Lower Left Ventricular Systolic Function Research Articles

1111 INTACT FIBROBLAST GROWTH FACTOR 23 TESTED BY A FULLY AUTOMATED ASSAY: CLINICAL CORRELATES AND PROGNOSTIC VALUE IN CHRONIC SYSTOLIC HEART FAILURE

Abstract Background and aims Fibroblast growth factor-23 (FGF23) has been associated with left ventricular (LV) hypertrophy, fibrosis, and heart failure (HF). We aimed to investigate the clinical correlates and prognostic value of intact FGF23 (iFGF23) in HF patients. Methods Patients with systolic HF (left ventricular ejection fraction – LVEF <50%) were prospectively enrolled. iFGF23 was tested with a fully automated immuno-chemiluminescent assay. Patients were divided into iFGF23 tertiles and followed-up for all-cause death, cardiac death, and the composite of all-cause death and HF hospitalizations. Results We enrolled 150 patients (82% males; median age 65 years). First, second, and third iFGF23 tertiles were <35.2 pg/mL, 35.2-50.9 pg/mL, and >50.9 pg/mL. Patients in the upper iFGF23 tertile had lower LVEF (p=0.014), higher N-terminal pro-B-type natriuretic peptide (NT-proBNP, p=0.001), and lower peak VO2 (p<0.001). Plasma phosphate, estimated glomerular filtration rate (eGFR), and LV mass index were independently associated with higher iFGF23 levels (all p<0.05). Patients in the upper tertile were at higher risk of all-cause death (p=0.001), cardiac death (p=0.001), and of the composite of all-cause death and HF hospitalizations (p=0.003). iFGF-23 was an independent predictor of all the endpoints after adjustment for age, LVEF, eGFR, and NT-proBNP. Conclusions Circulating iFGF23 is associated with renal dysfunction, disease severity and outcome in systolic HF. Figure. Prognostic impact of FGF23 levels in patients with systolic heart failure (HF). In a cohort of HF patients with systolic dysfunction, higher iFGF23 levels (marker of increased cardiac fibrosis and hypertrophy) were associated with a more severe disease, as expressed by lower left ventricular systolic function, higher circulating levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), lower oxygen consumption at cardiopulmonary exercise test and worse renal function. Moreover, iFGF23 elevation identified patients at higher risk for all-cause and cardiac mortality, and HF hospitalization.

Two-dimensional speckle tracking echocardiography demonstrates improved myocardial function after intravenous infusion of bone marrow mesenchymal stem in the X-Linked muscular dystrophy mice

BackgroundBone marrow mesenchymal stem cells (BMSCs) are commonly used in regenerative medicine. However, it is not clear whether transplantation of BMSCs can improve cardiac function of the X-Linked Muscular Dystrophy Mice (mdx) and how to detect it. We aimed to investigate the role of speckle tracking echocardiography (STE) in detecting cardiac function of the BMSCs-transplanted mdx in comparison with the untreated mdx.MethodsThe experimental mice were divided into the BMSCs-transplanted mdx, untreated mdx, and control mice groups (n = 6 per group). The BMSCs were transplanted via tail vein injections into a subset of mdx at 20 weeks of age. After four weeks, the cardiac functional parameters of all the mice in the 3 groups were analyzed by echocardiography. Then, all the mice were sacrificed, and the cardiac tissues were harvested and analyzed by immunofluorescence. The serum biochemical parameters were also analyzed to determine the beneficial effects of BMSCs transplantation.ResultsTraditional echocardiography parameters did not show statistically significant differences after BMSCs transplantation for the three groups of mice. In comparison with the control group, mdx showed significantly lower left ventricular (LV) STE parameters in both the long-axis and short-axis LV images (P < 0.05). However, BMSCs-transplanted mdx showed improvements in several STE parameters including significant increases in a few STE parameters (P < 0.05). Immunofluorescence staining of the myocardium tissues showed statistically significant differences between the mdx and the control mice (P < 0.05), and the mdx transplanted with BMSCs demonstrated significantly improvement compared with the untreated mdx (P < 0.05).ConclusionThis study demonstrated that the early reduction in the LV systolic and diastolic function in the mdx were accurately detected by STE. Furthermore, our study demonstrated that the transplantation of BMSCs significantly improved myocardial function in the mdx.

