Longitudinal Systolic Function Research Articles

Left and Right Ventricular Longitudinal Systolic Function Following Aortic Valve Replacement in the PARTNER 2 Trial And Registry.

Evaluation of left and right ventricular longitudinal systolic function may enhance risk stratification following aortic valve replacement (AVR). The study objective was to evaluate the changes in left and right ventricular longitudinal systolic function and RV-pulmonary artery (RV-PA) coupling from baseline to 30-days and 1-year after aortic valve replacement (AVR). LV longitudinal strain (LS), tricuspid annulus plane systolic excursion (TAPSE), and RV-PA coupling were evaluated in patients from the PARTNER-2A surgical AVR (SAVR) arm (n=985) and from the PARTNER-2 SAPIEN-3 registry (n=719). TAPSE and RV-PA coupling decreased significantly following SAVR, but remained stable following TAVR. Lower LV LS, TAPSE, or RV-PA coupling at baseline were associated with increased risk of the composite of death, hospitalization, and stroke at 5-years (Adjusted-HRs for LV LS<15%: 1.24 95%CI 1.05-1.45, p=0.001; TAPSE<14mm: 1.44 95%CI 1.21-1.73, p<0.001; RV/PA coupling<0.55mm/mmHg: 1.32 95% CI 1.07-1.63, p=0.011). Reduced TAPSE at baseline was the most powerful predictor of the composite endpoint at 5-years. Patients with LV ejection fraction <50% at baseline had increased risk of the primary endpoint with SAVR (HR: 1.34, 95%CI 1.08-1.68, p=0.009) but not with TAVR (HR: 1.12, 95%CI 0.88-1.42). Lower RV-PA coupling at 30-days showed the strongest association with cardiac mortality. SAVR but not TAVR was associated with a marked deterioration in RV longitudinal systolic function and RV-PA coupling. Lower TAPSE and RV-PA coupling at 30-days were associated with inferior clinical outcomes at 5-years. In patients with LVEF<50%, TAVR was associated with superior 5-year outcomes.

Feasibility Value of Right Ventricular Longitudinal Shortening Fraction and the Prognostic Implications in Patients With Heart Transplantation.

Right ventricular longitudinal shortening fraction (RVLSF) is a 2-dimensional speckle tracking echocardiography parameter based on tricuspid annular displacement analysis that could be used to assess right ventricular (RV) systolic function. The value of RVLSF in the assessment of RV systolic function in recipients of heart transplantation (HT) and whether RVLSF can replace strain parameters remains unknown. A total of 153 adult patients who underwent HT were consecutively enrolled in this prospective longitudinal study. All subjects were examined by conventional transthoracic 2-dimensional echocardiography and 2-dimensional speckle tracking echocardiography to evaluate the RV end-diastolic basal diameter, RV end-diastolic area, fractional area change, peak systolic velocity of tricuspid annulus, tricuspid annular plane systolic excursion, RV free wall strain, and RVLSF. Cox proportional hazards regression was used to test if the parameters of interest had independent prognostic value for adverse outcome prediction in patients who underwent HT. A significant positive correlation was found between the measurements of RVLSF and RV free wall strain (r=0.927, P<0.001). Compared with the event-free group, the adverse outcome group displayed reduced RVLSF and RV free wall strain and higher age (P<0.001, <0.001, =0.016, respectively) in patients who underwent HT. RVLSF and RV free wall strain were independently associated with poor prognosis in multivariable analysis (both P<0.001). RVLSF assessment provides an effective evaluation of RV longitudinal systolic function in the transplanted hearts and has prognostic value for adverse outcomes in patients undergoing HT.

Structural and functional remodeling of the heart in hypertensive patients with COVID-19: assessmentof changes at the end of hospitalization period and during a 1-month follow-up

COVID-19 is often accompanied by the long-term persistence of symptoms, the risk of which depends on the severity and duration of the acute phase, as well as existing comorbidities. Cardiac dysfunction is one of the possible mechanisms of impaired functional status of patients. While clinically manifest systolic heart failure is a rare phenomenon in such a situation, minor alterations in the structural and functional state of the heart may be contributing to persistence of general symptoms such as dyspnea, fatigue, and reduced work capacity.The aim – to study the role of hypertension in the formation of structural and functional changes of the heart during hospitalization for COVID-19, and the dynamics of detected changes in the early period after discharge.Materials and methods. 221 hospitalized patients with COVID-19 (age 53.4±13.6 years, 53 % female) underwent a comprehensive transthoracic echocardiographic examination 1-2 days before discharge and after 31 days of follow-up. The control group included 88 subjects matched by age, sex, height, weight, and existing comorbidities. The studied parameters included morphometry of the cardiac chambers, indices of longitudinal systolic function and diastolic filling of the ventricles; the participants were also performing a 6-minute walk test.Results. Geometric changes of the heart in hospitalized patients with COVID-19 at the time of discharge included an increase in absolute (10.1±1.5 vs 9.1±0.9 mm, p&lt;0.001) and relative LV walls thickness (0.45±0,07 vs 0.39±0.04, p&lt;0.001), indices of LV myocardial mass (38.1±8.9 vs 33.9±5.8 g/m2.7, p&lt;0.001) and left atrial volume index (28.6±6.6 vs 25.1±4.9 ml/m2, p&lt;0.001), as well as a decrease in LV global longitudinal strain (-17.5±2.4 vs -18.6±2.2 %, p&lt;0.001) and diastolic filling parameters (e’ – 9.2±2.2 vs 11.3±2.6 cm/s, p&lt;0.001; E/e’ – 7.5±1.8 vs 6.8±1.7, p=0.002). The observed changes were more pronounced in the cohort of hypertensive participants, but also persisted in normotensive patients, resulting in a high prevalence of concentric LV geometry (78 % and 43 %, respectively, p&lt;0.001 between groups and vs controls), mainly type I diastolic dysfunction (51 % and 25 %, p&lt;0.001 between groups and vs control), as well as abnormal values of global longitudinal strain (32 % and 19 %, p=0.027 between groups, p&lt;0.001 vs control), which persisted during a short observation period. The increase in the reached % of individually predicted 6-minute walk distance was 11.2±7.5 in hypertensive participants vs 12.8±7.6 in normotensives, p&gt;0.05.Conclusions. Patients with COVID-19 at the end of hospitalization period were characterized by a high prevalence of LV concentric geometry and diastolic dysfunction, as well as minor decrease in its longitudinal systolic function, which were more pronounced in the presence of concomitant hypertension and did not improve during the first month after discharge.

