Systolic Mitral Annular Velocity Research Articles

Changes of cardiac structure and function in pregnant women with different types of hypertensive disorders in pregnancy and their influencing factors

Objective: To analyze the changes in cardiac structure and function in women with different types of hypertensive disorders in pregnancy (HDP) and explore their influencing factors. Methods: A total of 1 967 pregnant women diagnosed with HDP who delivered at Peking University Third Hospital from January 1, 2014 to April 15, 2022 were included in the study. They were categorized into four groups based on specific HDP diagnoses: gestational hypertension (506 cases, 25.7%), pre-eclampsia (589 cases, 29.9%), pregnancy complicated with chronic hypertension (332 cases, 16.9%) and chronic hypertension with pre-eclampsia (540 cases, 27.5%). Differences in cardiac structure and function among four groups were retrospectively analyzed. Cardiac structure indicators included left atrial diameter (LAD), left atrial area (LAA), right atrial area (RAA), left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), systolic function indicators included left ventricular ejection fraction (LVEF), lateral systolic mitral annular velocity (Sm), diastolic function indicators included peak early diastolic mitral in flow velocity (E)/peak late diastolic mitral in flow velocity (A), and E/peak early diastolic myocardial velocity of the lateral mitral annulus early diastolic velocity (Em). Influencing factors on cardiac structure and function were analyzed using generalized linear regression. Influencing factors were assessed by generalized linear regression. Results: (1) General clinical data: the differences in age, gestational week at delivery, blood pressure, proportion of diabetes, and length of hospital stay were statistically significant among four different HDP types (all P<0.05). (2) Compared with pregnant women with pregnancy complicated with chronic hypertension, pre-eclampsia, and gestational hypertension, those with chronic hypertension with pre-eclampsia had larger LAD, LAA, RAA and LVEDD (all P<0.001), thicker IVST and LVPWT (all P<0.001), and reduced left ventricular diastolic function (E/A, lateral Em, E/Em) and systolic function (lateral Sm; all P<0.001). Pregnant women with gestational hypertension had the least changes in cardiac structure and function. Compared with pregnant women with pre-eclampsia, those with pregnancy complicated with chronic hypertension had smaller RAA (P<0.001) and lower E/A (P<0.001), with no significant difference in other indicators (all P>0.05). (3) Chronic hypertension with pre-eclampsia, pregnancy complicated with chronic hypertension, and pre-eclampsia were associated with larger LAD, LAA, and LVEDD, and lower lateral Em (all P<0.05). Conclusions: Different types of HDP are associated with distinct changes in cardiac structure and function. Chronic hypertension with pre-eclampsia demonstrates the most pronounced alterations, followed by pre-eclampsia and pregnancy complicated with chronic hypertension, and gestational hypertension showed the least changes.

A pilot study of the proarrhythmic effects of pimobendan injection in clinically healthy cats.

Pimobendan is not currently approved for use in cats, although its usefulness in feline hypertrophic cardiomyopathy has been suggested. Reports indicate an increase in arrhythmic events following oral administration to healthy cats. Given the greater potency of intravenous administration compared to oral intake, it is conceivable that the incidence of arrhythmias may be increased following pimobendan injection. Therefore, this study aimed to investigate the proarrhythmic effects of pimobendan injection in cats. Five clinically healthy cats underwent physical examination, echocardiography, blood pressure measurements, and 24-hour Holter electrocardiography immediately before and after receiving pimobendan as an intravenous bolus dose of 0.15mg/kg twice daily for 3 days. Additionally, a 24-hour Holter electrocardiography recording was conducted on the third day of pimobendan or placebo IV administration to assess heart rate, arrhythmias, and heart rate variability. Following pimobendan administration, there was a significant increase in total 24-hour heart rate. Echocardiography revealed a significant increase in mitral valve annulus systolic velocity (S') on the ventricular septal wall side, indicative of enhanced contractility. Only one cat exhibited paroxysmal ventricular tachycardia and an increase in the frequency of arrhythmic events. Conversely, in the remaining cats, a decreasing trend in the number of arrhythmias was observed. These findings indicate that intravenous administration of pimobendan may not be implicated in the onset of arrhythmias. Nevertheless, further research is warranted to explore the effects of intravenous pimobendan administration in cats with myocardial disease.

The association between myocardial early systolic lengthening and high risk angiographic territory involvement in patients with non-ST-segment elevation myocardial infarction.

