Systolic Function In Patients Research Articles

Correlation between Electrocardiogram Changes and Right Ventricular Systolic Function in Patients with Chronic Atrial Fibrillation

Background: Chronic atrial fibrillation (CAF) induces various electric disturbances, and a single mutation can cause multifarious phenotypes or combinations. Identifying the correlation of electrocardiogram changes corresponding to the disorders of electrical activity with right ventricular systolic function (RVSF) is important for the treatment and prognosis of CAF. Therefore, this study explored the correlation of electrocardiogram changes and RVSF in patients with CAF. Methods: From March 2022, to March 2023, 97 patients with CAF admitted to the Department of Cardiology of our hospital (study group) and 100 normal people who received health examination (control group) were subjected to echocardiogram and electrocardiogram to record relevant parameters for correlation analysis. Results: Significant differences were found in the electrocardiogram indices and right heart function parameters between the two groups. The study group had significantly higher heart rate, QTc interval, QT interval and T wave time than the control group (p < 0.05). The study group showed significantly higher right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV), and lower right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) than the control group (p < 0.05). Pearson correlation analysis showed that QTc interval, QT interval, and T wave time were positively correlated with RVESV (p < 0.05); QTc interval, QT interval, and T wave time were negatively correlated with RVSV (p < 0.05); and QTc interval was negatively correlated with RVEF (p < 0.05). Conclusion: A correlation exists between electrocardiogram changes and RVSF in patients with CAF.

Left ventricular systolic function in patients with acute coronary syndrome-risk profile

Abstract Funding Acknowledgements None. Introductions and objectives Left ventricular (LV) systolic dysfunction is one of the most important determinants of long-term outcome in acute coronary syndrome (ACS). Aim To determine the impact of the patient’s risk profile on the LV systolic function. Methods A single-center cross-sectional cohort study that included 3093 patients with ACS without pre-existing LV dysfunction. The comparison was performed between patients who did or did not develop a reduction in LV systolic function during the index event (<50%/≥50%), analyzing patients’ demographic, clinical, biochemical data, LV functional data, and anatomical distribution of the coronary artery disease (CAD). Result 1369 patients out of 3093 developed LV systolic dysfunction (44.3%). They were predominantly males 75.1% (1028), p=0.002; older (63.39±11.04 vs 61.21±11.12, p<0.00000); had higher level of cardiac troponin (p=0.00002), higher stress glycemia (9.2±5.3; p=0.0000001), HbA1c (6.9±1.8, p=0.000003), WBC (11.7±4.1, p=0.00001), blood urea nitrogen (BUN) (6.8±3.7, p=0.000003), and creatinine (93.2±45.1 p=0.000167), and had anemia (OR 0.35 (CI 0.29–41, p=0.000012). They had more severe CAD (SINTAX score 16.8±8.4 p=0.000012). Patients with preserved LV systolic function were predominantly females (29.7%, OR 1.1 95% CI 1.0-1.2), p = 0.002), younger (p<0.00000), and severely metabolically burdened (hypothyreosis (2.7%, OR 1.28 95% CI 0.93-1.76, p=0.052), higher levels of triglycerides (2.2±1.7 vs 1.9±1.5, p = 0.001), cholesterol (5.3±1.4 vs 5.2±1.4, p = 0.002), non-HDL-C (4.1±1.5 vs 3.9±1.3, p=0.006), however less likely to have pre-existing DM (OR 0.8 (CI 0.78–0.92), p=0.000094). They were more often NSTEMI [851 (49.4%), p = 0.000012]. Independent variables associated with a reduction in LV function were: advanced age, male gender, previous DM and anemia, stress glycemia, WBC, creatinine, and BUN. Conclusion Patients who developed reduced LV function had a very specific risk profile with bigger neuro-hormonal activation and inflammation, higher degree of myocardial damage, and worse renal function, whereas those with preserved LV systolic function after ACS were younger, predominantly females, more severely metabolically burdened, more often with NSTEMI and without LAD involvement.

Role of Multi-parameter-based Cardiac Magnetic Resonance in the Evaluation of Patients with Coronary Heart Disease Combined with Heart Failure.

