Ventricular Diastolic Dimension Research Articles

Myocardial work in idiopathic premature ventricular contractions: Assessing left ventricular function and prognosis.

Premature ventricular contractions (PVCs) can lead to impairment of left ventricular function. The noninvasive myocardial work technique, which incorporates left ventricular afterload, represents a new method for assessing left ventricular functional. The aim of this study is to explore the value of noninvasive myocardial work technique in assessing left ventricular systolic function in patients with PVCs. Compare the clinical data, two-dimensional echocardiography parameters, and myocardial work parameters of 66 patients with PVCs and 35 healthy volunteers and explore the relevant risk factors for postoperative recurrence in patients with PVCs. In patients with PVCs compared to the control group, they exhibit enlargement of left atrial diameter (LAD) and left ventricular internal dimension in diastole (LVIDd), as well as thickening of the left ventricular wall. The global work waste (GWW) increases, while the global work efficiency (GWE) decreases. There is a significant negative correlation between the PVC burden and GWE (r = -0.70, p <0.01), and a significant positive correlation between the PVC burden and GWW (r = 0.58, p <0.01). GWE is a sensitive indicator for predicting the recurrence of PVCs after radiofrequency ablation. Patients with GWE <91.5%, global longitudinal strain (GLS) <15.5%, and ejection fraction (EF) <62.5% have a higher postoperative recurrence rate. PVCs can cause impairment of left ventricular systolic function. GWE is the most sensitive indicator for predicting postoperative recurrence in patients with PVCs. Patients with GWE <91.5%, GLS <15.5%, and EF <62.5% have a higher postoperative recurrence rate.

Association of QRS Duration with Echocardiographic Left Ventricular Dimensions

Background: QRS duration (QRSd) is used to diagnose left bundle branch block (LBBB) and is important for determining cardiac resynchronization therapy eligibility. Others have reported associations of left bundle branch block (LBBB) and interventricular conduction delay with left ventricular (LV) systolic and diastolic dysfunction in patients without clinical HF. Individualized QRSd thresholds may improve diagnosis and intervention strategies. The goal of this study was to assess the relations of QRS duration to echocardiographic left ventricular (LV) dimensions in individuals. Methods: This was a hospital-based cross-sectional analytical study. A total of 134 purposively selected respondents were included in the study from the patients attending the outpatient or inpatient department of cardiology, Dhaka Medical College Hospital, advised for an echocardiogram. They were divided into two groups depending on their QRS complex duration (Group I≤100 ms and Group II&gt;100 ms). After taking informed written consent, a case record form was filled and Echo measurements were taken following standard procedure with confidentiality. Results: Among the respondents, the mean age was found 52.68 ± 14.24 years. The majority were male (68%), and around 1/3rd of the respondents were overweight or obese. Males were found to have less QRS duration than females (p&lt;0.001) but there was no difference in age (p=0.814) between the groups. All the risk factors considering obesity, diabetes mellitus, hypertension, family history, smoking status, and dyslipidemia were found in similar proportions in both groups (p&gt;0.05). The study found that the interventricular septum thickness and inferolateral wall thickness were higher among those having a QRS duration of more than 100 ms (Group II), but this difference was not significant (p &gt; 0.05). On the other hand, left ventricular diastolic dimension, systolic dimension, and left ventricular mass were found to be increased significantly (p&lt;0.05) with a reduction in ejection fraction in Group II (p&lt;0.05). Conclusion: Left ventricular diastolic and systolic dimensions along with left ventricular mass significantly increase according to QRS duration among the patients. Meanwhile, a reduction in ejection fraction was also evident. (Bangladesh Heart Journal 2024; 39(2): 144-150

Clinical and Hemodynamic Outcomes with Enalapril Orodispersible Minitablets in Young Children with Heart Failure Due to Congenital Heart Disease.

Background: The angiotensin-converting enzyme inhibitor (ACEI) enalapril is often administered to infants and young children with heart failure (HF) in various dosing regimens and formulations not adapted for their age. Methods: This prospective, two-center, open-label 8-week study evaluated an age-appropriate formulation of orodispersible minitablets (ODMTs) of enalapril (0.25 mg and 1 mg) in children aged 0 to 6 years with HF due to congenital heart disease. An age/weight-based dosing schedule was followed. Measures of echocardiographic parameters, blood pressure, heart rate, modified Ross score, and biochemistry were obtained over the 8-week period. The following two groups were assessed: ACEI-naïve and ACEI-pretreated patients. Results: In total, 53 children (age range of 0.05 to 4.8 years) were enrolled and 29 were ACEI-naïve. The average enalapril dose was 0.098 mg/kg (0.06-0.17 mg/kg) in the naïve group and 0.15 mg/kg (0.07-0.3 mg/kg) in pretreated patients. After 8 weeks, the modified Ross score and left ventricular diastolic dimension (LVD) z-score showed a significant decrease in both groups (p < 0.005). During 8 weeks follow-up, there were no difference in the z-scores for the systolic blood pressure (p = 0.071) or heart rate (p = 0.146). Conclusions: Pediatric patients treated with ODMTs of enalapril for 8 weeks had favorable improvements in LVD and HF symptoms.

