Left Ventricular Systolic Dimensions Research Articles

Prevalence of Atrial Fibrillation and Relation to Echocardiographic Parameters in a Healthy Asymptomatic Rural Korean Population.

Atrial fibrillation (AF) is the most common arrhythmia worldwide and a potent independent risk factor for stroke. This study aimed to determine the prevalence of AF in a population-based sample of adults in a rural region of Korea. Between January 2005 and December 2009, 4,067 individuals (60.2 ± 11.2 yr old, M: F = 1,582:2,485) over 21 who were residents of the county of Yangpyeong, Korea, participated in the study. AF was assessed on a resting 12-lead electrocardiogram (ECG) in 4,053 of the participants. Blood tests and transthoracic echocardiography (TTE) were also performed to investigate the relationship between left ventricular mass and AF in the study group. Fifty-four cases (32 men) were diagnosed as AF among the 4,053 subjects. The crude prevalence of AF was 1.3%. It was highest (2.3%) among sixty- and seventy- year olds, and higher in men than women in all age groups over 50. The prevalence in men was 2.0%, and in women 0.9%. In univariate analysis, age, male gender, body mass index, total serum cholesterol, alanine transaminase, serum creatinine, adiponectin level, and ischemic heart disease were associated with AF. Among the TTE parameters, systolic and diastolic left ventricular systolic internal dimension (LVID), and LV ejection fraction were associated with AF. In this relatively healthy population in a rural area of Korea, the prevalence of AF is 1.3%, and increases with age. Of the TTE parameters, systolic and diastolic LVID and left atrial diameter are related to prevalence of AF.

Relation of Indirect Vasodilator Use to Prognosis in Patients with Chronic Severe Mitral Regurgitation

Objectives: The relation of indirect vasodilator use to cardiac events (CE) is undefined for chronic severe nonischemic mitral regurgitation (MR). The aim of this study was to resolve this knowledge deficiency. Methods: Data from 52 consecutive patients in our prospective natural history study with isolated chronic severe nonischemic MR were assessed post hoc over 19 years to examine the relation of indirect vasodilator use to subsequent CE (death or indications for valve surgery). At entry, no patient had surgical indications, 14% had hypertension (HTN) and 7 chronically received vasodilators (5 angiotensin-converting enzyme inhibitor, 1 receptor blocker and 1 α-adrenergic blocker). CE differences were assessed by log-rank comparison of Kaplan-Meier curves. Results: During follow-up, CE included sudden death (1 patient), heart failure (7 patients), atrial fibrillation (6 patients), left ventricular (LV) systolic dimension >4.5 cm (12 patients), LV ejection fraction (EF) <60% (7 patients), right ventricular EF <35% (2 patients) and combination CE (7 patients). Overall, vasodilator use did not predict CE (not significant). However, patients without HTN had higher CE rates with vasodilators than without (p = 0.007), while those with HTN and vasodilators had lower CE rates than those without vasodilators (p = 0.04). Conclusion: Vasodilator use appears to confer no survival benefit in patients with chronic severe MR. The small number of patients with HTN precludes conclusions about modulation of vasodilator effect by HTN. Randomized trials are needed to conclusively evaluate this association.

Effects of intramuscular sedation with alfaxalone and butorphanol on echocardiographic measurements in healthy cats.

