Left Ventricular Recovery Research Articles

Cardioprotective Action of a Novel Synthetic 19,20-EDP Analog Is Sirt Dependent.

Mounting evidence suggests that cytochrome P450 epoxygenase-derived metabolites of docosahexaenoic acid, called epoxydocosapentaenoic acids (EDPs), limit mitochondrial damage after cardiac injury. In particular, the 19,20-EDP regioisomer has demonstrated potent cardioprotective action. Thus, we investigated our novel synthetic 19,20-EDP analog SA-22 for protection against cardiac ischemia-reperfusion (IR) injury. Isolated C57BL/6J mouse hearts were perfused through Langendorff apparatus for 20 minutes to obtain baseline function, followed by 30 minutes of global ischemia. Hearts were then treated with vehicle, 19,20-EDP, SA-22, or SA-22 with the pan-sirtuin inhibitor nicotinamide or the SIRT3-selective inhibitor 3-(1H-1,2,3-triazol-4-yl) pyridine (3-TYP) at the start of 40 minutes reperfusion (N = 5-8). We assessed IR injury-induced changes in recovery of myocardial function, using left ventricular developed pressure and systolic and diastolic pressure change. Tissues were assessed for electron transport chain function, SIRT1 and SIRT3, optic atrophy type 1, and caspase-1. We also used H9c2 cells in an in vitro model of hypoxia/reoxygenation injury (N = 3-6). Hearts perfused with SA-22 had significantly improved postischemic left ventricular developed pressure, systolic and diastolic recovery (64% of baseline), compared with vehicle control (15% of baseline). In addition, treatment with SA-22 led to better catalytic function observed in electron transport chain and SIRT enzymes. The protective action of SA-22 resulted in reduced activation of pyroptosis in both hearts and cells after injury. Interestingly, although nicotinamide cotreatment worsened functional outcomes, cell survival, and attenuated sirtuin activity, it failed to completely attenuate SA-22-induced protection against pyroptosis, possibly indicating EDPs exert cytoprotection through pleiotropic mechanisms. In short, these data demonstrate the potential of our novel synthetic 19,20-EDP analog, SA-22, against IR/hypoxia-reoxygenation injury and justify further development of therapeutic agents based on 19,20-EDP.

The impact of age on ablation outcomes in AF-mediated cardiomyopathy.

The absence of ventricular scar in patients with atrial fibrillation (AF) and systolic heart failure (HF) predicts left ventricular (LV) recovery following AF ablation. It is unknown whether age impacts the degree of LV recovery, reverse remodeling, or AF recurrence following catheter ablation (CA) among this population. To evaluate the impact of age on LV recovery and AF recurrence in a population with AF and systolic HF without fibrosis (termed AF-mediated cardiomyopathy) following CA. Consecutive patients undergoing CA between 2013 and 2021 with LV ejection fraction (LVEF) < 45% and absence of cardiac magnetic resonance imaging (CMR) detected LV myocardial fibrosis were stratified by age (<65 vs. ≥65 years). Following CA, participants underwent remote rhythm monitoring for 12 months with repeat CMR for HF surveillance. The study population consisted of 70 patients (10% female, mean LVEF 33 ± 9%), stratified into younger (age < 65 years, 63%) and older (age ≥ 65 years, 37%) cohorts. Baseline comorbidities, LVEF(34 ± 9 vs. 33 ± 8 ≥65 years, p = .686), atrial and ventricular dimensions (left atrial volume index:55 ± 21 vs. 56 ± 14 mL/m2 age ≥ 65, p = .834; indexed left ventricular end-diastolic volume: 108 ± 40 vs. 104 ± 28 mL/m2 age ≥ 65, p = .681), pharmacotherapy and ablation strategy (pulmonary vein isolation in all; posterior wall isolation in 27% vs. 19% age ≥ 65, p = .448; cavotricuspid isthmus in 9% vs. 11.5% age ≥ 65) were comparable (all p > .05) albeit a higher CHADS2 VASc score in the older cohort (2.7 ± 0.9 vs. 1.6 ± 0.6 age < 65, p < .001). Freedom from AF was comparable (hazard ratio: 0.65, 95% confidence interval: 0.38-1.48, LogRank p = .283) as was AF burden [0% (interquartile range, IQR: 0.0-2.1) vs. age ≥ 65: [0% (IQR 0.0-1.7), p = .516], irrespective of age. There was a significant improvement in LV systolic function in both groups (ΔLVEF + 21 ± 14% vs. +21 ± 12% age ≥ 65, p = .913), with LV recovery in the vast majority (73% vs. 69%, respectively, p = .759) at 13 (IQR: 12-16) months. This was accompanied by comparable improvements in functional status (New York Heart Association class p = .851; 6-min walk distance 50 ± 61 vs. 93 ± 134 min age ≥ 65, p = .066), biomarkers (ΔN-terminal-pro brain natriuretic peptide -139 ± 246 vs. -168 ± 181 age ≥ 65,p = .629) and HF symptoms (Short Form-36 survey Δphysical component summary p = .483/Δmental component summary, p = .841). In patients undergoing CA for AF with systolic HF in the absence of ventricular scar, comparable improvements in ventricular function, symptoms, and freedom from AF are achieved irrespective of age.

