Left Ventricular Dysfunction In Patients Research Articles

Abstract 10980: Echocardiographic Evaluation of the Left Ventricular Function in Patients With Noncompaction Cardiomyopathy: Biplane Method, Wall Motion Score or Global Longitudinal Strain?

Introduction: Noncompaction cardiomyopathy (NCCM) is characterized by left ventricular (LV) hypertrabeculation. Therefore, endocardial tracing / quantification of LV function could be cumbersome. Hypothesis: Accurate assessment of the (subclinical) LV dysfunction in NCCM patients could improve non-invasive monitoring of disease progression, risk stratification, and treatment. Method: We reviewed the echocardiographic images of 67 patients (54% male, median age 48 year [22-73]. LV function was assessed by conventional biplane disk summation, wall motion score (WMS), and global longitudinal strain (GLS). LV function was considered abnormal if LV ejection fraction (LVEF) <50% and GLS >-18,9%. Results: LV function measured by biplane vs WMS showed significantly lower LV EF with WMS (p-value: 0,0016; Figure ), while the average GLS in all patients was -11,0%, SD ±3,8 (normal values: -18,9%; p-value: p<0,001). By dichotomizing the group into LVEF <50% vs. ≥50%, biplane EF was abnormal in 68,7%, while this was with WMS 88,1% en GLS in 100% patients. In patient with EF <50% compared to ≥ 50% GLS in low biplane EF group was: -9.3% vs -14.5% (p<0.001). In the WMS EF was this respectively -10,3±3,6% versus -15.5± 1.5 (p<0.001). Conclusion: The systolic LV dysfunction in patients with NCCM noncompaction cardiomyopathy found by WMS and GLS was significantly lower compared to routine biplane EF measurement suggesting that WMS and GLS measurement are much more potential prognostic tool. Given the correct execution of WMS is limited by the assessor's experience, estimation of the LV function with GLS are probably most reliable. Future research should expel whether these results are representative in a larger group of patients and correlates with the clinically relevant endpoints.

Relationship between QRS duration on ECG and Left Ventricular Systolic Function by Echocardiography in patients with Non-ST elevated Myocardial Infarction

Background: Early risk stratification of patients with myocardial infarction is critical to determine optimum treatment strategies and enhance outcomes. The present study was therefore undertaken to determine the relationship between QRS duration (QRSd) on admission ECG and left ventricular ejection fraction (LVEF) as a measure of left ventricular function in non-ST elevated myocardial infarction (NSTEMI) patients. Methods: This observational study was carried out from January to December 2020 with total of 120 patients with a history of NSTEMI. Based on the cut-off value of QRS duration 100 msec, the patients were divided into two groups – one group with QRS duration d” 100 msec (normal QRS) and another group with QRS duration > 100 msec (prolonged QRS). Left ventricular systolic function was considered preserved, if it was e” 52% and reduced if it was < 52%. The association and correlation between QRS duration and LVEF was then observed. Results: The prevalence of reduced LVEF in patients with prolonged QRS duration (> 100 msec) was double (38%) than that of preserved (19.5%). The risk of having LV dysfunction in patients with prolonged QRS duration was 2.5 (95% CI = 1.1 – 6.2) times higher than that in patients normal QRS duration (d” 100 msec) (p = 0.039). The QRS duration and LVEF bear a significantly inverse relationship (r = -0.341, p < 0.001). The sensitivity of prolonged QRS duration (> 100 msec) in correctly detecting LV dysfunction was inappreciably low (38%), although its specificity in excluding those who did not have LV dysfunction was optimum (80.5%) with overall diagnostic accuracy being 52.5%. Conclusion: Prolonged QRS duration on a standard 12-lead ECG is associated with reduced echocardiographic LVEF. However, QRS duration in predicting LV dysfunction is much less sensitive, although its specificity is optimum indicating that QRS duration is not a good predictor of LV dysfunction (reduced LVEF), but it can dependably predict those who do not have LV dysfunction (preserved LVEF). Cardiovasc j 2022; 15(1): 36-41

Response to heart failure treatment in patients with anthracyclines and trastuzumab induced left ventricular dysfunction

