Left Ventricular Reverse Remodeling In Patients Research Articles

Left atrial conduit strain derived from cardiac magnetic resonance is an independent predictor of left ventricular reverse remodeling in patients with nonischemic cardiomyopathy

BackgroundIn some patients with nonischemic cardiomyopathy (NICM), left ventricular (LV) function improves with medical assistance, resulting in left ventricular reverse remodeling (LVRR). However, predictors of LVRR are not fully understood. The left atrium (LA) has been reported as a prognostic predictor in patients with heart failure (HF). The present study aimed to evaluate clinical predictors of LVRR related to LA function on cardiac magnetic resonance (CMR).MethodsA total of 103 patients with reduced left ventricular ejection fraction (LVEF) were enrolled in this retrospective study between September 2015 and July 2021. CMR parameters, including strain data, were measured in all patients. Echocardiographic data obtained approximately 2 years after enrollment were analyzed to assess LVRR.ResultsLVRR occurred in 46 patients (44.7%) during follow-up. The value of LA conduit strain was higher in the LVRR group than in the non-LVRR group (6.6 [interquartile range (IQR): 5.6–9.3]% versus 5.0 [IQR: 3.0-6.2]%; p < 0.001). The multivariate logistic regression analysis showed that LA conduit strain was an independent predictor of LVRR (odds ratio [OR]: 1.216, 95% confidence interval [CI]: 1.050–1.408; p = 0.009). The area under the receiver operating characteristic (ROC) curve of the LA conduit strain was 0.746, and the cutoff value was 6.2%. The Kaplan‒Meier analysis revealed that the incidence of adverse cardiac events was significantly lower in patients with LA conduit strain > 6.2% compared to those with ⩽6.2%. (log-rank test, p = 0.019).ConclusionsLA conduit strain derived from CMR is an independent predictor of LVRR in patients with NICM.

Abstract 14836: Left Ventricular Extracellular Volume on Computed Tomography is Useful for Predicting Reverse Remodeling After Catheter Ablation for Atrial Fibrillation

Introduction: In the CAMERA-MRI study, restoring sinus rhythm with catheter ablation (CA) for atrial fibrillation (AF) significantly improved left ventricular (LV) ejection fraction (EF), particularly in the absence of LV myocardial fibrosis, determined by magnetic resonance imaging (MRI). LV extracellular volume fraction (ECV) on MRI correlates with myocardial fibrosis. Recently analysis of LVECV on computed tomography (CT) has been feasible and LVECV on CT and MRI correlate well. Little is known about what predicts achieving LV reverse remodeling (LVRR) after CA. Hypothesis: LVECV on pre-ablation planning CT could predict LVRR after CA in patients with AF and reduced LVEF. Methods: One thousand three hundred twenty patients underwent CA for AF in our institutions from Apr 2014 to Aug 2022. Of these, 50 patients (4%) with LVEF under 50% on transthoracic echocardiography (TTE) were included. All patients underwent cardiac CT using 320-detector or 256-detector row CT before the CA. LVECV was measured by CT using non-contrast and late-phase cardiac images (Figure A). We defined LVRR as an LV end-systolic volume decrease of 15% or more, an increase in LVEF to 50% or more, or an absolute LVEF increase of 15% or more. We evaluated the utility of LVECV for the prediction of LVRR after CA. Results: LVRR was achieved in 31 patients (62%) after CA, and LVECV was significantly lower in them than in the others (31.3 ± 3.3% vs. 35.9 ± 6.6%, P &lt; 0.01) (Figure B). On receiver operating characteristic curve analysis, the best cut-off of LVECV for the prediction of LVRR was 34.8%, and the sensitivity and specificity of LVECV for the prediction of RR were 90 and 68% (the area under the curve was 0.72, Figure C). On multivariate logistic regression analysis, LVECV less than or equal to 34.8% was the only significant predictor of LVRR. Conclusion: LVECV on CT is useful for predicting LVRR in patients with AF after CA.

Prognostic importance of glycemic variability on left ventricular reverse remodeling after the first episode of ST-segment elevation myocardial infarction

BackgroundThis study aimed to investigate the effect of glycemic variability (GV), determined using a continuous glucose monitoring system (CGMS), on left ventricular reverse remodeling (LVRR) after ST-segment elevation myocardial infarction (STEMI).MethodsA total of 201 consecutive patients with STEMI who underwent reperfusion therapy within 12 h of onset were enrolled. GV was measured using a CGMS and determined as the mean amplitude of glycemic excursion (MAGE). Left ventricular volumetric parameters were measured using cardiac magnetic resonance imaging (CMRI). LVRR was defined as an absolute decrease in the LV end-systolic volume index of > 10% from 1 week to 7 months after admission. Associations were also examined between GV and LVRR and between LVRR and the incidence of major adverse cardiovascular events (MACE; cardiovascular death, acute coronary syndrome recurrence, non-fatal stroke, and heart failure hospitalization).ResultsThe prevalence of LVRR was 28% (n = 57). The MAGE was independent predictor of LVRR (odds ratio [OR] 0.98, p = 0.002). Twenty patients experienced MACE during the follow-up period (median, 65 months). The incidence of MACE was lower in patients with LVRR than in those without (2% vs. 13%, p = 0.016).ConclusionLow GV, determined using a CGMS, was significantly associated with LVRR, which might lead to a good prognosis. Further studies are needed to validate the importance of GV in LVRR in patients with STEMI.