Trans-aortic Valvular Ejection Fraction for Monitoring Recovery of Patients with Ventricular Systolic Heart Failure.

Durable mechanical circulatory support in the form of left ventricular (LV) assist device (LVAD) therapy is increasingly considered in the context of the recovery of native cardiac function. Progressive improvement in LV function may facilitate LVAD explantation and a resultant reduction in device-related risk. However, ascertaining LV recovery remains a challenge. In this study, we investigated the use of trans-aortic valvular flow rate and trans-LVAD flow rate to assess native LV systolic function using a well-established lumped parameter model of the mechanically assisted LV with pre-existing systolic dysfunction. Trans-aortic valvular ejection fraction (TAVEF) was specifically found to characterize the preload-independent contractility of the LV. It demonstrated excellent sensitivity to simulated pharmacodynamic stress tests and volume infusion tests. TAVEF may prove to be useful in the ascertainment of LV recovery in LVAD-supported LVs with pre-existing LV systolic dysfunction.

Early prediction of left ventricular function improvement in patients with new-onset heart failure and presumed non-ischaemic aetiology

ObjectivesTo determine baseline characteristics predictive of left ventricular ejection fraction (LVEF) recovery in patients diagnosed with heart failure with reduced ejection fraction (HFrEF) and presumed non-ischaemic aetiology.MethodsWe prospectively recruited patients...

Pheochromocytoma/paraganglioma-associated cardiomyopathy.

Pheochromocytoma/paraganglioma (PPGL) are neuroendocrine tumors that frequently produce and release catecholamines. Catecholamine excess can manifest in several cardiovascular syndromes, including cardiomyopathy. PPGL-induced cardiomyopathies occur in up to 11% of cases and are most often associated with an adrenal pheochromocytoma (90%) and rarely with a paraganglioma derived from the sympathetic ganglia (10%). PPGL-associated cardiomyopathies can be chronic or acute, with takotsubo cardiomyopathy being the most often reported. These two types of PPGL-induced cardiomyopathy seem to have different pathophysiological backgrounds. Acute catecholaminergic stress inundates myocardial β-adrenoceptors and leads to left ventricle stunning and slight histological apoptosis. In chronic cardiomyopathy, prolonged catecholamine exposure leads to extended myocardial fibrosis, inflammation, and necrosis, and ultimately it causes dilated cardiomyopathy with a low ejection fraction. Sometimes, especially in cases associated with hypertension, hypertrophic cardiomyopathy can develop. The prognosis appears to be worse in chronic cases with a higher hospital mortality rate, higher cardiogenic shock rate at initial presentation, and lower left ventricular recovery rate after surgery. Therefore, establishing the correct diagnosis at an early stage of a PPGL is essential. This mini-review summarizes current data on pathophysiological pathways of cardiac damage caused by catecholamines, the clinical presentation of PPGL-induced cardiomyopathies, and discusses treatment options.

