Severe Left Ventricular Diastolic Dysfunction Research Articles

Left ventricular diastolic dysfunction worsens prognosis in patients with heart failure due to dilated cardiomyopathy.

The prognostic significance of left ventricular (LV) diastolic dysfunction (LVDD) severity in patients with dilated cardiomyopathy (DCM) remains uncertain. This study aimed to evaluate the association of LVDD severity and elevated left atrial pressure (eLAP) with patient outcomes in stable, non-acutely decompensated patients with DCM. This single-centre, retrospective, observational study involved 740 DCM patients (either inpatients or outpatients) managed at our tertiary cardiac centre between 2010 and 2021. Due to incomplete data, 96 patients were excluded. LVDD and eLAP were assessed using echocardiography according to the 2016 guidelines of the European Association of Cardiovascular Imaging (EACVI). The primary outcomes were all-cause mortality and heart failure (HF)-related mortality. The final cohort comprised of 644 DCM patients [mean age: 52±12years, LV ejection fraction (LVEF): 26±10%]. Over a median follow-up period of 41 (18.5-66.7) months, 105 (16.3%) patients died: 8 (5.3%) patients in the normal left atrial pressure (nLAP) group and 97 (19.6%) patients in the eLAP group. eLAP was identified as an independent prognostic factor for both all-cause mortality [hazard ratio (HR) 2.0; 95% confidence interval (CI) 1.1-3.7; P=0.01] and HF-related mortality (HR 2.5; 95% CI 1.01-6.5; P=0.04), even after adjusting for LVEF and atrial fibrillation (AF) presence. Additionally, HF-related mortality rates were significantly higher in patients with moderate to severe LVDD compared with those with mild LVDD [5 (3.3%) vs. 67 (13.6%), P<0.05]. This study's findings highlight the importance of assessing the severity of LVDD in patients with DCM, which provides incremental prognostic information over LVEF.

Relationship between left atrial/left ventricular diameter ratio and outcomes in patients with hypertrophic cardiomyopathy

BackgroundAlthough diastolic dysfunction is the main pathophysiological feature of hypertrophic cardiomyopathy (HCM), it remains to be clarified whether parameters of diastolic function can reliably determine HCM prognosis. In patients with reduced left ventricular (LV) distensibility, chronic elevation of LV diastolic pressure is seen with a smaller than expected LV size. Accordingly, patients with HCM with severe LV diastolic dysfunction typically demonstrate left atrial (LA) dilation and a disproportionately smaller left ventricle. Therefore, we investigated the relationship between LA/LV diameter ratio, as a potential indicator of disease progression, and outcomes in patients with HCM. MethodsWe included 468 patients in whom LA and LV end-diastolic diameter were successfully evaluated by echocardiography at the initial assessment. We divided the patients into two groups: those with an LA/LV diameter ratio > 1 and those with an LA/LV diameter ratio ≤ 1. We compared the HCM-related death rates between the two groups. ResultsOf the 468 patients, 96 patients (20.5 %) with HCM showed an LA/LV diameter ratio > 1. In the univariate analysis, patients with an LA/LV diameter ratio > 1 had a significantly greater likelihood of HCM-related death than patients with an LA/LV diameter ratio ≤ 1 (log-rank p = 0.002). In the multivariate Cox proportional hazards analysis, when including LA/LV diameter ratio > 1 and imbalanced baseline variables, an LA/LV diameter ratio > 1 was an independent determinant of HCM-related death (adjusted hazard ratio: 1.87, 95 % confidence interval: 1.08–3.24; p = 0.024). ConclusionLA/LV diameter ratio can be easily evaluated and may be useful for risk stratification of HCM-related death in patients with HCM.

Transcatheter transfemoral aortic valve replacement in a patient with acromegaly and severe left ventricular myocardial hypertrophy. Case report

Main causes of secondary hypertrophic cardiomyopathy include acromegalic cardiomyopathy. Heart damage in patients with the acromegaly is mediated both by the direct action of growth hormone and insulin-like growth factor-1, and increased deposition of collagen and lymphomononuclear cells in the myocardium, which leads to architectural changes, disturbances in fluid and electrolyte balance, severe left ventricular myocardial hypertrophy, diastolic and systolic left ventricular dysfunction and chronic heart failure. This article presents the world's first described observation demonstrating the possibility of successful transfemoral aortic valve repair to a comorbid patient with severe aortic stenosis according to the potential risks caused by the active form of the acromegaly.

Association of left ventricular diastolic dysfunction with inflammatory activity, renal dysfunction, and liver-related mortality in patients with cirrhosis and ascites.

