Left Ventricular Diastolic Dimension Research Articles

Excellent Long-Term Survival After Weaning from Durable Ventricular Assist Device

<h3>Purpose</h3> It is reported that bridge to recovery was achieved in a limited number of cases after durable ventricular assist device (VAD). Thus, long-term survival over 5 years after removal of the device is not thoroughly examined. We aim to analyze long-term results and the trend of left ventricular (LV) function after weaning from a durable VAD in our hospital. <h3>Methods</h3> Since September 2006, 344 durable VAD implantations were performed in the University of Tokyo Hospital, among which 30 patients were successfully weaned from the device. Twenty-five patients were enrolled in this study after excluding 5 patients who were treated for fulminant myocarditis. The majority of causative disease was idiopathic dilated cardiomyopathy in 24. They were implanted with paracorporeal (n = 12) or implantable (n = 13) VAD according to a reimbursement policy. Aggressive pharmacological treatment including titration of beta-blocker and ACE inhibitor or ARB along with aerobic rehabilitation was planned in all cases. Once a sign of functional recovery was recognized, our weaning protocol was initiated, such as cardiopulmonary exercise testing, VAD off-test and volume challenging test. Twenty-five patients met the weaning criteria, and underwent a VAD removal via redo median sternotomy. Long term survival was examined including repeated VAD implantation. Analysis of LV diastolic dimension and ejection fraction by echocardiography and BNP level was conducted to monitor LV function. <h3>Results</h3> Patients were weaned from the VAD after 333-day-long support without in-hospital death. All patients were followed-up for an average of 6 years. One-, 5-, and 10-year survival was 100%, 89.7% and 89.7%, and re-VAD-free survival was 91.8%, 85.7% and 85.7%, respectively. Notably, there was no death in patients who were weaned from implantable VAD. LVDd (67.7 mm) was significantly reduced before weaning (52.3 mm) and stabilized for a year. LVEF (19.5%) was significantly improved before weaning (43.4%) and further increased toward 1 year. BNP was significantly reduced before weaning and in the same level at 1year. <h3>Conclusion</h3> Long-term prognosis of patients who were weaned from durable VAD through our structured protocol was excellent. Bridge to recovery seems to aggressively be reappraised as a vital choice for durable VAD treatment.

Brain Natriuretic Peptide Levels in Hypertensive Heart Failure Patients with and without Diabetes Mellitus: A Cross-sectional Study

Introduction: Heart Failure (HF) is a major disorder causing mortality and morbidity in the elderly population. Brain Natriuretic Peptide (BNP) is considered as the gold standard biomarker for diagnosis of HF. Aim: To find the association of plasma BNP levels with heart failure in hypertensive patients with and without diabetes mellitus. Materials and Methods: This cross-sectional study consisted of 35 hypertensive heart failure patients who attended the Outpatient General Medicine Department at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, between March 2020 to December 2020. The patients who belonged to class IV heart failure of the New York heart association were included. Total 35 HF patients were divided into two groups. Group 1 included 10 patients with hypertensive heart failure without diabetes mellitus. Group 2 included 25 patients with hypertensive heart failure with diabetes mellitus. Parameters such as Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), waist to hip ratio, Body Mass Index (BMI), Ejection Fraction (EF), transmitral filling velocities (E/A ratio), Left Ventricular Posterior Wall Thickness (LVPW), Left Ventricular Internal Dimension in diastole (LVIDd) and BNP level, random plasma glucose and HbA1c % were assessed in all the patients. Student’s t-test and Mann-Whitney U test were used to statistically analyze the data and p-value ≤ 0.05 was considered statistically significant. Results: Mean age of patients were 65.80±12.72 years in group 1 and 66.56±11.72 years in group 2. All patients in group 1 and most of the patients in group 2 (15,42%) were males. All the patients were in the obese category (BMI&gt;27 kg/m2 ). Serum BNP level was 1365 (243-3680) ng/L in group 1 and 691 (44.7-4261) ng/L in group 2, but this difference was not statistically significant (p-value=0.23). Echocardiography showed significant differences in left ventricular internal dimension in diastole, left ventricular posterior wall thickness and E/A ratio-integrated between hypertensives and hypertensives with diabetes mellitus. Serum BNP had a significant positive correlation with systolic blood pressure (r=0.33, p-value=0.05). There were highly significant differences in random plasma glucose and glycated haemoglobin between the groups. Conclusion: Plasma BNP levels were associated with systolic blood pressure in heart failure patients with hypertension. The significance of association is the same in hypertensives with diabetes mellitus. Thus, BNP as a biomarker plays a major role in the prediction of heart failure. But BNP could not differentiate whether the heart failure was due to hypertension alone or due to associated metabolic conditions.

Factors associated with cardiac allograft vasculopathy after heart transplantation.

