Left Ventricular Systolic Diameter Research Articles

Changes in left atrial structure and function over a decade in the general population.

Assessing left atrial (LA) size and function is an important part of the echocardiographic examination. We sought to assess how LA size and function develop over time, and which clinical characteristics promote atrial remodelling. We examined longitudinal changes of the LA between two visits in the Copenhagen City Heart Study (n = 1065). The median time between the examinations was 10.4 years. LA measurements included: maximal LA volume (LAVmax), minimal LA volume (LAVmin), and LA emptying fraction (LAEF). Clinical and echocardiographic accelerators were determined from linear regression. The value of LA remodelling for predicting incident atrial fibrillation (AF) and heart failure (HF) was examined by Cox proportional hazards regressions. During follow-up, LAVmax and LAVmin significantly increased by 8.3 and 3.5 mL/m2, respectively. LAEF did not change. Age and AF were the most impactful clinical accelerators of LA remodelling with standardized beta-coefficients of 0.17 and 0.28 for changes in LAVmax, and 0.18 and 0.38 for changes in LAVmin, respectively. Left ventricular (LV) systolic function, diameter, and mass were also significant accelerators of LA remodelling. Changes in both LAVmax and LAVmin were significantly associated with incident AF [n = 46, ΔLAVmax: HR = 1.06 (1.03-1.09), P < 0.001 and ΔLAVmin: HR = 1.14 (1.10-1.18), P < 0.001, per 1 mL/m2 increase] and HF [n = 27, ΔLAVmax: HR = 1.08 (1.04-1.12), P < 0.001 and ΔLAVmin: HR = 1.13 (1.09-1.18), P < 0.001, per 1 mL/m2 increase]. Both maximal and minimal LA volume increase over time. Clinical accelerators included age and AF. LV structure and systolic function also accelerate LA remodelling. LA remodelling poses an increased risk of clinical outcomes.

Correlation between the periodontal treatment and ecocardiographic changes in adult dogs

Periodontal disease is commonly diagnosed in dogs and has been associated with systemic lesions in several organs, however, studies correlating this oral condition with heart disease in the canine species are still scarce in the scientific literature. Thus, the objective of the present study was to evaluate such correlation in adult dogs, through serial echocardiographic exams and, nonetheless, to analyze the influence of dental treatment on cardiac function. For this, 60 dogs were used, distributed in two groups, the control (CG, n = 30: presence of periodontal disease, not submitted to oral treatment) and the treated (GT, n = 30: presence of periodontal disease and submitted to oral treatment). The animals of the CG were paired with those of the GT in terms of race, weight, age and degree of periodontal disease. Baseline echocardiographic examinations (D0) of the CG were performed and after 30 days (D30). In GT, examinations were also performed at D0 and D30, however, they were submitted to periodontal treatment after baseline measurements. The echocardiographic exams were performed at the Veterinary Cardiology Laboratory of the Veterinary Hospital of the University of Franca, to record and analyze the interventricular septum in diastole (SIVd), interventricular septum in systole (SIVs), diameter of the left ventricle in diastole (DVEd), left ventricular diameter in systole (EVDs), left ventricular free wall in diastole (PVEd) left ventricular free wall in systole (PVEs) shortening fraction of left ventricle (FS), final diastolic volume (VDF), final stroke volume (VSF), ejection fraction (EF), maximum pulmonary artery pressure gradient (max. GP AP) and left atrial and aortic artery diameter ratio (EA-AO). The results of the CG were statistically compared with those of the GT by means of simple analysis of variance (ANOVA). The data obtained regarding the SIVs, DVEd and PVEs parameters of the GT dogs at D30 showed a statistically significant decrease (p&lt;0.05) when compared to the D30 of the CG. Thus, given the established methodology and the results found, it is possible to infer that periodontal treatment may benefit some cardiac parameters of adult dogs, improving their quality of life and survival.

Heavy alcohol drinking and subclinical echocardiographic abnormalities of structure and function

ObjectiveThe aim of the study is to assess changes in heart structure and function associated with heavy alcohol use by comparing echocardiographic indices in a population-based sample to those in...

