Measures Of Left Ventricular Function Research Articles

Impact of Diabetes and Hypertension on Left Ventricular Structure and Function: The Jackson Heart Study.

Background Diabetes and hypertension have been associated with adverse left ventricular (LV) remodeling. While they often occur concurrently, their individual effects are understudied. We aimed to assess the independent effects of diabetes and hypertension on LV remodeling in Black adults. Methods and Results TheJHS (Jackson Heart Study) participants (n=4143 Black adults) with echocardiographic measures from baseline exam were stratified into 4 groups: neither diabetes nor hypertension (n=1643), only diabetes (n=152), only hypertension (n=1669), or both diabetes and hypertension (n=679). Echocardiographic measures of LV structure and function among these groups were evaluated by multivariable regression adjusting for covariates. Mean age of the participants was 52±1 years, and 63.7% were women. LV mass index was not different in participants with only diabetes compared with participants with neither diabetes nor hypertension (P=0.8). LV mass index was 7.9% (6.0 g/m2) higher in participants with only hypertension and 10.8% (8.1 g/m2) higher in participants with both diabetes and hypertension compared with those with neither (P<0.001). LV wall thickness (relative, posterior, and septal) and brain natriuretic peptide levels in participants with only diabetes were not significantly higher than participants with neither (P>0.05). However, participants with both diabetes and hypertension demonstrated higher LV wall thickness and brain natriuretic peptide levels than participants with neither (P<0.05). Conclusions In this cross-sectional analysis, diabetes was not associated with altered LV structure or function in Black adults unless participants also had hypertension. Our findings suggest hypertension is the main contributor to cardiac structural and functional changes in Black adults with diabetes.

Cardiac dysfunction in mixed connective tissue disease: a nationwide observational study

We aimed to identify cardiac function in patients with established mixed connective tissue disease (MCTD). This was a cross-sectional case–control study of well-characterised MCTD patients who had previously been included in a nationwide cohort. Assessments comprised protocol transthoracic echocardiography, electrocardiogram and blood samples. In patients only, we evaluated the findings of high-resolution pulmonary computed tomography and disease activity. We assessed 77 MCTD patients (mean age 50.5 ± 12.3 years) with a mean disease duration of 16.4 years, and 59 age- and sex-matched healthy controls (49.9 ± 11.7 years). By echocardiography, measures of left ventricular function, i.e. fractional shortening (38.1 ± 6.4% vs. 42.3 ± 6.6%, p < 0.001), mitral annulus plane systolic excursion (MAPSE) (13.7 ± 2.1 mm vs. 15.3 ± 2.3 mm, p < 0.001) and early diastolic velocity of the mitral annulus (e’) (0.09 ± 0.02 m/s vs. 0.11 ± 0.03 m/s, p = 0.002) were subclinical and lower in patients than controls. Right ventricular dysfunction was found in patients assessed by tricuspid annular plane systolic excursion (TAPSE) (22.7 ± 4.0 mm vs. 25.5 ± 4.0 mm, p < 0.001). While cardiac dysfunction was not associated with pulmonary disease, e’ and TAPSE were found to correlate with disease activity at baseline. In this cohort of MCTD patients, echocardiographic examinations demonstrated a higher frequency of cardiac dysfunction than in matched controls. Cardiac dysfunction was associated with disease activity at baseline, but was independent of cardiovascular risk factors and pulmonary disease. Our study indicates that cardiac dysfunction is part of the multi-organ affliction seen in MCTD.

Noninvasive assessment of myocardial work during left ventricular isovolumic relaxation in patients with diastolic dysfunction

BackgroundThis study aims to investigate the value of myocardial work (MW) parameters during the isovolumic relaxation (IVR) period in patients with left ventricular diastolic dysfunction (LVDD).MethodsThis study prospectively recruited 448 patients with risks for LVDD and 95 healthy subjects. An additional 42 patients with invasive measurements of left ventricular (LV) diastolic function were prospectively included. The MW parameters during IVR were noninvasively measured using EchoPAC.ResultsThe total myocardial work during IVR (MWIVR), myocardial constructive work during IVR (MCWIVR), myocardial wasted work during IVR (MWWIVR), and myocardial work efficiency during IVR (MWEIVR) of these patients were 122.5 ± 60.1 mmHg%, 85.7 ± 47.8 mmHg%, 36.7 ± 30.6 mmHg%, and 69.4 ± 17.8%, respectively. The MW during IVR was significantly different between patients and healthy subjects. For patients, MWEIVR and MCWIVR were significantly correlated with the LV E/e’ ratio and left atrial volume index, MWEIVR exhibited a significant correlation with the maximal rate of decrease in LV pressure (dp/dt per min) and tau, and the MWEIVR corrected by IVRT also exhibited a significant correlation with tau.ConclusionsMW during IVR significantly changes in patients with risks for LVDD, and is correlated to LV conventional diastolic indices, including dp/dt min and tau. Noninvasive MW during IVR may be a promising tool to evaluate the LV diastolic function.