Cardiac allograft vasculopathy (CAV) is a major threat to long-term survival after heart transplantation (HT). To determine factors associated with CAV detection in patients after HT. We analyzed 299 consecutive patients after HT who underwent routine visits at our institution between 2016 and 2018. Human interleukin 33 (IL-33) and suppression of tumorigenicity 2 (ST2) were measured by sandwich enzyme-linked immunosorbent assay with a commercially available kit (Human ST-2 and IL-33 ELISA, SunRedBio Technology Co, Ltd, Shanghai, China). The patients' median age was 59.00 years, and 74.2% were men. The frequency of CAV was 47.5%. Multivariable logistic regression analysis showed that IL-33 (odds ratio (OR) = 1.044 (1.029-1.059), p < 0.001) and ST2 (OR = 1.061 (1.040-1.083), p < 0.001) serum concentrations, donor age (OR = 1.046 (1.009-1.085), p = 0.015), left ventricular diastolic dimension (LVDD) (OR = 1.081 (1.016-1.149), p = 0.013), and time from HT to blood collection (OR = 1.256 (1.151-1.371), p < 0.001) were independent risk factors for CAV. The area under the receiver operating characteristics curve (AUC) indicated good prognostic power of IL-33 and ST2 concentrations (AUC = 0.779 and AUC = 0.784, respectively) and excellent prognostic power of the IL-33/ST2 score (AUC = 0.863). Lower IL-33 and higher ST2 serum concentrations, as well as older donor age, larger LVDD and longer time from HT to blood collection, are independently associated with CAV. IL-33 and ST2 have good discriminatory power and the IL-33/ST2 score has excellent strength for detecting CAV.

Body Mass Index: An Effective Predictor of Ejection Fraction Improvement in Heart Failure.

Background: Heart failure patients with higher body mass index (BMI) exhibit better clinical outcomes. Therefore, we assessed whether the BMI can predict left ventricular ejection fraction (EF) improvement following heart failure.Methods and Results: We included 184 patients newly diagnosed with dilated cardiomyopathy and reduced EF in our center and who underwent follow-up examination of EF via echocardiography after 6 months. The EF improved at 6 months in 88 participants, who were included in the heart failure with recovered EF (HFrecEF) subgroup. Patients in whom the EF remained reduced were included in the heart failure with persistently reduced EF (persistent HFrEF) subgroup. Our analyses revealed that EF increase correlated with age (r = −0.254, P = 0.001), left ventricular diastolic dimension (LVDD; r = −0.210, P = 0.004), diabetes (P = 0.034), brain natriuretic peptide (r = −0.199, P = 0.007), and BMI grade (P = 0.000). BMI grade was significantly associated with elevated EF after adjustment for other variables (P = 0.001). On multivariable analysis, compared to patients with persistent HFrEF, those with HFrecEF had higher BMI [odds ratio (OR) = 2.342 per one standard deviation increase; P = 0.001] and lower LVDD (OR = 0.466 per one standard deviation increase; P = 0.001). ROC-curve analysis data showed that BMI > 22.66 kg/m2 (sensitivity 84.1%, specificity 59.4%, AUC 0.745, P = 0.000) indicate high probability of EF recovery in 6 months.Conclusions: Our data suggest that higher BMI is strongly correlated with the recovered EF and that BMI is an effective predictor of EF improvement in patients with heart failure and reduced EF.

The paradoxical effect of aldosterone on cardiovascular outcome in maintenance hemodialysis patients.

BackgroundPatients with end-stage kidney disease face increased risk of cardiovascular events, and left ventricular diastolic dysfunction (LVDD) contributes to the high occurrence of cardiovascular mortality (CM). Although a high serum aldosterone (sALD) level is involved in the development of cardiovascular complications in the general population, this association is unclear in patients undergoing hemodialysis. We aimed to determine the impact of sALD on LVDD and CM among hemodialysis patients (HDPs).MethodsWe performed a prospective cohort study of maintenance HDPs without cardiovascular disease. The patients were divided into two groups according to the median level of sALD. All patients underwent baseline echocardiography to evaluate diastolic dysfunction (E/e' ratio > 15). The LVDD and CM rates were compared between the high and low aldosterone groups.ResultsWe enrolled a total of 60 adult patients (mean age, 57.9 ± 12.1 years; males, 30.0%). The low aldosterone group had an increased left ventricular diastolic dimension compared with the high aldosterone group (52.2 ± 8.4 mm vs. 50.3 ± 5.2 mm, respectively; p = 0.03). Low log-aldosterone (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.19–0.86) and large left atrial dimension (OR, 1.31; 95% CI, 1.11–1.54) were independent risk factors for LVDD at baseline. In addition, Cox regression analysis demonstrated that low sALD was an independent predictor of CM in HDPs (hazard ratio, 0.46; 95% CI, 0.25–0.85; p = 0.01) during follow-up.ConclusionLow sALD was not only associated with LVDD but was also an independent predictor of CM among HDPs regardless of their interdialytic weight gain.

