Left Ventricular Measurements Research Articles

Aortic valve area using computed tomography-derived correction factor to improve the validity of left ventricular outflow tract measurements.

Given the inherent inaccuracies stemming from the assumption that the left ventricular outflow tract (LVOT) is circular, this study aimed to improve the accuracy of transthoracic echocardiography (TTE)-based aortic valve area (AVA) calculation using continuity equation (CE) by introducing a correction factor (CF) derived from multidetector computed tomography angiography (MDCTA) images and validate it in aortic stenosis (AS) patients. This retrospective study used MDCTA images of 400 patients for modeling and 403 TTE dataset for validation. Echocardiographic parasternal long-axis view was modeled using MDCTA, and LVOT diameter (D1) was measured. Direct planimetry of LVOT area was performed and subsequently converted into a theoretical circle. The assumed circle (D2) diameter was derived, and D2/D1 was calculated and termed as the CF. The CF was 1.13, and it improved the agreement between MDCTA- and TTE-derived LVOT areas and correlation between AVA and peak velocity, mean pressure gradient, and velocity ratio. In discordant subgroups of severe AS, the CF reclassified patients to moderate AS in 40% in the low flow (LF), low gradient (LG), and low ejection fraction (EF) group; 53% in the LF, LG, and normal EF group; and 68% in the LF, high gradient, and normal EF group. CF of 1.13 derived from MDCTA improved the accuracy of TTE-derived LVOT area and AVA and improved correlation with hemodynamic variables in AS patients. Reclassification of AS patients using CF may have clinical applicability for patient selection for early intervention.

Protective effects of induced cardiosphere on myocardial ischemia-reperfusion injury through secreting interleukin 10

BackgroundsMyocardial ischemia-reperfusion injury (MI-RI) has many adverse complications with high mortality rate. It has been demonstrated that the induced cardiospheres (iCS), generated from adult skin fibroblasts via somatic reprogramming, represents a novel source for cell therapy in myocardial infarction. However, whether the iCS could also be applied to treat MI-RI remains unclear. Thus, we investigated the therapeutic application of iCS in the mice model MI-RI. MethodsThe mice model of MI-RI was established and the iCS cells were transplanted to the mice via tail-vein injection. Left ventricular (LV) dimensions and LV pressure-volume measurements were assessed by parasternal long-axis echocardiography. The infarct size was determined by histology analysis. And the inflammatory responses were analyzed by using enzyme-linked immunosorbent assay (ELISA). ResultsThe LV function was significantly improved after the iCS transplantation when compared to the vehicle control group, including the end-systolic pressure and dP/dtMax. Furthermore, the infarct size was significantly decreased after the iCS transplantation. The protein levels of pro-inflammatory cytokines, including tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), were down-regulated by the iCS transplantation while the IL-10 was up-regulated. The anti-inflammatory factor IL-10 was found to be expressed and secreted by the iCS cells and knocking down the IL-10 in iCS would significantly impair the therapeutic effects of iCS in the mice model of MI-RI. ConclusionThe present study indicated that the iCS had therapeutic effects on the mice model of MI-RI through secreting the IL-10.

Primed Left Ventricle Heart Perfusion Creates Physiological Aortic Pressure in Porcine Hearts.

This article presents a primed left ventricle heart perfusion method to generate physiologic aortic pressure (AoP) and perform functional assessment. Isolated hearts of male Yorkshire pigs were used to study the hemodynamic behaviors of AoPs generated in the primed left ventricle heart perfusion (n = 6) and conventional (zero-loaded left ventricle) Langendorff perfusion (n = 6). The measurement results show that left ventricular pressure generated in the primed left ventricle heart perfusion is a determinant of physiologic AoP (i.e. systolic and diastolic pressures within physiologic range). The aortic pulse pressure (systolic pressure = 124.5 ± 1.7 mm Hg, diastolic pressure = 87.8 ± 0.9 mm Hg, aortic pulse pressure = 36.7 ± 2.6 mm Hg) from the primed left ventricle heart perfusion represents close match with the in vivo physiologic data. The volume in the left ventricle remains constant throughout the primed left ventricle heart perfusion, which allows us to perform isovolumetric left ventricular pressure measurement in ex vivo heart perfusion (EVHP). Left ventricular contractility measurements (maximum and minimum rates of left ventricular pressure change) were derived for cardiac assessment. In summary, the proposed primed left ventricle heart perfusion method is able to create physiologic AoP and enables left ventricular functional assessment in EVHP in porcine hearts.

