Left Ventricular Systolic Function In Patients Research Articles

Efficacy and safety of colchicine use on LV systolic function using speckle – tracking Echocardiography in patients with anterior ST segment elevation myocardial infarction (STEMI) Undergoing Primary Percutaneous Coronary Intervention

Abstract Background acute ischemia causes myocardial necrosis with subsequent endogenous inflammation, leading to myocardial damage, ventricular dilatation, dysfunction, cardiac remodeling and dysfunction. Colchicine is a substance with potent anti- inflammatory properties, which allows for safe use in patients with cardiovascular disease, STE-based GLS can be used to assess global and regional LV function. The aim of this work is to study the efficacy and safety of colchicine administration on LV systolic function in patients with STEMI underwent primary PCI by using 2D speckle tracking Echocardiography. Methods The study included 200 STEMI patients divided into 2 equal subgroups; colchicine group, and control group. speckle tracking echocardiography was done to the whole subjects to asses LV systolic function. Results Assessment of LV systolic function (EF%) as calculated by Simpson’s method showed higher significant improvement in colchicine group (P-value = 0.011) and highly statically significant average GLS by speckle tracking echocardiography during follow up after 6 months, also colchicine was non inferior to placebo regarding acute and chronic complication. Conclusion the safety and efficacy of colchicine in anterior STEMI patients underwent PPCI. It significantly improve LV systolic function measured by Ejection fraction and average GLS speckle tracking Echocardiography after 6 months follow up.

Role of Multi-parameter-based Cardiac Magnetic Resonance in the Evaluation of Patients with Coronary Heart Disease Combined with Heart Failure.

Coronary Heart Disease (CHD) is one of the most common types of cardiovascular disease, and Heart Failure (HF) is an important factor in its progression. We aimed to evaluate the diagnostic value and predictors of multiparametric Cardiac Magnetic Resonance (CMR) in CHD patients with HF. The study retrospectively included 145 CHD patients who were classified into CHD (HF+) (n = 91) and CHD (HF-) (n = 54) groups according to whether HF occurred. CMR assessed LV function, myocardial strain and T1 mapping. Multivariate linear regression analyses were performed to identify predictors of LV dysfunction, myocardial fibrosis, and LV remodeling. CHD (HF+) group had impaired strain, with increased native T1, ECV, and LVM index. The impaired strain was associated with LVM index (p < 0.05), where native T1 and ECV were affected by log-transformed amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. ROC analysis showed the combination of global circumferential strain (GCS), native T1, and LVM had a higher diagnostic value for the occurrence of HF in CHD patients.<P> Meanwhile, log-transformed NT-proBNP was an independent determinant of impaired strain, increased LVM index, native T1 and ECV. HF has harmful effects on LV systolic function in patients with CHD. In CHD (HF+) group, LV dysfunction is strongly correlated with the degree of LV remodeling and myocardial fibrosis. The combination of the three is more valuable in diagnosing HF than conventional indicators.

Quantitative assessment of left ventricular myocardial work in patients with different types of atrial fibrillation by non-invasive pressure-strain loop technique.

This study aimed to analyze myocardial work in patients with atrial fibrillation (AF) using a noninvasive pressure strain loop (PSL) technique to provide a basis for the quantitative assessment of left ventricular (LV) systolic function. LV myocardial work of 107 AF patients (56 with paroxysmal atrial fibrillation and 51 with persistent atrial fibrillation) and 55 healthy individuals were assessed by the noninvasive PSL and then compared. Global longitudinal strain (GLS) in absolute values, global work index (GWI), global constructive work (GCW), and global work efficiency (GWE) were significantly lower in the AF group than control group, whereas peak strain dispersion (PSD) and global wasted work (GWW) were significantly higher (P<.05). Further subdivision according to the AF type revealed that, compared with the controls, GLS in absolute values and GWE decreased significantly; PSD and GWW increased significantly in the paroxysmal AF group (P<.05). Nevertheless, GWI and GCW were not significantly different between paroxysmal AF and control groups (P>.05). Compared to paroxysmal AF, persistent AF induced a further decrease in absolute GLS and GWE and a further increase in GWW (P<.05), but PSD did not increase further (P>.05). Multiple linear regression analysis showed that GWI and GCW were independently associated with systolic blood pressure. GWW was associated with types of AF and left atrial volume index (LAVI). GWE was correlated with age, types of AF, disease duration, and LAVI. Receiver operating characteristic curve analysis showed that the area under the curve predicting myocardial injury was higher for GWE and GWW than for GLS (area under the curve: .880, .846, and .821, respectively). Non-invasive PSL can quantitatively assess LV systolic function in patients with different kinds of AF and detect early subclinical myocardial injury in patients with paroxysmal AF. GWE and GWW outperform GLS and LV ejection fraction when assessing myocardial injury. Systolic blood pressure, type of AF, LVAI, disease duration, and age may be associated with myocardial injury in patients with AF.

