Preserved Left Ventricle Ejection Fraction Research Articles

#2246 Cardiovascular changes and outcomes across the early CKD spectrum: a UK Biobank cardiovascular MRI substudy

Abstract Background and Aims Chronic kidney disease (CKD) patients are at a significant risk of accelerated cardiovascular (CV) disease (CVD), which increases as glomerular filtration rate (GFR) declines. The prevalence of CVD in early CKD is high but there is lack of data on early myocardial changes in this group of patients. We investigated the associations of early CKD with alterations in cardiac structure and function and adverse CV outcomes using cardiovascular magnetic resonance (CMR) imaging. Method We used measures of CMR analysis from participants in the UK Biobank CMR imaging substudy to extract information on morphology and function of the four heart chambers. Early CKD was defined as an estimated GFR with cystatin (eGFRcys) between 60 and 90 ml/min. Patients with left ventricular ejection fraction <50%, history of CVD, eGFRcys < 60 ml/min, uACR > 3 mg/mmol, and those on renal replacement therapy were excluded. The association between early CKD and CMR parameters was analysed in 5 linear regression models: unadjusted, age adjusted, sociodemographic adjusted, sociodemographic and lifestyle adjusted, and a fully adjusted model also including clinical characteristics. Cox regression analyses were used to determine association between mildly decreased eGFR and adverse CV outcomes (myocardial infarction, stroke, CV death, and a composite CV outcome). Results A total of 33 124 individuals [17 825 (53.8%) women, age 64 (11) years] who received CMR imaging between 2014 and 2019 and fulfilled the inclusion criteria were identified: 19,919 with no CKD and 13,205 with early CKD. Participants with early CKD were more likely to be older, males and smokers. In the fully adjusted model, early CKD was associated with structural changes in the left ventricle (LV) [mass −1.04 g (−1.75 to −0.33), end-diastolic volume −2.69 mL (−4.01 to −1.38), end-systolic volume −0.95 mL (−1.30 to −0.60)], right ventricle (RV) [end-diastolic volume −3.24 mL (−4.67 to −1.82), end-systolic volume −1.73 mL (−2.55 to −0.91)], right atrium (maximum volume −2.81 mL (−4.09 to −1.53), minimal volume −1.46 mL (−2.30 to −0.62)]. Early CKD was also associated with a change in LV global circumference strain [-0.16 (−0.31 to −0.01)] but it was not associated with changes in the left atrium parameters or functional parameters [LV ejection fraction 0.21 (−0.05 to 0.48), RV ejection fraction 0.21 (−0.07 to 0.49)]. These changes were not associated with adverse CV outcomes on multivariable analyses (HR for MI 1.35, 95% CI 0.94-1.94; HR for stroke 0.98, 95% CI 0.63-1.50). Conclusion In a low-risk general population (without known CVD and with preserved LV ejection fraction) mildly reduced kidney function, as measured with eGFRcys, was associated with smaller LV and RV volumes, larger LV mass, and impaired LV global circumference strain. This early cardiac remodelling was not associated with adverse CV outcomes, but the event rate was very small during follow up. These findings suggest that cardiomyopathy associated with early CKD is not a regional condition of the left ventricle but affects the heart globally.

Dynamics of the left ventricular ejection fraction after revascularization in patients with heart failure with preserved ejection fraction, association with the TRAIL protein

Aim. To study the association of dynamics of the ejection fraction (EF) of the left ventricle (LV) with the development of adverse cardiovascular events within 12 months after revascularization in patients with chronic heart failure with preserved LV EF (HFpEF), and to determine the value of TNF-related apoptosis-inducing ligand (TRAIL) in predicting changes of LVEF. Materials and methods. 52 patients with HFpEF hospitalized for coronary artery bypass grafting (CABG) were included in the prospective study. The levels of plasma NTproBNP (before CABG) and TRAIL protein (before CABG and 10 days after CABG) were determined. Echocardiography was performed for these patients at the time of enrollment in the study and after 12 months of follow-up. The patients were divided into 2 groups: group 1 (n=23) included patients with increased LVEF, group 2 (n=29) – with unchanged or reduced LVEF. The development of a combined endpoint (cardiovascular death, decompensated of HF, repeat unplanned revascularization) was studied. Results. LVEF before CABG was comparable in the studied groups. The frequency of the combined endpoint was 0 in the first group and 17.2% in the second group (p=0.02). There was an inverse correlation between change of LVEF one year after revascularization and the dynamics of the TRAIL protein in the perioperative period (r=-0.45, p=0.049). The area under the ROC for perioperative TRAIL changes and changes in LVEF during a follow-up was 0.79 (95% confidence interval 0.6–0.985; p=0.018). Conclusion. The increase of LVEF 12 months after CABG in patients with HFpEF is associated with a rarer development of cardiovascular events. The changes of LVEF after CABG can be predicted based on the analysis of the perioperative changes of the TRAIL protein.

