Left Ventricular Diastolic Dimension Research Articles

#1688 Association of baseline serum activin levels with left atrial diameter at 5 years post-kidney transplantation: results from the KNOW-KT

Abstract Background and Aims Serum activin A inhibits muscle growth, promotes apoptosis, and impairs heart function. However, the role of serum activin remains unclear in kidney transplant patients, where cardiovascular complications are a significant cause of morbidity and mortality. In this multicenter, observational cohort study, we investigated a potential association of pre-transplant serum activin levels with the left atrial (LA) diameter, an indicator of diastolic burden and a predictor of cardiovascular complications, to indirectly assess the impact of pre-transplant activin levels on heart function in kidney transplant patients. Method Overall, 602 kidney transplant patients from KNOW-KT (Korean cohort study for outcome in patients with kidney transplantation) were analyzed. Activin levels were measured at baseline immediately before kidney transplantation (KT). The primary outcome was the LA diameter that was measured by transthoracic echocardiography at 5 years after KT. Results The mean age of study population was 45.4 years and 221 (46.7%) patients were men. Pre-transplant serum activin levels were 718.4 ± 363.2 (mean ± standard deviation). When activin levels were divided into categorical variables according to the median value, the ejection fraction of LV showed a lower tendency in the high-activin group (64.3 ± 7.0) compared to the low-activin group (65.3 ± 6.2); however, there was no statistical significance (P=0.069). LV diastolic dimension was significantly higher in the high-activin group (47.3 ± 5.3) compared to the low-activin group (46.3 ± 5.5) (P=0.021). Notably, the post-transplant LA diameter was 37.0 ± 7.0 mm in the low-activin group and 39.1 ± 6.5 mm in the high-activin group, showing a significant difference (P<0.001). The multivariate linear regression coefficient for association between activin groups and LA diameter was 1.08 (95% confidence interval [CI], 0.67-2.10, P=0.037). In an additional logistic regression analysis of LA diameter groups, the high activin group was significantly associated with the high LA diameters compared to the low-activin group in multivariate analysis (adjusted odds ratio [OR], 2.04; 95% CI, 1.34-3.09, P=0.001). When activin levels were used as a continuous variable, adjusted ORs of activin for high LA diameters were 1.29 (95% CI, 1.04-1.60, P=0.018). Conclusion Pre-transplant serum activin levels were independently associated with a higher post-transplant LA diameter, suggesting that activin may negatively affect heart functions in kidney transplant patients. Therefore, activin may be a potential prognostic and therapeutic target in kidney transplant patients.

Epicardial fat thickness among neonates of diabetic mothers attending the neonatal intensive care unit at Fayoum University Hospital: a case control study

BackgroundUsing conventional echocardiography, this study aimed to evaluate the epicardial fat thickness (EFT) and its role in discriminating infants of diabetic mothers (IDMs) from those of non-diabetic mothers (INDMs) and to assess its prognostic role in IDMs. This case control study was conducted at the Neonatology and Cardiology Units of Pediatric Department, Fayoum University Hospital, Egypt, between February and September 2023. A total of 54 neonates were enrolled into three groups: 18 IDMs with well-controlled diabetes mellitus (DM), 18 IDMs with poorly controlled DM, and 18 INDMs.ResultsThe sensitivity, specificity, and cutoff of EFT were 100%, 100%, and 3.950 mm for detecting cases of IDMs and were 66.7%, 72.2%, and 5.100 mm for differentiating controlled from uncontrolled diabetic mothers, respectively. The interventricular septum in diastole (IVSd), interventricular septum in systole (IVSs), estimated pulmonary artery pressure (PAP), left ventricle (LV) Tei index, and isovolumetric relaxation time (IVRT) of LV all showed a positive correlation with EFT (r = 0.35, 0.31, 0.41, 0.34, and 0.39; P = 0.009, 0.025, 0.002, 0.01, and 0.003; respectively). There was a significant negative correlation between EFT and left ventricular internal dimensions in diastole (LVIDd) and left ventricular internal dimensions in systole (LVIDs) (r = − 0.44 and 0.42, P = 0.001 and 0.001). Regarding tissue Doppler, there was a significantly higher Tei index in group I cases compared to control (0.59 ± 0.10 vs. 0.49 ± 0.09, P < 0.001).ConclusionsThe EFT is higher in IDMs than in INDMs, with a positive correlation with birth weight, IVSd, IVSs, Tei index of mitral, IVRT, and ESPAP and a negative correlation with LVIDd and LVIDs. Neonatal EFT can be used as one of the helpful parameters to detect IDMs. Also, it may be used as one of the prognostic factors in IDMs as it is positively correlated with the diastolic function of the LV.

