Recovery Of Systolic Function Research Articles

The response of total isovolumic time (t-IVT) to transcatheter aortic valve implantation (TAVI)

Abstract Background Total isovolumic time (t-IVT), the period of neither filling nor ejection, reflects global cavity dyssynchrony. It is free of geometric assumptions and has been demonstrated to serve as a reliable predictor of early response to various heart failure management strategies, medical and interventional. Purpose The aim of this prospective study is to assess the response of t-IVT to transcatheter aortic valve implantation (TAVI) as well as its relation to other echocardiographic parameters of myocardial function. Methods This is a single-center prospective study, which included patients with symptomatic, severe aortic stenosis (AS) who underwent TAVI. Echocardiographic myocardial function parameters included LV ejection fraction (EF), Tei-index and t-IVT and were assessed at three occasions; at baseline; within one month of TAVI and 3 months after procedure. Results The studied population consisted of 35 consecutive (81.6 ± 5.4 years, 19 males) patients. No deaths or major cardiovascular events were reported during the study period of 3 months after the TAVI. Seven (7) patients had LV EF ≤45%. After TAVI LV EF increased (from 51.7 ± 6.6 to 53.7 ± 5.6%; p=0.008), while Tei-index remained normal (from 0.33 ± 0.09 to 0.39 ± 0.06, p=0.02). Likewise, t-IVT shortened (from 9.1 ± 4.7 to 6.8 ± 4.8 s/min, p=0.005). Neither E/A (0.93 ±0.43 vs.0.94± 0.47, p=0.9) nor E/E’ (18±10.6 vs. 17.2± 8.7, p= 0.6) demonstrated any significant change. Finally, the BNP levels were reduced after TAVI (from 408.9 ± 497.9 to 289.5 ±276.9, p=0.03). An increase in LV EF>10% was observed in 17 patients in whom there was a significantly profound fall in t-IVT compared to the rest (36.3 ±16.2 vs. 24±12.2, p=0.001). Conclusion In patients with severe AS, t-IVT is prolonged particularly in those with worse LV EF. The significant recovery of both markers reflect better procedure related systolic and synchronous function recovery.

Echocardiography-derived regional strain for assessment of non-culprit stenosis and prediction of systolic function recovery in acute STEMI.

To compare echocardiographic regional longitudinal strain with quantitative coronary angiography and assess temporal changes in regional strain in patients with STEMI and multivessel coronary artery disease. Thirty-two patients with STEMI and multivessel coronary artery disease underwent coronary angiography with 3D quantification and baseline echocardiography. Regional longitudinal strain was measured as the average strain of three adjacent myocardial segments (RLS-3S) with the most impaired strain values. Forty-one stenosed vessels were identified (9 LAD [19%], 21 LCx [50%] and 11 RCA [31%]). RLS-3S did not correlate with diameter stenosis, area stenosis or minimal luminal diameter. Receiver operating curve analysis of RLS-3S for hemodynamic significant lesions (defined as positive fractional flow reserve or composite of ≥ 70% diameter stenosis and minimal luminal diameter < 1.2mm) demonstrated an area under the curve of 0.63 (95% CI 0.45-0.76) with an optimal cut-off value of < 9.8%. Sensitivity and specificity of RLS-3S was 86% (42-100) and 48% (31-66). RLS-3S < 9.8% at baseline in remote myocardium subtended by the stenosed coronary vessel predicted benefit from percutaneous coronary intervention in terms of regional functional recovery. RLS-3S does not correlate with individual coronary angiography measures and moderately predicts hemodynamically significant lesions. RLS-3S could be used to predict regional functional recovery after additional revascularization.

Iatrogenic Cardiac Arrest During Thyroid Storm.

Thyroid storm is a life-threatening condition with often severe cardiac implications. Correct treatment choices can vary depending on underlying cardiac systolic function. We present a case of a 47-year-old male with untreated Grave's disease who presented with a thyroid storm. After propranolol administration, he experienced a cardiac arrest with the return of spontaneous circulation after cardiopulmonary resuscitation. Further evaluation revealed severe thyroid-induced cardiomyopathy with left ventricular ejection fraction of 15-20%, which had decreased from 60-65% over one year. The patient was discharged home on hospital day 8 after an unremarkable ischaemic work-up. He experienced a full cardiac systolic function recovery with an ejection fraction of 60-65% at the 90-day follow-up. Thyroid storm can present with overt or subclinical heart failure. Prompt evaluation of cardiac systolic function with a transthoracic echocardiogram before beta-blockade and the use of shorter-acting beta blockers can prevent devastating suppression of myocardial function. Despite being first-line therapy, beta blockers can be beneficial or devastating in thyroid storm patients depending on the presence of low cardiac output or high cardiac output heart failure.Clinical awareness, prompt echocardiography and the use of shorter half-life beta blockers can prevent rapid cardiac deterioration in thyroid storm patients.