Remodeling Process in the Right and Left Atria and Ventricles Following Percutaneous Closure of the Atrial Septal Defect in Children and Adolescents: A Mid-term Study

Background: Atrial septal defect and its closure can lead to changes in the right and left cardiac cavities' function and size. In this study, Z-scores of the cardiac chambers and the heart function were assessed, and the important complications were mentioned. Methods: This interventional cross-sectional study was done on patients who had atrial septal defect closure aged younger than 18 years. All patients were recruited for transthoracic echocardiography. About half of the patients were randomly selected. The information of angiography and its side effects belong to all patients, but the echocardiographic parameters and Z-scores belong only to the selected group. Results: A total of 370 patients underwent the atrial septal defect closure, of whom 150 patients participated in the study. The patients' average age and weight were 9.25 ± 3.44 years and 15.12 ± 11.83 kg, respectively, and the mean follow-up time was 2.56 years. Z-scores of the interventricular septal dimension in diastole, the left ventricular posterior wall dimension in diastole, the left ventricular internal dimension in systole, and Z-scores of the size of the right atrium, right ventricle, pulmonary valve annulus, and the main pulmonary artery were more than Z-scores of the normal population. Furthermore, Z-scores of the E/A and the Eat/Aat of the tricuspid valve were less than their peers. Besides, the correlation between Z-scores and the atrial septal defect size and weight of the patients was assessed, which was statistically significant, and patients who underwent atrial special defect closure at the age of fewer than three years and less than 15 kg had more normal cardiac Z-scores. Conclusions: Z-scores of the cardiac chambers and pulmonary artery were more than normal after successful closure of the atrial septal defect in the mid-term follow-up.

The impact of substrate and trigger ablation for reduction of functional mitral regurgitation in patients with persistent atrial fibrillation

Abstract Background Functional mitral regurgitation (FMR) is not uncommon in atrial fibrillation (AF) patients. Left atrial (LA) substrate remodeling and corresponding mitral valve annulus dilation has been reported as the most possible cause of FMR. Percutaneous catheter ablation (CA) is an effective treatment for AF. Although significant FMR could be improved by sinus restoration, patients with mitral regurgitation were more likely to experience recurrent AF post ablation, especially those with significant mitral regurgitation. There is no information available on the efficacy of CA for persistent AF in patients with FMR. Purpose The purpose of this study is to investigate the predictors of FMR improvement by CA and to determine the efficacy of substrate and trigger CA for persistent AF in patients with FMR. Methods We prospectively studied 512 consecutive patients admitted for persistent AF ablation from the EARNEST-PVI (Prospective Multicenter Randomized Study of Effect of Extensive Ablation on Recurrence in Patients with Persistent Atrial Fibrillation Treated with Pulmonary Vein Isolation) trial. On admission, enrolled patients were randomly assigned in a 1:1 ratio to pulmonary vein isolation (PVI) or PVI-plus additional ablation (linear ablation or/and CFAE ablation). Of the 512 patients, we studied 94 patients with preoperative echocardiography showing moderate or greater baseline FMR. FMR grades were classified into 5 grades (0/1/2/3/4). The FMR improvement group (FMRI(+)) was defined as a case in which the FMR was improved by two or more grades compared the preoperative echocardiography and the one year follow-up examination. Results Of the 94 patients, 42 were in the PVI group and 52 were in the PVI-plus additional ablation group. There were 30 cases in the FMRI(+) group and 64 cases in the FMRI(−) group. There were no significant baseline differences in age, sinus rhythm maintenance, plasma B-type natriuretic peptide (BNP) level, left ventricular diastolic dimension, or left atrium dimension between the FMRI(+) and FMRI(−) groups. AF duration was significantly shorter in the FMRI(+) group than FMRI(−) groups (5.8±9.4 months vs 12.4±15.4 months, p&amp;lt;0.0001). In addition, significantly more additional ablation cases were observed in the FMRI(+) group than in the FMRI(−) group (73.3% vs 46.8%, p=0.016). In multivariate analyses, only additional ablation was an independent predictor of FMRI (odds ratio 0.226 95% CI 0.081–0.626; p=0.004). Conclusions Catheter ablation is a valid option for the treatment of AF in patients with functional MR and additional substrate and trigger ablation were the only independent predictor of FMR improvement. Funding Acknowledgement Type of funding sources: None.

Short-term amino acid, clinicopathologic, and echocardiographic findings in healthy dogs fed a commercial plant-based diet.

Consumer demand for commercially prepared plant-based (PB) dog food is increasing, but studies evaluating the short- or long-term effects of PB diets on canine health are lacking. The objective of this study was to assess the short-term amino acid (AA), clinicopathologic, and echocardiographic findings in 34 client-owned dogs fed a commercial extruded plant-based diet (PBD) in which pea protein was the primary protein source and 4 control dogs fed a commercial extruded traditional diet (TD). Plasma AA and whole blood taurine concentrations were measured in dogs at baseline and after 4 weeks on the PBD or the TD. Hematologic, serum biochemical, and echocardiographic testing were performed at baseline and after 12 weeks on the PBD or the TD. Four dogs in the PBD group did not complete the study. All essential AAs, except methionine, were higher in dogs after 4 weeks on the PBD compared to baseline. Taurine (plasma and whole blood) was also higher after 4 weeks on the PBD compared to baseline. A meaningful difference was detected in whole blood taurine between the PBD group and the control group at 4 weeks (P = .026) with the PBD group being higher. Median hematologic and biochemical results for the PBD group were within normal limits at baseline and at 12 weeks. In the PBD group, left ventricular internal diastolic dimension (LVIDd, P = < .001) and normalized LVIDd (P = .031) were higher 12 weeks post-PBD compared to baseline. There were no meaningful differences in left ventricular internal systolic dimension (LVIDs), normalized LVIDs, or fractional shortening 12 weeks post-PBD. There was no statistical evidence of difference between the 2 groups of dogs for any of the echocardiographic parameters at baseline or at 12 weeks. Essential AA or taurine deficiency was not observed in this cohort of dogs fed a commercial extruded PBD. Additionally, clinically relevant hematologic, serum biochemical and echocardiographic alterations were not detected. Further research is required to determine if long-term static feeding of PB diets can meet and maintain AA and other nutrient targets in dogs.