Effect of Sacubitril/Valsartan and enalapril on left ventricular function in patients with hematologic malignancies after bone marrow transplantation

Abstract Background and Aims Optimizing treatment for heart failure early after initiation of chemotherapy may prevent myocardial dysfunction. We hypothesized that early initiation of treatment with sacubitril/valsartan (sac/val) or enalapril (ena) may prevent cardiotoxicity. Patients and methods 90 patients (mean age 45.7 ± 14,1 years old, 52 male) with normal LV ejection fraction, who suffered from hematologic malignancies (lymphoma, leukemia) and underwent bone marrow transplantation, were randomized to receive sacubitril/valsartan 24/26 mg bid daily or enalapril 5 mg bid daily or placebo. We measured at baseline, before transplantation and after six months: i) Global Longitudinal Strain (GLS) of left ventricle (LV) by speckle tracking imaging, ii) myocardial global work index (GWI), global constructive work (GCW), global wasted work (GWW) and myocardial global work efficiency (GWE), by longitudinal strain-peripheral blood pressure loops, and iii) Left Ventricular Ejection Fraction (LVEF). Results The 3 treatment groups had similar age, sex, risk factors and cardiotoxic medication before and after bone marrow transplantation. Compared to baseline, patients treated with sacubitril/valsartan or enalapril for six months did not show a deterioration of LV GLS (-19.8±2.8 vs -19.3±4.1%, p=0.403 for sac/val, -20.3±2.8 vs -20.0±3.6%, p=0.634 for ena). Conversely, patients treated with placebo for six months, presented a significant impairment of LV GLS (-20.9±2.1% vs -18.5±2.2, p=0,001). No significant changes were found in LVEF after treatment with sacubitril/valsartan or enalapril for six months (57.5±4.9 vs 57.9±6.8%, p=0.826 for sac/val, 58.8±5.4 vs 60.7±7.1%, p=0.419, for ena), while a borderline deterioration was noticed after treatment with placebo (60.6±5.4 vs 57.7±6.7%, p=0.045). Moreover, in the sacubitril/valsartan group, we noticed a significant reduction of left ventricular end diastolic and end-systolic volume [(102.3±26.9 vs 93.9±21.5 ml, p=0.042 and 44.5±15.4 vs 38.6±9.6ml, p=0.012), respectively]. At 6 months, we did not observe any alteration in GWi, GCW, GWW, GWE in patients treated with enalapril (p>0.05). Conversely, in patients treated with sacubitril/valsartan GWE was improved (94.2±3.1 vs 95.8±1.8 %, p=0.030) and GWW was reduced (111.5±75.7 vs 86.4±43.1 mmHg%, p=0.045), while GWI and GCW did not show any significant alteration. Conversely, in the placebo group, GWI was reduced (1909.9±336.4 vs 1727.9±340.9 mmHg%, p=0.027), GWW was increased (80.7±60.6 vs 110.6±65.1 mmHg%, p=0.045), GWE was also reduced (94.2±3.1 vs 95.8±1.8 %, p=0.030) and GCW did not change at 6 months. Conclusions Treatment with sacubitril/valsartan or enalapril prevented deterioration of myocardial function six months after bone marrow transplantation in patients with hematologic malignancies and preserved LV ejection fraction. Moreover, sacubitril/valsartan showed a more favorable effect on myocardial work.

Abstract 18186: Four Chambers Strain Analysis in Patients Admitted With Acute Heart Failure: A New Characterization of Heart Involvement?

Introduction: In heart failure (HF), most of the data available on myocardial strain focused on the left ventricle (LV). Very few data concern the other cavities. Hypothesis: We hypothesized that all cardiac cavities are involved in HF and thus we evaluated all chambers strain profiles in patients admitted with acute HF. Methods: We prospectively evaluated 95 patients hospitalized for HF. Patients were divided into preserved left ventricle ejection fraction (LVEF) (LVEF ≥50%, HFpEF n=24), mildly reduced LVEF ((LVEF 41-49%, HFmrEF n=17), and reduced left ventricular ejection fraction (LVEF) (LVEF ≤40%, HFrEF n=54). In addition to the usual two-dimensional echocardiographic parameters, LV global longitudinal strain, left and right atrial strain (reservoir, conduit, contractile strain), right ventricular free wall strain were determined using speckle tracking transthoracic echocardiography at admission. Results: Patients with HFrEF were younger in comparison with patients with HFmrEF and HFpEF, (respectively 66.3 ± 14.2, 78.3.0 ±8.7, 75.6 ± 10.2 years p<0.001). Table 1 summarizes the main Doppler and echocardiographic comparisons. Myocardial strain analyses demonstrated that patients with HFrEF had significant lower LV global, right ventricular strain, left atrial reservoir strain, left and right atrial conduit strain (Figure 1). Conclusions: Beyond the alteration of LV function, HFrEF involves alteration of right ventricle, left and right atrial functions. Strain analysis is an interesting tool in addition to conventional echocardiographic parameters to assess heart function in heart failure. The prognostic impact of these finding remains to be studied.

Abstract 12234: Concurrent Amyloid Light-Chain Cardiac Amyloidosis and Abdominal Leiomyosarcoma - Diagnostic and Therapeutic Challenges