Usefulness of the angiographic anatomy of the vein of marshall for ablation procedures for persistant atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Ethanol Infusion in the Vein of Marshall (EIVOM) was recently proposed as an efficient adjunctive technique for obtaining mitral isthmus block during catheter ablation for persistent atrial fibrillation. Purpose Given these considerations the objective of this research was to delineate the angiographic anatomy of the Vein of Marshall (VOM). Methods Fluoroscopy images were obtained retrospectively in 124 patients with persistent atrial fibrillation who underwent coronary sinus angiography for EIVOM (96 patients) or cardiac resynchronization implant (18 patients). The measurements were performed using Osirix DICOM reader using the known diameter of the angiographic catheter for calibration. The distance between the ostium of the coronary sinus (CS) and the ostium of the VOM was measured in the anteroposterior view. Additionally, the angle at which the ostium of VOM opens in the CS was obtained. Results The diameter of the VOM ostium was 1.8 ± 0.6mm. The length of the VOM was 18.6 ± 9.1mm. The distancebetween the CS ostium and VOM ostium was as follows: less than 10mm for 1 patient (1%), between 11-20mm for 10 patients (10.41%), between 21-30mm for 38 patients (39.58%), 31-40mm for 31 patients (32.29%), between 41-50mm for 15 patients (15.62%) and &amp;gt;50mm for 1 patients (1%) (53mm). The average takeoff angleof the VOM from the CS between the main branch of the VOM and the CS was measured at 140 degrees (range 90-175 degrees). No correlation could be made between the takeoff angle and the distance between CS ostium and VOM ostium. In the group of patients undergoing cardiac resynchronization the takeoff angle from the CS was 153°±17° and it correlated significantly with the left ventricular systolic diameter and the left ventricular ejection fraction determined by echocardiography(r = 0.52; p = 0.008 and respectively r = 0.50; p = 0.009). Conclusions Understanding the anatomy of the Vein of Marshall (VOM) is crucial in helping operators efficiently exploit the therapeutic potential of ethanol injection after accurate localization of such an important branch of the left atrial venous system. Abstract Figure. 1 Fig 1 Angle CS-VOM

Cardiac Structure and Function Is Associated With Hemispatial Neglect Severity.

Background: Hemispatial neglect is a debilitating consequence of right hemispheric ischemic stroke (RIS), with evidence that patient-level factors influence neglect severity. Study objective: Determine if cardiac function is associated with presence and severity of neglect, independent of infarct size.Methods: Two hundred and eighteen non-demented, RIS with cerebral MRI and echocardiography who completed ≥1 of 4 tests evaluating neglect were included. Age- and sex- adjusted Z-scores defined neglect with severity categorized as no neglect, neglect on one or neglect on ≥2 tests. The dependent variable was presence of neglect (multivariable logistic regression), or neglect severity (multinomial logistic regression). The association with left ventricular (LV) structure/function (independent variable) was evaluated using separate nested adjustment models.Results: Patients were on average 61 yo (21–95), female (50%), black (53%), with an ejection fraction of 60% (IQR 20–75%). Fifty eight (27%) had neglect. Each 1 cm increase in LV systolic diameter was associated with a higher relative risk of having neglect on two tests compared to those with no neglect (RRR = 1.83, 95% CI 1.01–3.32), but not after adjusting for education and DWI volume (RRR = 1.68, 95% CI 0.89–3.19). Per 1 cm increase in left atrial (LA) diameter, the relative risk of having neglect on 2 tests vs. no neglect was over two times higher (95% CI 1.04–4.77), but lost significance in the final model (RRR = 1.73, 95% CI 0.76–3.94).Conclusions: We found an association between markers of diastolic dysfunction (enlarging LV, compensatory enlarging LA) and severity of neglect, suggesting that cardiac structure, and function affects not only lesion volume, but also the functional consequences of infarct volume.

Post hoc assessment of the relationship among coronary stenosis, electrocardiography, and ventricular function in patients with heart disease.

Cardiovascular diseases including cardiac arrhythmias lead to fatal events in patients with coronary artery disease; however, clinical associations from echocardiography, electrocardiography (ECG), and biomarkers remain unknown. We sought to identify the factors that may be related to elevated QRS intervals in patients with risk for coronary artery disease. In this study, we performed analysis of clinical data from 503 patients divided into two groups, i.e., patients with either <50% coronary artery stenosis or >50% coronary artery stenosis. We further examined patients with elevated ECG parameters such as QRS> 100ms and QTc> 440ms. Patients with >50% coronary artery stenosis exhibited significant increases in age, triglycerides, and troponin levels. Further, ECG parameters demonstrated increased QRS and QTc durations, while echocardiographic parameters highlighted a decrease in ejection fraction (EF) and fractional shortening (FS). Patients with QTc> 440ms exhibited increased brain natriuretic peptide and creatinine levels with a decrease in estimated glomerular filtration rate clearance rates. Patients with QRS> 100ms had greater left ventricular (LV) mass and LV internal diameter in systole and diastole. Multimodal logistic regression showed significant relation between QTc, age, and creatinine. These findings suggest that patients with significant coronary stenosis may have lower EF and FS with prolonged QRS intervals, demonstrating greater risk for arrhythmic events.

Reverse Remodeling in Human Heart Failure after Cardiac Resynchronization Therapy Is Associated With Reduced RHO-Kinase Activation.