P970 Significant differences in atrial structural and functional parameters leading to differing mechanisms of atrial fibrillation in athletes compared to non-athletes

Abstract Background/Introduction: There is an increased incidence of atrial fibrillation (AF) in endurance athletes. We sought to evaluate the likely mechanistic basis for this phenomenon. Methods 36 endurance athletes in sinus rhythm, with a previous history of AF (ATH-AF) were compared to age and gender matched endurance athletes with no prior history of AF (ATH), non athletes with paroxysmal AF (NONATH-AF) and age and gender matched healthy controls (CONTROL). A detailed transthoracic echocardiogram was performed with all groups in sinus rhythm, with detailed left atrial (LA) and left ventricular (LV) measurements, including strain analysis. Results All athletes had increased LA and LV size when compared with healthy controls (Table 1). Non athletes with paroxysmal AF had increased LA size when compared with controls. However, indexed LA/LV ratio was preserved in athletes and similar to healthy individuals, whilst AF patients had significantly increased LA/LV ratio. Athletes with AF had higher e’ velocity and lower E/e’, whereas e’ was reduced and E/e’ elevated in non-athlete AF patients. Athletes had impaired LA reservoir and contractile strain, and reduced LV global longitudinal strain (GLS) compared with healthy controls. Conclusions Compared to healthy controls, athletes have reduced LA and LV strain, with preserved LV diastolic function and LA/LV ratio. In contrast, altered diastolic function with differential increase in LA volume was observed in AF patients. The increased risk of AF in athletes is likely mediated by different mechanistic processes other than an atrial myopathy consequent to diastolic dysfunction as observed in non-athletes with AF. Table 1. LA and LV parameters Parameter ATH-AF ATH NONATH-AF CONTROL P value LVEDV indexed (ml/m2) 84 ± 12 79 ± 14 57 ± 10 51 ± 13 <0.001 LVESV indexed (ml/m2) 35 ± 6 34 ± 7 25 ± 8 27 ± 33 0.02 LV ejection fraction (%) 58 ± 4 56 ± 4 56 ± 10 58 ± 8 0.586 LV global longitudinal strain (%) 19.2 ± 1.7 18.9 ± 2.1 21 ± 3.1 21.7 ± 2.9 <0.001 e’ vel (cm/s) 10 ± 2 10 ± 3 8 ± 2 9 ± 2 0.007 E/e’ 5.7 ± 1.3 5.9 ± 1.8 9.1 ± 3.3 7.5 ± 1.5 <0.001 LAV max indexed (ml/m2) 45 ± 11 43 ± 12 38 ± 11 27 ± 8 <0.001 Indexed LAV/LVEDV ratio 0.5 ± 0.1 0.6 ± 0.2 0.7 ± 0.2 0.5 ± 0.1 <0.001 LA reservoir strain (%) 27.2 ± 4.8 28.2 ± 3.7 27.9 ± 8.4 33.2 ± 7.0 <0.001 LA conduit strain (%) 14.2 ± 4.5 14.4 ± 4.0 14.9 ± 5.5 16.6 ± 6.3 0.182 LA contractile strain (%) 13.0 ± 3.1 13.8 ± 3.6 13.0 ± 5.1 16.6 ± 3.1 <0.001 LV = left ventricular, LAV = left atrial volume, LA = left atrial

Systematic Assessment of the Impact of Ultrasound-Enhancing Agents upon Measurements of Cardiac Size and Function by Echocardiography

Echocardiography with an ultrasound-enhancing contrast agent (CON) is a powerful tool for identifying the endocardial border. However, the precise relationship of measurements obtained from CON to the reference values of two-dimensional unenhanced echocardiography (BASL) remains undefined, especially regarding wall thickness. The aim of this study was to systematically determine the differences between unenhanced and enhanced images for a broad range of left ventricular (LV) measurements and to define reference values for the relationship between the two methods. We examined the echocardiograms of 624 consecutive patients in whom CON was performed for clinical indications. We excluded 192 patients in whom studies were technically difficult for measurement by either or both methods. Echocardiograms were from standard parasternal and apical views according to American Society of Echocardiography guidelines. Recordings were measured for wall thickness and chamber dimension in 343 patients and for LV volumes and ejection fraction in 212 patients. LV wall thickness measurements were systematically reduced with a bias of 0.2cm with limits of agreement (LOA) from -0.5 to 0.16cm in interventricular septal thickness, and from -0.46 to 0.13cm in posterior wall thickness in CON. LV dimensions and volumes systematically increased with a bias of 0.2cm (LOA, -0.19 to 0.58cm) and 14 to 16mL (LOA, -11.9 to 42.8mL), respectively. LV ejection fraction systematically decreased with a bias of 3.4% (LOA, -13.5% to 6.8%) in CON compared to BASL. All differences showed normal distribution in the Kolmogorov-Smirnov test. CON yields significantly different measurements of cardiac size and function compared to unenhanced imaging. These data define the systematic differences in measurements between CON and BASL images; the range of differences is narrow. These differences may influence management when the measurement value is a borderline.

