Normal Left Ventricle Function Research Articles

His bundle pacing is continually relevant for patients with atrial fibrillation and bradycardia without prior atrioventricular nodal ablation, data from mid-term follow-up.

In patients with atrial fibrillation (AF) and symptomatic bradycardia, His Bundle pacing (HBP) is used to achieve an appropriate heart rate and physiological depolarization of the left ventricle (LV). We aimed to evaluate the impact of HBP on LV function in two different populations: normal LV ejection fraction (LVEF) and low LVEF (<50%). Patients who received HBP as de novo therapy or as an upgrade were divided into two groups based on initial LVEF, followed by echocardiographic and device monitoring. One hundred and twenty three patients (aged 76.0 [69.2-79.8] years, 74.0% men) with AF and bradycardia received HBP and completed follow-up with a median of 6.2 months (6.0-8.0). LV function remained unchanged in initially normal LV function patients (65 participants, LVEF 59.0% [55.0 - 62.0] vs. 58.0% [55.0-63.0]). In patients with low LVEF (58 participants), there was an increase in LVEF (37.5% [30.0-43.0] vs. 44.0% [35.0-50.0]; p < 0.0001), reduction of indexed LV end-systolic volume (62.4 [20.7] ml vs. 51.5 [21.5] ml; p = 0.001) and indexed LV end-diastolic volume (97.5 [26.2] ml vs. 88.1 [25.1] ml; p = 0.009), and improvement in the New York Heart Association class (2.3 [0.71] to 1.6 [0.9]; p < 0.0001). With permanent HBP, patients with AF and bradycardia and without prior atrioventricular nodal ablation did not experience LV systolic function deterioration. Those with reduced baseline LVEF experienced improvements in LV function and its reverse remodeling at the mid-term follow-up.

Ductal stenting for retraining the left ventricle in patients with transposition of great arteries with intact ventricular septum: a single-centre experience.

Ductal stenting in late presenters with transposition of great arteries with intact ventricular septum retrains the left ventricle before arterial switch operation. However, the experience is limited for its efficacy and safety. This study aims to highlight the efficacy and safety of ductal stenting for retraining the left ventricle. Eight children with transposition of great arteries-intact ventricular septum and regressed left ventricle underwent ductal stenting. Serial echocardiographic measurements of left ventricle shape, mass, volume, free wall thickness, and function were done, and arterial switch operation was performed once the left ventricle was adequately prepared. Post-operative outcome in terms of duration of mechanical ventilation, ICU stay, and improvement in left ventricle function were monitored. The procedure was successful in all patients. Babies were divided into two groups on basis of age at ductal stenting (group 1 age less than 90 days and group 2 age more than 90 days) and were evaluated for the degree of left ventricle retraining as evidenced by echocardiographic parameters and post-operative variables. The left ventricle posterior wall thickness and mass index after ductal stenting increased significantly in both the groups. Postoperatively, one baby of group two expired after seven days due to severe left ventricle dysfunction. Rest babies had an uneventful post-operative ICU stay with no statistical difference in the duration of invasive mechanical ventilation or ICU stay. On six-month follow-up, all surviving babies were doing well with normal left ventricle function. Ductal stenting is a good alternative measure as compared to surgical procedures for left ventricle retraining in transposition of great arteries with regressed left ventricle.

ECHO-MPS, a dual modality strategy of cardiac imaging to identify myocardial ischemia.

We aimed to evaluate an approach with resting echocardiography (TTE) and stress myocardial perfusion scintigraphy (MPS) compared to standard MPS in patients with stable angina and normal left ventricle (LV). We hypothesized that normal LV on TTE may allow for the elimination of rest MPS without compromising accuracy and offering an efficient diagnostic pathway with reduced radiation exposure. In a prospective, non-randomized study TTE was performed prior to MPS in patients (pts) referred for assessment of coronary artery disease (CAD). In pts with normal LV assessment was performed using the hybrid and the standard approach. TTE and MPS were interpreted by two TTE readers (ER1-2) and two MPS readers (NR1-2). ECHO-MPS was compared with standard MPS for diagnostic accuracy. 103 patients, mean age 61 ± 12 year, (63M, 40W) were recruited. Standard MPS were normal in 75 patients and abnormal in 28 patients, with the hybrid approach 79 studies were reported as normal and 24 studies as abnormal. Kappa values were 0.580, (p < 0.001) for large, 0.394, (p < 0.001) for medium, and 0.298 (p = 0.002) for small defects. With standard MPS as a reference, sensitivity for detection of perfusion defects by ECHO-MPS was 75% (95% CI 0.67-0.83) [NR2] and 78% (95% CI 0.70-0.86)[NR1]. Specificity was 95% (95% CI 0.90-0.99) [NR2] and 95% (CI 95%CI 0.90-0.99) [NR1]. ECHO-MPS protocol provides similar diagnostic accuracy as standard stress-rest MPS. In patients with normal systolic LV function in TTE, performing only stress MPS provides similar information as standard rest and stress MPS.

Analysis of left ventricle regional myocardial motion for cardiac radioablation: Left ventricular motion analysis.

