Ventricular Dysfunction In Patients Research Articles

Impact of epicardial adipose tissue volume upon left ventricular dysfunction in patients with mild-to-moderate aortic stenosis: A post-hoc analysis.

BackgroundAortic stenosis (AS) may lead to diastolic dysfunction and later on heart failure (HF) with preserved left ventricular ejection fraction (HFpEF) via increased afterload and left-ventricular (LV) hypertrophy. Since epicardial adipose tissue (EAT) is a metabolically active fat depot that is adjacent to the myocardium and can influence cardiomyocytes and LV function via secretion of proinflammatory cytokines, we hypothesized that high amounts of EAT, as assessed by computed tomography (CT), may aggravate the development and severity of LV hypertrophy and diastolic dysfunction in the context of AS.MethodsWe studied 50 patients (mean age 71 ± 9 years; 9 women) in this preliminary study with mild or moderate AS and mild to severe LV diastolic dysfunction (LVDD), diagnosed by echocardiography, who underwent non-contrast cardiac CT and echocardiography. EAT parameters were measured on 2nd generation dual source CT. Conventional two-dimensional echocardiography and Tissue Doppler Imaging (TDI) was performed to assess LV function and to derive myocardial straining parameter. All patients had a preserved LV ejection fraction > 50%. Data was analysed using Pearson’s correlation.ResultsOnly weak correlation was found between EAT volume or density and E/é ratio as LVDD marker (r = -.113 p = .433 and r = .260, p = .068 respectively). Also, EAT volume or density were independent from Global Strain Parameters (r = 0.058 p = .688 and r = -0.207 p = .239). E/é ratio was strongly associated with LVDD (r = .761 p≤0.0001) and Strain Parameters were moderately associated with LV Ejection Fraction (r = -.669 p≤0.001 and r = -.454 P≤0.005).ConclusionsIn this preliminary study in patients with AS, the EAT volume and density as assessed by CT correlated only weakly with LVDD, as expressed by the commonly used E/é ratio, and with LV strain function. Hence, measuring EAT volume and density may neither contribute to the prediction nor upon the severity of LVDD, respectively.

Differences in right ventricular dysfunction in patients with idiopathic pulmonary hypertension versus secondary pulmonary hypertension.

Right ventricular (RV) function in the setting of pulmonary hypertension based on different etiologies has not been well studied. In this study, we evaluated the RV function in patients with idiopathic pulmonary hypertension (IPH) versus secon-dary pulmonary hypertension (SPH) due to congestive heart failure. Forty-five patients with pulmonary hypertension and New York Heart Association (NYHA) functional class II or III were enrolled. Of these, 22 were diagnosed with IPH and 23 with SPH. Echocardiographic data, including Doppler and Doppler based strain, were assessed according to the American Society of Echocardiography (ASE) guidelines for detailed evaluation of RV function in these two groups. Mean PAP was 60 ± 14.5 mm Hg in patients with IPH versus 43 ± 11.5 mm Hg in patients with SPH (p = 0.001). Considering conventional indexes of RV function, only Sm and dp/dt were significantly better in the first group compared with the second group (p-value for Sm = 0.042 and for dp/dt = 0.039). RV end diastolic dimension was significantly higher in the IPH group (p = 0.013). Using deformation indexes of RV function, the basal and mid portion of RV free wall strain and basal RV strain rates were significantly worse in the chronic systolic heart failure (PH-HF) group in comparison to the IPH group (p < 0.001 in basal RV strain, p = 0.034 in mid RV strain and p = 0.046 in basal RV strain rate respectively). IPH has less impact on RV function in comparison to PH-HF. Considering both entities are in the category of RV pressure overload, we conclude that the etiology of pulmonary hypertension also plays an important role in RV function in addition to pressure overload.