Background: AL amyloidosis is a rare disorder characterized by organ infiltration of unstable misfolded light chain proteins. Diagnosis requires a high degree of suspicion, and cardiac involvement has poor outcomes. Anthracycline-based regimens are preferred for treating abdominal leiomyosarcoma (LMS) but pose a challenge in the presence of cardiac AL amyloidosis. Case: A 66-year-old male presented with bilateral leg edema and underwent evaluation for new heart failure. Echocardiography revealed preserved left ventricle ejection fraction (LVEF) with mild hypertrophy, increased interventricular septum thickness, and diastolic dysfunction. Due to concern for cardiac amyloidosis, the patient underwent nuclear scintigraphy scan, which was negative. Ongoing clinical suspicion prompted endomyocardial biopsy, which was positive for Congo Red staining, and serum studies revealed monoclonal lambda spike with increased free light chains. PET-CT was done to assess the lung nodule, revealing abdominal LMS. While Anthracycline is the drug of choice for LMS, its potential cardio-toxic effect in the presence of heart failure need be addressed. Treatment decisions involved a multidisciplinary team, resulting in bortezomib for AL amyloidosis, gemcitabine/paclitaxel for LMS, and symptomatic heart failure management. Decision-making: Anthracycline therapy was avoided due to potential cardiotoxicity. Daratumumab was added to expedite light chain reduction and minimize cardiotoxic effects. Individualized treatment considered the patient's clinical presentation and comorbidities. Conclusion: Diagnosing cardiac amyloidosis requires a high index of suspicion. Concurrent AL amyloidosis and LMS is extremely rare and presents a therapeutic dilemma, necessitating personalized management. Further research is needed to assess the potential cardio-toxic effect of anthracycline in the presence of cardiac AL amyloidosis.

Parameters of left ventricular deformation in elderly and senile patients with aortic stenosis after transcatheter implantation of the aortic valve

Aim: To evaluate the parameters of left ventricle (LV) myocardial deformation (longitudinal, circular and radial) in patients with symptomatic severe aortic stenosis (AS) with preserved LV ejection fraction after transcatheter aortic implantation valve (TAVI) in the early postoperative period.Material and Methods. The study included 31 patients after TAVI out of 69 with symptomatic severe AS. Echocardiography (EchoCG) using two-dimensional speckle tracking technology was performed before TAVI and in the early postoperative period (within 5 ± 1,7 days).Results. There were no significant differences in the analysis of deformation parameters before TAVI and in the early postoperative period. There was a tendency to increase the longitudinal deformation of the LV, including the longitudinal deformation of the basal, middle and apical segments in individual patients. The longitudinal deformation of the left atrium did not change after TAVI.Conclusion. There were no significant changes in deformation parameters in elderly and senile patients with severe AS and preserved LV ejection fraction and with reduced LV deformation (longitudinal, circular and radial) after minimally invasive TAVI in the early postoperative period. There is a tendency to increase the global longitudinal deformation of the LV.

The impact of continuous positive airway pressure therapy on left atrial function assessed by 2D speckle tracking echocardiography in patients with obstructive sleep apnoea

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Obstructive sleep apnoea (OSA) is associated with left atrium (LA) remodelling and dysfunction, developing even before left ventricle (LV) hypertrophy and diastolic dysfunction. Two-dimensional speckle-tracking echocardiography (2D-STE) may help to detect subclinical LA dysfunction before irreversible cardiac changes. Purpose To evaluate changes of LA geometry and function after short term continuous positive airway pressure therapy (CPAP) for OSA using 2D-STE. Methods 47 obese patients aged between 18 to 65 years old were enrolled in the study. Control group (N=13) consisted of healthy subjects who either did not have OSA, or it was mild (apnea/hypopnea index (AHI) 5 – 14/ hour). OSA group (N=34) consisted of subjects with moderate or severe OSA (AHI ≥ 15/ hour). Transthoracic echocardiography and 2D STE analysis performed before and after 3 months of treatment with CPAP, for control group – at a baseline only. Statistical analyses were performed using the SPSS 27.0 software. The value of p<0.05 was considered as statistically significant. Results Control group was younger, had more female patients, and prevalence of arterial hypertension was lower compared to OSA group. All patients had preserved LV EF (>50 %) without significant differences between groups. OSA was related to more prevalent LV diastolic dysfunction (p = 0.023) and increased LV myocardial mass when indexed by height (46.11 (8.23) vs 38.96 (5.9) g/m 2.7, p = 0.007). OSA patients had significantly higher LA diameter (43.58 (8.19) vs 36.23 (3.08) mm, p <0.001), while LA volume did not differ even when indexed by height (p>0.05). LA reservoir strain was significantly lower in patients with OSA (26.56 (1.38) vs 31.01 (1.56) %, p<0.001) when compared to control group. After 3 months of CPAP treatment LA diameter, LA volume, LV MMi, LA conduit and contractile strain did not change , but prevalence of LV diastolic dysfunction decreased and LA reservoir strain improved. (Table 1). Conclusions Our study showed more prevalent LV diastolic dysfunction, increased LV myocardial mass indexed by height, together with reduced LA reservoir strain in OSA patients with preserved LV ejection fraction. Short term CPAP treatment significantly improved LV diastolic function and LA reservoir strain in OSA patients.

Association between Severity of Diabetic Retinopathy and Cardiac Function in Patients with Type 2 Diabetes.

The purpose of this research was to assess the relationship between the severity of diabetic retinopathy (DR) and indexes of left ventricle (LV) structure and function in type 2 diabetes mellitus (T2DM). Retrospective analysis of 790 patients with T2DM and preserved LV ejection fraction. Retinopathy stages were classified as no DR, early nonproliferative DR, moderate to severe nonproliferative DR, or proliferative DR. The electrocardiogram was used to assess myocardial conduction function. Echocardiography was used to evaluate myocardial structure and function. Patients were divided into three groups based on the DR status: no DR group (NDR, n = 475), nonproliferative DR group (NPDR, n = 247), and proliferative DR group (PDR, n = 68). LV interventricular septal thickness (IVST) increased significantly with more severe retinopathy (NDR: 10.00 ± 1.09; NPDR: 10.42 ± 1.21; and PDR: 10.66 ± 1.58; P < 0.001). Multivariate logistic regression analysis showed that the significant correlation of IVST persisted between subjects with no retinopathy and proliferative DR (odds ratio = 1.35, P = 0.026). Indices of myocardial conduction function were assessed by electrocardiogram differences among groups of retinopathy (all P < 0.001). In multiple-adjusted linear regression analyses, the increasing degree of retinopathy was closely correlated with heart rate (β = 1.593, P = 0.027), PR interval (β = 4.666, P = 0.001), and QTc interval (β = 8.807, P = 0.005). The proliferative DR was independently associated with worse cardiac structure and function by echocardiography. Furthermore, the severity of retinopathy significantly correlated with abnormalities of the electrocardiogram in patients with T2DM.

