Analysis Of Left Ventricular Function Research Articles

The diabetic myocardial transcriptome reveals Erbb3 as a novel biomarker of incident heart failure

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart Foundation Background/Introduction People with diabetes mellitus (DM) are at high risk of developing heart failure, but the molecular basis of this is not well understood. Elucidating the mechanistic pathways may help to improve patient stratification and develop targeted therapies. Purpose We set out to define differentially expressed genes (DEGs) in diabetic myocardium and validate arising hits in their circulating protein form, with a view to informing biomarker development and improving understanding of diabetic heart disease. Methods Transcriptomic (RNA-seq) data from the Genotype-Tissue Expression (GTEx) project was used to compare gene expression in participants with (n=>100) versus without (n>300) DM (pooled type 1 and 2 diabetes mellitus), in both the right atrial (RA) and left ventricular (LV) myocardium; analyses were adjusted for technical, demographic and disease covariates. Where available, plasma proteomic data from the UK Biobank (UKB) cohort was used to validate DEGs from GTEx in their circulating protein form. Hits with directionally concordant differential expression in GTEx and UKB were further characterised as plasma proteins in UKB, including over 50,000 participants irrespective of DM status; this included analysis of incident heart failure, cardiovascular mortality and left ventricular function on cardiac magnetic resonance imaging. Results Pooled across the RA and LV, there were 64 DEGs associated with DM, with no overlap between the RA and LV hits. UKB plasma protein data was available for 6 of these. Only ERBB3 showed directional concordance with transcriptomic data, being lower in the myocardium and blood of people with DM. People in the lowest quartile of ERBB3 plasma protein had increased adjusted risk of incident heart failure and cardiovascular death than participants in all other quartiles. Lower concentrations of plasma ERBB3 protein were also associated with increased LV mass and impaired LV contractility. Conclusion Lower plasma ERBB3 concentration is more common in people with DM and is associated with LV dysfunction, incident heart failure and cardiovascular mortality. This highlights the potential of ERBB3 as a novel biomarker for individuals at risk of heart failure. Importantly, cancer therapies targeting ERBB3 and related family members can induce heart failure, and recombinant forms of the ERBB3 ligand neuregulin-1 appear to improve LV contractility, further suggesting a role of ERBB3 in the development of diabetic heart disease.

Deep cardiac phenotyping by cardiovascular magnetic resonance reveals subclinical focal and diffuse myocardial injury in patients with psoriasis (PSOR-COR study).

Psoriasis vulgaris (PV) is a chronic inflammatory disorder frequently associated with cardiovascular disease (CVD). This study aims to provide a prospective tissue characterization in patients with PV without major CVD using cardiovascular magnetic resonance (CMR). Patients with PV underwent laboratory assessment, a 12-lead and 24-h ECG, and a CMR exam at a 1.5-T scanner. Scan protocol included assessment of left (LV) and right (RV) ventricular function and strain analysis, native and post-contrast T1 mapping, T2 mapping and late gadolinium enhancement (LGE). In total, 60 PV patients (median(IQR) age in years: 50.0 (36.0-60.8); 34 men (56.7%)) were recruited and compared to 40 healthy volunteers (age in years: 49.5 (37.3-57.8); 21 men (53.0%)). No differences were found regarding LV and RV function (p = 0.78 and p = 0.75). Global radial and circumferential strains were lower in patients (p < 0.001 and p < 0.001, respectively). PV had higher global T1 times (1001 (982-1026) ms vs. 991 (968-1005) ms; p = 0.01) and lower global T2 times (48 (47-49) ms vs. 50 (48-51) ms; p < 0.001); however, all values were within local reference ranges. Focal non-ischemic fibrosis was observed in 17 (28.3%) PV patients. Deep cardiac phenotyping by CMR revealed subclinical myocardial injury in patients with PV without major CVD, despite preserved LV and RV function. Diffuse and focal fibrosis might be the first detectable signs of adverse tissue remodeling leading to reduced circumferential and radial myocardial deformation. In the background of local and systemic immunomodulatory therapy, no signs of myocardial inflammation were detected. The exact impact of immunomodulatory therapies on the myocardium needs to be addressed in future studies. ISRCTN71534700.

Agreement of ejection fraction measured by coronary computed tomography (CT) and cardiac ultrasound in evaluating patients with chronic heart failure: an observational comparative study.