Impact of microvascular resistance reserve on post-STEMI cardiac remodelling and diastolic function

Abstract Background Coronary microvascular dysfunction (CMD) is a common sequelae of ST-segment elevation myocardial infarction (STEMI), preventing adequate recovery of left ventricular (LV) perfusion. The interferences of con-commitment epicardial stenosis or hyperemic hemodynamic alterations limit traditional physiologic metrics. The microvascular resistance reserve (MRR) was developed to overcome these shortcomings. Purpose We aim to investigate the association between post-STEMI MRR, and the ensuing left ventricle (LV) diastolic dysfunction, and functional remodeling. Methods In this prospective, observational study, we enrolled STEMI patients with multivessel disease who successfully underwent primary percutaneous coronary intervention (PCI). At three months post-PCI, all patients received complete revascularization followed by coronary physiology assessment using the bolus thermodilution method to measure the fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR). MRR was calculated using the formula: MRR = (CFR/FFR) × (Pa rest/Pa hyper), where Pa rest and Pa hyper represent resting and hyperemic aortic pressure, respectively(1). CMD was defined as an MRR &amp;lt; 3.0 based on Boerhout et al(2). Diastolic dysfunction was defined according to the ASE 2016 guidelines. Functional LV remodelling (FLVR) was categorized according to Chimed et al(3). The relationship between CMD and the stages of FLVR and diastolic dysfunction was scrutinized over a 12-month follow-up period. Results We enrolled 210 patients, of whom 125 (59.5%) were men with a median age of 65 (IQR: 58–76). At the 3-month follow-up, the MRR was 3.46 (IQR 3.00, 3.92), with 56 (26.7%) patients having CMD (MRR&amp;lt;3.0). MRR is significantly correlated with the change of LVEF between primary PCI and 12 months (r=0.48, p&amp;lt;0.001, Fig1A). CMD patients have lower LVEF at 12 months (50.00% vs. 40.00%; p &amp;lt; 0.001) and demonstrated significantly less recovery in LV systolic function (-10.00% vs. 8.00%; p &amp;lt; 0.001, Fig 1B, 1C). CMD patients had a higher prevalence of grade 2 or 3 LV diastolic dysfunction (65.38% vs. 3.95%; p &amp;lt; 0.001, Fig 2A) and a higher incidence of advanced FLVR (Groups 3 and 4) compared to those without CMD (30.77% vs. vs. 10.53%; p &amp;lt; 0.001, Fig 2B). In multivariable logistic regression analysis, MRR was independently associated with LV diastolic dysfunction (0.17, 95%CI 0.08-0.33, p&amp;lt;0.001). Conclusions The novel parameter MRR is significantly related to LVEF recovery in STEMI patients and is an independent predictor for advanced LV diastolic dysfunction and FLVR. CMD patients, as diagnosed with MRR, showed a higher prevalence of advanced FLVR and diastolic dysfunction. These results suggest that MRR is a useful parameter for the identification and management of CMD in STEMI patients.

Selvester Score as a Predictor of Left Ventricular Systolic Function Recovery in ST-Segment Elevation Myocardial Infarction (STEMI) Patients with Reduced Ejection Fraction after Revascularization; MUST Egypt

Abstract Background Ischemic heart disease is the most common contributor to left ventricular dysfunction. The extent of left ventricular (LV) function varies considerably among patients with extensive coronary disease. Clinical, demographic, and angiographic characteristics differ among patients and are predictive of LV ejection fraction has not been determined. Early identification, preferably in the emergency department (ED), of patients at the highest risk for developing left ventricular (LV) dysfunction could serve to inform the use of certain therapies. Objective To assess the correlation between the Selvester score and the myocardial dysfunction by echocardiography to predict left ventricular dysfunction improvement in patients with anterior STEMI and reduced EF. Patients and Methods This prospective observational study was done on 54 patients with acute anterior STEMI with LVSD. All patients were subjected to full history taking a full general examination Further, reperfusion strategy, twelve lead surface ECG, and echocardiography data were performed for all patients. Results The difference in the Selvester Score on discharge and after three months showed no statistically significant correlation with LV dysfunction improvement. The studied patients demonstrated a cut-off point of ≥ 7 for the Selvester Score at discharge, the ROC analysis revealed a sensitivity of 85.71% and a specificity of 100.00%. The positive predictive value (+PV) is 100.0%, while the negative predictive value (-PV) is 79.2%. Conclusion Our findings may aid in the clinical management of patients with anterior STEMI in the early stages of their hospitalization. A high Selvester score at hospital admission can predict non-improvement of EF but can't be used alone as a follow-up after 3 months as a predictor of function improvement without Echocardiography.