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

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

Association of Left Ventricular Systolic Function with Diagonal Branch Flow in Patients with First Anterior ST-Elevation Myocardial Infarction Treated with Primary Angioplasty

Background: There are few studies about the impact of diagonal branch blood flow on echocardiographic findings in patients with first acute anterior myocardial infarction undergoing primary angioplasty. Objectives: We aimed to compare left ventricular systolic function measures in patients with first acute anterior ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty based on diagonal branch blood flow after the procedure. Methods: This study was a single-center study that enrolled patients with their first acute anterior STEMI treated with primary angioplasty in our center between October 2020 and March 2021. Patients were divided into two groups: The patients with final thrombolysis in myocardial infarction (TIMI) flow III in diagonal (sufficient diagonal flow) and patients with final TIMI flow less than III in diagonal (insufficient diagonal flow) after the procedure. The left ventricular Wall-Motion Score Index (WMSI) and left ventricular ejection fraction (LVEF) were compared between the two groups. Results: A total of 107 patients with first anterior STEMI treated with primary PCI were enrolled in the present study, of which 13 patients (12.1%) had insufficient diagonal flow after primary coronary angioplasty. The LVEF was lower in patients with insufficient diagonal flow (32.92 ± 7.29% vs. 39 ± 8.68%, P = 0.018). Also, this group had higher LV WMSI (1.68 ± 0.28 vs. 1.49 ± 0.26, P = 0.029). Conclusions: The present study showed that in patients with first acute anterior STEMI undergoing primary angioplasty, insufficient diagonal branch flow after the procedure was associated with worse left ventricular systolic function and higher LV WMSI.

A graphical analysis of aspects contributing to the spreading of measurements of left ventricular function

The Simpson’s method is the standard technique to determine left ventricular (LV) ejection fraction (EF) on echocardiography. The large inter-observer variability of measuring LVEF is well documented but not fully understood. A graphical analysis was used to elaborate what contributes to the inter-observer difference. Forty-two cardiologists (32 male, 39 ± 7 years) evaluated the LVEF using the Simpson’s method on 15 different echocardiograms (2 and 4 chamber view (2CH/4CH)); the program did not show the result of EF to prevent a bias. End-diastolic (ED) and end-systolic (ES) frames were predefined ensuring measurement at the same time point of the cardiac cycles. After standardization of the LV contour, the differences of the individual contours compared to a reference contour were measured. Also, the spreading of lateral/medial mitral annulus contours and the apex were depicted. A significant spreading of LV-contours was seen with larger contours leading to higher EFs (p < 0.001). Experience did not influence the determination of LVEF. ED-volumes showed more spreading than ES-volumes ((3.6 mm (IQR: 2.6–4.0) vs. 3.4 mm (IQR: 2.8–3.8), p < 0.001). Also, the differences were larger for the 2CH compared to the 4CH (p < 0.001). Variability was significantly larger for lateral than septal wall (p < 0.001) as well as the anterior compared to the inferior wall (p < 0.001). There was a relevant scattering of the apex and medial/ lateral mitral annulus ring. There was a large variability of LV-volumes and LVEF as well as position of mitral valve ring and apex. There were global differences (apical 2CH or 4CH), regional aspects (LV walls) and temporal factors (ED vs. ES). Thus, multiple factors contributed to the large variability.Trial registration: The study was registered at “Netherlands Trial Register” (www.trialregister.nl; study number: NL5131).

JS-HR-3: HEART DISEASE-FOCUS ON LEFT ATRIUM STRUCTURE-

Investigating potential biological relationships between heart failure (HF) with preserved ejection fraction (HFpEF) and associated diseases has been the focus of much research to establish personalized therapies. Hypertension is the most common concomitant disease in HFpEF patients, but the functional links between HFpEF and hypertension are still not fully understood and effective therapeutic strategies are still lacking. The structure of the left atrium (LA) is important for the diagnosis of HFpEF. In the SPRINT sub-analysis, intensive blood pressure control was not associated with ECG-defined LA abnormalities. In the ARGO-SIIA project, LA volumes indexed by height2 were more sensitive to subclinical hypertensive organ damage than those indexed by body surface area (BSA) in females. In the ARIC study, minimal LA volume index, but not standard assessment by maximum LA volume index, was associated with increased risk of incident HF or death regardless of measures of left ventricular function and NT-proBNP. In this presentation, the latest findings regarding the structure of the LA are updated and summarized in relation to HFpEF.

