Left Ventricle In Patients Research Articles

Utility of tissue Doppler imaging of systolic function to diagnose diastolic dysfunction in critically ill patients.

Diastolic dysfunction might be associated with increased mortality in severe sepsis and septic shock. In 2016 new American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines were published. They simplify our approach to diastolic dysfunction recognition, but they were not validated in critical care settings. The aim of the study was to assess the applicability of systolic tissue Doppler imaging of left ventricle in patients with and without diastolic dysfunction classified on the basis of the new guidelines. Two echocardiographers analyzed transthoracic echocardiography (TTE) exa-minations and assigned patients according to ASE/EASCVI guidelines to three groups: patients with systolic dysfunction and diastolic dysfunction, patients with normal systolic function and diastolic dysfunction, and patients with normal systolic and diastolic function. We performed 593 examinations in 320 patients and 390 examinations in 200 patients were included in the study. In 264 examinations with ejection fraction (EF) < 55% systolic and diastolic dysfunction was diagnosed (group 1). In 114 examinations with EF ≥ 55% normal systolic and diastolic function was diagnosed (group 2). In 12 examinations with EF ≥ 55% normal systolic and abnormal diastolic dysfunction was diagnosed (group 3). After analyzing mean systolic tissue Doppler of the mitral annulus we found a statistically significant difference between group 1 and 2 (P < 0.0001) and between group 2 and 3 (P < 0.0001). The difference in values of means in group 1 vs. 3 was not statistically significant (P = 0.853). Systolic tissue Doppler analysis of mitral annulus might help to diagnose diastolic dysfunction especially in patients with preserved ejection fraction.

Ablation in left ventricle in patient with electrical storm and two mitral valve clips.

Ablation in left ventricle in patient with electrical storm and two mitral valve clips.

Исследование механизмов ремоделирования миокарда левого желудочка у пациентов с метаболическим синдромом и обструктивным апноэ во сне

The dynamics of the main echocardiographic parameters of left ventricular myocardium (LVM), reflecting the mechanisms of myocardial remodeling of left ventricle in patients with metabolic syndrome and sleep obstructive apnea syndrome (SOAS) was studied. The research involved 98 men who are overweight (BMI > 30 kg/m 2 ) with established earlier a diagnosis of hypertension and blood pressure stabilization achieved against a background of adequate medical therapy. Study participants underwent cardiorespiratory monitoring night’s sleep for diagnosis of sleep obstructive apnea syndrome with assessment of apnea/hypopnea index and average nocturnal saturation, and EchoCG was performed to assess the structural parameters of LVM, such as left ventricle (LV) diameters, the thickness of the interventricular septum and posterior wall of LV with further calculation of LVM mass index. The data revealed reliable correlation of left atrium length and thickness of the left atrial posterior wall with an index of apnea/hypopnea (р < 0.05). No significant association study of structural parameters of LVM with the level of nocturnal hypoxemia have been identified. The study conclusions were drawn about the likely impact of the periodic independent upper airway obstruction in the remodeling of the left ventricle in the absence of a direct influence on the process of remodeling nocturnal hypoxemia.

Влияние методов фармакотерапии на ремоделирование миокарда левого желудочка сердца у больных острым инфарктом миокарда после перенесенной реперфузии в профилактике формирования ХСН (обзор литературы)

Влияние методов фармакотерапии на ремоделирование миокарда левого желудочка сердца у больных острым инфарктом миокарда после перенесенной реперфузии в профилактике формирования ХСН (обзор литературы)

Chronic heart failure with an&#x0D; intermediate ejection fraction of the left ventricle in patients hospitalized in the cardiology hospital.