Preoperative Echocardiographically Derived Mean dP/dTic Predicts Early Post-operative Dysfunction in Children Undergoing Mitral Valve Surgery.

Mean dP/dtic is a quantitative measurement of ventricular function that can be obtained noninvasively by echocardiography. In adults with mitral regurgitation (MR), it has been shown to be a more sensitive predictor of postoperative left ventricular ejection fraction (EF). The utility of dP/dtic in pediatric congenital heart diseases with MR has been underexplored. Patients (0 to ≤ 19years) with MR who underwent mitral valve (MV) repair or replacement from 2015 to 2021 were included. Echocardiographically derived mean dP/dtic, Tei index, and EF were used to assess and compare ventricular function prior to, shortly after, and late after MV surgery. Study cohort included 61 patients (age 4.5 [IQR 0.14, 18.7] years, 89% MV repair, 11% MV replacement). Median time intervals between surgery and preoperative, early postoperative, and late postoperative echocardiograms were 6days, 6days, and 350days, respectively. Median EF was 62% (z-score -0.40) preoperatively, 56% (z-score -1.40) early postoperatively, and 61% (z-score -0.60) late postoperatively. Median dP/dtic was 1393 (IQR 1029, 1775) mmHg/s preoperatively, 1178 (IQR 886, 1946) mmHg/s early postoperatively, and 1270 (IQR 791, 1765) mmHg/s late postoperatively. Preoperative median dP/dtic correlated with early and late postoperative EF. Preoperative EF was not significantly correlated with early postoperative EF, but was correlated with late postoperative EF. Mitral valve intervention in pediatric patients is associated with an initial decline but subsequent recovery of systolic function. Non-invasively derived mean dP/dtic may offer advantages over other preoperative echocardiographic indices to predict postoperative systolic function.

ST-segment depression and left ventricular systolic function recovery post-atrial fibrillation ablation in heart failure.

Catheter ablation (CA) of atrial fibrillation (AF) improves left ventricular ejection fraction (LVEF) in patients with heart failure with reduced ejection fraction (HFrEF). The impact of ST-segment depression before CA on LVEF recovery and clinical outcomes remains unknown. In the present study, we aimed to investigate the relationship between ST-segment depression during AF rhythm before CA and improvement in the LVEF and clinical outcomes in persistent atrial fibrillation (PerAF) patients with HFrEF. The present study included 122 PerAF patients (male; 98 patients, 80%, mean age: 69 [56, 76] years) from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry who had LVEF<50% and underwent an initial ablation. The patients who underwent percutaneous coronary intervention or coronary artery bypass grafting within the past 1month were not included in the enrolled patients. We assigned the patients based on the presence of ST-segment depression before CA during AF rhythm and evaluated improvement in the LVEF (LVEF≥15%) 1year after CA and the relationship between ST-segment depression and heart failure (HF) hospitalization/major adverse cardiovascular events (MACE), which are defined as a composite of HF hospitalization, cardiovascular death, hospitalization due to coronary artery disease, ventricular arrhythmia requiring hospitalization and stroke. The percentage of patients with improvement in the LVEF 1year after CA was significantly lower in the patients with ST-segment depression than those without (58.6% vs. 79.7%, P=0.012). Multiple regression analysis showed ST-segment depression was independently and significantly associated with improvement in the LVEF 1year after CA (HR: 0.35; 95% CI: 0.129-0.928, P=0.035). Kaplan-Meier analysis showed that the patients with ST-segment depression significantly had higher risk of HF hospitalization and MACE than those without (log rank P=0.022 and log rank P=0.002, respectively). Multivariable Cox proportional hazards analysis showed that ST-segment depression was independently and significantly associated with a higher risk of MACE (HR: 2.82; 95% CI: 1.210-6.584, P=0.016). ST-segment depression before CA during AF rhythm was useful prognostic predictor of improvement in the LVEF and clinical outcomes including HF hospitalization and MACE in PerAF patients with HFrEF.

Predictive value of early-phase heart rate reduction for subsequent recovery of left ventricular systolic function in heart failure with reduced ejection fraction.

