Parameters Of Left Ventricular Remodeling Research Articles

NT-pro-BNP Level is Related to Left Ventricular Remodeling in Patients With Primary Aldosteronism.

To assess the relationship between the left ventricular remodeling parameters of cardiac magnetic resonance and NT-pro-BNP in patients with primary aldosteronism (PA). Seventy-four PA and 39 essential hypertension patients were prospectively recruited and underwent cardiac magnetic resonance. Plasma NT-pro-BNP was measured before patients underwent cardiac magnetic resonance. Left ventricular remodeling parameters were defined as left ventricular function parameters, T1 mapping parameters, and strain parameters. Differences in continuous variables between two groups were analyzed using Student's t-test or Mann-Whitney U test. Differences in categorical variables between two groups were analyzed by chi-squared test. Spearman's correlation and linear regression were used to analyze the relationships between left ventricular remodeling parameters and plasma NT-Pro-BNP level. P<0.05 was considered as statistically significant. Patients with PA demonstrated higher NT-pro-BNP [86.0 (49.5, 145.5) vs. 45.0 (28.5, 73.5) pg/mL, P=0.001] and Native T1 (1227±41 vs. 1206±43 ms, P=0.015) level than essential hypertension patients. Compared to patients with normal NT-pro-BNP levels, those with abnormal levels demonstrated different left ventricular remodeling parameters. NT-pro-BNP level was independently related to native T1 (β=0.316, P=0.006), extracellular volume (β=0.419, P<0.001), short-axis global circumferential strain (β=0.429, P<0.001), four-chamber global longitudinal strain (β=0.332, P=0.002), and four-chamber global radial strain (β=-0.334, P=0.004) in patients after adjusting for baseline characteristics. NT-pro-BNP level was related to left ventricular remodeling parameters derived from cardiac magnetic resonance in patients with PA. This result implies that clinicians should pay attention to NT-pro-BNP assessment in patients with PA in routine clinical assessment.

Association of body adiposity with left ventricular concentric remodeling and diastolic dysfunction

AbstractBackgroundObesity is a significant risk factor for heart failure with preserved ejection fraction (HFpEF). In this study, we explore the relationships between body mass index (BMI) and adipose tissue compartments such as visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and epicardial adipose tissue (EAT), with respect to left ventricular (LV) structure and function in subjects with preserved LV systolic function.MethodsBetween January and December 2020, this retrospective study included 749 participants who exhibited preserved LV systolic function and underwent transthoracic echocardiography along with abdominal computed tomography. LV structural and functional variables as well as EAT, VAT, and SAT thickness were evaluated using echocardiography and computed tomography.ResultsSAT decreased, while VAT and EAT progressively increased with age. There were significant correlations between BMI and various adipose tissues, with the strongest correlation observed with SAT (r = .491, p &lt; .001) compared to VAT (r = .371, p &lt; .001) or EAT (r = .135, p &lt; .001). However, EAT demonstrated the most substantial association with decreased LV end‐diastolic dimension, LV end‐systolic dimension, and septal mitral annular velocity and increased relative wall thickness (all p &lt; .05), while VAT and SAT did not show significant associations with LV remodeling and functional parameters after adjusting for clinical variables.ConclusionEAT is the most critical adipose tissue influencing LV geometric and functional changes, compared with VAT or SAT. Thick EAT is associated small LV chamber size, concentric remodeling, and relaxation abnormalities.

Significance of catestatin in the pathogenesis of heart failure with preserved ejection fraction in patients with non-obstructive coronary artery disease

Aim. In patients with non-obstructive coronary artery disease (CAD), to evaluate the pathophysiological significance and diagnostic effectiveness of catestatin in detecting heart failure with preserved ejection fraction (HFpEF), as well as to assess the relationship of the levels of this biomarker with heart rate variability (HRV) parameters and the severity of diastolic dysfunction.Material and methods. The study included 83 patients (44 men, mean age, 62,0 [57,0; 68,5] years) with non-obstructive CAD and preserved left ventricular (LV) ejection fraction of 63 [60; 64]%). Echocardiography was performed according to a standard protocol. HRV was assessed using 24-hour electrocardiographic monitoring. Serum biomarker levels were determined using enzyme-linked immunosorbent assay.Results. Patients were divided into groups depending on HFpEF presence: group 1 (n=63) included patients with newly diagnosed HFpEF, and group 2 included patients without heart failure (n=20). Serum catestatin concentrations were 43,1% lower (p&lt;0,001) in patients with HFpEF than in patients without it. Catestatin had a negative correlation with levels of N-terminal pro-brain natriuretic peptide and C-reactive protein. Moreover, serum catestatin values were inversely correlated with LV remodeling parameters, whereas no relationship was found with HRV values. According to ROC analysis, catestatin £132,83 μg/ml (AUC=0,884; p&lt;0,001) were defined as threshold values associated with HFpEF.Conclusion. Decreased serum catestatin concentrations were associated with HFpEF and overexpression of heart failure and inflammation biomarkers. Moreover, serum catestatin values had a negative relationship with LV remodeling parameters, while no relationship was found with HRV values.

