Left Ventricular Function Ejection Research Articles

The prognostic value of echocardiographic right ventricular global longitudinal strain in heart failure: A systematic review and meta-analysis

Abstract Background Right ventricular (RV) dysfunction is a well-recognized adverse prognostic feature in patients with heart failure (HF). However, accurate RV functional assessment remains challenging in clinical practice. Recently, many studies have demonstrated that RV global longitudinal strain (RV GLS) assessed using speckle tracking echocardiography might be a powerful prognosticator in HF. Aim To systematically appraise and quantitatively synthesize the prognostic evidence of RV GLS derived by echocardiography, across the entire spectrum of left ventricular ejection function (LVEF) in HF. Methods A systemic literature review was conducted in MEDLINE, Scopus and Cochrane databases to identify every study reporting the predictive role of RV GLS in HF subjects irrespective of LVEF. A random-effects meta-analysis was conducted to quantify the adjusted and unadjusted hazard ratios [(a)HRs] for all-cause-mortality and the composite outcome of all-cause mortality or any HF-related hospitalization per each unit of increase in RV GLS. Subgroup analysis was feasible for patients with LVEF<45%. Results Thirteen studies were deemed eligible for inclusion in the systematic review. Of them, 8 provided appropriate quantitative data for the meta-analysis, encompassing a total of 3,736 patients. When adjusted for pre-specified clinically-relevant parameters, it was shown that each unit of increase in RV GLS conferred increased risk of all-cause mortality (pooled aHR=1.08 [1.03-1.13]; p<0.01; I²=76%) and the composite outcome (pooled aHR= 1.10 [1.06-1.15]; p<0.01; I²=0%) for patients with HF (Abstract Picture 1 and 2). Subgroup analysis for HF patients with LVEF<45% yielded similar results, with each increase of 1% in RV GLS being independently associated with increased risk of all-cause mortality (pooled aHR=1.10 [1.06-1.13]; p<0.01; I²=0) and the composite end-point (pooled aHR= 1.13 [1.07-1.20]; p<0.01; I²=0%) (Abstract Picture 1 and 2). Conclusion RV GLS assessed by speckle-tracking echocardiography is a novel echocardiographic biomarker that can further add in patient prognostication across a wide range of HF populations regardless of LVEF.RV GLS and all-cause mortalityRV GLS and the composite outcome

Effect of Beta-Blocker on Long-Term Major Cardiovascular Events in High Atherosclerotic Risk Population.

Beta-blocker is a frequently used medication in cardiovascular diseases. However, long-term benefit of beta-blocker in patients with preserved left ventricular ejection function (LVEF) on major adverse cardiovascular events (MACEs) is uncertain. The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) was a prospective study that enrolled Thai patients with high atherosclerotic risk including multiple atherosclerotic risk factors and established atherosclerotic cardiovascular diseases. Baseline demographic data, co-morbidities and medication were recorded. Patients were followed for 5 years. Patients with LVEF<50% were excluded. Primary outcome was the effect of beta-blocker on the occurrence of MACEs including all-cause death, non-fatal myocardial infarction and non-fatal stroke (3P-MACEs). Propensity score matching was used to control confounding factors. There was a total of 8513 patients in the pre-matched cohort, 4418 were taking beta-blocker and 4095 were not. After adjustment of confounders, beta-blocker was an independent predictor of 3P-MACEs (adjusted HR 1.29;95% CI 1.12-1.49;p<0.001). After propensity score matching, 4686 patients remained in the post-matched cohort. Propensity score analysis showed consistent results in which patient taking beta-blocker had higher risk of 3P-MACEs (adjusted HR 1.29;95% CI 1.10-1.53;p=0.002). Subgroup analysis in patients with coronary artery disease (CAD) indicated that taking beta-blocker did not increase the incidence of 3P-MACEs (adjusted HR 0.99;95% CI 0.76-1.29) while those without CAD did (adjusted HR 1.51; 95% CI, 1.22-1.86;p-interaction=0.015). In patients with high atherosclerotic cardiovascular risk, taking beta-blockers had a higher risk of 3P-MACEs. Care should be taken when prescribing beta-blockers to patients without a clear indication. TCTR20130520001 registered in Thai Clinical Trials Registry (TCTR) https://www.thaiclinicaltrials.org/ , date of registration 20 May 2013.

Evaluation of left ventricular function in patients with coronary slow flow: A systematic review and meta-analysis.

Coronary slow flow (CSF) is an angiographic finding defined as delayed distal vessel perfusion without severe stenosis of the epicardial coronary arteries. However, definite alterations in left ventricular (LV) function in patients with CSF remains inconsistent. This study aimed to clarify the changes in LV function in patients with CSF and explore the factors that may influence LV function. PubMed, Embase, and Cochrane Library databases were systematically searched. Standardized mean differences and 95% confidence intervals (CI) for the LV function parameters were calculated. Subgroup analysis, meta-regression analysis, and correlation analysis were performed to explore the factors influencing LV function. Twenty-two studies (1101 patients with CSF) were included after searching three databases. In patients with CSF, LV ejection function in patients with CSF was marginally lower (61.8%; 95% CI: 61.0%, 62.7%), global longitudinal strain was decreased (-18.2%; 95% CI: -16.7%, -19.7%). Furthermore, left atrial diameter, left atrial volume index, and E/e' were significantly increased, while E/A and e' were significantly decreased. The mean thrombolysis in myocardial infarction frame count (TFC) was linearly associated with LV function; the larger the mean TFC, the greater the impairment of LV function. Left ventricular systolic and diastolic functions were impaired in patients with CSF, and this impairment was aggravated with increasing mean TFC.