Effect of ischemic injury characteristics on left ventricular systolic function in patients with acute myocardial infarction

Aim. To study laboratory and magnetic resonance imaging (MRI) characteristics of infarction area depending on left ventricular (LV) global systolic function in patients with acute myocardial infarction (AMI) after revascularization.Material and methods. A total of 78 patients with primary AMI were included. On days 7-10, contrast-enhanced cardiac MRI was performed. Blood brain natriuretic peptide (BNP) was analyzed. Cardiac MRI was used to determine the characteristics of scar tissue, peri-infarct zone (PIZ), microvascular obstruction (MVO), intramyocardial hemorrhage (IMH) and the global contrast index.Results. According to the MRI, patients were divided into following groups: group 1 — LV ejection fraction (LVEF) ≥50% (n=50), group 2 — LVEF 40-49% (n=21), group 3 — LVEF &lt;40% (n=7).The BNP in groups 1, 2, 3 was 106,8 (37,5; 248), 232,6 (170,1; 337,7) and 548,5±236,4 ng/ml, respectively (p1-3&lt;0,05). The scar tissue mass in groups 1, 2, 3 was 10,3 (2,4; 20,0), 34,7±21,3, 59,4±37,6 g, respectively (p1-2, 3&lt;0,01). PIZ differences were found only between patients with preserved and mildly reduced EF. MVO was diagnosed in 26% of patients with LVEF ≥50%, in 47,6% of patients with LVEF of 40-49% and 85,7% with LVEF &lt;40% (p1-3&lt;0,01). The detection rate of IMH prevailed in the 2nd group (33,3%) compared with the 1st group (12%) (p1-2&lt;0,05). The global contrast index was the lowest in the 1st group (14,7 (8,8; 27,9)%), intermediate in the 2nd group (33,3±12,6%), the highest in the 3th group (54,2±19,5%) (р1-2, 3; 2-3&lt;0,05).Conclusion. The following risk factors for a decrease in LV systolic function in patients with AMI after revascularization were identified: the size of scar tissue, PIZ, MVO and IMH characteristics, global contrast index, BNP level.

The Impact of Dapagliflozin on Cardiac LV Systolic Function in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention Who Developed Post MI LV Dysfunction