Left ventricular diastolic dysfunction (LVDD) is the predominant cardiac abnormality in cirrhosis. We investigated the association of LVDD with systemic inflammation and its impact on renal function, occurrence of hepatorenal syndrome (HRS) and survival in patients with cirrhosis and ascites. We prospectively enrolled 215 patients with cirrhosis and ascites. We evaluated the diagnosis and grading of LVDD by Doppler echocardiography, inflammatory markers, systemic hemodynamics, vasoactive factors, radioisotope-assessed renal function and blood flow, HRS development and liver-related mortality. LVDD was diagnosed in 142 (66%) patients [grade 2/3: n = 61 (43%)]. Serum lipopolysaccharide-binding protein (LBP), plasma renin activity (PRA) and glomerular filtration rate (GFR) were independently associated with the presence of grade 2/3 LVDD and the severity of diastolic dysfunction. Serum tumor necrosis factor-α, cardiac output and plasma noradrenaline were also independently associated with the presence of grade 2/3 LVDD. The diastolic function marker E/e' was strongly correlated with serum LBP (r = 0.731; P < 0.001), PRA (r = 0.714; P < 0.001) and GFR (r = -0.609; P < 0.001) among patients with LVDD. The 5-year risk of HRS development and death was significantly higher in patients with grade 2/3 LVDD compared to those with grade 1 (35.5 vs. 14.4%; P = 0.01 and 53.3 vs. 28.2%; P = 0.03, respectively). The occurrence and severity of LVDD in patients with cirrhosis and ascites is closely related to inflammatory activity. Advanced LVDD is associated with baseline circulatory and renal dysfunction, favoring HRS development, and increased mortality.

The association between the severity of erectile dysfunction and left ventricular diastolic dysfunction in patients with and without cardiovascular disease.

Erectile dysfunction (ED) is considered a microvascular disorder and serves as an indicator for the potential development of cardiovascular disease (CVD). Although left ventricular diastolic dysfunction (LVDD) reflects early myocardial damage caused by microvascular disorders, the association between ED and LVDD remains poorly elucidated. A cross-sectional study was conducted on 123 patients with ED. They underwent RigiScan, and conventional echocardiography, and attempted International Index of Erectile Function (IIEF) questionnaire. ED severity was evaluated by measuring changes in the penile base circumference and duration of penile rigidity (≥70%) during erection. The early diastolic velocity of mitral inflow (E) and early diastolic velocity of the mitral annulus (e') were measured using echocardiography. The patients were grouped based on the presence of CVD. Among 123 patients, 29 had CVD and 94 did not. Patients with CVD exhibited more pronounced ED and more severe LVDD. Associations between increased penile circumference with echocardiographic parameters were more prominent in patients with CVD than in those without CVD (ΔTtop and e' wave, r=0.508 and r=0.282, respectively, p for interaction=0.033; ΔTbase and E/e' ratio, r=-0.338 and r=-0.293, respectively, p for interaction <0.001). In the multivariate linear regression, the increase of penile base circumference was an independent risk factor for LVDD (e', B=0.503; E/e' ratio, B=-1.416, respectively, p<0.001). ED severity correlated well with LV diastolic dysfunction, particularly in the presence of CVD. This study highlighted the potential role of ED assessment as early indicator of CVD development.

Abstract 17128: Detection of Hypertrophic Cardiomyopathy From Noisy Single-Lead Electrocardiography

Background: Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death among young people and be detected from ECGs using artificial intelligence. Wearable devices could allow for broad AI-based screening but obtain noisy ECGs. We report the development of a wearable-adapted AI-ECG model that retains performance for detecting HCM in noisy single-lead ECGs. Methods: In 11,883 ECGs obtained within 30 days of transthoracic echocardiograms from Yale New Haven Hospital (2015-2021), we defined HCM as interventricular septal wall thickness (end diastole) (IVSd) &gt; 15 mm and moderate to severe left ventricular diastolic dysfunction (LVDD). Standard and noise-adapted models were trained using a 1:10 age-sex matched dataset. For the noise-adapted model, each ECG was included four times in the training set, augmented each time with random gaussian noise within four distinct frequency ranges emulating different real-world noise sources. We evaluated the performance of the noise-adapted and standard models on an independent set of ECGs with four different real-world noisy artifacts, including noise extracted from a portable device ECG, at multiple signal-to-noise ratios (SNRs). Results: In single-lead ECGs without noise, the noise-adapted model outperformed the standard model, with an AUROC of 0.920 and 0.906, respectively for HCM. With the same ECGs augmented with noise ranging from half (SNR 2) to twice (SNR 0.5) the signal, the noise-adapted model maintained their performance across real-world noise signatures (A). At an SNR of 0.5, the noise adapted model had a significantly greater performance in detecting HCM in ECGs augmented with portable device ECG noise (AUROC 0.917 [0.861-0.974] vs 0.609 [0.398, 0.821]) (B). Conclusions: We developed a model which accurately screens for HCM in noisy single-lead ECGs. This approach represents a more accessible and scalable method for screening for HCM using wearable device ECGs.