Interaction between uric acid and obesity with myocardial dysfunction in diabetes

Abstract Funding Acknowledgements Type of funding sources: None. Background Both obesity and hyperuricemia are major risk factors for cardiovascular diseases. Few studies have investigated their impact on cardiac structural and functional changes in patients with diabetes. Purpose This study aims to evaluate the impact of obesity, hyperuricemia and their interaction on myocardial dysfunction in patients with diabetes. Methods A total of 1567 patients with diabetes were recruited from two Hospitals. Uric acid (UA), body mass index (BMI) and myocardial structure and function indicators, including left ventricular hypertrophy (LVH), left ventricular ejection function (LVEF), left ventricular global longitudinal strain (GLS), circumferential strain (CS) and radial strain (RS). Multivariate linear regression was conducted to evaluate the association between myocardial structure and function with UA in obesity and non-obesity. The generalised linear models were used to test for the interaction effects of obesity on the associations between UA level and myocardial structure and function. Results Compared to non-hyperuricemia patients, those who were hyperuricemia had a greater left ventricular mass index (LVMi), a higher proportion of LVH and worse GLS and CS (all P &amp;lt;0.05). Similar patterns were found for those with obesity compared to non-obesity (all P&amp;lt;0.05). In patients with obesity and non-obesity, increasing UA was independently related with decreased GLS and CS. There is a significant interaction between hyperuricemia and obesity on LVMi and GLS in patients with diabetes (P for interaction &amp;lt;0.05) but not on LVEF, CS and RS. Conclusions Obesity and hyperuricemia were associated with worse left ventricular remodeling and left ventricular myocardial function. Those who were obesity and with hyperuricemia had more pronounced LVMi and GLS. Our finding emphasizes lowering UA and BMI in patients with diabetes may effectively prevent myocardial remodeling and dysfunction.

Rapidly reversible acute neurological, renal, and cardiac impairment during malignant hypertension

BackgroundMalignant hypertension is a model of the rapid changes that a high afterload and renin-angiotensin levels can induce on target organs such as the heart. We present a case of a young man affected by malignant hypertension with multi-organ involvement who showed quick remission after adequate antihypertensive treatment.Case summaryA 41-year-old jazz pianist with a family history of coronary artery disease presented to the emergency department for asthenia and epigastric pain, associated with right eye visual impairment. No neurological symptoms. An echocardiogram showed left ventricular hypertrophy with severe impairment of ejection fraction (22%) due to global hypokinesia. There was renal insufficiency (creatinine 2.51 mg/dl, eGFR 34 ml/min, HS Troponin T 127 pg/dl, NT pro-BNP 22,672 pg/ml, CRP 32 mg/L, sodium 129 mEq/L with normal kaliemia. The following day, anterior T wave inversion was observed in the electrocardiogram. At a cardiac magnetic resonance. Concentric hypertrophy of the left ventricle was observed with normal myocardial T1 mapping values (1100 ± 38 ms), ruling out Fabry’s disease. There was no obvious myocardial edema at T2 weighted. The viral panel for acute myocarditis resulted in negative. After the exclusion of all possible secondary causes, malignant essential hypertension was the final diagnosis, and additional tests confirmed multi-organ damage. An ophthalmological examination demonstrated hypertensive retinopathy with hemorrhages, cottony exudates, and macular lipid exudation, especially in the right eye. A brain MRI showed small areolas of T2 hyperintensity in the white matter of both cerebral hemispheres, suggestive of chronic microangiopathy, and left nuclear micro lacunar ischemia.The patient was treated with full-dose calcium channel blockers (amlodipine 10 mg), beta-blockers (bisoprolol 10 mg), alpha2 agonists (slow-release clonidine patch), selective a1 blocker (doxazosine 16 mg), and furosemide 50 mg. After the exclusion of renal stenosis and improvement of renal function, Ramipril was added up to a final dose of 10 mg daily. In parallel with the achievement of a satisfactory blood pressure control, visual impairment disappeared with a reduction of retinal ischemic exudates and hemorrhages at the ophthalmological follow-up assessment.At the time of discharge, an echocardiographic re-evaluation confirmed concentric hypertrophy of the left ventricle with markedly reduced wall thicknesses, with a partial recovery in left ventricular ejection function (EF 44%).Six months after discharge, the patient is in good general condition under optimal medical therapy (without furosemide) with normalized blood pressure values (130–140/80 mmHg). At 6 months from discharge, creatinine was only mildly increased (1.5 mg/dl, eGFR 59.5 ml/min) and NT-pro BNP nearly normalized (452 pg/ml).DiscussionMalignant hypertension is a cardiovascular emergency and requires immediate and careful intervention to lower blood pressure and reduce organ injury. It is an exclusion diagnosis that can be advanced once the causes of secondary hypertension have been excluded. Remission of organ injury is possible and might be rapid under adequate antihypertensive treatment, but patients require a close follow-up.