Predictors of heart failure with recovered ejection fraction (HFrecEF) remain to be fully elucidated. This study investigated the impact of heart rate and its change on the recovery of left ventricular ejection fraction (LVEF) in heart failure with reduced ejection fraction (HFrEF). From 398 outpatients who had a history of hospitalisation for heart failure, 138 subjects diagnosed as HFrEF (LVEF < 40%) on heart failure hospitalisation were enrolled and longitudinally surveyed. During follow-up periods more than one year, 64 and 46 patients were identified as HFrecEF (improved LVEF to ≥ 40% and its increase of ≥ 10 points) and persistent HFrEF, respectively. In the overall subjects, the reduction of heart rate through the observation periods was closely correlated with the improvement of LVEF (r = -0.508, p < 0.001). Heart rate on hospital admission for heart failure was markedly higher in patients with HFrecEF (112 ± 26 bpm) than in those with persistent HFrEF (90±18 bpm). Whereas heart rate at the first outpatient visit after discharge was already lower in the HFrecEF group (80 ± 13 vs. 85 ± 13 bpm in the persistent HFrEF group). A multivariate logistic regression analysis revealed that the decrease in heart rate from admission to the first visit after discharge was a significant determinant of HFrecEF (p < 0.001), independently of confounding factors such as ischemic heart disease and baseline LVEF and left ventricular dimension. Our findings suggest that heart rate reduction in the early phase after heart failure onset is a powerful independent predictor of the subsequent recovery of LVEF in HFrEF patients.

Combination of trimetazidine and coenzyme Q10 for the treatment of acute viral myocarditis: a systematic review and meta-analysis.

Coenzyme Q10 (CoQ10) is considered to be beneficial for patients with acute viral myocarditis (AVM). In addition, trimetazidine may be also beneficial to patients with AVM by promoting cardiac energy metabolism. This systematic review and meta-analysis examined the efficacy and safety of combining trimetazidine and CoQ10 with respect to CoQ10 alone in patients suffering from AVM. PubMed, Embase, the Cochrane Library, Wanfang, and China National Knowledge Infrastructure (CNKI) databases were searched for relevant randomized controlled trials (RCTs). An analysis of random effects was employed to combine the results. Sixteen RCTs that included 1,364 patients with AVM contributed to the meta-analysis. Overall, 687 patients received the combined treatment, while 677 received the CoQ10 alone for a duration of 2-12 weeks (mean: 5.2 weeks). In contrast to monotherapy with CoQ10, combined treatment with trimetazidine and CoQ10 significantly improved overall therapy effectiveness (risk ratio [RR]: 1.19, 95% confidence interval [CI]: 1.13 to 1.24, p < 0.001; I2 = 0%). Differences in study parameters such as the incidence of heart failure upon admission, dosage of CoQ10, or length of treatment did not significantly alter the outcomes (p for all subgroup analyses > 0.05). The combined treatment was associated with improved myocardial enzyme levels and recovery of cardiac systolic function as compared to CoQ10 alone (p all < 0.05). In addition, trimetazidine combined with CoQ10 caused no greater increase in adverse events than CoQ10 alone. Trimetazidine combined with CoQ10 is an effective and safe treatment for AVM.

Outcome of Patients Presenting with Peripartum Cardiomyopathy in a Tertiary Care Center of Nepal

Purpose: Peripartum cardiomyopathy is a rare life-threatening cardiomyopathy of unknown etiology with significant maternal morbidity and mortality. It causes heart failure due to left ventricular systolic dysfunction with or without left ventricular dilatation in the last month of pregnancy up to 5 months postpartum in previously healthy women. We aimed to determine short-term outcomes of peripartum cardiomyopathy clinically as well as in terms of left ventricular systolic function and to study the clinical profile and associated risk factors. Patients and methods: A prospective observational study was carried out in the Department of Cardiology of Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Kathmandu, Nepal, from July 2018 to January 2022. All the patients with peripartum cardiomyopathy who presented to the department of cardiology were enrolled in the study and re-evaluated with echocardiography at 6 months. Results: A total of 68 women met the inclusion criteria. The mean age was 28.38 ± 5.5 years (range 19 to 44 years). The most common clinical presentation was dyspnea followed by lower limb edema. Six (8.8%) patients presented during the last month of pregnancy whereas 62 (91.2%) patients presented in the postpartum period. The mean left ventricular ejection fraction on presentation was 30.01 ± 8.54. A full recovery was observed among 60.29% at 6 months. The mortality rate was 4.41%. Conclusion: Timely diagnosis and management of peripartum cardiomyopathy with standard therapy for heart failure leads to better recovery of left ventricular systolic function.