Association Between Serial B-Type Natriuretic Peptide Levels, Vasoactive Drug Weaning, and Adverse Cardiovascular Outcomes in Pediatric Heart Failure.

Children hospitalized with acute decompensated heart failure (ADHF) frequently require intravenous vasoactive (IVV) support drugs and are at risk for adverse cardiovascular (ACV) outcomes. We wished to assess whether serial changes in B-type natriuretic peptide (BNP) levels are associated with successful weaning off IVV support and/or prespecified ACV outcomes in children hospitalized with ADHF. Children hospitalized with ADHF from 2005 to 2021 at our institution were assessed for serial changes in BNP, weaning off of IVV support, and ACV outcomes. Changes in BNP level were evaluated using linear mixed-effects modeling. Bonferroni correction was used to adjust for multiple hypothesis testing. In 131 hospitalizations of children with ADHF, the median age was 4.8 years, with 74% receiving IVV support. ACV outcomes occurred in 62 children. IVV support was associated with lower admission left ventricular ejection fraction (26.7% versus 32%, P=0.002), more severe left ventricular dilation (left ventricular internal diastolic dimension Z score 5.9 versus 3.1, P=0.021) moderate or more mitral regurgitation (41.3% versus 20.6%, P=0.038), and qualitative right ventricular systolic dysfunction (in 45.4% versus 11.8%, P<0.001). Decline in BNP levels was more rapid in patients who were successfully weaned from IVV support (-0.20 versus -0.03 2log pg/mL per day, P<0.001) and in the non-ACV group (-0.17 versus -0.03 2log pg/mL per day, P<0.001). Right ventricular systolic dysfunction was an independent risk factor for ACV (odds ratio, 2.49; P=0.045). The declining rate of serial BNP levels was associated with weaning from IVV support and no ACV outcomes in children hospitalized with ADHF. Right ventricular systolic dysfunction was associated with ACV outcomes.

Impact of DApagliflozin on Cardiac Functionnfollowing Anterior Myocardial Infarction in Non-diabetic Patients – DACAMI (a Randomized Controlled Clinical Trial)

Abstract Background This study aims at identifying if there is a role for Sodium glucose co- transporter 2 inhibitors (SGLT2i) in the event of acute myocardial infarction. Patients who presented with anterior ST- elevation myocardial infarction (STEMI) &amp; had undergone successful primary percutaneous coronary intervention for the left anterior descending coronary were randomized into a study group &amp; a control group. The study group received dapagliflozin 10 mg once daily. The primary endpoint was cardiac function assessed by both; a biomarker (i.e.: N-terminal pro-Brain Natriuretic Peptide – NT-proBNP) measured at baseline &amp; at 12 weeks post the cardiac event &amp; echocardiographic parameters (left ventricular ejection fraction, left ventricular diastolic dimension &amp; left ventricular mass index) assessed at baseline, 4-weeks &amp; 12-weeks post the cardiac event. Results From October 2021 to April 2022, a final 100 patients were randomized. The median drop of NT- proBNP in the study group was significant compared to the control group (p-value 0.043). In addition, the decrease in the left ventricular mass index (LV mass index) was also significant in the study group compared to the control group. Conclusions Dapagliflozin seems to have a role in preventing left ventricular dysfunction &amp; maintaining cardiac function following anterior ST-elevation myocardial infarction. More Large-scale trials need to be done to further confirm these findings. This trial is registered retrospectively at the US National Institutes of Health (ClinicalTrial.gov) with identifier number: NCT05424315 – June 16th, 2022. (https://ClinicalTrials.gov/ct2/show/nct05424315)

