Predictor Of Left Ventricular Remodeling Research Articles

99mTc-HFAPi SPECT imaging predicts left ventricular remodeling after acute myocardial infarction

BackgroundDespite improved treatments for acute myocardial infarction (AMI), myocardial fibrosis remains a key driver of adverse left ventricular (LV) remodeling and increased mortality. Fibroblast activation and proliferation significantly contribute to this process by enhancing cardiac fibrosis, which can lead to detrimental changes in LV structure. This study evaluates the effectiveness of 99mTc-labeled fibroblast activation protein inhibitor (99mTc-HFAPi) SPECT imaging in predicting LV remodeling over 12 months in post-AMI patients. MethodsA cohort of 58 AMI patients (46 males, median age 61 [53, 67] years) underwent baseline 99mTc-HFAPi imaging (5 ± 2 days post-MI), perfusion imaging (6 ± 2 days post-MI), and echocardiography (2 ± 2 days post-MI). Additionally, 15 patients had follow-up 99mTc-HFAPi and perfusion imaging, while 30 patients had follow-up echocardiography. Myocardial 99mTc-HFAPi activity was assessed at the patient level. LV remodeling was defined as a ≥10% increase in LV end-diastolic diameter (LVEDD) or LV end-systolic diameter (LVESD) from baseline to follow-up echocardiography. ResultsAMI patients displayed localized but non-uniform 99mTc-HFAPi uptake, exceeding perfusion defects. Baseline 99mTc-HFAPi activity exhibited significant correlations with BNPmax, LDHmax, cTNImax, and WBCmax, inversely correlating with LVEF. After 12 months, 11 patients (36.66%) experienced LV remodeling. Univariate regression analysis demonstrated an association between baseline 99mTc-HFAPi uptake extent and LV remodeling (OR = 2.14, 95%CI, 1.04, 4.39, P = 0.038). Conclusions99mTc-HFAPi SPECT imaging holds promise in predicting LV remodeling post-MI, providing valuable insights for patient management and prognosis.

Evaluation Serum Levels of Resistin and Interleukins-6 as Predictors of Left Ventricular Remodelling in Patients with Acute ST Elevation Myocardial Infarction

Objectives: To identify some biochemical parameters that help predict LV remodelling after STEMI. By determining serum levels of Resisten and IL-6 in patients with ST-segment elevation MI (STEMI) and apparently healthy controls. Patients & Methods: This prospective case-controlled study was conducted from beginning May 2023 to end of October 2023. This study was conducted on 110 individuals, including sixty-two patients (50 males and 12 females) who had undergone a STEMI and forty-eight healthy control subjects. The information about patients in this study was retrieved from patients' hospital records. The samples were collected from Azadi Teaching Hospital/ Kirkuk on patients with STEMI. Forty-eight of apparently healthy sex and age-matched controls were included in this study. The data were collected from the cases group as (G2) means: From the moment the patient arrives to internal resuscitation and up to 48 hours and at the baseline of the STEMI (ST elevation of the myocardial fraction), and (G3) means: After 4-6 months follow up, These states were also compared to the control group composed of (48) individuals who were apparently healthy. About five ml of blood was collected from the antecubital vein for both patients and healthy individuals in an anticoagulant tube to estimate the Resisten and IL-6 levels. Results: The results of the study showed that the serum level of resisten were significantly higher in group G2 (patients group) in comparison to those of the A1 (control group) P <0.01. The current research demonstrated non-significant differences in IL-6 levels between (G1 and G2), while showing highly significant differences between A1 and A3; this was also applicable for G2 and G3. Conclusion: The current study concluded that there are significantly increasing of Resistin levels in patients in matching to control groups. Also, it was noticed that IL-6 mean concentration levels were lower in A2 in comparison to A1 but higher than in A3.

Echocardiographic predictors of positive left ventricular remodeling in patients with a history of active myocarditis.

Myocarditis may be difficult to diagnose because of the variety of its clinical manifestations, and the clinical course of the disease can be unpredictable. Nevertheless, some patients may exhibit partial or full contractile recovery following myocarditis. Standard and speckle-tracking echocardiography may serve as tools to follow this recovery. We aimed to evaluate predictors of positive left ventricular (LV) remodeling after active myocarditis (AM). A database of a high‑volume, tertiary cardiology center was searched for patients with AM hospitalized between 2016 and 2019. They were included in the analysis based on clinical manifestations and presence of at least 1 of the following diagnostic criteria: positive findings on electrocardiography / Holter monitoring, echocardiography, elevated troponin T/I levels, functional or structural abnormalities on cardiac imaging, or tissue characterization by cardiac magnetic resonance. LV global longitudinal strain and mechanical dispersion (MD; defined as SD of the time to peak longitudinal strain derived from all LV segments in 3 apical views) were determined. Echocardiographic response (positive LV remodeling measured by transthoracic echocardiography) was defined as end‑systolic volume (ESV) reduction by 15% or greater or end-diastolic volume (EDV) reduction by 15% or greater from the baseline values. A total of 61 consecutive patients were recruited. The median follow‑up was 1.4 years (range, 0.3-4). The mortality rate was 1.6%. Echocardiographic response was noted in 24 patients (39.4%). A multivariable Cox regression model including significant baseline differences as covariates showed that QRS duration (hazard ratio [HR], 1.31; 95% CI, 1.17-1.57; P = 0.049), MD (HR, 1.03; 95% CI, 1.01-1.07; P = 0.04), and mineralocorticoid receptor antagonist [MRA] use (HR, 8.60; 95% CI, 1.50-46.49; P = 0.01) were independently associated with positive LV remodeling with ESV reduction. MD (HR, 1.04; 95% CI, 1.02-1.06; P = 0.04) was also independently associated with positive LV remodeling with EDV reduction. Mechanical dispersion, QRS duration, and MRA use are independent predictors of positive LV remodeling in individuals with a history of AM.

