart failure under allelic, recessive and additive genetic models, and the variants rs13003941 and rs1595065 were associated with increased risk of heart failure under allelic, dominant, and additive models. The G-G-C-C-T haplotype of rs10932374-rs13003941-rs1595064-rs1595065-rs3748960 in the ErbB4 gene increased the risk of heart failure (odd ratio 1.35, 95% confidence interval [CI] 1.06–1.70; P = .014). The T variant of rs13003941 was associated with larger left ventricle (dominant model, P = .014; additive model, P = .048), and increased risk of overall death (relative risk [RR] 1.48, 95% CI 1.01–2.18; P = .045) and cardiovascular death (RR 1.56, 95% CI 1.04–2.33; P = .03) after adjusting for age and sex. NRG-1/ErbB2 gene polymorphisms were not associated with heart failure risk or prognosis. ConclusionErbB4 gene polymorphisms were associated with the risk, severity, and prognosis of heart failure in a Northern Han Chinese population.

Single cusp replacement in patients with ventricular septal defect and aortic insufficiency.

The aim of this study was to analyze the mid- and long-term outcome of single cusp replacement in patients with ventricular septal defect and aortic insufficiency. From September 2005 through March 2014, 172 patients underwent single cusp replacement and ventricular septal defect (VSD) closure. The median age was 19.5 years (range, 9 months to 67 years). Additional techniques were used to repair associated anomalies including sinus of Valsalva aneurysm, patent ductus arteriosus, patent foramen ovale, subaortic membrane, and intramural coronary artery. One patient with large left ventricle (preoperative end-diastolic diameter: 9.8 cm) died after the procedure from incurable heart failure. Four patients required a second pump run for residual aortic insufficiency (AI) (two patients, 1.16%) and residual VSD (two patients, 1.16%). Four patients required re-exploration for postoperative bleeding or cardiac tamponade. Mean follow-up was 53.27 ± 25.37 months (median, 56.5 months; range, 3 to 104 months). Redo aortic valve surgery was performed in three patients. Three patients had moderate-severe AI during the following period without reoperation. There was no post-operative endocarditis. Single cusp replacement can be safely used in patients with VSD-AI.

Role of ventricular assist therapy for patients with heart failure and restrictive physiology: Improving outcomes for a lethal disease

Restrictive cardiomyopathy (RCM) patients have poor prognosis due to progressive heart failure characterized by impaired ventricular filling of either or both ventricles. The goal of this study was to evaluate the outcome of end-stage RCM patients after left ventricular assist device (LVAD) implantation and to determine factors that may be associated with improved survival. This investigation is a retrospective study of prospectively collected data that include 28 consecutive patients with end-stage RCM who received continuous-flow LVADs at the Mayo Clinic, Rochester, Minnesota. Outcome was assessed by survival with LVAD support until heart transplantation or all-cause mortality. The mean follow-up time post-LVAD implantation was 448 ± 425 days. The mean hospitalization time was 29 ± 19 days and was complicated mainly by post-operative right ventricular (RV) failure requiring short-term medical support. The short-term in-hospital mortality was 14%. Ten patients underwent heart transplantation with 100% survival post-transplant during the follow-up period. One-year survival for patients with LVADs without transplantation was 64%, and was not significantly different between amyloidosis and non-amyloidosis patients. Larger left ventricle (LV) end-diastolic and end-systolic dimensions were significantly associated with improved survival rates (RR = 0.94 and 0.95, p < 0.05, respectively), and left ventricular end-diastolic diameter (LVEDD) ≤46 mm was associated with increased mortality post-LVAD implantation. LVAD is a feasible, life-saving therapy for end-stage heart failure related to RCM, especially as a bridge to transplant and in patients with larger LV dimensions.

Impact of Surgical Ventricular Restoration on Cardiac Function, Ischaemic Mitral Regurgitation and Long-term Survival