Characterization of heterozygous and homozygous mouse models with the most common hypertrophic cardiomyopathy mutation MYBPC3c.2373InsG in the Netherlands

Hypertrophic cardiomyopathy (HCM) is frequently caused by mutations in the cardiac myosin binding protein-C (cMyBP-C) encoding gene MYBPC3. In the Netherlands, approximately 25% of patients carry the MYBPC3c.2373InsG founder mutation. Most patients are heterozygous (MYBPC3+/InsG) and have highly variable phenotypic expression, whereas homozygous (MYBPC3InsG/InsG) patients have severe HCM at a young age. To improve understanding of disease progression and genotype-phenotype relationship based on the hallmarks of human HCM, we characterized mice with CRISPR/Cas9-induced heterozygous and homozygous mutations. At 18–28 weeks of age, we assessed the cardiac phenotype of Mybpc3+/InsG and Mybpc3InsG/InsG mice with echocardiography, and performed histological analyses. Cytoskeletal proteins and cardiomyocyte contractility of 3–4 week old and 18–28 week old Mybpc3c.2373InsG mice were compared to wild-type (WT) mice. Expectedly, knock-in of Mybpc3c.2373InsG resulted in the absence of cMyBP-C and our 18–28 week old homozygous Mybpc3c.2373InsG model developed cardiac hypertrophy and severe left ventricular systolic and diastolic dysfunction, whereas HCM was not evident in Mybpc3+/InsG mice. Mybpc3InsG/InsG cardiomyocytes also presented with slowed contraction-relaxation kinetics, to a greater extent in 18–28 week old mice, partially due to increased levels of detyrosinated tubulin and desmin, and reduced cardiac troponin I (cTnI) phosphorylation. Impaired cardiomyocyte contraction-relaxation kinetics were successfully normalized in 18–28 week old Mybpc3InsG/InsG cardiomyocytes by combining detyrosination inhibitor parthenolide and β-adrenergic receptor agonist isoproterenol. Both the 3–4 week old and 18–28 week old Mybpc3InsG/InsG models recapitulate HCM, with a severe phenotype present in the 18–28 week old model.

Abnormal inter-ventricular diastolic mechanical delay in patients with ST-segment elevation myocardial infarction

BackgroundThis study aimed to investigate the ventricular mechanical relaxation pattern and its clinical influence in patients with ST-segment elevation myocardial infarction (STEMI).MethodsEchocardiography was performed to measure mitral and tricuspid diastolic opening times. Left ventricular diastolic mechanical delay (LVMDd) was defined as diastolic filling of the right ventricle earlier than that of the left ventricle, and right ventricular diastolic mechanical delay (RVMDd) was defined as the right ventricular diastolic filling later than left ventricular filling.ResultsAmong 152 patients with STEMI, 100 (65.8%) had LVMDd, and 47 (30.9%) had RVMDd. In-hospital complications were significantly increased in patients with RVMDd (61.6% vs. 41.0%, P = 0.017). Those with RVMDd exhibited significantly lower left ventricular global longitudinal strain (11.7 ± 4.1% vs. 13.2 ± 4.0%, P = 0.035), global work index (913.8 ± 365.9 vs. 1098.9 ± 358.8 mmHg%, P = 0.005) and global constructive work (1218.6 ± 392.8 vs. 1393.7 ± 432.7 mmHg%, P = 0.021). Mitral deceleration time significantly decreased (127.4 ± 33.5 vs. 145.6 ± 41.7 ms, P = 0.012), and the ratio of early mitral inflow to early mitral annular velocity (E/E’) significantly increased [13.0(11.0–20.0) vs. 11.9(9.3–14.3), P = 0.006] in the RVMDd group. Logistic regression analysis showed that age (odds ratio [OR]:0.920; P = 0.001), brain natriuretic peptide level (OR: 1.1002; P = 0.036) and mitral E/E’ (OR: 1.187; P = 0.003) were independently associated with RVMDd.ConclusionsDelayed right ventricular filling is related to more severe left ventricular systolic and diastolic dysfunction in STEMI patients. More attention should be paid to patients with RVMDd to prevent adverse events during hospitalization.