CASE STUDY OF NORMAL ECHOCARDIOGRAPHYIN AN ADULT SIBERIAN HUSKY DOG

Echocardiography is commonly used in veterinary medicine to assess cardiac structure and function in dogs. This case study was aimed to evaluate normal echocardiography of an adult Siberian Husky. Standard techniques, including B-Mode, M-Mode, and Color Flow Doppler, were carried out by using the Acclarix AX3 Vet USG and a micro convex probe 5-9 MHz. Examinations were conducted in the right parasternal and left apical positions. The results indicate that the six-year-old, 32 kg Siberian Husky in this study exhibited a normal heart. When comparing M-Mode echocardiography with the normal range for dogs of similar size, role, and weight, left ventricular internal dimension in diastole (LVIDd) was below the normal range, while left ventricular posterior wall in diastole (LVWPd) and left ventricular posterior wall in systole (LVPWs) were higher. These findings highlight the necessity for breed-specific reference intervals. This case study emphasizes the correlation between the normal echocardiography interpretation and canine cardiac function, as depicted by the value of ejection fraction (EF) 66.04% and fractional shortening (FS) 35.52%. The echocardiography results of the Siberian Husky in the study are comparable to reference interval values of similar breeds that are working dogs, making them valuable as reference values for future studies.

The Impact of Cardiac Rehabilitation on Psychosocial Factors, Functional Capacity, and Left Ventricular Function in Patients with Coronary Artery Disease: Systematic Review and Meta-Analysis

Background Cardiac rehabilitation is a multifaceted program implemented after adverse events. It aims at facilitating the return to normal life. This review aimed to examine the impact of cardiac rehabilitation on psychosocial risk factors, functional capacity, and left ventricular function. Methods The following databases: CINAHL, Scopus, PubMed, and Cochrane Library have been searched to retrieve the randomized controlled trials that investigate the effectiveness of cardiac rehabilitation versus usual care on anxiety, depression, peak oxygen consumption, six-minute walk distance, left ventricular ejection fraction, and left ventricular end-systolic and diastolic dimensions. Filters were set to retrieve trials that were published in the English Language between 2000 and 2024. Risk of bias was assessed using the Cochrane risk-of-bias tool (Rob2). Data were analysed meta-analytically. Results Twenty two (22) trials were included, randomized 2283 participants. A significant improvement favouring intervention groups was observed in anxiety SMD = -0.3890 (95% CI: -0.5640 to -0.2140; p˂0.001), depression SMD = -0.4032 (95% CI: -0.7114 to -0.0950; p= 0.002), peak oxygen consumption MD = 1.2471 (95% CI: 0.3963 to 2.0979; p = 0.004), six-minute walk distance MD = 36.0290 (95% CI: 7.7497 to 64.3082; p = 0.013), and left ventricular ejection fraction MD = 3.0650 (95% CI: 1.1279 to 5.0022; p = 0.001), Although cardiac rehabilitation had no significant effect in decreasing left ventricular end-diastolic dimension MD = -0.0480 (95% CI: -0.2609 to 0.1648; p = 0.658) and left ventricular end-systolic and MD = -0.0670 (95% CI: -0.2829 to 0.1489; p = 0.543) a favourable trend toward intervention group was seen. Risk of bias was high in 1 study and unclear in 7 studies. Conclusion For patients with Coronary Artery Disease, cardiac rehabilitation demonstrated effectiveness in improving psychological symptoms such as anxiety and depression, functional capacity as measured by peak oxygen consumption and six-minute walk test, and left ventricular function.

Left ventricular function in patients with advanced stages of chronic obstructive pulmonary disease in correlation with GOLD classification system

Background: Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory disease, with irreversible airflow obstruction, disease with high morbidity and early mortality rate. COPD is not just a disorder limited to the lungs. As the disease progresses, extra pulmonary co morbidities occur, where cardiovascular diseases are the most common. They mostly affect the right side of the heart, but sometimes changes also occur on the left side of the heart, as a result of long-term strain from the right ventricle (RV) and pulmonary hypertension which follows COPD. Material and methods: The design of our study was prospective-clinical crosssectional study with 2 years follow up. In the study were included 94 patients with previously confirmed chronic obstructive pulmonary disease with spirometry and classified by Tiffeneau index in four gold classes. We have analyzed the values of some echocardiographic parameters that were selected as indicators of left heart function, and also we have analyzed them in relation to the progression of COPD from milder to more severe Golden classes, such as: left ventricular diastolic dimension (LvdD - mm), left ventricular ejection fraction (EF %), myocardial performance index (MPI) of the left ventricle, global longitudinal strain (Gl strain - %) of LV, diastolic function (E/e'). Echo analysis was done by Vivid 7 echo machine with a special feature to left heart chamber characteristics and function. Results: All echocardiographic parameters analyzed in our study, underline their significance in disease progression in patients with COPD and increasing Gold classes. A varies of statistical methods and parameters were used to evaluate: left ventricular diastolic dimension(mm), Ejection fraction of left ventricle (%), MPI of the left ventricle obtain by Tissue Doppler, GL strain of left ventricle (%) and E/e' in correlation of disease progression and GOLD class. Echo-parameters MPI of the left ventricle and Global longitudinal strain LV (%), progressively grow with the rise of the gold class (form I to IV). On the contrary the values of the parameters LvdD and EF% gradually decrease with the progression of the disease and gold class. Echocardiographic parameter GL strain LV % has the highest value and statistically by decreasing the values of this parameter the risk of disease progression from gold stage I/II to Gold stage III/IV is 1.570 times higher, with high statistical significance(p&lt;0,01). The calculated value of the parameter EF% is lower than 0,75, which indicates that the model of prediction is not the best one but it's acceptable. Conclusion: COPD is a progressive disease that affects the dimensions of the right and left heart chambers, as well as the function of both chambers and the development of pulmonary hypertension. Monitoring echocardiographic parameters intended for assessment cardiac dimension and function can help tо predict disease progression for timely inclusion of specific therapeutic strategies. We suggest screening of all COPD patients for cardiac assessment using echocardiography as a non-invasive and repeatable method for their follow-up.