The relationship of atrial fibrillation with left atrial size in patients with essential hypertension

Atrial fibrillation (AF) is the most common sustained arrhythmia and it is a major public health problem worldwide. Hypertension is one of the major risk factors for the development of AF. This study is carried out to determine the prevalence and independent risk factors for atrial fibrillation (AF) in hypertensive patients and to evaluate the relationship of AF with left atrial size. This is a retrospective observational cross – sectional study that used a retrospective electronic chart review of all admitted patients to cardiology department at King Abdullah university hospital (KAUH) in Irbid, Jordan, with a diagnosis of hypertension along with various acute cardiac admissions, including AF during 1-year period (January 1st to December 31 of 2021). Risk factors for AF (age, sex, DM, coronary artery disease, valvular heart disease, Cor-pulmonale, obstructive sleep apnea, and congestive cardiac failure) were retrieved from electronic charts of the patients. A total of 958 patients were admitted to the coronary care unit (CCU) and intermediate care unit (IMCU) during a 1-year period. Among them, 276 had 2 or 3 admissions. The main reason of admission was acute coronary syndrome (n = 491), heart failure (n = 180), and AF (n = 144), indicating AF prevalence of 15%. However, there were 40 patients with combined causes. All patients in the study (n = 958) were diagnosed with hypertension, including patients with atrial fibrillation (n = 144). The mean age of patients was 61.4 (± 11.46) years, and approximately two thirds of them were males (65.4%). The binary logistic regression model demonstrated a significant statistical relationship of age, left atrial size, coronary artery disease, left ventricular ejection fraction, left ventricular dimensions in systole and diastole, and heart failure with the occurrence of AF after controlling for gender, smoking, and diabetes. Findings indicate that left atrial size plays a significant role in the development of AF in patients with hypertension. However, the prevalence of AF significantly increased with advancing age in both sexes because of increased left ventricular hypertrophy, which leads to increased left atrial size.

Left ventricular function in patients with advanced stages of chronic obstructive pulmonary disease in correlation with GOLD classification system

Background: Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory disease, with irreversible airflow obstruction, disease with high morbidity and early mortality rate. COPD is not just a disorder limited to the lungs. As the disease progresses, extra pulmonary co morbidities occur, where cardiovascular diseases are the most common. They mostly affect the right side of the heart, but sometimes changes also occur on the left side of the heart, as a result of long-term strain from the right ventricle (RV) and pulmonary hypertension which follows COPD. Material and methods: The design of our study was prospective-clinical crosssectional study with 2 years follow up. In the study were included 94 patients with previously confirmed chronic obstructive pulmonary disease with spirometry and classified by Tiffeneau index in four gold classes. We have analyzed the values of some echocardiographic parameters that were selected as indicators of left heart function, and also we have analyzed them in relation to the progression of COPD from milder to more severe Golden classes, such as: left ventricular diastolic dimension (LvdD - mm), left ventricular ejection fraction (EF %), myocardial performance index (MPI) of the left ventricle, global longitudinal strain (Gl strain - %) of LV, diastolic function (E/e'). Echo analysis was done by Vivid 7 echo machine with a special feature to left heart chamber characteristics and function. Results: All echocardiographic parameters analyzed in our study, underline their significance in disease progression in patients with COPD and increasing Gold classes. A varies of statistical methods and parameters were used to evaluate: left ventricular diastolic dimension(mm), Ejection fraction of left ventricle (%), MPI of the left ventricle obtain by Tissue Doppler, GL strain of left ventricle (%) and E/e' in correlation of disease progression and GOLD class. Echo-parameters MPI of the left ventricle and Global longitudinal strain LV (%), progressively grow with the rise of the gold class (form I to IV). On the contrary the values of the parameters LvdD and EF% gradually decrease with the progression of the disease and gold class. Echocardiographic parameter GL strain LV % has the highest value and statistically by decreasing the values of this parameter the risk of disease progression from gold stage I/II to Gold stage III/IV is 1.570 times higher, with high statistical significance(p&lt;0,01). The calculated value of the parameter EF% is lower than 0,75, which indicates that the model of prediction is not the best one but it's acceptable. Conclusion: COPD is a progressive disease that affects the dimensions of the right and left heart chambers, as well as the function of both chambers and the development of pulmonary hypertension. Monitoring echocardiographic parameters intended for assessment cardiac dimension and function can help tо predict disease progression for timely inclusion of specific therapeutic strategies. We suggest screening of all COPD patients for cardiac assessment using echocardiography as a non-invasive and repeatable method for their follow-up.

Obesity and heart failure with preserved ejection fraction.