Aim. Identification of clinical, anamnestic, etiological, echocardiographic features of chronic heartfailure with an intermediate ejection fraction of the left ventricle among patients hospitalized in the cardiology hospital. Material and methods. Analyzed 423 hospitalization. The diagnosis of CHF was present 378patients (89,6%), the median age was 62 [56; 69]. All patients underwent six-minute walk test, followed by determination of the functional class of heart failure, ultrasound of the heart. Results. In the group of patients Cnppv met significantly less complaints of shortness of breath and weakness, in comparison with patients suffering from Snfu and Ssfv (p&lt;0.05). The severity of violations of the functional state ofpatients with CHF was progressively increased by reducing the levels of LVEF less than 40%. The vast majority of the reason for the development of CHF was a combination of coronary heart disease and arterial hypertension found in 82% of cases in the total cohort. In isolation, these diseases were the cause of heart failure in 3% (coronary heart disease) and 3.4% (arterial hypertension) patients. Conclusion. The incidence of heart failure with an intermediate ejection fraction of the left ventricle among patients with CHF, hospitalized in the cardiology hospital, was 12%. Patients Cnppv had removed the clinical symptoms, despite significant pathological changes in echocardiographic parameters. In addition, the development of Snpf in 93% of cases on a background of myocardial infarction significantly aggravates the prognosis of life ofpatients suffering this pathology.

Hypertriglyceridemia and Remodeling of the Left Ventricle in Patients with Chronic Kidney Disease

Hypertriglyceridemia and Remodeling of the Left Ventricle in Patients with Chronic Kidney Disease

Arterial Stiffness and Ventricular Arterial Coupling and Pulsatative Load on the Left Ventricle in Patients with Hypertension with Initial and Fulminant Heart Failure and Preserved Ejection Fraction According to E/e’ Estimates

The objective: was to evaluate the cardiac structure and the contribution of arterial and ventricular stiffness to the mechanism of impaired cardiac hemodynamics and the development of clinical symptoms of HFpEF.Materials and methods. We attracted to the study prospectively 103 haemodynamically stable patients 43 to 85 years (mean age 65,4±10,8 years) with clinical signs and symptoms of HF with NYHA II–III with hypertension 1 degree that treated with antihypertensive therapy and EF LV ≥50%, signs of DD according to Doppler echoCG. Patients were tested for the levels of the NTproBNP, in addition to standard laboratory parameters. The pulse wave velocity (carotid-femoral) and hemodynamic indices were determined using aplanation tonometry. Echocardiography was determined standard values and diastolic stress test was obtained. HFpEF was diagnosis according to the recommendations of ESC2016. In case of presence or absence of elevation of E/E’ at rest &gt;13 in addition to the structural criteria, patients were divided into three groups. Group 1 consisted of patients with levels of NTproBNP &lt;125 pg/ml and having the structural criteria and group 2 allocated to the patient’s in the presence of structural criteria level NTproBNP &gt; 125 pg/ml, patients that with levels of NTproBNP &gt;125 mg including elevated levels of E/E’ &gt; 13 made group 3.Results. The groups 1 (without HF) consisted of 11 (10.6%) group 2 – 28 (27,18%), the groups have 3 – 64 (62,1%) patients. Signs of NYHA II were present in all patients of the 1st group and in 78,5% – 2 groups (p&gt;0,05), whereas in group 3 NYHA ІІІ (64,0%) prevailed (p&lt;0,01). The NTproBNP level progressively increased from 1 to 3 groups (all p&lt;0,01). According to EchoCG, there was an increase in end diastolic index and end systolic index in patients of group 3, compared with those in group 1, was accompanied to decrease in LV EF (by 11,5%; p&lt;0,05), with a progressive increase in LVMI and LAVI (p&lt;0,01). In evaluating the indicators of diastolic LV function, an increase in the indicators of active relaxation of the LV myocardium was observed, e’lateral, e’septal and their average value from 1 to 3 groups (p&lt;0,01). When evaluating the performance brachial and central arterial pressure level brachial central pulsative arterial pressure in the three groups were not different (p&gt;0,05). The analysis of SAP indices augmentation in the aorta showed a significant increase in AP and Alx 75 only patients in group 3 as compared with the other two groups, that noted as increase of PWV (as compared with those in groups 1 and 2; p&lt;0,01). At the same time, the endothelial dependent vasodilation was already reduced in patients of group 2 from initial HF (compared with group 1 by 38,5%; p&lt;0,01) in the absence of significant differences compared to patients with HF and E/e’ &gt; 13 at rest (p&gt;0,05). Patients of all groups were comparable in Ea (p&gt;0,05). Patients in Group 2 have decrease Ees index compared with patients in Group 1 12,8% (p&lt;0,01), which was accompanied by an increase Ea/Ees (21%; p&lt;0,01). At the same time, in group 3, the values of both indicators did not differ from those in group 2 from the initial HF (p&gt;0,05).Conclusions.1. In patients with AH and HFpEF, compared with those without HF, a violation of the ventricular-arterial coupling is noted by reducing the final systolic stiffness of theLV. With an initial HF with an increase of left venricular pressure according to E/e’ &gt; 13 only with exercice, these changes are accompanied by an increase in LVMI and LAVI by 7,7% and 5,1% and a moderate decrease in myocardial relaxation (e’ average by 23%).2. The progression of heart failure with E/e’ &gt; 13 at rest is not accompanied by subsequent modifications of ventricular–arterial coupling, but is associated with increased augmentation pulse wave, AP, Alx 75 and PWV and development of eccentric LV hypertrophy and a decrease in LV EF by 11,5%.