Abstract Aim and objectives To study the impact of dapagliflozin on LV systolic function in patients with ST Elevation Myocardial Infarction undergoing primary percutaneous Coronary Intervention who developed post MI LV dysfunction. Patients and Methods The study included 80 patient who presented with ST-segment elevation myocardial infarction and underwent primary PCI at the catheterization lab unit, Cardiology department, Ain Shams University. The patients were divided into 2 groups. The standard treatment was given to all patients according to the ESC guidelines including: ACEI or ARNi, a beta-blocker, and an MRA[1] uptitrated according to the clinical state of the patient. The study medication was 10 mg of dapagliflozin[1] given once daily in the morning to the case group and a placebo medication to the control group. LVEF was assessed in both groups post primary PCI and at follow-up after 3 months by the same Echo machine GE VIVED S5 after the procedure since first of June 2021 till end of January 2022. Results There were no statistically significant difference between both groups regarding gender distribution, mean age, and the incidence of different risk factors of CAD (smoking, Diabetes and hypertension). Regarding pain to door (PTD) time, there was no statistically significant difference between case and control groups (P-value = 0.695), and anterior STEMI was the most common presentation in both groups (90% in the case group and 77.5% in the control group in the control group). Subsequently, there was no statistically significant difference between case and control groups regarding TIMI flow, and post-MI EF with mean range 34.88% ± 3.55% in the case group and 34.58% ± 3.65% in the control group (P = 0.711). On the other hand, there was statistically significant improvement in follow-up EF in the case group which showed a mean range of 45.36% ± 7.13% in comparison with the control group which showed a mean range of 41.80% ± 6.93% (P = 0.027). Conclusion Dapagliflozin administration in the early phase after STEMI results in significant improvement in LV systolic function in comparison with the placebo. Abbreviations ACE-I: Angiotensin-converting enzyme inhibitor; ACS: Acute coronary syndrome; ARNI: Angiotensin receptor-neprilysin inhibitor; CBC: Complete blood picture; DM: Diabetes Mellitus; ECG: Electrocardiogram; FH: Family History; GLS: Global longitudinal strain; HF: Heart Failure; HFrEF: Heart Failure reduced Ejection Fraction; HTN: Hypertension IV: Intravenous; LV: Left ventricle; LVEF: Left ventricular ejection fraction; MI: Myocardial Infarction; MRA: Mineralocorticoid receptor antagonists; PCI: Primary percutaneous coronary intervention; SD: Standard deviation; SGLT-2: Sodium-glucose cotransporter-2 inhibitors; SPSS: Statistical Package for the Social Science; STEMI: ST-segment elevation myocardial infarction; T2D: Type 2 Diabetes Mellitus

Changes in Computed-Tomography-Derived Segmental Left Ventricular Longitudinal Strain After Transcatheter Aortic Valve Implantation

Patients with severe aortic stenosis (AS) may show left ventricular (LV) apical longitudinal strain sparing. Transcatheter aortic valve implantation (TAVI) improves LV systolic function in patients with severe AS. However, the changes in regional longitudinal strain after TAVI have not been extensively evaluated. This study aimed to characterize the effect of the pressure overload relief after TAVI on LV apical longitudinal strain sparing. A total of 156 patients (mean age 80 ± 7years, 53% men) with severe AS who underwent computed tomography before and within 1year after TAVI (mean time to follow-up 50 ± 30days) were included. LV global and segmental longitudinal strain were assessed using feature tracking computed tomography. LV apical longitudinal strain sparing was evaluated as the ratio between the apical and midbasal longitudinal strain and was defined as an LV apical to midbasal longitudinal strain ratio >1. LV apical longitudinal strain remained stable after TAVI (from 19.5 ± 7.2% to 18.7 ± 7.7%, p=0.20), whereas LV midbasal longitudinal strain showed a significant increase (from 12.9 ± 4.2% to 14.2 ± 4.0%, p ≤0.001). Before TAVI, 88% of the patients presented with LV apical strain ratio >1% and 19% presented with an LV apical strain ratio >2. After TAVI, these percentages significantly decreased to 77% and 5% (p=0.009, p ≤0.001), respectively. In conclusion, LV apical sparing of strain is a relatively common finding in patients with severe AS who underwent TAVI and its prevalence decreases after the afterload relief after TAVI.

Evaluation of Left Ventricular Function after Revascularization of Coronary Chronic Total Occlusion using Speckle Tracking Echocardiography

Objective: This study evaluated the role of two-dimensional speckle tracking echocardiography (2D-STE) in evaluation of the LV systolic function in patients had CTO of LAD at 1 day as well as at 3 months after revascularization Methodology: This prospective observational study included 100 patients diagnosed by coronary angiography to have a chronic complete occlusion of the left anterior descending artery. Percutaneous coronary intervention (PCI) was performed. When the residual stenosis was less than 30% of the intraluminal diameter and thrombolysis in myocardial infarction (TIMI) grade III flow was achieved without any major complications, the operation was considered a success. Using speckle-tracking echocardiography was to measure global longitudinal strain and left ventricular functions. Follow-up of patients was done at day 1 and 3 months later after PCI. Results: Global longitudinal strain (GLS) and wall motion score index (WMAI) difference at baseline and follow-up shows a positive correlation with left ventricular ejection fraction (LVEF) changes at baseline and follow-up (p˂0.001). Mean baseline left ventricular end systolic volume (LVESV) was 58.22±11.65 and follow-up LVESV was 50.60±14.07 with statistical difference (p=0.047). Mean value of baseline GLS (-14.26±0.93) and follow-up GLS was (-15.66±0.92) (p˂0.001). Periprocedural complications were contrast induced nephropathy in 3 %, cardiac tamponade 1 % and Emergency re-PCI 1 % Conclusion: Revascularization via PCI to CTO of LAD can improve LV function. These results of the study provide evidence to support the clinical use of 2D-STE to assess the early changes of LV function.