Comparison of tissue doppler derived systolic strain between different severities of left ventricular dysfunction in patients having rheumatic severe mitral regurgitation

Background: Tissue doppler derived systolic strain detects the subtle changes in left ventricular (LV) function. This new modality can detect LV dysfunction in severe rheumatic mitral regurgitation (MR) at earlier stages. The present study was conducted to compare tissue doppler derived peak systolic strain between patients with different severities of LV dysfunction in rheumatic severe MR and to look for the negative correlation between LV dysfunction and peak systolic strain.&#x0D; Subjects and methods: A descriptive correlational study was conducted from January 2017 to March 2018 at Punjab Institute of Cardiology, Lahore. Fifty healthy controls taken as group-I and 150 asymptomatic patients of rheumatic severe MR were divided into Group-II (with ejection fraction (EF) ≥60% and left ventricular end systolic dimension (LVESD) ≤40mm), Group-III (with EF≥ 60% and LVESD 41-50mm) and Group-IV (with EF &lt;60%).Longitudinal peak systolic strain (PSS) of the groups were measured by tissue doppler imaging and compared. The correlation between systolic dysfunction and PSS was further studied.&#x0D; Results: Out of 200 subjects, 91(45.5%) were male and 109 (54.5%) female. Mean age of study subjects was 31± 9.5 years. Moving from group-I to group-IV, mean LVESD increased from 23.3±2.4 to 49.3±3.0, mean LVEDD (left ventricle end diastolic dimension) increased from 46.4±3.4to 64.0±3.6, ejection fraction decreased from 63.6±2.1to45.7±6.7 and average PSS decreased from 17.8±0.53 to 8.31±0.52.Significant difference was found in average PSS between these groups (p&lt;0.001).There was a significant (p&lt;0.001)negative correlation (correlation coefficient = -0.968) between average PSS and LV dysfunction (i.e. group number).&#x0D; Conclusion: Inrheumatic severe mitral regurgitation, tissue doppler derived peak systolic strain decreases with increase of LV dysfunction showing a significant negative correlation between the two.

Invited Commentary

Strain measures myocardial deformation throughout the cardiac cycle. Tissue Doppler imaging calculates strain by measuring tissue velocities at a fixed point. Speckle tracking uses ultrasonic backscatter (speckles or kernels) to track tissue movement in 2 and 3 dimensions. Speckle tracking has gained acceptance because it allows more comprehensive vector analysis and is less dependent on the angle of the ultrasound beam. Longitudinal, radial, circumferential, and rotational vectors are used to quantify segmental, territorial, and global longitudinal strain. Global longitudinal strain is the most frequently reported measurement. Measurements vary by vendor.1Farsalinos K.E. Daraban A.M. Unlu S. Thomas J.D. Badano L.P. Voigt J.U. Head-to-head comparison of global longitudinal strain measurements among nine different vendors: the EACVI/ASE Inter-Vendor Comparison Study.J Am Soc Echocardiogr. 2015; 28: 1171-1181.e2Abstract Full Text Full Text PDF PubMed Scopus (333) Google Scholar This limitation largely results from postacquisition software, artificial intelligence, and machine learning.2Negishi K. Lucas S. Negishi T. Hamilton J. Marwick T.H. What is the primary source of discordance in strain measurement between vendors: imaging or analysis?.Ultrasound Med Biol. 2013; 39: 714-720Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar Machine learning (ML) can be broadly subdivided into supervised and unsupervised learning.3Gandhi S. Mosleh W. Shen J. Chow C.M. Automation, machine learning, and artificial intelligence in echocardiography: a brave new world.Echocardiography. 2018; 35: 1402-1418Crossref PubMed Scopus (40) Google Scholar Supervised learning includes human-derived algorithms. Each step is typically hand coded and can be easily analyzed for scientific validity. Unsupervised ML is more effective for pattern recognition. It is especially valuable for interpretation of images. Deep learning is a subcategory of unsupervised ML that uses electronic neural networks to mimic the human brain. The machine is presented with most of a large data set for training. The remaining data are used to test and validate training. Deep learning is ideal for strain. Unfortunately, there are limitations. The algorithms generated by deep learning cannot be interpreted by humans. They are not scientifically transparent. We can only analyze results. Each machine-derived strain measurement depends on software configuration and the group of patients originally presented to the machine. The latter is a major limitation in the global arena.4Asch F.M. Miyoshi T. Addetia K. et al.Similarities and differences in left ventricular size and function among races and nationalities: results of the World Alliance Societies of Echocardiography Normal Values Study.J Am Soc Echocardiogr. 2019; 32 (1396.e2-1406.e2)Abstract Full Text Full Text PDF Scopus (38) Google Scholar Finally, it is essential to recognize that there are statistically significant differences for normal values between vendors and these values may change with software updates.1Farsalinos K.E. Daraban A.M. Unlu S. Thomas J.D. Badano L.P. Voigt J.U. Head-to-head comparison of global longitudinal strain measurements among nine different vendors: the EACVI/ASE Inter-Vendor Comparison Study.J Am Soc Echocardiogr. 2015; 28: 1171-1181.e2Abstract Full Text Full Text PDF PubMed Scopus (333) Google Scholar In this issue of The Annals of Thoracic Surgery, Kislitsina and associates5Kislitsina O.N. Thomas J.D. Crawford E. et al.Predictors of left ventricular dysfunction after surgery for degenerative mitral regurgitation.Ann Thorac Surg. 2020; 109: 669-677Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar provide further evidence to support the use of strain to predict ventricular dysfunction after mitral intervention. The European Association of Cardiovascular Imaging/American Society of Echocardiography Industry Task Force consensus statement has reduced intervendor differences.6Potter E. Marwick T.H. Assessment of left ventricular function by echocardiography: the case for routinely adding global longitudinal strain to ejection fraction.JACC Cardiovasc Imaging. 2018; 11: 260-274Crossref PubMed Scopus (149) Google Scholar However, results still vary, especially with older software. As strain and other forms of artificial intelligence are incorporated into clinical practice, we must remain vigilant and recognize the limitations and risks of unsupervised machine learning and uninterpretable algorithms, and the results they generate. Predictors of Left Ventricular Dysfunction After Surgery for Degenerative Mitral RegurgitationThe Annals of Thoracic SurgeryVol. 109Issue 3PreviewThis study was performed to determine whether strain can supplement the ability of left ventricular (LV) ejection fraction (LVEF) to predict postoperative ventricular dysfunction in patients undergoing mitral valve surgery for degenerative mitral regurgitation (DMR). Full-Text PDF