Cardiac ultrasound is one of the most important examinations in cardiovascular medicine, but the technical requirements for the operator are relatively high, which to some extent affects the scope of its use. This study was dedicated to investigating the agreement of ejection fraction between coronary computed tomography (CT) and cardiac ultrasound and diagnostic performance in evaluating the clinical diagnosis of patients with chronic heart failure. We conducted a single-center-based retrospective study including 343 consecutive patients enrolled between January 2019 to April 2020, all of whom presented with suspected symptoms of heart failure within one month. All enrolled cases performed cardiac ultrasound and coronary CT scans. The CT images were analyzed using accurate left ventricle (AccuLV) artificial intelligence (AI) software to calculate the ejection fraction-computed tomography (EF-CT) and it was compared with the ejection fraction (EF) obtained based on ultrasound. Cardiac insufficiency was determined if the EF measured by ultrasound was below 50%. Diagnostic performance analysis, correlation analysis and Bland-Altman plot were used to compare agreement between EF-CT and CT. Of the 319 successfully performed patients, 220 (69%) were identified as cardiac insufficiency. Quantitative consistency analysis showed a good correlation between EF-CT and EF values in all cases (R square =0.704, r=0.837). Bland-Altman analysis showed mean bias of 6.6%, mean percentage error of 27.5% and 95% limit of agreement of -17% to 30% between EF and EF-CT. The results of the qualitative diagnostic study showed that the sensitivity and specificity of EF measured by coronary CT reached a high level of 91% [95% confidence interval (CI): 86-94%], and the positive diagnostic value was up to 96% (95% CI: 92-98%). The EF-CT and EF have excellent agreement, and AccuLV-based AI left ventricular function analysis software perhaps can be used as a clinical diagnostic reference.

Functional features of the myocardium in school-age children with chronic somatic pathology according to echocardiographic examination

The peculiarity of the modern pathology of childhood is the increasing frequency of transition of acute forms of diseases into recurrent and chronic ones and increasing primary chronic pathology. Systematic loads on «endurance» during training determine the necessity to study the possibilities of heart remodelling in school-age children against the background of chronic somatic pathology. Objective: to reveal structural and functional changes of myocardium in schoolchildren with chronic somatic pathology according to echocardiogram examination data. Materials and methods. We analysed 32 echocardiogram results in children aged from 7 to 17 years. The main group (n=16) - children with chronic somatic pathology out of exacerbation, control group (n=16) - children of the 2nd health group. Distribution of chronic somatic pathology in the main group: CNS diseases (n=4), kidney and urinary tract (n=5), GI (n=2), glands of internal secretion (n=3), vascular malformations (n=2). All children underwent echocardiogram examination with analysis of left ventricular ejection fraction systolic and diastolic myocardial function, left ventricular end-diastolic dimension, myocardial wall thickness, valve apparatus, presence/absence of physiological transudate in the pericardial cavity, and presence of small anomalies of cardiac development. Clinical and anamnestic data of the subjects, echocardiogram method and conventional statistical processing of the obtained results using STATISTICA for Windows software system were used to achieve the set goal and solve the research tasks. Results of the study. In the main group left ventricular ejection fraction was 61,8±1,57%, in the control group - 68,25±1,86% (p≤0,05). Left ventricular end-diastolic dimension was normal in both groups (p≥0.05). Concentric myocardial remodelling and increased myocardial wall thickness were found only in the main group in 18.8% (n=3) and 37.5% (n=6) of cases, respectively (p≤0.05). Valve pathology in the main and control groups was 43.8% (n=7) and 18.8% (n=3) of cases. Physiological transudate in the pericardial cavity was noted equally in both groups in 12.5% of cases. Small anomalies of cardiac development were detected in the main and control groups in 31.3% (n=5) and 18.8% (n=2) cases, respectively. Conclusion. Low values of left ventricular ejection fraction and increased myocardial wall thickness indicate a decrease in left ventricular function of the heart and a negative impact of metabolic disorders in children with chronic somatic pathology.

Efficacy of Artificial Intelligence Software in the Automated Analysis of Left Ventricular Function in Echocardiography in Central Vietnam.

In recent years, there has been a significant focus on the development of artificial intelligence (AI) applications in healthcare. However, current scientific evidence is still not convincing enough for the general public and the medical community to widely adopt AI in clinical practice. We conducted this study to investigate the correlation between left ventricular function indices assessed by AI and those evaluated by physicians. This cross-sectional descriptive study was conducted on 136 patients who attended and received treatment at Hue University of Medicine and Pharmacy Hospital from April 2022 to June 2023. Using QLAB version 15, Philips Healthcare. The AI software accurately identified 98.5% of the echocardiographic cine-loops. However, there were about 1.5% of cine-loops that the software failed to recognize. The sensitivity of Ejection Fraction (EF) calculated by AI was 73.3%, specificity was 81.3%, and accuracy stood at 78.6%. A strong positive correlation was observed between EF measured by AI and that assessed by physicians, r = 0.701, p < 0.01. The sensitivity of Global Longitudinal Strain (GLS) calculated by AI was 42.1%, specificity was 84.8%, and accuracy was 67.6%. A moderate positive correlation was found between GLS measured by AI and physician's assessment, r = 0.460, p < 0.01. The use of AI software for evaluating left ventricular function through ejection fraction and global longitudinal strain is rapid and yields results comparable to cardiologists' echocardiographic assessments. The AI-powered software holds a promising and feasible future in clinical practice.

