Subclinical Cardiac Abnormalities Research Articles

Three-dimensional speckle tracking echocardiography for evaluation of ventricular function in patients with systemic lupus erythematosus: relationship between duration of lupus erythematosus and left ventricular dysfunction by using global longitudinal strain

BackgroundCardiovascular diseases are leading causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Cardiac involvement in SLE can often go undetected. Three-dimensional (3D) speckle tracking echocardiography (STE) is a noninvasive imaging technique that can assess the function of the heart’s ventricles in an accurate and reproducible way. This makes it an attractive option for detecting early signs of heart disease in SLE patients. By identifying these subclinical cardiac abnormalities, 3D-STE may help reduce the negative impact of cardiovascular diseases in SLE population. Therefore, this study aimed to compare the left ventricular (LV) function between patients with SLE compared to age- and gender-matched controls using two-dimensional (2D) and 3D-STE.ResultsThe current study found no significant differences in left ventricle ejection fraction, left ventricle end-diastolic volume, left ventricle end-systolic volume, left ventricle end-diastolic mass, and left ventricle end-systolic mass between the two groups. However, the SLE group exhibited a significantly lower LV global longitudinal strain (GLS) compared to the control group according to all types of echocardiographic assessments, including 3D and 2D long-axis strain, apical 2-chamber, and apical 4-chamber assessments (all P values < 0.05). Furthermore, a good inter-rater reliability and intra-rater reliability were observed regarding the LVGLS measurement with 3D-STE. Additionally, the study identified a significant correlation between LVGLS and SLE duration (r (50) = 0.46, P < 0.001). The use of prednisolone and nephrology disorders was also found to impact LVGLS measurements.ConclusionsDespite a normal LVEF in patients with SLE, LVGLS measurements indicated that LV systolic dysfunction was observed more frequently in SLE patients compared to their healthy counterparts. Therefore, advanced 3D-STE techniques may be useful in identifying subtle abnormalities in LV function in SLE patients.

Echocardiographic findings in apparently healthy Czechoslovakian wolfdogs

IntroductionTo echocardiographically evaluate a large number of apparently healthy Czechoslovakian wolfdogs (CWDs) to identify possible subclinical cardiac abnormalities and to generate reference intervals. AnimalsOne-hundred and seventeen apparently healthy client-owned CWDs. Materials and methodsStandard two-dimensional, M-mode, and Doppler echocardiographic measurements were obtained on non-sedated, manually restrained standing dogs. Animals with no relevant echocardiographic abnormalities were used to generate reference intervals. Echocardiographic variables were compared between males and females and between dogs with and without mitral regurgitation (MR). Results and discussionAmong the 117 CWDs, 103 dogs were used to generate reference intervals. The 14 dogs with abnormalities had more than trivial MR (12 dogs), subaortic stenosis (one dog), and equivocal subaortic stenosis (one dog). The 44 males were heavier than 59 females (P<0.001) and had a larger maximum left atrial dimension (P=0.015), left ventricular internal dimension at end-diastole (P<0.001) and systole (P<0.001), and thicker interventricular septum thickness at end-diastole (P=0.016). A positive linear correlation was identified between bodyweight and aortic root and left atrial diameters and left ventricular dimensions and between age and aortic root and left atrial diameter and peak late transmitral flow velocity. A negative linear correlation was identified between age and peak early transmitral flow velocity and the ratio between peak early and late transmitral flow velocities. No differences in echocardiographic-derived cardiac dimensions were detected between healthy dogs and dogs with more than trivial MR. ConclusionsIn this population of CWDs, subclinical cardiac abnormalities were uncommon, and they were mainly classified as MR.

Changes in subclinical cardiac abnormalities 1 Year after recovering from COVID-19 in patients without clinical cardiac findings