Left ventricle (LV) regional myocardial displacement due to cardiac motion was assessed using cardiovascular magnetic resonance (CMR) cine images to establish region-specific margins for cardiac radioablation treatments. CMR breath-hold cine images and LV myocardial tissue contour points were analyzed for 200 subjects, including controls (n=50) and heart failure (HF) patients with preserved ejection fraction (HFpEF, n=50), mid-range ejection fraction (HFmrEF, n=50), and reduced ejection fraction (HFrEF, n=50). Contour points were divided into segments according to the 17-segment model. For each patient, contour point displacements were determined for the long-axis (all 17 segments) and short-axis (segments 1-12) directions. Mean overall, tangential (longitudinal or circumferential), and normal (radial) displacements were calculated for the 17 segments and for each segment level. The greatest overall motion was observed in the control group-long axis: 4.5±1.2mm (segment 13 [apical anterior] epicardium) to 13.8±3.0mm (segment 6 [basal anterolateral] endocardium), short axis: 4.3±0.8mm (segment 9 [mid inferoseptal] epicardium) to 11.5±2.3mm (segment 1 [basal anterior] endocardium). HF patients exhibited lesser motion, with the smallest overall displacements observed in the HFrEF group-long axis: 4.3±1.7mm (segment 13 [apical anterior] epicardium) to 10.6±3.4mm (segment 6 [basal anterolateral] endocardium), short axis: 3.9±1.3mm (segment 8 [mid anteroseptal] epicardium) to 7.4±2.8mm (segment 1 [basal anterior] endocardium). This analysis provides an estimate of epicardial and endocardial displacement for the 17 segments of the LV for patients with normal and impaired LV function. This reference data can be used to establish treatment planning margin guidelines for cardiac radioablation. Smaller margins may be used for patients with higher degree of impaired heart function, depending on the LV segment.

Lower left ventricular cardiac strain in patients who recovered from COVID-19

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic. Introduction The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes the highly contagious coronavirus disease 2019 (COVID-19). This disease has been linked to several cardiac problems. Studying heart deformation with cardiovascular magnetic resonance feature-tracking (CMR-FT) might help detect subtle systolic or diastolic dysfunction in patients who recovered from COVID-19. Purpose We aimed to characterize the left ventricular strain in patients who recovered from COVID-19 by using cardiovascular magnetic resonance feature tracking (CMR-FT). Methods In this study, we compared a cohort of 55 patients who recovered from COVID-19 (age 48 ± 16 years, time between diagnosis and CMR 46 (34 to 166) days) to 44 sex- and age-matched control subjects (age 47 ± 16 years) with a CMR examination before March 1st, 2020. All the participants were examined in our hospital. By using CMR-FT, we determined the left ventricle (LV) global circumferential strain (GCS), global longitudinal strain (GLS), and global radial strain (GRS). LV clinical parameters were indexed to the body surface area. The student's t-test and Wilcoxon rank-sum test were used to compare normally and non-normally distributed variables. The adjusted P-value was obtained by using a false discovery rate correction. Results Although the left ventricular ejection fraction was significantly lower in patients who recovered from COVID-19 than in controls (64 (60 to 70) % vs. 68 (64 to 73) %, P-value = 0.022), the former had normal systolic LV function. At the same time, they had higher LV end-systolic indexed volume (23.0 (15.4 to 30.4) ml/m2 vs. 19.4 (15.2 to 24.4) ml/m2, P-value = 0.048). Regarding the global LV strain, all parameters were significantly lower in the patients who recovered from COVID-19 than in controls (GCS −17.1 (−18.4 to −15.4) % vs. −18.1 (−19.7 to −17.0) %, P-value = 0.004; GLS −17.3 (−18.7 to −15.6) % vs. −18.2 (−19.3 to −16.9) %, P-value = 0.011; GRS 28.1 (23.8 to 31.8) % vs. 31.6 (28.4 to 34.3) %, P-value = 0.004). Conclusion Compared to controls, patients who recovered from COVID-19 exhibit lower global left ventricular strain values assessed by CMR-FT.

Serial Non-Invasive Myocardial Work Measurements for Patient Risk Stratification and Early Detection of Cancer Therapeutics-Related Cardiac Dysfunction in Breast Cancer Patients: A Single-Centre Observational Study

Serial transthoracic echocardiographic (TTE) assessment of LVEF and GLS are the gold standard in screening Cancer Therapeutics-Related Cardiac Dysfunction (CTRCD). Non-invasive left-ventricle (LV) pressure-strain loop (PSL) emerged as a novel method to quantify Myocardial Work (MW). This study aims to describe the temporal changes and longitudinal trajectories of MW indices during cardiotoxic treatment. We included 50 breast cancer patients with normal LV function referred for anthracycline therapy w/wo Trastuzumab. Medical therapy, clinical and echocardiographic data were recorded before and 3, 6, and 12 months after initiation of the chemotherapy. MW indices were calculated through PSL analysis. According to ESC guidelines, mild and moderated CTRCD was detected in 10 and 9 patients, respectively (20% CTRCDmild, 18% CTRCDmod), while 31 patients remained free of CTRCD (62% CTRCDneg). Prior to chemotherapy MWI, MWE and CW were significantly lower in CTRCDmod than in CTRCDneg and CTRCDmild. Overt cardiac dysfunction in CTRCDmod at 6 months was accompanied by significant worse values in MWI, MWE and WW compared to CTRCDneg and CTRCDmild. MW features such as low baseline CW, especially when associated with a rise in WW at follow-up, may identify patients at risk for CTRCD. Additional studies are needed to explore the role of MW in CRTCD.