Intrinsic Atrial Myopathy Precedes Left Ventricular Dysfunction and Predicts Atrial Fibrillation in Lamin A/C Cardiomyopathy.

In Lamin A/C (LMNA) cardiomyopathy, atrial fibrillation (AF) commonly occurs before dilated cardiomyopathy, and the ability to predict its incidence is limited. We hypothesized that left atrial (LA) echocardiographic phenotyping can identify atrial myopathy and harbingers of AF. Echocardiograms from patients with pathogenic or likely pathogenic variants in LMNA (n=77) with and without reduced left ventricular ejection fraction (LVEF, <50%) were compared to healthy individuals (n=70) and patients with Titin truncating variant cardiomyopathy (TTNtv) (n=35) with similar LVEF, sex, and age distributions. Echocardiographic analysis, blinded to genotype, included strain and volumetric measures of left ventricular and atrial function. The primary outcome was incident AF. At baseline, 43% of the patients with pathogenic or likely pathogenic LMNA variants had a history of AF, including 26% of those with LVEF ≥50%. Compared with healthy subjects, the patients with pathogenic or likely pathogenic LMNA variants and LVEF ≥50% had reduced LA contractile strain (LMNA, 11.8±6.1% versus control, 15.0±4.2%; P=0.003). Compared to LVEF-matched (TTNtv) patients, the patients with pathogenic or likely pathogenic LMNA variants and LVEF <50% displayed no difference in LA size, but a worse LA contractile dysfunction (6.4±4.7% versus 12.6±9.6%; P=0.02). Over a median follow-up of 2.8 (1.2-5.7) years, LA contractile strain was the only significant predictor of AF in multivariable Cox regression (hazard ratio, 4.0 [95% CI, 1.04-15.2]). LMNA cardiomyopathy is associated with early intrinsic atrial myopathy reflected by high AF prevalence and reduced LA contractile strain, even in the absence of LV dysfunction and LA dilation. Whether LA strain can be used as a monitoring strategy to detect and mitigate AF complications requires validation.

1082 LEFT VENTRICULAR FUNCTION ESTIMATION: WHEN VOLUMES MEASUREMENT IS NOT FEASIBLE

Abstract Background Contrast echocardiography is mainly performed for the assessment of global left ventricular (LV) function, left ventricular ejection fraction (LVEF) and stroke volume (SV) thanks to improved visualization of endocardial LV borders. Neverless in some patients estimation of ventricular volumes could be difficult also with contrast and assessment of LVEF can be really hard. The aim of the study was to find alternative methods for LV function evaluation independent from volume assessment. Methods Patients who underwent a contrast echocardiography between October 2015 and September 2022 were enrolled in the study. A complete transthoracic echocardiography was performed and Sonovue contrast was then injected. End-diastolic and end-systolic LV volume in apex 4 and 2 chamber views, were measured prior and after injecting contrast. Left ventricular outflow tract diameter (LVOTd) was measured and LVOT velocity time integral was traced in order to calculate LVOT VTI Stroke Volume (product of LVOT cross sectional area to the LVOT VTI). LVOT VTI SV obtained during traditional echocardiography was then compared to LV SV calculated as the difference between end-diastolic and end-systolic volume traced after contrast. After intravenous bolus injection of Sonovue pulmonary transit time (PTT) was recorded as contrast agent's transit time from right to left ventricle in apex 4 chamber view (seconds). PTT was then compared to measures of LV function: LVEF with and without Sonovue and LV SV with contrast. Results 149 patients were enrolled in the study, 86 had history of CAD, 31 presented dilatative cardiomyopathy, 5 hypertrophic cardiomyopathy (HMC), 113 had arterial hypertension, and 37 diabetes. Medium BMI was 28. The main indications for contrast echocardiography were measurement of EF and exclusion of thrombi in LV apex. LVOT VTI SV was calculated in 126 patients. In the same patients LVEF Stroke Volume was calculated. A strong correlation (P value &amp;lt; 0.0001) between LVOT VTI SV and LV SV was found (Figure 1). PPT was calculated in 74 patient and in the same patients LVEF with and without contrast (Figure 2) and LV SV were calculated. A strong correlation (P-value &amp;lt;0.048, p-value&amp;lt;0.006 and p-value &amp;lt; 0.046 respectively) was found. Conclusion This study demonstrates that, besides extremely poor acoustic windows, bedside echocardiography, with and without contrast, can be used to estimate LV function using volume-independent methods like PTT and LVOT VTI SV.

