Parameters Of Ventricular Function Research Articles

Double-blind comparison study on the reliability of binary assessment of left ventricular systolic function and dimensions between standard echocardiogram and handheld echocardiogram

Abstract Rationale Left ventricular systolic function parameters have considerable prognostic importance, but demand for echocardiographic examinations is greater than supply. The market availability of handheld echographs provides greater access to low-cost summary echocardiographic evaluation. Purpose of the study The purpose of the study is to compare in a double-blind manner the binary concordance ( yes/no) of an examination done with a handheld ultrasound and a standard echocardiographic examination on four parameters referred to the left ventricle ( LV) on the same patient 4 days apart. Method Thirteen volunteer cardiologists who had performed at least 1000 echocardiograms blindly performed on patients not known to them an evaluation with a handheld ultrasound machine and reported the result on a card stating the presence or absence in an eye-based manner of 4 conditions: LV dilatation, reduced LV systolic function ( left ventricular ejection fraction LVEF< 55%), presence of left ventricular segmental kinetics alterations. The two echocardiographic examinations were performed at a maximum time interval of two days and in the absence of any new procedures on the patient between the two examinations. The time taken for each examination was timed. A statistical analysis with Choen’s Kappa test was performed. Results A total of 107 examinations were performed on 86 patients, whose characteristics are shown in Table Number 1. The average number of examinations per cardiologist was 8.9 with a minimum of 5 examinations and a maximum of 10. There was excellent concordance on the VS dilatation parameter ( kappa 0.85, SE 0.05, 95% CI 0.77 to 0.99), with a number of 4 false positives and 0 false negatives; the ability to detect the presence of reduced global left ventricular systolic function was also excellent ( kappa 0.9 SE 0.04 95% CI 0.82 to 0.99). Concerning left ventricular hypertrophy there was a high percentage ( 22%9 of false negatives), referring to mild degree of LV hypertrophy, with concordance however ( kappa 0.42 SE 0.08 CI 95% 0.26 to 0.59); on segmental kinetics there was 9% false positives and no false negatives with fair concordance ( kappa 0.55 SE 0.09 95% CI 0.37 to 0.73). Results are summarized in table 2. Conclusions Qualitative assessment on left ventricular systolic function parameters with a handheld ultrasound machine compared with a standard echocardiographic examination is reliable for the recognition of left ventricular dilatation and dysfunction. This may have considerable use of the examination as a filter or screening for the recognition of relevant heart disease.

Operational feasibility and reproducibility of serial echocardiographic parameters of left ventricular remodelling and function for evaluation of drug efficacy in multicentre clinical trial settings

Abstract Background Operational feasibility and reproducibility of echocardiographic (Echo) parameters are essential for planning interventional trials with surrogate imaging endpoints. Existing data from large cohort studies performed at institutions with high expertise in Echo may not be representative of the multicentre clinical trial settings where substantial variability in local standards and equipment exists. Purpose To assess feasibility of standardized Echo data acquisition, measurability, and reproducibility of key Echo endpoints in a large multicentre clinical trial. Methods ENDEAVOR was a phase 2b/3 multicentre, international, placebo-controlled trial investigating the effects of mitiperstat on symptoms and function in participants with heart failure (HF) and left ventricular ejection fraction (LVEF) >40%. Echo was used for efficacy assessment at 3 time points (baseline, 16 and 24 weeks). Echo data were acquired according to the study protocol at sites with various equipment and expertise and analysed centrally by an academic core laboratory. Key Echo metrics were LVEF, LV global longitudinal strain (GLS), LV mass, E/E’ and left atrial volume (LAV). LVGLS was measured from three apical views (4, 2, and 3-chamber) by 2DSTRAIN TomTec software. All images were evaluated for image quality using the scale from 1 (Very poor) to 5 (Excellent) and measured by a single reader. Results 711 participants at 142 sites in 18 countries were randomised in ENDEAVOR trial (mean age 72.4y, mean BMI 30.5kg/m2). A total of 2052 Echo exams were analysed: 735 at baseline, 661 at 16 and 656 at 24 weeks. Majority were of excellent to good (1282/62%) or adequate (732/36%) image quality. Doppler images and apical 4ch view were the most feasible to acquire, while apical 2ch view was the most challenging (Fig, A). LVEF, LV mass, E/E’ and LAV were measurable in most studies (88-96%), however fewer studies were interpretable for LVGLS (61% at baseline to 70% at week 24). When matching echo exams at 2 or 3 visits were analysed, the number of interpretable matches dropped more significantly for LVGLS (to 47% for 2 and 41% for 3 time points), while the proportion of interpretable matches for standard echo endpoints remained acceptable (>83% and >75%, respectively). A total of 82 scans were re-read for reproducibility. Most of the echo endpoints demonstrated good or excellent reproducibility, with LVGLS showing better reproducibility than LVEF (Fig, B). Conclusions We report feasibility of Echo data acquisition, measurability, and reproducibility of key parameters of LV remodelling and function in a large multicentre, international, placebo-controlled clinical trial in HF and EF>40%. These data will help to inform future trial design to drive drug development decision making.

