Left Ventricle Systolic Dysfunction Research Articles

Study of the relation between speckle tracking echocardiography and BODE index in patients with chronic obstructive pulmonary disease

Background Chronic obstructive pulmonary disease (COPD) is a widespread lung disease with a high mortality and morbidity especially with co-morbid cardiac impairment. Severity of COPD can be assessed using BODE Index (body mass index, obstruction of airflow, dyspnea degree and exercise capacity). Aim To study the relationship between BODE index and right ventricle (RV) and left ventricle (LV) functions using Two-dimensional speckle-tracking echocardiography (2D-STE) in COPD patients. Subjects and methods Fifty stable COPD patients and matched fifty control subjects underwent transthoracic echocardiography, where conventional and speckle tracking parameters were taken. BODE indices were calculated and divided to quartiles (Q) (Q1; BODE index = 0–2, Q2; BODE index = 3–4 Q3; BODE index = 5–6, Q4; BODE index = 7–10). Results COPD patients had lower RV fractional area change (FAC%, P Conclusion COPD patients had RV, LV systolic dysfunction and LV diastolic dysfunction. The more COPD severity increased (assessed by BODE index) the more impairment of RV systolic function and LV diastolic function would be.

P375 To evaluate the effectiveness of primary prevention of anthracycline cardiotoxicity using modern STE technologies

Abstract Funding Acknowledgements without financial supports Introduction Despite the high efficiency, the use of chemotherapeutic drugs involves to the development of cardiomyopathy and heart failure. Correction of myocardial damage is most effective before the appearance of clinical manifestations of cardiomyopathy. Aim of study. To evaluate the effectiveness of primary prevention of anthracycline cardiotoxicity using modern STE technologies. Material and methods.The study included 65 patients with breast cancer. All patients had a collection of anamnesis, echocardiography with STE , were performed before the study. All patients were prescribed chemotherapy with anthracycline, after which the patients included in the study were randomly randomized into two groups. Patients of the first group, in which 27 patients were included, were additionally assigned ivabradine in a daily dose of 10 mg, followed by titration of the dose to achieve a heart rate of less than 70 beats per minute. The comparison group consisted of 38 patients who received only chemotherapy. Results A six-month treatment with ivabradine was accompanied by a significant decrease in heart rate by the first month (from 83.6 ± 9.5 to 67.1 ± 7.5 bpm, p <0.001) and persisted until the sixth month (from 83.6 ± 9.5 Up to 74.2 ± 14.9 beats per minute, p <0.001). The analysis of echocardiographic indices did not reveal significant differences between the groups.The reliable dynamics of the LV ejection fraction was not detected in both groups.To assess the effect of ivabradine on the development of subclinical systolic dysfunction of the left ventricle during chemotherapy, a global longitudinal systolic deformation was also evaluated. The groups did not differ in terms of global longitudinal strain (-20.4 ± 1.8% in the ivabradine group and -19.9 ± 2.0% in the control group). In the control group, there was a tendency to decrease global deformation (from -19.9 ± 2.0% to -19.0 ± 1.8% by 3 months to -18.9 ± 1.7% by the 6th month of observation), and in Group of ivabradine, the deformation parameters were at a stable level (from -20.4 ± 1.8% to-20.6 ± 2.4% by 3 months and -20.4 ± 1.9% by the 6th month of observation), which led to significant differences between groups at the first and third and sixth month of observation (-21.1 ± 1.8% to 1 month and -20.6 ± 2.4% to 3 months and -20.4 ± 1.9% to 6 months in the ivabradine group compared to -19.6 ± 2.1% to 1 Month and -19.0 ± 1.8% by 3 months and -18.9 ± 1.7 by the 6th month of observation p <0.05 in the control group). Conclusions.Therapy with ivabradine in patients with breast cancer with heart rate> 70 beats per minute is safe. The appointment of ivabradine is accompanied by a significant decrease in the number of patients with complaints of heart beat, contributes to the preservation of normal global longitudinal deformation of the left ventricle against chemotherapy, while in the control group has a negative dynamics with a maximum at the 6th month of follow-up

Prognostički pokazatelji prve i ponovljene hospitalizacije kod pacijenata sa srčanim zatajivanjem s reduciranom ejekcijskom frakcijom lijeve klijetke

Heart failure with reduced ejection fraction (HFrEF) is a progressive clinical syndrome defined by changes in the myocardial structure, which lead to predominant systolic myocardial function impairment, with a left ventricle ejection of fraction ≤40%. The rehospitalization burden in HFrEF patients (pts) remains very high, with poor quality of life, increased mortality and large healthcare expenditures. In this research project, we investigated the risk factors for first and repeated hospitalization in pts with HFrEF. This retrospective study included 50 adult pts with a diagnosis of HFrEF and who were within the age range of 55 to 89 years old and of both sexes. Demographic and clinical data (HFrEF etiology, renal function parameters, complete blood count, markers of nflammation, electrocardiogram, troponin I, NTproBNP, echocardiographic parameters and comorbidities data) were collected from the pts’ medical histories. Statistical analysis was performed via Fischer’s exact test, the Shapiro-Wilk test and the Spearman correlation coefficient. This study included 70% male and 30% female HFrEF pts. Males were younger in both group of pts and had a higher incidence of rehospitalization. The most important HFrEF etiologic risk factors are arterial hypertension (82%), coronary heart disease (54%), atrial fibrillation (52%) and diabetes mellitus (40%). The most important noncardiac comorbidity related with the first HFrEF hospitalization is pneumonia (P=0.03), while progression of left ventricle systolic and diastolic dysfunction is related to rehospitalization risk (left ventricle end systolic diameter, P=0.003; diastolic dysfunction degree, P=0.04). The troponin level was associated with an increased risk of rehospitalization, but this was not statistically significant at this sample size (troponin I, p=0.10). Following the first and repeated hospitalizations of HFrEF pts, comorbidities, ageing and gender difference are crucial to HFrEF development, while echocardiographic parameters and biomarkers critically affect HFrEF rehospitalization risk.