The level of endothelin-1 in prognostiсation of adverse cardiac remodeling after ST-elevation myocardial infarction

Most patients have a good survival after myocardial infarction due to modern methods of treatment. However, certain disadvantages are still present today: the incidence of heart failure is increasing dramatically. Supervision those patients needs grate expenses, especially during the war. That is why it is continuing the search of the predictors important in the prognostication of heart failure.
 Objective — to determine the value of endothelin‑1 (ET‑1) on prediction of adverse cardiac remodeling in ST‑elevation myocardial infarction (STEMI) patients successfully treated with primary percutaneous coronary intervention.
 Materials and methods. We prospectively enrolled 162 individuals with STEMI who were successfully treated with primary percutaneous coronary intervention. The biomarkers (ET‑1, cardiac troponins) and echocardiographic parameters were evaluated at the baseline.
 Results. The study group was divided into two: with high and low ET‑1 level, based on median 2.75 pg/ml, which was the cutoff point with the highest combination of sensitivity and specificity calculated using receiver operating characteristic (ROC). ROC analysis demonstrated endothelin prognostic potential for left ventricle remodeling. The cut‑off was less than 2.97 pg/ml (sensitivity — 83%, specificity — 62%, area under curve (AUC) — 0.70, 95% confident interval 0.516—0.847, p=0.03). Endothelin biomarker was evaluated as a possible predictor of left ventricular remodeling using logistic regression analysis. Endothelin‑1 showed properties of predicting adverse cardiac remodeling (95% confident interval 0.696—0.956, AUC — 0.861, χ2=9.03, p=0.43).
 Conclusions. Determination of ET‑1 level will allow to use adequate medical management in adverse cardiac remodeling prognosis in STEMI patients to prevent heart failure development.

Contrast-enhanced cardiac MRI is superior to non-contrast mapping to predict left ventricular remodeling at 6 months after acute myocardial infarction

ObjectivesParametric mapping constitutes a novel cardiac magnetic resonance (CMR) technique enabling quantitative assessment of pathologic alterations of left ventricular (LV) myocardium. This study aimed to investigate the clinical utility of mapping techniques with and without contrast agent compared to standard CMR to predict adverse LV remodeling following acute myocardial infarction (AMI).Materials and methodsA post hoc analysis was performed on sixty-four consecutively enrolled patients (57 ± 12 years, 54 men) with first-time reperfused AMI. Baseline CMR was obtained at 8 ± 5 days post-AMI, and follow-up CMR at 6 ± 1.4 months. T1/T2 mapping, T2-weighted, and late gadolinium enhancement (LGE) acquisitions were performed at baseline and cine imaging was used to determine adverse LV remodeling, defined as end-diastolic volume increase by 20% at 6 months.ResultsA total of 11 (17%) patients developed adverse LV remodeling. At baseline, patients with LV remodeling showed larger edema (30 ± 11 vs. 22 ± 10%LV; p < 0.05), infarct size (24 ± 11 vs. 14 ± 8%LV; p < 0.001), extracellular volume (ECVinfarct; 63 ± 12 vs. 47 ± 11%; p < 0.001), and native T2infarct (95 ± 16 vs. 78 ± 17 ms; p < 0.01). ECVinfarct and infarct size by LGE were the best predictors of LV remodeling with areas under the curve (AUCs) of 0.843 and 0.789, respectively (all p < 0.01). Native T1infarct had the lowest AUC of 0.549 (p = 0.668) and was inferior to edema size by T2-weighted imaging (AUC = 0.720; p < 0.05) and native T2infarct (AUC = 0.766; p < 0.01).ConclusionIn this study, ECVinfarct and infarct size by LGE were the best predictors for the development of LV remodeling within 6 months after AMI, with a better discriminative performance than non-contrast mapping CMR.Clinical relevance statementThis study demonstrates the predictive value of contrast-enhanced and non-contrast as well as conventional and novel CMR techniques for the development of LV remodeling following AMI, which might help define precise CMR endpoints in experimental and clinical myocardial infarction trials.Key Points• Multiparametric CMR provides insights into left ventricular remodeling at 6 months following an acute myocardial infarction.• Extracellular volume fraction and infarct size are the best predictors for adverse left ventricular remodeling.• Contrast-enhanced T1 mapping has a better predictive performance than non-contrast standard CMR and T1/T2 mapping.