Hypertension in peri- and postmenopausal women — pathophysiological mechanisms and approaches to treatment

This review presents epidemiological data on the effect of sex hormones and reproductive status on the level of blood pressure (BP) and the incidence of es­sential hypertension (EHT) in women. The role of estrogen deprivation and hyper­androgenism in the development of EHT in peri- and postmenopause is discussed. The main mechanisms of EHT in periand postmenopausal women: sympathetic and renin-angiotensin-aldosterone system hyperactivity, salt-sensitivity, high prevalence of abdominal obesity, metabolic syndrome, left ventricular hypertrophy, left atrial dilatation and high risk of atrial fibrillation, stroke and heart failure with preserved left ventricle ejection fraction. Data on the efficacy and tolerability of the main classes of antihypertensive drugs in women is presented. We discussed the mechanisms of selective I1-imidazoline receptor agonists and the results of cohort studies of moxonidine monotherapy and its combination with other antihypertensive drugs and hormonal menopausal therapy in peri- and post­menopausal women. Moxonidine reduces high blood pressure in peri- and postmenopausal women and has a beneficial effect on metabolic syndrome components, but is also effective in patients with hypertensive crises, especially with sympathetic hyperactivity.

198 ROLE OF CARDIAC MAGNETIC RESONANCE IMAGING IN ARRHYTMICH RISK STRATIFICATION

Abstract Introduction Danon disease (DD) is a rare multi-systemic disorder firstly described by Danon et al. in 1981 and characterized by a triad consisting with hypertrophic cardiomyopathy, skeletal myopathy, and intellectual disability. It is an inherited dominant X-linked condition, due to mutations in the lysosome-associated membrane protein 2 (LAMP2) gene. Typically, males present a more severe phenotype with earlier onset and rapid heart failure progression with extracardiac manifestations; female patients manifest a milder phenotype with later onset and isolated cardiac involvement. Female carriers may develop dilated cardiomyopathy (DCM). In recent years, it has been described a severe arrhythmogenic phenotype, particularly in women, with a high risk of sudden cardiac death (SCD). Case presentation Case 1 is a 16 y.o. woman referred to our outpatient cardiomyopathies clinic, diagnosed with left ventricle (LV) hypertrophy on the basis of ECG and echocardiography, performed in 2016, in view of cutaneous nevus surgical exeresis. At echocardiographic evaluation we found an asymmetric LV hypertrophy with preserved LV ejection fraction (LVEF 65%). A cMRI was performed, showing mild LV thickening and left ventricular hypertrabeculation morphology, mainly in the LV lateral wall, but not all criteria for LV noncompaction (NC) were satisfied. There was no late gadolinium enhancement (LGE) accumulation. She underwent a genetic screening with inconclusive results, so we started a clinical outpatient follow-up showing no significant arrhythmias at ECG Holter and no limitation of physical activities. In 2021, when she was 21 yo, her father died suddenly and no autoptic examination was performed. A genetic exam was repeated, highlighting a LAMP2 gene mutation. In 2016 her 3 years older sister, Case 2, underwent a familiar screening. She had a long history of mild dyspnea occurring during exertion. Echocardiography showed asymmetric hypertrophy with marked thickening of infero-lateral wall (25 mm,) with normal systolic function (EF 70%). She underwent a cMRI, highlighting diffuse asymmetric hypertrophy (max 24 mm) with LGE in lateral wall and lower septum. First genetic test was nonconclusive but after her father's death another test was performed, demonstrating LAMP2 gene mutation. In 2021 a follow-up cMRI showed markedly reduced myocardial thickness of the apex, with a pattern of noncompaction myocardial. We found a LVEF at lower limits, depressed longitudinal function (MAPSE 8 mm) and manly severe progression of fibrotic degeneration. ECG Holter revealed premature ventricular complex, in absence of nonsustained ventricular tachycardia. Following the evolution of fibrosis, cardioverter defibrillator (ICD) implantation was performed. Case 1 was clinically stable during strict follow-up. Conclusion Cardiac magnetic resonance imaging (cMRI) may be useful in arrhythmic risk stratification, accurate systolic dysfunction evaluation, and proper timing and indication for ICD implantation.

Additive effects of mitral regurgitation on left ventricular strain in essential hypertensive patients as evaluated by cardiac magnetic resonance feature tracking.