Non-ST-segment elevation myocardial infarction (NSTEMI) is more common than ST-segment elevation myocardial infarction (STEMI), consisting of 60-70% of myocardial infarctions. When left ventricular (LV) pressure increases during early systole, regionally ischaemic myocardium with a reduced active force exhibit stretching. The aim of this study was to evaluate the role of this parameter in determining high risk angiographic territory involvement in NSTEMI patients. This study was a descriptive correlational research that was conducted on 96 patients with NSTEMI and a left ventricular ejection fraction ≥ 50% who underwent coronary angiography (CAG). Patients were divided into two groups based on having or not having high risk angiographic territory involvement in CAG. All patients underwent a transthoracic echocardiography during the first day of hospitalization and early systolic lengthening (ESL), duration of ESL (DESL), left ventricular global longitudinal strain (LVGLS), pulsed-wave Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were determined. The results of this study showed DESL, DESLLAD, and DESLLCX were longer in high risk angiographic territory group than other one (P value 0.016, 0.044, and 0.04, respectively). The logistic regression analysis showed among different variables, only age and ESLLAD had an independent association with high risk angiographic territory involvement (P = 0.01, odds ratio [OR] 1.09, 95% CI 1.021-1.164, and P = 0.024, odds ratio [OR] 1.243, 95% CI 1.029-1.50, respectively). Assessment of myocardial ESLLAD by speckle-tracking echocardiography may be helpful in predicting high risk angiographic territory involvement in patients with NSTEMI. Indeed, a higher value can be considered as a high risk parameter which may show benefit of an early invasive strategy versus a conservative approach.

A pilot study for risk stratification of ventricular tachyarrhythmia in hypertrophic cardiomyopathy with routine echocardiography parameters

Ventricular tachyarrhythmia (VTA) are frequent arrhythmias in patients with hypertrophic cardiomyopathy (HCM). Representing a major risk factor for sudden cardiac death, Holter ECG at first clinical presentation appears insufficient. This study aims to investigate the ability of routinely obtained parameters associated with myocardial remodeling in stratifying for VTA in HCM. In this monocentric analysis, patients with HCM underwent 12-channel electrocardiography and echocardiography, including tissue doppler imaging. The study’s primary endpoint was the documentation of non-sustained and sustained ventricular tachycardia—summarized as ventricular tachyarrhythmias (VTA) on Holter ECG or active devices. The occurrence of VTA was exploratory. Based on our collective, we developed a risk model regarding VTA. Of 140 HCM patients, 38 (27.1%) had an episode of VTA. Patients with VTA were likelier to have a history of atrial fibrillation (p < 0.001), a thicker interventricular septum (p < 0.001) and lower peak systolic mitral annular velocity (p < 0.001). The parameters were independently associated with endpoint in univariate and multivariate logistic regression. We created a logistic equation and calculated a cut-off value. The resulting ROC curve revealed a discriminative ability with AUC of 0.80 (sensitivity, 63%; specificity, 88%). Our risk model including these widely available parameters is able to distinguish low and high-risk of VTA in patients with HCM.

The correlation between epicardial fat thickness and longitudinal left atrial reservoir strain in patients with type 2 diabetes mellitus and controls

BackgroundDiabetes mellitus (DM) has been documented among the strongest risk factors for developing heart failure with preserved ejection fraction (HFpEF). The earliest imaging changes in patients with DM are the left atrial (LA) functional and volumetric changes. The aim of this study was to determine the correlation between epicardial fat thickness (EFT) and longitudinal LA reservoir strain (LARS) in patients with type 2 DM (T2DM), as compared with non-diabetic controls.ResultsThe study samples in this case-control study comprised of consecutive patients with T2DM (n=64) and matched non-diabetic controls (n=30). An echocardiography was performed on all patients and EFT, volumetric and longitudinal LARS, left ventricular (LV) global longitudinal strain (LVGLS), pulsed-wave Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e′) and peak systolic (s') velocities were obtained. The study results demonstrated that the patients with T2DM had thicker EFT (5.96±2.13 vs. 4.10±3.11 mm) and increased LA volume index (LAVI) (43.05± 44.40 vs. 29.10±11.34 ml/m2) in comparison with the non-diabetic ones (p-value: 0.005 and 0.022, respectively). On the other hand, a direct association was observed between EFT and the E/e′ ratio, and an inverse correlation was established between EFT and LARS in patients with T2DM (r=0.299, p-value=0.020 and r=− 0.256, p-value=0.043, respectively). However, regression analysis showed only LV mass index (LVMI) (β=0.012, 95% CI 0.006–0.019, p-value<0.001), LAVI (β=− 0.034, 95% CI − 0.05–0.017, p-value<0.001), and EFT (β=− 0.143, 95% CI − 0.264–− 0.021, p-value=0.021) were independently correlated with LARS.ConclusionsLARS is considered as an important early marker of subclinical cardiac dysfunction. Thickened epicardial fat may be an independent risk factor for decreased LA reservoir strain. Diabetics are especially considered as a high risk group due to having an increased epicardial adipose tissue thickness.