Impact of diabetes mellitus on acute and short term left ventricular longitudinal systolic strain recovery after percutaneous coronary intervention in ischemic hypertensive patients

Impact of diabetes mellitus on acute and short term left ventricular longitudinal systolic strain recovery after percutaneous coronary intervention in ischemic hypertensive patients

Native T1 high region and left ventricular ejection fraction recovery in patients with dilated cardiomyopathy.

Native T1 mapping is used to assess myocardial tissue characteristics without gadolinium contrast agents. The focal T1 high-intensity region can indicate myocardial alterations. This study aimed to identify the association between the native T1 mapping including the native T1 high region and left ventricular ejection fraction (LVEF) recovery in patients with dilated cardiomyopathy (DCM). Patients with newly diagnosed DCM (LVEF of < 45%) who underwent cardiac magnetic resonance imaging with native T1 mapping were included in the analysis. Native T1 high region was defined as a signal intensity of > 5 SD in the remote myocardium. Recovered EF was defined as a follow-up LVEF of ≥ 45% and an LVEF increase of ≥ 10% after 2 years from baseline. Seventy-one patients met the inclusion criteria for this study. Forty-four patients (61.9%) achieved recovered EF. Logistic regression analysis showed that the native T1 value (OR: 0.98; 95% CI: 0.96-0.99; P = 0.014) and the native T1 high region (OR: 0.17; 95% CI: 0.05-0.55; P = 0.002), but not late gadolinium enhancement, were independent predictors of recovered EF. Compared with native T1 value alone, combined native T1 high region and native T1 value improved the area under the curve from 0.703 to 0.788 for predicting recovered EF. Myocardial damage, which was quantified using native T1 mapping and the native T1 high region were independently associated with recovered EF in patients with newly diagnosed DCM.

Left Ventricular Recovery after Transapical Transcatheter Aortic Valve Implantation Compared with Conventional Aortic Valve Replacement in Patients with Aortic Regurgitation and Reduced Ejection Fraction

Background and Aim of the Study. To evaluate differences in left ventricular recovery after transapical transcatheter aortic valve implantation and conventional aortic valve replacement in patients with aortic regurgitation and reduced left ventricular ejection fraction. Methods. All patients with reduced left ventricular ejection fraction who underwent aortic valve surgery for AR at our institution between January 2015 and November 2021 were retrospectively reviewed. Generalized estimating equations were used to compare left ventricular recovery and remodeling outcomes between the patient groups. Results. A total of 87 cases were included in this study, 36 patients for TA-TAVI and 51 patients for C-AVR. Transapical transcatheter aortic valve implantation was associated with better and faster recovery of left ventricular ejection fraction and left ventricular end-diastolic dimension (adjusted β = 0.002, 95% CI: 0.000 to 0.003, and p = 0.046 ; adjusted β = 0.330, 95% CI: 0.185 to 0.474, and p &lt; 0.001 , respectively) within the first 3 months postoperatively compared with left ventricular ejection fraction, with the same improvement in New York Heart Association function class (adjusted β = 0.381, 95% CI: −0.349 to 1.111, and p = 0.306 ). Conclusions. This study highlights patients who underwent transapical transcatheter aortic valve implantation for aortic regurgitation with reduced left ventricular ejection fraction. However, future randomized controlled prospective clinical trials with longer follow-up durations are required.

