Remodeling Of Left Ventricle In Patients Research Articles

In-Hospital Levels of Circulating MicroRNAs as Potential Predictors of Left Ventricular Remodeling Post-Myocardial Infarction.

Background and Objectives: Biochemical and molecular regulation of both adaptive and pathological responses of heart tissue to ischemic injury is widely investigated. However, it is still not fully understood. Several biomarkers are tested as predictors of left ventricle (LV) remodeling after myocardial infarction (MI). The aim of this study was to assess the relationship between selected microRNAs (miRNAs) and LV function and morphology in patients after MI. Materials and Methods: Selected miRNAs related to heart failure were assessed in the acute phase of MI: miR-150-3p, miR-21-5p, miR-19b-3p, miR-155-5p, miR-22-5p. Echocardiography with 3D imaging was performed at baseline and after 6 months. Remodeling was defined as >20% increase in LV end-diastolic volume, whereas reverse remodeling was defined as >10% reduction in LV end-systolic volume. Results: Eighty patients entered the registry. Remodeling occurred in 26% and reverse remodeling was reported in 51% of patients. In the presented study, none of the analyzed miRNAs were found to be a significant LV remodeling predictor. The observed correlations between miRNAs and other circulating biomarkers of myocardial remodeling were relatively weak. Conclusions: Our analysis does not demonstrate an association between the analyzed miRNAs and LV remodeling in patients with MI.

IMPACT OF RENAL DENERVATION TREATMENT ON LEFT VENTRICLE REMODELING IN RESISTANT HYPERTENSIVE PATIENTS: THREE YEARS FOLLOW-UP

Objective: Evaluation of effects of RDN on left ventricle remodeling in patients with resistant hypertension and heart failure with preserved ejection fraction. Design and method: The study enrolled 125 hypertensive patients, who after 3-week of standardized treatment with Losartan, Amlodipine and Indapamide and confirmation of their drug resistance, were randomly assigned into three groups depending on medication supplemented to previously administered: group I - selective I1-imidazoline agonist Moxonidine, group II - cardioselective beta-blocker Bisoprolol and group III - renal denervation. All patients underwent a transthoracic echocardiogram at baseline, one, two and three years follow-up. Renal denervation was performed in the main renal arteries and their branches. Results: Transthoracic echocardiography at baseline revealed LV hypertrophy in all patients. The majority of patients in all three research groups had concentric hypertrophy (52% versus 60% and 56% in group I, II and III, respectively), the normal pattern not being recorded in any group. An authentic reduction in LV mass index was noted from 1-year follow-up in all three observational groups, the progressive reduction being maintained until the end of the study, the group of patients undergoing renal denervation manifested a net superior effect to both pharmacological groups. So, at 3-years follow-up LV mass index was 128,57±4,91 g/m2 in Moxonidine group versus 126,0±5,34 g/m2 in Bisoprolol group and 94,44±3,90 g/m2 in RDN group, p < 0.001. Analyzing the impact of various therapeutic regimes on the geometric pattern of the LV, we can note the fact that both treatment schemes with SNS blockers and RDN favored LV reverse remodeling, its normal pattern being regained by 5 (10%) patients from group I and 7 (28%) patients from group III. This time as well RDN demonstrated absolute superiority over both pharmacological treatment regimens (Figure 1). Conclusions: The obtained data confirm the benefit of RDN treatment on the reverse remodeling of the LV by significantly reduction in LV mass index and inducing the recovery of its normal physiological pattern in practically a third of treated patients at 3 years post-procedurally.

Remodeling and regression of left ventricular hypertrophy in patients with arterial hypertension (literature review)