Aim: To perform an overall assessment of heart failure with preserved ejection fraction (HFpEF) adults with central obesity. Materials and Methods: We enrolled HFpEF patients with central obesity (n =73, mean age 52.4 ± 6.3 years) and without obesity (n =70, mean age 51.9 ± 7.1 years) and compared with an age-matched healthy subjects who had not suffered from HF (n = 69, mean age 52.3 ± 7.5 years). Physical examination, routine laboratory tests such as fasting blood glucose, fasting insulin, insulin resistance (HOMA) index, serum lipids, haemoglobin, creatinine, ALT, AST, uric acide, hs CRP, TSH, N-terminal proB-type natriuretic peptide (NT-proBNP) and standard transthoracic echocardiogram (2D and Doppler) examinations were performed and assessed. Results: The average values of diastolic blood pressure (DBP), glucose and lipid profiles, uric acide, hs CRP were found to be significantly higher among obese patients with HFpEF than non-obese. Despite more severe symptoms and signs of HF, obese patients with HFpEF had lower NT-proBNP values than non-obese patients with HFpEF (129±36.8 pg/ml, 134±32.5 pg/ml vs 131±30.4 pg/ml, 139±33.8 pg/ml respectively; p < 0.05). However, it was found that patients with high central (visceral) adiposity have more pronounced obesity-related LV diastolic dysfunction, lower E/e' ratio, lower mitral annular lateral e' velocity, an increased LV diastolic dimension and LV mass index. Compared with non-obese HFpEF and control subjects, obese patients displayed greater right ventricular dilatation (base, 35±3.13 mm, 36±4.7 mm vs 33±2.8 mm, 34±3.2 mm and 29±5.3 mm, 30±3.9 mm; length, 74±5 mm, 76±8 mm vs 67±4 mm, 69±6 mm and 60±3 mm, 61±5 mm respectively; p < 0.05), more right ventricular dysfunction (TAPSE 16±2 mm, 15±3 mm vs 17±2 mm, 17±1 mm and 19±2 mm, 20±3 mm respectively; p < 0.05). Conclusions: Obese patients with HFpEF have higher diastolic BP, atherogenic dyslipidemia, insulin resistance index values and greater systemic inflammatory biomarkers, despite lower NT-proBNP values, which increase the risk of cardiovascular events in future. Echocardiography examination revealed not only significant LV diastolic dysfunction, but also displayed greater RV dilatation and dysfunction.

Hemodynamic evaluation of extremely low birth weight infants during the first 7 days of life

Background and aimWe aimed to investigate the hemodynamic status of extremely low birth weight (ELBW) infants during the transitional period under intensive management. MethodsThis retrospective cohort study analyzed left ventricular ejection fraction (LVEF), left ventricular end-systolic wall stress (ESWS), left ventricular internal dimension in diastole (LVIDd), and mean arterial pressure (MAP) of ELBW infants during their first week of life. Small for gestational age (SGA), histological chorioamnionitis (hCAM), severe intraventricular hemorrhage (IVH), and non-survival to discharge infants were compared to their counterparts. ResultsSixty-two infants (25.7 ± 2.1 weeks, 700.7 ± 165.4 g) were analyzed. MAP gradually increased. Median LVEF was 69.8 % on day 1, decreased to 62.7 % on day 2, then increased throughout the week. ESWS was lowest at birth, rose to 28.2 g/cm2 on day 2, and decreased on day 6. There were no significant changes in LVIDd. SGA infants had higher MAP throughout, higher LVEF on day 2 and 3, but lower LVEF on day 5 to 7. LVIDd was lower in hCAM group. Severe IVH group had a more significant drop in LVEF on day 2, higher ESWS, and a higher incidence of hemodynamic significant patent ductus arteriosus (hsPDA). Non-survival had lower LVIDd. ConclusionsMAP increased gradually. Hemodynamic instability was observed in the first two days, with decreased LVEF and increased ESWS before stabilization. We observed an alteration in hemodynamic adaptation in SGA and hCAM infants. Severe IVH group experienced early hemodynamic instability and a higher incidence of hsPDA.

Abstract 12856: Electrocardiographic T Wave Inversion and Cardiac Structure and Function

Background: Electrocardiographic T wave inversion (TWI) has been associated with incident heart failure (HF) in Black Americans without known coronary heart disease (CHD). The aim of this study was to investigate the relationship between TWI and left ventricular (LV) structure and function to evaluate cardiac changes that may precede symptomatic disease among Black Americans. Methods: Among 4134 Black American participants in the Jackson Heart Study without prevalent HF or CHD at baseline. We defined TWI as having negative T wave amplitudes in each lead of the 12-lead electrocardiogram. Outcomes of interest included echocardiographic LV structure (LV mass index, LVMI, LV diastolic dimension, LVDd and relative wall thickness, RWT) and LV function (LV ejection fraction, LVEF). We investigated the associations between TWI and LV structure and function using multiple linear regression analysis. For participants with missing values in any covariate of interest, values were imputed using multiple imputation by chained equations. Results: In this cohort with median age 55 years and 65% women. The depth of the inverted T wave in leads I and aVL were positively associated with RWT (Figure). The depth of the inverted T waves in leads II, III, and aVF were associated with LVDd. The depth of the inverted T waves in all the leads except V1 and V2 were associated with LVMI, while T wave inversions in only aVF were associated with LVEF. Conclusion: The depth of inverted T waves in leads I and aVL (which were associated with incident HF with preserved EF) were associated with LV concentricity while T wave amplitudes in leads II, III, and aVF (which were associated with incident HF reduced EF) were associated with LV eccentricity. Simple electrocardiographic information may be useful for identifying patients at risk of HF (stage B/pre HF).