The aim of the study was to evaluate the effects of intramuscular (IM) injections of alfaxalone combined with butorphanol on echocardiographic (ECG) measurements in cats. Client-owned adult domestic shorthair cats younger than 5 years of age were recruited. All cats that were considered healthy on the basis of physical examination, blood work, urinalysis, blood pressure measurement and baseline ECG underwent a second ECG under sedation. Cats were sedated with two separate IM injections of butorphanol at 0.2 mg/kg and alfaxalone at 2 mg/kg. ECG variables were analysed using a linear mixed model, and sedation scores were analysed using an ordinal mixed logistic model. The significance level was set at α = 0.05 and adjusted at α = 0.0017 for multiple comparisons of the ECG measurements. Ten healthy cats were included. Sedation was uneventful, and recovery was smooth and quick for all cats. The mean duration of lateral recumbency was 36.3 ± 4.37 mins. Reduction in heart rate following sedation approached statistical significance (P = 0.002). The thickness of the interventricular septum, the thickness of the left ventricular free wall, and the left ventricular internal dimensions in diastole and systole were not affected by the sedation. The changes in left atrium/aortic ratio and shortening fraction were statistically significant. Although the peak velocity of early diastolic transmitral flow (E) and late diastolic transmitral flow (A), the peak early diastolic (Ea) mitral valve annulus velocity, and the peak late diastolic (Aa) mitral valve annulus velocity changed after sedation, the ratios E/A, E/Ea and Ea/Aa were not significantly different after sedation. IM injections of alfaxalone and butorphanol induced rapid, deep and short-lasting sedation. The mean differences after sedation were not clinically significant for most echocardiographic measurements.

Timing of aortic valve intervention in pediatric chronic aortic insufficiency.

The timing of aortic valve intervention (AVI) in pediatric patients with chronic aortic insufficiency (AI) is largely based on adult experience, which is fraught with uncertainty and controversy. Current adult guidelines in the absence of symptoms use left ventricular (LV) systolic function and LV dimensions to guide AVI timing, with few studies translating these recommendations to pediatric patients. This article reviews the current guidelines for AVI timing in chronic AI along with the emerging data for pediatric patients.

Postmyocardial infarction remodeling in male and female middle‐aged rats causes a comparable decline in left ventricular systolic properties (680.1)

Our previous study on post‐MI male and female middle‐aged rats has revealed the regional sex‐specific differences in the adaptive changes of the left ventricular (LV) cardiac myocytes and coronary vessels. However, the impact of such structural alterations on LV systolic properties remained unclear. Therefore, our current study is aimed to determine whether post‐MI cardiac remodeling in middle‐aged rats associates with sex‐related differences in LV systolic performance, function or contractility. A large MI was induced in 12‐month‐old male (M‐MI) and female (F‐MI) Sprague‐Dawley rats by ligation of the left coronary artery. Two months after the surgery, the various LV parameters were compared between the sexes using echocardiography, hemodynamics and morphometry. We found that although both sexes had a similar scale of global post‐MI LV remodeling, the F‐MI rats showed a significantly lesser degree of cardiac myocyte hypertrophy in the epimyocardium compared to males (353.3±21.4 vs. 479.0±20.6 μm², P蠄0.01). Nevertheless, rats in M‐MI and F‐MI groups demonstrated comparable values of stroke volume (0.23±0.03 vs. 0.17±0.02 mL), ejection fraction (28.1±3.9 vs. 38.68±4.74 %) and peak dP/dt (3068.3±240.6 vs. 3307.0±214.1 mmHg/sec). Thus, our data reveal that male and female middle‐aged rats have a similar degree of deterioration in LV systolic properties associated with cardiac remodeling after a large MI.

Circulation: Heart Failure Editors’ Picks

Summary : Lifelong exercise training maintains a youthful compliance of the left ventricle (LV), whereas a year of exercise training started later in life fails to reverse LV stiffening, possibly because of accumulation of irreversible advanced glycation end products. Alagebrium is a novel drug that breaks advanced glycation end product crosslinks and improves LV stiffness in aged animals. In this study, the authors prescribed alagebrium (200 mg daily) or placebo combined with aerobic exercise training or contact control in healthy, sedentary older individuals for 1 year. The authors evaluated overall cardiac function by the use of several modalities, including invasive pressure–volume measurements, exercise testing, and cardiac MRI before and after the training. To the authors’ knowledge, this is the first study to evaluate the effects of alagebrium and exercise training in healthy aged humans. After intervention, exercise training significantly increased exercise capacity, LV mass, and LV end-diastolic volume. Conversely, alagebrium had little effect on exercise capacity or LV geometry. However, alagebrium showed a modest improvement in LV stiffness compared with placebo. This favorable effect of alagebrium on LV stiffness was most prominent in individuals with combined alagebrium and exercise training. Conclusions : Alagebrium had no effect on hemodynamics, LV geometry, or exercise capacity in healthy, previously sedentary seniors. However, it did show a modestly favorable effect on age-associated LV stiffening.1 Summary : Maximum oxygen consumption (peak VO2) and efficiency of ventilation (VE) during exercise (VE/VCO2 slope) are known to stratify adults in heart failure for 1-year survival. On the basis of adult data, a recent American Heart Association scientific statement suggested that peak VO2<50% predicted for age and sex should be considered substantial impairment in exercise performance in children with heart disease and therefore a class I indication for heart transplant listing. This single-center study examined the association of …