Cardiac sympathetic activity and relationship to cardiac events and left ventricular reverse remodeling in patients with non-ischemic dilated cardiomyopathy.

Delayed heart-to-mediastinum ratio (HMR) has been associated with catecholamine levels and contractile reserve in dilated cardiomyopathy (DCM); however, there is scant evidence regarding the association between cardiac sympathetic activity and left ventricular reverse remodeling (LV-RR). We calculated the 123I-metaiodobenzylguanidine (123I-mIBG) HMR and washout rate (WR) in patients with DCM and investigated their associations with LV-RR. From April 2003 to January 2020, in 120 patients with DCM who underwent 123I-mIBG scintigraphy. 66 patients undergoing follow-up echo and taking a beta-blocker from baseline were examined the relationship between 123I-mIBG and LV-RR. After that, this prognostic value for composite cardiac events was evaluated in the entire 120 patients. In LV-RR analysis, patients were 50.4 ± 12.2years, with a mean left ventricular ejection fraction of 28.6%. Of 66 patients, 28 (42.4%) achieved LV-RR. Multiple logistic regression analysis of LV-RR revealed that not delayed HMR but the WR (cutoff value: 13.5%) was an independent predictor of LV-RR (odds ratio 6.514, p = 0.002). In the analysis for composite cardiac events, even though WR itself does not have the prognostic capacity, Kaplan-Meier survival curves divided by the cutoff value (delayed HMR = 2.0, WR = 13.5) showed that delayed HMR and WR values enabled the stratification of high-risk patients (log-rank p < 0.001). The 123I-mIBG WR was associated with the prevalence of LV-RR in patients taking 100% of beta-blockers and 98.5% of renin-angiotensin system inhibitors. Reflecting the contractile reserve, the combined assessment of the delayed HMR and WR could be used to further precisely stratify the patients with DCM.

Reverse Remodeling and Non-Contrast T1 Hypointense Infarct Core in Patients With Reperfused Acute Myocardial Infarction

Non-contrast T1 hypointense infarct cores (ICs) within infarcted myocardium detected using cardiac magnetic resonance imaging (CMR) T1 mapping may help assess the severity of left ventricular (LV) injury. However, because the relationship of ICs with chronic LV reverse remodeling (LVRR) is unknown, this study aimed to clarify it.Methods and Results: We enrolled patients with reperfused AMI who underwent baseline CMR on day-7 post-primary percutaneous coronary intervention (n=109) and 12-month follow-up CMR (n=94). Correlations between ICs and chronic LVRR (end-systolic volume decrease ≥15% at 12-month follow-up from baseline CMR) were investigated. We detected 52 (47.7%) ICs on baseline CMR by non-contrast-T1 mapping. LVRR was found in 52.1% of patients with reperfused AMI at 12-month follow-up. Patients with ICs demonstrated higher peak creatine kinase levels, higher B-type natriuretic peptide levels at discharge, lower LV ejection fraction at discharge, and lower incidence of LVRR than those without ICs (26.5% vs. 73.3%, P<0.001) at follow-up. Multivariate logistic regression analysis showed that the presence of ICs was an independent and the strongest negative predictor for LVRR at 12-month follow-up (hazard ratio: 0.087, 95% confidence interval: 0.017-0.459, P=0.004). Peak creatine kinase levels, native T1 values at myocardial edema, and myocardial salvaged indices also correlated with ICs. ICs detected by non-contrast-T1 mapping with 3.0-T CMR were an independent negative predictor of LVRR in patients with reperfused AMI.

Development of a new score to predict left ventricular reverse remodelling in patients with nonischemic cardiomyopathy