Prognostic role of left atrial morpho-functional parameters in left ventricular remodeling following acute st-elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite prompt reperfusion and optimal medical therapy of acute ST-elevation myocardial infarction (STEMI), patients may undergo left ventricular (LV) remodeling (REM), which may lead to systolic and/or diastolic heart failure. Little is known regarding factors and mechanisms leading to LV REM, and this knowledge gap hinders potential strategies to prevent this complication. Left atrium (LA) functional and dimensional parameters are emerging as independent prognostic markers in ischemic heart disease. Purpose The present study aims at exploring the potential role of LA morpho-functional parameters by CMR-FT in predicting LV REM following STEMI. Methods This study derives from a sub-analysis of the prospective and multicenter "VavirimS" trial. All patients were assessed through 2 consecutive CMR scans, at 1 and 6 months after STEMI. CMR-FT was applied to both LA and LV. The endpoint was to evaluate the association between LA volumes and phasic functions with LV REM at 6-month follow up, defined as: i) LV REMEDV: ≥10% increase in LV end diastolic volume (EDV); ii) LV REMEDV-ESV: ≥12% increase in LV EDV and ≥6% LV end systolic volume (ESV). Results Out of 193 patients included in the VavirimS trial, 149 were enrolled and 44 have been excluded either for inadequate image quality for CMR-FT analysis or for the presence of factors impacting on LA morphology and function (i.e. mitral regurgitation and atrial fibrillation). LV REMEDV occurred in 34 patients (23%), who showed worse LA strain parameters (reservoir, conduit and booster function), LV global radial strain (GRS) and LV global circumferential epicardial strain [Fig. 1]. At multivariate analysis, LA reservoir and LV global radial strain (GRS) were confirmed as independent predictors of LV-REMEDV [Fig. 1]. The best cut-off for LA reservoir and LV GRS were 20% (sensitivity 97%; specificity 45%) and 56% (sensitivity 67%; specificity 69%), respectively. LV REMEDV-ESV occurred in 17 patients (11%), who showed reduced LA strain and LV GRS [Fig. 1]. The only independent predictor of LV remodeling in this group was LA reservoir [Fig. 1]. A subgroup analysis has been performed on two groups, according to EF: i) p-EF: preserved ejection fraction, ii) r-EF: reduced ejection fraction. In the p-EF group both LA reservoir and LV GRS were confirmed to be associated with LV REM [Fig. 1], while in the r-EF group the only independent predictor of LV REM was LV GRS [Fig. 1]. Conclusions CMR-derived LA reservoir and LV GRS are independent predictors of LV remodeling following STEMI. In patients with preserved EF LA reservoir is confirmed as independent predictor of LV remodeling, hinting at early and subclinical impairment of left chambers compliance. LA functional parameters following STEMI may help physicians in identifying patients at higher risk of LV remodeling.

Left ventricular size may predict a better CRT response

Abstract Funding Acknowledgements Type of funding sources: None. Background We know that women have better responses to cardiac resynchronization therapy (CRT) (1). A possible explanation for this greater benefit has been attributed to sex difference in left ventricular (LV) size: sex-specific differences disappear when we normalize QRS duration to left ventricular end-diastolic volume (LVEDV) (2). QRS narrowing index (QI) has been showed predicting reverse left ventricular remodelling following CRT (3; 4). Purpose We sought to analyse the relationship between LV dimensions pre-CRT and QRS narrowing index, as a predictor of LV remodelling, and the relationship between LV dimensions pre-CRT and echocardiographic response 1 year after CRT. Methods We collected data from our Cardiovascular Implantable Electronic Device (CIED) outpatients’ database, selecting patients who underwent CRT, with analysable echocardiographic images in our local PACS, and with clinical, electrocardiographic, and echocardiographic data pre-CRT and at 1-year follow-up. Results We reviewed electrocardiograms and echocardiograms of 203 patients (M=120, 59,11%) who underwent CRT from 2015 to 2020. A higher QRS/LVEDV ratio and a higher QRS/LV mass ratio were associated with higher QI (p=0.03 and p&amp;lt;0.001, respectively). A higher QRS/LVEDV ratio was associated with higher LVEF (p&amp;lt;0.001), lower LVEDV (p&amp;lt;0.001) and lower LVESV (p&amp;lt;0.001) at follow up. Similarly, a higher QRS/LV mass ratio was associated with higher LVEF (p=0.04), lower LVEDV (p=0.02) and lower LVESV (p=0.01) at follow up. Conclusions LV size seems to have a role in prediction of a better response to CRT. Both the QRS/LVEDV ratio that the QRS/LV mass ratio may predict better electrocardiographic an echocardiographic response.