Three-month cardiac outcomes of survivors of COVID-19 presenting to a district general hospital in West Hertfordshire, UK

Abstract Background COVID-19 is novel entity associated with significant morbidity and mortality. Most patients recover completely, however, a proportion describe persistent symptoms consistent with cardiopulmonary disturbance. The long-term cardiac and respiratory outcomes of COVID-19 are not known. Purpose The aim of this study was to undertake a comprehensive cardiopulmonary assessment of survivors of COVID-19 with post recovery symptoms. The cardiac findings are presented here. Methods Survivors of COVID-19 presenting to a general hospital in West Hertfordshire between 18 March 2020 and 15 May 2020, were reviewed at 3 months using a structured prespecified protocol. Patients with persistent symptoms and those admitted to the intensive care unit (ICU) were invited to attend a clinical assessment comprising an electrocardiogram (ECG), echocardiography, chest x-ray (CXR) and pulmonary function tests. At follow up, patients were categorised according to disease course: 1) monitored via a community based virtual hospital, 2) admitted for supplemental oxygen, 3) requiring non-invasive ventilation and 4) ICU admission. Results 448 eligible patients were evaluated by telephone. 11 patients admitted to ICU and 147 patients with persistent symptoms were invited for further assessment. At presentation, hospitalised patients were older, had higher levels of obesity and increased rates of hypertension than those managed virtually (p&amp;lt;0.05). Among hospitalised patients, the degree of pulmonary infiltration on CXR was higher, ROX index for intubation lower, eGFR lower, C-reactive protein levels higher and lymphocyte counts lower, compared to those managed virtually (p&amp;lt;0.05). The prevalence of known respiratory conditions was higher among patients admitted to hospital, with a trend towards statistical significance (p=0.051). There were no differences in the prevalence of known cardiac disorders and other co-morbidities amongst both patient groups (table 1). At follow up, CXR appearances were improved and similar among patients monitored virtually, those admitted for supplemental oxygen, those requiring non-invasive ventilation and those treated on ICU. There were no differences in heart rhythm and ECG parameters in the four patient groups. Left ventricular systolic and diastolic dimensions, Simpson's biplane ejection fraction, left atrial volume and left ventricular filling pressures were similar in all four patient groups. There were no differences in right ventricular dimensions, right ventricular fractional area change, tricuspid annular plane systolic excursion and pulmonary artery systolic pressures among patients irrespective of disease severity (table 2). Conclusions At 3 months, we identified no differences in ECG indices and echocardiographic parameters of left and right ventricular function among survivors of COVID-19, independent of disease course. The findings of this study argue against significant cardiac sequalae following COVID-19 infection. Funding Acknowledgement Type of funding sources: None.

The Changes of Gene Expression and Protein Level of Stretch-Activated Chloride Channel in Atrial Myocardium of Dogs with Atrial Fibrillation.

ICl,stretch have been reported to be involved in the development of atrial fibrillation, so we observed the changes of transcription and translation levels of ICl,stretch in isolated atrial myocardium of heart failure canine models. In the control group (N = 10), five dogs were untreated and the other five received sham operation, while dogs in the heart failure group (N = 10) were implanted with cardiac pacemakers and underwent right ventricular pacing to induce heart failure. Cardiac structure and function were evaluated. The gene expression and protein level of ICl,stretch in the left atrial appendage were detected. The left atrial diameter, right atrial dimension, left ventricular diastolic dimension, and right ventricular diastolic dimension were significantly larger in the heart failure group (P < 0.05). In contrast, the ejection fraction and the left ventricular shorten fraction were higher in the control group (P < 0.05). Both the mRNA and protein expression levels of ICl,stretch in atrial myocardium of the heart failure group were significantly higher compared with the control group. ICl,stretch might play an important role in the vulnerability to atrial fibrillation in dilated atria with heart failure and could be a potential therapeutic target for atrial fibrillation.