Improvement of right and left ventricular echocardiographic parameters in obese patients after bariatric surgery

Abstract Background Severe obesity causes hemodynamic changes in the circulatory system, which leads to the development of heart failure with either preserved or reduced ejection fraction. Weight loss achieved through bariatric surgery is likely to possibly reverse many of hemodynamic and structural abnormalities caused by obesity. Purpose Assessment of left and right ventricular function in patients undergoing bariatric surgery. Methods Detailed echocardiographic parameters assessing left and right ventricular function in severely obese patients undergoing bariatric surgery were analyzed. The following parameters of left and right ventricular function were compared in the examinations performed before, 3 and 6 months after surgery: left ventricular ejection fraction (LVEF), LV and RV global longitudinal strain (GLS), peak early (e’) and late (a’) diastolic annular velocities (lateral and septal) with calculation of E/e’ ratios, left atrium volumeindex ( LAVI), TRV (tricuspid regurgitation velocity), tricuspid annular plane systolic excursion (TAPSE), maximum systolic velocity of the lateral part of the tricuspid annulus-s’ and accelerated pulmonary time (AcT). Results Forty obese patients (76% women) with mean BMI 40.3 (SD 5.6) and mean age of 42.4 (SD 11.9) years were enrolled. BMI as 6 months was 31.2 (SD 5.1). Baseline and follow-up results of echocardiography are presented for both left and right ventricular parameters in Table 1 and Table 2. Conclusions Only GLS for right and left ventricle, FWS and TRV improve significantly within 6 months from bariatric surgery. On the other hand, these changes are significant as early as 3 months after bariatric surgery. Left ventricular parameters Right ventricular parameters

Reverse structural and functional left atrial remodeling after successful catheter ablation for paroxysmal atrial fibrillation.

Abstract Background Catheter ablation is considered the most effective method for restoring sinus rhythm in patients with atrial fibrillation (AF). However, data on the reverse structural and functional remodeling of the left atrium (LA) after a successful procedure are still inconclusive, especially in patients with sinus rhythm during catheter ablation. The aim of the present study was to investigate echocardiographic parameters indicating the presence of reverse LA remodeling, following a successful procedure and long-term follow-up of sinus rhythm maintenance. Methods Of the 106 patients who had undergone successful catheter ablation (between January 2021 and May 2023) for paroxysmal AF (with sinus rhythm on echocardiography during ablation), 49 patients were included in the study up to now. The absence of AF recurrence was assessed during a follow-up consisting of outpatient visits/televisits and 7-day Holter monitoring (at 6 and 12 months after ablation). All patients underwent conventional and 2D speckle tracking echocardiography on the day of ablation and after the long-term of follow-up period of maintanance of sinus rhythm. Results A total of 48 patients were included in the study. The mean age of the study population was 60±11 years, of which 62.5% were male. The follow-up period was 17 ± 4month. A significant increase in LA reservoir strain (LASr) (median 23 vs. 25%, p<0.001) and e’ average (median 7.5 vs. 8.5 cm/s, p=0.02) was noted from baseline to follow-up. LA stiffness index (defined as E/e’average/LASr ratio) (median 0.33 vs. 0.28, p=0.001), LA area (median 23.8 vs. 22.1cm2, p=0.003) and LA volume index (median 35.9 vs. 32.9ml/m2, p<0.001) showed significant reduction over the same time period. In addition, left ventricular (LV) end-diastolic diameter, indexed LV mass index and right atrial area, decreased significantly (51 vs. 49 mm, p<0.001; 123 vs. 109g/m2, p<0.001, 17.2 vs. 15.5cm2, p=0.02, respectively). Left ventricular function parameters, such as LV ejection fraction or global LV longitudinal strain, remained unchanged. Conclusions During the long-term follow-up period after restoration and maintenance of sinus rhythm following catheter ablation for AF, both structural and functional echocardiographic parameters of the LA improved. Our preliminary results also suggest the possibility of reverse structural LV and RA remodeling after successful AF treatment.

Beyond heart rhythm: 12 months in the echocardiographic evaluation of cardiac resynchronization

Abstract Introduction Cardiac resynchronization therapy (CRT) is recommended in patients with heart failure (HF), but 1/3 of patients are "non-responders". More recent resynchronization algorithms promote electrical optimization by dynamically adjusting atrioventricular intervals, reducing QRS duration. However, their impact on left ventricular function parameters remains unclear. Objectives The following echocardiographic parameters were evaluated and compared pre-CRT and at 12 months follow-up: left ventricular (LV) diastolic and systolic volume; ejection fraction (LVEF), global longitudinal myocardial strain (GLS), left atrial (LA) volume; and analytical parameters: NT-ProBNP. Methods Retrospective, comparative study of patients who underwent CRT. All patients underwent echocardiographic study and clinical analysis before CRT implantation and at 12 months follow-up. The following echocardiographic parameters were assessed post-procedure: LVEF (Simpson biplane method); LV volumes and LA volumes indexed to body surface area and GLS (GE Echopac). NT-ProBNP values were collected. Results 50 patients (74 ± 1.3 years, 66% men) were studied, 50% with ischemic heart disease. In the comparative analysis before CRT and at 12-month follow-up, statistically significant differences were observed in LV diastolic and systolic volumes (96.5 ± 4.3 ml/m2 vs. 78. 2 ± 4 ml/m2, p=0.001; 65 ± 3 ml/m2 vs. 48 ± 3 ml/m2, p=0.001), with a significant improvement in LVEF at follow-up (33% ± 1.1 vs. 40% ± 1.4, p=0.001) as well as GLS (-7.8% ± 0.3 vs. -11.5% ± 1, p=0.003). LA volume also showed a significant decrease at follow-up (87 ± 4 ml vs. 71 ±3.8 ml). Reverse remodeling was more evident in patients without a history of ischemic heart disease, with a decrease in LV volumes, improved LVEF and GLS. NT-ProBNP levels also decreased significantly at follow-up (1945 ± 294 pg/mL vs. 783 ± 134 pg/mL, p=0.001). Conclusions CRT implantation is a therapeutic option for patients with HF refractory to medical treatment. Recent resynchronization algorithms show good results in reducing LV volumes as well as improving left ventricular function, and the prognosis of these patients.