Background: Reverse remodeling is a clinically relevant endpoint in heart failure with reduced ejection fraction (HFrEF). Rho-kinase (ROCK) signaling cascade activation correlates with cardiac remodeling and left ventricular (LV) systolic dysfunction in HFrEF patients. Cardiac resynchronization therapy (CRT) is effective in HFrEF, especially when there is a left bundle block, as this treatment may stimulate reverse remodeling, thereby improving quality of life and prolonging survival for patients with this severe condition. Here, we evaluate the hypothesis that ROCK activation is reduced after effective CRT in HFrEF. Methods: ROCK activation in circulating leukocytes was evaluated in 28 HFrHF patients, using Western blot (myosin light chain phosphatase subunit 1 phosphorylation, MYPT1p/t), before and three months after initiation of CRT. LV systolic function and remodeling were assessed by echocardiography. Results: Three months after CRT, LV ejection fraction increased an average of 14.5% (p < 0.001) in 13 patients (responders), while no change was observed in 15 patients (non-responders). End-systolic diameter decreased 16% (p < 0.001) in responders, with no change in non-responders. ROCK activation in PBMCs decreased 66% in responders (p < 0.05) but increased 10% in non-responders (NS). LV end-diastolic diameter was also 5.2 mm larger in non-responders vs. responders (p = 0.058). LV ejection fraction, systolic diameter, and ROCK activation levels were similar in both groups at baseline. Conclusion: In HFrEF patients, 3 months of effective CRT induced reverse myocardial remodeling, and ROCK activation was significantly decreased in circulating leukocytes. Thus, decreased ROCK activation in circulating leukocytes may reflect reverse cardiac remodeling in patients with heart failure.

Comparison of flexible, open with semi-rigid, closed annuloplasty-rings for mitral valve repair

BackgroundMitral regurgitation is a frequent valvular disease, with an increasing prevalence. We analysed the long-term outcomes of mitral valve repair procedures conducted over the last 10 years in our clinic using almost exclusively two different annuloplasty ring types.MethodsA single-centre, retrospective analysis of mitral valve surgeries conducted between January 2005 and December 2015 for patients undergoing first-line mitral valve repair with either open (Cosgrove) or closed (CE Physio / Physio II) annuloplasty (OA or CA, respectively) rings.ResultsIn total, 1120 patient documentations were available of which 528 underwent OA and 592 patients CA. The median age of patients was 64.0 years and 41.1% were female. The majority of these patients underwent the procedure because of degenerative valve disease. Rates of successful repair were about 90%, 72 h procedural mortality was 0.6% and the rate of re-intervention was 0.6% within the first 30 days. Functional (mitral regurgitation, left ventricular ejection fraction, left ventricular end-diastolic and systolic diameter and New York Heart Association class) as well as hard outcomes were comparable. 77.7 and 74.4% of patients were alive at the 10-year follow-up in the OA and CA groups, respectively. Upon multivariable adjustment, the hazard ratio was 0.926 (95% CI: 0.642–1.3135; p = 0.681).ConclusionsThe functional outcome and survival rates up to 10 years after mitral valve repair were comparable using open and closed annuloplasty rings. Whether this means these rings are interchangeable or a carefully selection of the best-for-the-patient devices will be subject of future investigations.

Effect of Musk Tongxin Dropping Pill on Myocardial Remodeling and Microcirculation Dysfunction in Diabetic Cardiomyopathy.

Objective To explore the effect of Musk Tongxin Dropping Pill (MTDP) on myocardial remodeling and microcirculation dysfunction in diabetic cardiomyopathy (DCM). Methods Forty male SD rats were randomly divided into control group (control group, n = 10), DCM model group (DCM group, n = 10), DCM model + pioglitazone group (DCM + PLZ group, n = 10), and DCM model + MTDP group (DCM + MTDP group, n = 10). An intraperitoneal single injection of 65 mg/kg streptozotocin (STZ) was used to establish rat model of DCM and the rats in control group were treated with the same dose of sodium citrate buffer solution. DCM + PLZ group was treated with 3 mg/kg/d PLZ by ig after modeling, DCM + MTDP group was treated with 22 mg/kg/d MTDP by ig, and DCM group was treated with 2 ml/kg/d sodium carboxymethyl cellulose (CMC-Na) by ig. The general condition of rats was continuously observed. After intervening for 3 weeks, the random blood glucose of rats was detected by tail vein, and the echocardiography examination was performed. Blood specimens were collected from the abdominal aorta, serum nitric oxide (NO) and endothelin-1 (ET-1) were detected to estimate endothelial function, and tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), IL-1β, malondialdehyde (MDA), and superoxide dismutase (SOD) were detected to observe the changes of inflammation and oxidative stress indexes. The heart mass index (HMI) was calculated through the ratio of heart mass (HM) to the corresponding body mass (BM). Myocardial pathological tissue staining was performed. Results Compared with control group, blood glucose in other three groups was higher. Left ventricular end systolic diameter (LVSD) and left ventricular end diastolic diameter (LVDD) in DCM group showed a significant increase, while left ventricular ejection fraction (LVEF) and heart rate (HR) in this group displayed an obvious decrease (P < 0.01). BM and HM in DCM group exhibited a reduction, and HM/BM × 103 revealed an apparent increase (P < 0.01). The levels of serum NO and SOD were distinctly downregulated (P < 0.01), and the levels of ET-1, MDA, TNF-α, IL-1β, and IL-6 were remarkably upregulated (P < 0.01). Compared with DCM group, a significant decrease was observed in LVSD and LVDD in DCM + MTDP group, while LVEF and HR obviously increased (P < 0.05). BM and HM indicated an apparent increase, but HM/BM ×103 reduced distinctly (P < 0.01). The levels of serum NO and SOD were markedly upregulated (P < 0.05), and the levels of ET-1, MDA, TNF-α, IL-1β, and IL-6 were significantly downregulated (P < 0.05). HE staining showed that myocardial cells arranged neatly in the control group but not in the DCM group. The intercellular space between myocardial cells in DCM group increased, accompanied by damage of myocardial fibers and infiltration of inflammatory cells. Masson staining displayed an increase in interstitial collagen fibers in DCM group. Carstairs staining showed that microembolization occurred in the myocardium in DCM group, while in DCM + MTDP and DCM + PLZ groups the corresponding myocardial pathological changes were significantly improved. Conclusions MTDP might show a positive effect on myocardial remodeling and microcirculation dysfunction in DCM rats.

