Left Ventricular Ejection Fraction In Patients Research Articles

Effect of Parathyroid Hormone on Left Ventricular Hypertrophy in Patients on Regular Hemodialysis

Abstract Background Cardiovascular disease is the most common cause of death in patients with end-stage renal disease (ESRD) and accounts for much of the morbidity in this population. Aim of the Work We therefore aimed to consider the evidences regarding the role of excess PTH in the development of left ventricular (LV) hypertrophy as well as LV ejection fraction in patients with end-stage renal disease under regular hemodialysis. Patients and Methods This study was cross sectional study and was conducted in hemodialysis unit, Elsahel Hospital. This study was conducted on 70 patients on regular hemodialysis (3 times a week for at least 6 months) for timing of study from January 2022 to June 2022. Results In our study, we demonstrated that there was statistically significant relation between P.T.H quartiles and LVMI which found higher in 2nd quartile and lower in 3rd quartile with p-value = 0.036. Our results showed that there was statistically significant positive correlation found between LVMASS and AP, LVEDD, PWT, IVST and LVMI and also negative correlation between LVMASS and weight, BMI and EF% among female patients. Conclusion our study suggested the role of hyperparathyroidism in the development of LVH, with a potential impact on cardiovascular outcome for patients on HD. Adverse effects of secondary hyperparathyroidism on LV function and structure showed the role of excess PTH in the development of left ventricular (LV) hypertrophy as well as low LV ejection fraction in patients with end-stage renal disease under hemodialysis which needs more attention to control of secondary hyperparathyroidism to reduce the risk of cardiovascular morbidity and mortality in dialysis patients.

Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial.

Background Left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information over LV ejection fraction in patients with heart failure (HF) and secondary mitral regurgitation. We examined the prognostic impact of LV GLS improvement in this population. Methods and Results The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial randomized symptomatic patients with HF with severe (3+/4+) mitral regurgitation to transcatheter edge-to-edge repair with the MitraClip device plus maximally tolerated guideline-directed medical therapy (GDMT) versus GDMT alone. LV GLS was measured at baseline and 6-month follow-up. The relationship between the improvement in LV GLS from baseline to 6 months and the composite of all-cause death or HF hospitalization between 6- and 24-month follow-up were assessed. Among 383 patients, 174 (45.4%) had improved LV GLS at 6-month follow-up (83/195 [42.6%] with transcatheter edge-to-edge repair+GDMT and 91/188 [48.4%] with GDMT alone; P=0.25). Improvement in LV GLS was strongly associated with reduced death or HF hospitalization between 6 and 24 months (P<0.009), with similar risk reduction in both treatment arms (Pinteraction=0.40). By multivariable analysis, LV GLS improvement at 6 months was independently associated with a lower risk of death or HF hospitalization (hazard ratio [HR], 0.55 [95% CI, 0.36-0.83]; P=0.009), death (HR, 0.48 [95% CI, 0.29-0.81]; P=0.006), and HF hospitalization (HR, 0.50 [95% CI, 0.31-0.81]; P=0.005) between 6 and 24 months. Conclusions Among patients with HF and severe mitral regurgitation in the COAPT trial, improvement in LV GLS at 6-month follow-up was associated with improved outcomes after both transcatheter edge-to-edge repair and GDMT alone between 6 and 24 months. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.

1177: PREVALENCE AND PROGNOSIS OF SEPSIS-INDUCED CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction: Sepsis is a critical systemic inflammatory syndrome caused by infection, leading to various organ failures. Sepsis-induced cardiomyopathy (SICM), which can be defined as new-onset left ventricular (LV) systolic dysfunction, is one of such sepsis-induced organ failures. Although previous meta-analyses suggested that LV systolic dysfunction defined by reduced LV ejection fraction in patients with sepsis was not associated with higher or lower mortality, studies included in these meta-analyses did not exclude patients with underlying myocardial diseases. Hence, the prevalence and prognosis of the new-onset LV dysfunction during sepsis remains unknown. Therefore, we conducted a systematic review and meta-analysis on the prevalence and prognosis of SICM. Methods: We searched MEDLINE, the Cochrane Central Register of Controlled Trials, and Embase. Inclusion criteria were as follows: (1), randomized controlled, cohort, or cross-sectional study, (2) adult patients (≥ 18 years) with sepsis, and (3) investigated the prevalence of SICM or compared short-term mortality between patients with and without SICM. Hereby, we defined SICM as a new-onset reduced LVEF during sepsis. We presented the results of all analyses with the use of random-effects models. The primary outcome was the prevalence of SICM and its impact on short-term mortality. P-value < 0.05 was considered statistically significant. Results: Thirty studies including 7,920 patients were included in the final meta-analysis. The sample size ranged from 35 to 3,530. All studies reported the prevalence of SICM in patients with sepsis and the pooled prevalence of SICM was 28% [95% confidence interval (CI), 23 to 34%]. Seventeen studies reported short-term mortality. The pooled odds ratio of short-term mortality associated with the presence of SICM was 1.88 (95% CI, 1.40–2.52; P< 0.001). Conclusions: In the meta-analysis, SICM was common in patients with sepsis, and it was associated with higher short-term mortality. This study suggests the importance of further investigation of personalized treatment in patients with SICM.

