Predictors Of Left Ventricular Systolic Dysfunction Research Articles

The let-7b-5p, miR-326, and miR-125a-3p are associated with left ventricular systolic dysfunction in post-myocardial infarction.

Acute ST-elevation myocardial infarction (STEMI) can lead to adverse cardiac remodeling, resulting in left ventricular systolic dysfunction (LVSd) and heart failure. Epigenetic regulators, such as microRNAs, may be involved in the physiopathology of LVSd. This study explored microRNAs in peripheral blood mononuclear cells (PBMC) of post-myocardial infarction patients with LVSd. Post-STEMI patients were grouped as having (LVSd, n = 9) or not LVSd (non-LVSd, n = 16). The expression of 61 microRNAs was analyzed in PBMC by RT-qPCR and the differentially expressed microRNAs were identified. Principal Component Analysis stratified the microRNAs based on the development of dysfunction. Predictive variables of LVSd were investigated through logistic regression analysis. A system biology approach was used to explore the regulatory molecular network of the disease and an enrichment analysis was performed. The let-7b-5p (AUC: 0.807; 95% CI: 0.63-0.98; p = 0.013), miR-125a-3p (AUC: 0.800; 95% CI: 0.61-0.99; p = 0.036) and miR-326 (AUC: 0.783; 95% CI: 0.54-1.00; p = 0.028) were upregulated in LVSd (p < 0.05) and discriminated LVSd from non-LVSd. Multivariate logistic regression analysis showed let-7b-5p (OR: 16.00; 95% CI: 1.54-166.05; p = 0.020) and miR-326 (OR: 28.00; 95% CI: 2.42-323.70; p = 0.008) as predictors of LVSd. The enrichment analysis revealed association of the targets of these three microRNAs with immunological response, cell-cell adhesion, and cardiac changes. LVSd alters the expression of let-7b-5p, miR-326, and miR-125a-3p in PBMC from post-STEMI, indicating their potential involvement in the cardiac dysfunction physiopathology and highlighting these miRNAs as possible LVSd biomarkers.

Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients—A single centre cross-sectional study

IntroductionCardiovascular diseases are associated with increased morbidity and mortality among CKD (chronic kidney disease) population. Recent studies have found increasing prevalence of PH (pulmonary hypertension) in CKD population. Present study was done to determine prevalence and predictors of LV (left ventricular) systolic dysfunction, LVDD (left ventricular diastolic dysfunction) and PH in CKD 3b-5ND (non-dialysis) patients. MethodsA cross sectional observational study was done from Jan/2020 to April/2021. CKD 3b-5ND patients aged ≥15 yrs were included. Transthoracic 2D (2 dimensional) echocardiography was done in all patients. PH was defined as if PASP (pulmonary artery systolic pressure) value above 35mm Hg, LV systolic dysfunction was defined as LVEF (left ventricular ejection fraction)≤50% and LVDD as E/e′ ratio >14 respectively. Multivariate logistic regression model was done to determine the predictors. ResultsA total of 378 patients were included in the study with 103 in stage 3b, 175 in stage 4 and 100 patients in stage 5ND. Prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%. Predictors of PH were duration of CKD, haemoglobin, serum 25-OH vitamin D, serum iPTH (intact parathyroid hormone) and serum albumin. Predictors of LVDD were duration of CKD and presence of arterial hypertension. Predictors of LV systolic dysfunction were eGFR (estimated glomerular filtration rate), duration of CKD, serum albumin and urine protein. ConclusionIn our study of 378 CKD 3b-5ND patients prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%.

Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients—A single centre cross-sectional study

