Left Ventricle Systolic Function Research Articles

Assessment of left ventricular myocardial deformation according to Speckle-tracking echocardiography in the long-term period in patients with takotsubo syndrome

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): North-Western State Medical University named after I.I. Mechnikov Complete improvement of left ventricle systolic function is an essential feature of takotsubo syndrome (TTS). Speckle -tracking echocardiography (STE) provides quantitative information about myocardial deformation, more accurately than conventional echocardiography. Objective to assess the global longitudinal strain (GLS) and global circumferential strain (GCS) by speckle-tracking echocardiography in patients with TTS in the long-term period. Materials and methods 14 female with TTS were monitored, average age 57.5 ± 28.5. The diagnosis was verified by ventriculography and echocardiography. 1 year after the attack, complaints of the patients, cardiovascular events (CE) and signs of heart failure were evaluated. All patients underwent echocardiography using a Vivid-4 (General Electric) with a Speckle-tracking function. The ejection fraction (EF) of the left ventricle (LV), the zone of disorders of local contractility, the level of GLS and GCS were evaluated. Results after an 1 year of observation, all patients had a good clinical condition, there were no CE, and heart failure was absent. The EF level was 56.3 ± 3.45%; no zones of disorders of local contractility were found in any patient. A GLS level below normal was observed in 7 patients (-12.05% ± 5.15%), and was normal in 7 patients (less than -18%), GCS level was reduced in 3 (21.4%) patients (- 9.7 ± 3.4%) at a normal level of -18 and below. Conclusions despite the absence of global and local contractility disorders in echocardiography, GLS was revealed in 50% of patients, GCS in 20% of patients. Thus, speckle-tracking shows that in some patients changes in LV contractility persist in the long term. It can be explained by a change in the orientation of the myocardial fibers due to remodeling, but this requires further evaluation.

Efficacy of high-intensity interval training compared with moderate-intensity continuous training on maximal aerobic potency in dogs: Trial protocol for a randomised controlled clinical study.

BackgroundHigh‐intensity interval training (HIIT) is a more efficient method to improve exercise capacity than moderate‐intensity continuous training (MICT) because of its greater physiological stimulus.ObjectiveThe aim of this protocol is to evaluate the efficacy of HIIT on maximal aerobic potency in dogs as compared to MICT.MethodsThis protocol is for a randomised, blinded controlled clinical trial, with three parallel groups for the purpose of demonstrating superiority. Thirty dogs aged between 12 and 84 months of both sexes and different breeds will be included. Dogs, before initiating and after finalising the training will perform an incremental exercise test on a treadmill to obtain maximal speed and lactate threshold; resting parameters of heart and respiratory rate, left ventricle chamber and systolic function will be measured. Dogs assigned to each intervention will endure a 42‐min session of HIIT or MICT during 12 weeks. HIIT comprises four intervals of 4 min each at a load of 85%, alternating with a 4‐min resting period. MICT group will have a continuous load of 60%. The control group will remain in a cage. An intention‐to‐treat statistical analysis will be implemented. Analysis of covariance will be used to estimate the effect of HIIT compared with MICT training on maximal aerobic potency, aerobic resistance, systolic function at rest, left ventricle chamber measurements and indexes, respiratory rate and HR at rest.ConclusionSignificant time and effort are invested into training sports/working dogs, which could benefit from improving physical capacity by means of the HIIT methodology.

Maska brzuszna ostrego zespołu wieńcowego czy ... ? Celowość włączenia badania przesiewowego aorty brzusznej do rutynowego protokołu badania echokardiograficznego

