Peak Ejection Rate Research Articles

Evaluation of biventricular function by cadmium-zinc-telluride SPECT gated tomographic radionuclide angiography: Comparison to conventional SPECT.

We compared and analyzed the consistency and repeatability of left and right ventricular ((LV/RV) functions obtained by gated-equilibrium radionuclide ventriculography (ERNV) with cadmium-zinc-telluride single-photon emission computed tomography (CZT-SPECT) and conventional SPECT (C-SPECT) with sodium iodide crystal detectors. Seventy-seven patients were included in the retrospective study. Both C-SPECT and CZT-SPECT imaging were performed on the same day. Correlations and differences in LV/RV ejection fraction (LVEF and RVEF), peak ejection rate (PER), and peak filling rate (PFR) were compared between the 2 models. Cardiac magnetic resonance (CMR) was partially used as the gold standard, and ultrasound results were included for comparative analysis. Interobserver reproducibility of each parameter obtained by the 2 cameras was compared. Between the 2 cameras, there were no significant difference in LVEF, LVPER, LVPFR, and RVPER (P > .05) and there were in RVEF and RVPFR (P < .05 or .001). The correlations (R value) were 0.831 (LVEF, excellent), 0.619 (RVEF, good), 0.672 (LVPER, good), 0.700 (LVPFR, good), 0.463 (RVPER, normal), and 0.253 (RVPFR, poor). There were no significant difference between CMR and CZT-SPECT in LVEF (P > .05) while there were between CMR and both C-SPECT and ultrasound (P < .05). The correlations were all good (R = 0.660, 0.658, and 0.695). There were no significant difference between CMR and both C-SPECT and CZT-SPET in RVEF (P > .05) and the correlations were good (R = 0.771 and 0.745). For repeatability, the intraclass correlation coefficient of RVPFR by C-SPECT was good (intraclass correlation coefficient = 0.698) and excellent for the rest of the groups (0.823-0.989). The repeatability of LVEF and RVEF was better for CZT-SPECT than for C-SPECT. The repeatability of PER was better for both cameras than PFR. CZT-SPECT tomographic ERNV correlated well with C-SPECT planar ERNV in evaluation of biventricular systolic function and LV diastolic function. Compared with the "gold standard" CMR, both models had good correlation in measuring LV/RVEF. CZT-SPECT had better inter-group reproducibility than C-SPECT. The accuracy of RV diastolic function need further study. CZT-SPECT tomographic ERNV will play an important and unique role in the clinical application of accurate evaluation of biventricular function in the future.

Sixteen-Frame Gated Myocardial Perfusion SPECT as a Surrogate for Equilibrium Radionuclide Angiography in Measurement of Systolic and Diastolic Indices: A Cross-Sectional Study

Abstract Introduction Equilibrium radionuclide angiography (ERNA) has long been assumed as the preferred method to assess cardiac volumes as well as left ventricular systolic and diastolic indices. ERNA was used to diagnose subtle changes in cardiac function during chemotherapy or early stages of heart failure. Gated myocardial perfusion SPECT (GMPS) was introduced as a more feasible and versatile alternative to ERNA, but the precision of GMPS to assess systolic and diastolic indices has not yet been fully reviewed. Method We studied the left ventricular systolic and diastolic functional indices measured by a 16-frame GMPS and compared the results with those of ERNA in 25 patients. All the images were analyzed visually, semi-quantitatively, and quantitatively using quantitative gated SPECT (QGS), quantitative blood pool SPECT (QBS), and planar gated blood pool (PGBP) software. The left ventricular functional indices calculated using QGS compared with those obtained using QBS and PGBP Result Our study found a significant correlation between the left ventricular ejection fraction (LVEF) calculated using the PGBP, QGS, and QBS methods. There was a significant correlation between the LV peak ejection rate (LVPER) calculated by the PGBP and QGS analyses, and there was no significant difference in the LVPER calculated with the QGS and QBS methods. This study also revealed a significant correlation between the LV peak filling rate (LVPFR) calculated by QBS and QGS, with no significant difference between them. We also found a significant correlation between LV end systolic volume (LVESV) calculated using QGS and QBS and between LV end diastolic volume (LVEDV) calculated using QGS and QBS software. This study also revealed a significant correlation between the LV mean filling rate over the first third of diastole (LVMFR/3) calculated using the QGS and QBS software. Conclusion Considering the significant correlation between LVEF, LVPER, LVPFR, LVESV, LVMFR/3, and LVEDV calculated using the QGS and QBS methods in our study, the 16-frame GMPS could be regarded as an acceptable substitute for ERNA in the investigation of systolic and diastolic indices.

Diastolic dysfunction in adults with uncomplicated obesity evaluated with left atrial and left ventricular tissue tracking and ventricular volume-time curve: a prospective cardiac magnetic resonance study.