AimTo evaluate the subclinical cardiac involvement in COVID-19 patients without clinical cardiac evidence using cardiac MR imaging. Material and methodsParticipants recovered from COVID-19 without cardiac symptoms and no cardiovascular medical history were enrolled in a prospective cohort study. They underwent baseline cardiac MR and follow-up cardiac MR > 300 days after discharge (n = 20). The study also included healthy controls (n = 20). Extracellular volume fraction (ECV), native T1, and 2D strain data were assessed and compared. ResultsThe ECV values of participants at baseline [30.0% (28.3%–32.5%)] and at follow-up [31.0% (28.0%–32.8%)] were increased compared to the healthy control group [27.0% (25.3%–28.0%)] (both p < 0.001). However, the ECV increase from baseline cardiac MR to follow-up cardiac MR was not significant (p = 0.378). There was a statistically significant difference in global native T1 between baseline [1140 (1108.3–1192.0) ms] and follow-up [1176.0 (1113.0–1206.3) ms] (p = 0.016). However, no native T1 difference was found between the healthy controls [1160.7 (1119.6–1195.4) ms] and the baseline (p = 0.394) or follow-up group (p = 0.168). The global T2 was 41(40–42) ms at follow-up which was within the normal range. In addition, We found a recovery in 2D GLS among COVID-19 participants between baseline and follow-up [-12.4(-11.7 to −14.3)% vs. −17.2(-16.2 to −18.3)%; p＜0.001]. ConclusionUsing cardiac MR myocardial tissue and strain imaging parameters, 35% of people without cardiac symptoms or clinical evidence of myocardial injury still had subclinical myocardial tissue characteristic abnormalities at 300 days, but 2D GLS had recovered.

Association of thyroid dysfunction in individuals ≥ 65 years of age with subclinical cardiac abnormalities.

The relationship between thyroid dysfunction and measures of myocardial disease in older individuals remains to be defined. To evaluate the impact of thyroid dysfunction on structure and function of the left-heart chambers and blood markers of cardiac disease. Cross-sectional analysis. The Cardiovascular Health Study, a community-based cohort of older individuals recruited from four urban areas in the United States. Of 3163 participants studied, 2477 were euthyroid, 465 had subclinical hypothyroidism (SCH), 47 overt hypothyroidism (OH), 45 endogenous (endo) subclinical hyperthyroidism (endo-SCT), and 129 had exogenous (exo) SCT due to thyroid hormone supplementation. Clinical evaluation, blood sampling and biomarker measurement, 2-dimensional and speckle-tracking echocardiography. Left heart myocardial deformation, circulating biomarkers of diastolic overload (NT-proBNP), fibrosis (sST2, gal-3), and cardiomyocyte injury (hs-cTnT). SCH was associated with higher NT-proBNP (beta = 0.17, p = 0.004), whereas OH was associated with higher hs-cTnT (beta = 0.29, p = 0.005). There were also suggestive associations of SCH with higher sST2, as well as endo-SCT with higher gal-3 and lower (worse) left atrial reservoir strain. Left ventricular longitudinal strain and end-diastolic strain rate did not differ significantly from euthyroid participants in SCH, OH, or exo-SCT. In this free-living elderly cohort, subclinical and overt hypothyroidism were associated with abnormalities of blood biomarkers consistent with diastolic overload and myocardial necrosis respectively, whereas subclinical hyperthyroidism tended to be associated with myocardial fibrosis and decreased left atrial strain. Our findings could represent stage B heart failure and illuminate distinct aspects of the pathobiology of heart disease related to thyroid gland dysfunction with potential clinical implications.

Kiosk 7R-FA-04 - Subclinical Cardiac Abnormalities in Thrombotic Thrombocytopenic Purpura (TTP) Survivors

Kiosk 7R-FA-04 - Subclinical Cardiac Abnormalities in Thrombotic Thrombocytopenic Purpura (TTP) Survivors

Cardiac Abnormalities in Relation to the Disease Activity Index Among Systemic Lupus Erythematosus Patients in a Tertiary Hospital: A Cross-Sectional Study.