An 86-year-old woman with a history of hypertension, paroxysmal atrial fibrillation, chronic kidney disease, type 2 diabetes and hypothyroidism, was admitted due to weakness and atypical chest pain accompanied by dyspnoea, abdominal pain, vomiting and lack of appetite. Also, a month ago the patient underwent left lower limb erysipelas and reported a 10 kg decrease in body weight over the past year. On admission, the patient was hemodynamically stable. Electrocardiography revealed sinus rhythm, first-degree atrioventricular block, and persistent ST-segment depression in the anterolateral loads. Biochemical tests revealed elevated high-sensitivity troponin level and high N-terminal pro-B-type natriuretic peptide concentration. Echocardiography showed normal left ventricle systolic function, ejection fraction of 50%, without evidence of significant valvular heart disease. Taking into consideration all of the above, the diagnosis of the acute coronary syndrome was proposed. Due to the standards applied in our echocardiography protocol (screening of abdominal aorta dimension in people over 65-years-old), a significant widening of the abdominal aorta was found. In computed tomography angiogram, abdominal 57 mm aortic aneurysm with a haemorrhagic thrombus and right iliac aneurysm with a large thrombus with deep ulceration were confirmed. The whole clinical picture suggests that the patien’s complaints resulted from the presence of large abdominal aortic and common iliac artery aneurysms, accompanied by pressure on the adjacent abdominal organs and with a high risk of sudden rupture. The described case confirms the validity of supplementing routine echocardiographic protocol with a screening assessment of the abdominal aorta, following European Society of Cardiology guidelines. Accurate diagnosis, in this case, protected the patient from acute coronary syndrome invasive treatment, which could result in intensive anticoagulant and antiplatelet therapy implementation and lead to life-threatening complications.

Aerobic exercise capacity of healthy young men with the early repolarization phenomenon

Data on the performance of individuals with the early repolarization phenomenon (ERP) are contradictory. Aim of the study was to investigate the aerobic physical performance of individuals with ERP. Material and methods. 536 healthy men aged 18–45 years, who do not have contraindications to perform a load test according to physical, laboratory and instrumental examination (ECG, spirometry, echocardiography, clinical blood analysis), and who reached the VO2max during cardiopulmonary exercise testing were included in the study. We compared physical performance of groups formed on the basis of ECG data: the main group - persons with ERP (113 people) and the control group-persons without ERP (423 people). Results. In the group with ERP, the VO2max, cardiac output, oxygen pulse and stroke volume at peak load were lower than in the group without ERP, by 5.8 % (p=0.03), 9.2 % (p=0.05), 7.2 % (p=0.01) and 8.9 % (p=0.04). When compared to echocardiography data, the final systolic size of the left ventricle in the group with ERP was 12.6 % larger than in the group without ERP (p=0.03). Conclusion. In individuals with ERP, a decrease in cardiac output was detected, which may be associated with a relative deterioration in left ventricle systolic function and may affect the aerobic physical performance. The described differences were revealed only after removing the influence of anthropometric, spirometric and laboratory indicators.

Assessment of left ventricular myocardial deformation according to Speckle-tracking echocardiography in the long-term period in patients with takotsubo syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): North-Western State Medical University named after I.I. Mechnikov Complete improvement of left ventricle systolic function is an essential feature of takotsubo syndrome (TTS). Speckle -tracking echocardiography (STE) provides quantitative information about myocardial deformation, more accurately than conventional echocardiography. Objective to assess the global longitudinal strain (GLS) and global circumferential strain (GCS) by speckle-tracking echocardiography in patients with TTS in the long-term period. Materials and methods 14 female with TTS were monitored, average age 57.5 ± 28.5. The diagnosis was verified by ventriculography and echocardiography. 1 year after the attack, complaints of the patients, cardiovascular events (CE) and signs of heart failure were evaluated. All patients underwent echocardiography using a Vivid-4 (General Electric) with a Speckle-tracking function. The ejection fraction (EF) of the left ventricle (LV), the zone of disorders of local contractility, the level of GLS and GCS were evaluated. Results after an 1 year of observation, all patients had a good clinical condition, there were no CE, and heart failure was absent. The EF level was 56.3 ± 3.45%; no zones of disorders of local contractility were found in any patient. A GLS level below normal was observed in 7 patients (-12.05% ± 5.15%), and was normal in 7 patients (less than -18%), GCS level was reduced in 3 (21.4%) patients (- 9.7 ± 3.4%) at a normal level of -18 and below. Conclusions despite the absence of global and local contractility disorders in echocardiography, GLS was revealed in 50% of patients, GCS in 20% of patients. Thus, speckle-tracking shows that in some patients changes in LV contractility persist in the long term. It can be explained by a change in the orientation of the myocardial fibers due to remodeling, but this requires further evaluation.

