Lateral Wall Of Left Ventricle Research Articles

Immunohistochemical Characterization of Heart Left Ventricle Morphogenesis in Rats Fetuses

Rats are the most common objects of preclinical studies, which determines the relevance of studying fetal cardiomorphogenesis in rats using modern methods of morphological studies. The aim is to study the dynamics of markers of proliferation (Ki67), apoptosis (caspase 3), vascularization (CD31), and stromal remodeling (MMP2 and MMP9) of the left ventricular myocardium of Wistar rat fetuses. Material and methods. A histological, immunohistochemical and morphometric study of the rat heart left ventricle wall was carried out on the 18th, 19th, 20th, 21st and 22nd days of the prenatal period of ontogenesis. Results. From the 18th to the 22nd day of the prenatal period of ontogenesis in rats, a twofold increase in the thickness of the left ventricle lateral wall is observed, due to both proliferation and differentiation and an increase in the size of cardiomyocytes. Ki67-positive cardiomyocytes are diffusely localized in the wall of the left ventricle, their number increases on day 19 of the prenatal period of development and remains at a high level until the end of the prenatal period in rats. From the 18th to the 22nd day of the prenatal period of ontogeny in rats, single caspase 3-positive cardiomyocytes are detected in the left ventricle. The growth of the left ventricular myocardium in the fetal period in rats is accompanied by an adequate rate of vascularization. The vascularization and proliferation of cardiomyocytes are accompanied by remodeling of the myocardial stroma, with the highest intensity of MMP2- and MMP9-immune staining observed at the beginning of the fetal period of ontogeny in rats. Conclusion. The short duration of prenatal ontogenesis in rats determines the high dynamics of cardiomorphogenetic processes. In the fetal period of rat ontogenesis in the left ventricle of the heart, the proliferation of cardiomyocytes prevails over the intensity of apoptosis. The intensity of proliferation of cardiomyocytes of the left ventricle of rats is high up to the 22nd day of the prenatal period of ontogenesis.

Abstract 18308: Effective Atomic Number and Electron Density Number in the Infarcted Myocardium Were Significantly Lower Than Normal Group and Non-Infarcted Myocardium Using the Latest Spectral CT

Introduction: Spectral CT with a dual layer detector can be used to acquire new parameters, such as effective atomic (EAN) and electron density number (EDN). Hypothesis: The EAN and EDN obtained from the latest spectral CT with a dual-layer detector in infarcted myocardium were lower than the myocardial in the normal group and non-infarcted myocardia of patients with previous myocardial infarction (MI). Methods: This retrospective study comprised two groups of patients: those with previous MI (MI group; n = 20; mean age, 73±7 years) and those with clinically suspected coronary artery diseases, no significant stenosis in the coronary arteries, and a normal ECG (normal group; n = 146; age 55±14 years). All patients underwent cardiac spectral CT (7500; Philips) with a dual-layer detector. The EAN and EDN were measured in the interventricular septum (IVS), left ventricle (LV) anterior wall of the (LVAW), and LV lateral wall (LVLW) within a 1.0 mm2 circle at the LV inflow level in axial images during the non-contrast phase and early phase (with a contrast agent). Results: During the non-contrast phase, the EAN in the infarcted myocardium was significantly lower than those in the normal group (P < 0.01) and the non-infarcted myocardia in the MI group (P < 0.05). During the early phase, the EAN in the infarcted myocardium was also significantly lower than those in the normal group (P < 0.01) and the non-infarcted myocardia in the MI group (P < 0.05). During both phases, the EDN in the infarcted myocardium was significantly lower than those in the normal group (P < 0.01) and the non-infarcted myocardia in the MI group (P < 0.05). Conclusion: During both phases, the EAN and EDN in the infarcted myocardium were significantly lower than those in the normal group and the non-infarcted myocardia in the MI group. Using this novel CT approach and the data from the non-contrast phase may aid in detecting abnormal characteristics (such as reduced blood flow, fibrotic changes, or inflammation) in the myocardium.

Left Ventricular Segmental Strain Based On Speckle Tracking Echocardiography Versus Indications Of Immune Inflammation In Patients After COVID-19 Pneumonia