ASSOCIATION OF EPICARDIAL FAT THICKNESS WITH EJECTION FRACTION IN PATIENTS WITH HEART FAILURE

Background: Heart failure (HF) has significant mortality and morbidity worldwide and affects more than 37 million people. The mortality and morbidity when the left ventricular ejection fraction (LVEF) is &gt; 40 %, is similar when there is low ejection fraction (LVEF &lt; 40 %), and there is an increasing health problem. Studies have shown that epicardial adipose tissue (EAT) has a role in HF pathogenesis. A proinflammatory process on the basis of HF has been shown to be related to EAT. Aim: We aimed to investigate ejection fraction and epicardial adipose tissue relationship. Methods: 159 symptomatic HF patients (New York Heart Association functional class ≥II) were included in our study. Age, gender, height, weight, body mass index, waist and demographic characteristics (diabetes mellitus, hypertension, smoking-nonsmoking, coronary artery disease) of all patients were recorded. Results: We examined 159 HF patients. In our population 46 (28.9 %) patients were female and 113 (71.1 %) patients, male. The mean age of our patients was calculated as 67.4 ± 12.6 years. In our study population 69 (43.4 %) of our patients had diabetes and 93 (58.5 %) had hypertension. 77 (48.4 %) of our patients had a history of smoking. We separated our patients into two groups: LV systolic function in HF with LVEF &gt; 40 % (n: 36) and HF with reduced ejection fraction, LVEF &lt; 40 % (n: 123). In our study EAT, LVEF, LVDD (left ventricular diastolic diameter), LVSD (left ventricular systolic diameter), diastolic septum wall thickness and diastolic posterior wall thickness had differences between groups. Differences in LVEF, LVDD, LVSD, diastolic septum wall thickness and diastolic posterior wall thickness were determined. Conclusions: Epicardial fat thickness and LVEF had a positive correlation in heart failure patients.

Donor heart preservation with hypoxic-conditioned medium-derived from bone marrow mesenchymal stem cells improves cardiac function in a heart transplantation model

BackgroundIn heart transplantation, donor hearts inevitably suffer from ischemia/reperfusion (I/R) injury, which leads to primary graft dysfunction and affects patients’ survival rate. Bone marrow mesenchymal stem cells (BMSCs) have been reported to attenuate myocardial I/R injury via their paracrine effects, which can be enhanced by hypoxic preconditioning. We hypothesized that the donor heart preservation with hypoxic conditioned medium (CdM) derived from BMSCs would improve post-transplant graft function.MethodsNormoxic or hypoxic CdM were isolated from rat BMSCs cultured under normoxic (20% O2) or hypoxic (1% O2) condition. Donor hearts were explanted; stored in cardioplegic solution supplemented with either a medium (vehicle), normoxic CdM (N-CdM), or hypoxic CdM (H-CdM); and then heterotopically transplanted. Antibody arrays were performed to compare the differences between hypoxic and normoxic CdM.ResultsAfter heart transplantation, the donor heart preservation with normoxic CdM was associated with a shorter time to return of spontaneous contraction and left ventricular systolic diameter, lower histopathological scores, higher ejection fraction, and fractional shortening of the transplanted hearts. The cardioprotective effects may be associated with the inhibition of apoptosis and inflammation, as reflected by less TUNEL-positive cells and lower levels of plasma proinflammatory cytokines (interleukin-1β, interleukin-6, tumor necrosis factor-α) and cardiac troponin I in the N-CdM group compared with the vehicle group. These therapeutic effects can be further enhanced by hypoxic preconditioning. Antibody arrays revealed that nine proteins were significantly increased in hypoxic CdM compared with normoxic CdM. Furthermore, compared with vehicle and N-CdM groups, the protein levels of PI3K and p-Akt/Akt ratio in the transplanted hearts significantly increased in the H-CdM group. However, no significant difference was found in the phosphorylation of Smad2 and Smad3 for the donor hearts among the three groups.ConclusionsOur results indicate that the cardioplegic solution-enriched with hypoxic CdM can be a novel and promising preservation solution for donor hearts.