Patients With Bicuspid Aortic Stenosis Demonstrate Adverse Left Ventricular Remodeling and Impaired Cardiac Function Before Surgery With Increased Risk of Postoperative Heart Failure.

Background:Differences in adverse cardiac remodeling between patients who have bicuspid (BAV) and tricuspid aortic valve (TAV) with severe isolated aortic stenosis (AS) and its prognostic impact after surgical aortic valve replacement remains unclear. We sought to investigate differences in preoperative diastolic and systolic function in patients with BAV and TAV who have severe isolated AS and the incidence of postoperative heart failure hospitalization and mortality.Methods:Two hundred seventy-one patients with BAV (n=152) or TAV (n=119) and severe isolated AS without coronary artery disease or other valvular heart disease, scheduled for surgical aortic valve replacement, were prospectively included. Comprehensive preoperative echocardiographic assessment of left ventricular (LV) diastolic and systolic function was performed. The heart failure events were registered during a mean prospective follow-up of 1260 days versus 1441 days for patients with BAV or TAV, respectively.Results:Patients with BAV had a more pronounced LV hypertrophy with significantly higher indexed LV mass ([LVMi] 134 g/m2 versus 104 g/m2, P<0.001), higher prevalence of LV diastolic dysfunction (72% versus 44%, P<0.001), reduced LV ejection fraction (55% versus 60%, P<0.001), significantly impaired global longitudinal strain (P<0.001), significantly higher NT-proBNP (N-terminal pro-brain natriuretic peptide) levels (P=0.007), and a higher prevalence of preoperative levosimendan treatment (P<0.001) than patients with TAV. LVMi was associated with diastolic dysfunction in both patients with BAV and TAV. There was a significant interaction between aortic valve morphology and LVMi on LV ejection fraction, which indicated a pronounced association between LVMi and LV ejection fraction for patients with BAV and lack of association between LVMi and LV ejection fraction for patients with TAV. Postoperatively, the patients with BAV required significantly more inotropic support (P<0.001). The patients with BAV had a higher cumulative incidence of postoperative heart failure admissions compared with patients with TAV (28.2% versus 10.6% at 6 years after aortic valve replacement, log-rank P=0.004). Survival was not different between patients with BAV and TAV (log-rank P=0.165).Conclusions:Although they were significantly younger, patients with BAV who had isolated severe AS had worse preoperative LV function and an increased risk of postoperative heart failure hospitalization compared with patients who had TAV. Our findings suggest that patients who have BAV with AS might benefit from closer surveillance and possibly earlier intervention.

Global Left Ventricular Myocardial Work Efficiency and Long-Term Prognosis in Patients After ST-Segment-Elevation Myocardial Infarction.

Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction in patients with ST-segment-elevation myocardial infarction. However, LV global longitudinal strain does not take into consideration the effect of afterload. Novel speckle-tracking echocardiographic indices of myocardial work integrate blood pressure measurements (afterload) with LV global longitudinal strain. The present study aimed to investigate the prognostic value of global LV myocardial work efficiency (GLVMWE; reflecting LV performance) obtained from pressure-strain loops with echocardiography in patients with ST-segment-elevation myocardial infarction. A total of 507 ST-segment-elevation myocardial infarction patients (mean age, 61±11 years; 76% men) were retrospectively analyzed. LV ejection fraction and GLVMWE were measured by transthoracic echocardiography within 48 hours of admission. GLVMWE was defined as the ratio of constructive work divided by the sum of constructive and wasted work in all LV segments and expressed as a percentage. Spline curve analysis was used to define the association between reduced GLVMWE and all-cause death. After a median follow-up of 80 months (interquartile range, 67-97 months), 40 (8%) patients died. Patients with reduced GLVMWE (<86%) showed higher cumulative rates of all-cause mortality (17.5% versus 4.7%; log-rank P<0.001) in comparison with patients with preserved GLVMWE (≥86%). Reduced GLVMWE (<86%) showed an independent association with all-cause mortality (hazard ratio, 3.167 [95% CI, 1.679-5.972]; P<0.001). Reduced GLVMWE (<86%) measured by transthoracic echocardiography within 48 hours of admission in ST-segment-elevation myocardial infarction patients is associated with worse long-term survival.

