Mitral Inflow Velocity Research Articles

Left ventricular myocardial performance index in prehypertensive patients with normal coronary arteries.

Prehypertension, which may be the precursor of hypertension, is an important public health problem in the community. Myocardial performance index (MPI) is a noninvasive Doppler measurement of global ventricular function. Thus, our aim was to evaluate left ventricule (LV) functions with the MPI in prehypertensive patients with normal coronary artery angiography. Forty prehypertensive patients (21 women and 19 men), with blood pressures between 120/80 and 139/89 mmHg, and 40 normotensive controls (18 women and 22 men), with blood pressures under 120/80 mmHg, were included in the study. Patient population comprised those who underwent coronary angiography because of typical angina and had normal coronary arteries. The MPI was calculated and compared between the two groups. No statistically significant differences were found between the two groups in terms of age, sex, or other demographic characteristics (P>0.05). Moreover, LV ejection fraction, late diastolic flow, deceleration time, isovolumetric contraction time, and ejection time values were not significantly different between the two groups (P>0.05). However, early diastolic mitral inflow velocity, E/A ratio, isovolumetric relaxation, and MPI were all significantly higher in the patient group than in the control group. The MPI was increased in prehypertensive patients. This result demonstrates that LV diastolic and systolic functions may be negatively affected in patients with prehypertension. The advantages of our method are as follows: it is simple, it does not demand special equipment, and it is not time consuming.

Determining Nt-proBNP Levels with Diastolic Dysfunction in Thalassemia Major Patients.

Beta thalassemia is an autosomal, recessive disorder, characterized by ineffective erythropoiesis. Chronic transfusions and inability of body to eliminate iron lead to an iron overload, thereby causing damage to heart. Natriuretic peptides (NPs) are produced within the heart, which are then released into the circulation in response to ventricular wall stress. We, therefore, aimed to study the relation between ventricular dysfunction and N-terminal pro-B-type natriuretic peptides (NT-proBNPs). We enrolled 105 patients with increased serum ferritin levels and echocardiography was performed. We collected blood samples and NT-proBNP levels were measured in them. Though we found that the studied group had no significant difference in the mean serum NT-proBNP levels, in patients with or without hypertrophy ( n = 37, p = 0.992), the NT-proBNP levels were found to be significantly increased in patients with diastolic dysfunction ( n = 24, p < 0.0001 with mean values of 577.67 ± 122.01 and 456.50 ± 48.40 pg/mL in patients with and without diastolic dysfunction, respectively). The NT-proBNP levels correlated well with the echocardiography indices, such as left ventricular end-systolic diameter (LVESD), ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/E' ratio), and ratio of the early (E) to late (A) ventricular filling velocities (E/A ratio), and were found to have significant positive correlation with the serum ferritin levels. The NT-proBNP levels correlated significantly with diastolic dysfunction; thus, serum ferritin levels could be useful for assessing the diastolic dysfunction in patients with beta thalassemia.

Prolonged QRS duration on surface electrocardiogram is associated with left ventricular restrictive filling pattern.

BackgroundProlonged QRS duration is associated with decreased left ventricular (LV) systolic function. However, the relation between LV restrictive filling pattern (RFP) and QRS duration has not been investigated yet. The purpose of our study was to assess this relationship.MethodsWe analyzed standard 12-lead surface electrocardiogram (ECG) of 155 consecutive patients. Mitral inflow and septal tissue velocities were obtained using the apical 4-chamber view with pulsed Doppler echocardiography. Patients were divided into 2 groups according to measured deceleration time (DT): restrictive (with DT ≤130 ms) or non-restrictive (with DT >130 ms).ResultsQRS duration was significantly longer in the restrictive group than in the non-restrictive group (0.101 vs. 0.090 s, p < 0.0001). QRS duration of >0.10 s was highly specific (82.6%), but modestly sensitive (64.7%), for the prediction of LV RFP. Multivariate analyses demonstrated that E/A ratio, peak E, peak A, septal e’, and a’ velocities were significantly associated with RFP. ConclusionsProlonged QRS duration (>0.10 s) obtained from a standard resting 12-lead ECG is associated with LV RFP. However, the relationship of QRS duration with RFP was not independent of echocardiographic parameters.

Adenosine A2A receptor agonist prevents cardiac remodeling and dysfunction in spontaneously hypertensive male rats after myocardial infarction.

