Left Ventricular Sphericity Index Research Articles

The role of 3D speckle-tracking echocardiography in predicting long-term outcomes after a first myocardial infarction

Aim. To determine the role of 3D echocardiography parameters in the prognosis of long-term cardiovascular complications in patients with a first acute myocardial infarction (AMI).Materials and methods. А prospective, single-center, observational study included 46 patients with a first AMI and successful PCI without a history of heart failure (HF) and shortness of breath upon admission. The examination of patients was performed in accordance with the Russian standards of medical care provision. Additionally, 3D echocardiography was performed, and N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined. The main outcomes assessed were hospitalization with HF, sudden cardiac death, and combined endpoint. Median follow-up was 554 days (IQR 550–785).Results. During the follow-up period, 9 hospitalizations with HF, 3 sudden cardiac deaths, and 12 combined endpoints were registered. The effect of 3D echocardiography parameters on the development of sudden cardiac death and combined endpoint has not been revealed. The effect of the studied parameters on the development of HF during the follow-up period that required hospitalization was evaluated. A statistically significant increase in the LV sphericity index was revealed in the group of patients with the registered outcome. We found significant direct correlations of left ventricular volume indices with prescription of diuretics in the post-discharge period; hospitalization with HF in the post-infarction period with the level of NT-pro-BNP, left atrial volume with the duration of index hospitalization, duration of eventless survival with ST elevation. We found a negative correlation of radial strain with prescription of diuretics in the post-discharge period. Predictors of hospitalization with HF in the post-infarction period were identified – parameters of radial strain, area strain, and circumferential strain, which were included in the model for calculating the risk of the outcome under study.Conclusion. In patients with the first AMI in the absence of clinical signs of HF, to calculate the risk of hospitalization with HF within 550 days after MI, it is advisable to take into account the level of radial strain and use a prognostic model (1), including parameters of circumferential and area strain (according to 3D echocardiography data).

Timing of Surgery for Asymptomatic Primary Mitral Regurgitation: Possible Value of Early, Serial Measurements of Left Ventricular Sphericity.

Asymptomatic primary mitral regurgitation due to myxomatous degeneration of the mitral valve leaflets may remain so for long periods, even as left ventricular function progresses to a decompensated stage. During the early compensated stage, the ventricle's initial response to the volume overload is an asymmetric increase in the diastolic short axis dimension, accomplished by a diastolic shift of the interventricular septum into the right ventricular cavity, creating a more spherical left ventricular diastolic shape, increasing diastolic filling and stroke volume. Early valve repair is recommended to reduce postoperative left ventricular dysfunction. Early serial measurements of left ventricular sphericity index [LV-Si]. during the compensated stage of mitral regurgitation might identify subtle changes in left ventricular shape and assist in determining the optimal earliest timing for surgical intervention.

Predictive significance of modern echocardiographic parameters, stress ultrasound of the lungs in patients with acute myocardial infarction and percutaneous coronary intervention

Abstract Introduction Improving the EF can reduce the risk of cardiovascular complications (CVC) in postinfarction period. Short-term periprocedural dynamics (PPD) of EF and its prognostic value in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) have not been studied. Stress lung ultrasound (LUS) can be used as an initial step in heart failure (HF) risk stratification. Speckle tracking Echo with assessment of myocardial work (MW) is promising in relation to the prediction of CVC in patients with AMI. The predictive abilities of 3D Echo deformity and rotation in patients with AMI are not well studied. Purpose Determination of the value of PPD EF, subclinical pulmonary congestion (PC) in stress LUS, parameters of MW and 3D-Echo in the prognosis of the development of CVC in long-term period in patients with the first AMI and PCI. Methods In 131 patients (89 men, mean age: 61.7±11.45 years, Me EF admission: 48%, multivessel coronary artery disease 66.4%) with a first MI without a history of HF with successful PCI, EF was assessed before PCI and at discharge, MW parameters, 3D-Echo parameters were determined, and stress LUS with physical activity was performed. An increase in EF>5% and an achievement of 50% or more were taken as a criterion for a positive PPD. After 3 months, the dynamics of 2- and 3D-Echo were evaluated. The observation period was 550 days. Hospitalization with HF, CV death, and composite point were assessed. Results Upon admission baseline EF<50% was detected in 56.5% of cases. 47.3% of patients from the group with baseline EF <50% did not have PPD EF after PCI, which is associated with an increased risk of hospitalization with HF (HR=7.13 p=0.004). An increase in PPD by 1% reduces the risks of hospitalization with HF by 1.31 times (p=0.013). According to the stress LUS, subclinical PC was detected in 99.1% of patients. In patients with baseline EF <50%, the sum of B-lines ≥10 during exercise increases the risks of hospitalization with HF by 2.4 times, and its combination with the absence of PPD - by 7.45 times during 1.5 years. With GLS<13.7%, the risk of hospitalization with HF increases by 2.34 times (p=0.048), GWW>161.5 mmHg% - by 2.65 times (p=0.028). The model for calculating the risk of hospitalization with HF included GLS (OR 0.75; p=0.006), GCW (OR 0.85; p=0.036) and ΔEF (OR 0.88; p=0.040). Patients hospitalized with HF after AMI showed a significant increase in the LV sphericity index after 3 months. The predictors of hospitalization with HF according to 3D Echo were indicators of circumflexial strain (CS)(OR 0.76; p=0.026), areal strain (AS)(OR 0.60; p=0.012), radial strain (RS)(OR 0.91; p=0.039), area strain dynamics over 3 months (HR 0.702; р=0.025). Conclusion In patients with the first AMI, it is advisable to conduct a comprehensive Echo with an assessment of MW, stress LUS to identify high-risk patients for the development of HF in the postinfarction period.