MULTI-LOOP TECHNIQUE FOR PAPILLARY MUSCLE RELOCATION IN ISCHEMIC MITRAL REGURGITATION

<h3>BACKGROUND</h3> The appropriate surgical management of ischemic mitral regurgitation (IMR) is still highly debatable: valve replacement is often favoured over repair with ring annuloplasty (RA) because the former is associated with lower MR recurrence. The addition of a sub-valvular intervention, such as papillary muscle relocation (PMR), has been suggested to improve the durability of the mitral repair. Therefore, our aim was to examine the outcomes of a novel technique for PMR involving a multi-loop suture in the treatment of IMR. <h3>METHODS AND RESULTS</h3> Between 2017 and 2020, 9 patients with severe chronic IMR were enrolled into this case series: a multi-loop suture was used to address PMR in addition to ring annuloplasty. In brief, the multi-loop suture was prepared with Gore-Tex sutures, which was then anchored to the posteromedial papillary muscle, and buttressed with pledgets. The sutures attached to the loop were passed through the aspect of the annulus corresponding to the tethered segment, thus, serving as neo-chordae. Length was determined by saline test. Once regurgitation was absent on visual inspection of the saline test, the chordae were secured above the annulus with pledgets on the atrial side. Eight patients also received concomitant coronary artery bypass graft (CABG) procedure. Clinical and echocardiographic outcomes during the perioperative and follow-up periods were assessed. The mean follow-up was 15 +/- 8 months. One patient who had a pre-operative EuroSCORE of 8.25% died within the early post-operative period. The mean transmitral gradient at discharge was 3.8±1.4 mmHg. At follow-up, there was no mortality and cardiac-related readmissions, and only one patient had MR recurrence. The left ventricular end-systolic diastolic dimension was significantly lower at follow-up compared with pre-operative (6.1±4.6mm vs 5.6±0.9mm, P=0.03). A non-significant trend towards improvement was noted at follow-up compared with pre-operative for left ventricular end-diastolic volume (147.9 ± 61.2 ml vs 161.1 ± 46.6 ml, p=0.74), and left ventricular end-systolic volume (84.8 ± 42.6 ml vs 87.3 ± 35.9 ml, p=0.78). Despite the use of an undersized RA, mitral stenosis was not noted at latest follow-up, and the mean transmitral gradient of 3.6 ± 1.4 mmHg. <h3>CONCLUSION</h3> In patients with severe IMR, PMR with a multi-loop suture adjunctive to RA appears to offer excellent clinical and echocardiographic outcomes during follow-up of up to 2 years post-operatively. Nevertheless, these preliminary findings warrant further validation in a larger series of patients.

Comparison of echocardiographic parameters during long and short interdialytic intervals in hemodialysis patients

Abstract Background Cardiovascular disease is the leading cause of mortality in patients receiving haemodialysis (HD). Most HD patients follow the typical schedule of three sessions per week, and thus remain outside dialysis for two short intervals (∼ 2 days in duration) and for a longer interval (∼3 days) at the end of each week. There is a link between the long interdialytic interval and worsened cardiovascular outcomes but few studies have examined the underlying mechanisms Objective To compare changes in echocardiographic parameters during the 2- day (short) and 3day (long) interdialytic intervals of prevalent HD patients. Patients and Methods The study involved 30 stable prevalent HD patients on thrice weekly regimen. Echocardiography was done before and after the short and long interdialytic interval to study left and right ventricle functions and inferior vena cava (IVC) diameter. Patients ages ranged between 28 and 75 years with mean age of 56.23±12.31 years (43.4% females and 56.7% males) Results Comparison of echocardiographic measurements was done before and after dialysis between the short (2-days) and long (3-day) interdialytic interval groups (Group 1 Vs Group 2). There were no statistically significant differences between left ventricular (LV) systolic and diastolic dimensions, septum affection, ejection fraction, or pulmonary artery pressure. There were statistically highly significant differences among left pulmonary capillary wedge pressure (PCWP), IVC diameter and interdialytic weight change after dialysis session between the short and the long interdialytic interval patients' groups. The intradialytic weight gain (2.45 ± 1.13 vs 1.19 ± 0.78 kg), IVC diameter (11 ± 2.98 vs 9.62 ± 2.32) and PCWP (11.13 ± 2.3 vs 10.13 ± 1.55) increase were higher during the 3-day versus the 2-day interval (P &amp;lt; 0.001) . Conclusion IVC, PCWP and intradialytic weight increase was higher during the 3-day versus the 2-day interval in post dialysis comparison. IVC, PCWP and intradialytic weight gain reflect degree of volume overload and their increase especially after interdialytic interval call for need to evaluate timing and frequency of prescribed HD regimens for some HD patients.

