Cardiac Chamber Size Research Articles

Left Atrial Volume as a Biomarker of Target Organ Damage in Cardionephrology: A Study in a Wide Range of Renal Function

Cardiac chamber size was previously studied by echocardiography, among patients with progressive kidney disease only. We aimed to explore the relations between all heart chamber volumes as assessed by CT pulmonary angiography and renal function, throughout all ranges. Using a novel technology for automatic four-chamber volumetric analysis, we analyzed CT pulmonary angiography results for 748 consecutive patients (between January 1 and December 31, 2014) without pulmonary embolism, and correlated the chamber volumes, indexed to body surface area, with the estimated glomerular filtration rates (eGFRs). After adjustment for age, all cardiac chamber volumes aside from that of the left ventricle inversely correlated with the eGFR. For every 10-unit decrease in eGFR, the volume indices of the left atrium, right atrium, and right ventricle were larger by 3.1%, 2.3%, and 1.5%(P< .001, P= .003, P= .007), respectively. There was a significant correlation between left atrial volume index and eGFR (r=-0.43; P< .001). In a categorical comparison, patients with even minimal renal dysfunction (eGFR, 60 to 90mL/min/1.73 m2) had a 10.3%larger left atrial volume index (95%CI, 3.1-17.9; P= .004) compared to patients with an eGFR > 90mL/min/1.73 m2. A simple concomitant volumetric analysis of all four cardiac chambers by CT pulmonary angiography demonstrated that differences in volume correlate with renal function even within the normal range spectrum. The difference was most evident in the left atrium. This finding may be the first clue to evolving cardiorenal syndrome and may serve as a target for early therapeutic interventions. ClinicalTrials.gov; Clinical Trials registration number (Helsinki Committee): 0603-15-TLV; URL: www.clinicaltrials.gov.

Fetal Mouse Cardiovascular Imaging Using a High-frequency Ultrasound (30/45MHZ) System.

Congenital heart defects (CHDs) are the most common cause of childhood morbidity and early mortality. Prenatal detectionof the underlying molecular mechanisms of CHDs iscrucial for inventing new preventive and therapeutic strategies. Mutant mouse models are powerful tools to discover newmechanismsand environmental stress modifiers that drive cardiac development and their potentialalteration in CHDs. However, efforts to establish the causality of these putative contributors have been limited to histologicaland molecular studiesin non-survival animal experiments, in whichmonitoring the key physiological and hemodynamic parameters isoften absent. Live imaging technology has become an essential tool to establish theetiology of CHDs. In particular,ultrasound imaging can be used prenatally without surgically exposing the fetuses,allowing maintainingtheir baseline physiology while monitoring the impact of environmental stresson the hemodynamic and structural aspects of cardiac chamber development. Herein, we use the High-Frequency Ultrasound (30/45)system to examine the cardiovascular system in fetal mice at E18.5 in utero at the baseline and in response to prenatal hypoxia exposure. We demonstrate the feasibility of the system to measure cardiac chamber size, morphology, ventricular function, fetal heart rate, and umbilical artery flow indices, and their alterations in fetal mice exposed to systemic chronic hypoxia in utero in real time.

The Ebb and Flow of Echocardiographic Cardiac Function Parameters in Relationship to Hemodialysis Treatment in Patients with ESRD.

Cardiovascular disease is the leading cause of mortality in patients receiving hemodialysis. Cardiovascular events in these patients demonstrate a day-of-week pattern; i.e., they occur more commonly during the last day of the long interdialytic interval and the first session of the week. The hemodialysis process causes acute decreases in cardiac chamber size and pulmonary circulation loading and acute diastolic dysfunction, possibly through myocardial stunning and other non-myocardial-related mechanisms; systolic function, in contrast, is largely unchanged. During interdialytic intervals volume overload, acid-base, and electrolyte shifts, as well as arterial and myocardial wall changes, result in dilatation of right cardiac chambers and pulmonary circulation overload. Recent studies suggest that these alterations are more extended during the long interdialytic interval or the first dialysis session of the week and are associated with excess volume overload or removal, respectively, thus adding a mechanism for the day-of-week pattern of mortality in patients receiving hemodialysis. This review summarizes the existing data from echocardiographic studies of cardiac morphology and function during the hemodialysis session, as well as during the interdialytic intervals.