Associations of Traditionally Determined Left Ventricular Mass Indices and Hemodynamic and Non-Hemodynamic Components of Cardiac Remodeling with Diastolic and Systolic Function in Patients with Chronic Kidney Disease.

We aimed to evaluate the extent to which different left ventricular mass parameters are associated with left ventricular function in chronic kidney disease (CKD) patients. We compared the associations between traditionally determined left ventricular mass indices (LVMIs) and hemodynamic (predicted LVMIs) and non-hemodynamic remodeling parameters with left ventricular function in patients with CKD; non-hemodynamic remodeling was represented by inappropriate left ventricular mass and inappropriate excess LVMIs (traditionally determined LVMIs-predicted LVMIs). Non-hemodynamic left ventricular remodeling parameters were strongly associated with impaired left ventricular systolic function (p < 0.001), whereas hemodynamic left ventricular remodeling was also related strongly (p < 0.001) but directly to left ventricular systolic function. Independent of one another, hemodynamic and non-hemodynamic left ventricular remodeling had associations in opposite directions to left ventricular systolic function and was associated directly with traditionally determined left ventricular mas indices (p < 0.001 for all relationships). Non-hemodynamic cardiac remodeling parameters discriminated more effectively than traditionally determined LVMIs between patients with and without reduced ejection fraction (p < 0.04 for comparison). Left ventricular mass parameters were unrelated to impaired diastolic function in patients with CKD. Traditionally determined LVMIs are less strongly associated with impaired systolic function than non-hemodynamic remodeling parameters (p < 0.04-0.01 for comparisons) because they represent both adaptive or compensatory and non-hemodynamic cardiac remodeling.

Extracellular volume is an independent predictor of peak cardiac power in asymptomatic patients with moderate-to-severe aortic stenosis

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The PRIMID study was funded by an NIHR fellowship (Post-Doctoral Fellowship supported by the National Institute for Health Research (NIHR-PDF 2011–04–51 Gerald P McCann.) Background Cardiac power (CP) describes the cardiac work done to maintain arterial pressure in the vasculature and peak CP is the ceiling of pumping performance the heart can achieve. Mean pressure gradient adjusted CP (MPG-CP) gives a more accurate representation of afterload in patients with aortic stenosis (AS) but its association with left-ventricular remodelling parameters is unknown. Purpose To establish the determinants of peak MPG-CP in asymptomatic patients with AS. Methods In this prospective, multi-centre observational study, asymptomatic patients with moderate to severe AS underwent echocardiography, cardiovascular magnetic resonance (CMR) imaging and cardiopulmonary exercise testing. Peak MPG-CP was calculated at peak exercise during an incremental symptom-limited exercise test on semi-supine ergometer, using the formula shown (Figure-1). Clinical and imaging univariable and multivariable associations of peak MPG-CP were assessed by linear regression. Results Peak MPG-CP was measured in 86 patients (mean age 66±12 years, 77% male, mean aortic valve area (AVA) 1.08±0.33 cm^2). On univariable analysis, peak MPG-CP was directly correlated with echocardiogram-measured AVA, peak pressure gradient, max velocity, and CMR-measured myocardial perfusion reserve (MPR), LV mass index (LVMI) and LV end-diastolic volume index (LVEDVI), and inversely correlated with extracellular volume (ECV) and NT-proBNP (Table-1). ECV was the only variable independently associated with peak MPG-CP regardless of which measure of AS severity was inputted in the multivariable model. Conclusions ECV, a marker of diffuse interstitial fibrosis, is an independent predictor of peak MPG-CP in asymptomatic patients with moderate-severe AS. Given ECV's role as a prognosticator, CP parameters may be important markers of subclinical disease and serve as surrogates for fibrotic burden and risk-stratification tools in asymptomatic AS.

Propensity score matching analysis of the aortiv valve replacement with the xenopericardial semi-framed prosthesis “T-Ara” and the framed xenopericardial prosthesis “UniLine”. Short-term results