Detection of early cardiac disease manifestation in propionic acidemia - Results of a monocentric cross-sectional study.

In propionic acidemia (PA) myocardial involvement is common and includes development of cardiomyopathy, life-threatening acute heart failure, and acquired long-QT syndrome. We sought to investigate which echocardiographic parameters of left ventricular systolic and diastolic function indicate early cardiac disease manifestation in PA. This is a prospective observational study (cross-sectional design) in a Tertiary Medical Care Center. Individuals with confirmed PA were enrolled and the following cardiac investigations were performed in all study individuals: echocardiographic measurements of systolic and diastolic left ventricular (LV) function (LV fractional shortening (LV-FS), LV ejection fraction by biplane modified Simpson's (LV-EF), mitral annular plane systolic excursion (MAPSE), LV global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE), pulsed Doppler analyses of mitral valve (MV) inflow velocities (MV E/A) and MV deceleration time (DT-E), tissue doppler imaging (TDI) of the mitral annulus (MV E/e'), and LV myocardial performance index (LV-MPI). LV and left atrial (LA) diameters were assessed. 12‑lead electrocardiograms (ECG) were recorded and corrected QT intervals (QTc) calculated. Clinical phenotype and laboratory parameters at the time of cardiac investigation were assessed. Besides descriptive analyses we analyzed frequency, onset, and combinations of echocardiographic and ECG data as well as their correlations with clinical and biochemical findings. The effects of 'age at visit' and LV functional parameters on QTc were analyzed with multiple regression. A total of 18 patients with confirmed PA were enrolled. Median age at PA onset was 6 days (range 1-357 days). Median age at visit for cardiac evaluation was 13.1 years (range 0.6-28.1 years). LV-GLS was abnormal in 72.2%, LV-EF in 61.1%, MAPSE in 50%, MV E/e' in 44.4%, LV-MPI in 33.3%, LV-FS in 33.3%, and MV E/A in 27.8%. In cases with normal or near normal LV-FS, LV-GLS was pathological in 5/10, LV-EF in 4/10, and MAPSE in 3/10. The probability of developing LV dysfunction - systolic and diastolic - increases with age. LV-MPI is a reliable parameter to indicate systolic LV-dysfunction in combination with a dilated LV, i. e. dilated cardiomyopathy (DCM) in PA. Multiple regression reveals a significant positive association between LV diameters and QTc. Abnormal LV-GLS significantly correlates with reduced muscle strength, muscle tone and/or abnormal gross motor function. Our data suggests a high prevalence of cardiac disease manifestation in PA, considerably higher than in previous studies, where only LV-FS was used to assess LV function. Usage of advanced echocardiographic techniques, such as LV-GLS assessment, may allow for early detection of subtle LV dysfunction in PA, and may lead to timely cardiac treatment but also consideration of liver transplantation to prevent development of manifest cardiac complications.

Abstract 14398: Novel Cardiac Electrical Activation Parameter Associated With CRT Response

Introduction: Simultaneous assessment of cardiac electrical activation and left ventricular (LV) function could identify optimal cardiac resynchronization therapy (CRT) pacing strategies, leading to improved CRT response and outcomes. Hypothesis: Changes in three-dimensional (3D) cardiac electrical activation timing correlate with LV function. Methods: 3D cardiac electrical activation maps from the CardioInsight 252-electrode mapping vest (Medtronic) and cardiac ultrasound images were acquired during and 6 months after CRT defibrillator implantation. Maps were acquired for intrinsic electrical activation and three CRT pacing configurations: synchronized LV pacing, right ventricular (RV) pacing, and biventricular (BIV) pacing. Three novel electrical activation parameters were calculated: LV80, RV80, and BIV80, defined as the time at which 80% of the LV, RV, or both ventricles, respectively, were electrically activated. Results: In 30 CRT patients (65.6 ± 11.3 years old, 36.7% female, 43.3% with LV scar, 57% with left bundle branch block [LBBB], and 43% with right bundle branch block [RBBB]), simultaneous measurements of electrical activation and LV function were obtained. Figure panels A and B show representative plots of the proportion of the LV and RV activated versus time within the QRS for a patient with LBBB. In this patient, BIV pacing improved the LV80 but worsened the RV80 compared with the intrinsic rhythm, consistent with a discordant effect on ventricular function. Panel C shows that synchronized LV pacing has a more unfavorable effect on RV activation than BIV pacing in this patient. In the entire cohort, the BIV80 was significantly associated with the change in LVESVI six months after CRT (p&lt;0.05) (panel D). Conclusion: A novel measurement of 3D cardiac electrical activation demonstrates the effects of different CRT pacing strategies on LV and RV function and predicts LV functional improvement after CRT.