IntroductionCardiovascular diseases are associated with increased morbidity and mortality among CKD (chronic kidney disease) population. Recent studies have found increasing prevalence of PH (pulmonary hypertension) in CKD population. Present study was done to determine prevalence and predictors of LV (left ventricular) systolic dysfunction, LVDD (left ventricular diastolic dysfunction) and PH in CKD 3b-5ND (non-dialysis) patients. MethodsA cross sectional observational study was done from Jan/2020 to April/2021. CKD 3b-5ND patients aged ≥15 yrs were included. Transthoracic 2D (2 dimensional) echocardiography was done in all patients. PH was defined as if PASP (pulmonary artery systolic pressure) value above 35mm Hg, LV systolic dysfunction was defined as LVEF (left ventricular ejection fraction)≤50% and LVDD as E/e′ ratio >14 respectively. Multivariate logistic regression model was done to determine the predictors. ResultsA total of 378 patients were included in the study with 103 in stage 3b, 175 in stage 4 and 100 patients in stage 5ND. Prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%. Predictors of PH were duration of CKD, haemoglobin, serum 25-OH vitamin D, serum iPTH (intact parathyroid hormone) and serum albumin. Predictors of LVDD were duration of CKD and presence of arterial hypertension. Predictors of LV systolic dysfunction were eGFR (estimated glomerular filtration rate), duration of CKD, serum albumin and urine protein. ConclusionIn our study of 378 CKD 3b-5ND patients prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%.

Association of left ventricular systolic dysfunction with coronary artery dilation in Kawasaki disease patients: Assessment with cardiovascular magnetic resonance

PurposeTo quantify global and regional left ventricular (LV) strain parameters in patients with Kawasaki disease (KD) using cardiovascular magnetic resonance (CMR) tissue tracking and assess the association of coronary artery dilation (CA dilation) with LV systolic dysfunction. MethodsThirty-one KD patients with CA dilation, 22 patients without CA dilation and 27 age- and sex-matched normal controls underwent 3.0 T CMR examination. Z score of >2 was defined as CA dilation. Global LV strain parameters and regional LV strain parameters in 16 American Heart Association segmentation, including radial, circumferential and longitudinal peak strain (PS) and LV function were measured and compared among groups. ResultsNo significant difference in LV ejection fraction has been observed among controls, KD patients with CA dilation and without CA dilation (all p > 0.05). However, global longitudinal PS (GLPS) was lower in groups with CA dilation than those without CA dilation (−12.6 ± 4.1% vs −14.9 ± 2.6%, p < 0.05). For regional strain parameters, the segments with CA dilation (n = 301) were lower than those in both normal controls (n = 416) and segments without CA dilation (n = 547) in regional radial, circumferential and longitudinal PS (all p < 0.05). The severity of CA dilation was positively correlated to GLPS and regional longitudinal PS (r = 0.388 and r = 0.222; both p < 0.05) in KD patients. After adjusting for clinical characteristics, the multivariate analysis demonstrated that Z score was independently associated with GLPS in KD patients (β = 0.469, p = 0.000, model R2 = 0.355). ConclusionsCMR tissue tracking could sensitively identify subclinical LV dysfunction in KD patients with CA dilation. LV systolic dysfunction occurs particularly in the myocardium dominated by the dilated coronary artery. CA dilation is an independent predictor of LV systolic dysfunction.

Novel biomarkers for subtle myocardial involvement in type I diabetes mellitus.

BackgroundEvaluation of certain biomarkers could be used to predict left ventricular (LV) and right ventricular (RV) function impairment in children with type 1 diabetes mellitus. The aim of this study was to determine the best cardiac biomarker for prediction of diabetic cardiomyopathy.MethodologyThis study was designed as case-control study. A total of 55 children with type 1 diabetes mellitus (group/G1) and 55 healthy controls (G2) were subjected to echocardiography including 3D-Speckle Tracking Echocardiography and tissue Doppler imaging for assessment of RV and LV systolic and diastolic functions. As well as HbA1c, troponin I, brain natriuretic peptide (BNP), plasma cardiotrophin (CT-1), activin-A, transforming growth factor-β, and human insulin-like growth factor binding protein-7 (IGFBP-7) measurements.ResultsDiabetic patients showed RV and LV systo-diastolic dysfunction compared to controls, the best predictor of LV systolic dysfunction was CT-1 (sensitivity: 69%, while IGFBP-7 was found to be the best predictor of RV systolic dysfunction (sensitivity: 63%). BNP was found to the best predictor of diastolic RV and LV dysfunction (sensitivity: 82% for both).ConclusionCT-1 has proven to be a diagnostic superiority in LV systolic dysfunction whilst BNP continues to prove every day through our study and through many others that it is the chief marker of diastolic dysfunction and HFpEF. This potential accuracy and the increasing availability of BNP in the outpatient setting make it clear that it should be used as a screening test for diabetic patients.