The article contains literature information concerning the pathogenesis of hypertrophy and remodeling of the left ventricle (LV) of the heart in patients with arterial hypertension (AH), regression of left ventricular hypertrophy (LVH) under the influence of anti-hypertensive treatment. Remodeling of the heart is its structural geometrical changes occurring under the influence of pathological factors: increasing the number of sarcomeres, length and thickness of cardiomyocytes, increasing or decreasing the wall thickness, and enlargement of the ventricular cavity. The renin-angiotensin-aldosterone system (RAAS) plays a central role in the pathogenesis of hypertrophy and remodeling of the myocardium with AH and heart failure. LVH is one of the most significant predictors of cardiovascular events, including myocardial infarction, stroke, life-threatening ventricular arrhythmias, mortality from cardiovascular diseases, and general mortality. Treatment with angiotensin-converting enzyme inhibitors (ACEI), dihydropyridine calcium channel blockers (CCB), АТ ІІ receptor blockers (ARB) promotes reverse development of LVH and regression of the processes of the heart muscle remodeling. ACEIs are found to be more effective in achieving regression of LVH in patients with AH compared to CCB and beta-blockers. An early beginning of anti-hypertensive therapy and attention to metabolic aspects are critically important to avoid irreversible LVH. The ESH/ESC recommendations (2018) indicate that ACEI and ARB are effective for the prevention or regression of LVH in patients with AH, and beta-blockers are less effective than RAAS blockers and CCB.Objective: to systematize literature data about the pathogenesis of the left ventricle remodeling in patients with arterial hypertension, and the role of anti-hypertensive therapy in the regression of left ventricular hypertrophy. Conclusion. Today, the concept about the role of the renin-angiotensin-aldosterone system in the pathogenesis of hypertrophy and remodeling of the left ventricle in patients with arterial hypertension has been formulated. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are the most effective in the prevention or regression of left ventricular hypertrophy in patients with arterial hypertension.

A Left ventricle remodeling in patients with bicuspid aortic valve.

We assessed the impact of bicuspid aortic valve (BAV), aortic stenosis (AS), and regurgitation (AR) on the metrics of left ventricular (LV) remodeling, as measured by electrocardiogram (ECG), transthoracic echocardiography (TTE), and cardiac magnetic resonance (CMR). This retrospective CMR study included 11 patients with both AS and AR (BAV-ASR), 30 with AS (BAV-AS), 28 with AR (BAV-AR), 47 with neither AS nor AR (BAV-no_AS/AR), and 40 with trileaflet aortic valve (TAV-no_AS/AR). CMR analysis included the LV end-diastolic volume index (LVEDVi), mass index (LVMi), and extracellular volume fraction (ECV). The Sokolow-Lyon and Cornell products by ECG and TTE-derived E/e' were measured. There were no differences in the ECG, TTE, and CMR parameters between BAV-no_AS/AR and TAV-no_AS/AR. However, the presence of aortic valve dysfunction resulted in an elevated Sokolow-Lyon product for BAV-ASR (p = 0.017) and BAV-AR (p = 0.001), as well as increased Cornell product (p = 0.04) and E/e' (p < 0.001) for BAV-AS compared with BAV-no_AS/AR. LVEDVi and LVMi were elevated in patients with BAV-ASR and BAV-AR compared with those with BAV-no_AS/AR (LVEDVi: 101 ± 29 ml/m2 and 112 ± 32 ml/m2 vs. 74 ± 15 ml/m2, p = 0.005 and p < 0.001, LVMi: 75 ± 7g/m2 and 64 ± 14g/m2 vs. 47 ± 9g/m2, respectively; p < 0.001). There was no difference in ECV between the BAV and TAV-no_AS/AR subgroups. Normally functioning BAV did not result in LV remodeling. However, concomitant AV dysfunction was associated with statistically significant morphological remodeling.

487 Increased CT Angiography-Derived Extracellular Volume Fraction Predicts Less Benefit In Left Ventricular Remodeling And Ejection Fraction After Transcatheter Edge To Edge Repair For Severe Mitral Regurgitation

Introduction: Mitral regurgitation (MR) leads to adverse structural remodeling of the left ventricle (LV), which may be reversed with timely transcatheter mitral valve edge to edge repair (TMR). Extracellular volume fraction (ECV), a marker of myocardial fibrosis, is associated with adverse LV remodeling and can be measured on cardiac computed tomography angiography (CTA). We evaluated the association between CTA-derived ECV and echocardiographic LV remodeling in patients with severe MR undergoing TMR.

Cardiac Computed Tomography Radiomics-Based Approach for the Detection of Left Ventricular Remodeling in Patients with Arterial Hypertension.

