Left Ventricular End-diastolic Volume Research Articles

Effect of sacubitril–valsartan on left ventricular remodeling in patients with acute myocardial infarction after primary percutaneous coronary intervention: a systematic review and meta-analysis

BackgroundSacubitril–valsartan has been widely reported for reducing the risk of cardiovascular death and improving left ventricular remodeling in patients with heart failure (HF). However, the effect of sacubitril–valsartan in patients with acute myocardial infarction (AMI) remains controversial. Therefore, we conducted this meta-analysis to investigate whether sacubitril–valsartan could reverse left ventricular remodeling and reduce cardiovascular adverse events in AMI patients after primary percutaneous coronary intervention (PPCI).Materials and methodsTwo researchers independently retrieved the relevant literature from PubMed, Embase, The Cochrane Library, China National Knowledge Infrastructure (CNKI), and the Wanfang database. The retrieval time was limited from inception to 1 June 2023. Randomized controlled trials (RCTs) meeting the inclusion criteria were included and analyzed.ResultsIn total, 21 RCTs involving 2442 AMI patients who underwent PPCI for revascularization were included in this meta-analysis. The meta-analysis showed that compared with the angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), sacubitril–valsartan treatment in AMI patients after PPCI significantly reduced left ventricular end-diastolic dimension (LVEDD) (weighted mean difference (WMD) −3.11, 95%CI: −4.05∼−2.16, p < 0.001), left ventricular end-diastolic volume (LVEDV) (WMD −7.76, 95%CI: −12.24∼−3.27, p = 0.001), left ventricular end-systolic volume (LVESV) (WMD −6.80, 95%CI: −9.45∼−4.15, p < 0.001) and left ventricular end-systolic dimension (LVESD) (WMD −2.53, 95%CI: −5.30–0.24, p < 0.001). Subgroup analysis according to the dose of sacubitril–valsartan yielded a similar result. Meanwhile, PPCI patients using sacubitril–valsartan therapy showed lower risk of major adverse cardiac events (MACE) (OR = 0.36, 95%CI: 0.28–0.46, p < 0.001), myocardial reinfarction (OR = 0.54, 95%CI: 0.30–0.98, p = 0.041) and HF (OR = 0.35, 95%CI: 0.26–0.47, p < 0.001) without increasing the risk of renal insufficiency, hyperkalemia, or symptomatic hypotension. At the same time, the change of LV ejection fraction (LVEF) (WMD 3.91, 95%CI: 3.41–4.41, p < 0.001), 6 min walk test (6MWT) (WMD 43.56, 95%CI: 29.37–57.76, p < 0.001) and NT-proBNP level (WMD −130.27, 95%CI: −159.14∼−101.40, p < 0.001) were statistically significant.ConclusionIn conclusion, our meta-analysis indicates that compared with ACEI/ARB, sacubitril–valsartan may be superior to reverse left ventricular remodeling, improve cardiac function, and effectively reduce the risk of MACE, myocardial reinfarction, and HF in AMI patients after PPCI during follow-up without increasing the risk of adverse reactions including renal insufficiency, hyperkalemia, and symptomatic hypotension.

Exploring the impact of recent COVID-19 infection on perfusion and functional parameters derived from gated myocardial perfusion imaging in patients undergoing evaluation for coronary artery disease.

This study seeks to evaluate how recent COVID-19 infection affects myocardial perfusion and functional parameters derived from gated myocardial perfusion imaging in patients undergoing evaluation for coronary artery disease. The goal is to enhance our understanding of COVID-19's influence on the cardiovascular system. Conducted at Farshchian Heart Hospital from 2022 to 2023, this case-control study enrolled patients suspected of coronary artery disease, stratified into two groups: those with confirmed COVID-19 infection within the past 6months (study group) and those without prior COVID-19 infection (control group). Employing a 2-day protocol, stress testing and gated SPECT MPI were performed. Statistical analysis included descriptive statistics, Chi-square test, Student's t test, and Mann-Whitney U test. Among the 86 patients included, 43 were in each group. Significantly higher summed stress core and summed difference score values were observed in the study group compared to the control group (p < 0.05). In addition, the study group exhibited significantly altered global left ventricular ejection fraction, end-diastolic volume, and end-systolic volume (p < 0.05). Non-perfusion findings, including transient ischemic dilation and transient right ventricular visualization, were more prevalent in the study group. Recent COVID-19 infection is associated with impaired myocardial perfusion and altered functional parameters as detected by MPI. These findings underscore the intricate interplay between COVID-19 and cardiovascular health, emphasizing the importance of comprehensive evaluation and management strategies to address cardiac complications in affected individuals. Further research is warranted to elucidate the underlying mechanisms and optimize patient care in the context of COVID-19-associated cardiovascular manifestations.