Abstract Background Chemotherapy treatments with anthracyclines and Trastuzumab are widely used in different hematologic or solid malignancies but myocardial injury and left ventricular dysfunction, usually called cardiotoxicity (CTX), is a frequent adverse effect. Some studies have demonstrated that early detection and treatment of CTX is essential for the recovery of left ventricular ejection fraction (LVEF), however its behavior after starting treatment is not well established. Purpose Evaluate the behavior of LVEF after starting treatment for heart failure in patients with diagnosis of CTX. Methods Patients with diagnosis of solid or hematologic malignancies scheduled to receive therapy including anthracyclines and/or trastuzumab were prospectively included. Echocardiogram was performed before starting treatment, and then 3 and 6 months after. CTX was defined, according to guidelines, as a drop of LVEF ≥10% to a value <53% and in these patients treatment of left ventricular dysfunction with B blockers and Enalapril/Losartan was promptly initiated and up-titrated to the maximal tolerated dose. Myocardial injury was defined as a drop of LVEF ≥10% and a value ≥53%, with a watchful waiting strategie, considering these patients as a control group. LVEF was re-evaluated 6 months after starting treatment or after diagnosis of myocardial injury. Primary endpoint was defined as a recovery of LVEF ≥10%. Results Of a total of 141 patients of the entire cohort (mean age 56±15 years, 85,8% women and 61,7% with diagnosis of breast cancer),17 patients (12%) met criteria of CTX and 21 (14,9%) of myocardial injury. There were no differences in relation to clinical characteristics or chemotherapy schemes between groups. In patients with CTX (intervention group), 88,2% reached the primary endpoint of recovery of LVEF ≥10% while only 23,8% did it in the control group (p<0,001). Patients with CTX had lowest LVEF at baseline, however no significant differences were observed at 12 months of follow up. Figure 1 represents the behavior of LVEF at baseline, 3, 6 and 12 months. A paired before-after analysis was performed between LVEF at baseline and at 12 months. Patients who received treatment showed no differences in LVEF (63,3±7,2% vs 61,5±9,6%, p=0,5). In contrast, patients who did not receive treatment showed a significant drop in LVEF (72,7±4,4% vs 66,2±5,4%; p<0,001) (figure 2). Conclusion Treatment of left ventricular dysfunction in patients with CTX is associated with a greater recovery of LVEF. Funding Acknowledgement Type of funding sources: None.

سوء وظيفة البطين الأيسر عند مرضى الداء الرئوي الانسدادي المزمن

Objective: studying the effects of chronic obstructive pulmonary disease on left ventricle (LV) systolic and diastolic functions. Patients and Methods: A total of 70 cases of diagnosed chronic obstructive pulmonary disease patients (Current smokers or quitters) with 70 age, sex matched healthy control subjects were included in this study. This study was conducted at the Cardiology and pulmonolgy departments in Tishreen University Hospital in Lattakia Syria. All patients with COPD underwent for 2D Echocardiography and the same was done for the controls. . Results: We note a decrease in the mean values of the left ventricular ejection fraction (LVEF) in patients (53.85±6.5) compared to the controls (63.12 ± 4.1%) with (P<0.05). And within the group of cases, it was decreasing with the increasing stage of COPD. Diastolic dysfunction was noticed in patients with COPD. In patients, there was a statistically significant increase in IVRT [ 93.87±12.4 ms] VS.[ 77.49±1.6 ms] in control group (P<0.05) and it is increasing with the increasing stage of COPD. We noticed a statistically significant increase in Myocardial Performance Index(MPI) in COPD patients [0.49±0.05] VS. [0.37±0.01] in control group (P<0.05) and also increases with the increasing stage of COPD. Conclusion: In patients with chronic obstructive pulmonary disease, LV systolic function decreases, LV diastolic dysfunction increases and MPI also increases which reflect both systolic and diastolic LV dysfunction and both of them increases with increasing stage of COPD.

Association between Anti-Erythropoietin Receptor Antibodies and Cardiac Function in Patients on Hemodialysis: A Multicenter Cross-Sectional Study.