The aim of the study is to verify the feasibility of a radiomics based approach for the detection of LV remodeling in patients with arterial hypertension. Cardiac Computed Tomography (CCT) and clinical data of patients with and without history of arterial hypertension were collected. In one image per patient, on a 4-chamber view, left ventricle (LV) was segmented using a polygonal region of interest by two radiologists in consensus. A total of 377 radiomics features per region of interest were extracted. After dataset splitting (70:30 ratio), eleven classification models were tested for the discrimination of patients with and without arterial hypertension based on radiomics data. An Ensemble Machine Learning (EML) score was calculated from models with an accuracy >60%. Boruta algorithm was used to extract radiomic features discriminating between patients with and without history of hypertension. Pearson correlation coefficient was used to assess correlation between EML score and septum width in patients included in the test set. EML showed an accuracy, sensitivity and specificity of 0.7. Correlation between EML score and LV septum width was 0.53 (p-value < 0.0001). We considered LV septum width as a surrogate of myocardial remodeling in our population, and this is the reason why we can consider the EML score as a possible tool to evaluate myocardial remodeling. A CCT-based radiomic approach for the identification of LV remodeling is possible in patients with past medical history of arterial hypertension.

Can Strain Imaging Predict Left Ventricle Remodeling? A Study from Eastern India

Background: Even persistently patent infarct-related artery has been shown to be associated with left ventricle (LV) remodeling. The purpose of this study was to evaluate the role of LV strain imaging by echocardiography in predicting LV remodeling in patients undergoing coronary revascularization. Materials and Methods: A total of 104 patients between the ages of 18 and 75 years of age undergoing percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS) were selected and subsequently followed up for 3 months. Echocardiography was obtained before PTCA and subsequently 3 months later with global longitudinal strain (GLS) measurements. Results: In our study, 24% patients studied developed LV remodeling at 1 month even after clinical, angiographic, and procedural success of percutaneous intervention. A value of LV GLS &lt;−10.8 predicted the development of LV remodeling with 80% sensitivity and 86% specificity with lower values having higher specificity. Conclusions: GLS assessment by echocardiography in the acute setting is feasible and easy to do with no complications and may be used with considerable sensitivity in predicting patients with adverse remodeling after ACSs.

Changes in left atrial function, left ventricle remodeling, and fibrosis after septal myectomy for obstructive hypertrophic cardiomyopathy

BackgroundThis study aimed to investigate the impact of septal myectomy on left atrial function, left ventricle remodeling, and fibrosis in patients with obstructive hypertrophic cardiomyopathy. MethodFrom May 2012 to September 2016, preoperative cardiac magnetic resonance imaging of 507 adult patients who underwent septal myectomy at Fuwai Hospital was retrospectively collected. Until October 2019, 57 patients were followed up with postoperative cardiac magnetic resonance imaging at 11.9 months (interquartile range, 6.4-25.3). Preoperative and postoperative left atrium and left ventricle changes, as well as late gadolinium enhancement as a surrogate of myocardial fibrosis, were analyzed. ResultsPatients with hypertrophic cardiomyopathy requiring myectomy showed increased left atrium volume, stroke volume, left ventricular ejection fraction, and left ventricle mass, as well as decreased left ventricle end-systolic volume. Echocardiography demonstrated that myectomy decreased the left ventricle outflow tract gradient, left atrium diameter, left ventricular ejection fraction, and posterior wall thickness. Postoperative cardiac magnetic resonance imaging showed that the minimal left atrium volume (P < .001), stroke volume (P = .009), left ventricle ejection fraction (P < .001), and left ventricle mass (166.9 [interquartile range, 135.8] vs 149.3 [interquartile range, 100.5] g, P < .001) decreased, whereas the left ventricle end-systolic volume (P = .001) and left atrium ejection fraction (37.9% ± 14.6% vs 47.8% ± 14%, P < .001) increased. However, left ventricle myocardial fibrosis, as detected by late gadolinium enhancement, still progressed after myectomy in patients with obstructive hypertrophic cardiomyopathy (15.2% ± 9.6% vs 18.6% [interquartile range, 21.6], P = .009). ConclusionsSeptal myectomy alleviated left ventricle hypertrophy and reversed left atrium and left ventricle remodeling in patients with obstructive hypertrophic cardiomyopathy. Late gadolinium enhancement in the left ventricle increased despite myectomy in patients with obstructive hypertrophic cardiomyopathy.