Left Ventricular Ejection Fraction Assessment: Unraveling the Bias between Area- and Volume-based Estimates.

Calculating left ventricular ejection fraction (LVEF) accurately is crucial for the clinical diagnosis of cardiac disease, patient management, or other therapeutic treatment decisions. The measure of a patient's LVEF often affects their candidacy for cardiovascular intervention. Ultrasound (US) is one of the imaging modalities used to non-invasively assess LVEF, and it is the most common and least expensive. Despite the advances in 3D US transducer technology, only limited US machines are equipped with such transducer to enable true 3D US image acquisition. Thus, 2D US images remain to be widely used by cardiologists to image the heart and their interpretation is inherently based on two dimensional information immediately available in the US images. Past knowledge indicates that visual estimation of the LVEF based on the area changes of the left ventricle blood pool between systole and diastole (as depicted in 2D ultrasound images) may significantly underestimate the ejection fraction, rendering some patients as suitable candidates for potentially unnecessary interventions or implantation of assistive devices. True LVEF should be calculated based on changes in LV volumes, but equipment and time constraint limit the current technique to assess 3D LV geometry. The estimation of the systolic and diastolic blood pool volumes requires additional work beyond a simple visual assessment of the blood pool area changed in the 2D US images. Specifically, following the manual segmentation of the endocardial LV border, 3D volume would be assessed by reconstructing a LV volume from multiple tomographic views. In this work, we leverage on two idealized mathematical models of the left ventricle - a truncated prolate spheroid (TPS) and a paraboloid geometric model to characterize the LV shape according to the range of possible dimensions gathered from our patient-specific multi-plane US imaging data. The objective of this work is to reveal the necessity of calculating LVEFs based on volumes by showing that LVEF estimated using area changes underestimate the LVEF computed using volume changes. Additionally, we present a method to reconstruct the LV volume from 2D blood pool representations identified in the multi-plane 2D US images and use the reconstructed 3D volume throughout the cardiac cycle to estimate the LVEF. Our preliminary results show that the area-based LVEF significantly underestimates the true volume-based LVEF across both the theoretical simulations using idealized geometric models of the LV shape, as well as the patient-specific US imaging data. Specifically, both the TPS and paraboloid model showed an area-based LVEF of 41.3 ± 4.7% and a volume-based LVEF of 55.4 ± 5.7%, while the US image data showed an area-based LVEF of 34.7 ± 11.9% and a volume-based LVEF of 48.0 ± 14.0%. In summary, the area-based LVEF estimations using both the idealized TPS and paraboloid models was 14.1% lower than volume- based LVEF calculations using corresponding models. Furthermore, the area-based LVEF based on reconstructed LV volumes are 13.3% lower than volume-based estimates. Evidently, there is a need to further investigate a method to enable practical volume-based LVEF calculations to avoid the need for clinicians to estimate LVEF based on visual, holistic assessment of the blood pool area changes that improperly infer volumetric blood pool changes.

A 6-week multidisciplinary tailored Cardiac Rehabilitation Program is able to improve Left-Ventricular Ejection Fraction in patients with Chronic Heart Failure

Background Cardiac rehabilitation (CR) is recommended to patients with chronic heart failure (CHF) and reduced Left-Ventricular ejection fraction (EF) at a class 1 evidence level. Purpose The aim of this prospective study was to assess the effect of a rehabilitation program on EF in patients with CHF. Methods One hundred and five patients (mean age: 5713 years, men: 67%, diabetic patients: 42%) with CHF (EF Reasons of admission were: coronary heart disease artery bypass graft surgery (17%), angioplasty percutaneous coronary interventions and stent (24%), angor pectoris or myocardial infarction (8%), aortic or mitral valve replacement or repair (10%), dilated cardiomyopathy (34%), other (7%). Patients received beta-blocker (96%), conversion enzyme inhibitor or angiotensine II receptor antagonist (42%), sacubitril-valsartan (48%), furosemide (60%), antialdosterone therapy (55%), ivabradine (12%), other (11%). EF assessed by echocardiography using the biplane Simpson's method, peak oxygen consumption (VO2), maximal walking distance (MWD) during 6 min walk test and NT-proBNP were assessed before and after rehabilitation. Results After 6 weeks, there were significantly improvements in EF (35% ± 7.23 vs. 40% ± 8.3 - P Conclusion Our study shows that a 6-week multidisciplinary tailored Cardiac Rehabilitation Program improves significantly Left-Ventricular ejection fraction in patients with Chronic Heart Failure. This should be relevant to improve prognosis.