Cardiac dysfunction is an important prognostic predictor of cardiovascular mortality in patients on hemodialysis (HD). Erythropoietin (EPO) has been reported to improve cardiac function by binding to the EPO receptor (EPOR) on cardiomyocytes. This study investigated whether anti-EPOR antibodies were associated with left ventricular cardiac function in patients undergoing HD. This multicenter, cross-sectional observational study included 377 patients (median age, 70 years; 267 (70.8%) males) with chronic kidney disease (CKD) undergoing stable maintenance HD. Serum levels of anti-EPOR antibodies were measured, and echocardiography was used to assess the left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Anti-EPOR antibodies were found in 17 patients (4.5%). LVMI was greater (median of 135 g/m2 vs. 115 g/m2, p = 0.042), and the prevalence of LVEF < 50% was higher (35.3% vs. 15.6%, p = 0.032) in patients with anti-EPOR antibodies than in those without. Multivariable linear regression and logistic regression analysis (after adjusting for known risk factors of heart failure) revealed that anti-EPOR antibodies were independently associated with LVMI (coefficient 16.2%; 95% confidence interval (CI) 1.0–35.0%, p = 0.043) and LVEF <50% (odds ratio 3.20; 95% CI 1.05–9.73, p = 0.041). Thus, anti-EPOR antibody positivity was associated with left ventricular dysfunction in patients undergoing HD.

Identification of subclinical myocardial dysfunction by Speckle Tracking Imaging in patients with myocardial infarction with non-occlusive coronary arteries (MINOCA).

The objective of this study was to investigate subclinical left ventricular dysfunction in patients diagnosed with myocardial infarction with non-occlusive coronary arteries (MINOCA). Thirty-five patients with MINOCA (average age 54.26 ± 12.24 years) and thirty-five patients with ischemia with non-obstructed coronary artery disease (INOCA) (average age 55.20 ± 8.36 years) were enrolled in the study. All clinical conditions that could affect left ventricular functions were considered exclusion criteria. Echocardiographic studies were conducted in the patient and control groups in the left lateral decubitus position using a medical ultrasound device (EPIQ 7, Philips Medical System, USA). The left ventricle was examined longitudinally with apical images of chamber 4-3-2 using the available software (QLAB 6.0). There were no differences in age, blood pressure level, baseline echocardiogram measurements, and tissue Doppler parameters between the two groups. In two-dimensional speckle tracking echocardiography (2D-STE) measurements, left ventricular longitudinal strain and strain rate in systole, early and late diastole from apical 4-3-2 chamber and global measurements of each parameter were significantly decreased in the MINOCA group compared to the INOCA group (p < 0.05). A significant negative correlation was observed between the global longitudinal strain rate and the troponin I in the MINOCA patients group (r=-0.43 p = 0.009). Our study showed that while standard echocardiographic parameters for patients diagnosed with MINOCA were normal, their left ventricular systolic and diastolic functions were reduced by the 2D-STE method.

Value of speckle tracking echocardiography for detection of clinically silent left ventricular dysfunction in patients with systemic lupus erythematosus

Background and Aims : Background: SLE is a chronic autoimmune inflammatory rheumatological disease. Characterized by autoantibodies directed against nuclear antigens. It is a disease of young women, with a peak incidence between the ages of 15 and 40 with a female: male ratio of 9:1. Cardiac involvement in patients with SLE is common. Subclinical involvement is more common than Clinically apparent cardiomyopathy or myocarditis Aim: Assess LV function in asymptomatic SLE patients by conventional, speckle tracking and tissue Doppler echocardiography.

Influence of the cardio-ankle vascular index on chronic-phase left ventricular dysfunction after ST-segment elevation myocardial infarction.

This study aimed to investigate the possible influence of arterial stiffness assessed by the cardio-ankle vascular index (CAVI) on chronic-phase left ventricular dysfunction in patients with ST-segment elevation myocardial infarction (STEMI). A total of 208 consecutive patients with first STEMI (age, 64 ± 11 years; 86% men) who underwent reperfusion therapy within 12 h of onset were enrolled. We analysed arterial stiffness by measuring CAVI in a stable phase after admission and performed two-dimensional echocardiography at baseline and 7 months' follow-up. Subsequently, we assessed left ventricular global longitudinal strain (LV-GLS) to evaluate left ventricular function. A total of 158 (75.9%) patients underwent baseline cardiac magnetic resonance (CMR). We estimated left ventricular infarct size by measuring peak levels of creatine kinase-myocardial band (CK-MB), and CMR-late gadolinium enhancement (LGE). On the basis of the median CAVI value, the patients were allocated into high CAVI (CAVI ≥ 8.575) and low CAVI (CAVI < 8.575) groups. The groups showed no statistically significant differences in LV-GLS at baseline (-13.5% ± 3.1 vs. -13.9% ± 2.7%, P = 0.324). However, LV-GLS was significantly worse in the high CAVI group than in the low-CAVI group at 7 months (-14.0% ± 2.9 vs. -15.6% ± 3.0%, P < 0.001). Stratified by CAVI and peak CK-MB or LGE, the four groups showed significant differences in LV-GLS at 7 months after STEMI (both P < 0.001). Multivariate linear regression analysis with the forced inclusion model showed that CAVI was an independent predictor of LV-GLS at 7 months ( P = 0.015). CAVI early after STEMI onset was significantly associated with chronic-phase LV-GLS. In addition, combining CAVI with CK-MB or LGE improves its predictive ability for evaluation of chronic-phase LV-GLS. Thus, the arterial stiffness assessment by CAVI was an important factor related to chronic-phase left ventricular dysfunction after the first STEMI.