Long‐Term Outcome in Dogs with Patent Ductus Arteriosus: 520 Cases (1994–2009)

BackgroundPublished information regarding survival and long‐term cardiac remodeling after patent ductus arteriosus (PDA) closure in dogs is limited.ObjectivesTo report outcome and identify prognostic variables in dogs with PDA, and to identify risk factors for persistent remodeling in dogs with a minimum of 12 months of follow‐up after closure.AnimalsFive hundred and twenty client‐owned dogs.MethodsRetrospective review of medical records of 520 dogs with PDA. Outcome was determined by contacting owners and veterinarians. Dogs with PDA closure and ≥ 12 months of follow‐up were asked to return for a re‐evaluation.ResultsIn multivariable analysis of 506 dogs not euthanized at the time of diagnosis, not having a PDA closure procedure negatively affected survival (HzR = 16.9, P < .001). In 444 dogs undergoing successful PDA closure, clinical signs at presentation (HzR = 17, P = .02), concurrent congenital heart disease (HD) (HzR = 4.8, P = .038), and severe mitral regurgitation (MR) documented within 24 hours of closure (HzR = 4.5, P = .028) negatively affected survival. Seventy‐one dogs with ≥ 12 months follow‐up demonstrated a significant reduction in radiographic and echocardiographic measures of heart size (P = 0) and increased incidence of acquired HD (P = .001) at re‐evaluation. Dogs with increased left ventricular size and low fractional shortening at baseline were more likely to have persistent remodeling at re‐evaluation.Conclusions and Clinical ImportancePatent ductus arteriosus closure confers important survival benefits and results in long‐term reverse remodeling in most dogs. Clinical signs at presentation, concurrent congenital HD, and severe MR negatively affect survival. Increased left ventricular systolic dimensions and systolic dysfunction at baseline correlated significantly with persistent remodeling.

Usefulness of Preoperative Cardiac Dimensions to Predict Success of Reverse Cardiac Remodeling in Patients Undergoing Repair for Mitral Valve Prolapse

Mitral valve repair for mitral regurgitation (MR) is currently recommended based on the degree of MR and left ventricular (LV) function. The present study examines predictors of reverse remodeling after repair for degenerative disease. We retrospectively identified 439 patients who underwent repair for myxomatous mitral valve degeneration and had both pre- and postoperative echocardiographic data available. Patients were categorized based on left atrial (LA) diameter and LV diameter standards of the American Society of Echocardiography. The outcome of interest was the degree of reverse remodeling on all heart dimensions at follow-up. Mean age was 57 ± 12 years, and 37% of patients were women. Mean preoperative LV end-diastolic diameter was 5.8 ± 0.7 cm, LV end-systolic diameter 3.5 ± 0.6 cm, LA 4.7 ± 0.7 cm, and median ejection fraction 60%. Median observation time was 81 months, and time to postoperative echocardiography was 38 months. Overall, 95% of patients had normal LV diastolic dimensions postoperatively, 93% normal LV systolic dimensions, and 37% normal LA dimensions. A Cox regression analysis showed that moderate (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.3 to 3.4) or severe preoperative LA dilatation (OR 2.7, 95% CI 1.7 to 4.4), abnormal preoperative LV end-systolic dimensions (OR 1.3, 95% CI 1.1 to 1.5), and age in years (OR 1.02, 95% CI 1.01 to 1.03) were predictive of less reverse remodeling on follow-up. In conclusion, preoperative LV end-systolic dimensions and LA dilatation substantially affect the likelihood of successful LA remodeling and normalization of all heart dimensions after mitral valve repair for MR. These findings support early operation for MR before the increase in heart dimensions is nonreversible.