Assessment of Diastolic Dysfunction Parameters and Cardiac Chamber Size in Smokers with COPD: A Case Control Study

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a critical health care burden across the globe. Pulmonary Hypertension (PH) is a widespread feature of advanced COPD and is estimated to affect 20% of individuals with advanced COPD.Aim: To compare the variables of cardiac function, chamber size and diastolic parameters across various stages of COPD.Materials and Methods: A prospective case control study was conducted among 50 subjects and 50 controls (convenient sampling) with COPD over a period of two years in kasturba Medical college, Manipal (July 2012-July 2014). Chronic smokers who met the criteria for COPD according to GOLD criteria were included in the study. All patients underwent Pulmonary Function Test (PFT) using spirometer.Results: Twenty seven out of 50 studied patients (54%) had Pulmonary Artery Hypertension (PAH). Nineteen patients had mild PAH (38%). Dimension of cardiac chamber across various stages of COPD were found to have a significant decrease in Left Atrial (LA) area. Our study found an increase in Isovolumic Relaxation Time (IVRT), Pulmonary Artery Pressure (PAP) and TEI index (myocardial performance index) across stages of COPD however it was not statistically significant.Conclusion: Majority of the patients with COPD had PH, with increasing frequency of PAH across the GOLD stages. A decrease in cardiac chamber size was demonstrated with increasing severity of COPD.

Characterisation of Changes in Cardiac Chamber Size and Function in Patients With Different Classes of Obesity

Background: Obesity is proposed to be associated with an increased susceptibility to the development of cardiac disease based on adaptive structural and functional changes in the heart. We hypothesise the end result of obesity-associated changes in myocardial structure and function may vary at distinct stages of weight gain, with many of these changes possible precursors to more overt forms of cardiac dysfunction and heart failure. Hence, the aim of this study was to characterise changes in cardiac structure and function based on weight.

Cardiovascular response to prescribed detraining among recreational athletes.

Exercise-induced cardiac remodeling (EICR) and the attendant myocardial adaptations characteristic of the athlete's heart may regress during periods of exercise reduction or abstinence. The time course and mechanisms underlying this reverse remodeling, specifically the impact of concomitant plasma volume (PV) contraction on cardiac chamber size, remain incompletely understood. We therefore studied recreational runners ( n = 21, age 34 ± 7 yr; 48% male) who completed an 18-wk training program (~7 h/wk) culminating in the 2016 Boston Marathon after which total exercise exposure was confined to <2 h/wk (no single session >1 h) for 8 wk. Cardiac structure and function, exercise capacity, and PV were assessed at peak fitness (10-14 days before) and at 4 wk and 8 wk postmarathon. Mixed linear modeling adjusting for age, sex, V̇o2peak, and marathon finish time was used to compare data across time points. Physiological detraining was evidenced by serial reductions in treadmill performance. Two distinct phases of myocardial remodeling and hematological adaptation were observed. After 4 wk of detraining, there were significant reductions in PV (Δ -6.0%, P < 0.01), left ventricular (LV) wall thickness (Δ -8.1%, <0.05), LV mass (Δ -10.3%, P < 0.001), and right atrial area (Δ -8.2%, P < 0.001). After 8 wk of detraining, there was a significant reduction in right ventricle chamber size (end-diastolic area Δ = -8.0%, P < 0.05) without further concomitant reductions in PV or LV wall thickness. Abrupt reductions in exercise training stimulus result in a structure-specific time course of reverse cardiac remodeling that occurs largely independently of PV contraction. NEW & NOTEWORTHY Significant reverse cardiac remodeling, previously documented among competitive athletes, extends to recreational runners and occurs with a distinct time course. Initial reductions in plasma volume and left ventricular (LV) mass, driven by reductions in wall thickness, are followed by contraction of the right ventricle. Consistent with data from competitive athletes, LV chamber volumes appear less responsive to detraining and may be a more permanent adaptation to sport.

