Normal Left Ventricular Ejection Research Articles

Subclinical left ventricular myocardial dysfunction in patients with obstructive sleep apnea syndrome: insights from noninvasive left ventricular myocardial work analysis

BackgroundObstructive sleep apnea syndrome (OSAS) is associated with various cardiovascular diseases and has aroused public concern. Early detection for declining myocardial function is of great significance. This study was aimed at noninvasively evaluating the subclinical left ventricular (LV) myocardial dysfunction with LV pressure–strain loop (PSL) in patients with OSAS having normal LV ejection fraction.MethodsWe enrolled 200 patients with OSAS who visited the Beijing Chaoyang Hospital between February 2021 and December 2021. According to the apnea–hypopnea index (AHI), patients were divided into mild, moderate, and severe groups. The global longitudinal strain (GLS) of the left ventricle was analyzed by two-dimensional speckle tracking echocardiography. The LV PSL was used to assess global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE), and comparisons were made among groups.ResultsGLS was significantly lower in the severe group than in mild and moderate group. GWI, GCW, and GWE were lower in the severe group than in mild and moderate groups. GWW was significantly higher in the severe group than in the mild group. GLS, GWI, and GWE were moderately correlated with AHI (Spearman’s ρ = −0.468, −0.321, and −0.319, respectively; P < 0.001), whereas GCW and GWW showed a weak correlation with AHI (Spearman’s ρ = −0.226 and 0.255 respectively; P < 0.001). Multiple regression analyses revealed AHI was independently associated with GWI after adjusting for SBP, GLS, e’, etc. AHI was independently associated with GCW after adjusting for SBP, GLS, etc.ConclusionsThe LV PSL is a new technique to noninvasively detect myocardial function deterioration in patients with OSAS and preserved LV ejection fraction. Increased severity of OSAS was independent associated with both decreased GWI and GCW.

Association between angiopoietin-2 and functional cardiac remodeling in hemodialysis patients with normal left ventricular ejection.

Cardiac remodeling is the initial process in heart failure development. The aim of this study is to evaluate the association between endothelium‐related biomarkers and cardiac remodeling in hemodialysis (HD) patients and how the presence of high blood pressure and diabetes mellitus modulates these associations. This was a cross‐sectional study with adult HD and normal left ventricular (LV) ejection fraction—LVEF—patients. The authors correlated several endothelium‐related biomarkers with echocardiographic indices—LV mass index (LVMi), LVEF, global longitudinal strain, mitral E/e’, and aortic root diameter. Seventy‐one patients were included, with 37 women (52.1%) and mean age of 54.3 ± 16.8 years. Angiopoietin‐2 (AGPT2) was inversely correlated with global longitudinal strain (r = ‐.374, p = .001) and directly with E/e’ (r = .265, p = .025). After adjustment, only AGPT2 was significantly associated with global longitudinal strain. blood pressure and diabetes mellitus were independent moderators for the AGPT2 and global longitudinal strain association. The conditional association was significant only when the mean pre‐HD blood pressure was above 97.5 mmHg or in diabetes mellitus patients. Finally, there was an interaction between diabetes mellitus and blood pressure when moderating the conditional effect of AGPT2 on global longitudinal strain. While in non‐diabetic patients, the association between AGPT2 with global longitudinal strain was significant only with pre‐HD blood pressure levels as high as 110 mmHg, in diabetic patients, this association was significant with pre‐HD blood pressure as low as 90 mmHg. Higher levels of AGPT2 were associated with worse cardiac function as determined by lower global longitudinal strain values. This association was moderated by blood pressure and diabetes mellitus, suggesting that the effects of AGPT2 on cardiac remodeling is dependent of such circumstances.

Validation of evaluating left ventricular diastolic function with estimated left atrial volume from anteroposterior diameter

BackgroundLeft atrial (LA) volume (LAV) is one of the recommended key variables for evaluating left ventricular (LV) diastolic function. However, only LA anteroposterior diameter (LAAP) is available in numerous large-scale existing databases. Therefore, this study aimed to validate whether LV diastolic function could be evaluated with estimated LAV from LAAP.MethodsA total of 552 inpatients with sinus rhythm were consecutively enrolled. LAV was measured by biplane Simpson’s disk summation method. LV diastolic function was evaluated according to the 2016 proposed recommendations. Best-fitting regression models of LAAP index (LAAPI)–LAV index (LAVI) were developed and equations with the highest F-value were chosen in the first 276 subjects (derivation set), and concordance for evaluating LV diastolic function between using estimated and observed LAVI was verified in the remaining 276 subjects (validation set).ResultsIn the derivation set, the linear model has the highest F-value in all subjects and in the subjects with normal or depressed LV ejection fraction. In the validation set, using the linear equation (LAVI = 2.05 × LAAPI − 13.86), the higher area under curve and narrower range of difference were shown between estimated LAVI and observed LAVI, respectively. Further, concordance for diagnosis (overall proportion of agreement, 88.4%; κ = 0.79) and grading (overall proportion of agreement, 84.8%; κ = 0.74) of LV diastolic dysfunction was substantial between using estimated and observed LAVI.ConclusionsLV diastolic function can be evaluated with estimated LAVI from LAAPI, which might provide a surrogate method when the direct measurement of LAV is not available.