BackgroundThis work evaluated the hypothesis that 3,4-methylenedioxybenzoyl-2-thienylhydrazone (LASSBio-294), an agonist of adenosine A2A receptor, could be beneficial for preventing cardiac dysfunction due to hypertension associated with myocardial infarction (MI).MethodsMale spontaneously hypertensive rats (SHR) were randomly divided into four groups (six animals per group): sham-operation (SHR-Sham), and myocardial infarction rats (SHR-MI) were treated orally either with vehicle or LASSBio-294 (10 and 20 mg.kg−1.d−1) for 4 weeks. Echocardiography and in vivo hemodynamic parameters measured left ventricle (LV) structure and function. Exercise tolerance was evaluated using a treadmill test. Cardiac remodeling was accessed by LV collagen deposition and tumor necrosis factor α expression.ResultsEarly mitral inflow velocity was significantly reduced in the SHR-MI group, and there was significant recovery in a dose-dependent manner after treatment with LASSBio-294. Exercise intolerance observed in the SHR-MI group was prevented by 10 mg.kg−1.d−1 of LASS-Bio-294, and exercise tolerance exceeded that of the SHR-Sham group at 20 mg.kg−1.d−1. LV end-diastolic pressure increased after MI, and this was prevented by 10 and 20 mg.kg−1.d−1 of LASSBio-294. Sarcoplasmic reticulum Ca2+ ATPase levels were restored in a dose-dependent manner after treatment with LASSBio-294. Fibrosis and inflammatory processes were also counteracted by LASSBio-294, with reductions in LV collagen deposition and tumor necrosis factor α expression.ConclusionIn summary, oral administration of LASSBio-294 after MI in a dose-dependent manner prevented the development of cardiac dysfunction, demonstrating this compound’s potential as an alternative treatment for heart failure in the setting of ischemic heart disease with superimposed chronic hypertension.

E/E’ &lt; 15 PERFORMS POORLY IN PATIENTS WITH ELEVATED LEFT FILLING PRESSURES AND ATRIAL FIBRILLATION/FLUTTER: A SIMULTANEOUS DOPPLER-CATHETERIZATION STUDY

Background: As reinforced by the 2016 American Society of Echocardiography (ASE) diastology guidelines, early mitral inflow velocity (E) to medial mitral early diastolic tissue Doppler velocity (e') ratio is a key component in the noninvasive assessment of left-sided filling pressures. However, the

RATIO OF TRANSMITTAL EARLY FILLING VELOCITY TO EARLY DIASTOLIC STRAIN RATE PREDICTS LONG TERM RISK OF CARDIOVASCULAR MORBIDITY AND MORTALITY IN A LOW RISK GENERAL POPULATION

Background: The ratio of early mitral inflow velocity (E) to global diastolic strain rate (e'sr) is a significant predictor in various patient populations; whether it works as a prognosticator of cardiovascular morbidity and mortality in a general population, is unknown. Method: In a general

Atrioventricular dyssynchrony from empiric device settings is common in cardiac resynchronization therapy and adversely impacts left ventricular morphology and function.

Echocardiographic atrioventricular (AV) optimization after cardiac resynchronization therapy (CRT) is uncommon due to time constraints and the use of vendor-specific device algorithms. It remains unclear whether optimization of mitral inflow velocities can still be useful. We aimed to investigate post implantation left ventricular (LV) inflow patterns to determine the incidence of AV dyssynchrony from empirically set devices. This was a retrospective study of patients undergoing CRT using empiric device settings. Forty-eight patients with clinical, echocardiographic, and pacemaker follow-up were grouped by their post implantation LV filling pattern. Baseline characteristics and echocardiographic measurements were compared with post implantation findings at median 6.3months (interquartile range [IQR], 3.9-17.0). Twenty-four patients demonstrated AV dyssynchrony (Group 1) after CRT, and 24 patients did not (Group 2). Group 1 patients had less LV reverse remodeling compared to Group 2 patients (ΔLV end-diastolic volume: -3.6mL vs -49.5mL, P<.05; ΔLV end-systolic volume: -16.9mL vs -53.5mL, P<.05) and did not experience significant improvements in LV outflow tract velocity time integral, stroke volume, or LV ejection fraction. There were no differences in new-onset atrial fibrillation, heart failure readmissions, or mortality between groups. Our study suggests that up to 50% of patients with empiric device settings have AV dyssynchrony at 6months despite atrioventricular delay optimization (AVO) algorithms. As AV dyssynchrony is common and has proven to be modifiable, a strategic approach to Doppler echocardiography-guided AVO after CRT is warranted, particularly in nonresponders where the LV filling pattern is fused or truncated.