Cardiac Thyrotropin-releasing Hormone Inhibition Improves Ventricular Function and Reduces Hypertrophy and Fibrosis After Myocardial Infarction in Rats

BackgroundCardiac thyrotropin-releasing hormone (TRH) is a tripeptide with still unknown functions. We demonstrated that the left ventricle (LV) TRH system is hyperactivated in spontaneously hypertensive rats and its inhibition prevented cardiac hypertrophy and fibrosis. Therefore, we evaluated whether in vivo cardiac TRH inhibition could improve myocardial function and attenuate ventricular remodeling in a rat model of myocardial infarction (MI). Methods and ResultsIn Wistar rats, MI was induced by a permanent left anterior descending coronary artery ligation. A coronary injection of a specific small interfering RNA against TRH was applied simultaneously. The control group received a scrambled small interfering RNA. Cardiac remodeling variables were evaluated one week later. In MI rats, TRH inhibition decreased LV end-diastolic (1.049 ± 0.102 mL vs 1.339 ± 0.102 mL, P < .05), and end-systolic volumes (0.282 ± 0.043 mL vs 0.515 ± 0.037 mL, P < .001), and increased LV ejection fraction (71.89 ± 2.80% vs 65.69 ± 2.85%, P < .05). Although both MI groups presented similar infarct size, small interfering RNA against TRH treatment attenuated the cardiac hypertrophy index and myocardial interstitial collagen deposition in the peri-infarct myocardium. These effects were accompanied by attenuation in the rise of transforming growth factor-β, collagen I, and collagen III, as well as the fetal genes (atrial natriuretic peptide, B-type natriuretic peptide, and beta myosin heavy chain) expression in the peri-infarct region. In addition, the expression of Hif1α and vascular endothelial growth factor significantly increased compared with all groups. ConclusionsCardiac TRH inhibition improves LV systolic function and attenuates ventricular remodeling after MI. These novel findings support the idea that TRH inhibition may serve as a new therapeutic strategy against the progression of heart failure.

SUBSTANTIAL CHANGES IN CARDIOVASCULAR HEALTH OCCUR FROM ADOLESCENCE TO EMERGING ADULTHOOD

Objective: 17–24 years is a distinct period of lifestyle change. However little is known regarding changes in cardiovascular (CV) health during this time. We explored changes in Left ventricle (LV) structure and function, arterial stiffness, compliance and resistance in a large population-based birth cohort and investigated associations with body composition, haemodynamics and lifestyle choices. Design and method: 724 participants had repeated echocardiography, blood pressure (BP) and body composition (using DEXA) measures aged 17y and 24y. Change in key outcomes and exposures from 17–24y were derived. Principal Component Analysis (PCA) was applied to reduce intercorrelated exposures into groups of independent factors. Principal Component (PC) 1: contained factors relating to change in blood pressure, PC2: change in body size (body mass index, fat mass and lean mass), and PC3: lifestyle (smoking and alcohol)). Linear regression assessed associations between PCs and change in CV outcomes. Results: From 17–24y systolic BP, pulse pressure and alcohol use decreased. All other exposures increased (Table). Indexed LV mass (LVMI) and systolic function (cardiac output (CO), Tissue Doppler peak S) increased, while diastolic function declined (Mitral E:e’). Pulse wave velocity (PWV) and compliance (TAC) increased, peripheral resistance (TPR) decreased. In age and sex adjusted regression analysis PC2 had the strongest association with all LV changes. Vascular changes (PWV,TPR) were most strongly associated with PC1. While PC3 showed the weakest associations. All associations remained after further adjustment for socioeconomic status, birth weight and education Conclusions: Substantial CV changes occur from adolescence to emerging adulthood. Changes in body size and composition have a considerable effect on LV structure and function, while changes in vascular health are associated with changing haemodynamics. These results imply that despite being relatively early in the life-course, this is an important time to control CV risk factors to improve future CV health.