Predicting adverse cardiac remodeling following ST-elevation myocardial infarction through the assessment of endothelin-1 levels

Abstract Adverse cardiac remodeling refers to a complex set of molecular, cellular, and interstitial changes. Cardiac remodeling is linked to an unfavorable prognosis due to its correlation with ventricular dysfunction and the occurrence of malignant arrhythmias. Endothelin-1 is a powerful vasoconstrictor that acts at the level of smooth muscle cells of the vascular wall. In patients with ST-elevation acute myocardial infarction (STEMI), increased circulating endothelin-1 is associated with left ventricular systolic dysfunction and major complication during the in-patient period. The purpose of the study is to evaluate the role of Endothelin-1 as a possible predictor of pathological remodeling six months after STEMI event. Materials and methods 162 patients with STEMI were initially enrolled into the study according to inclusion criteria (percutaneous coronary intervention performed first 12 hours after the event, age of participants 18 years and above). Blood samples for biomarker analysis were collected at admission (endothelin-1, cardiac troponin I). At the end of six months, patients came to the site for a routine check-up including echocardiography with strain. One year after the event, the patients were contacted to collect information about a primary composite endpoint. The primary endpoint was a combination of all-cause death, new incident of myocardial infarction, ischemic stroke or transient ischemic attack, heart failure decompensation with or without hospitalization, hospitalization due to any cardiovascular disease deterioration. All these were defined as a single study outcome. Secondary outcomes, measured as the change from baseline to 6 months in left ventricle (LV) end-diastolic volume &amp;gt;10% and / or LV end-systolic volume &amp;gt;10%. 9% of study subjects reached the primary study outcome. Results the study cohort was stratified into two groups: those with high and low endothelin levels, determined by the median of 2.75 pg/ml. In the group of endothelin above 2.75 pg/ml, a statistically significant increase in end-diastolic volume of the LV (p = 0.002), end-diastolic dimension (p = 0.015), left atrium size (p = 0.008), and indicators of diastolic dysfunction (p =0.024) and LV myocardial mass (p=0.015) 6 months after the event. The ROC analysis revealed that endothelin has prognostic potential for LV remodeling. The cut-off was less than 2,97 pg/ml (sensitivity - 83%, specificity - 62%, area under curve (AUC) 0,70, 95% confident interval (CI) 0,516 – 0,847, p=0,03). Logistic regression analysis was employed to assess the potential of the Endothelin-1 biomarker as a predictor for LV remodeling. Endothelin showed properties of predicting adverse cardiac remodeling (CI 95% 0.696 - 0.956, AUC - 0.861, χ2=9.03 p=0.43). Conclusion measuring the Endothelin-1 level can enable the implementation of appropriate medical interventions in STEMI patients with an unfavorable cardiac remodeling prognosis, helping to prevent the development of heart failure.

#1440 Analysis of risk factors for the development of coronary events in patients with chronic kidney disease stage 5

Abstract Background and Aims To analyze the number and presence of certain risk factors for the development of coronary events in patients with chronic kidney disease receiving program hemodialysis. Method To achieve this goal, we first conducted an information search in electronic databases of articles: in English - in PubMed, the search depth was from 2010 to 2020, after which we selected the most common risk factors for the development of coronary events in the conditions of Uzbekistan (Table 1). The study and recruitment of patients took place in the department of nephrology and hemodialysis of the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation in 2023. The study involved 73 (42.95%) men and 97 (57.05%) women; the average age of the patients was 54.00 ± 13.72 years. The main causes of chronic renal failure in the structure of the overall morbidity of the prospective study were: diabetic nephropathy - 41% (69), chronic glomerulonephritis - 40% (68), chronic pyelonephritis - 12.9% (22). Results All 170 patients were assessed for risk factors for the development of coronary events according to Table 1. Based on the current literature, we selected 30 risk factors for the development of coronary events. The most common risk factors for the development of coronary events were, that is, 2/3: albumin, body mass index, calcium, cardiovascular diseases, clinical and ambulatory blood pressure, chronic heart failure, diastolic blood pressure, hemoglobin, left ventricular hypertrophy, mean arterial pressure, systolic blood pressure, diuretic (urea), years with hypertension. The least significant risk factors for the development of coronary events were, that is, 1/3: diabetes, diabetic nephropathy, dyslipidemia, coronary heart disease, left ventricular end-diastolic volume, metabolic syndrome, parathyroid hormone, peripheral vascular disease, phosphorus, potassium, pulse pressure, sodium (in plasma), sodium-potassium ratio, smoking, total cholesterol. Conclusion In 2/3 of the studied patients of the main group, the presence of 15 risk factors for the development of coronary events was noted, in 1/3 of the patients, 21 risk factors for the development of coronary events were identified. The above risk factors together increase the incidence of coronary events in patients with stage 5 CKD several times. Coronary events are the leading causes of death in all groups. The most common were: acute left ventricular failure and sudden cardiac death. And predictors of the risk factor for death for coronary events include: blood albumin levels, BMI, blood hemoglobin, LVH, SBP, DAS, CHF, blood calcium, years since hypertension.

Left and right atrioventricular coupling index in patients with beta-thalassemia major.

The aim of this cross-sectional study was to investigate the relationship of left atrioventricular coupling index (LACI) and right atrioventricular coupling index (RACI) with demographics, clinical data, cardiovascular magnetic resonance findings, and cardiac complications (heart failure, arrhythmias, and pulmonary hypertension) in a cohort of patients with beta-thalassemia major (β-TM). We evaluated 292 β-TM patients (151 females, 36.72 ± 11.76years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project. Moreover, we assessed 32 sex- and age-matched healthy controls (12 females, mean age 40.78 ± 14.35years). LACI was determined by calculating the ratio of the left atrium end-diastolic volume to the left ventricle end-diastolic volume, while RACI was defined by calculating the ratio of the right atrium end-diastolic volume to the right ventricle end-diastolic volume. Compared to healthy control, β-TM demonstrated increased LACI (22.99 ± 13.58% vs. 16.05 ± 5.28%; p < 0.0001) and RACI (27.84 ± 10.30% vs. 17.06 ± 5.03%; p < 0.0001). Aging, diabetes, splenectomy, and the presence of late gadolinium enhancement (LGE) showed a significant positive association with both LACI and RACI. In stepwise regression analysis, the presence of LGE was found to be an independent predictor of both impaired LACI and RACI (β coefficient = 0.244, p < 0.0001 and β coefficient = 0.218, p = 0.003; respectively). LACI and RACI were not correlated with myocardial iron overload. Patients with cardiac complications had significantly higher LACI and RACI than patients without cardiac complications. In patients with β-TM, LACI and RACI were significantly associated with the presence of LV LGE. In addition, patients with cardiac complications had impaired LACI and RACI.