HEART FAILURE PATIENTS WITH IMPROVED EJECTION FRACTION: INSIGHTS FROM THE MECKI SCORE DATABASE

Abstract Aims Improvement of left ventricular ejection fraction is a major goal of heart failure (HF) treatment. However, data on clinical characteristics, exercise performance and prognosis in HF patients who improved ejection fraction (HFimpEF) are scarce. The study aimed to determine whether HFimpEF patients have a distinct clinical phenotype, biology and prognosis than HF patients with persistently reduced ejection fraction (pHFrEF). Methods 7948 patients enrolled in the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database were evaluated (median follow–up of 1490 days). We analyzed clinical, laboratory, ECG, echocardiographic, exercise, and survival data from HFimpEF (n=1504) and pHFrEF (n=6017) patients. The primary endpoint of the study was the composite of cardiovascular death, left ventricular assist device implantation, and urgent heart transplantation. Results Main results are shown in Figure 1. HFimpEF patients had lower HF severity: LVEF 44.0[41.0–47.0] vs. 29.7[24.1–34.5]%, BNP 122[65–296] vs. 373[152–888] pg/mL, hemoglobin 13.5[12.2–14.6] vs. 13.7[12.5–14.7] g/dL, renal function by MDRD 72.0[56.7– 89.3] vs. 70.4[54.5–85.3] mL/min, peakVO2 62.2[50.7–74.1] vs. 52.6[41.8–64.3]%pred, VE/VCO2 slope 30.0[26.9–34.4] vs. 32.1[28.0–38.0] in HFimpEF and pHFrEF, respectively (p&amp;lt;0.001 for all). Cardiovascular mortality rates were 26.6 and 46.9 per 1000 person–years for HFimpEF and pHFrEF, respectively (p&amp;lt;0.001). Kaplan–Meier analysis (Fig.2) showed that HFimpEF had better a long–term prognosis compared with pHFrEF patients. After adjustment for variables differentiating HFimpEF from pHFrEF, except echocardiographic parameters, the Kaplan–Meier curves showed the same prognosis. Conclusions HFimpEF represents a peculiar group of HF patients whose clinical, laboratory, ECG, echocardiographic, and exercise characteristics parallel the recovery of systolic function. Nonetheless, these patients remain at risk for adverse outcome.

Recovery of left ventricular systolic function in peripartum cardiomyopathy: an observational study from rural Tanzania

BackgroundThe aim of this study was to evaluate the recovery rate of the left ventricular systolic function of women diagnosed with peripartum cardiomyopathy receiving specialized care in rural Tanzania.MethodsIn this observational study, women diagnosed with peripartum cardiomyopathy at a referral center in rural Tanzania between December 2015 and September 2021 were included. Women diagnosed between February and September 2021 were followed prospectively, those diagnosed between December 2015 and January 2021 were tracked back for a follow-up echocardiography. All participants received a clinical examination, a comprehensive echocardiogram, and a prescription of guideline-directed medical therapy. The primary outcome was recovery of the left ventricular systolic function (left ventricular ejection fraction > 50%).ResultsMedian age of the 110 participants was 28.5 years (range 17–45). At enrolment, 49 (45%) participants were already on cardiac medication, 50 (45%) had severe eccentric hypertrophy of the left ventricle, and the median left ventricular ejection fraction was 30% (range 15–46). After a median follow-up of 8.98 months (IQR 5.72–29.37), 61 (55%) participants were still on cardiac medication. Full recovery of the left ventricular systolic function was diagnosed in 76 (69%, 95% CI 59.6–77.6%) participants. In the multivariate analysis, a higher left ventricular ejection fraction at baseline was positively associated with full recovery (each 5% increase; OR 1.7, 95% CI 1.10–2.62, p = 0.012), while higher age was inversely associated (each 10 years increase; OR 0.40, 95% CI 0.19–0.82, p = 0.012).ConclusionLeft ventricular systolic function recovered completely in 69% of study participants with peripartum cardiomyopathy from rural Tanzania under specialized care.

The Impact of Microvascular Resistance Reserve on the Outcome of Patients With STEMI

BackgroundMicrovascular resistance reserve (MRR) can characterize coronary microvascular dysfunction (CMD); however, its prognostic impact in ST-segment elevation myocardial infarction (STEMI) patients remains undefined. ObjectivesThis study sought to investigate the prevalence of CMD in STEMI patients and to elucidate the prognostic performance of MRR. MethodsThis prospective cohort study enrolled 210 STEMI patients with multivessel disease who underwent successful revascularization and returned at 3 months for coronary physiology assessments with bolus thermodilution. The prevalence of CMD (MRR <3) and the association between MRR and major adverse cardiovascular and cerebrovascular events (MACCEs) at 12 months were investigated. ResultsThe median age of patients was 65 years, and 59.5% were men. At the 3-month follow-up, 56 patients (27%) had CMD (MRR <3.0). The number of MACCEs at 12 months was higher in patients with vs without CMD (48.2% vs 11.0%; P < 0.001). MRR was independently associated with 12-month MACCEs (HR: 0.45 per unit increase; 95% CI: 0.31-0.67; P < 0.001) and with stroke, heart failure, and poorer recovery in left ventricular systolic function. The areas under the receiver-operating characteristic curves for predicting MACCEs at 12 months with fractional flow reserve, coronary flow reserve (CFR), the index of microvascular resistance (IMR), and MRR were 0.609, 0.762, 0.781, and 0.743, respectively. The prognostic performance of CFR, IMR, and MRR were all comparable. ConclusionsThe novel parameter MRR is a prognostic marker of MACCEs in STEMI patients with a comparable performance to CFR and IMR. (Impact of TMAO Serum Levels on Hyperemic IMR in STEMI Patients [TAMIR]; NCT05406297)