Global longitudinal strain as a predictor of short-term effect of oral antiviral regimens on myocardium in Egyptian patients with chronic viral hepatitis C

BackgroundHepatitis C virus (HCV) infection has been noted with various cardiovascular (CV) diseases, and patients with detected HCV-RNA had higher CV mortality than uninfected individuals. The new direct-acting antiviral drugs (DAA) proved to be more effective with fewer side effects compared to interferon in eradicating HCV, but their effect on myocardium is still questionable. In order to get some answers for such question, two-dimensional speckle tracking echocardiography (2D-STE) was studied before and after treatment with different DAA regimens in HCV patients with either mildly impaired or normal basic left ventricular ejection fraction (LVEF).ResultsGlobal longitudinal strain (GLS) significantly worsened after finishing antiviral treatment in patients with basic impairment of LVEF (n = 100) and those with normal basic LVEF (n = 20) [p = 0.006 and 0.039, respectively]; also, segmental strain showed significant worsening of many segments. Such worsening was significantly more in those with basic impairment of LVEF compared to those with normal basic LVEF (p = 0.036). No significant difference was observed in GLS and segmental strain when classifying and comparing patients according to gender, presence of diabetes mellitus, hypertension, ischemic heart disease and established cardiac medications, or according to DAA regimen received.ConclusionDAA may have a cardiotoxic effect that could be early detected by 2D-STE, which was more significant in patients with pre-treatment impairment of LVEF.

Abstract 16330: Evaluation of Cardiac Function in Children Undergoing Liver Transplantation

Introduction: Cirrhotic cardiomyopathy is a hemodynamic complication of cirrhosis resulting in cardiac dysfunction. It remains poorly characterized in children. Our aim was to assess cardiac function using speckle tracking echocardiography (STE), a marker of subclinical cardiac dysfunction, in patients undergoing liver transplant (LT) and correlate it with their post-operative (op) clinical course. Methods: This is a retrospective study of pre-LT echocardiograms performed on pediatric patients (pts) with cirrhosis at a single tertiary care center who received a LT. Demographic clinical and echocardiographic data was collected and STE was performed by a single observer using TomTec system. Descriptive data was expressed as mean (SD) and number (%). The relationship between clinical data and echocardiographic variables was assessed using Pearson correlation coefficient. Significance was set at P value &lt; 0.05. Results: Twenty-three pts underwent LT between 03/2013-12/2019 with median age 7.5 (IQR 0.1, 17) years and 31 % with biliary atresia. Five patients were listed as status 1A/1B. Their mean natural pediatric/model end-stage lived disease (PELD/MELD) score was 15. Their pre-LT echocardiogram showed normal left ventricular (LV) ejection fraction and normal right ventricular (RV) fractional area change. Tricuspid annular plane systolic excursion (TAPSE) was abnormal in 50% of pts. While LV global longitudinal strain (GLS) (23 ± 3%) and LV circumferential strain (27 ± 4%) were normal, RV GLS was abnormal in 65% of pts (22 ± 3%). There was no correlation between echocardiographic parameters and post-operative LT course (length of stay, duration of mechanical ventilation, surgical complications). Conclusions: Children undergoing liver transplant have RV dysfunction as evidenced by abnormal TAPSE and RV GLS on speckle tracking echocardiography. Echocardiographic parameters do not correlate with the immediate post-LT clinical status.

