Normalization Of Left Ventricular Function Research Articles

Long-Term Outcomes of Women With Peripartum Cardiomyopathy Having Subsequent Pregnancies

BackgroundLong-term maternal outcomes of subsequent pregnancies (SSPs) in patients with peripartum cardiomyopathy (PPCM) have not been analyzed. ObjectivesThe goal of this study was to evaluate the long-term survival of SSPs in women with PPCM. MethodsWe conducted a retrospective review of 137 PPCMs in the registry. The clinical and echocardiographic findings were compared between the recovery group (RG) and nonrecovery group (NRG), defined as left ventricular ejection fraction ≥50% and <50% after an index of pregnancy, respectively. ResultsForty-five patients with SSPs were included with a mean age of 27.0 ± 6.1 years, 80% were of African American descent, and 75.6% from a low socioeconomic background. Thirty (66.7%) women were in the RG. Overall, SSPs were associated with a decrease in mean left ventricular ejection fraction from 45.1% ± 13.7% to 41.2% ± 14.5% (P = 0.009). At 5 years, adverse outcomes were significantly higher in the NRG compared with the RG (53.3% vs 20%; P = 0.04), driven by relapse PPCM (53.3% vs 20.0%; P = 0.03). Five-year all-cause mortality was 13.33% in the NRG compared with 3.33% in the RG (P = 0.25). At a median follow-up of 8 years, adverse outcomes and all-cause mortality rates were similar in the NRG and RG (53.3% vs 33.3% [P = 0.20] and 20% vs 20%, respectively). ConclusionsSubsequent pregnancies in women with PPCM are associated with adverse events. The normalization of left ventricular function does not guarantee a favorable outcome in the SSPs.

Cardiac function in pediatric Ewing sarcoma during and after treatment: A longitudinal study.

While anthracycline therapy has been shown to improve outcomes in Ewing sarcoma, it may be associated with severe and even fatal cardiac dysfunction. We evaluated the burden and determinants of cardiac dysfunction in pediatric Ewing sarcoma (pES). This retrospective study included children aged 0-18 years with pES treated at our center with the EFT 2001 protocol (anthracycline and cyclophosphamide containing regimen), with/without radiation therapy from January 2001 to December 2018. Cardiac dysfunction was defined as left ventricular (LV) ejection fraction with an absolute value<50%. Amongst 650 eligible patients (median age at diagnosis 12 years and median follow-up duration 69 months), 85 (13%) developed cardiac dysfunction, at a median 13 months (range: 1-168 months). The cumulative incidence of cardiac dysfunction was 5.7% at 12 months, 12% at 2 years, 13% at 3 years, 14% at 5 years, and 15 % at 10 years. At a median follow-up duration of 25 (range: 3-212) months, 21 (24.7%) patients had normalization of LV function, whereas nine (10.6%) patients died of cardiac causes. Older age at diagnosis (7-12 years OR 5.1, p=.01, 13-18 years, OR 3.9, p=.03), female sex (OR 2.3, p=.004), undernutrition (OR 2.9, p=.001), and chest wall location (OR 8.7, p=.08) were risk factors for cardiac dysfunction. Children with Ewing sarcoma have a high incidence of cardiac dysfunction, which continues to develop even years after therapy, underlining the need for life-long surveillance. Undernourished children are at a higher risk for cardiac dysfunction and need stringent monitoring.