Interrelation of cognitive impairments and structural and functional features of the left ventricle of the heart in patients with hypertension

Objective — to study morphofunctional changes in the left ventricle in patients with arterial hypertension with cognitive impairment. Materials and methods. Examinations involved 76 patients with stage II arterial hypertension, and 12 practically healthy persons aged (51.55 ± 0.86) and (54.25 ± 2.74) years, respectively. To assess cognitive function, the Montreal Evaluation Scale (MoCA-test) was used. Patients were divided into 2 groups: the first included 40 subjects without cognitive impairment, the second group consisted from 36 patients with cognitive impairment (according to the ­MoCA-test). The structural and functional state of the heart was investigated based on the echocardiography data with evaluation of cardiac contractile function with method of speckle tracking echocardiography. Results and discussion. In all patients with arterial hypertension, regardless of the presence of cognitive impairment, the structural and functional parameters of the left ventricular myocardium according to echocardiography significantly differed from those of the control group. All patients had a preserved ejection fraction (60 ± 2.4) and (58 ± 3.2) % and left ventricular hypertrophy. There were no significant differences between the groups in the studied parameters in patients with arterial hypertension. The correlation between the expression of the left ventricular myocardial mass index and the sum of the MOCA-test scores in patients with arterial hypertension with cognitive impairment (r = – 0.31, p < 0.05) was revealed. According to speckle tracking echocardiography longitudinal deformation of the left ventricle in patients with arterial hypertension was reduced by 60 % of patients of the 1st group and by 91.7 % of patients of the second group and significantly differed both in the intergroup comparison and with the control group. A correlation was found between the index of the total longitudinal deformation of the left ventricle and the presence of cognitive impairment (r = – 0.44, p < 0.01). Conclusions. Decrease in the left ventricular function in the longitudinal direction is associated with cognitive impairment in patients with grade II and III arterial hypertension in addition to the presence of the left ventricular hypertrophy. The use of speckle tracking echocardiography can help in the early detection of subclinical systolic dysfunction of the left ventricle in patients with hypertension with a higher risk of developing cognitive impairment.

Abstract 17402: Increased Epicardial Adipose Tissue Volume is Associated With Left Ventricular Diastolic Function in Patients With Zero Coronary Artery Calcium Score