Short-term echocardiographic follow-up after hospitalization for COVID-19: a focus on early post-acute changes

BackgroundImpaired physical functional status is one of the typical long-term sequelae of COVID-19 infection that significantly affects the quality of life and work capacity. Minor changes in cardiac structure and function that are unable to cause the manifestation of overt heart failure may remain undetected in COVID-19 convalescents, at the same time potentially contributing to the persistence of symptoms and development of long COVID syndrome.PurposeTo study the typical features and short-term dynamics of cardiac remodeling and possible signs of cardiac dysfunction following hospitalization for COVID-19.MethodsThis is a combined cross-sectional and longitudinal cohort study in which 176 hospitalized patients (93 female and 83 male, mean age 53.4 ± 13.6 years) with COVID-19 infection underwent comprehensive transthoracic echocardiography pre-discharge (22.6 ± 7.1 days from the onset of symptoms) with repeated evaluation after 1 month. The control group included 88 age-, sex-, height- and weight-matched healthy individuals, with a subset of those (n = 53) matched to the subset of non-hypertensive study participants (n = 106).ResultsConcentric left ventricular geometry was revealed in 59% of participants, including 43% of non-hypertensive subjects; predominantly Grade I diastolic dysfunction was found in 35 and 25% of patients, respectively. Other findings were naturally following from described phenotype of the left venticle and included a mild increase in the absolute and relative wall thickness (0.45 ± 0.07 vs. 0.39 ± 0.04, p &amp;lt; 0.001), worsening of diastolic indices (e’ velocity 9.2 ± 2.2 vs. 11.3 ± 2.6 cm/s, p &amp;lt; 0.001, E/e’ ratio 7.5 ± 1.8 vs. 6.8 ± 1.7, p = 0.002) and global longitudinal strain (17.5 ± 2.4 vs. 18.6 ± 2.2, p &amp;lt; 0.001). No significant improvement was found on re-evaluation at 1 month.ConclusionsHospitalized patients recovering from COVID-19 were characterized by a high prevalence of left ventricular concentric remodeling, predominantly Grade I diastolic dysfunction, and a mild decrease in the longitudinal systolic function. These changes were less frequent but still prevalent in the non-hypertensive subgroup and largely persisted throughout the 1-month follow-up.

Cardiac damage extent in patient with isolated severe aortic stenosis referred to surgical aortic valve replacement: is it reversible after surgery?

Abstract Background Aortic stenosis (AS) may lead to progressive and adverse cardiac remodeling. A recently-proposed staging classification regarding extravalvular cardiac damage in AS patients undergoing aortic valve intervention was shown to have significant prognosis implications. However, cardiac damage evolution and reversibility after intervention remain unknown. Aims to assess extravalvular cardiac damage evolution after surgical aortic valve replacement (SAVR) in patients with isolated severe AS. Methodology we performed a single-center, prospective cohort study enrolling consecutive patients with severe aortic stenosis undergoing SAVR. Those with previous cardiomyopathy or concomitant severe valve dysfunction beyond AS were excluded. All patients performed transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) within 3 months before SAVR as well as at the 3rd to 6th post-operative month. Patients were classified according to the extent of cardiac damage into 4 groups: stage 0: no damage; stage 1: left ventricle (LV) hypertrophy (indexed LV mass &amp;gt;95 g/m2 [women] or &amp;gt;115 g/m2 [men]), LV diastolic (E/e′ &amp;gt; 14) or systolic (ejection fraction &amp;lt;50%) dysfunction; stage 2: dilated left atrium (&amp;gt;34mL/m2) or atrial fibrillation; stage 3: pulmonary hypertension (systolic pulmonary artery pressure ≥60mmHg); stage 4: significant right ventricle (RV) dysfunction. Global longitudinal strain (GLS) was also assessed to further characterize the extent of LV damage – a GLS &amp;gt; -14.7% was considered abnormal. Due to the impact of on-pump cardiac surgery on RV systolic longitudinal function, RV ejection fraction assessed by CMR (&amp;lt;45%) was used to define significant post-operative RV dysfunction. Results A total of 67 patients were included (mean age 71 ± 8 years; 50% male; mean valvular transaortic gradient 60 ± 19 mmHg; mean indexed aortic valve area 0.4 ± 0.01 cm2/m2; mean LV ejection fraction by TTE 58 ± 9%). Overall, a significant number of patients still showed sign of structural cardiac damage after surgery – 14 vs. 10 on stage 1, 44 vs. 39 on stage 2, 1 vs. 1 on stage 3 and 4 vs. 4 on stage 4 after AVR- figure 1. However, a statistically significant improvement in the number of patients at stage 0 after surgery (4 vs. 11, paired McNemar test p=0.016) was observed, as well as a significant improvement in GLS (mean GLS pre and post AVR -14.8 ± 3.6% vs. -16.6 ± 3.3%, respectively; 45 vs. 21% patients with abnormal GLS before and after AVR, p=0.001). Conclusion Extravalvular cardiac damage is common in a selected cohort of severe AS and potentially reversible after SAVR. A significant improvement in GLS, although not a part of the previously established staging system, was observed after AVR. Whether or not these findings may correlate with long-term patient prognosis or if additional favorable cardiac remodeling is seen on a longer-term follow-up remains to be determined.