Effect of papillary muscle and trabeculae on left ventricular function analysis via computed tomography: A cross-sectional study.

Deciding whether to include or exclude the papillary muscles and trabeculae to blood pool is essential, because quantifications of left ventricular (LV) functional parameters and myocardial mass are significantly affected. As a result, such inclusion or exclusion might produce different indices for diagnosis and therapy. Using cardiac computed tomography (CT), we obtained standard values of the portion of papillary muscle and trabeculae in normal adults, and to find out how the inclusion or exclusion of papillary muscle and trabeculae affect LV functional parameters depending on the patient group. Excluding the papillary muscles from the LV mass results in easier automated contour detection using CT. The percentage portions of papillary muscle and trabeculae to LV end-diastolic volume (EDV) and LV mass (LVM) were 11.9 ± 5.6% and 20.2 ± 4.3%, respectively, significantly affecting disease diagnosis. Imaging should be consistent at follow-up and include or exclude the papillary muscles and trabeculae to avoid introducing significant differences between measurements.

Clinical service evaluation of the feasibility and reproducibility of novel artificial intelligence based-echocardiographic quantification of global longitudinal strain and left ventricular ejection fraction in trastuzumab-treated patients.

Cardiotoxicity is a potential prognostically important complication of certain chemotherapeutic agents that may result in preclinical or overt clinical heart failure. In some cases, chemotherapy must be withheld when left ventricular (LV) systolic function becomes significantly impaired, to protect cardiac function at the expense of a change in the oncological treatment plan, leading to associated changes in oncological prognosis. Accordingly, patients receiving potentially cardiotoxic chemotherapy undergo routine surveillance before, during and following completion of therapy, usually with transthoracic echocardiography (TTE). Recent advancements in AI-based cardiac imaging reveal areas of promise but key challenges remain. There are ongoing questions as to whether the ability of AI to detect subtle changes in individual patients is at a level equivalent to manual analysis. This raises the question as to whether AI-based left ventricular strain analysis could provide a potential solution to left ventricular systolic function analysis in a manner equivocal to or superior to conventional assessment, in a real-world clinical service. AI based automated analyses may represent a potential solution for addressing the pressure of increasing echocardiographic demands within limited service-capacity healthcare systems, in addition to facilitating more accurate diagnoses. This clinical service evaluation aims to establish whether AI-automated analysis compared to conventional methods (1) is a feasible method for assessing LV-GLS and LVEF, (2) yields moderate to good correlation between the two approaches, and (3) would lead to different clinical recommendations with serial surveillance in a real-world clinical population. We observed a moderate correlation (r = 0.541) in GLS between AI automated assessment compared to conventional methods. The LVEF quantification between methods demonstrated a strong correlation (r = 0.895). AI-generated GLS and LVEF values compared reasonably well with conventional methods, demonstrating a similar temporal pattern throughout echocardiographic surveillance. The apical-three chamber view demonstrated the lowest correlation (r = 0.423) and revealed to be least successful for acquisition of GLS and LVEF. Compared to conventional methodology, AI-automated analysis has a significantly lower feasibility rate, demonstrating a success rate of 14% (GLS) and 51% (LVEF).

Right ventricular-pulmonary artery coupling in the early stages of infarction could optimize patient risk stratification over five years

Abstract Background Right ventricular (RV) dysfunction is recognized as a cardinal prognostic marker in heart failure (HF) patients. Myocardial infarction (MI) is often followed by unrecognized RV dysfunction, which can be associated with worse outcome. It is recently shown that the ratio between TAPSE and PASP (RV/PA) may depict cardiopulmonary hemodynamics better than the two parameters alone. Aim To evaluate the interactions between left ventricular (LV) and RV function in early phase of MI and to assess the prognostic significance of RV/PA coupling in patients with first MI during 5 years follow up. Methods The prospective study included 144 patients with the first MI treated with the primary percutaneous coronary intervention (p PCI) who underwent Doppler echocardiography within 2±1 days of MI. LV function analysis included: LV ejection fraction (EF), ratio between early diastolic velocity and tissue annular velocity (E/e) and global longitudinal strain (GLS). RV function and RV-PA interaction was expressed as ratio between TAPSE and PASP. During the five-year follow-up, major cardiovascular events and especially hospitalization for HF were analyzed. Results Progressive RV/PA uncoupling was associated with higher degree of LV impairment and dysfunction (EF p&amp;lt;0.001, E/e p=0.002, GLS p&amp;lt;0.001) and severity of mitral regurgitation (p=0.013). Lower baseline RV/PA coupling significantly reflects the frequency of hospitalizations for HF in the population of patients with first MI during five-year follow-up (0.62 v.s.0.51, p=0.021). After multivariate adjustment RV/PA remained an independent predictor of all major cardiac events (MACE) after five years (OR 14.0 [1.5–130.8], p=0.019). Conclusion A lower baseline RV-PA coupling, reflecting a higher degree of LV-induced pulmonary hypertension and secondary RV-dysfunction, is associated with decline of LV function in early phase of MI, and is independently associated with worse prognosis after five years. The value of RV-PA ratio as an prognstic marker warrants further investigation.