HFpEF score discriminates severity of cardiovascular profile in asymptomatic treated hypertensive patients: the campania salute network

Abstract Background The heart failure with preserved ejection fraction (HFpEF) score is easy to use and potentially useful to discriminate HFpEF from noncardiac causes of dyspnea. HFpEF score may be expressed also as probability to have HFpEF. Purpose We investigated whether a high HFpEF score can identify specific cardiovascular (CV) profile in treated hypertensive patients even without dyspnea. Methods From September to December 2019, we consecutively enrolled treated hypertensive patients without dyspnea, with normal left ventricular (LV) ejection fraction (&amp;gt;50%), and chronic kidney disease of no more than stage III. In addition to standard echocardiographic parameters we evaluated: 1) inappropriate LV mass, identified as a percent of predicted LV mass &amp;gt;128%, 2) myocardial energetic efficiency as the ratio of stroke volume to heart rate normalized by LV mass (MEEi), and 3) an estimate of arterial stiffness, i.e. the ratio of pulse pressure and stroke index (by allometric normalization by height), as previously reported. The probability of HFpEF was calculated from the HFpEF score, using body mass index, pulmonary systolic pressure, mitral E/E' ratio, age, and history or evidence of atrial fibrillation. Results 188 patients with complete data were analyzed (42% women, age 61±14 years, 9% diabetic). Patients were then divided into 3 groups according to HFpEF probability tertiles and compared by ANOVA and trend analysis (Table 1). Conclusions Probability of HFpEF using HFpEF score and non-standard echocardiographic parameters identify worse CV profile in treated hypertensive patients without dyspnea. Funding Acknowledgement Type of funding source: None

Relationship between right ventricular pacing and non-sustained ventricular arrhythmias in patients with dual-chamber pacemaker and normal range left ventricular ejection fraction

BackgroundRight ventricular pacing (RVP) increases heart failure, AF, and death rates in pacemaker patients and ventricular arrhythmias (VAs) in defibrillator patients. However, the impact of RVP on VAs burden and its clinical significance in pacemaker patients with normal range LVEF of > 50–55% remains unknown. We sought to evaluate the relationship of RVP and VAs and its clinical impact in a pacemaker patient population.MethodsRecords of 105 patients who underwent denovo dual-chamber pacemaker implant or a generator change (Medtronic™ or Boston Scientific™) for AV block and sinus node disease at a tertiary care center between September 1, 2015, and September 1, 2016, were retrospectively reviewed.ResultsData from 105 patients (51% females, mean age 76 ± 1 years, mean LVEF 61 ± 0.7%) without history of VAs (98.2%) were reviewed over 1044 ± 23 days. Dependent patients (100% RVP) exhibited the lowest VAs burden when compared to < 100% RVP (isolated PVCs, PVC runs of < 4 beats, and NSVT; p ≤ 0.001). Patients with < 1% RVP also exhibited low VA burden with intermediate RVP (1–99.9%) being most arrhythmogenic for PVC runs (p = 0.04) and for isolated PVCs (p = 0.006). Antiarrhythmics/beta and calcium channel blockers use and stress tests performed to evaluate VAs which were positive requiring intervention did not differ significantly. Burden of > 1/h of PVC runs and increasing PVC runs/h were significantly associated with hospitalization (p = 0.04) and all-cause mortality (p = 0.03), respectively.ConclusionsIn pacemaker patients with normal range LVEF (> 50–55%), 100% RVP is associated with the lowest burden of NSVT. Furthermore, patients with < 1% RVP also exhibit low VA burden; however, intermittent RVP seems to significantly correlate with non-sustained VAs.

Echocardiographic Profile in Newly Diagnosed Patients with Obstructive Sleep Apnoea (OSA) and Normal LV Ejection Fraction: A Prospective Study

OSA is considered as an independent risk factor for cardiovascular morbidity and mortality. Hypertension, atrial fibrillation, heart failure with reduced ejection fraction, stroke and metabolic syndrome are also known to be associated with OSA. Each of these conditions are associated with 2D-ECHO abnormalities and often present with increased hospitalization rates or morbidity. However, echocardiographic parameters in newly detected OSA, without any other associated illness, is poorly defined. The aim of this study is to evaluate systolic and diastolic dysfunction using 2D speckle tracking in patients with newly diagnosed OSA and normal left ventricle ejection fraction. The association between diastolic dysfunction, Global Longitudinal Strain (GLS), LV hypertrophy, LV mass, estimated pulmonary artery pressures and severity of OSA was also studied.The results indicated that most of the patients with OSA, without any other cardiovascular diseases, exhibited normal left ventricular (LV) ejection fraction (EF), but had clinical signs and symptoms of LV systolic dysfunction.