Abstract Background and purpose Implantable cardioverter-defibrillator is indicated in patients with dilated non-ischemic cardiomyopathy (DCM) and severely depressed left ventricular ejection fraction (LVEF) after a wait-and-see period of 3–9 months under optimised medical therapy. However, in the first 6 months after the disease debut, around 2% of patients might suffer life-threatening arrhythmias. The appearance of left ventricular reverse remodelling (LVRR) in patients with DCM is associated with a lower incidence of ventricular tachyarrhythmias. Therefore, it is relevant an early identification of the patients who will experience LVRR during the follow-up. Our aim was to develop a score to predict the appearance of LVRR in patients with DCM. Methods From 2014 to 2021, 201 patients with DCM and LVEF ≤45% were prospectively evaluated in our tertiary care hospital. All patients underwent a transthoracic echocardiogram and 1.5 Tesla scanner cardiac magnetic resonance (MR) as part of the diagnostic workup. LVRR was defined as an increase in LVEF ≥10 points or absolute LVEF ≥50% associated with a reduction in left ventricular end-diastolic diameter ≥10%. Results The median age of our cohort (n=201) was 61.6 (14.7) years, and 68% were male. Most patients (&amp;gt;90%) were treated with beta-blockers or RASS blockers, and 72% with mineralocorticoid receptor antagonists. During a mean follow-up period of 37.6 (33.9) months 45% of patients had LVRR. Patients with LVRR had a lower cardiovascular mortality (3.33 vs 9.59%; p=0.153), lower mortality due to heart failure (0% vs 8.22%; p=0.023), and a lower incidence of ventricular tachyarrhythmias (1.67% vs 19.18%; p=0.001). Table 1 shows the echocardiographic, MR and clinical characteristics of patients who experienced LVRR. Variables significantly associated with LVRR in the univariable analysis and considered clinically relevant were included in a multivariable logistic regression analysis. The final model included the presence of right ventricular end systolic volume index (RVESVi) &amp;gt;50 ml/m2 (2 points), left bundle brach block (LBBB) echo pattern (1 point), female gender (1 point) and tachycardiomyopathy/idiopathic/alcoholic/chemotherapy induced cardiomyopathy as the potencial cause of DCM (1 point). The score showed a good discrimination, with an area under the ROC curve of 0.82 (95% CI 0.69 to 0.94), 84% sensitivity and 80% specificity. The presence of 3 or more points was associated with a high probability to had LVRR (0 points: 1%; 1 points: 17%; 2 points: 38%; 3 points: 64%; 4 points: 84%%; 5 points: 94% and 6 points: 98%) (Figure 1). Conclusion A new score with four variables (RVESV, LBBB echo pattern, female gender and tachycardiomyopathy/idiopatic/alcoholic/chemotheapy induced cardiomyopathy as potential cause) accurately predicts the probability of LVRR. Considering patients who experience LVRR have less cardiovascular events, this score may be a helpful tool for patients' risk stratification. Funding Acknowledgement Type of funding sources: None.

Early prediction of clinical scores for left ventricular reverse remodeling using extreme gradient random forest, boosting, and logistic regression algorithm representations.

ObjectiveAt present, there is no early prediction model of left ventricular reverse remodeling (LVRR) for people who are in cardiac arrest with an ejection fraction (EF) of ≤35% at first diagnosis; thus, the purpose of this article is to provide a supplement to existing research.Materials and methodsA total of 109 patients suffering from heart attack with an EF of ≤35% at first diagnosis were involved in this single-center research study. LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) from ≥10% to a final value of >35%, with analysis features including demographic characteristics, diseases, biochemical data, echocardiography, and drug therapy. Extreme gradient boosting (XGBoost), random forest, and logistic regression algorithm models were used to distinguish between LVRR and non-LVRR cases and to obtain the most important features.ResultsThere were 47 cases (42%) of LVRR in patients suffering from heart failure with an EF of ≤35% at first diagnosis after optimal drug therapy. General statistical analysis and machine learning methods were combined to exclude a number of significant feature groups. The median duration of disease in the LVRR group was significantly lower than that in the non-LVRR group (7 vs. 48 months); the mean values of creatine kinase (CK) and MB isoenzyme of creatine kinase (CK-MB) in the LVRR group were lower than those in the non-LVRR group (80.11 vs. 94.23 U/L; 2.61 vs. 2.99 ng/ml; 27.19 vs. 28.54 mm). Moreover, AUC values for our feature combinations ranged from 97 to 94% and to 87% when using the XGBoost, random forest, and logistic regression techniques, respectively. The ablation test revealed that beats per minute (BPM) and disease duration had a greater impact on the model’s ability to accurately forecast outcomes.ConclusionShorter disease duration, slightly lower CK and CK-MB levels, slightly smaller right and left ventricular and left atrial dimensions, and lower mean heart rates were found to be most strongly predictive of LVRR development (BPM).

Predictive value of the echocardiographic noninvasive myocardial work index for left ventricular reverse remodeling in patients with multivessel coronary artery disease after percutaneous coronary intervention.

Coronary artery disease (CAD) can lead to left ventricular (LV) remodeling, which, in adverse cases, has been associated with heart failure and increased mortality. Here, we aimed to evaluate the predictive value of the noninvasive myocardial work index (NIMWI) for LV reverse remodeling in patients with multivessel CAD after percutaneous coronary intervention (PCI). A total of 88 consecutive patients with multivessel CAD treated with PCI were identified and categorized according to the presence of LV reverse remodeling 3 months after PCI [≥15% decrease in the LV end diastolic volume (LVEDV)]. With the LV pressure-strain loop (PSL) technique, NIMWIs, including the global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), were statistically compared between the reverse LV remodeling group and nonreverse LV remodeling group 1 week before PCI. Significantly lower GWI, GCW, and GWE, and significantly higher GWW were observed in the reverse LV remodeling group compared with the nonreverse LV remodeling group (P<0.05). Left ventricular mass index (LVMI), GCW, and GWE were independently associated with early LV reverse remodeling. Receiver operating characteristic (ROC) curve analysis demonstrated that GCW was the most powerful predictor of early LV reverse remodeling in patients with CAD [area under the curve (AUC) =0.867]. The optimal cutoff GCW value predictive of early LV reverse remodeling was 1,438.5 mmHg% (sensitivity, 85%; specificity, 70%). GCW, among the NIMWIs, may be the major predictor of LV reverse remodeling in patients with multivessel CAD after PCI. NIMWI could potentially provide a new reference index for the quantitative evaluation of LV myocardial work.