PP.15.23] CLINICAL CHARASTERISTICS, OFFICE BLOOD PRESSURE, MEDICAL THERAPY AND CARDIAC STRUCTURE IN SUBJECTS WITH SUSPECTED DRUG-RESISTANT HYPERTENSION REFERRED TO HYPERTENSION CLINIC

Objective: Backround: patients with suspected drug-resistant hypertension referred for non-pharmacological treatment are usualy not on optimal medical therapy Study objective: to analyse blood pressure control and composition of medical therapy in patients referred to hypertension clinic with suspected drug-resistant hypertension Design and method: Patients and methods: group of 60 consecutive patients (34 males, 26 females, mean age 66 years) and mean BMI 30 kg/m2 with suspected drug-resistant esential underwent BP office recording, laboratory examination and echocardiographic study same date in hypertension clinic. Patients had significant comorbidities: coronary artery disease 27%, dyslipidaemia had 88%, DM 57% and 78% were smokers. Office blood pressure was measured with automatic BP monitor Omron M6 after 5 minutes rest, mean value of three recordings was used. Medical therapy was analysed from patients records. Dual mode, Pulse-Doppler and Tissue Doppler Imaging were used for the assessment of: cardiac chambers size, left ventricular (LV) ejection fraction, calculation of LV mass index (LVMI) and RWT (relative wall thickness). Results: Mean systolic office BP was 146.8 mmHg and diastolic 86.9, with 82% patients above target sBP (140 or 130) and 53% (90 or 80) above target dBP. Total number of 37 (62%) patients were receiving ACEIs, 30% ARBs, 48% CCBs and 60% thiazide or thiazide –like diuretics, 65% patients were on BBs and 13% on spironolactone. Mean number of antihypertensive drugs was 3.4. Mean LVMI was 85,5 g/m2 and RWT 0,40 with only 18% male patients above LVMI upper normal limit (> 102 g/m2) and 19% females above 88 g/m2 and 37% subjects above RWT upper normal limit. Conclusions: Patients referred to tertiary care hypertension clinic are not on optimal medical therapy, low proportion of patients are treated with diuretics and spironolacton, high number are treated with betablockers. Despite not optimal therapy and BP control, only small number of patients had parameters of cardiac hypertrophy. Supported by Ministry of Health, Czech Republic - conceptual development of research organization (Nemocnice Na Homolce – NNH, 00023884), IG 150505.

Choice of approaches for surgical correction of tricuspid pathology in patients with rheumatic multi-valvular heart disease

Objective: To analyze the results of surgical correction of patients with tricuspid pathology in rheumatic multi-valvular heart disease. Methods: We retrospectively analyzed outcomes of surgical correction of tricuspid valve disease in 292 patients with rheumatic multi-valvular heart defects, who underwent surgery in our clinic. Results: The age of our patients ranged from 12 to 74 years (mean age 36.7 (9.4) years), among them 197 (67.4%) women and 95 (32.6%) - men. According to the degree of circulatory disorders, 21 (7.2%) patients were in NYHA class III and 271 (92.8%) patients - class IV. Of them 235 (80.5%) patients were operated by the method of De Vega using plastic fibrous ring. After tricuspid valve (TV) and fibrous ring repair in 26.9% - tricuspid regurgitation disappeared, in 62.8% - regurgitation decreased to the 1st degree, and the remaining 10.3% of patients had 2nd (moderate) degree tricuspid regurgitation. In 7 (2.38%) cases of infective endocarditis, the "open heart surgery" correction – replacement of TV with biological prosthesis was made. Creation of the bicuspid tricuspid valve techniques was used in 13.4% of cases. Conclusion: Our study demonstrated that correction of tricuspid valve disease in our cohort of patients, including valve repair and replacement and reconstructive surgery of fibrous ring alone or in combination with mitral or aortic valve replacement/ repair is accompanied by reduction of tricuspid regurgitation and reduction of cardiac chamber size and right ventricular pressure. No complications intrinsic to operative technique of tricuspid valve reconstructive surgery as advanced atrioventricular block or myocardial ischemia and infarction were recorded.

