Myocardial Mass Research Articles

Myocardial Contractility Pattern Characterization in Radiation-Induced Cardiotoxicity Using Magnetic Resonance Imaging: A Pilot Study with ContractiX.

Radiation therapy (RT) plays an integral role in treating thoracic cancers, despite the risk of radiation-induced cardiotoxicity. We hypothesize that our newly developed magnetic resonance imaging (MRI)-based contractility index (ContractiX) is a sensitive marker for early detection of RT-induced cardiotoxicity in a preclinical rat model of thoracic cancer RT. Adult salt-sensitive rats received image-guided heart RT and were imaged with MRI at 8 weeks and 10 weeks post-RT or sham. The MRI exam included cine and tagging sequences to measure left-ventricular ejection fraction (LVEF), mass, myocardial strain, and ContractiX. Furthermore, ventricular torsion, diastolic strain rate, and mechanical dyssynchrony were measured. Statistical analyses were performed between the sham, 8 weeks post-RT, and 10 weeks post-RT MRI parameters. The results showed that both LVEF and myocardial mass increased post-RT. Peak systolic strain and ContractiX significantly decreased post-RT, with a more relative reduction in ContractiX compared to strain. ContractiX showed an inverse nonlinear relationship with LVEF and continuously decreased with time post-RT. While early diastolic strain rate and mechanical dyssynchrony significantly changed post-RT, ventricular torsion changes were not significant post-RT. In conclusion, ContractiX measured via non-contrast MRI is a sensitive early marker for the detection of subclinical cardiac dysfunction post-RT, and it is superior to other MRI cardiac measures.

Role of cardiac magnetic resonance in the differential diagnosis between arrhythmogenic cardiomyopathy with left ventricular involvement and previous infectious myocarditis.

AimsArrhythmogenic cardiomyopathy with left ventricular involvement (ACM-LV), particularly in case of isolated left ventricular involvement (i.e. left dominant arrhythmogenic cardiomyopathy, LDAC) and previous infectious myocarditis (pIM) may have overlapping clinical and cardiac magnetic resonance (CMR) features. To date, there are no validated CMR criteria for the differential diagnosis between these conditions. The present study aimed to identify CMR characteristics to distinguish ACM-LV from pIM. Methods and resultsThis observational, retrospective, single-centre study included 30 pIM patients and 30 ACM-LV patients. In ACM-LV patients CMR was performed at diagnosis; in patients with pIM, CMR was performed six months after acute infection. CMR analysis included quantitative assessment of left ventricle (LV) volumes, systolic function and wall thicknesses, qualitative and quantitative assessment of late gadolinium enhancement (LGE) sequences. Compared with pIM, ACM-LV patients showed slightly larger LV volumes, more frequent regional wall motion anomalies and reduced wall thicknesses. ACM-LV patients had higher amounts of LV LGE and extension. Notably, the LDAC subgroup had the highest amount of LV LGE. LV LGE amount > 15 g and a LV LGE percentage > 30% of LV mass discriminated ACM-LV from pIM with a 100% specificity. LGE segmental distribution was superimposable among the groups, except for septal segments that were more frequently involved in ACM-LV and LDAC patients. ConclusionsA great extension of LV LGE (a cut-off of LGE >15 g and a percentage above 30% of LV LGE in relation to total myocardial mass) discriminates ACM-LV from pIM with extremely high specificity.

A compartment-based myocardial density approach helps to solve the native T1 vs. ECV paradox in cardiac amyloidosis

Cardiovascular magnetic resonance (CMR) plays an important clinical role for diagnosis and therapy monitoring of cardiac amyloidosis (CA). Previous data suggested a lower native T1 value in spite of a higher LV mass and higher extracellular volume fraction (ECV) value in wild-type transthyretin amyloidosis (ATTRwt) compared to light-chain amyloidosis (AL)—resulting in the still unsolved “native T1 vs. ECV paradox” in CA. The purpose of this study was to address this paradox. The present study comprised N = 90 patients with ATTRwt and N = 30 patients with AL who underwent multi-parametric CMR studies prior to any specific treatment. The CMR protocol comprised cine- and late-gadolinium-enhancement (LGE)-imaging as well as T2-mapping and pre-/post-contrast T1-mapping allowing to measure myocardial ECV. Left ventricular ejection fraction (LV-EF), left ventricular mass index (LVMi) and left ventricular wall thickness (LVWT) were significantly higher in ATTRwt in comparison to AL. Indexed ECV (ECVi) was also higher in ATTRwt (p = 0.041 for global and p = 0.001 for basal septal). In contrast, native T1- [1094 ms (1069–1127 ms) in ATTRwt vs. 1,122 ms (1076–1160 ms) in AL group, p = 0.040] and T2-values [57 ms (55–60 ms) vs. 60 ms (57–64 ms); p = 0.001] were higher in AL. Considering particularities in myocardial density, “total extracellular mass” (TECM) was substantially higher in ATTRwt whereas “total intracellular mass” (TICM) was rather similar between ATTRwt and AL. Consequently, the “ratio TICM/TECM” was lower in ATTRwt compared to AL (0.58 vs. 0.83; p = 0.007). Our data confirm the presence of a “native T1 vs. ECV paradox” with lower native T1 values in spite of higher myocardial mass and ECV in ATTRwt compared to AL. Importantly, this observation can be explained by particularities regarding myocardial density that result in a lower TICM/TECM “ratio” in case of ATTRwt compared to AL—since native T1 is determined by this ratio.