The potential role of the aortic valve calcium score by computed tomography scan in the diagnosis of concomitant cardiac amyloidosis in patients with severe aortic stenosis

Abstract Background Cardiac amyloidosis (CA) and aortic stenosis (AS) are two related, but the diagnosis of both these condition is challenging because of the common phenotype. Different predictors of CA in AS have been proposed in the last years. Purpose To identify a new red-flag of concomitant CA in patients with severe AS analyzing aortic valve calcium burden using calcium score, calcium mass and calcium volume by computed tomography scan (CT). Methods 55 patients with severe AS and suspicion of concomitant CA were retrospectively enrolled from 2009 to 2022. 5 Patients with a bicuspid aortic valve, previous aortic valve replacement, or an incomplete diagnostic workup for CA were excluded. 50 patients underwent CT-scan and were included in the final analysis. Results Of the 50 patients, 21 patients (AS-CA) had positive 99m Tc-DPD bone scintigraphy (19 with score 2 and 2 with score 3), none of the patients presented laboratory suspicion for AL amyloidosis, so all the patients had a diagnosis of transthyetin related CA. 29 patients (AS alone) had negative bone scintigraphy. AVA indexed were comparable between AS-CA and AS alone groups (0.3 mm2/m2, in both the group p: 0.88). Stroke volume, maximum and mean gradient were significatively lower in AS-CA group (29 vs 36 ml/m2, p: 0.01, 60 vs 72 mmHg, p: 0.016 and 34 vs 45 mmHg, p:0.01) with a higher percentage of low flow-low gradient aortic stenosis in AS-CA group (11 patients,52% vs 5 patients in AS-alone 17%, p: 0.014)ECG in AS-CA group showed atrial fibrillation in 12 patients (57%), versus 3 patients in the AS-alone group (10%), and lower QRS voltages (peripheral QRS score 44 mV vs 58 mV, p-value:0.017; total QRS score 120 mV versus 160 mV, p-value: 0.005). The echocardiogram showed a more thickened IVS and PW in AS-CA patients (17 versus 15 mm, p: 0.03 and 15 versus 14 mm, p: 0.01) with a decreases longitudinal systolic function (septal S wave at TDI 4.4 vs 5.1 cm/s, p: 0.011, lateral S wave 4.5 versus 5.6 cm/s, p: 0.014).CT- aortic valve calcium was quantified by an experienced operator. A statistically significant difference between AS-CA and AS-alone groups was observed in calcium score (3569 vs 4480 Agatston units, p: 0.017) calcium volume (2575 vs 3445 mm3, p: 0.012) and calcium mass (798 vs 1082 g, p: 0.016).At logistic regression analyses,confirmed perdictors of concomitant CA in AS were: AS low flow- low gradient (p:0.011), atrial fibrillation (p:0.001), lower QRS score periferical(p:0.004) and total (p:0.002) and a decreased longitudinal systolic function (p:0.028). Regarding the aortic valve calcium burden, calcium score( p:0.031) and calcium volume(p:0.026) were confirmed predictor of CA in AS. Conclusions This study shows that calcium burden at CT scan in patients with concomitant CA-AS is significatily lower than in patients with AS alone. Calcium burden at CT scan could be used in addition to the classical parameters as a potential red-flag of concomitant CA in AS severe.

Prognostic implications of right ventricular systolic and diastolic strain in heart failure

Abstract Background 2D- speckle-tracking echocardiography (2D-STE) has recently be used to assess subclinical myocardial dysfunction, however its utility in heart failure with reduced ejection fraction (HFrEF) has been specifically focusing on the longitudinal systolic function of the left ventricle (LV). Aim To assess the prognostic relation between right ventricular (RV) systolic and diastolic strain parameters with clinical outcome in patients with advanced heart failure (HFrEF). Methods and results Of the initial 2217 HFrEF patients screened for this study only 562 consecutive patients with HFrEF were eligible and retrospectively enrolled, and 2D-STE strain parameters assessed on the 2D-TTE images. All patients were prospectively followed for development of new outcome/cardiac events which included hospitalization for acute HF, CVS-related death, heart transplantation, or need for ventricular assist device implantation. Conventional TTE was performed in all subjects and reviewed. RV longitudinal strain parameters (RVLS, RVLD) by 2D-STE were assessed and averaged in all segments (apical 4CV, global RVLS and RVLD) and also averaged free-wall. Of the 562 patients at baseline, 263 had 117 new events during a mean follow-up of 1.4 ± 0.7 years. RV free wall and global RV systolic and diastolic strain parameters, elevated NT Pro-BNP, RV fractional area change, low TAPSE, LV end-diastolic volume and the presence of at least moderate TR, and PASP &amp;gt; 40mmHg were independently predictive of combined outcomes ( p &amp;lt;.001). Overall, the best performance parameters predictive of cardiovascular events were for RV Free Wall systolic and diastolic strain (AUC: 0.84 and 74), global RV systolic and diastolic strain (AUC: 0.77 and 70) and RV fractional area change (AUC: 0.67). The strongest association between the degree of RV dysfunction and the risk of cardiovascular events was only evident for RV strain (free wall &amp;gt; global strain). Conclusion Patients with HFrEF, RV strain parameters are stronger predictors of outcome than other conventional parameters and should be included for regular clinical screening as these parameters provide a stronger prognostic stratification.