Role of N-terminal pro B-type natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease

ObjectivesAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a major public health problem. Recognition of comorbid heart dysfunction in such patients is often difficult. The aim of this work is to evaluate the role of N-terminal pro B-type natriuretic peptide (Nt-pro BNP) in AECOPD with respiratory failure. Patients and methodsThis study was conducted on 20 patients with AECOPD and respiratory failure. All patients were subjected to history taking, clinical examination, routine laboratory investigations, arterial blood gases analysis, echocardiography and estimation of plasma level of NT-pro BNP. ResultsPatients were classified into 3 groups: Group I: those without heart dysfunction (40%), Group II: those with diastolic heart failure (40%), and Group III: those with systolic heart failure (20%). NT-pro BNP mean±SD in group I was 673.38±416.02, in group II 1962±847.88, and in group III 6776.75±1433.59pg/ml. There was a statistically significant difference between the three groups (p=0.001). NT-pro BNP showed a statistically significant inverse correlation with pH (p=0.005), ejection fraction (p=0.007) and a direct one with both left ventricular systolic (p=0.008) and diastolic (p=0.016) dimensions and E/A (p=0.016). The NT-pro BNP significantly decreased after recovery from AECOPD (p=0.030). The receiver operating characteristic curve demonstrated a ruling out of LV dysfunction in AECOPD of a sensitivity of 100% and a specificity of 60%; and a ruling in of a sensitivity of 48% and a specificity of 67%. ConclusionPlasma BNP is usually elevated in AECOPD and is related to right or left ventricular systolic or diastolic dysfunction.

Atrial fibrillation and prognosis in patients 80+ years old with chronic heart failure

It is well known that the prevalence of atrial fibrillation (AF) increases with age. The purpose was to evaluate the impact of AF at the 1-year outcome of patients aged 80? who suffered from chronic heart failure (CHF). The study included 220 consecutive patients at age 80–92 (mean 82.8 years, 45.5 % men) hospitalized for heart failure. The prospective analysis contains demographic and clinical data, basic laboratory tests with hsTnT and NT-proBNP, 12-lead resting electrocardiogram, echocardiography and coronary angiography results and the number of deaths at the 1-year followup. Patients were analyzed depending on AF in the resting electrocardiogram at hospital entry. AF was recorded in 52 patients (24 %). The relationship with AF was found for more advanced NYHA class III and IV (p\0.001), higher concentrations of hsCRP (p = 0.0005), hsTnT (p = 0.007) and NT-proBNP (p = 0.0098), higher heart rate in the electrocardiogram (p = 0.000) and longer hospitalization (p = 0.025), older age (p = 0.003) and lower left ventricular ejection fraction (p = 0.006). Annual mortality was 13 % and was higher if AF occurred (17 %). However, there was no association between deaths and AF (p = 0.3297). From the multivariate stepwise analysis, independent risk factors for annual mortality were male gender (OR = 3.432; p = 0.043), left ventricular systolic dimension (OR = 1.871; p = 0.004) and dyslipidemia (OR = 0.252; p = 0.043). In the oldest patients aged 80? who suffered from CHF, the incidence of atrial fibrillation and annual mortality was high. The independent variables, which enhanced the risk of death at the 1-year follow-up, were male sex and left ventricular systolic dimension, but not atrial fibrillation.