361 PATISIRAN EFFICACY ON MYOCARDIAL FUNCTION IN H-ATTR PATIENTS EVALUATED WITH THE USE OF CMR AND SPECKLE TRACKING ECOCARDIOGRAPHY

Abstract Introduction Hereditary transthyretin amyloidosis (h-ATTR) is a complex, systemic infiltrative disease characterized by extracellular deposition of transthyretin in different organs. Infiltrative cardiomyopathy and polyneuropathy represent two of the most common and severe manifestations of this pathology. Patisiran is a double-stranded interfering RNA drug, used to stop expression of TTR in h-ATTR. It is recommended in the treatment of cardiac h-ATTR with polyneuropathy or polyneuropathy alone. Recent studies showed the efficacy of Patisiran in slowing the progression of the disease, improving myocardial deformation indices, biomarkers and functional capacity. Aim We aimed to illustrate the efficacy of Patisiran on myocardial function and to evaluate the role of Speckle Tracking Echocardiography (STE) and Cardiac Magnetic Resonance (CMR) as markers of subclinical cardiac efficacy of Patisiran in two h-ATTR patients (males, with mean age 55 ± 1,4 years old) with infiltrative cardiomyopathy and polyneuropathy who were scheduled to receive this drug. Materials and Methods Before receiving Patisiran (T0) the following tests were performed: cardiovascular physical examination, complete echocardiogram including STE. All these exams were repeated after 6 months or 1 year (T1). CMR was performed at the baseline and three years after. Results The CMR evaluation showed, after the use of Patisiran, a significant reduction of myocardial mass (average reduction -13,29%) and myocardial walls thickness (average septal reduction -13,65%). After 1 year follow up myocardial performance indices were also improved: GLS values (average gain 2,3 pt), and myocardial work values (average increase GWI +311,5, GCW +188,5, GWW -114,5, GWE +5,5 pt) at echocardiography. Conclusion The results of our experience showed, according to evidences suggested by the APOLLO trial, the efficacy of Patisiran, in patients with cardiac h-ATTR and polyneuropathy, in reducing myocardial mass and improving myocardial function. STE and CMR could represent useful tools to study cardiac function in A-TTR patients undergoing Patisiran.

851 REPEATABILITY OF BOLUS AND CONTINUOUS THERMODILUTION FOR ASSESSING CORONARY MICROVASCULAR FUNCTION

Abstract Introduction The bolus thermodilution-derived index of microcirculatory resistance (IMR) has emerged over years as the standard of reference to invasively define coronary microvascular dysfunction (CMD). However, the technique still presents some limitations, mainly related to the fact that manual injection of saline bolus accounts for some variance in the measurements. Continuous intracoronary thermodilution has been recently introduced as a tool to directly quantify absolute coronary flow and microvascular resistance both at rest and during hyperemia and has shown to be safe and operator independent. Microvascular resistance reserve (MRR), derived from continuous thermodilution, has been validated as novel index specific for microcirculation and independent from myocardial mass. Purpose To compare head-to-head the intra-observer repeatability of bolus and continuous thermodilution for assessing microvascular function. Methods Patients undergoing coronary angiography in the absence of obstructive coronary artery disease were prospectively enrolled. Bolus and continuous intracoronary thermodilution measurements were performed in duplicates in the left anterior descending artery (LAD). Patients were randomly assigned in a 1:1 ratio to undergo first bolus thermodilution or first continuous thermodilution assessment. Results A total of 102 patients were enrolled. Average FFR was 0.86±0.06. Coronary Flow Reserve (CFR) calculated with continuous thermodilution (CFRthermo) was significantly lower than bolus thermodilution-derived CFR (CFRbolus) (2.63±0.65 and 3.29±1.17, respectively, p<0.001). CFRthermo showed a lower variability and a higher agreement than CFRbolus (variability 12.74 ± 10.41% vs 31.26±24.85%, respectively, p<0.001; ICC= 0.78 (0.70-0.85) and 0.48 (0.32-0.62), respectively, p<0.001, Figure 1). Both MRR and IMR showed a good agreement (ICC 0.81 (0.74-0.87) and 0.80 (0.71-0.86)) but the variability of the MRR was significantly lower (12.44 ± 10.06% vs 24.24±19.27, respectively, p<0.001, figure 1). Reproducibility data of all indices derived from duplicated measurements of bolus and continuous thermodilution are reported in Figure 2. Conclusion Continuous intracoronary thermodilution has a higher repeatability than bolus thermodilution in the assessment of CMD.