Coronary Heart Disease (CHD) is one of the most common types of cardiovascular disease, and Heart Failure (HF) is an important factor in its progression. We aimed to evaluate the diagnostic value and predictors of multiparametric Cardiac Magnetic Resonance (CMR) in CHD patients with HF. The study retrospectively included 145 CHD patients who were classified into CHD (HF+) (n = 91) and CHD (HF-) (n = 54) groups according to whether HF occurred. CMR assessed LV function, myocardial strain and T1 mapping. Multivariate linear regression analyses were performed to identify predictors of LV dysfunction, myocardial fibrosis, and LV remodeling. CHD (HF+) group had impaired strain, with increased native T1, ECV, and LVM index. The impaired strain was associated with LVM index (p < 0.05), where native T1 and ECV were affected by log-transformed amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. ROC analysis showed the combination of global circumferential strain (GCS), native T1, and LVM had a higher diagnostic value for the occurrence of HF in CHD patients.<P> Meanwhile, log-transformed NT-proBNP was an independent determinant of impaired strain, increased LVM index, native T1 and ECV. HF has harmful effects on LV systolic function in patients with CHD. In CHD (HF+) group, LV dysfunction is strongly correlated with the degree of LV remodeling and myocardial fibrosis. The combination of the three is more valuable in diagnosing HF than conventional indicators.

Two-dimensional speckle-tracking echocardiography in left ventricular systolic function in patients with systemic lupus erythematosus.

To investigate whether two-dimensional speckle-tracking echocardiography (2DSTE) can be considered a criterion for early left ventricular (LV) systolic impairment in patients with systemic lupus erythematosus (SLE) and to further explore the association with each other. We included 38 patients with SLE and assessed the degree of disease activity according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) 2000 scoring criteria, together with 38 healthy controls who were matched by sex and age. Routine LV systolic function evaluation parameters were obtained by echocardiography as well as 2DSTE measurement of LV strain parameters to obtain global longitudinal strain (GLS) values, respectively. (I) On routine LV function parameters such as ejection fractions (EF) and left ventricular end-diastolic internal diameter (LVIDd), the SLE group and the control group did not reflect differences. In contrast, on the LV strain parameter obtained from 2DSTE measurements, the GLS values in all cardiac planes were lower in the SLE group than in the control group and showed statistically significant differences. (II) Correlation analysis showed that there was a correlation between SLEDAI and GLS, especially a meaningful correlation with GLS Avg and GLS A4C, with correlation coefficients of 0.35 and 0.47, respectively. The use of 2DSTE can detect early impaired LV systolic function in SLE patients, and GLS is progressively gaining attention as an indicator of subclinical myocardial injury and LV function in SLE patients. The correlation that exists between GLS and SLEDAI might contribute to a better assessment of cardiac involvement in SLE patients. Key Points • Cardiac involvement has become one of the major factors in the poor prognosis of SLE patients, which directly affects the mortality of SLE patients. Traditional echocardiography is difficult to detect early left ventricular function impairment, thus affecting clinicians' judgment and diagnosis. • 2DSTE can recognize subclinical myocardial injury in SLE patients at an early stage, and its derived strain parameters may be used as an indicator to evaluate myocardial involvement and reflect disease activity in SLE patients.

Cardiac Magnetic Resonance Imaging Based Ischemic Injury Pattern in Patients with Acute Myocardial Infarction Sensu Left Ventricular Global Systolic Function.

The purpose of the study was to identify factors characterizing a decrease in LV global systolic function in patients with ST-segment elevation myocardial infarction (STEMI) after revascularization using cardiac magnetic resonance imaging (MRI)-based ischemic injury pattern and laboratory parameters sensu left ventricular global systolic function. A total of 109 STEMI patients were examined. The patients underwent contrast-enhanced cardiac MRI with a 1.5 Tesla GE SIGNA Voyager (GE HealthCare, Chicago, IL, USA) on the 7th-10th days from the onset of the disease. According to cardiac MRI analysis, the patients were divided into the following groups with regard to left ventricular ejection fraction (LVEF) values: Group 1-patients with LVEF ≥ 50%; group 2-patients with mildly reduced LVEF 40-49%; group 3-patients with low LVEF < 40%. A predominance of most parameters of the ischemic injury pattern was noted in patients with mildly reduced and low LVEF versus patient group with LVEF ≥ 50%. Some risk factors for a decrease in LVEF < 50% systolic function in STEMI patients after revascularization were revealed: male gender; time from the onset of the anginal attack to revascularization; coronary artery status; several LV parameters; ischemic injury characteristics; natriuretic peptide and troponin I levels.