The prognostic value of right ventricular strain and mechanical dispersion on mortality in patients with normal left ventricle function

AimsWe aimed to assess if right ventricular (RV) 4-chamber longitudinal strain (RV4CLS), RV free wall longitudinal strain (RVFWLS) and RV mechanical dispersion index (RVMDI) have prognostic independent value in patients with preserved ejection fraction (pEF), without clearly elevated LV filling pressure. MethodsRetrospective analysis of Peak RV4CLS, RVFWLS, RVMDI and comprehensive echocardiographic assessment including left ventricle (LV), atrium (LA) strain and RV parameters in patients with pEF (EF ≥ 50%; E/e’ < 14). Multivariate Cox regression hazards model were used to determine the independent association between RV strain parameters to all-cause mortality and cardiovascular events. ResultsWe analyzed 224 consecutive patients with pEF (age 65.2 ± 19.8, 44% female, Charlson Comorbidity Index median = 3.8), with all-cause mortality of 64 patients and 28 cardiovascular events, during a median follow-up of 8.2 years (interquartile range: 6.8 to 8.4 years). The best strain univariate predictors of mortality were RV4CSL [1.16 (1.07–1.26); p = 0.0001] and RVMDI [1.01 (1.001–1.02); p = 0.02] being superior to LV and LA strain, or other RV functional indices. Moreover, after adjustment for clinical (age, gender, Charlson Comorbidity Index), conventional echocardiographic parameters (LA volume, E/e’ average, LVEDD, routine RV functional indices), LV and LA STE, RV4CLS and RVFWLS remained statistically significant associates of all-cause mortality and cardiac events. RV4CLS, or RVFWLS remained statistically significant associated for all-cause mortality, after additional adjustment for RVFAC and RVMDI. ConclusionsRV4CSL and RVMDI provide significant prognostic additive value in patients with preserved ejection fraction with excellent reproducibility, incremental to routine clinical, hemodynamic and LV and LA STE parameters.

SUGAMMADEX ANAPHYLAXIS

<h3>Introduction</h3> Sugammadex is a neuromuscular reversal agent used at the conclusion of surgeries to reverse the effects of rocuronium and vecuronium. It was first used in 2008 and the incidence of anaphylaxis has been estimated to be around 0.02%. We report a case of anaphylaxis to sugammadex which manifested abruptly with hypotension, diaphoresis, and dyspnea but with absence of rash. <h3>Case Description</h3> A 71YOF underwent an uncomplicated laparoscopic cholecystectomy. At the end of the procedure, patient received 200mg sugammadex IV and within 3 minutes she became hypotensive, diaphoretic, and dyspneic. She did not have a rash. She never received this medication before. She received IV fluids and she was started on phenylephrine drip. Patient was initially phenylephrine refractory but after 10 minutes her hypotension resolved. The diagnosis was unclear, therefore a repeat laparoscopy to rule out bleeding was performed and intraoperatively transesophageal echocardiogram showed normal left ventricle function, but minimal filling. The blood loss was estimated to be 30 ml. Due to high suspicion, Sugammadex was preemptively listed as an allergy. One hour after her symptoms began, tryptase level was 48.7 mcg/L, followed by 61.5 mcg/L 2.5 hours later. Baseline tryptase was 4.5 mcg/L. At a follow up visit, skin prick testing to sugammadex was positive with a 1:1 concentration and to intradermal testing with a 1:1000 concentration. Skin testing of other agents which were administered prior to sugammadex were negative. <h3>Discussion</h3> Although rare, rapid recognition of possible sugammadex anaphylaxis, despite the lack of rash, is very important for adequate treatment and further testing.

Fetal growth of left-sided structures and postnatal surgical outcome in borderline left heart varies by cardiac phenotype.