Associations of the spatial QRS-T angle with clinical, laboratory and echocardiographic parameters in patients with arterial hypertension

Introduction. The prevalence of arterial hypertension (AH) among the adult population of Russia is high; up to 48% of deaths are due to its complications. Recently, prognostic indicators of the electrocardiogram (ECG) have attracted the attention of researchers. One of them is the QRS-T spatial angle (sQRS-Ta).The aim of the work is to study what clinical, laboratory and echocardiographic parameters are associated with increased sQRS-Ta in patients with AH.Material and methods. The study included 240 AH patients (48% men), mean age 62 ± 11 years. The study did not include patients with valvular disease, bundle branch block, preexcitation and ventricular pacing. Orthogonal leads were synthesized from digital ECGs in 12 leads and sQRS-Ta was calculated as a spatial angle between the integral QRS and T vectors. sQRS-Ta ≥ 90° was considered enlarged. We assessed the associations sQRS-Ta ≥ 90° with the following indicators by the method of logistic regression: sex; the presence of cardiovascular diseases; 5 age groups; overweight, obesity; smoking; heart rate (HR); systolic blood pressure (SBP), diastolic blood pressure; pulse blood pressure; blood glucose; total cholesterol; end-diastolic dimension (EDD) of the left ventricle (LV), LV wall thickness, relative LV wall thickness, left ventricular myocardial mass (LVMM), LVMM/body surface area (BSA); LVMM/height in the degree of 2,7, the presence of LV diastolic dysfunction.Results. According to univariate logistic regression, sQRS-Ta ≥ 90° associations were found with age, SBP, obesity, heart rate, LV EDD, LVMM, LVMM/BSA, and LVMM/ height2,7. In multivariate logistic regression models, the contribution of SBP ≥ 140 mmHg (odds ratio (OR) 2,22, 95% CI 1,20–4,10; p=0.01), age 55–64 years (OR 1,87; 1,01–3,44; p=0 .04), increased LV EDD (OR 2,70; 95% CI 1,27–5,72; p=0.01) and HR (OR 2,27; 95% CI 1,10–6,05; p =0.01) was independent.Conclusions. According to multivariate analysis, independent predictors of an increase in sQRS-Ta in patients with AH were SBP ≥ 140 mm Hg, an increase in LV EDD, HR > 80 beats/min, and age 55–64 years.

Personalized coronary blood flow model based on CT perfusion to non-invasively calculate fractional flow reserve

Coronary outlet resistance, influenced by quantification and distribution of total hyperemic coronary blood flow, is critical for accurately estimating the computation of fractional flow reserve from computed tomography angiography (FFRCT). However, accurate estimation of FFRCT is still a challenging task due to the impractical of non-invasively measuring coronary outlet resistance in the clinic. While traditional methods have been used to estimate outlet resistance through population-averaged physiological assumption models, individual differences between patients limit the reliability of the models. In this work, we propose a personalized coronary flow model based on dynamic stress computed tomographic perfusion (CTP), called CTPV, to achieve a noninvasive estimation of the outlet resistance and FFRCT. The CTPV model employs myocardial blood flow (MBF) obtained from CTP to quantify the total hyperemic coronary blood flow directly. Then, myocardial perfusion territories corresponding to coronary artery branches are proposed to distribute the outlet coronary blood flow. For this purpose, we use the Voronoi algorithm to segment the myocardial perfusion territory. Finally, the outlet resistance and FFRCT are estimated based on the outlet coronary blood flow. Experiment studies on a clinical dataset consisting of 138 vessels from 86 subjects show the superiority of our CTPV model against the CTPD and LVMD models, including the method of quantifying total hyperemic coronary blood flow based on left ventricular myocardial mass (LVM) and distributing the outlet coronary blood flow based on outlet diameter. The CTPV model estimates a higher AUC for FFRCT (AUC = 0.96) than the CTPD model (AUC = 0.93) and the LVMD model (AUC = 0.92). The accuracies of CTPV, CTPD, and LVMD models are 90.6%, 87.7%, and 84.1%, respectively. Additionally, we use different outlet truncation locations to evaluate the repeatability of the CTPV and CTPD models for estimating FFRCT on a random dataset of 10 vessels. The result shows that the repeatability of the CTPV model is better than the CTPD model. These compelling results evince that the proposed CTPV model can accurately estimate the coronary outlet resistance and improve the diagnostic performance and repeatability of FFRCT.

150 ECHO-DERIVED LEFT VENTRICULAR MECHANO-ENERGETIC EFFICACY CHARACTERIZES HYPERTENSIVE PATIENTS WITH IMPAIRED PET-DERIVED MYOCARDIAL BLOOD FLOW