Clinical Effect of Pulmonary Artery Diameter/Ascending Aorta Diameter Ratio on Left Ventricular Reverse Remodeling in Patients With Dilated Cardiomyopathy.

Many patients with dilated cardiomyopathy (DCM) progress to heart failure (HF), although some demonstrate left ventricular (LV) reverse remodeling (LVRR), which is associated with better outcomes. The pulmonary artery diameter (PAD) to ascending aortic diameter (AoD) ratio has been used as a prognostic predictor in patients with HF, although this tool's usefulness in predicting LVRR remains unknown.Methods and Results: Data from a prospective observational study of 211 patients diagnosed in 2000-2020 with DCM were retrospectively analyzed. Sixty-nine patients with New York Heart Association class I or II HF were included. LVRR was observed in 23 patients (33.3%). The mean LV ejection fraction (29%) and LV end-diastolic dimension (64.5 mm) were similar in patients with and without LVRR. The PAD/AoD ratio was significantly lower in patients with LVRR than those without (81.4% vs. 92.4%, respectively; P=0.003). The optimal PAD/AoD cut-off value for detecting LVRR was 0.9 according to the receiver operating characteristic curve analysis. Multivariate analysis identified a PAD/AoD ratio ≥0.9 as an independent predictor of presence/absence of LVRR. Cardiac events were significantly more common in patients with a PAD/AoD ratio ≥0.9 than those with a ratio <0.9, after a median follow up of 2.5 years (log-rank, P=0.007). The PAD/AoD ratio can predict LVRR in patients with DCM.

Left ventricular reverse remodelling and its predictors in non-ischaemic cardiomyopathy.

Adverse remodelling following an initial insult is the hallmark of heart failure (HF) development and progression. It is manifested as changes in size, shape, and function of the myocardium. While cardiac remodelling may be compensatory in the short term, further neurohumoral activation and haemodynamic overload drive this deleterious process that is associated with impaired prognosis. However, in some patients, the changes may be reversed. Left ventricular reverse remodelling (LVRR) is characterized as a decrease in chamber volume and normalization of shape associated with improvement in both systolic and diastolic function. LVRR might occur spontaneously or more often in response to therapeutic interventions that either remove the initial stressor or alleviate some of the mechanisms that contribute to further deterioration of the failing heart. Although the process of LVRR in patients with new‐onset HF may take up to 2 years after initiating treatment, there is a significant portion of patients who do not improve despite optimal therapy, which has serious clinical implications when considering treatment escalation towards more aggressive options. On the contrary, in patients that achieve delayed improvement in cardiac function and architecture, waiting might avoid untimely implantable cardioverter‐defibrillator implantation. Therefore, prognostication of successful LVRR based on clinical, imaging, and biomarker predictors is of utmost importance. LVRR has a positive impact on prognosis. However, reverse remodelled hearts continue to have abnormal features. In fact, most of the molecular, cellular, interstitial, and genome expression abnormalities remain and a susceptibility to dysfunction redevelopment under biomechanical stress persists in most patients. Hence, a distinction should be made between reverse remodelling and true myocardial recovery. In this comprehensive review, current evidence on LVRR, its predictors, and implications on prognostication, with a specific focus on HF patients with non‐ischaemic cardiomyopathy, as well as on novel drugs, is presented.