Abstract 15276: Polygenic Susceptibility to Dilated Cardiomyopathy Underlies Peripartum, Alcoholic, and Chemotherapy-Induced Cardiomyopathies

Introduction: Rare (monogenic) variants linked to dilated cardiomyopathy (DCM) are enriched among individuals with peripartum (PPCM), alcoholic (ACM), and chemotherapy-induced cardiomyopathies (CCM), but are present in &lt;15% of cases. Whether a common-variant (polygenic) susceptibility to DCM is also shared across these secondary cardiomyopathies is unknown. Methods: Cases of DCM, PPCM, ACM, and CCM were adjudicated using hospital billing codes only (in UK Biobank), or with additional chart reviews conducted by 2 medical doctors blinded to the genetic data (in Mass General Brigham [MGB] Biobank). A DCM polygenic score predicated on imaging-based measures of left ventricular structure and function was tested for association with each condition. In a subset of MGB Biobank participants with whole exome sequencing data, we determined the proportion of cases with a monogenic variant and/or a high (≥90 th percentile) polygenic score. Results: In MGB Biobank (n=30,837) and UK Biobank (n=304,687), 193 cases of PPCM (n=18), ACM (n=127) or CCM (n=48) were identified. A DCM polygenic score comprising 2.3 million common genetic variants associated comparably with DCM and all three secondary cardiomyopathies (meta-analyzed p&lt;0.001 for all) ( Figure ). Among chart-validated phenotypes in MGB Biobank, cases had higher median polygenic score percentiles than controls (Controls=50; DCM=68; PPCM=86; ACM=70; CCM=59), and a high polygenic score conferred 3.3-fold odds of any secondary cardiomyopathy (p&lt;0.001). In the whole exome sequencing subset (N=21,378; n=65 secondary cardiomyopathy cases), 9.2% of secondary cardiomyopathy cases harbored a monogenic variant, while 21.5% had a high polygenic score (including 1.5% who had both). Conclusion: Individuals with PPCM, ACM, and CCM are enriched for a high DCM polygenic score, further suggesting that these conditions arise from unique, extrinsic insults acting in the context of a common, underlying genetic susceptibility.

Abstract 15670: Clinical Relevance of a Polygenic Susceptibility to Dilated Cardiomyopathy

Introduction: Both rare and common genetic variants have been associated with dilated cardiomyopathy (DCM), but their contributions to DCM risk in the context of clinical factors remains unexplored. Methods: In the UK Biobank, we identified carriers of rare, monogenic variants of relevance to DCM (ClinGenLOF), and also computed a genome-wide, common-variant (polygenic) score (GPS) based on imaging-derived measures of left ventricular structure and function. We evaluated the contributions of ClinGenLOF status, the GPS, and clinical factors to incident DCM through measures of relative risk, phenotypic variance explained (i.e. population attributable fraction, PAF), and discrimination. Results: In 160,485 UK Biobank participants, mean age was 56.5 (SD 8.1), 89,888 (56%) were female, and 226 developed DCM during a median of 10.9 years of follow-up. ClinGenLOF carriers had the highest hazards of disease (HR=14.5, 95%CI: 9.43 to 22.11), followed by atrial fibrillation (HR=3.25, 95%CI:1.94 to 5.48), and chronic kidney disease (2.56 95%CI:0.81 to 8.12). In contrast, hypertension accounted for the greatest proportion of DCM risk in the population (PAF=23.2%) followed by having a high (&gt;80th percentile) polygenic score (PAF= 17.9%). On top of a reference model, improvements in discrimination were individually greatest with addition of ClinGenLOF status (delta C-index = 0.049) or the GPS (delta C-index = 0.031), comparable to the addition of all clinical factors combined (delta C-index = 0.032; Figure ). When added sequentially to a model inclusive of clinical factors, ClinGenLOF status (delta C-index = 0.046) and GPS (additional delta C-index = 0.021) further improved discrimination. Conclusions: Rare, monogenic variants, a polygenic score, and clinical factors all contribute substantially to risk of DCM. Considering cumulative genetic (monogenic and polygenic) risk on top of clinical factors improves the prediction of incident DCM in the general population.