Evaluation of left ventricular systolic function in patients with systemic lupus erythematosus using ultrasonic layer-specific strain technology and its association with cardiovascular events: a long-term follow-up study

BackgroundSystemic lupus erythematosus (SLE) is a multisystem, autoimmune disease with potential cardiovascular involvement. Layer-specific strain (LSS) analysis is a new method that allows early detection of subtle left ventricular (LV) systolic dysfunction. The aim of this study was to evaluate LV systolic function in patients with SLE using conventional echocardiographic measurements and longitudinal strain (LS) and circumferential strain (CS) by LSS. Furthermore, the association between echocardiographic parameters and the occurrence of cardiovascular events was assessed.MethodsA total of 162 patients with SLE (the SLE group) who underwent a dedicated multidisciplinary assessment, including echocardiography, were analyzed at the time of their first visits. The control group consisted of 68 age- and sex-matched healthy subjects. LS and CS on endocardial, mid-myocardial, and epicardial layers at 17 cardiac segments were measured. Transmural strain gradient was calculated as the differences in systolic strain between the endocardial and epicardial layers.ResultsCompared with control subjects, patients with SLE had significantly lower LV ejection fraction, LS, and CS values in all layers (P < 0.05); LV LS and CS gradient were all lower than control subjects (P < 0.05). During a median follow-up period of 83 months (interquartile range: 64–95 months), 59 patients (36.4%) developed cardiovascular events. Using multivariate Cox regression analysis, we found that LV endocardial LS (hazard ratio, 1.014; 95% CI, 1.002–1.035; P = 0.025) and CS (hazard ratio, 1.051; 95% CI, 1.027–1.077; P < 0.001) demonstrated independent associations with cardiovascular events; whereas LV ejection fraction was not significantly associated with cardiovascular events. The Kaplan–Meier survival curves showed that patients with SLE with lower LV endocardial LS and CS (based on the cutoff values of -21.5% and -29.0%, respectively) experienced higher cumulative rates of cardiovascular events compared with those with higher LV endocardial LS and CS.ConclusionsIn patients with SLE, LV systolic function measured by LV endocardial LS and CS were significantly lower than that of the control group and were associated with cardiovascular events, potentially representing a new technology to improve risk stratification in these patients

Impact of Left Ventricular Global Longitudinal Strain on Outcomes After Transcatheter Edge-to-Edge Repair in Secondary Mitral Regurgitation

Assessment of left ventricular (LV) systolic function is essential in patient selection for transcatheter edge-to-edge repair (TEER) in secondary mitral regurgitation (MR). Although LV ejection fraction (EF) is mostly used for assessing LV function, it represents the change of LV chamber size, but not myocardial contractility. LV global longitudinal strain (GLS) provides an alternative to assess LV systolic function in patients with secondary MR. This study included 380 patients with secondary MR (mean age 71.0 ± 13.0 years; 61.1% male) who underwent TEER. Patients were dichotomized based on baseline LV GLS (more impaired GLS [<7.0%] vs less impaired GLS [≥7%]) based on existing literature. The primary outcome was all-cause mortality, whereas the secondary outcome was the composite end point of all-cause mortality and heart failure hospitalization. The mean LV GLS was 8.1 ± 3.8%, and 162 patients had GLS <7%. Patients with more impaired GLS (<7%) were more likely to be male (68.5% vs 55.5%; p=0.01) and have larger LV end-diastolic volume (110.5 ± 36.5 ml/m2 vs 92.9 ± 34.3 ml/m2; p <0.001) and lower LVEF (22.2 ± 8.9% vs 36.4 ± 14.5%; p <0.001) than those with less impaired GLS (≥7%). The number of clips used and residual MR were similar between the 2 groups. Patients with more impaired LV GLS (<7%) had significantly higher 2-year event rates of the primary outcome (38.2% vs 25.9%; log-rank p=0.003) and the secondary outcome (52.5% vs 36.3%; log-rank p <0.001). Multivariate analysis showed that LV GLS (<7%) was independently associated with the primary outcome (hazard ratio 1.65, 95% confidence interval 1.16 to 2.34, p=0.005) and the secondary outcome (hazard ratio 1.54, 95% confidence interval 1.08 to 2.20, p=0.016) whereas such associations were not observed with LVEF. In conclusion, LV GLS (<7%) was independently associated with a higher risk of adverse events in patients with secondary MR who underwent TEER.