Evaluation of Left Ventricular Function in Patients With Severe Aortic Stenosis Utilizing Automated Cardiac Motion Quantitation Techniques

ObjectiveThe objective of this study is to explore the patterns of alteration in left ventricular systolic function among patients with severe aortic stenosis (SAS) through the application of automatic myocardial motion quantification (aCMQ) techniques. Furthermore, we seek to ascertain dependable quantitative markers for the assessment of impaired left ventricular function in patients with SAS and an ejection fraction (EF) ≥ 60%. MethodsSeventy patients who underwent echocardiography and received a diagnosis of severe aortic stenosis (SAS) in the hospital from November 2021 to August 2022 were selected for the SAS group and categorized into three subgroups based on ejection fraction (EF)—SAS group with EF ≥ 60%, SAS group with EF ranging from 50% to 59%, and SAS group with EF < 50%. Concurrently, 30 healthy individuals were recruited at the hospital during the same timeframe to serve as the control group. Participants from both groups underwent standard transthoracic echocardiography to assess conventional echocardiographic parameters. Dynamic images were examined using automatic myocardial motion quantification (aCMQ) software to derive longitudinal peak strain (LPS) parameters, which were then subjected to statistical analysis. ResultsIn comparison to the control group participants, the measurements of ascending aorta diameter (AoD), left atrium diameter (LAD), interventricular septal end diastolic thickness (IVSd), left ventricular posterior wall end diastolic thickness (LVPWd), peak systolic velocity (Vmax), and mean pressure gradient (MPG) were significantly higher in the SAS groups (p < 0.05). When compared to participants in the SAS group with an EF ≥ 60%, the values of IVSd, LVPWd, Vmax, and MPG in the SAS group with EF ranging from 50% to 59% were significantly elevated (p < 0.05). Similarly, left ventricular end-diastolic diameter (LVEDD), the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/e'), and the ratio of early to late diastolic mitral inflow velocities (E/A) in the SAS group with EF < 50% were significantly elevated (p < 0.05). The absolute values of longitudinal peak strain (LPS) in the SAS groups were significantly lower in comparison to those in the control group (p < 0.05). Furthermore, all measurements of left ventricular global longitudinal systolic peak strain (GLPS) showed a positive correlation with MPG, a moderate negative correlation with aortic valve area index (AVAI), and a moderate positive correlation with E/A. ConclusionsPatients with SAS and an EF < 50% exhibited the most profound impairment in left ventricular myocardial function. Utilizing the aCMQ technique enables the precise and quantitative evaluation of the severity of impaired left ventricular systolic function in patients within the SAS group with an EF ≥ 60%.

Quantitative assessment of left ventricular myocardial work in patients with different types of atrial fibrillation by non-invasive pressure-strain loop technique.

This study aimed to analyze myocardial work in patients with atrial fibrillation (AF) using a noninvasive pressure strain loop (PSL) technique to provide a basis for the quantitative assessment of left ventricular (LV) systolic function. LV myocardial work of 107 AF patients (56 with paroxysmal atrial fibrillation and 51 with persistent atrial fibrillation) and 55 healthy individuals were assessed by the noninvasive PSL and then compared. Global longitudinal strain (GLS) in absolute values, global work index (GWI), global constructive work (GCW), and global work efficiency (GWE) were significantly lower in the AF group than control group, whereas peak strain dispersion (PSD) and global wasted work (GWW) were significantly higher (P<.05). Further subdivision according to the AF type revealed that, compared with the controls, GLS in absolute values and GWE decreased significantly; PSD and GWW increased significantly in the paroxysmal AF group (P<.05). Nevertheless, GWI and GCW were not significantly different between paroxysmal AF and control groups (P>.05). Compared to paroxysmal AF, persistent AF induced a further decrease in absolute GLS and GWE and a further increase in GWW (P<.05), but PSD did not increase further (P>.05). Multiple linear regression analysis showed that GWI and GCW were independently associated with systolic blood pressure. GWW was associated with types of AF and left atrial volume index (LAVI). GWE was correlated with age, types of AF, disease duration, and LAVI. Receiver operating characteristic curve analysis showed that the area under the curve predicting myocardial injury was higher for GWE and GWW than for GLS (area under the curve: .880, .846, and .821, respectively). Non-invasive PSL can quantitatively assess LV systolic function in patients with different kinds of AF and detect early subclinical myocardial injury in patients with paroxysmal AF. GWE and GWW outperform GLS and LV ejection fraction when assessing myocardial injury. Systolic blood pressure, type of AF, LVAI, disease duration, and age may be associated with myocardial injury in patients with AF.

Impact of Epicardial Adipose Tissue on Infarct Size and Left Ventricular Systolic Function in Patients with Anterior ST-Segment Elevation Myocardial Infarction.