Machine learning models for accurate pretreatment prediction of chemotherapy associated LV dysfunction in patients with breast cancer and lymphoma receiving chemotherapy (WF-98213 PREVENT and CCCWFU9912 DETECT IV).

1553 Background: Cancer survivors receiving potentially cardiotoxic chemotherapy are at increased risk for developing left ventricular (LV) dysfunction. We implemented machine learning (ML) models to predict future LV dysfunction in patients with breast cancer or lymphoma scheduled to receive potentially cardiotoxic chemotherapy. Methods: We utilized prospectively collected data from NIH studies R01HL118740 (supported by the Wake Forest NCORP Research Base (UG1CA189824)) and R01CA167821. Data included measurements of LV function and demographic factors before, during, and 24 months after initiating potentially cardiotoxic chemotherapy. The two datasets were used both separately and collectively in the development of multiple ML models including penalized linear regression, support vector machine, and random forest (RF). A data preprocessing step properly handled missing information, data imbalance, and encoding. Hyperparameter tuning was performed using cross validation of training data. The final models were assessed with a 20% hold-out test dataset. Cardiotoxicity was defined as a pre- to 24-month post cancer treatment decline in LV ejection fraction (LVEF) of &gt; 10% or to an absolute value of &lt; 50%. Results: 276 patients were included in ML models (7% men, 93% women; age 52±13 years). The RF model based on the combined dataset had the best performance with a prediction accuracy, sensitivity, and specificity of 0.94, 0.81, and 0.98, respectively. The most important variables assessed pre-treatment as measured by the Gini impurity factor were in descending order, LVEF, global LV circumferential strain, LV end-systolic volume, body mass index, LV stroke volume, LV end-diastolic volume, and LV mass. Conclusions: Prior to cancer treatment, supervised ML methods such as RF models predicted declines in LVEF of &gt; 10% and/or to absolute values below 50% would occur 24 months after initiating chemotherapy for breast cancer or lymphoma. With further improvement and validation using larger datasets, these models may play an important role in cardio-oncology care during and following cancer treatment.

Association between cardiovascular risk factors and left ventricular strain distribution in patients without previous cardiovascular disease.

BackgroundSome cardiovascular (CV) risk factors, such as hypertension and diabetes mellitus, have been reported to reduce left ventricular (LV) longitudinal strain (LS) even in patients with preserved LV ejection fraction. We hypothesized that multiple CV risk factors might cause changes in myocardial strain. Our study aimed to assess the association between multiple CV risk factors and strain in patients without previous CV disease (CVD).MethodsWe retrospectively evaluated 137 patients without CVD, who underwent echocardiography at our institution between May 2017 and February 2020. They were divided into four groups based on the number of risk factors (group 0: no risk factor, group 1: one risk factor, group 2: two risk factors, and groups 3: three or four risk factors). Risk factors were hypertension, dyslipidemia, diabetes mellitus, and chronic kidney disease. Absolute values of global LS (GLS) and relative apical LS ratio (RALSR) defined using the equation: average apical LS/(average basal LS + average mid LS) and was used as a marker of strain distribution.ResultsOut of 137 patients, group 0 had 35 patients, group 1 had 35 patients, group 2 had 32 patients, and group 3 had 35 patients. GLS was 22.4 ± 2.0%, 21.7 ± 2.1%, 21.3 ± 1.8%, 20.7 ± 2.2%, and RALSR was 0.64 ± 0.06, 0.66 ± 0.06, 0.68 ± 0.08, 0.69 ± 0.07 in groups 0–3, respectively. The one-way ANOVA detected significant differences between groups in GLS (p = 0.005) and RALSR (p = 0.037), respectively. Group 3 had a significantly lower GLS and higher RALSR than group 0 (p < 0.05).ConclusionIn patients without previous CVD, LS decreased especially from the basal segment as the number of cardiovascular risks increased. The segmental LS may be markers of occult LV dysfunction in patients with CV risk factors.