Epicardial fat tissue can predict subclinical left ventricular dysfunction in patients with erectile dysfunction

Background Erectile dysfunction (ED) is an early form of atherosclerosis and subclinical myocardial dysfunction. Epicardial fat tissue (EFT) is associated with impaired left ventricular (LV) function, even in the absence of cardiovascular disease. The aim of this study was to investigate the association between EFT and LV systolic function in patients with erectile ED by speckle tracking echocardiography (2D-STE) method. Methods A total of 129 consecutive patients with ED were compared with 145 age- and sex-matched control subjects. ED was evaluated using the International Index of Erectile Function questionnaire. Thickness of EFT was measured by TTE. Global LV longitudinal strain (LV-GLS) and global LV circumferential strain (LV-GCS) were measured by 2D-STE method. Results The EFT thickness was significantly higher in the patients with ED (p <.01). LV-GLS and LV-GCS were revealed to be more deterioration in the ED group compared to controls (−18.2 ± 2.7 vs. (−21.1 ± 3.9, p<.001; −19.5 ± 4.1 vs. −21.9 ± 3.9, p<.001, respectively). It has been shown that EFT thickness is an independent predictor of LV dysfunction. Conclusions These results indicate that EFT thickness is associated with subclinical LV systolic dysfunction in patients with ED.

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

Assessment of regional left ventricular myocardial strain in patients with left anterior descending coronary stenosis using computed tomography feature tracking

BackgroundComputed tomography feature tracking (CT-FT) has emerged as a valuable method for the assessment of cardiac function. However, no studies have investigated the usefulness of CT-derived assessments of left ventricular (LV) strain in coronary artery disease (CAD). Our aim was to evaluate regional LV systolic deformation in patients with left anterior descending coronary artery (LAD) stenosis using CT-FT.MethodsSeventy-six patients with LAD stenosis were enrolled. The patients were divided into four groups according to the percentage of LAD stenosis: ≤25% was defined as group I (24 patients), 26 to 49% as group II (17 patients), 50 to 74% as group III (21 patients), and ≥ 75% as group IV (14 patients). Thirty-two sex- and age-matched healthy subjects were included as controls.ResultsNo intergroup differences were found between groups I-IV and the controls in terms of the left ventricular ejection fraction, end-diastolic volume and end-systolic volume. However, the longitudinal strain (LS) of the LAD territory was significantly reduced in groups I-IV compared with the controls (− 20.8, − 18.6%, − 18.6%, and − 17.0% vs − 23.7%, respectively). The circumferential strain (CS) of the LAD territory was significantly reduced in groups III and IV compared with the controls and groups I and II (− 22.4% and − 22.1% vs − 25.4, − 24.1%, and − 25.3%, respectively). Compared with the non-LAD territory, the LAD territory in groups II-IV showed significantly increased LS (− 18.6% vs − 21.9%, p = 0.07; − 18.6% vs − 21.9%, p = 0.024; − 17.5% vs − 20%, p = 0.032, respectively). The severity of LAD stenosis was positively correlated with the LS of the LAD territory (r = 0.438, p = 0.002).ConclusionCT-FT can detect decreasing LV systolic function in patients with LAD stenosis. LV regional systolic deformation of the LAD territory was reduced with increasing LAD stenosis severity.

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.

Sodium glucose cotransporter-2 inhibitor was associated with an improvement in left ventricular systolic function in patients with type 2 diabetes mellitus with impaired left ventricular systolic function.