Decreased biventricular longitudinal strain shortly after congenital heart defect surgery.

Impaired ventricular performance in patients who underwent surgery for congenital heart defect (CHD) may ultimately result in clinical heart failure. It is therefore important to regularly evaluate the left ventricular (LV) and right ventricular (RV) performance. We evaluated tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) before and after surgical correction of a CHD. Patients with CHD undergoing biventricular corrective surgery were included in this retrospective study. In addition, a group of healthy controls was included. The performance of LV, RV and interventricular septum (IVS) was assessed using mitral inflow velocities, TDI peak systolic (S'), peak early (E') and peak late (A') diastolic velocity. LV and RV global longitudinal strain (GLS) were assessed using STE. Measurements were performed preoperatively and at discharge. A total of 204 patients and 78 controls were included. All TDI measurements were significantly decreased after surgery. Nonetheless, LV S' and A' were still within normal limits. LV and RV GLS were significantly reduced after surgery and significantly lower compared to controls. A longer aortic cross-clamp time and cardiopulmonary bypass (CPB) time were associated with significantly lower TDI and strain parameters in the RV and IVS, but not in the LV. TDI and STE results generally imply a significantly lower ventricular performance in patients with CHD postoperatively. Furthermore, a negative correlation was observed between aortic cross-clamping and CPB time and several RV performance parameters. As this association was not observed in the LV, this could implicate less vulnerability of the LV to cardiopulmonary bypass.

Left Atrial Strain at Different Stages of Myxomatous Mitral Valve Disease in Dogs.

BackgroundDecreased function of the left atrium (LA) is a useful prognostic indicator in dogs with myxomatous mitral valve disease (MMVD). In humans, LA strain is a novel severity indicator of mitral regurgitation, but its clinical utility in dogs has not been confirmed.ObjectivesTo examine whether LA strain as evaluated with speckle‐tracking echocardiography is associated with MMVD stage in dogs.AnimalsFifty‐two client‐owned dogs with MMVD.MethodsCross‐sectional study. Dogs were classified as stage B1, B2, C, or D, according to the American College of Veterinary Internal Medicine consensus. Physical examination findings and echocardiographic variables were compared among the groups. To assess the comparative accuracy of echocardiographic variables in identifying dogs with the presence or history congestive heart failure (CHF), receiver operating characteristic curves and multivariate logistic analysis were used.ResultsThere were no significant differences in parameters of LA strain between B1 and B2 groups. However, LA longitudinal strain during atrial contraction (εA) (median, 19.1%; interquartile range, 15.3–24.3% in B1, 19.6%; 14.1–21.4% in B2, 6.2%; 3.18–11.2% in C/D) and during ventricular systole (εS) (32.7%; 28.9–39.2% in B1, 35.6%; 31.7–41.9% in B2, 23.6%; 16.9–26.1% in C/D) were significantly lower in stages C/D than in stages B1 and B2. In multivariate logistic regression analysis, εA and peak early diastolic mitral inflow velocity were identified as independent indicators of stage C/D.Conclusions and Clinical ImportanceεA was the best predictor of the presence or history of CHF. Further studies are needed to determine the clinical implications of these findings for treatment decisions and prognosis determination.

Relationships of insulin-like growth factor-1, its binding proteins, and cardiometabolic risk in hypertensive perimenopausal women

PurposeDuring the transition from premenopause to postmenopause, many women experience weight gain and central fat deposition; therefore, we hypothesized that circulating growth factors can play a role in the pathogenesis of hypertension, metabolic syndrome, and subclinical organ damage in perimenopausal women. Basic ProceduresThe study included 192 women aged 40 to 60years; 152 had newly diagnosed essential hypertension that had never been treated, and 40 were normotensive age-matched controls. For all subjects, 24-h ambulatory blood pressure monitoring (ABPM), echocardiographic examination with assessment of left ventricular mass (LVM) and systolic and diastolic functions (GE Vivid 7.0, General Electric Vingmed Ultrasound, Horten, Norway), carotid ultrasound with measurement of intima-media thickness, and carotid-femoral pulse wave velocity (PWV) measurement (SphygmoCor, AtCor Medical, Sydney, Australia) were performed. Serum levels of insulin-like growth factor 1 (IGF-1), insulin-like growth factor-binding protein 2 (IGFBP-2), and insulin-like growth factor-binding protein 3 (IGFBP-3) were measured using an immunochemical assay. Main FindingsHypertensive women had significantly lower IGFBP-2 levels than did normotensive controls (162.9±83.7 vs. 273.1±103.0μg/L, p<0.001); the groups did not differ regarding IGF and IGFBP-3 concentrations. After adjusting the covariates, multivariate analysis showed that IGFBP2 was significantly negatively correlated with 24-h systolic blood pressure (β=−0.31, p=0.02). The adjusted odds ratio for hypertension per standard deviation decrease in IGFBP-2 was 3.43 (95% confidence interval [CI] 1.65–7.13). IGFBP-2 showed a negative correlation with the number of metabolic syndrome components. Independent of body composition, IGFBP-2 was significantly related to left ventricular relative wall thickness and the ratio of mitral inflow velocities as parameter of diastolic function. Principal ConclusionsIn perimenopausal women, decreased IGFBP-2 levels may play a role in blood pressure regulation and the development of subclinical left ventricular diastolic dysfunction. Whether IGFBP-2 is a marker or a mediator of cardiovascular disease in this population merits further investigation.