Hemodynamic evaluation of extremely low birth weight infants during the first 7 days of life

Background and aimWe aimed to investigate the hemodynamic status of extremely low birth weight (ELBW) infants during the transitional period under intensive management. MethodsThis retrospective cohort study analyzed left ventricular ejection fraction (LVEF), left ventricular end-systolic wall stress (ESWS), left ventricular internal dimension in diastole (LVIDd), and mean arterial pressure (MAP) of ELBW infants during their first week of life. Small for gestational age (SGA), histological chorioamnionitis (hCAM), severe intraventricular hemorrhage (IVH), and non-survival to discharge infants were compared to their counterparts. ResultsSixty-two infants (25.7 ± 2.1 weeks, 700.7 ± 165.4 g) were analyzed. MAP gradually increased. Median LVEF was 69.8 % on day 1, decreased to 62.7 % on day 2, then increased throughout the week. ESWS was lowest at birth, rose to 28.2 g/cm2 on day 2, and decreased on day 6. There were no significant changes in LVIDd. SGA infants had higher MAP throughout, higher LVEF on day 2 and 3, but lower LVEF on day 5 to 7. LVIDd was lower in hCAM group. Severe IVH group had a more significant drop in LVEF on day 2, higher ESWS, and a higher incidence of hemodynamic significant patent ductus arteriosus (hsPDA). Non-survival had lower LVIDd. ConclusionsMAP increased gradually. Hemodynamic instability was observed in the first two days, with decreased LVEF and increased ESWS before stabilization. We observed an alteration in hemodynamic adaptation in SGA and hCAM infants. Severe IVH group experienced early hemodynamic instability and a higher incidence of hsPDA.

THU583 Cardioprotection By Nitric Oxide Is Mediated Via Mitochondrial Function In Rodents

Abstract Disclosure: K. Islam: None. R. Islam: None. A. Draper: None. Background: Reduced nitric oxide (NO)bioavailability and decreased expression of mitochondrial transcription factor A (TFAM) occurs in the setting of heart failure (HF). TFAM promotes transcription of mitochondrial DNA, mitochondrial biogenesis, respiratory chain activity, and ATP synthesis. We investigated the effects of oral NaNO2therapy to increase NO in chronic HF following acute myocardial infarction and examined the effects of NaNO2 on the activation of TFAM, mitophagy, and antioxidant signaling pathways. Methods: Male C57/BL6J mice underwent 60 minutes of myocardial ischemia (MI) induced by left coronary artery (LCA) occlusion followed by 4 weeks of reperfusion. NaNO2 or saline vehicle (VEH)was administered at a dose of 165 µg/kg at reperfusion and then daily for 4weeks in the drinking water (100 mg/L). Left ventricular ejection fraction (LVEF) was determined at baseline and at 4 weeks of reperfusion. At 4 weeks of reperfusion myocardial tissue samples were collected and analyzed by RT-qPCR, immunoblot, oxidative stress assay, and protein sulfhydration assay. Results: NaNO2 administration markedly preserved left ventricular ejection fraction (LVEF) and improved left ventricular diastolic and systolic dimensions at 4 weeks as compared to VEH. Mitochondrial antioxidant proteins, SOD2 (MnSOD), peroxiredoxin-3 (Prx-3) and thioredoxin 2 (TXN2) (p &amp;lt; 0.05) were markedly increased in NaNO2treated mice compared to VEH. Expression of mitophagic markers, p62 (p &amp;lt;0.05) and Map1lc3 (p &amp;lt; 0.05) were significantly increased in NaNO2treated HF mice as compared to VEH. Expression of mitochondrial quality control such as PINK1 and PARKIN2 were also markedly increased HF mice after treated with nitrite therapy as compared with VEH. Marked induction of sulfhydration of interferon regulator factor 1 (IRF-1) as well as upregulation of mitochondrial transcription factor A (TFAM) (p &amp;lt; 0.05) and suppression of DNA methyltransferase3a (Dnmt-3a) (p &amp;lt; 0.05) were observed in NaNO2 treated ischemic HF mice as compared with VEH. Conclusions: Our results clearly demonstrate thatNaNO2 therapy improves left ventricular function during ischemic HF through induction of antioxidant signaling, mitophagy, sulfhydration of IRF-1and TFAM resulting in increased mitochondrial biogenesis. Presentation: Thursday, June 15, 2023