Assessment of echocardiographic left ventricular dimensions with several clinical findings among healthy people

Background: The echocardiographic measurement of left ventricular dimensions and the changes of left ventricular dimensions may be important to assess cardiac as well as the cardiovascular conditions of patients. On the other hand, the QRS duration signifies the time for ventricular depolarization. Aim of the study: The aim of this study was to assess the echocardiographic left ventricular dimensions with several clinical findings among healthy people. Methods: This was an observational cross-sectional study which was conducted in the Department of Cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Dhaka over a period of 2 years from July 2008 to June 2010. In total 92 apparently healthy people without heart failure (HF) or myocardial infarction (MI) were included as the study population. Among them, 22 were in Referent (QRS duration &lt;100 ms), 40 in Incomplete BBB (QRS duration 100 – 119), and 30 in Complete BBB (≥ 120 ms) groups. Proper written consent was taken from all the participants and this study was approved by the ethical committee of the mentioned university. All data were processed, analyzed, and disseminated by MS Office and SPSS version as per need. Results: In this study, the left ventricular (LV) mass, left ventricular diastolic dimension, septal wall thickness, posterior wall thickness and left atrial size were significantly higher in complete BBB group than those in referent and incomplete BBB group (143.0 ± 30.2 vs. 182.6 ± 37.9 vs. 222.0 ± 61.0, p &lt; 0.001; 4.6 ± 0.3 vs. 4.9 ± 0.3 vs. 5.2±0.4, p&lt; 0.001; 0.9±0.1 vs. 1.0 ± 0.1 vs. 1.1± 0.1, p&lt;0.001; 0.9 ± 0.1 vs. 1.0 ± 0.1 vs. 1.1± 0.1, p&lt;0.001; and 3.3 ± 0.3 vs. 3.6±0.3 vs. 3.7±0.3, p&lt;0.001 respectively). However, fractional shortening and left ventricular ejection fraction were found to decrease significantly with the increase in QRS duration (p &lt; 0.001 and p &lt; 0.001 respectively). In this study the QRS duration was observed to be linearly correlated with LV mass, LV diastolic dimension, septal wall thickness, posterior wall thickness and left atrial size (r=0.577, p&lt;0.001; r=0.480, p&lt;0.001; r=0.583, p&lt;0.001; r=0.521, p&lt; 0.001 and r= 0.418, p&lt;0.001 respectively).&nbsp; However, QRS duration was found to maintain a negative correlation with fractional shortening and LVEF (r =- 0.637, p&lt;0.001 and r =- 0.701, p&lt;0.001 respectively). Conclusion: The present study revealed that longer electrocardiographic QRS duration was correlated with the increase in LV mass, LV diastolic dimensions, septal wall thickness, posterior wall thickness, and left atrial size. The association was most striking in individuals with complete BBB compared with a normal QRS duration. Meanwhile, the presence of prolonged QRS in a patient’s ECG can serve as a bedside clue to the presence of decreased fractional shortening and left ventricular ejection fraction.

Systemic iron deficiency does not affect the cardiac iron content and progression of heart failure

Chronic heart failure (HF) is often accompanied by systemic iron deficiency (ID). However, effects of ID on cardiac iron status and progression of HF are unknown. To investigate these effects rats underwent LAD ligation to induce post-myocardial infarction HF or sham operation. After 3 weeks the animals from both groups were randomized into three subgroups: control, moderate ID and severe ID+anemia (IDA) by a combination of phlebotomy and low iron diet for 5 weeks. Serum and hepatic iron content were reduced by 55% and 70% (ID) and by 80% and 77% (IDA), respectively, while cardiac iron content was unchanged in HF rats. Changes in expression of all cardiomyocyte iron handling proteins indicating preserved cardiomyocytes iron status in HF and ID/IDA. Contractile function of LV cardiomyocytes, Ca2+ transient amplitude, sarcoplasmic reticulum Ca2+ release and SERCA2a function was augmented by ID and IDA and it was accompanied by an increase in serum catecholamines. Neither ID nor IDA affected left ventricular (LV) systolic or diastolic function or dimensions. To sum up, systemic ID does not result in cardiac ID and does not affect progression of HF and even improves contractile function and Ca2+ handling of isolated LV cardiomyocytes, however, at the cost of increased catecholamine level. This suggests that intravenous iron therapy should be considered as an additional therapeutic option in HF, preventing the increase of catecholaminergic drive with its well-known long-term adverse effects.

Mitral annular disjunction of degenerative mitral regurgitation: 4D evaluation and implications for mitral repair

We aimed to assess mitral valvular/annular/ventricular dynamics in mitral valve prolapse (MVP) stratified by mitral annular disjunction (MAD) presence, in the context of mitral surgery. In 61 patients (62 ± 11 years; 25% women) with MVP and severe mitral-regurgitation undergoing mitral-surgery between 2009-2016, 2D transthoracic and 4D-transesophageal echocardiographic characteristics and left ventricular (LV) dimensions/dynamics were analyzed, stratified by to MAD presence, pre and post-surgery. MAD (8 ± 3 mm) was diagnosed in 27 (44%) patients [ERO of 0.50(0.36–65)cm 2 ], more frequently in bileaflet MVP (52 vs.19%, P = 0.007), involving consistently P2 ( P = 0.03). MAD displayed larger diastolic annular area (1646 ± 410 vs. 1380 ± 348 mm 2 , P = 0.008), circumference (150 ± 19 vs. 137 ± 16 mm, P = 0.005) and intercommissural diameter (48 ± 7 vs. 43 ± 6 mm, P = 0.03) vs. no-MAD. Dynamically, early-systolic annular contraction and saddle shape accentuation were unaffected but mid- and late-systolic excess inter-commissural diameter, annular area and circumference enlargement were associated with MAD (all P < 0.0001). MAD was also associated with dynamically larger prolapse volume and height ( P ≤ 0.007), with larger leaflet area (2053 ± 620 vs. 1692 ± 488 mm 2 , P = 0.01). LV diastolic dimensions were unaffected by MAD (all P > 0.07). However, despite similar ejection fraction (65 ± 5 vs. 62 ± 8%, P = 0.1), systolic basal posterior thickness was increased in MAD (19 ± 2 vs. 15 ± 2 mm, P < 0.001). After mitral repair, MAD disappeared, and LV diameters/wall-thickness showed no difference in MAD vs. no-MAD (all P > 0.50) ( Fig. 1 ). MAD is frequent in MVP, mostly associated with bileaflet/deep MVP and compounds profound annular alterations. MAD myocardial/annular slippage masquerades stronger LV function without benefit post-surgery. Hence, MAD valvular/ventricular alterations warrant careful detection and interpretation.