“End-Stage” Constrictive Pericarditis—A Case Report

Aim: To report a case of “end-stage” constrictive pericarditis with clinical manifestations such as ascites mimicking as cirrhosis of liver. Introduction: In “End-stage” constrictive pericarditis, the etiology remains unknown in majority of cases and inflammation plays a central role in its development. It has been readily confused with cirrhosis of liver in which there may be ascites, but venous pressure is normal, the neck veins are not engorged and cardiac enlargement is frequent in other causes of heart failure. Case Report: A 67 years old male presented with sudden onset of tachycardia. Clinical examination revealed right-sided heart failure, “Egg-shell” calcification in Chest X-ray and echocardiographic features of pericardial constriction such as septal bounce and dynamic respiratory changes in mitral inflow velocity. The patient was advised medical measures. Conclusion: When clinical signs of right heart failure become unresponsive to increased doses of diuretics, constrictive pericarditis is more likely the underlying disease since severe, right-sided failure develops in very advanced, the “end-stage” of the disease.

The Clinical Usefulness of Measurement of Visceral Fat Area Using Multi-Frequency Bioimpedance: The Association with Cardiac and Renal Function In General Population with Relatively Normal Renal Function.

Background: This study was performed to determine the clinical usefulness of measurement of visceral fat area (VFA) using bioimpedance analysis in relation with left ventricular hypertrophy (LVH), diastolic dysfunction parameters, and decreased estimated glomerular filtration rate (eGFR).Methods: A cross-sectional analysis was performed on 1028 patients with eGFR≥60 ml/min/1.73m2, aged 40 - 64 years, and who underwent routine health check-ups. Subjects were divided into tertiles based on their VFA. Associations of VFA with echocardiographic parameters and eGFR were evaluated.Results: Across the VFA teriltes, there was a significant trend for increasing left ventricular mass index (LVMi), left atrial diameter (LAD), and ratio of early mitral inflow velocity to peak mitral annulus velocity (E/E' ratio) and that for decreasing ratio of early to late mitral inflow peak velocities (E/A ratio) and eGFR. In multivariate linear regression analysis, log-transformed VFA was significantly associated with increased LVMi, LAD, and E/E' ratio, and with decreased E/A ratio and eGFR. After adjustment for body mass index, log-transformed VFA remained as a significant determinant for E/A ratio.Conclusion: VFA may be associated with LV structure and diastolic function, and decreased eGFR in middle-aged adults with normal or mildly impaired renal function.

Effects of postural change on transesophageal echocardiography views and parameters in healthy dogs.

The purpose of the present study is to investigate the effect of postural change on transesophageal echocardiography (TEE) views and parameters of interest anesthesia monitoring in healthy dogs. Twelve Beagle dogs were anesthetized and randomly positioned in one of four postures: right lateral-recumbency, left lateral-recumbency, supine position and prone position. After examinations in one posture, the same examination was demonstrated in another posture and repeated in all postures. In each posture, several standard TEE views were demonstrated: longitudinal cranial-esophageal aorta long-axis-view, transverse middle-esophageal mitral valve long-axis-view and transgastric middle short-axis-view. Additionally, echocardiographic parameters were attempted to measure, and direct blood pressure monitoring was performed in each view. As a result, oriented views, except for transgastric middle short-axis-view, could be obtained in all postures. Stroke volume and peak early diastolic velocity of mitral inflow were lower in supine position compared with those in right and left lateral-recumbency. Heart rate (HR) and systemic vascular resistance were higher in supine position compared with those in right and left lateral-recumbency. Left ventricular pre-ejection period/left ventricular ejection time corrected and uncorrected by HR were higher in supine position compared with those in right and left lateral-recumbency. In conclusion, longitudinal cranial-esophageal aorta long-axis-view and transverse middle-esophageal mitral valve long-axis-view provide useful information of interest anesthesia monitoring, because of their views enable to certainly obtain TEE parameters in various postures. Furthermore, TEE parameters allow to detect the changes of preload, afterload and HR that occur in supine position dogs.

