Ventricular Dysfunction In Patients Research Articles

Correlation between the triglyceride-glucose index and left ventricular global longitudinal strain in patients with chronic heart failure: a cross-sectional study

BackgroundLeft ventricular global longitudinal strain (GLS) holds greater diagnostic and prognostic value than left ventricular ejection fraction (LVEF) in the heart failure (HF) patients. The triglyceride-glucose (TyG) index serves as a reliable surrogate for insulin resistance (IR) and is strongly associated with several adverse cardiovascular events. However, there remains a research gap concerning the correlation between the TyG index and GLS among patients with chronic heart failure (CHF).Method427 CHF patients were included in the final analysis. Patient demographic information, along with laboratory tests such as blood glucose, lipids profiles, and echocardiographic data were collected. The TyG index was calculated as Ln [fasting triglyceride (TG) (mg/dL) × fasting plasma glucose (FPG) (mg/dL)/2].ResultsAmong CHF patients, GLS was notably lower in the higher TyG index group compared to the lower TyG index group. Following adjustment for confounding factors, GLS demonstrated gradual decrease with increasing TyG index, regardless of the LVEF level and CHF classification.ConclusionElevated TyG index may be independently associated with more severe clinical left ventricular dysfunction in patients with CHF.

Non-invasive imaging techniques for early diagnosis of bilateral cardiac dysfunction in pulmonary hypertension: current crests, future peaks.

Pulmonary arterial hypertension (PAH) is a chronic and progressive disease that eventually leads to heart failure (HF) and subsequent fatality if left untreated. Right ventricular (RV) function has proven prognostic values in patients with a variety of heart diseases including PAH. PAH is predominantly a right heart disease; however, given the nature of the continuous circulatory system and the presence of shared septum and pericardial constraints, the interdependence of the right and left ventricles is a factor that requires consideration. Accurate and timely assessment of ventricular function is very important in the management of patients with PAH for disease outcomes and prognosis. Non-invasive modalities such as cardiac magnetic resonance (CMR) and echocardiography (two-dimensional and three-dimensional), and nuclear medicine, positron emission tomography (PET) play a crucial role in the assessment of ventricular function and disease prognosis. Each modality has its own strengths and limitations, hence this review article sheds light on (i) ventricular dysfunction in patients with PAH and RV-LV interdependence in such patients, (ii) the strengths and limitations of all available modalities and parameters for the early assessment of ventricular function, as well as their prognostic value, and (iii) lastly, the challenges faced and the potential future advancement in these modalities for accurate and early diagnosis of ventricular function in PAH.

(816) - Best Practices to Manage Right Ventricular Dysfunction in Patients with Left Ventricular Assist Device Therapy

(816) - Best Practices to Manage Right Ventricular Dysfunction in Patients with Left Ventricular Assist Device Therapy

Use of the energy waveform electrocardiogram to detect subclinical left ventricular dysfunction in patients with type 2 diabetes mellitus

BackgroundRecent guidelines propose N-terminal pro-B-type natriuretic peptide (NT-proBNP) for recognition of asymptomatic left ventricular (LV) dysfunction (Stage B Heart Failure, SBHF) in type 2 diabetes mellitus (T2DM). Wavelet Transform based signal-processing transforms electrocardiogram (ECG) waveforms into an energy distribution waveform (ew)ECG, providing frequency and energy features that machine learning can use as additional inputs to improve the identification of SBHF. Accordingly, we sought whether machine learning model based on ewECG features was superior to NT-proBNP, as well as a conventional screening tool—the Atherosclerosis Risk in Communities (ARIC) HF risk score, in SBHF screening among patients with T2DM.MethodsParticipants in two clinical trials of SBHF (defined as diastolic dysfunction [DD], reduced global longitudinal strain [GLS ≤ 18%] or LV hypertrophy [LVH]) in T2DM underwent 12-lead ECG with additional ewECG feature and echocardiography. Supervised machine learning was adopted to identify the optimal combination of ewECG extracted features for SBHF screening in 178 participants in one trial and tested in 97 participants in the other trial. The accuracy of the ewECG model in SBHF screening was compared with NT-proBNP and ARIC HF.ResultsSBHF was identified in 128 (72%) participants in the training dataset (median 72 years, 41% female) and 64 (66%) in the validation dataset (median 70 years, 43% female). Fifteen ewECG features showed an area under the curve (AUC) of 0.81 (95% CI 0.787–0.794) in identifying SBHF, significantly better than both NT-proBNP (AUC 0.56, 95% CI 0.44–0.68, p < 0.001) and ARIC HF (AUC 0.67, 95%CI 0.56–0.79, p = 0.002). ewECG features were also led to robust models screening for DD (AUC 0.74, 95% CI 0.73–0.74), reduced GLS (AUC 0.76, 95% CI 0.73–0.74) and LVH (AUC 0.90, 95% CI 0.88–0.89).ConclusionsMachine learning based modelling using additional ewECG extracted features are superior to NT-proBNP and ARIC HF in SBHF screening among patients with T2DM, providing an alternative HF screening strategy for asymptomatic patients and potentially act as a guidance tool to determine those who required echocardiogram to confirm diagnosis.Trial registration LEAVE-DM, ACTRN 12619001393145 and Vic-ELF, ACTRN 12617000116325