89 Simultaneous ocurrence of hammock mitral valve and no-compaction cardiomyopathy

Abstract We report a 62-year-old man with a past medical history of dyslipidemia, paranoid schizophrenia and permanent atrial fibrillation. A ATTE performed at his district hospital revealed rheumatic mitral valve disease with double lesion: severe regurgitation and mild stenosis, plus moderate tricuspid regurgitation and a mean PAP of 32mm Hg. Cardiac catheterization showed no abnormalities of the coronary arteries. He was transferred to our hospital and scheduled for mitral valve replacement and tricuspid ring valvuloplasty. Preoperative transesophageal echocardiography showed an abnormal subvalvular mitral apparatus, with false tendons and multiple papillary muscles, resembling a hammock mitral valve. Most cordae tendinae arose from a single dominant papillary muscle at a posterior medial region, which provoke severe mitral regurgitation due to coaptation defect and mild subvalvular mitral stenosis. It could also be appreciated hypertrabeculation in the lateral medial, basal and apical segments. This suggested no-compaction cardiomyopathy associated with hammock mitral valve. Left ventricular systolic function was preserved. No evidence of rheumatic mitral valve disease was found in transesophageal echocardiographic study performed at our hospital. On the 30th April 2019 he underwent mechanic mitral valve replacement (Bicarbon 29mm) and tricuspid ring valvuloplasty (Edwards Physio 32mm) surgery. Once the patient was weaned from cardiopulmonary bypass, severe left ventricle systolic dysfunction ensued, predominantly localized in the anterior, inferior septal, inferior lateral basal and medial segments. Apical segments had preserved mobility An adrenalin infusion prior weaning from CBP was initiated. Preserved mobility of the mitral prosthesis discs was observed. The patient developed cardiogenic shock in spite of high doses of dobutamin and adrenaline infused. IACB was implanted with 1:1 assistance. The patient was transfered to the hemodynamic room in order to rule out coronary complications. Cardiac catheterization showed no significant angiographic lesions. During the first postoperative hours, the patient was stabilized allowing progressive lowering of the drugs (adrenaline, dobutamine). TTE showed normally functioning prosthetic mitral valve and preserved left ventricle systolic function. An MRI was performed demostrating no-compaction cardiomyopathy Conclusion This case report describes a rare presentation of simultaneous ocurrence of hammock mitral valve and no-compaction cardiomyopathy. Perioperative left ventricle dysfunction in no-compaction cardiomyopathy is related to subendocardial ischemia caused during extracorporeal circulation in the multiple prominent ventricular trabeculations with deep intertrabecular recesses corresponding to non-compacted myocardium .This must be taken account in those patients with no-compaction cardiomyopathy scheduled for cardiac surgery in order to take preventive measures. Abstract 89 Figure. non - compacted myocardium

P1430 Analysis of echocardiographic study findings prior to an allogeneic hematopoietic stem cell transplantation

Abstract Allogenic hematopoietic stem cell transplant (Alo-HSTP)has been a therapeutic revolution for patients with hematologic malignancies. Even though this therapy is associated with a high risk of cardiovascular (CV) events during follow-up, a baseline cardiology study is currently not standardised in most centers. Our aim was to analyse transthoracic echocardiogram (TTE) findings in patients candidates to Alo-HSTP. We undertook a retrospective and descriptive analysis that included all patients treated with Alo-HSTP in our center between 2016-2019. Baseline characteristics and TTE findings including global longitudinal strain (GLS) were analysed. We analyzed 144 patients (mean age 50 years, 60% males). Acute myeloblastic leucemia (38%) and non-Hodgkins lymphoma (18%) were the most frequent diseases. Figure. 18 patients (13%) had hypertension, 13% had dyslipidemia and 6% diabetes mellitus. Almost 10% had previous CV history. TTE found left ventricle systolic dysfunction (LVEF< 53%) in 10% of patients, diastolic dysfunction in 12%, valvular heart disease in 4 patients (5,5%) and GLS was abnormal (>-19%) in 35 patients (24%). Up to 47 (33%) patients studied has an abnormal TTE finding. Table. More than one third of patients candidates to Alo-HSTP had an abnormal TTE finding, increasing the risk for CV events during follow-up. A cardiologic study by the Cardio-Onco-Hematology team in these patients before Alo-HSTP could improve their prognosis. Age (years) 50 ± 18 Male (n,%) 86 (60%) Hypertension (n,%) 18 (13%) Diabetes mellitus (n,%) 8 (5,6%) Dyslipidemia (n, %) 18 (13%) Past or current smoking (n, %) 25 (18%) Previous cardiovascular history (n, %) 13 (9,3%) Abnormal TTE (n, %) 47 (33%) LVEDV(ml) 99 ± 29 LVESV (ml) 37 ± 16 LVEF (%) LV dysfunction (n, %) 63 ± 8 15 (10,4%) e/e´ Elevated filling pressures (n, %) 8,2 ± 7,3 4 (3%) Valvular heart disease (≥moderate) (n, %) Mitral Aortic Tricuspid 3 (2%) 4 (3%) 1 (1%) GLS (%) abnormal GLS , >-19% (n, %) -20,4 ± 2,8 35 (24%) LVEDV: Left ventricle end-systolic volume, LVESV: Left ventricle end-systolic volume, LVEF: Left ventricle ejection fraction, GLS: global longitudinal strain Abstract P1430 Figure. Haematologic malignancies

T-Peak to T-End Improvements After Beta-Blocker Administration in Peripartum Cardiomyopathy Patients.