Hypertension is one of the leading risk factors for cardiovascular disease. Mitral regurgitation (MR) is a heart valve disease commonly seen in hypertensive cases. This study aims to assess the effect of MR on left ventricle (LV) strain impairment among essential hypertensive cases and determine factors that independently impact the global peak strain of the LV. We enrolled 184 essential hypertensive patients, of which 53 were patients with MR [HTN (MR +) group] and 131 were without MR [HTN (MR-) group]. Another group of 61 age-and gender-matched controls was also included in the study. All participants had received cardiac magnetic resonance examination. The HTN (MR +) group was classified into three subsets based on regurgitation fraction, comprising mild MR (n = 22), moderate MR (n = 19), and severe MR (n = 12). We compared the LV function and strain parameters across different groups. Moreover, we performed multivariate linear regression to determine the independent factors affecting LV global radial peak strain (GRS), circumferential peak strain (GCS), and global longitudinal peak strain (GLS). HTN (MR-) cases exhibited markedly impaired GLS and peak diastolic strain rate (PDSR) but preserved LV ejection fraction (LVEF) compared to the controls. However, HTN (MR +) patients showed a decrease in LVEF and further deteriorated GRS, GCS, GLS, PDSR, and the peak systolic strain rate (PSSR) compared to the HTN (MR-) group and controls. With increasing degrees of regurgitation, the LV strain parameters were gradually reduced in HTN (MR +) patients. Even the mild MR group showed impaired GCS, GLS, PDSR, and PSSR compared to the HTN (MR-) group. Multiple regression analyses indicated that the degree of regurgitation was independently associated with GRS (β = -0.348), GCS (β = -0.339), and GLS (β = -0.344) in HTN (MR +) patients. GLS was significantly impaired in HTN (MR-) patients. MR may further exacerbate the deterioration of LV strain among essential hypertensive cases. Besides, the degree of regurgitation was independently correlated with GRS, GCS, and GLS in HTN (MR +) patients.

Endothelial protection does not prevent diastolic dysfunction in high fat diet + L-NAME treated mice

Schiattarella et al. introduced a new mouse model mimicking heart failure with preserved ejection fraction (HFpEF). In this model, diastolic dysfunction is induced by a high fat diet (HFD) regimen with L-NAME treatment. Small vessel disease is currently proposed to be responsible for HFpEF. Moreover, blocking Cdon, a negative co-receptor of Hedgehog signalling pathway, in endothelial cells in mice promote endothelium integrity in inflammatory conditions. Consequently, CdonECKO mice represent a good model of endothelial protection. To determine whether prevent endothelial dysfunction prevent diastolic dysfunction. Ovariectomized CdonECKO female mice were fed with HFD from 8 weeks of age. L-NAME treatment was initiated 2 weeks later. Cardiac function was assessed via echocardiography and left ventricle (LV) catheterization at 20 weeks of age. Immediately after, mice were sacrificed for histological and gene expression analyses. Consistently with our previous results, CdonECKO mice treated with HFD and L-NAME display a decreased permeability, a decreased expression of ICAM1 and a decreased infiltration of CD45+ leukocytes compared to their controls. Capillary density and mural cell coverage were not modified. Despite their endothelial improvement, mice displayed increased end diastolic pressure with a preserved LV ejection fraction. Diastolic dysfunction was associated with cardiac hypertrophy and fibrosis as in their controls. Prevention of endothelial dysfunction observed in HFpEF mice models does not prevent diastolic dysfunction in HFD + L-NAME treated mice supporting that small vessel disease is not the only key factor in the pathophysiology of HFpEF.

Diastolic stress echocardiography and biomarkers in patients with preserved left ventricle ejection fraction and heart failure symptoms.

Diastolic dysfunction (DD) is a diagnostic challenge in clinical practice. Our study aimed to evaluate the value of diastolic stress echocardiography (DSE) and heart failure (HF) biomarkers in patients with preserved left ventricular ejection fraction (LVEF) and HF symptoms. All the consecutive patients with HF symptoms, preserved LVEF, and suspected DD were examined on transthoracic echocardiography (TTE) and DSE using the protocol according to the American Society of Echocardiography recommendations. Moreover, blood samples were taken 30 minutes before and after DSE for the following lab markers: N-terminal pro-B type natriuretic peptide (NT-proBNP), mid regional pro-atrial natriuretic peptide (MR-proANP), and serum soluble ST2 receptor (ST2). The study group included 80 patients (mean [standard deviation, SD] age, 69 (8.1) years; 25% males) with dyspnea (New York Heart Association classification IIa - 53; IIb - 17; III - 10) and risk factors: hypertension (96%), diabetes (41%), obesity (56%), and known coronary artery disease (10%). The rest transthoracic echocardiography (TTE) showed preserved systolic function (mean [SD], LVEF 61.1 [10.5]%) and normal or indeterminate diastolic function. DSE revealed a positive result for diastolic dysfunction in 17 patients (21%). The receiver operating characteristic (ROC) analysis showed that age (the area under the curve [AUC], 0.725; P < 0.01), left atrial volume indexed for body surface area [LAVI] rest (AUC, 0.722; P < 0.01), E/e' rest (AUC, 0.790; P < 0.01), and baseline NT-proBNP (AUC, 0.713; P < 0.01) predicted positive DSE. Other parameters, including body mass index, baseline E/A, DT, or e' were not predictive of DSE results. DSE revealed diastolic dysfunction in 21% of study patients and improved the diagnostic value of echocardiography. Rest NT-proBNP, but not MR-proANP and ST2, provided a diagnostic value for diastolic dysfunction.

