Left Ventricle Peak Research Articles

Usefulness of tissue tracking to differentiate tachycardia-induced cardiomyopathy from dilated cardiomyopathy in patients admitted for heart failure.

Differentiation of tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DCM) in patients admitted for heart failure (HF) with left ventricular dysfunction and supraventricular tachyarrhythmia (SVT) remains challenging. The role of tissue tracking (TT) in this setting remains unknown. Forty-three consecutive patients admitted for HF due to SVT with left ventricular ejection fraction (LVEF) < 50% undergoing CMR were retrospectively included. Those eventually evolving to LVEF > 50% at follow-up were classified as TIC and those maintaining a LVEF < 50% were classified as DCM. Clinical, echocardiography, and CMR findings, including TT, were analyzed to predict LVEF recovery. Twenty-five (58%) patients were classified as TIC. Late gadolinium enhancement (LGE) was more frequent in DCM group (61% vs 16%, p = 0.004). Left ventricle (LV) peak systolic radial velocity and peak diastolic radial strain rate were lower in DCM group (7.24 ± 4.44mm/s vs 10.8 ± 4.5mm/s; p = 0.015 and -0.12 ± 0.33 1/s vs -0.48 ± 0.51 1/s; p = 0.016, respectively). Right ventricle (RV) peak circumferential displacement was lower in patients with TIC (0.2 ± 1.3 vs 1.3 ± 0.9°; p = 0.009). In the multivariate analysis, diabetes (p = 0.046), presence of LGE (p = 0.028), LV peak systolic radial velocity < 7.5mm/s (p = 0.034), and RV peak circumferential displacement > 0.5° (p = 0.028) were independent predictors of lack of LVEF recovery. In the setting of acute HF with LV dysfunction related to SVT, diabetes, LGE, LV peak systolic velocity, and RV peak circumferential displacement are independent predictors of lack of LVEF recovery and, therefore, represent clinically useful parameters to differentiate TIC from DCM.

Association of Pulmonary Transit Time and Pulmonary Blood Volume From First-Pass Perfusion Cardiac MRI With Diastolic Dysfunction and Left Ventricle Deformation in Restrictive Cardiomyopathy.

Patients with restrictive cardiomyopathy (RCM) have impaired diastolic filling and hemodynamic congestion. Pulmonary transit time (PTT) and pulmonary blood volume index (PBVi) reflect the hemodynamic status, but the relationship with left ventricle (LV) dysfunction remains unclear. To evaluate the PTT and PBVi in RCM patients, the association with diastolic dysfunction and LV deformation, and the effects on the occurrence of major adverse cardiac events (MACE) in RCM patients. Retrospective. 137 RCM patients (88 men, age 58.80 ± 10.83 years) and 68 age- and sex-matched controls (46 men, age 57.00 ± 8.59 years). 3.0T/Balanced steady-state free precession sequence, recovery prepared echo-planar imaging sequence, and phase-sensitive inversion recovery sequence. The LV function and peak strain (PS) parameters were measured. The PTT was calculated and corrected by heart rate (PTTc). The PBVi was calculated as the product of PTTc and RV stroke volume index. Chi-squared test, student's t-test, Mann-Whitney U test, Pearson's or Spearman's correlation, multivariate linear regression, Kaplan-Meier survival analysis, and Cox regression models analysis. A P-value <0.05 was considered statistically significant. The PTTc showed a significant correlation with the E/A ratio (r = 0.282), and PBVi showed a significant correlation with the E/e' ratio, E/A ratio, and diastolic dysfunction stage (r = 0.222, 0.320, and 0.270). PTTc showed an independent association with LVEF, LV circumferential PS, and LV longitudinal PS (β = 0.472, 0.299, and 0.328). In Kaplan-Meier analysis, higher PTTc and PBVi were significantly associated with MACE. In multivariable Cox regression analysis, PTTc was a significantly independent predictor of the MACE in combination with both cardiac MRI functional and tissue parameters (hazard ratio: 1.23/1.32, 95% confidence interval: 1.10-1.42/1.20-1.46). PTTc and PBVi are associated with diastolic dysfunction and deteriorated LV deformation, and PTTc independently predicts MACE in patients with RCM. 3 TECHNICAL EFFICACY: Stage 2.

Atrial Strain and Strain Rate in a General Population: Do These Measures Improve the Assessment of Elevated NT‐proBNP Levels?