CMR-based heart deformation analysis for quantification of hemodynamics and right ventricular dysfunction in patients with CTEPH.

Quantification of hemodynamics and right ventricular (RV) function is crucial for pulmonary hypertension (PH). Cardiovascular magnetic resonance-based heart deformation analysis (CMR-HDA) has been used to assess the ventricular strain. This study was to determine the correlation of right ventricular longitudinal strain (RVLS) assessed with CMR-HDA with RV function as well as hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Thirty-six CTEPH patients were prospectively included in this research. Each patients underwent CMR and right heart catheterization (RHC). RVLS and RV ejection fraction (RVEF) was quantified from cine images acquired with a retrospectively gated turbo FLASH gradient-echo sequence. The late gadolinium enhancement (LGE) images were acquired using a 2D inversion recovery phase-sensitive fast gradient-echo sequence. Hemodynamics were determined with RHC. Right ventricular longitudinal strain measured with CMR-HDA was -13.99±4.94%. Bland-Altman plots showed statistical agreement with RVLS with low intra- and interobserver variability. RVLS correlated with serum N-terminal-pro-B-type natriuretic peptide (r=0.615, P<.001). RVLS inversely correlated with RVEF (r=-0.699, P<.001), and it was positively correlated with both RVESV (r=0.664, P<.001) and myocardial the volume of LGE (r=0.447, P=.008). Receiver-operating characteristic (ROC) indicated that RVLS values of >-14.20% could be used to predict RVEF <40% with a 100% sensitivity and a 96.7% specificity. Hemodynamically, RVLS was positively correlated with mean pulmonary artery pressure (r=0.598, P<.001) and pulmonary vascular resistance (r=0.685, P<.001). Right ventricular longitudinal strain assessed by CMR-HDA is a readily available and reproducible parameters of RV function. RVLS >-14.20% suggests the presence of RV dysfunction.

Value of Speckle Tracking Echocardiography for Early Detection of Left Ventricular Dysfunction in Patients with Systemic Lupus Erythematosus.