A Multi-Center, Phase-2 Trial of Losartan for the Nephropathy of Sickle Cell Anemia

▪Background: Sickle nephropathy (SN) is a common and progressive manifestation of sickle cell anemia (SCA). Albuminuria indicates glomerular injury and portends renal failure. In a murine model of SCA, we found that increased TGF-Beta signaling underlies SN, and its downregulation by losartan, an angiotensin receptor blocker, reduced albuminuria and SN progression. The effect of losartan in humans with SCA has not been studied. We performed a phase-2, open-label study to inform the design of a phase-3 randomized trial to estimate the effect of losartan on SN. We also explored the effect of losartan on the cardiac phenotype of SCA.Methods: Oral losartan was administered for 6 months to individuals with SCA (HbSS or SBeta0-thalassemia) >6 years of age. Main exclusion criteria: chronic transfusions, GFR <60 mL/min/1.73m2, hyperkalemia, and contraindications to losartan. Enrollment was in 3 groups defined by urinary albumin-to-creatinine ratio (UACR): no albuminuria (NoA: <30mg/g); microalbuminuria (MicroA: 30-300); and macroalbuminuria (MacroA: >300). The primary endpoint was a >25% reduction UACR from baseline. Sample size was calculated to detect the primary endpoint in >30% of the MicroA group with >80% power. Secondary endpoints: urine osmolality, GFR, UACR classification and toxicity, and cardiac phenotyping by echocardiography and assessment of 6-minute walk distance (6MWD).Results: There were 36 participants (mean age 24.1y; 53% female) in 3 groups (NoA=15; MicroA=13; MacroA=8). Four were not evaluable based on pre-specified criteria (marked non-compliance and/or early termination). The primary endpoint (>25% reduction in UACR) was met in 83% (5/6) of the MacroA group, 58% (7/12) of the MicroA group, and 7% (1/14) of the NoA group (Figure A). The median fold-change in UACR was -0.74, -0.46, and 0.08 for the MacroA, MicroA, and NoA groups, respectively (Figure B). Among MacroA and MicroA participants, 67% (12/18) met the primary endpoint (Figure C). In MacroA and MicroA participants, UACR classification improved (MacroAˆMicroA or MicroAˆNoA) in 50% but worsened in 11%. Mean UACR was 202 mg/g (S.E.M. 59, median 50) before and 137 (S.E.M. 47, median 16) after losartan (P=0.29). Urine osmolality and GFR did not change significantly (393 vs 370 mosm/kg H20, P=0.11; 147 vs 139 mL/min/1.73m2, P=0.43). Losartan was discontinued for leg cramps (N=1); GFR decline >25% (N=1); and serum creatinine rise >50% (N=1). Interestingly, compared to those with NoA, participants with albuminuria (MicroA and MacroA, mean UACR 373±87 mg/g) had worse diastolic function indicated by lower early-to-late ratio of mitral inflow velocities, E/A (1.81±0.1 vs 2.3±0.1, P=0.018), and septal annular velocities ratio, e’/a’ (1.5±0.2 vs 2.4±0.2, P<0.001), and significantly larger left atrial volumes (57.2±3.1 vs 38.9±3.7 ml, P<0.001). Systolic function was normal and similar in both groups (shortening fraction 36.9±2% vs 36.7±1.5%, P=0.94). There was no difference in tricuspid regurgitant jet velocity, left ventricular (LV) mass, or LV diameter. Participants with albuminuria had significantly shorter 6MWD (1182±78 vs 1472±86 ft, P=0.018), which correlated significantly with the diastolic measures E/A and septal e’/a’ (P=0.013 and P=0.015, respectively). There was no change in echocardiographic parameters after losartan therapy.Conclusions: Losartan appeared to decrease SCA-related albuminuria in most participants. Those with baseline macroalbuminuria appeared to have the greatest benefit, nearly all of whom showed a response. Albuminuria, a marker of sickle nephropathy, is also associated with evidence of restrictive cardiac physiology, suggesting common underlying mechanisms. However, the short 6-month treatment with losartan had no obvious effects on the cardiac phenotype of SCA. A phase-3, randomized, placebo-controlled trial is being designed to determine the efficacy of losartan in SCA. [This work was supported by NIH R34 HL 108752 (PI: Malik, P)]. [Display omitted] DisclosuresQuinn:Silver Lake Research Corporation: Consultancy; Eli Lilly: Research Funding; Amgen: Research Funding. Raj:Novartis: Speakers Bureau.