Objectives: Adverse cardiac remodelling is a major cause of morbidity and mortality post myocardial infarction. The role of surgical ventricular restoration compared to medical and electrophysiological treatments has recently come under intense scrutiny. We aimed to evaluate 10-year clinical outcomes of surgical ventricular restoration in our institution. Methods: From January 2001 to 2011, surgical ventricular restoration was performed in 126 consecutive patients (M2.3: 1F), mean age 65.5 (44-86) years. All patients presented with angina, heart failure and/or ventricular tachycardia. Post-infarction left ventricular aneurysm was present in all patients and ischemic dilated cardiomyopathy with a large akinetic left ventricle in 11.6%. The preoperative left ventricular ejection fraction was 33.1 ± 8.9%. Multi-vessel disease was present in 117/126(93%) patients. Mitral regurgitation more than grade+2 was found in 39/126(31%). The mean Logistic EuroSCORE was 13.8 ± 5.9%. A minimum of two-year post-operative follow-up was obtained on all patients. Results: Most patients underwent endoventricular or elliptical patch repair; 94% had concomitant coronary revascularisation with a median of 2 grafts and 5% had mitral valve repair. Intra-aortic balloon pump was placed preoperatively in 24/126 (19%) patients while 21/126 (17%) needed inotropic support for more than 24 h. Postoperative stroke occurred in 2 patients. In-hospital mortality was 7/126 (5.5%). All cause cardiovascular mortality at ten years was 12/126 (9.5%). Mean follow-up in operative survivors was 8.2 ± 1.2 years. Actuarial survival was 95.3%, 90.6%, 86.3% and 79.1% at 1-month, 1, 5 and 10-years. Echocardiographic follow-up demonstrated a reduction in the mean left ventricular end-diastolic volume and left atrial diameter. Ejection fraction improved over first year from 33.1 ± 8.9 to 45 ± 8.6% (P<0.006). Conclusions: Left ventricular reconstruction surgery is a good surgical option for treatment of post-infarction left ventricular aneurysm.

Surgical Ventricular Restoration: Is There Any Difference in Outcome Between Anterior and Posterior Remodeling?

The purpose of this study was to compare the early and long-term outcomes in a consecutive population who underwent surgical ventricular reconstruction (SVR) for either anterior or posterior remodeling. Among 501 consecutive patients who underwent SVR at our institution between July 2001 and December 2011, 56 patients presented with posterior remodeling (group A; mean age, 65 ± 10 years), whereas anterior remodeling was evident in 445 patients (group B; mean age, 65 ± 9 years). The 2 groups were comparable regarding cardiac risk factors and comorbidities. Patients in group A presented with larger left ventricles, higher left ventricular (LV) cardiac mass, and higher ejection (EF) and stroke volume (p = 0.01) compared with patients in group B. Moderate to severe mitral regurgitation was present in 50% and 25% of patients in groups A and B, respectively (p = 0.01). Thirty-day mortality was not significantly different between the 2 groups (5.4% versus 8.3% in groups A and B, respectively; p = 0.32). At logistic regression analysis, only preoperative age, creatinine, and ejection fraction (ACEF) score was an independent predictor of early mortality. Sixteen patients (29%) in group A and 92 patients (21%) in group B died during follow-up (p = 0.12). Kaplan-Meier cumulative survival was comparable between the 2 groups (log-rank p = 0.27). At multivariate Cox regression analysis, preoperative age, advanced New York Heart Association (NYHA) class, preoperative severe mitral regurgitation (MR), and preoperative tricuspid annular plane systolic excursion (TAPSE) score less than 16 were independent predictors of late mortality. Patients presenting with posterior remodeling showed worse clinical signs of angina and congestive heart failure (CHF) and a higher proportion of moderate to severe MR; however in the present experience early and long-term outcomes after SVR seemed to be unaffected by remodeling location.

Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction

Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction. Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point. Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P < .0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (P = .022). Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with ischemic cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling.

Abstract 213: Fat Tissue specific Adipose Triglyceride Lipase as a major determinant for the development of pressure overload-induced heart failure