We aimed to assess the correlation of cardiovascular magnetic resonance (CMR)-derived epicardial adipose tissue (EAT) with infarct size (IS) and residual systolic function in ST-segment elevation myocardial infarction (STEMI). We enrolled patients discharged for a first anterior reperfused STEMI submitted to undergo CMR. EAT, left ventricular (LV) ejection fraction (LVEF), and IS were quantified at the 1-week (n = 221) and at 6-month CMR (n = 167). At 1-week CMR, mean EAT was 31 ± 13 mL/m2. Patients with high EAT volume (n = 72) showed larger 1-week IS. After adjustment, EAT extent was independently related to 1-week IS. In patients with large IS at 1 week (>30% of LV mass, n = 88), those with high EAT showed more preserved 6-month LVEF. This association persisted after adjustment and in a 1:1 propensity score-matched patient subset. Overall, EAT decreased at 6 months. In patients with large IS, a greater reduction of EAT was associated with more preserved 6-month LVEF. In STEMI, a higher presence of EAT was associated with a larger IS. Nevertheless, in patients with large infarctions, high EAT and greater subsequent EAT reduction were linked to more preserved LVEF in the chronic phase. This dual and paradoxical effect of EAT fuels the need for further research in this field.

Investigation of left ventricular strain by speckle-tracking echocardiography in patients with chronic obstructive pulmonary disease with preserved ejection fraction

Objective: To investigate the left ventricular strain parameters by speckle - tracking echocardiography in patients with chronic obstructive pulmonary disease with preserved ejection fraction. Find out the correlations and relationships between strain parameters with some conventional left ventricular echocardiographic indictors, Pulmonary artery pressure systolic, TAPSE index. Materials and methods: A controlled cross-sectional descriptive study consisted of 51 patients with chronic obstructive pulmonary disease diagnosed according to GOLD 2023. The control group consisted of 52 people with normal lung function. Results: Values ​​of strain parameters on speckle - tracking echocardiography in patients with COPD: GLS (%): -13.52 ± 1.77; GLSR (1/s): -1.64 ± 0.28; GCS (%): -22.07 ± 2.27; GCSR (1/s): -2.70 ± 0.38; longitudinal - circumference index: -17.80 ± 1.71; EF STE (%): 54.21 ± 4.23. These parameters were all reduced compared with the control group with p &lt; 0.05 while there was no statistically significant change of the indices on routine echocardiography. There was no correlation between the parameters of left ventricular systolic strain and the LVMI, FS and LVEF values ​​measured by M-Mode. Meanwhile, there is a positive correlation with PAPs (r = 0.499 - 0.629, p&lt;0.001). There is a negative correlation between GLS and TAPSE index (r = -0.311, p &lt; 0.001). Conclusion: Speckle - tracking echocardiography helps in early detection of cardiac dysfunction, especially left ventricular systolic function in patients with chronic obstructive pulmonary disease even when EF is normal. Key words: chronic obstructive pulmonary disease, Speckle tracking echocardiography.

Kiosk 5R-TA-05 - Impact of Edema and Myocardial Fibrosis on Systolic Function in Patients with Cardiotoxicity Due to Chemotherapy

Kiosk 5R-TA-05 - Impact of Edema and Myocardial Fibrosis on Systolic Function in Patients with Cardiotoxicity Due to Chemotherapy

Association between Time to Thrombolysis and Left Ventricular Systolic Function in Patients with St-Elevation Myocardial Infarction: Unraveling the Relationship

OBJECTIVES To determine the association between time to thrombolysis and left ventricular (LV) systolic function in patients with ST-elevation Myocardial Infarction (STEMI). METHODOLOGY T This descriptive case series study compared the time to thrombolysis and LV systolic function of 149 STEMI patients. LV systolic function was evaluated following thrombolysis, and data were collected and analyzed using SPSS version 21.0 software. This study was conducted at the Ayub Teaching Hospital Cardiology Department in Abbottabad from August 2022 to January 2023. RESULTSThe study examined how LV systolic function and symptoms in STEMI patients related to when thrombolysis was administered. The 149 patients analyzed included 28 with normal LV function, 86 with mildly impaired function, 26 with moderately impaired function, and 9 with severely impaired function. In contrast to delayed thrombolysis, which was linked to higher levels of impairment, immediate thrombolysis was correlated with a higher percentage of normal LV function. The prevalence of patients with severely compromised LV function was also higher in those who received thrombolysis within 3 to 6 hours and 9 to 12 hours. LV function was correlated with the type of myocardial infarction, with varying degrees of impairment seen in AWMI and IWMI patients. Gender had no discernible effect on LV function. CONCLUSION Improved LV function is associated with early thrombolysis within hours of STEMI symptoms, highlighting the significance of prompt intervention and minimizing wait times for better patient outcomes.