Bovine pericardial versus porcine stented replacement mitral valves: early hemodynamic performance and clinical results of a randomized comparison of the Perimount and the Mosaic valves.

BackgroundTo compare the hemodynamic and clinical outcomes following mitral valve replacement with the Perimount valve with those of the Mosaic valve.MethodsA total of 145 consecutive patients with rheumatic heart valve disease who underwent single bioprosthetic mitral valve replacement were randomized to receive either the Perimount (n=72) valve or the Mosaic bioprosthesis (n=73). The mean age of patients was 72.1 years (range, 58–89 years) with a sex distribution of 55.2% female and 44.8% male. Patients underwent follow up transthoracic echocardiography at 3 months and 1 year postoperatively. We compared demographics, preoperative clinical data, operative data, hemodynamic profiles, and clinical outcomes.ResultsThe cross-clamp time was similar, with 50.7±15.3 minutes for the Perimount and 50.7±21.8 minutes for the Mosaic bioprosthesis. The total bypass time was also similar, with 91.3±25.7 minutes for the Perimount and 87.8±25.6 minutes for the Mosaic valve. The peak and mean pressure gradients were lower in the Perimount group for all valve sizes and the difference was statistically significant at 1 year. The effective orifice area (EOA) was slightly larger in the Perimount valve (1.98±0.21 vs. 1.89±0.71 cm2, P=0.538) postoperatively, but there was no significant difference at 1 year. There were no differences in preoperative or postoperative left atrium diameter (LAD), left ventricular diastolic diameter (LVDD), left ventricular systolic diameter (LVSD), left ventricular ejection fraction (LVEF), pulmonary artery pressure (PAP). The mortality and major complications rate were similar between the two groups.ConclusionsThe Perimount prostheses is superior to the Mosaic prostheses after mitral valve replacement, achieving statistically significant lower gradients and larger EOA when compared on the basis of manufacturer-labeled valve sizes. Both valves appear to provide satisfactory clinical results.

Angiotensin Receptor Blocker and Neprilysin Inhibitor Suppresses Cardiac Dysfunction by Accelerating Myocardial Angiogenesis in Apolipoprotein E-Knockout Mice Fed a High-Fat Diet.

Materials and Methods Male apolipoprotein E-knockout mice fed a high-fat diet were divided into control (CTL), valsartan (30 mg/kg) (VAL), sacubitril (30 mg/kg) (SAC), and valsartan plus sacubitril (30 mg/kg each) (VAL/SAC) groups after 4 weeks of prefeeding and were subsequently treated for 12 weeks. Results The VAL/SAC group exhibited significantly higher serum brain natriuretic peptide levels; more subtle changes in left ventricular systolic diameter, fractional shortening, and ejection fraction, and significantly higher expression levels of natriuretic peptide precursor B and markers of angiogenesis, including clusters of differentiation 34, vascular endothelial growth factor A, and monocyte chemotactic protein 1, than the CTL group. Conclusions Valsartan plus sacubitril preserved left ventricular systolic function in apolipoprotein E-knockout mice fed a high-fat diet. This result suggests that myocardial angiogenic factors induced by ARNI might provide cardioprotective effects.

Left heart dimensions in anemic cats and dogs before and after blood transfusion.

BackgroundWhether anemic cats and dogs with increased left heart dimensions are at higher risk of transfusion‐associated circulatory overload, and the effect of blood transfusion on left heart dimensions in naturally occurring anemia is unknown.Hypothesis/objectivesTo evaluate the effect of blood transfusion on left heart dimensions in clinically relevant anemia.AnimalsTwenty dogs and 20 cats presenting to a university veterinary teaching hospital.MethodsIn this prospective observational study, anemic dogs and cats requiring blood transfusion were included. Packed cell volume (PCV), total solids, and echocardiography were performed before and within 24 hours of blood transfusion. Signalment, bodyweight, disease process, transfusion duration and volume, and prior treatments were recorded. Nonparametric statistics were reported as median [range]. Post hoc Bonferroni correction set significance at P < .006.ResultsAfter transfusion, PCV increased in cats (12% [6–16] to 18% [10‐33], P = .001) and dogs (14% [7–24] to 25% [9‐37], P = .001), heart rate decreased in dogs (104 bpm [86‐166] to 87 bpm [56‐138], P < .001), and fractional shortening decreased in cats (57.1% [36.0‐84.7] to 41.0% [28.1‐69.6], P = .002) and dogs (33.79% [19.33‐62.79] to 31.89% [19.06‐51.47], P = .006). Left ventricular internal diameter in systole increased in cats (6.5 mm [2.7‐9.8] to 7.9 mm [5.3‐11.1], P = .001). Normalized left ventricular internal diameter in diastole (1.48 [1.25‐1.79] to 1.57 [1.33‐2.00], P = .001) and systole (0.87 [0.58‐1.19] to 1.00 [0.74‐1.36], P = .001) increased in dogs. Incidence of volume overload did not differ before (14/20 cats, 70%; 9/20 dogs, 45%) or after (12/20 cats, 60%; 11/20 dogs, 55%) transfusion (P = .64).Conclusions and clinical importanceBlood transfusion is well tolerated when signs of volume overload are present before transfusion.