Systemic lupus erythematosus (SLE) is a multisystem autoimmune connective tissue disorder involving multiple organs and systems. Cardiovascular involvement in SLE patients is a major cause of morbidity and mortality. Although subclinical cardiac abnormalities exist among SLEpatients, they are rarely screened for. Echocardiography has been demonstrated to be a useful tool for the early diagnosis of cardiac abnormalities in SLE patients, many of which are clinically silent. Early recognition of cardiovascular abnormalities is vital for the prompt initiation of the appropriate management.This study aims to determine the prevalence of various structural and functional cardiac abnormalities among SLE patients and to determine its association with the modified SLE Disease Activity Index 2000 (modified SLEDAI-2K). The study was a cross-sectional study of SLE patients at the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana, from June to December 2021. The setting was the rheumatology outpatient clinic of the KBTH and included adult men and women, 18 years and above, diagnosed with SLE with no known cardiac abnormalities. The baseline demographic and clinical characteristics of the participants were determined. A detailed transthoracic echocardiogramwas performed for all patients. The frequency of common cardiac pathologies was determined and compared between those with a high modified SLEDAI-2K and those with a low modified SLEDAI-2K. Ninety-nine SLE patients participated in the study with a mean age of 35.12 years. Females formed the majority (90.9%) of the participants. The mean age at diagnosis of SLE was 28.7 years and the mean disease duration was 4.6 years. All of the participants were on at least two disease-modifying medications. The mean modified SLEDAI-2K score was 9.1. Thirty-five percent (35%) of the patients had mild to moderately active disease and 39% had severely active disease. Sixty-six (66%) out of the severely active disease group had abnormal echocardiographic findings, while 28% of those with mild to moderate disease had abnormal echocardiographic findings. Echocardiographic abnormalities were found in 56 patients (47%), out of which 8.7% had valvular involvement, 15.7% had diastolic dysfunction, 5.2% had left ventricular hypertrophy (LVH), and 0.9% had left ventricular systolic dysfunction (LVSD). About 12% of the participants had pulmonary hypertension and 1% had pericardial involvement. The odds of echocardiographic abnormalities were 13.7 times higher in SLE patients with high disease activity compared to those with low disease activity (odds ratio (OR) = 13.714, 95% confidence interval (CI) = 3.804-49.442, p < 0.001). There was no significant association between cardiac abnormalities and SLE duration. No significant correlation between cardiac abnormalities and modified SLEDAI-2K score was found. Conclusion:Cardiac abnormalities, especially left ventricular diastolic dysfunction (LVDD),valvular involvement, and pulmonary hypertension, are common in SLE patients.For SLE patients, especially those with active diseases, echocardiographicassessment should be considered in the management of SLE patients to enable early detection of cardiac abnormalities, early treatment, and thus a decrease in morbidity and mortality associated with cardiovascular involvement in SLE patients.

Clinical characteristics and management of immune checkpoint inhibitor-related cardiotoxicity: A single-center experience.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy in the past decade and amplify T-cell-mediated immune responses by disrupting immunoinhibitory signals. The augmented T-cell immune response has led to a range of immune-related adverse effects (irAEs). Immune-related cardiotoxicity has been reported in case series but has been underappreciated due to difficulties in diagnosis. This article describes epidemiological, clinical presentation, subtype, and treatment data and a new systematic framework for the clinical management of cardiotoxicity. Data were extracted for cancer patients who received ICIs in a single center between January 1, 2020, and February 28, 2022. ICI-associated cardiotoxicity was clinically diagnosed based on clinical presentations, biochemical biomarkers, and imaging features. We identified a total of 12 (2.46%) cases of ICI-related cardiotoxicity from 487 patients who received PD-1 or PD-L1 inhibitors. All patients were diagnosed with advanced or metastatic solid tumors. The severity of ICI-related cardiotoxicity ranged from subclinical cardiac abnormalities (subclinical type) with only asymptomatic troponin-I (TnI) elevations (25.0%) to symptomatic cardiac abnormalities (clinical type) (75.0%). Patients with symptomatic cardiac abnormalities had several manifestations, including tachyarrhythmia (16.7%), bradyarrhythmia (41.7%), or cardiac failure (8.3%). The median immunotherapy exposure time was 1.5 doses (range: 1 to 5), and the median time from the initial immunotherapy to the onset of ICI-related cardiotoxicity was 33.5 days (IQR: 20.3 to 46.8). Most patients, including those with subclinical cardiac abnormalities, were administered systemic corticosteroids (58.3%). One (8.3%) patient was put on mechanical ventilation, one (8.3%) received plasma exchange therapy, one (8.3%) was implanted with a pacemaker, and one (8.3%) was admitted to the ICU. Three patients with symptomatic cardiac abnormalities (25.0%) died, and other patients presented with significant clinical improvement with good outcomes. ICI-related cardiotoxicity is uncommon but critical with a high mortality rate and poor prognosis, especially for a small group of patients with symptomatic cardiac abnormalities. More attention should be given to cardiotoxicity associated with ICIs, and these patients should be given baseline examinations and biochemical analyses before and after the initiation of immunotherapy, intensive cardiac assessments, an accurate and rapid diagnosis, and timely multidisciplinary management with immunosuppressive agents and other necessary clinical interventions.