Evaluation of cardiac failure and recovery in acute myelogenous leukemia.

7038 Background: Cardiac failure causes significant comorbidity and death in acute myeloid leukemia (AML) patients, with incidence estimated at 10-15% (Neuendorff N Blood Adv. 2020). We sought to describe the post-treatment cardiac experience in AML survivors including factors associated with onset, persistence, and outcome of cardiac dysfunction during and following treatment. Methods: 86 patients with AML or other high-grade myeloid neoplasms treated with induction chemotherapy with or without allogeneic hematopoietic cell transplant were identified at the University of Washington/Fred Hutchinson Cancer Center from 1/2000-1/2022. All patients sustained cardiac dysfunction, defined as left ventricular ejection function (LVEF) decline of 10% with absolute LVEF below 50% during chemotherapy. A multivariable analysis was performed to compare those who recovered (LVEF recovery) and those who did not (LVEF non-recovery), examining baseline health factors, disease risk (ELN 2017), time to dysfunction and recovery, most probable cause of cardiac dysfunction based on cardiologist evaluation, and goal-directed medical therapy (GDMT) use and dosage. Results: 48% (41 out of 86) failed to recover following LVEF decline. This cohort tended to be older, male, and had more ASCVD risk factors ( p &lt; 0.05). Neither the choice of chemotherapy regimen ( p= 0.43) nor the cumulative anthracycline dose ( p= 0.44) was significantly different between the LVEF recovery and non-recovery groups. Onset of cardiac dysfunction tended to occur later in the LVEF recovery cohort (median 72 vs. 48.5 days, p= 0.660). In subjects who recovered, the median time to recovery was 87 days (range 2-268 days). When chemotherapy was identified as the probable cause, it was associated with greater likelihood of eventual recovery ( p= 0.014), whereas ischemic coronary etiology was associated with non-recovery ( p= 0.005). Failing to recover from cardiac dysfunction correlated with shorter survival (median 229 vs 650 days, p = 0.005). Multivariable analysis is shown in the Table below. Importantly, the use of GDMT with higher doses of renin-angiotensin inhibitor medications (RAASi) were associated with higher probability of recovery (not shown, p &lt; 0.05). Conclusions: The present study demonstrates recovery occurring in over half of AML patients who experienced cardiac dysfunction during their chemotherapy. Recovery was more common in patients whose cardiac dysfunction is precipitated by chemotherapy and in patients who received GDMT with aggressive use of RAASi. Since cardiac recovery was associated with improved survival, next steps include establishing a cardiac monitoring algorithm to initiate early and aggressive GDMT. [Table: see text]

Effects of CRT on atrial and ventricular arrhythmias in patients with HF

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac resynchronization therapy (CRT) is an accepted treatment for patients with heart failure (HF). Cardiac arrhythmias present a significant and complex issue in this patient group. Evidence exploring the influence of CRT on cardiac arrhythmias rate variations is limited. Purpose Our research investigates the effectiveness of CRT in the treatment of existing and newly diagnosed atrial and ventricular arrhythmias, and impact of epicardial lead position on these arrhythmias rate variations, as well as on the CRT response. Methods This single-center, prospective, observational study included 75 consecutive patients admitted for CRT implantation over a 12-month period. All included patients had episodes of atrial and/or ventricular arrhythmias, diagnosed by 12-lead ECG or 24-hour Holter monitoring. Pre-procedural demographic characteristics were collected for all patients, including ECG records, NYHA functional class, echocardiographic assessment of left ventricular ejection function and questionnaire for quality-of-life. During device follow up atrial and ventricular arrhythmias appearance was monitored. Additional assessment of echocardiographic parameters, NYHA - functional class, quality of life and rate of major cardiovascular complications and rehospitalizations was performed. Results The mean age of the patients was 62.4 ± 10.3 years, with 74.6% male and 25.3% females. 72% had a non-ischemic HF etiology. Pre-procedural paroxysmal AF was present in 34.7%, persistent AF in 36%, PVCs in 32%, NSVT 16%, and VT in 18,7% patients. 55% of the included patients were responders to CRT. Our results showed decrease in rate of all ventricular arrhythmias, with significant reduction in the percentage of VT (p=0.003), regardless of CRT response. Significant reduction of PVCs and NSVT rate (p=0.012 &amp; p=0.024) was found in the responder group of patients. Regarding AF, our results showed a decrease in the number of AF events in both patient groups, however this was most visible in the responder patients with paroxysmal AF (p=0.057). In CRT responders, left ventricular pacing lead was most commonly located in a lateral branch vein of the CS with middle and mid/lateral position. In terms of quality of life and general condition of the patients, we noticed a significant improvement in the NYHA - functional class (p &amp;lt;0.001), as well as in both parts of the quality-of-life assessment questionnaire (p=0.0135, p&amp;lt;0.001). Conclusion CRT is an effective treatment for atrial and ventricular arrhythmias in HF patients, especially in responders to this therapy. LV epicardial lead position proved to be very important influence in the process of LV reverse remodeling, which is in direct correlation of the CRT responders and its effectiveness in reducing the rate of cardiac arrhythmias.