The Value of Mitral valve E point septal separation as an index of assessment of left ventricular systolic function

Background and objectives: There are several methods of assessment of left ventricular function utilizing M-mode echocardiography, the most popular one being geometrically derived ejection fraction, for which its validity is compromised in case of abnormal geometry or regional wall motion abnormalities. Mitral valve E septal separation estimated by M mode echocardiography or cardiac magnetic resonance imaging can be used as an index of left ventricular systolic function assessment. The aim of this study is to assess the value of mitral valve E septal separation estimated by M mode echocardiography in evaluation of left ventricular systolic function in patients assessed in two hospitals in Erbil city. Methods: from March 2016 to May 2019, 564 patients were randomly selected in Rizgary and Erbil teaching hospitals were included in this study. For all cases; demographic data were recorded, echocardiography performed by cardiologists, ejection fraction estimated by the most appropriate method and mitral valve E septal separation estimated by M mode scanning. Results: Means of age, ejection fraction, mitral valve E septal separation were 52.4±14.8, 65.4±10.4% and 3.87±4.1 respectively. Male to female ratio was 0.64 (220/344). There was strong highly significant negative correlation between ejection fraction and E septal separation, value of 6.9 mm was the upper normal level representing ejection fraction of 55%. The sensitivity and specificity of mitral valve E septal separation more than 7 mm as a reference to low left ventricular systolic function were 100% and 99%. Conclusions: Mitral valve E septal separation is reliable and easily measurable index of assessment of left ventricular systolic function; value more than 7 mm is indicating abnormal systolic function with sensitivity of 100% and specificity of 99%.

VALUE OF COPEPTIN MEASUREMENT AS A NOVEL BIOMARKER FOR PROGNOSIS INACUTE HEART FAILURE

Abstract Background: Copeptin, C-terminal segment of pro-arginine vasopressin, is expected to be a strong novel biomarker for prognosis in acute heart failure (AHF).Participants & Methods: The study included 45 patients with acute decompensated heart failure(ADHF) to assess the relationship of serum copeptin level on admission and 72 hours after admission with adverse cardiac events (death, re-hospitalization and arrhythmias) in patients hospitalized for (ADHF) between May 2019 and November 2019 with median follow up period 6 months.Results: In this study,15 patients died, re-admission occurred in 22 patients and arrhythmias were documented in 14 patients with atrial fibrillation (n=9) and ventricular arrhythmias (n=5). Mortality rate was higher among elder smoker patients with higher heart rate, low left ventricular systolic function, higher rates of arrhythmias, impaired kidney function and high copeptin level.Furthermore, copeptin level at day 1 with cutoff value of ˃2.54 pmol/l predicted mortality with sensitivity 86.67% and specificity 53.33% while copeptin level at day 3 with cutoff value ˃ 2.74 pmol/l predicted mortality with sensitivity 93.33% and specificity 83.33%.Finally, change in copeptin level between day 1 and day 3 was associated with increased mortality. (p˂0.001)Conclusion: Copeptin is suggested to be a strong biomarker to predict adverse clinical outcomes in patients with acute decompensated heart failure including death.

Association of P-Wave Abnormalities With Sudden Cardiac and Cardiovascular Death: The ARIC Study.

Association of P-Wave Abnormalities With Sudden Cardiac and Cardiovascular Death: The ARIC Study.

Predictors and prognostic role of low myocardial mechano-energetic efficiency in chronic inflammatory arthritis.

To assess the variables associated with the status of low myocardial mechano-energetic efficiency (MEE) [the ratio between myocardial left ventricular (LV) work and magnitude of myocardial oxygen consumption] and whether low-MEE is a prognosticator of adverse cardiovascular outcome in patients with chronic inflammatory arthritis. A total of 432 outpatients with established chronic inflammatory arthritis without overt cardiac disease were recruited from March 2014-March 2016; 216 participants were used as comparison group. Low-MEE status was a priori identified by standard echocardiography at rest as less than 0.32 ml/s per g (5th percentile of MEE calculated in 145 healthy individuals). The pre-specified primary end-point of the study was a composite of cardiovascular death/hospitalization. Follow-up ended September 2019. MEE was significantly lower in chronic inflammatory arthritis patients than controls (0.35 ± 0.11 vs. 0.45 ± 0.10 ml/s per g; P < 0.001). Low-MEE was detected in 164 patients (38%). Independent predictors of low-MEE were older age, higher SBP, diabetes mellitus, LV concentric geometry and lower LV systolic function. During a follow-up of 36 (21-48) months, a primary end-point occurred in 37 patients (8.6%): 22/164 patients with low-MEE (13.4%) and 15/268 (5.6%) without low-MEE (P = 0.004). Low-MEE predicted primary end-points in multivariate Cox regression analysis [heart rate 2.23 (confidence interval 1.13-4.38), P = 0.02] together with older age, lower renal function and higher LV mass. Low-MEE is detectable in more than one-third of patients with chronic inflammatory arthritis and is associated with traditional cardiovascular risk factors and abnormalities in LV geometry and systolic function. In these patients low-MEE is a powerful prognosticator of adverse cardiovascular events.