Vasoactive use in early goal-directed therapy in dogs with severe sepsis and septic shock

The goal of this study was to see how to evaluate the changes in macrovascularand microvascular parameters in survivors (Sv) and non-survivors (non-Sv) dogs with severe sepsis and septic shock (SEVS &amp;amp; SEPS) in response to goal-directed hemodynamic optimization at the intensive care unit (ICU), and to evaluate norepinephrine (NE) and dobutamine (DT) ICU applications, and their effectiveness for predicting death. Thirty-five dogs with SEVS &amp;amp; SEPS were used. NE was given to 10 hypotensive dogs, despite receiving a single bolus of fluid therapy, at a constant infusion rate of 1.5 µg/kg/min for 2 h. The rate of NE infusion was doubled (3.0 µg/kg/min) if the clinical response was insufficient after 2 hours. DT was administered to 5 dogs with left ventricular systolic dysfunction (LVSD) (LVS’&amp;lt;7.5 cm/s) at a constant infusion rate of 5 µg/kg/min for 2 h. The Sv and non-Sv groups had no major differences in macrovascular and microvascular characteristics, PW-TDI septal mitral annulus systolic (S') and early diastolic (E') velocities, or DT applications. The only difference was the use of NE applications. non-Sv received a greater amount of NE, while Sv received a smaller amount of NE. In contrast, more Sv received a greater amount of DT applications. Total mortality rate was 25.7%. In conclusion, the effects of DT and NE in dogs with SEVS &amp;amp; SEPS are limited. To provide evidence-based guidelines for dogs with SEVS &amp;amp; SEPS, more research is needed.

Evaluation of left ventricular systolic function by tissue motion annular displacement of the mitral valve derived by speckle-tracking echocardiography in patients with coronary artery disease

ABSTRACT Objectives: Evaluation of the left ventricular systolic function using tissue motion annular displacement of mitral valve derived by speckle - tracking echocardiography and the correlation between mitral valve annular displacement and echocardiographic parameters for left ventricular systolic function in patients with coronary artery disease. Methods: Descriptive cross - sectional study on 106 patients with coronary artery disease and 106 controls, at Hue University of Medicine and Pharmacy Hospital, from 3/2019 - 10/2021. The study population meet all inclusion criteria according to research objectives. Mitral valve annular displacement derived by speckle - tracking echocardiography was acquired and analyzed offline with QLAB 13. Results: Median age was 66.09 ± 13.25 years and 66.7% was woman. Mitral valve annular displacement derived by speckle - tracking echocardiography in patients with coronary artery disease decreased statistically significant when comparing to control group (p &lt; 0.01). This index which was strongly correlated not only with left ventricular ejection fraction on 2D (r = 0.706) but also with peak mitral annular systolic velocity (S’ velocity) by tissue Doppler (r = 0.882). It was a favorable correlation with maximum mitral annular systolic displacement on M - mode (r = 0.419), but was not correlated with the location, degree, and number of coronary stenosis. Conclusions: Tissue motion annular displacement of the mitral valve derived by speckle - tracking echocardiography is a simple, rapid and endothelium - independent parameter that supports the left ventricular ejection fraction parameter in the evaluation of left ventricular systolic function when poor endocardial visualization.

Assessment of left ventricular systolic function by mitral annular displacement derived from speckle tracking echocardiography in patients with ischemic heart disease

Aims: Evaluation of left ventricular systolic function by mitral annular displacement derived from speckle tracking echocardiography in ischemic heart disease and investigate the relationship and correlation between the mitral annulus displacement and echocardiographic parameters to evaluate left ventricular systolic function, New York Heart Association (NYHA) classification. Methods: Cross-sectional descriptive study on 106 patients with ischemic heart disease examined and treated at Hospital of Hue Medical University and 106 controls who were health check-ups or inpatients without cardiovascular disease at Hospital of Hue Medical University from March 2019 to October 2021, meeting the criteria for selecting patients according to research objectives. Mitral annular displacement derived from speckle tracking echocardiography was measured in 2-chamber and 4-chamber views from the apex using Qlab 13 offline software. Results: Mean age is 66.09 ± 13.25 years old, male/female: 1.3. Mitral annular displacement derived by speckle tracking echocardiography in patients with coronary artery stenosis was significantly lower than in the control group (p &lt; 0.01). Mitral annular displacement derived by speckle tracking echocardiography has a strong positive correlation with left ventricular ejection fraction on 2D echocardiography (r = 0.82), and has a very strong positive correlation with the peak systolic mitral annular velocity on tissue Doppler (r = 0.88), moderately positive correlation with mitral annular plane systolic excursion on M-mode (r = 0.37). There is a statistically significant relationship between mitral annular displacement derived from speckle tracking echocardiography and New York Heart Association (NYHA) classification (p &lt; 0.05). Conclusions: Mitral annular displacement derived by speckle tracking echocardiography is a simple, rapid, endothelium-independent parameter and may be used in the assessment of left ventricle systolic function. Especially, for patients with difficulty to identify endothelium to evaluate EF. Key words: left ventricular systolic, mitral annular, Doppler.

Combination of SVI/S' and diagnostic scores for heart failure with preserved ejection fraction.