Initial insights into left ventricular mechanics of hypertrophic cardiomyopathy patients during follow up of mavacamten therapy

Abstract Introduction Mavacamten is a novel therapy for hypertrophic obstructive cardiomyopathy. Left ventricular (LV) ejection fraction (EF) has been used for monitoring of left ventricular systolic function during therapy. Currently there is limited data on advanced functional parameters based on speckle tracking strain values, such as global longitudinal strain (GLS) , myocardial work (MW) or 3D echocardiography. MW is an emerging method which incorporates left ventricular pressure and provides multiple parameters based on a LV pressure-strain loop. This study aimed to provide some insights into temporal changes of left ventricular deformation during mavacamten therapy. Purpose The purpose of this study was to examine left ventricular global and segmental strains and myocardial work parameters during mavacamten therapy. Methods The study involved 10 (5 women, 50%; aged 57±11 years) cases of mavacamten initiation and echocardiographic follow up (10 patients followed up to visit 1: 48±4.3 days, and 9 patients followed up to visit 2: 129±2.9 days). Comprehensive 2D and 3D resting echocardiography was performed. Speckle tracking based left ventricular strain values were measured. With a previously validated method left ventricular pressure was corrected for measurement of myocardial work parameters. The regional 2D based, LV strain and MW parameters were also examined. Results At the first follow up left ventricular obstruction gradient was already significantly lower compared to baseline and remained decreased at the second follow up (113±36 vs. 37±35 vs. 20±19 mmHg). EF or GLS did not differ significantly between visits (63.8±5.1 vs. 62.5±4.7 vs. 60.9±4.4 %, and -14.5±2.9 vs. -13.9±2.3 vs. -15.6±2.3 % respectively). Global Work Index (GWI) (2026±364 vs. 1588±351 vs. 1578±219 mmHg) and Global Constructive Work (2617±395 vs. 2010±400 vs. 1959±296 mmHg) significantly reduced at both visits when compared to baseline, but not between follow up visits. Global Wasted Work (GWW) (280±117 vs. 245±125 vs. 186±49) and Global Work Efficiency (GWE) (85.6±3.9 vs. 86.6±5.2 vs. 88.8±7.2 %) did not change significantly during follow up, similarly to no changes in 3D based strain, and rotational parameters. Peak Strain Dispersion, (102.8±40.7 vs. 93.8±35.3 vs. 75.9±29.8 ms). 3D based LV Mass (257±75 vs. 248±44 vs. 226±71 g) and Mass Index (137±44 vs. 131±42 vs. 119±41 g/m2) decreased at visit 2, but not at visit 1. The segmental analysis proved significant changes during follow-up compared to baseline in longitudinal strain (2 segments), MW (12 segments) wasted work (1 segment) and work efficiency (2 segments). Conclusions Among left ventricular functional parameters myocardial work has shown the most statistically significant differences during follow up, highlighting the reduction of the LV workload. The analysis of segmental data has shown a heterogeneous pattern of changes, primarily in MW.

Modern monitoring methods informativeness in assessing the risk of hemodynamic disorders in on pump cardiac surgery (pilot study)