Association Between Segmental Noninvasive Myocardial Work and Microvascular Perfusion in ST-Segment Elevation Myocardial Infarction: Implications for Left Ventricular Functional Recovery and Clinical Outcomes

Predicting left ventricular recovery (LVR) after acute ST-segment elevation myocardial infarction (STEMI) is of prognostic importance. This study aims to explore the prognostic implications of segmental noninvasive myocardial work (MW) and microvascular perfusion (MVP) after STEMI. In this retrospective study, 112 patients with STEMI who underwent primary percutaneous coronary intervention and transthoracic echocardiography after percutaneous coronary intervention were enrolled. Microvascular perfusion was analyzed by myocardial contrast echocardiography, and segmental MW was analyzed by noninvasive pressure-strain loops. A total of 671 segments with abnormal function at baseline were analyzed. The degrees of MVP were observed following intermittent high-mechanical index impulses: replenishment within 4seconds (normal MVP), replenishment >4seconds and within 10seconds (delayed MVP), and persistent defect (microvascular obstruction). The correlation between MW and MVP was analyzed. The correlation of the MW and MVP with LVR (normalization of wall thickening, >25%) was assessed. The prognostic value of segmental MW and MVP for cardiac events (cardiac death, admission for congestive heart failure, or recurrent myocardial infarction) was evaluated. Normal MVP was seen in 70 segments, delayed MVP in 236, and microvascular obstruction in 365. The segmental MW indices were independently correlated with MVP; 244 (36.4%) segments had segmental LVR at 3-month follow-up. Segmental MW efficiency and MVP were independently associated with segmental LVR (P<.05). The χ2 of combination of segmental MW efficiency and MVP was higher than either index alone for identifying segmental LVR (P<.001). At a median follow-up of 42.0months, cardiac events occurred in 13 patients; all regional MW parameters, high sensitivity troponin I, regional longitudinal strain, and so on were associated with cardiac events. Segmental MW indices are associated with MVP within the infarct zone following reperfused STEMI. Both are independently associated with segmental LVR, and regional MW is associated with cardiac events, providing prognostic value in STEMI patients.

Impact of in-Hospital Left Ventricular Ejection Fraction Recovery on Long-Term Outcomes in Patients Who Underwent Impella Support for HR PCI or Cardiogenic Shock: A Sub-Analysis from the IMP-IT Registry.

(1) Background: Percutaneous left ventricle assist devices (pLVADs) demonstrated an improvement in mid-term clinical outcomes in selected patients with severely depressed left ventricular ejection fraction (LVEF) undergoing percutaneous coronary interventions. However, the prognostic impact of in-hospital LVEF recovery is unclear. Accordingly, the present sub-analysis aims to evaluate the impact of LVEF recovery in both cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR PCI) supported with pLVADs in the IMP-IT registry. (2) Methods: A total of 279 patients (116 patients in CS and 163 patients in HR PCI) treated with Impella 2.5 or CP in the IMP-IT registry were included in this analysis, after excluding those who died while in the hospital or with missing data on LVEF recovery. The primary study objective was a composite of all-cause death, rehospitalisation for heart failure, left ventricle assist device (LVAD) implantation, or heart transplantation (HT), overall referred to as the major adverse cardiac events (MACE) at 1 year. The study aimed to evaluate the impact of in-hospital LVEF recovery on the primary study objective in patients treated with Impella for HR PCI and CS, respectively. (3) Results: The mean in-hospital change in LVEF was 10 ± 1% (p < 0.001) in the CS cohort and 3 ± 7% (p < 0.001) in the HR PCI group, achieved by 44% and 40% of patients, respectively. In the CS group, patients with less than 10% in-hospital LVEF recovery experienced higher rates of MACE at 1 year of follow-up (FU) (51% vs. 21%, HR 3.8, CI 1.7-8.4, p < 0.01). After multivariate analysis, LVEF recovery was the main independent protective factor for MACE at FU (HR 0.23, CI 0.08-0.64, p = 0.02). In the HR PCI group, LVEF recovery (>3%) was not associated with lower MACE at multivariable analysis (HR 0.73, CI 0.31-1.72, p = 0.17). Conversely, the completeness of revascularisation was found to be a protective factor for MACE (HR 0.11, CI 0.02-0.62, p = 0.02) (4) Conclusions: Significant LVEF recovery was associated with improved outcomes in CS patients treated with PCI during mechanical circulatory support with Impella, whereas complete revascularisation showed a significant clinical relevance in HR PCI.