Biomarkers and subclinical left ventricular dysfunction in patients with type 2 diabetes without clinical manifestations of cardiovascular diseases

Aim. To study the relationship between the structural and functional left ventricular (LV) parameters and N-terminal pro-brain natriuretic peptide (NT-proBNP) and inflammatory markers in patients with type 2 diabetes (T2D) without clinical manifestations of cardiovascular diseases, as well as to evaluate the possibility of their use for early diagnosis of subclinical LV dysfunction.Material and methods. Data from 120 patients of both sexes aged 45-75 years (57,11±7,9 years) were analyzed. They were divided into three following groups: 1st — with T2D (n=47), 2nd — with prediabetes (n=20), 3rd — control (n=53). All participants underwent transthoracic echocardiography with assessment of the linear and volumetric heart dimensions, systolic and diastolic LV function. Speckle tracking echocardiography was analyzed with calculation of LV global longitudinal strain (GLS). The blood levels of NT-proBNP and inflammatory markers were determined (high-sensitivity C-reactive protein (hsCRP), fibrinogen, interleukin-6).Results. According to echocardiography, patients with carbohydrate metabolism disorders revealed significantly higher LV mass values, LV posterior wall thickness, and relative wall thickness in comparison with the control group. Transmitral flow parameters, as well as tissue Doppler sonography, in the T2D and prediabetes groups were significantly different from those in the control group. GLS in the groups of patients with carbohydrate metabolism disorders was lower than in the control group (p=0,001). The level of NT-proBNP was significantly higher in the T2D and prediabetes groups compared to the control group, while in all three groups it did not exceed normal values (p&lt;0,001). A higher level of NT-proBNP was associated with hypertension — odds ratio (OR) 3,64 [1,02-13,04] (p=0,005), a decrease in LV ejection fraction — OR 1,25 [1,06-1 ,47] (p=0,007), concentric hypertrophy — OR 4,84 [1,43-16,41] (p=0,011) and decreased GLS — OR 1,85 [1,62-2,06] (p=0,005), an increase in the ratio of early and late diastolic transmitral flow (E/A) — OR 0,01 [0,008-0,416] (p=0,024) and isovolumic relaxation time (IVRT) — OR 1,08 [1,03-1,14] (p=0,03). The sensitivity and specificity of NT-proBNP as a test for predicting GLS reduction &lt;-18% were 86 and 27%, respectively. The hsCRP level, within the reference values, was significantly higher in the T2D and prediabetes groups compared to the control group (p&lt;0,001) and demonstrated a direct linear relationship with E/A, IVRT, early diastolic deceleration time (p&lt;0,05). A higher level of hsCRP was significantly associated with diastolic dysfunction — OR 1,16 [1,02-1,32] (p=0,023), as well as with a GLS decrease &lt;-18% — OR 1,58 [1,12-4,65] (p=0,03).Conclusion. In patients with T2D without clinical manifestations of cardiovascular disease, the presence of concentric LV myocardial hypertrophy, LV diastolic dysfunction and decreased GLS (&lt;-18%) is associated with higher blood levels of NT-proBNP and hsCRP. However, in all cases, the levels of biomarkers do not exceed the reference values, which does not allow their use in the early diagnosis of subclinical LV dysfunction in T2D.