BackgroundMany studies have shown that T-peak to T-end (TPTE) interval was associated with sudden cardiac events. Peripartum cardiomyopathy (PPCM) causes reversible left ventricle systolic dysfunction which may deteriorate into sudden cardiac death. This study aimed to evaluate beta-blocker as an antiarrhythmic agent to improve TPTE interval as a prognostic value of sudden cardiac death.MethodsA cohort experimental prospective study was performed. The PPCM was diagnosed from the emergency ward. A total of 54 cases were identified from 2014 to 2016. Thirty-four patients were followed up for further analysis. Electrocardiograms were conducted in all the patients, and TPTE interval was measured. After a follow-up of 6 months of beta-blocker treatment, the echocardiography and TPTE interval were measured again to obtain the repolarization heterogeneity.ResultsThe mean age of subjects was 32 ± 6.4 years. The mean left ventricular ejection fraction (LVEF) was 32.24±6.3%. The mean TPTE interval was 123.7 ± 28.2 ms. After 6 months of beta-blocker administration, the mean LVEF was 58.26±4.4% and the mean TPTE was 98.7 ± 39.5 ms. The paired t-test showed a significant difference between TPTE interval pre- and post-administration of beta-blocker (P value < 0.001).ConclusionsThere is an improvement of TPTE in PPCM patients after 6 months of beta-blocker administration. Administration of beta-blocker in PPCM patients is expected to prevent sudden cardiac death in PPCM populations.

P850 Role of echocardiography in a patient with heart failure and multiple cerebral strokes

Abstract A 78 years old male with a history of hypertension and heart failure from 10 years before presented to our hospital with dyspnea, transient loss of consciousness and fatigue. He also had a history of frequent transient ischemic attacks previously with the most recent one being one year before. He was on standard heart failure treatment without any echocardiography done during the past year. On physical examination, he had stable blood pressure and heart rate but increased respiratory rate and respiratory distress. He also had aphasia and rales in the base of his lungs. His oxygen saturation was 70% and was admitted in the intensive care unit. On baseline laboratory data he had a creatinine level of 3.6 mg/dl. After treatment with furosemide and oxygen (O2) therapy and stabilization, brain computed tomography (CT) was done for the patient which showed an old stroke in the territory of right posterior cerebral artery and a new stroke in the territory of the inferior division of the middle cerebral artery (shown in part A of the figure). Echocardiography was done for the patient which showed a large mobile apical left ventricle (LV) clot and moderate LV systolic dysfunction (Three chamber view is shown in part B of the figure) . He was put on anticoagulation and was a candidate for referral to a tertiary center for surgery but after consult due to his acute renal failure and taking in mind his own and family concerns and their refusal for surgery he stayed at our center for continuing his treatment. Unfortunately, after 2 days of treatment, his brain status deteriorated and he had more ischemic brain symptoms for which brain CT scan was done which showed a new infarct in the upper parietal lobes (shown in part C of the figure). Echocardiography was repeated (Three chamber view shown in part D of the figure) which showed a smaller LV clot which was possibly due to a partial detachment of the clot and embolization into the cerebral arteries. With heart failure treatment and proper hydration his creatinine level reduced to 1.1 mg/dl after 6 days of treatment but because of respiratory infection and distress he was intubated and put on mechanical ventilation (Lung CT scan is shown in part E of the figure). He was then put on antibiotic treatment and anticoagulation was done with heparin. His INR level increased and he had a high bleeding tendency which forced us to discontinue anticoagulation. Although his vital signs were stable all through treatment but unfortunately after 14 days of treatment he had bradycardia and asystole and did not respond to cardiopulmonary resuscitation. Conclusion: The case describes a patient with heart failure and multiple cerebral strokes because of an LV clot diagnosed by echocardiography. The case emphasizes the difficulties faced while treating a heart failure patient with co-morbid conditions and the role of echocardiography in diagnosis and guiding management. Abstract P850 Figure

414 Ventricular-arterial interaction predicts response to cardiac resynchronization therapy: a link with improvement of endothelial function and arterial elastic properties