Understanding post-surgical decline in left ventricular function in primary mitral regurgitation using regression and machine learning models.

Class I echocardiographic guidelines in primary mitral regurgitation (PMR) risks left ventricular ejection fraction (LVEF) < 50% after mitral valve surgery even with pre-surgical LVEF > 60%. There are no models predicting LVEF < 50% after surgery in the complex interplay of increased preload and facilitated ejection in PMR using cardiac magnetic resonance (CMR). Use regression and machine learning models to identify a combination of CMR LV remodeling and function parameters that predict LVEF < 50% after mitral valve surgery. CMR with tissue tagging was performed in 51 pre-surgery PMR patients (median CMR LVEF 64%), 49 asymptomatic (median CMR LVEF 63%), and age-matched controls (median CMR LVEF 64%). To predict post-surgery LVEF < 50%, least absolute shrinkage and selection operator (LASSO), random forest (RF), extreme gradient boosting (XGBoost), and support vector machine (SVM) were developed and validated in pre-surgery PMR patients. Recursive feature elimination and LASSO reduced the number of features and model complexity. Data was split and tested 100 times and models were evaluated via stratified cross validation to avoid overfitting. The final RF model was tested in asymptomatic PMR patients to predict post-surgical LVEF < 50% if they had gone to mitral valve surgery. Thirteen pre-surgery PMR had LVEF < 50% after mitral valve surgery. In addition to LVEF (P = 0.005) and LVESD (P = 0.13), LV sphericity index (P = 0.047) and LV mid systolic circumferential strain rate (P = 0.024) were predictors of post-surgery LVEF < 50%. Using these four parameters, logistic regression achieved 77.92% classification accuracy while RF improved the accuracy to 86.17%. This final RF model was applied to asymptomatic PMR and predicted 14 (28.57%) out of 49 would have post-surgery LVEF < 50% if they had mitral valve surgery. These preliminary findings call for a longitudinal study to determine whether LV sphericity index and circumferential strain rate, or other combination of parameters, accurately predict post-surgical LVEF in PMR.

Fetal cardiac function at midgestation and conception by in-vitro fertilization.

To assess differences in cardiac morphology and function at midgestation in fetuses conceived by in-vitro fertilization (IVF), using fresh or frozen embryo transfer, compared with those conceived naturally. This was a prospective study of 5801 women with a singleton pregnancy attending for a routine ultrasound examination at 19 + 0 to 23 + 6 weeks' gestation, including 343 that conceived by IVF. Conventional and more advanced echocardiographic modalities, including speckle-tracking analysis, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity index. Placental perfusion and function were assessed by measurement of uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF), respectively. Fetuses that were conceived by IVF, compared with those conceived spontaneously, had significantly lower right and left ventricular sphericity index, higher left ventricular global longitudinal strain and lower left ventricular ejection fraction. There were no significant differences in any of the cardiac indices within the IVF group between the fresh and frozen embryo transfers. In the IVF group, compared with spontaneously conceived pregnancies, UtA-PI was lower and PlGF was higher, suggesting better placental perfusion and function. Our study demonstrates that, in IVF pregnancies, compared with those conceived spontaneously, there is evidence of fetal cardiac remodeling at midgestation, which is not related to the use of fresh or frozen embryo transfer. In the IVF group, compared with naturally conceived pregnancies, fetal heart was globular and left ventricular systolic function was mildly reduced. Whether these cardiac changes are accentuated later in pregnancy and remain in the postnatal period remains to be established. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Abstract P670: Association of Left Atrial and Left Ventricular Sphericity With Left Ventricular Structure and Function