Assessment of left ventricular systolic function in patients with chronic coronary syndrome and heart failure with reduced ejection fraction after percutaneous coronary intervention

Objective: Describe the characteristic and change of left ventricular systolic function after percutaneous coronary intervention in patients with chronic coronary syndrome and heart failure with reduced ejection fraction after percutaneous coronary intervention. Methods: This prospective study involved the monitoring of 40 patients who had an ejection fraction of 40% or less and were diagnosed with chronic coronary artery disease. These patients underwent a successful percutaneous coronary intervention at the Vietnam National Heart Institute and Hanoi Medical University Hospital between September 2022 and August 2023. The main objective is to evaluate the left ventricular systolic function following the intervention using 2D echocardiography. Results: A total of 40 patients (34 male and 6 females) with a mean age of 68.3 ± 10.2, were assessed for left ventricular systolic function using 2D echocardiography before and after the intervention. In paired assessment at 90-day follow-up, baseline LVEF improved significantly (before intervention: 32.8 ± 7.2% and after: 38,7 ± 7,3%, p &lt; 0.01). Left ventricular longitudinal strain improved significantly on all cross-sections such as: 4-chamber GLS (before: -10.4 ± 3.97%, after: -13.6 ± 4.3%, p &lt; 0.01), 2-chamber GLS (before: -10.6 ± 3.8%, after: -13.1 ± 4.2%, p &lt; 0.01), 3-chamber GLS (before: -9.8 ± 3.7%, after: -12.3 ± 4.6%, p &lt; 0.01), GLS Avg (before: -10.3 ± 3.6%, after: -13 ± 4.1%, p&lt; 0.01), basal GLS (before: -11.2 ± 3.8%, after: -14 ± 4.5%, p &lt; 0.01), middle GLS (before: -9.3 ± 4.4%, after: -11.8 ± 3.9%, p &lt; 0.01), apical GLS (before: -11.5 ± 5.1%, after: -14.3 ± 5.9%, p &lt; 0.01). In comparison with the incomplete-revascularization group, there was a significant improvement in left ventricular systolic function in the complete-revascularization group (OR= 22.17, p &lt; 0.01). Conclusions: In patients with chronic coronary syndrome and a reduced left ventricular ejection fraction, the systolic function of the left ventricle was enhanced following percutaneous coronary intervention, particularly in the group that underwent complete revascularization.

Qp/Qs in ostium secundum atrial septal defect mitigates right ventricular dysfunction in patients with secondary pulmonary hypertension

Abstract Background Ostium-secundum atrial septal defect (OS-ASD) can potentially lead to pulmonary hypertension (PH) and associated right ventricle (RV) - pulmonary artery (PA) uncoupling. This, in turn, may eventually result in RV systolic dysfunction. Notwithstanding, whether the characteristics of the OS-ASD could mitigate this relationship is unclear. Purpose To evaluate a potential interaction of the OS-ASD shunt (Qp/Qs ratio) on the relationship with RV–PA coupling and RV systolic function in patients with secondary PH. Methods We designed a cross-sectional study of 63 adult patients with OS-ASD in which we performed a conventional transthoracic echocardiogram using Vivid 9X-clear equipment (GE Vingmed Ultrasound, Horten, Norway). We evaluated the OS-ASD shunt and other echocardiographic parameters, including the tricuspid annular plane systolic excursion (TAPSE), the systolic pulmonary artery pressure (sPAP) ratio and the right ventricular free wall longitudinal strain (RVFWLS). Polynomic adjusted correlations were performed to model the relationship between the TAPSE/sPAP ratio and the RVFWLS, then we evaluated an interaction effect of the OS-ASD shunt (Qp/Qs ratio), respectively adjusted for age, sex, body mass index, body surface area and right atrial area. Results In our study, 49 (78%) subjects were male, with a mean age of 41.8 (±15) years; 7.94% (n=5) had mild PH, 42.9% (n=27) had moderate PH and 49.2% (n=31) had severe PH. Mean echocardiographic parameters were: TAPSE 24.5 (±5.1) mm , sPAP of 55.9 (±20.7) mmHg, TAPSE/sPAP 0.49 (±0.2) mm/mmHg, RVFWLS -25.6 (±6.6) % and Qp/Qs 2.9 (±0.9). We observed a quadratic relationship between the TAPSE/sPAP ratio and the RVFWLS (r=0.691, p &amp;lt; 0.001; Figure 1). OS-ASD shunt had a positive interaction effect (β=10.9, 95% CI: 2.09-19.6, p=0.018) on the relationship between TAPSE/sPAP and RVFWLS after adjusting for covariates (Figure 2). Conclusions In conclusion, in patients with OS-ASD, the RV systolic function decreases as the RV-PA uncoupling increases, as reflected in the quadratic regression between the TAPSE/sPAP and the RVFWLS. Moreover, the increase in OS-ASD shunt decreases RVFWLS values in relationship to the TAPSE/sPAP ratio as observed in the interaction model. These results could suggest that the OS-ASD characteristics could potentially mitigate RV dysfunction in patients with secondary PH.Figure 1.Quadratic regressionFigure 2.Interaction model