Long-term follow up of left ventricular remodeling in ST segment myocardial infarction patients after primary percutaneous coronary intervention

Introduction The adaptive reaction known as left ventricular remodeling after ST-elevation myocardial infraction (STEMI) involves both the infarct zone and remote zones, and it lasts for at least 2 years after STEMI. In STEMI patients having primary percutaneous coronary intervention (PPCI), this study was conducted to look at long-term consequences of left ventricular remodeling. Patients and methods Ninety-three patients were successfully treated by primary PCI more than 2 years ago at Assiut University Heart Hospital were enrolled in this study. Detailed history, complete general examination and local cardiac examination were done. Electrocardiography, two-dimensional echocardiography before primary PCI, at discharge and 6 months after PPCI, coronary angiographic and PPCI data from patient admission sheet. Patients were examined by transthoracic 2DE using Phillips ie33 ultrasound system device. Results Thirty-six (38.7%) patients were determined to have left ventricular remodeling when their left ventricular end diastolic volume index increased by more than 20%, compared with 57 (61.3%) patients who did not. Mean age of patients 56.31 ± 11.11 years and mean overall duration of follow up was 3.69 ± 0.45 years. The long-term predictors of left ventricular remodeling were: extensive anterior MI (P &lt; 0.001), left anterior descending as infarct-related artery (P = 0.03), left ventricular end systolic volume index (P = 0.04) and wall motion index (P &lt; 0.001). Discussion Patients who had extensive anterior MI, a wall motion score index more than 1.5, and left anterior descending as infarct-related artery were seen as having a high probability of LV remodeling following PPCI. Only wall motion score index more than 1.5 and extensive anterior MI were independent indicators of LV remodeling following PPCI.

Ultrasonic Texture Features for Assessing Cardiac Remodeling and Dysfunction

BackgroundChanges in cardiac size, myocardial mass, cardiomyocyte appearance, and, ultimately, the function of the entire organ are interrelated features of cardiac remodeling that profoundly affect patient outcomes. ObjectivesThis study proposes that the application of radiomics for extracting cardiac ultrasonic textural features (ultrasomics) can aid rapid, automated assessment of left ventricular (LV) structure and function without requiring manual measurements. MethodsThis study developed machine-learning models using cardiac ultrasound images from 1,915 subjects in 3 clinical cohorts: 1) an expert-annotated cardiac point-of-care-ultrasound (POCUS) registry (n = 943, 80% training/testing and 20% internal validation); 2) a prospective POCUS cohort for external validation (n = 275); and 3) a prospective external validation on high-end ultrasound systems (n = 484). In a type 2 diabetes murine model, echocardiography of wild-type (n = 10) and Leptr−/− (n = 8) mice were assessed longitudinally at 3 and 25 weeks, and ultrasomics features were correlated with histopathological features of hypertrophy. ResultsThe ultrasomics model predicted LV remodeling in the POCUS and high-end ultrasound external validation studies (area under the curve: 0.78 [95% CI: 0.68-0.88] and 0.79 [95% CI: 0.73-0.86], respectively). Similarly, the ultrasomics model predicted LV remodeling was significantly associated with major adverse cardiovascular events in both cohorts (P < 0.0001 and P = 0.0008, respectively). Moreover, on multivariate analysis, the ultrasomics probability score was an independent echocardiographic predictor of major adverse cardiovascular events in the high-end ultrasound cohort (HR: 8.53; 95% CI: 4.75-32.1; P = 0.0003). In the murine model, cardiomyocyte hypertrophy positively correlated with 2 ultrasomics biomarkers (R2 = 0.57 and 0.52, Q < 0.05). ConclusionsCardiac ultrasomics-based biomarkers may aid development of machine-learning models that provide an expert-level assessment of LV structure and function.

Comparisons of electrophysiological characteristics, pacing parameters and mid- to long-term effects in right ventricular septal pacing, right ventricular apical pacing and left bundle branch area pacing