Utility of cardiac magnetic resonance for evaluation of mitral regurgitation prior to mitral valve surgery.

Mitral regurgitation (MR) is a common cause of morbidity worldwide and an accepted indication for interventional therapies which aim to reduce or resolve adverse clinical outcomes associated with MR. Cardiac magnetic resonance (CMR) provides highly accurate means of assessing MR, including a variety of approaches that can measure MR based on quantitative flow. Additionally, CMR is widely accepted as a reference standard for cardiac chamber quantification, enabling reliable detection of subtle changes in cardiac chamber size and function so as to guide decision-making regarding timing of mitral valve directed therapies. Beyond geometric imaging, CMR enables tissue characterization of ischemia and infarction in the left ventricular (LV) myocardium as well as within the mitral valve apparatus, thus enabling identification of structural substrates for MR. This review provides an overview of established and emerging CMR approaches to measure valvular regurgitation, including relative utility of different approaches for patients with primary or secondary MR. Clinical outcomes studies are discussed with focus on data demonstrating advantages of CMR for guiding diagnosis, risk stratification, and management of patients with known or suspected MR. Comparative data is reviewed with focus on diagnostic performance of CMR in comparison to conventional assessment via echocardiography (echo). Emerging literature is reviewed concerning potential new approaches that utilize CMR tissue characterization to guide clinical decision-making in order to improve therapeutic outcomes and clinical prognosis for patients with MR.

Evaluation of cardiac function in a group of small for gestational age school-age children treated with growth hormone

Introduction and objectivesSmall for gestational age (SGA) patients have an increased risk of developing a cardiovascular pathology, as well as a metabolic syndrome. Our objective is to evaluate the cardiac morphology and function of SGA children treated with growth hormone (GH), identifying changes that could potentially have long-term consequences. MethodsWe selected 23 SGA school-age patients and 23 healthy children. We measured their weight, height, blood pressure and heart rate. Using transthoracic echocardiography, we evaluated cardiac chamber size, ascending and abdominal aortic diameter as well as the systolic and diastolic function of both ventricles. ResultsSGA children have a higher systolic and diastolic blood pressure (p<.05) without significant changes in their heart rate. They also have a thicker interventricular septum (SGA Z-score 1.57 vs. 0.89; p=.026) and a worse right ventricular systolic function, with a lower TAPSE (SGA Z-score −0.98 vs. 0.95; p=.000), as well as a lower blood flow rate in the pulmonary artery (SGA 0.85m/s vs. 0.97m/s; p=.045). No significant difference was observed in the patients’ left ventricular function. SGA patients’ ascending aortic diameter was greater (SGA Z-score −1.09 vs. −1.93; p=.026), whereas the systolic abdominal aortic diameter was smaller (SGA Z-score−0.89 vs. −0.19; p=.015). ConclusionsWe found functional and morphological cardiac changes in SGA school-age patients treated with GH. It is important to follow-up this patient group in order to determine if these changes contribute to an increased cardiac morbidity in adulthood.

Pulmonary valve replacement in patients with corrected tetralogy of Fallot.