Procalcitonin as A Predictor of Left Ventricular Systolic Dysfunction in Sepsis Patients

Background : Release of cytokines in sepsis can cause left heart failure and left ventricular sys­tolic dysfunction (LVSD). In sepsis, there is a releasing of Procalcitonin (PCT) and tumor necrosis factor-α (TNF-α) because of the stimulation of cytokine pro inflammation affected by activated NF-kB. This study aimed to examine PCT as a predictor of LVSD in sepsis, the value of Area Under the curve (AUC), sensitivity, specificity, cut off point, and a probability of PCT and TNF-α as a predictor of LVSD, and then to identify the best diagnostic predictor of LVSD. Subjects and Method : This was a cross-sectional study. A sample of 71 sepsis patients aged >18 years old admitted to the intensive care unit (ICU) from November 2016 to March 2017was selected for this study. The dependent variable was left ventricle ejection fraction (LVEF). The independent variables were PCT and TNF-α. LVEF and diastolyc function were measured by transthoracic echocardiography. Data on PCT and TNF-α level were obtained from the medical record. Results : As many as 22 patients had mild sepsis (30.9%), 40 patients had severe sepsis (56.4%), and 9 patients had a septic shock (12.7%). The AUC value of PCT level was 0.81 (95% CI 0.71-0.91; p<0.001). The optimal cut-off point was ≥7.88 ng/mL and Diagnostic Odd Ratio (DOR) was 5.55. The AUC value of TNF-α level was 0.73 (95% CI 0.60-0.86; p= 0.002). Optimal cut off point was ≥7.36 pg/ml and DOR was 5.03. The multivariate analysis resulted that PCT was the best predictor of LVSD (AUC 0.70), and TNF-α (0.69). The combination of PCT + TNFα would increase diagnostic value with AUC 0.77. Conclusion: PCT was a better predictor of LVSD than TNF-α. This finding is significant since it will enable clinicians to easily diagnose LVSD by measuring PCT. The combination of PCT and TNFα was the best efficient diagnostic predictor of LVSD. Keywords: Left Ventricular Systolic Dysfunction, predictor, PCT, TNF-α Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Univer­sitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: trisulo.­wasyanto­@gmail.com. Indonesian Journal of Medicine (2018), 3(3): 139-145 https://doi.org/10.26911/theijmed.2018.03.03.03

Relationship between T-wave inversion and transmural myocardial edema as evidenced by cardiac magnetic resonance in patients with clinically suspected acute myocarditis: clinical and prognostic implications

BackgroundThe pathophysiologic mechanisms and the prognostic meaning of electrocardiographic (ECG) T-wave inversion (TWI) occurring in a subgroup of patients with clinically suspected acute myocarditis remain to be elucidated. Contrast-enhanced cardiac magnetic resonance (CMR) offers the potential to identify myocardial tissue changes such as edema and/or fibrosis which may underlie TWI. Methods and resultsWe studied 76 consecutive patients (median age 34years) with clinically suspected acute myocarditis, using a comprehensive CMR protocol which included T2 weighted sequences for myocardial edema. At the time of CMR, TWI was observed in 21 (27%) patients. There was a statistically significant association of TWI with the median number of left ventricular (LV) segments showing both any pattern of myocardial edema (transmural and non-transmural) [5 (3-7) vs. 3 (2-4); p=0.015] and myocardial late-gadolinium-enhancement [4 (3-7) vs. 3 (2-4); p=0.002]. Transmural myocardial edema involving ≥2 LV segments was found in 17/21 (81%) patients with TWI versus 13/55 (24%) patients without TWI (p<0.001) and remained the only independent predictor of TWI at multivariable analysis (OR=9.96; 95%CI=2.71–36.6; p=0.001). Overall, topographic concordance between the location of TWI across the ECG leads and the regional distribution of transmural myocardial edema was 88%. There was no association between acute TWI and reduced LV ejection fraction (<55%) at 6-months of follow-up. ConclusionsThis is the first study to demonstrate an association between LV transmural myocardial edema as evidenced by CMR sequences and TWI in clinically suspected acute myocarditis. As an expression of reversible myocardial edema, development of TWI during the acute disease phase was not a predictor of LV systolic dysfunction at follow-up.