The objective was to study the prognostic significance of intraoperative parameters of pulmonary artery catheterization (PAC), transesophageal echocardiography (TEE) and transpulmonary thermodilution (TPTD) in relation to the hemodynamic disorders in coronary artery bypass grafting (CABG).Material and Methods. A prospective observational study involved 67 patients aged 53 [46–64] years who underwent on-pump CABG. Hemodynamic parameters were recorded after the induction of anesthesia (stage I) and at the end of the surgery (stage II). Hemodynamic disorders were considered to be the inotropic index in post-bypass period >5, the duration of inotropic support >12 hours, the intensive care unit (ICU) stay >24 hours, the use of intraaortic balloon pumping (IABP), the ICU mortality, the presence of one or more complications (composite outcome). Logistic regression and ROC analysis were used.Results. At stage I, the left ventricular stroke work index (LVSWI) cut-off <31.7 gs•m/m2 was associated with ICU stay >24 hours (OR 0.9291, 95 % CI 0.8670–0.9958, AUC 0.716), and LVSWI <32.5 gs•m/m2 – with a composite the outcome (OR 0.9550, 95 % CI 0.9133–0.9985, AUC 0.704). The left ventricular area contraction fraction <34.2 % predicted the use of IABP (OR 0.9089, 95 % CI 0.8397–0.9839, AUC 0.889). At the II stage, the LVSWI cut-off <28.8 gs•m/m2 was associated with ICU stay >24 hours (OR 0.8805, 95 % CI 0.8226–0.9884, AUC 0.716), cut-off <25.6 gs•m/m2 – with the use of IABP (OR 0.8274, 95 % CI 0.7101–0.9641, AUC 0.804), and cut-off <23.0 gs•m/m2 – with mortality (OR 0.7486, 95 % CI 0.5951–0.9415, AUC 0.892). The left ventricular ejection fraction <26.1 % was also associated with mortality (OR 0.8901, 95 % CI 0.8164–0.9705, ACC 0.948). The global heart ejection fraction <18 % was associated with a composite outcome (OR 0.9018, 95 % CI 0.8297–0.9802, AUC 0.716). The other predictors cut-off values were practically normal. The remaining indicators provided models of average quality or had no predictive significance.Conclusion. To assess the risk of possible hemodynamic disorders in on-pump CABG, PAC and TEE are the most informative. In prebypass and in postbypass periods, LVSWI, reduced by 1.5–2.2 times, is associated with the risk of various hemodynamic complications and prolonged ICU stay. Decreased TEE parameters of left ventricular systolic function is associated with myocardial dysfunction and with the risk of mortality. The prognostic significance of the TPTD needs further investigations.

Analysis of 15 cases of critical pulmonary stenosis with intact ventricular septum in neonates treated by antegrade venous-arterial loop interventional therapy

Objective: To evaluate the clinical efficacy of percutaneous balloon pulmonary valvuloplasty (PBPV) via antegrade venous-arterial loop in neonates with critical pulmonary stenosis with intact ventricular septum (CPS-IVS). Methods: A retrospective case review was conducted. Fifteen neonates with CPS-IVS who underwent PBPV via antegrade venous-arterial loop at the Women and Children's Hospital, Qingdao University between September 2020 and September 2023 were included. Pre-and post-operative right ventricular functional parameters, surgical complications, and follow-up outcomes were analyzed. Paired-sample t-test was used to compare changes in right ventricular systolic pressure (RVSP), percutaneous oxygen saturation (SpO2), and echocardiographic findings pre-and post-operatively, as well as during the follow-up period. Results: Among the 15 neonates (9 males and 6 females) with CPS-IVS, the surgical age was (3.6±0.5) d. All neonates underwent successful PBPV via antegrade venous-arterial loop under general anesthesia. The immediate post-operative trans-pulmonary valve pressure gradient was (35±6) mmHg (1 mmHg=0.133 kPa), with a significant reduction in RVSP from (96±16) mmHg to (59±14) mmHg (t=6.70, P<0.001). SpO2 (with an inspired oxygen concentration of 0.48) increased from 0.86±0.07 pre-operatively to 0.97±0.03 post-operatively (t=4.81, P<0.001). One month postoperatively, SpO2 (without oxygen supplementation) normalized in all patients, with a statistically significant difference compared to pre-operative values (t=0.16, P<0.001). Immediately postoperative, mild to moderate diastolic pulmonary valve regurgitation was observed in 8 patients, with no cases of severe regurgitation. Additionally, the severity of tricuspid valve regurgitation decreased from severe to mild-to-moderate in 6 patients. Three months postoperatively, one patient underwent a second PBPV due to an increased trans-pulmonary valve pressure gradient of 74 mmHg, which decreased to 27 mmHg immediately after the procedure, with subsequent good recovery. Over a one-year follow-up period, all 15 patients demonstrated improvements in right ventricular indices. The Z-score of the tricuspid valve annulus significantly improved from -1.9±0.8 pre-operatively to -0.4±0.1 post-operatively (t=6.88, P<0.001). At the last follow-up, mild to moderate pulmonary valve regurgitation was observed in 3 patients, and mild tricuspid regurgitation in 2 patients, with no cases of moderate or severe regurgitation. Conclusion: Intervention via antegrade venous-arterial loop for the treatment of CPS-IVS in neonates is safe and effective.

Early Use of Liraglutide for the Treatment of Acute COVID-19 Infection: An Open-Label Single-Center Phase II Safety Study with Biomarker Profiling.

Glucagon-like peptide-1 (GLP-1) agonists are an existing treatment option for patients with insulin-resistant states, which elicit further pleiotropic effects related to immune cell recruitment and vascular inflammation. GLP-1 agonists downregulate the cluster of differentiation 147 (CD147) receptor, one of several receptors for the SARS-CoV-2 spike protein that mediate viral infection of host cells. We conducted an open-label prospective safety and tolerability study including biomarker responses of the GLP-1 agonist Liraglutide, administered for 5 days as an add-on therapy to the standard of care within 48 h of presentation in a cohort of 13 patients hospitalized with COVID-19 pneumonia. Biomarker responses were compared in patients admitted to critical care and those not requiring critical care admission (non-critical group). Liraglutide (0.6 mg, subcutaneously) was well tolerated by all patients and all patients were alive 30 days after diagnosis. Plasma soluble CD147 levels were reduced in the non-critical patient group at day 5 in contrast to critical care-treated patients, who demonstrated an increase in soluble CD147 levels between day 0 and day 5. Patients with milder COVID-19 pneumonia severity also demonstrated improvement in echocardiographic parameters of right and left ventricular function, reduction in plasma Troponin levels, increased CD147 expression on T lymphocytes, and reduction in plasma IL-8. This first-in-disease use of the GLP-1 agonist Liraglutide demonstrates its safety and tolerability in an unselected cohort of patients hospitalized with COVID-19 pneumonia across a range of clinical severities.