P289 HEART FAILURE DUE TO HIGH OUTPUT ARTERIOVENOUS FISTULA IN A DIALYSIS PATIENT AFFECTED BY AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Abstract Autosomal dominant polycystic kidney disease (ADPKD) can determine end stage renal disease (ESRD) which require haemodialysis. Surgical creation of arteriovenous fistula (AVF) has been associated with development of left ventricular (LV) dilatation and high output heart failure (HF) and right ventricle (RV) dysfunction at long term follow–up. Databases show an association between ADPKD and idiopathic dilated cardiomyopathy, suggesting that PKD mutations contribute to development of heart failure. 36 ys old female patient affected by ADPKD who required in 2018 bilateral nephrectomy, due to a relapse of severe urinary tract bleeding, and then put in thrice–weekly hemodialysis. Before the procedure in 2016 an echocardiogram showed normal biventricular function, with valvular defects. An AVF, between left humeral artery and the perforator vein of the elbow, was employed as vascular access. 6 months later she was referred to our center for atypical chest pain and palpitations. A transthoracic echocardiogram showed a diffuse hypokinesia with severe left ventricular dysfunction and dilation (EF 25%, VTDi 90ml/mq), a cardiac output of 6,5 l/min, moderate mitral insufficiency, hypokinetic RV, pulmonary artery systolic pressure (PASP) of 56mmHg, severe biatrial dilatation. No signs of congestion. She was admitted to our service. The coronary angiogram was normal, ruling out an underlying ischemic cardiomyopathy. Therapy with b–blocker and ACE–I was started. Doppler ultrasonography of the AVF was performed and showed an high output fistula. Two weeks later at Hospital discharge with medical therapy only, EF improved to 43%. Five months later, the AVF was ligated, after the creation of another more distal one. Echocardiographic re–evaluation one month after the intervention showed a normalization of left ventricular function and volumes ( EF 55%, VDTi 54ml/mq)and of PASP. In 2020 she underwent renaltransplant without complications. The patient is nowadays stable only on beta–blocker for some PVCs, with ongoing annual follow–up. Even if dilated cardiomyopathy and HF in patients affected by APDKD can be caused by genetic predisposition, in our case the main factor was a high output AVF, as showed by complete reversion of left ventricular dysfunction after its ligation.

Irregular ventricular tachycardia originating from the moderator band

Ventricular tachycardias (VT) may initially show beat to beat oscillations but rapidly stabilize into a regular tachycardia with a stable cycle length. A persistently irregular ventricular tachycardia is a rare phenomenon.We report a rare case of an “irregular” ventricular tachycardia with so pronounced oscillations in cycle length that it was initially misdiagnosed as atrial fibrillation with aberrant conduction. This ventricular tachycardia was incessant and resulted in a tachycardia induced cardiomyopathy refractory to several antiarrhythmic drugs. Mapping of the right ventricle demonstrated that the tachycardia had a focal origin in the moderator band close to its insertion into the anterior papillary muscle. Radiofrequency ablation eliminated the tachycardia with eventual normalization of left ventricular function. The moderator band and anterior papillary muscle of the right ventricle are known to be the source of short-coupled ventricular premature beats and regular ventricular tachycardias. However, an “irregular” ventricular tachycardia has not been previously reported to arise from these structures.

Case Studies of Cardiac Resynchronization Therapy "Nonresponders".

Outcomes following cardiac resynchronization therapy (CRT) vary widely, with some patients experiencing normalization of left ventricular function to some who seem to be harmed by biventricular pacing. The care of CRT patients postoperatively is complex and requires input from physicians specializing in electrophysiology, heart failure, and often cardiac imaging. In this section, cases of apparent CRT suboptimal response from a dedicated CRT optimization clinic are presented.

Optimal timing of follow-up cardiac magnetic resonance in patients with acute myocarditis