Left Ventricular Function in Healthy Term Neonates During the Transitional Period

To evaluate whether incorporating conventional, tissue Doppler imaging and speckle tracking echocardiography are reliable and can characterize changes in left ventricular (LV) function properly in healthy neonates in the early transitional newborn period. A prospective observational study was conducted in 50 healthy term neonates with a mean ± SD gestational age and birth weight of 39.3 ± 1.2 weeks and 3.5 ± 0.44 kg, respectively. All infants underwent serial echocardiograms at 15 ± 2 (day 1) and 35 ± 2 hours (day 2) of age. The LV dimensions and various functional indices including tissue Doppler imaging velocities and speckle tracking echocardiography-derived peak longitudinal strain, and systolic and diastolic strain rate were acquired and compared between time points. All measurements were feasible from each scan except speckle tracking echocardiography in 10% and 20% of images on days 1 and 2 of age, respectively. LV dimensions, but not functional measures, demonstrated a small to moderate positive correlation with birth weight. On day 2, a small reduction was observed in LV basal diameter, mitral valve inflow velocity time integral, and systolic velocity of the lateral wall and septum. Other indices remained unchanged. Tissue Doppler imaging-derived functional and flow-derived hemodynamic measures demonstrated the least measurement bias, and strain measurements demonstrated better reliability than strain rate, fractional shortening, and ejection fraction. The relative reliability of various echocardiographic indices to quantify LV function in neonates establish a normative dataset and provide evidence for their validity during the first 2 days of life.

Abstract 12659: Relationship Between Cardiac Structure and Function With Neurocognition in the Hispanic Community Health Study/ Study of Latinos (HCHS/SOL) Echocardiographic Study of Latinos (Echo-SOL) Ancillary Study

Background: Neurocognitive impairment is an important challenge facing the growing elderly population. The heart’s effect on the brain with regard to neurocognition is less well-studied. We evaluated the association between cardiac structure and function with neurocognition measurements in a population-based cohort. Methods: The Echo-SOL Ancillary Study of Hispanic adults aged 45-74 years provided comprehensive neurocognitive and echocardiography assessments for cross-sectional analysis. Neurocognitive measures included the Word Fluency (WF) Test, the Brief-Spanish English Verbal Learning Test (SEVLT), and the Digit Symbol Substitution Test (DSST); lower WF, SEVLT, and DSST scores signifying worse neurocognitive function. Multivariable linear and logistic regression models were fit using survey statistics and accounted for sampling probabilities, age, sex, diabetes, hypertension, and BMI. Results: 1818 participants were included in the analysis: mean age 56-years, and 56% women. Higher left ventricular mass index was associated with lower SEVLT and DSST scores, whereas lower Ejection Fraction and lower peak systolic velocity were associated with lower WF scores. Lower SEVLT scores were seen with a higher prevalence of abnormal left ventricular geometry and higher relative wall thickness. Mitral annular relaxation velocities (e’) were significantly associated with lower SEVLT and WF scores. Additionally, a higher ratio of mitral inflow velocity with mitral annular early diastolic velocity (E/e’) and more prevalent left ventricular diastolic dysfunction were significantly associated with lower SEVLT scores. Conclusion: Abnormalities in cardiac structure and function are associated with alterations in neurocognitive function in Hispanics/Latinos. Further study is needed to determine the mechanisms (e.g., impairment of cerebral flow, silent brain infarctions) mediating these potentially important heart-brain associations.