Background — The significance of cytokine activation and immune inflammation in subclinical damage to cardiomyocytes and resulting development of the congestive heart failure (CHF) is frequently discussed in published studies, as well as whether there are cardiac lesions in COVID-19 survivors identified by the speckle tracking echocardiography (STE). Objective — To examine the association of echocardiographic parameters with indications of immune inflammation in patients recovered from COVID-19 pneumonia depending on segmental longitudinal strain (LS) of the left ventricle (LV) identified by STE. Methods — Our study encompassed 216 patients (51.1% men, mean age of 50.1±11.1 years) distributed among two groups: Group I (n=108) included study subjects with segmental LS (≥3 LV segments) revealed by the STE; Group II (n=108) comprised patients without visually detectable LV lesions. All patients were examined three months after COVID-19 pneumonia. Results — Groups did not differ statistically significantly in terms of LV ejection fraction (68.7±4.3% in Group I vs. 68.6±4.3% in Group II; p=0.916). Global LS was significantly lower in the Group I than in the Group II at the time of the control follow-up visit three months later (-18.2 [-16.7; -19.4] % vs. -20.6 [-19.5; -22.1] %, respectively; p<0.001). When analyzing laboratory indications of immune inflammation in groups, we revealed statistically significantly higher values in Group I vs. Group II in the concentrations of interleukin 6 (3.1 [2.4;3.9] pg/mL vs. 2.5 [3.8;4.7] pg/mL; p=0.009), C-reactive protein (4.7 [2.9;8.3] mg/L vs. 3.0 [1.5; 5.3] mg/L; p<0.001), and tumor necrosis factor α (6.0 [4.8;4.1] pg/ml vs. 5.0 [4.0;6.4] pg/ml; p=0.001). In Group I, we detected diffuse lesion of LS (≥4 segments of the same LV level; 38.0% of patients) and regional lesion of LS (≥3 segments corresponding to the blood supply pools of the anterior, circumflex, or right coronary arteries; 62.0% of patients). According to logistic regression, the LS of the basal LV level (OR 3.028; 95% CI 1.909-4.802; р<0.001) in combination with LS of the apical LV level (OR 1.287; 95% CI 1.099-1.507; р=0.002) and LV lateral wall annular velocity assessed by tissue Doppler imaging, peak e’ (OR 0.774; 95% CI 0.657-0.911; р=0.002) had an independent relationship with each of diffuse and regional LS lesions. Conclusion — Based on STE data, we have identified a relationship of diffuse and regional LV lesions with features of systolic and diastolic LV dysfunction and markers of immune inflammation in patients three months after COVID-19 pneumonia.

P132 A CASE REPORT OF A STEMI MIMICKER IN A PATIENT WITH TUMORAL MYOCARDIAL INFILTRATION AND LITERATURE REVIEW

Abstract Introduction We report a case of ‘STEMI–like’ presentation, with marked STE on ECG in a patient with lung cancer and cardiac catheterization showing no significant coronary obstruction. A 76y woman presented in the emergency room with dyspnea and chest pain.She had a history of hypertension, obesity, previous cerebellar ischemia and pulmonary neoplasia with involvement of left upper lobe and stenosis of main left bronchus and mediastinal infiltration, on palliative treatment.First ECG showed atrial fibrillation (AF) 150 bpm and marked convex STE in I and aVL leads with reciprocal changes, so urgent coronary angiography (CA) was performed. Initial therapy was BB, ASA and UFH. CA surprisingly showed no significant coronary obstruction. Transthoracic echo (TTE) showed a large mass involving pericardium and left atrium, with infiltration of left myocardial lateral wall with a fingernail shape. HS troponin reached 10xN. The STE persisted on subsequent ECGs. In conclusion the ECG changes are due to neoplastic infiltration of left ventricle lateral wall, while AF is due to atrial infiltration. Discharged on day3, the patient was maintained on palliative care plus BB but no antithrombotic therapy due to very high risk of pulmonary bleeding and hemorrhagic infarction of ventricular wall. In our case no Thoracic CT Scan was performed, so we cannot differentiate between cardiac muscular involvement by pericardial metastasis and infiltration by the primary tumor, which is more likely because of the anatomic relationship between left upper lobe and the heart. Discussion Cardiac metastases varies in incidence (2.3 –18.3%), decrease with age, and most frequently origin from respiratory system. They can involve any heart chambers, clinical patterns depend on degree and site of myocardial infiltration.When ventricular wall is infiltrated pseudo–ischemic ECG changes may be induced;persistency of STE suggests tumour compression and/or myocardial infiltration. Patients with known malignancy with chest pain and STE should be screened for cardiac metastases and treated with a single (and not double) antiplatelet agent until coronary stenosis are confirmed. If systemic thrombolysis is considered, a bedside TTE should be performed before therapy.

P31 A RARE CASE OF PERSISTENT ECG CHANGES AT STRESS TEST

Abstract Background Cardiac lipomas are rare benign tumors. They carry usually a good prognosis and are often an incidental finding of cardiovascular imaging exams for cardiac evaluations. Methods We present a case of left ventricular intramyocardial lipoma detected during the work–up for a positive stress test. Results This case report involves a 55–year–old male, light smoker, with a history of glucose intolerance. Height 190 cm; weight 90 kg; BMI 24.93 kg/m2 He has always played sports and since the age of 16 he performed serial cardiological assessments and stress test for competitive fitness. Already from the first evaluation the ergometric test was markedly pathological (ST segment depression greater than 1 mm in leads V3 to V6), in absence of symptoms. The subsequent diagnostic exams performed (including an exercise myocardial scintigraphy) excluded ischemic aetiology. Competitive fitness has always been reconfirmed for many years. He also performed repeated holter–ECG in absence of any arrhythmias. He was admitted because of a routine check–up. A new stress test (ECG stress test) resulted positive for ECG changes and clinically negative (fig 1) Cardiac MRI demonstrated a small intramyocardial "round like" mass of about 7 mm, located on the middle–distal segment of the left ventricle lateral wall; MRI signals were consistent with a lipom: no evidenced of delayed enanchement (fig 2) and T1 weighted scans assessed perfusion lack of the mass (fig 3). Computed tomography confirmed this diagnosis; the coronary angiography excluded significant coronary artery stenosis. Conclusion We hypnotize that cardiac lipoma in our patient caused persistent ST changes at stress ECG since young age