Predictors factor of left ventricular (LV) remission peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a rare, life-threatening disease. The purpose was to identify the predictors of left ventricular (LV) recovery. We retrospectively reviewed 40 patients hospitalized between 2013–2022. We included women with signs of heart failure in the last month of pregnancy and up to 5 months postpartum, with absence of identifiable causes of heart failure, with LV systolic dysfunction by TEE such as depressed shortening fraction (> 30%), EF (> 45%) and LV end-diastolic dimension > 2.7 cm/m2. All patients were followed clinically and echocardiography at 6 months and over 1 year. Thirty-two patients were multiparous, 28 had multifetal pregnancies, caesarean section was performed in 20 patients, 15 patients had severe preeclampsia PPCM was discovered in antepartum in one case 5, postpartum in 35 cases with a mean time: 15 weeks after delivery. The symptomatology was dyspnea in 40 women, orthopnea in 15 cases, signs of pulmonary oedema in 20 cases and right heart failure in 9 cases. TEE at admission revealed dilatation of the LV with a mean EF 26%. A RV dysfunction in 16 cases, a functional MR in 15 cases; PH in 10 cases all patients received iv diuretics in case of AHF, CEI were prescribed in 35 cases, beta blockers and MRA in 22 cases. The duration of treatment was 6 months for 9 patients and over a year for others. Inotropic drug and circulatory support were necessary in 2 cases hospital mortality rate was of 1% because of cardiogenic shock. Twenty-five patients (45%) had “any improvement” in LVEF within 6 months and 3 patients during a mean follow-up of 26 months. Of these patients, 3 had complete improvement, 5 had partial recovery of LVEF. The factors associated with a higher likelihood of recovery were: postpartum diagnosis of PCCM, LVEF > 30%, LVEDD < 6 cm. PCCM is a complication of pregnancy with unknown causes. Preeclampsia and multiparity appears to be strong associations.

C-7 | Left Ventricular Recovery After Impella 5.5 Placement in Patients With Cardiogenic Shock

C-7 | Left Ventricular Recovery After Impella 5.5 Placement in Patients With Cardiogenic Shock

Meta-Analysis on Left Ventricular Unloading With Impella in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation

Meta-Analysis on Left Ventricular Unloading With Impella in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation

Enhanced Left Ventricular Recovery in Treatment of Mitral Regurgitation With Severe Left Ventricular Dysfunction

A 73-year-old male patient presented with shortness of breath at rest resulting from new-onset severe primary mitral regurgitation with a flail posterior leaflet, left ventricular dysfunction, and cardiogenic shock. After initial stabilization in the intensive care unit, multiple treatment options were considered for this patient, all associated with significant mortality. Ultimately, operative mitral valve repair with Impella 5.5 placement was performed for postoperative hemodynamic support. Surgical repair provided elimination of mitral regurgitation. Impella support was maintained for 7 days to provide unloading of the left ventricle. After device removal, the patient had sustained left ventricular recovery with significantly improved ejection fraction. Full left ventricular support and unloading may decrease operative risk and promote left ventricular recovery in patients with severe mitral regurgitation and left ventricular dysfunction. This case emphasizes the value of ventricular unloading to facilitate the recovery of left ventricular function as a treatment option for patients with challenging cases of severe mitral regurgitation and left ventricular dysfunction.

Complete Pump Stop as the Presentation of Left Ventricular Recovery in a Patient With Left Ventricular Assist Device.

Complete Pump Stop as the Presentation of Left Ventricular Recovery in a Patient With Left Ventricular Assist Device.