Assessment of left ventricular function in young type 1 diabetes mellitus patients by two-dimensional speckle tracking echocardiography: Relation to duration and control of diabetes

Abstract Background The effect of type 1 diabetes mellitus (T1DM) on myocardial function is still controversial. Aim To examine the usefulness of speckle tracking echocardiography (STE) in detecting subclinical left ventricular (LV) dysfunction in asymptomatic T1DM patients and detect whether any LV abnormalities are related to duration or control of DM. Methods Sixty young T1DM patients and 30 controls were subjected to conventional echocardiography and STE. The left ventricular (LV) peak systolic (PS) global longitudinal strain (GLS)/strain rate (GLSR) and diastolic global strain rate during the isovolumic relaxation period (GSRivr), early diastole (GSRe) and late diastole (GSRa) were calculated as the average of the 12 myocardial segments of the four and two-chamber views while the mid circumferential strain (MCS) was calculated as the average of strains of the 6 LV segments of the mid LV cavity. Results In diabetic patients, the LV end diastolic dimension (LVEDD) was significantly lower ( p = 0.000) while the LV myocardial performance index (LVMPI) and E/lateral E′ ratio were significantly higher ( p = 0.000 and p = 0.02 respectively) compared to controls. By STE, only the GLS was significantly lower in diabetic patients compared to controls ( p = 0.000). A significant negative correlation was detected between LDL-C and GLS ( r = −0.4; p = 0.002). Multivariate logistic regression analysis identified HbA1c as the only independent predictor of GLS in patients (beta = −0.34, 95% CI: −0.67 to −0.19; p = 0.001). Conclusion STE is useful to detect subclinical LV dysfunction in asymptomatic patients with T1DM. Control of DM but not duration of disease was an independent predictor of LV systolic dysfunction.

Incidence and Clinical Course of Left Ventricular Systolic Dysfunction in Patients with Carbon Monoxide Poisoning.

Background and ObjectivesCarbon monoxide (CO) poisoning can cause tissue hypoxia and left ventricular systolic dysfunction (LVSD) requiring intensive medical management. Our objectives were to find incidence and clinical course of LVSD CO intoxicated patients and make a clinical scoring to predict LVSD.Subjects and MethodsWe included all consecutive patients with CO exposure in the emergency room. LVSD was defined by LVEF <50% assessed by echocardiography. We compared their clinical, chemical, radiological and electrocardiographic patterns according to the presence of LVSD.ResultsFrom May 2009 to June 2015, we included a total of 81 patients (48 men, 47±19 years old) with CO exposure in this cohort. LVSD was found in about 25 patients (31%). Nine had regional wall motion abnormality. Follow up echocardiographic examinations were available in 21 patients. Of them, 18 patients showed complete recovery in about 3 days (mean 2.8±1.7 days). Of 3 patients without recovery, 2 had significant coronary artery stenosis. LVSD was significantly associated with initial heart rate (>100/min), pulmonary edema on chest X-ray, serum NT pro-BNP (>100 pg/mL), troponin-I (>0.1 ng/mL) and lactic acid (>4.0 mg/dL) after a univariate analysis. Combining these into a clinical score, according to their beta score after a multivariate analysis (rage=0-16), allowed prediction of LVSD with a sensitivity of 84% and specificity of 91% (reference ≥8, area under the curve=0.952, p<0.001)ConclusionAbout 31% showed LVSD in patients with CO poisoning, and most of them (86%, 18 of 21 patients) recovered within 3 days. Patients with a higher clinical score (≥8) might have LVSD.

Prevalence of asymptomatic left ventricular systolic dysfunction in hypertensive Nigerians: echocardiographic study of 832 subjects.

We sought to determine the prevalence of echocardiographically determined left ventricular systolic dysfunction in asymptomatic hypertensive subjects seen in Abeokuta, Nigeria. Echocardiography was performed in 832 consecutive hypertensive subjects referred for cardiac evaluation over a three-year period. Data were obtained in 832 subjects (50.1% women) aged 56.0 ± 12.7 years (men 56.9 ± 13.3 years, women 55.0 ± 12.0 years, range 15-88). The prevalence of left ventricular systolic dysfunction (LVSD) was 18.1% in the study population (mild LVSD = 9.6%, moderate LVSD = 3.7% and severe LVSD = 4.8%). In a multivariate analysis, male gender, body mass index and LV mass were the predictors of LVSD. Significant numbers of hypertensive subjects in this study had varying degrees of left ventricular systolic dysfunction. Early introduction of disease-modifying drugs in these patients, such as angiotensin converting enzyme inhibitors or angiotensin receptor blockers may retard or prevent the progression to overt heart failure.