Highlights. It is the first pseudorandomized comparative study of xenopericardial frame and half-frame bioprostheses treated with diepoxin in the aortic position use and its direct results.Aim. A comparative assessment using the Propensity Score Matching method of the in-hospital clinical and hemodynamic results of the semi-framed epoxy-treated xenopericardial prosthesis “T-ara” and the framed epoxy-treated xenopericardial prosthesis “UniLine” (“NeoKor”, Kemerovo, Russia) for isolated aortic valve replacement implantation.Methods. 33 recipients of the “UniLine” prosthesis were selected by Propensity Score Matching method in a ratio of 1:1 to 33 observations from the “T-ara” group according to the compliance criteria: gender, age, body surface area, end-diastolic volume of the left ventricle (LV) and the pre-operative presence/absence of the aortic regurgitation.Results. Hospital mortality in the “T-ara” and “UniLine” groups was 3.03 (n = 1) and 6.06% (n = 2), respectively, p = 0.920. Non-fatal complications in the “T-ara” and “UniLine” groups was 7 (21.2%) and 18 (54.6%), p = 0.163. The incidence of postoperative heart failure and arrhythmias was higher in “UniLine” recipients (p = 0.001). The average stay in the intensive care unit was longer in the “UniLine” group than in the “T-ara” group, p = 0.05. Postoperative end-systolic and end-diastolic dimensions and volumes (and the corresponding indexes) of the LV, as well as the myocardial mass and its index in both groups had no statistically significant changes in relation to preoperative data. The comparative assessment of left ventricular remodeling parameters depending on the prosthetic size revealed no significant differences. The average pressure gradient in the “T-ara» and “UniLine” group of size 21mm was 12.2±7.4 and 12.2±5.0 mm Hg. (p&gt;0.050). The average pressure gradient in the group “T-ara” and “UniLine” size 23–25 mm was 10.2±4.1 and 9.9±0.3 mm Hg, p&gt;0.050. The regression degree of LV myocardial mass index in the groups did not have significant differences.Conclusion. At the hospital stage, the semi-framed epoxy-treated biological prosthesis “T-ara” has a similar clinical and hemodynamic profile with the framed biological prosthesis “UniLine”. The frequency of postoperative heart failure and cardiac arrhythmias is statistically significantly higher in the “UniLine” group (framed bioprostheses).

Biomarker Phenotypes in Heart Failure with Preserved Ejection Fraction Using Hierarchical Clustering: A Pilot Study

Objectives: We hypothesized the existence of distinct phenotype-based groups within the very heterogeneous population of patients of heart failure with preserved ejection fraction (HFpEF) and using an unsupervised hierarchical clustering applied to plasma concentration of various biomarkers. We sought to characterize them as “biomarker phenotypes” and to conclude differences in their overall characteristics. Subjects and Methods: A cross-sectional study was conducted on 75 patients with HFpEF. An agglomerative hierarchical clustering was performed using the concentrations of cardiac remodeling biomarkers, BNP, and cystatin C. Results: According to the obtained heat map of this analysis, we concluded two distinctive biomarker phenotypes within the HFpEF. The “remodeled phenotype” presented with significantly higher concentrations of cardiac remodeling biomarkers and cystatin C (p < 0.001), higher prevalence of myocardial infarction (p = 0.047), STEMI (p = 0.045), atrial fibrillation (p = 0.047), and anemia: lower erythrocytes count (p = 0.037), hemoglobin concentration (p = 0.034), and hematocrit (p = 0.046), compared to “non-remodeled phenotype.” Echocardiography showed that patients within “remodeled phenotype” had significantly increased parameters of left ventricular remodeling: left ventricular mass index (p < 0.001), left ventricular mass (p = 0.001), diameters of the interventricular septum (p = 0.027), posterior wall (p = 0.003), and function alterations, intermediate pauses duration >2.0 s (p < 0.006). Conclusion: Unsupervised hierarchical clustering applied to plasma concentration of various biomarkers in patients with HFpEF enables the identification of two biomarker phenotypes, significantly different in clinical characteristics and cardiac structure and function, whereas one phenotype particularly relates to patients with reduced ejection fraction. These findings imply distinct underlying pathophysiology within a unique cohort of HFpEF.

Extent and predictors of exercise-induced changes in ischemic mitral regurgitation during handgrip exercise

Abstract Background Mitral regurgitation (MR) is frequent in patients with ischemic heart disease and carries a dismal prognosis. Recent studies suggest that ischemic MR is a dynamic condition influenced by global and regional left ventricular (LV) remodeling as well as mitral valvular deformation. Handgrip exercise may serve as alternative exercise intervention to bicycle exercise. Purpose To assess degree and determinants of exercise-induced changes in ischemic MR during handgrip exercise. Methods We prospectively enrolled 205 patients with at least mild ischemic MR that underwent echocardiography at rest and during three minutes of handgrip exercise according to a standardized protocol. Results Mean age in our patient cohort was 75±10 years, 30% were female, and 58% suffer from atrial fibrillation. Median NT-proBNP was 2657 (1331–6599) ng/l. Mean left ventricular ejection fraction was 44±14%. At rest, MR severity was graded as mild in 57% of patients, moderate MR in 34% and severe in 9%. Mean effective regurgitant orifice area (EROA) at rest was 15±6 mm2 and regurgitation volume was 25±11 ml. During handgrip exercise, 58 patients (28%) showed an increase in MR severity in at least one grade; 30 patients (15%) with non-severe MR at rest, developed severe MR during handgrip exercise. The EROA decreased (&amp;gt;5 mm2) in 5% of patients, remained unchanged in 50% (between −5 mm2 and +5 mm2), and increased (&amp;gt;5 mm2) in 45% of patients (Fig. 1B). A small increase (5–10 mm2) was observed in 30%, while 15% of patients revealed a marked increase in EROA (&amp;gt;10 mm2) (Fig. 1B). The degree of MR at rest was not associated with exercise-induced increases in EROA (r=−0.03; p=0.641)(Fig. 1C). However, echocardiographic parameters of local (e.g. tenting height) and global (e.g. LVESVi) LV remodeling, as well as mitral valvular deformation correlated with exercise-induced changes in EROA (Table 1). Conclusion In patients with secondary MR due to ischemic heart disease, handgrip echocardiography unmasks exercise-induced increases of MR severity in a significant proportion of patients. Dynamic MR during handgrip exercise is associated with parameters of global and local LV remodeling as well with parameters of mitral valvular deformation. Future studies need to address the prognostic importance of exercise-induced changes in MR severity in patients with ischemic cardiomyopathy. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich Heine University Düsseldorf to Maximilian Spieker for a Clinician Scientist Track.