Cardiac Hypertrophy in Neonates Born to Diabetic Mothers at Farhat Hached of Sousse University Hospital

<i>Introduction:</i> The association between cardiac hypertrophy and hyperinsulinism is mainly observed in the newborn, although the onset in older infants has also been described. The aim of our study is to research a cardiac hypertrophy in newborns of diabetic mothers. <i>Methodology</i>: This was a cross-sectional study, involving one hundred and twenty (120) newborns of diabetic mothers from August 1^stto November 30, 2020. These newborns of diabetic mothers had received an echocardiographic examination at the laboratory of the FARHAT HACHED University Hospital in Sousse (Tunisia) regardless of the associated cardiac or extracardiac pathology, during the study period, to detect cardiac hypertrophy. <i>Results:</i> The sex ratio was in favor of the female gender at 0.90. The average weight was 3554.04 g, with extremes ranging from 1,600 g to 5,200 g. Twelve (12) newborns had a weight greater than or equal to 4,000 g (10.00% of macrosomes). Among mothers, there were 03 types of diabetes: type 1 diabetes (2.65%), type 2 diabetes (0.88%) and gestational diabetes (96.46%). Echocardiography was normal in 91 neonates (75.83%) and abnormal in 29 neonates (24.17%). The prevalence of cardiac hypertrophy was 09.17% and that of other associated cardiac abnormalities was 21.66%. There were 11 cases of patent foramen ovale, 11 cases of patent ductus arteriosus, 02 cases of ostium secundum atrial septal defect, 01 case of interrupted aortic arch, 01 case of pulmonary stenosis. These abnormalities were associated on the one hand with the septal hypertrophy and on the other hand, associated with each other in the same newborn. Left ventricular ejection function was normal in all neonates with an average of 66% and extremes between 59% and 76%. <i>Conclusion:</i> Cardiac hypertrophy described in the newborn of diabetic mother is characterized by hypertrophy of the ventricular walls more often predominating over the septum. Transthoracic echocardiography is the reference (non-invasive) technique for diagnosing and monitoring these hypertrophies.

Safety and efficacy of intracoronary artery administration of human bone marrow-derived mesenchymal stem cells in STEMI of Lee-Sung pigs-A preclinical study for supporting the feasibility of the OmniMSC-AMI phase I clinical trial.

This study tested whether early left intracoronary arterial (LAD) administration of human bone marrow-derived mesenchymal stem cells (hBMMSCs, called OmniMSCs) in acute ST-segment elevation myocardial infarction (STEMI) of Lee-Sung pigs induced by 90 min balloon-occluded LAD was safe and effective. Young male Lee-Sung pigs were categorized into SC (sham-operated control, n = 3), AMI-B (STEMI + buffer/21 cc/administered at 90 min after STEMI, n = 6), and AMI-M [acute myocardial infarction (AMI) + hBMMSCs/1.5 × 107/administered at 90 min after STEMI, n = 6] groups. By 2 and 5 months after STEMI, the cardiac magnetic resonance imaging demonstrated that the muscle scar score (MSS) and abnormal cardiac muscle exercise score in the infarct region were significantly increased in the AMI-B than in the SC group that were significantly reversed in the AMI-M group, whereas the left ventricular ejection function by each month (from 1 to 5) displayed an opposite pattern of MSS among the groups (all p < 0.001). By 5 months, histopathological findings of infarct and fibrosis areas and isolectin-B4 exhibited an identical pattern, whereas the cellular expressions of troponin-I/troponin-T/von Willebrand factor exhibited an opposite pattern of MSS among the groups (all p < 0.001). The ST-segment resolution (>80%) was significantly earlier (estimated after 6-h AMI) in the AMI-M group than in the AMI-B group (p < 0.001). The protein expressions of inflammation (IL-1β/TNF-α/NF-κB)/oxidative stress (NOX-1/NOX-2/oxidized protein)/apoptosis (cleaved caspase-3/cleaved PARP)/DNA damage (γ-H2AX) displayed an identical pattern to MSS among the groups, whereas the protein expressions of angiogenesis factors (SDF-1α/VEGF) were significantly and progressively increased from SC, AMI-B, to AMI-M groups (all p < 0.001). Early intra-LAD transfusion of OmniMSC treatment effectively reduced the infarct size and preserved LV function in porcine STEMI.

Effectiveness and Safety of Mitral Valve Plasty in Patients with an Anomalous Origin of the Coronary Artery from the Pulmonary Artery

The study aimed to determine the effectiveness and safety of anomalous coronary artery from pulmonary artery (ACAPA) patients with moderate or severe mitral valve regurgitation (MVR) receiving mitral valve plasty (MVP) concurrently. Consecutive ACAPA patients undergoing surgery between 2015 and 2021 were retrospectively included. Patients were divided into three groups: moderate MVR without MVP (non-MVP (moderate) N = 14), moderate MVR with MVP (MVP (moderate) N = 13), and severe MVR with MVP (MVP (severe) N = 13). The primary safety endpoint was in-hospital surgery-related complications. The primary effectiveness outcome was left ventricular ejection function (LVEF) and left ventricular end-diastolic diameter (LVEDD) z-score at 2- and 24-month follow-ups. Multivariable linear regression models were used to obtain the β coefficient. The median age of the included patients was 7.5 years (IQR 1.4-26.5). The in-hospital surgery-related complication rates were 7.1%, 15.4%, and 7.7% in non-MVP (moderate), MVP (moderate), and MVP (severe) groups, separately. At the 2-month follow-up, the non-MVP (moderate) group had a better LVEF and LVEDD z-score compared with the MVP (moderate) group (LVEF β = 9.22, 95%CI 1.09 to 17.35; LVEDD z-score β = -2.49, 95%CI -4.53 to -0.45). At the 24-month follow-up, the LVEF of all patients and the LVEDD z-score of 90% of patients in the three groups returned to normal. For ACAPA patients with moderate MVR, MVP was not necessary, especially for pediatric patients (age < 3 years) and patients with secondary MVR. Further studies for ACAPA patients with severe MVR are still needed.