The Role of Macrophage Colony-Stimulating Factor in Patients With Acute Myocardial Infarction

We assessed whether macrophage colony-stimulating factor (M-CSF) levels are associated with left ventricular systolic dysfunction (LVSD) in patients with acute myocardial infarction (AMI). We studied 56 patients with AMI (mean age: 67 ± 12 years) and identified those with clinical (Killip class >II) or echocardiographic signs (ejection fraction ≤45%) of LVSD. We evaluated the established cardiovascular risk factors and measured several cardiovascular biomarkers, including M-CSF. Serum M-CSF concentrations (pg/mL) were significantly increased in patients with both clinical and echocardiographic signs of LVSD (460 ± 265 vs 290 ± 210, P = .0103 and 493 ± 299 vs 287 ± 174, P = .0028, respectively). We found a significant inverse association between M-CSF and ejection fraction (r = -.351, P = .0079). Logistic regression analysis revealed that, among all evaluated clinical and biochemical parameters, the stronger predictor of LVSD was M-CSF (odds ratios 2.1, 95% confidence interval 1.1-2.9, P = .0168). This is the first study reporting plasma M-CSF levels as independent determinants of low LV ejection fraction and clinical LV dysfunction in patients with AMI.

154 Patients receiving standard pacemaker generator replacements frequently have impaired left ventricular function and exercise intolerance, related to the percentage of right ventricular pacing

<h3>Background</h3> Right ventricular (RV) pacing is an accepted treatment for symptomatic bradycardia. However, long-term RV pacing is increasingly recognised to be detrimental to left ventricular (LV) systolic function. We wanted to establish the prevalence, associated features and predictors of LV systolic dysfunction (LVSD) and outcome in a contemporary group of patients with long–term RV pacemakers. <h3>Methods</h3> We prospectively recruited consecutive patients listed for PGR between 2008 and 2010 at Leeds General Infirmary. We performed echocardiography, exercise testing and recorded indications for pacing, pacing variables and duration of pacing, co-morbidities, current medication and renal function. <h3>Results</h3> Of 399 PGR procedures 342 subjects (86%), 184 men, attended. Non-attendees had similar pacing variables and were of similar age as attendees. Mean age (SE) was 76 (1), and mean duration of pacing was 10 (0.3) years. Comorbidites were common: diabetes mellitus in 11%, previous myocardial infarction in 15%, previous cardiac surgery in 26% and atrial fibrillation (AF) in 26%. Medical therapy included β-blockers in 60% and ACE inhibitors in 70%. Dual chamber devices were implanted in 77% (45% of all patients had rate responsive (RR) pacing programmed). Mean percentage of ventricular pacing (%VP) was 61 (2)%. Mean left ventricular ejection fraction (LVEF) was 49 (1)%, (44% had an LVEF &lt;50%). Mean peak oxygen uptake (pVo₂) (in 107 subjects) was 17 (1) ml/kg/min and mean creatinine was 108 (3) μmol/l. There was an inverse relationship between LVEF and %VP (0.42; p&lt;0.0001), and years since first implanted (p=0.09) but there was no effect on LVEF of age, the presence of AF and the pacing mode. In single chamber devices, RR pacing was associated with higher %VP (p=0.01), and a trend to worse LVEF (p=0.09). These differences were not seen in RR programmed dual chamber devices. There was a negative relationship between pVo₂ and %VP (r=0.21; p&lt;0.03). Even with a short follow-up period of 16 (0.5) months, 23 (7%) patients are dead. Patients dead at the censor date were older at the time of the assessment (p&lt;0.005), had a higher %VP (p&lt;0.03) and worse renal function (p&lt;0.001), but did not have significantly worse LVEF or pVo₂. The presence of a single chamber device was associated with a poorer outcome (p&lt;0.002) despite patients with a single chamber device being of similar age as those with a dual chamber device. <h3>Conclusions</h3> Patients receiving standard pacemaker generator replacements frequently have cardiovascular comorbidities, left ventricular dysfunction and impaired pVo₂ and suffer a high mortality rate. In an unselected population of patients with pacemakers, we have established that the amount of RV pacing is related not only to important surrogate measures of outcome such as exercise tolerance and LVEF but also mortality. Whether an aggressive policy of limiting RV pacing in patients at risk reduces mortality is unknown.

Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis

IntroductionLeft ventricular (LV) dysfunction frequently occurs after cardiac surgery, requiring inotropic treatment and/or mechanical circulatory support. In this study, we aimed to identify clinical, surgical and echocardiographic factors that are associated with LV dysfunction during weaning from cardiopulmonary bypass (CPB) in high-risk patients undergoing valve replacement for aortic stenosis.MethodsPerioperative data were prospectively collected in 108 surgical candidates with an expected operative mortality ≥9%. All anesthetic and surgical techniques were standardized. Reduced LV systolic function was defined by an ejection fraction <40%. Diastolic function of the LV was assessed using standard Doppler-derived parameters, tissue Doppler Imaging (TDI) and transmitral flow propagation velocity (Vp).ResultsDoppler-derived pulmonary flow indices and TDI could not be obtained in 14 patients. In the remaining 94 patients, poor systolic LV was documented in 14% (n = 12) and diastolic dysfunction in 84% of patients (n = 89), all of whom had Vp <50 cm/s. During weaning from CPB, 38 patients (40%) required inotropic and/or mechanical circulatory support. By multivariate regression analysis, we identified three independent predictors of LV systolic dysfunction: age (Odds ratio [OR] = 1.11; 95% confidence interval (CI), 1.01 to 1.22), aortic clamping time (OR = 1.04; 95% CI, 1.00 to 1.08) and Vp (OR = 0.65; 95% CI, 0.52 to 0.81). Among echocardiographic measurements, Vp was found to be superior in terms of prognostic value and reliability. The best cut-off value for Vp to predict LV dysfunction was 40 cm/s (sensitivity of 72% and specificity 94%). Patients who experienced LV dysfunction presented higher in-hospital mortality (18.4% vs. 3.6% in patients without LV dysfunction, P = 0.044) and an increased incidence of serious cardiac events (81.6 vs. 28.6%, P < 0.001).ConclusionsThis study provides the first evidence that, besides advanced age and prolonged myocardial ischemic time, LV diastolic dysfunction characterized by Vp ≤ 40 cm/sec identifies patients who will require cardiovascular support following valve replacement for aortic stenosis.

N-terminal Pro-Brain Natriuretic Peptide Levels Predict Left Ventricular Systolic Function in Patients with Chronic Kidney Disease

N-terminal pro-brain natriuretic peptide (NT-proBNP) can be a useful marker for left ventricular (LV) dysfunction in patients without kidney disease. This study was conducted to clarify the relationship between NT-proBNP and LV systolic function in patients with decreased renal function. We studied 256 chronic kidney disease (CKD) patients, patients on dialysis were excluded. The median glomerular filtration rate was 24 (13-36) mL/min/1.73 m2 and the median NT-proBNP was 4,849 (1,310-19,009) pg/mL. The prevalence of LV systolic dysfunction increased from the lower to the upper NT-proBNP quartiles (I, 17%; II, 34%; III, 61%; and IV, 72%; p<0.001 for trend). The NT-proBNP quartile was an independent predictor of LV systolic dysfunction after adjustment for renal function, compared with quartile I: II, odds ratio (OR) 3.99 (95% confidence interval [CI],1.34-11.93); III, OR 11.28 (95% CI, 3.74-33.95); and IV, OR 36.97 (95% CI, 11.47-119.1). Area under the curve and optimum cut points for NT-proBNP to detect LV systolic dysfunction were 0.781 and 2,165 pg/mL in CKD stage 3, 0.812 and 4,740 pg/mL in CKD stage 4, and 0.745 and 15,892 pg/mL in CKD stage 5. The NT-proBNP level was a predictor of LV systolic dysfunction in CKD patients. Optimum cut points should be stratified according to renal function.