Background: Recent publications suggested that epicardial adipose tissue (EAT) contributes to the pathogenesis of coronary atherosclerosis. Although some studies showed the association between EAT accumulation and left ventricular (LV) diastolic dysfunction, these associations are not fully understood. Methods: We evaluated 153 patients without coronary artery disease who underwent coronary computed tomography (CT) angiography and Doppler echocardiography. We evaluated 153 patients (mean age of 60 years and 54% men) with zero coronary artery calcium score in coronary CT. Visceral adipose tissue (VAT) area was simultaneously measured by abdominal scans, and EAT volume was also calculated. These measurements were corrected by body surface area; VAT area index (VATAI), and EAT volume index (EATVI). The early diastolic mitral annular velocity at the septal (septal E’) and lateral (lateral E’) were measured using tissue Doppler echocardiography. Results: The mean values of BMI, VATAI, EATVI, and LVMI were 23.7 ± 3.8 kg/m 2 , 52.6 ± 26.4 cm 2 /m 2 , 71.3 ± 29.8 cm 3 /m 2 , and 83.3 ± 17.7 g/m 2 , respectively. The mean septal E’ and lateral E’ velocities were 7.2 ± 2.2 cm/s and 9.8 ± 2.9 cm/s, respectively. Each E’ velocity was negatively correlated with EATVI (septal, R = 0.276, p &lt; 0.001; lateral, R = 0.342, p &lt; 0.001) and VATAI (septal, R = 0.241, p = 0.03; lateral, R = 0.255, p = 0.002; Figure). In contrast, each E’ velocity was not correlated with LVMI (septal, R = 0.161, p = 0.03; lateral, R = 0.118, p = 0.14) and BMI (septal, R = 0.182, p = 0.03; lateral, R = 0.152, p = 0.06). To determine each E’ velocity, we performed stepwise multiple regression analyses where all clinical parameters were entered. Diastolic blood pressure (p = 0.014), statin use (p = 0.011), LVMI (p = 0.003), and EATVI (p = 0.004) were independently correlated with septal E’ velocity, and statin use (p = 0.024), LVMI (p = 0.011), and EATVI (p &lt; 0.001) were independently correlated with lateral E’ velocity. Conclusion: An increase in EATVI was associated with the decrease of early diastolic mitral annular velocity along each side of the left ventricle in patients with coronary calcium score of zero. These findings indicate that EAT accumulation may cause LV diastolic dysfunction in the early phase of coronary artery disease.

Duration of interventricular septal shift toward the left ventricle is associated with poor clinical outcome in precapillary pulmonary hypertension: A cardiac magnetic resonance study

BackgroundRight ventricular pressure overload results in interventricular septal shift toward the left ventricle in patients with precapillary pulmonary hypertension (PH). We aimed to investigate the predictive role of the duration of septal curvature configuration during the cardiac cycle, as expressed by the novel marker curvature duration index (CDi) in precapillary PH. MethodsThis was a prospective study. All patients underwent cardiac magnetic resonance (CMR). CDi was defined by the number of CMR frames in which septal curvature configuration toward left ventricle is observed *100/total number of frames per cardiac cycle. Time from enrollment to first clinical failure event (death, hospitalization due to PH, and disease progression) was recorded. ResultsThe study included 36 patients with precapillary PH. During a median follow-up of 20 months (IQR 4-37 months), 14 clinical failure events were observed. Survival ROC analysis showed that the optimal cutoff value of CDi, which predicted clinical failure, was 67%. Kaplan–Meier survival analysis showed that CDi≥67% was associated with a 9.4-fold increase in the risk for clinical failure. Addition of CDi to baseline models including six-minute walk test distance (c-statistic = 0.65 vs. c-statistic = 0.79), NT-proBNP (c-statistic = 0.72 vs. c-statistic = 0.83), and WHO functional class (c-statistic = 0.76 vs. c-statistic = 0.81) improved risk stratification. ConclusionVentricular septal shift toward the left ventricle lasting for more than the two thirds of the cardiac cycle is associated with worse prognosis in precapillary PH.