Fibroblast Growth Factor 23 and Long-Term Cardiac Function: The Multi-Ethnic Study of Atherosclerosis.

Although FGF23 (fibroblast growth factor 23) is associated with heart failure and atrial fibrillation, the mechanisms driving these associations are unclear. Sensitive measures of cardiovascular structure and function may provide mechanistic insight behind the associations of FGF23 with various cardiovascular diseases. In MESA (the Multi-Ethnic Study of Atherosclerosis), we evaluated the associations of baseline serum FGF23 (2000-2002) with measures of left ventricular (LV) and left atrial mechanical function on cardiac magnetic resonance at 10-year follow-up (2010-2012). Of 2276 participants with available FGF23 and cardiac magnetic resonance at 10-year follow-up, participants with higher FGF23 levels were more likely White race, taking antihypertensive medications, and had lower kidney function. After covariate adjustment, FGF23 was associated with higher LV mass (β coefficient per 1 SD higher, 1.14 [95% CI, 0.16-2.12], P=0.02), worse LV global circumferential strain (β coefficient per 1 SD higher, 0.15 [95% CI, 0.05-0.25], P=0.003), worse LV midwall circumferential strain (β coefficient per 1 SD higher, 0.20 [95% CI, 0.08-0.31], P=0.001), and lower left atrial total emptying fraction (β coefficient per 1 SD higher, -0.52 [95% CI, -1.02 to -0.02], P=0.04). These associations were consistent across racial/ethnic groups and the spectrum of glomerular filtration rates. FGF23 was not associated with the presence of myocardial scar (odds ratio per 1 SD higher, 1.12 [95% CI, 0.86-1.45], P=0.42). In a multiethnic, community-based cohort, baseline FGF23 levels were independently associated with higher LV mass, lower LV systolic function, and reduced left atrial function over long-term follow-up. These findings provide potential mechanistic insight into associations of FGF23 with incident heart failure and atrial fibrillation.

Abstract P449: Associations of Unhealthy Food and Physical Activity Environments With Adverse Cardiac Function: The Coronary Artery Risk Development in Young Adults (Cardia) Study

Background: Substantial disparities in risk of heart failure (HF) exist by race, which may be driven by certain social or environmental factors. The relationship between the neighborhood built environment, including food and physical activity facilities, and risk of HF is unclear. The associations of the built environment and subclinical cardiac dysfunction may offer insight into mechanisms that lead to increased HF risk. Methods: In the CARDIA study, we evaluated the associations between measures of the neighborhood built environment and echocardiographic indices of cardiac function at the Year 25 exam (Y25). Built measures were assessed within a 3-km Euclidean distance from participant residence and included: 1) proportion of fast food restaurants or convenience stores relative to total food outlets and 2) number of public or commercial physical activity facilities. Results: Among 2,363 participants (44% male, 51% black) with available data from Y25, higher proportions of fast food restaurants and convenience stores were independently associated with lower left ventricular (LV) diastolic function (lower e’ tissue velocities and higher E/e’) ( Table ). Lower number of public and commercial physical activity facilities were independently associated with lower LV systolic function (LV longitudinal strain) and diastolic function. Conclusions: Food environments with higher proportions of fast food and convenience stores are associated with lower diastolic function, and environments with less physical activity facilities are associated with worse systolic and diastolic function. These findings suggest relationships between the built environment and subclinical HF.