Obesity is commonly linked with heart failure (HF) with preserved ejection fraction, with diastolic dysfunction playing an important role in this type of HF. However, diastolic function has not been well clarified in obese patients free of overt comorbidities. We aimed to comprehensively assess diastolic function in adults with uncomplicated obesity by combining left atrial (LA) and left ventricular (LV) strain and ventricular volume-time curve based on cardiac magnetic resonance (CMR), and to evaluate its association with body fat distribution. A cross-sectional study was conducted with 49 uncomplicated obese participants and 43 healthy controls who were continuously recruited in West China Hospital, Sichuan University from September 2019 to June 2022. LA strain indices [total, passive, and active strains (εs, εe, and εa) and peak positive, early negative, and late negative strain rates (SRs, SRe, and SRa)], LV strain rates [peak diastolic strain rate (PDSR) and peak systolic strain rate (PSSR)], and LV volume-time curve parameters [peak filling rate index (PFRI) and peak ejection rate index (PERI)] were measured. Body fat distribution was assessed by dual-energy X-ray absorptiometry. Correlation between body fat distribution and LA and LV function was evaluated by multiple linear regression. The obese participants had impaired diastolic function, manifested as lower LV circumferential and longitudinal PDSR (1.3±0.2 vs. 1.5±0.3 s-1, P=0.014; 0.8±0.2 vs. 1.1±0.2 s-1, P<0.001), LV PFRI (3.5±0.6 vs. 3.9±0.7 s-1, P=0.012), and declined LA reservoir function [εs and SRs (46.4%±8.4% vs. 51%±12%, P=0.045; 1.9±0.5 vs. 2.3±0.5 s-1, P<0.001)] and conduit function [εe and SRe (30.8%±8.0% vs. 35.5%±9.8%, P=0.019; -3.1±0.8 vs. -3.5±1.0 s-1, P=0.030)] compared with controls. The LA pumping function (εa and SRa) and LV systolic function [LV ejection fraction (LVEF), PSSR and PERI] were not different between obese and control participants. Multivariable analysis indicated that trunk fat had independent relationships with LA εe (β=-0.520, P<0.001) and LV circumferential PDSR (β=-0.418, P=0.003); visceral fat and peripheral fat were associated with LV longitudinal PDSR (β=-0.342, P=0.038; β=0.376, P=0.024); gynoid fat was associated with LA εs (β=0.384, P=0.014) and PFRI (β=0.286, P=0.047) in obesity. The obese participants (uncomplicated obese adults with preserved LVEF) had impaired subclinical diastolic function. Central adipose tissue deposits (trunk fat and visceral fat) may exhibit inverse relationships with LV and LA function in obesity. However, peripheral adipose tissue deposits (peripheral fat and gynoid fat) may show positive relationships with LV and LA function.

SUVmean ratios of liver/muscle and lung/muscle from 13N-NH3 PET perfusion outperformed traditional myocardial viability parameters in predicting survival after CABG.

Myocardial viability evaluation in predicting survival after coronary arterybypass graft (CABG) remains debatable. Thus, this study aimed to investigate the role of 13N-NH3/18F-FDG PET myocardial viability scan in predicting treatment outcomes and survival. 90 patients with CABG and pre-surgical PET-based myocardial viability scan were retrospectively reviewed. Perfusion-metabolism features, myocardium motion parameters, and patient characteristics were recorded. Additionally, the SUVmean of blood pool, lung, liver, spleen, and muscle were measured and the SUVmean ratios were calculated. Factors associated with treatment outcomes and survival were analyzed by Logistic and Cox regressions. Nomogram models were subsequently established to predict ejection fraction (EF) improvement and survival outcomes. The mean EF of these 90 patients was 38.1 ± 9.5% and 46.0 ± 9.2% before and after CABG surgery, and 35 patients (38.9%) achieved EF improvement ≥ 10%. EF measurements by PET and echocardiogram showed a reasonable linear correlation (R = 0.752). Sex, pre-surgical EF, mismatch of the left ventricle, total perfusion deficit (TPD), and peak ejection rate (PER) were independent predictive factors of EF improvements. Surgery waiting time, valve damage, and SUVmean ratio of Liver/Muscle were independently predictive of event-free survival (EFS), while valve damage, together with SUVmean ratio of either Liver/Muscle or Lung/Muscle, were independently predictive of overall survival (OS). Although traditional cardiac parameters from PET-based myocardial viability can effectively predict EF improvements after CABG, SUVmean ratios of liver/muscle and lung/muscle from 13N-NH3 PET perfusion outperformed these parameters in predicting survival.

Optimized gated a SPECT-derived myocardial salvage index: its prognostic significance in predicting major adverse cardiac events following acute myocardial infarction percussion.

Estimate myocardial salvage index (MSI) using a single-gated Single-Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging (GSMPI) early after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) and compare its predictive value with the traditional method especially for post-PCI left ventricular ejection fraction (LVEF) improvement and major adverse cardiac events (MACEs). GSMPI was performed in 62 patients with AMI early after PCI (3-10days). The MSI and the conventional parameters were obtained, including total perfusion deficit, LVEF, peak ejection rate (PER), and peak filling rate (PFR). The new calculation method (scoring evaluation method means the extent of abnormality is the percentage of the total scores of abnormal segments divided by the sum of the maximum scores of all myocardial segments using 4-point and 5-point scale semi-quantitative scoring method) and the reference method (number evaluation method means the extent of abnormality is the percentage of the number of abnormal segments divided by the total number of myocardial segments) were applied to acquire the MSI. We compared the predictive ability of the 2 methods based on the area under the receiver operating characteristic curve for LVEF improvement 6months after PCI using MSI. The Kaplan-Meier method was used for depicting survival curves for predicting MACEs by the 2 methods. Cox proportional-hazards regression was applied to confirm the independent predictors of MACEs. The MSI obtained by the new method indicated stronger prognostic significance in LVEF improvement [area under the curve (AUC): 0.793, 95% confidence interval (CI) 0.620-0.912, P < .001] compared with the reference method (AUC: 0.634, 95%CI 0.452-0.792, P = .187). Delong's test revealed a statistically significant difference in AUCs between the 2 methods (P < .05, 95%CI 0.003-0.316). The diagnostic value of the scoring evaluation method was higher than that of the number evaluation method. The Cox prevalence of MACEs was substantially higher in the < median MSI group than in the ≥ median MSI group (hazard ratio: 0.172; 95% CI 0.041-0.724; P < .05] using the new method, whereas no considerable differences were observed between the 2 groups using the reference method (P = .12). Further, the multivariate Cox regression analysis revealed that MSI was an independent indicator for predicting MACEs (P < .05). The MSI obtained from a simple GSMPI early after PCI, using the scoring evaluation method, was a reliable prognostic indicator for predicting LVEF improvement and MACEs in AMI. It remarkably improved the prognostic value compared with the previous reference methods.