Subclinical cardiac abnormalities in children with biliary atresia correlate with outcomes after liver transplantation.

There are subclinical cardiac abnormalities (SCA) in children with biliary atresia (BA). However, data on the consequences of these cardiac changes after liver transplantation (LT) remain controversial in the pediatric field. We aimed to determine the relationship between outcomes and the subclinical cardiac abnormalities in pediatric patients with BA based on two-dimensional echocardiography (2DE) parameters. A total of 205 children with BA were enrolled in this study. The relationship between 2DE parameters and outcomes, including death and serious adverse events (SAE) after LT, was analyzed by regression analysis. Using receiver operator characteristic (ROC) curves to determine the optimal cut-off values of 2DE parameters for outcomes. Differences in the AUCs were compared using DeLong's test. The Kaplan -Meier method with log-rank testing was used to evaluate survival outcomes between groups. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were found to be independently associated with SAE (OR: 1.112, 95% CI: 1.061 - 1.165, P < 0.001 and OR: 1.193, 95% CI: 1.078 - 1.320, P = 0.001, respectively). The cutoff value of LVMI for predicting the SAE was 68 g/m2.7 (AUC = 0.833, 95% CI 0.727-0.940, P < 0.001), and the cutoff value of RWT for predicting the SAE was 0.41 (AUC = 0.732, 95% CI 0.641-0.823, P < 0.001). The presence of subclinical cardiac abnormalities (LVMI > 68 g/m2.7, and/or RWT > 0.41) was associated with lower patient survival (1-year, 90.5% vs 100.0%; 3-year, 89.7% vs 100.0, log-rank P = 0.001). and higher incidence of SAE events. Subclinical cardiac abnormalities were correlated with post-LT mortality and morbidity in children with BA. LVMI can predict the occurrence of death and serious adverse events after liver transplantation.

Long-term impact of COVID-19 on cardiovascular health of healthcare workers of a tertiary care hospital of Bangladesh

Background: The coronavirus disease (COVID-19) is a multisystem disease that sometimes affects the cardiovascular system (CVS) during acute illness and follows a protracted course in a proportion of patients causing ‘post-COVID syndrome’. Exercise tolerance test (ETT) can assess functional capacity and imaging modalities like echocardiography and cardiac magnetic resonance (CMR) can assess structural and functional status of cardiovascular system (CVS) efficiently. However, the pattern of cardiovascular involvement and its effect on functional capacity in COVID-19 survivors long after the index illness are inadequately known. This study was carried out to detect the functional status and imaging findings in COVID-19 recovered healthcare workers.&#x0D; Methods: This cohort study was carried out in the Department of Cardiology of the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from July 2021 to December 2021. Thirty male healthcare workers, previously not known to have any cardiac disease, who suffered from reverse transcriptase polymerase chain reaction (RT-PCR)-confirmed COVID-19 of mild severity at least 3 months back were included. Besides clinical evaluation, ETT, echocardiography and CMR were done.&#x0D; Results: The mean age was 37.2±4.7 years. The mean time interval from RT-PCR positivity was 317.4±85.7 days. The functional capacity was good in the study subjects; the achieved metabolic equivalents (METs) were 13.0±1.5. The mean left ventricular ejection fraction (LVEF) was 66.9% ± 6.2%; all were within the normal range. The mean LV global longitudinal strain (LVGLS) was -19.2% ± -1.9%; 6 patients had LVGLS &lt;-18%. One patient had mildly reduced tricuspid annular plane systolic excursion (TAPSE) of 16 mm but 3 patients had reduced lateral tricuspid annulus peak systolic velocity (RVS’). CMR revealed subtle abnormalities in 14 (46.7%) patients. Eight patients (26.67%) had increased T2 signal indicating myocardial oedema, 2 (6.7%) had subepicardial late gadolinium enhancement (LGE).&#x0D; Conclusion: In healthcare workers who recovered from mild COVID-19, despite preserved functional capacity, subclinical cardiac abnormalities detected by echocardiography and CMR may be present. Long-term follow-up is warranted to define the clinical significance of these findings.&#x0D; BIRDEM Med J 2023; 13(1): 3-11

Abstract 15878: Relationship Between Cardiac Biomarkers and Echocardiographic Parameters of Cardiac Structure in Patients With Diabetes