Diagnostic utility of Speckle tracking Echocardiography in detection of subclinical left ventricular dysfunction in patients with Rheumatoid Arthritis

Diagnostic utility of Speckle tracking Echocardiography in detection of subclinical left ventricular dysfunction in patients with Rheumatoid Arthritis

Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure.

The prognostic value of right ventricular (RV) function in chronic heart failure (HF) has lately been well established. However, research on its role in acute heart failure (AHF) is sparse. This study comprised 195 patients, aged between 18 and 80years, with acute left-sided heart failure (HF) and a left ventricular ejection fraction (LVEF) < 50%. Patients with LVEF ≥ 50%, mechanical ventilatory or circulatory support, poor echocardiographic windows, prosthetic valves, congenital heart diseases, infective endocarditis, and/or life expectancy < 1year due to non-cardiac causes were excluded. The study participants' mean age was 57.7 ± 10.9years, and 74.9% were males. Coronary artery disease was present in 80.5% of patients. The mean LVEF was 31% ± 8.7. RV dysfunction (RVD), defined as tricuspid annular plane systolic excursion (TAPSE) < 17mm, RV S' < 9.5cm/s and/or RV fractional area change (FAC) < 35%, was identified in 48.7% of patients. The RV was dilated in 67.7% of the patients. RVD was significantly associated with a longer HF duration, atrial fibrillation, and idiopathic dilated cardiomyopathy. The primary outcome, a 6-month composite of cardiovascular death or hospitalization for worsening HF (HHF), occurred in 42% of the participants. Cardiovascular mortality and HHF occurred in 30.5% and 23.9% of the patients, respectively. The primary endpoint and longer CCU stays were significantly more common in patients with RVD than in those with normal RV function. RV dilatation was significantly associated with the primary outcome, whether alone or in combination with RVD. Multivariate regression analysis showed that only RV global longitudinal strain (GLS) independently predicted poor outcomes. RVD and RV dilatation strongly predict CV death and HHF in patients with AHF and LVEF < 50%. Multivariate analysis showed that RV GLS was the only predictor of a composite of CV death and HHF.

Clot ratio, new clot burden score with deep learning, correlates with the risk stratification of patients with acute pulmonary embolism.

Risk stratification for patients with acute pulmonary embolism (APE) is significantly important for treatment and prognosis evaluation. We aimed to develop a novel clot burden score on computed tomography pulmonary angiography (CTPA) based on deep learning (DL) algorithm for risk stratification of APE. The study retrospectively enrolled patients newly diagnosed with APE in China-Japan Friendship Hospital consecutively. We collected baseline data and CTPA parameters, and calculated four different clot burden scores, including Qanadli score, Mastora score, clot volume and clot ratio. The former two were calculated by two radiologists separately, while clot volume and clot ratio were based on the DL algorithm. The area under the curve (AUC) of four clot burden scores were analyzed. Seventy patients were enrolled, including 17 in high-/intermediate-high risk and 53 in low-/intermediate-low risk. Clot burden was related to the risk stratification of APE. Among four clot burden scores, clot ratio had the highest AUC (0.719, 95% CI: 0.569-0.868) to predict patients with higher risk. In the patients with hemodynamically stable APE, only clot ratio presented statistical difference (P=0.046). Clot ratio is a new imaging marker of clot burden which correlates with the risk stratification of patients with APE. Higher clot ratio may indicate higher risk and acute right ventricular dysfunction in patients with hemodynamically stable status.