Introduction: Spherical remodeling of atria and ventricles is associated with cardiovascular disease (CVD) and mortality. We hypothesized that volumetric left atrial (LA) and left ventricular (LV) sphericity index (SI) are associated with adverse measures of LV structure and function in older adults free of CVD. Methods: Framingham Heart Study 2nd generation participants without prevalent CVD with echocardiography at exam 8 were studied (n=1701). Volumetric LA SI was calculated as the ratio of biplane LA volume to the volume of a sphere [4/3*pi*(r^3)] calculated using the radius of LA length (r=½ average length of the atria in 4- and 2-chamber views in diastole). Volumetric LV SI was calculated as the ratio of LV end-diastolic volume (LVEDV) to the volume of a sphere calculated using the radius of LV length (r= ½ length of LV in 4-chamber view in diastole). LVEDV was measured by biplane area-length method. In multivariable models adjusting for CV risk factors including age, sex, BMI, hypertension, dyslipidemia, diabetes, and smoking, we evaluated the relations of LA and LV SI with echocardiographic LV structure and function: wall thickness (septal and posterior wall average), mass, global longitudinal strain, ejection fraction (EF), and log-transformed mitral Doppler E/A. β coefficients are presented as standard deviation (SD) change in outcome per SD change in predictor variable. Results: Descriptives are presented in the Table . There was no association of LA or LV SI with sex (p=0.48, p=0.61, respectively). LA SI was associated with worse (positive) LV global longitudinal strain (std β±SE: 0.08±0.03, p=0.016). LV SI was associated with LV wall thickness (std β±SE: 0.24±0.03, p&lt;0.0001), mass (0.45±0.03, p&lt;0.0001) and log-Doppler E/A (0.07±0.03, p=0.015) and was inversely associated with LV EF (-0.12±0.03, p&lt;0.0001). Conclusions: In a large community sample without prevalent CVD, spherical remodeling of the heart was associated with unfavorable LV structure and both systolic and diastolic dysfunction.

Cardiac Magnetic Resonance Imaging in Appraising Myocardial Strain and Biomechanics: A Current Overview.

Subclinical alterations in myocardial structure and function occur early during the natural disease course. In contrast, clinically overt signs and symptoms occur during late phases, being associated with worse outcomes. Identification of such subclinical changes is critical for timely diagnosis and accurate management. Hence, implementing cost-effective imaging techniques with accuracy and reproducibility may improve long-term prognosis. A growing body of evidence supports using cardiac magnetic resonance (CMR) to quantify deformation parameters. Tissue-tagging (TT-CMR) and feature-tracking CMR (FT-CMR) can measure longitudinal, circumferential, and radial strains and recent research emphasize their diagnostic and prognostic roles in ischemic heart disease and primary myocardial illnesses. Additionally, these methods can accurately determine LV wringing and functional dynamic geometry parameters, such as LV torsion, twist/untwist, LV sphericity index, and long-axis strain, and several studies have proved their utility in prognostic prediction in various cardiovascular patients. More recently, few yet important studies have suggested the superiority of fast strain-encoded imaging CMR-derived myocardial strain in terms of accuracy and significantly reduced acquisition time, however, more studies need to be carried out to establish its clinical impact. Herein, the current review aims to provide an overview of currently available data regarding the role of CMR in evaluating myocardial strain and biomechanics.

Three-dimensional echocardiographic assessment of left ventricular geometric changes following acute myocardial infarction

Acute ST-segment elevation myocardial infarction (STEMI) is associated with left ventricular (LV) structural and functional consequences. We aimed to elucidate LV geometric changes following STEMI using three-dimensional (3D) echocardiography (3DE) and to assess their functional implications using two-dimensional (2D) speckle tracking echocardiography (STE). The study included 71 patients with STEMI who underwent baseline and 6-month follow-up 2D- and 3DE. Measured parameters included LV dimensions, biplane volumes, wall motion assessment, 2D LV global longitudinal strain (GLS), and 3D LV volumes, sphericity index and systolic dyssynchrony index. According to 3DE, LV geometric changes were classified as, adverse remodeling, reverse remodeling, and minimal LV volumetric changes. The occurrence of in-hospital and follow-up major adverse cardiovascular events (MACE) was assessed among the study population. The incidence of developing adverse remodeling was 25.4% while that of reverse remodeling was 36.6%. Adverse remodeling patients had significantly higher in-hospital MACE. Reverse remodeling was associated with significantly improved GLS, that was less evident in those with minimal LV geometric changes, and non-significant improvement for adverse remodeling group. LV baseline 2D GLS significantly correlated with follow-up 3D volumes among both reverse and adverse remodeling groups. Female gender and higher absolute GLS change upon follow-up were significantly associated with reverse remodeling. ROC-derived cutoff for adverse remodeling reallocated a substantial number of patients from the minimal change group to the adverse remodeling. Following acute STEMI, two-dimensional GLS was associated with and potentially predictive of changes in LV volumes as detected by three-dimensional echocardiography.