Right Axillary Artery Conduit Is a Safe and Reliable Access for Implantation of Impella 5.0 Microaxial Pump

Impella 5.0 is a powerful mechanical circulatory support device placed into the left ventricle of patients in cardiogenic shock not responding to pharmacologic support alone. This therapy can support patient hemodynamics from weeks to several months, and patients can potentially ambulate with the device implanted while awaiting destination therapy. From July 2012 to September 2017, 22 Impella 5.0 devices (Abiomed Inc., Danvers, MA) were implanted via right axillary artery at our center. All devices were implanted under fluoroscopic and transesophageal echocardiographic guidance. Eighty-one percent of patients were male, and average age was 61years (range 27-73). A 10- or 12-mm graft was used in 96% of the cases, most commonly Hemashield (Maquet, Rastatt, Germany; 46%) or Dacron (DuPont, Wilmington, DE; 23%). The graft was tunneled laterally in a subcutaneous plane in 91% of the cases. All attempts at right axillary artery conduit creation and device implantation were successful. The angle of end-to-side anastomosis was 45-60°. The average duration of therapy was 8.8days (range 1-19). There were no brachial plexus injuries, patients with upper extremity ischemia, or bleeding requiring intervention in the postoperative period. One patient was coagulopathic and developed a hemorrhagic stroke. Concurrent use of mechanical circulatory support for the right heart was present in 27% of the cases. Twenty-seven percent of patients bridged successfully to ventricular assist devices, 18% recovered to have the device explanted, and 55% of patients died within 30days of device implantation. Right axillary artery conduit is a safe and reliable access for implantation of Impella 5.0. This technique appears to be associated with low complication rates when implanted with a standardized technique.

STRUCTURAL AND FUNCTIONAL FEATURES OF LEFT VENTRICLE IN PATIENTS WITH HEART FAILURE, CORONARY HEART DISEASE AND THYROTOXICOSIS

Aim.This study was designed to determine the structural and functional features of left ventricle in patients with heart failure, coronary heart disease and thyrotoxicosis.Materials and methods.85 patients aged 58.3±5.6 years were divided into 3 groups: the main one – 25 patients with coronary heart disease (CHD), chronic heart failure (CHF) II-III functional classes (FC) and thyrotoxicosis, average age –59.23±3.81; the 1st comparison group – 30 patients with CHD and CHF FC II-III without thyroid dysfunction, the average age – 57.6±2.73; the 2nd comparison group – 30 patients with thyrotoxicosis without concomitant cardiovascular diseases (CVD), the average age – 45.4±3.51. The structure and function of the thyroid gland were examined in all patients. The echocardiographic (EchoCG) examination was performed to evaluate the structural and functional indicators of the left ventricle (LV).Results.The LV pathologic remodeling in patients of the main group is represented by two types: concentric left ventricle hypertrophy (CLVH) and eccentric left ventricle hypertrophy (ELVH), CLVH was more common than in patients without thyroid dysfunction but with CHF and CHD (84.0%, р=0.01). The LV myocardium contractility was reduced in patients of both groups with CHF, the values of the ejection fraction corresponded with the intermediate type of HF, there was no significant difference between the indices (p = 0.1). The main group had significantly more pronounced decrease in the ratio of the blood flow velocity of early diastolic filling of the LV and the maximal atrial systolic velocity (E / A) − 0.63 and the increase in the isovolumic relaxation time (IVRT) – 84.69 ms in comparison with the indicators of the CHD and CHF patients without thyroid dysfunction (p = 0.021, p = 0.034).Conclusion.For patients with CHF, CHD and thyrotoxicosis, predominance of LV remodeling according to the type of CLVH (84.0% of cases) is typical as well as a moderate decrease in the contractility of the LV and a more pronounced diastolic dysfunction. It determines the structural and functional features of the left ventricle in patients with CHF with this comorbidity.

Evaluation of diastolic left ventricular energy loss in patients with pregnancy-induced hypertension using vector flow mapping