Echocardiographic predictors of left ventricular reverse remodeling after aortic valve replacement in patients with paradoxical aortic stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Paradoxical aortic stenosis (AS) is low-flow (SVi ≤ 35ml/m2) , low- gradient (Mean PG ≤ 40mmHg) severe aortic stenosis (AVA &amp;lt; 1cm2) in patients with preserved ejection fraction (EF ≥ 50%) usually associated with female gender, advanced age, small body size and history of hypertension. Left ventricular (LV) reverse remodeling presents with LV hypertrophy reversal following aortic valve replacement (AVR) and is associated with better long term prognosis. Purpose The purpose of our study was to asses echocardiographic predictors of better outcome in patients with paradoxical severe AS following AVR. Methods Detailed transthoracic echocardiographic (TTE) evaluation with left ventricular strain analysis was performed using 2D Philips Epique 7 in patients with severe aortic stenosis with AVR indication before and 4 months after the intervention. Results Among 75 patients with severe AS and indication for AVR, 20 (31, 7%) were paradoxical AS with low- flow, low –gradient and preserved ejection fraction. Sixty percent were female and eighty percent had hypertension where all echocardiographic parameters improved following AVR including improvement of LV global longitudinal strain (LS) as well as reduction of left ventricular mass indicating left ventricular reverse remodeling (Figure 1). The patients with paradoxical AS compared to the other forms of severe AS had the lowest values for MAPSE and s’TDI before and after AVR. Independent predictors of LV reverse remodeling before AVR were end systolic LV volume (ESV) , AVA/BSA and the number of segments with LS &amp;lt; 13%. Conclusion Paradoxical severe AS is associated with worse post AVR prognosis compared to the high gradient severe AS. Echocardiographic predictors of LV reverse remodeling in patients with paradoxical severe AS following AVR are LV ESV, AVA/BSA and number of segments with LS &amp;lt; 13%. Timely diagnosis and AVR referral of patients with paradoxical severe AS is of major importance in the management of aortic valvular disease. Abstract Figure. Descriptive of 20pts with paradoxical AS Abstract Figure. Predictors of LV reverse remodeling

Abstract 9479: Novel Predictors of Left Ventricular Reverse Remodeling in Patients With Recent-onset Dilated Cardiomyopathy Using T1 and T2 Mapping on Cardiac Magnetic Resonance

Introduction: The prognosis of patients with idiopathic dilated cardiomyopathy (DCM) has improved in recent decades with guideline-directed medical therapy. There is an essential need for better biomarkers to predict left ventricular reverse remodeling (LVRR) in DCM. Native T1, T2 and left ventricular (LV) global strain by cardiac magnetic resonance (CMR) without contrast agents provides a novel quantitative method for myocardial tissue characterization. Hypothesis: CMR parameters predict LVRR in patients with DCM. Methods: A total 34 patients ( 58 ± 13 years, 25 male) with DCM underwent baseline CMR imaging (3T Philips), including cine, late gadolinium enhancement (LGE) CMR, and triple-slice T1 and T2 mapping (short modified look locker inversion recovery ShMOLLI sequence). The 6SD-LGE (% area), global circumferential strain (GCS), global radial strain (GRS), global longitudinal strain (GLS), global radial strain (GRS), LV mass index (LVMI), LV end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were calculated from multiple short-axis views. Echocardiography was conducted before and &gt; 1 year after after optimal medical therapy. Results: The patients were divided into two groups, LVRR with LVEF increase of &gt;10% and the final value of ≥40% for those without. There were no significant differences in LV mass index, LVEDV, LVESV, and LVEF between the two groups (80 ± 20 g/m 2 vs 78 ± 19 g/m 2 ; 174 ± 54 ml vs 165 ± 48 ml; 134 ± 51 ml vs 122 ± 46 ml; 24 ± 9% vs 28 ± 9%, respectively). The any LV global strain showed no significant difference between the two groups. The 6SD-LGE, native T1, and T2 values were significantly lower in LVRR+ group than in LVRR-group (15.3 ± 15.5 % vs 5.9 ± 6.8%;1376 ± 59 ms vs 1301 ± 42 ms;55 ± 3.5 ms vs 50 ± 2.5 ms,respectively). The LGE-6SD &lt; 13%. native T1 value &lt; 1330 ms and T2 values &lt; 53ms were the best threshold values for predicting LVRR (The LGE-6SD: sensitivity, 82%; specificity, 41%; AUC 0.72, T1:sensitivity, 82%; specificity, 71%; AUC 0.87, and T2: sensitivity, 82%; specificity, 63%; AUC 0.88). Conclusions: Native T1 and T2 mapping values may be useful for assessing of the LVRR in patients with DCM even without contrast.

Beta-blockers are associated with reverse remodeling in patients with dilated cardiomyopathy and mid-range ejection fraction

BackgroundBeta-blockers have been shown to induce left ventricular reverse remodeling (LVRR) in heart failure with reduced ejection fraction. This study aimed to determine whether beta-blockers could induce LVRR in patients with heart failure with mid-range ejection fraction (HFmrEF). MethodsWe analyzed the national database from clinical personal records of dilated cardiomyopathy (DCM) maintained by Japanese Ministry of Health, Labour and Welfare, between 2003 and 2014. Patients with left ventricular ejection fraction (LVEF) of ≥40% and < 50% were included. Patients who did not have echocardiography at 2 years of follow-up were excluded. Eligible patients were divided into two groups according to the use of beta-blockers. Patient characteristics of two groups were adjusted by propensity score matching. The primary outcome was LVRR at 2 years of follow-up, defined as an improvement in LVEF ≥10%. ResultsOut of 3064 patients, propensity score matching yielded 602 pairs. The mean age was 59.3 years and 896 patients (74.4%) were male. The primary outcome was observed more frequently in beta-blocker group (24.3% vs. 17.8%; Odds ratio [OR], 1.48; 95% confidence interval [CI], 1.12–1.96; P = 0.006). Subgroup analysis demonstrated that patients with heart rate ≥ 75 bpm (≥ 75 bpm; OR, 2.61; 95% CI, 1.66–4.11: < 75 bpm; OR, 1.03; 95% CI, 0.72–1.48; P for interaction = 0.002) and atrial fibrillation (AF) (AF; OR, 2.30; 95% CI, 1.37–3.86: No AF; OR 1.23; 95% CI, 0.88–1.72; P for interaction = 0.046) were benefited by beta-blockers. ConclusionsBeta-blockers could induce LVRR in patients with DCM and HFmrEF.