BackgroundAs a near-physiological pacing innovation, left bundle branch area pacing (LBBAP) has drawn much attention recently. This study was aimed to investigate the electrophysiological characteristics, unipolar/bipolar pacing parameters and mid- to long-term effects and safety of three different pacing methods and identify possible predictors of adverse left ventricular remodeling.MethodsNinety-two patients were divided into the LBBAP group, right ventricular septal pacing (RVSP) group and right ventricular apical pacing (RVAP) group. Baseline information, electrophysiological, pacing and echocardiographic parameters were collected.ResultsThe three pacing methods were performed with a similar high success rate. The paced QRSd was significantly different among the LBBAP, RVSP and RVAP groups (105.93 ± 15.85 ms vs. 143.63 ± 14.71 ms vs. 155.39 ± 14.17 ms, p < 0.01). The stimulus to left ventricular activation time (Sti-LVAT) was the shortest in the LBBAP group, followed by the RVSP and RVAP groups (72.80 ± 12.07 ms vs. 86.29 ± 8.71 ms vs. 94.14 ± 10.14 ms, p < 0.001). LBBAP had a significantly lower tip impedance during the procedure and 3-month follow up as compared to RVSP and RVAP (p < 0.001). Higher bipolar captured thresholds were observed in LBBAP during the procedure (p < 0.001). Compared to the baseline values, there was a greater reduction in left ventricular end-diastolic dimension (LVEDD) in the LBBAP group (p = 0.046) and a significant enlargement in LVEDD in the RVAP group (p = 0.008). Multiple regression analysis revealed that the Sti-LVAT was a significant predictor of LVEDD at 12 months post-procedure. At the 24-h post-procedure, significant elevations were observed in the cTnI levels in LBBAP (p < 0.001) and RVSP (p < 0.05). More transient RBB injury was observed in LBBAP. But no significant difference was found in cardiac composite endpoints among three groups (p > 0.05).ConclusionsLBBAP demonstrated a stable captured threshold, a low tip impedance and a high R-wave amplitude during the 12-month follow-up. Left ventricular remodeling was improved at 12 months post-procedure through LBBAP. The Sti-LVAT was a significant predictor of left ventricular remodeling. LBBAP demonstrated its feasibility, effectiveness, safety and some beneficial electrophysiological characteristics during this mid- to long-term follow-up, which should be confirmed by further studies.

Genito-thyroid index (Neutrophil-to-lymphocyte ratio) and basophils as predictors of left ventricular remodeling after acute myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background The neutrophil-to-lymphocyte ratio (NLR) is associated with inflammation. The theory of Endobiogeny is a complex systems theory of physiology that evaluates the relationship between biomarkers and endocrine management of adaptation response. NLR is referred to in this system as the "Genito-thyroid index" (GTI) due to the roles of estrogen and thyroid hormones in immune response. Basophils correlate with worse outcomes in critical illness and are stimulated by ACTH when there is delayed cortisol excretion from the adrenal cortex. These biomarkers are routinely obtained after acute myocardial infarction (AMI), but their relationship to AMI and left ventricular ejection fraction (LVEF) have not been established. Purpose The aim of this study was to assess the relationship between the GTI and %Basophils to LVEF in first time AMI. Methods This prospective study included 52 consecutive patients diagnosed with AMI, admitted to the intensive care unit of our university hospital from April 2017 to November 2017. Percent neutrophils, lymphocytes and basophils were determined on admission (GTI1, Basophil1) and before discharge (GTI2, Basophil2). Diagnostic coronary angiography and percutaneous coronary intervention (PCI) was performed for all patients. All patients underwent transthoracic echocardiography within hospitalization period (LVEF1) and after 6 months (LVEF2) during follow up period. Echocardiography was performed using a Philips machine. LV function was assessed by the measurement of EF using the biplane Simpson’s disc summation method through QLAB ultrasound cardiac analysis on apical two- and four-chamber views. Statistical analyses were performed using the SPSS 20.0 software. Spearman’s rank correlation coefficient was used to examine the relationship between different variables. A p-value &amp;lt;0.05 was considered statistically significant. Results Study population mean age was 63.9 ± 11.6 years. Mean GTI1 was 4.5 ± 2.8 (1.5-2.5). Mean GTI2 was 2.8 ± 1.4. Δ GTI1-2 significantly and positively correlated with Δ LVEF1-2 (r = 0.380, p = 0.019). Mean Basophils1 was 0.3 ± 0.2% (&amp;lt;0.2%). Mean Basophil2 was 0.4 ± 0.3%. Δ Basophil1-2 positively correlated with Δ LVEF 1-2 (r = 0.435, p = 0.015). No significant correlation was found between GTI1 and Δ LVEF1-2 (r = 0.137, p = 0.332), or Basophil1 and Δ LVEF1-2 (r = -0.186, p = 0.196). Conclusion Admission values of GTI and basophils, while both elevated did not correlate with LVEF1-2. However, Δ GTI1-2 and Δ basophils1-2 did. From this we conclude that relative recovery of the systemic response to AMI is more significative than initial response and affects myocardial recovery. Monitoring GTI and basophils is commonly performed and inexpensive. It reflects a role of the endocrine system not before investigated in myocardial recovery post-AMI. It may be useful for identifying patients at risk of poor LVEF post-AMI.

IL-6, IL-1RA and Resistin as Predictors of Left Ventricular Remodelling and Major Adverse Cardiac Events in Patients with Acute ST Elevation Myocardial Infarction.

