Reduced Left Ventricle Ejection Fraction Research Articles

Maternal cardiac remodeling and dysfunction in preeclampsia: a three-dimensional speckle-tracking echocardiography study.

Aims preeclampsia (PE) is a pregnancy complication that remains a main cause of maternal morbidity and mortality. The aims of this study were to investigate left ventricle (LV) performance in PE and to compare maternal cardiac function between early-onset preeclampsia (EP) and late-onset preeclampsia (LP) by novel threedimensional (3D) speckle-tracking echocardiography (STE) parameters while considering LV loading and shape. Methods and Results Two-dimensional echocardiography and 3D STE were performed in 43 women with EP, 41 women with LP, and 81 normal pregnancies. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were measured using 3D speckle-tracking software. There was eccentric hypertrophy and reduced LV ejection fraction (EF) in PE; meanwhile, GLS in EP and LP, GCS in LP, as well as GAS and GRS in EP significantly decreased in PE versus controls. All 3D strain indices were correlated with gestation age. Increased left atrial (LA) volume index was detected in PE. Higher LV mass index and lower 3D-derived strain value were present in women with EP compared to that in women with LP. Conclusion PE cases exhibited significant eccentric hypertrophy, ventricular dysfunction, and LA remodeling. Furthermore, myocardial deformation abnormalities preceded chamber dysfunction in this hypertensive disorder complicated pregnancy. Compared with LP, women with EP demonstrated more remarkable cardiac damage.

Left ventricular early inflow-outflow index: a novel echocardiographic indicator of mitral regurgitation severity.

BackgroundNo gold standard currently exists for quantification of mitral regurgitation (MR) severity. Classification by echocardiography is based on integrative criteria using color and spectral Doppler and anatomic measurements. We hypothesized that a simple Doppler left ventricular early inflow–outflow index (LVEIO), based on flow velocity into the left ventricle (LV) in diastole and ejected from the LV in systole, would add incrementally to current diagnostic criteria. LVEIO was calculated by dividing the mitral E-wave velocity by the LV outflow velocity time integral.Methods and ResultsTransthoracic echocardiography reports from Montefiore Medical Center and its referring clinics from July 1, 2011, to December 31, 2011 (n=11 235) were reviewed. The MR severity reported by a cardiologist certified by the National Board of Echocardiography was used as a reference standard. Studies reporting moderate or severe MR (n=550) were reanalyzed to measure effective regurgitant orifice area by the proximal isovelocity surface area method, vena contracta width, MR jet area, and left-sided chamber volumes. LVEIO was 9.3±3.9, 7.0±3.2, and 4.2±1.7 among those with severe, moderate, and insignificant MR, respectively (ANOVA P<0.001). By receiver operating characteristic analysis, area under the curve for LVEIO was 0.92 for severe MR. Those with LVEIO ≥8 were likely to have severe MR (likelihood ratio 26.5), whereas those with LVEIO ≤4 were unlikely to have severe MR (likelihood ratio 0.11). LVEIO performed better in those with normal LV ejection fraction (≥50%) compared with those with reduced LV ejection fraction (<50%) (area under the curve 0.92 versus 0.80, P<0.001). By multivariate logistic regression analysis, LVEIO was independently associated with severe MR when compared with vena contracta width, MR jet area, and effective regurgitant orifice area measured by the proximal isovelocity surface area method.ConclusionLVEIO is a simple-to-use echocardiographic parameter that accurately identifies severe MR, particularly in patients with normal LV ejection fraction.

Abstract 12770: Left-Atrial Contractile Contribution to Left Ventricle Filling is Preserved in Moderate Chronic Heart Failure