Introduction: Current guidelines recommend N-terminal pro-brain natriuretic peptide (NT-proBNP) screening to identify subclinical structural cardiac abnormalities in patients at risk for developing clinical heart failure (HF) such as those with diabetes (DM). High-sensitivity cardiac troponin (hs-cTn) is another cardiac biomarker that can predict incident HF in patients with DM. It is unclear how the addition of hs-cTn to NT-proBNP screening impacts the detection of subclinical abnormalities of cardiac structure in patients with DM. Methods: Participants with DM but without known CVD at visit 5 (2011-2013) of the Atherosclerosis Risk in Communities (ARIC) study who had available cardiac biomarker data and detailed echocardiographic assessment were included. The associations of abnormal hs-cTn and/or NT-proBNP (defined as hs-cTn ≥ 6 ng/L and NT-proBNP ≥ 125 pg/mL) with abnormal echocardiographic measures of cardiac structure were assessed using multivariable adjusted linear regression analysis. Results: Participants (N=797, mean age 75±5y, 43% male, 77% White) had mean BMI 31±6 kg/m 2 , systolic blood pressure 129±17 mmHg, and serum creatinine 1.0±0.3 mg/dL. As shown in the table, abnormal NT-proBNP was associated with higher left ventricular (LV) mass, LV end-diastolic volume (EDV), left atrial (LA) volume, and E/A ratio. Abnormal hs-cTn was associated with lower global longitudinal strain (GLS), but no other measures of cardiac structure. The combination of abnormal hs-cTn and NT-proBNP was associated with higher LV EDV and LA volume and lower GLS. Conclusion: Among participants with DM free of CVD, abnormal NT-proBNP was associated with several echocardiographic parameters of abnormal cardiac structure. The addition of hs-cTn to NT-proBNP did not significantly improve detection of structural cardiac abnormalities other than low GLS.

Untargeted global metabolomic profiling of healthy dogs grouped on the basis of grain inclusivity of their diet and of dogs with subclinical cardiac abnormalities that underwent a diet change.

To compare metabolomic profiles of dogs eating grain-free (GF) versus grain-inclusive (GI) diets (1) for healthy dogs at baseline and (2) for dogs with subclinical cardiac abnormalities at 12 months after a diet change. Serum samples from 23 dogs eating GF diets and 79 dogs eating GI diets, of which 17 (8 eating a GF diet and 9 eating a GI diet) were reevaluated 12 months after a diet change. Metabolomic profiles were developed by means of ultrahigh-performance liquid chromatography-tandem mass spectroscopy of serum samples. Baseline results for the GF group were compared with those for the GI group. Dogs from both groups with subclinical cardiac abnormalities were transitioned to a GI, pulse-free, intervention diet, and samples collected 12 months later were compared between diet groups. Statistical significance for biochemical group differences was defined as P < .05 with a false discovery rate (q) < .10. Baseline differences in lipid metabolism and amino acid metabolism were found between the GF and GI diet groups. There were 46 metabolites that were higher and 82 metabolites that were lower in the GF group (n = 23), compared with the GI group (79). Comparison of the GF (n = 8) and GI (9) groups 12 months after the diet change showed only 6 metabolites that were higher and 11 metabolites that were lower in the GF group, compared with the GI group. Metabolomic pathway differences between dogs eating GF versus GI diets highlight the important effect of diet in metabolomics analyses. The clinical importance of these differences and how they might relate to cardiac disease in dogs remains undetermined.

Altered cardiac structure and function in newly diagnosed people living with HIV: a prospective cardiovascular magnetic resonance study after the initiation of antiretroviral treatment