B-PO04-181 AN EVALUATION OF LEFT VENTRICULAR REVERSE REMODELING IN PATIENTS WITH LEFT BUNDLE BRANCH BLOCK AND QRS DURATION LESS THAN 150MS

The benefit of cardiac resynchronization therapy (CRT) for patients with left bundle branch block (LBBB) and QRS duration (QRSd) between 120 and 150 milliseconds (ms) remains contested. Left ventricular (LV) reverse remodeling may help identify the benefit of CRT in these patients. We hypothesized that patients with LBBB QRSd between 120 and 150ms would have significant LV reverse remodeling on echocardiography after initiation of CRT comparable to patients with LBBB QRSd > 150ms. We aimed to study the effects of CRT on LV reverse remodeling in patients with LBBB QRSd < 150ms compared to patients with QRSd > 150ms. From a cohort of 258 patients who initiated CRT between 2016 and 2019, we performed a retrospective case-control study comparing the reduction in LV end-systolic volume (LVESV) of 19 patients with New York Heart Association Class II-III symptoms on goal-directed medical therapy (GDMT) with LBBB and QRSd < 150ms who received CRT and 19 controls with QRSd > 150ms. LVESV was measured on echocardiography within 6 months prior to CRT implantation and at least 1 year after implantation. There was a significant reduction in LVESV (mL) in patients with QRSd < 150ms from 121.25 to 84.91 (p = 0.0399) and in patients with QRSd > 150ms from 162.2 to 140.1 (p = 0.019). There was no significant difference in the absolute or relative magnitude of the reduction in LVESV between the two groups (absolute: 25.74 vs 44.98 mL, p = 0.48, relative: 27.67% and 28.91%, p = 0.91). Spacing of the echocardiograms before and after CRT introduction did not significantly differ between cases and controls (432.4 vs 460.9 days, p = 0.579). LV reverse remodeling occurred significantly and comparably in both patients with LBBB and QRSd < 150ms and patients with LBBB and QRSd > 150ms. As reduction in LVESV is an important predictor of survival with biventricular pacing, CRT may provide benefit to patients with systolic dysfunction on GDMT with LBBB and QRSd < 150ms.

A clinical score for predicting left ventricular reverse remodelling in patients with dilated cardiomyopathy.

AimsLeft ventricular reverse remodelling (LVRR) is a well‐established predictor of a good prognosis in patients with dilated cardiomyopathy (DCM). The prediction of LVRR is important when developing a long‐term treatment strategy. This study aimed to assess the clinical predictors of LVRR and establish a scoring system for predicting LVRR in patients with DCM that can be used at any institution.Methods and resultsWe consecutively enrolled 131 patients with DCM and assessed the clinical predictors of LVRR. LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) from ≥10% to a final value of >35%, accompanied by a decrease in left ventricular end‐diastolic dimension (LVEDD) ≥ 10% on echocardiography at 1 ± 0.5 years after a diagnosis of DCM. The mean patient age was 50.1 ± 11.9 years. The mean LVEF was 32.2 ± 9.5%, and the mean LVEDD was 64.1 ± 12.5 mm at diagnosis. LVRR was observed in 45 patients (34%) at 1 ± 0.5 years. In a multivariate analysis, hypertension [odds ratio (OR): 6.86; P = 0.002], no family history of DCM (OR: 10.45; P = 0.037), symptom duration <90 days (OR: 6.72; P < 0.001), LVEF <35% (OR: 13.66; P < 0.0001), and QRS duration <116 ms (OR: 5.94; P = 0.005) were found to be independent predictors of LVRR. We scored the five independent predictors according to the ORs (1 point, 2 points, 1 point, 2 points, and 1 point, respectively), and the total LVRR predicting score was calculated by adding these scores. The LVRR rate was stratified by the LVRR predicting score (0–2 points: 0%; 3 points: 6.7%; 4 points: 17.4%; 5 points: 48.2%; 6 points: 79.2%; and 7 points: 100%). The cut‐off value of the LVRR predicting score was >5 in receiver‐operating characteristic curve analysis (area under the curve: 0.89; P < 0.0001; sensitivity: 87%; specificity: 78%). An LVRR predicting score of >5 was an independent predictor compared with the presence of late gadolinium enhancement on cardiovascular magnetic resonance or the severity of fibrosis on endomyocardial biopsy (OR: 11.79; 95% confidence interval: 2.40–58.00; P = 0.002).ConclusionsThe LVRR predicting score using five predictors including hypertension, no family history of DCM, symptom duration <90 days, LVEF <35%, and QRS duration <116 ms can stratify the LVRR rate in patients with DCM. The LVRR predicting score may be a useful clinical tool that can be used easily at any institution.