Introduction: Development of pulmonary insufficiency in patients with surgically corrected tetralogy of Fallot (TOF) may lead to severe right heart failure with serious consequences. We herein present our experience with pulmonary valve replacement (PVR) in these patients. Methods: From 2005-2013, 99 consecutive patients (71 males/28 females, mean age 38±8 years), underwent PVR after 7 to 40 (mean 29 ± 8) years from the initial correction. Seventy nine of the symptomatic patients presented in NYHA II, 14 in III and 2 in IV. All underwent PVR with a stented bioprosthetic valve, employing a beating heart technique with normothermic extracorporeal circulation support. Concomitant procedures included resection of aneurysmal outflow tract patches (n = 37), tricuspid valve annuloplasty (n = 36), augmentation of stenotic pulmonary arteries (n = 9), maze procedure (n = 2) and pulmonary artery stenting (n = 4). Results: There were 2 perioperative deaths (2%). One patient developed sternal dehiscence requiring rewiring. Median ICU and hospital stay was 1 and 7 days respectively. Postoperative echocardiography at 6 and 12 months showed excellent bioprosthetic valve performance, significant decrease in size of the right cardiac chambers and reduction of tricuspid regurgitation (TR) in the majority of the patients. At mean follow-up of 3.6 ± 2 years, all surviving patients remain in excellent clinical condition. Conclusion: Probability of reoperation for pulmonary insufficiency in patients with surgically corrected TOF increases with time and timely PVR by preventing the development of right heart failure is crucial for long-term survival. Current bioprosthetic valve technology in combination with the beating heart technique provides excellent immediate and short-term results. Further follow-up is necessary to evaluate long-term outcome.

Assessment of Cardiac Chamber Sizes in Acute Phase Takotsubo Cardiomyopathy Compared to Acute Anterior Myocardial Infarction

Background: The ECG and clinical findings of Takotsubo cardiomyopathy (TCM) and acute myocardial infarction (AMI) can be very similar. However, the regional wall motion abnormalities seen in TCM are pathognomonic and different to AMI. Dilatation of cardiac chambers have been described post AMI, including dilatation of the left atrium (LA) which has been shown to have prognostic value. The aim of our study was to determine if similar changes in the size of cardiac chambers occurred during the acute phase of TCM as seen post AMI. Methods: Consecutive patients with TCM presenting to our institution were compared to age and LVEF matched patients with acute anterior ST-segment elevation myocardial infarction (STEMI), a major differential diagnosis of TCM. A range of echocardiographic variables quantifying left and right heart chamber size and function were examined from transthoracic echocardiograms performed within 48 hours of presentation and compared between the cohorts. Results: 14 consecutive patients with TCM (mean age 68.4 ± 13.7 years; 100% female) were compared to 14 patients with an anterior STEMI (67.2 ± 13.9 years; 57% female). Patients with acute anterior STEMIs demonstrated significantly higher indexed left ventricular (LV) volumes compared to TCM patients despite no significant difference in systolic function. Interestingly, the indexed left atrial volume (LAVi) was also higher in patients with acute infarcts compared to TCM. Conclusion: Despite characteristic regional wall motion abnormalities seen with TCM, there does not appear to be a significant increase in the left and right ventricular volumes or left atrial size compared to acute infarct patients.Tabled 1TCMSTEMISignificance(p value)Age (years)68.4 ± 1367.2 ± 13.90.83Females, n (%)14 (100%)8 (57%)0.016LVEF (%)44 ± 9.944 ± 9.60.99LV end diastolic diameter (mm/m2)27 ± 528 ± 70.61LV end systolic diameter (mm/m2)19 ± 420 ± 60.49LV end diastolic volume (ml/m2)47 ± 1369 ± 260.01LVend systolic volume (ml/m2)27 ± 942 ± 230.04E/A1.1 ± 0.41.1 ± 0.40.84Average E/e’12.2 ± 3.016.5 ± 7.80.08LA volume indexed (ml/m2)34 ± 947 ± 200.043Right atrial area (cm2)14 ± 315 ± 50.61RV basal diameter (mm)30 ± 433 ± 40.045RVS’ (m/s)11.8 ± 3.211.8 ± 2.70.96 Open table in a new tab

Echocardiographic Parameters of Cardiac Chamber Size and Function in Patients with Non-Valvular Atrial Fibrillation Below 65 Years

Echocardiographic Parameters of Cardiac Chamber Size and Function in Patients with Non-Valvular Atrial Fibrillation Below 65 Years

Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from the UK Biobank population cohort