Longitudinal Analysis of Quality of Life, Clinical, Radiographic, Echocardiographic, and Laboratory Variables in Dogs with Myxomatous Mitral Valve Disease Receiving Pimobendan or Benazepril: The QUEST Study

Myxomatous mitral valve disease (MMVD) is an important cause of morbidity and mortality in dogs. To compare, throughout the period of follow-up of dogs that had not yet reached the primary endpoint, the longitudinal effects of pimobendan versus benazepril hydrochloride treatment on quality-of-life (QoL) variables, concomitant congestive heart failure (CHF) treatment, and other outcome variables in dogs suffering from CHF secondary to MMVD. A total of 260 dogs in CHF because of MMVD. A prospective single-blinded study with dogs randomized to receive pimobendan (0.4-0.6 mg/kg/day) or benazepril hydrochloride (0.25-1.0 mg/kg/day). Differences in outcome variables and time to intensification of CHF treatment were compared. A total of 124 dogs were randomized to pimobendan and 128 to benazepril. No difference was found between groups in QoL variables during the trial. Time from inclusion to 1st intensification of CHF treatment was longer in the pimobendan group (pimobendan 98 days, IQR 30-276 days versus benazepril 59 days, IQR 11-121 days; P = .0005). Postinclusion, dogs in the pimobendan group had smaller heart size based on VHS score (P = .013) and left ventricular diastolic (P = .035) and systolic (P = .0044) dimensions, higher body temperature (P = .030), serum sodium (P = .0027), and total protein (P = .0003) concentrations, and packed cell volume (P = .030). Incidence of arrhythmias was similar in treatment groups. Pimobendan versus benazepril resulted in similar QoL during the study, but conferred increased time before intensification of CHF treatment. Pimobendan treatment resulted in smaller heart size, higher body temperature, and less retention of free water.

Three-dimensional echocardiography in classification of Ebstein’s anomaly: a case report on agenesis of the tricuspid valve posterior leaflet

Cardiologia CROATICA We present an echocardiographic evaluation of a 27-yearold young male patient who was referred to our institution after a loud systolic murmur was found during his occupational health check-up.. Besides the murmur, his physical exam, and results of his laboratory tests were normal. He has no significant complaints. His first 2D transthoracic echocardiogram (TTE) revealed severely dilated right ventricle (RV area greater than left ventricular area), volume overloaded and excentrically hypertrophied (wall thickness >6 mm), with severe tricuspid regurgitation (vena contracta 12 mm), large abundant sail-like anterior leaflet of the tricuspid valve (TV), apically displaced short septal leaflet (17 mm), and in the same time normal left ventricular systolic function and dimensions. These findings, especially apical displacement of septal leaflet indicate Ebstein’s anomaly. Ebstein’s anomaly is a rare congenital heart defect that occurs in only about <1% of congenital heart disease. In normal human hearts the apical displacement of the septal and posterior TV leaflets is <8 mm/m body surface area from the level of anterior mitral valve insertion. Differential diagnosis includes TV dysplasia, TV prolapse, TV endocarditis, and arrhythmogenic right ventricular cardiomyopathy, to name a few. With 2D TTE we were positive that this patient had some form of Ebstein’s anomaly, however we could not generate important information about valvular apparatus, such as morphology of the leaflets, the true origin of septal and posterior leaflets as well as precise coaptation. Those information are necessary in order to complete classification of TV pathology. Therefore we obtained 3D TTE and 3D TEE, and with multiplanar review mode and 3D reconstruction revealed complete agenesis of the posterior leaflet leaving almost unguarded tricuspid orifice with a large zone of lack of coaptation as the origin of severe tricuspid regurgitation. Subsequent 3D analysis also verified absence of complete posterior leaflet subvalvular apparatus, or in the context of embryological development, complete absence of posterior leaflet delamination. We used 2D echocardiography to study morphology and function of right ventricle, but 3D echocardiography provided additional important information regarding the morphology and orientation of TV and its apparatus. Only 3D TEE obtained agenesis of the posterior leaflet. According to parameters derived by 2D TTE and 3D TEE this patient was classified as type I Ebstein’s anomaly.