Concordancia de la evaluación ecocardiográfica básica funcional del ventrículo izquierdo entre médicos no expertos y cardiólogos especialistas en ecocardiografía

IntroductionThe clinical decisions of patients in the intensive care unit are based on the integration of the clinical history and complementary tests. The echocardiographic evaluation can reveal decisive information in the interventions and in the prognosis of the patients. ObjectiveTo determine the concordance in the analysis of left ventricular systolic function performed by physicians with basic training in echocardiography compared with the assessment by expert cardiologists. MethodologyCross-sectional study of diagnostic concordance with prospective recruitment. Patients hospitalized in the intensive care unit during 2023 in a university clinic with a high level of complexity were included. The concordance between the trained physician and the expert was analyzed using the Kappa index (κ) for the qualitative variables, and the intraclass correlation coefficient for the quantitative ones. Results131 patients were included, with a mean age of 62 years. The concordance of the echocardiographic assessment was determined, finding very good concordance for left ventricular contractility (κ: 0.97), pericardial effusion (κ: 0.82) and its location (κ: 0.85), contractility disorders (κ: 0.84) and in the quantitative measurement of the ejection fraction (intraclass correlation coefficient: 0.91). ConclusionsThere is agreement in the evaluation of left ventricular systolic function in patients hospitalized in the intensive care unit by non-expert medical personnel with training and expert cardiologists. The results should be interpreted as part of a comprehensive assessment at the patient's bedside and not as an isolated diagnosis, always under quality standards and with the necessary verification.

Significant dependency of left atrial strain on left ventricular longitudinal motion.

The effects of left ventricular longitudinal function on the left atrial strain, including the left atrial reservoir function, have not been adequately quantified. A total of 124 patients who underwent echocardiography were enrolled in this study. Left atrial strain analysis was performed using two-dimensional speckle tracking echocardiography, and the left atrial volume was derived using the modified Simpson's method. The peak left atrial strain (LAS) and left atrial expansion index (LAEI), as indices of left atrial reservoir function, were measured. The global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE), which are indices of contractile motion toward the left ventricular apex, were also measured. The correlation between LAS and candidate determinants, including left ventricular systolic longitudinal function, was evaluated, and multivariate regression analysis was performed. A significant correlation was found between LAS and left ventricular systolic longitudinal functions, GLS (r = 0.63, p < 0.001), and MAPSE (r = 0.65, p < 0.001). Two models, which were selected by multiple regression analyses for LAS, included GLS or MAPSE as independent determinants. GLS and MAPSE were also the strongest predictors, among other factors. LAS, when determined by evaluating the left atrial reservoir function, was significantly associated with left ventricular function, especially the systolic longitudinal function. Left ventricular function should be considered when assessing left atrial function by LAS.

P282 PAUCISYMPTOMATIC POST–COVID MYOCARDITIS IN A YOUNG ATHLETE DURING THE DIAGNOSTIC INVESTIGATIONS BEFORE RETURNING TO COMPETITIVE PRACTICE, POSSIBLE USEFULNESS OF THE GLS ANALYSIS

Abstract It is now known that the Covid19 infection can cause myocardial inflammatory damage. Several studies have shown that the echocardiographic parameter of the global longitudinal strain (GLS) was reduced compared to the general population even in paucisymptomatic patients. A young competitive athlete came to our observation for the diagnostic investigations before returning to competitive practice (return to play protocol) after Sars–Cov2 infection. The electrocardiogram did not show significant abnormalities as well as spirometry examination. Negative inflammation indexes and markers of myocardial damage were observed. The cycloergometer test showed no signs of myocardial distress, rapid chronotropic increase and dyspnea at 100W work load. HolterECG was performed showing 830 isolated ventricular ectopic beats. Echocardiographic examination showed preserved left ventricular systolic function (FEVS 59% – Simpson method) with a moderate reduction of GLS parameter –16,9%. The cardiopulmonary exercise test (CPET) showed an early anaerobic threshold and a normal pVO2max but not in line with the presumed range for a top–level athlete. Putting together the symptoms described, the CPET data and GLS parameter, despite the negative first–level investigations he underwent MRI that documented a myocardial edema in the mid–basal region of inferior and inferolateral walls of the left ventricle. Suitability for competitive practice was blocked, a gradual physical readaptation path was started and therapy with low–dose bisoprolol was set. An important clinical improvement is reported at the 6–month follow–up with evidence of normalization of the GLS parameter –23%. The CPET howed a realignment of the HR/VCO2 curve with a late threshold and increment of pVO2max. The 6–month control MRI examination showed almost no signs of myocardial inflammation and so the patient was made suitable for returning to competitive sport. In our case first–level investigations did not support any hypothesis of myocardial inflammation. The presence of stress symptoms confirmed by CPET data but especially the reduction of GLS parameter led to a deepening investigation with MRI that confirmed the presence of myocardial inflammatory lesion. Our case suggests that within a “return to play” protocol for athletes with recent SarsCov2 infection, the analysis of left ventricular systolic function by GLS may represent an additional useful element to be considered in support of standard investigations.