Cryoballoon ablation for atrial fibrillation in patients with heart failure and reduced left ventricular ejection fraction: A systematic review and meta-analysis.

The coexistence of atrial fibrillation (AF) with heart failure (HF) is prevalent, leading to severe complications. This review aimed to investigate the success rate and efficacy of cryoballoon ablation (CBA) by measuring the improvement in the New York Heart Association (NYHA) classification and the effect on the left ventricular systolic function in patients with AF accompanied by heart failure with reduced ejection fraction (HFrEF). Electronic databases search included PubMed, Web of Science, and Scopus in January 2023. Outcomes addressed the following: left ventricular ejection fraction (LVEF) improvement, AF recurrence, NYHA classification improvement, and mortality. STATA 17.0 software was used for data analysis. The effect size for the studies was a standard mean difference (SMD) with a 95% confidence interval (CI) for outcomes. Proportion analysis with 95% CI was used for freedom from early AF and AF after 2 years and all-cause death. We included six studies, including 1699 HF patients with 365 HFrEF patients. The SMD of postoperative LVEF compared to preoperative LVEF in HFrEF was 0.99 ([95% CI: 0.60, 1.39], p = .00), and for NYHA was -1.12 ([95% CI: -1.36, -0.87], p = .00). The analysis results in HFrEF patients for freedom from AF after 1 year was 65% ([95% CI: 0.55, 0.75], and after 2 years was 39% ([95% CI: 0.10, 0.67]). Proportional analysis was conducted for all-cause death, resulting in 3% mortality ([95% CI: -0.01, 0.07]). Cryoablation of AF accompanied by HFrEF appeared safe as it reduced AF recurrence and enhanced clinical outcomes.

Abbreviated cardiac magnetic resonance imaging versus echocardiography for interval assessment of systolic function in Duchenne muscular dystrophy: patient satisfaction, clinical utility, and image quality.

Poor acoustic windows make interval assessment of systolic function in patients with (Duchenne Muscular Dystrophy) DMD by echocardiography (echo) difficult. Cardiac magnetic resonance imaging (CMR) can be challenging in DMD patients due to study duration and patient discomfort. We developed an abbreviated CMR (aCMR) protocol and hypothesized that aCMR would compare favorably to echo in image quality and clinical utility without significant differences in exam duration, patient satisfaction, and functional measurements. DMD patients were recruited prospectively to undergo echo and aCMR. Modalities were compared with a global quality assessment score (GQAS), clinical utility score (CUS), and patient satisfaction score (PSS). Results were compared using Wilcoxon signed-rank tests, Spearman correlations, intraclass correlations, and Bland-Altman analyses. Nineteen DMD patients were included. PSS scores and exam duration were equivalent between modalities, while CUS and GQAS scores favored aCMR. ACMR scored markedly higher than echo in RV visualization and assessment of atrial size. Older age was negatively correlated with echo GQAS and CUS scores, as well as aCMR PSS scores. Higher BMI was positively correlated with aCMR GQAS scores. Nighttime PPV requirement and non-ambulatory status were correlated with worse echo CUS scores. Poor image quality precluding quantification existed in five (26%) echo and zero (0%) aCMR studies. There was moderate correlation between aCMR and echo for global circumferential strain and left ventricular four chamber global longitudinal strain. The aCMR protocol resulted in improved clinical relevance and quality scores relative to echo, without significant detriment to patient satisfaction or exam duration.