Cardiac Tumor and Arrhythmia Induced Cardiomyopathy: Management with Pace Suppression

<h3>Introduction</h3> Pediatric cardiac tumors are rare and can present clinical challenges, including arrhythmias, which can lead to arrhythmia-induced cardiomyopathy (AIC). Primary management is often surgical resection but may include antiarrhythmic therapy, implantable cardiac defibrillator, ablation, or ultimately heart transplant. We discuss a case in which pace suppression aided in ventricular function recovery and surgical candidacy after a cardiac tumor initially resulted in a wide QRS tachycardia leading to AIC and surgical ineligibility. <h3>Case Report</h3> A cardiac mass was detected in the left ventricle (LV) of a fetus (Figure 1A). At birth, the echocardiogram demonstrated a 2.7 cm x 2.3 cm LV tumor without significant inflow or outflow obstruction (Figure 1B). A cardiac magnetic resonance imaging (MRI) showed a 4 cm x 3.5 cm x 3.1 cm mass infiltrating the inferoseptal LV myocardium (Figure 1C). By one year of age, she developed VT requiring medical treatment. Amiodarone controlled her heart rate, but she had a wide QRS with a left bundle branch morphology that progressed to AIC with an ejection fraction of 20% (Figure 1D). This resulted in poor growth and many ICU admissions. She was considered ineligible for surgery because of her small size and mass burden. Thus, she was referred for cardiac pacing to improve ventricular synchrony by suppressing the left bundle morphology tachycardia. She underwent transvenous placement of a Medtronic single chamber pacemaker and a bipolar lead in the right atrium. Her VT was pace suppressed with settings of AAI at 120 bpm. Her LV dilation and systolic function improved, though she continues with intermittent periods of VT controlled with amiodarone. She is now 4 years old and is scheduled for surgical debulking. <h3>Summary</h3> AIC is a significant complication of pediatric cardiac tumors. Pace suppression via a transvenous pacemaker may be a reasonable alternative approach to achieve stabilization and recovery, particularly in patients who are not surgical or defibrillator candidates.

Intrauterine Growth Retardation is a Risk Factor for Anthracycline Toxicity

Background Anthracycline chemotherapy is used to treat a variety of cancers. However, late cardiac effects of anthracycline chemotherapy, such as subclinical left ventricular dilatation and/or dysfunction, have been observed in more than half of long-term survivors of childhood cancers. A major risk factor for anthracycline cardiotoxicity is intrauterine growth restriction (IUGR). We assessed the significance of IUGR as an important risk factor for late cardiotoxic effects of anthracycline therapy in asymptomatic long-term survivors of childhood cancers. Materials and methods The study included 61 survivors of childhood cancers. Cardiac functions were prospectively studied using both conventional and non-conventional echocardiographic methods (two-dimensional speckle tracking echocardiography) after completion of the treatment. The patients were divided into two groups based on their birth weights: Group 1 (patients with IUGR) and Group 2 (patients with normal birth weight). Results Conventional echocardiography revealed a similar and normal range of left ventricle systolic and diastolic functions in both groups. However, global longitudinal and circumferential strain values demonstrated subclinical left ventricular systolic dysfunction in both groups as compared with normal reference strain values. Furthermore, Group 1 patients had significantly lower global longitudinal and circumferential strain and strain rate values than those in Group 2 patients. Conclusion Asymptomatic long-term survivors of childhood cancers with a history of IUGR may have an increased risk of anthracycline cardiotoxicity due to the low content of mitochondrial DNA (mtDNA). IUGR is a risk factor for late anthracycline cardiotoxicity.

Goal-directed ultrasound protocol in patients with nontraumatic undifferentiated shock in the emergency department: prospective dual centre study.

Early identification of the cause of shock is associated with better prognosis. The aim of this study was to explore the performances of an ultrasound protocol (echoSHOCK) to diagnose the cause of shock in the emergency department (ED). This was a prospective study performed in two EDs. Included patients were older than 18 years admitted with shock. After routine workup strategy, the suspected cause of shock and the planned treatment were reported. The echoSHOCK protocol, using only B mode, was then performed. After performing echoSHOCK, the investigator reported the same two items. echoSHOCK protocol that assessed: compressive pericardial effusion (tamponade), right ventricle dilatation and flattening of the septum, left ventricle dimension and systolic function, indices of hypovolemia. We defined four different causes for shock (tamponade, acute cor pulmonale, cardiogenic and hypovolemia). The primary endpoint was the degree of agreement of the routine workup and echoSHOCK with an expert panel. 85 patients [mean age of 73 (14) years] were included. Kappa coefficients between routine strategy and echoSHOCK for the cause of shock, with the expert panel were 0.33 (95% CI, 0.26-0.4) and 0.88 (95% CI, 0.83-0.93), respectively. Likewise, for the planned treatment, kappa were 0.21 (95% CI, 0.14-0.28) and 0.9 (95% CI, 0.85-0.94), respectively. The physician's confidence increased from 3.9 (2.1) before echoSHOCK to 9.3 (1.1) after, (P < 0.001). This study suggested that echoSHOCK significantly increased the ability to determine the cause of undifferentiated shock in the ED.