Predictors of Left Ventricular Dysfunction After Surgery for Degenerative Mitral Regurgitation

This study was performed to determine whether strain can supplement the ability of left ventricular (LV) ejection fraction (LVEF) to predict postoperative ventricular dysfunction in patients undergoing mitral valve surgery for degenerative mitral regurgitation (DMR). From 2004 to 2017, 520 patients with an LVEF of 60% or more underwent mitral valve surgery (98% repair) for DMR. All patients had preoperative, predischarge, and follow-up (mean, 5.0 ± 3.6 years) echocardiograms. Speckle tracking was performed in 119 of 520 patients (22.9%) to determine LV strain, right ventricular free-wall strain, and left atrial longitudinal strain. Multivariate logistic and Cox regression models were used in this subgroup to evaluate associations with early postoperative LV dysfunction and medium-term overall survival, respectively. Median preoperative LVEF of the entire cohort was 65%. Based on predischarge echocardiogram, 449 patients (86.3%) maintained postoperative LVEF of 50% or greater. Seventy-one patients (13.7%) had a predischarge LVEF of less than 50%, 49 (9.4%) had a predischarge LVEF of 40% to 49%, and 22 (4.2% overall) had a predischarge LVEF of less than 40%. Abnormal preoperative LV, right ventricular, and left atrial strain measurements were significantly associated with the development of postoperative LV dysfunction, but preoperative hemodynamic and non-strain echo parameters did not vary enough in absolute values to be clinically useful as predictors of postoperative LV dysfunction. Preoperative strain measurements in DMR patients were significantly associated with superior capabilities of detecting underlying LV dysfunction despite preserved preoperative LVEF. Strain analysis may serve as another marker for optimal timing of surgical intervention in DMR patients.

Global longitudinal strain is a hallmark of cardiac damage in mitral regurgitation: the Italian arm of the European Registry of mitral regurgitation (EuMiClip)

BackgroundThe search for reliable cardiac functional parameters is crucial in patients with mitral regurgitation (MR). In the Italian arm of the European Registry of MR, we compared the ability of global longitudinal strain (GLS) and left ventricular (LV) ejection fraction (LVEF) to detect cardiac damage in MR.MethodsFive hundred four consecutive patients with MR underwent a complete echo-Doppler exam. A total of 431, 53 and 20 patients had degenerative, secondary and mixed MR, respectively. The main echocardiographic parameters, including LV and left atrial (LA) size measurements, pulmonary artery systolic pressure (PASP) and GLS were compared between patients with mild MR (n = 392) vs. moderate to severe MR (n = 112).ResultsLVEF and GLS were related one another in the pooled population, and separately in patients with mild and moderate/severe MR (all p < 0.0001). However, a certain number of patients were above the upper or below the lower limits of the 95% confidence interval (CI) of the normal relation in the pooled population and in patients with mild MR. Only 2 patients were below the 95% CI in moderate to severe MR. After adjusting for confounders by separate multivariate models, LVEF and GLS were independently associated with LV and left atrial size in the pooled population and in mild and moderate/severe MR. GLS, but not LVEF, was also independently associated with PASP in patients with mild and moderate to severe MR.ConclusionsBoth LVEF and GLS are independently associated with LV and LA size, but only GLS is related to pulmonary arterial pressure. GLS is a powerful hallmark of cardiac damage in MR.

Assessment By MRI T2*of Iron Accumulation and Removal in Transfusion Dependent MDS Patients