Association of Lipoprotein (a) variants with risk of cardiovascular disease: a Mendelian randomization study

BackgroundThere is a well-documented empirical relationship between lipoprotein (a) [Lp(a)] and cardiovascular disease (CVD); however, causal evidence, especially from the Chinese population, is lacking. Therefore, this study aims to estimate the causal association between variants in genes affecting Lp(a) concentrations and CVD in people of Han Chinese ethnicity.MethodsTwo-sample Mendelian randomization analysis was used to assess the causal effect of Lp(a) concentrations on the risk of CVD. Summary statistics for Lp(a) variants were obtained from 1256 individuals in the Cohort Study on Chronic Disease of Communities Natural Population in Beijing, Tianjin and Hebei. Data on associations between single-nucleotide polymorphisms (SNPs) and CVD were obtained from recently published genome-wide association studies.ResultsThirteen SNPs associated with Lp(a) levels in the Han Chinese population were used as instrumental variables. Genetically elevated Lp(a) was inversely associated with the risk of atrial fibrillation [odds ratio (OR), 0.94; 95% confidence interval (95%CI), 0.901–0.987; P = 0.012)], the risk of arrhythmia (OR, 0.96; 95%CI, 0.941–0.990; P = 0.005), the left ventricular mass index (OR, 0.97; 95%CI, 0.949–1.000; P = 0.048), and the left ventricular internal dimension in diastole (OR, 0.97; 95%CI, 0.950–0.997; P = 0.028) according to the inverse-variance weighted method. No significant association was observed for congestive heart failure (OR, 0.99; 95% CI, 0.950–1.038; P = 0.766), ischemic stroke (OR, 1.01; 95%CI, 0.981–1.046; P = 0.422), and left ventricular internal dimension in systole (OR, 0.98; 95%CI, 0.960–1.009; P = 0.214).ConclusionsThis study provided evidence that genetically elevated Lp(a) was inversely associated with atrial fibrillation, arrhythmia, the left ventricular mass index and the left ventricular internal dimension in diastole, but not with congestive heart failure, ischemic stroke, and the left ventricular internal dimension in systole in the Han Chinese population. Further research is needed to identify the mechanism underlying these results and determine whether genetically elevated Lp(a) increases the risk of coronary heart disease or other CVD subtypes.

Left ventricular function and cardiac valvar annular dimensions among children with sickle cell anemia compared to those with hemoglobin AA type in Enugu, Nigeria.

Enumerating the relationship between cardiac structures, function and chamber sizes in children with sickle cell anemia would help in delineating some cardiovascular abnormalities which will aid the Pediatric cardiologist and the cardiac surgeons in a number of decision-making situations. The objectives of this study are to assess the dimension of cardiac structures and left ventricular function in children with sickle cell anemia in steady state and controls using echocardiography. A cross-sectional prospective study that assessed cardiac structures and left ventricular function among fifty-one children with sickle cell anemia (HBSS) and compared with fifty children with HB AA type serving as controls. A significant high proportion of children with sickle cell anemia had abnormal Valvar dimension and left ventricular function above two standard deviations (2-SD) from the mean of the standard population compared to the control group, showing a statistically significant difference (χ2 = 10.42, p= 0.001).All the mean annular valves diameter, left ventricular internal dimension in systole and diastole, inter-sinus distance diameter and sinu-tubular junction diameter are higher in children with sickle cell anemia than controls and this is statistically significant. (p<0.005). This result shows that children with sickle cell anemia have increased valvar size diameter compared with those with normal hemoglobin type. A significantly higher proportion of respondents in type SS group had abnormal left ventricular systolic and diastolic dysfunction when compared with those in type AA group.