The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains a challenge. There are three methods proposed as diagnostic tools. H2 FPEF score was determined by six weighted clinical characteristics and echocardiographic variables. Heart Failure Association (HFA)-PEFF algorithm consists of various functional and morphological variables as well as natriuretic peptides. SVI/S' is a novel echocardiographic parameter calculated by stroke volume index and mitral annulus systolic peak velocity. This study aimed to compare the three approaches in patients with suspected HFpEF. Patients referred to right heart catheterization for suspected HFpEF were classified into low-, intermediate- and high-likelihood groups according to H2 FPEF or HFA-PEFF scores. A diagnosis of HFpEF was confirmed by pulmonary capillary wedge pressure (PCWP) of ≥15 mm Hg according to the guidelines. In result, a total of 128 patients were included. Of these, 71 patients with PCWP ≥15 mm Hg and 57 patients with PCWP <15 mm Hg. Moderate correlations were observed between H2 FPEF score, HFA-PEFF score, SVI/S' and PCWP. The area under curve of SVI/S' was 0.82 for diagnosis of HFpEF, compared with 0.67 for H2 FPEF score and 0.75 for HFA-PEFF score by receiver-operating characteristics analysis. Combining SVI/S' with diagnostic scores showed higher Youden index and accuracy than each score alone. Kaplan-Meier analysis reported that the high-likelihood group showed poorer outcomes regardless the method used for diagnosis. Among the contemporary tools for identifying HFpEF in this study, the combination of SVI/S' with risk scores showed best diagnostic ability. Each of the strategies can determine rehospitalisation because of heart failure.

RESPIRATORY VARIABILITY OF VALVULAR PEAK SYSTOLIC VELOCITY AS A NEW INDICATOR OF FLUID RESPONSIVENESS IN PATIENTS WITH SEPTIC SHOCK.

Objective: The aim of this study was to evaluate the reliability and feasibility of pulse Doppler measurements of peak velocity respiratory variability of mitral and tricuspid valve rings during systole as new dynamic indicators of fluid responsiveness in patients with septic shock. Methods: Transthoracic echocardiography (TTE) was performed to measure the respiratory variability of aortic velocity-time integral (∆VTI), respiratory variability of tricuspid annulus systolic peak velocity (∆RVS), respiratory variability of mitral annulus systolic peak velocity (∆LVS), and other related indicators. Fluid responsiveness was defined as a 10% increase in cardiac output after fluid expansion, assessed by TTE. Results: A total of 33 patients with septic shock were enrolled in this study. First, there was no significant difference in the population characteristics between the fluid responsiveness positive group (n = 17) and the fluid responsiveness negative group (n = 16) ( P > 0.05). Second, Pearson correlation test showed that ∆RVS, ∆LVS, and TAPSE with the relative increase in cardiac output after fluid expansion ( R = 0.55, P = 0.001; R = 0.40, P = 0.02; R = 0.36, P = 0.041). Third, multiple logistic regression analysis demonstrated that ∆RVS, ∆LVS, and TAPSE were significantly correlated with fluid responsiveness in patients with septic shock. Fourth, receiver operating characteristic (ROC) curve analysis revealed that ∆VTI, ∆LVS, ∆RVS, and TAPSE had good predictive ability for fluid responsiveness in patients with septic shock. The area under the curve (AUC) of ∆VTI, ∆LVS, ∆RVS, and TAPSE for predicting fluid responsiveness was 0.952, 0.802, 0.822, and 0.713, respectively. The sensitivity (Se) values were 1.00, 0.73, 0.81, and 0.83, whereas the specificity (Sp) values were 0.84, 0.91, 0.76, and 0.67, respectively. The optimal thresholds were 0.128, 0.129, 0.130, and 13.9 mm, respectively. Conclusion: Tissue Doppler ultrasound evaluation of respiratory variability of mitral and tricuspid annular peak systolic velocity could be a feasible and reliable method for the simple assessment of fluid responsiveness in patients with septic shock.

Using Mitral Annular Plane Systolic Excursion (MAPSE) and Tissue Doppler Imaging Systolic Velocity (TDIS’) As Surrogates of Left Ventricular Systolic Function

Purpose: Echocardiography has become a useful method for assessing structural diseases of the heart. MAPSE and TDI S’ have also been shown to be reproducible assessments of longitudinal heart changes as LVEF is ineffective in cases of sub-optimal echocardiographic imagery caused by artefacts or air trapping.&#x0D; Methodology: One hundred patients referred for echocardiography at the cardiac laboratory of DELSUTH, Oghara, Nigeria was recruited for the study. All patients had trans-thoracic echocardiography done with M-Mode, 2D and Spectral Doppler and Tissue Doppler echocardiographic images acquired. Data obtained was analyzed using IBM-SPSS version 22. A p-value of ≤0.05 was considered significant for all comparisons.&#x0D; Findings: Hypertension was the commonest indication for an echocardiogram. The prevalence of abnormal left ventricular function was 13%, 24% and 28% as determined using LVEF, TDI S’ and MAPSE. MAPSE had a higher specificity than TDI S’ with statistically significant correlations found between TDI S’ (p&lt;0.001); MAPSE (p=0.032) and LVEF. Multiple linear and binomial logistic regression analysis showed significant relationships (beta=0.423; p &lt;0.001) and odd ratios [OR(CI) = 10.80(2.56- 49.07)] respectively between TDI S’ and LVEF.&#x0D; Unique Contribution to Theory, Policy and Practice: MAPSE’s specificity allows for diagnosis of longitudinal heart functional changes even in cases where the LVEF may be within normal limits. A combination of both MAPSE and TDI S’ offer a greater prognostic significance. The correlation between MAPSE and TDI S’ were good. Thus, MAPSE and TDI S’ can serve as surrogates for LVEF in assessing left ventricular systolic function and prognosticating cardiac disease