Diagnostic value of parameters of myocardial work in patients after myocardial infarction with ST segment elevation

Abstract Funding Acknowledgements Type of funding sources: None. Objective to reveal the differences in the global parameters of myocardial work of the left ventricle (LV) in patients with preserved LV ejection fraction (EF) after ST-segment elevation myocardial infarction (STEMI) and healthy individuals. Methods the study included 45 people with primary STEMI (group 1): 13 women and 32 men aged 38 to 66 years (52.3 ± 7.4). The control group (group 2) consisted of 70 healthy individuals aged 39.3 ± 8.9 years, including 34 men and 36 women. Myocardial infarction was confirmed by ECG data, a diagnostically significant level of cardiospecific markers (troponin T, CPK-MB) and by the results of coronary angiography with the presence of one infarct-related coronary artery in the absence of hemodynamically significant stenosis of other arteries. Echocardiography was performed on the 7th-9th day and 6 months after STEMI using a Vivid GE 95 Healthcare ultrasound scanner (USA). Echocardiographic image analysis was performed using EchoPAC software version 202 (GE Healthcare). The standard echo parameters were determined: end-diastolic volume (EDV, ml), end-systolic volume (ESV, ml), LV myocardial mass index (LVMI, g / m2), EF by the Simpson biplane method,%. The preserved EF was considered the value of EF greater than or equal to 50%. The following indicators of myocardial work were assessed: global myocardial work index (GWI, mm Hg%), global constructive work (GCW, mm Hg%), global wasted work (GWW, mm Hg%), global work efficiency (GWE,%). Statistical data processing was performed using the Statistica 13.0 software package (StatSoft Inc., USA). Results 6 months after STEMI, 26 subjects had an EF ≥50% (58.8 ± 5.8%). The mean LVEF in group 2 was 60.8 ± 4.6% (p = 0.12). EDV in group 1 was 122.5 [95% CI 104.4; 140.7] ml, in group 2 - 104.7 [95% CI 99.1; 110.3] ml (p = 0.003). ESV in group 1 - 83.8 [95% CI 28.5; 139.0] ml, in group 2 - 40.7 [95% CI 37.6; 43.7] ml (p = 0.02); in group 1, LVMI was 89.3 [95% CI 77.4; 101.1] g / m2, in group 2 - 67.4 [95% CI 63.7; 71.1] g / m2 (p = 0.03). GWI was 1890.1 [95% CI 1730.0; 2050.2] mm Hg% in group 1, in group 2 - 2039.8 [95% CI 1956.3; 2123.3] mmHg% (p = 0.002), GCW - 2132.4 [95% CI 1958.5; 2306.3] mmHg% and 2335.5 [95% CI 2251.7; 2419.4] mm Hg% (p = 0.003), respectively. GWE 95.4 [95% CI 94.1; 96.6] and 97.1 [95% CI 96.8; 97.4]% (p = 0.02), GWW 76.6 [95% CI 55.9; 97.3] and 50.0 [95% CI 44.0; 56.0] m Hg% (p = 0.06) in the corresponding groups. Conclusion Thus, despite the satisfactory values of LVEF, the indicators of myocardial work, except for global wasted work, had lower values in patients with STEMI compared with healthy individuals.

Assessment of subclinical left ventricle myocardial dysfunction using global myocardial work in type 2 diabetes mellitus patients with preserved left ventricle ejection fraction

BackgroundThe purpose of this study was to assess subclinical left ventricle (LV) myocardial dysfunction using global myocardial work (MW) in type 2 diabetes mellitus (T2DM) patients with preserved left ventricle ejection fraction (LVEF).MethodsSixty T2DM patients and 60 normal controls were enrolled in the study. Apical 4-, 3- and 2-chamber views were acquired by two-dimensional echocardiography. Peak systolic myocardial global longitudinal strain (GLS), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and myocardial work efficiency (GWE) were determined by speckle-tracking echocardiography (STE).ResultsThe GLS values in the T2DM patients were significantly lower than those in normal controls (p < 0.001). The GWW in T2DM patients was significantly greater than that in normal controls, while GWI, GCW and GWE was significantly lower (p < 0.001). Receiver operating characteristic (ROC) analysis showed there were no significant different difference between GWW, GWE and GLS in the area under the curves (AUCs). In T2DM patients, fasting plasma glucose was positively correlated with GWW but negatively correlated with GWE, and GLS was negatively correlated with GWI and GCW.ConclusionFrom the research, we found that global MW as new technique could detect the subclinical LV myocardial dysfunction and confirm that the impaired LV function in T2DM patients with preserved LV systolic function.

Clinical Profiles and CMR Findings of Young Adults and Pediatrics with Acute Myocarditis Following mRNA COVID-19 Vaccination: A Case Series.

Messenger RNA (mRNA) coronavirus disease of 2019 (COVID-19) vaccines have been recently associated with acute myocarditis, predominantly in healthy young males. Out of 231,989 vaccines administrated in our region (Marche, Italy), we report a case series of six healthy patients (four males and two females, 16.5 years old (Q1, Q3: 15, 18)) that experienced mRNA-COVID-19-vaccines side effects. All patients were hospitalized due to fever and troponins elevation following the second dose of an mRNA-based COVID-19 vaccine. Cardiovascular magnetic resonance (CMR) was performed 72–96 h after vaccination. All patients were treated with colchicine and ibuprofen. Myocarditis was prevalent in males. It was characterized by myocardial edema and late gadolinium enhancement (LGE) in the lateral wall of the left ventricle (LV). One patient showed sole right ventricular involvement, while the females presented with myopericarditis (myocarditis + pericardial effusion). All patients in our series had preserved LV ejection fraction and remained clinically stable during a relatively short inpatient hospital stay. One case presented with atrial tachycardia. At the follow-up, no significant CMR findings were documented after a three-month medical treatment. According to other recently published case series, our report suggests a possible association between acute myocarditis and myopericarditis with mRNA COVID-19 vaccination in healthy young adults and pediatric patients. Not only males are involved, while some arrhythmic manifestations are possible, such as atrial tachycardia. Conversely, we here highlight the benign nature of such complications and the absence of CMR findings after a three-month medical treatment with colchicine and ibuprofen.