Natural history of cardiac findings in mucopolysaccharidosis type I: report from an international registry.

Mucopolysaccharidosis type I is an inborn error of glycosaminoglycan catabolism with phenotypes ranging from severe (Hurler syndrome) to attenuated (Hurler-Scheie and Scheie syndromes). Cardiovascular involvement is common and contributes significantly to morbidity and mortality. We conducted a retrospective analysis of the prevalence and natural history of cardiac abnormalities in treatment-naïve individuals enrolled in the international Mucopolysaccharidosis Type I Registry. Interrogation of echocardiography data (presence of cardiac valve regurgitation and/or stenosis; measurements of left ventricular chamber dimensions in diastole and systole, diastolic left ventricular posterior wall and interventricular septal thicknesses and ventricular systolic function (shortening fraction)) showed that mitral regurgitation was the most common and earliest finding for individuals with both severe (58.3%, median age 1.2 years) and attenuated (74.2%, median age 8.0 years) disease. Left-sided valve stenosis was also common in individuals with attenuated disease (mitral 30.3%; aortic 25%). Abnormal ventricular wall and septal thickness (Z-scores ≥2) were observed early in both phenotypes. Z-scores for diastolic left ventricular posterior wall and interventricular septal thicknesses increased with age in the severe phenotype (annualised slopes of 0.2777 [p = 0.037] and 0.3831 [p = 0.001], respectively); a similar correlation was not observed in the attenuated phenotype (annualised slopes of -0.0401 [p = 0.069] and -0.0029 [p = 0.875], respectively). Decreased cardiac ventricular systolic function (defined as shortening fraction <28%) was uncommon but, when noted, was more frequent in infants with the severe phenotype. While cardiac abnormalities occur early in both severe and attenuated mucopolysaccharidosis type I, the pattern of valve dysfunction and progression of ventricular abnormalities vary by phenotype.

THU583 Cardioprotection By Nitric Oxide Is Mediated Via Mitochondrial Function In Rodents

Abstract Disclosure: K. Islam: None. R. Islam: None. A. Draper: None. Background: Reduced nitric oxide (NO)bioavailability and decreased expression of mitochondrial transcription factor A (TFAM) occurs in the setting of heart failure (HF). TFAM promotes transcription of mitochondrial DNA, mitochondrial biogenesis, respiratory chain activity, and ATP synthesis. We investigated the effects of oral NaNO2therapy to increase NO in chronic HF following acute myocardial infarction and examined the effects of NaNO2 on the activation of TFAM, mitophagy, and antioxidant signaling pathways. Methods: Male C57/BL6J mice underwent 60 minutes of myocardial ischemia (MI) induced by left coronary artery (LCA) occlusion followed by 4 weeks of reperfusion. NaNO2 or saline vehicle (VEH)was administered at a dose of 165 µg/kg at reperfusion and then daily for 4weeks in the drinking water (100 mg/L). Left ventricular ejection fraction (LVEF) was determined at baseline and at 4 weeks of reperfusion. At 4 weeks of reperfusion myocardial tissue samples were collected and analyzed by RT-qPCR, immunoblot, oxidative stress assay, and protein sulfhydration assay. Results: NaNO2 administration markedly preserved left ventricular ejection fraction (LVEF) and improved left ventricular diastolic and systolic dimensions at 4 weeks as compared to VEH. Mitochondrial antioxidant proteins, SOD2 (MnSOD), peroxiredoxin-3 (Prx-3) and thioredoxin 2 (TXN2) (p &amp;lt; 0.05) were markedly increased in NaNO2treated mice compared to VEH. Expression of mitophagic markers, p62 (p &amp;lt;0.05) and Map1lc3 (p &amp;lt; 0.05) were significantly increased in NaNO2treated HF mice as compared to VEH. Expression of mitochondrial quality control such as PINK1 and PARKIN2 were also markedly increased HF mice after treated with nitrite therapy as compared with VEH. Marked induction of sulfhydration of interferon regulator factor 1 (IRF-1) as well as upregulation of mitochondrial transcription factor A (TFAM) (p &amp;lt; 0.05) and suppression of DNA methyltransferase3a (Dnmt-3a) (p &amp;lt; 0.05) were observed in NaNO2 treated ischemic HF mice as compared with VEH. Conclusions: Our results clearly demonstrate thatNaNO2 therapy improves left ventricular function during ischemic HF through induction of antioxidant signaling, mitophagy, sulfhydration of IRF-1and TFAM resulting in increased mitochondrial biogenesis. Presentation: Thursday, June 15, 2023

Preoperative left ventricular diastolic dimension index is associated with outcomes after HeartMate 3 implantation.