Epidemiological Aspects of Acute Coronary Syndromes in Saint-Louis, Senegal

Introduction: The prevalence of cardiovascular diseases has been rapidly increasing in developing countries, leading to an increasing incidence of acute coronary syndrome which is becoming a major health concern. Few studies have been conducted in hospital settings, which has led us to conduct this cross-sectional, descriptive study in Saint Louis in the north of Senegal, (250 km away from the capital) whose objective is to describe the epidemiological aspects of acute coronary syndrome (ACS) in hospital settings. Methodology: This is a cross-sectional descriptive and retrospective study lasting two years from January 1, 2018 to 31 December 2019 which included all patients hospitalized in the cardiology department of the regional hospital of salary for an ACS. Results: Out of 475 patients admitted to the department of cardiology, 47 presented with acute coronary syndrome which is a prevalence of 9.89%. The mean age was 63+/-13.14 years. There was a male predominance with a sex ratio of 1.5. The meantime between the beginnings of symptoms to hospitalization was 50 hours. The most frequent clinical presentation was acute coronary syndrome with ST segment elevation (STEMI: ST-segment Elevation Myocardial Infarction) in 39 patients. Hypertension was the most common cardiovascular risk factor in 23 patients and chest pain was the most common symptoms 72.3%. In STEMI patients, the ECG abnormalities were mainly in the anterior region and in NSTEMI (Non-ST-segment Elevation Myocardial Infarction) patients the ECG abnormalities were mainly in the inferior region. On echocardiography, 64% of patients had an altered left ventricular ejection function in STEMI patients whereas in NSTEMI patients, the left ventricular ejection function was preserved in 71% of cases. STEMI patients received within the first 12 hours represented 66% of our population of which 84% benefited from thrombolysis with streptokinase with a success rate of 52%. The mean time to thrombolysis was six hours. Six patients or 12.76% were sent for coronarography. The most common complication was cardiovascular collapse (11%), 15% of patients died. Conclusion: The prevalence of acute coronary syndrome is increasing in West Africa with a predominance of ST segment elevation acute coronary syndromes. The main issues encountered were long leading times between onset of symptoms and hospital admission along with limited availability of medical facilities.

Evaluation of cardiac function and 30-day clinical outcome with synchronized analysis of phonocardiogram and electrocardiogram in patients with acute myocardial infarction

Abstract Background Acute myocardial infarction (AMI) is associated with short-term and long-term mortality. Survivors of AMI suffer from cardiovascular events, among which heart failure (HF) is the most important factor affecting the prognosis. Echocardiography is a traditional method of measuring cardiac function, but it is inconvenient. Previous studies have identified the effectiveness of a new wearable coin-sized phonocardiogram (PCG) and electrocardiogram (ECG) device in HF patients. In our study, we apply this device in the hospitalization monitoring of post-AMI patients. Purpose The purpose of this study was to evaluate the role of the synchronized analysis of PCG and ECG in identifying cardiac functions in hospitalized AMI patients and to forecast adverse events for 30-days post-AMI in general clinical practice. Methods One hundred and sixty-three ST-elevated myocardial infarction (STEMI) patients and sixty-nine non-ST-elevated myocardial infarction (NSTEMI) patients were enrolled. All were admitted to the hospital and diagnosed with AMI. The left ventricular ejection function (LVEF) was determined by echocardiography and synchronized PCG and ECG signals were recorded using the wearable coin-sized PCG and ECG device on the first day of admission. PCG and ECG signals were analyzed to determine electromechanical activation time (EMAT), EMAT/RR (EMAT%), pre-ejection period/RR (PEP%), left ventricular systolic time/RR (LVST%), left ventricular ejection time/RR (LVET%). Primary endpoint was defined as the occurrence of major adverse cardiovascular events (MACE) following AMI in thirty days. Results ROC analysis demonstrated that the sensitivity and specificity of EMAT% &amp;gt;12.1% for the diagnosis of LVEF &amp;lt;50% were 81% and 82%, respectively. Overall, 232 patients were enrolled who were divided into four groups according to the classification of AMI and EMAT%. Patients in STEMI group with EMAT% &amp;gt;12.1% had a lower LVEF% (p&amp;lt;0.001), greater EMAT (p&amp;lt;0.001), PEP% (p&amp;lt;0.001), LVET% (p&amp;lt;0.001), LVST% (p=0.001), LVEDV (p&amp;lt;0.001) and LVESV (p&amp;lt;0.001). The same pattern was observed in NSTEMI patients between EMAT% &amp;gt;12.1% and EMAT≤12.1% group. Twenty-eight STEMI patients (17.28%) and seventeen NSTEMI patients (24.6%) developed a MACE event. Compared with EMAT≤12.1% group, EMAT% &amp;gt;12.1% group showed a higher occurrence of MACE, especially in post-STEMI patients (36.54% vs 8.11%, p&amp;lt;0.001). Conclusion PCG and ECG offer the possibility to assess the systolic parameters associated with left ventricular (LV) function and clinical status that differ between normal and heart failure states in acute AMI patients, with EMAT% &amp;gt;12.1% as a cut-off for deceased LV systolic function. Moreover, EMAT% &amp;gt;12.1% showed strong association with clinical outcome, suggesting EMAT% may be helpful to further improve the risk stratification of post-AMI patients, especially STEMI patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Shanghai Clinical Research Center for Interventional Medicine,Clinical Research Plan of SHDC