AimsRecent studies indicated that sodium glucose cotransporter‐2 inhibitors (SGLT2i) reduced heart failure hospitalization in patients with type 2 diabetes mellitus (T2DM). However, whether SGTL2i can improve left ventricular (LV) systolic and diastolic function remained unclear. This study aimed to compare the change in echocardiographic parameters in T2DM patients receiving SGLT2i with a different baseline LV ejection fraction (LVEF). The change in echocardiographic parameters was also compared between T2DM patients treated with SGLT2i and those treated with dipeptidyl peptidase‐4 inhibitor (DPP4i).Methods and resultsThis multicentre cohort study consecutively enrolled 665, 119, and 132 T2DM patients treated with SGLT2i with a preserved (≥50%), moderately reduced (40–50%), and reduced baseline LVEF (<40%), respectively, with paired baseline and post‐treatment echocardiographic data available between 1 June 2016 and 31 May 2018. There were 212 patients treated with DPP4i with paired baseline and post‐treatment echocardiographic data available at the same time. For those patients treated with DPP4i, 45 patients had impaired baseline LVEF of <50%. Echocardiographic parameters, including LVEF, LV end‐diastolic volume, LV end‐systolic volume (LVESV), and LV diastolic function, were analysed at baseline and after treatment. After a median SGLT2i treatment period of 230 days, patients with reduced LVEF were associated with an improvement in LVEF from 29.4 ± 7.4% to 42.2 ± 15.2% (P < 0.0001) and decrease in LVESV from 133.2 ± 49.2 to 117.4 ± 60.1 mL (P = 0.0002). Patients with moderately reduced LVEF were associated with an improvement in LVEF from 44.8 ± 2.9% to 49.7 ± 12.4% (P < 0.0001) and decrease in LVESV from 90.7 ± 31.1 to 80.0 ± 36.2 mL (P = 0.0017). Patients with preserved LVEF did not show an improvement in LVEF and LVESV after SGLT2i treatment. There were no significant changes of LV end‐diastolic volume, LV diastolic function, and LV wall thickness in three study groups after SGLT2i treatment. In contrast, patients with impaired baseline LVEF (<50%) did not show any change in LVEF and LVESV after DPP4i treatment.ConclusionsSodium glucose cotransporter‐2 inhibitor was associated with an improvement in LV systolic function in patients with T2DM with reduced and moderately reduced LVEF. In contrast, DPP4i treatment was not associated with any improvement in LVEF among patients with impaired LVEF.

Intracoronary Injection of Autologous CD34+ Cells Improves One-Year Left Ventricular Systolic Function in Patients with Diffuse Coronary Artery Disease and Preserved Cardiac Performance—A Randomized, Open-Label, Controlled Phase II Clinical Trial

This phase II randomized controlled trial tested whether intracoronary autologous CD34+ cell therapy could further improve left ventricular (LV) systolic function in patients with diffuse coronary artery disease (CAD) with relatively preserved LV ejection fraction (defined as LVEF >40%) unsuitable for coronary intervention. Between December 2013 and November 2017, 60 consecutive patients were randomly allocated into group 1 (CD34+ cells, 3.0 × 107/vessel/n = 30) and group 2 (optimal medical therapy; n = 30). All patients were followed for one year, and preclinical and clinical parameters were compared between two groups. Three-dimensional echocardiography demonstrated no significant difference in LVEF between groups 1 and 2 (54.9% vs. 51.0%, respectively, p = 0.295) at 12 months. However, compared with baseline, 12-month LVEF was significantly increased in group 1 (p < 0.001) but not in group 2 (p = 0.297). From baseline, there were gradual increases in LVEF in group 1 compared to those in group 2 at 1-month, 3-months, 6-months and 12 months (+1.6%, +2.2%, +2.9% and +4.6% in the group 1 vs. −1.6%, −1.5%, −1.4% and −0.9% in the group 2; all p < 0.05). Additionally, one-year angiogenesis (2.8 ± 0.9 vs. 1.3 ± 1.1), angina (0.4 ± 0.8 vs. 1.8 ± 0.9) and HF (0.7 ± 0.8 vs. 1.8 ± 0.6) scores were significantly improved in group 1 compared to those in group 2 (all p < 0.001). In conclusion, autologous CD34+ cell therapy gradually and effectively improved LV systolic function in patients with diffuse CAD and preserved LVEF who were non-candidates for coronary intervention (Trial registration: ISRCTN26002902 on the website of ISRCTN registry).