198 ROLE OF CARDIAC MAGNETIC RESONANCE IMAGING IN ARRHYTMICH RISK STRATIFICATION

Abstract Introduction Danon disease (DD) is a rare multi-systemic disorder firstly described by Danon et al. in 1981 and characterized by a triad consisting with hypertrophic cardiomyopathy, skeletal myopathy, and intellectual disability. It is an inherited dominant X-linked condition, due to mutations in the lysosome-associated membrane protein 2 (LAMP2) gene. Typically, males present a more severe phenotype with earlier onset and rapid heart failure progression with extracardiac manifestations; female patients manifest a milder phenotype with later onset and isolated cardiac involvement. Female carriers may develop dilated cardiomyopathy (DCM). In recent years, it has been described a severe arrhythmogenic phenotype, particularly in women, with a high risk of sudden cardiac death (SCD). Case presentation Case 1 is a 16 y.o. woman referred to our outpatient cardiomyopathies clinic, diagnosed with left ventricle (LV) hypertrophy on the basis of ECG and echocardiography, performed in 2016, in view of cutaneous nevus surgical exeresis. At echocardiographic evaluation we found an asymmetric LV hypertrophy with preserved LV ejection fraction (LVEF 65%). A cMRI was performed, showing mild LV thickening and left ventricular hypertrabeculation morphology, mainly in the LV lateral wall, but not all criteria for LV noncompaction (NC) were satisfied. There was no late gadolinium enhancement (LGE) accumulation. She underwent a genetic screening with inconclusive results, so we started a clinical outpatient follow-up showing no significant arrhythmias at ECG Holter and no limitation of physical activities. In 2021, when she was 21 yo, her father died suddenly and no autoptic examination was performed. A genetic exam was repeated, highlighting a LAMP2 gene mutation. In 2016 her 3 years older sister, Case 2, underwent a familiar screening. She had a long history of mild dyspnea occurring during exertion. Echocardiography showed asymmetric hypertrophy with marked thickening of infero-lateral wall (25 mm,) with normal systolic function (EF 70%). She underwent a cMRI, highlighting diffuse asymmetric hypertrophy (max 24 mm) with LGE in lateral wall and lower septum. First genetic test was nonconclusive but after her father's death another test was performed, demonstrating LAMP2 gene mutation. In 2021 a follow-up cMRI showed markedly reduced myocardial thickness of the apex, with a pattern of noncompaction myocardial. We found a LVEF at lower limits, depressed longitudinal function (MAPSE 8 mm) and manly severe progression of fibrotic degeneration. ECG Holter revealed premature ventricular complex, in absence of nonsustained ventricular tachycardia. Following the evolution of fibrosis, cardioverter defibrillator (ICD) implantation was performed. Case 1 was clinically stable during strict follow-up. Conclusion Cardiac magnetic resonance imaging (cMRI) may be useful in arrhythmic risk stratification, accurate systolic dysfunction evaluation, and proper timing and indication for ICD implantation.

307 A CARDIAC MASS IN A PATIENT WITH GORLIN-GOLTZ SYNDROME: INCIDENTAL DIAGNOSIS OR SOMETHING TO LOOK FOR?

Abstract Aims Gorlin-Goltz syndrome or nevoid basal cell carcinoma syndrome (NBCCS) is a rare autosomal dominant, multisystem, tumor-predisposing disorder. The primary manifestation of NBCCS is the development of multiple basal cell carcinomas (BCCs) but is also associated with a variety of other benign and malignant tumors. Cardiac fibromas are increased in frequency in patients with NBCCS, developing in approximately 3 percent of affected individuals. They typically present in infancy. They are benign growths, and almost all develop within the ventricular myocardium. Although usually asymptomatic, they can result in impaired left ventricular function and conduction defects, necessitating resection. Methods and results we presented a case of a 59-years-old woman with a diagnosis of Gorlin-Goltz syndrome and no history of cardiovascular diseases who underwent a right knee arthroplasty in our hospital. After the surgery the patient was admitted to rehabilitation department. Electrocardiogram that showed sinusal rhythm with inverted T waves in lateral leads and a transthoracic echocardiography examination were performed. Echocardiography showed a large mass within the basal and middle segments of left ventricle lateral wall. Left ventricular ejection fraction was preserved. Cardiac magnetic resonance (CMR) revealed an intramyocardial mass with well-defined borders and several calcifications, hypointense on T1-weighted and T2-weighted images and delayed-contrast hyper-enhancement with hypoenhancing central cores. Based on these imaging features, the mass was suggestive of cardiac fibroma with calcifications. The patients was asymptomatic. Afterwards, a total body CT was performed to exclude other tumours in other sites. This case was discussed with cardiac surgeons and since the patient was asymptomatic with no conduction abnormalities or heart failure signs, urgent surgical intervention was excluded. The patient was discharged with a 3 months follow-up. Conclusion our case highlights the importance of echocardiography evaluation before surgery in patients with genetic syndrome like Gorlin-Goltz syndrome. Last guidelines published in 2021 recommend that all patients with NBCCS should be screened with a cardiac ultrasound and if cardiac symptoms occur in a patient with NBCCS, a cardiac ultrasound should be repeated to exclude a late-onset cardiac tumour. Furthermore, CMR plays an important role in characterizing cardiac masses and determining the management.