Abstract Background Chronic left ventricular (LV) pressure overload determines both morphological and functional alterations in the heart and in the vascular system with occurrence of LV hypertrophy, coronary rarefaction and metabolic impairment, predisposing to heart failure. We aim at investigating early cardiac involvement in hypertensive disease by both Positron emission tomography (PET) and echo assessment and possible associations between alterations of PET-derived myocardial blood flow (MBF) and echocardiographic parameters of LV performance including mechano-energetic efficiency indexed for myocardial mass (MEEi), in a population of symptomatic hypertensive patients without flow-limiting epicardial coronary artery disease (CAD). Methods The study population included 78 symptomatic hypertensive patients without flow-limiting epicardial CAD. All patients underwent standard echocardiographic assessment, including evaluation of LV MEEi, and PET assessment with evaluation of MBF and MBF/mass ratio at rest and after stress and myocardial flow reserve (MFR). Results The study population included 67% males, 55% with dyslipidaemia, 42% with smoking habits and 21% obese. Prevalence of LV hypertrophy was of 43%. Among parameters of LV systolic performance, hyperaemic MBF/mass ratio resulted significantly correlated with LV MEEi (r=0.54, p<0.0001), midwall fractional shortening (r=0.38, p=0.001) but not with LVEF (r=0.10, p=0.47). Similarly, resting MBF/mass ratio resulted to have statistically significant correlations with LV MEEi (r=0.51, p<0.0001), midwall fractional shortening (r=0.29, p=0.01) but not with LVEF (r=0.11, p=0.39). LV MEEi reached the highest correlation coefficient with both resting and stress MBF/mass ratio. On the other hand, the correlation between MEEi and MFR did not reach statistical significance (r=0.11, p=0.33). In a multiple linear regression analysis, after adjusting for sex, systolic blood pressure, prevalence of LV hypertrophy and therapy with diuretics, the association between LV MEEi and hyperaemic MBF/mass ratio remained significant (beta coefficient =0.40, p=0.007). In a subsequent multivariate model, adjusting for the same confounders, by replacing hyperaemic MBF/mass ratio with resting MBF/mass ratio, LV MEEi and resting MBF/mass ratio continued to be significantly associated (beta coefficient =0.32, p=0.015). Conclusions In a population of hypertensive patients without flow-limiting epicardial CAD, an early myocardial impairment possibly related to coronary rarefaction and inadequate angiogenesis contributing to the altered myocardial metabolic demand and efficacy is detectable by both PET and echo-derived LV MEEi. Indeed, an independent association between LV MEEi and both MBF/mass ratio at rest and after stress exists, LV MEEi having the advantage over PET of being easily derived from standard echocardiography and not needing radiation exposure.

Results of a Russian multicenter open prospective study of the efficacy and safety of Telmista® and Telmista® H in patients with arterial hypertension 1 and 2 degrees

Relevance. The proportion of angiotensin receptor blockers has increased significantly among prescribed antihypertensive agents. To a large extent, this is facilitated by the emergence of new high-quality generic drugs available to the widest range of patients.Study objectives. Evaluation of effectiveness and safety of Telmista® (Telmisartan 40 mg, 80 mg, tablets, JSC Krka, d.d., Novo Mesto, Slovenia) and Telmista® H (hydrochlorothiazide + telmisartan 12.5 mg + 40 mg , 12.5 mg + 80 mg, 25 mg + 80 mg, tablets, JSC «Krka, dd, Novo Mesto», Slovenia) in patients with arterial hypertension of 1 and 2 degrees.Materials and methods. The study included 50 patients, 25 men and 25 women with arterial hypertension of 1–2 degrees. All patients underwent office blood pressure assessment, 24-hour blood pressure monitoring (ABPM), total cholesterol, HDL cholesterol, LDL cholesterol, TG, creatinine, glucose, insulin and glycated hemoglobin levels, HOMA index was calculated, urine microalbumin was determined, LV myocardial mass and LVMI were assessed according to ECHOCG at baseline and throughout the study. BP was re-measured after 4, 8, 12, 16, 20, 24 weeks of therapy, ABPM - after 16 weeks, the rest of the listed examinations - after 24 weeks.Results. During therapy with Telmista® and Telmista® H, 89% of patients with grade 1–2 AH achieved the target BP level, which was accompanied by an improvement in the metabolic profile, a decrease in LVMI and urinary microalbumin (in 50% of patients), alongside with an improvement in the quality of life after 24 weeks treatment. Thus, due to high antihypertensive and organoprotective efficacy, excellent tolerability and availability, Telmista® and Telmista® can be the drugs of choice in hypertensive patients, especially those with metabolic disorders, to maximize the reduction of cardiovascular risk in this category of patients.

Fibroblast growth factor 23 as a predictor of left atrial appendage thrombosis in patients with nonvalvular atrial fibrillation and various risk of stroke

Aim. To study the role of fibroblast growth factor 23 (FGF-23) as a predictor of left atrial appendage (LAA) thrombosisin patients (pts) with non-valvular atrial fibrillation (AF) and different risk levels of thromboembolic complications (TEC) according to the CHA2DS2-VASc score.Methods. The study included 250 pts with non-valvular AF hospitalized for radiofrequency ablation, divided into 2 groups: group (gr.) 1 - with 0-1 points (n=79) and gr.2 - with ≥2 points on the CHA2DS2-VASc scale (n=171). According to the results of transesophageal echocardiography, pts of each group were divided into subgroups depending on the presence of LAA thrombosis, which was found in 19 pts of gr.1 and 72 of gr.2. Patients underwent transthoracic echocardiography, determination of blood biomarkers: NT-proBNP (pg/ml), GDF-15 (pg/ml), FGF-23 (pmol/l), highly sensitive C-reactive protein (mg/l), cystatin C (mg/l).Results. Pts with LAA thrombosis in both groups had in common: a longer history of arterial hypertension, a greater proportion of coronary artery disease and persistent AF, lower GFR, higher values of atrial volume indices, left ventricle myocardial mass, systolic pressure in the pulmonary artery, median NT-proBNP, FGF-23 and GDF-15. Logistic regression analysis performed separately in the groups revealed the same independent predictors of LAA thrombosis in both groups: LA volume index (LAVI) and the level of FGF-23 in the blood. At the same time, the threshold value of FGF-23, separating pts by the presence of LAA thrombosis, was higher in gr.1 (≥0.85 and ≥0.5 pmol/l, respectively), and the area under the AUC curve for FGF-23 in gr.1 was greater: 0.964 vs 0.865 in gr.2 (p=0.026).Conclusion. The serum level of FGF-23, along with the LAVI, is an independent predictor of LAA thrombosis in pts with AF and various risk of TEC according to CHA2DS2-VASc; the threshold level of FGF-23 for pts at low risk of TEC is significantly higher than for high risk pts, and allows more accurate prediction of the presence of LAA thrombosis.