Despite continuous advances in diagnostic and therapeutic methods, acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. Considering the role of inflammation in AMI etiopathogenesis, we aimed to explore the role of a group of three inflammatory cytokines (IL-1RA, IL-6 and resistin) as an independent prognostic factor for LVR assessed by 3D echocardiography and MACE in patients with STEMI. We enrolled 41 patients with STEMI who underwent primary PCI. We assessed the occurrence of LVR (defined as an increase of over 20% in end-diastolic left ventricular volume at 6 months compared with baseline values) and MACE. Using the enzyme-linked immunosorbent assays (ELISA) method, we measured plasmatic levels of IL-6, IL-1RA and resistin (within 48 h after AMI and at 6 months). Out of 41 STEMI patients, 20.5% presented signs of LVR at follow up, and in 24.4%, MACE occurred. In univariate logistic regression analysis, baseline levels of IL-6 (OR = 1.042, p = 0.004), IL-1RA (OR = 1.004, p = 0.05) and resistin (OR = 1.7, p = 0.007) were all significantly associated with LVR. ROC analysis showed that the three cytokines as a group (AUC 0.946, p = 0.000) have a better predictive value for LVR than any individual cytokine. The group of cytokines also proved to have a better predictive value for MACE together than separately (AUC = 0.875, p = 0.000 for ROC regression model). IL-6, IL-1RA and resistin plasma levels at baseline have a good predictive value both as independent variables and also as a group for the development of adverse LVR and MACE at 6 months follow up after STEMI.

The role of macrophage migration inhibitory factor in predicting left ventricular remodeling in patients with acute myocardial infarction

Objective — to assess the role of circulating markers of inflammation and macrophage migration inhibitory factor (MIF) in the development of left ventricular (LV) remodeling 6 months after acute ST‑segment elevation myocardial infarction (STEMI).&#x0D; Materials and methods. The study involved 120 patients after STEMI and successful primary percutaneous coronary intervention (PCI). Transthoracic echocardiography with Doppler was performed within 24 — 48 hours after PCI and after 6 months of follow‑up to assess LV remodeling. The levels of MIF and inflammatory markers were measured before and after PCI. All patients were divided into two groups according to the median MIF level &lt; 2501 pg/ml (first group, n = 60) and &gt; 2501 pg/ml (second group, n = 60).&#x0D; Results. Patients with the high levels of circulating MIF had a higher frequency of complications in the hospital and long‑term periods (p = 0.024), including newly diagnosed heart failure or decompensation with hospitalizations. High MIF levels in patients of the second group were accompanied by a significant enlargement of end‑diastolic and end‑systolic LV volumes (p = 0.028; p = 0.031, respectively), the development of secondary mitral regurgitation (p = 0.024) and decreased LV systolic function (p = 0.037). MIF threshold values for predicting remodeling &gt; 2694 pg/ml (sensitivity 69.2 %, specificity 71.4 %, AUC = 0.714; 95 % CI 0.509 — 0.870; p = 0.0375) and LV dysfunction &gt; 2484 pg/ml (sensitivity 90.0 %, specificity 58.0 %, AUC = 0.782; 95 % CI 0.675 — 0.867, p = 0.0003) were determined using ROC analysis. According to the results of univariate and multivariate analysis, levels of MIF (p = 0.028) and soluble suppressor of tumorigenesis‑2 (p = 0.042) were most significant predictors of LV remodeling. A correlation between the levels of MIF and white blood cells count (r = 0.33, p = 0.0001), C‑reactive protein (r = 0.19, p = 0.032), troponin (r = 0.44, p = 0.002) has been established.&#x0D; Conclusions. An early increase of MIF levels is associated with the development of adverse structural and functional changes in left ventricle of patients after acute ST‑segment elevation myocardial infarction.

Mid-regional pro-adrenomedullin and lactate dehydrogenase as predictors of left ventricular remodeling in patients with myocardial infarction treated with percutaneous coronary intervention.

The main impact of myocardial infarction (MI) is shifting from acute mortality to adverse remodeling, chronic left ventricular (LV) dysfunction, and heart failure. The aim of this study was to assess relationships between levels of circulating biomarkers and the function of LV after MI. This was a prospective study of 80 patients with MI treated with percutaneous coronary intervention. Novel biomarkers including mid‑regional pro‑adrenomedullin (MR‑proADM), Notch‑1, syndecan‑4, myeloperoxidase, S‑100 protein, soluble ST‑2, as well as markers of inflammatory response and tissue injury: galectin‑3, C‑reactive protein (CRP), lactate dehydrogenase (LDH), and interleukin‑6 (IL‑6) were assessed in the acute phase of MI. Echocardiography was performed at baseline and 6 month Results: Adverse remodeling, defined as more than 20% increase in LV end‑diastolic volume, occurred in 26% of patients. Reverse remodeling (>10% reduction in LV end‑systolic volume) was observed in 52% of patients. In the univariable analysis, higher levels of MR‑proADM and LDH were predictors of adverse remodeling and higher levels of MR ‑proADM, LDH, CRP, and IL ‑6 were negative predictors of reverse remodeling. In the multivariable model, LDH remained an independent predictor of adverse remodeling (odds ratio [OR], 3.13; 95% CI, 1.42-8.18; P = 0.003) and a negative predictor of reverse remodeling (OR, 0.37; 95% CI, 0.17-0.8; P = 0.005). LDH and MR ‑proADM seem to be promising biomarkers of adverse remodeling. On the other hand, higher levels of these biomarkers were associated with reduced chance of occurrence of favorable reverse remodeling in MI patients. However, further studies on larger groups of patients are necessary to confirm these data.