P4681Early findings in patients with noncompaction cardiomyopathy and normal ejection fraction: a cardiopulmonary exercise test, echocardiographic and biomarkers study

Abstract Background Noncompaction cardiomyopathy (NCC) is a cardiomyopathy with controversial diagnostic criteria. Furthermore, it has been discussed whether asymptomatic individuals with normal left ventricular (LV) ejection fraction (EF) and diagnostic criteria for this disease could be classified as NCC. Therefore, the objective of this study was to evaluate the functional capacity of patients with NCC and the relation with echocardiographic and biomarkers indices. Methods Fifty-nine patients with NCC were prospectively divided into three groups: ejection fraction (EF)&gt;50% (G1), EF between 40 - 50% (G2) and EF &lt;40% (G3). In addition, 11 normal healthy volunteers were selected for control group (CG). All subjects underwent 2D echocardiography with tissue Doppler and myocardial deformation indices, cardiopulmonary exercise test (CPET), troponin I and BNP measurements. Results There was a decrease in VO2 peak (ml/km/min) in all NCC groups compared to CG (GC= 34.5±5.3, G1= 25.56±5.6, G2= 25.12±7.7 and G3= 21.86±6.3 ml/kg/min, p&lt;0.001), but no difference was shown among NCC patients (p=0.37). In addition, the VO2 at anaerobic threshold (AT) was lower in all NCC groups compared to CG (GC= 22.88±3.3, G1= 17.30±4.7, G2= 18.58±5.2, e G3= 15.65±3.7 ml/kg/min, p&lt;0.001). There was an increase in indexed ventricular mass in all NCC groups when compared to CG (p&lt;0.001), but it was similar among NCC groups (p=0.72). Regarding to diastolic function, G2 and G3 presented a reduction in the peak velocity of the septal E' when compared to the control group (GC= 14.0±2.4, G2= 8.92±3.0 e G3= 6.86±3.9 cm/s, p&lt;0,001), while E/E' was increased in G3 compared to all groups (p&lt;0.001). G2 and G3 presented a decrease in global longitudinal strain (GLS) when compared to CG and G1 (p&lt;0.001). The BNP levels were higher in G3 compared to the other groups (p&lt;0.05), but no difference was found in troponin I levels. There was a positive correlation between VO2 peak and E' (r=0.56, p&lt;0.001) and a negative correlation between VO2 peak and E/E' (r=−0.53, p&lt;0.001). In addition, there was an inverse correlation between VO2 peak and BNP (r=−0.50, p&lt;0.001). Conclusion Our results show that NCC patients present alterations in functional capacity, echocardiographic indices and biomarkers values according to LV dysfunction. Moreover, patients with preserved LV function already present predominant alterations in CPET suggesting subclinical myocardial dysfunction. For this reason, clinical treatment could be considered in this initial stage of this disease.

Outcomes following veno-arterial extracorporeal membrane oxygenation for post-cardiotomy cardiogenic shock in adult cardiac surgical patients with a normal preoperative left ventricular ejection fraction

Introduction Post- cardiotomy cardiogenic shock (PCCS) is a syndrome that occurs following separation from cardiopulmonary bypass or anytime in the immediate postoperative Course(1). The aim of our study was to identify risk factors for mortality and outcomes in patients with normal preoperative left ventricular ejection fraction (LVEF) who received veno- arterial extracorporeal membrane oxygenation (VA ECMO) for PCCS in first 48 h post-cardiac surgery. Methods Retrospective cohort analysis of adult patients, who received VA ECMO for PCCS from 1998-2018. Association between all collected variables and mortality were analyzed, with bivariate and multivariate analysis. Results Of the 62,125 patients who underwent cardiac surgery procedures at our institution during the study period, a total of 173 patients (0.3%) with normal preoperative LVEF required PCCS. The mean age was 65 years (46.8% females) and a logistic Euroscore was 14.7%. 53% of patients were elective. Procedures were isolated coronary artery bypass grafting (CABG) in 24.2%, valve surgery 32.3%, CABG plus valve surgery 15.1%, aortic valve+ascending aorta 22.0%, aortic arch surgery 6.4%. Amongst these, 28.0% of patients were redo procedures, 11.6% had endocarditis, and 2.3% Type A dissection. VA ECMO was instituted in 74.6% patients on the day of surgery (49.6% in operating room, 25.0% after admission to the ICU), 16.8% on first postop day, and 8.7% on the second day. The median duration of ECMO support was 5 days. The reasons for ECMO implantation was: acute coronary insufficiency in 43.4% of patients, arrythmias (8.7 %), pulmonary embolism (1.2%), valvular insufficiency (1.7%), and cardiogenic shock in 46.2%. ECMO complications were bleeding in 40.0%, acute kidney injury (18.0%), stroke (6.4%), gastrointestinal complications (5.2%), sepsis (5.8%), limb thrombosis (3.0%). No complications were noted in 21.4% of patients. The overall in-hospital mortality was 57.8 %. Causes of mortality were therapy refractory shock in 40.0%, LCOS (Low cardiac output syndrome)after ECMO weaning (17.0%) multiorgan dysfunction (33.0%), and cerebral insult (10.0%). Independent risk factors for mortality were female gender (OR 2 (95%CI 1.1-3.7), Diabetes mellitus (DM) (OR 2 (95%CI 1.1-3.9), preoperative peripheral vascular disease (PVD) (OR 2.2 (95%CI 1.1-4.5), prior cardiac surgery (OR 3 (95%CI 1.4-6.3) and postoperative MI (Myocardial infarction) (OR 2.4 (95%CI 1.1-5.4). Non survivors had a median hospital stay of 7 (2-11) days and survivors had a median of hospital stay after ECMO of 19 (11-28) days. Discussion VA-ECMO is associated with high mortality for PCCS in adult cardiac patients with normal preoperative LVEF. In our cohort of patients, female gender, DM, preoperative PVD, prior cardiac surgery and postoperative MI were independent predictors of in-hospital mortality.