Clinical phenotypes of patients with ischemic heart disease and borderline coronary artery stenoses

Background. Ischemic heart disease, despite ongoing therapeutic and preventive measures, remains the leading cause of disability and mortality in people of working age.
 Aim. Study of cardiovascular risk factors and assessment of the clinical and angiographic picture in patients with stable coronary heart disease and borderline coronary artery stenoses of various clinical phenotypes.
 Material and methods. 236 patients with functional class IIII stable angina pectoris aged 4959 years with borderline (4070%) coronary artery stenoses were examined. All patients underwent a general clinical examination, cardiac ultrasound and coronary angiography. The nonparametric MannWhitney U-test was used to compare indicators between groups. To compare binary and categorical indicators, Fisher's exact two-tailed test was used. Differences in the compared parameters were considered statistically significant at p 0.05.
 Results. The predominance of the following clinical phenotypes, which determined the further distribution into groups, was revealed: coronary heart disease without myocardial infarction the first group; coronary heart disease with myocardial infarction more than 6 months old the second group; coronary heart disease with a metabolically unhealthy phenotype of obesity without diabetes mellitus the third group, coronary heart disease with diabetes mellitus the fourth group. In the third and fourth groups, there was no significant difference in the frequency of myocardial infarction in the past, and patients in the third group with a history of myocardial infarction suffered it at the earliest age (44.3 [41; 50] years, p 0.01). Despite the presence of arterial hypertension in 97.5% of groups of patients with different phenotypes, the fourth group showed the highest values of the left ventricular myocardium mass index (240.6 [146.3; 286.3], p 0.01). In the same group, multivessel coronary artery lesions were more frequently recorded during angiographic examination in 25 patients (47.2 [33.4; 52.3]%, p 0.01).
 Conclusion. Despite the absence of obstructive coronary artery disease, patients with stable coronary heart disease and borderline coronary artery stenoses are at risk of cardiovascular complications due to the presence of arterial hypertension in the vast majority, a significant incidence of obesity, dyslipidemia, and carbohydrate metabolism disorders.

Features of hemodynamic and structural parameters of the heart in young people with varying stages of cardiometabolic risk

Background. Cardiometabolic diseases are one of the leading causes of disability and mortality worldwide, which justifies the relevance of studying their early manifestations.
 Aim. To analyze the hemodynamic and structural echocardiographic parameters of the heart in relation to cardiometabolic risk factors and its staging according to the Cardiometabolic Disease Staging (CMDS) scale in young patients.
 Material and methods. 109 patients were examined: 57 males (52.3%) and 52 females (47.7%) aged with a median of 36.1 [32.639.2] years without cardiometabolic diseases. The design of the study was a cross-sectional case-control study. The parameters of cardiometabolic risk were assessed with its calculation and assessment taking into account the stage according to the CMDS scale. Echocardiography was performed in M- and B-modes. The data were processed using the SPSS Statistics 23 program. The MannWhitney U test, the KruskalWallis test, and the Pearson and Fisher 2 tests were used. Correlation analysis according to Spearman was carried out.
 Results. The first stage of cardiometabolic risk was established in 17 examined patients (15.6%), the rest had stage 2 (n=57; 52.3%) or stage 3 (n=35; 32.1%) of cardiometabolic risk. Deviations from the normal values of hemodynamic echocardiographic parameters were not revealed. The frequency of increase in the index of relative thickness, the thickness of the posterior wall of the left ventricle, the interventricular septum thickness, the myocardium mass of the left ventricle did not differ (p=0.1980.983). A direct correlation between the left atrial, end-systolic and diastolic volumes, left ventricle wall thickness, and an inverse relationship between the left ventricular ejection fraction and cardiometabolic risk factors was established. At the 3rd stage of cardiometabolic risk, higher values of the left atrial volume (47 [4649] ml; p=0.005), end-systolic (30.42 [29.2332.04] ml; p=0.001) and diastolic (79 [7881] ml; p=0.003) volumes of the left ventricle and lower left ventricular ejection fraction (61 [60.3562.65] ml; p=0.004) than on the 1st and 2nd stages were diagnosed.
 Conclusion. An increase in the cardiometabolic risk is associated with an increase in preload and afterload on the left heart.