Preoperative left ventricular diastolic dimension index is associated with outcomes after HeartMate 3 implantation.

We investigated the association between indexed left ventricular diastolic dimension and clinical outcomes after HeartMate 3 implantation. We retrospectively reviewed patients implanted with the HeartMate 3 at our centre between November 2014 and September 2021. Left ventricular diastolic dimension was assessed via preoperative transthoracic echocardiography and left ventricular diastolic dimension index was calculated as left ventricular diastolic dimension/body surface area. The primary outcome was a composite of death or readmission due to right heart failure or stroke. The cut-off left ventricular diastolic dimension index value most closely associated with outcomes was determined by receiver-operating characteristic curve and restricted cubic spline analyses. Left ventricular diastolic dimension index measurements were available for 252 of 253 (99.6%) patients. Using a left ventricular diastolic dimension index cut-off value of 33.5 mm/m2, the cohort was divided: left ventricular diastolic dimension index ≤ (n = 131) or > (n = 121) 33.5 mm/m2. While there were no significant differences in age, INTERMACS level and preoperative haemodynamics between groups, patients with smaller left ventricular diastolic dimension index were more likely to have a larger body surface area (2.1 vs 1.9 m2, P < 0.001), ischaemic cardiomyopathy [64 (49%) vs 40 (33%), P = 0.01] and smaller left atrium volume index [40.5 (32.3-54.0) ml/m2 vs 54.0 (43.0-66.8) ml/m2, P < 0.001]. Smaller left ventricular diastolic dimension index patients had significantly worse survival (74% vs 88%, log-rank P = 0.009) and freedom from adverse events (55% vs 73%, log-rank P = 0.005) at 3-year follow-up. Smaller left ventricular diastolic dimension index was independently associated with the composite outcome (Hazard ratio 2.24, P = 0.002). Smaller preoperative left ventricular diastolic dimension index is associated with worse outcomes in patients undergoing HeartMate 3 implantation.

Cardiological Reference Intervals in Adult American Staffordshire Terrier Dogs.

The aim of this study was to determine reference intervals (RI) for echocardiography, electrocardiography (ECG), vertebral heart score (VHS) measurement, and arterial systolic blood pressure (SBP) in American Staffordshire Terrier dogs. The study population included 29 clinically healthy AST dogs of different ages, genders, and body weights. SBP measurement, ECG, thoracic radiography, and echocardiography were performed on each dog. Compared to RIs available for the general population of dogs, the duration of the P wave and QRS complex was longer and VHS was higher. Moreover, the left ventricular dimension in diastole and systole, left atrial dimension, and end point to septal separation values were higher, while the interventricular septum in diastole and systole and aortic root diameter were lower compared to general similar average body weight. The AST breed has a different heart shape, which in this breed is more rounded compared to other dog breeds, especially the deep chest. The specific body structure and the shape of the heart had an impact on the results of the cardiological examination.

Parameters associated with improvement of systolic function in patients with heart failure

AimsIdentifying clinical and echocardiographic parameters associated with improvement in systolic function in outpatients with heart failure with reduced ejection fraction (HFrEF) could lead to more targeted treatment improving systolic function...