Early detection strain/strain rate and time to strain/strain rate abnormalities for left atrial mechanical function in hypertensive patients

Objective: To evaluate left atrial (LA) deformation parameters strain (S)/strain rate (SR) and time to peak S/SR obtained by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension for three LA mechanical phases and to compare them with the same indices in the control subjects.Methods: Fifty-five patients with hypertension (HT) and 29 healthy controls were included in the study. All patients had normal LA poster-anterior diameter, LA and left ventricular ejection fractions (LVEF >50%) in two-dimensional echocardiography (2-DE). The peak S/SR values (PS/PSR), the time to peak S/SR (TPS/TPSR) were measured using the 12-segment model for the left atrium during contractile (CP) reservoir (RP) and conduit period (COP) of the LA cycle.Results: For two periods (RP and COP), all of the PS and PSR values were significantly lower in hypertensive patients with preserved LAEF and LVEF compared to those in the controls, except for the CP. Similarly, hypertensive patients had significantly higher TPS and TPSR than those in the controls for the RP and COP in the LA wall, except for the CP.Conclusion: LA mechanical function was impaired in hypertensive patients with preserved LA and LV ejection fraction compared to the controls. Although the PS and PSR were decreased for the RP and COP of LA mechanical phases, the TPS/TPSR were prolonged in the HT patients compared to the controls. This might be additional diagnosis criteria to detect the LA myocardial dysfunction and might be a predisposing factor for atrial arrhythmia formation in the hypertensive patients.

S.25.03 - Reward processing in bipolar disorders

To determine whether the administration of ketamine during coronary artery bypass grafting (CABG) surgery leads to a reduction in the quantity of opioids required over the first 48 hours after surgery.Randomized, controlled, double-blind clinical trial.Single university academic center.Patients undergoing CABG surgery with a normal left ventricular ejection fraction.Ketamine administered intravenously as a bolus dose of 0.5 mg/kg before skin incision, followed by an infusion of 0.5 mg/kg/h until the end of surgery.One hundred eighty-three patients were screened, and 80 patients were randomized. Baseline characteristics were similar between the 2 groups. The intervention group received 53.6 mg (95% confidence interval [CI] 47.1-60.1 mg) of morphine equivalents in the first 48 hours after surgery, whereas the placebo group received 55.7 mg (95% CI 48.4-63.1 mg) over the same time period (p = 0.66). No significant difference was noted in morphine equivalents over the first 6, 12, or 24 hours postoperatively or in maximum, minimum, or average pain scores on postoperative days 1 or 2.The administration of ketamine during CABG surgery did not result in reduced opioid consumption or pain scores postoperatively.

Trastuzumab-related cardiotoxicity in patients with non-limiting cardiac comorbidity.

e12043 Background: Significant and symptomatic cardiac comorbidity (CC) is a contraindication to adjuvant trastuzumab (T) in breast cancer patients (pts). However, some pts with asymptomatic, non-limiting CC and normal baseline left ventricular ejection fraction (LVEF) receive T in the clinical practice. We sought to describe the tolerability of T in these pts. Methods: Retrospective analysis of pts with baseline asymptomatic non-limiting CC receiving adjuvant T with chemotherapy (CT) at 6 Institutions between Jul 2006 and Jan 2016. Results: Thirty-seven patients HER2-positive, operable BC at high risk of relapse BC were studied. Median age was 64y (range 36-82, 80% post-menopausal), median baseline LVEF was 61% (range 50-85%) and median BMI 26 (18-42, obesity 22%). Thirteen patients (35%) received T with adjuvant anthracycline and taxane-based, 19 (51%) taxane-based and 3 (8%) other adjuvant CT regimens (13 pts sequential, 22 pts concomitant with CT) and 2 (5%) with endocrine therapy. Prior non-limiting CC was ischemic heart disease (35%), valvular disease (30%), atrial fibrillation (19%), conduction disorders (13%), aortic aneurism (3%), and other (19%). Nine (29%) pts experienced TRC: congestive heart failure (1 pt, 3%), LVEF reduction (6 pts, 16%) and rhythm disturbances (1 pt, 3%). TRC occurred in pts with ongoing multiple cardiovascular risk factors (i.e. obesity and hypertension). Seven pts discontinued T because of TRC (19%), 5 permanently (14%) and 2 temporarily (5%). These latter pts, were able to resume and complete T after TRC resolution. At the end of adjuvant treatment, all pts showed LVEF within normal limits, except one of those who experienced a TRC (last FU value 46 %). Conclusions: This is the first analysis of TRC in pts receiving adjuvant T in the presence prior non-limiting CC. Despite the small size, our analysis shows that T is feasible in these pts and most of the TRC events were reversible at T withdrawal. Caution is needed in pts with significant ongoing cardiovascular risk factors, but when adjuvant T is deemed beneficial on breast cancer outcomes, non-limiting CC should not preclude treatment.