C45 LATE CARDIAC OUTCOMES IN PATIENTS AFTER COVID–19: A CARDIAC MAGNETIC RESONANCE STUDY

BackgroundMyocardial injury can occur in patients with coronavirus disease (COVID)–19. Cardiac magnetic resonance (CMR) provides information on functional and morphological cardiac parameters, as well myocardial tissue characterization. Actually, there are few data on late cardiac outcomes in patients after COVID–19.Aim of the StudyTo assess late functional, morphological and myocardial tissue parameters in patients positive to COVID–19 Methods 55 patients (age 50±16 yrs, Female n = 17) with a prior diagnosis of COVID 19, without a previous history of cardiac disease were enrolled in the study. Of these, 35 were hospitalized. The time interval between COVID–19 diagnosis and CMR was 418±28 days. Cardiac function and myocardial tissue characterization have been evaluated with the current CMR techniques. In particular, the presence of late gadolinium enhancement (LGE), as a sign of myocarditis outcome has been evaluated.ResultsLGE was present in 19 patients (34.5%). In all cases, LGE was localized at the level of lateral wall of left ventricle within the myocardium or at the subepicardial level (non–ischemic pattern). Left and right ventricular (LV, RV) ejection fraction were within normal values (mean±SD 65±5% and 65±7%, respectively), as well as volumes (LV endiastolic and endsystolic volumes 71±15 and 27±8 ml/m2; RV endiastolic and endsystolic volumes 72±15 and 25±9 ml/m2). In one case, LGE was associated to regional wall hypokinesia. Among the hospitalized patients, the following factors were associated to the presence of LGE: prone position during assisted ventilation, duration of hospitalization. LGE was present in 67% of patients put in prone position, against 33% of patients not pronated (p = 0.009 Fisher‘s exact test). Duration of hospitalization was 9±5 and 16±7 respectively in patients without and with LGE (p = 0.007)ConclusionLGE, as an outcome of myocarditis, is present in a significant number of patients with a history of COVID–19, but it is not associated with dilatation or global and regional dysfunction of left ventricle. LGE is mainly present in pts with more severe clinical presentation of COVID–19

406 A 50 years old man with a late presentation of arrhythmogenic cardiomyopathy

Abstract In January 2014 a 50 years old man without previous medical history experienced a syncopal episode. During evaluation at Emergency department (ED) a sustained ventricular tachycardia (VT) with haemodynamic compromise was found and successfully treated with DC shock. The patient was admitted to the Coronary Care Unit (CCU) where the ECG showed diffuse low QRS voltages and flattened T waves. Coronary angiography showed normal coronary arteries. 2-D echocardiogram documented the presence of a mildly dilated left ventricle (LV) with a mildly decreased systolic function (EF : 41%); the right ventricle (RV) was severely dilated (REDV : 41 cmq/mq) with a severe systolic dysfunction (fractional area change: 21%) with diffuse hypokinesia and akinesia of subtricuspid region. Cardiac magnetic resonance (CMR) confirmed ventricular dimensional and kinetic abnormalities and tissue characterization sequences demonstrated the presence of fatty infiltration of the epicardial segments of LV lateral wall and of RV free wall. After gadolinium injection, late gadolinium enhancement (LGE) presented the same distribution of the fatty infiltration. A diagnosis of arrhythmogenic cardiomyopathy (AC) was made and ICD in secondary prevention was implanted. The patient was treated with Sotalol (240 mg/daily) and remained asymptomatic and free from sustained ventricular arrhythmias for five years. In January 2019 he started to complain asthenia, dyspnoea (NYHA II) and anorexia and he was admitted to ED where a persistent slow VT was detected. Echocardiogram showed a severely dilated LV with severe systolic dysfunction (EF: 30%) with substantially unchanged RV features. One year later he experienced an heart failure (HF) episode with further reduction of LV systolic function (EF: 21%). Cardiopulmonary test documented a severe ventilation/perfusion mismatch (VE/VCO2 slope 50.6) and severe reduction of the exercise tolerance (VO2 peak 9.2 ml/kg/min). In March 2021 the patient started heart transplantation check list. Three weeks after the discharge he was transplanted. In conclusion, this clinical case highlights an infrequent late presentation of AC, with an initial high arrhythmic burden and a following rapid progression to refractory HF requiring heart transplantation.

Effect of Experimentally Induced Chronic Kidney disease on Skeletal, Cardiac and Smooth Muscle fibers of albino rat