Parameters associated with successful weaning of veno-arterial extracorporeal membrane oxygenation: a systematic review

PurposeVeno-arterial (VA) extracorporeal membrane oxygenation (ECMO) can be used to restore organ perfusion in patients with cardiogenic shock until native heart recovery occurs. It may be challenging, however, to determine when patients can be weaned successfully from ECMO—surviving without requiring further mechanical support or heart transplant. We aimed to systematically review the medical literature to determine the biomarkers, hemodynamic and echocardiographic parameters associated with successful weaning of VA-ECMO in adults with cardiogenic shock and to present an evidence-based weaning algorithm incorporating key findings.MethodWe systematically searched PubMed, Embase, ProQuest, Google Scholars, Web of Science and the Grey literature for pertinent original research reports. We excluded studies limited to extracorporeal cardiopulmonary resuscitation (ECPR) as the neurological prognosis may significantly alter the decision-making process surrounding the device removal in this patient population. Studies with a mixed population of VA-ECMO for cardiogenic shock or cardiac arrest were included. We excluded studies limited to patients in which ECMO was only used as a bridge to VAD or heart transplant, as such patients are, by definition, never “successfully weaned.” We used the Risk of Bias Assessment tool for Non-Randomized Studies. The study was registered on the International prospective register of systematic reviews (PROSPERO CRD42020178641).ResultsWe screened 14,578 records and included 47 that met our pre-specified criteria. Signs of lower initial severity of shock and myocardial injury, early recovery of systemic perfusion, left and right ventricular recovery, hemodynamic and echocardiographic stability during flow reduction trial and/or pump-controlled retrograde trial off predicted successful weaning. The most widely used parameter was the left ventricular outflow tract velocity time integral, an indicator of stroke volume. Most studies had a moderate or high risk of bias. Heterogeneity in methods, timing, and conditions of measurements precluded any meta-analysis.ConclusionsIn adult patients on VA-ECMO for cardiogenic shock, multiple biomarkers, hemodynamic and echocardiographic parameters may be used to track resolution of systemic hypoperfusion and myocardial recovery in order to identify patients that can be successfully weaned.Graphical

Dyssynchronous Heart Failure: A Clinical Review.

Dyssynchrony occurs when portions of the cardiac chambers contract in an uncoordinated fashion. Ventricular dyssynchrony primarily impacts the left ventricle and may result in heart failure. This entity is recognized as a major contributor to the development and progression of heart failure. A hallmark of dyssynchronous heart failure (HFd) is left ventricular recovery after dyssynchrony is corrected. This review discusses the current understanding of pathophysiology of HFd and provides clinical examples and current techniques for treatment. Data show that HFd responds poorly to medical therapy. Cardiac resynchronization therapy (CRT) in the form of conventional biventricular pacing (BVP) is of proven benefit in HFd, but is limited by a significant non-responder rate. Recently, conduction system pacing (His bundle or left bundle branch area pacing) has also shown promise in correcting HFd. HFd should be recognized as a distinct etiology of heart failure; HFd responds best to CRT.

Abstract 14516: Systolic Slope of the Outflow Cannula Predicts Heart Failure Readmission Risk in Patients With Heartmate 3 Left Ventricular Assist Device

Introduction: Left ventricular assist devices (LVAD) may lead to left ventricular (LV) recovery in patients with heart failure with reduced ejection fraction (HFrEF) via LV offloading and subsequent positive remodeling. Current echocardiographic markers of LV recovery in LVAD patients are not well defined. The peak systolic slope, also known as systolic acceleration, of the outflow cannula has recently been shown to be a marker of underlying LV contractility and a tool to assess for LV recovery. We hypothesized that variations in the systolic slope would predict heart failure (HF) admissions. Methods: A total of 63 unique patients with LVAD at The University of Chicago Medical Center had HeartMate 3 (HM3) outflow tract Doppler signals obtained during routine transthoracic echocardiography (TTE) of suitable quality between 2015 and 2022. Systolic acceleration, systolic deceleration, diastolic acceleration, and the presence of flow reversal were measured. Mortality and HF admissions were recorded up to one year from the date of the TTE. Results: Increased systolic acceleration through the HM3 outflow cannula was associated with a decreased 1-year HF admission risk (352.8 [241.9, 515.8] cm/sec 2 vs 249.2 [164.0, 316.5] cm/sec 2 among readmitted patients, p = 0.03; Figure 1A). Systolic deceleration also predicted 1-year HF admission (-318.6 [-477.9, -244.0] cm/sec 2 vs -217.8 [-304.5, -188.8] cm/sec 2 among readmitted patients, p = 0.04; Figure 1B). Other variables, including the presence of flow reversal and diastolic acceleration, were not significantly associated with HF admission risk. Conclusions: Systolic acceleration, which reflects LV contractility, and systolic deceleration, which represents LV relaxation, are predictive of HF admission in patients with the HM3 LVAD.