Abstract Background Cardiac magnetic resonance (CMR) plays a central role in the diagnosis, follow-up and prognostic stratification of acute myocarditis. Several CMR features, including the extent of late gadolinium enhancement (LGE) at baseline, have been proposed as factors associated with a worse outcome. Recent studies evaluated temporal evolution of LGE and edema repeating CMR either at 6 months or at 12 months, demonstrating that persistence or worsening of LGE represents a negative prognostic marker. However, the time-course of edema resolution and LGE stabilization is currently unknown and therefore the optimal timing to repeat CMR for acute myocarditis prognostic stratification remains unclear. Purpose We aimed to assess the time course of edema and LGE evolution in order to identify the optimal timing to repeat CMR in patients with acute myocarditis. Methods We enrolled 36 patients with a diagnosis of acute myocarditis according to ESC position statement definition. All patients underwent CMR at clinical presentation (CMR-1), after 3–4 months (CMR-2) and after 12-months (CMR-3) follow-up. CMR evaluation included assessment of edema and LGE, and evaluation of structural and functional parameters including left (LVEF) and right ventricular ejection fraction (RVEF), left (LVGLS) and right ventricular global longitudinal strain (RVGLS) and indexed left ventricular mass (iLVM). After CMR-3 all patients were followed-up by yearly clinical evaluation, electrocardiogram (ECG) and 2D-echocardiography. Results The mean age was 28,8±10,3 years with 35 (97%) being male. All patients showed edema and LGE at CMR-1 with a LVEF of 58,5±12,2. At CMR-2 a significant reduction of edema (T2 positive segments 0,4±0,9 vs. 4,1±3,2 p&amp;lt;0.0001) and LGE extent (LGE ≥5SD 5,1±5,3 vs. 9,6±8,4 p&amp;lt;0.0001) was observed, with only 3 patients showing edema persistence. A significant improvement of LVEF (62,7±5,6 vs. 58,5±12,2 p&amp;lt;0.05), RVGLS (−24,4±5,4 vs. −21,6±7,4 p&amp;lt;0.05), associated with a significant reduction of iLVM (71,2±13,7 vs 78,1±15,2 g/mq) was also observed. At CMR-3 no further significant reduction of LGE extent was observed with no further improvement of LVEF, RVGLS and iLVM. In the 3 patients with persisting edema at CMR-2, a complete resolution was observed at CMR-3. After a mean follow-up of 60±23 months, no major cardiovascular events nor myocarditis recurrences were observed, with no patients showing left ventricular dysfunction nor progression to dilated cardiomyopathy at 2D-echocardiography. Conclusions In most patients with acute myocarditis a complete resolution of the inflammatory process with LGE stabilization and normalization of left ventricular function and mass can be observed after 3–4 months. Further CMR assessment should limited to patients with persisting oedema at 3–4 months CMR. Our findings suggest to redefine the follow-up schedule and imaging-based prognostic stratification strategies in patients with acute myocarditis. Funding Acknowledgement Type of funding sources: None. Figure 1

Echocardiographic Findings Associated with Transplantation-Free Survival and Left Ventricular Systolic Function at Midterm Follow-Up after Ross Procedure in Infants with Critical Aortic Stenosis

The Ross operation is an important option for children with critical aortic stenosis with residual disease, but operation in infancy is associated with significant morbidity and mortality. The aim of this study was to evaluate echocardiographic correlates of transplantation-free survival, reintervention, and left ventricular (LV) function in midterm follow-up. This retrospective, single-center study included all infants with critical aortic stenosis who underwent Ross by 1year of age from January 2000 to September 2018. Serial echocardiograms were analyzed for LV ejection fraction (LVEF) and systolic and diastolic longitudinal strain. The primary outcome was mortality or transplantation; secondary outcomes were reintervention and abnormal LVEF (≤55%). Among 40 infants (30 male [75%]; median age at Ross, 51days) with median follow-up duration of 3.3years (interquartile range, 1.0-9.4years), the primary outcome was met in 11 (28%). Rates of transplantation-free survival was 79%, 77%, and 69% at 1, 5, and 10years after Ross. Predictors of transplantation or death included neonatal surgery, cross-clamp time, and preoperative left atrial dilatation and lower LVEF. Median freedom from reintervention was 7.1years after Ross, with no identified associations. LV longitudinal strain improved 1year after Ross (-21.1±3.8% vs -17.4±5.1%, P=.02), although LVEF did not reach significance. Lower LVEF at 1year was related to pre-Ross left atrial dilatation (P=.02), abnormal LVEF (P=.04), and lower early diastolic longitudinal strain rate (P=.03). LVEF remained stable3years after Ross. Both transplantation-free survival and normalization of LV function after Ross in infancy are associated with preoperative LV systolic and diastolic measures, highlighting the prognostic value of echocardiography in this population. Further data are necessary in a larger, multicenter cohort to allow more precise risk stratification.

Abstract 15512: Predictors of Normalization of Left Ventricular Systolic Function After Acute Myocarditis -multicenter Observational Study