The Value of Stress-Gated Blood Pool SPECT in Predicting Early Postoperative Period Complications in Ischemic Cardiomyopathy Patients: Focus on Mechanical Dyssynchrony.

(1) Objective: The objective of this study was to assess the prognostic value of stress-gated blood pool SPECT (GBPS) estimates in patients with ischemic cardiomyopathy (ICM) in the early postoperative period. (2) Methods: A total of 57 patients (age 59.7 ± 6.6, 47 men) with ICM and LV ejection fraction (30 [27.5; 35]%) were enrolled in the study. Before surgical treatment, all patients underwent GBPS (rest-stress, dobutamine doses of 5/10/15 µg/kg/min). Stress-induced changes in left ventricular (LV) ejection fraction, peak ejection rate, volumes, and mechanical dyssynchrony (phase histogram standard deviation, phase entropy (PE), and phase histogram bandwidth) were estimated. Two-dimensional transthoracic echocardiography was performed baseline. Serum levels of NT-proBNP were analyzed with enzyme-linked immunoassay. (3) Results: After surgical treatment, patients were divided into two groups, one, with death, the need for an intra-aortic balloon pump (IABP) or/and inotropic support with a stay in the intensive care unit for more than two days and two, without complications in the early postoperative period (EPOP). Complicated EPOP (CEPOP) was observed in 17 (30%) patients (death-2, IABP-4, extra inotropic support in intensive care unit-11), and 40 patients had no complications (NCEPOP). GBPS showed differences in LV EDV (mL) (321 [268; 358] vs. 268 [242; 313], p = 0.02), LV ESV (mL) (242 [201; 282] vs. 196 [170; 230], p = 0.005), and stress-induced changes in PE (1 (-2; 3) vs. -2 (-4; 0), p = 0.02). Aortic cross-clamp time and stress-induced changes in PE between rest and dobutamine dose of 10 µg/kg/min were the only independent predictors of CEPOP. An increase in LV entropy ≥ 1 on the dobutamine dose of 10µg/kg/min in comparison to rest investigation showed AUC = 0.853 (sensitivity = 62%, specificity = 90%, PPV = 71%; NPV = 85%; p < 0.0001). Conclusion: Stress-induced changes in PE obtained during low-dose dobutamine GBPS are associated with a complicated course of the early postoperative period after surgical treatment for ICM.

Association of cardiovascular magnetic resonance diastolic indices with arrhythmia in repaired Tetralogy of Fallot

BackgroundPatients with repaired Tetralogy of Fallot (rTOF) experience a high burden of long-term morbidity, particularly arrhythmias. Cardiovascular magnetic resonance (CMR) is routinely used to assess ventricular characteristics but the relationship between CMR diastolic function and arrhythmia has not been evaluated. We hypothesized in rTOF, left ventricular (LV) diastolic dysfunction on CMR would correlate with arrhythmias and mortality. MethodsAdolescents and adults with rTOF who underwent CMR were compared to healthy controls (n = 58). Standard ventricular parameters were assessed and manual planimetry was performed to generate filling curves and indices of diastolic function. Chart review was performed to collect outcomes. Univariate and multivariable logistic regression was performed to identify outcome associations. ResultsOne-hundred sixty-seven subjects with rTOF (mean age 32 years) and 58 healthy control subjects underwent CMR. Patients with rTOF had decreased LV volumes and increased right ventricular (RV) volumes, lower RV ejection fraction (RVEF), lower peak ejection rate (PER), peak filling rate (PFR) and PFR indexed to end-diastolic volume (PFR/EDV) compared to healthy controls. Eighty-three subjects with rTOF had arrhythmia (63 atrial, 47 ventricular) and 11 died. Left atrial (LA) volumes, time to peak filling rate (tPFR), and PFR/EDV were associated with arrhythmia on univariate analysis. PER/EDV was associated with ventricular (Odds ratio, OR 0.43 [0.24–0.80], p = 0.007) and total arrhythmia (OR 0.56 [0.37–0.92], p = 0.021) burden. A multivariable predictive model including diastolic covariates showed improved prediction for arrhythmia compared to clinical and conventional CMR measures (area under curve (AUC) 0.749 v. 0.685 for overall arrhythmia). PFR/EDV was decreased and tPFR was increased in rTOF subjects with mortality as compared to those without mortality. ConclusionsSubjects with rTOF have abnormal LV diastolic function compared to healthy controls. Indices of LV diastolic function were associated with arrhythmia and mortality. CMR diastolic indices may be helpful in risk stratification for arrhythmia.