Kiosk 7R-FC-03 - Prevalence, Associations, and Prognostic Relevance of Right Ventricular Dysfunction in Patients with Chronic Ischemic Cardiomyopathy Undergoing Cardiovascular Magnetic Resonance Imaging

Kiosk 7R-FC-03 - Prevalence, Associations, and Prognostic Relevance of Right Ventricular Dysfunction in Patients with Chronic Ischemic Cardiomyopathy Undergoing Cardiovascular Magnetic Resonance Imaging

Severity of Left Ventricular Dysfunction in Patients With Tachycardia-Induced Cardiomyopathy: Impacts on Remodeling After Atrial Flutter Ablation

Tachycardia-induced cardiomyopathy is defined as a reversible left ventricular (LV) systolic dysfunction (SeD) resulting from a sustained fast heart rate. LV remodeling in patients with severe LV dysfunction at diagnosis remains poorly understood. In this retrospective cohort study, we described LV remodeling in 50 patients who underwent atrial flutter ablation. These patients were divided into severe LV SeD (LV ejection fraction [EF] ≤30%) and LV nonsevere SeD (LVEF 31% to 50%) at baseline. All continuous variables are expressed as median and interquartile range. LVEF was 18% (13 to 25) and 38% (34 to 41) in the SeD (n=29) and LV nonsevere SeD (n=21) groups, respectively. At baseline, patients with SeD had higher LV end-diastolic diameter (56 [54 to 59] vs 49mm [47 to 52], p<0.01), LV end-systolic diameter (48 [43 to 51] vs 36mm [34 to 41], p<0.01), LV end-diastolic volume (71 [64 to 85] vs 56ml/m2 [46 to 68], p<0.01), LV end-systolic volume (56 [53 to 70] vs 36ml/m2 [27 to 42], p<0.01), and lower tricuspid annular plane systolic excursion (12 [10 to 13] vs 16mm [13 to 19], p<0.01). At last follow-up, LVEF was not statistically significantly different between groups. However, LV end-systolic diameter (36 [34 to 39] vs 32mm [32 to 34], p=0.01) and LV end-systolic volume (29 [26 to 35] vs 25ml/m2 [20 to 29], p=0.02) remained larger in the SeD group. Seven patients (14%), all from the SeD group, had a LVEF ≤35% 2months after rhythm control, and reverse remodeling was observed up to 9months. In conclusion, more than half of patients with tachycardia-induced cardiomyopathy and atrial flutter had LVEF ≤30% at baseline. LVEF recovery and LV remodeling were observed beyond 2months, highlighting the importance of rhythm control and early guideline-directed medical therapy in these patients.

Predictors of Right Ventricular Dysfunction in Patients with Atrial Fibrillation and its Clinical Implications: Single Centre Experience

Predictors of Right Ventricular Dysfunction in Patients with Atrial Fibrillation and its Clinical Implications: Single Centre Experience

Assessment of pulmonary vascular resistance via doppler echocardiography in ischemic heart disease with reduced ejection fraction

Objectives: To determine pulmonary vascular resistance (PVR) by echocardiography - Doppler; and evaluate the correlation between pulmonary vascular resistance and some variables such as left ventricular EF, PASP, TAPSE, and tissue S-wave of the tricuspid valve in patients with ischemic heart disease. Method: Observational study on 82 heart failure patients with reduce ejection fraction brought upon by ischemic heart disease, at the Cardiology Department of the University of Medicine and Pharmacy from 04/2016 - 05/2017. Results: The average PVR is 3.91 ± 1.85 WU. There was not significant difference between age and gender groups (p &gt; 0.05), but there was a statistically significant difference of PVR in patients with NYHA III and IV compared to NYHA I, II (p &lt; 0.05). When EF &lt; 30%, the rate of increased PVR is higher than the normal value (35.4 % vs 4.9%). There is a strong correlation between LVEF and PVR (r = - 0.545, p &lt; 0.001), especially when PVR &lt; 8 WU (r = - 0.618, p &lt; 0.001). When the PASP increases, the rate of increased PVR is higher than normal value (54.9% vs. 9.8%, p &lt; 0.001), with an enough correlation coefficient (r = 0.361, p &lt; 0.001). In patients with RV systolic dysfunction evaluated by TAPSE and S’ wave, there was a significant difference in the rate of increased PVR from the normal value (41.5% vs 1.2%; 34.1 vs 8.5%, p 0.001). PVR is closely correlated with TAPSE (r = -0.590; p &lt; 0.001) and is inversely correlated with S’ wave (r = -0.590; p &lt; 0.001). Conclusions: Increased PVR is the primary mechanism for pulmonary hypertension and right ventricular dysfunction in patients with HFrEF brought upon by IHD. The evaluation of PVR in patients with left ventricular dysfunction by echocardiography is important in clinical practice

