Left Ventricular Stroke Research Articles

Long-term efficacy and safety of elamipretide in patients with Barth syndrome: 168-week open-label extension results of TAZPOWER

PurposeEvaluate long-term efficacy and safety of elamipretide during the open-label extension (OLE) of the TAZPOWER trial in individuals with Barth syndrome (BTHS). MethodsTAZPOWER was a 28-week randomized, double-blind, and placebo-controlled trial followed by a 168-week OLE. Patients entering the OLE continued elamipretide 40 mg subcutaneous daily. OLE primary endpoints were safety and tolerability; secondary endpoints included change from baseline in the 6-minute walk test (6MWT) and BarTH Syndrome Symptom Assessment (BTHS-SA) Total Fatigue score. Muscle strength, physician- and patient-assessed outcomes, echocardiographic parameters, and biomarkers, including cardiolipin (CL) and monolysocardiolipin (MLCL), were assessed. ResultsTen patients entered the OLE; 8 reached the week 168 visit. Elamipretide was well tolerated, with injection-site reactions being the most common adverse events. Significant improvements from OLE baseline on 6MWT occurred at all OLE time points (cumulative 96.1 m of improvement [week 168, P = .003]). Mean BTHS-SA Total Fatigue scores were below baseline (improved) at all OLE time points. Three-dimensional (3D) left ventricular stroke, end-diastolic, and end-systolic volumes improved, showing significant trends for improvement from baseline to week 168. MLCL/CL values showed improvement, correlating to important clinical outcomes. ConclusionElamipretide was associated with sustained long-term tolerability and efficacy, with improvements in functional assessments and cardiac function in BTHS.

Cardiac structure and function in resistant hypertension: The beneficial role of blood pressure control.

Cardiac structure and function in resistant hypertension: The beneficial role of blood pressure control.

Correlation between standard and adjusted echocardiographic quantitative methods for evaluating tricuspid regurgitation severity

Abstract Funding Acknowledgements Type of funding sources: None. Background Current guidelines advocate for a multi-parametric approach to echocardiographic quantitation of tricuspid regurgitation (TR). The primary quantitative measure of TR severity uses the proximal isovelocity surface area (PISA) method to calculate effective regurgitant orifice area (EROA) and regurgitant volume (RegVol). However, EROA-PISA may underestimate TR severity due to low flow and tethering of the tricuspid leaflets. Purpose The purpose of this study was to compare standard EROA-PISA quantitation of TR to alternative quantitative measures, including quantitative Doppler (EROA-Doppler), flow- and angle-corrected PISA method (EROA-Corrected), and three-dimensional vena contracta area (3D-VCA), in addition to the comparison of calculated RegVol-PISA, RegVol-Doppler, and RegVol-3DVCA. Methods Patients undergoing both transthoracic (TTE) and transesophageal (TEE) echocardiographic evaluation of TR severity for transcatheter treatment were included in this study. Patients were excluded if they had ≥ moderate aortic regurgitation. TTE measurements of EROA-PISA and RegVol-PISA were performed as per American Society of Echocardiography guidelines. EROA-Doppler was performed by quantifying RegVol-Doppler (diastolic stroke volume using biplane annular area, minus left ventricular outflow stroke volume) and deriving EROA. EROA-Corrected was calculated by adjusting for both aliasing velocity and leaflet angle as per published methods. 3D-VCA was measured on TEE performed within 14 days of TTE. Results Of 44 consecutive patients, the median age was 80 ± 9 years, 61% were female, and 89% had atrial fibrillation. Most patients (86%) had functional TR, 71% had a EROA-PISA ≥ 0.4 cm2. Table 1 shows the EROA and RegVol results for each method. EROA-PISA and RegVol-PISA were significantly lower than EROA-Doppler and RegVol-Doppler, as well as 3D-VCA and RegVol-3DVCA (all p < 0.0001). There was no significant difference between EROA-Doppler and 3D-VCA (p = 0.51), and RegVol-Doppler and RegVol-3DVCA (p = 0.66). EROA-Corrected reduced the absolute difference with EROA-Doppler (51% to 33%, p < 0.0001) and 3D-VCA (52% to 32%, p < 0.0001), but remained statistically lower than EROA-Doppler and 3D-VCA. Although EROA-PISA was strongly correlated to EROA-Doppler (r = 0.75, p < 0.0001) and 3D-VCA (r = 0.68, p < 0.0001), the correlation between EROA-Doppler and 3D-VCA was greatest (r = 0.77, p < 0.0001). Adjusting EROA-PISA for angle and flow demonstrated improved correlation to EROA-Doppler without affecting correlation to 3D-VCA (Figure 1). Conclusion Our study demonstrated that EROA-PISA significantly underestimates the severity of TR by EROA-Doppler and 3D-VCA. Although PISA correction methods reduced the underestimation, both EROA-Corrected and RegVol-Corrected remained significantly lower. EROA-Doppler and 3D-VCA and the calculated RegVol by each method, were closely correlated and not significantly different. Abstract Table 1 Abstract Figure 1

The frequency and types of posterior aortoplasty during implantation of stented bioprosthesis NEO-COR «UNI-LINE» -21 in aortic position