Evaluating cardiac performance in beagle dogs: Transesophageal echocardiography and myocardial work assessment.

This study aimed to establish standard transesophageal echocardiographic (TEE) measurements of left ventricular (LV) morphology, function, and myocardial work parameters in healthy Beagle dogs using pressure-strain loops (PSL). Additionally, it sought to standardize optimal TEE imaging techniques and explore the potiential application of myocardial work analyis in veterinary medicine. Thirty-seven healthy male Beagle dogs were anesthetized, intubated, and mechanically ventilated for TEE examinations. LV systolic and diastolic function were evaluated, with simultaneous invasive femoral artery pressure measurements. Left ventricular global longitudinal strain (GLS), myocardial work parameters, PSL-derived metrics were analyzed. The mean LV GLS was -16.0±4.0%, and the LV global myocardial work index (GWI) was 888±298.6mmHg∗%. Global Myocardial work efficiency (GWE) was 88±3%, while global myocardial wasted work (GWW) was 152mmHg∗% (38-431mmHg∗%). LV ejection fraction (LVEF) averaged 58.7±4.4%. Left ventricular end-diastolic (LVEDV) and end-systolic volume (LVESV) were 19.3±5.2ml and 8.0±2.3ml, respectively. Regional myocardial work analysis revealed significant differences between the interventricular septum and lateral wall. The lateral wall demonstrated reduced segmental work efficiency (SWE), work index (SWI), and constructive work (SCW) but higher wasted work (SWW) compared to the septum (p<0.05). TEE provides detail morphological and functional assessments of the Beagle hearts, offering reference data for future studies. Myocardial work analysis presents a novel method for evaluate myocardial contractility and mechanical properties, with promising applicatons in veterinary medicine.

Hemodynamic Response to Lipopolysaccharide Infusion and Effect of Meloxicam Administration on Cardiac Function in Donkeys.

Systemic inflammatory response syndrome (SIRS) in donkeys is observed to be secondary to colic, diarrhea or pleuropneumonia, among other disorders. Horses with SIRS develop secondary disturbances such as hyperlipemia, laminitis, disseminated intravascular coagulopathy, and hemodynamic and cardiac derangements, which impair their prognosis and increase the mortality rate. In donkeys, no information is available on the effect of experimentally induced endotoxemia in the cardiovascular system. Acute experimental endotoxemia was induced by lipopolysaccharide (LPS) infusion in six healthy adult non-pregnant jennies. Physical signs, arterial (systolic, diastolic and mean) and central venous pressure were monitored during 360 min. Cardiac troponin I (cTnI) concentrations were measured in blood samples, and echocardiography was performed. LPS infusion caused an increase in cTnI, hypotension and diminution of central venous pressure, cardiac dysfunction, with a decrease in stroke volume (SV), cardiac output (CO) and cardiac index, and impairment of ultrasonographic ventricular function parameters. Intravenous meloxicam administration prevented the cTnI increase, hypotension, diminution of SV and CO, and changes in ultrasonographic parameters related to ventricular dysfunction. Thus, meloxicam could be proposed as an effective therapeutical option to control the hemodynamic and cardiac derangements observed in donkeys with SIRS.

Feasibility of three dimensional and strain transthoracic echocardiography in a single-centre dedicated NHS cardio-oncology clinic

BackgroundFollowing the publication of international cardio-oncology (CO) imaging guidelines, standard echocardiographic monitoring parameters of left ventricular systolic function have been endorsed. Recommendations highlight that either two-dimensional (2D) or three-dimensional (3D) left ventricular ejection fraction (LVEF), alongside global longitudinal strain (GLS) should be routinely performed for surveillance of patients at risk of cancer therapy-related cardiac dysfunction (CTRCD). We studied the feasibility of 3D-LVEF, 2D-GLS and 2D-LVEF in a dedicated CO service.MethodsThis was a single-centre prospective analysis of consecutive all-comer patients (n = 105) referred to an NHS CO clinic. Using a dedicated Philips EPIQ CVx v7.0, with X5-1 3D-transducer and 3DQA software, we sought to acquire and analyse 2D- and 3D-LVEF and 2D-GLS, adhering to the British Society of Echocardiography (BSE) and British Cardio-Oncology Society (BCOS) transthoracic echocardiography protocol.ResultsA total of 105 patients were enrolled in the study; 5 were excluded due to carcinoid heart disease (n = 5). Calculation of 3D-LVEF was achieved in 40% (n = 40), 2D-GLS in 73% (n = 73), and 2D-LVEF in 81% (n = 81). LV quantification was not possible in 19% (n = 19) due to poor myocardial border definition. Strong correlation existed between 2D-LVEF and 3D-LVEF (r = 0.94, p < 0.0001). Bland–Altman plot demonstrated no statistical differences in that the mean deviation between 2D-LVEF and 3D-LVEF were consistent throughout a range of LVEF values. The most persistent obstacle to 3D-LVEF acquisition was insufficient myocardial border tracking (n = 30, 50%).ConclusionThis study demonstrates the high feasibility of 2D-GLS and 2D-LVEF, even in those with challenging echocardiographic windows. The lower feasibility of 3D-LVEF limits its real-world clinical application, even though only a small difference in agreement with 2D-LVEF calculation was found when successfully performed.