Introduction: Myocardial metabolism undergoes change in response to pathological cardiac hypertrophy (PH), characterized by increased reliance on glucose oxidation, decreased free fatty acid (FFA) oxidation and a loss of metabolic flexibility. Cardiac metabolism is influenced by other organs such as adipose tissue. Hence, we aimed to investigate the effect of Adipose Triglyceride Lipase (ATGL) in adipose tissue on the development of PH and heart failure (HF) in a pressure overload-induced cardiac hypertrophy model in mice. Methods: Male adipose tissue specific ATGL-knock out (atATGL-KO) and wild type mice (WT) underwent sham surgery (sham) or transverse aortic constriction (TAC). After 11 weeks, mice were sacrificed and organs were harvested. We performed echocardiography one week before and 11 weeks after surgery. Left ventricular mass (LVM), left ventricular mass/tibia length (LVM/TL) and ejection fraction (EF) were calculated. Beta-myosin heavy chain (β-MyHC) was measured in RNA of hearts. Insulin resistance was assessed by an intraperitoneal glucose tolerance test (GTT) and an insulin tolerance test (ITT). FFAs were measured in serum in total. Results: LVM and LVM/TL in WT was significantly higher compared to atATGL-KO after TAC (LVM/TL [mg/mm] WT-TAC: 18,0±2,2; atATGL-KO-TAC: 13,1±2,3; p&lt;0,01). The higher increase of LVM in WT was associated with a larger left ventricle internal diameter. Reduction of EF was significantly more pronounced in WT compared to atATGL-KO ([%] WT: 28,81±6,9 atATGL-KO: 42,39±4,5; p&lt;0,01). Beta-MyHC, a marker for PH, was markedly higher in WT-TAC than in atATGL-KO-TAC (WT-TAC: 11,3±3,6; atATGL-KO-TAC: 1.9±0,6; p&lt;0,01). While WT-TAC showed higher Serum FFA-levels than atATGL-KO-TAC ([mmol/l] WT-TAC: 0,97±0,086; atATGL-KO-TAC: 0,49±0,032; p&lt;0,001), GTT and ITT revealed a higher insulin sensitivity in atATGL-KO-TAC compared to WT-TAC. Conclusion: The present study demonstrates that atATGL is a crucial determinant for the development of pressure overload-induced PH and HI. The lack of ATGL in adipose tissue, the associated reduction of fatty acid release in the circulation and subsequent switches in cardiac energy substrates from free fatty acids to glucose are potential underlying mechanisms of this process.

Trajectories of heart failure self-care management and changes in quality of life

Heart failure patients vary considerably in their self-care management behaviors (i.e. recognizing and responding to symptoms). The goal of this study was to identify unique patterns of change in heart failure self-care management and quantify associations between self-care management and quality of life (HRQOL) over time. A prospective cohort study among adults with symptomatic heart failure was designed to measure changes in self-care management (Self-care of Heart Failure Index) and HRQOL (Kansas City Cardiomyopathy Questionnaire) over six months. Growth mixture modeling was used to identify unique trajectories of change in self-care management. The mean age (n=146) was 57 years, 70% were male, and 41% had class II heart failure. Two trajectories of self-care management were identified (entropy = 0.88). The larger trajectory (73.3%) was characterized by a significant decline in self-care management over time and no change in HRQOL. The smaller trajectory (26.7%) was characterized by marked improvements in self-care management and HRQOL. Changes in heart failure self-care management occurred in the absence of change in routine self-care maintenance behaviors, functional classification, and physical and psychological symptoms. Patients with greater physical symptoms at enrollment (odds ratio (OR) =1.04, p=0.037), larger left ventricles (OR=1.50, p=0.044), and ischemic heart failure (OR=3.84, p=0.014) were more likely to have the declining trajectory of self-care management. Higher levels of depression at enrollment were associated with reduced odds of having a decline in self-care management over time (OR=0.85, p<0.001). There are unique and clinically-relevant trajectories of change in heart failure self-care management that are associated with differences in HRQOL.

Myocardial Infarction and Functional Outcome Assessment in Pigs

Introduction of newly discovered cardiovascular therapeutics into first-in-man trials depends on a strictly regulated ethical and legal roadmap. One important prerequisite is a good understanding of all safety and efficacy aspects obtained in a large animal model that validly reflect the human scenario of myocardial infarction (MI). Pigs are widely used in this regard since their cardiac size, hemodynamics, and coronary anatomy are close to that of humans. Here, we present an effective protocol for using the porcine MI model using a closed-chest coronary balloon occlusion of the left anterior descending artery (LAD), followed by reperfusion. This approach is based on 90 min of myocardial ischemia, inducing large left ventricle infarction of the anterior, septal and inferoseptal walls. Furthermore, we present protocols for various measures of outcome that provide a wide range of information on the heart, such as cardiac systolic and diastolic function, hemodynamics, coronary flow velocity, microvascular resistance, and infarct size. This protocol can be easily tailored to meet study specific requirements for the validation of novel cardioregenerative biologics at different stages (i.e. directly after the acute ischemic insult, in the subacute setting or even in the chronic MI once scar formation has been completed). This model therefore provides a useful translational tool to study MI, subsequent adverse remodeling, and the potential of novel cardioregenerative agents.

Myocardial infarction and functional outcome assessment in pigs.