Aim. To study the frequency and validity of posterior aortoplasty for bioprosthetics of the aortic valve.Materials and methods. To study the problem of the required aortoplasty frequency and reliability of the study, 99 patients with Neo-Cor “Uniline” 21-size bioprosthesis implantation were selected. According to the presence/absence of posterior arthroplasty, patients were divided into two groups. In the postoperative period the groups were compared according to the following criteria: left ventricular end-diastolic volume (LV EDV), ejection fraction (LV EF), stroke volume (LV SV), peak and mean valve gradients. Following parameters were calculated stroke volume index (SVI) and valve effective orifice area index (EOAI).Results. There were no significant differences in postoperative data between the groups. In the group without an aortic aneurysm, left ventricular end-diastolic volume (LV EDV), stroke volume (LV SV), peak and mean valve gradients. were slightly larger. In the second group, ejection fraction (LV EF), and peripheral perfusion index were slightly larger. Which with lower gradients on the valve indicates more optimal contractility of the left ventricle.Conclusion. In our practice in all cases, posterior aortoplasty was performed as indicated. Group of patients with aortoplasty demonstrated more optimal left ventricle function. Probably aortoplasty is to be applied more frequently.

Effect of salt intake on clinical course and hemodynamics in patients with hypertrophic cardiomyopathy

Aim. To evaluate the relationship between the salt intake (NaCl) and the clinical and hemodynamic parameters in patients with hypertrophic cardiomyopathy (HCM).Material and methods. Forty four patients with HCM (mean age, 60,4±15,3 years) were examined. Particular attention was paid to intraventricular obstruction and hypovolemic syncope. NaCl consumption was estimated by 24-hour urine sodium test.Results. An inverse correlation was found between syncope and 24-hour natriuresis (r=-0,3, p=0,04). At 24-hour natriuresis <50 mmol/day, syncope was more common (p=0,02): odds ratio (OR), 12,3 (95% confidence interval (CI): 1,3-121,3, p=0,03), as well as <65 mmol/day (p=0,04): OR, 8,3 (95% CI: 1,13-60,3; p=0,04). At higher 24-hour urine sodium values, no reduction in syncope risk was recorded. A correlation was found between low values of left ventricular (LV) stroke volume index (SVI) (<26 ml/m2) and 24-hour urine sodium (<50 mmol/day) (r=0,5, p=0,01). An inverse correlation was observed between LV SVI and syncope at 24-hour natriuresis <50 mmol/day (r=-0,9; p=0,05). An inverse relationship was found between the intraventricular obstruction and 24-hour urine sodium (r=-0,4, p=0,01). The prevalence of obstruction increased as natriuresis decreased: at 120 mmol/day, OR was 4,3 (95% CI: 1,01-18,6, p=0,048), at 110 mmol/day, OR — 4,6 (95% CI: 1,218,1, p=0,03), and at 100 mmol/day, OR — 4,0 (95% CI: 1,1-11,7, p=0,04). An increase in 24-hour urine sodium >130 mmol/day was not followed by a further decrease in obstruction prevalence.Conclusion. To reduce the obstruction risk, the optimal 24-hour urine sodium level is ≥130 mmol/day (NaCl, 7,5 g/day). To reduce the syncope risk, regardless of obstruction presence, the optimal level of 24-hour natriuresis is ≥65 mmol/day (NaCl, 3,8 g/day).

Sex and age interaction in fundamental circulatory volumetric variables at peak working capacity

BackgroundWhether the fundamental hematological and cardiac variables determining cardiorespiratory fitness and their intrinsic relationships are modulated by major constitutional factors, such as sex and age remains unresolved.MethodsTransthoracic echocardiography, central hemodynamics and pulmonary oxygen (O2) uptake were assessed in controlled conditions during submaximal and peak exercise (cycle ergometry) in 85 healthy young (20–44 year) and older (50–77) women and men matched by age-status and moderate-to-vigorous physical activity (MVPA) levels. Main outcomes such as peak left ventricular end-diastolic volume (LVEDVpeak), stroke volume (SVpeak), cardiac output (Qpeak) and O2 uptake (VO2peak), as well as blood volume (BV), BV–LVEDVpeak and LVEDVpeak–SVpeak relationships were determined with established methods.ResultsAll individuals were non-smokers and non-obese, and MVPA levels were similar between sex and age groups (P ≥ 0.140). BV per kg of body weight did not differ between sexes (P ≥ 0.118), but was reduced with older age in men (P = 0.018). Key cardiac parameters normalized by body size (LVEDVpeak, SVpeak, Qpeak) were decreased in women compared with men irrespective of age (P ≤ 0.046). Older age per se curtailed Qpeak (P ≤ 0.022) due to lower heart rate (P < 0.001). In parallel, VO2peak was reduced with older age in both sexes (P < 0.001). The analysis of fundamental circulatory relationships revealed that older women require a higher BV for a given LVEDVpeak than older men (P = 0.024).ConclusionsSex and age interact on the crucial circulatory relationship between total circulating BV and peak cardiac filling, with older women necessitating more BV to fill the exercising heart than age- and physical activity-matched men.