Abstract Background Chronic kidney disease (CKD), or chronic renal failure (CRF) as it was historically termed, includes all degrees of decreased renal function, starting from mild, and moderate, to severe chronic kidney failure. Skeletal muscle atrophy frequently complicates the course of CKD and is associated with excess morbidity and mortality. Cardiovascular diseases have been reported to be the leading causes of death in CKD patients. Chronic Kidney Disease was also reported to be associated with an increased incidence of acid-related gastrointestinal disorders. Aim of the work The aim of this study was to investigate the effect of chronic kidney disease experimentally induced by gentamicin intramuscular injection on the histological structure of gastrocnemius skeletal muscle, left ventricular cardiac muscle and smooth muscle fibers of lower esophagus. Materials and methods Twenty male adult Wistar albino rats were randomly and equally divided into two groups. Group I (control group) received physiological saline intramuscular injection, once daily for 28 consecutive days, in a dose equivalent to that taken in group II. Group II (Gentamicin-treated group) were given Gentamicin intramuscular injection for induction of CKD. Gentamicin was given as Gentamycin sulfate, 40 mg/ml (Sandoz, Switzerland), once daily, in a dose of 80 mg/kg/day for 28 days to induce CKD. After 28 days of the first injection of gentamicin, rats were anaesthetized and blood samples were collected to measure the level of serum urea and creatinine. The left kidneys, the middle third of left gastrocnemius muscle, the lateral wall of left ventricle (LV) and the gastroesophageal junction of all rats of both groups (I and II) were processed for light microscopic study. The middle third of left gastrocnemius muscle, the lateral wall of left ventricle (LV) were further processed for transmission electron microscopic study. Histomorphometrical and statistical analysis were also done. Results The LM examination revealed moderate obliteration of glomeruli, dilatation in some renal tubules and collapse in others, mainly in distal convoluted tubules, with significant fibrosis of renal parenchyma. Serum urea and creatinine levels were increased significantly. The skeletal muscle fibers of the rats in group II (CKD) showed focal areas of myofibers degeneration with siginificant fibrosis. The cardiac muscle fibers of the rats in the group II (CKD) showed focal areas of cardiomyocytes degeneration and other areas of significantly hypertrophied fibers. The smooth muscle fibers of the lower esophageal sphincter of the rats in group II (CKD) showed no significant structural changes compared with the control group, however, the myenetric plexus showed multiple pyknotic and karyolitic nuclei with vacuolated cytoplasm. In addition, insignificant increase in the amount of collagen fibers was observed in almost all layers. Conclusion CKD produced moderate atrophy of skeletal muscle fibers, significant increase in the cardiomyocyte size and no significant structural effect of smooth muscle fibers of the lower esophageal sphincter.

An unruptured “Pocket – Like” giant apical pseudoaneurysm of the left ventricle: A case report

Cardiac pseudoaneurysm is rare and appears mostly as tardive complication of Acute Myocardial Infarct (AMI). Its apical localization is also scarce as it is usually described in posterior or lateral wall of left ventricle. Its diagnosis is based on cardiac imaging. We report a case of a hypertensive, diabetic and smoking 64-year-old man with a past history of anterior AMI. He was symptomatic of chest discomfort. Physical examination indicates an apical murmur, his electrocardiogram showed a regular sinus rhythm and a complete left branch block. The Transthoracic (TTE) echocardiography revealed a giant apical pocketlike aneurysm lined with a clot. Cardiac Magnetic Resonance Imaging (CMRI) confirmed the diagnosis of an apical pseudoaneurysm due to ischemic heart disease in the stage of severe heart failure.

Development of the Z-score for the measurement of myocardial thickness by two-dimensional echocardiography in normal fetuses.

In the current literature, there is a tendency to describe normal values of echocardiographic measurements by means of the Z-score. In fetal cardiology, these Z-score equations are still being established. Measurement of myocardial thickness is an important assessment, especially in fetuses of diabetic mothers, because of the risk of developing myocardial hypertrophy secondary to elevated maternal blood glucose levels. To determine the percentiles and to develop the Z-score equations of right and left ventricular lateral walls and interventricular septum measurements using two-dimensional echocardiography in normal fetuses between 24 and 34 weeks of gestation. This is a prospective cross-sectional study that was performed in single fetuses with normal heart from nondiabetic pregnant women. Measurements of the lateral walls of the right and left ventricles and the interventricular septum were made. Eight hundred and seventy three pregnant women were included. We determined the percentiles of the measurements for each gestational age. The Z-score equation was developed for each of the measurements: right ventricular lateral wall measurement [RVLW = x-(-1 + 0.109 * GA)/0.4], left ventricle lateral wall measurement [LVLW = x-(-1.366 + 0.12 * GA)/0.43], and interventricular septum, both at the four-chamber view [IVS4ch = (x-(-1.113 + 0.107 * GA)/0.4] and at the left ventricular outflow tract plane [IVSLVOT = (x-(-0.581 + 0.084 * GA)/0.35]. The present study allowed the demonstration of the percentiles and the Z-score equations for each of the measurements studied.

Novel device prototyping for endoscopic cell sheet transplantation using a three-dimensional printed simulator.