Introduction: Transfusion dependency in Myelodysplastic syndrome (MDS) patients is associated with shortened over-all survival and leukemia-free survival; however, it is not clear whether this detrimental effect is mediated by transfusional iron overload itself or whether the need for RBC transfusion is a surrogate marker of disease severity. Additionally, despite the negative effects of anemia and transfusion dependence on disease outcomes and patient quality of life, the clinical impact of iron overload in MDS remains controversial. Overall, the most common non-leukemic cause of death in MDS is heart failure. Recent T2* cardiac MRI (CMR) studies have shown that cardiac iron accumulation in MDS patients is variable and infrequent. T2* CMR is noninvasive, robust and the best available modality for assessing iron organ quantification. The current study assessed iron overload in transfusion dependent MDS patients using ferritin levels combined with myocardial and liver iron quantification using T2* CMR. The study monitored iron accumulation dynamics while on iron chelation therapy. Methods: We collected retrospectively clinical data in 18 RBC transfusion dependent MDS patients that had a CMR in our institution; some of the patients have serial scans. All scans were obtained using a 1.5 T scanner (Signa HDx ver 15 GE). Scans interpretation was performed using a dedicated workstation (Medis Medical imaging version 7.6, the Netherlands) for left ventricular ejection fraction measurement and T2* investigation as previously described. T2* values were recorded in milliseconds and converted to mg/gr dry tissue of myocardial liver and pancreatic tissue. Results: Ten of 18 patients were chelated. During the study period 4 patients have died from pneumonia, brain tumor, complications of Allo BMT and transformation to AML. Demographic data and prognostic score of MDS are shown in table 1. Before the first CMR, patients were treated with median of 48 PC (14-145) with median ferritin levels 1691.3ng/ml (269.4-3730ng/ml). In Table 2 we show iron accumulation in the first CMR. Iron accumulation in the heart was seen in 2 patients. The results are shown as severity of accumulation and not absolute numbers, as normal and abnormal range is different in the different organs. Seven patients had yearly serial CMR done, 6 of them were treated with iron chelation. We found iron accumulation in the heart in 4 of them. In table 3 we show example of a patient that was treated with chelation. Another patient, that had decrease ejection fraction with only moderate accumulation in the heart in CMR, improved her heart function with chelation. During the study period all patients continue to be transfusion dependent except 1 patient that became transfusion independent. She was transfused with 182 PC with maximal ferritin of 6926ng/ml. She was chelated with deferiprone and then with desferal. She is now transfusion independent for a year. Conclusion: Blood transfusion dependency in MDS patients, leads to high ferritin levels and evidences in CMR of iron accumulation in parenchymal orangs including the heart. During the study 4 patients had evidence of iron accumulation in the heart with 2 of them with severe accumulation that improved with iron chelation. Liver and pancreas accumulation was seen in 12 and 8 patients accordingly. Prospective studies documenting the correlation between chelation therapy and improvement in organ damage and survival are needed. Disclosures No relevant conflicts of interest to declare.

Short- and mid-term effects of sleeve gastrectomy on left ventricular function with two-dimensional speckle tracking echocardiography in obese patients.

This study aimed to investigate left ventricular functions of obese patients with no known heart disease who underwent laparoscopic sleeve gastrectomy by speckle tracking echocardiography in their early and medium-term postoperative follow-up. Thirty-seven obese patients (10M, 27 F) without coronary artery disease or heart failure who had undergone LSG were included in the study. Apical four-, three-, and two-chamber images were analyzed longitudinally by conventional methods and speckle tracking echocardiography (STE) for left ventricle functions preoperatively, at the postoperative Month 1 and at the postoperative Month 6 (QLAB 6.0), using current software. No difference was found between standard echocardiography and Doppler parameters in terms of the 1-month versus 6-month follow-up values compared to baseline. Left ventricular STE longitudinal measurements demonstrated significantly higher longitudinal strain and strain velocity parameters in the follow-up values at Month 6 compared to the values at Month 1 and at baseline. Global longitudinal strain (GLS) was -17.48±1.09% in 6-month follow-up, -16.16±1.26% in 1-month follow-up, and -16.06±1.25% at baseline (P<.001). A significant correlation was found between delta GLS, which represents patients' GLS change in 6months, and delta weight, which represents patients' body weight change in 6months. Obese patients who had undergone LSG were observed to have improved left ventricular function in the mid-term.

Microstructurally Motivated Constitutive Modeling of Heart Failure Mechanics

Heart failure (HF) is one of the leading causes of death worldwide. HF is associated with substantial microstructural remodeling, which is linked to changes in left ventricular geometry and impaired cardiac function. The role of myocardial remodeling in altering the mechanics of failing hearts remains unclear. Structurally based constitutive modeling provides an approach to improve understanding of the relationship between biomechanical function and tissue organization in cardiac muscle during HF. In this study, we used cardiac magnetic resonance imaging and extended-volume confocal microscopy to quantify the remodeling of left ventricular geometry and myocardial microstructure of healthy and spontaneously hypertensive rat hearts at the ages of 12 and 24 months. Passive cardiac mechanical function was characterized using left ventricular pressure-volume compliance measurements. We have developed a, to our knowledge, new structurally based biomechanical constitutive equation built on parameters quantified directly from collagen distributions observed in confocal images of the myocardium. Three-dimensional left ventricular finite element models were constructed from subject-specific in vivo magnetic resonance imaging data. The structurally based constitutive equation was integrated into geometrically subject-specific finite element models of the hearts and used to investigate the underlying mechanisms of ventricular dysfunction during HF. Using a single pair of material parameters for all hearts, we were able to produce compliance curves that reproduced all of the experimental compliance measurements. The value of this study is not limited to reproducing the mechanical behavior of healthy and diseased hearts, but it also provides important insights into the structure-function relationship of diseased myocardium that will help pave the way toward more effective treatments for HF.