Ventricular-arterial coupling changes as an early predictor of left ventricular remodelling in atrial fibrillation

Abstract Objective Atrial fibrillation (AF) can be associated with adverse atrial and ventricular remodelling also in the absence of persistently elevated heart rate. Ventricular–arterial coupling (VAC) plays a pivotal role in cardiac and aortic adaptation to pathophysiological conditions. The aim of this study was to investigate changes in conventional and novel VAC indexes in long lasting paroxysmal AF. Methods Participants with paroxysmal AF, in sinus rhythm on admission, with preserved left ventricle (LV) systolic function and carotid – femoral pulse wave velocity (PWV) within normal range were carefully selected from consecutive patients admitted to University Hospital in Krakow for scheduled AF ablation. We excluded those with established coronary artery disease, moderate or severe heart valves disease, with uncontrolled hypertension or other comorbidities. The anthropometric and demographic data, medical history, and habits were collected using standardized questionnaire. A total of 51 (mean age 57.7 yrs; 37 men) patients underwent simultaneous echocardiographic and arterial data acquisition. End-systolic pressure was determined from central pulse wave analyses. Arterial elastance (Ea) and LV elastance (Ees) were calculated as end-systolic pressure/stroke volume and end-systolic pressure/end-systolic volume. Two-dimensional speckle tracking was used to derive LV global longitudinal strain (GLS), and then PWV to GLS ratio was calculated. Results Patient presented moderate (EHRA class median = 2b) and long-lasting symptoms (median of AF history 3 years). There was an association of Ees (parameter estimate (PE) 0.12; P=0.0004) and VAC (Ea/Ees) (PE=−0.13; P=0.33) with duration of AF history in the univariate linear regression model and this association retain statistically significant in a model including age, sex, history of hypertension and hypercholesterolemia. Longer history of AF was related to lower PWV to GLS ratio, however this association reached statistical significance only among patients with AF lasting more than 3 years (PE=−0.14; P=0.024) and persisted significant after accounting for covariates. Conclusion The relationship between AF and LV dysfunction is complex and potentially bi-directional. Paroxysmal AF however, can contribute to abnormality in heart–vessel coupling, even when LV function remained within the normal range, indicating early stage of ventricular remodelling due to arrythmia. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Collegium Medicum, Jagiellonian University, Krakow

Impact of high platelet reactivity on left ventricular remodeling in patients with acute coronary syndrome

Abstract Background/Introduction Previous studies demonstrated that high platelet reactivity (HPR) predicts future cardiovascular death and coronary events in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). However, few studies have focused on the impact of HPR on left ventricular remodeling (LVR) and each echocardiographic parameter. Purpose The purpose of this study was to investigate the impact of HPR in ACS patients on LVR and changes in echocardiographic volume indexes and LV ejection fraction. Methods This is a retrospective cohort study of prospectively collected data in a single center that enrolled patients who underwent emergency PCI for ACS including STEMI and NSTEMI with prasugrel loading. The primary outcome of the study was LVR associated with HPR. Secondary endpoints were changes in indexed LVESV, LVEDV, LVEF, E/e' and LAVI between baseline and follow-up. The P2Y12 reaction unit (PRU) value in response to prasugrel was assessed by the VerifyNow P2Y12 assay. Blood samples were collected once per procedure immediately after PCI. LVR index was calculated as the relative change in LVEDV observed at follow-up compared with baseline. LVR was defined as a relative increase in LVEDV ≥20%, measured at follow-up visit compared with the baseline value before discharge. Results A total of 196 ACS patients who underwent emergency PCI between January 2016 and July 2020 were enrolled in the study. The mean age of the study population was 69.9 years, and 76.0% were male. On echocardiography at follow up visit of mean duration of 7.0±4.0 months, LVR was found in 38 patients (19.4%). The optimal cutoff for PRU associated with increased LVR assessed by receiver-operating characteristic curve analysis was 245.5 (AUC: 0.656; 95% CI: 0.564 to 0.749; p=0.003). On the basis of this cutoff, HPR was found in 82 patients (42.1%) and the prevalence of LVR was significantly higher in the HPR group compared to the non-HPR group (30.5% vs. 11.4%; p=0.001). Multiple Cox regression analysis showed that HPR was an independent predictor of LVR (OR 4.22, 95% CI 1.83–9.71, p=0.001). In addition, Δ% EDV and Δ% ESV increased in the HPR group, and decreased in the non-HPR group with significant differences (5.8±32.6% vs. −8.0±26.2% in Δ% EDV; p=0.002, 2.0±37.5% vs. −13.3±33.0% in Δ% ESV; p=0.004, respectively). Δ%EF, Δ%E/e', Δ%LAVI were numerically improved in the non-HPR group compared with the HPR group, but this difference did not reach statistical significance. Conclusion In patients with ACS, HPR defined as PRU ≥246 immediately after emergency PCI was an independent predictor of LVR in the chronic phase. Funding Acknowledgement Type of funding sources: None. Predictors of the presence of LVRChanges (Δ%) of LVEDV and LVESV