IntroductionConsidering higher risks of candidates for cardiac regenerative therapy with compromised cardiac function, it is anticipated to develop less invasive surgical procedures. In the present study, we aimed to develop a prototype of totally endoscopic cell sheet delivery device and evaluate the surgical technique for epicardial cell sheet placement using three-dimensional (3D) printed simulators based on human computed tomography data.MethodsWe designed an endoscopic cell sheet delivery device with outer and inner frame with self-expandable applicator which can be opened in thoracic cavity. We launched spout line to provide liquids on the applicator surface and tension line to gently bend the applicator dorsally. We prepared human mesenchymal stem cell (MSC) sheets and compared wet/dry conditions of 3D printed heart/porcine heart and applicator to identify suitable conditions for cell sheet transplantation. Finally we validated the feasibility of endoscopic transplantation to anterior and lateral wall of left ventricle using 3D printed simulators.ResultsMoist condition of both 3D printed heart/porcine heart surface and applicator at transplantation yielded highest successful rate (100%, p = 0.0197). For both endoscopic transplantation sites, MSC sheets were successfully deployed. The procedure duration was 157 ± 23 s for anterior wall and 123 ± 13 s for the lateral wall in average, respectively.ConclusionsWe developed a novel prototype of endoscopic cell sheet delivery device for minimally-invasive cardiac regenerative therapy utilizing a 3D printed simulator. The commercialization of the prototype may provide a safe minimally-invasive method to deliver potential cardiac regenerative therapy in the future.

Subtle cardiac dysfunction in nephropathic cystinosis: insight from tissue Doppler imaging and 2D speckle tracking echocardiography.

Nephropathic cystinosis is a rare autosomal recessive lysosomal storage disorder that initially affects the kidney progressing to multi-organ failure due to accumulation of cystine in all tissue compartments. The main objective of this study is the evaluation of cardiac function in cystinosis patients using non-conventional echocardiographic modalities like pulsed wave tissue Doppler imaging (PW-TDI) and 2D speckle tracking echocardiography (2D-STE). This is a case control study conducted on fifteen patients with cystinosis and 15 normal controls. Echocardiography was done for all participants and PW-TDI was performed for measurement of S', E', A' velocities and myocardial performance index (MPI) at basal parts of septal, left ventricle (LV), and right ventricle (RV) free walls. 2D-STE was done for evaluation of global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) of LV. Mitral E and A velocities and tricuspid annular plane systolic excursion (TAPSE) were also measured. The GLS, GRS, and S' velocity at basal septum and LV lateral wall were significantly lower in patients denoting LV systolic dysfunction (p = 0.005, p < 0.0001, p = 0.001, p = 0.006, respectively), while E/E' were significantly higher in patients group denoting LV diastolic dysfunction (p < 0.001). For RV function, TAPSE, S', and E' velocity were significantly lower in patients group (p 0.013, p < 0.01, p = 0.05, respectively) indicating RV systolic and diastolic dysfunction. The TDI-derived MPI for both LV and RV were significantly higher in patients group (p < 0.0001, p < 0.01, respectively) indicating both ventricular systolic and diastolic dysfunction. For prediction of cardiac dysfunction among patients, the receiver operating characteristic (ROC) curve showed that GRS ≤ 29% had sensitivity 93.3% and specificity 100%, GLS > - 20.1% had sensitivity 66.7% and specificity 93.3%, LV-E/E' >7.87had sensitivity 73.3% and specificity 93.3%, and MPI-LV > 0.36 had sensitivity 100% and specificity 93.3% while MPI-RV > 0.29 had sensitivity 80% and specificity 93.3% and TAPSE ≤ 19mm had sensitivity 80% and specificity 73.3%. Patients with cystinosis have significant both left and right ventricular dysfunction, which can be better evaluated using the non-conventional echocardiographic modalities like TDI and 2D-STE for early detection of subtle cardiac dysfunction.

P357Epicardial abnormal electrical activity in unselected patients with ischemic ventricular tachycardia: a pilot mapping study

Abstract Background radiofrequency catheter ablation (RFA) on the endocardial ventricular surface is widely used for post-myocardial infarction (post-MI) ventricular tachycardia (VT) treatment. It has been described that about 10% of patients with post-MI require additional epicardial ablation for successful VT termination. However, there is still lack of data regarding the extent of scarring and the presence of local abnormal ventricular electrical activity (LAVA, low-voltage and/or fractionated signals) on the epicardial surface in patients with ischemic VT. Purpose to assess the extent of epicardial electrophysiological substrate in patients with remote myocardial infarction and indications for VT ablation. Methods thirteen out of 59 patients with sustained ischemic VT (12 men; mean age 59,9 ± 9,5) and without previous cardiac surgery signed an informed consent to undergo epicardial mapping and comprized the study population. Endocardial access was used previously as primary method in 4 patients ICD/ CRT-D had been previously implanted in 11 patients: mean left ventricle ejection fraction was 38,8 ± 10,6 %: hemodynamically unstable VT was present in 10 patients; the most frequent scar localization by ECG and transthoracic echocardiography – left ventricle (LV) inferior wall (10 patients), LV lateral wall – (7 patients). All patients underwent full clinical evaluation. Electrophysiological procedure and catheter ablation was performed under general anesthesia. Epicardial access was obtained through percutaneous subxyphoid puncture. Voltage mapping of endocardial and epicardial surfaces was performed. Maps were evaluated for the presence of LAVA. Ablation was performed at sites of LAVA on either side of the ventricular wall. Results epicardial access was successful in 12 patients. Bi- and unipolar mapping was successfully performed and analyzed in 11 subjects. LAVA was present in all but one patient on endocardial surface and in 9 (82%) out of 12 patients on epicardial surface. Localization of endocardial and epicardial LAVA coincided in 8 (67%) patients suggesting transmural ischemic scar. One patient had only epicardial scar, 1 patient had septal endocardial scar without LAVA on the epicardial surface. In one patient LAVA sites were localized on different left ventricle walls. More extensive unipolar than bipolar endocardial scar area was found (11,8 (IQR:2,0;31,6) vs 45,8 (IQR:17,1;86,5) сm2; р=0,03). Epicardial unipolar scar area prevailed over bipolar scar area: median 46.0 cm2 (IQR: 15.9;55.5) vs 107.7 cm2 (IQR: 84.3;168.9) р=0,04. LAVA epicardial area was wider than endocardial: 19.7 cm2 (IQR: 2.3; 29.7) vs 4.1 cm2 (IQR: 0.4; 23.8) р=0.03. Conclusion according to the results of our pilot study in unselected patients with ischemic VT, epicardial arrhythmogenic substrate was detected in 82% of cases. Epicardial LAVA area significantly prevailed over endocardial LAVA area.