There are two borderline left-heart phenotypes in the fetus: (1) severe aortic stenosis (AS), which is associated with a 'short, fat', globular left ventricle (LV), LV systolic dysfunction and LV growth arrest; and (2) severe left-heart hypoplasia (LHH), which is associated with a 'long, skinny' LV, laminar flow across hypoplastic mitral and aortic valves and arch hypoplasia. Both phenotypes may be counseled for possible single-ventricle palliation. We aimed to compare the rates of left-sided cardiac structure growth and Z-score change over gestation and to describe the postnatal outcomes associated with these two phenotypes. We hypothesized that the left-sided structures would grow faster in fetuses with LHH compared to those with AS, and that those with LHH would be more likely to achieve biventricular circulation. This was a retrospective cohort study using data collected in an institutional cardiology database between April 2001 and April 2018. We included fetuses with severe AS or severe LHH, and with at least two fetal echocardiograms. Inclusion criteria for the AS group included: aortic-annulus Z-score < -2.0, severe AS, depressed LV function, retrograde systolic flow in the aortic arch and endocardial fibroelastosis. Inclusion criteria for the LHH group included: aortic-annulus Z-score < -2.0, hypoplastic but apex-forming LV, normal LV function and retrograde systolic flow in the aortic arch. Exclusion criteria were: abnormal cardiac connections, other forms of structural congenital heart disease, cardiomyopathy, history of fetal aortic valvuloplasty and participation in a maternal hyperoxygenation study. Measurements and respective Z-scores for the aortic-valve annulus, mitral-valve annulus, LV long- and short-axis dimensions, along with aortic-arch measurements, were collected longitudinally for each fetus and plotted over time for both cohorts. Mean slopes of change in dimension and Z-scores over gestation were calculated and compared between the two groups using mixed generalized linear regression accounting for repeated measures. A subanalysis was performed, matching six fetuses from each group for initial aortic-annulus Z-score and gestational age, due to the significant differences in these two variables between the original cohorts. In total, 53 fetuses with 158 echocardiograms were included. In the AS cohort, there were 20 (38%) fetuses with 65 echocardiograms, and in the LHH cohort there were 33 (62%) fetuses with 93 echocardiograms. On the first echocardiogram, LHH fetuses had a later gestational age and a larger aortic-annulus diameter. The rate of aortic-annulus growth was greater in the LHH group compared with the AS group (mean ± SD, 0.15 ± 0.01 mm/week for LHH vs 0.07 ± 0.01 mm/week for AS (P < 0.001)). While the LHH group had a decrease in aortic-annulus Z-score over time, this was at a slower rate than the decrease in the AS group (mean ± SD, -0.04 ± 0.02/week for LHH vs -0.13 ± 0.02/week for AS (P < 0.001)). A similar pattern was seen for the mitral-valve and LV short-axis-dimension Z-scores. Subanalysis of six fetuses from each group matched for initial aortic-annulus Z-score and gestational age demonstrated similar findings, with the LHH group Z-scores decreasing at a slower rate than those in the AS group. Fifty-two of the 53 fetuses were liveborn, one LHH fetus dying in utero. Of the 20 liveborn in the AS cohort, 15 (75%) infants underwent single-ventricle palliation, two (10%) underwent biventricular repair and three (15%) died prior to intervention. Of the 32 liveborn in the LHH cohort, three (9.4%) underwent single-ventricle palliation, 28 (87.5%) achieved biventricular circulation, of which six required no surgery, and one (3.1%) died prior to intervention. The left-sided cardiac structures grow at a faster rate in fetuses with severe LHH than they do in fetuses with severe AS, and the Z-scores decrease at a slower rate in fetuses with severe LHH than they do in those with severe AS. The majority of infants in the LHH group did not undergo single-ventricle palliation. This information can be useful in counseling families on the expected growth potential of the fetus's aortic valve, mitral valve and LV, depending on the cardiac phenotype. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Use of speckle tracking echocardiography to detect late anthracycline-induced cardiotoxicity in childhood cancer: A prospective controlled cross-sectional study

BackgroundThis study aimed to detect late sub-clinical patterns of cardiac dysfunction using speckle tracking echocardiography (STE) in children with cancer remission more than 12 months after the end of anthracycline treatment. MethodsThis prospective controlled study enrolled 196 children, 98 of which had been treated with anthracyclines (mean age 10.8 ± 3.6 years; 51% female) and 98 were age- and gender-matched healthy subjects in a 1:1 case-control design. Conventional echocardiographic variables were collected for left ventricle (LV) and right ventricle (RV). STE analyses were performed in the LV longitudinal, radial, and circumferential displacements and in the RV free wall longitudinal displacement. The association between LV global longitudinal strain (GLS) and the main clinical and biological parameters was evaluated. ResultsAfter a mean time interval of 5.1 ± 3.2 years since the end of chemotherapy (mean cumulative anthracycline dose of 192 ± 96 mg/m2), conventional echocardiographic measures were normal. GLS was significantly decreased in the anthracycline group (−19.1% vs. −21.5%, P < 0.0001), with a higher proportion of children with abnormal values (Z-score < −2 in 18.6% vs. 1.0%, P < 0.0001). No association was found between GLS and clinical or biological parameters. Circumferential strain was significantly worse in the anthracycline group (−16.8% vs. −19.4%, P < 0.0001), and radial strain significantly better (+51.4% vs. +35.9%, P < 0.0001). RV conventional echocardiography and STE parameters were normal and not different between anthracycline and control groups. ConclusionsThe existence of a modified LV strain despite normal LV function in children treated with anthracyclines represents an important perspective for cardiomyopathy surveillance in childhood cancer survivors.Clinical Trial Registration -ClinicalTrials.gov Identifier: NCT02893787.