BackgroundCardiovascular magnetic resonance (CMR) is the gold standard method for the assessment of cardiac structure and function. Reference ranges permit differentiation between normal and pathological states. To date, this study is the largest to provide CMR specific reference ranges for left ventricular, right ventricular, left atrial and right atrial structure and function derived from truly healthy Caucasian adults aged 45–74.MethodsFive thousand sixty-five UK Biobank participants underwent CMR using steady-state free precession imaging at 1.5 Tesla. Manual analysis was performed for all four cardiac chambers. Participants with non-Caucasian ethnicity, known cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Remaining participants formed the healthy reference cohort; reference ranges were calculated and were stratified by gender and age (45–54, 55–64, 65–74).ResultsAfter applying exclusion criteria, 804 (16.2%) participants were available for analysis. Left ventricular (LV) volumes were larger in males compared to females for absolute and indexed values. With advancing age, LV volumes were mostly smaller in both sexes. LV ejection fraction was significantly greater in females compared to males (mean ± standard deviation [SD] of 61 ± 5% vs 58 ± 5%) and remained static with age for both genders. In older age groups, LV mass was lower in men, but remained virtually unchanged in women. LV mass was significantly higher in males compared to females (mean ± SD of 53 ± 9 g/m2 vs 42 ± 7 g/m2). Right ventricular (RV) volumes were significantly larger in males compared to females for absolute and indexed values and were smaller with advancing age. RV ejection fraction was higher with increasing age in females only. Left atrial (LA) maximal volume and stroke volume were significantly larger in males compared to females for absolute values but not for indexed values. LA ejection fraction was similar for both sexes. Right atrial (RA) maximal volume was significantly larger in males for both absolute and indexed values, while RA ejection fraction was significantly higher in females.ConclusionsWe describe age- and sex-specific reference ranges for the left ventricle, right ventricle and atria in the largest validated normal Caucasian population.

Evaluación de la función cardiaca en un grupo de niños pequeños para la edad gestacional en edad escolar en tratamiento con hormona de crecimiento

Introduction and objectivesSmall for gestational age (SGA) patients have an increased risk of developing a cardiovascular pathology, as well as a metabolic syndrome. Our objective is to evaluate the cardiac morphology and function of SGA children treated with growth hormone (GH), identifying changes that could potentially have long-term consequences. MethodsWe selected 23 SGA school-age patients and 23 healthy children. We measured their weight, height, blood pressure and heart rate. Using transthoracic echocardiography, we evaluated cardiac chamber size, ascending and abdominal aortic diameter as well as the systolic and diastolic function of both ventricles. ResultsSGA children have a higher systolic and diastolic blood pressure (P<.05) without significant changes in their heart rate. They also have a thicker interventricular septum (SGA Z-score 1.57 vs. 0.89; P=.026) and a worse right ventricular systolic function, with a lower TAPSE (SGA Z-score −0.98 vs. 0.95; P=.000), as well as a lower blood flow rate in the pulmonary artery (SGA 0.85m/s vs. 0.97m/s; P=.045). No significant difference was observed in the patients’ left ventricular function. SGA patients’ ascending aortic diameter was greater (SGA Z-score −1.09 vs. −1.93; P=.026), whereas the systolic abdominal aortic diameter was smaller (SGA Z-score−0.89 vs. −0.19; P=.015). ConclusionsWe found functional and morphological cardiac changes in SGA school-age patients treated with GH. It is important to follow-up this patient group in order to determine if these changes contribute to an increased cardiac morbidity in adulthood.

Impact of sickle cell anaemia on cardiac chamber size in the paediatric population.

Right ventricle and left ventricle diastolic diameters, left ventricle mass estimate, left ventricle shortening fraction, myocardial performance index, and an index of myocardial relaxation (E/E') were calculated and correlated with haematological parameters. A total of 110 patients (65% haemoglobin SS, 29% haemoglobin SC) were studied at a mean age of 12.14±5.26 years. Right ventricle dilatation and left ventricle dilatation were present in 61.5 and 42.9%, respectively. Left ventricle mass was abnormal in 21.9%; all patients had normal myocardial performance index, 31.4% had abnormal E/E', and left ventricle shortening fraction was low in 38.1%. Cardiac dilatation was best correlated with haemoglobin, aspartate aminotransferase, reticulocytosis and bilirubin. Best subset regression analysis yielded significant additional prediction for right ventricle or left ventricle dilatation with haemoglobin, bilirubin, and lactate dehydrogenase. Abnormal E/E' was solely predictable with haemoglobin level. Hydroxyurea-treated patients had improved diastolic function. Right ventricle dilatation was more prevalent than left ventricle dilatation. The long-term consequences of right ventricular dilatation, clinical consequences, and association with pulmonary vasculopathy need to be further determined.