Clinical characteristics and outcomes of black African heart failure patients with preserved, mid‐range, and reduced ejection fraction: a post hoc analysis of the THESUS‐HF registry

AimsLimited data are available on clinical characteristics and prognosis of heart failure (HF) in black African populations especially with respect to current classifications and HF management guidelines.Methods and resultsIn this post hoc analysis, African patients admitted with acute HF and enrolled in the THESUS‐HF registry in one of 12 hospitals in 9 countries were classified as having preserved left ventricular ejection fraction (LVEF) (HFpEF), mid‐range LVEF (HFmrEF), and reduced LVEF (HFrEF) based on echocardiography performed close to the time of admission. Sociodemographic and clinical characteristics, management, and 60 and 180 day outcomes were compared between the groups. Of 888 patients with LVEF available, there were 472 (53.2%) with HFrEF, 174 (19.6%) with HFmrEF, and 243 (27.3%) with HFpEF. History of atrial fibrillation was higher in patients with HFmrEF (28.5%) than in patients with HFrEF (14.5%). Patients with HFrEF had a larger mean LV systolic diameter (54.1 ± 9.67 mm) than patients with HFmrEF (42.9 ± 8.47 mm), who had a larger mean LV diameter than patients with HFpEF (32.6 ± 8.64 mm); a similar pattern with LV diastolic diameter was observed. The mean posterior diastolic wall thickness (10.2 ± 2.94 mm) was lower in patients with HFrEF than in those with HFmrEF (11.1 ± 2.59 mm) and HFpEF (11.2 ± 2.90 mm). Patients with HFpEF were less likely to use angiotensin‐converting enzyme inhibitor/angiotensin receptor blockers, and aldosterone inhibitors, and more likely to use beta‐blockers than those with HFrEF at either admission or discharge/Day 7. Death or readmission rates through Day 60 and 180 day death rates did not differ significantly among the groups; unadjusted hazard ratios relative to patients with HFrEF were 1.32 [95% confidence interval (CI) 0.84–2.08] and 1.24 (95% CI 0.82–1.89) for 60 day death or readmission and 0.92 (95% CI 0.59–1.43) and 0.78 (95% CI 0.51–1.20) for 180 day death in patients with HFmrEF and HFpEF, respectively.ConclusionsClassification by LVEF according to European Society of Cardiology guidelines revealed some differences in clinical presentation but similar mortality and rehospitalization rates across all EF groups in Africans admitted for HF.

Abstract 14550: Sex Differences on Time-dependent Changes in Brain-type Natriuretic Peptide Among Patients With Hypertrophic Cardiomyopathy

Introduction: Sex differences in biomarkers such as brain-type natriuretic peptide (BNP) have not been fully elucidated among patients with hypertrophic cardiomyopathy (HCM). Hypothesis: Sex affects transition of BNP concentration among patients with HCM. Methods: This retrospective cohort study analyzed clinical personal record of HCM, a national database of Japanese Ministry of Health, Labor and Welfare, between 2009 and 2014. This record annually collected HCM patient data. Patients with HCM who were assessed with BNP concentration both at baseline and 2-year follow-up were included. Patients were excluded if they received ventricular assist device or heart transplantation during follow-up period. Outcomes were assessed according to sex. The primary endpoint was BNP concentration at 2-year follow-up. The log-transformed BNP concentration at 2-year was analyzed by analysis of covariance adjusted for baseline characteristics including baseline BNP. The cubic spline analysis of BNP concentration at 2-year for sex by BNP concentration was performed. Results: Out of 3,570 patients enrolled in the clinical personal record of HCM, 611 patients were included in the present analysis. Mean age was 60.4 years and female and male were 254 (41.6%) and 357 (58.4%), respectively. Left ventricular (LV) ejection fraction was higher in female (64.7 ± 14.5 vs. 61.4 ± 16.0%, P =.012), LV diastolic diameter (43.4 ± 7.8 vs. 48.0 ± 8.0 mm, P &lt;.001), LV systolic diameter (27.3 ± 8.9 vs. 31.2 ± 9.0 mm, P &lt;.001), posterior wall thickness (11.2 ± 3.0 vs. 11.9 ± 3.8 mm, P =.011), and left atrial diameter (41.8 ± 8.8 vs. 45.8 ± 10.1 mm, P &lt;.001) were smaller in female. Baseline BNP concentration was higher in female (320.3 [159.0-583.1] vs. 182.8 [86.1-363.9], P &amp;lt;.001). Female sex was associated with higher log-transformed BNP at 2-year in both complete case analysis (coefficient 0.31; 95% confidence interval [CI] 0.13-0.48; P &lt;.001) and multiple imputation analysis (coefficient 0.63: 95% CI 0.44-0.82; P &lt;.001). Cubic spline analysis showed that female sex was associated with higher BNP concentration at 2-year irrespective of baseline BNP concentration. Conclusions: Female sex was associated with higher BNP levels at 2-year follow-up compared with male sex in HCM.