The association between tissue doppler-derived E/(e′s′) ratio and coronary atherosclerosis severity measured by the SYNTAX score in patients with non-ST elevation-acute coronary syndrome

BackgroundThe prognosis of patients hospitalized with non-ST elevation-acute coronary syndrome (NSTE-ACS) is typically determined by the existence and severity of myocardial necrosis and left ventricular (LV) remodeling.AimThe present study was to assess the association between the E/(e′s′) ratio and the coronary atherosclerosis severity, measured by the SYNTAX score, in patients with NSTE-ACS.MethodsUtilizing a descriptive correlational research design, this study was prospectively conducted on 252 patients with NSTE-ACS, undergoing an echocardiography to determine the left ventricular ejection fraction (LVEF), the left atrial (LA) volume, the pulsed-wave (PW) Doppler-derived transmitral early (E) and late (A) diastolic velocities, and the tissue Doppler (TD)-derived mitral annular early diastolic (e′) and peak systolic (s′) velocities. After that, a coronary angiography (CAG) was performed, and the SYNTAX score was calculated.ResultsThe patients were divided into two groups, viz., those with the E/(e′s′) ratio < 1.63 and the cases with the ratio ≥ 1.63. The results revealed that the patients with a high ratio were older, had a higher prevalence of females, a SYNTAX score ≥ 22, and a lower glomerular filtration rate than those with a low ratio (p-value < 0.001). Besides, these patients had larger indexed LA volume and lower LVEF than others (p-value: 0.028 and 0.023, respectively). Furthermore, the multiple linear regression outcomes established a positive independent association between the E/(e′s′) ratio ≥ 1.63 (B = 5.609, 95% CI 2.324–8.894, p-value = 0.001) and the SYNTAX score.ConclusionThe study results demonstrated that the patients hospitalized with NSTE-ACS and the E/(e′s′) ratio ≥ 1.63 had worse demographic, echocardiographic, and laboratory profiles and a higher prevalence of a SYNTAX score ≥ 22 than those with a lower ratio.

The Association Between Postsystolic Index and SYNTAX Score in Hospitalized Patients With Non-ST-Elevation Acute Coronary Syndrome

Objective: Non-ST-elevation acute coronary syndrome (NSTE-ACS) is a heterogeneous disorder including subgroups with a low or high risk for myocardial ischemia. The presence of postsystolic index (PSI) is associated with myocardial ischemia. The focus of this study was to find probable association between PSI and severity of coronary artery disease (CAD) in a cohort of patients. Materials and Methods: This was a cross-sectional study that consisted of 83 patients with unstable angina, non-ST-segment myocardial infarction (UA/NSTEMI), and a left ventricular ejection fraction ≥50%, without visible regional wall motion abnormalities. All patients underwent echocardiography, and global longitudinal strain (GLS), PSI, and mitral annular peak systolic (s′) and early diastolic (e′) velocities were measured. Coronary angiography was then performed, and a SYNTAX score was calculated. Results: The patient cohort was divided into two groups based on their high and low SYNTAX scores. PSI and GLS were higher in those patients with a higher SYNTAX score than in individuals with a lower score (85.04% ± 67.02% vs 46.67 ± 39.03, P = .001 and −16.09 ± 3.70 vs −17.99 ± 2.87, P = .012, respectively). Among the different variables assessed, only PSI was an independent predictor of a high SYNTAX score ( B = 1.014, 95% confidence interval [CI]: 1.001–1.027, P = .034). Conclusion: This cohort study demonstrated that a cumulative PSI may be predictive of much more complex and extensive CAD, especially in patients with UA/NSTEMI.

Complementary Value of Tissue Doppler Imaging in Dobutamine Stress Echocardiography: A Prospective Cohort Study