Introduction: The extent that left atrium (LA) functional remodeling is impacted by left ventricle (LV) systolic function or clinical history in patients with chronic heart failure (HF) is unresolved. Cardiac imaging and plasma biomarkers may provide valuable information in this regard. Hypothesis: Elastic and active contributions to LV stroke volume (LV SV) are variable, independent of LV systolic function and reflected in natriuretic peptide measurements. Methods: We recruited 27 controls without overt cardiovascular disease and 68 patients with moderate HF, including preserved and reduced LV ejection fraction (LVEF). Cardiac MRI was used to evaluate LV volumes at end diastole and end systole, and LA volumes at end diastole, diastasis and end systole to determine passive and active volume changes. Plasma mid-region pro-atrial and N-terminal pro-brain natriuretic peptides (MR-proANP and NT-proBNP, respectively) were measured. Results: Elastic LA contribution to LV SV was significantly lower in HF (median, IQR: 14%, 8-23%) than controls (24%, 17-30%; p=0.001), but active contribution was not (23%, 0-34% vs 24%, 21-31%; p=0.163). In patients with HF, active LA contribution to LV SV was negatively associated with history of hypertension (β=-0.41, p=0.007) and positively associated with aging (β=0.40, p=0.008) in a multiple linear regression model. Seven of nine subjects with HF and a history of atrial fibrillation (AF), but in sinus rhythm (SR) on the day of study, had active LA contributions to LV SV &gt;15%. Increased LA volume at end diastole (β=0.51, p=0.001) and LVEF (β=-0.33, p=0.008) were independently associated with NT-proBNP (β=0.51, p=0.001) in a model that included age and history of AF. Similarly, LA volume at end diastole (β=0.48, p=0.001) was independently associated with MR-proANP in a model that included age and history of AF. Notably, natriuretic propeptides were not associated with elastic or active LA contributions to LV SV. Conclusions: Heart failure is characterized by preserved LA active contribution to LV SV, regardless of LVEF, which increases with age, and is modifiable by hypertension and AF. Imaging-based assessment can elucidate the contribution of LA function in HF and may provide insight into the impact of AF in patients with HF.

Myocardial Tissue Characterization By Cardiac MR Imaging In Myelodysplastic Syndromes

IntroductionMagnetic Resonance Imaging (MRI) provides unique insight regarding tissue characterization in the heart. We reported the baseline MRI findings at the end of the recruitment in the MIOMED (Myocardial Iron Overload in MyElodysplastic Diseases) study. In particular, we evaluated the distribution of iron overload in the whole left ventricle (LV) and he presence of myocardial fibrosis in patients with myelodysplastic syndromes (MDS); the association with LV function was also investigated. No data are available in the literature about this issue. MethodsMIOMED is an observational, MRI multicentre study in low and intermediate-1 risk MDS patients who have not received regular iron chelation therapy. Out of the 51 MDS patients enrolled, 48 underwent the baseline MRI exam. Mean age was 71.7±8.5 years and 17 patients were females. MIO was assessed using a multislice multiecho T2* approach. Biventricular function parameters were quantified by cine sequences. Myocardial fibrosis was evaluated by late gadolinium enhancement acquisitions. ResultsWe found 27 (56.3%) patients with no MIO (all 16 segmental T2* values >20 ms). The remaining patients showed an heterogeneous MIO (some segments with T2* values >20 ms and other segments with T2* values <20 ms) and of them 2 (9.5%) showed a global T2* value <20 ms, indicating significant MIO. A reduced LV ejection fraction (EF) was found in the 29.5% of cases and a reduced RV EF in the 23.3%. There was not a significant association between heart T2* values and LV EF.Myocardial fibrosis was detected in the 35.9% of the patients. Three patients showed an ischemic pattern and one of them had a transmural fibrosis in the LV apical region. Out of the 3 patients with an ischemic pattern, only one patient had a positive history for a previous myocardial infarction. The majority of the patients had two or more foci of myocardial fibrosis, involving more frequently the septal segments. Patients with myocardial fibrosis were significantly older (75.4±7.9 vs 68.9±7.6 yrs; P=0.019). Global heart T2* and LV volumes were not significantly different between patients with and without fibrosis. The LV EF was lower in fibrotic patients but the statistical significance was not reached (58.4±11.7 vs 64.8±8.9 %; P=0.067). ConclusionsAlthough a significant heart iron was found only in two cases, nearly half the patients had abnormal T2* values in at least one myocardial segment. This finding underlines the importance to use a multislice approach in order to perform an early diagnosis and prevent a more diffuse iron distribution by chelation therapy. This goal could be critical in patients with myocardial fibrosis that seems to be a relative common findings in the old MDS patients. In fact, an underlying heart damage as represented by fibrosis could make the hearts of the old MDS patients more sensitive to lower levels of accumulated iron. Disclosures:No relevant conflicts of interest to declare.