Introduction: The clinical presentation of acute myocarditis is highly variable, and its prognosis is occasionally unpredictable. Even the patients discharge alive, left ventricular (LV) remodeling occurs during the follow-up period in some cases, which causes the progression of dilated cardiomyopathy or sudden cardiac death. Purpose: We aimed to investigate the predictors of the recovery of LV ejection fraction (LVEF) in patients with acute myocarditis. Methods: This multicenter observational study included 20 patients [average age 38 years, 18 (90%) male] suffering acute myocarditis who were urgently hospitalized between 2007 and 2019. Enrolled patients were assigned into 2 groups depending on a recovery of LV function that was defined as LVEF ≥55% by transthoracic echocardiography (TTE) within 12 months after the onset; the Recovery group (n=8) and Non-recovery group (n=12). Results: Overall, LVEF increased from 37% to 52% (p&lt;0.001) during the follow-up period (median interval: 180 (IQR: 42-332) days). There was no statistically differences in baseline clinical profiles or medications at discharge between the groups. However, LVEF at admission was significantly higher in the Recovery group than Non-recovery group (47±13% vs. 31±13%, p=0.014). The univariate logistic regression analysis showed that baseline LVEF was related to a recovery of LV function (odds ratio, 1.12; 95% confidence interval, 1.00-1.26). The ROC curve for a recovery of LV function revealed that the cut-off value of LVEF at admission was 42% (sensitivity: 75%, specificity: 83%, area under the curve: 0.83, Figure A ). Patients with baseline LVEF ≥42% achieved significantly higher rates of LV functional recovery after acute myocarditis than those with LVEF &lt;42% (17% vs 75%, p=0.019, Figure B ). Conclusions: Baseline LVEF could predict a normalization of LV function in patients with acute myocarditis. Close observation and TTE follow-up should be considered in such a refractory population.

179 The Happy Heart Syndrome

Takotsubo cardiomyopathy is classically associated with stressful events but has been rarely described after a joyous event- the Happy Heart Syndrome. A 73-year-old lady presented with acute onset of dyspnoea whilst walking to her car after watching the Mamma Mia movie at the cinema. Past medical history included gastroesophageal reflux disease. Clinical examination was consistent with acute pulmonary oedema with an elevated jugular venous pressure to 6cm and bilateral crepitations to the midzones. The electrocardiogram revealed widespread deep T wave inversions with prolonged QTC interval of nearly 500ms. Troponins were elevated to 4.8 (ULN 0.05). Coronary angiography revealed minor coronary artery disease. Left ventriculogram displayed the classical appearance of apical ballooning due to apical and mid ventricular akinesia with hyperdynamic basal function consistent with Takotsubo cardiomyopathy. She was treated with diuretics, beta blocker and ace-inhibitor therapy. Repeat echocardiography at the 3-month mark showed normalization of left ventricular function. In a vast majority of cases (96% in a large European Registry), Takotsubo cardiomyopathy occurs due to extreme bad news. However, in small proportion of patients, it can also occur after a joyous moment. The clinical sequelae and management are similar irrespective of the inciting event.

Surgical outcomes for anomalous left coronary artery from the pulmonary artery: Influence of late presentation

ObjectivesAlthough surgical outcomes for anomalous left coronary artery from the pulmonary artery (ALCAPA) are excellent in the modern era with the coronary reimplantantion technique, mortality remains high in Chinese population. This study was undertaken to review the surgical management for ALCAPA in our center and assess the midterm outcomes. MethodsThis was a retrospective review of 105 patients who underwent surgical repair for ALCAPA from January 2008 to January 2018. ResultsThe diagnosis of ALCAPA was not made before referred to our hospital in 31 patients (30%). Median age at repair was 7.6 months (interquartile range, 4.3-25.4 months). Mean preoperative left ventricular ejection fraction was 47.3% ± 16.9%. Concomitant mitral intervention was performed in 52 patients (50%). Mechanical circulatory support was used in 15 patients (14%). Early mortality was 14%. Classification and regression tree analysis identified 3 risk groups for early mortality, among which patients with preoperative left ventricular ejection fraction ≤41.6% and age at repair >127 days were the most likely to suffer from mortality. Using nonlinear mixed-effect model to assess the time course for postoperative left ventricular ejection fraction, patients of this group also needed significantly longer time for recovery of left ventricular function after surgery (P < .0001). ConclusionsLate referral of patients with ALCAPA is not uncommon in our center. Older age at repair in patients with preoperative left ventricular dysfunction is the main reason for higher early mortality, and is also associated with longer time to normalization of left ventricular function after surgery.