HIV associated cardiomyopathy (HIVAC) is a poorly understood entity that may progress along a continuum. We evaluated a group of persons newly diagnosed with HIV and studied the evolution of cardiac abnormalities after ART initiation. We recruited a group of newly diagnosed, ART naïve persons with HIV and a healthy, HIV uninfected group. Participants underwent comprehensive cardiovascular evaluation, including cardiovascular magnetic resonance imaging. The HIV group was started on ART and re-evaluated 9 months later. The cardiovascular parameters of the study groups were compared at diagnosis and after 9 months. The ART naïve group’s (n = 66) left- and right end diastolic volume indexed for height were larger compared with controls (n = 22) (p < 0.03). The left ventricular mass indexed for height was larger in the naïve group compared with controls (p = 0.04). The ART naïve group had decreased left- and right ventricular ejection fraction (p < 0.03) and negative, non-linear associations with high HIV viral load (p = 0.02). The left ventricular size increased after 9 months (p = 0.04), while the systolic function remained unchanged. The HIV group had a high rate of non-resolving pericardial effusions. HIV infected persons demonstrate structurally and functionally altered ventricles at diagnosis. High HIV viral load was associated with left- and right ventricular dysfunction. Cardiac parameters and pericardial effusion prevalence did not show improvement with ART. Conversely, a concerning trend of increase was observed with left ventricular size. These subclinical cardiac abnormalities may represent a stage on the continuum of HIVAC that can progress to symptomatic disease if the causes are not identified and addressed.

169-LB: Structural Echocardiographic Abnormalities in T2D —Mexico Cohort of Take Care of Me Program

Rationale: Due to gaps in detecting subclinical cardiac abnormalities in T2D, we evaluated prevalence and clinical manifestations of early echocardiographic (echo) abnormalities in primary care in Mexico. Methods: Mexico cohort of the ongoing ‘Take CaRe of Me program’ enrolled 2760 people with T2D (between 7 Dec 2020 - 10 Dec 2021) and no cardiorenal disease per index visit history. We present descriptive data of documented echo performed by cardiologists as routine clinical care (499) in high-risk T2D identified by Systematic Coronary Risk Evaluation (ESC 2019) . Results: With mean age of 54.2±11.4 years, 55.4% were females and 189 patients (37.9%) had echo abnormalities — left ventricular hypertrophy (21%, 105) , left atrial enlargement (24.2%, 121) , diastolic dysfunction (6.8%, 34) , pulmonary hypertension (5.4%, 27) and valvular disease (4.8%, 24) . Substantial proportion of people with echo abnormalities had high or very high CV risk (Table) . Overall, 23 people had presumptive diagnosis of pre-HF based on symptoms and echo. Per documented data, 18 people had HF with preserved ejection fraction (EF) , 4 had mid-range EF and 1 had reduced EF. Conclusion: Structural abnormalities are prevalent in 37.9% of people with T2D referred for an echo, even in absence of symptoms. Timely diagnosis of silent structural heart abnormalities in T2D is an opportunity for using novel cardiorenal pharmacotherapy for preventing HF. Disclosure G. Sahagun-sanchez: None. P. Gutiérrez-fajardo: None. O. Meza-ledezma: None. F. Rodriguez-valadez: None. F. J. Lavalle-gonzalez: Speaker's Bureau; Abbott Diagnostics, AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi, Servier Laboratories. E. Vazquez-mendez: None. Funding TCoM study was funded by AstraZeneca International. We are thankful to the cardiologists at the investigation centers for performing echocardiography and primary care physicians of Clinicas del Azcar for recruiting the patients.

443-P: Structural Echocardiographic Abnormalities in T2D: Mexico Cohort of Take Care of Me Program

Rationale: Due to gaps in detecting subclinical cardiac abnormalities in T2D, we evaluated prevalence and clinical manifestations of early echocardiographic (echo) abnormalities in primary care in Mexico. Methods: Mexico cohort of the ongoing ‘Take CaRe of Me program’ enrolled 2760 people with T2D (between 7 Dec 2020 - Dec 2021) and no cardiorenal disease per index visit history. We present descriptive data of documented echo performed by cardiologists as routine clinical care (499) in high-risk T2D identified by Systematic Coronary Risk Evaluation (ESC 2019) . Results: With mean age of 54.2±11.4 years, 55.4% were females and 189 patients (37.9%) had echo abnormalities — left ventricular hypertrophy (21%, 105) , left atrial enlargement (24.2%, 121) , diastolic dysfunction (6.8%, 34) , pulmonary hypertension (5.4%, 27) and valvular disease (4.8%, 24) . Substantial proportion of people with echo abnormalities had high or very high CV risk (Table) . Overall, 23 people had presumptive diagnosis of pre-HF based on symptoms and echo. Per documented data, 18 people had HF with preserved ejection fraction (EF) , 4 had mid-range EF and 1 had reduced EF. Conclusion: Structural abnormalities are prevalent in 37.9% of people with T2D referred for an echo, even in absence of symptoms. Timely diagnosis of silent structural heart abnormalities in T2D is an opportunity for using novel cardiorenal pharmacotherapy for preventing HF. Disclosure G.Sahagún-sánchez: None. C.Bhograj: None. P.Gutiérrez-fajardo: None. F.Rodriguez-valadez: None. F.J.Lavalle-gonzalez: Speaker's Bureau; Abbott Diagnostics, AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi, Servier Laboratories. E.Vazquez-mendez: None. O.Meza-ledezma: None. Funding The preparation of the abstract was funded by AstraZeneca Pharma Limited.