Subclinical left ventricular dysfunction in patients with obesity and chronic obstructive pulmonary disease

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Acute myocardial injury and infarction in patients under 45 years old - a single centre experience

Abstract Funding Acknowledgements Type of funding sources: None. Acute myocardial injury and infarction is vastly described in patients over 45 years of age. However, the higher incidence of coronary artery disease (CAD) in young patients in recent decades has led to a concomitant increase in the importance of excluding coronary artery disease in this group. The aim of this study was to analyse the prognosis in young patients with acute myocardial injury and infarction. Additionally, we intend to evaluate the clinical features and angiographic profile. We retrospectively analysed all patients under 45 years of age with acute chest pain and elevated troponin who underwent coronary angiography in our department from January 2017 to April 2021. Patient selection and information collection were obtained through medical records. The patients were categorized into three groups, based on discharge diagnosis: group 1 for ST-segment elevation myocardial infarction (STEMI) patients, group 2 for non-ST-segment elevation myocardial infarction (NSTEMI) patients and group 3 for patients with angiographically normal coronary arteries. Outcomes were left ventricular dysfunction, assessed by left ventricular ejection fraction (LVEF) in transthoracic echocardiography; the occurrence of electrical complication during hospitalization, including sustained ventricular tachycardia, ventricular fibrillation or cardiorespiratory arrest; and in-hospital mortality. Group comparisons were performed. A p-value less than 0.05 was considered significant. Statistical analysis was performed using SPSS software v.25.0. One hundred twenty-one patients were analysed: 59 (48.8%) in group 1, 28 (23.1%) in group 2 and 34 (28.1%) in group 3. Table 1 describes the main baseline characteristics. There was a significant difference between the groups for smoking (p-value = 0.03), more prevalent in group 1 and less prevalent in group 3. Regarding outcomes, there was a significant difference for left ventricular dysfunction at discharge, with a mean LVEF of 50% in group 1, 53% in group 2, and 58% in group 3 (p-value &amp;lt; 0.01). The existence of electrical complications was similar for the three groups (p-value = 0.99), and all patients were discharged alive. In conclusion, young patients with acute myocardial injury and infarction have a similar clinical history, with the exception of smoking in STEMI patients. There was a higher prevalence of left ventricular dysfunction in patients with STEMI, similar to that observed in older patients. A multicentric analysis, as well as a long-term follow-up, would be interesting to confirm these results.

Frequency of fragmented QRS on ECG and relationship with left ventricular dysfunction in patients with subclinical hypothyroidism.