Mid-Term Outcome for Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

This study is a single-centre experience with surgical intervention of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). A retrospective review was performed of patients who underwent ALCAPA repair between November 1991 and October 2017. A total of 138 patients with a median age of 36 months underwent ALCAPA repair. The median follow-up period was 3.5 years. Overall, 114 (82.6%) patients received coronary reimplantation, 21 (15.2%) underwent Takeuchi repair, and three (2.1%) were treated by closure of the ALCAPA plus coronary artery bypass graft. Concomitant mitral repair was performed in 50 patients with moderate-to-severe mitral regurgitation (MR). Three (2.1%) patients died in hospital. Three (2.1%) patients needed extracorporeal membrane oxygenation (ECMO) support. Seven (5.0%) patients needed delayed sternal closure. In patients with decreased preoperative left ventricular ejection fraction (LVEF) (<50%), the LVEF significantly improved from 25% to 33% at discharge (p = 0.001). The percentage of more than moderately significant MR decreased from 36.2% to 5.2% (p = 0.02). There was no late mortality. Two patients needed reoperation because of baffle leaks after Takeuchi repair. Three patients had severe MR. All patients had normal LVEF at last follow-up. The median normalisation time of left ventricular function was 6 months. Short-term and mid-term outcomes of surgical treatment for ALCAPA patients were excellent. The concomitant mitral valve repair did not increase the perioperative risk but had satisfactory mid-term outcomes. Normalisation of left ventricular function is expected within the first 6 months.

Dilated cardiomyopathy in a pediatric population: etiology and outcome predictors - a single-center experience.

The aim of the study was to assess predictors of outcome in patients hospitalized for dilated cardiomyopathy (DCM) and severe left ventricular dysfunction. Patients& methods: 83 pediatric patients hospitalized for heart failure due to DCM with coexistent left ventricular dysfunction were enrolled. Overall, 5-year survival free from heart transplantation was 69.8%. Normalization of left ventricular function was achieved in 39.8% of patients during follow-up: younger age, less necessity of inotropic support and other than idiopathic DCM predicted left ventricular function, while familial history for cardiac disease or sudden death and inotropic support during hospitalization were associated with poorer outcome. Almost 40% of patients with DCM experienced a complete normalization of cardiac function. Outcome was extremely variable according to the type of DCM.

Centrifugal-flow ventricular assist device support in children: A single-center experience

BackgroundOur institutional policy is to continue centrifugal-flow ventricular assist device support for 3 months or more without activation on the transplant wait-list for physical recovery and assessment of possible myocardial recovery. We evaluated our single-institutional outcomes with centrifugal-flow ventricular assist device support in children. MethodsProspectively collected outcomes data in consecutive patients aged 18 years or less with centrifugal-flow ventricular assist device support were reviewed. ResultsThere were 40 implantations in 39 patients (28 with cardiomyopathy, 11 with congenital heart disease, including 3 with univentricular physiology). The median support was 8 months (range, 1-79), with 13 patients (33%) supported for 12 months or more and a cumulative duration of 41 patient-years. The median age and weight at implantation were 11 (4-18) years and 35 (14-98) kg, respectively. The median body surface area was 1.1 (0.7-2.2) m2, with 16 patients (40%) having a body surface area less than 1.0 m2. Thirty-four patients (85%) had Interagency Registry for Mechanically Assisted Circulatory Support 1 or 2. Children with congenital heart disease were significantly smaller (P < .01) and had more prior cardiac interventions (P < .01) than those with cardiomyopathy. There were 2 early mortalities (5%) in children with cardiomyopathy. Of the 38 patients with successful implantations, 36 (95%) were discharged home and managed as outpatients. Overall adverse event rates were 5.1 (bleeding), 0.8 (device malfunction), 6.1 (infection), 3.9 (neurologic dysfunction), and 1.0 (renal dysfunction) (per 100 patient-month). In the 21 patients with cardiomyopathy supported for 3 months or more, 5 (24%) experienced normalization of left ventricular function; 4 underwent successful explantation, and 1 remains on support. ConclusionsThis study demonstrates favorable outcomes of centrifugal-flow ventricular assist device support in children, including those with congenital heart disease, with an increased incidence of cardiac recovery.