INCREASED SUPAR SERUM CONCENTRATIONS IN PATIENTS WITH LEFT AND RIGHT VENTRICULAR REMODELING DUE TO PRESSURE OVERLOAD IS ASSOCIATED WITH MYOCARDIAL MASS

<h3>Background</h3> Soluble urokinase plasminogen activator receptor (suPAR) is a novel biomarker, which has been investigated as a screening tool for risk stratification and to monitor therapeutic responses in various cardiovascular diseases.1 However, it has never been investigated whether suPAR plasma levels differ in left compared to right heart dysfunction. Therefore, we investigated suPAR in patients with right ventricular remodelling due to pressure overload resulting from chronic thromboembolic pulmonary hypertension (CTEPH) and compared it with suPAR in patients with left ventricular remodelling due to pressure-overload resulting from aortic valve stenosis (AS). In addition, we monitored the time course of suPAR after transcatheter- and surgical aortic valve replacement (TAVR) and (SAVR). <h3>Methods</h3> We analyzed blood samples of 78 CTEPH patients with pulmonary hypertension and 42 patients with left ventricular remodeling due to severe AS. Blood samples were drawn prior to pulmonary endarterectomy in CTEPH and prior to either SAVR or TAVR in patients with AS. Further, we investigated the therapeutic response of SAVR and TAVR 10 days and 3 months after surgery or intervention. ELISA testing of suPAR was performed according to manufacturers` instructions. <h3>Results</h3> Patients diagnosed with severe AS had significantly higher suPAR levels compared to patients with CTEPH and healthy volunteers [median 3.6 ng/ml (2.6, 7.3); p<0.05], [median 2.8 ng/ml (2.0, 3.9); p<0.05] and [median 1.5 ng/ml (1.0; 2.4); p<0.05] (Figure). Three months after TAVR, suPAR serum concentrations further increased compared to baseline levels prior to the intervention [median 4.7 (2.7; 8.5) to median 6.0 (3.9; 17.9); p<0.05]. In contrast, AS patients undergoing SAVR showed significantly decreased suPAR serum concentrations 10 days after surgery [median 3.3 ng/ml (2.5; 3.9) to median 2.3 ng/ml (2.0; 4.4); p<0.05]. <h3>Conclusion</h3> suPAR serum concentrations are more elevated in left compared to right heart pressure-overload and healthy volunteers, suggesting that suPAR is rather associated with myocardial mass than with pulmonary hypertension. The exact mechanisms leading to elevated suPAR levels in this context still have to be evaluated.

Feasibility of CT Angiography-derived Kinetic Energy of Coronary Flow to Improve the Detection of Hemodynamically Significant Coronary Stenosis.

To investigate whether coronary flow kinetic energy has incremental value over simulated fractional flow reserve (sFFR) in diagnosing hemodynamically significant stenosis assessed with coronary CT angiography and invasive fractional flow reserve (FFR). This single-center retrospective study included 113 patients (mean age, 68 years ± 9 [SD]; 80 men) who underwent coronary CT angiography showing intermediate stenosis (30%-70% stenosis) and subsequent invasive FFR between December 2015 and March 2020. Kinetic energy was calculated using proximal coronary diameter and myocardial mass of the stenotic region. A mesh-free simulation was performed to calculate the sFFR. Invasive FFR of 0.80 or less indicated hemodynamically significant stenosis. Models using diameter stenosis, kinetic energy, and sFFR were compared by analyzing the receiver operating characteristic curve. Of the 144 vessels evaluated, 53 vessels (37%) had hemodynamically significant stenosis. Kinetic energy of vessels with significant stenosis was higher than that of vessels with nonsignificant stenosis (79 mJ/kg [IQR, 58-104 mJ/kg] vs 36 mJ/kg [IQR, 23-59 mJ/kg]; P < .001). Multivariable analysis including diameter stenosis and sFFR showed that kinetic energy (per 20 mJ/kg; odds ratio, 1.92; 95% CI: 1.37, 2.95; P < .001) was a predictor of hemodynamically significant stenosis. Adding kinetic energy to diameter stenosis and sFFR improved the area under the receiver operating characteristic curve from 0.89 (95% CI: 0.84, 0.95) to 0.93 (95% CI: 0.89, 0.97) (P = .04). Kinetic energy had incremental value over sFFR in detecting hemodynamically significant stenosis assessed with invasive FFR.Keywords: Coronary CT Angiography, Coronary Arteries, Fractional Flow Reserve, Kinetic Energy, Cardiac Supplemental material is available for this article © RSNA, 2022.

Does the right ventricle size influence the left ventricle size and function in children with Ebstein anomaly?