An echocardiographic study of healthy Border Collies with normal reference ranges for the breed

ObjectivesThe objectives of this study were to obtain standard echocardiographic measurements from healthy Border Collies and to compare these measurements to those previously reported for a general population of dogs. AnimalsStandard echocardiographic data were obtained from twenty apparently healthy Border Collie dogs. These data (n = 20) were compared to data obtained from a general population of healthy dogs (n = 69). MethodsBorder Collies were deemed healthy based on normal history, physical examination, complete blood count, serum biochemical profile, electrocardiogram, and blood pressure, with no evidence of congenital or acquired heart disease on echocardiographic examination. Standard two dimensional, M-mode, and Doppler echocardiographic measurements were obtained and normal ranges determined. The data were compared to data previously obtained at our hospital from a general population of normal dogs. ResultsTwo dimensional, M-mode, and Doppler reference ranges for healthy Border Collies are presented in tabular form. Comparison of the weight adjusted M-mode echocardiographic means from Border Collies to those from the general population of dogs showed Border Collies to have larger left ventricular systolic and diastolic dimensions, smaller interventricular septal thickness, and lower fractional shortening. ConclusionsThere are differences in some echocardiographic parameters between healthy Border Collies and the general dog population, and the echocardiographic reference ranges provided in this study should be used as breed specific reference values for Border Collies.

Rheb (Ras Homologue Enriched in Brain)-dependent Mammalian Target of Rapamycin Complex 1 (mTORC1) Activation Becomes Indispensable for Cardiac Hypertrophic Growth after Early Postnatal Period

Cardiomyocytes proliferate during fetal life but lose their ability to proliferate soon after birth and further increases in cardiac mass are achieved through an increase in cell size or hypertrophy. Mammalian target of rapamycin complex 1 (mTORC1) is critical for cell growth and proliferation. Rheb (Ras homologue enriched in brain) is one of the most important upstream regulators of mTORC1. Here, we attempted to clarify the role of Rheb in the heart using cardiac-specific Rheb-deficient mice (Rheb(-/-)). Rheb(-/-) mice died from postnatal day 8 to 10. The heart-to-body weight ratio, an index of cardiomyocyte hypertrophy, in Rheb(-/-) was lower than that in the control (Rheb(+/+)) at postnatal day 8. The cell surface area of cardiomyocytes isolated from the mouse hearts increased from postnatal days 5 to 8 in Rheb(+/+) mice but not in Rheb(-/-) mice. Ultrastructural analysis indicated that sarcomere maturation was impaired in Rheb(-/-) hearts during the neonatal period. Rheb(-/-) hearts exhibited no difference in the phosphorylation level of S6 or 4E-BP1, downstream of mTORC1 at postnatal day 3 but showed attenuation at postnatal day 5 or 8 compared with the control. Polysome analysis revealed that the mRNA translation activity decreased in Rheb(-/-) hearts at postnatal day 8. Furthermore, ablation of eukaryotic initiation factor 4E-binding protein 1 in Rheb(-/-) mice improved mRNA translation, cardiac hypertrophic growth, sarcomere maturation, and survival. Thus, Rheb-dependent mTORC1 activation becomes essential for cardiomyocyte hypertrophic growth after early postnatal period.

Effects of Exercise on Left Ventricular Systolic and Diastolic Properties in Patients With Heart Failure and a Preserved Ejection Fraction Versus Heart Failure and a Reduced Ejection Fraction

The purpose of the current study was to define exercise-induced changes in indices of left ventricular (LV) systolic and diastolic properties in patients with chronic heart failure (HF), compare these changes in patients with HF and a reduced ejection fraction (EF) versus HF and a preserved EF, and compare the hemodynamic responses to activities of daily living with symptom-limited upright exercise. Subjects with HF and a preserved EF (n=8) and subjects with HF and a reduced EF (n=5) underwent symptom-limited Naughton protocol treadmill exercise tests. Implantable hemodynamic monitor data and echocardiographic data were obtained before exercise and at peak exercise. Implantable hemodynamic monitor data were obtained during activities of daily living during a 24-hour time period. In patients with HF and a reduced EF, limited exercise time (639±164 seconds) was associated with a marked rise in right ventricular systolic, diastolic, and estimated pulmonary artery diastolic (ePAD) pressures and an increase in LV end diastolic volume (EDV). LV systolic properties, namely EF, end systolic elastance, stroke work, and preload recruitable stroke work, all decreased. The ePAD/EDV ratio increased; to a large extent, this was dependent on an increase in EDV. By contrast, in HF and a preserved EF, limited exercise time (411±128 seconds) and the marked rise in right ventricular systolic, diastolic, and ePAD pressures were associated with no change in LV EDV. LV systolic properties increased or were unchanged; ePAD/EDV ratio increased during exercise, but the increase was independent of a change in EDV. The ranges of right ventricular systolic, diastolic, and ePAD pressures during activities of daily living were higher than the ranges of these values during the exercise stress test. Although exercise limitations were similar between HF and a reduced EF and HF and a preserved EF, there were significant differences in exercise-induced changes in LV systolic and diastolic properties. These differences likely reflect the different pathophysiologies of these clinical syndromes of HF.