Abstract Background Endothelial dysfunction (ED) is a hall mark of chronic heart failure and has been linked to disease progression, hospitalizations and mortality. Purpose to evaluate the impact of cardiac resynchronization therapy (CRT) in ED and to determine predictors of response to CRT Methods CRT recipients from 19/07/2016 until 19/10/2018 were studied at baseline and 3 months after. In each visit we evaluated a 12 lead ECG, carotid to femoral pulse wave velocity (cfPWV), flow-mediated dilatation of the brachial artery (FMD), left ventricle ejection fraction (LVEF) and left ventricle (LV) global longitudinal strain (GLS). We evaluated arterial elastance (Ea) to ventricular elastance (Ees) ratio (Ea/Ees) by echocardiography and the ratio of cfPWV to GLS, as valid markers of ventricular-arterial interaction. We also assessed the layer of endothelial glycocalyx by measurement of Perfused Boundary Region (PBR) of the sublingual microvessel range:5-25 microns. Results 32 patients with a mean age 65.5 (±10.9) years and severe LV systolic dysfunction were enrolled. During follow-up, LVEF, GLS, LVESV and all ED markers exhibited significant improvement (table 1). 23 patients were responders. Among the baseline vascular function markers, only the ratio cfPWV/GLS predicted response to CRT (OR: 0.245, 95%CI: 0.042-0.759, p = 0.044).Threshold analysis showed that the best threshold of cfPWV/GLS for response to CRT was 2.75 (specificity: 0.67%, sensitivity: 0.94%). Conclusions After 3 months of CRT, endothelial function, arterial elasticity and ventricular arterial interaction are improved. The baseline ratio cfPWV/GLS, a novel marker of ventricular arterial interaction, can be applied to predict response to CRT. table 1 Baseline Follow-up Change Measurement mean (sd) mean (sd) mean (sd) p-value SBP (mmHg) 126 (19) 128 (16) 2.18 (11.98) 0,465 DBP (mmHg) 79 (9) 80 (9) 1.06 (8.58) 0,618 LVEF (%) 27 (7) 35 (9) 7.50 (4.77) &amp;lt;0.001 LVESV (mL) 151 (42) 120 (46) -26.91 (17.20) &amp;lt;0.001 GLS (%) 6.47 (2.89) 9.33 (4.18) 2.85 (2.28) &amp;lt;0.001 FMD (%) 5.88 (2.79) 10.25 (3.67) 4.37 (3.34) &amp;lt;0.001 Ea/Ees 2.81 (1.10) 2.04 (0.99) -0.77 (0.47) &amp;lt;0.001 cfPWV 11.11 (2.61) 10.01 (2.45) -1.10 (1.56) 0,003 PBR 5-25(microns) 2.26 (0.20) 2.14 (0.24) -0.13 (0.25) 0,028 cfPWV/GLS 2.18 (1.46) 1.45 (1.11) -0.73 (0.55) &amp;lt;0.001 Measurements at baseline, follow-up and their change during study Abstract 414 Figure. picture 1

P664 Relationship of left atrial function assessed by 2D speckle tracking echocardiography with left ventricular systolic function in patients with degenerative mitral regurgitation

Abstract Funding Acknowledgements none Background In degenerative mitral regurgitation (DMR), left ventricle (LV) and left atrium (LA) undergo progressive volume overload leading to chamber remodelling and dysfunction in advanced stages. Speckle tracking echocardiography (STE) is an estabilished technique able in detecting subclinical LA and LV dysfunction in this setting. However data are lacking on the relationship of LA and LV function in DMR patients. Purpose Our aim was to assess LA function in patients with DMR and to explore its possible correlations with LV dimensions and systolic function. Methods We enrolled 95 patients with mild to severe DMR, dichotomizing them on the basis of mitral regurgitation severity (DMR 1-2: mild and mild-to-moderate MR; DMR 3-4: at least moderate to severe MR). LA function was assesed with 2D speckle tracking echocardiography. Results The two groups were well matched. DMR 3-4 group (n= 48) showed higher LA and LV volumes, lower right ventricle longitudinal systolic function and higher values of systolic pulmonary pressure. There was not significant difference in LV ejection fraction (LVEF) and global longitudinal strain (GLS). Among LA function indexes, only peak systolic reservoir strain was significantly reduced in DMR 3-4 group (21,9± 6,2% vs 24,7± 7,2% ; p= 0,04). Then population study was further divided in two groups according to the presence (LA dys+) or absence (LA dys-) of LA dysfunction, defined as reservoir strain values below the median [median 23.7%; LAdys- group (n. 49), LAdys+ group (n.46) ]. At the comparison of continuous variables (Tab.1), LAdys+ group showed larger LV end systolic diameter and more impaired LVEF (60,9± 9,8% vs 65,4± 4,8%; p: 0,004) and GLS (20,04 ± 3,7% vs 23,53 ± 2,7%; p &amp;lt;0,001). Conclusions Our data showed that LA reservoir strain was impaired in patients with moderate to severe DMR. Furthermore, patients with LA dysfunction showed reduced LVEF and GLS values. Consequently, LA dysfunction assessed with STE may be a novel marker of early LV systolic dysfunction in patients with degenerative mitral regurgitation. Tab.1 LAdysf- (n = 49) LAdysf+ (n = 46) P value LVESD (mm) 31.78 ± 4.1 34.74 ± 7.6 0.020 LAVI (mL/mq) 44.5 ± 15.1 55.6 ± 25.6 0.015 TAPSE (mm) 26.30 ± 3.96 24.02 ± 3.31 0.004 sPAP (mmHg) 31.4 ± 7.0 36.4 ± 10.9 0.009 LVEF (%) 65.4 ± 4.8 60.9 ± 9.8 0.004 GLS (%) 23.5 ± 2.7 20.0 ± 3.7 &amp;lt;0.001 Comparison of continuous variables between patients with and without LA dysfunction.

P253 Withdrawal of beta- blockers and ACE inhibitors after left ventricular systolic function recovery in patient with dilated cardiomyopathy randomized control trial