Background. Noninvasive assessment of elevated filling pressure in the left ventricle (LV) remains an unresolved problem. Of the many echocardiographic parameters used to evaluate diastolic pressure, the left atrial strain and strain rate (LA S/SR) have shown promise in clinical settings. However, only a few previous studies have evaluated LA S/SR in larger populations. Methods. A total of 2033 participants from Norwegian (Tromsø 7) and Russian (Know Your Heart) population studies, equally distributed by age and sex, underwent echocardiography, including atrial and ventricular S/SR and NT‐proBNP measurements. Of these, 1069 were identified as healthy (without hypertension (HT), atrial fibrillation (AF), or structural cardiac disease) and were used to define the age‐ and sex‐adjusted normal ranges of LA S/SR. Furthermore, the total study population was divided into groups according to ejection fraction (EF) ≥50%, EF &lt;50%, and AF. In each group, uni‐ and multiple regression and receiver operating characteristic curve analyses were performed to test LA and LV functional parameters as potential indicators of NT‐proBNP levels above 250 ng/ml. Results. The mean LA S/SR values in this study were higher than those in previous large studies, whereas the lower references were comparable. In normal hearts, atrial total strain (ATS) and mitral valve E deceleration time (MV DT) were independent factors indicating elevated NT‐proBNP levels, whereas in hearts with reduced EFs, the independent indicators were peak atrial contraction strain (PACS) and LV stroke volume. The areas under the curve for these significant indicators to discriminate elevated NT‐proBNP levels were 0.639 (95% confidence interval (CI): 0.577–0.701) for normal EF and 0.805 (CI: 0.675–0.935) for reduced EF. Conclusion. The results confirm good intrastudy reproducibility, with mean values in the upper range of previous meta‐analyses. In the future, automated border‐detection algorithms may be able to generate highly reproducible normal values. Furthermore, the study showed atrial S/SR as an additional indicator of elevated NT‐proBNP levels in the general population, demonstrating the incremental value of both ATS and PACS in addition to conventional and ventricular strain echocardiography. Thus, the LA S/SR may be regarded as an important addition to the multiparametric approach used for evaluating LV filling.

Myocardial deformation imaging by 2D speckle tracking echocardiography for assessment of diastolic dysfunction in murine cardiopathology

Diastolic dysfunction is increasingly identified as a key, early onset subclinical condition characterizing cardiopathologies of rising prevalence, including diabetic heart disease and heart failure with preserved ejection fraction (HFpEF). Diastolic dysfunction characterization has important prognostic value in management of disease outcomes. Validated tools for in vivo monitoring of diastolic function in rodent models of diabetes are required for progress in pre-clinical cardiology studies. 2D speckle tracking echocardiography has emerged as a powerful tool for evaluating cardiac wall deformation throughout the cardiac cycle. The aim of this study was to examine the applicability of 2D speckle tracking echocardiography for comprehensive global and regional assessment of diastolic function in a pre-clinical murine model of cardio-metabolic disease. Type 2 diabetes (T2D) was induced in C57Bl/6 male mice using a high fat high sugar dietary intervention for 20 weeks. Significant impairment in left ventricle peak diastolic strain rate was evident in longitudinal, radial and circumferential planes in T2D mice. Peak diastolic velocity was similarly impaired in the longitudinal and radial planes. Regional analysis of longitudinal peak diastolic strain rate revealed that the anterior free left ventricular wall is particularly susceptible to T2D-induced diastolic dysfunction. These findings provide a significant advance on characterization of diastolic dysfunction in a pre-clinical mouse model of cardiopathology and offer a comprehensive suite of benchmark values for future pre-clinical cardiology studies.

CARD16: Prolonged Normothermic Ex Vivo Heart Perfusion with Hemofiltration in Resting and Intermittent Working-heart Models

Introduction: Cold static storage (5C) or normothermic (37C) ex vivo heart perfusion (NEVHP) in the beating but resting mode (Langendorff) successfully preserves hearts for transplantation for up to 6 hours. Previous attempts to prolong the preservation period increases morbidity and mortality following transplantation. In addition, the 6-hour limit imposes geographic restrictions for recipients, prevents optimal organ assessment, and reduces the number of hearts available for transplantation. We have successfully maintained 10 consecutive pediatric hearts (60±8.8 g) for 24 hours using NEVHP with hemofiltration in the beating, resting-heart mode. Although this prolonged NEVHP model was successful, cardiac function could not be comprehensively assessed in the beating, resting-heart mode. We sought to expand our prolonged NEVHP model to include intermittent left atrial (LA) perfusion that would allow cardiac assessment in the working-heart mode. Methods: We performed 24-hour NEVHP on 5 consecutive hearts (276 ±22.6 g). Following anesthetic induction, sternotomy, cardioplegia administration, explantation, and back-table instrumentation, NEVHP was initiated in beating, resting mode. After 1 hour the circuit was transitioned to LA perfusion working-heart mode for 30 minutes, baseline working-heart parameters were documented (Figure 1) and perfusion was returned to beating, resting-heart mode. Intermittent LA perfusion with working-heart assessment was performed every 4-6 hours. Final working-heart measurements were obtained at 24 hours. Results: All hearts survived 24 hours and all maintained working-heart parameters statistically identical to baseline. Mean LA pressure was 8.2±7.5 mmHg, peak left ventricle (LV) pressure was 33.9±8.7 mmHg, mean LV pressure was 12.0±13.7 mmHg, peak aortic pressure was 35.6±7.8 mmHg, mean aortic pressure was 22.8±7.7 mmHg, coronary resistance 0.15±0.05 mmHg/L/min, and lactate levels were 2.7±0.6 mmol/L. Conclusions: We have successfully developed and validated a porcine NEVHP model for assessment of cardiac function in the working-heart mode using intermittent LA perfusion. While intermittent LA perfusion is an important step toward comprehensive ex vivo assessment of donor heart function, proof of cardiac preservation following prolonged NEVHP still requires successful transplantation and complete assessment in the recipient. We plan to perform this as our next step toward prolonged ex vivo heart preservation. Techniques and cannula for intermittent LA perfusion in the pediatric model will also be developed.

Novel use of an irrigated ablation catheter to monitor real-time hemodynamics during ablation.