Effect of diet change in healthy dogs with subclinical cardiac biomarker or echocardiographic abnormalities.

BackgroundA recent study showed higher high‐sensitivity cardiac troponin I (hs‐cTnI) concentrations in healthy dogs eating grain‐free (GF) compared to those eating grain‐inclusive (GI) diets.Hypothesis/ObjectivesHealthy dogs with subclinical cardiac abnormalities eating GF diets at baseline will show improvements in cardiac biomarkers and echocardiographic variables after diet change, whereas healthy dogs eating GI diets at baseline will not improve.AnimalsTwenty healthy dogs with subclinical cardiac abnormalities (12 Golden Retrievers, 5 Doberman Pinschers, 3 Miniature Schnauzers).MethodsThis prospective study included dogs with increased hs‐cTnI or N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) concentrations, or echocardiographic abnormalities. Mixed modeling was used to evaluate echocardiographic, hs‐cTnI, and NT‐proBNP differences between groups (GF or GI diet at baseline) over time (1 y after diet change).ResultsTen GF and 10 GI dogs were evaluated. There were statistically significant time: group interactions for hs‐cTnI (P = .02) and normalized left ventricular internal systolic diameter (LVIDsN; P = .02), with GF dogs showing larger decreases in these variables than GI dogs. Median (range) hs‐cTnI (ng/mL) for GF dogs was 0.141 (0.012‐0.224) at baseline and 0.092 (0.044‐0.137) at 1 y, and for GI dogs was 0.051 (0.016‐0.195) at baseline and 0.060 (0.022‐0.280) at 1 y. Median LVIDsN for GF dogs was 1.01 (0.70‐1.30) at baseline and 0.87 (0.79‐1.24) at 1 y, and for GI dogs was 1.05 (0.84‐1.21) at baseline and 1.10 (0.85‐1.28) at 1 y.Conclusions and Clinical ImportanceDecreased hs‐cTnI and LVIDsN in GF dogs after diet change supports reversibility of these subclinical myocardial abnormalities.

Prospective study of dilated cardiomyopathy in dogs eating nontraditional or traditional diets and in dogs with subclinical cardiac abnormalities.

BackgroundRecent studies have investigated dogs with presumed diet‐associated dilated cardiomyopathy (daDCM), but prospective studies of multiple breeds are needed.Hypothesis/ObjectivesTo evaluate baseline features and serial changes in echocardiography and cardiac biomarkers in dogs with DCM eating nontraditional diets (NTDs) or traditional diets (TDs), and in dogs with subclinical cardiac abnormalities (SCA) eating NTD.AnimalsSixty dogs with DCM (NTD, n = 51; TDs, n = 9) and 16 dogs with SCA eating NTDs.MethodsEchocardiography, electrocardiography, and measurement of taurine, cardiac troponin I, and N‐terminal pro‐B‐type natriuretic peptide were performed in dogs with DCM or SCA. Diets were changed for all dogs, taurine was supplemented in most, and echocardiography and cardiac biomarkers were reassessed (3, 6, and 9 months).ResultsAt enrollment, there were few differences between dogs with DCM eating NTDs or TDs; none had low plasma or whole blood taurine concentrations. Improvement in fractional shortening over time was significantly associated with previous consumption of a NTD, even after adjustment for other variables (P = .005). Median survival time for dogs with DCM was 611 days (range, 2‐940 days) for the NTD group and 161 days (range, 12‐669 days) for the TD group (P = .21). Sudden death was the most common cause of death in both diet groups. Dogs with SCA also had significant echocardiographic improvements over time.Conclusions and Clinical ImportanceDogs with DCM or SCA previously eating NTDs had small, yet significant improvements in echocardiographic parameters after diet changes.

State-of-the-art myocardial strain by CMR feature tracking: clinical applications and future perspectives.