Association between the triglyceride–glucose index and left ventricular global longitudinal strain in patients with coronary heart disease in Jilin Province, China: a cross-sectional study

BackgroundThis study aimed to investigate the association between the triglyceride–glucose (TyG) index and left ventricular global longitudinal strain (GLS) in patients with coronary heart disease and to examine the role of left ventricular GLS in detecting early changes in cardiac function in patients with coronary heart disease in the subclinical stage.MethodsA cross-sectional study involving 178 participants with symptomatic coronary artery disease excluding myocardial infarction or left ventricular dysfunction was conducted in Jilin Province, China. Basic clinical, biochemical, and echocardiographic data were obtained from all participants. Myocardial strain parameters were compared between patients with higher TyG index and those with lower TyG index, and the association between the gradually elevated TyG index and on subclinical cardiac function in patients with coronary heart disease was evaluated.ResultsThe GLS of left ventricle was lower in the higher TyG index group than in the lower TyG index group. As the TyG index increases, the GLS progressively decreases. The results remained stable after adjusting for confounding factors.ConclusionsA higher TyG index maybe independently associated with subclinical left ventricular dysfunction in patients with coronary heart disease.

Aortic stenosis and right ventricular dysfunction

At the present time, right ventricular function in patients with aortic stenosis is insufficiently taken into account in the decision-making process of aortic valve replacement. The aim of our study was to evaluate significance of right ventricular dysfunction in patients with severe aortic stenosis by modern 3D echocardiographic methods. This is prospective analysis of 68 patients with severe high and low-gradient aortic stenosis. We evaluated function of left and right ventricle on the basis of 3D reconstruction. Enddiastolic, endsystolic volumes, ejection fraction and stroke volumes of both chambers were assessed. There were more patients with right ventricular dysfunction in low-gradient group (RVEF < 45%) than in the high-gradient group (63.6% vs 39%, p = 0.02). Low-gradient patients had worse right ventricular function than high-gradient patients (RVEF 36% vs 46%, p = 0.02). There wasn’t any significant correlation between the right ventricular dysfunction and pulmonary hypertension (r = − 0.25, p = 0.036). There was significant correlation between left and right ejection fraction (r = 0.78, p < 0.0001). Multiple regression analysis revealed that the only predictor of right ventricular function is the left ventricular function. According to our results we can state that right ventricular dysfunction is more common in patients with low-gradient than in high-gradient aortic stenosis and the only predictor of right ventricular dysfunction is left ventricular dysfunction, probably based on ventriculo-ventricular interaction. Pulmonary hypertension in patients with severe AS does not predict right ventricular dysfunction.

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

Left ventricular afterload reduction by transcatheter aortic valve implantation acutely alleviates right ventricular pacing-induced left ventricular dysfunction in patients with aortic stenosis

Abstract Introduction In patients with left bundle branch block (LBBB) cardiac function has been found to be particularly sensitive to alterations in left ventricular (LV) afterload. Nevertheless, whether the detrimental hemodynamic effect of right ventricular pacing (RVP)-induced electromechanical dyssynchrony on LV function is also associated with afterload dependency, has not been investigated yet. Purpose Hence, in the current study we sought to examine the acute effect of RVP on LV function in patients with aortic stenosis (AS) before (with elevated afterload) and after (without elevated afterload) transcatheter aortic valve implantation (TAVI). Methods Patients with a previously implanted permanent pacemaker (PM) and significant AS referred for TAVI at our heart and vascular center university were screened for this observational study. Only those patients who had an intrinsic, regular, narrow QRS or right bundle branch block (RBBB) morphology rhythm were included. From 2022 March to 2023 February, nine patients with a DDD PM (with sick sinus syndrome and maintained AV conduction) and four patients with a VVI PM (with atrial fibrillation and complete AV block but stable junctional escape rhythm) were enrolled. Following TAVI, four patients were excluded due to the development of new-onset persistent LBBB. Transthoracic conventional and advanced echocardiography and non-invasive blood pressure monitoring were performed immediately before TAVI and on the second postoperative day. The measurements were carried out during intrinsic QRS rhythm and during frequency-matched RVP as well. Global longitudinal strain was determined by speckle-tracking echocardiography, then using LV pressure curves estimated from systolic blood pressure and mean aortic gradient, global myocardial work index (GMWI) was calculated to assess LV contractility. Results Mean aortic gradient was decreased after TAVI (40.2±3.6 vs. 6.7±1.3mmHg before vs. after TAVI, P&amp;lt;0.001) indicating successful reduction of LV afterload. Compared to the intrinsic QRS rhythm, RVP decreased GMWI before TAVI (GMWI: 1967±206 vs. 1240±174mmHg% intrinsic QRS vs. RVP, P&amp;lt;0.001) and after TAVI (GMWI: 1399±149 vs. 1020±121mmHg% intrinsic QRS vs. RVP, P=0.019) as well. Nevertheless, the extent of RVP-induced LV contractility impairment (expressed as ΔGMWI) was significantly alleviated after pressure unloading therapy (ΔGMWI: -37.1±6.6 vs. -24.5±7.8% before TAVI vs. after TAVI, P=0.024). Conclusion Our preliminary results indicate that RVP-induced LV dysfunction is afterload dependent. Hence, in patients with AS and a high percentage of RVP, TAVI might entail substantial functional improvement.