Predictors of left ventricular reverse remodeling after percutaneous therapy for mitral regurgitation with the MitraClip system.

To investigate the predictors and clinical impact of left ventricular reverse remodeling (LVRR) after MitraClip (MC) therapy for degenerative (DMR) and functional mitral regurgitation (FMR). MC therapy induces LVRR in patients with mitral regurgitation (MR) at high-risk for surgery. However, specific data on predictors of LVRR therapy are limited. This study included 164 patients treated by MC implantation with complete clinical and echocardiographic evaluation at baseline, 6 months, and 12 months. LVRR was defined as a decrease of ≥10% of the left ventricular end-diastolic diameter after 12 months and was found in 49% of the patients. LVRR was associated with significantly reduced event rate 2 years after MC procedure. In the total cohort, multivariate regression analysis determined severe recurrent/residual MR after 12 months (p = .010, odds ratio [OR] = 0.26), male gender (p = .050, OR = 0.49) and left ventricular ejection fraction (LVEF) <20% (p = .046, OR = 0.24) as predictors of absence of LVRR. In the subgroup analysis according to etiology of MR, multivariate regression analysis revealed severe recurrent/residual MR after 12 months (p = .04, OR = 0.184) to inversely predict LVRR only in the DMR subgroup. In FMR, residual severe tricuspid regurgitation (TR) inversely predicts LVRR (p = .032, OR = 0.361). LVRR occurs in half of the patients after MC and is associated with reduced MACCE rates at follow-up. Combined information on residual/recurrent MR, baseline LVEF and gender predict LVRR after MC procedure. While residual/recurrent MR is the independent predictor for the absence of LVRR in DMR, in FMR only severe residual TR independently predict LVRR.

Clinical significance of discrepant mid-wall late gadolinium enhancement in patients with nonischemic dilated cardiomyopathy.

A drawback of visual assessment for late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is the subjectivity and reproducibility of the results. The aim of this study was to investigate the relationship between left ventricular (LV) reverse remodeling in response to optimal pharmacotherapies and the definite or discrepant mid-wall LGE with visual assessment in patients with dilated cardiomyopathy (DCM). A total of 65 patients who had been hospitalized with newly diagnosed DCM and had undergone CMR, were enrolled. When the visual assessment of the presence or absence of mid-wall LGE was confirmed by the two observers, patients were classified into either the positive- (n = 20) or negative-LGE (n = 29) groups. If there was discordance between the diagnoses of the two observers, patients were classified into the discrepant-LGE (n = 16) group. LV reverse remodeling was defined as an increase in LV ejection fraction by at least 10% concomitant with a decrease in the LV end-diastolic dimension by at least 10%. Among the three groups, the frequency of early LV reverse remodeling within a 1-year follow-up was significantly different (p = 0.0068). The frequency of LV reverse remodeling within a 1-year follow-up was 59, 31, and 15%, and over 2years was 83, 62, and 40%, in patients with negative-, discrepant-LGE, and positive-LGE, respectively. The survival rate for composite end-points of cardiovascular mortality, sustained ventricular tachycardia, appropriate cardioverter-defibrillator discharge, or rehospitalization for decompensated heart failure was lower in positive-LGEs than in negative-LGEs (p =0.0011), whereas, there were no significant differences between both negative- and discrepant-LGEs, and discrepant- and positive-LGEs. This study showed that the discordance for LGE visual assessment occupied an intermediate position between positive and negative for LGE in LV reverse remodeling in patients with DCM.

Predictive factors of left ventricular reverse remodeling in patients with idiopathic or secondary dilated cardiomyopathy