Importance of Basal Soluble ST2 and Global Longitudinal Strain 2D-Speckle Tracking Echocardiography to Detect Left Ventricle Remodeling in Post-Myocardial Infarction Patients

Left ventricle (LV) remodeling often occurs after acute myocardial infarction (AMI), and early detection and prompt treatment on this condition may improve prognosis of the patients. Basal soluble ST2 and Global Longitudinal Strain (GLS) 2D-speckle tracking echocardiography can detect early changes before LV remodeling occurs. This is an analytic observational study using one group pre-test and post-test design for correlation. Forty-five patients of AMI during August until December 2015 from ICCU and cardiology ward were analyzed and followed up for 12 weeks. There were 45 subjects with AMI, 38 (84.4%) patients with STEMI and seven (15.6%) patients with NSTEMI. There were significant differences of left ventricle end diastolic volume (LVEDV) baseline from 76±29.69ml/m2 to 98.11±36.84ml/m2 after 12 week follow-up (p=0,003). There was significant correlation between high baseline soluble ST2 with and low GLS baseline with LV remodeling (p=0.015). High baseline soluble ST2 and low GLS value can predict LV remodeling in patients with AMI.

P778Valsartan reduces level of soluble ST2 and left ventricle remodeling in patients with dual chamber pacemaker

Abstract Introduction Permanent right ventricle pacing leads to left ventricle remodeling, its systolic dysfunction and symptomatic heart failure in the long run. Valsartan is well known for its preventive anti-remodeling function in the post infarction heart remodeling. Objectives To assess the effect of valsartan on left ventricle remodeling in patients with second and third degree atrioventricular block with first-time implantation of dual chamber pacemaker. Methods This was a randomized, double-blind, placebo controlled single center study. One hundred eligible patients were assigned in a 1:1:1 fashion to receive placebo, valsartan 80mg or 160mg once daily, respectively. Echocardiographic assessment of left ventricle geometry, its systolic and diastolic function was performed at baseline and at twelve months. One patient from placebo group suffered stroke. We present the baseline date for 100 enrolled patients and follow-up data for 88 patients who have completed the study. Data in valsartan arms are pooled in one group. Concentration of soluble ST2 was measured in duplicates with Aspect Reader (Critical Diagnostics). Results Results are presented in table. Data are presented as mean and standard deviation. Table 1 Placebo (n=28) Valsartan (n=60) ANOVA Baseline 12 mths Baseline 12 mths sST2, ng/mL 36.0±16.0 39.4±15.3 35.1±15.2 19.9±6.5 0.01 LVEF, % 60±8 55±9 60±8 58±8 0.01 LVEDD, mm 48±5 50±4 48±6 49±5 NS LVESD, mm 29±4 32±5 29±5 31±4 NS LVEDV, mL 79±12 84±13 80±12 81±13 NS LVESV, mL 32±5 38±7 31±5 34±6 0.01 E/A 0.94±0.12 0.92±0.13 0.94±0.15 0.95±0.15 NS DecT, ms 211±38 226±43 223±45 218±37 0.01 IVRT, ms 98±14 108±17 101±17 99±18 0.01 Conclusion Valsartan has protective effect of left ventricle remodeling and function. It may be useful in prevention of pacing induced heart failure. Decrease in soluble ST2 concentration may help explain the alternative mechanism for protective role of valsartan. (NCT01805804)

Is Late Left Ventricle Remodeling After Repair of Degenerative Mitral Regurgitation Worse in Women?

Recent data suggest sex-specific differences in left ventricle (LV) remodeling in patients with ventricular dysfunction or volume overload. Data describing LV remodeling in patients after repair of degenerative mitral regurgitation (MR) is scarce. Between 2002 and 2017, 1012 patients underwent repair of MR due to myxomatous degeneration and were monitored serially in a dedicated clinic. Patients were a mean age of 63.8 ± 12.7 years, and 277 (27%) were women. Mean preoperative indexed LV end-systolic dimension was 19.0 ± 4.3 mm/m2. Clinical and echocardiographic follow-up averaged 5.1 years and extended to 14.7 years. There were 3112 postoperative echocardiograms performed for these patients. Overall, freedom from recurrent MR exceeding 2+ was 98.3% ± 5.5% at 5 years and 86.9% ± 2.0% at 10 years. After a mean of 5.1 years, the mean postoperative indexed LV end-systolic dimension was 17.3 ± 4.2 mm/m2. Postoperative indexed LV end-systolic dimension decreased compared with their preoperative measurement in 63% of patients. Notably, women were less likely to experience a postoperative decrease in indexed LV end-systolic dimension than men (hazard ratio, 0.7 ± 0.1; P= .04), even after adjusting for differences in age, preoperative atrial fibrillation status, preoperative right ventricle systolic pressure, and the subsequent development of recurrent MR. Similar results were also obtained in a propensity analysis of 275 matched female-male pairs (hazard ratio, 0.7 ± 0.1; P= .03). Few data are available describing LV remodeling after repair of degenerative MR. In a large population registry, we have observed sex-specific differences in late LV remodeling. These data therefore raise equipoise that earlier surgical intervention of women with degenerative MR may be warranted.