Reference data for left ventricular filling and atrial function in children using cardiovascular magnetic resonance

BackgroundDiastolic dysfunction is associated with morbidity and mortality in multiple pediatric disease processes. Cardiovascular magnetic resonance (CMR) provides a non-invasive method of studying left ventricular (LV) diastolic dysfunction through the assessment of LV filling curves and left atrial (LA) volume and function. However, there are no normative data for LV filling curves and the standard method is time-intensive. This study aims to compare an alternate, more rapid method of obtaining LV filling curves to standard methodology and report normative CMR diastolic function data for LV filling curves and LA volumes and function. MethodsNinety-six healthy pediatric subjects (14.3 ± 3.4 years) with normal CMR defined by normal biventricular size and systolic function without late gadolinium enhancement were included. LV filling curves were generated by removing basal slices without myocardium present throughout the cardiac cycle and apical slices with poor endocardial delineation (compressed method), then re-generated including every phase of myocardium from apex to base (standard method). Indices of diastolic function included peak filling rate and time to peak filling. Systolic metrics included peak ejection rate and time to peak ejection. Both peak ejection and peak filling rates were indexed to end-diastolic volume. LA maximum, minimum and pre-contraction volumes were calculated using a biplane method. Inter-and intra-observer variability were assessed with intraclass correlation coefficient. Multivariable linear regression was used to assess the effects of body surface area (BSA), gender and age on metrics of diastolic function. ResultsBSA had the largest effect on LV filling curves. Normal LV filling data are reported for both compressed and standard methods. The time to perform the compressed method was significantly shorter than the standard method (median 6.1 min vs. 12.5 min, p < 0.001). Both methods had strong to moderate correlation for all metrics. Intra-observer reproducibility was moderate to high for all LV filling and LA metrics except for time to peak ejection and peak filling. ConclusionsWe report reference values for LV filling metrics and LA volumes. The compressed method is more rapid and produces similar results to standard methodology, which may facilitate the use of LV filling in clinical CMR reporting.

Clinical and imaging characteristics of cardiac magnetic resonance presenting with myocardial infarction with non-obstructive coronary arteries in China

BackgroundThe characteristics are still unclear due to lack of systematic research on patients with myocardial infarction non-obstructive coronary arteries (MINOCA) in China. This study aimed to explore the clinical and imaging features of MINOCA patients.MethodsThe patients who were diagnosed as suspected MI were studied. Cardiac magnetic resonance (CMR) was performed after coronary angiography or coronary computed tomographic angiography examination within one week. Myocardial infarction (MI) was determined by late gadolinium enhancement CMR.The patients with MI were divided into MINOCA and MICAD group according to whether the degree of coronary stenosis was greater than 50%. Cardiac function and imaging characteristics between the two groups were analyzed.Results21 patients with MINOCA and 30 patients with myocardial infarction with obstructive coronary artery disease (MICAD) were analyzed. MINOCA patients were younger, and the electrocardiogram was commonly featured by non-ST-elevation. The parameters of left ventricular function were significantly different between the two groups including left ventricular ejection fraction, stroke volume, cardiac output, myocardial mass, and peak ejection rate (P < 0.05). Besides, MINOCA patients had smaller area of MI, less score of transmural extent, fewer involved segments. Furthermore, the transmural extent of MI in MINOCA patients was mainly grade I, that is, most of them were subendocardial MI, which was significantly negatively correlated with the amount of first-pass perfusion.ConclusionsThe clinical characteristics combined with imaging features of CMR may be effective to evaluate the cardiac function in order to make clinical decision for MINOCA patients in China.

Low-dose dobutamine stress gated blood pool SPECT assessment of left ventricular contractile reserve in ischemic cardiomyopathy: a feasibility study.

The purpose of the present study was to evaluate the feasibility of gated blood pool single-photon emission computed tomography (GBPS) with low-dose dobutamine (LDD) stress test, performed on a single-photon emission computed tomography (SPECT) camera equipped with cadmium-zinc-telluride (CZT) solid-state detectors, in assessing of left ventricle (LV) contractile reserve in patients with ischemic cardiomyopathy (ICM). A total of 52 patients (age 59 ± 7.2years, 47 men and 5 women) with ICM and a control group of 10 patients without obstructive coronary artery lesion underwent GBPS and transthoracic echocardiography (TTE) at rest and during LDD stress test (5, 10, 15µg/kg/min). The duration of each GBPS step was 5min. Stress-induced changes in LV ejection fraction (ΔLVEF), peak ejection rate, LV volumes, and mechanical dyssynchrony (phase histogram standard deviation, phase histogram bandwidth and entropy) obtained with GBPS were estimated. All GBPS indices except end-diastolic volume showed significant dynamics during stress test in both groups. The majority of parameters in ICM patients showed significant changes at a dobutamine dose of 10µg/kg/min as compared to the rest study. Seventeen percent of ICM patients, but none from the control group, showed a decrease in LVEF during stress, accompanied by a significant increase in entropy. The intra- and inter-observer reproducibility was excellent for both rest and stress studies. There was a moderate correlation (r = 0.5, p = 0.01) between GBPS and TTE, with a mean difference value of - 1.7 (95% confidence interval - 9.8; 6.4; p = 0.06) in ΔLVEF. Low-dose dobutamine stress GBPS performed with high-efficiency CZT-SPECT cameras can be performed for evaluating stress-induced changes in LV contractility and dyssynchrony with lower acquisition time. A dobutamine dose of 10µg/kg/min can potentially suffice to detect stress-induced changes in patients with ICM during GBPS. ClinicalTrials.gov identifier: NCT04508608 (August 7, 2020).