ACUTE MYOCARDIAL INFARCTION

Background: Death and morbidity are commonly occurred worldwide due toheart diseases and are becoming an increasingly important problem in the developing countriesincluding Pakistan. The left ventricular ejection fraction (LVEF) serves as a good assessmenttool to document beneficial effects of cardiac rehabilitation (CR) program in cardiac patients.Objectives: To evaluate the effect of short-term CR program on LVEF in patients with myocardialinfarction (MI). Study Design: Cross sectional and Case series study. Setting: Departments ofCardiology, Liaquat University Hospital, Hyderabad. Period: 1st January 2014 to 30th June 2014.Methods: 100 patients of less than 75 years of age with acute uncomplicated anterior wall oranterolateral wall MI, inferior and RV MI. Cases were randomized into two groups of age andsex matched 50 patients each. Group I (study group) patients were administered secondaryprevention advice and were started on the CR exercise protocol, Group II (control group) patientswere administered secondary prevention advice only. Results: At baseline, LVEF was 42.5% inthe study group and 41.4% in the control group patients and was statistically comparable. After10 weeks study group showed the LVEF of 47.78% and control group had LVEF of 42.26%. Thedifferences are being statistically significant. Conclusion: Significant improvement in LVEF inpatients who had been engaged in CR program besides the secondary prevention strategieswhen compared with the control group patients who followed secondary prevention strategiesonly. The present study is amplify the beneficial effects of simple CR program, which additionallyimproves the key cardiac parameters like LVEF in the recovery period.

ASSESSMENT OF LEFT VENTRICULAR EJECTION FRACTION IN PATIENTS UNDERGOING CARDIAC REHABILITATION FOLLOWING ACUTE MYOCARDIAL INFARCTION

Background: Death and morbidity are commonly occurred worldwide due toheart diseases and are becoming an increasingly important problem in the developing countriesincluding Pakistan. The left ventricular ejection fraction (LVEF) serves as a good assessmenttool to document beneficial effects of cardiac rehabilitation (CR) program in cardiac patients.Objectives: To evaluate the effect of short-term CR program on LVEF in patients with myocardialinfarction (MI). Study Design: Cross sectional and Case series study. Setting: Departments ofCardiology, Liaquat University Hospital, Hyderabad. Period: 1st January 2014 to 30th June 2014.Methods: 100 patients of less than 75 years of age with acute uncomplicated anterior wall oranterolateral wall MI, inferior and RV MI. Cases were randomized into two groups of age andsex matched 50 patients each. Group I (study group) patients were administered secondaryprevention advice and were started on the CR exercise protocol, Group II (control group) patientswere administered secondary prevention advice only. Results: At baseline, LVEF was 42.5% inthe study group and 41.4% in the control group patients and was statistically comparable. After10 weeks study group showed the LVEF of 47.78% and control group had LVEF of 42.26%. Thedifferences are being statistically significant. Conclusion: Significant improvement in LVEF inpatients who had been engaged in CR program besides the secondary prevention strategieswhen compared with the control group patients who followed secondary prevention strategiesonly. The present study is amplify the beneficial effects of simple CR program, which additionallyimproves the key cardiac parameters like LVEF in the recovery period.

Usefulness of Electrocardiographic Strain to Predict Survival After Surgical Aortic Valve Replacement for Aortic Stenosis