Hemodynamic decompensation during catheter ablation occurs due to prolonged procedure time and irrigant delivery directly into the cardiac chambers. Real-time hemodynamic monitoring of patients undergoing catheter ablation procedures may identify patients at risk of decompensation; we set out to assess the feasibility of a novel, real-time, intracardiac pressure monitoring system using a standard irrigated ablation catheter. We studied 13 consecutive who underwent pressure measurement of the left atrium (LA) and left ventricle (LV) via transeptal access with a Swan Ganz (SG) catheter followed by two commercially available irrigated ablation catheters. Pressure waveform data was extracted to compare LA peak pressure, LV peak systolic pressure, LV end-diastolic pressure, and waveform analysis. Comparison between the SG and ablation catheters (AblA; AblB) demonstrated that LV systolic pressure (0.61-16.8 mmHg; 1.32-18.2 mmHg), and LV end-diastolic pressure (-3.4 to 2.8 mmHg; -3.0 to 3.35 mmHg) were well correlated and had accepted repeatability. Ablation waveforms demonstrated an 89.9 ± 6.4% correlation compared to SG waveforms. Pressure measurements derived from an irrigated ablation catheter are accurate and reliable when compared to an SG catheter. Further studies are needed to determine how real-time pressure monitoring can improve outcomes during ablation procedures.

Serum biomarkers and left ventricular mechanics in the diagnosis of diastolic dysfunction in patients with epicardial obesity

Highlights. Patients with epicardial obesity develop myocardial fibrosis (the underlying mechanism of left ventricular diastolic dysfunction) the preclinical diagnosis of which is difficult to perform. In this regard, the search for non-invasive methods for diagnosing diastolic dysfunction at an early stage, including the methods of determining the serum level of biomarkers of heart failure and studying the parameters of left ventricular mechanics using speckle-tracking echocardiography, seems quite relevant.Background. Currently, the search for serum biomarkers and non-invasive methods for diagnosing diastolic dysfunction (DD) of the left ventricle (LV) at the preclinical stage in obese patients is relevant.Aim. To study the levels of heart failure biomarkers and their association with profibrotic factors and LV mechanics in patients depending on the presence of epicardial obesity (EO).Methods. Out of 143 men with general obesity, depending on the severity of EO, determined by the thickness of epicardial adipose tissue (tEАT), 2 groups of patients were identified: the EO (+) group with tEАT 7 mm or more (n = 70), and the EO (–) group with tEАT less than 7 mm (n = 40). The exclusion criteria from the study were: arterial hypertension, type 2 diabetes mellitus, coronary artery disease, and the presence of LVDD detected by echocardiography (echo). Levels of profibrotic factors (type I and type III collagen, procollagen type I C-terminal propeptide (PICP), matrix metalloproteinase-3 (MMP-3), transforming growth factor-β (TGF-β), vascular endothelial growth factor A (VEGF-A), sST2, and NT-proBNP were determined in all patients using enzyme immunoassay. With the help of speckle-tracking echocardiography, the mechanics of LV were analyzed.Results. The EO (+) group presented with increased sST2 level (22.11±7.36 ng/mL) compared to the EO (–) group (sST2 level 9.79±3.14 ng/mL (p&lt;0.0001). In the EO (+) group, a significant influence of tEAT on sST2 level was identified (F = 8.57; p = 0.005). In the EO (+) group, an increase in the level of MMP-3, type I collagen, type III collagen, PICP, transforming growth factor-β, and VEGF-A was revealed. Moreover, in the EO (+) group, a statistically significant relationship between sST2 and type III collagen was revealed (p = 0.01). When comparing the parameters of speckle-tracking echo, the EO group (+) presented with increased LV untwisting rate of –128.31 (–142.0; –118.0) deg/s-1 (p = 0.002), and increased time to LV peak untwisting rate of – 476.44 (510.0; 411.0) msec compared with the EO group (–) (p = 0.03). Moreover, a significant association between LV untwisting rate and sST2 level was revealed in the EO (+) group (r = 0.35; p = 0.02).&gt;˂0.0001). In the EO (+) group, a significant influence of tEAT on sST2 level was identified (F = 8.57; p = 0.005). In the EO (+) group, an increase in the level of MMP-3, type I collagen, type III collagen, PICP, transforming growth factor-β, and VEGF-A was revealed. Moreover, in the EO (+) group, a statistically significant relationship between sST2 and type III collagen was revealed (p = 0.01). When comparing the parameters of speckle-tracking echo, the EO group (+) presented with increased LV untwisting rate of –128.31 (–142.0; –118.0) deg/s-1 (p = 0.002), and increased time to LV peak untwisting rate of – 476.44 (510.0; 411.0) msec compared with the EO group (–) (p = 0.03). Moreover, a significant association between LV untwisting rate and sST2 level was revealed in the EO (+) group (r = 0.35; p = 0.02).Conclusion. The data obtained indicate that patients with EO have LVDD, which could not be detected using echo criteria for LVDD, and the determination of serum levels of the heart failure biomarker - sST2 can be used for the diagnosis of LVDD at the early stage.

Interobserver Agreement and Reference Intervals for Biventricular Myocardial Deformation in Full-Term, Healthy Newborns: A 2D Speckle-Tracking Echocardiography-Based Strain Analysis.