Use of speckle tracking echocardiography to detect anthracycline-induced cardiotoxicity in childhood cancer: A prospective controlled cross-sectional study

To detect sub-clinical patterns of cardiac dysfunction using speckle tracking echocardiography (STE) in children with cancer remission more than 12 months after the end of anthracycline treatment. This prospective controlled study enrolled 196 children, 98 of which had been treated with anthracyclines (mean age 10.8 ± 3.6 years; 51% female) and 98 were age- and gender-matched healthy subjects in a 1:1 case-control design. Conventional echocardiographic variables were collected for left ventricle (LV) and right ventricle (RV). STE analyses were performed in the LV longitudinal, radial, and circumferential displacements and in the RV free wall longitudinal displacement. The association between LV global longitudinal strain (GLS) and the main clinical and biological parameters was evaluated. After a mean time interval of 5.1 ± 3.2 years since the end of chemotherapy (mean cumulative anthracycline dose of 192 ± 96 mg/m2), conventional echocardiographic measures were normal. GLS was significantly decreased in the anthracycline group (−19.1% vs. −21.5%, P < 0.0001), with a higher proportion of children with abnormal values (Z-score < −2 in 18.6% vs. 1.0%, P ≤ 0.0001). No association was found between GLS and clinical or biological parameters. Circumferential strain was significantly worse in the anthracycline group (−16.8% vs. −19.4%, P < 0.0001), and radial strain significantly better (+51.4% vs. +35.9%, P < 0.0001). RV conventional echocardiography and STE parameters were normal and not different between anthracycline and control groups. The existence of a modified LV strain despite normal LV function in children treated with anthracyclines represents an important perspective for cardiomyopathy surveillance in childhood cancer survivors.

Prevalence and predictors of right ventricular dysfunction in cancer patients treated with cardiotoxic chemotherapy – a prospective cardiovascular magnetic resonance study

Abstract Background Right ventricular (RV) function has an established incremental prognostic value in cardiomyopathy. Studies on cancer therapeutics-related cardiac dysfunction (CTRCD) primarily focused on the left ventricle (LV), with conflicting results from small studies dedicated to RV dysfunction. Purpose We sought to investigate the influence of chemotherapy on RV function relative to LV function using serial cardiac magnetic resonance (CMR). Methods Patients were enrolled as part of Cardiotoxicity Prevention Research Initiative (CAPRI) Registry aimed at evaluating CMR-based markers for surveillance of CTRCD. Patients underwent non-contrast CMR imaging prior to initiation of anthracyclines and/or trastuzumab and serially every 3 months during the first year, then annually thereafter. We included patients who had a baseline and ≥1 follow-up scan and excluded those with baseline LV ejection fraction (EF)&amp;lt;50%, providing 320 patients completing 1,453 CMR studies. Cine images were analysed to calculate chamber volumes indexed to body surface area and EF. We defined LV CTRCD using CMR modality specific criteria of a drop in LV EF ≥5% from baseline to &amp;lt;57%; RV CTRCD as a drop ≥5% to &amp;lt;49% in females and &amp;lt;47% in males. We used linear mixed models to study the changes in ventricular volumes and EF with time. Results The majority of patients were females (80%), had breast cancer (68%) or lymphoma (32%), with a mean age of 52.7±13 years. Figure 1 shows temporal changes in mean ventricular volumes and function over the first year. Mean changes in RV function followed those of the LV, with the nadir of EF and maximum of volumes occurring at 6 months. Respective values for mean decrease in LV and RV EF at this time point versus baseline were 4.1 and 2.9% (p&amp;lt;0.001). Concomitant mean increase in indexed RV end-diastolic (ED) and end-systolic (ES) volumes were 1.6 and 2.7 ml/m2 (p=0.2 and &amp;lt;0.001). There was significant interaction of chemotherapy regimen with time for RV volumes (p=0.001 and 0.003), but not RV EF (p=0.7), with worst changes occurring with combined anthracyclines and trastuzumab. In all, 70 (22%) and 28 (9%) patients met criteria for LV and RV CTRCD, respectively. Among those who developed RV CTRCD, 10 had persistently normal LV function. Figure 2 shows the results of logistic regression to predict RV CTRCD. Significant univariable predictors included combined chemotherapy regimen and baseline LV and RV volumes and LV EF. Adjusting for age, sex, and chemotherapy regimen, baseline RV ED volume remained associated with RV CTRCD (odds ratio 1.6; p=0.005). Conclusion In this large study, RV volumes and function were similarly influenced by chemotherapy versus comparable LV-based measures. Using similar threshold criteria, the incidence of RV CTRCD was lower than for LV CTRCD; however, one third of those who develop RV CTRCD showed normal LV function. Future studies are warranted to study the prognostic influence of RV injury in cancer patients. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Alberta InnovatesGenome Alberta Figure 1. Temporal changes in LV &amp; RV functionFigure 2. Predictors of RV CTRCD

Reverse remodelling criteria to predict cardiovascular death in heart failure with reduced or mid-range ejection fraction