Abstract Funding Acknowledgements The Rosenfeld Heart Fund Introduction recovery of left ventricle (LV) systolic function with normalization of ejection fraction (LVEF) occurs in 10 - 27% of patients with 80% maintaining recovery. However, the need for medical therapy after recovery is often questioned. Previous randomized studies of treatment withdrawal were small, not selected for non-ischemic dilated cardiomyopathy (DCM) and had a reference of improved or recovered EF to &amp;gt; 40% or &amp;gt; 10% change from LVEF at time of diagnosis. Hypothesis: In patients with DCM with recovery of the LV systolic function to an EF (&amp;gt;50%), medical therapy withdrawal is possible without rebound LV systolic dysfunction. Method: This was a pilot randomized control open-label trial with 2:1 randomization for withdrawal of b-blockers and ACE inhibitors in patients with recovered LV systolic function. Patients’ medication discontinuation occurred in 2 phases with a six-month interval and patients were followed for one year. The primary endpoint was LVEF reduction (&amp;lt; 40%). Results: There were 22 patients (10 females) enrolled. The mean age was 60 ± 12y. The mean LVEF at enrollment was 58 ± 5% with no significant difference in the mean LVEF in both groups. Sixteen patients were assigned to the withdrawal group and 6 assigned to the control group. The primary endpoint occurred in 31% of the withdrawal group compared to none of the control. The rate of 1ry outcome after withdrawal of medical therapy was 19%, p-value 0.15. The mean LVEF at 1 year for the treatment withdrawal group was 46.8 ± 12% and control 55 ± 6%, p-value 0.15. In the medication withdrawal group, the mean LVEF reduction was 10.6 ± 11% and the difference between the mean LVEF at enrollment and at 1 year was 10.6 ± 11% with 95% CI (4.6,16.49), p-value 0.0017. Conclusion: In DCM patients with recovery of LV systolic function, we observed worsening of LVEF after withdrawal of b-blockers and ACE inhibitors. Abstract P253 Figure.

P1687 When the easiest answer is the right one

Abstract A 42 year-old woman presented with moderate exertion dyspnea within the past months. She was hypertensive, with end stage-chronic kidney disease (CKD) on hemodialysis for 8 years, initially by arteriovenous fistula and then by central venous catheter. She associated thrombosis of both common femoral veins. Clinical examination revealed mild leg edema, hepatomegaly, III/VI systolic murmur, left brachiocephalic arteriovenous fistula with aneurismal dilation and subclavian central venous catheter. Resting ECG showed atrial flutter with variable block and biventricular hypertrophy. Lab studies highlighted mild anemia, glomerular filtration rate (MDRD) 13.5 ml/min/1.73m2, hyperhomocysteinemia. Transthoracic echocardiography revealed left ventricle (LV) with normal diameters and mild concentric hypertrophy, mild systolic LV dysfunction and diastolic dysfunction (Fig A), dilation of both atria, mild mitral regurgitation, dilated RV with moderate global dysfunction, moderate tricuspid regurgitation and secondary pulmonary hypertension (PH) with estimated systolic pulmonary artery pressure of 79 mmHg (Fig C), moderate pulmonary regurgitation, moderate dilatation of pulmonary artery. Vascular Doppler ultrasonography showed thrombosis of the arteriovenous fistula and of right jugular vein. To confirm PH, right heart catheterization was necessary. The intervention could not be realized on femoral approach due to thrombosis of both common femoral veins. We considered the jugular approach, but weighing the risks/benefits balance, with one functional jugular vein, we decided not going for it, as the jugular approach was the only vascular approach for dialysis. We performed left catheterization right after a dialysis session and an LV end-diastolic pressure of 13 mmHg was measured. The possible causes of PH considered in this case were the CKD by itself, a pulmonary thromboembolic component in a patient with hyperhomocisteinemia and thrombosis of both femoral veins and a left heart component given the borderline value of LV end-diastolic pressure. The patient received treatment with beta-blockers, blockers of the renin-angiotenins-aldosterone system, calcium channel blockers and oral anticoagulation. She was evaluated after two months describing improvement of symptoms. The resting ECG showed sinus rhythm and the echocardiography revealed improved parameters of LV diastolic function (Fig B), with reduction of systolic pulmonary artery pressure (Fig D) and improvement of right heart parameters. PH is a frequent complication in patients with CKD on hemodialysis. Possible mechanism of its development include RV overload with increased pulmonary flow or creating a fistula with an increased flow through arteriovenous shunt. Thromboembolic complications and hyperhomocysteinemia are other frequent findings in these patients. Despite all the above, the left heart involvement with LV diastolic dysfunction remains a common and amendable cause of PH in this setting. Abstract P1687 Figure.

Evaluation of cardiac performance among asymptomatic obese subjects in comparison with normal individual

Background: Obesity constitutes a major health issue in the modern world. The purpose of this prospective study was to assess the effect of obesity on ventricular function by conventional 2D echocardiography and echocardiogram for assessment of early cardiac changes.Methods: In the present study, 50 asymptomatic obese subjects having BMI &gt;30 were compared with 50 normal individuals having BMI in the range 20-24.9 to assess cardiac performance. The study was conducted over a period of 2 years, from 2009 to 2011.Results: There were 20(40%) males and 30(60%) females in both the groups. The ejection fraction was not significantly affected in obese subjects (60.86±1.34%) than normal individual (60.42±1.18%) which was found to be statistically not significant. So, in this study systolic function was not affected. The thickness of left ventricle was significantly increased in obese subjects (1.016±0.113 cm) than normal individual (0.77+0.073 cm) which was found to be statistically significant.Conclusions: The current study revealed increased wall thickness and mass of Left Ventricle (LV), significantly increased risk of LV diastolic dysfunction, evidence of Left Atrial (LA) enlargement associated with diastolic dysfunction, evidence of subclinical LV systolic dysfunction and Right Ventricular (RV) dysfunction among obese subjects in comparison with normal individuals.

Global longitudinal strain can predict heart failure exacerbation in stable outpatients with ischemic left ventricular systolic dysfunction.