Does Transcatheter Pulmonary Valve Replacement Affect Left Ventricle Systolic Function: A 2 Dimensional Speckle Tracking Study?

Does Transcatheter Pulmonary Valve Replacement Affect Left Ventricle Systolic Function: A 2 Dimensional Speckle Tracking Study?

Prognostic nutritional index is related to myocardial performance index in newly diagnosed nondiabetic hypertensive patients

ABSTRACT Background: Arterial hypertension (AH) leads to systolic and/or diastolic dysfunction of the left ventricle (LV) by causing structural changes in the myocardium. Myocardial performance index (MPI) provides the evaluation of LV systolic and diastolic functions together. Prognostic nutritional index (PNI) is an indicator of immunonutritional status. PNI was studied in patients with malignancy, malnutrition, and cardiovascular diseases so far. It was aimed to investigate the relationship between PNI and MPI in hypertensive patients. Methods: A total of 91 consecutive patients with newly diagnosed AH were included in the study. PNI was calculated according to the following formula: ((10 × serum albumin (g/dL))+(0.005 × total lymphocyte count)). MPI was obtained by dividing the sum of isovolumetric relaxation time (IVRT) and isovolumetric contraction time (IVCT) by the ejection time (ET) ((IVRT+IVCT)/ET). Patients were divided into two groups according to MPI is above or below the value of 0.5. The demographic characteristics and PNI values of patients were compared between two groups. Results: There were 65 patients in the higher and 26 patients were in the normal MPI group. Higher MPI group had male predominance (p = .002). Diastolic blood pressure (p = .021), interventricular septum thickness (p = .005), posterior wall thickness (PWT) (p = .001), serum albumin concentration (p = .045), and PNI (p = .013) were differed between groups. Multivariate logistic regression analysis revealed that PWT [OR = 1.835, 95% CI: 1.126–2.992, p = .015] and PNI [OR = 1.161, 95% CI: 1.004–1.343, p = .018] predicted higher MPI. Conclusion: Higher PNI was an independent predictor of LV dysfunction in newly diagnosed hypertensive patients. Immunonutritional status may be used as an indicator of the left ventricular function in patients with AH.

Circulating biomarkers of cardiac fibrosis: do they correlate with the echocardiographic parameters of the myocardial mechanics in systemic sclerosis?

Abstract Funding Acknowledgements Type of funding sources: None. Background In systemic sclerosis (SSc) myocardial fibrosis contributes to the impairment of the myocardial function resulting in manifest diastolic and subclinical systolic dysfunction of the left ventricle (LV) and impaired left atrial (LA) function. The pathophysiology of this connective tissue disease is still not fully elucidated. Recently, however, elevated serum levels of galectin-3 and soluble suppression of tumorigenicity 2 (sST2) have been reported in SSc patients suggesting that these fibrotic markers may participate in the fibrotic process in this disease. Thus we aimed to investigate the potential associations between galectin-3 and sST2 levels and the echocardiographic markers of the LV and LA function in SSc patients. Methods Forty patients (57.3 ± 13.7 years, 36 female) were enrolled into the study. In addition to the conventional echocardiography, tissue Doppler and speckle-tracking-derived strain techniques were used to estimate the LV systolic and diastolic function as well as the LA size and function. To assess the correlations between galectin-3 and sST2 levels and the echocardiographic variables, partial correlation method was used with age as correcting factor. Results In age adjusted analysis galectin-3 level showed significant correlation with LV global longitudinal strain (r = 0.460, p = 0.005); grade of LV diastolic dysfunction (r = 0.394, p = 0.013); septal e’ (r=-0.369, p = 0.021); septal E/e’ (r = 0.380, p = 0.017) and with the grade of mitral regurgitation (r = 0.323, p = 0.048) (Figure 1). No significant correlation was found between sST2 levels and the echocardiographic variables. Conclusions Galectin-3 levels, but not sST2 levels show significant correlation with the parameters of the LV diastolic function and with LV global longitudinal strain, a parameter reflecting the subclinical impairment of the LV systolic function. Galectin-3 may be a useful biomarker for identifying SSc patients with high risk for cardiac involvement. Abstract Figure 1

Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity

Abstract Funding Acknowledgements Type of funding sources: None. Background Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure. Purpose To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography. Methods Fifty Her-2 positive breast cancer women (age = 53.6 ± 11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction &amp;lt; 50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline &amp;gt;15%. Results None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p &amp;lt; 0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p &amp;lt; 0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=-0.40, p = 0.006) and after TRZ completion (r=-0.62, p &amp;lt; 0.0001). Conclusions Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients. Abstract Figure.

Clinical outcome analysis in patients with COVID 19 using echocardiography and biochemical markers

Funding AcknowledgementsType of funding sources: None. BACKGROUND AND PURPOSECardiac involvement in patients with COVID-19 is still unclear. We made a systematic echocardiographic and biochemical assessment of patients admitted with COVID-19 infection to assess correlation with various clinical outcomes.METHODSWe prospectively assessed 119 consecutive COVID-19 positive in-patients with full echocardiography studies, including left ventricle (LV) systolic function, right ventricle (RV) basal dimension and systolic function using Tricuspid Annular Plane Systolic Excursion (TAPSE) and systolic pulmonary artery pressure (SPAP). We excluded all patients with known left ventricular systolic dysfunction (LVSD) prior to admission. We also recorded laboratory biochemical findings including troponin-T, D-dimer and NT-proBNP levels. We carried out correlation analyses of the echocardiography and the laboratory biochemical findings with various clinical outcomes including mortality, length of stay (LOS), admission to Intensive Care Unit (ICU) and the three month re-admission rates.RESULTS119 patients (38% female); age range 35 to 96 years (mean 71, median 73). 37 (31%) patients died during hospital admission. The mean LOS for surviving patients was 32 days.20 (17%) patients had significant LSVD (by biplane Simpson method, EF cut off 45%), 31 (26%) patients had RV dilatation, 28 patients (24%) had RV systolic dysfunction by TAPSE and 41 (35%) patients had raised pulmonary artery pressures. There was a weak Pearson’s correlation between mortality and LVSD (0.184, p 0.046), a moderate correlation with RVSD (0.303, p 0.001) and RV dilatation (0.231, p 0.012). Raised troponin-T and NT-proBNP levels correlated moderately with mortality (0.254, p 0.013 and 0.253, p 0.02 respectively). D-dimer levels did not correlate with mortality or any of the other clinical outcomes. Raised troponin-T levels had moderate correlation with admission to ICU and LOS (0.210, p 0.043 and 0.267, p 0.01 respectively). SPAP in isolation did not correlate with any of the clinical outcomes. None of the echocardiography or laboratory biochemical variants correlated with re-admission rates.CONCLUSIONIn our cohort of patients with COVID-19 infection there is a weak to moderate mortality correlation with LV function, RV function and RV size. Laboratory biochemical markers especially troponin-T correlated more widely and moderately with clinical outcomes.

Left ventricle longitudinal strain alterations in asymptomatic or mildly symptomatic pediatric patients with recent SARS-CoV-2 infection