Acute redistribution of regional left ventricular work by cardiac resynchronization therapy determines long-term remodelling.

Investigating the acute impact of cardiac resynchronization therapy (CRT) on regional myocardial work distribution in the left ventricle (LV) and to which extent it is related to long-term reverse remodelling. One hundred and thirty heart failure patients, referred for CRT implantation, were recruited in our prospective multicentre study. Regional myocardial work was calculated from non-invasive segmental stress-strain loop area before and immediately after CRT. The magnitude of volumetric reverse remodelling was determined from the change in LV end-systolic volume, 11 ± 2 months after implantation. CRT caused acute redistribution of myocardial work across the LV, with an increase in septal work, and decrease in LV lateral wall work (all P < 0.05). Amongst all LV walls, the acute change in work in the septum and lateral wall of the four-chamber view correlated best and significantly with volumetric reverse remodelling (r = 0.62, P < 0.0001), with largest change seen in patients with most volumetric reverse remodelling. In multivariate linear regression analysis, including conventional parameters, such as pre-implant QRS morphology and duration, LV ejection fraction, ischaemic origin of cardiomyopathy, and the redistribution of work across the septal and lateral walls, the latter appeared as the strongest determinant of volumetric reverse remodelling after CRT (model R2 = 0.414, P < 0.0001). The acute redistribution of regional myocardial work between the septal and lateral wall of the LV is an important determinant of reverse remodelling after CRT implantation. Our data suggest that the treatment of the loading imbalance should, therefore, be the main aim of CRT.

1106 Twins with uncertain significant mutations, slightly different cardiomyopathies and different oucmes

Abstract Dilated cardiomyopathy (DCM) is defined as left ventricle (LV) dilatation and dysfunction in the absence of abnormal loading conditions or coronary artery disease enough to cause global systolic impairment. It is the leading cause of heart failure and sudden cardiac death, and even in the early stages of life 5,7/1.000.000 children are diagnosed each year. Lately, genetic screening has revealed that 30-50% of the cases have a familial origin, with a high genetic heterogeneity. We present the case of a 4-month-old boy (case A) referred to our Hospital with high suspicion of dilated cardiomyopathy. He had a twin brother, pregnancy went without complications, pre-birth ultrasound and blood tests were completely normal and a caesarean birth was planned at 37 weeks of pregnancy. He also has an older sibling with no medical history. Our patient was the first to be born and was admitted to the neonatal-ICU due to tachypnea, labored breathing and desaturation. In the physical exam a 5cm hepatomegaly was detected and on the X-Ray a cardiomegaly and enlarged mediastinum were confirmed. ECG showed no electrical abnormalities besides vague repolarization changes. A TTE was done, showing remarkable left cavities enlargement with severe left ventricle dysfunction and moderate mitral regurgitation, comprising the right filling and therefore the right cardiac output. These findings were confirmed by MRI, not detecting enhancement patterns compatible with myocarditis. A genetic test was performed in the index case detecting the presence of a mutation in the desmin gene (Des C.568 + 10c) and the myosin heavy chain 7 gene (Myh7p - glu883Ala) both associated either with dilated and noncompaction cardyomiopathies. Due to the elevated chances of a familiar-DCM his twin brother was admitted to study (case B), with no symptoms or clinical signs besides an isolated bronchitis episode. The clinical examination and EKG were normal, detecting in the TTE a slightly dilated left ventricle with non-compactation morphology in the LV lateral wall, but no left ventricle dysfunction. Also, a TTE was performed in their father with similar findings: mild LV dilatation with minor systolic disfunction and uncertain non-compactation morphology in the LVl apex. Abnormalities of specific genes are now known to be responsible for different types of congenital heart diseases with important implications in genetic counseling. We want to emphasize the different manifestation of a single mutation on different members of a family, even in this two twin-brothers that, under the same probable conditions during preganancy, had slightly different cardyomyopathies but very different severity, and probable mid to long term prognosis. Abstract 1106 Figure.