A Rare Presentation of Reverse Takotsubo Cardiomyopathy with Acute Porphyria

A 32-year-old woman had multiple presentations to the emergency department with severe abdominal pain and vomiting in context of a previous diagnosis of endometriosis with multiple endometrial ablations. Cardiology was consulted for sinus tachycardia. She had no electrocardiogram changes and had an initial Hs-trop of <5, peaking later at 200. An echocardiogram revealed severe left ventricular dysfunction with apical hyperkinesis and circumferential akinesis of the mid and basal ventricle. Cardiac magnetic resonance imaging revealed no evidence of myocardial oedema or fibrosis. Computed coronary angiogram was entirely normal. In the interim, the patient had an extensive work-up and multidisciplinary reviews for her abdominal pain, with no obvious cause. The diagnosis was suspected when a urine sample awaiting collection by the bedside turned red. Urinary porphobilinogen and porphyrins were highly elevated. Molecular genetic testing confirmed HMBS mutation, associated with acute intermittent porphyria. The patient was started on intravenous haema-arginate with resolution of symptoms. Serial transthoracic echocardiograms over the next 2 weeks revealed normalisation of left ventricular function. The patient continues to receive human hemin injections regularly and has had no further cardiac issues.

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots.

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial valve might not meet the functional needs. The implantation of a too-small stented pericardial valve, leading to an effective orifice area indexed to a body surface area less than 0.85 cm2/m2, is regarded as prosthesis-patient mismatch (PPM). A PPM negatively affects the regression of left ventricular hypertrophy and thus the normalization of left ventricular function and the alleviation of symptoms. Persistent left ventricular hypertrophy is associated with an increased risk of arrhythmias and sudden cardiac death. In the case of predictable PPM, there are three options: 1) accept the PPM resulting from the implantation of a stented pericardial valve when comorbidities of the patient forbid the more technically demanding operative technique of implanting a larger prosthesis, 2) enlarge the aortic root to accommodate a larger stented valve substitute, or 3) implant a stentless biological valve or a homograft. Compared to classical aortic valve replacement with stented pericardial valves, the full-root implantation of stentless aortic xenografts offers the possibility of implanting a 3-4 mm larger valve in a given patient, thus allowing significant reduction in transvalvular gradients. However, a number of cardiac surgeons are reluctant to transform a classical aortic valve replacement with stented pericardial valves into the more technically challenging full-root implantation of stentless aortic xenografts. Given the potential hemodynamic advantages of stentless aortic xenografts, we have adopted full-root implantation to avoid PPM in patients with small aortic roots necessitating an aortic valve replacement. Here, we describe in detail a technique for the full-root implantation of stentless aortic xenografts, with emphasis on the management of the proximal suture line and coronary anastomoses. Limitations of this technique and alternative options are discussed.

Speckle Tracking in ALCAPA Patients After Surgical Repair as Predictor of Residual Coronary Disease.

Surgical re-implantation of the left coronary artery (LCA) is the treatment of choice in anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Despite normalization of left ventricular function after surgery, residual coronary lesions or myocardial fibrosis may be found. The aim of this study was to detect regional left ventricular dysfunction predictive of coronary lesions or residual myocardial fibrosis using speckle tracking. We enrolled ten patients treated with surgical re-implantation of LCA for ALCAPA. All patients were asymptomatic, and ejection fraction (EF) was normal. Using S-SR imaging, we studied longitudinal, radial, and circumferential function. A cardiac MRI was performed to assess myocardial fibrosis and the anatomy of the coronaries. In case of suspected coronary stenosis, a coronary angiography was performed. Finally, 20 normal subjects were enrolled as control group. Median age at surgery was 188days, and mean follow-up was 8.7 ± 4.7years. Longitudinal and circumferential functions were reduced in LCA territory compared to RCA territory and normal. MRI showed LCA stenosis in three of ten patients, confirmed by coronary angiography: these patients had the lowest longitudinal strain values in LCA territories (-11.7, -14.7 and -14.8%). Radial strain was preserved (Normal 45.6 ± 12.1, ALCAPA 43.5 ± 10.7%, p = ns), while circumferential strain was mildly depressed (-23.5 ± 3.8 vs. -20.3 ± 2.0%, p < 0.05). After LCA re-implantation, ALCAPA patients showed a residual sub-endocardial damage in LCA territories. Despite a normal systolic and diastolic function, the prevalence of residual coronary lesions was high. A mean longitudinal strain >-15% in LCA territories was able to identify those patients.