Central and Peripheral Cannulation for Cardiopulmonary Bypass in Fetal Sheep: A Comparative Study.

Objective: In-utero correction is an option for treatment of critical congenital heart diseases (CHDs). Fetal cardiac surgery for CHDs is dependent on the reliable use of fetal cardiopulmonary bypass (CPB), but this technology remains experimental. In this study, we established fetal CPB models with central and peripheral cannulation to explore the differences between the two cannulation strategies.Methods: Ten fetal sheep with 90–110 gestational days were randomized into central cannulation (n = 5) and peripheral cannulation (n = 5) groups. All fetal CPB models were successfully established. At each time point (0, 30, and 60 min after initiation of CPB), echocardiography was performed. Blood samples were also collected for blood gas analysis and tests of myocardial enzymes and liver and kidney function.Results: In the central cannulation group, right ventricular Tei index significantly increased (p = 0.016) over time. Compared with the peripheral cannulation group, the left ventricular Tei index of the central cannulation group was significantly higher (1.96 ± 0.31 vs. 0.45 ± 0.19, respectively; p = 0.028) and the stroke volume was lower (0.46 ± 0.55 vs. 2.13 ± 0.05, respectively; p = 0.008) at 60 min after CPB. Levels of liver and kidney injury markers and of acid-base balance, including alanine aminotransferase (ALT), aspartate aminotransferase/ALT ratio, blood urea nitrogen (BUN), BUN/creatinine ratio, base excess and bicarbonates, were significantly higher for peripheral than for central cannulation. Other important physiologic parameters, including heart rate, blood pressure, myocardial enzymes, umbilical artery beat index and resistance index, left ventricular Tei index, and left and right ventricular stroke volume, were comparable between the two groups.Conclusions: Both central and peripheral cannulations can be used to establish fetal CPB models. Central cannulation causes more adverse impacts for cardiac function, whereas peripheral cannulation is more susceptible to complications related to inadequate organ perfusion.

Quantification of chronic aortic regurgitation using left and right ventricular stroke volumes obtained from two new automated three-dimensional transthoracic echocardiographic software: feasibility and accuracy.

The present study aimed to evaluate the feasibility and accuracy of chronic aortic regurgitation (CAR) quantification using left and right ventricular stroke volumes (LVSV and RVSV, respectively) obtained from two new automated three-dimensional transthoracic echocardiographic software-Dynamic HeartModel (DHM) and 3D Auto RV. Patients (n=116) with more than mild isolated CAR were included and divided into two groups: central (n=53) and eccentric CAR (n=63) groups. LVSV and RVSV were automatically measured by DHM and 3D Auto RV. Next, aortic regurgitant volume (ARVol) was calculated three ways: as the difference between LVSV and RVSV, by the two-dimensional proximal isovelocity surface area (PISA) method, and using effective regurgitant orifice area derived from real-time three-dimensional echocardiography (RT3DE) multiplied by CAR velocity time integral (the reference standard). DHM plus 3D Auto RV correlated well with RT3DE in ARVol measurement in both groups (central, r = 0.90; eccentric, r = 0.96), with no significant difference based on consistency analysis. In the eccentric group, PISA led to an obvious underestimation (mean difference= - 4.20 ml, P < 0.05). The kappa agreement between DHM plus 3D Auto RV and RT3DE in grading CAR severity in both groups was good (central, k = 0.89; eccentric, k = 0.86), but that between PISA and RT3DE in the eccentric CAR group was suboptimal (k = 0.74). This study indicates that ARVol quantification using DHM plus 3D Auto RV is feasible and reproducible in patients with more than mild isolated CAR. This new method has great correlation and agreement with RT3DE in ARVol measurement, with evident advantages over PISA in eccentric CAR.

Comparison of echocardiographic parameters of patients with COVID-19 pneumonia in hospital and three months after discharge

Abstract Background COVID-19 affects firstly the respiratory system of patients however cardiovascular system is also damaged. To study the impact of a novel coronavirus infection on the cardiovascular system, in particular on echocardiographic parameters after SARS-CoV-2 is very important. Purpose To compare echocardiographic parameters in patients with COVID-19 pneumonia in hospital and 3 months after hospital discharge. Methods A total of 106 patients with confirmed COVID-19 pneumonia were included in the period from April to July 2020 within “One-year Cardiac Follow-up of COVID-19 Pneumonia”. All patients underwent clinical examination including transthoracic echocardiography in hospital and 3 months ± 2 weeks after discharge. Mean age of patients was 47±16 years (19–84 years), mean body mass index was 28.2±5.7 kg/m2, females were 49%. During hospitalization, chest computed tomography detected mild lesions in 29.2%, moderate lesions in 31.1%, severe lesions in 27.4% and critical lesions in 5.7%. Cardiovascular pathology detected in 52% of patients. Results Three months after discharge significant dynamics of mean echocardiographic parameters was observed. Left ventricular end-diastolic, end-systolic and stroke volume decreased (113.8±26.8 vs 93.5±29.4 ml; 37.7±13.0 vs 31.3±14.2 ml; 77.2±17.8 vs 62.2±18.7 ml, respectively; all p&amp;lt;0.001). End-diastolic right ventricular outflow tract diameter, pulmonary artery trunk diameter decreased (26.0 [24.0–9.3] vs 25.0 [23.0–27.0] mm, p=0.004; 21.7±3.6 vs 18.7±2.5 mm, p&amp;lt;0.001), as well as pulmonary artery systolic pressure (28.0 [25.0–32.25] vs 21.5 [17.0–25.0] mmHg) and rate of moderate to severe tricuspid regurgitation (52.4 vs 19.8%, both p&amp;lt;0.001). Right atrium volume (42.0 [37.0–50.0] vs 31.0 [22.0–36.5] ml, p&amp;lt;0.001) and width decreased (36.1±4.6 vs 34.5±6.5 mm, p=0.023), however right atrium length increased (46.7±6.8 vs 48.6±7.1, p=0.021). Conclusions In patients after COVID-19 pneumonia echocardiography showed decrease of the load predominantly on the right heart 3 months after discharge. A subgroup analysis is planned depending on the severity of lung damage and presence of cardiovascular pathology. Funding Acknowledgement Type of funding sources: None.