Troponin I and echocardiography in patients with systemic sclerosis and matched population controls

Objectives: Cardiac manifestations in systemic sclerosis (SSc) are associated with poor prognosis. Few studies have investigated cardiac troponins in SSc. We studied the relationships between echocardiographic abnormalities, cardiac biomarkers, and disease manifestations in a population-based cohort of patients with SSc and controls.Method: The study comprised 110 patients with SSc and 105 age- and sex-matched population-based controls. We examined ventricular function, heart valves, and estimated pulmonary arterial pressure (ePAP) by echocardiography in all participants. Disease characteristics, manifest ischaemic heart disease (IHD), and measurements of N-terminal prohormone brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI) were tabulated.Results: NT-proBNP and hs-cTnI levels were higher in SSc patients than controls. Both NT-proBNP and hs-cTnI were associated with the presence of echocardiographic abnormalities. Forty-four SSc patients and 23 control subjects had abnormal echocardiograms (p = 0.002). As a group, SSc patients had lower (but normal) left ventricular ejection fraction (LVEF, p = 0.02), more regional hypokinesia (p = 0.02), and more valve regurgitations (p = 0.01) than controls. Thirteen patients and four controls had manifest IHD. Decreased right ventricular (RV) function (n = 7) and elevated ePAP (n = 15) were exclusively detected among SSc patients.Conclusions: Both NTproBNP and hs-cTnI were associated with echocardiographic abnormalities, which were more prevalent in SSc patients than in controls. Our results thus suggest that hs-cTnI could be a potential cardiac biomarker in SSc. Low RV function and signs of pulmonary hypertension (PH) were uniquely found in the SSc group. SSc patients had more valve regurgitation than controls, an observation that warrants more clinical attention.

Patients with Diabetes and Significant Epicardial Coronary Artery Disease Have Increased Systolic Left Ventricular Apical Rotation and Rotation Rate at Rest.

The purpose of this study was to determine whether resting myocardial deformation and rotation may be altered in diabetic patients with significant epicardial coronary artery disease (CAD) with normal left ventricular ejection fraction. A prospective observational study. Diagnosis of epicardial CAD in patients with diabetes. Eighty-four patients with diabetes suspected of epicardial CAD scheduled for cardiac catheterization had a resting echocardiogram performed prior to their procedure. Echocardiographic measurements were compared between patients with and without significant epicardial CAD as determined by cardiac catheterization. Measurement of longitudinal strain, strain rate, apical rotation, and rotation rate, using speckle tracking echocardiography. Eighty-four patients were studied, 39 (46.4%) of whom had significant epicardial CAD. Global peak systolic apical rotation was significantly increased (14.9 ± 5.1 vs. 11.0 ± 4.8 degrees, P < 0.001) in patients with epicardial CAD along with faster peak systolic apical rotation rate (90.4 ± 29 vs. 68.1 ± 22.2 degrees/sec, P < 0.001). These findings were further confirmed through multivariate logistic regression analysis (global peak systolic apical rotation OR = 1.17, P = 0.004 and peak systolic apical rotation rate OR = 1.05, P < 0.001). Patients with diabetes with significant epicardial CAD and normal LVEF exhibit an increase in peak systolic apical counterclockwise rotation and rotation rate detected by echocardiography, suggesting that significant epicardial CAD and its associated myocardial effects in patients with diabetes may be detected noninvasively at rest.