Abstract 11706: Association of Left Atrial Function With Incident Chronic Kidney Disease: Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Echocardiographic measures of left ventricular (LV) structure and function are associated with incident chronic kidney disease (CKD). Reduced left atrial (LA) function is an emerging novel risk factor for cardiovascular disease but its association with incident CKD is unknown. Hypothesis: Lower LA function is independently associated with incident CKD in older adults in the ARIC study, a prospective community-based cohort. Methods: We included ARIC participants without prevalent CKD (as defined by eGFR&lt;60ml/min/1.73m 2 ) who underwent echocardiographic exam at visit 5 (2011-13). LA function measures included LA reservoir strain, contractile strain, and conduit strain. Incident CKD was defined as a composite outcome of &gt;25% decline to eGFR &lt;60 mL/min/1.73m 2 , hospitalization with CKD diagnosis, or incident end-stage kidney disease through 2017. Cox proportional hazards model was used. Results: Among the 3,970 participants (mean [SD] age, 75 [5] years; 58% women; 20.9% Black individuals), 382 cases of incident CKD were ascertained over a median follow-up of 5.5 years. Lower LA reservoir and contractile strain were significantly associated with higher risk of CKD (HR [95% CI] lowest vs highest quintile: 2.76 [1.91-3.98], and 2.56 [1.79-3.65], respectively) (Table). The associations remained significant after accounting for other major echocardiographic parameters (model 2) including left atrial volume index (model 3). LA conduit strain was not significantly associated with CKD. Conclusions: Lower LA function is significantly associated with incident CKD, independent of CKD risk factors, LV size and function, and LA size. These findings indicate that impaired LA function is a novel predictor marker for CKD.

Indicators of haemodynamic instability and left ventricular function in a porcine model of esmolol induced negative inotropy

To investigate if the Hypotension Prediction Index was an early indicator of haemodynamic instability in a negative inotropy porcine model, and to assess the correlation of commonly measured indicators of left ventricular systolic function. Eight anaesthetised pigs were volume resuscitated and then underwent an incremental infusion of esmolol hydrochloride (0-3000 mg/hr), following which it was then reduced in a stepwise manner. Full haemodynamic measurements were taken at each stage and measurements of left ventricular systolic function including left ventricular stroke work index, ejection fraction and peripheral dP/dT were obtained. At an infusion rate of 500 mg/hr of esmolol there were no significant changes in any measured variables. At 1000 mg/hr MAP was on average 11 mmHg lower (95% CI 1 to 11 mmHg, p = 0.027) with a mean of 78 mmHg, HPI increased by 33 units (95% CI 4 to 62, p = 0.026) with a mean value of 63. No other parameters showed significant change from baseline values. Subsequent increases in esmolol showed changes in all parameters except SVV, SVR and PA mean. Correlation between dP/dt and LVSWI was 0.85 (95% CI 0.77 to 0.90, p < 0.001), between LVEF and dP/dt 0.39 (95% CI 0.18 to 0.57, p < 0.001), and between LSWI and LVEF 0.41 (95% CI 0.20 to 0.59, p < 0.001). In this model haemodynamic instability induced by negative inotropy was detected by the HPI algorithm prior to any clinically significant change in commonly measured variables. In addition, the peripheral measure of left ventricular contractility dP/dt correlates well with more established measurements of LV systolic function.

Real-time, single breath-hold, multi-slice, 2D cine radial MR image reconstruction using sc-GROG k-t ESPIRiT

Background: Multi-slice, multiple breath-hold ECG-gated 2D cine MRI is a standard technique for evaluating heart function and restricted to one or two images per breath-hold. Therefore, the standard cine MRI requires long scan time and can result in slice-misalignments because of various breath-hold locations in the multiple acquisitions. Methods: This work proposes the sc-GROG based k-t ESPIRiT with Total Variation (TV) constraint (sc-GROG k-t ESPIRiT) to reconstruct unaliased cardiac real-time cine MR images from highly accelerated whole heart multi-slice, single breath-hold, real-time 2D cine radial data acquired using the balanced steady-state free precession (trueFISP) sequence in 8 patients. The proposed method quality is assessed via Artifact Power (AP), Root-Mean Square Error (RMSE), Structure Similarity Index (SSIM), Peak Signal-to-Noise Ratio (PSNR), blood-pool to myocardial Contrast-to-Noise-Ratio (CNR), Signal-to-Noise-Ratio (SNR) and spatial-temporal intensity plots through the blood-myocardium boundary. The proposed method quantitative results are compared with the NUFFT based k-t ESPIRiT with Total Variation (TV) constraint (NUFFT k-t ESPIRiT) approach. Furthermore, clinical analysis and function quantification are assessed by Bland–Altman (BA) analyses. Results: As supported by the visual assessment and evaluation parameters, the reconstruction results of the sc-GROG k-t ESPIRiT approach provide an average 21%, 12%, 1% and 47% improvement in AP, RMSE, SSIM and PSNR, respectively in comparison to the NUFFT k-t ESPIRiT approach. Furthermore, the proposed method gives on average 45% and 58% improved blood-pool to myocardial CNR and SNR than the NUFFT k-t ESPIRiT approach. Also, from the BA plot, the proposed method gives better left ventricular and right ventricular function measurements as compared to the NUFFT k-t ESPIRiT scheme. Conclusions: The sc-GROG k-t ESPIRiT (Proposed Method) improves the spatio-temporal quality of the whole heart multi-slice, single breath-hold, real-time 2D cine radial MR and semi-automated analysis using standard clinical software, as compared to the NUFFT k-t ESPIRiT approach.