Objective To quantify the diastolic average energy loss (EL) of left ventricle in patients with pregnancy-induced hypertension (PIH) by vector flow mapping (VFM) technique and explore the clinical significance of EL in evaluating left ventricular diastolic function in patients with PIH. Methods Fifty-seven cases of singletonic PIH in late pregnancy (PIH group) and 38 cases of the third trimester normal singleton pregnancy (control group) were enrolled in this study. VFM were used to analyze the total average energy loss (ELt) and average energy loss at the basal level (ELb), the papillary muscle level (ELp), and the apical level (ELa) in isovolumic relaxation, rapid filling, mid-diastol and atrial systole phases, and the differences between the two groups were compared. The correlation between ELt and E/e in both groups were analyzed. Results In PIH group, ELt, ELb, ELp and ELa in the mid-diastolic and atrial systolic phases were significantly higher than those in control group (all P<0.01); ELt, ELp, ELa in isovolumic diastolic phase and ELt, ELb and ELa in fast filling phase were higher than those in control group (all P<0.05). There was a positive correlation between ELt and E/e in isovolumic diastolic phase, rapid filling phase and atrial systolic phase in PIH group (r=0.326, 0.386, 0.403; all P<0.05). There was a positive correlation between the ELt of fast filling and atrial systolic phases and E/e in control group (r=0.498, 0.371; all P<0.05). Conclusions Increased left ventricular diastolic flow EL in PIH patients reflects the abnormal intraventricular hemodynamic changes, and it is related to left ventricular diastolic function parameters for the quantitatively evaluation of PIH patients, and might be feasible to reveal the extent and mechanism of left ventricular diastolic dysfunction. Key words: Vector flow mapping; Pregnancy-induced hypertension; Ventricular function, left; Energy loss

Features of left ventricular remodeling in hypertension patients with comorbid gout

Gout is the most common cause of inflammatory arthritis in men elder than 30 years. The association of gout with hypertension is up to 80 % of cases. Study of cardiovascular system remodeling is very relevant. Aim. To compare the left ventricle remodeling features in patients with hypertension combined with primary gout and patients with essential hypertension without disorders of purine metabolism. Materials and methods. 50 men with hypertension manifested on the gout background, 30 men with essential hypertension without disorders of purine metabolism and 20 healthy men were examined. The main parameters of left ventricle were determined using echocardioscopy. Results. The statistically significant increase in volumetric parameters of the left ventricle in patients with hypertension on the gout background in contrast to the comparison groups and significant decrease in ejection fraction as compared to healthy men were found. The significant increase in left ventricular mass, myocardial mass index and diastolic left ventricle dysfunction in patients with gout were revealed. Using the multivariate analysis of variance we determined an effect of hypertension degree, gout duration and abdominal obesity presence on the process of left ventricle remodeling. The increase in serum uric acid concentration correlated with an increase in left ventricular mass and myocardial mass index. The most of patients with hypertension and gout had the concentric left ventricular hypertrophy. Conclusions . Arterial hypertension on the gout background is characterized by a significant increase in left ventricular mass and myocardial mass index and the prevalence of concentric hypertrophy pattern of left ventricular geometric remodeling in comparison to patients with essential hypertension. Significant increase in myocardial stiffness and its diastolic dysfunction occurred in patients with hypertension on the gout background. Concentration of serum uric acid correlates with the increase in left ventricular mass and myocardial mass index.

ВАСКУЛОЕНДОТЕЛІАЛЬНИЙ ФАКТОР РОСТУ А ТА ПОЛІМОРФІЗМ G634C ГЕНА ВЕФР-A У ХВОРИХ ІНФАРКТОМ МІОКАРДА В ГОСТРИЙ ТА ВІДДАЛЕНИЙ ПЕРІОДИ

&#x0D; &#x0D; &#x0D; Vascular endothelial growth factor A (VEGF-A) promotes the survival of endothelial cells during acute myocardial infarction, accelerates the development of collateral blood supply to ischemic myocardium, and affects the size diminishing of the necrotic lesion area. The synthesis of the VEGF- A in response to standard stimuli is different between people that is genetically determined. The aim was to study the association of polymorphous variants of the VEGF-A gene (G634C) with the dynamics of structural and functional parameters of left ventricle in patients with acute ST elevation myocardial infarction (STEMI) during a 6-month period.A significantly higher VEGF-A concentration was determined in the carriers of the GG genotype compared to the GC genotype (p = 0.047) in the acute period. It has been established that the genotype GC in patients with acute myocardial infarction ST-elevation (STEMI) is associated with more pronounced changes in the left ventricular geometry during the acute period. The GC genotype is associated with a better blood pressure control and a decrease in the left ventricle mass after 6 months’ observation.&#x0D; &#x0D; &#x0D;