A Case of Functional Mitral Stenosis Reversed by Medical Treatment for Heart Failure

A 52-year-old man had a history of heart failure (HF) with severe mitral regurgitation (MR) due to P3 prolapse 4 years ago. He underwent mitral valve plasty with triangular resection, edge-to-edge anastomosis, and annuloplasty with a 30 mm Physioring. After the surgery, HF improved and postoperative echocardiography confirmed a normal sized left ventricle (LV) and normal ejection fraction (EF). There were preserved mitral valve opening with mitral valve area (MVA) of 1.8 cm, a mean pressure gradient of 4.4 mmHg, and no residual MR. However, he developed HF again 4 years later. Two-dimensional echocardiography demonstrated moderately dilated LV, reduced LV EF of 40%, and mild MR. There was also limited mitral valve opening caused by dilated LV, resulting in MS with an MVA of 1.2 cm, and a mean pressure gradient of 8.4 mmHg. Both the etiologies of the MS and MR were considered as functional. His HF symptom disappeared after initiation of vasodilators and diuretics. Repeated echocardiography after HF treatment demonstrated a reduction of LV size without MR, improvement of mitral valve opening to an MVA of 1.7 cm, and a mean pressure gradient of 4.6 mmHg. We report a case of HF and functional MS after MV plasty, which were reversed by aggressive medical treatment for HF.

Congenital left ventricular aneurysm: a cause of impaired myocardial torsion and peripheral thrombo-embolic events

Congenital aneurysms of the left ventricle (LV) are rare cardiac abnormalities and in most instances, are asymptomatic. However, some patients may present cardiac rupture, tamponade, ventricular arrhythmias, and eventually sudden death. Herein, we describe a case of a 64-year-old male patient who was hospitalized for critical limb ischaemia because of an acute embolic event. Transthoracic contrast echocardiography revealed a congenital aneurysm of the LV apex with a small thrombus and a reduced LV ejection fraction. Speckle tracking imaging showed an impaired myocardial torsion. Diagnosis was confirmed after surgical resection of the aneurysm. LV torsion and ejection fraction were normalized after surgery.

Predictors of Left Ventricular Performance After Valve Replacement in Children and Adolescents with Chronic Aortic Regurgitation

Aortic valve replacement has been recommended in patients who have severe symptoms, in patients with extreme left ventricle (LV) dilatation (end diastolic dimension >4 SD above normal) or LV ejection fraction <50%. However, the occurrence of advanced symptoms or severe LV dilatation raises concern about irreversible LV dysfunction. This study sought to determine the influence of preoperative symptoms, LV size and function on mortality, and postoperative LV performance in children and adolescence after valve replacement for aortic regurgitation (AR). A total of 49 patients 18 years old or younger (mean, 13.9 +/- 3) who underwent valve replacement for chronic AR between 1991 and 2001 were followed up for 1-10 years (mean, 3.3 +/- 2.1). Baseline and postoperative characteristics were compared between 13 patients (group 1) with extreme LV dilatation and 34 patients (group 2) with a lesser degree of LV enlargement. Preoperative low ejection fraction (p < 0.008), extreme LV dilatation (p < 0.05), and LV end systolic dimension >4 SD above normal (p < 0.05) were predictors of persistent LV dysfunction. Extreme LV dilatation (p < 0.0003), LV end systolic dimension (p < 0.0007), and reduced LV ejection fraction (p < 0.01) predicted persistent LV dilatation. In the setting of chronic AR, preoperative symptoms, LV systolic function, and LV internal dimensions are the main predictors for persistent LV dysfunction and dilatation. Surgical correction should be performed before LV systolic dysfunction and/or extreme LV enlargement occurs.

Late left ventricular diastolic flow propagation velocity determined by color M-mode Doppler in the assessment of diastolic dysfunction

Background Early color M-mode Doppler flow propagation (Ep) through the left ventricle (LV) has been proposed as a useful noninvasive index for assessing LV relaxation, whereas data concerning late velocity propagation (Ap) is lacking. Methods We studied 51 patients with delayed relaxation (group I) and 50 with pseudonormal filling pattern (group II). Another 51 aged-matched healthy persons served as the control group. Results Patients showed increased left atrial dimensions, atrial wave of the pulmonary vein flow, and Ap, and reduced LV ejection fraction, Ep, and Ep/Ap ratio compared with the control group. Patients in group II revealed increased left atrial dimensions ( P = .001), atrial wave of the pulmonary vein flow ( P < .001), and Ep/Ap ratio ( P < .001), and reduced LV ejection fraction and Ap ( P < .001) compared with group I. Regression analysis showed that the strongest independent variable distinguishing normal from pseudonormal filling pattern was the Ep/Ap ratio. Conclusion Ap evaluation offers a new diagnostic diastolic index, especially in the field of the pseudonormal pattern where the separation from normal is difficult.