Relationship between Cardiac Remodeling and Exercise Capacity in Elite Athletes: Incremental Value of Left Atrial Morphology and Function Assessed by Three-Dimensional Echocardiography

Data are scarce regarding left atrial (LA) adaptation to regular physical exercise. The aim of this study was to examine left ventricular (LV) and also LA morphologic and functional remodeling in elite athletes using three-dimensional (3D) echocardiography. In this retrospective analysis, the study group consisted of 138 elite athletes (mean age, 20±4years; 62% men) and 50 sedentary control subjects. Electrocardiographically gated full-volume 3D data sets were obtained for offline analysis using dedicated software for 3D LA and LV measurements. Body surface area-indexed LA maximal volume (LAVmax) and LV end-diastolic volume were determined. LA total emptying fraction, LA passive and LA active emptying fraction, and LV global longitudinal strain were also calculated. Athletes also underwent cardiopulmonary exercise testing to determine peak oxygen uptake. Athletes demonstrated higher 3D LAVmax (32±6 vs 26±8mL/m2) and indexed LV end-diastolic volume (85±12 vs 62±10mL/m2) compared with control subjects (P<.001 for both). Functional measures of the left ventricle and left atrium, such as the absolute value of 3D LV global longitudinal strain (19±2% vs 22±2%), LA total emptying fraction (58±6% vs 64±6%), and active emptying fraction (24±10% vs 32±10%) were lower in athletes (P<.001 for all). Male athletes had higher indexed LV end-diastolic volume compared with female athletes (89±13 vs 80±8mL/m2, P<.001), but LAVmax did not differ between genders (32±6 vs 33±5mL/m2, P=.18). Besides heart rate, gender, and body surface area, 3D LAVmax, LV global longitudinal strain, and LA passive emptying fraction were independent predictors of peak oxygen uptake. Regular physical exercise results in marked LA and LV remodeling with considerable gender differences as explored by 3D echocardiography. In contrast with various cardiovascular diseases, more pronounced LA dilation and lower resting functional measures are associated with better exercise performance.

P4461Chronic administration of Empagliflozin induces cardioprotection in vivo in absence of diabetes mellitus

Abstract Background/Introduction We have recently shown that empagliflozin (EMPA), a sodium-glucose cotransporter 2 (SGLT2) inhibitor approved for type 2 diabetes mellitus management reduces myocardial infarct size in diabetic mice undergone ischemia/reperfusion (I/R) after chronic administration. However its effect on non-diabetic myocardium remains unspecified. Purpose We aimed to investigate: (i) the effect of EMPA on myocardial function and infarct size after I/R in healthy mice, in the absence of diabetes mellitus, (ii) the underlying signaling pathways, (iii) its effects on cell survival in rat embryonic-heart-derived cardiomyoblasts (H9C2) treated with the inhibitor of STAT3, STATTIC. Methods C57BL/6 mice were initially randomized into two groups, Control and EMPA (n=7 per group) and treated with 5% DMSO in water for injection and EMPA at a dose of 10mg/kg/day with 5% DMSO in water for injection, respectively, for 6 weeks. After this period, the mice were subjected to 30 minutes of I and 2 hours of R and infarct size was evaluated. Body weight, blood pressure, blood glucose levels and left ventricular shortening measurements by echocardiography, were taken at baseline and at the end of the treatment. Furthermore, in order to assess potential differences in the signaling cascades involved at different time points of reperfusion, additional mice were randomized into Control and EMPA groups which were furtherly subdivided into groups (n=4) of 10' and (n=4) of 120' of reperfusion each. The mice were subjected to I/R and myocardial biopsies were obtained for the assessment of the signaling cascade at the 10th and 120th minutes of reperfusion. H9C2 cells subjected to ischemia–reoxygenation were treated with STATIC (0.5, 1, and 10 μM) during the 3 hours of reoxygenation and evaluated for viability. Results Body weight, blood pressure and glucose levels remained unchanged between the groups. We observed no statistically significant change in left ventricular fractional shortening in both groups at baseline (41.0% ± 1.92 vs 40.5% ± 2.7) and after the end of the 6th week (42.7% ± 2.8 vs 40.9% ± 4.1). Infarct size was significantly reduced in EMPA group compared to the Control one (29.5% ± 3.0 vs 45.8% ± 3.2, p&lt;0.05). Phosphorylation of STAT3 was significantly increased at the 10th minute of reperfusion but remained unchanged at the 120th compared to control. The contribution of STAT3 in EMPA-mediated effects was evaluated in H9C2 cells using different doses of STATIC; our results indicate that EMPA completely lost its activity when STAT3 is inhibited. However STATIC per se induces cell death even at low doses. Conclusion(s) EMPA reduces infarct size in healthy mice indicating that its cardioprotective effect is independent of the presence of diabetes mellitus. STAT3 activation can be considered as a cardioprotective mechanism of EMPA, however other signaling pathways could be involved in EMPA mechanism of action and are currently under investigation.