DILATED CARDIOMYOPATHY, GUIDELINES PERSONALIZATION OF CARE

Abstract The term Dilated cardiomyopathy (CMD) refers to a family of diseases characterized by complex interactions between environment and genetic predisposition. Diagnostic tools as cardiac magnetic resonance imaging (MRI) must be systematically implemented in clinical practice to define the etiological cause and undertake a specific therapeutic treatment. We present the case of a young man with CMD and severe left ventricular dysfunction (ejection fraction, EF: 14%; left ventricular end–diastolic volume (LVEDV): 251 ml/m2; left ventricular end–systolic volume (LVESV): 197 ml/m2. The patient has a family history of sudden cardiac death (SCD). He is affected by a psychiatric pathology (ADHD) and has a history of alcohol and drug addiction. Many diagnostic hypotheses have been considered for etiological research (viral myocarditis, genetic or alcoholic–induced cardiomyopathy, toxic substances such as narcotics and psychiatric drug–induced cardiomyopathy). MRI after 11 days in hospital confirmed FE 14%, LVEDV: 320 ml/m2, LVESV: 275 ml/m2; reduction of the wall thickness at the antero–septal wall to the middle tract; areas of altered signal, hyperintense in T2W sequences, at the left ventricular myocardial wall suspected of myocardial edema, associated with extended signal hyperintensity of periventricular tissue, which show marked enhancement immediately after intravenous contrast agent administration (Fig. 1). The underlying psychiatric pathology and the possibility of poor adherence to the maintenance of the wearable defibrillator did not facilitate the clinical follow–up which should have included the identification of the etiological cause and the appropriate treatment guaranteeing the temporary prevention of SCD. So, it was decided to make a personalized therapeutic choice, the patient underwent implantation of a subcutaneous defibrillator, pending a better diagnostic definition and the possible need of other therapies as cardiac transplantation/implantation of mechanical assistance device.

THE EFFICACY OF VERY LOW CALORIE KETOGENIC DIET (VLCKD) ON CARDIO–METABOLIC PROFILE IN PATIENTS WITH OBESITY

Abstract Background Obesity is associated with alterations in cardiac structure and haemodynamics leading to cardiovascular mortality and morbidity. Very low calorie ketogenic diet (VLCKD) has been proposed as an effective intervention to achieve a significant weight loss in obese patients in a short time period. Furthermore, hyperketonemia induced by VLCKD is associated with beneficial cardiovascular effects. In addition, ketogenic diet is able to prevent mitochondrial fission, improve mitochondrial function, suppress oxidative stress and attenuate cardiac myocytes apoptosis in the heart of mice. Aim To evaluate the role of VLCKD on cardio–metabolic risk factors, cardiac dysfunction and myocardial remodelling in obese patients. Materials and Methods Ten obese patients treated with VLCKD were enrolled. All patients were characterized from an anthropometric, cardio–metabolic and echocardiographic point of view at baseline and 8 weeks after VLCKD treatment. In addition, each patient underwent measurement of global myocardial work efficiency (GWE), a novel indicator that accounts for deformation and afterload, which may provide additional value for assessment of myocardial function. The insulin resistance (IR) was evaluated by HOMA–IR. Results As expected, all the patients showed a significant reduction in body weight and an overall improvement of body composition parameters after VLCKD. Weight (kg) (from 105.1 ± 18.2 to 83.7 ± 16.7, P &amp;lt;0.05), BMI (kg/m2) (from 40.1 ± 4.7 to 31.8 ± 4.8, P= 0.002) and waist circumference (cm) (from 115 ± 13.6 to 101.8 ± 12.4, p &amp;lt; 0.05) were significantly lower after VLCKD treatment. VLCKD treatment improved also significantly fasting glucose levels (P &amp;lt;0.05), fasting insulin levels (P =0.004), HOMA–IR values (P &amp;lt;0.001), lipid profile and systolic and diastolic blood pressure levels. In addition, the echocardiogram evaluation showed an improved in end–diastolic left ventricular volume, end–systolic left ventricular volume, left ventricular mass and left ventricular mass index. Interestingly, a significantly changes in GWE was observed (P&amp;lt;0.05). Conclusion Although preliminary, our data suggest that VLCKD treatment is able to reduce cardio–metabolic risk factors and to improve cardiac dysfunction and myocardial function.