Empagliflozin restores autophagy and ameliorates ponatinib-induced cardiomyocyte death

Abstract Background The tyrosine kinase inhibitor ponatinib has proven cardiovascular toxicity, for which no counteractive treatment is available at the moment. Sodium-glucose cotransporter type 2 (SGLT-2) inhibitors are approved drugs treat patients with chronic heart failure of different aetiologies. They play direct anticancer activity in SGLT2-expressing cancer cells, independent of glucose metabolism and through inhibition of oxidative phosphorylation. Ongoing studies are now testing empagliflozin (EMPA) in the prevention of left ventricular dysfunction in patients receiving high cumulative doses of anthracyclines. Aims To determine the effect of EMPA on cardiomyocytes in an in vitro model of PON-induced cardiac toxicity, and to assess underlying cardioprotective mechanisms. Methods and Results We exposed cardiomyocytes to PON (1.7 nM) or vehicle (DMSO) in the presence or absence of EMPA (100 and 500 nM) for 24 hours. Compared with vehicle, incubations with PON significantly reduced cell viability at 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay, decreased autophagic cells at immunofluorescence assay (1±0.5 vs 6±1 fluorescence intensity/total area, p=0.0006, Figure 1), and increased cell senescence (15±5 vs 4±2 β-gal positivity/tissue area, p&amp;lt;0.02), effects all reverted by EMPA (p&amp;lt;0.01). We observed no significant effects of PON or EMPA on formation of reactive oxygen species. Compared with vehicle, PON significantly reduced serum response factor (SRF)/serum response elements (SRE) binding activity (25±9 vs 218±15 SRE complex abundance, arbitrary units, p&amp;lt;0.001), in parallel with a reduction in cardiac actin expression (0.32±0.06 vs 0.98±0,12 cardiac actin/GAPDH ratio, arbitrary units, p=0.001), which was reversed by EMPA (p=0.001). Conclusion EMPA attenuates PON cardiotoxicity by reducing senescence and enhancing autophagy, apparently independent of antioxidant mechanisms. This study suggests the design of clinical studies aimed at assessing the effects of EMPA on PON-induced cardiotoxicity.Legend to Figure 1.CON, control (vehicle, DMSO); PON, ponatinib; EMPA 100, empagliflozin 100 nM; EMPA 500, empagliflozin 500 nM

Left ventricular dysfunction in patients following high-dose chemotherapy and autologous hematopoietic stem cell transplantation

To evaluate the dynamics of LV global longitudinal strain (GLS) and other EchoCG parameters after high-dose chemotherapy (HDCT) and autologous hematopoietic stem cell transplantation (aHSCT). The risk of LV dysfunction in patients after HDCT followed by aHSCT has not been sufficiently studied. This study included 74 patients with hemoblastosis aged 20 to 65 years who had undergone HDCT followed by aHSCT. All patients had a history of antitumor treatment. EchoCG with assessment of LV GLS and measurements of troponin T and N-terminal pro-brain natriuretic peptide (NT-proBNP) were performed for all patients before and after the treatment. A decrease in GLS by 15 % or more from the baseline was detected in 6 (8.1 %) patients. The decrease in GLS was associated with increased NT-proBNP &gt;125 pg / ml at baseline (odds ratio, 8.667; 95 % confidence interval, 1.419-52.942; p=0.022). The decrease in LV GLS in patients after aHSCT was associated with increased NT-proBNP before the intervention.