Diastolic Dysfunction and Health Status Outcomes After Transcatheter Aortic Valve Replacement

BackgroundBaseline left ventricular diastolic dysfunction (LVDD) is associated with poor health status in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but health status improvement after TAVR appears similar across all grades of LVDD. Here, we aim to examine the relationship between changes in LVDD severity and health status outcomes following TAVR. MethodsPatients who underwent TAVR and had evaluable LVDD at both baseline and 1 year in the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registries and PARTNER 3 trial were analyzed. LVDD grade was evaluated using echocardiography core lab data and an adapted definition of American Society of Echocardiography guidelines. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score. The association between ΔLVDD severity and ΔKCCQ-OS was examined using linear regression models adjusted for baseline KCCQ-OS. ResultsOf 1100 patients, 724 (65.8%), 283 (25.7%), and 93 (8.5%) had grade 0/1, 2, and 3 LVDD at baseline, respectively. At 1 year, LVDD severity was unchanged in 790 (71.8%) patients, improved in 189 (17.2%), and worsened in 121 (11.0%). Among 376 patients with baseline grade 2 or 3 LVDD, 50.3% had improvement in LVDD. In the overall cohort, KCCQ-OS score improved by 21.9 points at 1 year. There was a statistically significant association between change in LVDD severity (improved, unchanged, and worsened) and ΔKCCQ-OS at 1 year (p = 0.007). ConclusionsChange in LVDD grade was associated with change in health status 1 year following TAVR.

Fenestration: Integrating Wings Into the Atrial Septal Occluder for Navigating a Challenging Terrain.

Background Atrial septal defect (ASD) closure with significant left-to-right shunt and concurrent comorbidities poses challenges for intervention. A fenestrated atrial septal defect (FASD) device is a viable option for patients who cannot undergo complete occlusion due to hemodynamic and medical reasons. This study explores the use of FASD occluders in patients with secundum ASD and associated comorbidities where complete occlusion is difficult. Methodology This retrospective study collected the details of patients recommended for FASD closure diagnosed with significant secundum ASD and who had additional comorbidities between July 2015 and July 2023 in a tertiary cardiac center in eastern India. Among this cohort, patients who underwent FASD device placement were subjected to a comprehensive analysis. Results In total, 16 patients diagnosed with secundum ASD, characterized by significant left-to-right shunt and concurrent comorbidities, were considered for FASD closure during the study period. Ultimately, 13 patients (first group) underwent fenestrated atrial septal occluder implantation. The average age was 45.07 years, with the majority being females (n = 9). Comorbidities among this cohort included substantial left ventricular diastolic dysfunction (n = 7), left ventricular diastolic dysfunction coupled with moderate pulmonary hypertension (n = 1), severe pulmonary hypertension (n = 1), severe pulmonary valvular stenosis with right ventricular diastolic dysfunction (n = 2), and systemic lupus erythematosus (SLE) (n = 2). From this cohort, three patients did not undergo the intervention. The second group consisted of an elderly patient with severe left ventricular diastolic dysfunction, a young adult with a history of left atrial arrhythmia, and achild with Duchenne muscular dystrophy (DMD). The average ASD size among patients who underwent the intervention was 26.38 mm, with a thick-to-thick dimension measuring 31.15 mm. The procedure was successful in all 13 patients, with the most frequently used device being a 34 mm occluder (range = 28-40 mm). All devices, excluding the initial one, were custom-made atrial septal occluders (Lifetech Scientific). Among the patients, 12 exhibited left-to-right fenestration flow, while one patient experienced fenestration constriction, likely due to occluder overcrowding. The first patient hada handmade 5 mm fenestration in a 40 mm Amplatzer septal occluder, which got closed off at the one-year follow-up. The procedure was well-tolerated hemodynamically in all patients, with no major complications during the peri-procedural period. Short-term follow-up indicated favorable patient progress. Conclusions FASD closure emerges as a pivotal alternative for intricate scenarios involving secundum ASD coupled with concurrent comorbidities, offeringindividualized tailored solutions. Alongside the conventional associated comorbidities, such as left ventricular diastolic dysfunction and pulmonary hypertension, FASD devices hold the potential to extend their benefits to patients grappling with other complexities, including severe pulmonary valvular stenosis, SLE, predisposition to left atrial arrhythmia, and conditions like DMD. Ensuring meticulous evaluation of patient suitability and providing ongoing vigilant care becomes paramount for achieving optimal outcomes. The validation of these findings and the broadening of the comprehension of this approach necessitate further comprehensive investigations.