Introduction of newly discovered cardiovascular therapeutics into first-in-man trials depends on a strictly regulated ethical and legal roadmap. One important prerequisite is a good understanding of all safety and efficacy aspects obtained in a large animal model that validly reflect the human scenario of myocardial infarction (MI). Pigs are widely used in this regard since their cardiac size, hemodynamics, and coronary anatomy are close to that of humans. Here, we present an effective protocol for using the porcine MI model using a closed-chest coronary balloon occlusion of the left anterior descending artery (LAD), followed by reperfusion. This approach is based on 90 min of myocardial ischemia, inducing large left ventricle infarction of the anterior, septal and inferoseptal walls. Furthermore, we present protocols for various measures of outcome that provide a wide range of information on the heart, such as cardiac systolic and diastolic function, hemodynamics, coronary flow velocity, microvascular resistance, and infarct size. This protocol can be easily tailored to meet study specific requirements for the validation of novel cardioregenerative biologics at different stages (i.e. directly after the acute ischemic insult, in the subacute setting or even in the chronic MI once scar formation has been completed). This model therefore provides a useful translational tool to study MI, subsequent adverse remodeling, and the potential of novel cardioregenerative agents.

Analysis of risk factors in obese patients with coronary artery disease, with and without diabetes mellitus type two

Diabetes mellitus type 2 is one of the leading chronic diseases in the world and in our country, which is an important risk factor for development of cardiovascular morbidity and mortality. Objective. The aim of this research was making the estimation of risk factors in the etiology of coronary heart disease in obese patients with diabetes mellitus type 2. The study included 82 obese patients, of which 52 with diabetes mellitus and 30 without diabetes mellitus, in all of them coronary artery disease proven by coronary angiography. All were examined by clinical examination, laboratory tests and echocardiography. Based on the test results we found that the distribution of risk factors such as hypertension, family burden coronary artery disease, smoking, alcohol intake was the same in the obese patients with diabetes mellitus, and of those without diabetes mellitus. Echocardiography showed significantly larger left ventricle, lower ejection fraction, larger left atrium and significant mitral regurgitation. Also, in a group of patients with diabetes mellitus, there was significantly higher number of patients with multiple vessel coronary disease. Despite the small sample, we can conclude that the present of diabetes mellitus in obese patients is crucial for severe forms of coronary artery disease. Severity is expressed through significant structural and functional changes in the left ventricle and the number of diseased coronary arteries.

Incremental Value of Left Ventricular Systolic and Diastolic Function to Determine Outcome in Patients with Acute ST‐Segment Elevation Myocardial Infarction: The Echocardiographic Substudy of the OASIS‐6 Trial

The echocardiographic substudy of the OASIS-6 trial evaluated the prognostic implications of left ventricle (LV) systolic and diastolic dysfunction early postacute ST-segment elevation myocardial infarction (STEMI) in patients treated with fondaparinux versus usual care. Comprehensive echocardiograms were performed a median of 6 days after the index STEMI in 528 patients, 258 randomized to fondaparinux and 270 to usual care (unfractionated heparin or placebo), to assess LV systolic and diastolic function, LV mass, and LV end-systolic and end-diastolic volumes. A total of 245 (46.4%) patients were followed up for 3 months and 283 (53.6%) for 6 months. Major cardiac events (MACE) were defined as the composite of death, reinfarction, heart failure, or cardiogenic shock and resuscitated cardiac arrest. Patients with LV ejection fraction (LVEF) ≤ 45% and restrictive diastolic function (RDF) were at greatly increased risk of MACE (hazard ratio [HR] = 8.85, 95% CI, 4.21–18.60) compared to patients with LVEF ≥ 45% and without RDF. RDF remained a strong predictor for MACE in patients with LVEF ≥ 45% (HR = 4.38, 95% CI, 1.52–12.60) and in multivariate models adjusted for LVEF, LV end-systolic volume, and clinical variables. In this large international trial, LV systolic and diastolic function, as determined by echocardiography early following STEMI, are incremental predictors of MACE. In addition, RDF is a strong independent predictor of MACE after STEMI across a broad range of LVEF.