Patients with Ebstein anomaly (EA) have a variety of clinical manifestation. The assessment of structural and geometric characteristics of the heart is important for optimal management. We retrospectively analyzed echocardiography database from 2009 to 2020. We evaluate patients in two groups: patients with EA were in Group 1 and children without cardiovascular pathology were in Group 2. All children in both groups underwent echocardiography according to American Society of Echocardiography recommendations. The shape of the heart chambers and their function were studied in both groups. There were 153 in Group 1 and 2000 children without cardiovascular disease in Group 2. It was shown that in children with EA, the shape of the ventricle became less spherical, which was accompanied by a decrease in myocardial mass, and the ejection fraction was reduced 34% of patients. The functional volume (non-atrialized part) of the right ventricle in patients with EA was reduced, and its contractility was preserved in 62% of cases. Preservation of the contractile properties of the right ventricle in most cases was associated with higher systolic pressure in its cavity. TAPSE, TESV, and the velocity of the annulus fibrous ring movement according to tissue dopplerography in patients with EA do not allow us to assess the contractility of the right ventricle. The myocardial performance index (MPI) characterizes a decrease in the functional volume of the right ventricle.

Ultrasonic Texture Features for Assessing Cardiac Remodeling and Dysfunction

BackgroundChanges in cardiac size, myocardial mass, cardiomyocyte appearance, and, ultimately, the function of the entire organ are interrelated features of cardiac remodeling that profoundly affect patient outcomes. ObjectivesThis study proposes that the application of radiomics for extracting cardiac ultrasonic textural features (ultrasomics) can aid rapid, automated assessment of left ventricular (LV) structure and function without requiring manual measurements. MethodsThis study developed machine-learning models using cardiac ultrasound images from 1,915 subjects in 3 clinical cohorts: 1) an expert-annotated cardiac point-of-care-ultrasound (POCUS) registry (n = 943, 80% training/testing and 20% internal validation); 2) a prospective POCUS cohort for external validation (n = 275); and 3) a prospective external validation on high-end ultrasound systems (n = 484). In a type 2 diabetes murine model, echocardiography of wild-type (n = 10) and Leptr−/− (n = 8) mice were assessed longitudinally at 3 and 25 weeks, and ultrasomics features were correlated with histopathological features of hypertrophy. ResultsThe ultrasomics model predicted LV remodeling in the POCUS and high-end ultrasound external validation studies (area under the curve: 0.78 [95% CI: 0.68-0.88] and 0.79 [95% CI: 0.73-0.86], respectively). Similarly, the ultrasomics model predicted LV remodeling was significantly associated with major adverse cardiovascular events in both cohorts (P < 0.0001 and P = 0.0008, respectively). Moreover, on multivariate analysis, the ultrasomics probability score was an independent echocardiographic predictor of major adverse cardiovascular events in the high-end ultrasound cohort (HR: 8.53; 95% CI: 4.75-32.1; P = 0.0003). In the murine model, cardiomyocyte hypertrophy positively correlated with 2 ultrasomics biomarkers (R2 = 0.57 and 0.52, Q < 0.05). ConclusionsCardiac ultrasomics-based biomarkers may aid development of machine-learning models that provide an expert-level assessment of LV structure and function.

Myocardial effects of a low-protein diet in experimental kidney dysfunction

THE AIM: to evaluate the effect of low protein diet supplemented with ketosteril on morphological and epigenomic changes in the myocardium of Wistar rats with simulated kidney dysfunction . MATERIALS AND METHODS. The work was performed on male Wistar rats subjected to 5/6 nephrectomy (NE). The first group after NE received a standard diet (20.16% animal protein ), the second – low protein diet (LPD), including 10% ketosteril . Control rats received a standard diet . After 4 months , blood pressure (BP) and left ventricular mass index (LVMI) were assessed in rats , and a histological examination of the myocardium was performed . In the myocardium , the relative expression levels of NF- kB , miRNA-21, miRNA-133, and miRNA-203 were determined . RESULTS. After 4 months in rats with NE on a standard diet , an increase in blood pressure , an increase in the mass index of the LV myocardium was recorded . MBD with the inclusion of 10% Ketosteril slowed down the growth of systolic blood pressure and the development of LV myocardial hypertrophy in rats with kidney dysfunction . At the histological level , the use of LPD provided a decrease in the degree of hypertrophy of cardiomyocytes and degenerative changes in cardiomyocytes . Animals treated with LPD had less pronounced diffuse and perivascular fibrosis compared with animals fed normal food . The use of MBD slowed down the increase in the relative level of expression of the NFκB gene and miRNA-21 in the myocardium of rats with NE and promoted an increase in the expression level of miRNA-133 and miRNA-203 compared to the indices of animals with NE that received standard food . CONCLUSION: long-term use of LPD with the use of ketoanalogues of essential amino acids can have a potential cardioprotective effect in CKD, slowing down the growth of blood pressure , an increase in LV myocardial mass and the formation of structural changes in the myocardium . It is possible that a decrease in the expression of NF- kB and miRNA-21, as well as an increase in the expression of miRNA-203 and 133 in the myocardium , can play a significant role in this .