Incidence and Risk Factors for Long-Term Persistence of Diastolic Dysfunction after Aortic Valve Replacement for Aortic Stenosis Compared with Aortic Regurgitation

(1) Background: Severe left ventricular (LV) diastolic dysfunction with a restrictive diastolic pattern (LVDFP) is generally associated with a worse prognosis. Its evolution and reversibility in the short- and medium-term after aortic valve replacement (AVR) has been little-studied. We aimed to evaluate the evolution of LV remodeling and LV systolic and diastolic function after AVR in aortic stenosis (AS) patients compared to aortic regurgitation (AR). Moreover, we tried to identify the main predictive parameters for postoperative evolution (cardiovascular hospitalization or death and quality of life) and the independent predictors for the persistence of restrictive LVDFP after AVR. (2) Methods: A five-year prospective study on 397 patients undergoing AVR for AS (226 pts) or AR (171 pts), evaluated clinically and by echocardiography preoperatively and until 5 years postoperatively. (3) Results: 1. In patients with AS, early post AVR, LV dimensions decreased and diastolic filling and LV ejection fraction (LVEF) improved more rapidly compared to patients with AR. At 1 year postoperatively, persistent restrictive LVDFP was found especially in the AR group compared to the AS group (36.84% vs. 14.16%). 2. Cardiovascular event-free survival at the 5-year follow-up was lower in the AR group (64.91% vs. 87.17% in the AS group). The main independent predictors of short- and medium-term prognosis after AVR were: restrictive LVDFP, severe LV systolic dysfunction, severe pulmonary hypertension (PHT), advanced age, severe AR, and comorbidities. 3. The persistence of restrictive LVDFP after AVR was independently predicted by: preoperative AR, the E/Ea ratio > 12, the LA dimension index > 30 mm/m2, an LV endsystolic diameter (LVESD) > 55 mm, severe PHT, and associated second-degree MR (p < 0.05). (4) Conclusions: AS patients had an immediate postoperative evolution in terms of LV remodeling, and LV systolic and diastolic function were more favorable compared to those with AR. The restrictive LVDFP was reversible, especially after the AVR for AS. The main prognostic predictors were the presence of restrictive LVDFP, advanced age, preoperative AR, severe LV systolic dysfunction, and severe PHT.

The Relationship of Left Ventricular Diastolic Dysfunction and Asymmetrical Dimethylarginine as a Biomarker of Endothelial Dysfunction with Cardiovascular Risk Assessed by Systematic Coronary Risk Evaluation2 Algorithm and Heart Failure—A Cross-Sectional Study

Background: Cardiovascular (CV) risk factors, causing endothelial dysfunction (ED) and left ventricular diastolic dysfunction (LVDD), contribute to an increased risk of heart failure (HF). The aim of this study was to determine the relationship between the occurrence of LVDD and ED with CV risk assessed by the Systematic Coronary Risk Evaluation2 (SCORE2) algorithm and HF. Methods: In the period from November 2019 to May 2022, a cross-sectional study that included 178 middle-aged adults was conducted. Transthoracic echocardiography (TTE) was used to assess left ventricular (LV) diastolic and systolic function. ED was assessed using the plasma values of asymmetric dimethylarginine (ADMA) and was determined using the ELISA method. Results: The majority of subjects with LVDD grades 2 and 3 had high/very high SCORE2, developed HF and all were taking medication (p < 0.001). They also had significantly lowest plasma ADMA values (p < 0.001). We found that the reduction of ADMA concentration is influenced by certain groups of drugs, or more significantly, by their combinations (p < 0.001). Conclusions: In our study, we confirmed a positive correlation between LVDD, HF and SCORE2 severity. The results showed a negative correlation between the biomarkers of ED, LVDD severity, HF, and SCORE2, which we believe is due to medication effects.

Clinical Features of Heart Failure in Patients With Hypertrophic Cardiomyopathy in a Regional Japanese Cohort - Results From the Kochi RYOMA Study.

The clinical features of heart failure (HF) in patients with hypertrophic cardiomyopathy (HCM) in Japan have not been fully elucidated.Methods and Results: In 293 patients with HCM (median age at registration, 65 (57-72) years) in a prospective cardiomyopathy registration network in Kochi Prefecture (Kochi RYOMA study), HF events (HF death or hospitalization for HF) occurred in 35 patients (11.9%) (median age, 76 (69-80) years), including 11 HF deaths during a median follow-up of 6.1 years. The 5-year HF events rate was 9.6%. Atrial fibrillation, low percentage of fractional shortening, and high B-type natriuretic peptide level at registration were predictors of HF events. The combination of these 3 factors had a relatively high positive predictive value (55%) for HF events and none of them had a high negative predictive value (99%). There were 4 types of HF profile: left ventricular (LV) systolic dysfunction (40%), severe LV diastolic dysfunction (34%), LV outflow tract obstruction (LVOTO) (20%), and primary mitral regurgitation (MR) (6%). HF deaths occurred in patients with LV systolic dysfunction or LV diastolic dysfunction, but none of patients with LVOTO or primary MR due to additional invasive therapies. In a Japanese HCM cohort, HF was an important complication, requiring careful follow-up and appropriate treatment.