Electrocardiographic (ECG) strain has been reported as a specific marker of midwall left ventricular (LV) myocardial fibrosis, predictive of adverse clinical outcomes in aortic stenosis (AS), but its prognostic impact after aortic valve replacement (AVR) is unknown. We aimed to assess the impact of ECG strain on long-term mortality after surgical AVR for AS. From January 2005 to January 2014, patients with interpretable preoperative ECG who underwent isolated AVR for AS were included. ECG strain was defined as ≥1-mm concave downslopping ST-segment depression with asymmetrical T-wave inversion in lateral leads. Mortality was assessed over a follow-up period of 4.8 ± 2.7 years. Among the 390 patients included, 110 had ECG strain (28%). They had significantly lower body mass index, higher mean transaortic pressure gradient and Cornell-product ECG LV hypertrophy than in those without ECG strain. There was also a trend for lower LV ejection fraction in patients with ECG strain as compared with those without. Patients with ECG strain had significantly lower 8-year survival than those without. ECG strain remained associated with reduced survival both in patients with and without LV hypertrophy (p <0.0001 for both). After adjustment, ECG strain remained a strong and independent determinant of long-term survival (hazard ratio 4.4, p <0.0001). Similar results were found in patients with LV hypertrophy or without LV hypertrophy. In the multivariate model, the addition of ECG strain provided incremental prognostic value (p <0.0001). In conclusion, in patients with AS, ECG strain is associated with 4-fold increased risk of long-term mortality after isolated AVR, regardless of preoperative LV hypertrophy.

Recent advances in the diagnosis and treatment of acute myocardial infarction.

The Third Universal Definition of Myocardial Infarction (MI) requires cardiac myocyte necrosis with an increase and/or a decrease in a patient's plasma of cardiac troponin (cTn) with at least one cTn measurement greater than the 99(th) percentile of the upper normal reference limit during: (1) symptoms of myocardial ischemia; (2) new significant electrocardiogram (ECG) ST-segment/T-wave changes or left bundle branch block; (3) the development of pathological ECG Q waves; (4) new loss of viable myocardium or regional wall motion abnormality identified by an imaging procedure; or (5) identification of intracoronary thrombus by angiography or autopsy. Myocardial infarction, when diagnosed, is now classified into five types. Detection of a rise and a fall of troponin are essential to the diagnosis of acute MI. However, high sensitivity troponin assays can increase the sensitivity but decrease the specificity of MI diagnosis. The ECG remains a cornerstone in the diagnosis of MI and should be frequently repeated, especially if the initial ECG is not diagnostic of MI. There have been significant advances in adjunctive pharmacotherapy, procedural techniques and stent technology in the treatment of patients with MIs. The routine use of antiplatelet agents such as clopidogrel, prasugrel or ticagrelor, in addition to aspirin, reduces patient morbidity and mortality. Percutaneous coronary intervention (PCI) in a timely manner is the primary treatment of patients with acute ST segment elevation MI. Drug eluting coronary stents are safe and beneficial with primary coronary intervention. Treatment with direct thrombin inhibitors during PCI is non-inferior to unfractionated heparin and glycoprotein IIb/IIIa receptor antagonists and is associated with a significant reduction in bleeding. The intra-coronary use of a glycoprotein IIb/IIIa antagonist can reduce infarct size. Pre- and post-conditioning techniques can provide additional cardioprotection. However, the incidence and mortality due to MI continues to be high despite all these recent advances. The initial ten year experience with autologous human bone marrow mononuclear cells (BMCs) in patients with MI showed modest but significant increases in left ventricular (LV) ejection fraction, decreases in LV end-systolic volume and reductions in MI size. These studies established that the intramyocardial or intracoronary administration of stem cells is safe. However, many of these studies consisted of small numbers of patients who were not randomized to BMCs or placebo. The recent LateTime, Time, and Swiss Multicenter Trials in patients with MI did not demonstrate significant improvement in patient LV ejection fraction with BMCs in comparison with placebo. Possible explanations include the early use of PCI in these patients, heterogeneous BMC populations which died prematurely from patients with chronic ischemic disease, red blood cell contamination which decreases BMC renewal, and heparin which decreases BMC migration. In contrast, cardiac stem cells from the right atrial appendage and ventricular septum and apex in the SCIPIO and CADUCEUS Trials appear to reduce patient MI size and increase viable myocardium. Additional clinical studies with cardiac stem cells are in progress.

Left ventricular diastolic performance at rest is essential for exercise capacity in patients with non-complicated myocardial infarction