The Effect of Strict Volume Control Assessed by Repeated Bioimpedance Spectroscopy on Cardiac Function in Peritoneal Dialysis Patients

Adequate fluid management plays an important role in decreasing cardiovascular risk in peritoneal dialysis (PD) patients. We evaluated whether strict volume control monitored by bioimpedance spectroscopy (BIS) affects cardiac function in PD patients. This study is a secondary analysis of a multicentre, prospective, randomized, controlled trial. Fluid overload was assessed by the average overhydration/extracellular water (OH/ECW) at baseline, 6 months and 12 months. Patients were categorized as time-averaged overhydrated (TA-OH/ECW ≥15%) or normohydrated (TA-OH/ECW <15%), and echocardiographic parameters were compared between groups. Among a total of 151 patients, 120 patients exhibited time-averaged normohydration. Time-averaged overhydrated patients had a significantly higher left atrial (LA) diameter and E/e′ ratio and a lower left ventricular (LV) ejection fraction at 12 months than time-averaged normohydrated patients. LA diameter, end-systolic volume and end-diastolic volume were decreased at 12 months compared to baseline in time-averaged normohydrated patients only. TA-OH/ECW was independently associated with ejection fraction at 12 months (β = −0.190; p = 0.010). TA-OH/ECW, but not OH/ECW at 12 months, was an independent risk factor for LV dysfunction (odds ratio 4.020 [95% confidence interval 1.285–12.573]). Overhydration status based on repeated BIS measurements is an independent predictor of LV systolic function in PD patients.

Increased prevalence of cerebral microbleeds in patients with low left ventricular systolic function.

Gradient-echo T2-star (T2*)-weighted magnetic resonance imaging (MRI) is a sensitive method to detect cerebral microbleeds (CMBs). The presence of CMBs was reported to be a marker of future cardiovascular mortality and is associated with various cardiovascular risk factors, use of antithrombotic drugs, and cognitive dysfunction. However, the relationship between cardiac function and CMBs remains unclear. We investigated the association between cardiac function and presence of CMBs in patients with cardiovascular diseases. This single-center retrospective study included a total of 424 participants (mean age 70 ± 12years; men 286 (67%); mean left ventricular ejection fraction (LVEF) 61% ± 12%] who underwent echocardiography and brain T2*-weighted MRI within 1 month without neurologic abnormality. CMBs were found in 118 (28%) patients. There was no significant relationship between CMBs and anticoagulant or antiplatelet therapy. LVEF was significantly lower in patients with CMBs than in those without CMBs (59% ± 13% vs. 62% ± 11%, P < 0.05). On multivariate logistic analysis, lower LVEF [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.96-1.00; P < 0.05] and age (OR 1.02, 95% CI 1.00-1.05; P < 0.05) were significantly associated with CMBs. The presence of CMBs was frequently observed in the patients with cardiovascular disease and was significantly associated with age and LVEF.

Ghrelin Derangements in Idiopathic Dilated Cardiomyopathy: Impact of Myocardial Disease Duration and Left Ventricular Ejection Fraction.

Background: Ghrelin may exert positive effects on cardiac structure and function in heart failure (HF) patients. Methods: We assessed ghrelin levels in 266 dilated cardiomyopathy (DCM) patients and in 200 age, gender and body mass index (BMI) matched controls. Further, we evaluated the expression of ghrelin and growth hormone secretagogue-receptor (GHSR) in the myocardium of 41 DCM patients and in 11 controls. Results: DCM patients had significantly lower levels of total, acylated and unacylated ghrelin when compared to controls (p < 0.05 for all). In controls, we observed a negative correlation of ghrelin with age, male gender and BMI. These correlations were lost in the DCM group, except for male gender. Total ghrelin was higher in patients with more recent diagnosis when compared to patients with longer duration of the DCM (p = 0.033). Further, total ghrelin was higher in patients with lower left ventricular systolic function (<40% LVEF, vs. 40% ≤ LVEF < 49% vs. LVEF ≥ 50%: 480.8, vs. 429.7, vs. 329.5 pg/mL, respectively, p = 0.05). Ghrelin prepropeptide was expressed more in DCM patients than in controls (p = 0.0293) while GHSR was expressed less in DCM patients (p < 0.001). Furthermore, ghrelin showed an inverse correlation with its receptor (ρ = −0.406, p = 0.009), and this receptor showed a significant inverse correlation with Interleukin-1β (ρ = −0.422, p = 0.0103). Conclusion: DCM duration and severity are accompanied by alterations in the ghrelin–GHSR system.