We investigated the association between indexed left ventricular diastolic dimension and clinical outcomes after HeartMate 3 implantation. We retrospectively reviewed patients implanted with the HeartMate 3 at our centre between November 2014 and September 2021. Left ventricular diastolic dimension was assessed via preoperative transthoracic echocardiography and left ventricular diastolic dimension index was calculated as left ventricular diastolic dimension/body surface area. The primary outcome was a composite of death or readmission due to right heart failure or stroke. The cut-off left ventricular diastolic dimension index value most closely associated with outcomes was determined by receiver-operating characteristic curve and restricted cubic spline analyses. Left ventricular diastolic dimension index measurements were available for 252 of 253 (99.6%) patients. Using a left ventricular diastolic dimension index cut-off value of 33.5 mm/m2, the cohort was divided: left ventricular diastolic dimension index ≤ (n = 131) or > (n = 121) 33.5 mm/m2. While there were no significant differences in age, INTERMACS level and preoperative haemodynamics between groups, patients with smaller left ventricular diastolic dimension index were more likely to have a larger body surface area (2.1 vs 1.9 m2, P < 0.001), ischaemic cardiomyopathy [64 (49%) vs 40 (33%), P = 0.01] and smaller left atrium volume index [40.5 (32.3-54.0) ml/m2 vs 54.0 (43.0-66.8) ml/m2, P < 0.001]. Smaller left ventricular diastolic dimension index patients had significantly worse survival (74% vs 88%, log-rank P = 0.009) and freedom from adverse events (55% vs 73%, log-rank P = 0.005) at 3-year follow-up. Smaller left ventricular diastolic dimension index was independently associated with the composite outcome (Hazard ratio 2.24, P = 0.002). Smaller preoperative left ventricular diastolic dimension index is associated with worse outcomes in patients undergoing HeartMate 3 implantation.

Cardiological Reference Intervals in Adult American Staffordshire Terrier Dogs.

The aim of this study was to determine reference intervals (RI) for echocardiography, electrocardiography (ECG), vertebral heart score (VHS) measurement, and arterial systolic blood pressure (SBP) in American Staffordshire Terrier dogs. The study population included 29 clinically healthy AST dogs of different ages, genders, and body weights. SBP measurement, ECG, thoracic radiography, and echocardiography were performed on each dog. Compared to RIs available for the general population of dogs, the duration of the P wave and QRS complex was longer and VHS was higher. Moreover, the left ventricular dimension in diastole and systole, left atrial dimension, and end point to septal separation values were higher, while the interventricular septum in diastole and systole and aortic root diameter were lower compared to general similar average body weight. The AST breed has a different heart shape, which in this breed is more rounded compared to other dog breeds, especially the deep chest. The specific body structure and the shape of the heart had an impact on the results of the cardiological examination.

Parameters associated with improvement of systolic function in patients with heart failure

AimsIdentifying clinical and echocardiographic parameters associated with improvement in systolic function in outpatients with heart failure with reduced ejection fraction (HFrEF) could lead to more targeted treatment improving systolic function...

P109: Influence Of Body Surface Area, And Ventricular Dimensions On Impella 5.5 Outcomes

Background: There has been an increase in the use of the Impella 5.5 pump for patients with refractory cardiogenic shock in a number of different patient scenarios. There is a scarcity of data on the influence of patient Body Surface Area (BSA) and ventricular dimensions prior to implant on overall pump efficiency, safety, and outcomes. Methods: Patients undergoing Impella 5.5 implantation at a single institution between August 2020 and November 2022 were included. Patient BSA was collected at the time of pump implantation, as well as ventricular dimensions from the pre-Impella echocardiography or cardiac MRI. Other clinical data included death within 30 days, and other demographic variables, as well as suspected hemolysis defined as an LDH value of over 1000 IU/L. Left Ventricular Diastolic and Systolic Dimensions (LVEDD, LVESD) were indexed by dividing them by the BSA as iLVEDD and iLVESD, respectively. Results: One hundred patients with complete data were reviewed, of which, the analysis was limited to patients with chronic heart failure (n=75). The median LVESD was 5.8 cm (IQR 4.5, 6.2), and LVEDD 6.3 cm (5.3, 6.8). 17 patients (23%) died within 30 days of Impella implantation, with no difference in gender, age, BSA, or occurrence of hemolysis in those that died vs alive at 30 days. Patients that died within 30 days had smaller indexed LVEDD (2.6 vs 2.93, p=0.01), and smaller indexed LVESD (2.14 vs 2.79, p=0.002). Conclusion: Patients with smaller indexed LVEDD and indexed LVESD at time of Impella implantation have a higher risk of 30 day mortality that appears to be independent of hemolysis risk. This maybe due to less efficient pump function in small ventricles in higher BSA individuals requiring higher levels of forward flow.