Concordancia de la evaluación ecocardiográfica básica funcional del ventrículo izquierdo entre médicos no expertos y cardiólogos especialistas en ecocardiografía

IntroductionThe clinical decisions of patients in the intensive care unit are based on the integration of the clinical history and complementary tests. The echocardiographic evaluation can reveal decisive information in the interventions and in the prognosis of the patients. ObjectiveTo determine the concordance in the analysis of left ventricular systolic function performed by physicians with basic training in echocardiography compared with the assessment by expert cardiologists. MethodologyCross-sectional study of diagnostic concordance with prospective recruitment. Patients hospitalized in the intensive care unit during 2023 in a university clinic with a high level of complexity were included. The concordance between the trained physician and the expert was analyzed using the Kappa index (κ) for the qualitative variables, and the intraclass correlation coefficient for the quantitative ones. Results131 patients were included, with a mean age of 62 years. The concordance of the echocardiographic assessment was determined, finding very good concordance for left ventricular contractility (κ: 0.97), pericardial effusion (κ: 0.82) and its location (κ: 0.85), contractility disorders (κ: 0.84) and in the quantitative measurement of the ejection fraction (intraclass correlation coefficient: 0.91). ConclusionsThere is agreement in the evaluation of left ventricular systolic function in patients hospitalized in the intensive care unit by non-expert medical personnel with training and expert cardiologists. The results should be interpreted as part of a comprehensive assessment at the patient's bedside and not as an isolated diagnosis, always under quality standards and with the necessary verification.

Effects of Ivabradine on Right Ventricular Systolic Function in Patients With Chronic Obstructive Pulmonary Disease and Cor Pulmonale

Cor pulmonale is a clinical syndrome associated with pulmonary hypertension, frequently complicated by congestive heart failure, commonly caused by chronic obstructive pulmonary disease (COPD). Most patients with cor pulmonale have tachycardia. However, heart rate (HR) reduction represents a primary treatment goal to improve the survival and quality of life in these patients. Ivabradine can selectively slow HR at rest and during exercise. In this prospective study, we tested the hemodynamic effects, invasively determined using right-sided cardiac catheterization, of reducing HR with ivabradine. We selected 18 patients (13 men [72.2%], mean age 67 ± 10years) with COPD and cor pulmonale, presenting with sinus tachycardia. All patients performed clinical evaluation, electrocardiogram, spirometry, echocardiogram, 6-minute walking distance, and right-sided cardiac catheterization within 1month of enrollment. All tests were repeated after 6months of ivabradine treatment (median assumed dose 11.9mg/die). We noticed a significant decrease of HR (from 98 ± 7 to 77 ± 8beats/min, p=0.0001), with a concomitant reduction of the congestion index (from 25.9 ± 5.1 to 19.4 ± 5.7mm Hg, p=0.001), and the consequent improvement of the right ventricular systolic performance (right ventricular stroke volume augmented from 56.7 ± 7.9 to 75.2 ± 8.6ml/beat, p=0.0001). This allows an improvement in clinical status and exercise tolerance (Borg scale score decreased from 5.2 ± 1.4 to 4.1 ± 1.3, p=0.01 and the 6-minute walking distance increased to 252 ± 65 to 377 ± 59m, p=0.001). In conclusion, HR reduction significantly improves hemodynamic and clinical status of patients with tachycardia affected by COPD and cor pulmonale.

Effect of ischemic injury characteristics on left ventricular systolic function in patients with acute myocardial infarction

Aim. To study laboratory and magnetic resonance imaging (MRI) characteristics of infarction area depending on left ventricular (LV) global systolic function in patients with acute myocardial infarction (AMI) after revascularization.Material and methods. A total of 78 patients with primary AMI were included. On days 7-10, contrast-enhanced cardiac MRI was performed. Blood brain natriuretic peptide (BNP) was analyzed. Cardiac MRI was used to determine the characteristics of scar tissue, peri-infarct zone (PIZ), microvascular obstruction (MVO), intramyocardial hemorrhage (IMH) and the global contrast index.Results. According to the MRI, patients were divided into following groups: group 1 — LV ejection fraction (LVEF) ≥50% (n=50), group 2 — LVEF 40-49% (n=21), group 3 — LVEF &lt;40% (n=7).The BNP in groups 1, 2, 3 was 106,8 (37,5; 248), 232,6 (170,1; 337,7) and 548,5±236,4 ng/ml, respectively (p1-3&lt;0,05). The scar tissue mass in groups 1, 2, 3 was 10,3 (2,4; 20,0), 34,7±21,3, 59,4±37,6 g, respectively (p1-2, 3&lt;0,01). PIZ differences were found only between patients with preserved and mildly reduced EF. MVO was diagnosed in 26% of patients with LVEF ≥50%, in 47,6% of patients with LVEF of 40-49% and 85,7% with LVEF &lt;40% (p1-3&lt;0,01). The detection rate of IMH prevailed in the 2nd group (33,3%) compared with the 1st group (12%) (p1-2&lt;0,05). The global contrast index was the lowest in the 1st group (14,7 (8,8; 27,9)%), intermediate in the 2nd group (33,3±12,6%), the highest in the 3th group (54,2±19,5%) (р1-2, 3; 2-3&lt;0,05).Conclusion. The following risk factors for a decrease in LV systolic function in patients with AMI after revascularization were identified: the size of scar tissue, PIZ, MVO and IMH characteristics, global contrast index, BNP level.