Immunomodulation by adoptive regulatory T-cell transfer improves Coxsackievirus B3-induced myocarditis.

Regulatory T (Treg) cells offer new therapeutic options for controlling undesired systemic and local immune responses. The aim of the current study was to determine the impact of therapeutic Treg administration on systemic and cardiac inflammation and remodeling in coxsackievirus B3 (CVB3) -induced myocarditis. Therefore, syngeneic Treg cells were applied intravenously in CVB3-infected mice 3 d after infection. Compared with CVB3 + PBS mice, CVB3 + Treg mice exhibited lower left ventricular (LV) chemokine expression, accompanied by reduced cardiac presence of proinflammatory Ly6ChighCCR2highCx3Cr1low monocytes and higher retention of proinflammatory Ly6CmidCCR2highCx3Cr1low monocytes in the spleen. In addition, splenic myelopoiesis was reduced in CVB3 + Treg compared with CVB3 + PBS mice. Coculture of Treg cells with splenocytes isolated from mice 3 d post-CVB3 infection further demonstrated the ability of Treg cells to modulate monocyte differentiation in favor of the anti-inflammatory Ly6ClowCCR2lowCx3Cr1high subset. Treg-mediated immunomodulation was paralleled by lower collagen 1 protein expression and decreased levels of soluble and insoluble collagen in LV of CVB3 + Treg compared with CVB3 + PBS mice. In agreement with these findings, LV systolic and diastolic function was improved in CVB3 + Treg mice compared with CVB3 + PBS mice. In summary, adoptive Treg transfer in the inflammatory phase of viral-induced myocarditis protects the heart against inflammatory damage and fibrosis via modulation of monocyte subsets.-Pappritz, K., Savvatis, K., Miteva, K., Kerim, B., Dong, F., Fechner, H., Müller, I., Brandt, C., Lopez, B., González, A., Ravassa, S., Klingel, K., Diez, J., Reinke, P., Volk, H.-D., Van Linthout, S., Tschöpe, C. Immunomodulation by adoptive regulatory T-cell transfer improves Coxsackievirus B3-induced myocarditis.

The effect of septal flash on left ventricular function and systolic synchrony in patients with complete left bundle branch block and preserved left ventricular ejection fraction

Objective To evaluate the effect of septal flash (SF) on left ventricular function and systolic synchrony in patients with complete left bundle branch block (CLBBB) and preserved left ventricular ejection fraction (LVEF) by two-dimensional speckle-tracking imaging (2D-STI). Methods Sixty CLBBB patients with preserved LVEF were selected, and 30 healthy individuals serving as control group. The SF of CLBBB patients were evaluated using 2D-STI, and the CLBBB patients were categorized into two groups (SF group and NSF group) based on the present SF. Conventional echocadiography and 2D-STI were performed for all individuals. Results ①SF was present in 53.3% of CLBBB patients with preserved LVEF and was not present in control group. ②LV longitudinal peak stain of global (LS-G) in SF group was lower than those in both control group and NSF group (P 0.05). ③Compared with control group, there were significant increase of left atrial dimension and Mitral E/e′ and decrease in mitral E/A and mitral e′ in SF group and NSF group (P 0.05). ④There was an increase in standard deviation of time to peak systolic strain for the 18 LV segments (LV-SDt) in SF group and NSF group, and the LV-SDt in SF group was higher than that in NSF group (P<0.01). Conclusions SF is present in 53.3% of CLBBB patients, patients of CLBBB with SF have lower left ventricular systolic function and systolic synchrony. Key words: Echocardiography; Bundle-branch block; Ventricular function, left; Septal flash; Strain

Determinants and prognosis of high-sensitivity cardiac troponin T peak plasma concentration in patients hospitalized for non-cardiogenic shock