IntroductionIn patients with recent myocardial infarction (MI) limited exercise capacity during physical activity is an important symptom and the base for future treatment. The myocardial injury after MI leads to both systolic and diastolic left ventricular (LV) dysfunction. ObjectiveThe aim of this study was to assess the relevance of systolic and diastolic LV function for cardiopulmonary exercise capacity in patients with prior MI. MethodsSixty-five consecutive patients after first MI without signs and symptoms of heart failure, aged 52 ± 6 years, were included in the study. The following echo parameters were evaluated: LV ejection fraction (LVEF), peak early and late diastolic velocities (E, A), deceleration time of E wave (dec t E), ratio of early trans-mitral to early annular diastolic velocities (E/e′), velocity propagation of early filling (Vp), and diameters and volumes of LV and left atrium (LA). CPET variables included: oxygen uptake at peak exercise (peak VO2), oxygen pulse (VO2 HR), VE/VCO2 slope, circulatory power (CP) and recovery half time (T1/2). ResultsSignificant correlations were demonstrated between peak VO2 and E/e’ (p < 0.001), peak VO2 and dec t E (p < 0.001), VO2 HR and E/e′ (p = 0.002) and between VE/VCO2 and E/e′ (p < 0.001). Twenty patients with elevated LV filling pressure achieved significantly lower peak VO2 (1624 vs. 1932 ml, p = 0.027) VO2 HR (11.70 vs. 14.05, p = 0.011) and CP (287,073 vs. 361,719, p = 0.014). By using multivariate regression model we found that only E/e′ (p = 0.001) and dec t E (p = 0.008) significantly contributed to peak VO2. ConclusionsDiastolic dysfunction, particularly LV filling pressure, determine exercise capacity, despite differences in LV ejection fraction in patients with prior MI.

(547) - Mineralocorticoid Receptor Antagonists Enhance Cardiac Function during Continuous Flow Left Ventricular Assist Device Support

Mineralocorticoid Receptor Antagonists (MRAs) reduce mortality and improve LV ejection fraction in patients with systolic heart failure. However, the impact of MRAs on cardiac function during Continuous Flow Left Ventricular Assist Device (CF LVAD) support remains unknown.

Role of insulin-like growth factor 1 in stent thrombosis under effective dual antiplatelet therapy.

IntroductionAccumulating evidence now indicates that insulin-like growth factors (IGF) and their regulatory proteins are growth promoters for arterial cells and mediators of cardiovascular diseases.AimWe hypothetised that IGF-1 levels could play a role in the development of stent thrombosis (ST), and aimed to investigate the associations between stent thrombosis under effective dual antiplatelet therapy and IGF-1 levels and other related factors such as disease severity and LV ejection fraction in patients undergoing coronary stent placement.Material and methodsA total of 128 patients undergoing coronary stent implantation were included in the analysis. Seventy-seven patients experiencing ST in the first year after stent implantation were defined as the ST group. Fifty-one patients without ST at least 1 year after stent implantation were defined as the no-thrombosis (NT) group. The IGF-1 levels, Gensini scores, and other related factors were measured.ResultsThe IGF-1 levels were significantly higher in the stent thrombosis group than in the no-thrombosis group (122.22 ±50.61 ng/ml vs. 99.52 ±46.81 ng/ml, respectively, p < 0.039). The left ventricle ejection fraction (LVEF) values were significantly lower (44.13 ±9.25% vs. 55.81 ±8.77%, p < 0.0001) and Gensini scores were significantly higher (63.74 ±26.54 vs. 48.87 ±23.7, p < 0.004) in the ST group than in the NT group, respectively. In the linear regression analysis, IGF-1, Gensini score, LVEF, total cholesterol, and triglycerides were found to be independent risk factors for ST.ConclusionsThis study revealed that the plasma IGF-1 levels, disease severity, were significantly higher and LVEF was lower in patients with ST. High IGF-1 levels may identify patients who are at increased risk for ST. Future trials are necessary to confirm these results.

B-Адреноблокаторы: нереализованность задач или неготовность врачей в Российской Федерации к оптимизации лечения?

The purpose of the study. The achievedheart rate of 50-60 beats per minute in patients after acute myocardial infarction, and up to50-70 beats per minute for patients with stable angina is considered effective. Assuming that in Russia low doses of β-blockers are often used, thequestion was raised: «How common tachycardia can bein patients with coronary heart disease (CHD) and chronic heart failure (CHF), and whether there are strategic approaches to achieving the targets in heart rate in these patients in real clinical practice and are β-blockers often used in patients for whom this group of drugs is the basic one?»Materials and Methods. Work carried out in the framework of the Russian epidemiological study of a representative sample of the European partof the Russian Federation. All patients with CHF and coronary artery disease were divided into two subgroups: heart rate reducers not receiving medicines and receiving at least one heart rate reducing drug (a β-blocker, calcium channel 1 and 3rd type (AK) blockers, glycosides).Results and discussion. In a representative sample of the program in healthy individuals (without clinical manifestations of coronary arterydisease) tachycardia was diagnosed in 7,1% of cases. Almost all respondents without CHD (87,3%) had normal heart rate from 61 to 80 beats per minute. Number of respondents without CHD with heart rate of 70 to 79 bpm. per min. (54,1%) turned out to be significantly less than that of patients with rhythm in any form of coronary artery disease (p<0,001).In a population of patients with CHF a clinical symptom of tachycardia was established in 73,5% of patients.Analysis of the prescribed β-blockers therapy in patients with CHF showed that in 54% of cases the use of beta-blockers did not result in effectivecontrol of the rhythm in patients with CHF. β-Blockers recommended for the treatment of CHF were used only 36,2% of patients.Conclusions. Early intravenous β-blockers (drug Betalok) use before percutaneous coronary intervention reduces infarct size and increases leftventricular ejection fraction in patients with myocardial infarction of ST segment elevation. Answering the question posed in the title, you can say: doctors are not ready to take an active position in prescribing and achievingthe target doses of β-blockers. This situation immediately generates the lack of task implementation in terms of optimization of therapy and reduces the risk of cardiovascular mortality in coronary artery disease and heart failure.