Systolic Dysfunction of the Heart in Type 1 Diabetes Mellitus.

Impaired insulin synthesis is accompanied by hyperglycemia and the development of diabetic cardiomyopathy. Echocardiography and left-ventricular catheterization were employed for studying the contractile function of the left ventricle in 2 weeks after administration of streptozotocin (60 mg/kg). The results obtained by both methods were similar and indicated the development of systolic dysfunction with a 27% decrease in cardiac output. The invasive study showed that the maximum rate of left-ventricular pressure development, the contractility index, and systolic left-ventricular pressure were within the normal range, but the peak ejection rate was reduced by 28%. BP was normal, but the vascular stiffness index was increased by about 1.5 times and inversely correlated with the peak ejection rate (r=-0.69). The results showed that systolic dysfunction in type 1 diabetes model was due to reduced ejection from the left ventricle at normal rate of left-ventricular pressure development.

The impact of overweight and obesity on the development of systolic and diastolic myocardial dysfunction in patients with type 2 diabetes mellitus

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf I.M. Sechenov First Moscow State Medical University Background Obesity and type 2 diabetes mellitus (DM) promote the development of systolic and diastolic myocardial dysfunction. The method of equilibrium radionuclide ventriculography (ERVG) can be used to estimate these dysfunctions. Purpose We conducted a comparative ERVG evidence-based analysis in patients with type 2 diabetes mellitus and varying degree of overweight. We analyzed the correlation between body mass index (BMI) and ERVG data. Methods The study included 42 patients (8 male and 34 female): group 1 – 12 patients with BMI 25.0-29.9 kg / m2, group 2 – 16 patients with BMI 30.0-34.9 kg / m2, group 3 – 14 patients with BMI 35.0-39.9 kg / m2. The average duration of type 2 diabetes mellitus was 11 ± 3.8 years. The average age of patients in each group was 65.8 ± 5 y.o., 57.7 ± 6 y.o., 64.6 ± 8 y.o. respectively. The groups were comparable in duration of type 2 diabetes mellitus, level of glycated hemoglobin, presence and severity of combined pathology. The patients with postinfarction cardiosclerosis and decompensated heart failure were excluded. The following ERVG indices of left ventricle (LV) and right ventricle (RV) were examined: systolic function – ejection fraction (EF), peak (PER) and average (AER) ejection rates, ejection within 1/3 of systole (ejec.1/3 s.), end-systolic volume (ESV), stroke volume (SV), diastolic function – peak filling rate (PFR), filling within 1/3 diastole (fil. 1/3 d.), end-diastolic volume (EDV). Results the EF of the LV in all examined patients was more than 40%. In group 2 we discovered an increase in the EDV and ESV indices of the LV, ESV of the RV compared to group 1 (123.8 ± 23.6 ml, 52.4 ± 14.5 ml, 66.3 ± 21.6 ml - in group 2 and 96.5 ± 22.7 ml, 37.9 ± 10.7 ml, 50.2 ± 16.7 ml - in group 1, respectively, p &amp;lt;0.05). SV of the LV in group 3 was considerably larger compared to group 1 (76.4 ± 17.8 ml vs 59.1 ± 15.6 ml, p &amp;lt;0.05). In all groups fil. 1/3 d. for LV and RV was below normal equal to 50% of EF. The correlation analysis revealed a negative association between fil. 1/3 d. of the RV and BMI (r = -0.46, p &amp;lt;0.05) in group 1. Conclusions As long as BMI increases in patients with type 2 diabetes mellitus, there is a significant increase in the ESV of both ventricles and EDV of the LV. The most sensitive ERVG indices during the obesity progression are ESV, EDV, and filling within 1/3 diastole. The revealed diastolic dysfunctions in absence of a significant decrease in EF are a manifestation of a myocardial stiffness. Early diagnosis of these disorders and correction of treatment can improve the prognosis of patients with type 2 diabetes mellitus and varying degree of overweight.

Significant Impact of Coffee Consumption on MR-Based Measures of Cardiac Function in a Population-Based Cohort Study without Manifest Cardiovascular Disease.

Subclinical effects of coffee consumption (CC) with regard to metabolic, cardiac, and neurological complications were evaluated using a whole-body magnetic resonance imaging (MRI) protocol. A blended approach was used to estimate habitual CC in a population-based study cohort without a history of cardiovascular disease. Associations of CC with MRI markers of gray matter volume, white matter hyperintensities, cerebral microhemorrhages, total and visceral adipose tissue (VAT), hepatic proton density fat fraction, early/late diastolic filling rate, end-diastolic/-systolic and stroke volume, ejection fraction, peak ejection rate, and myocardial mass were evaluated by linear regression. In our analysis with 132 women and 168 men, CC was positively associated with MR-based cardiac function parameters including late diastolic filling rate, stroke volume (p < 0.01 each), and ejection fraction (p < 0.05) when adjusting for age, sex, smoking, hypertension, diabetes, Low-density lipoprotein (LDL), triglycerides, cholesterol, and alcohol consumption. CC was inversely associated with VAT independent of demographic variables and cardiovascular risk factors (p < 0.05), but this association did not remain significant after additional adjustment for alcohol consumption. CC was not significantly associated with potential neurodegeneration. We found a significant positive and independent association between CC and MRI-based systolic and diastolic cardiac function. CC was also inversely associated with VAT but not independent of alcohol consumption.