Effect of vitamin D levels on the hormonal and metabolic status in patients with metabolic syndrome and chronic kidney disease

Aim. To assess the association of vitamin D deficiency with hormonal and metabolic disorders, including with insulin resistance and leptin levels, in patients with metabolic syndrome (MS) and chronic kidney disease (CKD).Material and methods. The study included 81 patients with MS and CKD aged 45-59 years (mean age, 51±4 years). Depending on vitamin D level, the patients were divided into two groups: group 1 (n=49) — patients with reduced level (23,2±5,1 ng/ml); group 2 (n=32) — patients with an adequate level (54,8±12,1 ng/ml). Statistical processing was carried out using STATISTICA 10.0 software.Results. In patients of the first group, the following parameters were higher than in the second one: waist circumference by 9,0% (p&lt;0,05), waist-to-hip ratio by 8,2% (p&lt;0,05), body mass index by 15,1% (p&lt;0,05). The groups did not differ significantly in systolic and diastolic blood pressure levels. In the first group, the level of total cholesterol by 18,6% (p&lt;0,01), low density lipoprotein cholesterol by 11,9% (p&lt;0,05), triglycerides by 20,8% (p&lt;0,01), Homeostasis Model Assessment Insulin Resistance (HOMA-IR) by 42,5% (p&lt;0,001), leptin by 30,5% (p&lt;0,01) were higher than in the second group. More severe left ventricular diastolic dysfunction in the first group than in the second one was determined as follows: lower left ventricular early to late filling (E/A) by 13,2% (p&lt;0,05) and deceleration time of the early transmitral flow velocity by 13,1% (p&lt;0,05).Conclusion. The results obtained indicate that patients with MS, CKD and vitamin D deficiency are more likely to have general obesity, more pronounced carbohydrate (HOMA-IR index) and fat (levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides) metabolism disorders, as well as high serum levels of leptin compared with patients with adequate levels of this vitamin.

Acute Unilateral Lung Edema Following Reperfusion in a Lung Transplant Recipient: A Case Report Discussing the Role of Double Chambered Right Ventricle

<h3>Introduction</h3> Acute unilateral lung edema immediately following reperfusion of newly transplanted lung is rare. We present a case of a hemodynamic collapse with acute lung edema during a sequential single lung transplantation (LTx) for emphysema in a patient with post-operatively diagnosed double-chambered right ventricle (DCRV). <h3>Case Report</h3> A 61-year old woman underwent LTx. Pre-operative trans-thoracic echocardiography (ECHO) showed only mild signs of pulmonary hypertension with a septal bounce sign. Invasively measured pulmonary pressures were normal at induction. One hour following reperfusion of the first transplanted right lung (RL) the graft developed severe edema and the patient developed severe systemic hypotension. Therefore, urgent VA-ECMO was installed. Trans-esophageal ECHO excluded pulmonary vein stenosis (PVS) of the congested lung (<i>Fig 1, A</i>). A biopsy excluded hyperacute rejection (HAR). After 30 minutes of ECMO support recovery of the graft occured (<i>Fig 1, B</i>). ECMO was continued until post-operative day (POD) 2. Computed tomography (CT) on POD 32 revealed RV hypertrophy, RV outflow tract stenosis causing DCRV (<i>Fig 1, D&E</i>) and reduced sternum-spine diameter. (<i>Fig 1, G</i>). Heart catheterization on POD 87 showed a RVOT gradient of 26 mmHg and severe left ventricular (LV) diastolic dysfunction (DD) (end diastolic pressure 33mmHg). <h3>Summary</h3> The differential diagnosis of intra-operative acute unilateral edema after LTx includes primary graft dysfunction (PGD), PVS, HAR or cardiogenic edema. PGD was unlikely due to the nature and evolution of the edema. Cardiogenic origin is possible based on LV DD. This can be due to underlying cardiac disease, acute ischemia or the effect of DCRV (reverse Bernheim effect: <i>Fig 1, F</i>). It is not clear if the DCRV was present before LTx. Our case demonstrates the essential role of proper assessment of both LV and RV morphology and function before LTx.