Особливості ремоделювання лівого шлуночка у хворих артеріальною гіпертензією на фоні первинної подагри в залежності від функціонального стану нирок

Особливості ремоделювання лівого шлуночка у хворих артеріальною гіпертензією на фоні первинної подагри в залежності від функціонального стану нирок

Study of factors that affect clinical prognosis and heart remodeling in patients with myocardium infarction with ST segment elevation in remote period

Aim. To determine factors, connected with the unfavorable prognosis of patients with myocardium infarction (MI) with ST element elevation, who underwent the thrombolytic therapy (TLT).Materials and methods. There were examined 100 patients with MI with ST segment elevation, who underwent TLT, admitted at hospital during the first 6 hours of the disease. The average time of TLT was 154±75,56 minutes, TLT was realized at the pre-hospital stage in 35(38,5 %) patients.Blood samples for determining biochemical parameters, especially asymmetric dimethylarginine (ADMA) and high-sensitive C-reactive protein (CRP), were taken at admission at hospital. ADMA level was determined using the high-effective liquid chromatography, the level of high-sensitive CRP – by the immunoturbdiametric analysis. For determining the allele condition of T786C polymorphism of the gene of endothelial NO synthase (eNOS), there was used polymerase chain reaction. All patients underwent echocardioscopy (EchoCS). Patients were examined repeatedly in 1 year. The information as to undesirable clinical events was accessible in 91 persons, 60 patients underwent the repeated EchoCS.Results. Undesirable clinical events took part in 13 (14,3 %) of 91 patients. Among patients, who underwent undesirable events, reliably more patients had the previous localization of MI (39,7 % and 76,9 %, respectively, р=0,03). They had also the more heart rate for the second day of the disease (71,01±12,38 st/min and 77,36±7,84 st/min, respectively, p=0,045). The reliably more part of patients from this group had angina before the development of the current MI - 1 (1,3 %) and 3 ( 23,1 %), respectively, р=0,009. Patients, who had undergone undesirable events, had the reliably higher level of the high-sensitive CRP at admission to hospital (37,47±28,08 against 11,70±12,21in І group, р=0,006). The regression analysis established that the increase of the risk of undesirable events by 9,9 % is connected with angina before MI, by 7,3 % with the previous MI localization, by 5,6 % with the decrease of the emission fraction (EF) in the acute period of MI, by 5,1 % with the increase of the level of the high-sensitive CRP, by 5,1 % with the decrease of smoking length, and by 5,1 % with female sex.The left ventricle (LV) remodeling (increment of the end diastolic volume (EDV) over 20 % comparing with the results of the first EchCS) was observed in 13 (21,7 %) of 60 examined persons. It was revealed, that patients with the further development of LV remodeling had better parameters of the intracardiac hemodynamics in the acute period of MI – less values of LV EDV (р=0,028), LV end systolic volume (ESV) (р=0,049), LV myocardium mass (р=0,031). At the analysis of laboratory data, it was revealed, that these patients had the reliably higher level of the high-sensitive CRP and ADMA. The method of regression analysis demonstrated that the increase of the risk of LV remodeling is connected with the less size of the left atrium by 12,5 % and by 9,1 % - with the less MMLV in the acute MI period, by 5,9 % with smoking at the moment of MI, by 5,1 % with the increase of the level of high-sensitive CRP, by 4,7 % with angina before MI, by 4,6 % with the previous MI localization.Conclusions. The risk of clinical undesirable events and LV remodeling in patients with MI with ST segment elevation depends on their anamnesis, infarction localization and clinical course of the disease and also on several biochemical indices

Left ventricle remodeling in patients with β-thalassemia major. An emerging differential diagnosis with left ventricle noncompaction disease

To differentiate left ventricle non-compaction (LVNC) from hypertrabeculated myocardium due to LV remodeling in β-thalassemia major (β-TM) patients, cardiac magnetic resonance (CMR) images of 38 β-TM patients and 10 LVNC patients were compared using 3 diagnostic criteria: ratio of diastolic segmental non-compacted to compacted myocardium (NC/C ratio) >2.5, percentage of non-compacted LV mass (NC-LVM%) >20% and >25% of global LV mass. Specificity of NC/C ratio of >2.5 was the lowest (58%) and of NC-LVM% of >25% the highest (93%). A NC-LVM% >20% showed sensitivity 100% and specificity 87%. Disease differentiation depends on the selected CMR criterion and is better with NC-LVM%.