Relative apical sparing in severe aortic stenosis: does it mean concomitant amyloid cardiomyopathy?

Abstract Background Relative apical sparing (RAS) of left ventricular (LV) longitudinal strain (LS) is a red flag marker for the suspicion of amyloid cardiomyopathy. However, it has also been described in patients with severe aortic stenosis (AS). Aim To assess the prevalence of RAS in patients with severe symptomatic AS referred for surgical aortic valve replacement (AVR), to evaluate its clinical significance and assess its presence after surgery. Methods We prospectively studied 135 consecutive patients (age: 73 y [IQR 68–77 y], 49% men) with severe symptomatic AS – mean transaortic pressure gradient (AVmean): 60.9±17.7 mmHg; mean aortic valve area: 0.7±0.2 cm2, referred for surgical AVR with no previous history of ischemic cardiomyopathy or other. Beyond 12 lead-ECG and transthoracic echocardiography (TTE), all patients underwent cardiac magnetic resonance (CMR) before surgery. RAS was defined by the ratio &amp;gt;1 of average LS at apical segments/sum of the average basal and mid LS at speckle tracking analysis. AVR with septal myocardial biopsy, for investigational purposes, was performed in 80 patients. AS severity indexes, LV remodeling and tissue characterization parameters were compared in both groups of patients, with and without RAS. LS deformation pattern was reassessed at 3–6 months after AVR. Results RAS was present in 24 patients (18%). In the whole cohort there were neither pseudoinfarct pattern or low voltage ECG criteria, nor infiltration suspicion from CMR (native T1 value 1053 ms [IQR 1025–1071 ms] for institutional reference values: 972–1070 ms; ECV 24% [IQR 21–27%]). None of the patients had amyloid deposition at histopathology. Overall, mean CMR LV ejection fraction (LVEF) was 59.6±10.5% and 98 patients (74%) had non-ischemic delayed enhancement, with a median fibrosis fraction of 4.1% [IQR 1.6–7.8%]. RAS cohort had a significantly higher AVmean gradient, relative wall thickness, maximum septal thickness, peak systolic dispersion, with lower global LS at TTE, as well as higher LV mass and lower LVEF at CMR. RAS group has also higher NT-proBNP ambulatory values (Table 1). Follow-up evaluation after AVR revealed RAS disappearance in 19 patients (79.2%). Conclusions RAS occurs in almost one-fifth of the patients in this cohort despite the absence of signs of myocardial infiltration. This deformation pattern elapses with worse indexes of LV remodeling consistent with a more advanced stage of the disease, being reversible after AVR, which stands for the absence of concomitant myocardial infiltration. Funding Acknowledgement Type of funding sources: None.

Dynamics of the Indicators of Low Dose Dobutamine Stress-Echocardiography under the Influence of High Doses of Atorvastatin in Patients with ST Elevation Myocardial Infarction

The aim of investigation: to study the effect of early administration high doses of atorvastatin in the acute period of STEMI on the indicators of low dose dobutamine stress-echocardiography and parameters of left ventricular remodeling. Material and Methods: The study included 164 patients with STEMI All patients underwent myocardial revascularization (TLT or PCI) within the first 6 hours. The 1st group included 82 patients who received basic therapy (atorvastatin 20 mg), the 2nd group included 82 patients who took a loading dose of atorvastatin (at a dose of 80 mg per day). Low dose dobutamine stress-echocardiography was performed to detect myocardial stunning after stabilization of the patients condition on 4–6 days of the disease. In addition to general clinical and conventional laboratory research methods, on the 1st day and on the 10th day of treatment, the level of CPK MB, ESR, the number of blood leukocytes, and the level of fibrinogen (FN) were determined. Results: On the 10th day of therapy in patients of both groups, there was a significant increase in ESR (in the 1st group by 2.1 times, in the 2nd - by 1.6 times) and a decrease in the level of CRP (by 3 and 2.65 times, respectively) compared to the first day. The dynamics of these indicators reflects the regular processes of the course of AMI. A more significant change in these parameters was recorded in patients of the 2nd group who took atorvastatin at a dose of 80 mg. At the same time, on the 10th day of AMI, the number of peripheral blood leukocytes significantly decreased in them (p&lt;0.05 when compared between groups). The number of dobutamine-responsive segments (segments with reversible dysfunction) in the group of patients treated with atorvastatin at a dose of 80 mg during myocardial reperfusion was significantly higher than in the control group (p&lt;0.05). Conclusion: It was revealed that conducting of myocardium reperfusion in infarct-related coronary artery with simultaneous use of atorvastatin’s high doses promoted the limitation of myocardial necrosis development, reducing ischemic and reperfusion injuries of myocardium and influenced on the formation of myocardial stunning zones which is a reversible disfunction. The use of atorvastatin in the dose of 80 mg/per day in the first hours after acute myocardial infarction development promotes the improvement of LV systolic indices, prevents the progressing of LV cavity postinfarction dilatation.