Introduction: In patients with Coronary Artery Diseases (CAD), the presence of viable myocardium predicts the recovery of Left Ventricular (LV) systolic function after revascularisation. The identification of myocardial viability during dobutamine stress echocardiography is subjective and with observer bias. Tissue Doppler Imaging (TDI) echocardiography has opened new possibilities for non-invasive quantification of myocardial function by directly interrogating myocardial velocity with high temporal and spatial resolution. Aim: To determine the baseline regional myocardial and mitral annular Maximum Systolic Velocities (MSV) in patients with LV dysfunction and to compare the MSV values in viable and nonviable myocardium. Materials and Methods: In this prospective Cohort study, TDI of regional and annular LV myocardial velocities was performed at the baseline (at rest) in 352 patients with CAD and LV dysfunction who were referred for Dobutamine stress Echocardiography. Viability assessment by 2 Dimensional (2D) methods was done simultaneously using routine Dobutamine stress protocol. Patients were grouped in two groups based on the presence or absence of viability with 2D stress echocardiography. TDI velocities were compared in the two groups of patients with and without myocardial viability. Measurements of regional wall thickness, Ejection Fraction(EF) and Wall Motion Score Index (WMSI) were done to assess the regional and global LV function in these patients. Those patients who underwent revascularisation were subsequently assessed for functional recovery by 2D and TDI echocardiography before discharge from the hospital. Analyses were conducted using Statistical Package for Social Sciences(SPSS) version 16.0. Results: Among 352 patients studied (124 females and 228 males), mean age 58 years (range 36 to 75 years). A total of 243 patients (69%) with viable myocardium as per 2D echocardiography had higher cut-off Baseline Regional Maximum Systolic Velocity (BRMSV) &gt;0.03 m/s and baseline mitral annular systolic velocity &gt;0.06 m/s with high sensitivity and specificity compared to patients with severe contractile dysfunction and non-viable myocardium. Conclusion: Tissue doppler parameters like regional myocardial systolic and mitral annular velocities have shown significantly higher cut-off values in those patients with ischaemic and viable myocardium compared to non-viable myocardium.

1179: NOVEL ECHOCARDIOGRAPHIC PHENOTYPES FOR ASSESSMENT OF SYSTOLIC FUNCTION IN PATIENTS WITH SEPSIS

Introduction: LVEF in often influenced by loading conditions compared to mitral annular peak systolic velocity (MASV). Therefore, the clinical utility of LVEF under varying physiologic states especially in septic shock patients is unclear. We plan to identify distinct echocardiographic phenotypes using systolic wave (s’) obtained with Tissue Doppler Imaging (TDI) to assess left ventricle (LV) systolic function. Methods: We conducted a retrospective study between 2011 – 2020 of all adult patients admitted to the medical intensive care unit (MICU) with sepsis and septic shock that underwent a transthoracic echocardiogram (TTE) within 72 hours of admission. We excluded any patient without LVEF or mitral annular peak systolic velocity (MASV) measurements. Patients were divided into 4 novel phenotypes based on their LVEF and average MASV (α, β, γ, and δ). α = LVEF ≥ 55% & MASV average ≥ 8.5 cm/sec, β = LVEF ≥ 55% & MASV average < 8.5 cm/sec, γ = LVEF < 55% & MASV average ≥ 8. 5 cm/sec and finally δ = LVEF < 55 & MASV average < 8.5 cm/sec. The primary outcome was to identify the derived phenotype (α, β, γ, and δ) frequency and its association with in-hospital mortality. Results: Total of 3120 patients were admitted with sepsis or septic shock during the study period, of which 2481 met the inclusion criteria. Of the 4 derived phenotypes, the α phenotype was the most common (n =1,063; 43%) and included patients with lowest median age 43 (34 - 51) and had more liver dysfunction (n= 231, 22%); β phenotype (n = 599; 24%) had older patients 51 (42 - 60) and more chronic illness (Diabetes and chronic obstructive pulmonary disease); in the γ phenotype (n = 266; 11%), patients had the highest acute physiology score 73 (53 - 95); and in the δ phenotype (n = 593; 24%), patients had highest Mitral E/e′ ratio (12.6) and lowest TAPSE measurement (1.6). The ICU mortality was 28% for the α phenotype; 36% for the β phenotype; 29% for the γ phenotype; and 35% for the δ phenotype. Conclusions: In this analysis of systolic function among patients with sepsis, β (LVEF ≥ 55% & MASV < 8.5 cm/sec) and δ (LVEF < 55 & MASV < 8.5 cm/sec) phenotypes were associated with higher mortality. Further research is needed to establish the utility of these distinct LV systolic function phenotypes in outcomes of patient with sepsis and septic shock.

Echocardiographic Findings in Hemodialysis Patients in a Tertiary Care Hospital

Objective: To find out the echo abnormalities in a south Asian cohort on maintenance hemodialysis in a tertiary care hospital. &#x0D; Study Design: Descriptive cross-sectional study.&#x0D; Place and Duration of Study: Combined Military Hospital Abbottabad, from Feb 2022 to Apr 2022.&#x0D; Methodology: 57 adult patients on maintenance hemodialysis had a non-contrast transthoracic echocardiographic study recording parameters of left and right ventricular systolic and diastolic function.&#x0D; Results: We had 57 patients. 71.9% (n=41) were male, and females 28.1% (n=16), diabetics 47.4 % (n=27), hypertensives 84.2%(n=48), smoking 28.1% (n=16); 15.8%(n=9) had some form of ischemic heart disease. Left ventricular hypertrophy was noted in 78.9% (n=45) of the entire patient population. 84% (n=48) of hypertensive patients had LVH. Overall, 82% (n=47) of hypertensive patients had some degree of diastolic dysfunction compared to non-hypertensive patients (p&lt;0.0001). Diastolic dysfunction of Grades I, II, III was seen in 35.1%(n=20), 29.8%(n=17), 17.5% (n=10). Mean E/e' ratio was 24.9±15, with 40.3%(n=23) having a value ≥15. The LV systolic dysfunction noted was: Mild 26.3%(n=15), Moderate 19.3%(n=11), Severe 1.8%(n=1). For the medial mitral annular systolic velocity(s’) 19.3%(n=11) had normal s’, while 80.7%(n=46) had reduced s’.The mean Pulmonary artery acceleration time (PA-AT) was was &lt;100 ms in 68.4%(n=39). The mean tricuspid plane systolic excursion (TAPSE) was &lt; 17 mm in 19.3%(n=11) of patients indicating RV systolic dysfunction. The Minimum PASP was 16, max 64, mean 41.5±14mm Hg.&#x0D; Conclusion: In our study of CKD patients on regular hemodialysis, we found high rates of LVH, DD, LV systolic dysfunction,RV systolic function, and pulmonary hypertension. This creates a case for a larger scale study of these patients in a south Asian cohort as well as institution of a screening program in CKD patients on hemodialysis.