NOVEL INTEGRATED IMAGING PARAMETERS FOR RISK STRATIFICATION OF ATRIAL FIBRILLATION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY

Abstract Background Atrial fibrillation (AF) impacts prognosis of hypertrophic cardiomyopathy (HCM) by promoting progressive heart failure (HF) and increasing risk of stroke. Over the past years, several indexes and methods to predict AF among HCM patients have been proposed. However, they are limited by a lack of accuracy. Aims of our study was to evaluate the role of new echocardiographic parameters in predicting new onset of AF and to validate them by cardiac magnetic resonance (CMR). Methods and Results We analyzed clinical and imaging data of 141 HCM patients in sinus rhythm who underwent first evaluation at our center (51.2 ± 17.3 years, mean follow up 5.3 ± 3 years). Main parameters analyzed were left atrium (LA) end–diastolic volume (LAV min), end–systolic volume (LAVmax), LA ejection fraction (LAEF), left atrioventricular coupling index (LACI), and LA diameter (LAD). LACI was defined by the LAVmin divided by the LV end–diastolic volume (LVEDV); this parameter was assessed in previous studies as a good detector of early atrial remodeling and impaired LV compliance. 35 patients developed new–onset AF (after a mean period of 4 ± 3.2 years). At the baseline evaluation, LACI, LAD, and LAVmin showed to be significantly greater in patients who developed AF compared to patients who did not. At CMR, LACI &amp;gt;44% accurately predicted new–onset AF (sensitivity 85%, specificity 70%; AUC 0.81). LACI by ETT showed similar accuracy (AUC 0.75) and was superior to that shown by LAD (AUC 0.71) (Figure 1). Patients who did not develop AF had significantly higher LAEF at ETT (49.3 ± 11% vs 37 ± 9.6%; p &amp;lt; 0.0001). CMR analysis confirmed this result. LAEF &amp;gt;43% was a good predictor of AF free survival (log rank&amp;lt;0.001). Conversely, at a multivariate analysis, LAFE &amp;lt;43% by ETT was independently associated with AF occurrence (OR 4.5, 95% CI 1.4–13.7) (Figure 2). 11 patients experienced death or heart transplant (HTx). Higher values of LACI and LAVmin and lower values of LAEF were found to be associated the composite outcome of death or HTx. LACI&amp;gt;60% predicted the composite of death or HTx with good accuracy (AUC 0.74) (Figure 3). Conclusions LACI and LAEF showed to improve accuracy in predicting the new onset of AF in HCM patients without severe LA dilatation (LAD&amp;gt;45mm). Higher LACI and Lower LAEF (namely &amp;lt;43%) identify patients at higher risk of new onset AF, and, therefore, worthy of a more strict follow–up.

EFFECTS OF VERY LOW CALORIE KETOGENIC DIET VS SLEEVE GASTRECTOMY ON CARDIO–METABOLIC PROFILE IN PATIENTS WITH OBESITY

Abstract Background Obesity is a complex, multifactorial disease with deleterious effects on cardiac function. Currently, the obesity treatment is one of the most difficult challenges. Very low calorie ketogenic diet (VLCKD) has been proposed as an effective intervention for obesity. Furthermore, hyperketonemia induced by VLCKD is associated with beneficial cardiovascular effects. On the other hand, sleeve gastrectomy (SG) has been proven to be the most effective long–term weight management treatment. However, to date, it is still unclear whether the positive effects of SG on cardiovascular disease are mediated only by weight loss. Aim To evaluate the changes in anthropometric and metabolic parameters and in cardiac structure and function after treatment with SG or VLCKD. The results obtained in the two groups have been compared to verify if, in the short time, there were differences between these two treatments. Methods Twenty obese patients were enrolled. All the patients underwent a complete anthropometrical evaluation, laboratory determinations and echocardiogram evaluation. Ten patients have been treated with SG and 10 with VLCKD. The two group were comparable for weight loss: –26 kg (28%) after 3 months in patients treated with VLCKD and –25 kg (27.5%) after 6 months in patients treated with SG. Results An improvement in the anthropometric and metabolic profile was observed in all the patients. There were significant improvements in cardiovascular risk factors, including total cholesterol levels, triglyceridis, fasting glycemia, systolic and diastolic blood pressure, serum uric acid and HOMA–IR values. Similarly, the echocardiogram evaluation showed, in both groups of treatment, a reduction of the end–diastolic left ventricular volume, a reduction of the end–systolic left ventricular volume and a reduction of interventricular septal thickness and posterior wall thickness. Furthermore, an increase in the Ejection Fraction has been observed. No significantly differences between two groups were observed. Interestingly, in patients in treatment with VLCKD, a significant change in the global myocardial work efficiency (GWE) was observed. Conclusion Our data showed that VLCKD and SG have the potential to protect cardiometabolic health and myocardial remodeling in obese patients. VLCKD is a promising lifestyle intervention that can be used to prevent or treat cardiovascular disease. However, its effectiveness in the medium to long term must be evaluated.

HAEMODYNAMIC FORCES ANALYSIS IN PATIENTS WITH PARAVALVULAR REGURGITATION AFTER TAVR: A PROPENSITY–SCORE MATCHED RETROSPECTIVE STUDY