Impact of cardiac stem cell sheet transplantation on myocardial infarction

Myocardial infarction (MI) remains a major cause of mortality because of the limited regenerative capacity of the myocardium. Transplantation of somatic tissue-derived cells into the heart has been shown to enhance the endogenous healing process, but the magnitude of its therapeutic effects is dependent upon the cell-source or cell-delivery method. We investigated the therapeutic effects of C-Kit positive cardiac cell (CSC) cell-sheet transplantation therapy in a rat model of MI. CSCs of human origin were sorted and cultured to generate scaffold-free CSC cell-sheets. One-layered or 3-layered cell-sheets were transplanted into nude rats 1 h after left coronary artery ligation. We observed a significant increase in the left ventricular ejection fraction and a significant decrease in left ventricular systolic dimension at 2 and 4 weeks in the 3-layer group, but not in the 1-layer or sham groups. Consistently, there was less accumulation of interstitial fibrosis in the 3-layer group than in the 1-layer or sham groups. Moreover, capillary density was significantly greater in the 3-layer group than in the 1-layer or sham groups. The 3-layered cell-sheet improved cardiac function associated with angiogenic and anti-fibrotic effects. Thus, CSC is a promising cell-source to use with the cell-sheet method for the treatment of cardiac failure, as long as a sufficient number of cells are delivered.

Comparison of left ventricular geometry after HeartMate II and HeartWare left ventricular assist device implantation

BackgroundHeartMate II (HM II) and HeartWare (HW) Left Ventricular Assist Devices have been successfully used in end-stage heart failure patients as a bridge to transplantation, recovery, or decision. We set out to compare their effect in off-loading the left ventricle and its geometry.MethodsThe left ventricular end diastolic (LVEDD) and end systolic (LVESD) diameters were compared between first time HM II (n = 25) and HW implantations (n = 24) before and after the operation at 1, 3, and 6 months. A p value of less than 0.05 was considered as significant.ResultsPost-operative LVEDD and LVESD at 1, 3, and 6 months were significantly reduced in comparison with pre-operative values in both HM II and HW groups. No significant difference was found comparing HM II and HW groups together before and after the operation.ConclusionsOur study shows that both HM II and HW can significantly reduce the left ventricular systolic and diastolic dimensions and off-load the left ventricle. The miniaturized nature of HW does not affect its performance and it could be as effective as HM II.

Stress Cardiomyopathy Associated with Diffuse Alveolar Hemorrhage after Colonoscopy

Stress cardiomyopathy (SCM) is usually precipitated by a physiologically or psychologically stressful event. Although it occurs only rarely, hypoxia- and hypercapnia-induced sympathetic activation may also cause SCM. We present the case of a 37-year-old woman affected with SCM after a routine colonoscopy. During the procedure, she aspirated residual polyethylene glycol from her stomach. Hypotension, resting dyspnea, and hemoptysis were subsequently observed. Laboratory findings revealed elevated cardiac enzymes, and a transthoracic echocardiogram revealed left ventricular (LV) global hypokinesia. She was ultimately diagnosed with diffuse alveolar hemorrhage-associated SCM. After successful treatment with a ventilator and corticosteroids, her LV systolic function and dimensions normalized and she was discharged without complications.