Echocardiographic evaluation of left ventricular function using an automated analysis algorithm is feasible for beginners and experts: comparison with invasive and non-invasive methods

AimsEchocardiographic measurement of left ventricular function using a user-friendly automated three-dimensional algorithm is highly attractive as it promises quick and accurate diagnosis, circumventing limitations associated with visual estimation or manual biplane measurements. We sought to assess the feasibility and correlation of such automated analysis with clinically established methods.MethodsA total of 198 patients undergoing transthoracic echocardiography (TTE) with assessment of left ventricular parameters by automated software algorithm (Philips 3D-Heartmodel; 3D-HM) which additionally had either left ventricular angiography (LVA) or cardiac magnetic resonance (CMR) within 24 h of the TTE examination were analyzed. Left ventricular parameters (left ventricular end-diastolic volume, LVEDV, left ventricular end-systolic volume, LVESV as well as left ventricular ejection fraction, LVEF) were compared between 3D-HM, CMR and LVA.ResultsCorrelation of left ventricular measurements was overall good to excellent and stronger for CMR (EF r = 0.824) than for LVA (EF r = 0.746). Unexperienced and expert clinicians yielded comparable good results. For CMR, highest correlation was detected in patients with BMI < 25 and excellent image quality. High agreement was seen between 3D-HM and CMR or LVA when stratifying patients according to heart failure categories.ConclusionsEchocardiographic quantification of left ventricular parameters using a software-based algorithm correlated well with established invasive and non-invasive modalities in the clinical setting, even for unexperienced clinicians. Such automated approaches are promising as they allow a reliable, more observer-independent as well as reproducible assessment of left ventricular function.

Relationship between QRS duration on ECG and Left Ventricular Systolic Function by Echocardiography in patients with Non-ST elevated Myocardial Infarction

Background: Early risk stratification of patients with myocardial infarction is critical to determine optimum treatment strategies and enhance outcomes. The present study was therefore undertaken to determine the relationship between QRS duration (QRSd) on admission ECG and left ventricular ejection fraction (LVEF) as a measure of left ventricular function in non-ST elevated myocardial infarction (NSTEMI) patients. Methods: This observational study was carried out from January to December 2020 with total of 120 patients with a history of NSTEMI. Based on the cut-off value of QRS duration 100 msec, the patients were divided into two groups – one group with QRS duration d” 100 msec (normal QRS) and another group with QRS duration &gt; 100 msec (prolonged QRS). Left ventricular systolic function was considered preserved, if it was e” 52% and reduced if it was &lt; 52%. The association and correlation between QRS duration and LVEF was then observed. Results: The prevalence of reduced LVEF in patients with prolonged QRS duration (&gt; 100 msec) was double (38%) than that of preserved (19.5%). The risk of having LV dysfunction in patients with prolonged QRS duration was 2.5 (95% CI = 1.1 – 6.2) times higher than that in patients normal QRS duration (d” 100 msec) (p = 0.039). The QRS duration and LVEF bear a significantly inverse relationship (r = -0.341, p &lt; 0.001). The sensitivity of prolonged QRS duration (&gt; 100 msec) in correctly detecting LV dysfunction was inappreciably low (38%), although its specificity in excluding those who did not have LV dysfunction was optimum (80.5%) with overall diagnostic accuracy being 52.5%. Conclusion: Prolonged QRS duration on a standard 12-lead ECG is associated with reduced echocardiographic LVEF. However, QRS duration in predicting LV dysfunction is much less sensitive, although its specificity is optimum indicating that QRS duration is not a good predictor of LV dysfunction (reduced LVEF), but it can dependably predict those who do not have LV dysfunction (preserved LVEF). Cardiovasc j 2022; 15(1): 36-41

Prevalence of Wolff-Parkinson-White syndrome, association with congenital heart disease, and natural history in newborns