Comparison of cardiovascular magnetic resonance features and clinical consequences in patients with left ventricular non-compaction with and without mitral regurgitation-a multi-institutional study of the retrospective cohort study.

Mitral regurgitation (MR) is common in patients with ischemic or idiopathic cardiomyopathies and may be associated with a poor prognosis; however, the impact of different degrees of MR on cardiovascular magnetic resonance images, left ventricular features, and clinical outcomes of left ventricular noncompaction are unknown. We aimed to investigate and compare cardiovascular magnetic resonance characteristics and clinical consequences in patients with left ventricular non-compaction (LVNC) with and without MR. A cohort of 75 patients with left ventricular noncompaction were retrospectively studied from three institutions; all had undergone cardiovascular magnetic resonance examination with subsequent clinical follow-up. MR was evaluated by echocardiography. Left ventricular myocardial strains including global radial, circumferential, and longitudinal peak strains and left ventricular geometric and functional parameters, including left ventricular ejection fraction, end-diastolic volume, end-systolic volume, left ventricular mass, left ventricular sphericity index, longitudinal shorten, and late gadolinium enhancement (LGE) were measured and compared among groups. The primary endpoint was a composite of heart transplantation, implantable cardioverter-defibrillator insertion, and cardiac death. Compared with the no MR group, the MR groups showed significant deterioration in left ventricular myocardial strains (all P<0.05), and impaired left ventricular geometry and function, including lower left ventricular ejection fraction and greater left ventricular end-systolic volume and left ventricular mass (P<0.05). In the subgroup of moderate-severe MR, patients showed more impaired cardiovascular magnetic resonance features, including left ventricular sphericity index, left ventricular end-diastolic volume, and longitudinal shorten (P<0.05). In this subgroup, Kaplan-Meier analysis showed a significant difference in clinical outcomes (log-rank χ2=4.516, P=0.034; log-rank χ2=4.419, P=0.036, respectively). Additionally, multivariate analyses showed a 6.5-fold higher [hazard ratio, 6.5 (95% CI, 1.015-41.881)] risk of cardiac death with LGE in the moderate-severe MR cohort. In patients with left ventricular noncompaction, MR induced more maladaptive left ventricular remodeling. The incidence of adverse outcomes may be related to the degree of MR. In moderate-severe MR patients, coexisting of LGE may have an additive deleterious effect on clinical outcomes.

CMR predictors of secondary moderate to severe mitral regurgitation and its additive prognostic role in previous myocardial infarction

BackgroundWe aimed to determine predictors and the additive prognostic role of moderate to severe (MS) ischemic mitral regurgitation (MR) in myocardial infarction (MI). MethodsFour hundred twenty-two patients with previous MI underwent cardiac magnetic resonance (CMR) imaging for the assessment of left ventricular (LV) ejection fraction (EF), end-diastolic (EDV) and end-systolic volume (ESV), sphericity index, wall motion score index (WMSI), and late gadolinium enhancement (LGE). Echocardiography was performed to assess MR. ResultsThirty-eight had from moderate to severe MR (MS-MR group) and 384 did not (No MS-MR group). The S-MR group had higher LV volumes, sphericity index, WMSI, and LGE extent, and lower LVEF. At univariate logistic regression analysis, dilated volumes, SI >0.43, dyskinesia of inferolateral wall, papillary muscle (PM)-LGE, and LGE extent >16% were associated with MS-MR. At multivariate analysis, only SI (OR=5.7) and PM-LGE (OR=3) were independently associated with MS-MR. Considering only patients without LV dilatation, only dyskinesia in the inferolateral wall was a predictor of MS-MR (OR 34.8). Thirty cardiac events (cardiac death, appropriate implantable cardioverter-defibrillator firing, and resuscitated cardiac arrest) occurred during a median follow-up of 1,276 days. After adjusting the prognostic variables at univariate analysis by age (>65 years) and selecting those that were significant (EDV > 95 ml/m2, ESV >53 ml/m2, EF <30%, WMSI >1.65, LGE >12%, S-MR), only WMSI >1.65 and MS-MR remained an independent predictor of cardiac events. ConclusionsIncreased WMSI and PM-LGE in the overall population and inferolateral dyskinesia in patients without ESV dilatation are predictors of MS-MR; MS-MR and elevated WMSI have independent negative prognostic value.