Data regarding reference intervals for strain parameters derived from 2D speckle-tracking echocardiography in full-term newborns are limited and still under development. Our objectives were to establish the level of reproducibility and reference intervals in assessing myocardial function using 2D speckle-tracking echocardiography for longitudinal and regional strain measurements. A total of 127 full-term newborns were examined to be included in the study, of which 103 were analyzed. We used two-dimensional acquisitions from apical four-chamber view of both ventricles and analyzed the autostrain function offline. We obtained interobserver agreement between the two observers ranging from good to excellent for all speckle-tracking parameters except for the strain of the medial portion of the left ventricle (LV) lateral wall and the strain measured on the basal portion of the inter-ventricular septum, which reflected a fair interobserver reproducibility (ICC = 0.52, 95% IC: 0.22–0.72 and ICC = 0.43, 95% IC: 0.12–0.67, respectively). The reference values obtained for the LV peak longitudinal strain were between −24.65 and −14.62, those for the right ventricle (RV) free wall were from −28.69 to −10.68, and those for the RV global four-chamber were from −22.30 to −11.37. In conclusion, two-dimensional peak longitudinal LV and RV strains are reproducible with good to excellent agreement and may represent a possible alternative for the cardiac assessment of healthy newborns in the clinical practice.

Low-dose dobutamine stress gated blood pool SPECT assessment of left ventricular contractile reserve in ischemic cardiomyopathy: a feasibility study.

The purpose of the present study was to evaluate the feasibility of gated blood pool single-photon emission computed tomography (GBPS) with low-dose dobutamine (LDD) stress test, performed on a single-photon emission computed tomography (SPECT) camera equipped with cadmium-zinc-telluride (CZT) solid-state detectors, in assessing of left ventricle (LV) contractile reserve in patients with ischemic cardiomyopathy (ICM). A total of 52 patients (age 59 ± 7.2years, 47 men and 5 women) with ICM and a control group of 10 patients without obstructive coronary artery lesion underwent GBPS and transthoracic echocardiography (TTE) at rest and during LDD stress test (5, 10, 15µg/kg/min). The duration of each GBPS step was 5min. Stress-induced changes in LV ejection fraction (ΔLVEF), peak ejection rate, LV volumes, and mechanical dyssynchrony (phase histogram standard deviation, phase histogram bandwidth and entropy) obtained with GBPS were estimated. All GBPS indices except end-diastolic volume showed significant dynamics during stress test in both groups. The majority of parameters in ICM patients showed significant changes at a dobutamine dose of 10µg/kg/min as compared to the rest study. Seventeen percent of ICM patients, but none from the control group, showed a decrease in LVEF during stress, accompanied by a significant increase in entropy. The intra- and inter-observer reproducibility was excellent for both rest and stress studies. There was a moderate correlation (r = 0.5, p = 0.01) between GBPS and TTE, with a mean difference value of - 1.7 (95% confidence interval - 9.8; 6.4; p = 0.06) in ΔLVEF. Low-dose dobutamine stress GBPS performed with high-efficiency CZT-SPECT cameras can be performed for evaluating stress-induced changes in LV contractility and dyssynchrony with lower acquisition time. A dobutamine dose of 10µg/kg/min can potentially suffice to detect stress-induced changes in patients with ICM during GBPS. ClinicalTrials.gov identifier: NCT04508608 (August 7, 2020).

652 Myocardial work in patients undergoing transcatheter aortic valve implantation: clinical value and implications for outcome

Abstract Aims Non-invasive myocardial work (MW) quantification has emerged in the last years as an alternative echocardiographic tool for myocardial function assessment. This new parameter provides a less loading-dependent evaluation of myocardial performance through the combined assessment of global longitudinal strain (GLS) and non-invasive left ventricle (LV) pressures. The role of MW as a marker of cardiac dysfunction and reverse remodelling in patients with severe aortic stenosis (AS) after aortic valve implantation (TAVI) has not been adequately investigated. This study aims to evaluate MW indices as early echocardiographic markers of LV reverse remodelling within a month after TAVI and their prognostic value. Methods and results We conducted a single-centre prospective study, enrolling 70 consecutive patients (mean age 80.1 ± 5.5 years) with severe AS undergoing TAVI between 2018 and 2020, selected from the EffecTAVI registry. Exclusion criteria were prior valve surgery, severe mitral stenosis, permanent atrial fibrillation, left bundle branch block (LBBB) at baseline, and suboptimal quality of speckle-tracking image analysis. Echocardiographic assessment was performed before TAVI and at 30-day follow-up. Clinical, demographic, and resting echocardiographic data were recorded, including quantification of 2D global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). LV peak systolic pressure was estimated non-invasively from the sum of systolic blood pressure and trans-aortic mean gradient. One month after the procedure, there was a significant improvement of LV GLS (−17.94 ± 4.24% vs. −19.35 ± 4.31%, before and after TAVI respectively, P = 0.002), as well as a significant reduction of GWI (2430 ± 586 mmHg% vs. 1908 ± 472 mmHg%, P &amp;lt; 0.001), GCW (2828 ± 626 mmHg% vs. 2206 ± 482 mmHg%, P &amp;lt; 0.001), and GWW (238 ± 207 mmHg% vs. 171 ± 118 mmHg%, P = 0.006). Conversely, MWE did not significantly change early after intervention (90.53 ± 6.05% vs. 91.45 ± 5.05%, P = 0.204). After TAVI, 30 patients (42.8%) developed LV dyssynchrony due to LBBB or pacemaker implantation. When the population was divided according to the presence or absence of LV dyssynchrony at 30-day follow-up, a significant reduction in GWW was found only in those without dyssynchrony (244 ± 241 vs. 141 ± 110 mmHg% with and without dyssynchrony respectively, P = 0.002). Consistently, in this subgroup, MWE significantly improved post-TAVI (90 ± 7 vs. 93 ± 5%, P = 0.002), while a trend of MWE reduction was observed in patients who developed dyssynchrony post-TAVI (91 ± 4 vs. 89 ± 5%, P = 0.164). In the overall population, a baseline value of MWE&amp;lt; 92% was associated with an increased rate of cardiovascular events (composite of all-cause death and rehospitalization for heart failure) at 1-year follow-up (22.2 vs. 3.1%, long rank, P = 0.016). Conclusions In patients with severe AS undergoing TAVI a significant reduction of GWW and improvement of MWE can be detected only in those who did not develop LV dyssynchrony. In this setting, MWE lower than 92% at baseline is associated with poor outcome. Thus, MWE could represent an alternative tool for myocardial function assessment in patients receiving TAVI.