Analysis of Right Ventricular Strain in Heart Failure with Preserved Ejection Fraction

Introduction: The complexity of the geometry and the unique architecture of the right ventricular (RV) myocardial fibers make the study of its function a significant challenge. However, the advent of new imaging techniques, such as RV strain imaging, has improved our understanding of its function. The aim of our study is to specify the principles of studying right ventricular deformation and its impact on the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). Materials and Methods: This is a two-year prospective study comparing echocardiographic parameters of right ventricular function in 87 patients followed in our unit for HFpEF at the Cardiology Department of ERRAZI Hospital, CHU Mohammed VI, Marrakech. Results: Over the past two years, our unit has hosted 87 patients diagnosed with HFpEF. The average age was 68 years and 5 months, with a female predominance. The most common cardiovascular risk factors were hypertension and obesity (BMI &gt; 30). Symptomatic presentations were dominated by exertional dyspnea, observed in 84% of cases, with resting dyspnea and cough affecting about half of the patients. Signs of left heart failure, such as crackling rales, were present in 44% of patients, while signs of right heart failure, such as lower limb edema, were noted in 41%, with jugular distension and hepatojugular reflux in 19%. Echocardiography revealed left ventricular hypertrophy in 57% of patients and left atrial dilatation in 65%. Right ventricular function was markedly impaired, with significant abnormalities in TAPSE (Tricuspid Annular Plane Systolic Excursion), S' wave, and Tei index values, highlighting a marked correlation between the Tei index and the deformation of the right ventricular lateral wall. Rehospitalization for heart failure occurred in 40.2% of the cohort, emphasizing the severe clinical implications of right ventricular dysfunction in this patient population. Discussion and Conclusion: RV strain in HFpEF is an analysis that has not yet revealed all its intricacies. This study demonstrates that there is an alteration in RV strain in patients with HFpEF, which has a prognostic impact on mortality and rehospitalization for cardiac decompensation. This suggests that this parameter should be integrated into routine evaluations of RV systolic function.

The prognostic value of the Dandel's index in patients undergoing tricuspid transcatheter edge‐to‐edge repair

AimsConventional parameters of right ventricular (RV) function are load‐dependent and therefore do not accurately reflect contractility in patients with relevant tricuspid regurgitation (TR). RV adaptability to load has been characterized using the Dandel's index in patients with heart failure, but its prognostic value in patients undergoing tricuspid transcatheter edge‐to‐edge repair (T‐TEER) has not been investigated so far.Methods and resultsFrom the EuroTR registry (2019 to 2022), patients with complete datasets and a minimum of 2‐years of follow‐up were included. RV functional parameters (i.e. tricuspid annular plane systolic excursion [TAPSE], fractional area change [FAC], TAPSE/systolic pulmonary arterial pressure [sPAP]), as well as a echocardiographic RV load adaptation index (Dandel's index) were assessed and their predictive value in terms of all‐cause mortality evaluated using logistic multivariate logistic regression. The majority of the 364 patients had secondary TR (96%) and were severely symptomatic (New York Heart Association class ≥III; 92%). At 2‐year follow‐up, 36% of patients had died. Functional RV parameters (TAPSE: hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.62–0.84; FAC: HR 0.73, 95% CI 0.59–0.91), coupling index (TAPSE/sPAP: HR 0.8, 95% CI 0.65–0.99) and Dandel's index (HR 0.67, 95% CI 0.53–0.85) were all associated with mortality at 2 years in univariable analyses. In a multivariate logistic regression model, the Dandel's index maintained its predictive value (p &lt; 0.001), along with TAPSE and absence of signs of right heart failure, with an optimal threshold of 20.5 determined by the receiver‐operating characteristic analysis. This threshold also successfully predicted cardiac hospital readmission. A multivariate analysis was conducted to identify parameters linked to RV function and predicting clinical outcomes.ConclusionAssessment of the RV capacity to adjust for changes in loading conditions predicted mortality in patients with severe symptomatic TR undergoing T‐TEER. The use of a multiparametric approach including the Dandel's index to assess RV function had an incremental value for the stratification of patients into subgroups with different prognosis.

Effect of insulin resistance on left ventricular remodelling in essential hypertensives: a cross-sectional study.