Subclinical hypothyroidism (SH) is a biochemical definition that has been proven to be associated with cardiovascular diseases. Fragmented QRS (fQRS) is defined as an electrocardiographic (ECG) reflection of cardiac fibrosis. It is associated with increased cardiovascular mortality and morbidity. In this study, we aim to evaluate the presence and frequency of fQRS in SH patients and determine the relationship between fQRS presence and left ventricular dysfunction by using the myocardial performance index (MPI). Our study included 50 newly diagnosed SH and 50 healthy participants with similar demographic characteristics. We compared demographic characteristics, laboratory findings, electrocardiographic and echocardiographic measurements of the study population. SH patients were evaluated as two groups in the subgroup analysis: [fQRS(+) SH] with fQRS and [fQRS(-) SH] without fQRS. We analyzed the correlation of thyroidstimulating hormone (TSH) levels with demographic characteristics, electrocardiographic and echocardiographic data. Independent predictors of fQRS presence were evaluated by logistic regression analysis. The mean age of SH patients was 44 ± 8 years, and 46% (n = 23) of the patients were women. In the control group, the mean age was 45 ± 11 years, and 52% (n = 26) of the participants were women. MPI was found to be significantly higher in the SH group compared to the control group (0.53 ± 0.07 vs. 0.41 ± 0.08, p< 0.001). fQRS was found to be significantly higher in the SH group compared to the control group (p= 0.004). In echocardiographic measurements, isovolumic relaxation time (IVRT) was found to be significantly longer in the fQRS(+) SH group (105.6 ± 21.8 ms vs. 91.1 ± 24.4 ms, p < 0.001), while isovolumic contraction time (IVCT) was not significantly different between the groups. Ejection time (ET) was significantly longer in the fQRS (-) SH group (286.9 ± 32.1 ms vs. 274.2 ± 30.6 ms; p = 0.011). MPI was 0.57 ± 0.12 in the fQRS (+) SH group and 0.48 ± 0.06 in the fQRS (-) SH group, which was significantly higher (p = 0.001). TSH was found to be 8.82 ± 4.58 in fQRS (+) SH group and 5.73 ± 3.10 in fQRS (-) SH group (p = 0.003). It was found that MPI (r = 0.302, p < 0.001) and fQRS (r = 0.321, p < 0.001) were significantly positively correlated with TSH. TSH levels [OR = 1,645, 95% CI = 1,322 to 2,067 (p = 0.001)], IVRT [OR = 1,502, 95% CI = 1,119 to 95% (p = 0.003)], and MPI [OR = 1,408, 95% CI = 0.989 - 1.806 (p = 0.001)] were found to be independent predictors of the presence of fQRS. The frequency of fQRS in SH patients was found to be higher than in the healthy population. MPI values were higher in fQRS (+) SH patients compared to fQRS (-) SH patients, resulting indirectly having a higher risk of tendency to left ventricular systolic/diastolic dysfunction. MPI and fQRS had a significant positive correlation with TSH. TSH, IVRT, and MPI were found to be independent predictors of the presence of fQRS in SH patients.

Left ventricular dysfunction in patients with HIV/AIDSon HAART in correlation with CD4 count

According to World Health Organization (WHO) global HIV report 2019, people living with HIV is about 38 million. Especially after the advent of antiretroviral therapy (ART), in PLHIV, cardiovascular complications signify an increasingly important health concern. This vastly active HAART regimen has provided more efficient prophylactic treatment. With the increased duration of survival, this has progressed to an increased episodes of cardiovascular complications associated with PLHA. The following review overviews the left ventricular dysfunction in patients with HIV infection on HAART focusing on early diagnosis, therapy and prognosis. It is a Cross sectional study conducted on HIV infected patients attending ART clinic and admitted in medicine wards of MKCG medical college &amp; Hospital from MARCH 2017 to OCTOBER 2018 were included in the study. Maximum patients were in the age group 25 – 49 years (68.44%) in our study. Mean age of the study group 41.32 + 11.24 years. Gender distribution shows that 82.46% of the patients were males and 14.04% were females. 4 (7%) patients have cardiac disorder. All the patients having cardiac disorders are male. Only 2 patients (3.5%) had left ventricular dysfunction with reduced ejection fraction. Males are involved more than females. Most patients are in the middle age group between 25 – 49 years. Heterosexual mode was the most common mode of transmission. Most of the study population belonged to rural area 61.4%. Three patients (5.3%) were on anti tubercular drugs. The systolic LV dysfunction was found in 50% of PLHA patients with cardiac disorders. CD4 count was positively correlated with fractional shortening. Presence of cardiac dysfunction was significantly associated with the adherence to ART treatment.

Effect of hypertension on the optimal anthracycline cumulative dose for developing left ventricular dysfunction in patients with malignant lymphoma.