Abstract 15238: Cardiomyocyte Specific Pellino1 Knockout Leads to Increased Oxidative Stress, Reduced Anti-apoptotic Signaling and Cardiac Dysfunction in a Murine Myocardial Infarction Model

Introduction: Ischemic heart disease is the leading cause of death in adults in the US. We have shown that overexpression of E3 ligase Pellino1 (Peli1) increased vessel density, triggered anti-apoptotic signaling, and preserved cardiac function in the infarcted myocardium. In the present study, we aimed to explore whether the loss of Peli1 function in cardiomyocytes has any effect on cardiac function using a genetically-modified murine myocardial infarction (MI) model. Methods: Wild type (WT) and cardiomyocyte-specific Peli1 knockout (CP1KO -/- ) mice were divided into 4 groups [wild-type-sham (WTS), CP1KO -/- sham (CP1KO -/- S), WTMI and CP1KO -/- MI] to undergo either left anterior descending artery ligation or sham surgery. Phosphorylation of Mitogen-Activated Protein Kinase-Activated Protein Kinase-2 (p-MK2) and expression of VEGF, Bcl2, and cIAP2 were quantified by Western blot analysis. Cardiac function by two-dimensional echocardiography was performed at 30 days post-op to assess ejection fraction (EF), fractional shortening (FS), left ventricular internal diameter in both systole and diastole (LVIDs and LVIDd). Results: We observed no significant change in cardiac functions between WTS and CP1KO-/-S group. However, in MI groups, CP1KO -/- mice showed significant loss of systolic functions, represented by both EF (26.60%±2.340 vs. 33.46%±1.84; p&lt;0.029, n=13) and FS (12.43%± 1.19 vs. 15.93%±0.98; n=13, p&lt;0.03) when compared to WTMI group. Western blot analysis of heart tissue 24-hour post-MI showed a significant reduction in the expression of p-MK2 (p=0.0045) in CP1KO -/- group compared to WT mice. Similarly, expression of VEGF (p=0.0227), BCl-2 (p=0.0073) and cIAP2 (p=0.0483) was also found to be significantly downregulated in CP1KO -/- group compared to WTMI group at 4-day post-MI. We also analyzed oxidative stress marker, 3-NT, which was significantly upregulated (p=0.0001) in CP1KO mice compared to WTMI. Conclusion: Loss of Peli1 in cardiomyocyte results in the impairment of cardiac function along with increased oxidative stress, reduced angiogenic and survival protein expression, which suggests Peli1 plays an important role in the cardiomyocyte signaling during myocardial infarction.

Visceral Fat Area, Not Subcutaneous Fat Area, is Associated with Cardiac Hemodynamics in Type 2 Diabetes.

BackgroundThis study was conducted in patients with type 2 diabetes mellitus (T2DM) to assess the association between visceral fat area (VFA) and cardiac hemodynamics.MethodsA total of 568 patients with type 2 diabetes (mean age 54±12 years; 40.8% of women) were enrolled. Visceral fat area (VFA, m2) and subcutaneous fat area (SFA, m2) were evaluated by a bioelectrical impedance analyzer. Cardiac hemodynamics were measured by echocardiography, and other clinical and laboratory variables were also assessed and recorded. Patients were divided into those with VFA ≤ 100 (n=369) and those with VFA > 100 (n=199).ResultsVFA, SFA, LVMI (left ventricular mass index), left atrial diameter, left ventricular diastolic diameter (LvDd), interventricular septal thickness (IVST), left ventricular systolic diameter (LvSd), and posterior wall thickness (PWT) levels in high-V groups were significantly higher than those in low-V groups. Correlation analysis showed that VFA was positively correlated with LVMI (r=0.120, p=0.004), LVM (r=0.249, p<0.0001), left atrial diameter (r=0.375, p<0.0001), aortic root diameter (r=0.243, p<0.0001), left ventricular systolic diameter (LvSd) (r=0.211, p<0.0001) and negatively correlated with LVEF (r=−0.107, p=0.011). In multivariate linear regression analysis, VFA was the strongest independent determinant of LVMI (β=0.04, p=0.016), LVEF (β=−0.01, p=0.023), and left atrial diameter (β=0.035, p<0.0001), Internal diameter of the aortic root (β=0.014, p<0.0001) and LvSd (β=0.017, p<0.0001). In addition, the VFA also better predicted cardiovascular disease risk with AUC of 0.609 (95% CI:0.563–0.656), compared with SFA, waist–hip ratio (WHR), in a statistically significant manner.ConclusionWe found a significant correlation between VFA (but not SFA) and cardiac hemodynamic parameters. The VFA has advantages as a predictor of visceral obesity and is significantly associated with the development of cardiovascular risk factors (CVD) in T2DM patients.