Association between subclinical left ventricular ejection fraction and platelet-to-lymphocyte ratio in patients with peritoneal dialysis.

Reduced left ventricular ejection function (LVEF) was associated with increased mortality in patients with peritoneal dialysis (PD) in Asia and the United States of America. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were correlated with LVEF in PD. However, little information is available regarding the relationship between monocyte-to-lymphocyte ratio (MLR), left ventricular ejection fraction (LVEF), and the use of NLR, PLR, and MLR in predicting left ventricular systolic dysfunction (LVSD) in patients with PD. All 181 patients with PD were enrolled between 2014 and 2021 from the Nephrology Department of the First Affiliated Hospital of the University of South China. Demographic features, clinical characteristics, laboratory values, and echocardiographic parameters were collected. The mean age of patients with PD was 47.4 ± 12.6, and 90 (49.7%) of the patients were men. LVEF showed a negative correlation with PLR (r = -0.200, p = 0.007) and MLR (r = -0.146, p = 0.049). The levels of NLR, PLR, and MLR were elevated in patients with PD with LVSD compared with those without (all p < 0.05). PLR (OR 4.331, 95% CI: 1.223, 15.342) and albumin (OR 13.346, 95% CI: 3.928, 45.346) were significantly associated with LVSD patients with PD in the multivariate logistic analysis. For differentiating patients with PD with LVSD, optimal cutoffs of NLR, PLR, MLR, and albumin were 4.5 (sensitivity: 76.7%, specificity: 55.0%, and overall accuracy: 58%), 202.6 (sensitivity: 66.7%, specificity: 69.5%, and overall accuracy: 69%), 0.483 (sensitivity: 53.3%, specificity: 72.8%, and overall accuracy: 30%), and 34.6 (sensitivity: 72.2%), respectively. Our results revealed that PLR was better than NLR, MLR, and albumin in predicting LVSD in PD.

Prognostic value of echocardiographic evaluation of cardiac mechanics in patients with aortic stenosis and preserved left ventricular ejection fraction.

Left ventricular ejection function (LVEF) is not reliable in identifying subtle systolic dysfunction. Speckle Tracking (ST) plays a promising role and hemodynamic forces (HDFs) are emerging as marker of LV function. The role of LV myocardial deformation and HDFs was investigated in a cohort of patients with aortic stenosis (AS) and normal LVEF. Two hundred fifty three patients (median age 79 years, IQR 73 - 83 years) with mild (n = 87), moderate (n =77) and severe AS (n =89) were retrospectively enrolled. 2D echocardiographic global longitudinal strain (GLS), circumferential strain (GCS) and HDFs were determined. The worsening of AS was associated with raising inappropriate LV mass (p < 0.001) and declined LVEF, despite being in the normal range (p < 0.001). ST and HDFs parameters declined as the AS became severe (p<0.0001, for all). When patients were grouped based on the median of LV endocardial GLS value (> -19,9%) and LV systolic longitudinal force (LVsysLF) value (< 12,49), patients with impaired ST and lower HDFs components had increased incidence of aortic valve replacement (AVR) and worse survival (p <0.024 and p <0.037, respectively). Among ST and HDFs parameters, only LVsysLF was independently associated with AVR and all causes mortality on multivariable Cox regression analysis (HR 0.94; 95% CI 0.89-0.99; p= 0.012). Reduced values of LVsysLF were associated with AVR and reduced survival in AS patients. LVsysLF could provide useful information in the stratification of patients with AS and possibly in the choice of timing for AVR.