Lifestyle intervention improves Left atrial strain in type 2 diabetes: results from the DIASTOLIC randomised trial

Abstract Introduction Left atrial (LA) strain has been shown to be an independent predictor of cardiovascular events in many conditions and superior to conventional measures of LA function (LA volumes and emptying fraction). The effects of low-energy diet or exercise on cardiovascular function in younger adults with type 2 diabetes (DIASTOLIC) study has previously demonstrated an improvement in left ventricle peak early diastolic strain rate in response to aerobic exercise in patients with type-2 diabetes (T2D). However, the effect of lifestyle intervention on LA function, assessed by cardiac magnetic resonance (CMR) imaging, is unknown. Methods The DIASTOLIC study was a prospective, randomised, open-label, blind endpoint trial, that randomised 90 obese participants with T2D (aged 18–65 years) to a 12-week intervention of: (i) routine care, (ii) aerobic exercise training, or (iii) low energy (≈810kcal/day) meal replacement plan (MRP). CMR was performed at baseline and week-12. Images were analysed using Medis v3.1. LA strain (LAS) was assessed using Feature Tracking (QStrain v2.0), corresponding to LA reservoir (LAS-r), conduit (LAS-cd), and booster pump (LAS-bp) using 4- and 2-chamber standard steady-state free precession cine images, and average values calculated. LA emptying fraction (LAEF) was calculated using biplane area-length method (QMass v8.1) for total, passive and active EF. Results 73 participants with T2D completed the trial and had analysable LA images (28 routine care, 22 exercise and 23 MRP). There was no significant change in CMR measured standard LA volumetric function (LAV/LAEF) and echocardiogram measured LV filling pressures (E/e') in any groups. The routine care arm showed no significant change in body mass index (BMI) or LAS (see Table). In the MRP group, there were significant reductions in BMI (4.8 kg/m2), mean systolic blood pressure (SBP) (13mmHg), and a significant increase in LAS-r and LAS-bp (29.9±7.0 to 32.3±7.0,p=0.036 and 14.6±5.3 to 17.2±3.7,p=0.034). The exercise arm showed a small reduction in BMI (0.8kg/m2), with no significant change in BP or LAS. Conclusion There was significant improvement in LAS post-lifestyle intervention in young adults with T2D, despite no change in volumetric measurements. MRP led to weight loss and improved SBP, with associated improved LA filling and contraction. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health Research (NIHR) a career development fellowship.

Subclinical cardiac impairment relates to traditional pulmonary function test parameters and lung volume as derived from whole-body MRI in a population-based cohort study

To evaluate the relationship of cardiac function, including time-volume-curves, with lung volumes derived from pulmonary function tests (PFT) and MRI in subjects without cardiovascular diseases. 216 subjects underwent whole-body MRI and spirometry as part of the KORA-FF4 cohort study. Lung volumes derived semi-automatically using an in-house algorithm. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and residual volume were measured. Cardiac parameters derived from Cine-SSFP-sequence using cvi42, while left ventricle (LV) time-volume-curves were evaluated using pyHeart. Linear regression analyses assessed the relationships of cardiac parameters with PFT and MRI-based lung volumes. Mean age was 56.3 ± 9.2 years (57% males). LV and right ventricular (RV) end-diastolic-, end-systolic-, stroke volume, LV peak ejection- and early/late diastolic filling rate were associated with FEV1, FVC, and residual volume (excluding late diastolic filling rate with FEV1, LV end-systolic/stroke volume and RV end-diastolic/end-systolic volumes with residual volume). In contrast, LV end-diastolic volume (ß = − 0.14, p = 0.01), early diastolic filling rate (ß = − 0.11, p = 0.04), and LV/RV stroke volume (ß = − 0.14, p = 0.01; ß = − 0.11, p = 0.01) were inversely associated with MRI-based lung volume. Subclinical cardiac impairment was associated with reduced FEV1, FVC, and residual volume. Cardiac parameters decreased with increasing MRI-based lung volume contrasting the results of PFT.

Preservation of left ventricle peak and mean pulse flow blood velocity despite progressive deterioration of cardiac function in a chronic heart failure murine model.