Hypereosinophilic Cardiac Involvement Presenting With Left Ventricular Massive Thrombus and Cardioembolic Stroke: A Case Report

Introduction: It is well known that the tendency toward thrombosis is increased in cancer patients. The increase in cancer procoagulant and tissue factor levels, endothelial damage, and stasis due to compression are among the most accused causes of thrombosis in cancer patients. Hypereosinophilia is a rare condition that causes endothelial damage leading to thrombosis. Case Presentation: We present a 64-year-old male patient with cardiac involvement of hypereosinophilia which developed in the T-cell lymphoma ground resulting in a fatal cardioembolic stroke. Despite normal left ventricular (LV) contractions, almost half of the ventricular volume was full of thrombus in this case. Conclusion: Hypereosinophilia is a rare cause of thrombus formation in the left ventricle in patients with preserved ejection fraction. However, hypereosinophilic cardiac involvement can lead to rapid, progressive, life-threatening complications.

Moderate Aortic Stenosis and Reduced Left Ventricular Ejection Fraction: Current Evidence and Challenges Ahead.

Moderate aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF) constitute a clinical entity that has been proposed as a therapeutic target for transcatheter aortic valve replacement (TAVR). It is defined by a mean trans-aortic gradient between 20 and 40 mmHg and an aortic valve area between 1.0 and 1.5 cm2 in patients with LVEF < 50%. Retrospective data suggests a prevalence of 0.8% among patients referred for echocardiographic assessment. These patients are younger and show a higher frequency of previous myocardial infarction than those with severe AS randomized to TAVR in recent trials. In two retrospective studies including patients with moderate AS and reduced LVEF, a one-year mortality rate of 9 and 32% was reported, the latter in patients treated with medical therapy only during follow-up. Echocardiographic diagnosis of moderate AS poses challenges as current guidelines are directed to determine severe AS, and different presentations of moderate and mild AS have been generally neglected. Thus, the nomenclature would need to be revised and a description of possible scenarios is provided in this review. Dobutamine stress echocardiography and computed tomography are promising complementary tools. Likewise, a standardized clinical pathway is needed, in which a high level of suspicion and a low threshold for referral to a heart valve center is warranted. The Transcatheter Aortic Valve Replacement to UNload the Left ventricle in patients with Advanced heart failure (TAVR UNLOAD) trial (NCT02661451) is exploring whether TAVR would improve outcomes in patients receiving optimal heart failure therapy.

CHARACTERISTICS OF CLINICAL CURRENT AND STRUCTURAL-FUNCTIONAL STATE OF LEFT VENTRICULAR IN DECOMPENSATION OF CHRONIC HEART FAILURE IN PATIENTS WITH ISCHEMIC CHRONIC HEART FAILURE WITH SYSTOLIC DYSFUNCTION AND INFLAMMATION OF THE MYOCARDIUM