Cardiovascular complications of chimeric antigen receptor (CAR)-T cell therapy

Abstract Background Mechanisms of cardiotoxicity during chimeric antigen receptor (CAR)-T cell therapy remain unclear to this day, with the main hypotheses revolving around IL-6 mediated myocardial depression during cytokine release syndrome (CRS), stress-induced or takotsubo cardiomyopathy, and direct toxicity from CAR-T cells. Hereby we present the experience of a regional referral centre for CAR-T therapy and the program developed with a dedicated cardio-oncology centre. Purpose To provide preliminary data on cardiovascular-related toxicity of CAR-T therapy in terms of incidence and management. Methods All consecutive candidates for CAR-T therapy were prospectively enrolled since the inception of the CAR-T program in our institution (2021). All patients were refractory to at least two lines of immune chemotherapy and had already undergone anthracycline treatment. After conditioning, all patients were treated with autologous CAR-T cells (tisagenlecleucel, Kymriah). Prior to CAR-T cell therapy, all patients underwent baseline cardiac evaluation at our cardio-oncology facility, including a 12-lead ECG, a complete echocardiogram and cardiac biomarkers. The same routine was performed before discharge, after one month. Supplementary evaluations were performed by an on-call cardio-oncology team according to the attending physicians. Results Eleven patients (6 males, mean age 60±11 years) underwent CAR-T cell infusion. Over the course of follow-up, six patients (54%) experienced CRS after a median follow-up of 12 days (7-40). Two patients with mild symptoms (Grade I) were managed with non-cardiac-related therapy while three Grade 2 patients had to start cardioprotective drugs (ACE-Is and beta-blockers) for transient left ventricular systolic dysfunction (mean lowest LVEF 44.8±3.7%). One patient experienced a Grade IV CRS due to takotsubo syndrome complicated by cardiogenic shock on day 4 and required high-dose vasopressors and mechanical ventilation. Patients experiencing a CRS had similar demographical characteristics and medical history but standard echocardiogram before CAR-T showed a lower baseline LVEF (54.5±5.6% vs 64.6±6.7%; p=.02) and lower baseline right longitudinal systolic function markers (TAPSE: 19±3 vs. 24±4 mm; p=.02 S': .09±.01 vs .13±.02 m/s; p=.03). Cardiac biomarkers (high-sensitivity Troponin I and NT-proBNP) did not show any significant predictive power at baseline. All CRS patients showed a progressive recovery of ventricular function and survived up to one-year of follow-up. Conclusions CAR-T therapy is associated with an increased risk of cardiotoxicity, with up to 36% of all patients requiring unscheduled cardio-oncology evaluation and management both during admission and after discharge. Cardiac adverse events range in degree of severity and should be promptly managed by a dedicated team.

The Relationship Between the Decrease in Longitudinal Systolic Function and High Filling Pressures in The Hypertensive Patients

Introduction: Heart failure with preserved LVEF (left ventricular ejection fraction) is an important cause of mortality and morbidity in hypertensive patients. A close correlation between the achievement of diastolic function and longitudinal systolic dysfunction could have several explanations, first the diastole is a dependent energy process, especially during its first phase, it also includes active systolic components during the iso volumetric relaxation phase. The objective of this work is to determine the effect of diastolic function on the drop in GLS (global longitudinal strain) in hypertensive patients with preserved LVEF. Materials and methods: This work is to perform in a series of 400 hypertensive patients (aged 25-75 years) an echo study full cardiographic, including the study of the systole-diastolic function, and the evaluation of the function by the longitudinal 2D strain. Results: Of the 400 hypertensive patients, 356 patients (89%) had impaired diastolic function, of which 46 patients (13%) had high filling pressures.144 patients had a high LA(left atrial) volume, of which 46 patients had high filling pressures. Of the 144 patients with high LA volume 118 patients (81.9%) had low GLS. The mean of blood pressure was significantly higher in patients with low GLS. There is a statistically very significant relationship between lower GLS, increased left atrium volume, and increased left ventricular filling pressures in hypertensive patients. Conclusion: The decline in longitudinal index of function, despite preserved LVEF, correlates well with increased left atrial volume, filling pressures in hypertensive patients with LVH (left ventricular hypertrophy). The association between hypertension with LVH and the deterioration of asymptomatic diastolic function is well recognized.