LEFT VENTRICULAR REMODELING IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH AND WITHOUT ST SEGMENT ELEVATION

Aim. To study the remodeling of the left ventricle (LV) in patients with ST segment elevation (STEMI) and non-ST segment elevation (non-STEMI) myocardial infarction (MI). Materials and methods. Patients (n=99) with acute MI (48 – with STEMI, 51 – with non-STEMI) were examined. Diagnosis of MI was set on the basis of the dynamics of myocardial damage markers, data of clinical and electrocardiogram examination. The comparison group consisted of 33 patients with stable angina functional class 2. The control group included 35 healthy men. Structural and functional state of the LV myocardium and types of its remodeling were assessed by echocardiography. Results. It was found that the LV eccentric hypertrophy was the predominated type of LV remodeling in patients with STEMI. Besides, these patients demonstrated disorders of the LV contractile function (LV ejection fraction 40.2±5.49% vs. 61.4±3.91% in control; p&lt;0.05), the LV dilatation (end-systolic volume index 54.1±5.27 vs. 25.2±2.22 ml/m2 in the control; p&lt;0.05), the lowest LV wall thickness (relative wall thickness 0.36±0.01 vs. 0.44±0.01 in control; p&lt;0.05), increase in the LV myocardial stress (168.3±20.17 vs. 108.6±9.82 dynes/cm2 in control; p&lt;0.05), and LV spherification. The majority of patients with non-STEMI revealed combination of concentric and eccentric types of LV remodeling. Their hemodynamic parameters were comparable to those in patients with stable angina, but exceed the control data. Conclusion. In patients with acute MI severity of the LV remodeling correlated with the depth and vastness of myocardial damage. The most significant hemodynamic changes were observed in STEMI.

Influence of renin-angiotensin-aldosterone system block on the systemic inflammation activity and left ventricle remodeling in patients with Q-myocardial infarction after thrombolysis

Aim. Inflammatory cytokines play a role in adaptive postinfarction remodeling of the heart. In order to study the influence of treatment on the condition of systemic inflammatory markers, the incidence of post-infarction aneurysm and thrombus formation in the left ventricle of patients with Q-wave myocardial infarction after thrombolytic therapy serum levels of interleukin-6, interleukin-1-beta, von-Willebrand factor, fibrinogen were studied in 92 patients with immunoassay analysis. Results and discussion. Remodeling, systolic and diastolic function of the heart were evaluated with echocardiography. Under the influence of the treatment reduction of systemic inflammatory markers activity was showed, which accompanied by improvement of left ventricular systolic function and low frequency of left ventricle aneurysm and thrombus formation.

Randomized placebo controlled blinded study to assess valsartan efficacy in preventing left ventricle remodeling in patients with dual chamber pacemaker — Rationale and design of the trial

BackgroundDual chamber pacing is known to have detrimental effect on cardiac performance and heart failure occurring eventually is associated with increased mortality. Experimental studies of pacing in dogs have shown contractile dyssynchrony leading to diffuse alterations in extracellular matrix. In parallel, studies on experimental ischemia/reperfusion injury have shown efficacy of valsartan to inhibit activity of matrix metalloproteinase-9, to increase the activity of tissue inhibitor of matrix metalloproteinase-3 and preserve global contractility and left ventricle ejection fraction. PurposeTo present rationale and design of randomized blinded trial aimed to assess whether 12month long administration of valsartan will prevent left ventricle remodeling in patients with preserved left ventricle ejection fraction (LVEF≥40%) and first implantation of dual chamber pacemaker. MethodsA total of 100 eligible patients will be randomized into three parallel arms: placebo, valsartan 80mg/daily and valsartan 160mg/daily added to previously used drugs. The primary endpoint will be assessment of valsartan efficacy to prevent left ventricle remodeling during 12month follow-up. We assess patients' functional capacity, blood plasma activity of matrix metalloproteinases and their tissue inhibitors, NT-proBNP, tumor necrosis factor alpha, and Troponin T. Left ventricle function and remodeling is assessed echocardiographically: M-mode, B-mode, tissue Doppler imaging. ConclusionIf valsartan proves effective, it will be an attractive measure to improve long term prognosis in aging population and increasing number of pacemaker recipients. ClinicalTrials.org (NCT01805804).