Abstract Background Wolff-Parkinson-White (WPW) syndrome is characterized by an accessory electrical pathway between the atria and ventricles. Clinically, the condition can lead to supraventricular tachycardia, and is associated with sudden cardiac death and congenital heart disease. Studies investigating the prevalence, associated structural cardiac abnormalities, and natural history in newborns are few. Purpose To determine the prevalence of WPW syndrome in newborns, describe electrocardiographic and echocardiographic characteristics, and the natural history in childhood. Methods Electrocardiograms (ECGs) and echocardiograms of newborns (aged 0–30 days) from a large, prospective, general population study were included. WPW cases were identified through manual evaluation of outliers in PR-interval, QRS-duration, and QRS axis. Newborns with suspected or confirmed pre-excitation on their initial ECG were offered a cardiac follow-up. Localization of the accessory pathway was assessed utilizing a QRS polarity algorithm. Cases were matched 1:4 to controls by age, sex, weight and gestational age. Results Among the 17,489 ECGs we identified 17 (76% boys) newborns with definite WPW syndrome consistent with a prevalence of 0.1%. At follow-up (available in 12/17 children) at a mean age of three years, the WPW pattern remained in three children while the ECG had normalized in the nine remaining children. The median values for the newborns' heart rate, PR-interval, QRS-duration, QTc(Bazett), the maximum amplitude in R-V1 and S-V6 in cases and controls were 131 vs. 142 beats per minute, 80 vs. 96 ms, 74 vs. 56 ms, 449 vs. 420 ms, 1,562 vs. 1,028 μV and 546 vs. 693 μV, respectively (all p&amp;lt;0.05, Figure 1). The newborns' QRS axis, max amplitude in S-V1 and R-V6 did not differ among cases and controls (all p&amp;gt;0.05). Echocardiographic measurements of the newborns' left ventricular diameter and function, wall thicknesses, and doppler measurements of trans-mitral- and main pulmonary artery blood flow did not differ significantly between cases and controls (all p&amp;gt;0.05). The accessory electrical pathway was left-sided in 14 (82%) of the newborns. One newborn had significant mitral regurgitation while all other newborns had structurally normal hearts; there were no cases of Ebstein's anomaly. Conclusion The prevalence of WPW syndrome in our cohort of asymptomatic newborns was 0.1%. The syndrome was more frequent in boys, the accessory pathway was mostly left-sided, and was associated with changes in several ECG parameters, but generally not associated with structural heart disease. A striking observation was, that the WPW pattern in the majority of children could not be reproduced on follow-up ECGs at a mean age of three years, suggesting either that the ECG pattern is intermittent, or normalization occurs. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

The prognostic significance of the echocardiographic evaluation of left ventricular myocardial deformation indices at peak cardiopulmonary exercise in patients with severe dilated cardiomyopathy

Abstract Background Cardiopulmonary exercise testing (CPET) integrally estimates exercise capacity (peak VO2) and cardiovascular (CV) prognosis (VE/VCO2 slope) in patients with dilated cardiomyopathy (DCM). Myocardial deformation indices (MDI), measured by speckle tracking imaging (STI), allow reliable measurements of left ventricular (LV) function. Little is known about the exercise-induced changes of the multidimensional mechanical properties of the heart and their impact in patient's survival. We aimed to investigate the predictive role regarding 3-year survival of LV MDI (at rest and peak exercise) as well as the main CPET parameters (peak VO2, VE/VCO2 slope) in DCM patients with reduced ejection fraction (EF) using as primary combined end-point the heart transplantation and all cause death. Patients and methods We evaluated LV function using STI at rest and at peak exercise during the same CPET session in 53 DCM patients (54±12 years, 76% males, ejection fraction 33±9%).We measured global longitudinal strain (GLS), longitudinal strain rate at systole (LSRS) and diastole (LSRD) at baseline and at peak CPET along with CPET parameters. After a period of 38±15 months, all DCM patients were evaluated by a telephone interview. Results From the whole population, totally 7 patients (13%) reached the primary end-point (Group A) as 2 patients were submitted to heart transplantation and 5 patients died (60±13 years, 86% males, EF = 28±9%) while 46 patients remained alive at 3-year follow-up (Group B, 53±12 years, 74% males, EF = 33±9%). We found that Group A patients had similar age, sex and EF but reduced peak VO2 (p=0.04) and increased VE/VCO2 slope (p=0.004), impaired GLS at baseline and peak exercise (p=0.02 and p=0.04, respectively) as well as LSRS at peak exercise (p=0.05) compared to Group B patients. Conclusions The evaluation of GLS (rest and peak exercise) and LSRS (peak exercise) as systolic indices of LV myocardial deformation adds valuable information regarding CV prognosis in patients with severe idiopathic DCM. A combined baseline work-up protocol consisted of MDI evaluation at rest and exercise plus the CPET indices may characterize the true severity of heart failure in a DCM population. Funding Acknowledgement Type of funding sources: None.