Hybrid telerehabilitation in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction and preserved left ventricular ejection fraction-the randomised clinical trial

Abstract Background Hypertrophic cardiomyopathy (HCM) is the most common hereditary heart disease, and its diagnosis is often associated with limited physical activity. Little is known about cardiac rehabilitation programs for patients with HCM. Therefore the novel hybrid cardiac telerehabilitation (HCTR) model consisting of hospital-based rehabilitation and home-based telemonitored rehabilitation might be an option to improve physical capacity in patients with HCM. Purpose To evaluate the safety, effectiveness and adherence to HCTR in patients with HCM without the left ventricle (LV) outflow tract obstruction and preserved LV ejection fraction. Methods The study group comprised 60 patients with HCM (51.1±13.3 years; NYHA II-III; LV ejection fraction 66.1±6.9%). Patients were randomised (1:1) to either HCTR program (hospital-based rehabilitation [1 month] based on cycloergometer training and home-based telemonitored rehabilitation [2 months] based on Nordic walking, five times a week, at 40–70% of maximal estimated heart rate) - training group (TG), or to a control group (CG). All patients had implantable cardioverter-defibrillator. In order to perform home-based telemonitored rehabilitation, a special device was used which enabled patients to: (1) do Nordic walking training according to a preprogrammed plan, (2) record and send electrocardiograms (ECGs) via mobile phone network to the monitoring centre. The moments of automatic ECGs registration were pre-set and coordinated with exercise training. The effectiveness of HCTR was assessed by changes - delta (Δ) in duration (t) of the workload, peak oxygen consumption (pVO2) in cardiopulmonary exercise test, 6-minute walking test distance (6-MWT) as a result of comparing t (s), pVO2 (ml/kg/min), 6-MWT (m) from the beginning and the end of the program. Results Safety of HCTR. Neither death nor other serious adverse events occurred during HCTR. We did not observe any ICDs intervention during the HCTR. Effectiveness of HCTR: Within-group analysis: t, pVO2, 6-MWT increased significantly in TG: t 657±183 vs 766±181 (p&amp;lt;0.001), pVO2 19.2±5.0 vs 20.6±4.9 (p=0.007), 6-MWT 445±88 vs 551±77 (p&amp;lt;0.001). In the untrained CG, the unfavourable results were observed: 695±198 vs 717±187 (p=0.114), pVO2 21.2±5.1 vs 21.1±5.6 (p=0.723), 6-MWT 512±83 vs 536±84 (p=0.061). Between-group analysis: The differences between TG and CG were statistically significant: in Δt (p&amp;lt;0.001); ΔpVO2 (p=0.012); Δ6-MWT (p&amp;lt;0.001). Adherence to HCTR: In TG 28 patients (93%) completed the HCTR program. Two patients did no undergo HCTR because of personal issues. Conclusion Hybrid cardiac telerehabilitation in patients with HCM without the left ventricle (LV) outflow tract obstruction and preserved LV ejection fraction is safe and effective. The adherence to HCTR is high. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Statutory work in The Cardinal Stefan Wyszyński National Institute of Cardiology in Warsaw, Poland

Assessment of the left ventricle function using Two-Dimensional Speckle-Tracking Echocardiography among patients with chronic Hepatitis C infection with preserved left ventricle ejection fraction

Background: Subclinical left ventricle dysfunction among patient with chronic hepatitis C is under detected and therefore untreated. The current study aimed to use the Two-Dimensional Speckle tracking echocardiography in the assessment of global and regional function of the left ventricle (LV) myocardium in chronic viral hepatitis C patients with preserved left ventricle ejection fraction (LVEF). Methodology: In this cross-sectional study, 100 participants were divided into 2 groups; 50 patients with chronic hepatitis C and 50 normal healthy matched volunteers as controls. All participants were investigated using conventional echocardiography and 2D speckle tracking. Results: There was no statistically significant difference between hepatitis C group in comparison with control group according to Ejection Fraction (EF%) and fraction shortening (FS) (P= 0.074 and 0.393, respectively). It was be found that 14% of patients suffered from abnormal global longitudinal strain regardless a normal Left ventricular ejection fraction (LVEF). There was significant difference at the level of average GLS (P &lt; 0.001) and as regard regional longitudinal strain, there were significant difference in many segments either basal segments showed in anteroseptal PLSS, inferolateral PLSS, inferior PLSS and infero-septal Peack longitudinal systolic strain (PLSS) (P= 0.012, 0.02, 0.011 and 0.001, respectively). Mid segments in anteroseptal PLSS, anterior PLSS A, anterolateral PLSS A and infero-lateral PLSS A (P= 0.003, 0.011, 0.002 and &lt;0.001, respectively) and Apical segments in anterior PLSS B, lateral PLSS and Septal PLSS (P= 0.013, 0.001 and 0.031, respectively). Conclusion: In chronic hepatitis C patients, left ventricle systolic dysfunction is significantly more common when assessed by global longitudinal strain than by 2D LVEF. To signalize patients with subclinical left ventricle systolic dysfunction irrespective a normal LVEF, 2D STE may be useful for the long-term handling in this high-risk populationm.