Baseline Plasma Adiponectin Levels as a Predictor of Left Ventricular Systolic Dysfunction in Patients Referred for Coronary Angiography

The objective of the present study was to determine the association between plasma adiponectin and left ventricular (LV) systolic function. Baseline plasma adiponectin was measured in 389 patients undergoing coronary angiography for a variety of indications at a Veterans Affairs Medical Center. Detailed demographic, clinical, laboratory, and angiographic data were available for patients. LV systolic function was assessed using ventriculography, and patients were grouped into those with normal or mild dysfunction (ejection fraction > or =45%) versus those with moderate to severe systolic dysfunction (ejection fraction <45%). After adjusting for a variety of clinically relevant covariates known to affect LV systolic function, adiponectin was independently associated with LV systolic function in the entire cohort of patients (p = 0.0002) using multivariate linear regression analysis. In addition, using multivariate logistic regression analysis, adiponectin was an independent predictor of the presence of moderate to severe LV dysfunction (odds ratio 1.54, 95% confidence interval 1.21 to 1.97, p = 0.0005). Moreover, baseline adiponectin was also independently associated with LV function in both the myocardial infarction (MI) and non-MI subpopulations of patients (p = 0.0401 and p= 0.0023, respectively). Finally, in the non-MI subpopulation, baseline adiponectin was an independent predictor of moderate to severe LV systolic dysfunction (odds ratio 1.52, 95% confidence interval 1.15 to 2.02, p = 0.0034). In conclusion, baseline plasma adiponectin was an independent predictor of LV systolic dysfunction in a population of patients referred for coronary angiography.

302: Female gender is associated with cardiac dysfunction in brain dead organ donors

Purpose: In the setting of acute subarachnoid hemorrhage, female gender is associated with left ventricular (LV) systolic dysfunction and regional wall motion abnormalities (RWMA). This form of neurocardiogenic injury, which is often reversible, is likely due to excessive myocardial catecholamine release. We studied the association between female gender and LV dysfunction in a diverse population brain dead patients evaluated for organ donation. Methods and Materials: All potential cardiac organ donors managed by the California Transplant Donor Network between 2002-03, aged 14-60 years and without coronary artery disease, were included in this analysis. Univariate predictors of LV dysfunction were identified and multiple regression analysis was used to assess the relative independent contribution of each predictor. Results: 197 potential donors (122 male, 75 female, mean age 38 14 years) were studied. The cause of brain death was trauma in 64 potential organ donors, and non-traumatic (cerebrovascular death, anoxia, or other) in 133 potential donors. 12% had LV systolic dysfunction (LV ejection fraction 50%) and 15% had RWMA by echocardiography. Univariate analyses revealed that female gender, smaller donor size (weight, height, and body-mass index), and higher heart rate were independent predictors of LV systolic dysfunction and RWMA. Donor cause of death, cardiopulmonary resuscitation, and history of cocaine or methamphetamine use, smoking, and hypertension did not predict LV dysfunction or RWMA. In a multivariable model, after adjusting for donor age, size, and heart rate, female gender remained a strong independent predictor of LV systolic dysfunction (OR 5.75, 95% CI 1.76-18.76, p 0.004) and RWMA (OR 5.73, 95% CI 2.02-16.20, p 0.001). Conclusions: Female gender is associated with the presence of LV systolic dysfunction and RWMA in brain dead organ donors. Further studies assessing the reversibility of LV dysfunction and suitability of these organs for transplantation are required.

Clinical Features of Isolated Ventricular Noncompaction in Adults Long-Term Clinical Course, Echocardiographic Properties, and Predictors of Left Ventricular Failure

Isolated ventricular non-compaction (IVNC) is a rare disorder characterized by prominent trabecular meshwork and deep recesses. We retrospectively assessed the clinical characteristics and natural course of IVNC in adults diagnosed at our hospital. Sixty-seven adult patients (44 male, mean age 41 +/- 18 years) with the diagnosis of IVNC were evaluated in this retrospective cohort. Its prevalence was found to be .14%. Forty-seven patients (70%) had class I/II functional capacity. Fifty-seven patients (85%) had electrocardiographic abnormalities, and the most common one was left ventricular (LV) hypertrophy (25%). LV systolic function was depressed in 44 patients (66%), with a median ejection fraction (EF) of 35% (range: 20%-48%) at diagnosis. Multiple regression analysis revealed that age at initial presentation, the total number of affected segments, and the ratio of non-compaction/compaction (NC/C) were the independent predictors of LV systolic dysfunction. Familial occurrence of IVNC was 33%. During a mean follow-up of 30 months (range: 9-50 months), major complications including ventricular tachycardia, heart failure requiring hospitalization, and cerebrovascular events were observed in 36%, 34%, and 9% of the patients, respectively. Ten patients (15%) with IVNC died in this study. LVEF at initial presentation and functional capacity at last visit were found to be independent predictors of mortality. This study suggests that IVNC is a form of cardiomyopathy with higher prevalence and relatively better prognosis than previously reported. Age at initial presentation, ratio of NC/C, and number of affected segments seem to be major determinants of LV systolic dysfunction, while initial LVEF and last functional capacity predict mortality in this cohort.