Abstract 11330: E/e’ is a Powerful Predictor of Survival After a First-Ever Non-ST Elevation Myocardial Infarction

Introduction: Significant LV diastolic dysfunction is associated with a poorer prognosis following acute MI. The ratio of early mitral inflow velocity to mitral annular early diastolic velocity (E/e’) is a strong non-invasive correlate of LV filling pressures. Septal E/e’ &gt;15 has been well-validated as a predictor of survival in patients with STEMI, with limited data for patients with NSTEMI. Aim: To assess the prognostic significance of E/e’ measured early after a first-ever NSTEMI. We hypothesised that a septal E/e’ &gt;15 would predict poorer survival following NSTEMI. Methods: Data analysis on 332 consecutive patients who underwent coronary angiography for a first-ever NSTEMI at a single large tertiary referral centre from January 2013 to December 2014. Transthoracic echocardiography was performed within 24 hours of admission. Outcomes data were obtained from a statewide registry, with the primary endpoint being all-cause mortality. Results: At a median follow-up time of 36 months, death occurred in 41 (12%) patients. Septal E/e’ was &gt;15 in 66 patients (20%) and was associated with excess mortality (log-rank statistic 17.7, P&lt;0.0001) (Figure 1). On univariate Cox regression analysis, E/e’ &gt;15, age &gt;80 years, diabetes, chronic kidney disease, LVEF, left atrial volume index &gt;34ml/m 2 and tricuspid regurgitation peak velocity &gt;2.8m/s were associated with the primary endpoint. On multivariate analysis, E/e’ &gt;15 was an independent predictor of all-cause mortality (HR 2.30, 95%CI 1.24-4.33, p=0.028), as was chronic kidney disease (HR 2.73, 95%CI 1.32-5.66, p=0.007) and LVEF (HR 0.96, 95%CI 0.93-0.98, p=0.001). Furthermore, E/e’ &gt;15 showed incremental prognostic value when added to LVEF. Conclusion: E/e’ is a powerful, independent predictor of survival following a first-ever NSTEMI. It is superior, in this setting, to most clinical variables and other echocardiographic parameters of diastolic dysfunction, and has additive prognostic value over LVEF.

14 Myocardial dysfunction in ANCA vasculitis measured by two-dimensional speckle tracking echocardiography

Aim Myocardial involvement in patients with systemic vasculitis portends a poorer prognosis. We sought to determine the extent of myocardial dysfunction in Granulomatosis with polyangitis and Churg Strauss disease using speckle tracking and strain imaging. Methods 20 patients and 22 controls with no prior cardiac history were recruited from December 2015 to April 2016. Baseline demographics recorded included age, sex, cardiovascular risk factors, time since diagnosis, immunosuppressive therapy and vasculitis damage index score (VDI). We performed transthoracic echocardiography using Vivid 7 GE machine along with twelve lead electrocardiograms (ECG) and biochemical analysis at the study visit. A single blinded operator utilising Echo Pac 11 software performed offline analysis of strain and speckle tracking measurements. Results Mean age of the vasculitis group was 56 ± 10 years with 50% being male, while mean age of controls was 53 ± 9 years with 55% male. There were no significant differences between groups in age, incidence of hypertension (p = 0.3) or diabetes (p = 0.6). Radial strain was significantly reduced in the vasculitis cohort (P = 0.05). The vasculitis cohort also showed a non-significant reduction in longitudinal strain and abnormal diastology as reflected in a reduction in tissue Doppler E’ velocities, decreased transmittal E/A ratio and increased E/E’ ratio when compared to controls (Table 1). There were negative correlations between increasing VDI score and reduction in mitral inflow velocities r = −0.5 (p = 0.02), number of clinical relapses and tissue Doppler E’ r = −0.6 (p = 0.009) and length of cyclophosphamide use with tissue Doppler E’ r = −0.5 (p = 0.02). Conclusion This is one of the largest studies investigating myocardial dysfunction in ANCA positive vasculitis. Patients demonstrated a reduction in radial strain and evidence of abnormal left ventricular relaxation. This may be indicative of underlying cardiac involvement.

Effect of Aldosterone Antagonism on Exercise Tolerance in Heart Failure With Preserved Ejection Fraction