Evaluation of cardiac function and 30-day clinical outcome with synchronized analysis of phonocardiogram and electrocardiogram in patients with acute myocardial infarction

Abstract Background Acute myocardial infarction (AMI) is associated with short-term and long-term mortality. Survivors of AMI suffer from cardiovascular events, among which heart failure (HF) is the most important factor affecting the prognosis. Echocardiography is a traditional method of measuring cardiac function, but it is inconvenient. Previous studies have identified the effectiveness of a new wearable coin-sized phonocardiogram (PCG) and electrocardiogram (ECG) device in HF patients. In our study, we apply this device in the hospitalization monitoring of post-AMI patients. Purpose The purpose of this study was to evaluate the role of the synchronized analysis of PCG and ECG in identifying cardiac functions in hospitalized AMI patients and to forecast adverse events for 30-days post-AMI in general clinical practice. Methods One hundred and sixty-three ST-elevated myocardial infarction (STEMI) patients and sixty-nine non-ST-elevated myocardial infarction (NSTEMI) patients were enrolled. All were admitted to the hospital and diagnosed with AMI. The left ventricular ejection function (LVEF) was determined by echocardiography and synchronized PCG and ECG signals were recorded using the wearable coin-sized PCG and ECG device on the first day of admission. PCG and ECG signals were analyzed to determine electromechanical activation time (EMAT), EMAT/RR (EMAT%), pre-ejection period/RR (PEP%), left ventricular systolic time/RR (LVST%), left ventricular ejection time/RR (LVET%). Primary endpoint was defined as the occurrence of major adverse cardiovascular events (MACE) following AMI in thirty days. Results ROC analysis demonstrated that the sensitivity and specificity of EMAT% &amp;gt;12.1% for the diagnosis of LVEF &amp;lt;50% were 81% and 82%, respectively. Overall, 232 patients were enrolled who were divided into four groups according to the classification of AMI and EMAT%. Patients in STEMI group with EMAT% &amp;gt;12.1% had a lower LVEF% (p&amp;lt;0.001), greater EMAT (p&amp;lt;0.001), PEP% (p&amp;lt;0.001), LVET% (p&amp;lt;0.001), LVST% (p=0.001), LVEDV (p&amp;lt;0.001) and LVESV (p&amp;lt;0.001). The same pattern was observed in NSTEMI patients between EMAT% &amp;gt;12.1% and EMAT≤12.1% group. Twenty-eight STEMI patients (17.28%) and seventeen NSTEMI patients (24.6%) developed a MACE event. Compared with EMAT≤12.1% group, EMAT% &amp;gt;12.1% group showed a higher occurrence of MACE, especially in post-STEMI patients (36.54% vs 8.11%, p&amp;lt;0.001). Conclusion PCG and ECG offer the possibility to assess the systolic parameters associated with left ventricular (LV) function and clinical status that differ between normal and heart failure states in acute AMI patients, with EMAT% &amp;gt;12.1% as a cut-off for deceased LV systolic function. Moreover, EMAT% &amp;gt;12.1% showed strong association with clinical outcome, suggesting EMAT% may be helpful to further improve the risk stratification of post-AMI patients, especially STEMI patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Shanghai Clinical Research Center for Interventional Medicine,Clinical Research Plan of SHDC

Correlation between catecholamines and echocardiographic parameters in patients with pheochromocytoma and paraganglioma.

To analyze the correlation between catecholamines and echocardiographic parameters in patients with pheochromocytoma and paraganglioma (PPGL). Sixty-six patients who underwent surgical resection of pathologically proven PPGL from January 2016 to June 2019 were examined. Echocardiographic parameters were compared between patients with elevated catecholamine concentrations and those with normal concentrations. The percentage of patients with elevation of any catecholamine (NE, DA, or E, and their metabolites) did not significantly differ between patients with normal and abnormal left ventricular ejection function (LVEF) or diastolic function (LVDF). E wave deceleration time (EDT) was significantly lower in patients with elevation of any catecholamine than in those with normal concentrations (p=0.024). EDT was significantly lower in patients with elevated NE and its metabolites than in patients with normal NE concentration (p=0.004). After adjusting for gender and age, EDT was significantly negatively correlated with elevated NE and its metabolites in regression analysis (B-value, -39.853; p=0.023) and correlation analysis (r=-0.349; p=0.004). NE and its metabolites may have an impact on left ventricular diastolic function, which can be reflected by EDT. EDT was negatively correlated with elevated NE and its metabolites.

Combined cardiac surgery in a Marfan syndrome patient with severe scoliosis via lower hemisternotomy: a case report

BackgroundScoliosis is one of the symptoms manifested by patients with Marfan syndrome (MFS). Deformity of the thoracic cavity due to severe scoliosis may cause difficulty during cardiac surgery in terms of the surgical approach and instrument manipulation; however, only a few reports have been available regarding the surgical case of MFS with severe scoliosis. Here, we report a case of combined aortic valve replacement and left atrial appendage closure in a patient with MFS who had severe scoliosis using lower hemisternotomy.Case presentationA 62-year-old female with MFS was referred to our hospital after being diagnosed with severe aortic regurgitation and paroxysmal atrial fibrillation with a history of cerebral thromboembolism. The aortic valve showed severe insufficiency due to cusp prolapse, whereas the aortic root was moderately dilated (42 mm). Echocardiography revealed severe regurgitation with reduced left ventricular ejection function (32%) and massive left ventricular diastolic dimension (88 mm). Moreover, combined aortic valve replacement and left atrial appendage closure was indicated. However, the patient had chest deformity due to severe scoliosis. Thus, conventional full sternotomy or thoracotomy was considered an inappropriate surgical approach. Lower hemisternotomy was selected on the basis of three-dimensional reconstruction imaging of the aorta, left atrial appendage, sternum, and rib. Sternal elevation and rib retraction with the costal arch folded back provided enough surgical field for the combined procedures to be safely conducted. The postoperative course was uneventful, except for predicted prolonged mechanical ventilation with the assistance of intraaortic balloon pumping. Thereafter, the patient has been free from any cardiac and cerebrovascular event.ConclusionsLower hemisternotomy can be useful for combined cardiac surgery in MFS with severe scoliosis.