BackgroundDespite advancements in pharmacological and device-based treatment, heart failure (HF) continues to impose an enormous burden for health care system worldwide. Decompensation of HF is one of the main causes of hospitalization, therefore the identification of patients with the highest risk of such complication is still of great clinical importance. The prognostic significance and utility of global longitudinal strain (GLS) has been previously studied in patients with the broad spectrum of cardiovascular diseases in various endpoints, however its role in assessing the risk of hospitalization due to HF exacerbation of optimally treated outpatients has not been fully explored. Therefore, the aim of the study was to verify whether the GLS of the left ventricle (LV) derived by 2D speckle tracking echocardiography has, independently of other well-known clinical parameters, an additional impact on the risk of HF decompensation in stable patients with LV systolic dysfunction of ischemic origin.MethodsIn 193 clinically stable HF outpatients with LV ejection fraction (LVEF) ≤ 50%, GLS, additionally to other clinical parameters, was analyzed. During 34 (14–71) months of follow-up, 58 patients were hospitalized due to HF decompensation (EVENT).ResultsEVENT was significantly associated with age, QRS width, NYHA functional class, left atrium diameter, LV systolic and diastolic volume, LVEF, hemoglobin, brain natriuretic peptide, diuretic treatment, absence of beta-blockers, impaired renal function and history of diabetes in univariate Cox analyzes. GLS with pre-specified cut-off value of -9.4% was also significantly associated with the EVENT (HR 15.16; 95% CI 1.81–126.91). After adjusting for above-mentioned parameters GLS was still a significant predictor of hospitalization due to HF decompensation.ConclusionsGLS measurement can provide incremental information on the risk of HF decompensation in stable outpatients with LV systolic dysfunction of ischemic origin.

Myocarditis Causing Premature Ventricular Contractions

Premature ventricular contractions are a common clinical presentation that drives further diagnostic workup. We hypothesize the presence of underlying inflammation is often unrecognized in these patients with a potential for continued disease progression if not diagnosed and treated early in the disease course. This is a single-center, prospective study including 107 patients with frequent symptomatic premature ventricular contractions (>5000/24 h) and no known ischemic heart disease. Patients underwent a combination of laboratory testing, 18F-fluorodeoxyglucose positron emission tomography scan, cardiac magnetic resonance imaging, and biopsy. Patients were diagnosed with myocarditis based on a multidisciplinary approach and treated with immunosuppressive therapy. The mean age of the cohort was 57±15 years, 41% were males, and left ventricular ejection fraction was 47±11.8%. Positive positron emission tomography scan was seen in 51% (55/107), of which 51% (28/55) had preserved left ventricle function. Based on clinical profile, 18F-fluorodeoxyglucose-positron emission tomography imaging, cardiac magnetic resonance, and histological data 58% patients (32/55) received immunosuppressive therapy alone and 25.4% (14/55) received immunosuppressive therapy and catheter ablation. Optimal response was seen in 67% (31/46) over a mean follow-up of 6±3 months. In patients with left ventricle systolic dysfunction, 37% (10/27) showed an improvement in mean left ventricular ejection fraction of 13±6%. Approximately 51% of patients presenting with frequent premature ventricular contractions have underlying myocardial inflammation in this cohort. 18F-fluorodeoxyglucose-positron emission tomography scan can be a useful modality for early diagnosis and treatment with immunosuppressive therapy in selected patients can improve clinical outcomes.

Effects of chronic cigarette smoking on myocardial deformation parameters by two-dimensional speckle tracking echocardiography.

Cigarette smoking causes myocardial damage with several mechanisms such as sympathetic nervous system activation, oxidative stress, and endothelial dysfunction. Chronic smokers have an increased risk of morbidity and mortality associated with cardiac events. We aimed to compare the myocardial deformation parameters between chronic smokers and nonsmoker healthy population. Forty-two healthy participants (mean age 33.48±10.00years) without smoking history, 40 participants (mean age 33.98±9.27years) who had been smoking were prospectively included. In addition to conventional echocardiographic measurements, global longitudinal strain (GLS) of left ventricle (LV), GLS of right ventricle (RV), left atrial strain, and strain rate were analyzed. Smokers had lower peak early diastolic velocity (E) and E/a (early diastolic velocity/late diastolic velocity) ratio in mitral inflow (70.0±13.9cm/sec vs 77.1±13.3cm/sec, P=.023; 1.4±0.4 vs 1.7±0.4, P=.011; respectively). Peak early diastolic velocity of mitral valve septal annulus (Em) and Em/Am ratio (peak early diastolic velocity of mitral valve/late diastolic velocity of mitral valve)(11.0±2.1cm/sec vs 12.1±2.4cm/sec, P=.023; 1.2±0.3 vs 1.4±0.4, P=.039; respectively) were lower in smokers. LV GLS and RV GLS were significantly lower in smokers (-17.6%±3.01 vs -19.2%±2.5; P=.013, -18.9%±4.4 vs -21.0%±4.5; P=.039; respectively). Impaired LV and RV deformation were found in chronic smokers in our study. Although there was no statistically significant difference with left ventricular ejection fraction, LVGLS which is the early indicator of LV systolic dysfunction was lower in chronic smokers. The assessment of early harmful effects of smoking on left and right ventricle might be evaluated with speckle tracking echocardiography.