Evaluation of Subclinical Left Ventricular Systolic Dysfunction By Global Longitudinal Strain Using 2D Speckle Tracking Echocardiography in Angina With Normal Epicardial Coronary Arteries

Background: Global longitudinal strain (GLS), assessed by 2D speckle tracking echocardiography (2D-STE), may offer a valuable non-invasive method to assess subclinical left ventricular (LV) systolic dysfunction in patients with chest pain but normal epicardial coronary arteries. The primary objective of the study was to detect subclinical LV systolic dysfunction by GLS using 2D-STE in patients with angina with normal coronary arteries and conventional echocardiograms at baseline. Methods: This was a comparative case–control study that included patients with complaints of an ischaemic pattern of chest pain despite normal coronary arteries (cases) and healthy individuals (controls). Resting LV systolic function was assessed by transthoracic echocardiography and GLS using 2D-STE analysis. The results of all three planes in GLS (the apical four-chamber, two-chamber, and three-chamber views) were combined in a single ‘bull’s eye’ summary (agreeing with the standard 17-segment model), which presented the analysis of each segment along with a global peak systolic strain value for the LV. Results: The study included 120 participants (60 cases and 60 controls). The normal reference value of the mean GLS in the control group was −19.7 ± 1.84%. GLS assessed by 2D-STE was significantly impaired in patients with angina-like syndrome with normal epicardial coronary arteries (−18.78 ± 1.87 versus −19.7 ± 1.84%; p&lt;0.007) compared with the control group despite preserved LV ejection fraction. In the case group, GLS reduced significantly in eight patients (13.3%) than control group. Conclusion: Patients with angina with normal epicardial coronary arteries are likely to have microvascular disease. GLS assessed by 2D-STE has the potential to improve the value of echocardiography in coronary microvascular disease detection. Despite normal LV ejection fraction, significant impairment of LV global longitudinal systolic function can differentiate a microvascular group of patients from others who have angina with normal coronaries.

Acute Changes in Right Ventricular Function in Pediatric Patients with Pulmonary Valve Stenosis Undergoing Percutaneous Valvuloplasty: A Speckle-Tracking Study.

Pulmonary valve stenosis determines multiple effects on the right ventricular dimension and function. Percutaneous balloon valvuloplasty is the treatment of choice in severe pulmonary valve stenosis in patients of all ages. However, little is known regarding right ventricular function immediate changes after percutaneous balloon dilation. Pediatric patients with isolated pulmonary valve stenosis represent a pure clinical model of chronic RV pressure overload not affected by other confounders or comorbidities. This study seeks to explore right ventricle (RV) mechanics in pediatric patients early after percutaneous balloon pulmonary valvuloplasty (BPV) for valvar pulmonary stenosis (PS). Forty-three pediatric patients (19 males), mean age 3.2 ± 4.9 years old, with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited. All patients underwent standard transthoracic echocardiography (TTE), and speckle-tracking echocardiography (STE) with an analysis of right ventricle free-wall longitudinal strain (RVFWLS) one day before and one day after the procedure. For each patient, we collected invasive parameters during the interventional procedure before and after BPV. After the procedure, there was an immediate significant reduction in both peak-to-peak transpulmonary gradient (peak-to-peak PG) and ratio between the right ventricle and aortic systolic pressure (RV/AoP) with a drop of ∆29.3 ± 14.67 mmHg and ∆0.43 ± 0.03, respectively. Post-procedural echocardiography showed peak and mean transvalvar pressure gradient drop (∆50 ± 32.23 and ∆31 ± 17.97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, affecting 29% of our patients post-BPV (p = 0.007). The analysis of right ventricular mechanics showed a significant improvement of fractional area change (FAC) immediately after BPV (40.11% vs. 44.42%, p = 0.01). On the other hand, right ventricular longitudinal systolic function parameters, TAPSE and global RVFWLS, did not improve significantly after intervention. The segmental analysis of the RVFWLS showed a significant regional increase in the myocardial deformation of the apical segments. Percutaneous BPV represents an efficient and safe procedure to relieve severe pulmonary valve stenosis. The analysis of the right ventricular function on echocardiography demonstrated an immediate global systolic function improvement, while longitudinal systolic function was persistently impaired 24 h after intervention, possibly due to the necessity of a longer recovery time.

Significant dependency of left atrial strain on left ventricular longitudinal motion.

The effects of left ventricular longitudinal function on the left atrial strain, including the left atrial reservoir function, have not been adequately quantified. A total of 124 patients who underwent echocardiography were enrolled in this study. Left atrial strain analysis was performed using two-dimensional speckle tracking echocardiography, and the left atrial volume was derived using the modified Simpson's method. The peak left atrial strain (LAS) and left atrial expansion index (LAEI), as indices of left atrial reservoir function, were measured. The global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE), which are indices of contractile motion toward the left ventricular apex, were also measured. The correlation between LAS and candidate determinants, including left ventricular systolic longitudinal function, was evaluated, and multivariate regression analysis was performed. A significant correlation was found between LAS and left ventricular systolic longitudinal functions, GLS (r = 0.63, p < 0.001), and MAPSE (r = 0.65, p < 0.001). Two models, which were selected by multiple regression analyses for LAS, included GLS or MAPSE as independent determinants. GLS and MAPSE were also the strongest predictors, among other factors. LAS, when determined by evaluating the left atrial reservoir function, was significantly associated with left ventricular function, especially the systolic longitudinal function. Left ventricular function should be considered when assessing left atrial function by LAS.