Preventative effects of dapagliflozin on early ventricular dysfunction and remodeling in patients with acute anterior STEMI - The PREDOMINACE trial

BackgroundSodium glucose cotransporter 2 inhibitors (SGLT-2i) are oral hypoglycemic drugs that can reduce the risk of deteriorating heart failure (HF) or cardiovascular death in patients with HF. Although some animal models have shown that SGLT-2i can effectively inhibit reperfusion injury after acute myocardial infarction (AMI), there is no clinical evidence to prove that SGLT-2i can also play a significant role in improving reperfusion injury in patients with AMI. Therefore, PREDOMINACE study enrolled patients with acute anterior large ST-segment elevation myocardial infarction, who are at high risk of developing HF in the future. The aim of this trial is to study the prevention effects of dapagliflozin on early ventricular dysfunction and remodeling in patients with acute anterior ST-segment elevation myocardial infarction (STEMI), and to explore the efficacy and safety of dapagliflozin in the treatment of patients with diabetes and without diabetes after acute anterior STEMI. MethodsWithin a multi-center, randomized, single-blind, controlled trial we will recruit patients with acute anterior STEMI from the Second Hospital of Tianjin Medical University and Tianjin Chest Hospital, who are randomly divided into intervention group or control group in a 1:1 ratio. The intervention group was given dapagliflozin (10 mg once daily) before primary percutaneous coronary intervention (PPCI) and 30 days after PPCI, while the control group is not given SGLT-2i. The primary endpoint is the impact of dapagliflozin on changes of NT-proBNP levels in 30 days of acute anterior STEMI. Secondary endpoints include changes in echocardiographic left ventricular remodeling parameters (LVESV, LVEDV, EF), and the changes of ECG (Q wave leads 30 days after PPCI/ST-segment elevation leads at baseline,ST-segment decline degree 24 h and 7 days after PPCI). Hospitalization rate due to HF or other causes, incidence of malignant arrhythmias, and all-cause mortality will be assessed as exploratory secondary endpoints. DiscussionThe PREDOMINACE trial will test dapagliflozin in patients with acute anterior STEMI, regardless of the presence or absence of diabetes. Therefore, the PREDOMINACE trial may support that the effects of SGLT-2i on improving cardiac remodeling, reducing cardiac pre and after load and improving cardiac metabolism are independent of its antidiabetic effects. Results will provide the clinical rationale for SGLT-2i to improve prognosis in patients with AMI.Trial registration: Chinese Clinical Trial Registry. Identifier: ChiCTR2100048157. Registered 23 September 2021.

The effect of surgical ventricular restoration technics on left ventricular remodeling in different heart failure phenotypes

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac remodeling represents a major cause of heart failure (HF) as well as cardiac morbidity and mortality [1], surgical ventricular restoration (SVR) improve left ventricular function, clinical condition and heart failure [2]. Objectives We assessed the early outcomes after open-heart surgery, which included techniques of ventricular restorations on left ventricular dimensions and function. Additionally we evaluated the effect of SVR according to the heart failure phenotypes. Material and Methods A 4 months prospective observational study enrolled 100 patients that underwent procedures of surgical ventricular restoration through Dor and Jatene method. All patients were evaluated through chest echocardiography at presentation, before surgery and at the end of heart rehabilitation program. In addition, we analyzed the left ventricle indices according to three heart failure phenotypes: group 1 (Gr.1) – HF with preserved EF, group 2 (Gr. 2) – HF with mildly reduced EF, group 3 (Gr. 3) – HF with reduced EF. Results The left ventricle diameter and volume in systole and diastole registered statistically significant differences (p &amp;lt;0.001) both in the general group and in the different clinical phenotypes of HF. The end-systolic diameter of the left ventricle decreased significantly in the general group compared to the rehabilitation stage and the preoperative by – 2, 0 ± 0, 6. Regarding the end-systolic volume of the left ventricle, the statistical significant differences (p&amp;lt;0.001, Fig.1) were marked at the stage of cardiac rehabilitation compared to the preoperative stage both in the general group with -13.0 ± 4.6. The same comparative analysis showed the relation between the groups Gr. 1: -1.2 ± 3.4, Gr. 2: -6.9 ± 8.5, Gr. 3: -42.5 ± 11.8. The systolic function of the left ventricle expressed through the EF (Fig.2) also meets a growth / improvement dynamics (p &amp;lt;0.001) assessed by comparative analysis of data at the stage of cardiac rehabilitation compared to the preoperative stage. It was found for the general group an increase of 1.0 ± 0.7, and a more obvious increase for Gr. 2: 3.6 ± 1.5 and Gr. 3: 4.2 ± 1.4. Conclusion The dynamics of left ventricular remodeling parameters in patients undergoing surgery shows statistically significant growth both in the general group and in the sub-group analysis. It induces significant decrease in the end-systolic and end-diastolic diameters and volumes of the left ventricle at the post-rehabilitation stage in all three groups. Therefore, surgical ventricular restorations influence the further positive outcomes on left ventricular function. The contraction function of the left ventricular myocardium registered a slightly positive dynamics, fact highlighted by the comparative analysis of the post-rehabilitation phase with the preoperative one, the increase of the EF being subtle in the general group and more expressed for the group with the slightly reduced ejection and with low ejection fraction.