137 - QRS Voltage Increases during Recovery from Fulminant Myocarditis

Introduction: Fulminant myocarditis is a rare subclass of lymphocytic myocarditis known to have a favorable long-term prognosis if the patient survives the acute illness. The evolution of electrocardiograms (ECGs) in fulminant myocarditis has not been well described. Hypothesis: Improvement in QRS voltage correlates with clinical and echocardiographic recovery from fulminant myocarditis. Methods: A single-center retrospective analysis was conducted in all patients who underwent endomyocardial biopsy. Patients met the inclusion criteria as fulminant myocarditis if: (1) biopsy result met Dallas criteria for lymphocytic myocarditis, (2) mechanical circulatory support (MCS) or high-dose inotrope or vasopressor infusion was required, and (3) symptom onset was heralded by febrile illness. 12-lead ECGs and echocardiograms during the acute and recovery phases were reviewed. Recovery was defined as normalization of left ventricular function or discontinuation of MCS and vasoactive medications due to clinical improvement. Low voltage was defined as a maximum QRS amplitude <0.5 mV in all limb leads. Result: Seven patients met the inclusion criteria. Three patients required ECMO support and one patient needed support with an IABP. None of the patients received immunosuppression. The interval between initial ECG and recovery phase ECG was 9.6 ± 4.3 days. All patients met the criteria for low voltage during the acute phase. Maximum QRS amplitude in the limb leads during the acute phase was 0.32 ± 0.08 mV and increased to 0.74 ± 0.24 mV (P = .001) during the recovery phase. The sum of all 12 QRS amplitudes during the acute phase was 5.13 ± 0.96 mV and increased to 8.14 ± 1.68 mV (P = .001) during the recovery phase. Ejection fraction was 31 ± 6% during the acute phase and improved to 52 ± 11% (P = .001) during the recovery phase. There was a downward trend of septal thickness from 0.98 ± 0.15 cm to 0.84 ± 0.07 cm (P = .056) during the recovery, while left ventricular diastolic dimension remained unchanged (P = .77). None of the patients had a significant pericardial effusion. Conclusion: Low QRS voltage was observed in patients with fulminant myocarditis. Increase in QRS voltage parallels the improvement in ejection fraction and ventricular wall inflammation.

EFFECT OF ENDOVASCULAR MYOCARDIAL RETROPERFUSION ON FUNCTIONAL STATUS OF LEFT VENTRICULE IN PATIENTS WITH ACUTE CORONARY SYNDROME AND SEVERE FORMS OF CORONARY ARTERY DISEASE

Myocardial retroperfusion in patients with acute coronary syndrome (ACS) is an actual scientific problem. Objective: To assess left ventricular (LV) function in patients with ACS in the medium term after the intervention with myocardial retroperfusion. The study included 24 patients with ACS: Group 1 consisted of 12 (50%) patients with ACS who has ST segment elevation, Group 2 - 12 (50%) patients with ACS who had no ST segment elevation. Both groups were divided in two subgroups: subgroup A - patients with retroperfusion; subgroup B - patients without retroperfusion. Results: In group 1 postoperative normalization of LV function was observed in 6 patients in the subgroup of A and in 1 patient in the subgroup B in the medium term; in group 2 postoperative normalization of LV function was observed in 4 patients in subgroup A and in 2 patients in the subgroup B. Conclusion: It is advisable to apply a retroperfusion support of myocardial blood supply technique during the intervention in patients with ACS.

Heart Failure in Thyrotoxic Cardiomopathy: Extracorporeal Membrane Oxygenation Treatment for Graves’ Disease

Thyrotoxicosis-induced cardiomyopathy and consequent heart failure is one of the most grave complications of uncontrolled hyperthyroidism. In such patients, early recognition of thyrotoxicosis, and directed antithyroid therapy can lead to rapid normalization of left ventricular function. Herein, we present a case of a 29-year-old male with Graves’ disease who developed heart failure with severe deterioration of left ventricular function and eventually, circulatory collapse. Height and weight of the patient were 1.8 m and 84 kg, respectively. The patient was placed on venoarterial extracorporeal membrane oxygenation for immediate circulatory support, with restoration of cardiac function after 6 days.

What We Can Learn from "Super-responders".

This review discusses the state of the art of knowledge to help decision making in patients who are candidates for cardiac resynchronization therapy (CRT) and to analyze the long-term total and cardiac mortality, sudden death, and CRT with a defibrillator intervention rate, as well as the evolution of echocardiographic parameters in patients with a left ventricular (LV) ejection fraction of greater than 50% after CRT implantation. Owing to normalization of LV function in super-responders, the need for a persistent defibrillator backup is also considered.