Purpose:The aim of this study was to assess the determinants and prognostic value of high-sensitivity cardiac troponin T peak plasma concentration in intensive care unit patients with non-cardiogenic shock.Material and methods:A prospective observational cohort study was conducted in a single intensive care unit between November 2014 and December 2015.Results:During the study period, 206 patients were hospitalized in the intensive care unit for non-cardiogenic shock and the median peak high-sensitivity cardiac troponin T was 55.1 [24.5–136] pg/mL. A multivariate analysis combining all variables showed that higher body mass index (t = 2.52, P = 0.01), lower left ventricular systolic function (t = −2.73, P = 0.007), higher white blood cell count (t = 3.72, P = 0.0001), lower creatinine clearance (t = −2.84, P = 0.0005), higher lactate level (t = 2.62, P = 0.01) and ST-segment depression (t = 3.98, P = 0.0001) best correlated with log10-transformed high-sensitivity cardiac troponin T peak plasma concentration. After multivariate analysis, the high-sensitivity cardiac troponin T peak was not associated with a significant reduction of in-hospital mortality (adjusted odds ratio = 0.99 (95% confidence interval: 0.93–1.02)).Conclusion:High-sensitivity cardiac troponin T elevation was very common in patients hospitalized for non-cardiogenic shock. The factors significantly associated with high-sensitivity cardiac troponin T peak plasma concentration were higher body mass index, decreased left ventricular systolic ejection fraction, higher leucocyte count, decreased renal function, increased lactate level, and ST-segment depression. The high-sensitivity cardiac troponin T peak was not significantly associated with in-hospital mortality in this setting.

Plasma dipeptidyl-peptidase-4 activity is associated with left ventricular systolic function in patients with ST-segment elevation myocardial infarction

Plasma dipeptidyl-peptidase-4 activity (DPP4a) is inversely associated with left ventricular function in patients with heart failure (HF) or diabetes. However, the association between DPP4a and left ventricular function in ST-segment elevation myocardial infarction (STEMI) patients has not been reported. We studied this association in 584 consecutive STEMI patients at a tertiary referral center from July 2014 to October 2015. DPP4a and plasma N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) levels were quantified by enzymatic assays. The median serum NT-proBNP levels were highest in patients of the lowest tertile (T1) of DPP4a compared with that of the highest tertile (T3) (p = 0.028). The STEMI patients in T1 exhibited lower left ventricular systolic function (T1 vs. T3: left ventricular ejection fraction (LVEF): 50.13 ± 9.12 vs. 52.85 ± 6.82%, p = 0.001). Multivariate logistic-regression analyses (adjusted for confounding variables) showed that a 1 U/L increase in DPP4a was associated with a decreased incidence of left ventricular systolic dysfunction (LVSD) (adjusted odds ratio: 0.90; 95% CI: 0.87–0.94; p < 0.01). In conclusion, low DPP4a is independently associated with LVSD in STEMI patients, which suggests that DPP4 may be involved in the mechanisms of LVSD in STEMI patients.

Gender Differences in Clinical Profiles of Stress-Induced Cardiomyopathy.

BackgroundAlthough stress-induced cardiomyopathy (SCMP) is reported to be more common in women, little is known about gender differences in patients with SCMP. The aim of the study was to describe clinical features of patients with SCMP according to gender.MethodsOne hundred and three patients diagnosed with definite SCMP at a single tertiary institute from January 1997 to August 2014 were enrolled. SCMP was more common in women than in men.ResultsAge at presentation was not significantly different between the two groups (p = 0.758). Preceding physical stress, especially acute medical illness, was more common in male patients (p = 0.014), whereas emotional stress was more common in female patients (p = 0.016). Severity of medical illness classified by the Acute Physiology and Chronic Health Evaluation (APACHE) II score at the time of SCMP diagnosis was not significantly different between men and women (p = 0.752). Clinical characteristics, including symptoms, laboratory and electrocardiographic findings, were similar. However, pump failure was more severe in men (p = 0.024). Clinical outcomes were not statistically different (p = 0.220). Preceding physical stress and lower left ventricular systolic function after 2 months were independent risk factors for all-cause mortality for both genders. Women with an APACHE II score ≥ 15 and men with reduced left ventricular ejection fraction after 2 months had a greater risk of poor prognosis.ConclusionSCMP was more common in female patients. Female patients more commonly experienced preceding emotional stress, whereas physical stress was more common in male patients. Systolic dysfunction was more severe in men. Long-term clinical outcomes appeared to be similar between men and women.

Disease activity is associated with reduced left ventricular systolic myocardial function in patients with rheumatoid arthritis

ObjectivesDisease activity has emerged as a new, independent risk factor for cardiovascular disease in patients with rheumatoid arthritis (RA). We tested if disease activity in RA was associated with lower...