Impact of type 2 diabetes mellitus on left ventricular diastolic function in patients with essential hypertension: evaluation by volume-time curve of cardiac magnetic resonance

BackgroundEssential hypertension and type 2 diabetes mellitus (T2DM) are two common chronic diseases that often coexist, and both of these diseases can cause heart damage. However, the additive effects of essential hypertension complicated with T2DM on left ventricle (LV) diastolic function have not been fully illustrated. This study aims to investigate whether T2DM affects the diastolic function of the LV in patients with essential hypertension using the volume-time curve from cardiac magnetic resonance (CMR).MethodsA total of 124 essential hypertension patients, including 48 with T2DM [HTN(T2DM +) group] and 76 without T2DM [HTN(T2DM-) group], and 52 normal controls who underwent CMR scans were included in this study. LV volume-time curve parameters, including the peak ejection rate (PER), time to peak ejection rate (PET), peak filling rate (PFR), time to peak filling rate from end-systole (PFT), PER normalized to end-diastolic volume (PER/EDV), and PFR normalized to EDV (PFR/EDV), were measured and compared among the three groups. Multivariate linear regression analyses were performed to determine the effects of T2DM on LV diastolic dysfunction in patients with hypertension. Pearson correlation was used to analyse the correlation between the volume-time curve and myocardial strain parameters.ResultsPFR and PFR/EDV decreased from the control group, through HTN(T2DM −), to HTN(T2DM +) group. PFT in the HTN(T2DM-) group and HTN(T2DM +) group was significantly longer than that in the control group. The LV remodelling index in the HTN(T2DM −) and HTN(T2DM +) groups was higher than that in the normal control group, but there was no significant difference between the HTN(T2DM −) and HTN(T2DM +) groups. Multiple regression analyses controlling for covariates of systolic blood pressure, age, sex, and heart rate demonstrated that T2DM was independently associated with PFR/EDV (β = 0.252, p < 0.05). The volume-time curve method has good repeatability, and there is a significant correlation between volume-time curve parameters (PER/EDV and PFR/EDV) and myocardial peak strain rate, especially circumferential peak strain rate, which exhibited the highest correlation (r = − 0.756 ~ 0.795).ConclusionsT2DM exacerbates LV diastolic dysfunction in patients with essential hypertension. The LV filling model changes reflected by the CMR volume-time curve could provide more information for early clinical intervention.

Effects of selective heart rate reduction with ivabradine on LV function and central hemodynamics in patients with chronic coronary syndrome.

ObjectivesWe assessed left ventricular (LV) function and central hemodynamic effects in patients with a heart rate (HR) at rest of ≥70 beats per minute (bpm) and chronic coronary syndrome (CCS) after long-term treatment with ivabradine compared to placebo by cardiac magnetic resonance (CMR) imaging.Methods and resultsIn a randomized, double-blinded, prospective cross-over design, 23 patients (18 male, 5 female) were treated with ivabradine (7.5 mg bid) or placebo for 6 months. CMR imaging was performed at baseline and after 6 and 12 months to determine LV functional parameters.Mean resting HR on treatment with ivabradine was 58 ± 8.2 bpm and 70.2 ± 8.3 bpm during placebo (p < 0.0001).There was no difference in systolic LV ejection fraction (ivabradine 57.4 ± 11.2% vs placebo 53.0 ± 10.9%, p = 0.18), indexed end-diastolic (EDVi) or end-systolic volumes (ESVi). Indexed stroke volume (SVi) (ml/m2) remained unchanged after treatment with ivabradine. Volume time curve parameters reflecting systolic LV function (peak ejection rate and time) were unaffected by ivabradine, while both peak filling rate (PFR) and PFR/EDV were significantly increased. Mean aortic velocity (cm/s) was significantly reduced during treatment with ivabradine (ivabradine 6.7 ± 2.7 vs placebo 9.0 ± 3.4, p = 0.01). Aortic flow parameters were correlated to parameters of vascular stiffness. The strongest correlation was revealed for mean aortic velocity with aortic distensibility (AD) (r = −0.86 [−0.90 to −0.85], p < 0.0001).ConclusionLong-term reduction of HR with ivabradine in patients with CCS improved diastolic function and reduced mean aortic flow velocity.

Combination of Linagliptin and Empagliflozin Preserves Cardiac Systolic Function in an Ischemia-Reperfusion Injury Mice With Diabetes Mellitus.

BackgroundSodium-glucose co-transporter 2 inhibitor (SGLT2i) and dipeptidyl peptidase 4 inhibitor (DPP4i) are oral hypoglycemic agents. Although SGLT2i has been shown having the beneficial effects on heart failure in basic and clinical studies, the combined effects of SGLT2i and DPP4i have not been established well. We investigated the effects of SGLT2i and DPP4i against diabetes mice model of myocardial ischemia-reperfusion injury.MethodsStreptozotocin-induced diabetic C57BL/6J mice were divided into control (vehicle), empagliflozin (30 mg/kg/day), linagliptin (3 mg/kg/day) and combination (30 mg/kg/day and 3 mg/kg/day, respectively) groups. After 7 days of drug administration, 30 min of myocardial ischemia was performed. We investigated body weight, heart weight, blood glucose, and cardiac functions by pressure-volume Millar catheter followed by 28 days of additional drug administration.ResultsBlood glucose levels, body weight, and heart weight were not significantly different between the groups. In Millar catheter analysis, left ventricular volume at the peak left ventricular ejection rate which is one of the cardiac systolic parameters in combination group was significantly preserved than that in control (P = 0.036). The cardiac index in the combination group tended to be preserved compared to that in the control (P = 0.06). The pathological fibrotic area in the left ventricle in the combination group also tended to be smaller (P = 0.08).ConclusionsCombination therapy with linagliptin and empagliflozin preserved cardiac systolic function on the diabetes mice model of myocardial ischemia-reperfusion injury independent of blood glucose levels.