Evaluation of Regional Left and Right Ventricular Function in Patients with Ostium-Secundum Atrial Septal Defect Using Speckle Tracking Echocardiography

The aim of this study was to provide evidence of abnormalities of right ventricular (RV) and left ventricular (LV) function using speckle tracking echocardiography (STE) in adults with ostium secundum-atrial septal defect (OS-ASD) and pulmonary hypertension (PH). Sixty-three adult patients with OS-ASD were enrolled. Control group (n=10) with mean pulmonary arterial pressure (MPAP) ≤25 mmHg. Three PH groups were divided based on pulmonary artery systolic pressure (PASP): mild (n=18), moderate (n=24) and severe (n=11). RV free wall strain (RVFWS) and LV global longitudinal strain (LVGLS) were measured. RVFWS and RV fractional area change were significantly lower in the severe PH group. No difference was found in LVGLS among groups. The moderate PH group had significantly higher right atrial (RA) volume and RV impaired relaxation. RVFWS had a positive correlation with PASP and MPAP. STE is a valuable non-invasive technique to assess RV and LV systolic function in patients with OS-ASD.

P1271 Systolic dysfunction in obese and extreme obese patients and preliminary results after bariatric surgery

Abstract Background Obesity is known to be associated with left ventricular (LV) diastolic dysfunction, heart failure and some risk factors for early atherosclerosis: diabetes mellitus, arterial hypertention, dyslipidemia. Very few studies investigate extremely obese patients and how this condition impairs LV systolic function. The aim of the study is to explore the effect of obesity and extreme obesity on LV systolic function in patients without diabetes mellitus and the effect of bariatric surgery on that function. Methods We prospectively investigated 55 patients with obesity class 1 and 2 and 23 patients with extreme obesity who underwent bariatric surgery. The participants were grouped according to body mass index (obesity class 1 and 2 BMI ≥ 30 ≤ 40 kg/m2 and extreme obesity ≥ 40 kg/m2). Systolic function was assessed by ejection fraction by Simpson and Teicholz, global longitudinal strain, Tei index. Results In the studied groups statistical analysis proved the relation between all investigated echographic parameters and BMI. The mean left ventricular ejection fraction and GLS values were 55% (±10%) vs. − 17.3% (±3.3%) for obese and 51% (±8%) vs. − 16.5% (2.3%) for extreme obese (p &amp;lt; 0.05). Patiets with extreme obesity, who underwent bariatric surgery increased LV ejection fraction faster and more than patients who underwent only diatry and medical treatment. 5.0 (9.0) % vs. 3.0 (10.0) % (p &amp;lt; 0.05). Conclusion Obesity and extreme obesity impair all studied parameters for LV systolic function. Bariatric surgery is treatment option for extreme obesity patients and a possibility for significant and fast improvement of LV systolic parameters.

Real Time 3-D Echocardiography for Evaluation of Left Ventricular Systolic Function in Patients with Liver Cirrhosis Caused by Hepatitis C Virus

Background: Cardiovascular changes are associated with Liver cirrhosis so, it is important to assess its function in cirrhotic patients. Child-Pugh scoring system is the simplest clinical method used for classifying liver cirrhosis. 3D echo and 2D speckle tracking echocardiography (2D-STE) are the most recent imaging modalities able to evaluate LV systolic function accurately. Aim: To assess LV systolic function in patients with chronic liver cirrhosis caused by HCV by different echocardiographic modalities including 3D and STE and correlation of the results with the severity of cirrhosis based on Child-Pugh score. Material and methods: A prospective study was done in Cardiology Department, AlZahraa University Hospital including a total of 75 subjects; 45 cirrhotic patients and 30 subjects as a control. 2D, 3D LV volumes and EF and 2D-STE of the LV were measured. Then, the patients’ group was divided into 3 subgroups according to Child Pugh score then LV systolic function were assessed with different echo modalities (2D, 3D and MM, TDI (Sm) and, 2D STE). Results: The LVEF increased significantly in patient group by M-mode and 2D but decreased by TDI, 3D echo and STE. Increased systolic velocity (Sa) by TDI in group III of cirrhosis but lowered systolic function by using STE. Also, there was a significant correlation between severity of liver cirrhosis and LVEF by 2D STE, 3D and 2D. Conclusions: The recent noninvasive 3D echo and 2-D STE techniques are a promising methods for early detection of LV systolic dysfunction in asymptomatic patients with viral liver cirrhosis. Also, the LV systolic dysfunction is related to the extent of severity of liver cirrhosis.