Abstract 9997: Sex Differences in Chamber Remodeling Associated with Non-Ischemic Cardiomyopathy and Functional Mitral Regurgitation: A Cardiac Magnetic Resonance Study

Background: Sex differences in the chamber sizes of healthy individuals by echocardiography and magnetic resonance imaging (MRI) are well-established, however chamber remodeling discrepancies in cardiomyopathies and functional mitral regurgitation (FMR) are not well understood. This study compared MRI chamber quantification and remodeling parameters by sex in patients with non-ischemic cardiomyopathy (NICM) and varying degrees of FMR. Methods: We retrospectively studied 633 adult NICM patients undergoing MRI during 2002-2017. Quantitative chamber size, function and left ventricular remodeling parameters by MRI were compared by sex, adjusted for age, hypertension and diabetes, and assessed against FMR severity. Results: Mean age was 52.6 years and 256 (40.4%) patients were women. Significant adjusted women minus men mean differences (95%CI) include left ventricular end-diastolic volume indexed (LVEDVi) -8.5 (-15.1, -1.9)mL/m2 P=0.012, left ventricular mass indexed -11.7 (-15.6, -7.9)g/m2 P&lt;0.001, sphericity ratio -0.08 (-0.13, -0.03) P=0.002, relative wall thickness (RWT) -4.5 (-7.2, -1.8)% P=0.001, right ventricular end-diastolic volume indexed (RVEDVi) -16.0 (-20.3, -11.8) mL/m2 P&lt;0.001, right ventricular ejection fraction +5.2 (+3.2, +7.2)% P&lt;0.001, and right atrial volume indexed (RAVi) -10.5 (-13.6, -7.4) mL/m2 P&lt;0.001, while left ventricular ejection fraction, late gadolinium enhancement score and left atrial volume indexed were similar. With increasing FMR severity, LVEDVi and LAVi had a more prominent increase in women than men, while LVMi, sphericity ratio, RWT, RVEDVi and RAVi were consistently lower for women(Figure). Conclusion: Although women had significantly lower chamber size, RWT and sphericity ratio in NICM than men, their left-sided chamber sizes increased more steeply as FMR increased. These exploratory MRI findings highlight sex differences in chamber remodeling in NICM and responses to greater degree of FMR.

Associations of Brachial-Ankle Pulse Wave Velocity With Left Ventricular Geometry and Diastolic Function in Untreated Hypertensive Patients.

Background: Although brachial-ankle pulse wave velocity (baPWV) is simple and convenient, its usefulness as an initial screening test for hypertensive patients is not well-known. This study aimed to investigate the association of baPWV with left ventricular (LV) geometry and diastolic function in treatment-naive hypertensive patients.Methods: A total of 202 untreated hypertensive patients (mean age, 62 years; males, 51.5%) without documented cardiovascular diseases were prospectively enrolled. Both baPWV and transthoracic echocardiography were performed on the same day before antihypertensive treatment.Results: In multiple linear regression analysis after adjustment for potential confounders, baPWV had significant correlations with structural measurements of LV including relative wall thickness (β = 0.219, P = 0.021) and LV mass index (β = 0.286, P = 0.002), and four diastolic parameters including septal e′ velocity (β = −0.199, P = 0.018), E/e′ (β = 0.373, P < 0.001), left atrial volume index (β = 0.334, P < 0.001), and maximal velocity of tricuspid regurgitation (β = 0.401, P < 0.001). The baPWV was significantly increased in patients with LV hypertrophy, abnormal LV remodeling, or diastolic dysfunction, compared to those without (P = 0.008, P = 0.035, and P < 0.001, respectively). In the receiver operating characteristic curve analysis, the discriminant ability of baPWV in predicting LV hypertrophy and diastolic dysfunction had an area under the curve of 0.646 (95% confidence interval 0.544–0.703, P = 0.004) and 0.734 (95% confidence interval 0.648–0.800, P < 0.001), respectively.Conclusion: baPWV was associated with parameters of LV remodeling and diastolic function in untreated hypertensive patients. The baPWV could be a useful screening tool for the early detection of adverse cardiac features among untreated hypertensive patients.