Abstract 332: Does Concomitant Left Ventricular Unloading Improve Outcomes Of Cardiogenic Shock Managed By Venoarterial Extracorporeal Membrane Oxygenation? Analysis Of National Inpatient Sample Database 2019

Introduction: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is often used in patients with cardiogenic shock. However, this strategy can lead to left ventricular (LV) distention, thus compromising myocardial recovery. Therefore, concomitant LV unloading with an Impella device (Abiomed, Danvers, MA) has gained a wide interest to promote LV recovery. We aimed to investigate the in-hospital outcomes of patients with myocardial infarction and cardiogenic shock undergoing VA-ECMO with Impella (ECPELLA) versus VA-ECMO alone. Methods: We conducted a retrospective cohort study using the 2019 National Inpatient Sample Database. Variables were identified using their International Classification of Diseases, 10th revision (ICD-10) codes. Descriptive bivariate and multivariate analyses were performed. A p-value &lt;0.05 was considered statistically significant. Results: A total of 1915 records of acute myocardial infarction and cardiogenic shock treated with VA-ECMO were identified. Of these, 625 underwent ECPELLA, and 1,290 underwent VA-ECMO alone. Baseline characteristics and complication rates are listed in Table 1. Inpatient mortality rate was not statistically different between the ECPELLA and the VA-ECMO groups [50.4% (n=315) vs 46.1% (n=595), respectively, p=0.08]. In addition, a multivariable logistic regression model adjusting for potential confounders (baseline characteristics in Table 1, as well as primary expected payer, left heart catheterization, and initial presentation with cardiac arrest) did not show a mortality benefit for ECPELLA over VA-ECMO (OR 1.206, 95% CI 0.967-1.50, p=0.097). However, rates of acute renal failure requiring hemodialysis and intracranial hemorrhage were lower in the ECPELLA group. Conclusion: Our data suggests that there is no survival to hospital discharge benefit for ECPELLA vs VA-ECMO. Prospective studies are warranted to validate our findings. .

Usefulness of layer-specific strain for evaluating and predicting recovery of left ventricular myocardial function in patients undergoing hybrid coronary revascularization.

This study aimed to determine if layer-specific strain (LSS) can be used to evaluate and predict left ventricular (LV) recovery in patients with multi-vessel coronary artery disease (CAD) undergoing hybrid coronary revascularization (HCR) using speckle tracking echocardiography (STE). A total of 187 consecutive CAD patients who received HCR in our hospital were prospectively enrolled. 30 healthy individuals with matched age and gender were enrolled as a control group. Echocardiography was performed for CAD patients before and 1, 2, and 6 months after HCR. Comprehensive conventional and LSS echocardiography parameters were collected. LV recovery was defined as improvement in LV ejection fraction (LVEF) > 5% at 6-months follow-up compared with baseline. Logistic regression analysis was used to test the correlates of LV recovery. Receiver operating characteristic curve analysis was used to determine the optimal cutoff value of correlates for predicting LV recovery. LVEF and LV strain in CAD patients were significantly decreased compared with control subjects. Endocardial global longitudinal strain (Endo-GLS) improved significantly at 1-month follow-up (14.2 ± 1.6% vs. 13.8 ± 1.5%, P < 0.05), and LVGLS and global circumferential strain (GCS) improved significantly at 2-months follow-up. Multivariate regression revealed that Endo-GLS, GLS, and SYNTAX score before HCR were independently correlated to LV recovery. Endo-GLS had an optimal cutoff value of 13.2% for predicting LV recovery with sensitivity of 91% and specificity of 78%. LV myocardial systolic function in CAD patients was impaired before HCR and significantly improved after HCR. Endo-GLS was independently correlated to and has optimal predictive value for LV recovery.