Funding AcknowledgementsType of funding sources: None.BackgroundEvidence suggests that clinical manifestations of children’s COVID-19 may be less severe. However, it has been described the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) which resembles other inflammatory conditions (i.e. Kawasaki disease). Patients affected by PIMS-TS showed cardiac involvement with myocardial injury, reduced left ventricle systolic function and coronary artery abnormalities. Little is known regarding cardiac involvement in pediatric patients with asymptomatic or mildly symptomatic SARS-CoV-2 infection.MethodsWe analyzed 23 pediatric patients (13males, 56%) with diagnosis of SARS-CoV-2 infection based on PCR analysis of nasopharingeal swab (NPS), and asymptomatic or only mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram (TTE) within 2-3 month from diagnosis and after negative NPS for SARS-CoV-2. We performed offline analysis with GE EchoPAC software to measure global longitudinal strain (GLS) of the LV using 2D speckle tracking imaging. Therefore, we compared the results with a matched group of 23 controls (13males, 56%).ResultsCases and controls were similar regarding age (5.9 ± 4.1years vs. 6.4 ± 4.4 years, p = 0.63), body surface area (0.98 ± 0.3m2 vs. 0.8 ± 0.4m2, p = 0.17), LV FS (37.9 ± 5.9% vs. 36.4 ± 8.3%, p = 0.74) and LV biplane EF (63.9 ± 5.2% vs. 66.4 ± 5.3%, p = 0.11). GLS analysis showed significant strain reduction of the LV mid-wall segments and of the basal anterior, posterior and septal inferior segments among cases compared to controls. Furthermore, in the case group there were 7 subjects (30%) with a strain below 16.5% in at least 3 segments.ConclusionSARS-CoV-2 infection may affect LV deformation in asymptomatic or only mildly symptomatic children, showing a peculiar pattern with lower longitudinal strain in all mid-wall segments of LV compared to control subjects. The clinical significance of this findings is unclear and follow-up is needed to verify the reversibility of this alterations.

Differences Between Pediatric Acute Myocarditis Related and Unrelated to SARS-CoV-2.

Acute myocarditis (AM) is defined as inflammation of the myocardium. The aim of our study is a comparative analysis of the differences between AM related and unrelated to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The retrospective study included children with AM treated from January 2018 to November 2020. The study included 24 patients; 7 of 24 had AM related to SARS-CoV-2 and they were older than 7. They were more likely to have abdominal pain (P = 0.014), headache (P = 0.003), cutaneous rash (P = 0.003), and conjunctivitis (P = 0.003), while fulminant myocarditis was commonly registered in AM unrelated to SARS-CoV-2 (P = 0.04). A multisystem inflammatory syndrome in children associated with COVID-19 was diagnosed in six adolescents. Patients with AM related SARS-CoV-2 had lower serum cardiac troponin I (cTnI) (P = 0.012), and platelets (P < 0.001), but had a higher C-reactive protein (CRP) value (P = 0.04), and N-terminal-pro hormone BNP in comparison to patients with AM unrelated to SARS-CoV-2. The patients with AM related to SARS-CoV-2 had significant reduction of CRP (P = 0.007). Inotropic drug support was used for shorter durations in patients with AM related to SARS-CoV-2, than in others (P = 0.02). Children with AM related to SARS-CoV-2 had significant improvement of left ventricle systolic function on the third day in hospital (P = 0.001). Patients with AM unrelated to SARS-CoV-2 AM had more frequent adverse outcomes (P = 0.04; three died and four dilated cardiomyopathy). In contrast to patients with AM unrelated to SARS-CoV-2, patients with AM related to SARS-CoV-2 had a higher CRP value, polymorphic clinical presentation, shorter durations of inotropic drugs use as well as prompt recovery of left ventricle systolic function.

QUALITY OF LIFE IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION AND CHRONIC INFLAMMATORY PULMONARY DISEASE

Relevance. Problems of chronic heart failure (HF) after myocardial infarction (MI) prevention of in young and middle-aged men with chronic inflammatory pulmonary diseases (CIPD) remain relevant due to their high prevalence and social significance. Aim. To evaluate changes in the quality of life (QL) indicator associated with heart failure (HF) in men under 60 years old with MI and CIPD to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with CIPD - 166 patients; II - control, without it - 490 patients. A comparative analysis of the QL indicator associated with HF (HFQL) (V. Ironosov) was performed in the selected groups in the first 48 hours (I) and at the end of the third week (II) of MI. The changes and correlations (C. Spearmen) of HFQL with clinical features, metabolic parameters, central and peripheral hemodynamics were studied. Results. HFQL in patients with CIPD was worse than in the control group in both phases of the study (I: 63.6 ± 21.6 and 59.2±20.1; II: 20.7 ± 11.7 and 18.0 ± 12.0, respectively; p˂0.05). Reliable correlations between HFQL and heart rate, blood pressure, parameters of the left ventricle (LV) systolic and diastolic functions, its volume, indicators of the pulmonary circulation, lipid, nitrogen and electrolyte metabolism were revealed. Conclusions. The QL associated with HF is significantly worse in patients with CIPD in the acute and subacute MI periods. The most pronounced negative effect on this indicator in the study group is associated with tachycardia, LV dilatation, its systolic and diastolic dysfunction, pulmonary hypertension, impaired lipid and nitrogen metabolism. The HFQL method is useful as an addition to the complex of examination of patients with MI and MS, starting from the first hours of the disease, for early identification of risk groups for adverse outcomes and the formation of chronic HF.