Real Time 3-D Echocardiography for Evaluation of Left Ventricular Systolic Function in Patients with Liver Cirrhosis Caused by Hepatitis C Virus

Background: Cardiovascular changes are associated with Liver cirrhosis so, it is important to assess its function in cirrhotic patients. Child-Pugh scoring system is the simplest clinical method used for classifying liver cirrhosis. 3D echo and 2D speckle tracking echocardiography (2D-STE) are the most recent imaging modalities able to evaluate LV systolic function accurately. Aim: To assess LV systolic function in patients with chronic liver cirrhosis caused by HCV by different echocardiographic modalities including 3D and STE and correlation of the results with the severity of cirrhosis based on Child-Pugh score. Material and methods: A prospective study was done in Cardiology Department, AlZahraa University Hospital including a total of 75 subjects; 45 cirrhotic patients and 30 subjects as a control. 2D, 3D LV volumes and EF and 2D-STE of the LV were measured. Then, the patients’ group was divided into 3 subgroups according to Child Pugh score then LV systolic function were assessed with different echo modalities (2D, 3D and MM, TDI (Sm) and, 2D STE). Results: The LVEF increased significantly in patient group by M-mode and 2D but decreased by TDI, 3D echo and STE. Increased systolic velocity (Sa) by TDI in group III of cirrhosis but lowered systolic function by using STE. Also, there was a significant correlation between severity of liver cirrhosis and LVEF by 2D STE, 3D and 2D. Conclusions: The recent noninvasive 3D echo and 2-D STE techniques are a promising methods for early detection of LV systolic dysfunction in asymptomatic patients with viral liver cirrhosis. Also, the LV systolic dysfunction is related to the extent of severity of liver cirrhosis.

A Comparative Study of Bisoprolol with Carvedilol 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. Recent data suggest that beta-blockers are beneficial in patients with CHF. Among β-blocker class of drugs, bisoprolol is a highly selective β1-adrenergic receptor blocker whereas Carvedilol is non-selective. Many large-scale trials have confirmed that both these β-blockers are superior to placebo and other β-blockers. This study was designed to compare the effects of carvedilol and bisoprolol in patients with chronic HF in a single center.Methods: It was a quasi experimental study. A total of 288 cases of heart failure were selected by purposive sampling, from January 2017 to June 2017. Each patient was allocated into either of the two groups, and was continued receiving treatment with either bisoprolol (Group-I) or carvedilol (Group-II). Each patient was evaluated clinically and echocardiographically at the beginning of treatment (baseline) and at the end of 3rd month. Echocardiography was performed to find out change in left ventricular systolic function.Result: After 3 months of treatment, ejection fraction was found higher in the bisoprolol group (42.6 ± 6.5 versus 38.3 ± 4.6%; P &lt; 0.05). Ejection fraction (EF) changes were 8.4% in bisoprolol group and 4.1% in carvedilol group. 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 (3.2±0.1 in group I versus 2.3±0.5 in group II; P&lt;0.05) occurred after 3 months of treatment. But no significant differences were observed in left ventricular end-diastolic volume (10.1±3.2 versus 6.1±6.4; P=0.101) and left ventricular diastolic diameter (1.7±0.8 versus 1.3±0.8; P=0.081) between groups. Three months after treatment, heart rate was reduced in the bisoprolol group from 87.7±9 to 74.5±8.1 and carvedilol group from 88.8±9.1 to 80.1±8.7. Differences in heart rate responses between 2 groups were not statistically significant (P=0.113). Assessment of blood pressure three months later of treatment shows, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were improved in both group but difference between two groups were statistically non significant (p&gt;0.05).Conclusion: In this study, bisoprolol was superior to carvedilol in increasing left-ventricular ejection fraction, improving left ventricular end systolic volume and left ventricular end systolic diameter but no significant difference was observed in LV end diastolic volume, LV end diastolic diameter, heart rate and blood pressure.University Heart Journal Vol. 14, No. 1, Jan 2018; 3-8