In clinical practice, left ventricular hypertrophy (LVH) is defined by physical findings and electrocardiographic criteria, which are useful but imperfect tools, echocardiographic criteria and cardiac magnetic resonance imaging. In echocardiography, LVH is defined not by left ventricular wall thicknesses but by left ventricular mass. The latter is calculated according to Devereux's formula, and is increased by insulin resistance/hyperinsulinaemia. It is however unclear whether insulin resistance, hyperinsulinaemia, or both, is actually causative and what their collective or individual influence is on the components of Devereux's formula and parameters of left ventricular diastolic function. This study evaluated the associations of the homeostatic model assessment for insulin resistance (HOMAIR) and fasting plasma insulin levels with components of Devereux's formula and parameters of left ventricular diastolic function. Relevant clinical data were collected from 220 hypertensive patients recruited between January and December 2019. The associations of components of Devereux's formula and parameters of diastolic function with insulin resistance were tested using binary ordinal, conditional and classical logistic regression models. Thirty-two (14.5%) patients (43.9 ± 9.1 years), 99 (45%) patients (52.4 ± 8.7 years) and 89 (40.5%) patients (53.1 ± 9.8 years) had normal left ventricular geometry, concentric left ventricular remodelling and concentric left ventricular hypertrophy, respectively. In multivariable adjusted analysis, 46.8% of variation in interventricular septum diameter (R² = 0.468; overall p = 0.001) and 30.9% of E-wave deceleration time (R² = 0.309; overall p = 0.003) were explained by insulin level and HOMAIR, 30.1% of variation in left ventricular end-diastolic diameter (R² = 0.301; p = 0.013) by HOMAIR alone, and 46.3% of posterior wall thickness (R² = 0.463; p = 0.002) and 29.4% of relative wall thickness (R² = 0.294; p = 0.007) by insulin level alone. Insulin resistance and hyperinsulinaemia did not have the same influence on the components of Devereux's formula. Insulin resistance appeared to act on left ventricular end-diastolic diameter, while hyperinsulinaemia affected the posterior wall thickness. Both abnormalities acted on the interventricular septum and contributed to diastolic dysfunction via the E-wave deceleration time.

The Relationship between Left Ventricular Diastolic Function Parameters and Coronary Artery Disease Severity.

The relationship between diastolic function parameters and the severity of coronary artery disease (CAD) is controversial. This study aimed to determine the relationship between left ventricular diastolic function and the severity of CAD. This cross-sectional study included 63 patients with Ischemic heart disease (IHD) or those suspected of having IHD, who underwent angiography. The study was conducted in Shafa Hospital, Kerman, Iran, from 2021 to 2022. Two-dimensional (2D) strain echocardiography was used to assess left ventricular (LV) function parameters, followed by coronary angiography. Based on the severity of the disease, patients with significant CAD were placed in the case group, and patients with insignificant CAD were placed in the control group. The correlation between the CAD severity and the severity of LV diastolic dysfunction was computed. Descriptive tests, independent t tests, and Spearman correlation coefficients were used. P<0.05 was considered statistically significant. The results indicated that there was no correlation between E/e' (P=0.103), left atrial volume index (LAVI) (P=0.168), tricuspid regurgitation velocity (TRV) (P=0.217), myocardial performance index (MPI) (P=0.106), E wave deceleration time (dt) (P=0.644), and late diastolic strain rate (P=0.502) with CAD severity based on SYNTAX score. However, there was a correlation between left atrial (LA) strain (P=0.017), global longitudinal strain (GLS) (P<0.001), early diastolic strain rate (P<0.001), and systolic strain rate (P=0.047) with SYNTAX score. Besides, there was a correlation between LA strain (P=0.017), GLS (P<0.001), early diastolic strain rate (P<0.001), and late diastolic strain rate (P=0.035) with numbers of epicardial coronary arteries with significant lesions. In contrast with 2D strain echocardiography, this study showed that conventional echocardiography parameters had no significant relationship with CAD severity. GLS had the strongest correlation with CAD severity, and diastolic strain rates had a weaker correlation with CAD severity.

Comparison between Different Echocardiographic Parameters of Right Ventricular Function in Patients with Pulmonary Hypertension

Comparison between Different Echocardiographic Parameters of Right Ventricular Function in Patients with Pulmonary Hypertension

Evaluating the Impact of Maternal Lipid Profiles on Fetal Cardiac Function at Mid-Gestation: An Observational Study.

Background: Maternal dyslipidemia during pregnancy may influence fetal cardiac development and function, potentially predisposing offspring to cardiovascular diseases later in life. This study aims to evaluate the relationship between maternal lipid profiles and fetal cardiac function at mid-gestation, utilizing detailed echocardiographic assessments. Methods: In this prospective cohort study conducted at the Obstetrics and Gynecology Clinic of the Timișoara Municipal Emergency Hospital, 19 pregnant women aged 27-40 years were recruited and divided into two groups based on their triglyceride levels: Group A (triglycerides ≤ 150 mg/dL, n = 48) and Group B (triglycerides > 150 mg/dL, n = 28). Maternal demographic data and lipid profiles were recorded. Fetal echocardiographic measurements, including global longitudinal strain and ventricular function parameters, were obtained between 20 and 24 weeks of gestation. Statistical analyses, including subgroup comparisons, correlations, and regression analyses, were performed. Results: Maternal BMI was significantly higher in Group B compared to Group A (31.94 ± 2.80 vs. 27.01 ± 2.40 kg/m2, p < 0.001). Group B showed higher mean triglyceride levels (163.43 ± 11.34 mg/dL) compared to Group A (131.42 ± 10.57 mg/dL, p < 0.001). Fetal echocardiographic measurements indicated reduced global longitudinal strain in fetuses of Group B mothers (LV strain: -19.86% ± 6.83% vs. -26.14% ± 5.92%, p = 0.017). Significant correlations were found between maternal triglyceride levels and fetal LV strain (r = 0.536, p = 0.019). Regression analysis identified maternal triglyceride levels and BMI as significant predictors of reduced fetal LV strain (β = 0.45, p = 0.021 and β = 0.39, p = 0.038, respectively). Conclusions: Elevated maternal triglyceride levels, LDL cholesterol, and BMI are associated with altered fetal cardiac function parameters at mid-gestation, suggesting that maternal lipid profiles may impact fetal cardiac development. These findings underscore the importance of monitoring lipid levels during pregnancy and suggest potential benefits of managing dyslipidemia to improve fetal cardiac outcomes. However, the study included only a small sample; therefore, the study needs to be continued with a larger group.