Effects of late aerobic exercise on cardiac remodeling of rats with small myocardial infarction

Abstract Background Physical exercise has been highlighted as an important non-pharmacological therapy for prevention and treatment of several cardiovascular diseases. However, its effects on hearts with minor cardiac remodeling are not clear. Purpose To evaluate the influence of aerobic physical exercise on functional capacity, cardiac structure, left ventricular (LV) function, and gene expression of NADPH oxidase subunits in rats with small-sized myocardial infarction (MI). Methods Three months after MI induction, Wistar rats were divided into three groups: Sham; sedentary MI (MI-SED); and aerobic exercised MI (MI-EA). Rats exercised three times a week for 12 weeks on a treadmill. Echocardiogram was performed before and after experimental period. Infarction size and cardiomyocyte diameters were evaluated by histology. Gene expression was assessed by RT-PCR. Results Only rats with MI size lower than 30% of LV total area were included in the study. Functional capacity was higher in MI-AE than the other groups. Infarction size did not differ between groups. Infarcted rats had increased LV diastolic and systolic diameter, left atrial diameter, and LV mass, with systolic dysfunction. LV diastolic posterior wall thickness was higher in MI-AE than Sham, and relative wall thickness was lower in MI-SED than MI-AE and Sham groups. Cardiomyocyte diameter was smaller in infarcted groups than Sham. Myocardial gene expression of the NADPH oxidase subunits NOX2, NOX4, p22phox, and p47phox did not differ between groups. Conclusion Small-sized myocardial infarction changes cardiac structures and left ventricular systolic function. Late aerobic physical exercise improves functional capacity and cardiac remodeling by preserving left ventricular geometry. NADPH oxidase subunits gene expression is not involved in cardiac remodeling or modulated by aerobic exercise in rats with small myocardial infarction. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): CNPq; CAPES

Comparison between Spironolactone and Eplerenone on LV Systolic Function in Patients with Chronic Heart Failure

Background:Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Clinical trials have demonstrated mortality and morbidity benefits of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure. These studies have used either eplerenone or spironolactone as the MRA. Eplerenone is a selective aldosterone antagonist expected to have a lower incidence of hormonal side effects than spironolactone. The present study is designed to compare these two drugs in chronic heart failure patients as no head to head trial between these two drugs is found regarding improvement of systolic function, tolerability and safety. The aim of this study is to compare the effects of eplerenone and spironolactone on LV systolic function in patients with chronic heart failure in a single center.&#x0D; Methods:It was a randomized clinical trial single blind study. A total of 224 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV were selected by random sampling, from July 2017 to June 2018. Each patient was randomly allocated into either of the two arms, and was continued receiving treatment with either spironolactone (Arm-I) or eplerenone(Arm-II). Each patient was evaluated clinically, biochemically and echocardiographically at the beginning of treatment (baseline) at 1 month and at the end of 6th month. Echocardiography was performed to find out change in left ventricular systolic function.&#x0D; Result: After 6 months of treatment, ejection fraction was found higher in the eplerenonearm (40.3 ± 6.5 versus 38.3 ± 4.6%; P &lt; 0.05). Ejection fraction (EF) changes were 6.2% in eplerenone group and 4.1% in spironolactonearm. A significant reduction in left ventricular end-systolic volume (21.9±2.5 in group I versus 14.9±5.7 in group II; P &lt; 0.05) and left ventricular systolic diameter (48.7±4.0 in arm I versus 45.2±4.9 in arm II; P&lt;0.05) occurred after 6 months of treatment. But no significant differences were observed in left ventricular end-diastolic volume (187.8±37.4 versus 184.5±33.9; P=0.101) and left ventricular diastolic diameter (60.1±4.5 versus 61.0±4.9; P=0.0818) between arms. Assessment of blood pressure six months after treatment shows, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were improved in both arms but difference between two arms were statistically non-significant (p&gt;0.05).&#x0D; Conclusion: In this study, the improvement in systolic function was more in eplerenone arm, which also had fewer adverse side effects when compared to spironolactone arm. So, it can be concluded that eplerenone can be advised in patient with chronic heart failure in addition to other drugs that are used to treat heart failure.&#x0D; University Heart Journal Vol. 16, No. 2, Jul 2020; 65-70