The goal of this study was to assess the alterations in left ventricle (LV) blood flow velocity patterns in relation to progressive impairment of cardiac function in the course of heart failure (HF) in a unique murine model of chronic HF in Tgαq*44 mice. Doppler- and MRI-based assessments of blood velocity and cardiac performance, respectively, were performed in Tgαq*44 mice at the age of 1, 2, 4, 6, 8 and 12 months as compared with age-matched FVB control mice. One-month-old Tgαq*44 mice displayed elongated early diastolic phase with fully preserved cardiac function that, however, progressively deteriorated in older Tgαq*44 mice. As early as in 2-month-old Tgαq*44 mice, the filling rate (FR), max. radial strain and end-systolic volume increased; in 4-month-old Tgαq*44 mice, the ejection fraction, max. circ. strain and ventriculo-arterial coupling decreased, and the ejection time was prolonged; in 6 - 8-month-old Tgαq*44 mice, the stroke volume, max. (both) strains decreased, end-systolic volume, FR and end-diastolic volume increased, and finally, in 12-month-old Tgαq*44 mice, the ejection fraction, cardiac output and stroke volume were all severely impaired. In the early phase of HF development, no differences were observed in Tgαq*44 mice versus FVB mice regarding systolic LV flow pattern, but indices of mitral diastolic flow were considerably increased in 1-month-old Tgαq*44 mice versus FVB mice. In the late phase of HF, despite progressive deterioration of cardiac function, LV pulse flow blood velocity was not altered in Tgαq*44 mice up to the age of 8 months. Systolic peak velocity and mean acceleration time deteriorated only in 12-month-old Tgαq*44 mice, with peak acceleration and mean velocity values still preserved. We demonstrated that the cardiac mitral diastolic flow pattern displayed adaptive changes in the very early phase of HF development in Tgαq*44 mice and that these changes preceded early alterations in LV haemodynamics. Then, despite the progressive deterioration of cardiac haemodynamics, peak and mean in- and out-flow velocities remained unchanged for a relatively long time and deteriorated only at the end-stage HF. Altogether, we revealed that in addition to cardiac performance, adaptive vascular performance represents an important factor determining LV mitral inflow and ejection flow phenotype during the progression of chronic HF in Tgαq*44 mice.

Cardiac involvement in COVID-19 patients: mid-term follow up by cardiovascular magnetic resonance

BackgroundCoronavirus disease 2019 (COVID-19) induces myocardial injury, either direct myocarditis or indirect injury due to systemic inflammatory response. Myocardial involvement has been proved to be one of the primary manifestations of COVID-19 infection, according to laboratory test, autopsy, and cardiovascular magnetic resonance (CMR). However, the middle-term outcome of cardiac involvement after the patients were discharged from the hospital is yet unknown. The present study aimed to evaluate mid-term cardiac sequelae in recovered COVID-19 patients by CMRMethodsA total of 47 recovered COVID-19 patients were prospectively recruited and underwent CMR examination. The CMR protocol consisted of black blood fat-suppressed T2 weighted imaging, T2 star mapping, left ventricle (LV) cine imaging, pre- and post-contrast T1 mapping, and late gadolinium enhancement (LGE). LGE were assessed in mixed both recovered COVID-19 patients and healthy controls. The LV and right ventricle (RV) function and LV mass were assessed and compared with healthy controls.ResultsA total of 44 recovered COVID-19 patients and 31 healthy controls were studied. LGE was found in 13 (30%) of COVID-19 patients. All LGE lesions were located in the mid myocardium and/or sub-epicardium with a scattered distribution. Further analysis showed that LGE-positive patients had significantly decreased LV peak global circumferential strain (GCS), RV peak GCS, RV peak global longitudinal strain (GLS) as compared to non-LGE patients (p < 0.05), while no difference was found between the non-LGE patients and healthy controls.ConclusionMyocardium injury existed in 30% of COVID-19 patients. These patients have depressed LV GCS and peak RV strains at the 3-month follow-up. CMR can monitor the COVID-19-induced myocarditis progression, and CMR strain analysis is a sensitive tool to evaluate the recovery of LV and RV dysfunction.

Deformation Parameters of the Heart in Endurance Athletes and in Patients with Dilated Cardiomyopathy-A Cardiac Magnetic Resonance Study.

A better understanding of the left ventricle (LV) and right ventricle (RV) functioning would help with the differentiation between athlete’s heart and dilated cardiomyopathy (DCM). We aimed to analyse deformation parameters in endurance athletes relative to patients with DCM using cardiac magnetic resonance feature tracking (CMR-FT). The study included males of a similar age: 22 ultramarathon runners, 22 patients with DCM and 21 sedentary healthy controls (41 ± 9 years). The analysed parameters were peak LV global longitudinal, circumferential and radial strains (GLS, GCS and GRS, respectively); peak LV torsion; peak RV GLS. The peak LV GLS was similar in controls and athletes, but lower in DCM (p < 0.0001). Peak LV GCS and GRS decreased from controls to DCM (both p < 0.0001). The best value for differentiation between DCM and other groups was found for the LV ejection fraction (area under the curve (AUC) = 0.990, p = 0.0001, with 90.9% sensitivity and 100% specificity for ≤53%) and the peak LV GRS diastolic rate (AUC = 0.987, p = 0.0001, with 100% sensitivity and 88.4% specificity for >−1.27 s−1). The peak LV GRS diastolic rate was the only independent predictor of DCM (p = 0.003). Distinctive deformation patterns that were typical for each of the analysed groups existed and can help to differentiate between athlete’s heart, a nonathletic heart and a dilated cardiomyopathy.