PP.20.18] CORRELATION OF BIOMARKERS OF CARDIAC REMODELLING, INFLAMMATION AND MYOFIBROSIS WITH PARAMETERS OF CARDIAC STRUCTURE AND FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: Several studies showed role of novel biomarkers of cardiac remodelling and myofibrosis in prediction of risk of heart silure in patient with arterial hypertension (AH). Aim of the study was to evaluace relation of biomarkers of cardiac remodelling (NT-proBNP, soluble receptor ST2), marker of inflammation ceruloplasmin and marker of myofibrosis (galectin-3) with parameters of cardiac structure and function as assessed by echocardiography. Design and method: Patients population and methods: group of 64 patients (37 males, 27 females, mean age 64 years) with esential AH underwent laboratory examination and echo study same date in hypertsnion clinic. Biomarkers were assessed by RayBio™ Custom Quantibody Array. Dual mode, Pulse-Doppler and Tissue Doppler Imaging were used for the assessment of: cardiac chambers size, left ventricular (LV) ejection fraction, calculation of LV mass index (LVMI) and RWT (relative wall thickness) assessment of LV diastolic function with E/A (early filling velocity to atral contraction velocity) ratio and E/E [Combining Acute Accent] (early filling to mean mitral annulus motion velocity) ratio. Results: Mean NT-proBNP level was 16.5 pmol/ll, sST2 139,9 pg/ml, galectinu3 1470 pg/ml and ceruloplasminu 200 mg/l. Mean LV EF was 66,8 % (median 66), E/A ratio 0,9 (0,85), E/E [Combining Acute Accent] ratio 6,8 (6,3), LVMI 84,1 (83) g/m2 and RWT 0,40 (0,41). NT-proBNP correlated with ceruloplasmin level only (r = 0,222, but p = 0,08), other correlation between biomarkers were not significant too. NT-proBNP correlated with urea level (r = 0,333, p < 0,01), ceruloplasmin correlated with urea (r = 0,316, p < 0,05) and sST2 correlated with uric acid (0,416, p < 0,05). Concentration of biomarkers did not correlate with echocardiography parameters. Conclusions: Novel biomarkers of cardiac remodelling, inflammation and myofibrosis do not correlate with parameters of cardiac structure and function in patients with arterial hypertension.

A Review of the Potential Pathogenicity and Management of Frequent Premature Ventricular Contractions.

Very frequent premature ventricular complexes (PVCs) may be a reversible cause of dilated cardiomyopathy. Literature on this largely unrecognized entity has increased in the last 15 years. This paper reviews the literature on the consequences of frequent PVCs on myocardial function and management of PVC-associated cardiomyopathy. The authors reviewed articles published in English before June 2015 describing pathophysiology, risk factors, symptoms, time course, treatment, and outcome of cardiomyopathy associated with PVCs. The search was conducted using Medline and Embase. Keywords included: cardiomyopathy, catheter ablation, antiarrhythmic drug (AAD), pathophysiology, and ventricular premature contractions or synonyms. PVC-associated cardiomyopathy is associated with a high burden of PVC (over 20% of heartbeats). Other risk factors include electrophysiological characteristics, such as PVC QRS width, presence of ventricular tachycardia, retrograde P waves, interpolation, polymorphic PVCs, and longer coupling intervals. Symptoms include palpitations, light-headedness, dyspnea, cough, and dysphagia. The systolic dysfunction and chamber dilatation progress over a few years. Once the PVCs are suppressed by radiofrequency ablation or AADs, the cardiomyopathy usually resolves within 6 months. The pathophysiology remains unknown, but hypotheses mainly include ventricular dyssynchrony resulting in hemodynamic disturbances and abnormalities in calcium handling and oxygen consumption. PVC-associated cardiomyopathy remains a largely unrecognized entity. It is a reversible cause of dilated cardiomyopathy that results from abnormal calcium and oxygen handling within the myocyte, dyssynchrony, and hemodynamic compromise from inefficient heartbeats. Suppression of the PVCs improves myocardial function, cardiac chamber sizes, and patient's symptoms.