P109: Influence Of Body Surface Area, And Ventricular Dimensions On Impella 5.5 Outcomes

Background: There has been an increase in the use of the Impella 5.5 pump for patients with refractory cardiogenic shock in a number of different patient scenarios. There is a scarcity of data on the influence of patient Body Surface Area (BSA) and ventricular dimensions prior to implant on overall pump efficiency, safety, and outcomes. Methods: Patients undergoing Impella 5.5 implantation at a single institution between August 2020 and November 2022 were included. Patient BSA was collected at the time of pump implantation, as well as ventricular dimensions from the pre-Impella echocardiography or cardiac MRI. Other clinical data included death within 30 days, and other demographic variables, as well as suspected hemolysis defined as an LDH value of over 1000 IU/L. Left Ventricular Diastolic and Systolic Dimensions (LVEDD, LVESD) were indexed by dividing them by the BSA as iLVEDD and iLVESD, respectively. Results: One hundred patients with complete data were reviewed, of which, the analysis was limited to patients with chronic heart failure (n=75). The median LVESD was 5.8 cm (IQR 4.5, 6.2), and LVEDD 6.3 cm (5.3, 6.8). 17 patients (23%) died within 30 days of Impella implantation, with no difference in gender, age, BSA, or occurrence of hemolysis in those that died vs alive at 30 days. Patients that died within 30 days had smaller indexed LVEDD (2.6 vs 2.93, p=0.01), and smaller indexed LVESD (2.14 vs 2.79, p=0.002). Conclusion: Patients with smaller indexed LVEDD and indexed LVESD at time of Impella implantation have a higher risk of 30 day mortality that appears to be independent of hemolysis risk. This maybe due to less efficient pump function in small ventricles in higher BSA individuals requiring higher levels of forward flow.

PO-03-019 ECHOCARDIOGRAPHIC OUTCOMES OF HIS BUNDLE AND LEFT BUNDLE BRANCH AREA PACING: A SINGLE CENTER EXPERIENCE

Traditional right ventricular apical pacing is associated with risk of pacing induced cardiomyopathy (PICM), atrial fibrillation, and heart failure. Conduction system pacing (CSP) via the His or left bundle branch area (HBP, LBBAP) may mitigate or even prevent the development of these complications. To evaluate the effects of CSP on cardiac function as measured by standard 2D-echocardiography. Consecutive patients undergoing HBP or LBBAP implantation between Feb 2014 and July 2022 at Virginia Commonwealth University were analyzed. Ejection fraction (EF), left ventricular diastolic dimension (LVIDd), left ventricular systolic dimension (LVIDs), tricuspid regurgitation severity, and mitral regurgitation severity were compared pre- and post- CSP. Only patients with echo data at 90 days or greater from time of implant were included. A total of 340 patients with CSP had echocardiographic data available. Mean clinical follow up time was 810 days from implant, and median time until post-implant EF was 483 days (IQR 324-763). 77 had reduced EF (<50%) at baseline. Pacing burden exceeded 20% across the cohort. The mean pre- and post- CSP implantation EF in the overall group was 53.8% ±10.9% vs 54.7% ±9.1% (p=0.08). Mean pre- and post- CSP implant LVIDd was 4.59±0.73cm vs 4.37 ±0.72 cm (p<0.001). Mean pre- and post- CSP implant LVIDs was 3.23± 0.79cm vs 3.05± 0.76cm (p<0.001). TR and MR severity were unchanged after pacemaker implantation. In the subset of patients with reduced EF, mean pre-implant EF was 37% ±9.4% and post-implant EF was 47% ±11.6% (p<0.001). Mean pre-implant LVIDd was 5.02cm ±0.86cm and post-implant LVIDd was 4.60cm ±0.75cm (p<0.001). Mean pre-implant LVIDs was 4.05cm ±1.0cm and post-implant this dropped to 3.44cm ±0.96 (p<0.001). CSP via HBP or LBBAP is not associated with PICM in patients requiring high ventricular pacing burdens. In patients with a reduced EF, it may significantly improve systolic function along with positive structural remodeling.

Cardiac Magnetic Resonance Imaging Detects Myocardial Abnormalities in Naturally Infected Dogs with Chronic Asymptomatic Chagas Disease.

Trypanosoma cruzi infection causes inflammation and fibrosis, resulting in cardiac damage in dogs. The objectives of this study were to describe cardiac magnetic resonance imaging (CMR) in naturally infected dogs with chronic Chagas disease and the frequency of abnormalities for CMR and cardiac diagnostic tests. Ten asymptomatic, client-owned dogs seropositive for T. cruzi were prospectively enrolled in an observational study evaluating echocardiography, ECG (standard and ambulatory), cardiac troponin I (cTnI), and CMR. Standard ECG measurements (3/10) and cTnI concentration (1/10) outside the reference range were uncommon. Ambulatory ECG abnormalities were documented more frequently (6/10 dogs) than with standard ECG and included ventricular arrhythmias (4), supraventricular premature beats (3), second-degree atrioventricular block (2), and sinus arrest (1). Echocardiographic abnormalities were documented in 6/10 dogs including mildly increased left ventricular internal dimension in diastole (1) and decreased right ventricular (RV) systolic function based on reductions in tricuspid annular plane systolic excursion (3) and RV S' (4). Abnormalities were detected with CMR in 7/10 dogs including delayed myocardial enhancement in 5 of which 2 also had increased extracellular volume, abnormal wall motion in 5, and loss of apical compact myocardium in 1. In conclusion, CMR abnormalities were common, and the results of this study suggest CMR can provide useful information in dogs with T. cruzi infection and may support naturally infected dogs for future clinical investigation as an animal model for Chagas disease.