Aortic root dysfunctioning and its effect on left ventricular function in Ross procedure patients assessed with magnetic resonance imaging

Background This study evaluated the diameters and distensibility of the aortic root as well as the degree of aortic regurgitation (AR) and its effect on left ventricular (LV) function in patients 8.2 ± 3.1 years after they underwent the Ross procedure, with a comparison of these parameters between patients and matched healthy subjects. Methods Eighteen Ross procedure patients (16 male patients, age [mean ± SD] 19.2 ± 3.8 years) and 18 matched healthy subjects (16 male patients, age [mean ± SD] 19.7 ± 4.2 years) underwent magnetic resonance imaging. Measurements for diameters (at 4 levels) and the distensibility of the aortic root were performed using a steady-state free precession sequence. Aortic flow was assessed with a velocity-encoded phase-contrast sequence. Left ventricular systolic function was assessed with a gradient-echo sequence in the short-axis plane. Comparison of parameters was performed using the Mann-Whitney U test. Correlations between diameters, distensibility, AR fraction, and LV systolic function were expressed with Spearman rank correlation coefficients. Linear regression analysis was used to identify predictors of LV systolic dysfunction. Results Aortic root diameters were increased in Ross procedure patients as compared with healthy subjects (mean difference 6.3-11.6 mm, P ≤ .02 at all 4 levels). Distensibility of the aortic root was lower in patients (1.9 ± 1.1 vs 7.8 ± 3.3 mm Hg −1, P < .01). An AR fraction >5% was present in 14 of the 18 patients (mean AR fraction 8% ± 5% vs 1% ± 1%, P < .01). Left ventricular ejection fraction was lower in patients (50% ± 6% vs 57% ± 6%, P < .01). Dilatation, decreased distensibility, and AR fraction were correlated with impaired LV systolic function ( P < .05 for all). The AR fraction predicted impaired LV systolic function ( P < .01). Conclusions Magnetic resonance imaging shows dilatation and decreased distensibility of the aortic root, AR, and consequent impaired LV systolic function in patients after the Ross procedure.

Efficient utilization of echocardiography for the assessment of left ventricular systolic function

Background We hypothesized that patients could be selected for echocardiographic evaluation of left ventricular (LV) systolic function on the basis of historic, clinical, radiographic, and electrocardiographic criteria. Methods and Results We prospectively evaluated 300 consecutive inpatients referred for the echocardiographic assessment of LV function, of whom 124 (41 %) had LV systolic dysfunction (LVSD) (LV ejection fraction <0.45). Among the historic variables, male sex was the only predictor of LVSD, whereas of the abnormal physical and radiographic findings, cardiomegaly on chest radiography was the only predictor. Among the electrocardiographic findings, the presence of left bundle branch block was positively correlated with the presence of LVSD, whereas a normal electrocardiogram was negatively correlated with this finding. Only 2 patients with LVSD had a normal electrocardiogram. The addition of significant predictors on physical examination and chest radiography doubled the predictive value of the historic variables for determining LVSD. The addition of electrocardiographic findings further doubled the predictive value of the model. Almost 45% of the predictive power of the final multivariate model (chi-square of 48 of the total chi-square of 108) was based on the absence of normal electrocardiogram in patients with LVSD. When chest radiographic findings were excluded from the model, the overall predictive power of the model did not change, with the normal electrocardiogram gaining greater prominence: Full 56% of the predictive power of the model (chi-square of 60 of the total chi-square of 108) resided in the ability of a normal electrocardiogram to discriminate between patients with and those without LVSD. Conclusions Historic, chest radiographic, and electrocardiographic variables can be used to predict low likelihood of LVSD on echocardiography. In particular, when the electrocardiogram is normal, it is extremely unlikely to have LVSD. It can be argued that such patients should not be referred for echocardiography.