Mechanism of angiotensin receptor-neprilysin inhibitor in suppression of ventricular arrhythmia

BackgroundThe mechanisms underlying angiotensin receptor-neprilysin inhibitor (ARNi) suppression of ventricular arrhythmia (VA) are unclear. This study aimed to investigate the mechanism of ARNi-related suppression of VA in a heart failure (HF) model. MethodsNew Zealand white rabbits (n = 6 per group) were assigned to normal, HF [4 weeks of left ascending artery (LAD) ligation], angiotensin receptor blocker (ARB, valsartan at 27 mg/kg/day for 3 weeks after 1 week of LAD ligation), and ARNi (sacubitril at 34 mg/kg/day and valsartan at 27 mg/kg/day for 3 weeks after 1 week of LAD ligation) groups. Experiments involving echocardiogram, optical mapping, histological of trichrome stain and immunostain, and flow cytometry were performed. ResultsHF group had larger left ventricular (LV) internal dimensions in diastole and systole, and lower LV ejection fraction and fractional shortening than normal, ARB, and ARNi groups. HF group had a prolonged action potential duration (APD) and decreased conduction velocity (CV), which was mitigated in ARB and ARNi groups. HF group had a prolonged QRS duration, QT and QTc intervals, which was reversed in ARB and ARNi groups. HF group had a steeper maximum slope of APD restitutions, which was attenuated in normal, ARB, and ARNi groups. HF group had increased number of phase singularities (PSs) and VA inducibility than normal, ARB, and ARNi groups. A higher content of fibrosis was found in HF group than that in normal, ARB, and ARNi groups. Compared to ARB group, ARNi had a lower context of fibrosis. HF group had more peripheral blood CD4+ and CD8+ cells count than normal, ARB, and ARNi group. ConclusionsIn a rabbit model of ischemic HF, ventricular arrhythmogenesis could be suppressed by ARNi treatment. This appears to be mediated by reversing changes in the APD, CV, maximum slope of the APDR, PSs, fibrosis, and inflammation.

Short Term Predictors of Success after Cardiac Resynchronization Therapy

AbstractBackground: In patients with symptomatic Heart Failure (HF) and wide QRS duration, cardiac resynchronization therapy (CRT) causes reduction of morbidity and mortality. However, it's unclear which patient features predict short‐term response to this device therapy. Aim of the Work: The research aimed to study which cases characteristics could expect short-term clinical and echocardiographic response to CRT. Subjects and methods: This prospective cohort study involved 40 patients indicated for CRT device. The study was conducted in the cardiology departments, faculty of medicine, Zagazig University, and Police hospital at the period from October 2018 to October 2020. Clinical, laboratory, electrocardiographic, and echocardiographic assessments were performed pre and six months after implantation. Results: Forty patients undergoing CRT implantation were included among which, 30 (75%) patients were considered responders after six months. From the present study, the responders to CRT were more frequently to be females with younger age than non -responders. Non-ischemic HF, left bundle branch block (LBBB) morphology and New York Heart Association (NYHA) functional class III were significantly more frequent in responders. Furthermore, responders had significantly wider baseline QRS duration, smaller baseline LV diastolic and systolic dimension and volumes, greater ejection fraction, lower levels of brain natriuretic peptide (BNP), and more baseline intra-ventricular dyssynchrony. Conclusion: We concluded that pre-implantation independent Predictors of good CRT response are LBBB morphology, septal to posterior wall mechanical delay, wide QRS duration, interventricular mechanical delay, NYHA functional class III, and lower levels of BNP. Large scale study is recommended for further verification of study results.

Berlin Heart Explantation Systematic Approach Protocol in a Single Center Experience

Introduction Berlin Heart EXCOR ventricular assist device (VAD) implantation in children is widely used as a bridge-to-heart transplantation. VAD support as a bridge-to-recovery is rare. There is scarcity of literature describing systematic evaluation of cardiac recovery employed in VAD explanation in children. Case Report A 13 month-old boy presented to the emergency department with acute congestive heart failure secondary to myocarditis. Echocardiogram demonstrated severely depressed left ventricular (LV) function with severe mitral regurgitation. He developed ventricular tachycardia with hemodynamic compromise necessitating institution of veno-arterial extracorporeal membranous oxygenation (ECMO). He was decannulated 11 days later after a successful trial off, but due to no further improvement in cardiac status, he underwent Berlin Heart EXCOR LVAD placement as a bridge-to-transplant. After 3 months of VAD support, we noted evidence of myocardial recovery and discussed the possibility of VAD explant. A weaning protocol was developed that consisted of two phases. The first phase consisted of a trial off with echocardiographic monitoring of biventricular function, atrioventricular valve regurgitation and LV diastolic dimension. The second phase was performed one week later in the cardiac catheterization suite, while monitoring hemodynamic measurements at baseline and with manual pumping followed by dobutamine challenge at the end of trial off. Clinical data was satisfactory and patient met established goals to undergo explant. Berlin explantation was succesfully performed the following day. His recovery was unremarkable and was discharged 2 weeks after explant. Patient was seen for follow-up at 1, 2 and 3 months post-discharge and he is doing well. Summary We established guidelines for trialing off VAD support to maximize the identification of potential candidates for VAD explantation. This protocol includes three main stages: screening, trial-off with echocardiography and trial-off in the catheterization suite. This case demonstrates that myocardial recovery can take longer than previously recognized in children with myocarditis and it highlights that strong consideration should be given to patients with a stable VAD course to remain inactive on the heart transplant waitlist to allow time for myocardial recovery and successful explantation.