Impact of dapagliflozin on cardiac function following anterior myocardial infarction in non-diabetic patients – DACAMI (a randomized controlled clinical trial)

BackgroundThe role of Sodium-glucose co-transporter 2 inhibitors (SGLT2i) in heart failure is established. Early data also suggests their favorable role in patients with acute coronary syndromes, but more evidence is still needed. MethodsIn this dual center, double-blinded randomized controlled trial, non-diabetic patients (N = 100) who presented with anterior ST- elevation myocardial infarction (STEMI) & had undergone successful primary percutaneous coronary intervention, but their left ventricular ejection fraction was below 50%, were randomized to dapagliflozin 10 mg or a placebo once daily. The primary endpoint was a change in cardiac function assessed by N-terminal pro-Brain Natriuretic Peptide – NT-proBNP measured at baseline & 12 weeks post the cardiac event &/or echocardiographic parameters (left ventricular ejection fraction, left ventricular diastolic dimension & left ventricular mass index) assessed at baseline, 4-weeks & 12-weeks post the cardiac event. ResultsFrom October 2021 to April 2022, 100 patients were randomized. The mean drop of NT- proBNP in the study group was more significant compared to the control group by 10.17% (95% CI: −3.28–19.67, p-value 0.034). In addition, the decrease in the left ventricular mass index (LV mass index) was also significant in the study group compared to the control group by 11.46% (95% CI: −19.37 to −3.56, p-value 0.029). ConclusionsDapagliflozin seems to have a role in preventing left ventricular dysfunction & maintaining cardiac function following anterior ST-elevation myocardial infarction. More Large-scale trials need to be done to confirm these findings further.This trial is locally registered at the National Heart Institute, Cairo – Egypt, and Faculty of Medicine, Ain Shams University, with reference numbers CTN1012021 & MS-07/2022, respectively. It is also registered retrospectively at the US National Institutes of Health (ClinicalTrial.gov) with identifier number: NCT05424315 – June 16th,2022.

Systolic Anterior Motion of the Mitral Valve in the Presence of Annular Calcification

Mitral annular calcification (MAC) has been reported as a possible cause of systolic anterior motion (SAM) of the mitral valve and dynamic left ventricular outflow tract (LVOT) obstruction. While morphologic features predisposing to SAM in other clinical settings have been described, patients with MAC+SAM have not been systematically investigated. We hypothesized that bulky calcium deposits in the mitral annulus could displace the valve toward the septum, thus promoting development of SAM. We studied 30 patients with severe MAC who had SAM with septal contact. Three comparator groups (matched for age and sex) were developed: 30 controls without MAC or SAM, 30 with severe MAC but no SAM, and 30 with SAM but no MAC. Significant differences were found across groups for mitral valve coaptation point-septal distance (CSD), anterior mitral leaflet (AML) length, left ventricular diastolic dimension, and ejection fraction. Comparing all MAC subjects (n=60) with controls, CSD was less (20.5±4.1 vs 23.2±3.7mm, P=.003) and ejection fraction was higher (67.7%±7.8% vs 60.9%±6.4%, P<.0001) in MAC patients. Within MAC subjects AML was longer (21.9±3.0 vs 17.4±2.2mm, P<.0001) and CSD was smaller (18.0±2.7 vs 23.1±3.6mm, P<.0001) when SAM was present despite similar height of the calcium bar in the 2 MAC groups (12.4±2.9 vs 11.1±3.1mm, P=.11). Regression analysis confirmed AML length and CSD as independent predictors of SAM. MAC+SAM patients also had more echocardiographic risk factors for SAM (acute aortomitral angle, small LVOT, long AML, small CSD, and presence of a septal bump) than MAC/no-SAM patients (3.4±0.9 vs 1.8±1.0, P<.0001). Bulky MAC appears to contribute to dynamic LVOT obstruction when it accumulates in such a way that the mitral valve is displaced anteriorly toward the septum. However, other features are also associated with SAM in these patients, particularly a long AML. A combination of morphologic features and favorable hemodynamics may be needed for SAM to develop in patients with severe MAC.