Effect of ulinastatin in heavy heart failure patients with coronary heart disease

Objective To investigate the therapeutic effect of ulinastatin in treatment for heavy heart failure patients with coronary heart disease (CHD).Methods Eighty-two patients with heavy heart failure (NYHA ratings Ⅲ ～ Ⅳ class) and CHD were randomly divided into two groups,all patients used diuretic,angiotensin converting enzyme,etc.And test group was given intravenous drip with ulinastatin for 7 days.The CRP,NT-proBNP and the left ventricular ejection fraction (EF) changes were observed.Results After treatment,CRP and NT-proBNP could be reduced,the clinical heart function of the patients in the two groups was improved; the left ventricular EF of patients in the test group was higher than that in the control group.Conclusion Conventional treatment plus ulinastatin could significantly improve the immune condition and reduce the inflammatory reaction in CHF patients. Key words: Ulinastatin; Coronary heart disease (CHD); Chronic heart failure (CHF); pro-BNP; CRP

Early impairment of left ventricular function in patients with systemic hypertension: New insights with 2-dimensional speckle tracking echocardiography

Two-dimensional strain imaging allows rapid and accurate analysis of regional left ventricular (LV) principal strains in the longitudinal, radial, and circumferential directions. The aim of this study was to assess the ability of subtle differences in LV principal strains to characterize features of subclinical LV dysfunction in patients with systemic hypertension and apparently preserved LV systolic function. 2-dimensional echocardiographic (2DE) images of the LV were acquired in apical 4-chamber and parasternal short-axis at the basal, mid, and apical levels in 59 subjects, including 25 healthy controls (33 ± 4 yrs, 14 male) and 34 patients with systemic hypertension (36 ± 3 yrs, 24 male). Longitudinal (LS), circumferential (CS) and radial strains (RS) were quantified in an 18-segment model using a novel speckle tracking system (2D Cardiac Performance Analysis, TomTec Imaging System, Munich, Germany). In comparison with normal controls, peak LS was markedly attenuated in the subendocardial and subepicardial regions in patients with systemic hypertension. However, circumferential strain was reduced only in subepicardial region; radial strain was not significantly different in the two groups. The subendocardial-to-subepicardial gradient of circumferential deformation correlated with the radial strains in both controls and hypertensive patients (R = 0.87, p < 0.001). Despite reduced longitudinal shortening, LV wall thickening in patients with systemic hypertension remains unaltered due to relatively preserved circumferential shortening. Characterizing the disparities in LV principal strains reveals the presence of subclinical LV dysfunction and provides unique insights into functional adaptations that maintain global LV ejection fraction in patients with systemic hypertension.

Cardiac Resynchronization Induces Major Structural and Functional Reverse Remodeling in Patients With New York Heart Association Class I/II Heart Failure