Wild at heart: 34-year-old male with new onset dyspnea, heart failure and history of amphetamine use; a case report

BackgroundSpontaneous coronary artery dissection (SCAD) is a rather rare cause of acute coronary syndrome with a preponderance for young female patients. Amphetamines are now the second most widely used substance drugs in the world and they are associated with a myriad of cardiac diseases including cardiomyopathies and SCADs. There is much uncertainty regarding the best treatment strategy in such cases and decision-making remains mostly individualized and based on expert opinions.Case presentationA 34-year-old male with an unremarkable past medical history presented to a cardiologist with prominent dyspnea and orthopnea. He reported occasional methamphetamine use from 3 years before the presentation. An echocardiogram showed an enlarged left ventricle and severe systolic dysfunction with an ejection fraction of 10–15%. Coronary angiography revealed multiple linear dissections in both left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX). The patient’s right coronary artery (RCA) showed occlusion in the proximal segment. The patient was diagnosed with amphetamine-induced spontaneous coronary artery dissection and resultant ischemic cardiomyopathy. After thorough evaluation, medical treatment ensued.ConclusionsMethamphetamine abusers have a 3.7 fold risk of developing some form of a cardiomyopathy in comparison to individuals without amphetamine abuse. Coronary artery dissection and increased thrombus burden are some of the mechanisms responsible for ischemic cardiomyopathy in these groups of patients.

P6403Predictors of bleeding in elderly patients with myocardial infarction: data from the real world

Abstract Background The population of elderly patients with acute myocardial infarction (MI) is clearly underrepresented in contemporary clinical trials. This population presents a higher risk of both cardiovascular and bleeding events, making the decision of the antithrombotic strategy particularly challenging. Purpose To characterize the antithrombotic therapy used in patients with MI and age ≥75 years, and to identify predictors of major bleeding and cardiovascular events in this population. Methods Retrospective analysis of patients with a diagnosis of MI and age ≥75 years included in the Portuguese Registry of Acute Coronary Syndromes between October 2010 and January 2018. Logistic regression analysis was used to identify predictors of major bleeding and of the combined endpoint of in-hospital mortality and reinfarction. Results The analysis included 17.868 patients of which 30.1% with age ≥75 years. This population had a mean age of 82±5 years, 57% were male and 36% had a diagnosis of STEMI. On admission 10% presented with Killip-Kimball (KK) class III or IV, 14% were on atrial fibrillation (AF), and the mean Hb and creatinine levels were 13±2 g/dl and 1.6±1.2 mg/dl, respectively. In comparison with younger patients, this population had higher Grace and Crusade scores (178 vs 139, and 41 vs 24, respectively). Most elderly patients (74%) underwent coronary angiography (71% by radial artery access) and 75% were submitted to percutaneous revascularization, 9% to surgery, and 1% to an hybrid strategy. Aspirin was used in 96% of patients, clopidogrel in 82%, ticagrelor in 13% (vs 25% of younger patients; p&lt;0.001), and glycoprotein IIb/IIIa inhibitors (GPI) in 11%. Most patients were anticoagulated with enoxaparin (68 vs 56% of younger patients; p&lt;0.001), 22% with unfractionated heparin (vs 30%; p&lt;0.001), and 13% with fondaparinux (vs 14%; p=0.018). Complications were more common in the elderly population, including mechanical complications (1 vs 0.5%), atrioventricular block (5 vs 3%), stroke (1 vs 0.6%), major bleeding (3 vs 1%), in-hospital death (8 vs 2%) and reinfarction (2 vs 1%) (p&lt;0.001 for all). In multivariate logistic regression analysis, the predictors of major bleeding were diastolic blood pressure (BP) on admission &lt;50 mmHg, maximum creatinine ≥2 mg/dl and the use of GPI. The predictors of the combined endpoint were a diagnosis of STEMI, previous history of cancer, chronic kidney disease or demencia, and the presence on admission of an heart rate &lt;60 bpm, systolic BP &lt;90 mmHg or ≥180 mmHg, KK class &gt; I, AF, left bundle branch block, and left ventricle systolic dysfunction. Conclusions This study reflects the contemporary national reality of the management of elderly patients with MI. Overall, this population has a high risk of major bleeding, but several characteristics are associated with an even higher risk, such as the hemodynamic profile, renal function, and the use of GPI.

P1610The genetic background of the disease in a group of patients with severe course of hypertrophic cardiomyopathy

Abstract Background End-stage hypertrophic cardiomyopathy (esHCM) indicates the most progressive form of HCM with progression to left ventricle remodeling and systolic dysfunction and is common indication to heart transplant. It affects 2.4–15.7% of HCM cases and is associated with a poor prognosis (mortality in this group of patients reaches 11%). Purpose In this study patients with esHCM were investigated using next generation sequencing in order to examine the genetic causes of the most severe course of the disease. Despite huge amount of data from many studies, a clear genotype-phenotype correlation is still lacking and predictive value of genetic testing is sometimes undermined. However, there is an ongoing need for a prediction factors in HCM patients. Methods Fifty seven patients (21 male, 36.8%) with esHCM were genetically investigated with next generation sequencing of a TruSight Cardio panel by Illumina that provides coverage of 174 genes with known associations to cardiac conditions including cardiomyopathies (n=52) or custom panel of 35 cardiomyopathies genes (n=5). Results Disease-causing variants where found in 47 probands (82.5%). Thirty-two probands (77.2%) had a single pathogenic or potentially pathogenic mutation in one of the sarcomeric genes: MYBPC3 (13, 22.8%), MYH7 (11, 19.3%), TNNT2 (3, 5.3%), TNNI3 (3, 5.3%), MYL3 (1, 1.8), TPM1 (1, 1.8%). In 13 (22.8%) probands we found a double mutation: in 7 (12.3) both variants sarcomeric (MYBPC3 and TNNT2 with MYH7, MYBPC3 and ACTA1) and in 5 (8.8%) one sarcomeric and the second non-sarcomeric cardiomyopathy variant (BAG3, ILK, PRKAG2, RBM20, SCN5A). In 3 (5.3%) probands we identified mutations or potentially disease-causing variants in genes associated Danon disease (LAMP2), glycogen storage disease of heart (PRKAG2) and double mutation FHL1 + PTPN11 (myopathy/Emery-Dreifuss muscular dystrophy and Noonan syndrome). In 10 (17.5%) patients, genetic examination did not reveal a candidate for disease-causing mutation. Surprisingly, a half of them had documented familial history of the disease. The majority of mutations in MYBPC3 were truncating variants (14/18, 78%). Thirty-three probands (57.9%) had a heart transplant or qualification to the procedure. Conclusion Despite a similar background of typical HCM and esHCM and still ambiguous genotype-phenotype correlation, results may indicate that certain mutations (and not genes) may determine a more severe course of the disease. The majority of truncating variants in MYBPC3 gene may suggest their very strong impact on the course of the disease. Also, 3 neighboring variants in TNNT2 gene indicate a hot spot region for esHCM in our population. As expected, in single cases esHCM was related to specific non-sarcomeric genes (LAMP2, PRKAG2, FHL1). 17.5% of unsolved cases suggests that in such cases whole exome/genome sequencing might be needed to recognize the disease-causing mutation, especially when disease is familial. Acknowledgement/Funding This work was supported by a grant 2.7/II/17 from the Institute of Cardiology, Warsaw, Poland.