Echocardiographic Risk Assessment to Guide Screening for Atrial Fibrillation

Although atrial fibrillation (AF) is a significant population health burden, and an avoidable cause of stroke, AF screening remains controversial. The aim of this study was to investigate whether coincidental echocardiography could provide information about patients at risk for AF. Asymptomatic participants ≥65years of age with more than one AF risk factor (N=445) undergoing echocardiography for risk evaluation were followed over a median of 15months for incident AF. Left atrial volume index (LAVi), left ventricular (LV) global longitudinal strain (GLS; absolute value), left atrial (LA) strain, and LV mass were measured. During the follow-up period, AF was diagnosed clinically by primary care physicians or by using a single-lead portable electrocardiographic monitoring device (five 60-sec recordings performed by participants over 1week). AF was diagnosed in 45 patients (10%; mean age, 70.5±4.2years; 55% women). AF detection was higher in those with LV hypertrophy, GLS < 16%, LAVi > 34mL/m2, and LA reservoir strain < 34%. GLS, LAVi, and LA reservoir strain were independently associated with AF (P<.05). Those with AF had reduced GLS, higher LAVi, and higher LV mass (P<.05), but LA strain was similar in both groups (P>.05). GLS and LAVi were the strongest predictors, and cut points of 14.3% for GLS and 39mL/m2 were associated with increased risk for developing AF. Those with all four risk parameters (LV hypertrophy, GLS<16%, LA reservoir strain <34%, and LAVi>34mL/m2) had a 60% AF detection rate, compared with 7% without these features (P=.004). Echocardiography is widely used in patients at risk for AF, and simple LV and LA measurements may be used to enrich the process of AF screening.

Three-Dimensional Echocardiography for Transcatheter Aortic Valve Replacement Sizing: A Systematic Review and Meta-Analysis.

BackgroundTranscatheter aortic valve replacement (TAVR) is the standard of care for many patients with severe symptomatic aortic stenosis and relies on accurate sizing of the aortic annulus. It has been suggested that 3‐dimensional transesophageal echocardiography (3D TEE) may be used instead of multidetector computed tomography (MDCT) for TAVR planning. This systematic review and meta‐analysis compared 3D TEE and MDCT for pre‐TAVR measurements.Methods and ResultsA systematic literature search was performed. The primary outcome was the correlation coefficient between 3D TEE– and MDCT‐measured annular area. Secondary outcomes were correlation coefficients for mean annular diameter, annular perimeter, and left ventricular outflow tract area; interobserver and intraobserver agreements; mean differences between 3D TEE and MDCT measurements; and pooled sensitivities, specificities, and receiver operating characteristic area under curve values of 3D TEE and MDCT for discriminating post‐TAVR paravalvular aortic regurgitation. A random effects model was used. Meta‐regression and leave‐one‐out analysis for the primary outcome were performed. Nineteen studies with a total of 1599 patients were included. Correlations between 3D TEE and MDCT annular area, annular perimeter, annular diameter, and left ventricular outflow tract area measurements were strong (0.86 [95% CI, 0.80–0.90]; 0.89 [CI, 0.82–0.93]; 0.80 [CI, 0.70–0.87]; and 0.78 [CI, 0.61–0.88], respectively). Mean differences between 3D TEE and MDCT between measurements were small and nonsignificant. Interobserver and intraobserver agreement and discriminatory abilities for paravalvular aortic regurgitation were good for both 3D TEE and MDCT.ConclusionsFor pre‐TAVR planning, 3D TEE is comparable to MDCT. In patients with renal dysfunction, 3D TEE may be potentially advantageous for TAVR measurements because of the lack of contrast exposure.

Evaluation of left ventricular function with continuous echocardiography concomitant with left ventricular pressure measurement in isoflurane anesthetized rats for safety pharmacology study

Evaluation of left ventricular function with continuous echocardiography concomitant with left ventricular pressure measurement in isoflurane anesthetized rats for safety pharmacology study

Effect of comprehensive initial training on the variability of left ventricular measures using fast-SENC cardiac magnetic resonance imaging