Predictors of systolic function recovery after atrial fibrillation ablation in heart failure patients

Introduction and ObjectivesAtrial fibrillation (AF) and heart failure (HF) often coexist. AF catheter ablation improves left ventricular ejection fraction (LVEF), but its impact varies between patients. We aimed to identify predictors of LVEF improvement in HF patients with impaired LVEF undergoing AF ablation. MethodsWe conducted a retrospective single-center study in HF patients with LVEF <50% undergoing AF catheter ablation between May 2016 and May 2022. The primary endpoint was the LVEF recovery rate (‘responders’). Secondary endpoints were one-year safety and effectiveness. We also aimed to validate a prediction model for LVEF recovery. ResultsThe study included 100 patients (79% male, median age 60 years, 70% with probable tachycardia-induced cardiomyopathy [TIC], mean LVEF 37%, 29% with paroxysmal AF). After a median follow-up of 12 months after catheter ablation, LVEF improved significantly (36±10% vs. 53±10%, p<0.001), with an 82% responder rate. A suspected diagnosis of TIC (OR 4.916 [95% CI 1.166–20.732], p=0.030), shorter QRS duration (OR 0.969 [95% CI 0.945–0.994], p=0.015), and smaller left ventricle (OR 0.893 [95% CI 0.799–0.999], p=0.049) were independently associated with LVEF improvement. Freedom from any documented atrial arrhythmia was 86% (64% under antiarrhythmic drugs), and the rate of adverse events was 2%. The prediction model had a good discriminative performance (AUC 0.814 [95% CI 0.681–0.947]). ConclusionIn AF patients with HF and impaired LVEF, suspected TIC, shorter QRS duration, and smaller LV diameter were associated with LVEF recovery following AF catheter ablation.

Impact of Coronary Microvascular Dysfunction on Functional Left Ventricular Remodeling and Diastolic Dysfunction.

Coronary microvascular dysfunction (CMD) is a common complication of ST-segment-elevation myocardial infarction (STEMI) and can lead to adverse cardiovascular events. Whether CMD after STEMI is associated with functional left ventricular remodeling (FLVR) and diastolic dysfunction, has not been investigated. This is a nonrandomized, observational, prospective study of patients with STEMI with multivessel disease. Coronary flow reserve and index of microcirculatory resistance of the culprit vessel were measured at 3 months post-STEMI. CMD was defined as index of microcirculatory resistance ≥25 or coronary flow reserve <2.0 with a normal fractional flow reserve. We examined the association between CMD, LV diastolic dysfunction, FLVR, and major adverse cardiac events at 12-month follow-up. A total of 210 patients were enrolled; 59.5% were men, with a median age of 65 (interquartile range, 58-76) years. At 3-month follow-up, 57 patients (27.14%) exhibited CMD. After 12 months, when compared with patients without CMD, patients with CMD had poorer LV systolic function recovery (-10.00% versus 8.00%; P<0.001), higher prevalence of grade 2 LV diastolic dysfunction (73.08% versus 1.32%; P<0.001), higher prevalence of group 3 or 4 FLVR (11.32% versus 7.28% and 22.64% versus 1.99%, respectively; P<0.001), and higher incidence of major adverse cardiac events (50.9% versus 9.8%; P<0.001). Index of microcirculatory resistance was independently associated with LV diastolic dysfunction and adverse FLVR. CMD is present in ≈1 of 4 patients with STEMI during follow-up. Patients with CMD have a higher prevalence of LV diastolic dysfunction, adverse FLVR, and major adverse cardiac events at 12 months compared with those without CMD. URL: https://www.clinicaltrials.gov; Unique Identifier: NCT05406297.

Case Series Study on Recovery of Left Ventricle Systolic Function After Percutaneous Coronary Intervention In ST-Segment Elevation Myocardial Infarction Patients at FMIC Hospital in Kabul, Afghanistan.