Predictive value of global longitudinal strain and geometry of left ventricle in patients with noncompaction cardiomyopathy

Aim. To assess the prognostic role of a decrease in longitudinal strain and an increase in the left ventricular sphericity index as predictors of NYHA class III heart failure (HF) progression, requiring hospitalization in a cohort of patients with noncompaction cardiomyopathy (NCM) in combination with dilated cardiomyopathy (DCM).Material and methods. We examined 90 patients with a combination of NCM and DCM aged 18 to 72 years (median age, 41 years; men — 73; women — 17), who, in addition to conventional echocardiographic and magnetic resonance imaging (MRI) characteristics, were studied for two-dimensional strain and global longitudinal strain (GLS) parameters and left ventricular sphericity index (SI) using cardiac MRI. The endpoints included NYHA class III HF progression, requiring hospitalization.Results. During the follow-up period (median follow-up, 36 (6; 152) months) in 59 of 90 (65,5%) patients with NCM in combination with DCM, symptoms progressed to NYHA class III HF, requiring hospitalization. Multivariate analysis showed following independent risk factors for HF-related hospitalization: a decrease in GLS &lt;10% (hazard ratio (HR), 5,1; 95% confidence interval (CI), 1,6-16,7, p&lt;0,007) and an increase in SI &gt;0,5 (HR, 9,0; 95% CI, 2,2-37,8, p&lt;0,003) .The 3-year event-free survival rate for patients with one risk factor (GLS, %&lt;10 and SI &lt;0,5; GLS, %&gt;10 and SI &gt;0,5) was 79,2±16,9% and 64,4±24,6%, respectively, while for the group with two risk factors (GLS, %&lt;10 and SI&gt;0,5) — 12,3%.Conclusion. Global longitudinal strain characteristics according to 2D Strain echocardiography and SI according to cardiac MRI are associated with adverse events in NCM and DCM combination and can be used to identify patients with a high risk of HF progression to NYHA class III, requiring hospitalization.

The association of the expression of calcium handling proteins and their polymorphic variants of genes with the structural and functional state of the heart of patients with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The Russian Science Foundation, the Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences. Background. The cellular mechanisms of the genesis of atrial fibrillation are associated with impaired intracellular transport of calcium ions, which is determined by the activity of calcium-transporting proteins of the sarcoplasmic reticulum (SR). The aim of the study to investigate the expression of calcium handling proteins of the sarcoplasmic reticulum and their polymorphic variants of genes with the structural and functional state of the heart of patients with permanent atrial fibrillation. Methods. The study included 45 patients aged 29 to 65 years with atrial fibrillation. A complete echocardiographic study was performed according to standard views (parasternal and apical views) by an En Visor CHD Philips sonograph (Netherlands). All patients underwent catheter ablation, during which a biopsy of myocardial tissue from the top of the left ventricle (1-3 mg) was taken. The protein content of SERCA2a and calsequestrin (CASQ2) was determined by immunoblotting in patient’s myocardium. We identified polymorphic variants rs1860561 of the SERCA2a and rs6684209 and rs7521023 of the CASQ2 gene by real-time polymerase chain reaction. Results. The expression of both SERCA2a and CASQ2 proteins correlated with the size of the left atrium (LA). Thus, a higher level of SERCA2a expression in the myocardium corresponded to a larger LA size in patients. Despite the fact that the LV ejection fraction did not correlate with the expression level of the studied proteins, a direct correlation was found between the SERCA2a level and the values of LV end-diastolic and systolic volumes. In addition, the hemodynamic parameters of the heart, characterizing the diastolic function of the heart of patients, such as the rates of early (peak E) and late diastolic filling (peak A) LV were lower in patients with a higher SERCA2a level, although the ratio of these parameters (peak E/peak A) had no significant differences. In the homozygous GG genotype of the ATP2A2 gene, the expression level of the SERCA2a protein was (p = 0.039) higher than in patients with the heterozygous genotype (GA). Analysis of the parameters of the ECHO-KG study showed that the presence of the A allele of the rs1860561 variant of the ATP2A2 gene is associated with an increase in the LV sphericity index. The expression of the CASQ2 protein in patients with CC genotype of the rs6684209 variant of the CASQ2 gene was 2.5 times higher than in patients with CT genotype. The genotypes of the rs7521023 variant of the CASQ2 gene were not associated with the level of expression of the corresponding protein in the myocardium of the studied patients. Conclusions. The different genotypes of the rs1860561 variant of the ATP2A2 gene and rs6684209 of the CASQ2 gene can modulate the expression level of the SERCA2a protein and the CASQ2 protein. Moreover, the expression of calcium handling proteins to a greater extent affects the functional and structural characteristics of the heart of patients with permanent AF.