Abstract Aims Reverse remodelling (RR) is the recovery from left ventricle (LV) dilatation and dysfunction. There are no established definitions of RR. We sought to identify RR criteria that better predicted cardiovascular death. Methods and results Forty-two studies used 25 criteria to define RR, most commonly (n=12) as LV end-systolic volume (LVESV) reduction ≥15%. We evaluated 927 patients with LV ejection fraction (LVEF) &amp;lt;50% undergoing 2 echocardiograms within 12±2 months. Over a median 2.8-year follow-up after the second echocardiogram (1.3–4.9), 123 cardiovascular deaths occurred (13%). Model 1 included age, LVEF, N-terminal pro-B-type natriuretic peptide (NT-proBNP), ischaemic aetiology, cardiac resynchronization therapy (CRT), estimated glomerular filtration rate (eGFR), New York Heart Association (NYHA), and LVESV index (LVESVi), and Model 2 the validated 3C-HF score. Two RR criteria proved particularly effective in risk reclassification over Model 1 and Model 2: LVEF increase ≥1 category (severe [LVEF ≤30%], moderate [LVEF 31–40%], mild LV dysfunction [LVEF 41–55%] and normal LV function [LVEF ≥56%]), and LVEF increase &amp;gt;10 U. The same 2 criteria yielded independent prognostic significance and improved reclassification also in patients with LVEF &amp;lt;40% or LVEF ≤35%. LVEF increase ≥1 category and LVEF increase &amp;gt;10 U displayed a stronger prognostic value than LVESV reduction ≥15%, both in the whole population and the subsets with LVEF &amp;lt;40% or ≤35%. Funding Acknowledgement Type of funding sources: None.

Left ventricular myocardial deformation assessment in asymptomatic patients with recently diagnosed sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis

BackgroundSarcoidosis is a systemic granulomatous disease affecting different organs including the heart. Myocardial strain analysis could potentially detect the early stages of cardiac dysfunction in sarcoidosis patients. The present study aims to assess the use of cardiac magnetic resonance (CMR) strain analysis using feature tracking (FT) in the detection of early cardiac involvement in asymptomatic patients with sarcoidosis.MethodsOne hundred and thirteen CMR studies of patients with sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis without pre-existing known cardiovascular disease were included in the study and analysed using FT and compared to 22 age and gender-matched controls. Global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) of the left ventricle (LV) were measured.ResultsThe sarcoidosis patients did not significantly differ from the controls in basic demographic data and had normal global and regional systolic LV function—LV ejection fraction (EF) 66 ± 7% vs 65 ± 5% in the controls (p = NS). No statistically significant differences were found in all strain parameters between patients and controls: GLS (− 13.9 ± 3.1 vs. − 14.2 ± 2.5), GCS (− 23.4 ± 4.0 vs. − 22.2 ± 2.9) and GRS (53.4 ± 13.5 vs. 51.2 ± 13.6%) (p = NS).ConclusionPatients with sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis had normal myocardial deformation measured by CMR-FT derived global strain

Global longitudinal strain in heart transplantation recipients using different vendors: reliability and validity in a tertiary hospital in Colombia.

Global Longitudinal Strain (GLS) is a useful tool to follow-up heart transplant (HT) recipients. Important inter-vendor variability of GLS measurements has been reported in healthy subjects and different conditions, but there is still limited evidence among HT patients. We assessed the reliability and validity of GLS using two vendors (General Electric and Philips) in a group of consecutive and stable adult HT recipients. Patients underwent two concurrent GLS analyses during their echocardiographic follow-up. We evaluated GLS inter-vendor reliability using Bland-Altman's limits of agreement (LOA) plots, computing its coverage probability (CP) and the intraclass correlation coefficient (ICC). Validity was assessed though receiver operating characteristics (ROC) curves, predictive values, sensitivity and specificity of GLS for each vendor to detect a normal left ventricle function. 78 pairs of GLS studies in 53 stable HT patients were analyzed. We observed a modest inter-vendor reliability with a broad LOA (less than 50% of values falling out our CP of 2% and an ICC of 0.49). ROC analyses (areas under the curve of 0.824 Vs. 0.631, p < 0.05) and diagnosis test indices (Sensitivity of 0.73 Vs. 0.64; and Specificity of 0.79 Vs. 0.50) favored GE over Philips. Inter-vendor variability for GLS analysis exceeded clinically acceptable limits in HT recipients. GLS from GE software seemed to show higher validity as compared to Philips'. The present study provides evidence to consider caution for the interpretation of GLS for clinical management in the follow-up of HT patients, especially when GLS is measured by different vendors.

TO STUDY RIGHT VENTRICLE (RV) AND LEFT VENTRICLE ( LV) DYSFUNCTION IN TRANSFUSION DEPENDENT BETA THALASSEMIA CHILDREN AT TERTIARY CARE HOSPITAL IN NORTH WEST RAJASTHAN