Difference in cardiac manifestation between liver transplantation candidates with alcoholic and hepatitis related cirrhosis

Purpose: Cardiac event is the main cause of mortality during liver transplantation and patients with cirrhosis are associated with myocardial dysfunction. However, limited data is available regarding the characteristics of cardiac function between LTx candidates with alcoholic and hepatits related cirrhosis. The aim of the study was to compare the cardiac function between patients with alcoholic and hepatitis related cirrhosis who were candidates for LTx. Methods: A total of 88 patients with cirrhosis referred for LTx and 88 age and gender- matched controls were evaluated by transthoracic echocardiography. Clinical parameters, conventional echocardiographic and tissue Doppler-derived parameters of the left ventricle (LV) were obtained in all subjects. Liver status of cirrhotic patients was evaluated by the model for end-stage liver disease (MELD) scores. Results: Despite a similar LV dimension and LV ejection fraction, patients with cirrhosis had a higher prevalence of diastolic dysfunction (54% vs. 37%, p=0.01) and LV filling pressure as estimated by E/E' ratio (10.9±3.9 vs. 7.4±1.9, p<0.01) compared with controls. Age, gender and MELD were similar between patients with alcoholic and hepatitis related cirrhosis. The prevalence of diastolic dysfunction was also similar (54% vs 52%, p=1.0). However, patients with alcoholic related cirrhosis had lower LV ejection fraction (n=20; 51±14% vs. n=68; 62±8%) and larger LV end-systolic dimension (51±22ml vs. 31±12ml) and LV mass index (104±20g/m2 vs. 87±22g/m2) compared with patients with hepatitis related cirrhosis (all p<0.01). Conclusion: LTx candidates are associated with diastolic dysfunction and a higher LV filling pressure compared with controls. Importantly, patients with alcoholic related cirrhosis had a lower LV systolic function and a larger LV dimension compared with patients with hepatitis related cirrhosis. These important difference in cardiac dysfunction in patients with alcoholic related cirrhosis suggested the need for intensive preoperative risk stratification and monitoring during LTx.

症例 僧帽弁閉鎖,三尖弁両室挿入を伴ったL型大血管転換 [S,L,L] の1例

症例 僧帽弁閉鎖,三尖弁両室挿入を伴ったL型大血管転換 [S,L,L] の1例

Assessment of the trabeculated to compacted layer ratio of the left ventricle using short and longitudinal axis views in young patients presenting with ventricular dysrhythmias

Background Cardiac MRI (CMR) is increasingly being used clinically to assess the regional thickness of the compacted and trabeculated layers of the left ventricle (LV) in patients with suspected non-compaction. However, there is no consensus on whether the short or longitudinal axis view is preferred. We sought to assess the compacted and trabeculated layers in a young ventricular dysrhythmia population with age matched controls and to compare the measurements derived from both the short axis and longitudinal views. Methods The study consisted of 91 patients aged 20 to 49 years with ventricular dysrhythmia (VT) and 23 age-matched normal subjects. Regional wall thickness was assessed in short axis CMR cine views using a basal, mid and apical slice as well as in longitudinal views using the 2, 3, and 4 chamber view. The images were analyzed at end-diastole where the compacted layer was measured following the standardized 16-segment model. The apical segments were chosen 2 cm from the most apical portion of the LV for both short and longitudinal views. Within each wall segment, the most prominent trabeculation was measured, and the ratio of the trabeculated to compacted layer was compared between the VT group and controls in both views. Results The mean age was 38 years and 48 (42%) were men. In the VT group, 31 had premature ventricular contractions and 60 had ventricular tachycardia. VT patients were associated with larger LV end-diastolic volumes (89.7 ml/ m2 vs. 82.6 ml/m2, p=0.05), larger LV mass (58 g/m2 vs. 49.9 g/m2 p=0.001), and lower LV ejection fraction (50% vs. 60% p=0.015) as compared to the control group, respectively. Using the short axis view, the prevalence of trabeculated to compacted layer ratios ≥ 2.0, ≥ 2.1, ≥ 2.2 and ≥ 2.3 were 18.4%, 15.2%, 9.2% and 8.7% in the VT group, respectively while the prevalence in the control group was 13% for a ratio ≥ 2.0 with no segments ≥ 2.1. Using the same ratio cut points for the longitudinal view, the prevalence was 39.1%, 32.6%, 27.2% and 16.3% in the VT group and 43%, 39.1%, 21.7%, and 13% in controls, respectively. Conclusions In this young cohort, the trabeculated to compacted ratio ≥ 2.1 is only present in patients with ventricular dysrhythmias and not seen in normal controls using short axis planes, suggesting that increased thickness of the trabeculated layer in young subjects may be associated with the risk of ventricular dysrhythmia. However, the ratio ≥ 2.3 is equally prevalent in both groups using longitudinal planes. Our findings suggest that the short axis view may be more discriminatory then the longitudinal view in identifying normal subjects. More importantly, there is a clear need to standardize the assessment of the trabeculated to compacted layer ratio in clinical practice.