Left ventricular diastolic dysfunction and cardiovascular disease in different ambient air pollution conditions: A prospective cohort study

Although previous studies indicated that the left ventricular diastolic dysfunction (LVDD) is associated with cardiovascular disease (CVD), it remains unclear whether effects would be enhanced or accelerated by long-term air pollution exposure. During 4.65 years (107,726 person-years) of follow-up, 942 cases of CVD events incident were identified among 23,143 participants from the China Hypertension Survey (CHS). Grading diastolic dysfunction was based on Recommendations for the evaluation of left ventricular diastolic function by echocardiography (2009). The annual average PM2.5, PM10 and NO2 concentrations were obtained by the chemical data assimilation system. Cox proportional hazards models were employed to estimate hazard ratios (HRs) for CVD in relation to LVDD. At baseline, the participants' mean age was 56.7 years, 46.8% were male. Compared to normal group, the HR (95% CI) of LVDD was 1.27 (1.07–1.50) after adjusting for all covariates. When stratified by ambient air pollution, we found that in middle and worst third PM2.5 areas, increased CVD risk was associated with increasing LVDD grade, both P for trend <0.05; The HRs (95% CI) of the CVD incidence were 1.52 (0.68–3.44), 4.97 (1.76–14.03) and 4.07 (1.44–11.49) for severe LVDD in the best, middle and worst third PM2.5 areas, respectively. Similar results were also presented for PM10 and NO2. In conclusion, our study highlights a stronger detectable adverse association between LVDD with CVD in worse ambient air quality assessed by any of the three primary ambient air pollutants (PM2.5, PM10 and NO2). Our study calls for appropriate interventions to reduce air pollution, which may promote great benefits to public health potentially by providing protection against the adverse CVD events.

Left ventricular diastolic dysfunction: a surrogate predictor of poor transplant-free survival in patients with decompensated cirrhosis

Background and Aim: Left Ventricular Diastolic Dysfunction (LVDD) is a primal manifestation of Cirrhotic Cardiomyopathy. Few studies have addressed its relationship with mortality outcomes. We evaluated the impact of LVDD along with other parameters on the short-term survival of patients with Decompensated Cirrhosis. Methods: 192 patients with Decompensated Cirrhosis underwent investigations including 2D echocardiography with Tissue Doppler imaging. The diagnosis of LVDD was based on the American Society of Echocardiography guidelines and the patients were followed up for 6 months. Results: 42.2% (n=81) had grade 1 LVDD and 30.7%(59) had grade 2 LVDD at enrolment. 69.2%(128) were alive at 6 months. Among the non-survivors, 5.9% had no LVDD, 23.4% had grade-1 and 62.1% had grade-2 LVDD (p=<0.001). Median survival of LVDD grades 0, 1, and 2 was 177±3, 163±3, and 122±3 days respectively. Kaplan Meier survival analysis showed poor survival in patients with LVDD (p<0.001), E/e'>10 (p=0.029) and PCWP >15mmHg (p=0.003). The Cox regression model showed a hazard ratio of 10.3 for grade-2 LVDD, and 5.7 for any LVDD compared to 1.07 for MELD score as an independent predictor of mortality. MELD score cut-off for predicting mortality was 17 (84% sensitivity; 62% specificity). Mortality in patients with MELD >17 was 52.9% with LVDD vs 9.5% without LVDD (p<0.001), and MELD >17 was 16.7% with LVDD vs 3.4% without LVDD(p=0.08). In multivariate analysis, the MELD score and LVDD were independent predictors of survival. Among echocardiography parameters, patients with a ratio of early filling velocity to early diastolic mitral annular velocity(E/e') >10 and Pulmonary capillary wedge pressure(PCWP) >15mmHg were significantly associated with the severity and mortality of the patients. Conclusions: The presence and severity of LVDD are better predictors of poor transplant-free survival than MELD in patients with Decompensated Cirrhosis. Therefore, cardiac parameters could be an add-on to the MELD score for prognostication of Decompensated Cirrhosis patients.