Background Left ventricle dysfunction is the most recurrent consequence of ST-elevated myocardial infarction, and still, it is a powerful predictor of mortality. The percutaneous coronary intervention of the culprit artery disease in acute coronary syndrome is related to a significant improvement of left ventricle segmental function. It is a retrospective case series study on a patient population with the diagnosis of ST-elevated myocardial infarction patients who presented to the hospital within 12 hours and underwent percutaneous coronary intervention at the French Medical Institute of Mother and Children Hospital. Data was collected retrospectively from the patient's medical record files and analyzed. We took the patients with Left ventricle dysfunction on echocardiography on the first presentation before percutaneous coronary intervention and saw the left ventricle function after three months of follow-up. We reviewed the charts of 102 patients (78.4% male and 21.6% female) with a diagnosis of St-elevated myocardial infarction who presented within 12 hours of chest pain. Of 102 patients, 55.9% had hypertension, 21.6% diabetes, 22.5% dyslipidemia, and 19.6% history of smoking, and their mean age was 58.11 ± 11.993 years. We noticed that percutaneous coronary intervention led to significant left ventricle dysfunction improvement in the patient population with ST-elevated myocardial infarction who presented within 12 hours of chest pain.

Inflammation in endomyocardial biopsies correlates with improved cardiac recovery and correlates inversely with mortality in patients with non-ischemic heart failure with reduced ejection fraction

Abstract Background Heart failure (HF) is a major cause of morbidity, mortality and healthcare costs worldwide. Although the overall mortality is high, individual outcomes show a large variability, reflecting our incomplete comprehension of the complex pathophysiology. Effective treatment requires rapid therapy initiation addressing the specific etiology. Purpose As reliable predictors of the outcome of HF remain ambiguous, we retrospectively analyzed patients with non-ischemic HF with reduced ejection fraction (HFrEF) to identify prognostic factors of myocardial recovery and mortality. Methods We included N = 305 consecutive patients from our MyBiopsy-HF study (DRKS #00022178)) who presented with non-ischemic, non-valvular HFrEF (Left ventricular ejection fraction LVEF ≤40%) as quantified by echocardiography and received a comprehensive medical workup including endomyocardial biopsy (EMB) at the time of initial diagnosis and follow-up echocardiography at 6 months. We defined HF with improved LVEF (HFimpEF) as LVEF&amp;gt;40% and ≥10% increase from initial LVEF. Myocardial inflammation was classified according to the current recommendations by the Dallas criteria or immunohistologic criteria (≥14 leucocytes/mm² with the presence of CD3 positive T-lymphocytes ≥7 cells/mm²). Viral persistence was quantified by qPCR from the EMB tissue. We obtained patients’ mortality data from the Rhineland-Palatinate mortality register. Results The presence of myocardial inflammation in the EMB at the time of initial diagnosis was a significant predictor of increased transition to HFimpEF (83 of 143 patients, 58,0% with inflammation vs 63 of 151 patients, 41,7% without inflammation, odds ratio (OR) 1,93, confidence interval (CI) = 1,20-3,09, p-value 0,006). Viral persistence did not differ significantly between groups. Also, female patients (55 of 91 patients, 60,4%) were more likely to transition to HFimpEF compared to male patients (94 of 214 patients, 43,9%, OR 2,27, 95% CI = 1,35-3,85, p-value 0,002). Transition to HFimpEF was associated with better survival: After five years, 71 of the 78 patients with HFimpEF were alive (91,0%) as compared to 68 of the 88 patients (77,3%) with persistent HFrEF (OR 2,58, CI = 1,08-6,20, p-value 0,03). Transition of HFimpEF was the lone age-adjusted significant predictor of five-year survival. All other factors (presentation with dyspnea, angina pectoris, palpitations, history of hypertension, diabetes, or hyperlipidemia, initial LVEF, heart failure medication and immunosupressive treatment) were not found to be of significance. Conclusion Presence of myocardial inflammation and female sex are predictors of increased recovery of cardiac systolic function as measured by LVEF in patients with HFrEF. Recovery of cardiac systolic function in turn predicts five-year survival. These findings may help to stratify HF therapy and indicate that further studies are needed to foster our understanding of the phenomenon of myocardial inflammation.