Abstract 4115846: Early Right and Left Ventricular Echocardiographic Parameters Improvement in Obese Patients After Bariatric Surgery.

Background: Severe obesity causes hemodynamic changes in the circulatory system, which leads to the development of heart failure with either preserved or reduced ejection fraction. Weight loss achieved through bariatric surgery is likely to possibly reverse many of hemodynamic and structural abnormalities caused by obesity. Hypothesis: Right and left ventricular parameters of heart failure and function improve as soon as 3 months after surgery. Methods: Detailed echocardiographic parameters assessing left and right ventricular function in severely obese patients undergoing bariatric surgery were analyzed. The following parameters of left and right ventricular function were compared in the examinations performed before, 3 and 6 months after surgery: left ventricular ejection fraction (LVEF), LV and RV global longitudinal strain (GLS), peak early (e’) and late (a’) diastolic annular velocities (lateral and septal) with calculation of E/e’ ratios, left atrium volume index ( LAVI), TRV (tricuspid regurgitation velocity), tricuspid annular plane systolic excursion (TAPSE), maximum systolic velocity of the lateral part of the tricuspid annulus-s’ and accelerated pulmonary time (AcT). Results: Forty obese patients (76% women) with mean BMI 40.3 (SD 5.6) and mean age of 42.4 (SD 11.9) years were enrolled. BMI as 6 months was 31.2 (SD 5.1). Baseline and follow-up results of echocardiography are presented for both left and right ventricular parameters in Table 1 and Table 2. Conclusions: Only GLS for right and left ventricle, FWS and TRV improve siginicantly within 6 months from bariatric surgery. On the other hand, these changes are significant as early as 3 months after bariatric surgery.

Abstract 4116486: Association of assessment of clinical congestion in patients with heart failure compared with assessment using bioimpedance and microwave spectroscopy

Background: Physicians have to find a balance between decongestion therapy and the risk of dehydration so non-invasive methods assessing congestion are of great importance. Purpose: The study aimed to compare the clinical assessment of congestion to bioimpedance and microwave spectroscopy. Methods: 27 hospitalized HF patients with congestion (40% females) (Congestion Group) and 59 HF patients without fluid overload (66% females) (NON-Congestion Group) were included. Clinical examination, chest x-ray, laboratory results, echocardiography, non-invasive body mass analysis (Tanita Pro), NT-poBNP, and selected modern biomarkers concentrations [GDF-15, galectin-3, FABP, copeptin, VEGF were performed. Additionally, we assessed pulmonary congestion using a proprietary sensor with a microwave spectroscopy method based on analyzing the dielectric properties of an object (patent applications P.442466). Results: There were no differences in body mass index, blood pressure values, left ventricular ejection fraction (LVEF), and echocardiographic parameters of diastolic left ventricular function between groups. In the Congestion Group, we observed significantly more patients in NYHA Class 3 and 4 (p&lt;0.001), lower values of fT3 (median 2.4 vs 2.7; p=0.02), higher a FIB-4 index (p=0.04), lower GFR MDRD (median 52.7 vs 66.7;p=0.04), higher concentrations of: NT-proBNP (pg/ml) (median 545 vs 101; p&lt;0.001), galectin-3 (ng/ml) (median 15.01 vs 11.35; p=0.01), GDF-15 (pg/ml) (median 2069.27 vs 734.64; p=0.01), FABP (pg/ml) (median 293.6 vs 101; p=0.008) compared to NON-Congestion Group, and a larger number of detected congestion in chest x-ray (p&lt;0.01) and more patients with limb edema (p= 0.0037). The patients with congestion also needed longer hospitalizations (p=0.008). Patients with congestion had lower total body water content in kg and intracellular water (ICW) (kg) (p=0.02 and p=0.01, respectively), and the higher extracellular water/total body water index (ECW/TBW) (p=0.001) assessed in bioimpedance and significantly higher Absorption Loss evaluated with the use of microwave spectroscopy (p=0.02). In a multiple logistic regression model, the factor that was independently associated with clinically diagnosed congestion was NT-proBNP &gt;1095 pg/ml (OR 111.6, 95% CI: 2.6-50.6; p=0.001) (Figure 1). Conclusions: Absorption Loss and ECW/TBW are valuable new diagnostic tools in diagnosing lung congestion in patients with heart failure.