The effect of pulmonary arterial hypertension specific treatment on the left ventricle in patients with pulmonary arterial hypertension

Abstract Background Pulmonary arterial hypertension (PAH) is characterized by right ventricular (RV) pressure overload, leading to RV dilation, failure and death. In the course of the disease, the left ventricle (LV) is often impaired, due to interventricular interaction. Although the impact of PAH treatment on the RV has been well described, less is known on the LV. Purpose To examine effects of advanced PAH treatments on the volumes, function and strain of the left atrium and ventricle. Methods This is a retrospective study. All patients underwent CMR and right heart catheterization, both at diagnosis and at 12-months follow up. Ventricular volumes and LV filling rate were calculated from the stack of short axis cine images using Simpsons method while left atrial (LA) volumes from the 4-chamber cine images using the area-length method. Tissue tracking was used for the evaluation of myocardial deformation. The LV endocardial and epicardial borders were manually delineated in all analysed sections with the initial contour set at end-diastole. All analyses were performed offline using dedicated software. Results In total, 66 patients (mean age 56.3±17.9 years, 67%women, 77%idiopathic and heritable PAH, 23% connective tissue disease associated PAH) and 29 normal controls were included. The improvement in metrics of right and left heart size and function after the initiation of advanced PAH treatment, are presented in panel A. Of note, LV stroke volume was markedly increased (54.6±19.6ml at baseline vs 70.8±21.7ml at follow up, p&amp;lt;0.0001) to reach controls. LV filling was markedly increased in latter two-thirds of the diastolic phase (panel B), especially at atrial kick point (arrow). Change in LA max volume was associated with changes in diastolic filling (r=0.354, p=0.004), LV end-diastolic and end-systolic volumes and stroke volume. These correlations were more robust in patients that increased LV filling compared to those that failed to increase LV filling (panels C-E). No association between changes in LV circumferential strain and LV volume load was observed. A weak correlation of change of LV peak longitudinal strain with stroke volume (r=−0.345, p=0.006), LV end diastolic volume (r=−0.284, p=0.027), LV ejection fraction (r=−0.337, p=0.008) and LA maximum area (r=−0.447, p&amp;lt;0.0001) was observed. The changes of LV strain showed no correlation with the changes in patients' haemodynamics. Conclusion Improvement in stroke volume after the initiation of advanced PAH treatment is associated with an increase in LA size, LV end diastolic volume and normalisation of strain. This reflects the improved filling state of the left ventricle and the potential of the left atrium to monitor treatment effects. Changes after PAH treatment Funding Acknowledgement Type of funding source: None

2D Speckle Tracking echocardiography in the prognostication of left ventricle diastolic dysfunction

The aim of the study: to develop prediction comprehensive criteria for the diastolic dysfunction (DD) of the left ventricle (LV) according to 2D Speckle Tracking echocardiography (STE).Materials and methods. A clinical and instrumental study of 91 patients aged 64.0 was performed [58.0; 70.0] years in the Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology in 2019. Criteria for inclusion: sinus rhythm, essential arterial hypertension, chronic coronary artery disease, previous left myocardial infarction, after which at least six months have passed to stabilize the LV structural and functional parameters, chronic heart failure, patient informed consent. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or prosthetics, congenital heart defects, acute and chronic diseases of the kidneys, lungs. Transthoracic echocardiography and STE was performed on ultrasound machine Vivid E9 (GE Healthcare, USA).Results. The leading functional anomalies, interconnected in the development of LV DD, are decline of the LV longitudinal diastolic, regional and global systolic strain, LV mechanical dispersion and dyssynergy. Correlations between LV DD type II and the mechanical dispersion index (r = 0.69, p &lt; 0.001), delta of LV time to peak longitudinal deformation (r = 0.66, p &lt; 0.001), LV global post-systolic index (r = 0.58, p &lt; 0.001), GLSAVG (r = 0.63, p &lt; 0.001) were established. LV DD is characterized by early diastolic longitudinal strain E of the LV basal lateral segment &gt; −6.75%, LV basal septal segment &gt; −5.22%, early and late diastolic longitudinal strain ratio E/A of the LV basal lateral segment ≤0.91, basal-septal segment ≤0.69. LV DD type I is characterized by an LV mechanical dispersion index &gt;49.34 ms, LV delta time to peak longitudinal strain &gt;157 ms. Prognostic values for LV DD type II are LV mechanical dispersion index &gt;49.34 ms, delta time to peak longitudinal strain is &gt;136 ms, global post-systolic index &gt;6.24%, mechanical dyssynergy index &gt;4.60%, global LV peak longitudinal displacement ≤9.88 mm, GLSAVG &gt; −18.5% (sensitivity 88.2%, specificity 83.3%).Conclusions. The use of the developed STE prediction value in practical public health will increase the efficiency of diagnosis of LV DD.