Abstract 16873: Takotsubo Variant is Associated With Worse Right and Left Ventricular Systolic Function Than Other Stress Cardiomyopathy Variants

Introduction: Stress cardiomyopathy (SCM) is usually associated with reduced systolic function on echocardiogram. However, the prevalence of systolic dysfunction between different variables of SCM has not been established. Hypothesis: Whether Takotsubo variant SCM is associated with worse systolic function compared to other SCM variants. Methods: We conducted a retrospective cohort study evaluating echocardiograms of all patients with SCM between 2010 and 2022 at Hennepin Healthcare, MN, USA. The diagnosis of SCM was made based on the International Takotsubo (InterTak) diagnostic criteria. Results: Between January 2010 and December 2022, 296 patients presented with SCM. The majority of patients (N= 173, 58.4%) had the apical (Takotsubo) variant, compared to 78 (26.3%) patients with the midventricular variant and 45 (15.2%) with the basal variant. The three groups had no significant difference in the left ventricular outflow tract and septal diameters. Patients with the apical variant had a lower ejection fraction on presentation compared to mid-ventricular and basal variants (28.1% vs. 36.8% and 35.7%, respectively, p&lt;0.001). Patients with Takotsubo CM had the lowest cardiac output and cardiac index among the three groups ( table 1 ). Right ventricular systolic function, evaluated by Tricuspid Annular Plane Systolic Excursion (TAPSE), was lowest in patients with apical SCM (mean TASPE 1.58 cm, p=0.027). All patients had similar ejection fraction recovery at follow-up (mean EF &gt; 55%, p=0.793, mean follow-up time &lt; 4 weeks, p=0.913). Conclusion: Takotsubo variant is associated with worse right and left ventricular systolic function compared to other SCM variants, with similar systolic function recovery at follow-up.

The Evolving Paradigm of Revascularization in Ischemic Cardiomyopathy: from Recovery of Systolic Function to Protection Against Future Ischemic Events.

We aim to reevaluate how the assessment of myocardial viability can guide optimal treatment strategies for patients with ischemic cardiomyopathy (ICM) based on a more contemporary understanding of the mechanism of benefit of revascularization. The assessment of viability in left ventricular (LV) segments with diminished contraction has been proposed as key to predict the benefit of revascularization and, therefore, as a requisite for the selection of patients to undergo this form of treatment. However, data from prospective trials have diverged from earlier retrospective studies. Traditional binary viability assessment may oversimplify ICM's complexity and the nuances of revascularization benefits. A conceptual shift from the traditional paradigm centered on the assessment of viability as a dichotomous variable to a more comprehensive approach encompassing a thorough understanding of ICM's complex pathophysiology and the salutary effect of revascularization in the prevention of myocardial infarction and ventricular arrhythmias is required.

Heart failure patients with improved ejection fraction: Insights from the MECKI score database.

Improvement of left ventricular ejection fraction is a major goal of heart failure (HF) treatment. However, data on clinical characteristics, exercise performance and prognosis in HF patients who improved ejection fraction (HFimpEF) are scarce. The study aimed to determine whether HFimpEF patients have a distinct clinical phenotype, biology and prognosis than HF patients with persistently reduced ejection fraction (pHFrEF). A total of 7948 patients enrolled in the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database were evaluated (median follow-up of 1490 days). We analysed clinical, laboratory, electrocardiographic, echocardiographic, exercise, and survival data from HFimpEF (n = 1504) and pHFrEF (n = 6017) patients. The primary endpoint of the study was the composite of cardiovascular death, left ventricular assist device implantation, and urgent heart transplantation. HFimpEF patients had lower HF severity: left ventricular ejection fraction 44.0 [41.0-47.0] versus 29.7 [24.1-34.5]%, B-type natriuretic peptide 122 [65-296] versus 373 [152-888] pg/ml, haemoglobin 13.5 [12.2-14.6] versus 13.7 [12.5-14.7] g/dl, renal function by the Modification of Diet in Renal Disease equation 72.0 [56.7-89.3] versus 70.4 [54.5-85.3] ml/min, peak oxygen uptake 62.2 [50.7-74.1] versus 52.6 [41.8-64.3]% predicted, minute ventilation-to-carbon dioxide output slope 30.0 [26.9-34.4] versus 32.1 [28.0-38.0] in HFimpEF and pHFrEF, respectively (p < 0.001 for all). Cardiovascular mortality rates were 26.6 and 46.9 per 1000 person-years for HFimpEF and pHFrEF, respectively (p < 0.001). Kaplan-Meier analysis showed that HFimpEF had better a long-term prognosis compared with pHFrEF patients. After adjustment for variables differentiating HFimpEF from pHFrEF, except echocardiographic parameters, the Kaplan-Meier curves showed the same prognosis. Heart failure with improved ejection fraction represents a peculiar group of HF patients whose clinical, laboratory, electrocardiographic, echocardiographic, and exercise characteristics parallel the recovery of systolic function. Nonetheless, these patients remain at risk for adverse outcome.