Abstract Background Paravalvular regurgitation (PVR) after TAVR is a frequent complication, but its direct quantification and grading with conventional echocardiography is still limited by several factors. LV remodeling has still a role in the evaluation of PVR and its pathophysiology. Hemodynamic forces (HDF) analysis has emerged as a new tool to evaluate LV cardiac function in addiction to ejection fraction (EF) and global longitudinal strain (GLS). Aim of the study: To evaluate the difference in pre– and post–TAVR HDF in patients with preserved EF, using a propensity–matched analysis comparing patients with more than mild PVR to patients with mild or no PVR. Medis Ultrasound Suite software has been used for the estimation of HDF in order to differentiate earlier LV function modification between the two groups and its relationship with clinical outcomes. Material and Methods 25 patients from two European high–volume centers with more than mild PVR and coupled pre– and post–TAVR echocardiographic evaluation available for HDF analysis were retrospectively included, paired 1:2 with 50 patients, matched for characteristics that may influence HDF analysis and with mild or none PVR. Clinical outcome was a composite of heart failure (HF) valve–related hospitalization and worsening HF at 1 year. Results No significative differences were found at baseline clinical and echocardiography evaluation between the two groups: median age was 83 years, mean LVEF was 61%. Post–procedural echocardiographic evaluation was performed at 34 days after TAVR (IQR 5 – 50). Patients with significant PVR had higher LV end–diastolic volume (p = 0.044), lower endocardial GLS (p = 0.07) and lower LV diastolic apex–base longitudinal forces (LVD Apex–Base) (p = 0.045). The difference between LVD Apex–base pre– and post–TAVR was significantly lower in the significant PVR group (–0.8 vs 0.3%, p = 0.021). At Cox regression analysis, LV longitudinal force (LVLF) Ratio turned out to be predictive of clinical outcome (HR 1.11, 95CI 1.02 – 1.20, p = 0.017) in the overall population. Conclusion HDF analysis seems to be superior to conventional echocardiographic values of left ventricular cardiac function to detect the early effects of LV volume overload in patients with significant PVR after TAVR. Furthermore, in the overall population, LVLF Ratio predicts clinical outcomes and could be a promising new index to better evaluate the development of heart failure in patients with AS undergoing TAVR.

Mechanical and electrical uncoupling: the role of cardiac magnetic resonance imaging in arrhythmogenic cardiomyopathy proof of concept

Abstract Funding Acknowledgements None. Introduction Arrhythmogenic Cardiomyopathy (ACM) has a high risk of sudden cardiac death, especially under 60 years old (1:5,000 prevalence). ACM involves the replacement of normal heart tissue with fibro-adipose tissue in specific areas of the right ventricle (RV). Cardiac Magnetic Resonance Imaging (CMR) is vital for ACM stratification and prognosis, focusing on RV volume and ejection fraction. Simulations suggest that ACM's abnormal deformation patterns are primarily due to mechanical changes like reduced contractility and increased stiffness, rather than electrical issues. Ventriculo-arterial coupling (VAC) is a valuable metric for assessing RV efficiency, with the TAPSE/sPAP index reflecting the RV's length-force relationship. CMR assists in ACM stratification and prognosis, with VAC potentially serving as a key predictor of outcomes based on mechanical and structural abnormalities identified through CMR. Purpose Examine and establish a relationship between mechanical uncoupling, ventricular arrhythmias, and findings from CMR in patients with ACM. Methods We examined 25 ACM patients (median age 34, 72% men) using the 2019 Modified Task Force and Padua criteria. We investigated two key factors in ACM: Right ventricular-arterial coupling (TAPSE/SPAP ratio) and clinically relevant ventricular tachycardia (requiring cardioversion). We compared clinical, ECG, and imaging data (transthoracic echocardiogram and CMR as the gold standard). We used Spearman rank tests for correlations, Fisher exact tests for nominal characteristics, and Mann-Whitney-U tests for group comparisons. In predefined regression models involving left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) function with VAC, we used flexible nonparametric regressions. A p-value &amp;lt;0.05 was considered statistically significant. The analysis was conducted using SPSSv22 and SAS-University-Edition. Results A positive association of VAC with LVEF (ρ=0.472, p=0.023), RVEF (ρ=0.522, p=0.038) and RV indexed stroke volume (ρ=0.79, p&amp;lt;0.001) was found. Low-rank regression splines showed a mainly positive association of LVEF (df=3 F=20.75 p&amp;lt;0.001), RVEF (df=4 F=24.34 p&amp;lt;0.001) and the RV indexed stroke volume, a positive linear association (df=1 F=31.67 p&amp;lt;0.001). In comparison with patients without crVT, those with crVT had a positive correlation with RV shortening, reduced RVEF (39.6 vs. 32.2%. p=0.025), higher LV mass (38.99 vs. 45.55, p=0.045), and LV end-diastolic volume (LVEDV) (56.99 vs. 68.15 ml/m2, p=0.045) by echocardiogram and CMR respectively; notwithstanding positive associations for VAC were seen with LVEDV (p=0.039), LV mass (p=0.039); and negative with RVEF by CMR (p=0.023), and RV shortening by echo (p=0.026). Conclusions We found that right VAC by echo correlates with RV and LV EF by CMR and RV stroke volume in patients with ACM. RVEF, LV mass, and end-diastolic volume correlate with clinically relevant arrhythmias.

Impairment of Left Ventricular Function in the Depressed Chinese Miniature Swine Model by Cardiovascular Magnetic Resonance Feature-Tracking: A Preliminary Study.

Individuals with depression have an increased risk of cardiovascular disease, and more often have a poor prognosis with cardiovascular disease. This study aimed to investigate the impact of depression on Left Ventricular (LV) alterations using Cardiovascular Magnetic Resonance Featuretracking (CMR-FT). Seven anesthetized, healthy Chinese miniature swine were included in the study. Basic data, including CMR scans at baseline and after 14 days of depression modeling, were collected. Behavioral tests, including the Open-field Test (OFT), Sucrose Preference Test (SPT), and measurements of the time taken to consume a specific amount of food and sugar, were conducted to assess the success of the depression models. CMR cine images were acquired and CVI software was employed to analyze Global Longitudinal Strain (GLS), Global Circumferential Strain (GCS), and Global Radial Strain (GRS). Late Gadolinium Enhancement (LGE) imaging was used to detect myocardial infarction and/or scar. The outcomes demonstrated successful depression modeling, indicated by reduced scores in the OFT and SPT, as well as an extended time to intake food and sugar compared to baseline. However, no significant differences were observed in LV End-diastolic Volume (LVEDV), LV Endsystolic Volume (LVESV), LV Ejection Fraction (LVEF), LV End-diastolic Myocardial Mass (LVMASSED), and Cardiac Output (CO) before and after modeling. Regarding LV global strain parameters, there was a downward trend in GRS (25.35% ± 6.9% vs. 22.86% ± 6.4%, P=0.021), GCS (-16.71% ± 4.2% vs. -14.78% ± 2.3%, P=0.043), and GLS (-17.66% ± 2.9% vs. -14.53% ± 2.5%, P=0.056), respectively, after modeling. GRS and GCS were significantly reduced after modeling compared to baseline. The study suggests that depression may contribute to early LV systolic dysfunction, particularly affecting LV GCS and GRS.