The Relationship Between Oxygen Uptake and the Rate of Myocardial Deformation During Exercise

ABSTRACT Background: The relationship between resting echocardiographic measures of cardiac function and exercise capacity is weak. The details of ventricular augmentation may provide insight into determinants of cardiac efficiency for optimal exercise performance. The aims of this study were to establish how much of the variability in exercise performance could be explained by myocardial recruitment and which parameters describing cardiac function were most closely related to exercise performance. Methods: Untrained volunteers were recruited before training for the London Marathon. All performed a cardiopulmonary exercise test combined with stress echocardiography. Systolic and diastolic longitudinal velocities (S′ and E′), left ventricular ejection fraction (LVEF), stroke volume (SV), and strain (GLS) were obtained throughout exercise. Results: A variety of parameters including S′, E′, GLS, and SV showed a correlation with V̇o2 throughout exercise (ρ = 0.83, P &amp;lt; 0.0001). At the prespecified sample point (respiratory exchange ratio &amp;gt; 1.0) only SV and S′ were predictive of V̇o2peak. LVEF and E′ as well as both global longitudinal and circumferential strain showed no correlation with V̇o2peak. The systolic efficiency slope (SES) that we developed by determining the individual regression lines for V̇o2 and S′ showed a relationship between with V̇o2 peak for both septal S′, r = 0.57, P &amp;lt; 0.001, and lateral S′, r = 0.53, P &amp;lt; 0.001. Conclusion: A detailed description of myocardial function is described, linear for S′ and E′ and a plateau for EF and GLS. S′ during exercise is a better predictor of exercise performance than LVEF, SV, or GLS. The SES slope predicted V̇o2peak, suggesting the process driving systolic velocity and its augmentation is a key determinant of exercise ability.

Quantification of mitral regurgitation and biventricular assessment is feasible during continuous supine exercise cardiovascular magnetic resonance in primary mitral regurgitation patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Biventricular volume and great vessel flow assessment during continuous supine free-breathing exercise cardiovascular magnetic resonance (Ex-CMR) is feasible in healthy volunteers using Compressed SENSEx3 (CS3) sequences1. Exercise transthoracic echocardiography (TTE) provides prognostic information in primary mitral regurgitation (MR). Resting CMR offers reference standard biventricular assessment and MR quantification with superior reproducibility to TTE. Ex-CMR assessment of biventricular volumes and quantitated MR may offer additional prognostic information. Purpose Determine the feasibility of biventricular assessment and MR quantification in primary MR patients during continuous supine Ex-CMR using the recently validated protocol1. Methods 10 asymptomatic patients with at least moderate primary MR on TTE (8 male, median age 62, 55-67years interquartile range) underwent continuous in-scanner (1.5T Philips Ingenia) supine cycle ergometer (Lode BV) Ex-CMR. Target heart rates (THR) were individually prescribed using heart rate reserve (HRR) and age predicted maximal heart rate model. Participants exercised for 2-minutes at no resistance, then an increase of 25-Watts every 2-minutes until THR achieved at low (30-39% HRR), then moderate (40-59% HRR) stages. CMR imaging: free-breathing CS3 respiratory navigated short axis cine imaging and free-breathing CS3 aortic phase-contrast magnetic-resonance at rest, low and moderate exercise stages. MR was quantified indirectly from left ventricular (LV) and aortic stroke volumes. Intra/inter-observer reproducibility was assessed by coefficient of variance (CV). Results All patients completed the Ex-CMR protocol without complication. During exercise, no statistically significant changes occurred in LV volumes, global left ventricular ejection fraction (LVEF), right ventricular end-diastolic or systolic volumes (Table 1). From rest to low and moderate exercise: right ventricular ejection fraction increased (55 ± 5.4% to 60 ± 6.0% and 63 ± 6.6% respectively, p = 0.001) and MR fraction decreased (40 ± 14% to 36 ± 11% and 30 ± 15% respectively, p = 0.006) allowing effective forward LVEF (aortic stroke volume/ left ventricular end-diastolic volume) to increase (38 ± 9.3% to 43 ± 9.3% and 46 ± 11% respectively, p = 0.004). Intra-observer reproducibility (Table 2) was excellent (CV &amp;lt;10%), except right ventricular stroke volumes (RVSV) during low, MR volumes and fraction during moderate and right ventricular end-systolic volumes (RVESV) during both exercise stages, which were good (CV10-20%). Inter-observer reproducibility (Table 2) was excellent (CV &amp;lt; 10%), except RVESV and MR volumes at all stages, LV end-systolic volumes during low and MR fraction during moderate exercise, which were good (CV 10-20%). Conclusion Biventricular assessment and MR quantification during continuous supine Ex-CMR is feasible in asymptomatic primary MR patients, further research assessing the techniques prognostic ability is now warranted.