Prognostic impact and change of concomitant mitral regurgitation after surgical or transcatheter aortic valve replacement for aortic stenosis

BackgroundSignificant aortic stenosis (AS) is frequently associated with mitral regurgitation (MR) of varying degrees. We sought to assess the change in MR grade after the aortic valve procedure, to find predictors of MR improvement and finally to determine the prognostic impact of persistent MR. MethodsWe retrospectively analyzed a group of 101 AS patients who underwent aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) at our institution between January 2007 and March 2014 and who presented with MR grade 2 or higher on preoperative echocardiogram – 35 patients underwent an isolated AVR, 18 underwent TAVI, and the rest underwent a combined procedure, which included coronary artery bypass grafting. The mean follow-up was 28.5±21 months. ResultsMR improved significantly after the procedures (2.4±0.5 vs. 1.9±0.9, p<0.001) and a decline in the severity of MR was observed regardless of etiology (degenerative/post-rheumatic, functional/ischemic, combined) without significant changes between groups (p=0.667). Downgrading of MR severity was associated with improvement in ejection fraction (p=0.021) and reduction in the size of cardiac chambers, especially the left atrium (left atrial diameter, p<0.001). None of the preoperatively evaluated factors (severity of AS, MR etiology, ejection fraction, cardiac chamber dimensions, coronary artery disease, and New York Heart Association functional class) was a significant predictor of MR improvement. Persistence of higher degrees of MR was associated with a more frequent need for cardiovascular hospitalization, while the survival rate 3 years after procedure was not affected (p=0.146). ConclusionsIn the majority of AS patients, an aortic valve procedure leads to reduction in coexistent MR. A significant decrease in the severity of MR in our study was observed regardless of etiology and preoperative grade of MR. Persistence of higher degrees of MR was associated with increased patient morbidity.

VLDL from Metabolic Syndrome Individuals Enhanced Lipid Accumulation in Atria with Association of Susceptibility to Atrial Fibrillation.

Metabolic syndrome (MetS) represents a cluster of metabolic derangements. Dyslipidemia is an important factor in MetS and is related to atrial fibrillation (AF). We hypothesized that very low density lipoproteins (VLDL) in MetS (MetS-VLDL) may induce atrial dilatation and vulnerability to AF. VLDL was therefore separated from normal (normal-VLDL) and MetS individuals. Wild type C57BL/6 male mice were divided into control, normal-VLDL (nVLDL), and MetS-VLDL (msVLDL) groups. VLDL (15 µg/g) and equivalent volumes of saline were injected via tail vein three times a week for six consecutive weeks. Cardiac chamber size and function were measured by echocardiography. MetS-VLDL significantly caused left atrial dilation (control, n = 10, 1.64 ± 0.23 mm; nVLDL, n = 7, 1.84 ± 0.13 mm; msVLDL, n = 10, 2.18 ± 0.24 mm; p < 0.0001) at week 6, associated with decreased ejection fraction (control, n = 10, 62.5% ± 7.7%, vs. msVLDL, n = 10, 52.9% ± 9.6%; p < 0.05). Isoproterenol-challenge experiment resulted in AF in young msVLDL mice. Unprovoked AF occurred only in elderly msVLDL mice. Immunohistochemistry showed excess lipid accumulation and apoptosis in msVLDL mice atria. These findings suggest a pivotal role of VLDL in AF pathogenesis for MetS individuals.