BackgroundImpaired functional capacity is a hallmark of patients with heart failure with preserved ejection fraction (HFpEF). Despite the association of HFpEF with reduced myocardial compliance attributed to fibrosis, spironolactone has not been shown to alter outcomes—perhaps reflecting the heterogeneity of underlying pathological mechanisms. ObjectivesThe authors sought to identify improvement in exercise capacity with spironolactone in the subset of patients with HFpEF with exercise-induced increase in ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e′) reflecting elevation of left ventricular (LV) filling pressure. MethodsIn this randomized, blinded, parallel-group, placebo-controlled trial, 150 subjects (age 67 ± 9 years) with exertional dyspnea (New York Heart Association functional class II to III, left ventricular ejection fraction >50%, diastolic dysfunction, and exertional E/e′ >13), excluding those with ischemic heart disease, were recruited in a tertiary cardiology center. Patients were randomized to 6 months of oral spironolactone 25 mg/day or matching placebo. Primary outcomes were improvements in peak oxygen uptake (VO2) and exertional E/e′ ratio, and secondary outcomes were improvements in exercise blood pressure response and global LV longitudinal strain. ResultsAt follow-up, 131 patients completed therapy—64 taking spironolactone and 67 placebo. At baseline, subjects had substantial exercise limitation (peak VO2 64 ± 17% predicted). The spironolactone group showed improvement in exercise capacity (increment in peak VO2 [2.9 ml/min/kg (95% confidence interval [CI]: 1.9 to 3.9 ml/min/kg) vs. 0.3 ml/min/kg (95% CI: −0.5 to 1.1 ml/min/kg); p < 0.001], anaerobic threshold [2.0 ml/min/kg (95% CI: 0.9 to 3.2 ml/min/kg) vs. −0.9 ml/min/kg (95% CI: −3.4 to 1.6 ml/min/kg); p = 0.03], and O2 uptake efficiency [0.19 (95% CI: 0.06 to 0.31) vs. −0.07 (95% CI: −0.17 to 0.04); p = 0.002]), with reduction in exercise-induced increase in E/e′ (−3.0 [95% CI: −3.9 to −2.0] vs. 0.5 [95% CI: −0.6 to 1.6]; p < 0.001). There was a significant interaction of spironolactone and change in E/e′ on VO2 (p = 0.039). ConclusionsIn patients with HFpEF and abnormal diastolic response to exertion, improvement in exercise E/e′ mediates the beneficial effect of spironolactone on exercise capacity. Identification of exercise-induced increase in LV filling pressure in patients with HFpEF may define a subgroup with warranting trial of spironolactone.

PP.09.09] EFFECT OF HEMODIALYSIS ON NOVEL ECHOCARDIOGRAPHIC AND TISSUE DOPPLER-DERIVED INDICES OF LEFT VENTRICULAR FUNCTION IN END-STAGE RENAL DISEASE PATIENTS

Objective: Left ventricular (LV) systolic and diastolic dysfunction is common and contributes to the increased cardiovascular morbidity and mortality in end-stage-renal-disease (ESRD). Hemodynamic alterations and shifts in volume status during hemodialysis acutely affect LV sizing and function. However, the effect of hemodialysis on novel, less volume-dependent, tissue Doppler-derived indices is not fully understood. This study evaluated acute changes in novel echocardiographic and tissue Doppler-derived indices of LV dysfunction during the first and mid-week dialysis session. Design and method: Forty-one stable ESRD patients receiving thrice-weekly hemodialysis for at least 3 months underwent 2-dimensional echocardiographic and tissue-Doppler imaging evaluation with a Vivid 7 cardiac ultrasound device. Echocardiographic studies were performed shortly before and after the first and second weekly dialysis sessions. Results: Body weight (1st session: 72.2 ± 12.6 vs 69.3 ± 12.5 kg, p < 0.001; 2nd session: 71.5 ± 12.7 vs 68.9 ± 12.5 kg, p < 0.001) and systolic blood pressure (1st session: 145.5 ± 21.6 vs 135.9 ± 23.5 mmHg, P < 0.05; 2nd session: 143.1 ± 19.8 vs 135.2 ± 20.4 mmHg, P < 0.05) were reduced during both dialysis sessions. Significant reductions in left atrial volume, LV end-systolic and end-diastolic volume were noted from pre-to post-dialysis in both sessions studied. LV systolic function assessed by LV ejection fraction, stroke volume and cardiac output, remained unchanged from pre- to postdialysis. In contrast, peak early (E) and the ratio of peak early to late mitral inflow velocity (E/A) were significantly decreased during both sessions (1st session: 1.15 ± 0.48 vs 0.92 ± 0.49, p = 0.001; 2nd session: 1.18 ± 0.48 vs 0.86 ± 0.48, p < 0.001). Peak tissue velocity around the mitral annulus during early diastole (mean Em) was significantly decreased during the 1st weekly session, but not during the mid-week dialysis (1st session: 0.188 ± 0.03 vs 0.167 ± 0.03 cm/s, p < 0.001; 2nd session: 0.188 ± 0.04 vs 0.179 ± 0.05 cm/s, p = 0.366). Mean isovolumetric relaxation time was stable in both occasions. Conclusions: This study shows that hemodialysis improves LV sizing and reduces LV filling pressures during diastole. This effect seems to be more prominent during the first weekly dialysis session. Additional research efforts are warranted to fully elucidate whether these acute intradialytic alterations translate into long-term deterioration of cardiac function.