Cardiac magnetic resonance (CMR) is becoming the imaging modality of choice in multicenter studies where highly reproducible measurements are necessary. The purpose of this study was to assess the effect of comprehensive initial training on reproducibility of quantitative left ventricular (LV) parameters estimated using strain-encoded (SENC) imaging. Thirty participants (10 patients with heart failure (HF) and preserved LV ejection fraction (HFpEF), 10 patients with HF and reduced LV ejection fraction (HFrEF) and 10 healthy volunteers) were examined using fast-SENC imaging. Four observers with different experience in non-invasive cardiac imaging completed comprehensive initial training course and were invited to perform CMR data analysis. To assess agreement between observers, LV volumes, mass, ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) were estimated using dedicated software (MyoStrain, USA). To test intraobserver agreement data analysis was repeated after 4 weeks. SENC imaging and analysis were fast and were completed in less than 5 minutes. LV end-diastolic volume index (LVEDVi), LVEF and strain were significantly lower in HFpEF patients than in healthy volunteers (p = 0.019 for LVEDVi; p = 0.023 for LVEF; p = 0.004 for GLS and p < 0.001 for GCS). All LV functional parameters were further reduced in HFrEF. Excellent interobserver agreement was found for all LV parameters independently of the level of experience. The reproducibility of LV mass was lower, especially at the intraobserver level (ICC 0.91; 95% CI 0.74–0.96). LV volumetric and functional parameters derived using fast-SENC imaging, are highly reproducible. The appropriate initial training is relevant and allows to achieve highest concordance in fast-SENC measurements.

Cardiac function assessed by myocardial deformation in adult polycystic kidney disease patients

BackgroundPatients with autosomal dominant polycystic kidney disease (ADPKD) have an increased risk of cardiovascular morbidity and mortality. Impaired left ventricular (LV) global longitudinal strain (GLS) can be a sign of subclinical cardiac dysfunction even in patients with otherwise preserved ejection fraction (EF). Transmitral early filling velocity to early diastolic strain rate (E/SRe) is a novel measure of LV filling pressure, which is often affected early in cardiac disease.MethodsA total of 110 ADPKD patients not on dialysis were included in this prospective study. All patients underwent an extensive echocardiographic examination including two-dimensional speckle tracking. GLS and strain rates were measured. The distribution of GLS and E/SRe was determined and patient characteristics were compared by median levels of GLS (− 17.8%) and E/SRe (91.4 cm). Twenty healthy participants were included as control group.ResultsThere was a significantly worse GLS in the ADPKD patients (mean: − 17.8 ± 2.5%) compared to the healthy controls (mean: − 21.9 ± 1.9%), p < 0.001. The same was true for E/SRe (mean: 10.0 ± 0.3 cm) compared to the control group (mean: 6.5 ± 0.3 cm), p < 0.001. In simple logistic regression, male gender (OR: 4.74 [2.10–10.71], p < 0.001), fasting glucose (odds ratio (OR) 1.05 [1.01–1.10], p = 0.024), htTKV (OR: 1.07 [1.01–1.13], p = 0.013), HDL cholesterol (OR: 0.97 [0.94, 0.996], p = 0.025), triglycerides (OR: 1.01 [1.00–1.02], p = 0.039), hemoglobin (OR: 1.50 [1.11–2.04], p = 0.009), and β-blocker use (OR: 1.07 [1.01, 1.13], p = 0.013) were all associated with higher GLS. After multivariate logistic regression with backward model selection, only male gender (OR: 5.78 [2.27–14.71], p < 0.001) and β-blocker use (OR: 14.00 [1.60, 122.51], p = 0.017) remained significant. In simple logistic regression models, BMI (OR: 1.11 [1.02–1.20], p = 0.015), systolic blood pressure (OR: 1.03 [1.00–1.06], p = 0.027) and β-blocker use (OR: 17.12 [2.15–136.20], p = 0.007) were associated with higher E/SRe - a novel measure of left ventricular filling pressure. After backward elimination, only β-blocker use (OR: 17.22 [2.16, 137.14], p = 0.007) remained significant.ConclusionHigher GLS and E/SRe are common in ADPKD patients, even in patients with preserved eGFR and normal left ventricular EF. GLS and E/SRe may aid in cardiovascular risk stratification in patients with ADPKD as they represent early markers of cardiac dysfunction.