Cardiac dysfunction and pulmonary systolic hypertension among patients with homozygous VHLR200W mutation (Chuvash polycythemia)

Pulmonary hypertension occurs with chronic high-altitude hypoxia and is exacerbated by iron deficiency. Chuvash polycythemia, due to homozygosity for the R200W mutation in the von Hippel Lindau gene ( VHL ), is characterized in normoxia by elevated levels of hypoxia inducible factors HIF-1 and HIF-2, transcription factors regulating many hypoxia-inducible genes. Three cross-sectional clinical and echocardiography study in Chuvashia, Russian Federation among 120 child and adult VHL R200W homozygotes and 31 VHL- wildtype controls under basal conditions. VHL R200W homozygotes had frequently been treated by phlebotomy and were often iron-deficient based on low ferritin. After adjustment for age, sex, and hemoglobin concentration, the mean ± SD systolic blood pressure tended to be lower in VHL R200W homozygotes compared to controls (112 ± 15.1 vs. 119 ± 17.2 mm Hg; P = .045). In contrast, the echo-determined tricuspid regurgitation velocity (TRV), which reflects right ventricular systolic pressure, was significantly higher in the VHL R200W homozygotes (2.5 ± 0.3 vs. 2.3 ± 0.4 m/s, P = .007). The left ventricular diastolic dimension (4.8 ± 0.5 vs. 4.5 ± 0.6 cm; P = .039) and left atrial diameter (3.4 ± 0.5 vs. 3.2 ± 0.5; P = .045) tended to be larger in the VHL R200W homozygotes, but this was not the case for the mitral valve E/Etdi ratio. Among VHL R200W homozygotes, phlebotomy therapy was associated with lower ferritin, and low ferritin independently predicted higher TRV (standardized beta = −0.29; P = .009). Children and adults with congenital upregulation of HIF-1 and 2 tend to have higher right ventricular systolic pressure as estimated by echocardiography than control subjects. Similar to high-altitude pulmonary hypertension, iron deficiency may contribute to elevated right ventricular systolic pressure in Chuvash polycythemia.

Abstract 068: Genetic Mechanisms Of Cardiac Hypertrophy And Fibrosis In Global Npr1 Gene-ablated Male And Female Mice

Genetic ablation of guanylyl cyclase/natriuretic peptide receptor-A (GC-A/NPRA) in mice triggers cardiac remodeling associated with hypertrophy, fibrosis, and heart failure. The objective of this study was to determine the mechanisms regulating the developments of cardiac hypertrophy and fibrosis in global Npr1 (encoding NPRA) gene-knockout (KO) mice and whether transforming growth factor-beta 1 (TGF-β1) plays a critical role in this process. Both male and female Npr1 KO ( Npr1 -/- , 0-copy), heterozygous ( Npr1 +/- , 1-copy), and wild-type (WT; Npr1 +/+ , 2-copy) mice were administered with TGF-β1 receptor antagonist GW788388 (2 mg/kg/day) by intraperitoneal (ip) injection for 28 days. The heart weight/body weight (HW/BW) and tibia length (TL) to BW (TL/BW) ratios were determined. Echocardiography was used to determine the cardiac structure and function. Quantitative polymerase chain reaction (qPCR) and Western blot were used to quantify the hypertrophic and fibrotic markers. HW/BW and TL/BW ratios were significantly higher in Npr1 KO mice and significantly greater in males than females. The Npr1 -/- mice showed significant induction of cardiac hypertrophic marker collagen-1α (3.5-fold) and fibrotic markers, monocyte chemoattractant protein (MCP, 4-fold), connective tissue growth factor (CTGF, 5-fold), alpha-smooth muscle actin (α-SMA, 4-fold) compared with WT mice. The expression of phosphorylated extracellular regulated kinase 1/2 (pERK1/2) was also upregulated in Npr1 -/- mice. Left ventricular end-systolic and diastolic dimensions (LVED-s, LEVD-d) and posterior wall thickness (PWT) were significantly increased in male KO mice than female KO mice compared with WT mice. The fractional shortening (FS) was compromised in male KO mice than female KO mice. The Treatment of Npr1 -/- mice with GW788388, prevented the development of cardiac hypertrophy and fibrosis compared to vehicle-treatment. The results suggest that the cardiac hypertrophy and fibrosis in Npr1 -/- mice is regulated through TGF-β1- SMAD-pathways.