The most serious adverse effect of anthracycline chemotherapy is progressive dose-dependent left ventricular (LV) dysfunction, and a total cumulative doxorubicin dose ≥ 240mg/m2 has been classified as putting patients at high risk for developing cardiac dysfunction. Hypertension is the single most important risk factor for heart failure and chemotherapy-induced LV dysfunction, but the effect of hypertension on the total cumulative doxorubicin dose to prevent the development of LV dysfunction in patients scheduled for anthracycline chemotherapy remains uncertain. The aim of this study was to investigate the effect of hypertension on the optimal total cumulative anthracycline dose to prevent the development of LV dysfunction in patients with malignant lymphoma. We retrospectively studied 92 patients with malignant lymphoma and preserved LV ejection fraction (LVEF) who underwent anthracycline chemotherapy. Echocardiography was performed before and 2 months after anthracycline chemotherapy. LV hypertrophy (LVH) was defined as concentric hypertrophy, and LV dysfunction after chemotherapy as a relative decrease in LVEF ≥ 5%. The cutoff value of the total cumulative doxorubicin dose for the development of LV dysfunction was lower for hypertensive patients (n = 23) than for non-hypertensive patients (n = 69) (259.3mg/m2 vs. 358.9mg/m2). Importantly, the cutoff value of the total cumulative doxorubicin dose to prevent the development of LV dysfunction in hypertensive patients with LVH was even lower at 40.1mg/m2. A lower cumulative anthracycline dose can cause LV dysfunction in hypertensive patients with malignant lymphoma, especially when complicated by LVH. Our findings can thus be expected to have clinical implications for better management of such patients.

Opportunistic screening for asymptomatic left ventricular dysfunction in type 2 diabetes mellitus

BackgroundInternational guidelines recommend natriuretic peptide biomarker-based screening for patients at high heart failure (HF) risk to allow early detection. There have been few reports about the incorporation of screening procedure...

Opportunistic screening for asymptomatic left ventricular dysfunction in type 2 diabetes mellitus.

International guidelines recommend natriuretic peptide biomarker-based screening for patients at high heart failure (HF) risk to allow early detection. There have been few reports about the incorporation of screening procedure to existing clinical practice. To implement screening of left ventricular dysfunction in patients with type 2 diabetes mellitus (DM). A prospective screening study at the DM complication screening centre was performed. Between 2018 and 2019, 1043 patients (age: 63.7±12.4 years; male: 56.3%) with mean glycated haemoglobin of 7.25%±1.34% were recruited. 81.8% patients had concomitant hypertension, 31.1% had coronary artery disease, 8.0% had previous stroke, 5.5% had peripheral artery disease and 30.7% had chronic kidney disease (CKD) stages 3-5. 43 patients (4.1%) had an elevated N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration above the age-specific diagnostic thresholds for HF, and 43 patients (4.1%) had newly detected atrial fibrillation (AF). The prevalence of elevated NT-proBNP increased with age from 0.85% in patients aged <50 years to 7.14% in those aged 70-79 years and worsening kidney function from 0.43% in patients with CKD stage 1 to 42.86% in CKD stage 5. In multivariate logistic regression, male gender (OR: 3.67 (1.47-9.16), p = 0.005*), prior stroke (OR: 3.26 (1.38-7.69), p = 0.007*), CKD (p<0.001*) and newly detected AF (OR: 7.02 (2.65-18.57), p<0.001*) were significantly associated with elevated NT-proBNP. Among patients with elevated NT-proBNP, their mean left ventricular ejection fraction (LVEF) was 51.4%±14.7%, and 45% patients had an LVEF <50%. NT-proBNP and ECG screening could be implemented with relative ease to facilitate early detection of cardiovascular complication and improve long-term outcomes.

Early Detection of Subclinical Left Ventricular Dysfunction in Patients with Systemic Lupus Erythematosus: A Case-Control Study

Background: The aim of this study was to evaluate subclinical left ventricular (LV) dysfunction by two-dimensional (2D) speckle tracking echocardiography (STE) and three-dimensional echocardiography in patients with systematic lupus erythematosus (SLE). Methods: This case-control study was performed on 106 patients, divided into the two groups of case (53 patients with SLE) and control (53 healthy individuals). All study participants were evaluated by transthoracic echocardiography, as well as Tissue Doppler echocardiography. Accordingly, ventricular dimensions and LV ejection fraction (LVEF) were assessed. Moreover, E velocity, A velocity, E/A ratio, and E/E’ ratio were evaluated in both groups. The LV global longitudinal strain (GLS) was measured by 2D STE in all individuals. Results: There was no significant difference between the two study groups regarding LVEF based on traditional echocardiography. However, E velocity, A velocity, and the E/e’ ratio were higher in the SLE patients (P &lt; 0.05). In addition, the anti-double-stranded DNA (anti-dsDNA) positivity in SLE patients was associated with the lower levels of LVEF. No significant correlation was found between disease duration, LVEF, and LV GLS (P &gt; 0.05). Conclusions: Detection of subclinical LV systolic dysfunction by GLS is possible in SLE patients despite normal LVEF in traditional echocardiography. Therefore, LV could be used for the early detection and prevention of cardiac involvement in SLE patients.