Perindopril treatment promote left ventricle remodeling in patients with heart failure screened positive for autoantibodies against angiotensin II type 1 receptor

BackgroundAutoantibodies specific to the angiotensin II type I receptor (anti-AT1-AR) have been implicated in the pathology of congestive heart failure (CHF). Anti-AT1-AR may be associated with left ventricular function in CHF patients treated with perindopril.MethodsSynthetic angiotensin II type 1 receptor (AT1-R) peptides served as the target antigen. ELISA was used to screen the sera of 156 CHF patients, which were divided into positive and negative groups based on their anti-AT1-AR reactivity. Echocardiography and a 6-minute walk test were performed at baseline and after one year of perindopril therapy. The end-point events were compared over a 5-year follow-up.ResultsFinal analysis covered 138 patients, including 82 positive and 56 negative. The frequency and geometric mean titre of anti-AT1-AR were significantly lower in the positive group after one year of treatment (all P < 0.01, from 100% to 73.2% and from 1:125.3 ± 1.0 to 1:69.2 ± 1.1). Of these, 22 patients showed no antibodies. Both groups showed improvement in left ventricular end-diastole, end-systolic dimensions, ejection fraction, and a 6-minute walk test by perindopril in combination with standard treatment regime for one year (all P < 0.01). However, the 82 patients positive for anti-AT1-AR showed more pronounced improvement than the 56 negative patients (all P < 0.05). However, after 5 years of follow-up, the rate of all causes and cardiovascular mortality attributable to any cause and the re-hospitalisation rate showed no significant differences between the two groups (all P > 0.05).ConclusionsPerindopril treatment significantly decreased the frequency and geometric mean titre in patients positive for anti-AT1-AR, even to complete ablation. These patients showed greater improvement in left ventricular remodeling and heart function than negative that in patients after one year of perindopril treatment in combination with standard treatment, but no significant differences in endpoint events were observed in the following 5 years. Anti-AT1-AR might be a useful biomarker of over-activation of the renin-angiotensin-aldosterone system for clinical medication.

Effects of delayed percutaneous coronary intervention on left ventricle remodeling in patients with acute myocardial infarction

ObjectiveTo assess the effect of delayed percutaneous coronary intervention (PCI) on left ventricle remodeling after acute myocardial infarction (AMI).MethodsNinety six patients with ST-segment elevation acute interior wall myocardial infarction (AAMI)...

Neopterin predicts left ventricular remodeling in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Background Left ventricle remodeling (LVR) is a relatively common and unfavourable event occurring after acute myocardial infarction. A link exists between inflammation and LVR. Neopterin, a marker of inflammation and macrophage activation, is a predictor of left ventricular dysfunction in patients with coronary artery disease. We therefore sought to assess whether both neopterin and brain natriuretic peptide (BNP), a marker of LV dysfunction and patient outcome, correlate with LVR in patients with ST-segment elevation myocardial infarction (STEMI). Methods We prospectively assessed 108 STEMI patients (age 64 ± 11 years; 85% male) undergoing primary percutaneous coronary intervention (PCI) who were assessed echocardiographycally assessment was performed at 96 ± 10 h after the onset of symptoms and 12 month after STEMI. LVR was defined as >20% increase in LV end-diastolic volume at 12 months of follow-up compared to baseline. Neopterin and BNP serum concentrations were measured immediately before primary PCI. Results At 1 year, 21 patients (19%) showed LVR and 87 (81%) had no LVR. Patients with LVR had higher levels of neopterin at study entry (7.45 ± 1.04 vs 5.19 ± 1.39 nmol/L; p < 0.001). After adjustment for relevant confounders, neopterin levels were found to be an independent predictor of LVR (OR ranging from [3.10, CI 95% 1.928–4.990, p < 0.001] to [3.32, CI 95% 1.999–5.532, p < 0.001]). ROC analysis showed an area under the curve of 0.901 for neopterin (CI 95% 0.84–0.96, p < 0.0001) compared to 0.579 for BNP (CI 95% 0.409–0.748) regarding LVR. Conclusions In STEMI patients undergoing primary PCI, high neopterin levels – but not BNP – predict LVR at 1-year follow-up.