Predictors of functional mitral regurgitation recurrence after percutaneous mitral valve repair

We aimed to identify predictors of mitral regurgitation recurrence (MR) after percutaneous mitral valve repair (PMVR) in patients with functional mitral regurgitation (FMR). Patients with FMR were enrolled who underwent PMVR using the MitraClip® device. Procedural success was defined as reduction of MR of at least one grade to MR grade ≤ 2 + assessed at discharge. Recurrence of MR was defined as MR grade 3 + or worse at one year after initially successful PMVR. A total of 306 patients with FMR underwent PMVR procedure. In 279 out of 306 patients (91.2%), PMVR was successfully performed with MR grade ≤ 2 + at discharge. In 11.4% of these patients, MR recurrence of initial successful PMVR after 1 year was observed. Recurrence of MR was associated with a higher rate of heart failure rehospitalization during the 12 months follow-up (52.0% vs. 30.3%; p = 0.029), and less improvement in New York Heart Association (NYHA) functional class [68% vs. 19% of the patients presenting with NYHA functional class III or IV one year after PMVR when compared to patients without recurrence (p = 0.001)]. Patients with MR recurrence were characterized by a higher left ventricular sphericity index {0.69 [Interquartile range (IQR) 0.64, 0.74] vs. 0.65 (IQR 0.58, 0.70), p = 0.003}, a larger left atrium volume [118 (IQR 96, 143) ml vs. 102 (IQR 84, 123) ml, p = 0.019], a larger tenting height 10 (IQR 9, 13) mm vs. 8 (IQR 7, 11) mm (p = 0.047), and a larger mitral valve annulus [41 (IQR 38, 43) mm vs. 39 (IQR 36, 40) mm, p = 0.015] when compared to patients with durable optimal long-term results. In a multivariate regression model, the left ventricular sphericity index [Odds Ratio (OR) 1.120, 95% Confidence Interval (CI) 1.039–1.413, p = 0.003)], tenting height (OR 1.207, 95% CI 1.031–1.413, p = 0.019), and left atrium enlargement (OR 1.018, 95% CI 1.000–1.038, p = 0.047) were predictors for MR recurrence after 1 year. In patients with FMR, baseline parameters of advanced heart failure such as spherical ventricle, tenting height and a large left atrium might indicate risk of recurrent MR one year after PMVR.

Abstract 14546: Left Ventricular Sphericity Index as a Predictor of Appropriate Implantable Cardioverter-defibrillator Therapy

Introduction: We assessed the hypothesis that markers of LV wall stress, such as LV sphericity index (SI), may predict appropriate therapy for ventricular arrhythmias (VA) in patients with primary prevention defibrillators, independent of LV ejection fraction. Methods: We performed a retrospective analysis of consecutive patients with new ICD or CRT-D placement for primary prevention at a single hospital from 01/01/2015 to 06/30/2018. TTE images were used for calculating LV SI, which was defined as the ratio of bi-plane LV end-diastolic volume to the volume of a hypothetical sphere with a diameter of LV end-diastolic length in apical 4-chamber view. Device interrogations were reviewed for appropriate therapy for VA and inappropriate therapy for non-VAs. Kaplan-Meier curves stratified by LV SI tertile were constructed, and Cox proportional hazards models were used to evaluate time to appropriate and inappropriate therapy, and all-cause mortality. Results: A total of 282 patients (ICD 154, CRT-D 128) were included. Baseline characteristics are described in the Table. We found a trend towards increased appropriate therapy as LV SI increased in the ICD but not the CRT-D group, but this was non-significant in both (ICD log-rank 0.63, p-value 0.73; CRT-D log-rank 0.07, p-value 0.96). There was no correlation between LV SI and time to all-cause mortality in the ICD (log-rank 0.53, p-value 0.76) or the CRT-D patients (log-rank 0.51, p-value 0.77). LV SI correlated significantly with time to inappropriate therapy in the ICD (log-rank 8.6, p-value 0.01), but not the CRT-D patients (log-rank 2.4, p-value 0.3). Conclusions: LV SI demonstrated a non-significant trend towards increased appropriate device therapy in the ICD but not the CRT-D group. LV SI predicted inappropriate therapy in the ICD but not the CRT-D group. Study power was limited by lower than expected event rates, possibly due to changes in device programming and improvements in heart failure therapies over time.