Valid and Reproducible Quantitative Assessment of Cardiac Volumes by Echocardiography in Patients with Valvular Heart Diseases-Possible or Wishful Thinking?

The analysis of left ventricular function is predominantly based on left ventricular volume assessment. Especially in valvular heart diseases, the quantitative assessment of total and effective stroke volumes as well as regurgitant volumes is necessary for a quantitative approach to determine regurgitant volumes and regurgitant fraction. In the literature, there is an ongoing discussion about differences between cardiac volumes estimated by echocardiography and cardiac magnetic resonance tomography. This viewpoint focuses on the feasibility to assess comparable cardiac volumes with both modalities. The former underestimation of cardiac volumes determined by 2D and 3D echocardiography is presumably explained by methodological and technical limitations. Thus, this viewpoint aims to stimulate an urgent and critical rethinking of the echocardiographic assessment of patients with valvular heart diseases, especially valvular regurgitations, because the actual integrative approach might be too error prone to be continued in this form. It should be replaced or supplemented by a definitive quantitative approach. Valid quantitative assessment by echocardiography is feasible once echocardiography and data analysis are performed with methodological and technical considerations in mind. Unfortunately, implementation of this approach cannot generally be considered for real-world conditions.

Cardiac cine with compressed sensing real-time imaging and retrospective motion correction for free-breathing assessment of left ventricular function and strain in clinical practice.

Free-breathing cardiac cine magnetic resonance imaging (MRI) comparable to the traditional breath-hold 2D segmented cine imaging (SegBH) is clinically required for cardiac function and strain analysis. This study is to assess the feasibility and accuracy of a free-breathing cardiac cine technique (RTCSCineMoCo) combined with highly accelerated real-time acquisition, compressed sensing, and fully automated non-rigid motion correction for left ventricular (LV) function and strain analysis, using SegBH as the reference and comparing with free-breathing single-shot real-time compressed sensing cine imaging (RTCSCine) without motion correction. A total of 67 patients scheduled for clinical cardiac MRI were included. Cine images were acquired using three techniques (SegBH, RTCSCineMoCo, RTCSCine) consecutively at 3.0 T. LV functional parameters, including ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volumes (SV), and LV mass (LVM) were measured and compared. Strain parameters including global radial (GRS), circumferential (GCS), and longitudinal (GLS) strain as well as corresponding time to peak strain (TPS) were computed by magnetic resonance (MR) feature tracking and compared. Subgroup analyses were performed according to heart rate (HR), left ventricular ejection fraction (LVEF), and etiology. All quantitative parameters of LV function and strain measured by RTCSCineMoCo (r≥0.766) and RTCSCine (r≥0.712) showed strong correlations with SegBH (all P<0.001). LV functional parameters were not statistically different between RTCSCineMoCo and SegBH (all P>0.05), but an overestimation of LV end-systolic volume (LVESV) and underestimation of LVEF and LVM were observed using RTCSCine (all P<0.001). GRS, GCS, and GLS by RTCSCineMoCo and RTCSCine were significantly different than those by SegBH (all P<0.05). All TPS values by RTCSCineMoCo showed no significant differences (all P>0.05) compared with SegBH, but TPS in longitudinal directions (TPSL) by RTCSCine was significantly different (P=0.011). There were no significant differences for GRS or GCS between RTCSCineMoCo and SegBH in patients with HR <70 bpm or LVEF <50%. GRS by RTCSCineMoCo showed similar results compared to SegBH in patients with pulmonary hypertension. RTCSCineMoCo is a promising method for robust free-breathing cardiac cine imaging, yielding more precise quantitative analytic results for LV function compared with RTCSCine. RTCSCineMoCo mildly underestimated GRS, GCS, and GLS, but showed smaller bias compared to RTCSCine in LV strain analysis.