Background- Regular blood transfusions used for long term survival in ß-thalassemia major patients cause a secondary state of tissue iron overload. Myocardial iron deposition can result in cardiomyopathy, and heart failure remains the leading cause of death. This study was planned to see the Right Ventricle (RV) and Left Ventricle(LV)dysfunction in beta thalassemia transfused patients.&#x0D; Method- Patients of ß thalassemia major above 2 years of age received regular blood transfusions at least for 1 year duration, attending OPD in the Department of Pediatrics, S P Medical College, Bikaner were included.Echo was correlated with serum ferritin Level(SFL).&#x0D; Results- Tissue Doppler imaging(TDI) parameters of 50 patients at mitral annulus e.g. Em septal, Em Lateral, Am septal, Am lateral, Sm Septal and Sm Lateral were abnormal(&lt;2SD and &gt;2SD)in 70% &amp; 0%, 50% &amp; 4%, 10% &amp; 46%, 34% &amp; 24%, 40% &amp; 22% and 60% &amp; 10% patients respectively.TDI parameters at tricuspid valvee.g. Et, At and St were abnormal(&lt;2SD)in 98%, 96% and 98% patients respectively. The differences in mean values of Et, At and St, when compared in the SFL groups &lt;2500,2500-5000 and&gt;5000, was non significant(p&gt;0.05).&#x0D; Conclusion- TDI is superior to conventional echocardiography in giving an early evidence of diastolic myocardial dysfunction in asymtopmatic and normal LV function patients.TDI can be applied as an integrated part of assessment of children &amp; adolescents with ß-thalassemia. Septal Sm, Em &amp; lateral Em, Sm, Am and RV Et, At, St were reduced early in majority of patients. Our study showed early involvement of septum and RV in thalassemic patients.&#x0D; Key Words: ß-thalassemia major ;Right Ventricle (RV) and Left Ventricle ( LV) dysfunction; Echocardiogram ;Tissue Doppler Imaging

Assessment of subclinical left atrial myocardial dysfunction in essential hypertension patients with normal left ventricle function by two-dimensional strain and volume-derived variables.

To investigate subclinical left atrial (LA) myocardial dysfunction in essential hypertension (EHT) patients by using volume-derived and two-dimensional strain. We enrolled in this study 51 normal subjects and 95 EHT patients. The LA volume-derived index was measured in apical 4- and 2-chamber views. LA strain and strain rate, reservoir, conduit, and booster pump functions were measured by two-dimensional speckle tracking echocardiography (STE). LA ejection fraction (LAEF) and absolute strain-derived values were significantly lower in EHT patients than in controls. LAEF (total, passive), absolute values of LA strain (S-reservoir and S-conduit), and strain rate (Sr-reservoir and Sr-conduit) were significantly lower in EHT patients with left ventricular hypertrophy (LVH) than in patients without LVH and in controls. However, there were no significant difference in active LAEF or S-booster pump and Sr-booster pump functions between EHT patients without LVH and normal subjects. The areas under the curves of the combination of volume-derived values, LA strain, and strain rate were significantly higher than those of individual indices. In our population, EHT patients showed impaired LA functions and greater stiffness than normal subjects. EHT patients with LVH showed greater impairment of LA reservoir and conduit functions than patients without LVH. EHT patients without LVH had normal LA booster pump function, which was impaired in patients with LVH. Volume-derived and 2D strain values could provide a sensitive and reproducible method for detecting subclinical LA myocardial dysfunction in EHT.

A study of etiology, clinical characteristics, electrocardiographic and echocardiographic findings in patients with cardiac tamponade in a tertiary care hospital in Western Odisha

Background: Cardiac tamponade is a life-threatening condition characterized by elevated intracardiac pressure, limitation of diastolic filling, and reduction of cardiac output and mostly requires urgent therapeutic intervention. Pericardial disease in on the rise attributed to improved survival of malignancy, growing no of cardiac interventions, chronic kidney diseases with dialysis, advent of modern chemo-radiotherapy. Still, there are paucity of data on etiology, clinical characteristics, electrocardiogram (ECG) and echocardiographic features in patients with cardiac tamponade from Odisha. Aim of this study was to emphasize the etiology, clinical characteristics, electrocardiographic and echocardiographic features in patients with cardiac tamponade.Methods: A prospective observational study of 1-year duration was undertaken for patients with cardiac tamponade admitted at VIMSAR, a cardiology unit. Data on etiology, clinical characteristics, Echocardiography, ECG findings were documented. Echo guided pericardiocentesis followed culture, cytological and biochemical analysis done.Results: Most common symptom was dyspnoea (88%), clinical signs were tachypnoea (96%), raised jugular venous pulse (64%), tachycardia (84%), pulsus paradoxus (60%). Classical beck’s triad was seen in 42% cases. X-ray showed cardiomegaly (94%) &amp; pleural effusion (64%). Common ECG findings were sinus tachycardia (84%), low voltage QRS (68%) and electrical alternans (44%). Echocardiography showed 80% and 68% of patients had right atrium collapse and right ventricle collapse respectively. Both inferior vena cava plethora and transmitral flow variation were seen in 88% of cases. 96% had normal left ventricle function. 80% had large effusion. Pericardiocentesis yield was mostly in between 500-1000ml (mean 908 ml) with 72% with haemorrhagic aspirate. All malignancy cases and 76% tubercular cases had haemorrhagic effusion. Most common etiology was tubercular (50%), followed by malignancy (28%). 6% remained idiopathic. chronic kidney disease, systemic lupus erythematosus, post MI intervention, hypothyroid were some of the other causes.Conclusions: Initial assessment with investigation and careful follow-up can yield a causal diagnosis in most cases. Early diagnosis and intervention by pericardiocentesis can be lifesaving.