Prevalence, correlates and prognostic relevance of mid-wall late gadolinium enhancement in patients with ischaemic cardiomyopathy

Abstract Background LGE imaging is an established CMR imaging technique for the assessment of myocardial replacement fibrosis. The presence of mid-wall LGE has been described in ∼30% of patients with non-ischemic dilated cardiomyopathy and is known to be associated with poor outcome. Conversely, little is known regarding the clinical significance of mid-wall LGE in patients with ischemic cardiomyopathy (ICM). Aim of the present study was to investigate the prevalence, correlates and prognostic role of mid-wall late gadolinium enhancement (LGE) in a consecutive cohort of patients with ICM. Methods A total of 319 consecutive outpatients with ICM (mean age 64±11 years, 87% males) were included. All patients had CMR with LGE imaging and were followed for a median of 13 months. The outcome end-point was a composite of cardiovascular death, aborted sudden cardiac death, appropriate implantable cardioverter-defibrillator therapy, heart failure hospitalisations, implantation of left ventricular (LV) assist device or occurrence of heart transplant. Results Mean LV ejection was 37±9%, mean ischemic-type LGE expressed as % of LV mass was 16±9%, while mid-wall LGE was observed in 32 (10%) patients. LVEDV index (OR 1.02, 95% CI 1.01–1.03, p=0.001) and LV sphericity index (OR 1.04, 95% CI 1.01–1.07, p=0.024) were the only variables significantly and independently related to the presence of mid-wall LGE. The outcome end-point was documented in 37 (12%) patients. Ischemic-type LGE expressed as % of LV mass (HR 1.04, 95% CI 1.01–1.08; p=0.015) and the presence of mid-wall LGE (HR 4.5, 95% CI 2.2–9.2; p&amp;lt;0.001) were the only independent predictors of the composite outcome. Mid-wall LGE had significant incremental predictive value compared to the extent of ischemic-type LGE (Δχ2=16.5, p&amp;lt;0.001). The Kaplan-Meier survival curves showing survival from the composite end-point according to the presence/absence of mid-wall LGE in patients with ischemic-type LGE expressed as % of LV mass &amp;lt; the median value 14.6% and. ≥14.6% are shown in the Figure. Conclusions Mid-wall LGE is observed in a substantial minority of patients with ICM. In this population, the presence of mid-wall LGE is associated with adverse LV remodeling and worse prognosis. Figure 1 Funding Acknowledgement Type of funding source: None

Prognostic role of left ventricular diastolic function assessed by speckle tracking echocardiography in patients after surgical ventricular repair

Abstract Background Assessment of left ventricular (LV) diastolic function brings important prognostic information for patients with heart failure and could be evaluated by speckle tracking echocardiography (STE). Less known about its role in patients planned for surgical ventricular repair due to LV aneurysm. Purpose The aim of this study was to evaluate the prognostic role of STE parameters of LV diastolic function for prediction of all-cause mortality in patients after surgical ventricular repair. Methods We retrospectively evaluated data of 163 consecutive pts (mean age 62.3±11.5 years, 74.8% males) with anteroapical LV aneurysm who underwent surgical ventricular repair combined with coronary artery bypass surgery (71.8%) Prognostic role for prediction of all-cause mortality was assessed for various STE parameters, including left atrial strain (LAS) measured as peak reservoir strain and for the ratio of early to late global longitudinal strain rate (GLSRe/GLSRa). Results During a median follow-up of 4.7 years (IQR: 1.6–8.9 years) there were 65 deaths, 5 year survival rate was 73.8 (95% CI 67–79%). Baseline ejection fraction, end-diastolic and end-systolic volumes of LV did not differ between pts who died and survived at 5 year after the surgery, whereas LAS was significantly higher and GLSRe/GLSRa was significantly lower in survivors. Cox proportional hazard model adjusted to demographic and clinical variables demonstrated that LAS and GLSRe/GLSRa were independent predictors of all-cause death, with HR of 0.79 (95% CI 0.66–0.95, p=0.012) for each 5% increase of LAS and HR of 1.24 (95% CI 1.1–1.4, p=0.001) for each 0.5 increase of GLSRe/GLSRa. Moreover, GLSRe/GLSRa remained an independent predictor after additional adjustment for LV end-systolic volume, sphericity index and presence of mitral insufficiency of grade 2 and higher. A significant difference in median survival time was demonstrated according to the following cut-offs: LAS ≥16.7% (12.1 vs. 6.4 years, p=0.01), GLSRe/GLSRa ratio ≥2.3 (3.3 years vs. 10.2 years, p=0.0005) (Figure). The classification and regression tree analysis with the application of all two-dimensional, Doppler and various speckle-tracking echocardiographic parameters revealed that GLSRe/GLSRa and LAS were the most important echocardiographic variables for risk stratification for 5-year mortality. Conclusion This study demonstrates that STE parameters of LV diastolic function are important predictors of all-cause mortality after surgical ventricular repair due to anteroapical aneurysm of LV and could be used in the preoperative decision-making process. Funding Acknowledgement Type of funding source: None

Effect of pericardial incision on left ventricular morphology and systolic function in patients during coronary artery bypass grafting

BackgroundAccurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG). LV ejection fraction (LVEF) is conventionally used to evaluate LV systolic function; deformation parameters can be used to detect subtle LV systolic dysfunction. It is unclear whether an incised pericardium without sutures during CABG could affect LV morphology and function. We investigated the effect of pericardial incision on LV morphology and systolic function during CABG.MethodsIntraoperative transesophageal echocardiography was performed in 27 patients during elective off-pump beating heart CABG 5 min before and after pericardial incision. LV longitudinal and mid-cavity transversal diameters, sphericity index, volumes, and LVEF were measured. LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and twist obtained by two-dimensional speckle tracking echocardiography were measured simultaneously.ResultsLV mid-cavity transversal diameter increased, while the LV sphericity index decreased (P < 0.001) immediately after pericardial incision. The GLS, GCS, and twist significantly decreased, while the GRS notably increased (P < 0.001). The LV volumes and LVEF remained unchanged.ConclusionsPericardial incision immediately transformed LV morphology from an ellipsoid to sphere, with decreased longitudinal and circumferential strain and twist, and increased radial strain, while LVEF remained unchanged. This should be considered when evaluating LV systolic function in patients after CABG.

Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy.

To investigate the relationship between left ventricular (LV) long-axis strain (LAS) and LV sphericity index (LVSI) and outcomes in patients with nonischemic dilated cardiomyopathy (NIDCM) and myocardial replacement fibrosis confirmed by late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging (cMRI), we conducted a prospective study on 178 patients (48 ± 14.4 years; 25.2% women) with first NIDCM diagnosis. The evaluation protocol included ECG monitoring, echocardiography and cMRI. LAS and LVSI were cMRI-determined. Major adverse cardiovascular events (MACEs) were defined as a composite outcome including heart failure (HF), ventricular arrhythmias (VAs) and sudden cardiac death (SCD). After a median follow-up of 17 months, patients with LGE+ had increased risk of MACEs. Kaplan-Meier curves showed significantly higher rate of MACEs in patients with LGE+ (p < 0.001), increased LVSI (p < 0.01) and decreased LAS (p < 0.001). In Cox analysis, LAS (HR = 1.32, 95%CI (1.54–9.14), p = 0.001), LVSI [HR = 1.17, 95%CI (1.45–7.19), p < 0.01] and LGE+ (HR = 1.77, 95%CI (2.79–12.51), p < 0.0001) were independent predictors for MACEs. In a 4-point risk scoring system based on LV ejection fraction (LVEF) < 30%, LGE+, LAS > −7.8% and LVSI > 0.48%, patients with 3 and 4 points had a significantly higher risk for MACEs. LAS and LVSI are independent predictors of MACEs and provide incremental value beyond LVEF and LGE+ in patients with NIDCM and myocardial fibrosis.

Left Ventricular Sphericity Index is a reproducible bedside echocardiographic measure of geometric change between acute phase Takotsubo's syndrome and acute anterior myocardial infarction.

•TS and AMI are separate cardiac conditions with similar clinical presentations.•TS have a higher LVSI than AMI, indicating a more spherical left ventricle.•LVSI may be utilised acutely to assist differentiation of acute phase TS and AMI.

372 Left Ventricular Sphericity Index is a Predictor of Cardiovascular Events in Patients With Anterior Transmural Myocardial Infarction but not in Takotsubo Syndrome

Left ventricular sphericity index (LVSI) is a simple measure to evaluate changes in left ventricular (LV) geometry. The aim of our study was to evaluate the prognostic role of LVSI in patients with Takotsubo Syndrome (TS) and Anterior Myocardial Infarction (AMI). Consecutive patients with TS admitted to our institution in the period of Jan 2013 to Dec 2018 were evaluated (n=66). Patients with complete two-dimensional transthoracic echocardiograms were included in analysis (n=49) and matched with a cohort of AMI (n=50). Appraisal of demographic, clinical and echocardiographic parameters of patients was undertaken, and patients were followed for the composite outcome of cardiovascular death, heart failure and arrhythmia. Biplane SI was calculated as an average of the short- and long-axis length in the 4- and 2-chamber apical views. TS patients (64.3±13.7 years, 92% female) were followed for a median of 25.6 months, with a total of 9 patients reaching a primary outcome. LVSI was not predictive of cardiovascular outcomes for patients with TS (p=0.34). Patients with anterior STEMI (62.10±12.84 years, 73% male) were followed up for a median of 29.06 months with 9 patients reaching a primary outcome. In the AMI group, there was a significant association between LVSI and composite primary outcomes (p=0.04). LVSI is reflective of geometric changes in the left ventricle and is associated with adverse cardiovascular outcomes in patients with AMI but not TS (likely secondary to the reversible nature of TS). LVSI may be an important prognostication tool for patients with AMI.