PO-03-019 ECHOCARDIOGRAPHIC OUTCOMES OF HIS BUNDLE AND LEFT BUNDLE BRANCH AREA PACING: A SINGLE CENTER EXPERIENCE

Traditional right ventricular apical pacing is associated with risk of pacing induced cardiomyopathy (PICM), atrial fibrillation, and heart failure. Conduction system pacing (CSP) via the His or left bundle branch area (HBP, LBBAP) may mitigate or even prevent the development of these complications. To evaluate the effects of CSP on cardiac function as measured by standard 2D-echocardiography. Consecutive patients undergoing HBP or LBBAP implantation between Feb 2014 and July 2022 at Virginia Commonwealth University were analyzed. Ejection fraction (EF), left ventricular diastolic dimension (LVIDd), left ventricular systolic dimension (LVIDs), tricuspid regurgitation severity, and mitral regurgitation severity were compared pre- and post- CSP. Only patients with echo data at 90 days or greater from time of implant were included. A total of 340 patients with CSP had echocardiographic data available. Mean clinical follow up time was 810 days from implant, and median time until post-implant EF was 483 days (IQR 324-763). 77 had reduced EF (<50%) at baseline. Pacing burden exceeded 20% across the cohort. The mean pre- and post- CSP implantation EF in the overall group was 53.8% ±10.9% vs 54.7% ±9.1% (p=0.08). Mean pre- and post- CSP implant LVIDd was 4.59±0.73cm vs 4.37 ±0.72 cm (p<0.001). Mean pre- and post- CSP implant LVIDs was 3.23± 0.79cm vs 3.05± 0.76cm (p<0.001). TR and MR severity were unchanged after pacemaker implantation. In the subset of patients with reduced EF, mean pre-implant EF was 37% ±9.4% and post-implant EF was 47% ±11.6% (p<0.001). Mean pre-implant LVIDd was 5.02cm ±0.86cm and post-implant LVIDd was 4.60cm ±0.75cm (p<0.001). Mean pre-implant LVIDs was 4.05cm ±1.0cm and post-implant this dropped to 3.44cm ±0.96 (p<0.001). CSP via HBP or LBBAP is not associated with PICM in patients requiring high ventricular pacing burdens. In patients with a reduced EF, it may significantly improve systolic function along with positive structural remodeling.

Cardiac Magnetic Resonance Imaging Detects Myocardial Abnormalities in Naturally Infected Dogs with Chronic Asymptomatic Chagas Disease.

Trypanosoma cruzi infection causes inflammation and fibrosis, resulting in cardiac damage in dogs. The objectives of this study were to describe cardiac magnetic resonance imaging (CMR) in naturally infected dogs with chronic Chagas disease and the frequency of abnormalities for CMR and cardiac diagnostic tests. Ten asymptomatic, client-owned dogs seropositive for T. cruzi were prospectively enrolled in an observational study evaluating echocardiography, ECG (standard and ambulatory), cardiac troponin I (cTnI), and CMR. Standard ECG measurements (3/10) and cTnI concentration (1/10) outside the reference range were uncommon. Ambulatory ECG abnormalities were documented more frequently (6/10 dogs) than with standard ECG and included ventricular arrhythmias (4), supraventricular premature beats (3), second-degree atrioventricular block (2), and sinus arrest (1). Echocardiographic abnormalities were documented in 6/10 dogs including mildly increased left ventricular internal dimension in diastole (1) and decreased right ventricular (RV) systolic function based on reductions in tricuspid annular plane systolic excursion (3) and RV S' (4). Abnormalities were detected with CMR in 7/10 dogs including delayed myocardial enhancement in 5 of which 2 also had increased extracellular volume, abnormal wall motion in 5, and loss of apical compact myocardium in 1. In conclusion, CMR abnormalities were common, and the results of this study suggest CMR can provide useful information in dogs with T. cruzi infection and may support naturally infected dogs for future clinical investigation as an animal model for Chagas disease.