The aimwas to study the clinical course of CHF decompensation and the structural and functional state of the left ventricle in patients with ischemic CHF with systolic dysfunction and myocardial inflammation.Material and Methods.This study is open, non-randomized, prospective, registered on the ClinicalTrials.gov website, identification number: NCT02649517. The analysis included 25 patients (84% men, LVEF 29.17±9.4%) with ADHF of ischemic etiology. The average age of the patients was 60.12±9.3 years. All the patients underwent an echocardiography including 2D-speckle tracking technique to assess LV deformation. All patients underwent invasive coronary angiography to exclude the progression of coronary atherosclerosis, as a cause of CHC decompensation. An endomyocardial biopsy was performed to diagnose the presence of myocardial inflammation. We performed a comparative analysis of clinical, laboratory, instrumental indicators depending on the fact of diagnosis of inflammation in the myocardium.Results.There were no specific features of the clinical course of decompensation of ischemic CHF with systolic LV dysfunction depending on the inflammation in the myocardial tissue. However, in patients with inflammation, aortocoronary bypass surgery was more often performed (p=0.00650). In addition, in patients with inflammation, there was a decrease in apical rotation (p=0.0313), its systolic velocity (p=0.0157 with decompensation of CHF. A year later, improvement in LV biomechanics, but a continuing decrease in the absolute modulus of global longitudinal LV deformation (p=0.0431) after the anti-inflammatory treatment. Also a year later, in both groups there was an increase in the LV end-diastolic volume index (p=0.0180 and p=0.0280, respectively), a decrease in the interventricular septum of the LV (p=0.0491) in the group with inflammation, and an increase in the myocardial mass index of the LV (p=0.04995) in patients with inflammation.Conclusion.Decreased apical LV rotation and its systolic velocity in patients with ischemic CHF and LV systolic dysfunction, in view of the lack of clinical improvement after optimal myocardial revascularization, may be an additional criterion of concomitant inflammation in the myocardium. Among patients with ischemic CHF and LV systolic dysfunction, more pronounced cardiac remodeling, manifested by LV dilatation and thinning of LV wall, was observed in the group with inflammation.

Impella Placement Guided by Echocardiography Can Be Used as a Strategy to Unload the Left Ventricle During Peripheral Venoarterial Extracorporeal Membrane Oxygenation

At the authors' institution, before 2015, patients cannulated for peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) did not undergo left ventricular (LV) decompression with the use of an LV vent. After 2015, the authors' institution began using the Impella device to vent the left ventricle in patients on VA-ECMO. The authors hypothesized that survival outcomes would improve in patients on VA-ECMO with the use of an Impella for LV venting. Retrospective, chart based review study. Single center, university-based hospital. All adult patients at the authors' institution who required VA-ECMO between January 2015 and May 2017. An Impella (Abiomed, Danvers, MA) device was placed percutaneously in patients cannulated for VA-ECMO as a mechanism to provide LV venting and decompression, therefore unloading the heart. Manual chart review was conducted, and a survival analysis was performed. It was observed that patients on VA-ECMO in whom an Impella was implanted had improved survival and an improvement in LV function as demonstrated by echocardiography compared with patients maintained on VA-ECMO alone. Patients on VA-ECMO plus Impella implantation demonstrated improved survival compared with patients treated with VA-ECMO alone. Key echocardiographic characteristics such as improved LV function after Impella placement and LV cavity size reduction during therapy may help predict those patients who may benefit most from this cannulation strategy.

The Effect of Hemodialysis on Kinetic Segment of Left Ventricular in Stage V Chronic Kidney Diseases Patients

Chronic kidney disease (CKD) stage V attacks other organs such as heart that can cause cardiovascular disease (CVD). One of them is CVD caused by CKD stage V that is the kinetic segment of left ventricle. Cardiovascular disease occurs due to excess fluid and buildup of uremic toxin. Chronic kidney disease stage V can not be cured so it requires therapy that is hemodialysis (HD). Hemodialysis can reduce excess fluid, uremic toxin, and maintain electrolyte balance in stage V stage. Improved fluid and decreased uremic toxin can reduce the burden of the heart and strain so that blood supply to certain myocardial areas increases and the left ventricular kinetic segment increases. The purpose of this study is to determine the effect of HD on left ventricular kinetic changes in CKD stage V patients in dr. Soebandi hospital in Jember. The research design used was quasi-experimental one group pretest-postest design. The sample was 30 patients. Respondents were determined by nonprobability sampling technique with purposive sampling method. The data used are primary data and secondary data. Data analysis using Wilcoxon test. Based on the results of the study, the distribution of the sample based on the age of the most in the range of 45-54 years, based on the sex obtained more women, based on the duration of hemodialysis obtained the period of most hemodialysis&gt; 24 months and based on blood pressure before and after hemodialysis obtained patients with hypertension. Hypothesis test using Wilcoxon test got p-value (0.000). From the results of the analysis can be concluded that there is influence of hemodialysis on kinetic segment of left ventricle in patient of CKD stage V in dr. Soebandi hospital in Jember.&#x0D;