Association Between Intermittent Hypoxia and Left Ventricular Remodeling in Patients With Obstructive Sleep Apnea-Hypopnea Syndrome.

The present study was undertaken to examine the association between intermittent hypoxia and left ventricular (LV) remodeling and explore which parameter of intermittent hypoxia is most relevant to LV remodeling in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Two hundred eighty six patients underwent polysomnographic examination were enrolled. Based on apnea-hypoxia index (AHI), patients were divided into no, mild, moderate and severe OSAHS groups. Between-group differences in LV remodeling and the association between parameters of intermittent hypoxia and LV remodeling was evaluated. Patients with severe OSAHS were more likely to have hypertension, and higher values of LV mass (LVM) and LVM index (LVMI). In univariate regression analysis, male, body mass index (BMI), systolic and diastolic blood pressure (BP), statins, antihypertensive drugs, creatinine, and parameters of intermittent hypoxia (AHI, obstructive apnea index [OAI], lowest oxygen saturation [LSpO2], oxygen desaturation index [ODI], time spent below oxygen saturation of 90% [TS90%], and mean nocturnal oxygen saturation [MSpO2]) were associated with LVMI. After multivariate regression analyses, only male gender, BMI, systolic BP, creatinine, and ODI remained significantly associated with LVMI. Compared to those without LV hypertrophy (LVH), patients with LVH had higher ODI. Compared to patients with normal LV, concentric remodeling and eccentric LVH, those with concentric LVH had higher ODI. In conclusion, intermittent hypoxia was significantly associated with left ventricular remodeling; and among various parameters of intermittent hypoxia, ODI was the most relevant to LV remodeling.

Texture-based machine learning in LGE-CMRI for automatic scar assessment

Abstract Background Conventional methods for the estimation of infarct size by late-enhanced cardiac magnetic resonance imaging use analyzes from each slice which in turn is added to generate a volume. We present a novel method based on machine learning, called texture based probability mapping (TPM). TPM is based upon expressing the probability of scarring in a pixel based upon analysing textural information in patches around each pixel. Purpose To explore our method and assess its utility as a tool to scar size and compare it with four established methods. Methods In 54 patients with ischemic scars, our method was compared with four 2D methods. 2 patients were excluded due to low image quality and artefacts. The most basal and apical short axis image slices were exclude due to partial volume artefacts. Myocardial infarction (MI) size was estimated manually, and TPM performed. Cardiac segments were defined as myocardial regions with pixel probabilities within a specified range. By varying the lower probability threshold while keeping the upper threshold fixed at 1, different cardiac segments were defined. Using the Sørensen-Dice coefficient the optimal probability range with the highest correlation to manual estimation of infarct size was identified. Results TPM-range 0.341–1.0 is best correlated to manual demarcation (median Dice 0.70). The method demonstrated stronger correlations between scar size and left ventricular remodeling parameters (LV ejection fraction: r=−0.731, p&amp;lt;0.0005; LV end-diastolic volume: r=0.641, p&amp;lt;0.0005; LV end-systolic volume: r=0.672, p&amp;lt;0.0005) compared with manual method. Conclusion Using TPM, infarct size can be measured automatically without using signal intensity as a reference value. It is without the need for manual demarcation of the scar and is less time consuming and less vulnerable to interobserver variability. It has a strong correlation with left ventricular remodeling parameters crucial in guiding further medical therapy. The use of this method is however not primarily dedicated for scar size estimation, but a tool to evaluate different properties of the tissue that cannot be visualized by the naked eye. It's an important step towards better understanding of myocardial damage pattern causing ventricular arrhythmia and SCD. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Helse Vest

Impact of Mitral Regurgitation Severity and Left Ventricular Remodeling on Outcome After MitraClip Implantation: Results From the Mitra-FR Trial

ObjectivesThis study aimed to identify a subset of patients based on echocardiographic parameters who might have benefited from transcatheter correction using the MitraClip system in the MITRA-FR (Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation) trial. BackgroundIt has been suggested that differences in the degree of mitral regurgitation (MR) and left ventricular (LV) remodeling may explain the conflicting results between the MITRA-FR and the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trials. MethodsIn a post hoc analysis, we evaluated the interaction between the intervention and subsets of patients defined based on MR severity (effective regurgitant orifice [ERO], regurgitant volume [RVOL] and regurgitant fraction [RF]), LV remodeling (end-diastolic and end-systolic diameters and volumes) and combination of these parameters with respect to the composite of death from any cause or unplanned hospitalization for heart failure at 24 months. ResultsWe observed a neutral impact of the intervention in subsets with the highest MR degree (ERO ≥30 mm2, RVOL ≥45 ml or RF ≥50%) as in patients with milder MR degree. The same was seen in subsets with the milder LV remodeling using either diastolic or systolic diameters or volumes. When parameters of MR severity and LV remodeling were combined, there was still no benefit of the intervention including in the subset of patients with an ERO/end-diastolic volume ratio ≥ 0.15 despite similar ERO and LV end-diastolic volume compared with COAPT patients. ConclusionsIn the MITRA-FR trial, we could not identify a subset of patients defined based on the degree of the regurgitation, LV remodeling or on their combination, including those deemed as having disproportionate MR, that might have benefited from transcatheter correction using the MitraClip system. (Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation [MITRA-FR]; NCT01920698)