Clinical characteristics and cardiac hemodynamic changes of patent ductus ateriosus in preterm infants

To study clinical characteristics and evaluate cardiac hemodynamic changes in premature infants with patent ductus ateriosus (PDA). One hundred and five infants born at ≤ 34 weeks' gestational age (GA) and ≤2 000 g birth weight (BW) were prospectively enrolled, including 63 males and 42 females, and the mean GA was (31. 1 ± 1.9) weeks and BW (1 401 ± 314) g. Echocardiography was done to detect hemodynamically significant PDA (hsPDA) and to evaluate left ventricular function at 2, 3, 5 and 7 d respectively after birth. On the basis of clinical symptoms and echocardiographic outcome, all the cases were divided into 3 groups: hsPDA group (n = 34), non-hsPDA (nhsPDA) group (n = 44) and non-PDA (nPDA) group (n = 27) to survey and compare general conditions, DA diameter, shunt direction, left ventricular function and complications. The hsPDA group had smaller GA ((30. 5 ± 2. 1) vs. (31. 6 ± 1. 6) weeks, P = 0. 01) and greater proportion of pulmonary surfactant use and mechanical ventilation (2, 3, 5 d of birth) than the nhsPDA and the nPDA group (χ2 = 11. 62, 14. 95, 12. 73, 1:1. 59, P = 0. 00; 0. 00, 0. 01, 0. 01). Univariate and multivariate Logistic regression analysis indicated that the average length of stay (ALOS) was correlated with hsPDA (F =3. 52 and P =0. 03, OR 1. 03 and P =0. 02). The ALOS was longer in the hsPDA group than in the nhsPDA and the nPDA group ((39 ±23)vs. (30 ± 16)and(29 ±13) d, P =0.02, 0.03). There was no significant.difference in rates of mortality/giving-up of treatment among the three groups (5. 9% (2/34)vs. 0 (0/44) and 3. 7% (1/27), χ2 = 5. 26, P = 0. 06). Diastolic blood pressure and mean blood pressure were significantly lower in the hsPDA group than in the other two groups (P all <0. 05) at 2, 3 and 5 days after birth and the pulse pressure was found significantly higher in the hsPDA group than in the nPDA group at 2 d after birth. Univariate and multivariate Logistic regression analysis demonstrated that hsPDA was correlated significantly with neonatal respiratory distress syndrome (NRDS) and bronchopulmonary dysplasia (BPD) (χ2 =7. 34 and 7. 39, P = 0. 02 and 0. 02; OR = 3. 46 and 4. 01, P = 0. 04 and 0. 02). Premature infants with hsPDA had normal left ventricular fractional shortening (FS) and left ventricular ejection fraction (LVEF), although the cardiac output (CO) of left ventricle increased significantly(F = 6. 93, P <0. 01) within seven days of birth. There was no significant difference in cardiac hemodynamic parameters among closed group of hsPDA group, nhsPDA group and nPDA group simutaneously reexamined at 7th day after birth. The CO was extremely significantly different among premature infants who had different GAs and BWs. The lower the GAs and the BWs, the lower the value of CO(F =5. 16 and 14. 87, P all <0. 01). The DA diameter was reduced much more dramatically after ibuprofen treatment than before in hsPDA group(t = 5. 58, P <0. 01). The GA, PS use and mechanical ventilation were probably associated with hsPDA. The mean blood pressure and diastolic blood pressure were decreased and pulse pressure was increased in preterm infants with hsPDA that correlated significantly with ALOS, NRDS and BPD. In addition, increased CO values were found in hsPDA group. Oral ibuprofen administered to preterm infants for hsPDA at > 24 h of life promoted ductal closure.

The changing landscape of cardiac pacing.

A number of trials have shown that irrespective of baseline QRS duration, left ventricular (LV) dysfunction and heart failure are more common in patients with right ventricular (RV) than in those with biventricular (BiV) pacing. By contrast, preliminary results of the BIOPACE trial (follow-up 5.6years) yielded a disappointing comparison of RV vs. BiV pacing. Pacemaker-induced cardiomyopathy (PIC) may occur in patients with normal and abnormal LV ejection fractions (LVEF) and tends to occur if there is RV pacing more than 40 % of the time. Yet, some pacemaker-dependent patients do not develop LV dysfunction. PIC can be improved in about two thirds of patients by upgrading to a BiV system and the results are comparable to de novo BiV pacing in patients with a wide QRS complex. The findings of the BLOCK HF trial (2013) suggested that patients requiring pacing virtually 100 % of the time might benefit from BiV pacing irrespective of the LVEF (< 50 %), manifestations of heart failure, QRS duration, or functional class. These characteristics would generate many patients for BiV pacing. However, these recommendations should now be weighed against a more conservative approach based on the recently announced results of the BIOPACE trial. Organizational guidelines recommend BiV pacing for bradycardia irrespective of QRS duration for patients with LVEF < 35 %. At this time, BiV pacing for antibradycardia therapy (irrespective of QRS duration) has to be individualized in the setting of a normal or decreased LVEF (> 35 %) and according to the expected percentage of RV pacing. The benefit of BiV pacing should be considered against procedural complications, which are more frequent than with traditional RV pacing.