Based on conventional cine sequences of cardiac magnetic resonance (CMR), feature tracking (FT) is an emerging tissue tracking technique that evaluates myocardial motion and deformation quantitatively by strain, strain rate, torsion, and dyssynchrony. It has been widely accepted in modern literature that strain analysis can offer incremental information in addition to classic global and segmental functional analysis. Furthermore, CMR-FT facilitates measurement of all cardiac chambers, including the relatively thin-walled atria and the right ventricle, which has been a difficult measurement to obtain with the reference standard technique of myocardial tagging. CMR-FT objectively quantifies cardiovascular impairment and characterizes myocardial function in a novel way through direct assessment of myocardial fiber deformation. The purpose of this review is to discuss the current status of clinical applications of myocardial strain by CMR-FT in a variety of cardiovascular diseases. KEY POINTS: • CMR-FT is of great value for differential diagnosis and provides incremental value for evaluating the progression and severity of diseases. • CMR-FT guides the early diagnosis of various cardiovascular diseases and provides the possibility for the early detection of myocardial impairment and additional information regarding subclinical cardiac abnormalities. • Direct assessment of myocardial fiber deformation using CMR-FT has the potential to provide prognostic information incremental to common clinical and CMR risk factors.

Changes in Subclinical Cardiac Abnormalities 1 Year after Recovering from COVID-19 in Patients without Clinical Cardiac Findings

Changes in Subclinical Cardiac Abnormalities 1 Year after Recovering from COVID-19 in Patients without Clinical Cardiac Findings

Cardiac function abnormalities in rheumatoid arthritis and its association with duration of disease: a hospital-based case control study

Background: Rheumatoid Arthritis is associated with many extra-articular manifestations including cardiac abnormalities, which increases the risk of morbidity and premature death. Sub-clinical cardiac abnormalities occur many years before their clinically overt manifestations. The objective of the present study is to compare cardiac function abnormality in rheumatoid arthritis patients and healthy controls by echocardiography and to determine its relation with duration of disease.Methods: A hospital based case control study was conducted at a tertiary care centre of northern India including 70 rheumatoid arthritis patients and 70 controls. All subjects were evaluated by Electrocardiography and Trans-thoracic Echocardiography to determine cardiac function abnormalities.Results: ECG abnormalities were detected in 30% of RA cases as compared to only 7.1% of controls. Most common ECG abnormality was LV diastolic dysfunction (p=0.001), followed by pericardial effusion. A weak positive correlation was found between duration of disease and IVRT (r=0.329, p=0.005) indicating worsening of cardiac function with increasing duration of disease.Conclusions: Echocardiographic abnormalities are fairly common among RA patients with LV diastolic dysfunction being most common. Cardiac abnormalities increase with duration and severity of disease.

Study of cardiac involvement in liver cirrhosis patients

Background: Cirrhosis liver is characterized by diffuse destruction and regeneration of hepatic parenchymal cells. Various studies have been carried out over the years to evaluate the cardiac and hemodynamic changes in cirrhosis of the liver.Methods: Study is conducted on 50 consecutive patients with cirrhosis liver admitted in various medical wards of the Mc Gann Hospital attached to Shimoga institute of medical sciences, Shimoga from January, 2020 to September 2020. Detailed history was taken and a through physical examination was done. Blood investigations are done. Echocardiography, Chest radiography done. All patients were subjected to USG abdomen to confirm the diagnosis of cirrhosis.Results: There were 35 males and 15 females. Average age is 54±6.6 years. Alcoholism (64%) and idiopathic (16%) are commonest associations. Commonest symptom is anaemia (88%) followed by pedal oedema (80%) followed by fatigue (66%), ascites (60%) and jaundice (60%). Pleural effusion seen in 38%, diastolic dysfunction 32%, pericardial effusion 16%, wall motion abnormality in 11%. Hypertension, arrhythmias and LVF is seen in 8%. Cardiomyopathy in 6%. ECG changes are Hemiblock in 4 (8%), QTc prolongation in 34%. LVH in 12%, Low voltage complex are seen in 24%. cardiomegaly seen in 20%.Conclusions: Study shows that, there was significant incidence of subclinical cardiac abnormalities observed in chronic liver disease patients which increase with duration of illness. Early detection of subclinical cardiac changes is important to reduce morbidity and mortality in chronic liver disease patients.