Left atrial strain and ventricular global longitudinal strain in cirrhotic patients using the new criteria of Cirrhotic Cardiomyopathy Consortium.

The new criteria of Cirrhotic Cardiomyopathy Consortium (CCC) propose the use of left ventricular global longitudinal strain (LV-GLS) for evaluation of systolic function in patients with cirrhosis. The aim of this study was to evaluate LV-GLS and left atrial (LA) strain in association with the severity of liver disease and to assess the characteristics of cirrhotic cardiomyopathy (CCM). One hundred and thirty-five cirrhotic patients were included. Standard echocardiography and speckle tracking echocardiography (2D-STE) were performed, and dual X-ray absorptiometry was used to quantify the total and regional fat mass. CCM was defined, based on the criteria of CCC, as having advanced diastolic dysfunction, left ventricular ejection fraction ≤50% and/or a GLS <18%. LV-GLS lower or higher than the absolute mean value (22.7%) was not associated with mortality (logrank, p = 0.96). LV-GLS was higher in patients with Model for end stage liver disease (MELD) score ≥15 compared to MELD score <15 (p = 0.004). MELD score was the only factor independently associated with systolic function (LV-GLS <22.7% vs. ≥22.7%) (Odds Ratio:1.141, p = 0.032). Patients with CCM (n = 11) had higher values of estimated volume of visceral adipose tissue compared with patients without CCM (median: 735 vs. 641 cm3 , p = 0.039). On multivariable Cox regression analysis, MELD score [Hazard Ratio (HR):1.26, p < 0.001] and LA reservoir strain (HR:0.96, p = 0.017) were the only factors independently associated with the outcome. In our study, absolute LV-GLS was higher in more severe liver disease, and LA reservoir strain was significantly associated with the outcome in patients with end-stage liver disease.

Assessment left ventricular function by speckle tracking in patients with mitral valve replacement in Hanoi heart hospital

Background: The evaluation of left ventricular dysfunction in patients with severe mitral valve disease is very important for diagnosis, surgical indication and postoperative follow-up assessments. Speckle Tracking provides additional information to conventional echocardiographic parameters. Objective: Research global longitudinal strain by Speckle Tracking in patiens underwent mitral valve surgery at Hanoi Heart Hospital. Subjects and methods: 35 patients underwent mitral valve surgery at Hanoi Heart Hospital from July 2018 to September 2019. This is a prospective, longitudinal follow-up for at least 3 months research. Results: Postoperative myocardial global longitudinal strain of the left ventricular decreased compared to pre-surgery (-19.85 ± 2.24 vs -16.54 ± 3.01; p &lt; 0.001). The global myocardial longitudinal strain of the left ventricular decreased more in the group whose postoperative EF decreased by ≥10% compared with the group whose EF decreased &lt;10% after surgery (-17.73 ± 2.71 versus -15.28 ± 2.85; p. &lt; 0.05). Mean global myocardial longitudinal strain (GLS avg) after surgery has a linear correlation with left ventricular contraction fraction FS after surgery (r = -0.508; p &lt; 0.005), with left ventricular ejection fraction EF after surgery (r = - 0.402; p &lt; 0.05), with ejection fraction EF biplane after surgery with (r = - 0.768; p &lt; 0.001) and global myocardial longitudinal strain (GLS avg) after surgery há a linear correlation with the degree of change in EF after surgery ≥ 10% (r) = 0.601; p &lt; 0.001). Conclusion: Longitudinal LV deformation assessed by speckle tracking is significant in assessing the decline in left ventricular systolic function in patients with mitral valve surgery.