Long-term prognosis of left ventricular re-remodeling after surgery of ischemic cardiomyopathy: the potential of tomographic radionuclide ventriculography

Aim. To assess the potential of stress tomographic radionuclide ventriculography (T-RVG) in long-term prognosis of left ventricular (LV) re-remodeling after surgery of ischemic cardiomyopathy.Material and methods. Thirty patients with ischemic cardiomyopathy, before surgical treatment, underwent resting T-RVG and with increasing doses of dopamine (5/10/15 pg/kg/min (5 min/dose). All patients underwent two-dimensional echocardiography before surgery, in the short- (7-14 days) and long-term postoperative period. In the long-term postoperative period (476±36 days), the patients were divided into two groups: group 1 (n=19) — patients with ongoing LV remodeling (increase in the LV end-systolic volume (ESV) or decrease &lt;10% relatively short-term postoperative period), group 2 (n=11) — patients with decreased LV ESV &gt;10%.Results. The results revealed significant differences between the groups in the dynamics (Δ) of the LV ejection fraction (EF) (%) (2 (2;8); 11 (5;12), p=0,02), peak ejection rate (%) (32 (14;51); 63 (34;79), p=0,009), LV dyssynchrony (PSDo (3 (0;7); -2 (-9;3), p=0,004); Entropy (%) (2 (-1;6); 0 (-4;2), p=0,01)). Univariate regression showed that ΔLVEF (odds ratio (OR), 0,88; confidence interval (CI), 0,8; 0,97; p=0.008), ΔLVPSD (OR, 1,13; CI, 1,03; 1,25; p=0,005), and coronary stenosis &gt;75% (OR, 4,25; CI, 1,57; 11,48; p=0,001) had a predictive value. According to the ROC-analysis, the sensitivity, specificity, and AUC were 87%, 64% and 0,727 for ΔLVPSD (threshold &gt;-1); 84%, 46% and 0,691 for coronary stenosis &gt;75% &gt;75% (threshold &gt;2); 65%, 82% and 0,674 for ΔLVEF (threshold ≤4), respectively. The logistic model, which included these parameters and the presence of diabetes, showed a significantly greater AUC (0,907, p&lt;0,05) compared with these indicators taken separately.Conclusion. Preoperative values of ΔLVEF and ΔLVPSD obtained with stress T-RVG have prognostic significance in relation to LV long-term re-remodeling.

Central hemodynamic effects in patients with chronic coronary syndrome after long-term ivabradine therapy

Abstract Objectives We sought to assess central hemodynamic effects in 23 patients (18 male, 5 female) with a resting heart rate (HR) of ≥70 beats per minute (bpm) and chronic coronary syndrome after long-term ivabradine therapy (6 months) by cardiac magnetic resonance (CMR). Methods and results In a cross-over design, all patients were treated with ivabradine (Iva, 7.5 mg bid) and placebo for 6 months each. CMR was performed three times (at baseline, after 6 and 12 months) to determine left ventricular (LV) function parameters, including end-diastolic and end-systolic volumes (EDVi, ESVi), stroke volume (SVi) and ejection fraction (EF) as well as volume-time curve (VTC) parameters, including peak ejection rate (PER), peak ejection time (PET), peak filling rate (PFR), peak filling time from ES (PFT), peak ejection rate normalized to EDV (PER/EDV) and peak filling rate normalized to EDV (PFR/EDV) for global LV function (systolic and diastolic) assessment. Flow measurements of the ascending aorta were performed with phase-contrast velocity imaging. Treatment with Iva led to a HR reduction of 11.4 bpm (Iva 58.8±8.2 bpm vs placebo 70.2±8.3 bpm, p&amp;lt;0.0001).There was no difference in LVEF (%) (Iva 57.4±11.2 vs placebo 53.0±10.9, p=0.18), EDVi or ESVi. SVi (ml/m2) remained comparatively unchanged after long-term treatment with Iva (Iva 40.6±9.6 vs placebo 35.7±8.8, p=0.08). VTC parameters reflecting systolic LV function (PER, PET) were unaffected by Iva, while both PFR and PFR/EDV were significantly increased (PFR/EDV (s-1) Iva 2.4±0.4 vs placebo 2.1±0.4, p=0.03). There was a trend to longer PFT during treatment with Iva, though not reaching statistical significance. Medium and maximum aortic flow were not affected by treatment with Iva, while mean velocity (cm/s) was significantly reduced (Iva 6.7±2.7 vs placebo 9.0±3.4, p=0.01). Aortic flow parameters were correlated to aortic distensibility (AD), as surrogate parameter for arterial stiffness. AD was significantly correlated to both aortic flow and flow velocity, whereby mean velocity showed the strongest correlation to AD (r=0.74 [0.61 to 0.83], p&amp;lt;0.0001). Conclusion Systolic LV function was unaffected by treatment with Iva, while the filling during diastole was significantly improved. While medium and maximum aortic flow were not affected by Iva, mean velocity was significantly reduced. Aortic distensibility as surrogate parameter for arterial stiffness was significantly correlated to aortic mean velocity. This study confirms the underlying physiological principle of the If-current inhibitor Ivabradine. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): This work was supported by the Deutsche Herzstiftung (German Heart Foundation) (F/14/11 to F.C.) and the Deutsche Forschungsgemeinschaft (DFG KFO 196 to U.L., S.H.S and M.B. and SFB TTR 219, S-01 to M.B.). The Saarland University Medical Center has received an unrestricted grant from Servier (France).