Successful percutaneous mitral valve leaflet repair for primary mitral regurgitation results in functional improvement and positive cardiac reverse remodelling

Abstract Funding Acknowledgements Type of funding sources: None. Background Percutaneous mitral valve leaflet repair can be an effective treatment for primary mitral regurgitation (MR) patients deemed high-risk for surgery. Accurate assessment of cardiac reverse remodelling is essential to optimise future patient selection. Cardiovascular magnetic resonance (CMR) is the reference standard for cardiac volumetric assessment and compared to transthoracic echocardiography (TTE) provides superior reproducibility in MR quantification. Prior CMR studies have analysed cardiac reverse remodelling following percutaneous intervention in combined cohorts of primary and secondary MR patients. However, as aetiology of MR can significantly impact outcomes, focused studies are warranted. Purpose Assess cardiac reverse remodelling and quantify changes in MR following percutaneous mitral valve leaflet repair for primary MR using the reference standard (CMR). Methods 12 patients with at least moderate-severe MR on TTE were prospectively recruited to undergo CMR imaging and 6-minute walk tests (6MWT) at baseline and 6 months following percutaneous mitral valve leaflet repair (MitraClip). CMR protocol involved: left-ventricular (LV) short axis cines (bSSFP, SENSE-2, 10mm, no gap), transaxial right-ventricular (RV) cines (bSSFP, SENSE-2, 8mm, no gap), two and four chamber cines and aortic through-plane phase contrast imaging, planned at the sino-tubular junction. MR was quantified indirectly using LV and aortic stroke volumes. Results 12 patients underwent percutaneous mitral valve leaflet repair (MitraClip) for posterior mitral valve leaflet prolapse, however 1 patient declined follow up after single-leaflet clip detachment resulting in 11 patients (age 83 ± 5years, 9 male) completing follow up imaging. At 6-months: significant improvements occurred in New York Heart Association functional class (Table 1) and 6MWT distances (223 ± 71m to 281 ± 65m, p = 0.005) and significant reductions occurred in indexed left ventricular end-diastolic volumes (LVEDVi) (118 ± 21ml/m2 to 94 ± 27ml/m2, p = 0.001), indexed left ventricular end-systolic volumes (58 ± 19ml/m2 to 48 ± 21ml/m2, p = 0.007) and quantitated MR volume (55 ± 22ml to 24 ± 12ml, p = 0.003) and MR fraction (49 ± 9.4% to 29 ± 14%, p= &amp;lt;0.001). There were no statistically significant changes in left ventricular ejection fraction (LVEF), right ventricular dimensions/ejection fraction or bi-atrial dimensions (Table 1). All patients demonstrated decreased LVEDVi and quantified MR (Figure 1). Conclusion Successful percutaneous mitral valve leaflet repair for primary MR results in reduction in MR, positive LV reverse remodelling, preservation of LVEF, and functional improvements. Larger CMR studies are now required to further guide optimal patient selection.

Systolic and Diastolic Functions After a Brief Acute Bout of Mild Exercise in Normobaric Hypoxia.

Acute hypoxia (AH) is a challenge to the homeostasis of the cardiovascular system, especially during exercise. Research in this area is scarce. We aimed to ascertain whether echocardiographic, Doppler, and tissue Doppler measures were able to detect changes in systolic and diastolic functions during the recovery after mild exercise in AH. Twelve healthy males (age 33.5 ± 4.8 years) completed a cardiopulmonary test on an electromagnetically braked cycle-ergometer to determine their maximum workload (Wmax). On separate days, participants performed randomly assigned two exercise sessions consisting in 3 min pedalling at 30% of Wmax: (1) one test was conducted in normoxia (NORMO) and (2) one in normobaric hypoxia with FiO2 set to 13.5% (HYPO). Hemodynamics were assessed with an echocardiographic system. The main result was that the HYPO session increased parameters related to myocardial contractility such as pre-ejection period and systolic myocardial velocity with respect to the NORMO test. Moreover, the HYPO test enhanced early transmitral filling peak velocities. No effects were detected for left ventricular volumes, as end-diastolic, end-systolic, and stroke volume were similar between the NORMO and the HYPO test. Results of the present investigation support the hypothesis that a brief, mild exercise bout in acute normobaric hypoxia does not impair systolic or diastolic functions. Rather, it appears that stroke volume is well preserved and that systolic and early diastolic functions are enhanced by exercise in hypoxia.