Clinical and prognostic significance of left ventricular dysfunction predictors in patients with ventricular ectopy and without structural heart disease

Aim. To determine the predictors of left ventricular dysfunction in patients with ventricular ectopic beats without structural heart disease.Material and Methods. We modeled ventricular ectopy in rats through early afterdepolarization (aconitine-induced arrhythmia) and delayed afterdepolarization (adrenaline arrhythmia). In addition, we modeled ventricular ectopy in rabbits and cats by delayed afterdepolarization (barium chloride-induced and strophanthin arrhythmias, respectively) and also modeled ventricular ectopy in dogs by re-entry hydrogen peroxide-induced arrhythmia. In addition to conventional electrocardiography parameters, we analyzed pre-ectopic interval, its variability, and the internal deviation index. Further, the study included 514 patients aged 16 to 34 years (mean 21.2 ± 0.2 years), and the number of premature ventricular contractions (PVCs) per day of observation ranged from 6,157 to 37,254 (mean 19,706 ± 656 PVCs). We registered the same parameters as in experimental arrhythmias but calculated them separately for mono- and polymorphic, left and right ventricular out-flow tract arrhythmias. The duration of follow-up of patients was up to 10 years. The endpoint was the detection or absence of cardiovascular and/or extracardiac pathology.Results. We recorded polymorphic PVCs and early monomorphic PVCs when modeling ventricular arrhythmias by the mechanism of delayed post-depolarization and early post-depolarization, respectively. Both early and late monomorphic PVCs were documented when inducing ventricular arrhythmias by re-entry. When modeling hydrogen peroxide-induced and strophanthin arrhythmias, we observed significantly higher values of PVC-QRS complex and ventricular arrhythmia internal deviation index in comparison with aconitine-induced arrhythmia. Favourable outcome was registered in 50.97% of patients, whilst coronary artery disease, arterial hypertension, and mitral valve prolapse were documented in 7.98%, 16.73% and 2.92% patients. The rest of the patients had gastrointestinal diseases. In patients with favourable outcome, the signs of monomorphic PVCs correlated with those revealed during the modeling of ventricular ectopy by early afterdepolarization (r = 0.92), whereas those signs of polymorphic PVCs correlated with those observed at barium chloride-induced delayed afterdepolarization (r = 0.94). In patients with CAD, signs of PVCs correlated with those registered during re-entry hydrogen peroxide-induced arrhythmia (r = 0.93), Finally, in patients with arterial hypertension and mitral valve prolapse signs of PVCs correlated with those documented at strophanthin-(r = 0.92) and adrenaline-induced delayed afterdepolarization (r = 0.89). In these patients, the values for both monomorphic and polymorphic PVCs, ventricular arrhythmia internal deviation index, duration of PVC-QRS complex and PVC-QRS/QRSaverage did not exceed 0.42 units, 149 ms and 1,44 units, respectively. The development of coronary artery disease and arterial hypertension well correlated with an increase in ventricular arrhythmia internal deviation index ≥ 0.56 units and QRS complex duration ≥ 157 ms. Mitral valve prolapse was associated with the duration of the QRS complex ≥ 159 ms of polymorphic PVCs.Conclusion. In patients with ventricular ectopy but without structural heart disease, an increase in the values of ventricular arrhythmia internal deviation index and the duration of PVC-QRS complex was ≥ 0.48 units and 149 ms, respectively, associated with the development of cardiovascular pathology. Development of coronary artery disease and hypertension correlated with ventricular arrhythmia internal deviation index ≥ 0.56 units, and QRS complex duration ≥ 157 ms in monomorphic and polymorphic PVCs, whereas development of mitral valve prolapse correlated QRS complex duration ≥ 159 ms in polymorphic PVCs.

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.