Optimal period for analysis of left ventricular diastolic function during stress-echocardiography with treadmill test

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Описать протокол диастолического стресс-теста у пациентов с ишемической болезнью сердца (ИБС) с указанием временных рамок оценки диастолической функции (ДФ) левого желудочка (ЛЖ), а также определить диагностическую точность диастолического стресс-теста по разработанному протоколу в верификации ИБС. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Обследованы 80 пациентов старше 18 лет; 12 из них имели подтвержденные данные о перенесенном инфаркте миокарда со снижением систолической функции ЛЖ; 15 — исходно сниженную ДФ ЛЖ. Средний возраст пациентов составил 56,0±12,2 года. Пациенты с абсолютными противопоказаниями к нагрузочному тестированию входили в группу исключения. Всем пациентам после сбора анамнеза, физикального осмотра, измерения артериального давления и электрокардиографии в покое была выполнена стресс-эхокардиография с использованием тредмил-теста. Оценку ДФ начинали на 10, 20, 40 и 60-й секундах после прекращения нагрузки в течение в среднем 12 с. Всем пациентам была выполнена визуализация коронарных артерий с контрастированием. <h3>РЕЗУЛЬТАТЫ</h3> Наибольшая диагностическая точность динамики параметров ДФ ЛЖ (сравнение данных ДФ до и после нагрузки) в выявлении значимого поражения коронарного русла выявлена на 10—20-й секунде после нагрузки: чувствительность 81,2% (95% ДИ 65,1—92,5), специфичность 89,3% (95% ДИ 82,0—97,7), прогностическая значимость положительного результата 90,2% (95% ДИ 80,0—95,2), прогностическая значимость отрицательного результата 84,6% (95% ДИ 77,2—93,2), диагностическая точность 86,9% (95% ДИ 80,2—94,2). <h3>ВЫВОД</h3> Оценку параметров ДФ ЛЖ после достижения пика нагрузки при тредмил-тесте оптимально начинать в течение 40 с после нагрузки. Следует получить необходимые изображения в течение 10—15 с. Анализ параметров ДФ, зарегистрированных с 40—60-й секунды после нагрузки, приводит к снижению чувствительности и специфичности диастолического стресс-теста.

TRATAMENTO INVASIVO: BASES PARA A DECISÃO

The spectrum of clinical conditions associated with the presence of myocardial ischemia and related symptoms (angina pectoris or equivalent), regardless of the cau-sative mechanism (obstructive disease, microvascular dysfunction or coronary spasm) is called chronic coronary syndrome (CCS). Although the essence of the treatment of patients with SCC consists of changes in lifestyle and strict control of cardiovascular risk factors, in addition to antianginal therapy in maximally tolerated doses, surgical or percutaneous revascularization procedures are indicated when medical treatment fails to offer adequate symptoms control or in scenarios in which they provide a reduction in the risk of events compared to clinical therapy alone. Thus, patients with left main disease, multivessel disease (especially diabetics or those with high angiographic complexity), patients with HFrEF of ischemic etiology, and those with the last remaining patent vessel or proximal lesion of the anterior descending artery should be candidates for intervention. The choice of the intervention modality should be based on robust scientific evidence as proposed by current guidelines. In general terms, clinical parameters (patient frailty, comorbidities, and analysis of left ventricular function, for example), angiographic para-meters (anatomical complexity), and technical parameters (experience of the local team and availability of specific devices such as IVUS) are analyzed by the Heart Team in the decision-making process.

CT analysis of left ventricular function predicts short term survival in patients following transcatheter aortic valve implantation: 1-year outcome data

Abstract Introduction Contrast-enhanced cardiac CT routinely performed prior to transcatheter aortic valve implantation (TAVI), allows assessment of cardiac morphology and function. We assessed left ventricular function in CT as a predictor of survival following TAVI. Methods 500 consecutive patients referred for CT assessment of aortic root anatomy prior to TAVI were screened for inclusion in this analysis. All CT data sets were acquired using a third-generation dual source system. For assessment of aortic root anatomy, acquisitions were acquired using ECG-gated retrospective spiral acquisition and multiphase reconstructions in 10% increments of the cardiac cycle were rendered (slice thickness 0.75, increment 0.4 mm). left ventricular endocardial contours were automatically traced by a dedicated software (syngo. via, Siemens Healthineers, Forchheim, Germany) throughout the cardiac cycle and manually adjusted if required. Global left ventricular function parameters (end-diastolic and end-systolic volumes, stroke volume, cardiac output and ejection fraction) were derived by volumetric assessment. Results Out of 500 patients, 439 patients (mean age 80±6 years, 56% males, and Log EuroScore 23±14%) were included in this analysis (61 patients were excluded due to poor CT image quality or missing outcome data). Previous cardiac surgery had been performed in 15% of the patients, 50% had obstructive CAD with previous interventional or surgical revascularisation and 18% had a previous acute coronary syndrome. One-year survival was 83% (366/439 patients). Parameters of left ventricular function were as follows: mean LVEDV 172±56 ml, mean LVESV 78±62 ml, mean LV ejection fraction 59±18%, mean LV stroke volume index 51±22 ml/m2, mean LV cardiac output 6.6±3.3 L/min and LV cardiac index 3.5±1.7 l/min/m2. Cluster analysis of multiple LV-function surrogate parameters identified a group of patients with higher 1-year mortality, with LVEF identified as a predictor of 1-year survival with a cut-0ff of ≥37% associated with an OR 0f 0.52 (95% CI 0.27 to 0.98). Conclusion Assessment of left ventricular function using functional CT data sets is feasible and allows risk stratification of patients following TAVI. Among LV functional parameters, CT derived LV-ejection fraction with a cut-off ≥37% identifies patients with better short-term outcome. Funding Acknowledgement Type of funding sources: None.