Galectin-3 as a Predictor for Left Ventricular Remodeling After Anterior Wall Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Galectin-3 as a Predictor for Left Ventricular Remodeling After Anterior Wall Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Acute regional changes in myocardial strain may predict ventricular remodelling after myocardial infarction in a large animal model

To identify predictors of left ventricular remodelling (LVR) post-myocardial infarction (MI) and related molecular signatures, a porcine model of closed-chest balloon MI was used along with serial cardiac magnetic resonance imaging (CMRI) up to 5–6 weeks post-MI. Changes in myocardial strain and strain rates were derived from CMRI data. Tissue proteomics was compared between infarcted and non-infarcted territories. Peak values of left ventricular (LV) apical circumferential strain (ACS) changed over time together with peak global circumferential strain (GCS) while peak GLS epicardial strains or strain rates did not change over time. Early LVR post-MI enhanced abundance of 39 proteins in infarcted LV territories, 21 of which correlated with LV equatorial circumferential strain rate. The strongest associations were observed for D-3-phosphoglycerate dehydrogenase (D-3PGDH), cysteine and glycine-rich protein-2, and secreted frizzled-related protein 1 (sFRP1). This study shows that early changes in regional peak ACS persist at 5–6 weeks post-MI, when early LVR is observed along with increased tissue levels of D-3PGDH and sFRP1. More studies are needed to ascertain if the observed increase in tissue levels of D-3PGDH and sFRP1 might be casually involved in the pathogenesis of adverse LV remodelling.

The prognostic value of left atrial and left ventricular strain in patients after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

Global longitudinal strain (GLS) based on two-dimensional speckle-tracking echocardiography (2D-STE) might better reflect left ventricular (LV) contractile performance than conventional parameters. Recently, left atrial (LA) strain has been used as a more accurate alternative to assessing LA performance. The aim in this study was to assess the clinical prognostic value of left ventricular GLS (LV GLS) and peak atrial longitudinal strain (PALS) in patients after ST-segment elevation myocardial infarction (STEMI). The study enrolled 199 patients who underwent primary percutaneous coronary intervention (pPCI) for first STEMI. Conventional and 2D-STE were performed within 48 h after pPCI. LV GLS and PALS were related to LV remodeling at 6-month follow-up and to adverse events. Diabetes mellitus, GLS and PALS independently predicted LV remodeling. With multivariable Cox proportional hazards, diabetes mellitus, GLS and PALS were predictive of adverse clinical outcomes. However, PALS did not add significant incremental value beyond LV GLS in the prediction of LV remodeling (increase in area under the receiver-operator characteristic curve [AUC]: 0.05, p = 0.24) and clinical events (even a decrease in AUC: 0.03, p = 0.69). Both GLS and PALS provide independent prognostic value for adverse LV remodeling and clinical outcomes after STEMI. However, the ability of the combination of PALS and GLS to predict LV remodeling and clinical outcomes may not be superior to that of a single indicator.

Remodelling is inversely proportional to left ventricular dimensions in a real-life population of patients with chronic heart failure after therapy with sacubitril/valsartan

Background Left ventricular (LV) remodelling is a major mechanism underlying disease progression in patients with heart failure (HF) with reduced ejection fraction (EF). Previous studies that LVEF improvement and reverse remodelling can be achieved after therapy with Sacubitril/Valsartan in real-world settings. Therefore, we sought to investigate possible predictors of LV remodelling, in particular echocardiographic parameters derived by Tissue Doppler Imaging. Methods Patients with chronic HF, LV dysfunction (EF < 35%), NYHA class II–III were followed up between September 2016 and January 2019. All patients underwent clinical and echocardiography follow up at baseline and after 12 months of therapy with sacubitril/valsartan. Results Fifty-four consecutive outpatients were enrolled in the study. At follow-up visit LVEF (38 ± 9 vs. 30 ± 5%, p < 0.0001), LVEDD (61 ± 8 vs. 62 ± 8 mm, p = 0.0085), LVESV (114 ± 57 vs. 130 ± 56 mm3, p = 0.0001), mitral regurgitation severity (1 ± 1 vs. 2 ± 1, p < 0.0001), and left atrial area (23 ± 6 vs. 24 ± 6 mm2, p = 0.0121) changed compared to the baseline value. Changes in LVEF (follow up vs baseline) correlated with baseline levels of heart rate (r = 0.24, p = 0.048), LVEDD (r= −0.33, p = 0.004), LVEDV (r= −0.39, p = 0.001), LVESV (r = 0.37, p = 0.002), and changes in LVESV (r=−0.34, p = 0.006). Correlations remained significant even after correction at multivariate analysis including age and gender. Conclusions Treatment with sacubitril/valsartan in patients with systolic dysfunction is associated with an improvement in LVEF in a real world scenario. Smaller LV volumes are associated with better reverse LV remodelling.