Accuracy of stroke volume measurement with phase-contrast cardiovascular magnetic resonance in patients with aortic stenosis

BackgroundPhase contrast (PC) cardiovascular magnetic resonance (CMR) in the ascending aorta (AAo) is widely used to calculate left ventricular (LV) stroke volume (SV). The accuracy of PC CMR may be altered by turbulent flow. Measurement of SV at another site is suggested in the presence of aortic stenosis, but very few data validates the accuracy or inaccuracy of PC in that setting. Our objective is to compare flow measurements obtained in the AAo and LV outflow tract (LVOT) in patients with aortic stenosis.MethodsRetrospective analysis of patients with aortic stenosis who had CMR and echocardiography. Patients with mitral regurgitation were excluded. PC in the AAo and LVOT were acquired to derive SV. LV SV from end-systolic and end-diastolic tracings was used as the reference measure. A difference ≥ 10% between the volumetric method and PC derived SVs was considered discordant. Metrics of turbulence and jet eccentricity were assessed to explore the predictors of discordant measurements.ResultsWe included 88 patients, 41% with bicuspid aortic valve. LVOT SV was concordant with the volumetric method in 79 (90%) patients vs 52 (59%) patients for AAo SV (p = 0.015). In multivariate analysis, aortic stenosis flow jet angle was a strong predictor of discordant measurement in the AAo (p = 0.003). Mathematical correction for the jet angle improved the concordance from 59 to 91%. Concordance was comparable in patients with bicuspid and trileaflet valves (57% and 62% concordance respectively; p = 0.11). Accuracy of SV measured in the LVOT was not influenced by jet eccentricity. For aortic regurgitation quantification, PC in the AAo had better correlation to volumetric assessments than LVOT PC.ConclusionLVOT PC SV in patients with aortic stenosis and eccentric jet might be more accurate compared to the AAo SV. Mathematical correction for the jet angle in the AAo might be another alternative to improve accuracy.

LV non-compaction in patients with coarctation of the aorta: prevalence and effects on cardiac function

Left ventricular non-compaction has been associated with heart failure, arrhythmia, thromboembolism and sudden death. The prevalence of non-compaction in patients with coarctation of the aorta and its clinical significance remains unknown, although obstructive left heart disease is common in patients with non-compaction. We sought to evaluate the prevalence of left ventricular non-compaction in patients with repaired aortic coarctation as well as its effect on left ventricular size and systolic function. In total, 268 patients (Mean age 26 (inter-quartile range 21-37) years, 63% male) undergoing cardiac magnetic resonance imaging for clinical follow-up were included from three tertiary centres for adult congenital heart disease. Clinical data was obtained from medical records and correlated with ventricular volumes and function. Left ventricular non-compaction was defined as a diastolic non-compacted:compacted dimension ratio >2.3 in the worst affected segment on a long-axis view. Left ventricular non-compaction was present in 8.2% of patients with repaired coarctation. Left ventricular end-diastolic volumes and stroke volumes were significantly higher in patients with non-compaction compared to those without. There were no significant differences in ventricular mass or ejection fraction in these two groups. Left ventricular non-compaction is relatively common in patients with repaired coarctation of the aorta and correlates with increased left ventricular end-diastolic volumes.

Tissue characteristics of the athlete"s heart: differentiation of physiological and pathological hypertrophy using parametric T1 and T2 mapping

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Fund of Hungary Background Intensive physical exercise leads to structural and functional cardiac adaptation termed athlete’s heart. Cardiac magnetic resonance (CMR) has an important role in the differentiation of physiological adaptation and pathological conditions. Beside the precise measurement of the ventricular volumes, mass, and function, it provides tissue specific information. Recently, native T1 mapping technique has been applied as a non-contrast method to detect myocardial fibrosis. Previous studies suggested that native T1 mapping can identify myocardial pathology before other CMR imaging techniques. T2 mapping values are elevated in case of myocardial edema. Purpose The aim of our study was to investigate the differences in CMR characteristics especially the native T1 and T2 mapping values of highly trained healthy athletes, healthy controls and patients with hypertrophic cardiomyopathy (HCM). Methods A total of 43 healthy athletes (water polo, swimming, football, 22 ± 8 training hours/week), 27 non-athlete healthy control and 25 HCM patients were involved in the study. Our inclusion criteria were: age &amp;gt;18 years, in the athlete group &amp;gt;7 training hours per week . We evaluated the left ventricular (LV) end-systolic, end-diastolic (EDVi) and stroke volume (SVi) index, mass index (LVMi), ejection fraction (EF) and maximal end-diastolic wall thickness (EDWT). In a basal short axis slice the native T1 and T2 mapping values were evaluated. Results Athletes had significantly higher LV volumes compared to the control and HCM group (LVEDVi 114 ± 13 vs. 86 ± 11; 84 ± 15 ml/m2, LVSVi 64 ± 7 vs. 51 ± 7; 54 ± 10 ml/m2, respectively, p &amp;lt; 0.0001). HCM patients had the highest LVMi (72 ± 14 g/m2) and EDWT (18 ± 4 mm) compared to athletes and controls, athletes had higher LVMi (60 ± 11 vs. 42 ± 8 g/m2) and EDWT (10 ± 2 vs. 8 ± 1 mm) compared to the controls (p &amp;lt; 0.001). The native T1 mapping values differed significantly in the three groups, athletes had the lowest, HCM patients had the highest T1 values (athletes: 956 ± 19 ms, controls: 971 ± 20 ms, HCM patients: 993 ± 39 ms; p &amp;lt; 0.0001). There was no difference in the T2 mapping values between athletes and controls (44 ± 2 vs. 43 ± 2 ms), HCM patients had higher T2 values (45 ± 2 ms) compared to the other two groups (p &amp;lt; 0.01). Conclusion Intensive and regular training may lead to tissue specific changes of the myocardium. T1 and T2 mapping are potentially useful tools for differentiating between athlete"s heart and patients with hypertrophic cardiomyopathy. Abstract Figure. T1 mapping in HCM and athlete