Treprostinil in Neonates with Congenital Diaphragmatic Hernia-Related Pulmonary Hypertension

To describe our experience with treprostinil, evaluate correlations with cardiac function, and assess for adverse effects in neonates with congenital diaphragmatic hernia-related pulmonary hypertension (CDH-PH). A retrospective review of a single-center prospective registry at a quaternary care children's hospital. Patients included in the study had CDH-PH treated with treprostinil between April 2013 and September 2021. Assessed outcomes were brain-type natriuretic peptide levels and quantitative echocardiographic parameters collected at baseline, 1week, 2weeks, and 1month after treprostinil initiation. Right ventricular (RV) function was assessed by tricuspid annular plane systolic excursion Z-score and speckle tracking echocardiography (global longitudinal and free wall strain). Septal position and left ventricular (LV) compression were assessed by eccentricity index and M-mode Z-scores. Fifty-one patients were included, with an average expected/observed lung-to-head ratio of 28.4±9.0%. Most patients required extra-corporeal membrane oxygenation (n=45, 88%). Survival to hospital discharge was 31/49 (63%). Treprostinil was initiated at a median age of 19days with a median effective dose of 34ng/kg/minute. Median baseline brain-type natriuretic peptide level decreased from 416.9 pg/mL to 120.5 pg/mL after 1month. Treprostinil was associated with improved tricuspid annular plane systolic excursion Z-score, RV global longitudinal strain, RV free wall strain, LV eccentricity index, and LV diastolic and systolic dimensions, reflecting less compression by the RV, regardless of ultimate patient survival. No serious adverse effects were recorded. In neonates with CDH-PH, treprostinil administration is well tolerated and is associated with improved RV size and function.

Impact of dapagliflozin on cardiac function following anterior myocardial infarction in non-diabetic patients – DACAMI (a randomized controlled clinical trial)

BackgroundThe role of Sodium-glucose co-transporter 2 inhibitors (SGLT2i) in heart failure is established. Early data also suggests their favorable role in patients with acute coronary syndromes, but more evidence is still needed. MethodsIn this dual center, double-blinded randomized controlled trial, non-diabetic patients (N = 100) who presented with anterior ST- elevation myocardial infarction (STEMI) & had undergone successful primary percutaneous coronary intervention, but their left ventricular ejection fraction was below 50%, were randomized to dapagliflozin 10 mg or a placebo once daily. The primary endpoint was a change in cardiac function assessed by N-terminal pro-Brain Natriuretic Peptide – NT-proBNP measured at baseline & 12 weeks post the cardiac event &/or echocardiographic parameters (left ventricular ejection fraction, left ventricular diastolic dimension & left ventricular mass index) assessed at baseline, 4-weeks & 12-weeks post the cardiac event. ResultsFrom October 2021 to April 2022, 100 patients were randomized. The mean drop of NT- proBNP in the study group was more significant compared to the control group by 10.17% (95% CI: −3.28–19.67, p-value 0.034). In addition, the decrease in the left ventricular mass index (LV mass index) was also significant in the study group compared to the control group by 11.46% (95% CI: −19.37 to −3.56, p-value 0.029). ConclusionsDapagliflozin seems to have a role in preventing left ventricular dysfunction & maintaining cardiac function following anterior ST-elevation myocardial infarction. More Large-scale trials need to be done to confirm these findings further.This trial is locally registered at the National Heart Institute, Cairo – Egypt, and Faculty of Medicine, Ain Shams University, with reference numbers CTN1012021 & MS-07/2022, respectively. It is also registered retrospectively at the US National Institutes of Health (ClinicalTrial.gov) with identifier number: NCT05424315 – June 16th,2022.

PS-C14-6: THE USEFULNESS OF C-REACTIVE PROTEIN TO PREDICT IMPROVING LEFT VENTRICULAR FUNCTION AFTER AORTIC VALVE REPLACEMENT IN AORTIC REGURGITATION PATIENTS

Background: We aimed to clarify the predictive factors for left ventricular (LV) function after aortic valve replacement (AVR) in patients with aortic regurgitation (AR). Methods and Results: Among 555 patients who underwent AVR at our institution from January 2015 to December 2020, we enrolled 44 patients for whom only AVR (or AVR + aortic replacement) was performed. We defined LV dysfunction under any of the following criteria: LV ejection fraction (LVEF) &lt; 50%, LV diastolic dimension&gt; 65 mm, LV systolic dimension (LVDs) &gt; 50 mm, or LVDs/body surface area &gt; 25 mm/m2. Multivariable logistic regression analysis revealed high natural logarithm (ln) C reactive protein (CRP) and low LVEF in the pre AVR period significantly associated with LV dysfunction after AVR (ln CRP: odds ratio [OR] 4.15, 95% confidence interval [CI] 1.44 to 11.98, p &lt; 0.01; LVEF: OR 0.79, 95%CI 0.65 to 0.97, p &lt; 0.05). Receiver operating characteristic analysis revealed an area under curve of CRP and LVEF in the pre AVR period for LV dysfunction after AVR of 0.84 and 0.83, respectively. Upon dividing the patients into four groups according to cutoff values of CRP (0.13 mg/dL) and LVEF (50%) in the pre AVR period, no patients (0/19) had LV dysfunction in the low CRP (&lt; 0.13 mg/dL) and high LVEF ( 50%) group, and all patients (5/5) in the high CRP ( 0.13 mg/dL) and low LVEF (&lt; 50%) group had LV dysfunction after AVR. Conclusion: High CRP level was significantly and independently associated with LV dysfunction after AVR. Combination of CRP and LVEF values might be useful for predicting improvement in LV function after AVR.