THE ASSOCIATION OF HYPERTENSION AND OBESITY: WHAT IMPACT ON THE LONGITUDINAL SYSTOLIC FUNCTION OF THE LEFT VENTRICLE

Objective: Hypertension and obesity are well known each result in heart failure with preserved ejection fraction. Indeed, there is ample evidence that the accumulation of adipose tissue in obese subjects negatively affects the left atrial and ventricular structure, as well as diastolic and systolic function. Predisposing factors for heart failure with preserved LVEF are advanced age, hypertension, diabetes, dyslipidemia and obesity. The development of the 2D strain has made it possible to make an early diagnosis of ventricular dysfunction in patients with cardiovascular risk factors. Design and method: This work consists of performing in a series of 128 hypertensive patients divided into two subgroups: 58 obese patients and 70 patients with normal BMI. A complete cardiographic echo study was performed in both subgroups, including LVEF by Simpson biplane method, calculation of indexed left ventricular mass and parietal relative thickness, analysis of diastolic function and finally study of longitudinal LV deformation by speckle tracking technique. Results: We note in this work that dyslipidemia and diabetes were significantly more prevalent in the HTA+obesity arm. The average blood pressure figures were slightly higher in the HTA+obesity arm. LVH was clearly predominant in the HTA+obesity arm with a more consequent decrease in the longitudinal contraction index. In obese hypertensive patients, LVH was most often concentric (53.4%). An increase in filling pressures was found in 11 obese hypertensive patients compared to only 4 non-obese hypertensive patients (p = 0.0001), with a good correlation with the decrease in GLS. These results suggest that increased BMI is closely associated with atrioventricular interaction in patients with hypertension, with a perfect correlation with impairment of longitudinal systolic function and diastolic function compared to the control group. Conclusions: Although the pathophysiological mechanism behind obesity is disputed, several possible explanations have been proposed: obesity has been considered a state of chronic volume overload, increased blood volume, neurohormonal activation, thus increasing oxidative stress. Therefore, obesity is associated with mild ventricular dilation (eccentric remodeling). However, this finding is in contrast to other studies that associate obesity with a concentric rather than eccentric remodeling of the LV.

P69 SHORT–TERM EFFECT OF DAPAGLIFLOZIN ON LEFT VENTRICULAR LONGITUDINAL FUNCTION IN PATIENTS WITH HEART FAILURE WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION

Abstract Background It is known that sodium–glucose cotransporter 2 (SGLT2) inhibitors have been shown to confer important clinical benefits in patients with congestive heart failure (HF). Several evidences show SGLT2 influence the longitudinal systolic function of the left ventricle after medium and long term follow–up (FUP) in patients with HF. The aim of this study is to demonstrate how dapagliflozin can modify the global longitudinal strain (GLS) in a population of patients with systolic congestive heart failure (HFrEF) evaluating possible correlations with the basal functional capacity. Methods Clinical and echocardiographic data were retrospectively analyzed in 60 HFrEF patients treated with dapagliflozin, within a dedicated outpatient HF clinic. Pre–treatment data were correlated with to clinical and instrumental FUP date that was generally performed after two months of treatment. The clinical and instrumental data consisted of the NYHA functional class, the left ventricular ejection fraction (LVEF) and the GLS. Results There was no significant change between baseline and FUP date on LVEF (25.2 ± 9.9% vs 25.6 ± 9.6% p.s.), while GLS showed significant improvement (13.1 ± 3.7% vs 14.3 ± 3.1% p &amp;lt; 0.03). GLS improvement in HFrEF patients with more impaired functional class (NYHA III/IV) was more significant from 10.9 ± 3.4% to 13.1 ± 2.2% (p &amp;lt; 0.01), compared to that in HFeEF patients with less compromised functional class (NYHA I–II) from 13.6 ± 2.4% to 14.1 ± 2.1% (p 0.07). Conclusions Dapagliflozin was associated with short term improvement in longitudinal left ventricular myocardial function in patients with chronic congestive systolic heart failure. This improvement is more evident in patients who start from a more impaired functional capacity than in clinically more stable patients.

P372 PULMONARY EMBOLISM IN CARDIAC INTENSIVE CARE UNIT–REAL–WORLD EXPERIENCE OF A TERTIARY CENTER

Abstract Introduction Pulmonary thromboembolism represents a therapeutic challenge for patients admitted to cardiology intensive care units, given the variety of clinical presentations and available treatment opportunities. Methods This retrospective, single–center study recruited patients hospitalized in cardiology intensive care units with a diagnosis of pulmonary thromboembolism between April 2010 and May 2022. For each hospitalized patient, Wells and PESI scores were calculated, the location of the PE was identified, and acute PE resolution at discharge was determined. Patients with cardiac arrest (CCA) and/or cardiogenic shock were identified, and RV longitudinal systolic function (TAPSE) and pulmonary arterial systolic pressure (PASP) were studied. Patients were then stratified based on their clinical risk of in–hospital or 30–day mortality (early mortality); acute phase and discharge treatments and patients who developed major bleeding complications were identified. Results A total of 148 patients were recruited, with a median age of 66 years and predominantly male (51.4%). In 6.4% of patients, in–hospital death occurred (from 0% in low–risk patients to 25% in high–risk patients), 12.2% developed cardiogenic shock and/or CCA. 25.0% of patients had an ongoing neoplasm. Systemic thrombolytic therapy and Sonos were the most effective in terms of mortality (p=0.015) and RV function at discharge in high–risk patients, although associated with a high risk of bleeding. Intermediate–low–risk patients treated with reperfusion therapy showed better RV function parameters, although the sample size did not allow for statistical significance. Conclusions The results obtained are in line with those of the literature with regard to epidemiology, total hospital stay, correlation between acute PE and neoplasms, in–hospital death and FU death. Furthermore, Sonos represents an effective alternative to full–dose systemic thrombolysis in high–risk patients who cannot undergo the latter. Finally, in intermediate–low risk patients, there may be a role for reperfusion therapy in selected patients with very low bleeding risk.