Evaluation of Left Atrial Function with Strain Imaging: Is it Ready for "Prime Time"?

Nearly one in three or four adults in the world (over 50 million people in the US alone) has systemic hypertension, many of whom are unaware and untreated. Hypertension is listed among the three leading risk factors for death from cardiovascular diseases by the World Health organization and thus, has been called “the silent killer”. It is also a leading cause of heart failure with preserved ejection fraction. Although the mechanisms by which hypertension leads to heart failure are not well elucidated, studies over the past three decades have identified changes in vascular stiffness, structural remodeling of the left ventricle and development of diastolic dysfunction (impaired relaxation and decreased compliance) as important components. (1) The term, “diastolic heart failure” has been used for years and preceded the more recently proposed term, “heart failure with preserved ejection fraction”. Regardless how these factors interact with each other, the fact is that by the time clinical manifestations of heart failure occur, patients show clear evidence of diastolic dysfunction and the majority have enlargement of the left atrium (LA). (2) Subtle abnormalities of myocardial contraction and relaxation have been documented in asymptomatic hypertensive patients with normal left ventricular (LV) ejection fraction. In 1992, Habib et al reported abnormalities of diastolic filling consistent with impaired relaxation in both ventricles of asymptomatic hypertensive patients using pulsed- wave Doppler. (3) The magnitude of changes in the right ventricle paralleled those observed in the left. Since then a multiple of publications have described diastolic abnormalities in hypertensive patients, and although they tend to worsen with concentric hypertrophy, they can occur in the absence of hypertrophy and improve with sustained blood pressure reduction.(4) Likewise, there are several reports of reduced systolic mid-wall circumferential strain, longitudinal systolic strain and mitral annular descent in asymptomatic hypertensive patients with normal EF. (5-7) Furthermore, contraction abnormalities have been shown to relate closely with diastolic abnormalities, implying a functional and/or structural effect of the disease on the contractile apparatus of the myocardium. (6) In this issue of Revista Argentina de Cardiologia, Deschle et al report finding subtle contractile abnor

Impaired global and segmental myocardial deformation assessed by two-dimensional speckle tracking echocardiography in patients with vitamin B12 deficiency

Contrary effects of vitamin B12 deficiency have been shown on the cardiovascular system. Aim of our study was to analyze left ventricular (LV) myocardial deformation, by using the two dimensional (2D) speckle tracking echocardiography (STE) in patients with vitamin B12 deficiency and normal LV ejection fraction. Twenty-five patients with vitamin B12 deficiency (B12 levels < 200 pg/mL; mean age: 29.6 ± 8.2 years, 15 female), and 27 healthy controls (B12 levels > 200 pg/mL; mean age: 30.1 ± 6.9 years, 13 female) were included in the study. 2D echocardiography images were transferred to a workstation for further offline analysis. Longitudinal peak systolic (LPSS) and global strain (LGS) was obtained from 4 chamber and apical long axis (APLAX) views. Standard echocardiographic parameters and tissue Doppler imaging (TDI) velocities were compared between the groups. All LPSS values in the patient group except for apical 4C septal wall longitudinal strain were significantly decreased than those in the control group. There was a positive correlation between B12 levels and strain values except apical 4C septal wall strain values. We found that in patients with vitamin B12 deficiency, global and segmental myocardial deformation was impaired and this impairment was correlated with the levels of vitamin B12.

Severity of Coronary Artery Disease and Echocardiographic Parameters of Ventricular Diastolic Function

The objective of this study was to determine the relation between the severity of the coronary artery disease (CAD) and left ventricular (LV) diastolic function in patient with stable CAD and normal LV ejection fraction. Sixty patients with stable CAD were included in the study. All angiographic variables pertinent to SYNTAX Score (SS) and Gensini score (GS) calculation were computed by two experienced interventional cardiologists. All patients underwent echocardiographic examination. We divided the patients into 4 groups according to median of SS and GS. It was observed that LV diastolic function was impaired in 26 patients (86.7%) in under group of SS, 23 patients (76.7%) in upper group of SS, and 27 patients (87.1%) in under group of GS, and 22 patients (75.9%) in upper group of GS. There was no significant difference between the SS, GS, clinical, and echocardiographic findings. The diastolic function did not demonstrate any impairment according to the severity of the CAD in patients which coronary angiography performed with the diagnosis of stable CAD.