Patterns of Left Ventricular Hypertrophy and Late Gadolinium Enhancement onCardiac Magnetic Resonanace in Patients with Hypertrophic Cardiomyopathy

Objective: To evaluate the patterns of left ventricular hypertrophy (LVH) and late gadolinium enhancement (LGE) inhypertrophic cardiomyopathy.&#x0D; Study Design: Analytical cross-Sectional Study.&#x0D; Place and Duration of Study: Tertiary Cardiac Care Center, Rawalpindi Pakistan from 01 June 2020 to 30 Dec 2021.&#x0D; Methodology: This study was carried out at a tertiary cardiac care center retrospectively from 1 June 2020 to 31 December 2021. Patients having LV hypertrophy due to aortic stenosis, hypertension, athlete’s heart, and infiltrative disorders were excluded from study. Cases were included using nonprobability consecutive sampling. Sample size estimated by taking 0.2- 0.5 % (1 in 200-500) prevalence of hypertrophic cardiomyopathy using open epi sample size calculator was (n=38) taking 99.99% confidence interval. For the purpose of study all patients with confirmed HCM undergoing CMR during given period were included in study.Approval from the ethical review committee with IERB (IERB letter # 9/2/R&amp;D/2022/179) was sought. CMR was performed using MRI 3 Tesla. Data analysis was done on SPSS version-26. Quantitative variables were expressed as Mean±SD. Qualitative variables were expressed as frequencies and percentages. ANOVA and student t-test (95% CI and 5% margin of error) was applied to compare the study variables. p-vale &lt;0.05 was considered statistically significant.&#x0D; Results: Majority 77(86.7%) of patients were males. Most common pattern of involvement for LV hypertrophy was asymmetrical septal hypertrophy in 47 (52.8%) followed by apical HCM in 29(32.6%). LVOT obstruction was observed in 30(33.7%) of patients. Mean maximum LV wall thickness was 22mm±5.47.&#x0D; Conclusion: Our study shows association, between the extent of Late Gadolinium Enhancement and LV wall thickness, myocardial mass index in HCM patients.

Adipokines and the cardiorespiratory system in young patients with type 1 diabetes mellitus

To assess the predictive value of adipokines in relation to a personalized approach to the need for an in-depth examination of young patients with T1DM. The study included 98 patients without CVD: 70 patients with T1DM (mean age 26.4±8.1 years) and 28 patients without DM (mean age 27±9 years). All patients underwent a general clinical examination, the levels of adipokines were determined, ergospirometry, echocardiography, and bioimpedancemetry were performed. Changes in the cardiorespiratory system in patients with T1DM were revealed, in comparison with persons without T1DM: anaerobic threshold was reached faster (p=0.001), maximum oxygen consumption was lower (p=0.048), metabolic equivalent was reduced (p=0.0001). Signs of myocardial remodeling were found in the T1DM group: there was an increase in the relative wall thickness (p=0.001), the posterior wall of the left ventricle (p=0.001), myocardial mass index (p=0.049), in comparison with persons without T1DM. Changes in the adipokines system were revealed: higher levels of resistin (p=0.002) and visfatin (p=0.001), lower level of adiponectin (p=0.040) in T1DM. A positive correlation was found between posterior wall of the left ventricle and visfatin (p=0.014) and a negative relationship between adiponectin and relative wall thickness (p=0.018) in T1DM. In T1DM, even at a young age, there are multifactorial changes in the heart, which can be detected even at the preclinical stage. The data obtained can be used to identify groups of patients at high risk of developing dangerous CVD in T1DM, which can form the basis for determining the timing of the start of preventive therapy.

The renal function in men with hypertension in conditions of purine and carbohydrate metabolism disorders

Aim. To assess the condition of renal function in hypertensive men in conditions of disorders of purine and carbohydrate metabolism Material and methods. 60 male patients (aged from 18 to 65 years) with stage I–II of arterial hypertension (AH) and purine and carbohydrate metabolism disorders were examined. In these patients, the level of uric acid (UA) in daily urine, fractional excretion of UA, creatinine in daily urine, microalbumin in urine and the cystatin C level were determined. Hemodynamics was studied by daily blood pressure monitoring. Assessment of kinetics and deformation of the myocardium in offline mode using the Xstrain software package integrated into the ultrasound device (Esaote, Italy) was made. Patients were divided into 2 clinical groups – 1 group of AH with hyperuricemia, 2 – AH without uricemia. Statistical analysis of the results was performed using the Statistica 13.0 software package (Statsoft, USA). Results. Correlation analysis in group 1 showed a positive correlation of cystatin C with the average daytime systolic blood pressure (SBP) (r = 0.408) and the variability of diastolic blood pressure (DBP) at night (r = 0.405), urinary microalbumin with the average SBP at night (r = 0.390) and average pulse blood pressure (r = 0.402), LV posterior wall thickness (r = 0.438), LV myocardial mass index (r = 0.621), end-diastolic index (EDI) (r = 0.492), end-systolic index (ESI) (r = 0.426), LV anterior-posterior size (r = 0.385). A negative correlation was established between blood serum SC and ejection fraction (EF) of the LV (r = -0.410), urinary microalbumin with cardiac index (SI) (r = -0.555) and the speed of movement of the lateral (e’ lat) part of the annulus fibrosus mitral valve (r = -0.453). Conclusions. As a result of the studies, the negative influence of hyperuricemia and hyperglycemia in patients with AH on renal function was established. These changes were evidenced by an increase in microalbuminuria level, a decrease in the fractional excretion of UA, an increasing the serum UA level, remodeling of the myocardium, and worsening of the heart systolic function, worsening of the daily blood pressure profile.