The role of conventional echocardiographic parameters on detecting subclinical anthracycline therapy related cardiac dysfunction-The SATRACD study.

Subclinical anthracycline therapy related cardiac dysfunction (ATRCD) can be detected with speckle tracking echocardiographic image (STE), which is not widely available in Uganda. We aimed to investigate the role of the two conventional echocardiographic parameters [mitral annular plane systolic excursion (MAPSE) and mitral annular peak systolic tissue Doppler velocity (S')] on diagnosing subclinical ATRCD. 207 cancer patients who underwent anthracycline based chemotherapy were recruited at baseline and followed up until 6 months after ending anthracycline therapy. Comprehensive echocardiographic data were collected at each visit. Global longitudinal strain (GLS) by STE was used as the gold standard diagnostic test to define the case of subclinical ATRCD. Data of the 200 patients who had no evidence of clinical ATRCD were analyzed. One hundred and seventy-two (86.0%) were female, with a median age of 42 years and 47 (23.5%) patients were diagnosed with subclinical ATRCD at the end of anthracycline therapy by GLS criteria. The area under the curve (AUC), cutoff point, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of reduction of MAPSE (ΔMAPSE) were 0.6736 (95% CI: 0.5885, 0.7587), ≥ 2 mm, 74.5% (95% CI: 59.7%, 86.1%), 54.9% (95% CI: 46.7%, 63.0%), 33.7% (95% CI: 24.7%, 43.6%), and 87.5% (95% CI: 79.2%, 93.4%). The AUC, cutoff point, sensitivity, specificity, PPV, and NPV of reduction of S' (ΔS') were 0.6018 (95% CI: 0.5084, 0.6953), ≥ 0.5 cm/s, 61.7% (95% CI: 46.4%, 75.5%), 52.7% (95% CI: 44.4%, 60.9%), 29.0% (95% CI: 20.4%, 38.9%), and 76.1% (95% CI: 72.4%, 88.6%). When ΔMAPSE and ΔS' are used as parallel test, the net sensitivity and specificity is 89.4% and 28.8%, respectively, the net PPV and NPV is 27.8% and 90.0%, respectively. The ΔMAPSE and ΔS' showed fairly good accuracy, sensitivity and NPV to detect subclinical ATRCD in Ugandan cancer patients. These conventional echocardiographic parameters may serve as screening tools for detecting subclinical ATRCD in resource limited settings.

Abstract 12827: The Prognostic Value of Peak Mitral Annulus Systolic Velocity in Relation to Incident Heart Failure in the General Population - The Copenhagen City Heart Study

Introduction: Peak mitral annulus systolic velocity (s’) measured by color tissue Doppler echocardiography can be used to evaluate longitudinal systolic function of the left ventricle (LV). The prognostic value of s’ has previously been documented in patients with ischemic heart disease and heart failure (HF). We sought to investigate the prognostic value of s’ in association with incident HF in the general population with low cardiovascular risk. Methods: This prospective cohort consists of participants from the 5th Copenhagen City Heart Study. All participants had echocardiography performed. Exclusion criteria were prevalent HF, prevalent atrial fibrillation and inadequate image quality for s’ assessment. Multivariable Cox regression models adjusted for; sex, age, smoking-status, diabetes, ischemic heart disease, hypertension, heart rate, left atrial volume index and E/e’, were used to assess the association between s’ and HF. Results: Of 4,110 participants included (mean age 56 years ± 17.4 year, 56.8% female), 90 (2.2%) developed HF during a median follow-up of 5.4 years, [IQR: 4.4-6.3]. The mean s’ was 6.05 cm/s ± 1.2. Following multivariable adjustment, decreasing s’ remained significantly associated with HF (HR 1.60 (95% CI: 1.24; 2.07 p&lt;0.001) per 1 cm/s decrease) (Figure). An optimal cut-off value for s’ was calculated to be 5.9 cm/s. Participants with s’ below this cut-off had a 3-fold increased risk of HF (HR 3.15 (95% CI: 1.97; 5.03 p&lt;0.001). In participants with s’ ≥ 5.9 cm/s, the incidence rate of HF was 2.1 per 1000 person-years (95% CI: 1.39; 3.09) and 6.5 per 1000 person-years (95% CI: 5.13; 8.31) when s’ &lt; 5.9 cm/s. The cut-off value had a sensitivity of 73.3% (95% CI: 63; 82.1), a specificity of 54.0 (95% CI: 52.4; 55.6), and a negative predictive value of 98.9% (95% CI: 98.4; 99.3). Conclusion: In the general population, s’ is an independent prognosticator for the development of HF. Figure. The assocation between s’ and HF.