Myocardial perfusion improvement and mechanism after percutaneous intramyocardial septal radiofrequency ablation in obstructive hypertrophic cardiomyopathy: a study of myocardial contrast echocardiography.

The data on myocardial perfusion of the percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) for obstructive hypertrophic cardiomyopathy (HOCM) are still lacking, although PIMSRA have been proved to be of great safety and efficacy. The aim of this study was to quantitatively analyze the changes in myocardial perfusion after PIMSRA using myocardial contrast echocardiography (MCE). 27 HOCM patients treated with PIMSRA were retrospectively analyzed, and their echocardiographic parameters and perfusion parameters of MCE were collected before and 12 months after PIMSRA. A reperfusion curve was used to quantify microvascular blood volume (A), microvascular flux rate (β), and microvascular blood flow (MBF) of each segment. Then the value difference (Δ) of parameters between post- and pre-operation were calculated. Finally, the correlation between the changes in MBF and in each echocardiographic parameter was analyzed. (1) Compared with baseline, the global A, β and MBF were significantly increased in HOCM patients after PIMSRA (all P < 0.001). The β, MBF were increased in the interventricular septum (P < 0.001, respectively), and the A, β, MBF were increased in the left ventricular wall (all P < 0.001). (2) Correlation analysis showed that the ΔMBF of interventricular septum was mainly negatively correlated with the maximum interventricular septum thickness (ΔIVSTmax, r=-0.670, P < 0.001), mean interventricular septum thickness (ΔIVSTmean, r=-0.690, P < 0.001), and left ventricular mass index (ΔLVMI, r=-0.774, P < 0.001), while the ΔMBF of left ventricular wall was positively correlated with left ventricular end-diastolic volume index (ΔLVEDVI, r = 0.621, P = 0.001) and stroke volume index (ΔSVI, r = 0.810, P < 0.001). Myocardial perfusion was improved at both interventricular septum and ventricular wall in HOCM patients after PIMSRA. MCE can provide a new dimension for the efficacy evaluation to PIMSRA procedure.

Investigation of left atrial mechanical function and left ventricular systolic and diastolic parameters in athletes performing resistance exercise and combined exercise

Some individuals who go to fitness centers for various purposes perform resistance exercise (RE) alone, while others engage in combined exercise (CE) by including cardio exercises along with RE. Studying the effects of these two different training methods on left ventricular (LV) systolic and diastolic parameters and left atrial mechanical function is an important step toward understanding the effects of different types of exercise on cardiac function. This knowledge has significant implications for public health, as it can inform the development of targeted and effective exercise programs that prioritize cardiovascular health and reduce the risk of adverse outcomes. Therefore, the primary aim of this study is to comprehensively investigate the LV systolic and diastolic parameters of athletes who engage in RE and CE using ECHO, to contribute to the growing body of literature on the cardiovascular effects of different types of exercise. Forty-two amateur athletes aged between 17 and 52 were included in our study. The participants consisted of the RE (n = 26) group who did only resistance exercise during the weekly exercise period, and the CE group (n = 16) who also did cardio exercise with resistance exercises. After determining sports age (year), weekly exercise frequency (day), and training volume (min) in addition to demographic information of RE and CE groups, left ventricular systolic and diastolic parameters and left atrial functions were determined by ECHO. Findings from our study revealed that parameters including the left ventricular end-diastolic diameter (LVEDD) (p = .008), left ventricular end-diastolic volume (LVEDV) (p = .020), stroke volume index (SV-I) (p = .048), conduit volume (CV-I) (p = .001), and aortic strain (AS) (p = .017) were notably higher in the RE group compared to the CE group. Also left atrial active emptying volüme (LAAEV) of CE was higher than the RE group (p = .031). In conclusion, the cardiac parameters of the RE group showed more athlete’s heart characteristics than the CE group. These results may help to optimize the cardiovascular benefits of exercise routines while minimizing the potential risks associated with improper training.

Acute effect of ultramarathon on systolic and diastolic cardiac function: Systematic review and meta-analysis