Background:Cardiac dysfunction due to systemic lupus erythematosus (SLE) may be subclinical, but those patients are at high risk for developing clinical heart failure.Aim:The aim of this study is to assess the role of speckle tracking echocardiography (STE) in the early detection of systolic dysfunction in SLE patients.Patients and Methods:This was a case–control study. Participants were subdivided into two groups: Group 1 included 50 SLE patients and Group 2 included 50 healthy controls. Clinical evaluation, echocardiography, tissue Doppler, and STE were performed.Results:Global longitudinal strain (GLS) was significantly reduced in SLE group (−18.95 ± 2.02 vs. −21.4 ± 2.1, P < 0.001). However, there was no significant difference in left ventricular ejection fraction between both groups (P = 0.801). There was a significant positive correlation between the disease duration and age (r = 0.480, P < 0.001), pulmonary artery systolic pressure (PASP) (r = 0.628, P < 0.001), and GLS (%) (r = 0.417, P = 0.012). There was also a significant positive correlation between the disease activity index and GLS (%) (r = 0.7, P < 0.001) and PASP (r = 0.522, P < 0.001).Conclusion:SLE group had GLS % lower than the control group, and this was statistically significant, denoting early systolic dysfunction. Longer duration and high SLE activity index significantly affect GLS. GLS is an excellent noninvasive tool for early detection of subclinical left ventricular systolic dysfunction in SLE patients.

Ventricular Dysfunction in Patients with Coronary Slow-Flow Phenomenon: A Single-center Case-control Study.

Background:Coronary slow-flow phenomenon (CSFP), characterized by delayed distal vessel opacification of contrast, in the absence of significant epicardial coronary stenosis, has effects on exercise capacity and clinical outcomes. The aim of this study was to explore the systolic and diastolic function of patients with CSFP and to compare it with a group of controls with normal coronary anatomy and flow.Materials and Methods:In this case–control study, 45 consecutive CSFP patients and 45 age-, body mass index-, and presentation season-matched controls with normal coronary arteries and normal coronary flows were enrolled from Seyyedoshohada Heart Center from March 2015 to March 2016. A transthoracic echocardiography was done by a blinded echocardiographer using both conventional and tissue Doppler imaging techniques.Results:Patients with CSFP were more likely to be male (P = 0.006) and smoker (P = 0.02) compared to controls. Other risk factors were not different between the two groups. There were no differences between groups in terms of the peak early (E) and late (A) diastolic velocities, deceleration time, early (E’) and late (A’) peak diastolic velocities at the mitral annulus, and the systolic mitral annular velocity (S’). Global longitudinal strain and peak systolic strain rates was lower in patients with CSFP compared to controls (−16.7% ±2.4% vs. −18.9% ±1.6%, P < 0.001 and 1.10 ± 0.1 vs. 1.24 ± 0.3, P = 0.008, respectively).Conclusion:Patients with CSFP showed signs of the left ventricular systolic dysfunction in tissue Doppler echocardiography, which underlines the importance of close follow-up in these patients. Patients with CSFP should be screened for ventricular function preferably by tissue Doppler echocardiography.

Dyspnea and right ventricular dysfunction in patients with isolated mitral stenosis: A retrospective study

Patients with severe and very severe mitral stenosis (MS) are not homogenous regarding symptomatology, and some suffer more than others. The RV systolic function is an important determinant of clinical symptoms, exercise capacity, preoperative survival, and postoperative outcome in patients with mitral stenosis The objectives of this study, is to compare RV function in symptomatic and asymptomatic patients with isolated mitral stenosis. This is a descriptive and analytique study, conducted in Ibn Rochd Center of Cardiology from January 2014 to December 2018, which included all patients with pure severe and very severe MS, devided into two groups according to their functional capacity. Group I (asymptomatic group) with NYHA class I and group II (symptomatic group) with class II–III–IV. The RV systolic function was evaluated by both Doppler tissue imaging, and pulse Doppler, we consider a RV dysfunction when TAPSE 16 mm and S’ 9,5 cm/s. In our series there was a female predominance (69%) symptomatic than men (84,42%, versus 69, 23%). Younger patients < 45 years old, were slightly predominant (51%). Group I consisted of 64 patients (25%), group II had 192 patients (75%). RV was dilated in 17% in group I, versus 34% of group II RV systolic dysfunction was found in: 29% of symptomatic patients and 14% in asymptomatic patients ( P < 0.001) Patient with and impaired RV function are more symptomatic than those with better RV systolic function, without significant difference. This result is confirmed by 2studies conducted in Turkey and India.