P4134Impaired left ventricular systolic function in alcohol abusers expressed by both 3D calculated ejection fraction and longitudinal strain by AFI

Abstract Aim Despite knowledge regarding the existence of alcohol cardiomyopathy the exact impact of alcohol abuse in consecutive subject is poorly examined. We aimed to evaluate the left ventricle (LV) function in chronic abusers group and compared classical and novel echocardiography parameters in alcohol abusers (ALC) and control group (C). Methods We compared 75 adults (mean age 48±12, 60 male) without other overt heart disease, coronary artery disease excluded, but with alcohol abuse history: average alcohol intake 32 alcohol unit per week (AUW) with control group consisted of 40 subjects without history of excessive drinking, abstinents or drinking ≤8 AUW (mean age 50±4, 16 men). One unit was defined as 10 grams of pure etanol. All patients underwent TTE examination including ejection fraction (EF) calculation with 3D and longitudinal strain assessment by AFI method. Results ALC group showed LV systolic dysfunction expressed as EF 48±14 vs 60±9%, global longitudinal strain (AFI GLS) −15.6±6.6 vs −18.7±3.4; p&lt;0.0001 and p 0.0064, respectively. On the other hand the LV and left atrial diameters as well as diastolic function were similar in both groups, indicating on relatively low advancement of heart remodeling. ALC vs Control group comparison ALC N75 C N40 p value Age 48±12 50±4 ns BMI 24±6 28±6 0.0009 LVd 48±13 47±4 ns LVs 34±15 32±4 ns LA 38±9 38±3 ns EF 48±14 60±9 &lt;0.0001 E/A 1.1±0.6 1.1±0.3 ns E' lateral 10.6±3.9 10.6±2.9 ns AFI 2ch −15.9±6.9 −18.8±4.8 0.0143 AFI 3ch −15.9±6.9 −18.9±3.6 0.0116 AFI 4ch −15.2±7.1 −18.6±3.5 0.0053 AFI GLS −15.6±6.6 −18.7±3.4 0.0064 Conclusions Chronic alcohol abuse revealed harmful effect on LV systolic function which can be assessed quantitatively by both decreased EF and absolute values of myocardial longitudinal strain. This systolic function impairment seems to anticipate the overt remodelling of the heart.

Reversal of angiotensin-(1–12)-caused positive modulation on left ventricular contractile performance in heart failure: Assessment by pressure-volume analysis

BackgroundAngiotensin-(1–12) [Ang-(1–12)] is a renin-independent precursor for direct angiotensin-II production by chymase. Substantial evidence suggests that heart failure (HF) may alter cardiac Ang-(1–12) expression and activity; this novel Ang-(1–12)/chymase axis may be the main source for angiotensin-II deleterious actions in HF. We hypothesized that HF alters cardiac response to Ang-(1–12). Its stimulation may produce cardiac negative modulation and exacerbate left ventricle (LV) systolic and diastolic dysfunction. Methods and resultsWe assessed the effects of Ang-(1–12) (2 nmol/kg/min, iv, 10 min) on LV contractility, LV diastolic filling, and LV-arterial coupling (AVC) in 16 SD male rats with HF-induced by isoproterenol (3 mo after 170 mg/kg sq. for 2 consecutive days) and 10 age-matched male controls. In normal controls, versus baseline, Ang-(1–12) increased LV end-systolic pressure, without altering heart rate, arterial elastance (EA), LV end-diastolic pressure (PED), the time constant of LV relaxation (τ) and ejection fraction (EF). Ang-(1–12) significantly increased the slopes (EES) of LV end-systolic pressure (P)-volume (V) relations and the slopes (MSW) of LV stroke wok-end-diastolic V relations, indicating increased LV contractility. AVC (quantified as EES/EA) improved. In contrast, in HF, versus HF baseline, Ang-(1–12) produced a similar increase in PES, but significantly increased τ, EA, and PED. The early diastolic portion of LV PV loop was shifted upward with reduced in EF. Moreover, Ang-(1–12) significantly decreased EES and MSW, demonstrating decreased LV contractility. AVC was decreased by 43%. ConclusionsIn both normal and HF rats, Ang-(1–12) causes similar vasoconstriction. In normal, Ang-(1–12) increases LV contractile function. In HF, Ang-(1–12) has adverse effects and depresses LV systolic and diastolic functional performance.