BackgroundUltramarathon running poses physiological challenges, impacting cardiac function. This systematic review and meta-analysis explore the acute effects of single-stage ultramarathon running on cardiac function. MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations were followed. Searches covered Medline, Embase, CINAHL, SPORTDiscus, Web of Science, Central Cochrane, and Scopus. Random effects meta-analyses assessed left ventricular (LV) and right ventricular (RV) variables, expressed as mean differences (MD) with 95% confidence intervals (CI). ResultsAmong 6972 studies, 17 were included. Post-ultramarathon reductions were found in LV end-diastolic diameter (LVEDD) (−1.24; 95% CI = −1.77, −0.71 mm), LV end-diastolic volume (LVEDV) (−9.92; 95% CI = −15.25, −4.60 ml), LV stroke volume (LVSV) (−8.96 ml, 95% CI -13.20, −4.72 ml), LV ejection fraction (LVEF) (−3.71; 95% CI = −5.21, −2.22%), LV global longitudinal strain (LVGLS) (−1.48; 95% CI = −2.21, −0.76%), E/A (−0.30; 95% CI = −0.38, −0.22 cm/s), .E' (−1.35 cm/s, 95% CI -1.91, −0.79 cm/s), RV fractional area change (RVFAC) (−3.34, 95% CI = −5.84, −0.84%), tricuspid annular plane systolic excursion (TAPSE) (−0.12, 95% CI = −0.22, −0.02 cm), RV global longitudinal strain (RVGLS) (−1.73, 95% CI = −2.87, −0.59%), with increases in RV end-diastolic area (RVEDA) (1.89, 95% CI = 0.63, 3.14 cm2), RV Peak A' (1.32 cm/s, 95% CI 0.20, 2.44), and heart rate (18.24, 95% CI = 15.16, 21.32). No significant differences were observed in LV end-systolic diameter (LVESD), LV end-systolic volume (LVESV), RV end-diastolic diameter (RVEDD), RV Peak E', and RV Peak S′. ConclusionsEvidence suggests immediate impairment of systolic and diastolic cardiac function post-ultramarathon running.

Dapagliflozin Alleviates Myocardial Ischaemia Reperfusion Injury by Activating Mitophagy via the AMPK-PINK1/Parkin Signalling Pathway.

Myocardial ischaemia reperfusion injury (MIRI) determines infarct size and long-term outcomes after acute myocardial infarction (AMI). Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, alleviates MIRI in animal models. We investigated the potential mechanisms underlying the cardioprotective effect of dapagliflozin against MIRI, focusing on mitochondrial injury and mitophagy. MIRI mouse and H9C2 cell models were established. 2,3,5-Triphenyltetrazolium chloride (TTC) staining showed a significant alleviation of MIRI after pre-treatment of dapagliflozin compared to the model group (14.91±1.76 vs. 40.47±3.69%). Data from the pre-treatment dapagliflozin group showed a significant decrease in left ventricular ejection fraction (LVEF) (44.8±2.7 vs. 28.5±5.3%, P<0.01), left ventricular end-diastolic volume (LVEDV) (70.6±9.5 vs. 93.5±13.8 ul, P<0.05), and left ventricular end-systolic volume (LVESV) (39.0± 8.3 vs. 67.9±13.7 ul, P<0.05) compared to the model group. Dapagliflozin also reduced the levels of reactive oxygen species (ROS) and fragmented mitochondrial DNA, reversed the decrease in mitochondrial membrane potential, and suppressed apoptosis. Further study showed that dapagliflozin could protect against mitochondrial injury by rapidly clearing damaged mitochondria via mitophagy in a phosphatase and tensin homologue (PTEN)-induced putative kinase 1 (PINK1)/parkindependent manner. Dapagliflozin regulated mitophagy in cardiomyocytes by suppressing the adenosine 5'monophosphate-activated protein kinase (AMPK)-PINK1/parkin signalling pathway, resulting in attenuated MIRI. Dapagliflozin alleviated MIRI by activating mitophagy via the AMPK-PINK1/parkin signalling pathway.

The protective effects of alamandine on angiotensin II-induced cardiac dysfunction and remodeling in rats

Alamandine (Ala), a relatively recent addition to the renin-angiotensin system (RAS), is a heptapeptide sharing structural similarities with angiotensin-(1-7). This peptide has garnered significant attention due to its distinctive antihypertensive, vasodilatory, and antifibrotic effects. In this study, we sought to determine whether Ala acts as a counter-regulatory agent against angiotensin II-induced cardiac hypertrophy, fibrosis, and inflammation in rats. Male SD rats (n=6 in each group) received a two-week subcutaneous infusion of vehicle (saline), angiotensin II (ANG II, 150 ng/kg/min), or a combination of ANG II and Ala (50 ng/kg/min) via mini osmotic pumps. Left ventricular (LV) function was evaluated through echocardiography. Histological analysis of cardiac hypertrophy and fibrosis was conducted using Hematoxylin Eosin and Trichome-Mason staining, respectively. Compared to the vehicle group, treatment with Ala significantly (*p&lt;0.05) attenuated ANG II-induced cardiac mass (659.27 ± 54.26* vs. 824.48 ± 40.38 mg) with reduced LV thickness and end-diastolic volume. Ala treatment also improved cardiac function, as indicated by reduced global longitudinal strain and myocardial performance index. Histological images revealed that Ala treatment markedly reduced cardiomyocyte area (383.63* ± 7.20 vs 490.59 ± 13.13 μm²) and fibrosis area (5.22* ± 0.93 vs. 9.64 ± 0.36%) in rats treated with ANG II, along with reduced mRNA expression of pro-hypertrophic markers such as brain natriuretic peptide (4.29 ± 0.50* vs 7.53 ± 0.68, fold change) and β-myosin heavy chain (6.11 ± 0.61* vs 10.29 ± 1.02), as well as pro-fibrosis markers collagen 1 (5.72 ± 0.59* vs 10.56 ± 1.69), fibronectin (2.18 ± 0.34* vs 4.69 ± 0.70), and α-smooth muscle actin (2.14 ± 0.42* vs 3.85 ± 0.06), when compared to the rats treated with ANG II alone. Flow cytometry analysis also showed that Ala treatment significantly reduced ANG II-induced immune responses in the heart by reducing immune cell populations including CD4, CD8 T cells, B cells and NK cells, and increasing presence of anti-inflammatory M2 monocytes. Additionally, the mRNA levels of interlukin-6, CD 68, and chemokine monocyte chemoattractant protein-1 were significantly decreased in Ala-treated rats. Furthermore, treatment with Ala reversed ANG II-induced alterations in the mRNA expression of angiotensin-converting enzyme (ACE, 2.05 ± 0.16* vs. 3.08 ± 0.25), angiotensin type 1 receptor (1.45 ± 0.22* vs. 2.56 ± 0.31), and ACE 2 (1.08 ± 0.10** vs. 0.38 ± 0.06) in the LV of the heart. Taken together, these findings demonstrate that alamandine exerts a protective effect against ANG II-induced cardiac dysfunction, hypertrophy, fibrosis, and inflammation, potentially acting as a protective component of the RAS to counteract the adverse effects of ANG II. Alamandine might be a potential therapeutic agent in the treatment of cardiovascular disorders. Supported by NIH grants R01 HL139521 &amp; 155091. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Вибір блокатора ренін-ангіотензин-альдостеронової системи для лікування серцевої недостатності при гострому міокардиті