Hybrid telerehabilitation in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction and preserved left ventricular ejection fraction-the randomised clinical trial

Abstract Background Hypertrophic cardiomyopathy (HCM) is the most common hereditary heart disease, and its diagnosis is often associated with limited physical activity. Little is known about cardiac rehabilitation programs for patients with HCM. Therefore the novel hybrid cardiac telerehabilitation (HCTR) model consisting of hospital-based rehabilitation and home-based telemonitored rehabilitation might be an option to improve physical capacity in patients with HCM. Purpose To evaluate the safety, effectiveness and adherence to HCTR in patients with HCM without the left ventricle (LV) outflow tract obstruction and preserved LV ejection fraction. Methods The study group comprised 60 patients with HCM (51.1±13.3 years; NYHA II-III; LV ejection fraction 66.1±6.9%). Patients were randomised (1:1) to either HCTR program (hospital-based rehabilitation [1 month] based on cycloergometer training and home-based telemonitored rehabilitation [2 months] based on Nordic walking, five times a week, at 40–70% of maximal estimated heart rate) - training group (TG), or to a control group (CG). All patients had implantable cardioverter-defibrillator. In order to perform home-based telemonitored rehabilitation, a special device was used which enabled patients to: (1) do Nordic walking training according to a preprogrammed plan, (2) record and send electrocardiograms (ECGs) via mobile phone network to the monitoring centre. The moments of automatic ECGs registration were pre-set and coordinated with exercise training. The effectiveness of HCTR was assessed by changes - delta (Δ) in duration (t) of the workload, peak oxygen consumption (pVO2) in cardiopulmonary exercise test, 6-minute walking test distance (6-MWT) as a result of comparing t (s), pVO2 (ml/kg/min), 6-MWT (m) from the beginning and the end of the program. Results Safety of HCTR. Neither death nor other serious adverse events occurred during HCTR. We did not observe any ICDs intervention during the HCTR. Effectiveness of HCTR: Within-group analysis: t, pVO2, 6-MWT increased significantly in TG: t 657±183 vs 766±181 (p&amp;lt;0.001), pVO2 19.2±5.0 vs 20.6±4.9 (p=0.007), 6-MWT 445±88 vs 551±77 (p&amp;lt;0.001). In the untrained CG, the unfavourable results were observed: 695±198 vs 717±187 (p=0.114), pVO2 21.2±5.1 vs 21.1±5.6 (p=0.723), 6-MWT 512±83 vs 536±84 (p=0.061). Between-group analysis: The differences between TG and CG were statistically significant: in Δt (p&amp;lt;0.001); ΔpVO2 (p=0.012); Δ6-MWT (p&amp;lt;0.001). Adherence to HCTR: In TG 28 patients (93%) completed the HCTR program. Two patients did no undergo HCTR because of personal issues. Conclusion Hybrid cardiac telerehabilitation in patients with HCM without the left ventricle (LV) outflow tract obstruction and preserved LV ejection fraction is safe and effective. The adherence to HCTR is high. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Statutory work in The Cardinal Stefan Wyszyński National Institute of Cardiology in Warsaw, Poland

Predictors of exercise capacity in patients with asymptomatic primary moderate to severe mitral regurgitation and preserved left ventricle ejection fraction

Abstract Introduction Patients with primary moderate or severe mitral regurgitation (MR) often remain asymptomatic for a long time due to mechanisms of compensation. Exercise stress could provoke symptoms, unmask subclinical changes of left and right ventricles and reveal decreased functional capacity. Reduced exercise capacity is related to worse outcomes. Purpose The aim of this study was to evaluate an exercise capacity and factors influencing it in patients with asymptomatic primary moderate to severe MR and preserved left ventricle (LV) ejection fraction (EF). Methods 60 patients with asymptomatic moderate or severe MR and LV EF &amp;gt;60% underwent resting and stress (bicycle–ergometry as per protocol 25 + 25W every 3 minutes) echocardiography. Their exercise capacity was evaluated in Watts (W) and metabolic units (MET). The blood sample for NT-proBNP evaluation was collected just before the stress test. Results Patients with primary MR achieved 84.74±35.16 W and 4.87±1.51 MET. According to univariate linear regression analysis exercise capacity in MET was significantly related to age (B=−0.066, p&amp;lt;0.001), systolic pulmonary artery pressure (SPAP) at rest (B=−0.048, p=0.034), resting E wave (B=−0.015, p=0.031) and NT-proBNP (B=−0.003, p=0.006). Predictors of exercise capacity in W also were age (B=−1.273, p=0.002), resting E wave (B=−0.318, p=0.041), NT-proBNP (B=−0.057, p=0.018). Higher concentration of NT-proBNP and bigger SPAP at rest correlated with lower exercise capacity (picture 1). In patients who had exercise induced pulmonary hypertension (EIPH; SPAP &amp;gt;60 mmHg during peak stress) ergometry was more frequently terminated prematurely (19 (95%) and 24 (60%), p=0.012). They also had significantly lower exercise capacity than subjects without EIPH ((W: p=0.015 and MET: p&amp;lt;0.001). Conclusions Age, NT-proBNP concentration, resting SPAP and E wave were predisposing factors of exercise capacity in patients with asymptomatic primary moderate to severe MR and preserved LV EF. EIPH and elevated NT-proBNP were related to premature exercise termination and lower exercise capacity. Funding Acknowledgement Type of funding sources: None. Picture 1