Cardiac resynchronization therapy (CRT) improves LV structure, function, and clinical outcomes in New York Heart Association class III/IV heart failure with prolonged QRS. It is not known whether patients with New York Heart Association class I/II systolic heart failure exhibit left ventricular (LV) reverse remodeling with CRT or whether reverse remodeling is modified by the cause of heart failure. Six hundred ten patients with New York Heart Association class I/II heart failure, QRS duration > or =120 ms, LV end-diastolic dimension > or =55 mm, and LV ejection fraction < or =40% were randomized to active therapy (CRT on; n=419) or control (CRT off; n=191) for 12 months. Doppler echocardiograms were recorded at baseline, before hospital discharge, and at 6 and 12 months. When CRT was turned on initially, immediate changes occurred in LV volumes and ejection fraction; however, these changes did not correlate with the long-term changes (12 months) in LV end-systolic (r=0.11, P=0.31) or end-diastolic (r=0.10, P=0.38) volume indexes or LV ejection fraction (r=0.07, P=0.72). LV end-diastolic and end-systolic volume indexes decreased in patients with CRT turned on (both P<0.001 compared with CRT off), whereas LV ejection fraction in CRT-on patients increased (P<0.0001 compared with CRT off) from baseline through 12 months. LV mass, mitral regurgitation, and LV diastolic function did not change in either group by 12 months; however, there was a 3-fold greater reduction in LV end-diastolic and end-systolic volume indexes and a 3-fold greater increase in LV ejection fraction in patients with nonischemic causes of heart failure. CRT in patients with New York Heart Association I/II resulted in major structural and functional reverse remodeling at 1 year, with the greatest changes occurring in patients with a nonischemic cause of heart failure. CRT may interrupt the natural disease progression in these patients. Clinical Trial Registration- Clinicaltrials.gov Identifier: NCT00271154.

Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction

Myocardial haemorrhage is a common complication following reperfusion of ST-segment-elevation acute myocardial infarction (MI). Although its presence is clearly related to infarct size, at present it is unknown whether post-reperfusion haemorrhage affects left ventricular (LV) remodelling. Magnetic resonance imaging (MRI) can be used to identify MI, myocardial haemorrhage, and microvascular obstruction (MVO), as well as measure LV volumes, function, and mass. Ninety-eight patients (14 females, 84 males, mean age: 57.7 years) with MI reperfused with percutaneous coronary intervention (PCI) were studied within the first week (1W) and at 4 months (4M) after the event. T2-weighted MRI was used to differentiate between haemorrhagic (i.e. hypointense core) and non-haemorrhagic infarcts (i.e. hyperintense core). Microvascular obstruction and infarct size were determined on contrast-enhanced MRI, whereas cine MRI was used to quantify LV volumes, mass, and function. Twenty-four patients (25%) presented with a haemorrhagic MI. In the acute phase, the presence of myocardial haemorrhage was related to larger infarct size and infarct transmurality, lower LV ejection fraction, and lower systolic wall thickening in the infarcted myocardium (all P-values <0.001). At 4M, a significant improvement in LV ejection fraction in patients with non-haemorrhagic MI was seen (baseline: 49.3 +/- 7.9% vs. 4M: 52.9 +/- 8.1%; P < 0.01). Left ventricular ejection fraction did, however, not improve in patients with haemorrhagic MI (baseline: 42.8 +/- 6.5% vs. 4M: 41.9 +/- 8.5%; P = 0.68). Multivariate analysis showed myocardial haemorrhage to be an independent predictor of adverse LV remodelling at 4M (defined as an increase in LV end-systolic volume). This pattern was independent of the initial infarct size. Myocardial haemorrhage, the presence of which can easily be detected with T2-weighted MRI, is a frequent complication after successful myocardial reperfusion and an independent predictor of adverse LV remodelling regardless of the initial infarct size.

An aldosterone synthase gene variant is associated with improvement in left ventricular ejection fraction in dilated cardiomyopathy

To assess whether renin-angiotensin-aldosterone (RAA) system gene polymorphisms shown to be associated with alterations in the activity of the system, may predict cardiac function changes subsequent to initiating medical therapy in heart failure. The impact of RAA system genotypes on left ventricular ejection fraction (LVEF) following therapy to patients with idiopathic dilated cardiomyopathy (IDC) and class II-III heart failure was assessed. In 107 patients LVEF and LV dimensions were determined using radionuclide ventriculography and echocardiography prior to and subsequent to receiving furosemide, digoxin and angiotensin-converting enzyme (ACE) inhibitor therapy. Patients and controls were genotyped for variants of the ACE (insertion-deletion polymorphism), angiotensinogen (AGT; M235T polymorphism) and the aldosterone synthase (CYP11B2, C-344T polymorphism) genes. RAA system genotypes were not significantly associated with LVEF prior to initiating medical therapy. However, the CYP11B2 gene variant (P=0.0064 on covariate analysis [adjusted for multiple genotyping] with a 1-2% chance of false positive data), but neither the ACE, nor the AGT variants, predicted improvement in LV ejection fraction in patients on medical therapy. A CYP11B2 gene variant predicts the variable improvement in LV ejection fraction that occurs subsequent to initiating medical therapy in IDC. These data suggest a role for the aldosterone synthase locus in regulating the progression of heart failure.