An association between echocardiographic left ventricle longitudinal strain and hypertension in general population depending on blood pressure control

Background . Ultrasound assessment of myocardial strain allows non-invasive identification of early stages of heart failure with preserved ventricular ejection fraction. A decline of the left ventricle (LV) global longitudinal strain in hypertension (HT) accompanied by LV hypertrophy (LVH) was reported in clinical samples with manifest HT. Data on the relationship between longitudinal strain and blood pressure (BP) and HT in general population is lacking. Objective . We studied the relationship between LV peak systolic global longitudinal strain ( GLS ) and strain rate ( GSR ) in subjects with high and controlled BP from a general population sample aged over 55 years. Design and methods . The cross-sectional study was based on a population cohort (HAPIEE, Novosibirsk). In a random sample (n = 416, aged 55–84 years old) we performed echocardiography and evaluated GLS and GSR of LV by speckle tracking technique. ANOVA multivariable models were applied. Results. In the studied sample, the prevalence of HT comprised 78,9 %. The mean GLS value was –18,7 ± 3,79 %, and it was lower in men than in women (–18,2 ± 3,85 % vs –19,2 ± 3,66 %, p = 0,005). The mean GSR value was –0,84 ± 0,17s –1 , and did not differ by sex. The absolute value of GLS in HT was lower than in normotensives: –18,5 ± 3,73 % vs –19,9 ± 3,42 %, p = 0,003; this difference was independent of age, sex and LV myocardial mass index (IMM), p = 0,011; but it was attenuated in a multivariable-adjusted model including body mass index (BMI). In HT groups, the GLS was the lowest among those “treated ineffectively” and significantly lower than in normotensives independently of age, sex and myocardium mass index (p = 0,008). The absolute value of GSR in HT was lower than in normotensives: –0,90 ± 0,17 s –1 vs –0,83 ± 0,17s –1 , p < 0,001; and persisted in multivariable models. GSR was the lowest among those “treated ineffectively” and significantly lower than in normotensives in multivariable models independently of age, sex, BMI and myocardial mass index (p = 0,017; 0,002). The average values of LV ejection fraction (Simpson) in all groups were above 50 % without significant inter-group differences (p = 0,904). conclusions. In the studied population sample, GLS and GSR of LV were associated with HT; however, the association between GLS and HT was largely explained by BMI. In hypertensives, the lowest GLS and GSR , as well as higher extent of LVH, were found among those treated ineffectively, which might point at the initial reduction of systolic ventricular function in HT with inadequate BP control.

Increasing venoarterial extracorporeal membrane oxygenation flow puts higher demands on left ventricular work in a porcine model of chronic heart failure

BackgroundVenoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in the treatment of circulatory failure, but repeatedly, its negative effects on the left ventricle (LV) have been observed. The purpose of this study is to assess the influence of increasing extracorporeal blood flow (EBF) on LV performance during VA ECMO therapy of decompensated chronic heart failure.MethodsA porcine model of low-output chronic heart failure was developed by long-term fast cardiac pacing. Subsequently, under total anesthesia and artificial ventilation, VA ECMO was introduced to a total of five swine with profound signs of chronic cardiac decompensation. LV performance and organ specific parameters were recorded at different levels of EBF using a pulmonary artery catheter, a pressure–volume loop catheter positioned in the LV, and arterial flow probes on systemic arteries.ResultsTachycardia-induced cardiomyopathy led to decompensated chronic heart failure with mean cardiac output of 2.9 ± 0.4 L/min, severe LV dilation, and systemic hypoperfusion. By increasing the EBF from minimal flow to 5 L/min, we observed a gradual increase of LV peak pressure from 49 ± 15 to 73 ± 11 mmHg (P = 0.001) and an improvement in organ perfusion. On the other hand, cardiac performance parameters revealed higher demands put on LV function: LV end-diastolic pressure increased from 7 ± 2 to 15 ± 3 mmHg, end-diastolic volume increased from 189 ± 26 to 218 ± 30 mL, end-systolic volume increased from 139 ± 17 to 167 ± 15 mL (all P < 0.001), and stroke work increased from 1434 ± 941 to 1892 ± 1036 mmHg*mL (P < 0.05). LV ejection fraction and isovolumetric contractility index did not change significantly.ConclusionsIn decompensated chronic heart failure, excessive VA ECMO flow increases demands and has negative effects on the workload of LV. To protect the myocardium from harm, VA ECMO flow should be adjusted with respect to not only systemic perfusion, but also to LV parameters.

Perceived Dark Rim Artifact in First-Pass Myocardial Perfusion Magnetic Resonance Imaging Due to Visual Illusion.

To demonstrate that human visual illusion can contribute to sub-endocardial dark rim artifact in contrast-enhanced myocardial perfusion magnetic resonance images. Numerical phantoms were generated to simulate the first-passage of contrast agent in the heart, and rendered in conventional gray scale as well as in color scale with reduced luminance variation. Cardiac perfusion images were acquired from two healthy volunteers, and were displayed by the same gray and color scales used in the numerical study. Before and after k-space windowing, the left ventricle (LV)-myocardium boarders were analyzed visually and quantitatively through intensity profiles perpendicular the boarders. k-space windowing yielded monotonically decreasing signal intensity near the LV-myocardium boarder in the phantom images, as confirmed by negative finite difference values near the board ranging -1.07 to -0.14. However, the dark band still appears, which is perceived by visual illusion. Dark rim is perceived in the in-vivo images after k-space windowing that removed the quantitative signal dip, suggesting that the perceived dark rim is a visual illusion. The perceived dark rim is stronger at peak LV enhancement than the peak myocardial enhancement, due to the larger intensity difference between LV and myocardium. In both numerical phantom and in-vivo images, the illusory dark band is not visible in the color map due to reduced luminance variation. Visual illusion is another potential cause of dark rim artifact in contrast-enhanced myocardial perfusion MRI as demonstrated by illusory rim perceived in the absence of quantitative intensity undershoot.