Abstract 9658: Concomitant Maze Procedure Reduces Adverse Clinical Events in Patients with Left Ventricular Dysfunction Undergoing Open Cardiac Surgery

Background: Clinical benefits of concomitant maze procedure can be offset by surgical risks added by the procedure especially in patients with left ventricular (LV) dysfunction undergoing open heart surgery. Methods: Between January 1999 and March 2011, a total of 139 patients (mean age 52.7±12.3 years, 54 females) with valvular atrial fibrillation (AF) and a LV ejection fraction (EF) of 40% or less underwent open heart surgery with (n=77) or without (n=62) the concomitant maze procedure. We compared primary adverse outcomes (death; composite of death, thromboembolic events, or congestive heart failure [CHF]) during a median follow-up period of 66.9 months (inter-quartile range, 27.8-105.5 months). Results: Primary outcomes occurred in 41 patients including 36 deaths, 7 thromboembolic events and 8 hospitalizations due to CHF. After adjustment for baseline risk profiles, patients who had undergone the maze procedure were at similar risks of death (hazard ratio, 0.48; 95% confidence interval, 0.17-1.35; P =0.17) but a significantly lower risk of the composite adverse outcomes (hazard ratio, 0.34; 95% confidence interval, 0.14-0.83; P =0.017) compared with those who did not undergo the maze procedure (Figure). For 23 propensity-score matched pairs, the combination of the maze procedure resulted in decreased LV systolic ( P =0.013) and diastolic ( P =0.041) dimensions, and increased LV EF (56.2±7.9% vs. 49.9±11.9%, P =0.010) compared with cardiac surgery alone on echocardiographic assessments performed at a median of 62.8 months (inter-quartile range, 26.5-119.0 months) after surgery. At the end of follow-up, patients who had undergone the maze procedure had superior New York Heart Association functional status than those who did not ( P =0.008). Conclusion: Adding the maze procedure in patients with valvular AF and LV dysfunction reduced adverse outcomes, and improved LV systolic function and functional status as compared with cardiac surgery alone.

Abstract 18562: Severity of Posterior Coaptation Displacement of the Anterior Mitral Leaflet Contributes to Irreversibility of Mitral Regurgitation Following Left Ventricular Assist Device Placement

Background The usefulness of concomitant mitral valve surgery at the time of left ventricular assist device (LVAD) placement has not been fully elucidated. We investigated factors associated with irreversibility of mitral regurgitation (MR) after LVAD surgery. Methods We reviewed 61 consecutive patients undergoing continuous-flow LVAD placement at Columbia University between 2007 and 2010. Echocardiograms within 2 weeks before and 1 week after surgery were analyzed. Irreversibility of MR was defined as the persistence of moderate or severe MR after LVAD placement. We evaluated clinical characteristics and echocardiographic parameters including left ventricular (LV) dimension, left atrial area (LAA), and the mitral leaflet configuration quantified by posterior (D P ) and apical (D A ) displacement of the coaptation point of anterior mitral leaflet (AML). (Figure) The change ([[Unable to Display Character: ⊿]]) of each parameter before and after LVAD placement was also calculated. Results Fifty-six patients (92.9%) showed a reduction of LV dimension after LVAD placement. Thirty-three patients (54.1%) had moderate to severe MR before surgery. Among those, 5 patients (5/33, 15.2%) underwent concomitant mitral valve repair at the time of LVAD placement, and 19 patients (19/33, 67.9%) showed only mild or less MR due to mechanical unloading by LVAD, but 9 (32.1%) still had at least moderate MR. The [[Unable to Display Character: ⊿]]LV end-diastolic dimension was correlated with [[Unable to Display Character: ⊿]]D P and [[Unable to Display Character: ⊿]]D A (r=0.408, p=0.002, r=0.468, p&lt;0.0001, respectively). Pre-operative echo-parameters associated with irreversibility of MR were LV end-diastolic and systolic dimensions, LAA and D p . Multivariate analysis revealed that only D p was significantly associated with irreversible MR (HR 1.278, 95%CI 1.015-1.610, p=0.037). Conclusions Pre-operative echocardiographic severe posterior coaptation displacement of the AML may predict irreversibility of MR following LVAD placement, and could help identify patients that might benefit from MV repair.