Systolic function in dogs with pulmonic stenosis of different severities and the effect of balloon valvuloplasty

Introduction/objectivesPulmonic stenosis (PS) is one of the most common congenital heart diseases in dogs leading to right ventricular (RV) pressure overload, myocardial remodeling, and potential RV dysfunction. Our objectives were to investigate the extent of RV systolic dysfunction in canine PS and to examine the immediate influence of balloon valvuloplasty (BV) on systolic function. Animals, materials and methodsThis prospective study evaluated 72 dogs with PS and 86 healthy dogs. Echocardiographic parameters of systolic function included normalized tricuspid annular plane systolic excursion (N-TAPSE), normalized systolic myocardial tissue Doppler velocity of the lateral tricuspid annulus (N-RVFW-S′), fractional area change, and speckle-tracking longitudinal endocardial RV strain. Forty-four dogs underwent BV and were re-examined after surgery. ResultsSystolic function at the basal segment of the RV was significantly lower in the PS group when compared to healthy dogs (mean N-TAPSE 4.29 ± standard deviation 1.18 mm/kg0.285 vs. 5.60 ± 1.29 mm/kg0.285; median N-RVFW-S′ 5.28 [lower-upper 25% quantile 4.35–6.43 cm/s/kg0.186] vs. 7.82 [6.73–8.79 cm/s/kg0.186]; all P<0.001). Global longitudinal RV endocardial strain showed no significant difference between the two groups (−28.50 ± 6.23% vs. 28.61 ± 4.64%; P=0.886), but segmental strain analyses revealed basal hypo- and potential compensatory hyperkinesis of the apical RVFW. Furthermore, BV affected most parameters of systolic function, but not the segmental strain values and N-TAPSE. ConclusionsRight ventricular basal longitudinal systolic function is decreased in dogs with PS in comparison to a healthy cohort. Regional and global function does not necessarily coincide.

Echocardiography-directed management of hemodynamically unstable neonates in tertiary care hospitals

BackgroundHemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by clinical signs such as heart rate, blood pressure, capillary refill time, and measurement of urine output and serum lactate. Unfortunately, all of these parameters are surrogate markers of cardiovascular well-being, and they provide limited direct information regarding the adequacy of blood flow and tissue perfusion. A bedside point-of-care echocardiography can provide real-time hemodynamic information by assessing cardiac function, loading conditions (preload and afterload), and cardiac output, which makes it an ideal tool for monitoring hemodynamic assessment in neonates and children.MethodsA prospective cross-section study was carried out on all neonates admitted to the NICU of Cairo University Children’s Hospital (CUCH) during the period from September 2017 through August 2018 in whom manifestations of hemodynamic instability were elected regardless of gestational age, weight, gender, or type of disease.ResultsThere is a positive correlation between EF, FS, LVOT, RVOT, LVTI, RVTI, MAPSE, and TAPSE with birth weight. There is a negative correlation between birth weight and either LVO or RVO. In neonates weighted > 1500 g, there is a significant correlation between decreases in longitudinal systolic function of the heart (TAPSE and MAPSE) and either hemodynamic instability or need for echo-directed management, but there is no significant correlation between both in neonates weighted ≤ 1500 g. There is a significant relationship between birth weight and survival “the more the births weight the better survival chance and between complete compliance with ECDM protocol and achieving normal hemodynamic state.”ConclusionsDecreases in EF, FS, TAPSE, and MAPSE in low birth weight neonates’ ≤ 1500 g are late signs of hemodynamic instability. TAPSE and MAPSE are the earliest parameters noticed to be decreased in hemodynamically unstable neonates > 1500 g even before EF and FS but return to normal values latterly. There is a significant relationship between complete compliance with ECDM protocol and achieving normal hemodynamics. Birth weight of ≤ 1500 g was an independent predictor of mortality regardless of the degree of compliance with the protocol.

635 AMYLOIDOSIS AND THE ILE68LEU MUTATION OF THE TTR GENE: A RARE DISEASE YOU CAN TREAT.

Abstract Case presentation During the last year, a 66-year-old man was repetitively hospitalized for anasarcatic heart failure in an infiltrative heart disease with an impaired left ventricular function. In March 2022 the patient first presented to our emergency department with clinical signs of decompensated heart failure. An accurate diagnosis was made during the inpatient care. The electrocardiogram documented sinus bradycardia, degree I atrioventricular block, and right bundle branch block. Echocardiography showed a slight reduction in biventricular function, concentric hypertrophy and a significant reduction in longitudinal systolic function (GLS -11.8%) with an apical-sparing pattern. At the same time, the presence of mild to moderate circumferential pericardial effusion was documented. According to the clinical suspicion, a cardiac MRI was performed, revealing consistent amyloid infiltrative disease. A 99-mTc-HDP myocardial scintigraphy confirmed pathological accumulation of trans-thyretine with a Perugini Score 2. Serum and urinary immunofixation were negative. A genetic test was subsequently performed whereby a heterozygous Ile68Leu (p.Ile88Leu) pathogenic mutation in the TTR gene was documented. Follow-up neurologic evaluation ruled out the indication to start Patisiran therapy due to the absence of significant neurologic involvement. In the meantime, the patient was put on Torasemide therapy with moderate clinical benefit. Few months ago, shortly after the diagnosis, the patient was hospitalized again for anasarcatic heart failure complicated by a severe ascites, underwent a paracentesis. During this hospitalization, therapy with Tafamidis was started. The patient is currently in good cardiovascular clinical compensation. Discussion This clinical case offers the chance to investigate the characteristics and phenotype of cardiac amyloidosis caused by the Ile68Leu mutation. The typical Ile68Leu ATTRm patient is caucasian, tipically a 70 years’man (slightly younger than ATTRwt fenotipe), seeks medical attention with heart failure symptoms, and receives the correct diagnosis of cardiac amyloidosis almost 1 year after the onset of these symptoms. Usually, the mutation leads to predominantly cardiac manifestations, instead of a combined form (cardiac and/or neurological manifestations). The Ile68Leu TTR mutation is a cause of cardiac amyloidosis that leads to a phenotype similar to ATTRwt. The electrocardiogram and echocardiogram features described in the clinical case are typical and often indistinguishable from that of ATTRwt. The age at diagnosis and advanced heart failure symptoms at presentation were the only factors independently associated with mortality. The subject patient is younger than the average affected ones and suffers from an aggressive form of the disease. The take home message could be that we should definitely learn and remember the importance of etiologic screening in infiltrative diseases, especially in young people, now that there are effective therapies capable to reduce mortality and improve quality of life.