Reproducibility of global LV function and dyssynchrony parameters derived from phase analysis of gated myocardial perfusion SPECT: A multicenter comparison with core laboratory setting

BackgroundGated myocardial perfusion scintigraphy (GMPS) phase analysis is an important tool to investigate the physiology of left ventricular (LV) dyssynchrony. We aimed to test the performance of GMPS LV function and phase analysis in different clinical settings and on a diverse population. MethodsThis is a post hoc analysis of a prospective, non-randomized, multinational, multicenter cohort study. Clinical evaluation and GMPS prior to cardiac resynchronization therapy (CRT)(baseline) and 6-month post CRT (follow-up) were done. LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), LV ejection fraction (LVEF), LV phase standard deviation (LVPSD), and percentage of left ventricle non-viable (PLVNV) were obtained by 10 centers and compared to the core lab. Results276 GMPS studies had all data available from individual sites and from core lab. There were no statistically significant differences between all variables except for LVPSD. When subjects with no mechanical dyssynchrony were excluded, LVPSD difference became non-significant. LVESV, LVEF, LVPSD and PLVNV had strong correlation in site against core lab comparison. Bland–Altman plots demonstrated good agreement. ConclusionsThe presented correlation and agreement of LV function and dyssynchrony analysis over different sites with a diverse sample corroborate the strength of GMPS in the management of heart failure in clinical practice.

Assessment of Left Ventricular Systolic Function by Cardiovascular Magnetic Resonance Compressed Sensing Real-Time Cine Imaging Combined With Area-Length Method in Normal Sinus Rhythm and Atrial Fibrillation

BackgroundThe most-commonly used multi-slice Simpson's method employed with routine two-dimensional segmented cine images makes it difficult to evaluate left ventricular (LV) volume and function due to endocardial border blurring and beat-to-beat variation during atrial fibrillation (AF) status.ObjectivesTo assess the feasibility of compressed sensing real-time (CSRT) cine imaging combined with an area-length method for quantification of LV systolic function in normal sinus rhythm (NSR) and AF.MethodsThe CSRT cine sequence and routine segmented balanced Steady-State-Free-Precession cine sequence were performed in 71 patients with NSR (n = 36) or AF (n = 35). Image quality and edge sharpness for both sequences were assessed. The LV functional measurements in patients with NSR included end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), cardiac index (CI), and LV mass (LVM); all were assessed using segmented cine with Simpson's rule in short axis (SegSA_Simpson, as a reference standard) and area-length (AL) method in the two chamber (Seg2CH_AL) or four chamber (Seg4CH_AL) and CSRT cine with AL method in the two chamber (CSRT2CH_AL) or four chamber (CSRT4CH_AL). Finally, the mean, maximum, and minimum values of each LV functional parameter [EDV/ESV/SV/EF/CO/CI/LVM/heart rate (HR)] from 4~5 consecutive heartbeats were measured using CSRT2CH_AL in patients with AF.ResultsIn patients with NSR, measurements of EDV (p > 0.05), ESV (p > 0.05), SV (p > 0.05), EF (p > 0.05), and LVM (p > 0.05) assessed with CSRT2CH_AL did not differ significantly from those obtained with SegSA_Simpson. In patients with AF, CSRT image quality score (p < 0.001) and edge sharpness (p < 0.001) both were significantly higher than those obtained from segmented cine. The CSRT2CH_AL provided significantly different results among mean, maximum, and minimum values of each LV parameter from 4~5 consecutive heartbeats (all p < 0.001) with strong inter- and intra-observer agreement in AF.ConclusionsThe CSRT cine sequence combined with two chamber area-length analysis accurately assessed LV systolic function in NSR. This approach is expected to permit the assessment of multiple parameters in consecutive heartbeats with good inter- and intra-observer reproducibility for beat-to-beat analysis of LV function in AF.