The comparison of mitral annular plane systolic excursion (MAPSE) and mitral annular systolic velocity (Sm) in determining subclinical left ventricular systolic dysfunction in patients with type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (T2DM) is an independent factor in increasing the risk of heart failure in the absence of coronary heart disease and hypertension. Global longitudinal strain (GLS) as the gold standard in determining subclinical left ventricular (LV) systolic dysfunction is not available on all echocardiographic tools and requires good-quality images. Mitral annular plane systolic excursion (MAPSE) and mitral annular peak systolic velocity (Sm) are simpler, faster, and widely available method that can determine left ventricular systolic dysfunction regardless of image quality. Methods: This study involved 72 asymptomatic T2DM patients, divided into two groups, patients with subclinical left ventricular systolic dysfunction (GLS &gt;-18%) and normal systolic function (GLS ≤-18%). GLS was obtained from the mean of 18 left ventricular segments on the apical 4-chamber, 3-chamber and 2-chamber images. MAPSE was obtained on the septal and lateral sides of the mitral annulus using M-mode on apical 4-chamber view, while Sm was obtained using tissue doppler imaging (TDI). Results: The study included 72 asymptomatic T2DM patients, 34 samples (47.2%) were found with subclinical LV systolic dysfunction. According to receiver operating characteristic (ROC) curve analysis, lateral TDI Sm had the highest area under the curve (AUC), it was 0.85, followed by average TDI Sm was 0.83 and average MAPSE was 0.81. The cut-off value of average TDI Sm &lt;7.425 cm/s had the best sensitivity and specificity, 82.4% and 81.6%, while cut-off value of average MAPSE &lt;13.4 mm had sensitivity of 76.5% and specificity of 73.7%. Conclusion: TDI Sm had better accuracy than MAPSE in determining subclinical LV systolic dysfunction in T2DM patients. However, both of them can be used as alternative diagnostic methods of GLS.

The role of conventional echocardiographic parameters on detecting subclinical anthracycline therapy related cardiac dysfunction

Abstract Background Subclinical anthracycline therapy related cardiac dysfunction (ATRCD) can be detected with speckle tracking echocardiographic image (STE), which is not widely available in Uganda. We aimed to investigate the accuracy, sensitivity and specificity of the two conventional echocardiographic parameters (reduction of mitral annular plane systolic exertion (MAPSE) and reduction of mitral annular peak systolic tissue Doppler velocity (s')) on diagnosing subclinical ATRCD. Method and results 207 cancer patients who underwent anthracycline based chemo therapy were recruited at baseline and followed up until 6 months after ending anthracycline therapy. Comprehensive echocardiographic data were collected at each visits. Global longitudinal strain (GLS) by STE was used as the gold standard diagnostic test to define the case of subclinical ATRCD. Data of the 200 patients who had no evidence of clinical ATRCD were analyzed. 172 (86.0%) were female, with a median age of 42 years and cumulative incidence of ATRCD at the end of anthracycline therapy was 23.5% by GLS criteria. The AUC, cutpoint, sensitivity, specificity, PPV and NPV of reduction of MAPSE were 0.6736 (95% CI: 0.5885, 0.7587), ≥2 mm, 74.47% (95% CI: 59.65%, 86.06%), 54.90% (95% CI: 46.66%, 62.95%), 33.70% (95% CI: 24.68%, 43.58%) and 87.50%% (95% CI: 79.18%, 93.37%). The AUC, cutpoint, sensitivity, specificity, PPV and NPV of reduction of S' were 0.6018 (95% CI: 0.5084, 0.6953), ≥0.5 mm/s, 61.70% (95% CI: 46.38%, 75.49%), 52.67% (95% CI: 44.36%, 60.87%), 29.00% (95% CI: 20.36%, 38.93%) and 76.14%% (95% CI: 72.27%, 88.62%). Conclusion The reduction of MAPSE and S' demonstrated fairly good accuracy, sensitivity and negative predictive value to detect subclinical ATRCD in Ugandan cancer patients. These conventional echocardiographic parameters may serve as screening tools for detecting subclinical ATRCD in resource limited settings. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): NURTURE Research Training and Mentoring Program for Career Development of Faculty at MakerereUniversity College of Health Sciences, Uganda supported by the Office Of The Director, National Institutes of Health, National Institute of Dental and Craniofacial Research, National Institute Of Neurological.