Clinical Course and Outcomes in Patients with Left Ventricular Dysfunction Due to Myocardial Infarction After Kawasaki Disease.

Long-term outcomes of patients with left ventricular dysfunction after Kawasaki disease (KD) remain unknown. The clinical course of 37 patients (29 males 8 females) with left ventricular ejection function (LVEF) less than 45% after KD since 1978 was retrospectively investigated. Cardiac events in this study were defined as admissions because of heart failure, fatal ventricular arrhythmias, heart transplantation, and death. Their ages when evaluated ranged from 1 to 70years (median 35years). The onset of KD ranged from 2months to 20years (median 21months). All patients had bilateral coronary artery lesions, and multi-vessel occlusion occurred in 31 patients (84%). Previous myocardial infarction (MI) was found in 28 patients (76%). The interval from the onset of acute KD to the initial MI ranged from 15days to 25years (median 3months). Reperfusion therapy was successful in 6 patients (30%), and coronary artery bypass grafting was performed in 23 patients (62%). Non-sustained ventricular tachycardia and fatal ventricular arrhythmias were detected in 11 patients and 22 patients, respectively. There were 15 deaths (41%). The 20-year and 50-year survival rates after KD were 84% (95% CI 67-92) and 54% (34-73), respectively (n = 37). The 30-year cardiac event-free rate after the detection of low LVEF was 42% (95% CI 27-59). The cutoff point of the left ventricular end-diastolic dimension for cardiac events was 65mm. Patients with low LVEF had fatal ventricular arrhythmias and a worsening of their ischemic cardiomyopathy after 30years of age and their outcomes were poor.

Early recruitable coronary collaterals preserve miocardial viability in late presentation infarctions.

Previous studies showed conflicting results regarding the contribution of coronary collateral circulation (CCC) to myocardial perfusion and function in the setting of myocardial infarction (MI). In the primary angioplasty era, the role of CCC in these studies may have been influenced by the effect of early reperfusion. The true impact of CCC could be clarified by studying its effect on nonreperfused patients. The aim of our study was to evaluate the effect of CCC on myocardial viability of late presentation MI. Between 2008 and 2019, we included 167 patients with a late presentation MI who had a complete angiographic occlusion in a major coronary artery in which myocardial viability of the culprit territory was assessed. Patients were divided according to the presence of angiographic early recruited CCC (ERCC) (Rentrop 2-3) or poor CCC (PCC) (Rentrop 0-1). A lower left ventricular ejection function (LVEF) at discharge (54.2 ± 9 vs. 47.9 ± 12; <0.01) and a more severe left ventricular wall motion abnormalities in the culprit territory were observed in PCC patients. The presence of ERCC was the main independent predictor of myocardial viability in late presentation MI (hazard ratio, 4.24; 95% confidence interval, 1.68-10.6; P < 0.001). At follow-up, wall motion score increased significantly (2.05 ± 0.16; P = 0.02) in patients with ERCC but not in PCC patients (0.07 ± 0.16; P = 0.4), and LVEF improvement was significantly higher in ERCC than in PCC patients (9.7 ± 2.6 vs. 3.8 ± 4.2; P = 0.02). The presence of ERCC was the main independent predictor of myocardial viability in late presentation MI.

The comparative effects of sacubitril/valsartan versusenalapril on pulmonary hypertension due to heart failure with a reduced ejection fraction.

The purpose of this study was to investigate the effects of sacubitril/valsartan on right ventricular (RV) function in patients with pulmonary hypertension (PH) due to heart failure with reduced ejection fraction (HFrEF). We prospectively enrolled patients with HFrEF‐induced PH admitted to the Department of Cardiology between August 2018 and December 2019. Patients were randomized to receive oral treatment with sacubitril/valsartan or enalapril. Epidemiological data were recorded before treatment. Echocardiography was performed at admission and 6 months of follow‐up, and all parameters were compared. Major adverse cardiac events (MACEs) were compared between baseline and 6 months follow‐up. There were no significant differences in the baseline characteristics between the two groups. After 6 months of treatment, both treatment groups improved the following parameters from baseline (mean ± SD): left atrium, left ventricle, the left ventricular ejection function (LVEF), RV systolic function (the tricuspid annular plane systolic excursion [TAPSE], the systolic pulmonary artery pressure [sPAP], and TAPSE/sPAP). After 6 months, sacubitril/valsartan improved significantly the following parameters compared with enalapril (all p < 0.05): LVEF (47.07 ± 6.93% vs. 43.47 ± 7.95%); TAPSE (15.33 ± 1.31 vs. 14.78 ± 1.36 mm); sPAP (36.76 ± 14.32 vs. 42.26 ± 12.07 mmHg); and TAPSE/sPAP ratio (0.50 ± 0.23 vs. 0.39 ± 0.14), respectively. There was no difference in readmissions due to recurrent heart failure. Sacubitril/valsartan seems to provide more beneficial effects among patients with HFrEF‐induced PH to improve RV function, along with a decrease in pulmonary pressure.