Disorders of the Cardiovascular System in Patients with Chronic Viral Hepatitis

Aim. To study some structural and functional parameters of the heart and the parameters of hepato-lienal blood flow in patients with chronic viral hepatitis (CVH).Material and methods. 74 patients with CVH were examined, the average age was 41 years, the disease duration – 3.6 years. The patients were divided into 2 groups: group 1 – patients with minimal biochemical activity of hepatitis (n=39); group 2 – patients with moderate hepatitis activity (n=35). The control group included 22 healthy patients. Parameters of tissue doppler echocardiography, hepato-lienal blood flow were evaluated depending on the laboratory activity of CVH.Results. The systolic velocity of the fibrous ring displacement of the tricuspid valve in patients of groups 1 and 2 was lower than in the control by 15% and 17%, respectively (p&lt;0.001). Em decreased in groups 1 and 2 in comparison with healthy individuals in the basal segment of the left ventricle lateral wall, on the mitral valve fibrous ring, in the basal segment of the interventricular septum (p&lt;0.001). The Em/Am ratio decreased in patients of groups 1 and 2 compared with healthy patients in the basal segment of the left ventricle lateral wall, in the medial segment of the interventricular septum, on fibrous ring of the tricuspid valve, in the basal and medial segments of the right ventricular lateral wall (p&lt;0.001). Isovolumic contraction and relaxation time as well as the volume index of the left atrium were increased in patients of the 1st and 2nd groups in comparison with control; more severe violations were observed in patients of the 2nd group (p&lt;0.001). In patients of both groups, acceleration of blood flow and dilation of arteries and veins in the hepato-lienal circulation system (p&lt;0.001) were found. Besides, in patients with moderate hepatitis activity there was an acceleration of blood flow in the hepatic artery in comparison with the control (p&lt;0.001).Conclusion. In patients with CVH the follow disorders were observed: decrease in the global longitudinal systolic function of the right ventricle, violation of diastolic relaxation of the ventricles, increase in the volume index of the left atrium, as well as expansion of the arteries and veins of the hepato-lienal circulation system. These violations were more pronounced in patients with a moderate laboratory activity of CVH. Correlations between cardiohemodynamic parameters, indicators of hepato-lienal blood flow and viral load were revealed.

The effect of biventricular pacing on cardiac function after open heart surgery

Background: Temporary postoperative pacing could enhance recovery of the cardiac function. The right ventricular pacing (RV) is commonly used, but it can cause dyssynchronous contraction of both ventricles. Biventricular pacing (BV) could improve the systolic function by synchronizing the ventricular contraction. The aim of this study is to evaluate the effectiveness of biventricular pacing in improving the hemodynamics in the early postoperative period compared to other pacing modes.&#x0D; Methods: This is a clinical crossover trial including 50 patients who underwent open cardiac surgery in the period from September 2017 to September 2018. Mean age was 46.78± 12.09 years, and 50% were males. Temporary pacing leads were attached to the anterior wall of the right ventricle 1-2 cm paraseptally and the lateral wall of left ventricle 1-2 cm paraseptally. Each patient was paced for 3 minutes in the first 1-4 postoperative hours with 20 minutes washout period between different pacing modes. Study endpoints included cardiac output, ejection fraction (EF) and wall motion abnormality.&#x0D; Results: Biventricular and right ventricular pacing increased postoperative cardiac output (6.31± 1.28 and 5.2±0.72 L/min; respectively), but BV pacing was superior to RV pacing (P-value &lt;0.001). The effect of BV pacing was more evident in patients with EF &lt; 50% (7.27± 0.895 vs. 5.26 ± 0.634 L/min; p&lt; 0.001). The postoperative EF improved during BV pacing (53.16± 4.71%) compared to RV pacing (49.4± 4.07%; P-value &lt;0.001). Both BV and RV pacing were associated with less paradoxical septal wall motion abnormality (P-value &lt;0.001).&#x0D; Conclusions: Temporary postoperative biventricular pacing improves hemodynamics compared to right ventricular and no pacing. Routine BV pacing is recommended especially in patients with low ejection fraction.

Endocardial biventricular pacing for chronic heart failure patients: Effect on transmural dispersion of repolarization.

Background and AimConventional epicardial cardiac resynchronization therapy (CRT) can cause fatal arrhythmia associated with increased transmural dispersion of repolarization (TDR). It is unknown whether endocardial biventricular pacing in various locations will decrease TDR and hence the occurrence of fatal arrhythmia. This study aimed to find out the most effective location of endocardial biventricular pacing resulting in the shortest homogenous TDR.MethodsA before‐and‐after study on adult chronic heart failure (CHF) patients undergoing endocardial biventricular pacing in several defined locations. The changes in TDR from baseline were compared among various pacing locations.ResultsFourteen subjects were included with age ranged 36‐74 years old, of which 10 were males. Location revealed the highest post biventricular pacing TDR (113.4 (SD 13.8) ms) was the outlet septum of right ventricle in combination with lateral wall of left ventricle (RVOTseptum‐LVlateral) while the lowest one (106.1 (SD 11.6) ms) was of the right ventricular apex and posterolateral left ventricle (RVapex‐LVposterolateral). Two CRT locations resulted in the most homogenous TDR, that is the right ventricular apex ‐ left ventricular lateral wall (RVapex‐LVlateral, mean difference −9.43; 95% CI (−19.72;0.87) ms, P = 0.07) and right ventricular apex ‐ left ventricle posterolateral wall (RVapex‐LVposterolateral, mean difference −6.85; 95% CI (−13.93;0.22) ms, P = 0.056).ConclusionEndocardial biventricular pacing on right ventricular apex and left ventricular lateral/posterolateral walls results in the most homogenous TDR.