Abstract 469: Genomic Context Predicts Dilated but Not Hypertrophic Cardiomyopathy

Rationale: Cardiomyopathies are a major cause of heart failure and have a strong heritable component. Objective: Determine the role of both common and rare nonsynonymous genetic variation in hypertrophic (HCM) and dilated familial cardiomyopathy (DCM). Methods and Results: Whole genome sequencing was used to determine common and rare nonsynonymous genetic variation in familial cases of HCM (n=56) or DCM (n=71). Variation was evaluated in 102 cardiomyopathy genes routinely assayed in clinical and commercial gene testing panels. We used cardiac gene expression data from GTEx (Genotype-Tissue Expression database) to define additional genes expressed in the heart. The number of nonsynonymous single nucleotide variants (nsSNVs), the majority of which were missense variants, was correlated with echocardiographic measurements. Principal component analysis (PCA) of left ventricular measures separated HCM and DCM. Regression of the first principal component using all nonsynonymous single nucleotide variants (nsSNVs) in cardiomyopathy genes showed the number of nsSNVs predicted DCM but not HCM. DCM probability in the cohort significantly increased as the number of cardiomyopathy gene nsSNVs increased (p&lt;0.02). The increase in nsSNVs in cardiomyopathy genes significantly associated with reduced left ventricular ejection fraction and increased left ventricular diameter in DCM. Resampling methods identified genes with deviant cumulative allele frequencies, identifying potential modifier genes for cardiomyopathy. Conclusions: DCM subjects carry a greater burden of nsSNVs in cardiomyopathy genes. This genomic burden translates to impaired systolic cardiac function in DCM. In contrast, nsSNV burden in cardiomyopathy genes did not correlate with the probability or manifestation of left ventricular measures in HCM. These findings support a complex inheritance for DCM where increased variation in cardiomyopathy genes creates a genetic background that predisposes to DCM and increased disease severity. The distinct genetic landscapes of HCM and DCM suggest that greater genetic variation in cardiac genes provokes unfavorable ventricular remodeling with reduced systolic function.

Echocardiographic quantitation of left heart size and function in 122 healthy dogs: A prospective study proposing reference intervals and assessing repeatability

BackgroundBroadly applicable reference intervals (RIs) for measurements of left atrial (LA) and left ventricular (LV) size and function generated prospectively using statistically appropriate methods are limited.ObjectivesTo generate body size‐independent RIs for linear, area, and volume measurements of LA size and LV size and function.AnimalsHealthy adult dogs (n = 122) of variable size and somatotype.MethodsProspective study. All dogs underwent an echocardiogram performed by the same examiner. Effects of body weight, sex, age, and heart rate were evaluated by regression and correlation analyses. Scaling exponents and prediction intervals were generated for linear measurements using the allometric equation. After normalization to body weight, 95% RIs were determined using nonparametric methods with 2.5 and 97.5 percentiles serving as the lower and upper limits (each with 90% confidence intervals), respectively.ResultsLinear LA and LV measurements were strongly correlated (R 2 ≥ 0.79) with body weight. Scaling exponents were close to the expected 1/3 (0.299‐0.392). Prediction intervals for linear measurements of LV chamber size were considerably narrower than previously reported. Weak correlations (r = −0.42 to −0.50) among LV fractional shortening, fractional area change, and ejection fraction and body weight were identified. No other meaningful relationships were identified between the measurements and sex, age, and heart rate.Conclusions and Clinical ImportanceBody size‐independent RIs for several linear, area, and volume measurements of LA and LV size and function were generated prospectively from a large and diverse reference population and are available for clinical use.

Inter-vendor reproducibility and accuracy of segmental left ventricular strain measurements using CMR feature tracking.

Our aim was to evaluate the inter-vendor reproducibility of cardiovascular MR feature tracking (CMR-FT) for the measurement of segmental strain (SS) of the left ventricle (LV) as well as to test the accuracy of CMR-FT to detect regional myocardial pathology. We selected 45 patients: 15 with normal CMR findings, 15 with dilated cardiomyopathy, and 15 with acute myocardial infarction. Segmental longitudinal, circumferential, and radial strains were assessed with 4 different software. The inter-vendor difference as well as intra- and inter-observer variability was investigated. Furthermore, the accuracy of CMR-FT for the detection of structural (infarcted segments) as well as functional pathology (septal vs. lateral wall strain in left bundle branch block) was tested. Between vendors, there were significant differences in values for all strains (p < 0.001). The software using a non-rigid algorithm for image registration and segmentation demonstrated the best intra- as well as inter-observer variability with interclass correlation coefficient (ICC) > 0.962 and coefficient of variation (CV) < 24%. For infarct location, the same software yielded the highest area under the curve values for radial and circumferential SS (0.872 and 0.859, respectively). One of the other three software using optical flow technology performed best for longitudinal SS (0.799) and showed the largest differences in SS between septum and lateral wall in the dilated cardiomyopathy group. SS values obtained by CMR-FT are not interchangeable between vendors, and intra- and inter-observer reproducibility shows substantial variability among vendors. Overall, the different packages score relatively well to depict focal structural or functional LV pathology. • Segmental myocardial strain values obtained by CMR feature tracking are not interchangeable between different vendors. • Intra- and inter-observer reproducibility shows substantial variability among vendors. • Segmental myocardial strains measured by CMR feature tracking score relatively well to depict focal structural or functional LV pathology.