B-type natriuretic peptide and cardiac remodelling after myocardial infarction: a randomised trial

ObjectiveB-type natriuretic peptide (BNP) has favourable effects on left ventricular remodelling, including antifibrotic and antiapoptotic properties. We tested the hypothesis that infusion of BNP after an acute myocardial infarction would...

A low-cost texture-based pipeline for predicting myocardial tissue remodeling and fibrosis using cardiac ultrasound.

BackgroundMaturation of ultrasound myocardial tissue characterization may have far-reaching implications as a widely available alternative to cardiac magnetic resonance (CMR) for risk stratification in left ventricular (LV) remodeling.MethodsWe extracted 328 texture-based features of myocardium from still ultrasound images. After we explored the phenotypes of myocardial textures using unsupervised similarity networks, global LV remodeling parameters were predicted using supervised machine learning models. Separately, we also developed supervised models for predicting the presence of myocardial fibrosis using another cohort who underwent cardiac magnetic resonance (CMR). For the prediction, patients were divided into a training and test set (80:20).FindingsTexture-based tissue feature extraction was feasible in 97% of total 534 patients. Interpatient similarity analysis delineated two patient groups based on the texture features: one group had more advanced LV remodeling parameters compared to the other group. Furthermore, this group was associated with a higher incidence of cardiac deaths (p = 0.001) and major adverse cardiac events (p < 0.001). The supervised models predicted reduced LV ejection fraction (<50%) and global longitudinal strain (<16%) with area under the receiver-operator-characteristics curves (ROC AUC) of 0.83 and 0.87 in the hold-out test set, respectively. Furthermore, the presence of myocardial fibrosis was predicted from only ultrasound myocardial texture with an ROC AUC of 0.84 (sensitivity 86.4% and specificity 83.3%) in the test set.InterpretationUltrasound texture-based myocardial tissue characterization identified phenotypic features of LV remodeling from still ultrasound images. Further clinical validation may address critical barriers in the adoption of ultrasound techniques for myocardial tissue characterization.FundingNone.

In situ nuclear DNA methylation in dilated cardiomyopathy: an endomyocardial biopsy study.

AimsAlthough distinct DNA methylation patterns have been reported, its localization and roles remain to be defined in heart failure. We investigated the cellular and subcellular localization of DNA methylation and its pathophysiological significance in human failing hearts.Methods and resultsUsing left ventricular (LV) endomyocardial biopsy specimens from 75 patients with dilated cardiomyopathy (DCM; age: 58 ± 14 years old, %female: 32%) and 20 patients without heart failure (controls; age: 56 ± 17 years old, %female: 45%), we performed immunohistochemistry and immunoelectron microscopy for methylated DNA, 5‐methylcytosine (5‐mC). We next investigated possible relations of the incidence of 5‐mC‐positive (%5‐mC+) cardiomyocytes with clinicopathological parameters. Immunopositivity for 5‐mC was detected in the cardiomyocytes and other cell types. The %5‐mC+ cardiomyocytes was significantly greater in DCM hearts than in controls (57 ± 13% in DCM vs. 25 ± 12% in controls, P < 0.0001). The localization of 5‐mC immunopositivity in cardiomyocyte nuclei coincided well with that of heterochromatin, as confirmed by immunoelectron microscopy. Substantial DNA methylation was also observed in interstitial non‐cardiomyocytes, but the incidences did not differ between control and DCM hearts (39 ± 7.9% in DCM vs. 41 ± 10% in controls, P = 0.4099). In DCM patients, the %5‐mC+ cardiomyocytes showed a significant inverse correlation with LV functional parameters such as heart rate (r = 0.2391, P = 0.0388), end‐diastolic pressure (r = 0.2397, P = 0.0397), and ejection fraction (r = −0.2917, P = 0.0111) and a positive correlation with LV dilatation (volume index at diastole; r = 0.2442, P = 0.0347; and volume index at systole; r = 0.3136, P = 0.0062) and LV hypertrophy (mass index; r = 0.2287, P = 0.0484)—that is, LV remodelling parameters. No significant correlations between DNA methylation and the histological parameters of the biopsies, including cardiomyocyte hypertrophy, fibrosis, and inflammatory cell infiltration, were noted.ConclusionsThe present study revealed increased nuclear DNA methylation in cardiomyocytes, but not other cell types, from DCM hearts, with predominant localization in the heterochromatin. Its significant relations with LV functional and remodelling parameters imply a pathophysiological significance of DNA methylation in heart failure.