Measurements of transmural strain variations by two dimensional ultrasound speckle tracking

Background: Myocardial infarction (MI) is known to progress from the inner layers towards the epicardium. Since it is important to detect MI early, to prevent a negative remodeling process of the left ventricle (LV), the hypothesis of this study was that evaluation of layer-specific strains is feasible, and it will enable differentiation between subjects with large MI, small MI and normal LV. Methods: In this study a commercial speckle tracking echocardiography (STE) program was modified to measure the strains at three myocardial layers instead of for the total-wall-thickness. After a validation process by using software implemented phantoms, the commercial and modified programs were applied to echocardiography of 54 subjects. Results: The validation study results for 972 segments showed an agreement between the endocardial strains, manually measured by the commercial program, and automatically measured by the modified program. Finally, the algorithm was applied to scans of 15 normal subjects, 9 patients with small MI and to 6 patients with large MI. The results show that the strain elevated from the endocardium towards the epicardium for the normal and small MI groups, but not for the large MI group. Conclusions: In conclusion, the layer-specific STE method allows accurate analysis of the transmural variations of the strains.

Ventricular Structure and Function in Children With Sickle Cell Disease Using Conventional and Tissue Doppler Echocardiography

Conventional 2-dimensional, M-mode, and spectral Doppler echocardiographic techniques have documented abnormal ventricular function in adults with sickle cell disease (SCD), but assessments in children are conflicting. Tissue Doppler echocardiography (TDE) provides additional information about myocardial function. Two-dimensional, M-mode, tricuspid regurgitation jet velocity (TRJV) data, and tissue Doppler echocardiographically derived myocardial velocity measurements of left ventricular (LV) and right ventricular function were taken from children with SCD compared to those of similar healthy historical controls and correlated with clinical characteristics and hemoglobin levels. Compared to 55 controls, 54 children with SCD (mean age 14.2 years, range 6 to 21) had a larger left ventricle, greater LV mass, and higher LV fractional shortening; 30% had increased pulmonary artery pressure (TRJV ≥2.5 m/s). Conventional echocardiographic measurements of LV systolic function and spectral Doppler measurements of LV and right ventricular diastolic function were essentially normal, but TDE indicated that 31% of SCD children had evidence of LV diastolic dysfunction (peak early diastolic velocity of LV inflow Doppler/peak early diastolic velocity at lateral mitral valve annulus >8), a finding that correlated with lower hemoglobin levels. Although decreasing hemoglobin levels in children with SCD correlated with LV hypertrophy, LV dilation, and LV diastolic dysfunction, long-term transfusion or hydroxyurea therapy did not affect these measurements. In conclusion, 1/3 of children with SCD had tissue Doppler echocardiographic evidence of LV diastolic dysfunction, which was correlated with hemoglobin levels. Adding serial assessments of ventricular function with TDE to conventional echocardiography may detect early cardiac changes, especially in children with severe anemia.

Prognostic Value of Left Atrium Remodeling after Primary Percutaneous Coronary Intervention in Patients with ST Elevation Acute Myocardial Infarction

The purpose of this study is to assess the relationship between left atrial (LA) size and outcome after acute myocardial infarction (AMI) in patients undergoing primary percutaneous coronary intervention (PCI) and to evaluate dynamic changes in LA size during long-term follow-up. Echocardiographic analyses were performed on 253 AMI patients (174 male and 79 female, 65.4 ± 13.7 yr) undergoing PCI. These subjects were studied at baseline and at 12 months. Clinical follow-up were done at 30.8 ± 7.5 months. We assessed LA volume index (LAVI) at AMI-onset and at 12-month. Change of LAVI was an independent predictor of new onset of atrial fibrillation or hospitalization for heart failure (P = 0.002). Subjects who survived the 12-month period displayed an increased LAVI mean of 1.86 ± 4.01 mL/m2 (from 26.1 ± 8.6 to 28.0 ± 10.1 mL/m2, P < 0.001). The subject group that displayed an increased LAVI correlated with a low left ventricular ejection fraction, large left ventricle systolic and diastolic dimensions and an enlarged LA size. In conclusion, change of LAVI is useful parameter to predict subsequent adverse cardiac event in AMI patients. Post-AMI echocardiographic evaluation of LAVI provides important prognostic information that is significantly greater than that obtained from clinical and laboratory parameters alone.

ORAL PRESENTATION

ORAL PRESENTATION