PS-BPB02-8: CURCUMIN, AN INHIBITOR OF P300-HAT ACTIVITY, PREVENTS HYPERTENSION-INDUCED CARDIAC HYPERTROPHY WITH PRESERVED SYSTOLIC FUNCTION IN DAHL RATS

Background: Hypertension causes left ventricular hypertrophy (LVH) with a preserved systolic function. While LVH might be a compensatory process, its presence of LVH is associated with an increased incidence of cardiovascular events and heart failure. Recently, we found that curcumin, a major curcuminoid isolated from Curcuma longa, inhibits the histone acetyltransferase (HAT) activity of p300 as well as the p300-induced acetylation of histones and a hypertrophy-responsive transcription factor, GATA-4, in cultured cardiomyocytes. Furthermore, curcumin prevents deterioration of the systolic function in rat heart failure models in vivo. However, whether curcumin prevents the development of hypertension-induced LVH at an early stage of hypertension is unclear. Objective: To solve this problem, we have utilized a salt-sensitive Dahl rat (DS) model of hypertension. Methods: We randomized 6-week-old DS (n = 19) and control salt-resistant Dahl rats (DR, n = 10) to curcumin or the vehicle group. Then, these rats were given a high-salt diet and subjected to daily oral treatment with 50 mg/kg/day of curcumin or its vehicle (1% Gum arabic) for 6 weeks. Results: There were no differences between curcumin and vehicle in any data examined before treatment (6 weeks of age). The high-salt diet-induced a similar degree of hypertension in these two groups of DS compared with DR. At 12 weeks of age, transthoracic echocardiography in the vehicle group showed that the LV wall thickness, LV mass, and LV fractional shortening were significantly higher in DS compared with DR, and the LV systolic and diastolic dimensions were significantly smaller in DS than DR. Curcumin treatment significantly (p &lt; 0.01) decreased the LV wall thickness in DS but not DR. Curcumin also significantly (p &lt; 0.01) decreased the LV mass in DS, but not in DR. However, LV fractional shortening in DS was similar between the two groups. Curcumin also prevented the increases in hypertension-induced myocardial cell hypertrophy and perivascular fibrosis. Furthermore, curcumin significantly attenuated the up-regulation of hypertrophy-response gene transcriptions as well as acetylation of GATA4 but not phosphorylation of ERK1/2 and GATA4 in the heart. Conclusions: The natural compound, curcumin, inhibits the development of hypertension-induced concentric LVH without affecting the systolic function through inhibition of GATA4-acetylation. Thus, this compound might be applicable to patients with early-stages hypertensive heart diseases.

Systolic Anterior Motion of the Mitral Valve in the Presence of Annular Calcification

Mitral annular calcification (MAC) has been reported as a possible cause of systolic anterior motion (SAM) of the mitral valve and dynamic left ventricular outflow tract (LVOT) obstruction. While morphologic features predisposing to SAM in other clinical settings have been described, patients with MAC+SAM have not been systematically investigated. We hypothesized that bulky calcium deposits in the mitral annulus could displace the valve toward the septum, thus promoting development of SAM. We studied 30 patients with severe MAC who had SAM with septal contact. Three comparator groups (matched for age and sex) were developed: 30 controls without MAC or SAM, 30 with severe MAC but no SAM, and 30 with SAM but no MAC. Significant differences were found across groups for mitral valve coaptation point-septal distance (CSD), anterior mitral leaflet (AML) length, left ventricular diastolic dimension, and ejection fraction. Comparing all MAC subjects (n=60) with controls, CSD was less (20.5±4.1 vs 23.2±3.7mm, P=.003) and ejection fraction was higher (67.7%±7.8% vs 60.9%±6.4%, P<.0001) in MAC patients. Within MAC subjects AML was longer (21.9±3.0 vs 17.4±2.2mm, P<.0001) and CSD was smaller (18.0±2.7 vs 23.1±3.6mm, P<.0001) when SAM was present despite similar height of the calcium bar in the 2 MAC groups (12.4±2.9 vs 11.1±3.1mm, P=.11). Regression analysis confirmed AML length and CSD as independent predictors of SAM. MAC+SAM patients also had more echocardiographic risk factors for SAM (acute aortomitral angle, small LVOT, long AML, small CSD, and presence of a septal bump) than MAC/no-SAM patients (3.4±0.9 vs 1.8±1.0, P<.0001). Bulky MAC appears to contribute to dynamic LVOT obstruction when it accumulates in such a way that the mitral valve is displaced anteriorly toward the septum. However, other features are also associated with SAM in these patients, particularly a long AML. A combination of morphologic features and favorable hemodynamics may be needed for SAM to develop in patients with severe MAC.