To investigate the occurrence of left ventricular reverse remodeling (LVRR) and its predictive factors in patients with idiopathic or secondary dilated cardiomyopathy (DCM). A cross-sectional survey was conducted in a consecutive cohort of patients with DCM admitted in our department between January, 2012 and June, 2016. Based on dynamic echocardiographic findings, LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) by ≥100% or an absolute value of LVEF ≥45% with simultaneously an absolute decrease in end-diastolic diameter (LVEDD) ≥10 mm or an absolute value of LVEDD ≤55 mm (in men) or ≤50 mm (in women). The patients with LVRR and those without LVRR were compared for clinical data at admission to identify the potential factors for predicting LVRR. A total of 462 patients, who were followed up for 24.13±15.60 months, were included in this survey. In patients with idiopathic DCM who had LVRR, LVEDD was reduced (P < 0.01), LVEF was improved (P < 0.01) and the mean exercise tolerance was increased significantly (P < 0.01) compared with those in patients without LVRR. Multiple logistic regression analysis showed that a shorter course of heart failure (OR=0.913, P < 0.01), a high systolic blood pressure (OR=1.062, P < 0.01), absence of electrolyte imbalance (OR=0.347, P < 0.01), a low red cell distribution width (OR=0.205, P < 0.01), a smaller LVEDD (OR=0.799, P < 0.01) and a greater LVEF (OR= 1.142, P < 0.01) were independent predictors of LVRR in the idiopathic patients. In patients with secondary DCM, LVEDD was reduced (P < 0.01), LVEF was improved (P < 0.01), and the mean exercise tolerance was increased significantly (P < 0.01) compared with those in patients without LVRR. Multiple logistic regression analysis showed that a shorter course of heart failure (OR= 0.954, P < 0.01), a low red cell distribution width (OR=1.011, P < 0.01), and implementation of etiological treatment (OR=1.073, P < 0.01) were independent predictors of LVRR in patients with secondary DCM. The exercise tolerance, cardiac structure and function can be reversed in some of the patients with idiopathic or secondary DCM by administration of standard therapy for heart failure and etiological treatment.

Abstract 100: A MicroRNA Signature for Left Ventricular Reverse Remodeling in Chronic Systolic Heart Failure

Introduction: Left ventricular reverse remodeling (LVRR) in heart failure (HF) is linked to improved patient outcomes. Current strategies to identify individuals who respond favorably to therapy in HF are limited. Though circulating microRNAs (miRs) show epigenetic regulation of LVRR in vivo , there is little clinical data linking plasma-circulating miRs to LVRR. Here we employ a point-of-care microRNA assay, Firefly, in silico analyses, and murine models of HF to characterize profiles of circulating miRs that prognosticate LVRR in patients with HF undergoing guideline directed therapy. Hypothesis: Profiles of miRs in circulating plasma will prognosticate LVRR in patients with HF better than the current clinical model alone and may play a functional role in LVRR. Methods: Plasma from 64 patients from the PROTECT study who had serial echocardiography and available plasma at pre-randomization study visit were run on Abcam’s Firefly platform to assay levels of 51 miRs, selected on prior sequencing efforts (for discovery) and published roles in CVD. miR levels were subject to PC analysis to predict LVRR. Candidate miRs were then validated in a murine model of transverse aortic constriction-induced heart failure (TAC-HF) and their function assessed in cardiomyocyte culture systems. Results: Principle component analysis revealed 4 PCs accounting for 62.4% of the observed variation without significant association with extant markers of HF. When PC2 miR levels were added to the clinical model prognostic ability for LVRR improved substantially (AIC 79.5, (OR=6.84, 95% CI 1.81-25.80, P= 0.005). In silico analysis was then applied to generate networks of mRNAs regulated by PC2 miRs. In the murine TAC-HF model, miRs 423, 212, 221, 193b were differentially regulated, as were the predicted targets of these miRs. These miRs, particularly in combination, appeared to be regulators of cardiac hypertrophy in vitro . Conclusions: Circulating miR profiles in HF improve prognosticative ability for patients who will undergo LVRR over the clinical model alone. Additionally these miRs and their targets are dynamically regulated in murine models of HF, suggesting they may have functional and potential therapeutic utility in addition to their prognostic power.

QRS duration shortening predicts left ventricular reverse remodelling in patients with dilated cardiomyopathy after cardiac resynchronization therapy

Objective The relationship between the QRS duration, severity of mechanical dyssynchrony and effi cacy of cardiac resynchronization therapy (CRT) is poorly understood. We determined if QRS duration shortening in patients with dilated cardiomyopathy after treatment with CRT was predictive of left ventricular (LV) reverse remodelling.Methods Thirty patients with dilated cardiomyopathy were enrolled. Electrocardiographic and echocardiographic recordings were obtained before and 6 months after CRT. Patients were classifi ed as CRT responders or non-responders based on their echocardiographic parameters 6 months following CRT.Results After 6 months of CRT, 9 patients (30%) were classifi ed as non-responders. Surprisingly, no signifi cant diff erences in any of the preoperative metrics were found between CRT responders and non-responders. In sharp contrast, the postoperative parameters of the CRT responder group had signifi cantly improved compared to the non-responder group. The average QRS duration of the CRT responders was signifi cantly shorter than that of the non-responders (-37 ± 23 ms vs 0 ± 23 ms; P < 0.01). The relationships between preoperative parameters, the change in QRS duration and LV end-diastolic diameter were analysed for each patient using multi-linear correlation and regression analyses. We found that the change in QRS duration positively correlated with the change in LV end-diastolic diameter (R = 0.583, P= 0.001). Furthermore, multi-linear regression analysis suggested that changes in QRS duration had a signifi cant eff ect on LV end-diastolic diameter (y = 9.739 + 0.272 x, P= 0.006).Conclusion CRT-mediated changes in the QRS duration are predictive of LV reverse remodelling in patients with dilated cardiomyopathy.