Platelet counts on admission affect coronary flow, myocardial perfusion and left ventricular systolic function after primary percutaneous coronary intervention.

Patients with acute ST-elevation myocardial infarction (STEMI) and increased platelet count treated by fibrinolysis have worse outcomes. The aim of this study was to test the hypothesis that platelet blood count at admission in patients with acute STEMI treated by primary percutaneous coronary intervention affects coronary flow, myocardial perfusion and recovery of left ventricular systolic function. A total of 174 patients presenting with acute anterior STEMI and treated with primary percutaneous coronary intervention were included and divided into subgroups of admission platelet blood count of <200 K, 200-300 K, 300-400 K and >400 K. Evaluation of coronary artery flow and myocardial blush grade was performed according to the TIMI criteria. Electrocardiographic ST elevation resolution post-primary percutaneous coronary intervention was evaluated. Doppler echocardiographic evaluation of left anterior descending coronary artery velocities early and late after primary percutaneous coronary intervention and assessment of left ventricular ejection fraction and wall motion score index (WMSI) of left ventricular and left anterior descending coronary artery territory were performed. Post-primary percutaneous coronary intervention TIMI, myocardial blush grade and ST elevation resolution were similar in all groups. Patients with platelet counts <200 K had higher peak diastolic left anterior descending coronary artery velocity both early and late after primary percutaneous coronary intervention, and higher prevalence of left anterior descending coronary artery velocity deceleration time exceeding 600 ms, (45.5% vs. 40%, P<0.05). Patients with platelet counts >400 K presented with worse left ventricular ejection fraction, left ventricular WMSI and left anterior descending coronary artery WMSI, and before discharge this subgroup had worse left ventricular WMSI and left anterior descending coronary artery WMSI, P<0.01. Patients with anterior STEMI treated by primary percutaneous coronary intervention with lower admission platelet count had higher left anterior descending coronary artery diastolic velocities, better myocardial perfusion with more patients having left anterior descending coronary artery-descending coronary artery velocity deceleration time >600 ms. Patients with higher platelet counts had lower left ventricular systolic function both at admission and before discharge.

Electrical storm in dilated cardiomyopathy treated using epicardial radiofrequency ablation as a first line therapy

We report a patient with non-ischemic dilated cardiomyopathy and low left ventricular systolic function (28%) presenting with an electrical storm originated in epicardial scar and ablated by radiofrequency. This case report suggests that a strategy of epicardial catheter ablation is reasonable for the patient presenting with electrical storm related to structural disease with a low left ventricular ejection fraction.

Practical applicability of landiolol, an ultra-short-acting β1-selective blocker, for rapid atrial and ventricular tachyarrhythmias with left ventricular dysfunction

BackgroundLandiolol effectively controls rapid heart rate in atrial fibrillation or flutter (AF/AFL) patients with left ventricular (LV) dysfunction. However, predicting landiolol Responders and Non-Responders and patients who will experience adverse effects remains a challenge. The aim of this study was to clarify the potential applicability of landiolol for rapid AF/AFL and refractory ventricular tachyarrhythmias (VTs) in patients with heart failure. MethodsA total of 39 patients with AF/AFL with ventricular response ≥120bpm and 12 VTs were retrospectively enrolled. Landiolol Responders for rapid AF/AFL were defined as patients whose ventricular response was suppressed to less than 110bpm or decreased by ≥20% from the initial heart rate after administration of landiolol. Responders for VTs were defined as patients with no recurrent VTs during the 24h after the initiation of landiolol. ResultsFor AF/AFL, 29 patients (74%) were Responders. In nine patients (31%), AF was spontaneously terminated after starting landiolol. Eight Non-Responders (80%) needed to have AF terminated by cardioversion. Left ventricular ejection fraction (LVEF) at baseline was significantly associated with landiolol efficacy. For VTs, seven patients (58%) were Responders, and smaller LV diastolic and systolic diameters were associated with landiolol efficacy. Hypotension after landiolol treatment occurred in 5 of 51 patients, and lower LV systolic function was associated with the development of adverse events. ConclusionsLandiolol is effective in patients with heart failure not only due to rapid AF/AFL but also due to VTs. However, preserved LVEF is important for efficacy and safety in landiolol treatment.