Impact of type II diabetes on LV remodeling and function in patient with severe aortic stenosis

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): PHRC inter régional Background Type II diabetes (T2DM) can specifically cause left ventricular (LV) remodeling and systolic and/or diastolic abnormalities. This diabetic cardiomyopathy is associated with an increased risk of heart failure. T2DM is frequently associated with LV pressure overload as encountered in aortic stenosis (AS). The effect of T2DM on LV remodeling induced by AS remained unclear. Purpose We aimed to evaluate the impact of T2DM on left ventricular (LV) remodeling and function in patients with severe AS referred for aortic valve replacement. Methods We included patients with severe AS and no overt heart disease referred for aortic valve replacement. Patients with atrial fibrillation, left ventricular ejection fraction (LVEF) &amp;lt;50%, significant coronary stenosis or a more than mild associated valvular heart disease were excluded. Baseline ultrasound parameters were measured including 2D and 3D left ventricle mass (LVM), LVEF, posterior wall thickness (PWT) and global longitudinal strain (GLS). We also studied LV diastolic function and left ventricular filling pressure according to current guidelines. Results 82 patients were included; 32 were diabetics. Hypertension and dyslipidemia were more frequent in T2DM patients. Aortic mean gradient, aortic valve area and cardiac index were similar between the two groups. There was no difference in valvuloarterial impedance indexed to height^2.04. PWT, 3D LVM and 3D LVM index to height^2.7 were higher in T2DM patients (p = 0.03, p = 0.01 and p = 0.04, respectively). In multivariable analysis, after controlling for age, gender, BMI and hypertension, T2DM remained associated with a greater 3D LVM index (p= 0.04). Diabetic patients also presented a worse LV systolic function with a lower absolute value of GLS compared to non-diabetics (15.1 ± 2.7 vs. 17.8 ± 2.0; p &amp;lt; 0.01). The association of T2DM with a decreased GLS remained significant in multivariate analysis (p &amp;lt; 0.01; Table 1). Estimated left ventricular filling pressure was not significantly affected by T2DM. However, there was a trend towards more patients with elevated LV filling pressure in T2DM group (40% vs 22% in non T2DM patients; p = 0.08). Conclusion T2DM increases LV hypertrophy and LV dysfunction in patients with severe AS. Prognostic issues should be further assessed as it may encourage an earlier management of T2DM patients with severe AS. Abstract Figure. Parameters Associated with GLS

Risk factors for developing pacing induced LV dysfunction: Experience from a tertiary center in the UK.

The risk factors for developing pacing induced left ventricular dysfunction (LVD) in patients with high burden of right ventricular pacing (RVP) is poorly understood. Therefore, in the present study, we aimed to assess the determinants of pacing induced LVD. Our data were retrospectively collected from 146 patients with RVP>40% who underwent generator change (GC) or cardiac resynchronization therapy (CRT) upgrade between 2016 and 2019 who had left ventricular ejection fraction (EF) ≥50% at initial implant. A total of 75 patients had CRT upgrade due to pacing induced LVD (EF<50%) and 71 patients with preserved LV function (EF≥50%) had a GC. Primary indication for pacing in both groups was complete heart block. Male predominance (p=.008), prior myocardial infarction (MI) (p=.001), atrial fibrillation (AF) (p=.009), chronic kidney disease (CKD) (p=.005), and borderline low systolic function (BLSF) (EF 50%-55%) (p=.04) were more prevalent in the CRT upgrade group. Presence of AF (odds ratio [OR]=3.05, 95% confidence interval [CI] 1.42-6.58; p=.004), BLSF (OR=3.8, 95% CI 1.22-11.8; p=.02), and male gender (OR=2.41, 95% CI 1.14-5.08; p=.02) were independent predictors for RVP induced LVD. Age (OR=1.08, 95% CI 1.02-1.14; p=.005) and BLSF (OR=5.33, 95% CI 1.26-22.5; p=.023) were independent predictors of earlier development of LVD after implant. Our results suggested that AF, BLSF, and male gender are predictors for development of pacing induced LVD in patients with high RVP burden. LVD can occur at any time after pacemaker implant with BLSF and increasing age associated with earlier development of LVD.