Abstract 10997: Long-Term Prognostic Value of Catheter-Derived Left Ventricular Diastolic Stiffness in Patients Undergoing Transcatheter Aortic Valve Replacement

Introduction: Despite successful transcatheter aortic valve replacement (TAVR), low flow rate (FR) severe aortic stenosis (AS) patients reportedly experienced poorer clinical outcomes than normal FR AS patients. Left ventricular (LV) diastolic function influences stroke volume, though limited data on TAVR outcomes in patients with severe LV diastolic dysfunction is available. Hypothesis: AS patients with severe LV diastolic dysfunction may develop adverse cardiac events, such as heart failure, even after TAVR. Methods: Consecutive patients with severe AS and preserved LV ejection fraction (&gt; 50%) who underwent hemodynamic assessment of LV function using cardiac catheterization before TAVR were enrolled. The average slope of the end-diastolic pressure-volume relationship was calculated to determine LV diastolic stiffness. Adverse cardiac events were defined as cardiac death or heart failure hospitalization. High LV stiffness (&gt; 190 mmHg/L) patients were compared to normal LV stiffness patients. Results: Of the 78 patients (age 83.2 ± 5.1 years; 21 men), 30 (38.5%) were classified to the high LV stiffness group. Low FR (&lt; 200 mL/s) severe AS was more likely in patients with high LV stiffness than in those with normal LV stiffness (66.7% vs 33.3%, P = 0.004). Adverse cardiac events increased in the high LV stiffness group (Figure, Log rank P = 0.054). Cox regression analysis revealed that LV stiffness was associated with increased adverse cardiac events, after adjusting for age, sex, aortic valve area, and renal function (HR, 1.008; 95%CI, 1.001-1.014; P = 0.026). Conclusion: Increased LV stiffness derived from cardiac catheterization was related to low FR and was also associated with poor clinical outcomes after TAVR.

Abstract 10150: Distinct Gut Microbiota Composition Among Older Adults with Impaired Left Ventricular Diastolic Function

Introduction: Recent research has demonstrated shifts in intestinal microbial composition in response to cardiovascular disease (CVD) development. Left ventricular (LV) diastolic dysfunction is an early manifestation of myocardial ageing. We aimed to examine whether gut microbial composition is associated with LV diastolic function among healthy older adults. Methods: Among community older adults, 15 subjects with preserved LV ejection fraction on echocardiography underwent gut microbial composition examination in this proof-of-concept cross-sectional study. Myocardial relaxation (diastolic function) was impaired in those subjects with lower ratios of peak early (E) to late diastolic (A, atrial contraction) velocities. Metagenomic reads from stool samples were analyzed after excluding human reference genome data, and classified into various microbial taxonomic groups using lowest-common-ancestor algorithm. Statistical analysis was performed using linear discriminant analysis (LDA). Results: The subjects (53% males, mean age 75±4 years) were stratified into Groups 1 (n=8) and 2 (n=7) with more severe and lesser diastolic dysfunction, respectively, based on E/A ratios (0.77 vs. 1.28, p&lt;0.0001). In Group 1, there was significantly higher prevalence of certain bacteria (p&lt;0.05), including Bacteroides sp, Ruminococcus sp., and Paraprevotella (Figure 1). The largest relative effect size was with Bacteroides sp., including Bacteroides xylanisolvens (logarithmic LDA score 3.0). In Group 2, there was significantly higher prevalence (p&lt;0.05) of Oscillibacter sp., Peptostreptococcaceae, Clostridioides difficile, Prevotella timonensis, and Blautia producta. Relative effect size was largest with Oscillibacter sp. (log 2.8). Conclusions: Distinct gut microbiota were associated with more severe vs. lesser LV diastolic dysfunction. Future validation in larger cohorts is warranted for targeting the microbiome in myocardial ageing.

Development of a nomogram for predicting the risk of left ventricular diastolic function in subjects with type-2 diabetes mellitus

Left ventricular diastolic dysfunction (LVDD) can be affected by many factors, including epicardial adipose tissue (EAT), obesity and type-2 diabetes mellitus (T2DM). The aim of this study was to establish and validate an easy-to-use nomogram that predicts the severity of LVDD in patients with T2DM. This is a retrospective study of 84 consecutive subjects with T2DM admitted to the Endocrinology Department, the First People’s Hospital of Zunyi City between January 2015 and October 2020. Several echocardiographic characteristics were used to diagnose diastolic dysfunction according to the 2016 diastolic dysfunction ASE guidelines. Anthropometric, demographic, and biochemical parameters were collected. Through a least absolute shrinkage and selection operator (LASSO) regression model, we reduced the dimensionality of the data and determined factors for the nomogram. The mean follow-up was 25.97 months. Cases were divided into two groups, those with LVDD (31) and those without (53). LASSO regression identified total cholesterol (Tol.chol), low-density lipoprotein (LDL), right ventricular anterior wall (RVAW) and epicardial adipose tissue (EAT) were identified as predictive factors in the nomogram. The ROC curve analysis demonstrated that the AUC value for most clinical paramerters was higher than 0.6. The nomogram can be used to promote the individualized prediction of LVDD risk in T2DM patients, and help to prioritize patients diagnosed with echocardiography.