The Prevalence of Pulmonary Hypertension Among Maintenance Dialysis Patients With ESRD and Its Associated Factors: A Retrospective Study.

Aim: To determine the prevalence of pulmonary hypertension (PH) and its associated factors among end-stage renal disease (ESRD) patients who underwent maintenance dialysis.Methods: A total of 491 patients received echocardiography examinations and underwent pulmonary artery systolic pressure (PASP) assessments. A subgroup of 283 patients were subjected to plasma creatinine (Cr) and blood urea nitrogen concentration (BUN) tests, routine blood examinations and electrolyte analysis. First, we compared the differences in echocardiographic, Cr and BUN, blood routine and electrolyte parameters between PH and non-PH groups. The correlations between PASP and the parameters mentioned above were also analyzed. Furthermore, univariate and adjusted logistic regression analyses were performed to identify the independent associated factors.Results: The incidence of PH among ESRD patients who were treated with maintenance dialysis was 34.6%. Most of the echocardiographic parameters, including end-diastolic internal diameters of the left atrium, left ventricle, right atrium, and pulmonary artery, as well as interventricular septum mobility, left ventricular posterior wall mobility, fractional shortening, stroke volume and left ventricle ejection fraction (LVEF), were associated with PH. Furthermore, Mg2+ (p = 0.037) and Cl− (p = 0.043) were significantly associated with PASP. However, after adjustments were made in the regression analysis, only internal diameters of the left atrium, right atrium, and LVEF were independently associated with PH.Conclusion: PH is prevalent, with a relatively high incidence among ESRD patients who undergo maintenance dialysis. The sizes of the left and right atria as well as LVEF were independently associated with PH, but further cohort and basic mechanistic studies are needed to confirm this finding.

Abstract 14082: The Effect of Diagnostic Ultrasound Mediated High Mechanical Impulses on Cardiac Output During an Ultrasound Enhancing Agent Infusion

Introduction: Diagnostic ultrasound high mechanical index (MI) impulses are used during an ultrasound enhancing agent (UEA) infusion to improve endocardial border resolution and study myocardial perfusion. They have also been shown to cause endothelial shear, resulting in prolonged increases in ATP release and augment microvascular flow. The potential for these high MI impulses to alter cardiac output (CO) are unknown. Hypothesis: To study the impact of high MI impulses on CO Methods: Fifty one patients (mean age 63±15 years; 41% female) referred for contrast echocardiography underwent very low MI imaging with intermittent high MI impulses (1.6-1.7 Megahertz) in three different apical windows during either a Definity (Lantheus Medical) or Lumason (Bracco Diagnostics) infusion or bolus. CO was determined from Doppler measurements of left ventricular outflow tract stroke volume and heart rate. Mean contrast enhanced biplane left ventricular ejection fraction (LVEF) was 53±15%; (range 10-75%). CO from baseline without contrast (COwoC) and baseline after contrast (COwC) before high MI impulses were compared to CO after contrast and after high MI impulses (COaHMI). All CO measurements were made by an independent reviewer blinded to time of measurement (before or after high MI impulses). Results: Although heart rate did not change before and after intermittent high MI impulse administration, COaHMI increased significantly when compared to COwoC and COwC (p&lt; 0.001 for both comparisons; Figure). In nine patients (18%), CO increased by more than 20%. In patients with LVEF &lt; 40% COwC was 2.4±0.8 liters per minute (LPM) and COaHMI increased to 2.7± 0.8 LPM (p=0001). In patients with LVEF≥40%, COwC was 3.4±1.06 LPM while COaHMI increased to 3.8± 1.2 LPM (p=0.00001). Conclusions: Application of diagnostic guided high MI impulses during a commercially available microbubble infusion significantly increases CO irrespective of underlying left ventricular systolic function.

