Ventricle Posterior Wall Thickness Research Articles

Abstract MP228: The Role Of Gut Microbiome Secreted Short Chain Fatty Acids In The Development Of Heart Failure With Preserved Ejection Fraction HFpEF

More than 50% of patients with heart failure are diagnosed with heart failure with preserved ejection fraction (HFpEF), and 80% of them are obese. It is a prominent disease with no available treatments. It is characterized by diastolic dysfunction that involves increase in left ventricle stiffness and decrease in its relaxation during diastole. To better understand the pathogenesis of obesity associated HFpEF, our studies focus on the early asymptomatic changes in cardiac mechanics that occurs before the increases in intracardiac pressure. Therefore, we have developed an obesity associated mouse model that we called pre-HFpEF where mice were fed either Normal Chow or Western Diet for 14 weeks. Our echocardiography measurements indicated the presence of early cardiac dysfunction consistent with obesity associated pre-HFpEF phenotype. Mice on WD had decrease in Global Longitudinal Strain (%GLS) and Longitudinal strain rate reverse (LSRr) indicating early signs of systolic and diastolic dysfunction, as well as increase in left ventricle anterior and posterior wall thickness during diastole (LVAWd, LVPWd). Obesity is also known to cause microbiome imbalance, which plays a significant role in the development of cardiovascular diseases through changes in short chains fatty acids, which are products of dietary fiber fermentation by the gut bacteria. In order to study the association between gut microbiome imbalance and HFpEF development, we treated our obese pre-HFpEF mice with fecal matter transplantation (FMT) from either lean or obese mice, and we found that FMT from lean mice led to significant improvements in systolic and diastolic dysfunction by increasing %GLS and LSRr and preventing hypertrophy by decreasing LVAWd and LVPWd. In addition, WD reduced butyrate producing bacteria, however circulating levels of butyrate were significantly increased with lean FMT treatment. Using an in-vitro approach to mimic WD we found butyrate treatment to inhibit the activation of NLRP3 inflammasome and NF-KB. Therefore, since FMT treatment improved cardiac dysfunction in obesity associated pre-HFpEF mice, and that butyrate is increased after FMT and can play a role in metabolic homeostasis, we predict that butyrate could be an important player in FMT improvements through cardiac metabolic regulation and cardiac inflammation suppression

Identification of high-risk Fontan candidates by intraoperative pulmonary flow study

BackgroundPre-Fontan risk stratification is still less than optimal. We aimed to evaluate the effectiveness of intraoperative pulmonary flow study (IOFS), in combination with conventional preoperative evaluation, in the identification of high-risk candidates for the Fontan operation. MethodData from 37 patients (age: 38.1 ± 4.9 months) who underwent the Fontan operation with IOFS were retrospectively reviewed. After anastomosing the Gore-Tex vascular graft to the confluent pulmonary artery, IOFS was performed through the graft at various cardiac indices (CI) (1–4 L/min/m2) generated from a roller pump. Mean pulmonary artery pressure (mPAP) and left atrial pressure (LAP) were recorded. The patients were divided into two groups: those who required Fontan circuit fenestration (group Ff) and those who did not (group Fn). ResultsEleven patients (29.7%) required fenestration, intraoperatively (n = 4) and postoperatively (n = 7), due to hemodynamic instability. Heterotaxy syndrome (P = 0.005) and atrioventricular valvar regurgitation (P = 0.04) were more frequent, and ventricle posterior wall thickness (VPWT) was higher (P = 0.024) in group Ff. On IOFS, the increase in mPAP by CI was sharper in group Ff than in group Fn (P < 0.001) owing to an increase in LAP. On multivariable analysis, mPAP at a CI of 3.0 L/min/m2 from IOFS was the only predictor of fenestration and correlated with preoperative VPWT (R = 0.543, P = 0.001). ConclusionsIOFS may be helpful to identify high-risk Fontan candidates, and high mPAP at CI of 3.0 L/min/m2 on IOFS is a significant predictor of the requirement for fenestration. VPWT is an important preoperative risk factor which correlates with the IOFS results.

Gene expression of nuclear factor of activated T-cells in children with bicuspid aortic valve.

The genes of nuclear factor of activated T-cells ( NFATC ) play a key role both in heart valves formation and immune response. The genes belong to transcriptional factors and lead to myocardial hypertrophy in postnatal period that is confirmed by experimental models on animals. The purpose of this study was to reveale NFATC1 and NFATC4 genes expression level in the blood of 30 children with congenital heart diseases (CHD), 15 of them had bicuspid aortic valve, 15 had CHD without valve anomalies and 15 healthy children of the control group. No patients had signs of heart failure. At the first sage of Doppler heart ultrasound study a significant increase of the left ventricle posterior wall and ventricular septum thickness in comparison with CHD and control was revealed in BAV group. At the second stage a significant rise of relative normalized expression of NFATC1 in BAV children compared to CHD and control without differences in the expression of NFATC4 gene were established. Thus, in children with bicuspid aortic valve, formation of early myocardial hypertrophy with changes in nuclear factor of activated T-cells genes expression with prevailing of NFATC1 expression takes place. The detection of NFATC1 expression level in the blood of children could be considered as an early marker of progressive myocardial hypertrophy.