Вибір блокатора ренін-ангіотензин-альдостеронової системи для лікування серцевої недостатності при гострому міокардиті

Rate of Change in Cardiac Magnetic Resonance Imaging Measures Is Associated With Death in Duchenne Muscular Dystrophy.

Cardiovascular disease is the leading cause of death among patients with Duchenne muscular dystrophy (DMD). Identifying patients at risk of early death could allow for increased monitoring and more intensive therapy. Measures that associate with death could serve as surrogate outcomes in clinical trials. Duchenne muscular dystrophy subjects prospectively enrolled in observational studies were included. Models using generalized least squares were used to assess the difference of cardiac magnetic resonance measurements between deceased and alive subjects. A total of 63 participants underwent multiple cardiac magnetic resonance imaging and were included in the analyses. Twelve subjects (19.1%) died over a median follow-up of 5 years (interquartile range, 3.1-7.0). Rate of decline in left ventricular ejection fraction was faster in deceased than alive subjects (P<0.0001). Rate of increase in indexed left ventricular end-diastolic (P=0.0132) and systolic (P<0.0001) volumes were higher in deceased subjects. Faster worsening in midcircumferential strain was seen in deceased subjects (P=0.049) while no difference in global circumferential strain was seen. The rate of increase in late gadolinium enhancement, base T1, and mid T1 did not differ between groups. Duchenne muscular dystrophy death is associated with the rate of change in left ventricular ejection fraction, midcircumferential strain, and ventricular volumes. Aggressive medical therapy to decrease the rate of progression may improve the mortality rate in this population. A decrease in the rate of progression may serve as a valid surrogate outcome for therapeutic trials.

Ketone body levels and its associations with cardiac markers following an acute myocardial infarction: a post hoc analysis of the EMMY trial

BackgroundSodium-glucose co-transporter 2 inhibitors (SGLT2i) have been suggested to exert cardioprotective effects in patients with heart failure, possibly by improving the metabolism of ketone bodies in the myocardium.MethodsThis post hoc analysis of the EMMY trial investigated the changes in serum β-hydroxybutyrate (3-βOHB) levels after acute myocardial infarction (AMI) in response to 26-week of Empagliflozin therapy compared to the usual post-MI treatment. In addition, the association of baseline and repeated measurements of 3-βOHB with cardiac parameters and the interaction effects of Empagliflozin were investigated. Cardiac parameters included N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), left ventricle end-systolic volume (LVESV), left ventricle end-diastolic volume (LVEDV), and left ventricular filling pressure (E/é ratio).ResultsThe mean 3-βOHB levels increased from baseline (46.2 ± 3.0 vs. 51.7 ± 2.7) to 6 weeks (48.8 ± 2.2 vs. 42.0 ± 2.3) and 26 weeks (49.3 ± 2.2 vs. 35.8 ± 1.9) in the Empagliflozin group compared to a consistent decline in placebo over 26 weeks (pinteraction < 0.001). Baseline and longitudinal measurements of 3-βOHB were not significantly associated with NT-proBNP and E/é ratio. Baseline 3-βOHB value was negatively associated with LVEF (coefficient: − 0.464, 95%CI − 0.863;− 0.065, p = 0.023), while an increase in its levels over time was positively associated with LVEF (0.595, 0.156;1.035, 0.008). The baseline 3-βOHB was positively associated with LVESV (1.409, 0.186;2.632, 0.024) and LVEDV (0.640, − 1.170;− 2.449, 0.488), while an increase in its levels over time was negatively associated with these cardiac parameters (LVESV: − 2.099, − 3.443;− 0.755, 0.002; LVEDV: − 2.406, − 4.341;− 0.472, 0.015). Empagliflozin therapy appears to modify the association between 3-βOHB, LVEF (pinteraction = 0.090), LVESV (pinteraction = 0.134), and LVEDV (pinteraction = 0.168), particularly at 26 weeks; however, the results were not statistically significant.ConclusionThis post hoc analysis showed that SGLT2i increased 3-βOHB levels after AMI compared to placebo. Higher baseline 3-βOHB levels were inversely associated with cardiac function at follow-up, whereas a sustained increase in 3-βOHB levels over time improved these markers. This highlights the importance of investigating ketone body metabolism in different post-MI phases. Although more pronounced effect of 3-βOHB on cardiac markers was observed in the SGLT2i group, further research is required to explore this interaction effect.