Left ventricular global function index: prognostic value in patients with heart failure aged 60 years and older

Left ventricular (LV) global function index (LVGFI) is a novel marker that incorporates the functional and structural characteristics of the LV.Aim. To evaluate the prognostic value of LVGFI in outpatients with heart failure with preserved ejection fraction (HFpEF) aged 60 years and older.Material and methods. The study included 78 patients (male, 42%) aged 74 (67-77) years with NYHA class II-III heart failure. LVGFI was defined as LV stroke volume/LV global volume х 100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/ density).Results. The median LVGFI was 21,7% (interquartile range 19,3 to 22,9%). Higher NYHA class of HF was associated with worse LVGFI:class II HF was associated with LVGFI of 22,0 (20,3-23,1)%, class III HF — with 20,4 (17,5-22,4)%. During the 3—month (24-48) follow-up period, 15 (19,2%) patients died. Among patients with NYHA class II HF, 6 out of 61 (9,8%) died, with class III HF — 9 out of 17 (53,0%) (p&lt;0,001). According to ROC analysis, the optimal LVGFI cut-off point for the prediction of an unfavorable prognosis in patients with HFpEF aged 60 years was ≤21,1% (p&lt;0,001). The sensitivity was 73,3%, specificity — 70,0%. Patients with LVGFI ≤21,1% had significantly lower survival: among patients with LVGFI ≤21,1%, 11 out of 30 (36,7%) died; among those with LVGFI &gt;21,1%, 4 out of 48 (8,3 %) died (p=0,016).Conclusion. Higher NYHA class of HF was associated with worse LVGFI. Patients with lower LVGFI have significantly lower survival. The optimal LVGFI cut-off point for the prediction of an unfavorable prognosis in patients with HFrEF aged 60 years was &lt;21,1%.

Ventricular stroke work indices to predict mortality after successful percutaneous edge-to-edge-repair for severe mitral valve regurgitation

Abstract Background Several studies identified predictors of worse clinical outcome despite successful transcatheter mitral valve repair (TMVR). The capability of invasively measured left and right ventricular stroke work indices (LVSWi, RVSWi) to predict mortality after successful TMVR is unclear. Purpose To assess the impact of LVSWi and RVSWi on mortality in patients with chronic heart failure (CHF) and severe mitral regurgitation (MR) undergoing TMVR. Methods Consecutive patients (pts.) with CHF (LV ejection fraction ≤50% from any cause) and severe MR who underwent successful TMVR (MR≤2+ at discharge) were included and followed prospectively. Primary endpoint was defined as all-cause mortality during a median follow-up period of 16±9 months. LVSWi was calculated as: Stroke volume index × (mean arterial pressure − postcapillary wedge pressure) × 0.0136 = g/m–1/m2. RVSWi was calculated as: Stroke volume index × (mean pulmonary artery pressure − right atrial pressure) × 0.0136 = g/m–1/m2. Receiver operator characteristic (ROC) analysis was used to determine discriminative capacity of LVSWi and RVSWi. Kaplan-Meier estimate was used for survival analysis. A multivariable Cox proportional-hazards regression analysis was performed to identify independent risk factors for all-cause mortality. Results 140 patients (median age 74±9.9 years, 67.9% male) at high operative risk (LogEuro-SCORE 34.6±14.1%) were enrolled. Mean LVSWi and RVSWi were 22.3±10.7 g/m–1/m2 and 8.9±4.1 g/m–1/m2, respectively. 46 pts. died (33.1%). Pts. who died presented higher LogEuro-SCORE (27.8±16.6% vs. 20.1±13.7%; p=0.001), higher levels of NT-proBNP (12121±10602 ng/l vs. 6745±10820 ng/l; p=0.001), higher levels of creatinine (1.8±0.8 mg/dl vs. 1.4±0.8 mg/dl; p&amp;lt;0.001), lower LVSWi (18.9±8.1 g/m–1/m2 vs. 24.0±11.4 g/m–1/m2; p=0.01) and RVSWi (7.8±3.2 g/m–1/m2 vs. 9.4±4.4 g/m–1/m2; p=0.037), respectively. ROC curve analysis revealed that optimal sensitivity and specificity were achieved using a threshold of 24.8 g/m–1/m2 for LVSWi (sensitivity 80.4%, specificity 40.2%, area under the curve (AUC) 0.71 [0.60–0.81]; p=0.001) and 8.3 g/m–1/m2 for RVSWi (sensitivity 67.4%, specificity 57.0%, AUC 0.67 [0.56–0.78]; p=0.006), respectively. At long-term follow-up, a significantly lower survival rate was observed in pts. with LVSWi ≤24.8 g/m–1/m2 (20.0% vs. 39.4%; log-rank p=0.038) and in pts. with RVSWi ≤8.3 g/m–1/m2 (22.1% vs. 43.7%; log-rank p=0.026), respectively. In Cox regression analysis a LVSWi of ≤24.8 g/m–1/m2 and a RVSWi of ≤8.3 g/m–1/m2 were independent predictors for all-cause mortality (hazard ratio (HR) 2.83; 95% confidence interval (CI) 1.1 to 7.6; p=0.04; HR 2.52; 95% CI 1.04 to 6.1; p=0.041). Conclusions LVSWi and RVSWi are associated with mortality among pts. with CHF undergoing successful TMVR for severe MR. A LVSWi cut-off value of &amp;gt;24g/m–1/m2 and a RVSWi cut-off value of &amp;lt;8g/m–1/m2 seem to predict mortality independent of other clinical and echocardiographic factors. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital Links der Weser, Bremen, Germany