Cardiac diastolic function of 8–9-year-old singletons following fresh or frozen embryo transfer compared to naturally conceived – a cardiac magnetic resonance study

Abstract Background Epigenetics may alter the cardiovascular system of children conceived after assisted reproductive technology (ART). Singletons born after frozen embryo transfer (FET) are more likely to be large for gestational age and fresh embryo transfer (ET) are at risk of being small for gestational age. Children conceived after ART may have endothelial dysfunction, and high body mass index and arterial blood pressure (ABP). Such changes may be associated with cardiac diastolic dysfunction. Purpose We investigate whether children conceived after fresh ET and FET are at risk of cardiac changes including left ventricular (LV) diastolic dysfunction. Methods 150 9-year-old singletons have been recruited in a cardiac magnetic resonance imaging study (all scanned by April 2020). 50 children were born after natural conception (NC); 50 children after FET; and 50 children after fresh ET. Left atrium (LA) maximal volume, LA early emptying fraction (LAEEF), LV peak filling rates (PFR) and the peak ejection rate (PER)/PFR ratio are reported to assess the diastolic function. Results Preliminary data analyzed in a blinded manner from 59 children show no differences in ambulatory ABP, LV and right ventricular ejection fraction, end-diastolic and end-systolic volumes, stroke volumes and LV mass between the groups. With respect to LV diastolic function, no differences were seen in LA maximal volume and LAEEF; but the Fresh ET group tended to have lower PFR with a resultant PER/PFR ratio now increasing above unity compared to the other groups. Conclusion Preliminary data suggest a possible trend towards diastolic dysfunction in children born after fresh ET. If the lack of significant difference in heart function between NC and FET can be ascertained in the full cohort, this is reassuring. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Novo Nordisk Foundation

Predictive value of phase analysis of gated myocardial perfusion imaging for major adverse cardiac events in patients with coronary artery disease

Objective To evaluate the value of phase analysis of gated myocardial perfusion imaging (GMPI) in predicting major adverse cardiac events (MACE) in patients with coronary atherosclerotic heart disease. Methods Patients who underwent two-day rest-stress GMPI in the Department of Nuclear Medicine of Beijing Hospital from September 2012 to January 2014 were selected as observed subjects and analyzed retrospectively. The general clinical information, GMPI images and related parameters including phase standard deviation (PSD), phase histogram bandwidth (PBW), entropy, left ventricular ejection fraction (LVEF), summed stress score (SSS), peak ejection rate (PER), peak filling rate (PFR) were noted. Patients were followed up until the onset of MACE (cardiac death, nonfatal myocardial infarction, and late revascularization within 60 d after GMPI). χ2 test, independent-sample t test or Wilcoxon rank sum test were used to compare data between different groups. The independent risk factors of MACE were obtained by Cox proportional risk regression model. Kaplan-Meier survival curve analysis was used to analyze the cumulative survival rate without MACE. Results A total of 505 patients (235 males, 270 females, median age: 73 years) were followed up successfully, with a median follow-up period of 55.6(52.0, 60.5) months. There were 54 cases (10.7%) with MACE: 6 patients with cardiac death, 27 patients with non-fatal myocardial infarction, and 21 patients with late revascularization. The incidence of hypertension and hyperlipidemia in patients with MACE was significantly higher than that in patients without MACE (χ2 values: 4.126, 6.021, both P 80°), abnormal entropy(>58 J·mol-1·K-1) and SSS≥12 were independent risk factors for MACE (odds ratio(OR) values: 2.795(95% CI: 1.259-6.201), 3.213(95% CI: 1.468-7.029), 3.640 (95% CI: 1.999-6.628), all P 26.7°), abnormal PBW group and abnormal entropy group were 51.2%, 63.2% and 46.7%, which were significantly lower than those of normal PSD group (92.3%; χ2=77.768, P<0.05), normal PBW group (94.2%; χ2=77.741, P<0.05) and normal entropy group (92.8%; χ2=117.437, P<0.05). The 5-year cumulative MACE-free survival rate (31.7%) of patients with abnormal PBW and SSS≥12 was significantly lower than that of patients with normal PBW or patients with abnormal PBW and SSS<12 (80.1%-94.4%; χ2=185.4, P<0.01). The combination analysis of entropy and SSS showed similar results. Conclusions PBW and entropy obtained by GMPI phase analysis are independent risk factors for predicting MACE in coronary artery disease. GMPI phase analysis is useful for coronary artery disease risk stratification. Key words: Coronary artery disease; Prognosis; Myocardial perfusion imaging; Tomography, emission-computed, single-photon; Tomography, X-ray computed; Technetium Tc 99m sestamibi