Abstract 12827: The Prognostic Value of Peak Mitral Annulus Systolic Velocity in Relation to Incident Heart Failure in the General Population - The Copenhagen City Heart Study

Introduction: Peak mitral annulus systolic velocity (s’) measured by color tissue Doppler echocardiography can be used to evaluate longitudinal systolic function of the left ventricle (LV). The prognostic value of s’ has previously been documented in patients with ischemic heart disease and heart failure (HF). We sought to investigate the prognostic value of s’ in association with incident HF in the general population with low cardiovascular risk. Methods: This prospective cohort consists of participants from the 5th Copenhagen City Heart Study. All participants had echocardiography performed. Exclusion criteria were prevalent HF, prevalent atrial fibrillation and inadequate image quality for s’ assessment. Multivariable Cox regression models adjusted for; sex, age, smoking-status, diabetes, ischemic heart disease, hypertension, heart rate, left atrial volume index and E/e’, were used to assess the association between s’ and HF. Results: Of 4,110 participants included (mean age 56 years ± 17.4 year, 56.8% female), 90 (2.2%) developed HF during a median follow-up of 5.4 years, [IQR: 4.4-6.3]. The mean s’ was 6.05 cm/s ± 1.2. Following multivariable adjustment, decreasing s’ remained significantly associated with HF (HR 1.60 (95% CI: 1.24; 2.07 p&lt;0.001) per 1 cm/s decrease) (Figure). An optimal cut-off value for s’ was calculated to be 5.9 cm/s. Participants with s’ below this cut-off had a 3-fold increased risk of HF (HR 3.15 (95% CI: 1.97; 5.03 p&lt;0.001). In participants with s’ ≥ 5.9 cm/s, the incidence rate of HF was 2.1 per 1000 person-years (95% CI: 1.39; 3.09) and 6.5 per 1000 person-years (95% CI: 5.13; 8.31) when s’ &lt; 5.9 cm/s. The cut-off value had a sensitivity of 73.3% (95% CI: 63; 82.1), a specificity of 54.0 (95% CI: 52.4; 55.6), and a negative predictive value of 98.9% (95% CI: 98.4; 99.3). Conclusion: In the general population, s’ is an independent prognosticator for the development of HF. Figure. The assocation between s’ and HF.

Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis.

Background and Aim: Dobutamine stress echocardiography (DSE) is a well-established noninvasive investigation for significant coronary artery disease (CAD). The aim of this study was to evaluate the accuracy of cardiac Doppler parameters in predicting CAD. Methods: We prospectively studied 103 consecutive patients with suspected CAD based on typical symptoms; 59 proved to have CAD, and 44 patients proved to have no-CAD (n = 44). All patients underwent a complete stress Doppler echocardiographic examination. Total isovolumic time (T-IVT) as a marker of cavity dyssynchrony and wall motion score index (WMSI) were also calculated. Results: At peak dobutamine stress, the compromised LV longitudinal excursion (MAPSE), systolic septal and lateral velocities (s’), and diastolic indices were more pronounced in the CAD patients compared with those without CAD, but LV dimension did not differ between groups (p > 0.05). The WMSI was higher and t-IVT more prolonged in patients with CAD (p < 0.01 for both). Similarly, the changes were more pronounced in patients with significant CAD compared with insignificant CAD. On multivariate model, Δ mean s’, OR 2.016 (1.610 to 3.190; p < 0.001), Δ E velocity OR 2.502 (1.179 to 1.108; p < 0.001), Δ t-IVT 2.206 (1.180 to 2.780; p < 0.001) and Δ WMSI OR 1.911 (1.401 to 3.001; p = 0.001) were the most powerful independent predictors of the presence of CAD, particularly when significant (>75%). Δ mean s’ < 5.0 was 85% sensitive, 89% specific with AUC 0.92. Respective values for Δ E velocity <6.0 cm/s were 82%, 90% and 0.91; for Δ t-IVT > 4.5, 78%, 77% and 0.81 and for Δ FT ≥ 150 ms, 76%, 78% and 0.84 in predicating significant CAD. WMSI ≥ 0.7 was 75% sensitive, 77% specific with AUC of 0.81 in predicting significant CAD. The accuracy of DSE was higher in significant CAD compared to insignificant CAD (80% vs. 74%; p = 0.03). Conclusions: Compromised LV longitudinal systolic function, lower delta E wave, prolonged t-IVT, and increased WMSI were the most powerful independent predictors of the presence and significance of CAD. These finding strengthen the role of comprehensive DSE analysis in diagnosing ischemic disturbances secondary to significant CAD.