Value of tissue doppler indices for prediction of early atrial fibrillation recurrence after cardioversion

Abstract Background Spectral tissue Doppler-derived E/e' ratio has been proposed as the best parameter in the prediction of atrial fibrillation (AF). Although relaxation and contraction are equivalent parts of a continuous cardiac cycle, where systolic and diastolic abnormalities have a variable contribution to the left ventricle (LV) failure. A new doppler index, E/(e'×s') ratio, combining an index of diastolic function (E/e') and marker of systolic LV function (s'), has been confirmed as a good predictor of new-onset AF, although value of E/(e'×s') ratio to predict AF recurrence was not evaluated. Purpose The aim of this study was to investigate whether E/(e'×s') may be better parameter than E/e' to predict AF recurrence after the electrical cardioversion (ECV) of persistent AF in patients with normal LV function. Methods The prospective study included 77 patients with persistent AF with preserved LV ejection fraction (&amp;gt;50%) and successfully performed ECV. Plasma level of NT-proBNP was measured for all the patients before the ECV. Transthoracic echocardiography was performed within the first 24 hours after successful ECV. Primary outcome was the early (at 1 month) recurrence of AF. Results At 1 month follow-up, 39 patients (50.6%) were in sinus rhythm. Binary logistic regression analysis showed that LV enddiastolic diameter &amp;gt;50 mm (HR 3.70, 95% CI 1.29–10.58, p=0.02), NT-proBNP &amp;gt;2000 ng/L (HR 3.28, 95% CI 1.01–10.71, p=0.04), E/e' (HR 1.74, 95% CI 1.27–2.39, p=0.001) and E/(e'×s') ratios (HR 8.17, 95% CI 1.57–42.4, p=0.01) were significant predictors of AF early recurrence after ECV. When we developed multivariate models using these potential confounding factors. To minimize the problem of collinearity E/e'and E/(e'×s') were included in 2 separate models. Multivariate analysis identified that E/(e'×s') ratio and E/e' ratio in combination with LV enddiastolic diameter &amp;gt;49.3 mm and NT-proBNP &amp;gt;2000 ng/L are able to predict early AF recurrence after ECV in 74% and 79% cases, respectively. E/(e'×s') ratio showed higher contribution in the model to predict AF recurrence compared to E/e' ratio (for E/(e'×s') ratio HR 18.94, 95% CI 2.39–149.66, p=0.005; for E/e' ratio HR 1.95, 95% CI 1.31–2.91, p=0.001). On ROC analysis, the diagnostic accuracy of E/(e'×s') and E/e' ratios were found to have the largest areas under the curve (E/(e'×s') ratio, AUC = 0.71, p=0.002 and E/e' ratio, AUC = 0.75, p&amp;lt;0.0001) with an optimal E/(e'×s') ratio cut-off value of 1.15 (sensitivity 97%, specificity 58%) and E/e' ratio value of 8.79 (sensitivity 89%, specificity 41%) for predicting early recurrence of AF after ECV. Conclusions Spectral tissue Doppler-derived ratios (E/(e'×s') and E/e') together with higher NTproBNP level and larger LV enddiastolic diameter predicted early AF recurrence after ECV. E/(e'×s') seems to be a more powerful predictor of AF early recurrence than E/e' ratio. Funding Acknowledgement Type of funding source: None

Echocardiographic assessment of left atrial morphology and function to predict maintenance of sinus rhythm after electrical cardioversion in patients with non-valvular persistent atrial fibrillation and normal function or mild dysfunction of left ventricle.

The aim of this study was to assess whether echocardiographic measurements of left atrial (LA) morphology and function could predict sinus rhythm maintenance after electrical cardioversion among patients with atrial fibrillation (AF) and normal function or mild dysfunction of the left ventricle (LV). One hundred seventeen patients with persistent AF who underwent successful electrical cardioversion were prospectively enrolled. Echocardiography was performed one day subsequent to successful cardioversion. Patients were followed up clinically and electrocardiographically at 1, 6, and 12 months. At 12 months, 61 (52%) patients had maintained sinus rhythm (SR). Compared to patients who maintained SR, those with AF recurrence had larger LAs, worse LA systolic function, and increased LV filling pressure. On multivariate stepwise logistic regression, E/A ratios (odds ratio [OR] 0.550, 95% confidence interval [CI] 0.341-0.886; p = 0.014) and E/e' ratios (OR 0.871, 95% CI 0.771-0.985; p = 0.027) were significant predictors of AF recurrence. On receiver operator characteristic curve analysis of AF recurrence at 12 months, the area under curve for both E/A and E/e' ratios were 0.726. With an E/A cutoff of 2.2, the sensitivity for predicting AF recur-rence at 12 months was 72%, and specificity was 73%. With an E/e' cutoff of 9.17, the sensitivity for predicting AF recurrence at 12 months was 72%, and specificity was 74%. Left ventricular filling pressure assessed with E/A and E/e' ratios predict AF recurrence after electrical cardioversions among patients with AF and normal function of LV.