Invasive exercise hemodynamics predict survival in patients with clinical heart failure irrespective of left ventricular systolic function

Abstract Funding Acknowledgements Type of funding sources: None. Introduction When aiming to stratify heart failure patients for mortality risk, exercise stress testing has proven to be relevant in specific populations of heart failure patients, but is not universally applied. Analysis of left ventricular systolic function (LVEF) remains the cornerstone for stratifying heart failure patients for prognosis and clinical treatment. The aim of the present study is to investigate the prognostic capabilities of invasive exercise testing in a real-world cohort of suspected heart failure patients in whom non-cardiac causes of dyspnea were excluded. Methods We retrospectively analyzed survival of patients who underwent right heart catheterization at rest and during exercise between 2007 to 2017 for dyspnea and expected heart failure. Pulmonary capillary wedge pressure (PCWP) at rest and the PCWP response to exercise, expressed as the ratio of PCWP at peak exercise to workload normalized to body weight [PCWL (mmHg/W/kg)], were determined. Mortality data was deducted from the official German death registry. Results A total of 682 patients [aged 64.1 ± 12 years, 269 (39.2%) women] were included. Based on LVEF, 515 patients (76.4%) had sustained LVEF ≥50%, 71 patients (10.5%) had heart failure with mildly-impaired LVEF (40-49%) and 88 patients (13.1%) had heart failure with reduced LVEF (≤40%). Absolute LVEF was not associated with all-cause mortality (HR 0.995; 95% CI 0.99-1.00; p=0.231). While increases in PCWP at rest an PCWL during exercise were both associated with death, the discriminative properties of pressure measurements derived during exercise were superior in ROC-analysis (AUC 0.637 for PCWP and AUC 0.728 for PCWL, p&amp;lt;0.001) Exercise hemodynamics and systolic function were next used to re-classify patients in four groups based on normal vs. impaired LVEF (≥/&amp;lt; 50%) and response to exercise (PCWL≥/&amp;lt;25.5 mmHg/W/kg for normal LVEF and PCWL≥/&amp;lt;34.7 mmHg/W/kg for impaired LVEF). In multivariate models adjusted for pertinent baseline parameters, patients with pathological response to exercise carried a 2.0-fold (with sustained LVEF, 95% CI 1.17-3.52, p=0.011) to 3.2-fold (with impaired LVEF, 95% CI 1.83-5.91, p&amp;lt;0.001) increased risk for death. Patients with impaired LVEF but featuring a normal response to exercise did not carry an increased risk for death (HR 1.117, 95% CI 0.453-2.757, p=0.810). Discussion: In patients with clinical heart failure, invasive exercise testing improves the prediction of mortality. Subjects with a normal response to exercise have a relatively low mortality irrespective of systolic function.

Speckle tracking analysis of left ventricular function in patients with type 1 diabetes mellitus and kidney failure

Abstract Funding Acknowledgements Type of funding sources: None. Background Speckle tracking echocardiography (STE) is an excellent tool to detect early myocardial dysfunction when conventional parameters such as left ventricular ejection fraction are still unaltered. Reduced left ventricular strain has been described in patients with chronic kidney disease as well as in patients with diabetes mellitus. However, diabetes mellitus as a systemic microvascular disease can affect renal and cardiac function, potentially leading to kidney failure and diabetic cardiomyopathy. Purpose Aim of this study was to assess left ventricular function by speckle tracking analysis to delineate cardiac function in patients with diabetes mellitus type 1 and kidney failure (DM1 + KF) from patients with kidney failure without diabetes mellitus (KF). Methods We conducted a retrospective study and included 16 patients with DM1 + KF who were listed for a simultaneous pancreas-kidney-transplantation and received an echocardiogram between 2013 to 2016 in our clinic. They were compared to a sex- and age-matched group of kidney failure patients without diabetes mellitus (n= 20) and a healthy control group (n= 48). Results Subjects in all groups were young in age and had normal BMI. In the DM1 + KF group, 62.5% of patients were on dialysis as compared to 95% of patients in the KF group. As to be expected, only patients in the DM1 + KF group had elevated HbA1c plasma levels (Table 1). Left ventricular ejection fraction was not significantly different between all three groups. Hypertrophy was present in the DM1 + KF group and even more in the KF group, as indicated by left ventricular mass index. Diastolic function was impaired in both patient groups compared to healthy controls. STE analysis revealed reduced global longitudinal strain (GLS) in the DM1 + KF (-13.07 ± 2.67 %) as well as KF group (-14.68 ± 4.87 %) to a similar extent in comparison to healthy control (-19.78 ± 1.89 %, p &amp;lt; 0.001). Interestingly, DM1 + KF patients had significantly worse global radial strain (GRS) and global circumferential strain (GCS) than KF patients, as shown in Table 2. Conclusions DM1 + KF and KF patients displayed comparable impairment in left ventricular function when using conventional echocardiography. STE analysis provided more differentiated results, showing significantly worse GRS and GCS in patients with DM1 + KF, even though hypertrophy was more pronounced in KF patients. These parameters seem to capture the detrimental effects of diabetic microvasculopathy on the myocardium, in addition to the interdependency of the reno-cardiac axis. Abstract Figure. Patient characteristics Abstract Figure. Echocardiographic estimates