Aortic regurgitation: epidemiologic, etiologic, and pathophysiologic characteristics

The presented review concerns aortic regurgitation which occupies a significant place in the structure of valvular heart disease. The detailed anatomic and physiologic description of the aortic valve is provided. The characteristics of sinotubular, ventricular-aortic junctions, and virtual aortic annulus are presented. There are data about prevalence of aortic regurgitation on the basis of results of population studies, indicating the increase in incidence of aortic regurgitation among individuals older 70–74 years. The detailed etiologic structure of this valvular pathology is described with specifying of the most common causes of both aortic disease and aortic cusps alterations. In particular, there are some aortic diseases, resulting in acute aortic regurgitation, including acute aortic dissection and paravalvular regurgitation in incompetence of the prosthetic aortic valve; in chronic one – idiopathic dilation of the aortic root, inherited connective tissue dysplasias (Ehlers–Danlos, Marfan, and Loeys–Dietz syndromes), bicuspid aortic valve, aortitis of various origin, seronegative arthropathies (reactive, psoriatic arthritis, ankylosing spondylitis) etc. Infective endocarditis and traumatic exposure are commonly responsible for development of acute regurgitation due to aortic cusps abnormalities. Chronic aortic regurgitation as a consequence valve defects occurs in rheumatic heart disease, degenerative changes, congenital anomalies, systemic connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis), non-specific aortoarteritis, etc. The special attention is paid to pathophysiologic features of acute and chronic aortic regurgitation in the review. Acute aortic regurgitation is characterized by sudden increase in end-diastolic volume and due to the noncompliant left ventricle of normal size, it undergoes abrupt exposure a significant pre-load and after-load which results in decrease of left ventricle systolic function and stroke volume despite on relative preservation of contractile function of myocardium. In contrast to acute aortic regurgitation it is remarkable in its chronic form slow, progressive influence by increased overload of the left ventricle with possibility to adapt driven by its gradual dilation and hypertrophy.

Relationship Between Mitral Leaflet Size and Coaptation and Their Associated Factors in Patients with Normal Left Ventricular Size and Systolic Function.

Enlargement of the mitral valve (MV) has gained attention as a compensatory mechanism for functional mitral regurgitation (FMR). We aimed to determine if MV leaflet area is associated with MV coaptation-zone area and identify the clinical factors associated with MV leaflet size and coaptation-zone area in patients with normal left ventricle (LV) systolic function and size using real-time 3D echocardiography (RT3DE).We performed RT3DE in 135 patients with normal LV size and ejection fraction. MV leaflet and coaptation-zone areas were measured using custom 3D software. The clinical factors associated with MV leaflet and coaptation-zone areas were evaluated using univariate and multivariate linear regression analyses.There was a significant relationship between MV leaflet and coaptation-zone areas (r = 0.499, P < 0.001). MV leaflet area was strongly associated with body surface area (BSA) (r = 0.905, P < 0.001) rather than LV size and age. MV leaflet area/BSA was independently associated with male gender (P = 0.002), lower diastolic blood pressure (P = 0.042), and LV end-diastolic volume (LVEDV) index (P = 0.048); MV coaptation-zone area/BSA was independently associated with lower LVEDV index (P = 0.01).In patients with normal LV systolic function and size, MV leaflet size has a significant impact on competent MV coaptation. MV leaflet area might be intrinsically determined by body size rather than age and LV size, and the MV leaflet area/BSA is relatively constant. On the other hand, some clinical factors might also influence MV leaflet and coaptation-zone area.