P1754 Regional left ventricular longitudinal myocardial dysfunction in mitral valve prolapse could be primary

Abstract Background Regional left ventricular dysfunction in patients with mitral valve prolapse (MVP) and normal ejection fraction has been described by different Authors, and recent data point to a dysfunction (prevalently longitudinal strain) of the myocardium of the LV base secondary to dilatation of the mitral annulus. Purpose To investigate degree and extent of regional LV dysfunction and its mechanisms in patients with MVP, severe regurgitation and normal global systolic function, compared to patients with equivalent degree of regurgitation but functional etiology (FMR). Methods Speckle-tracking echocardiography was performed in 30 controls (N), and in severe primary (MVP, n= 50) or functional (FMR, n= 20) mitral regurgitation, to measure global, regional and segmental longitudinal peak systolic strain (LPSS, %), and time delay of peak maximum strain (TTPd, ms, calculated as time to peak maximum strain - time of aortic valve closure). Maximum and minimum mitral annulus diameters and area were measured with 3D echo. We also evaluated as recommended: LV end-diastolic volume index (EDVi, ml/m2), ejection fraction (EF, %), and left atrial end-systolic volume index (LAESVi, ml/m2) with 2D echo; LV stroke volume index, and non-invasive pulmonary systolic (PSP, mmHg) and diastolic pressures (PDP), mmHg) with Doppler echo. Results Age, heart rate, BSA and systolic blood pressure were similar between groups. Atrial fibrillation was present in 34% of MVP and 71% of FMR patients. LV EF was normal in MVP and reduced in FMR (43 ± 14 % vs N, p&amp;lt;.001). LV EDVi (MVP: 77 ± 20 ml/m2; FMR: 107 ± 35, both p&amp;lt;.001 vs N) and LAESVi (MVP: 91 ± 26 ml/m2; FMR: 80 ± 30, both p&amp;lt;.001 vs N) were similarly increased (volume overload) in MVP and FMR, as were PSP (MVP: 42 ± 23 ml/m2; FMR: 52 ± 25, both p&amp;lt;.001 vs N) and PDP (MVP: 16 ± 6 ml/m2; MVP: 15 ± 5, both p&amp;lt;.001 vs N). In FMR, LPSS was reduced globally (-12.8 ± 3.3, p&amp;lt;.001 vs N and MVP) and similarly at LV base, papillary and apical levels. In contrast, in MVP global (-19.4 ± 3.7%) and apical (-23.4 ± 4.5%) LPSS were normal, whereas LV base (-12.3 ± 5.8%, p=.003 vs N) and papillary (-17.1 ± 4%, p=.024 vs N) LPSS were reduced; further, LPSS reduction was localized to the anterior (-16 ± 4, p=.028 vs N), lateral (-17 ± 5, p=.006 vs N) and posterior (-16 ± 6, p=.007 vs N) segments, and was associated with an increased TTPd in the same segments in MVP but not in FMR patients. At multivariate analysis, degree and localisation of regional myocardial dysfunction in patients with MVP was not related to the prolapsing scallop, dimension of the mitral annulus, degree of volume overload or pulmonary pressures, or stroke volume index. Conclusions In patients with MVP, severe regurgitation and normal EF, there is a specific dysfunction pattern of regional LV longitudinal function which appears to be primary and not dependent on the degree of preload increase, mitral annulus dilatation, or localization of the prolapsing scallop.

Predictors of Left Ventricular Dysfunction After Surgery for Degenerative Mitral Regurgitation

This study was performed to determine whether strain can supplement the ability of left ventricular (LV) ejection fraction (LVEF) to predict postoperative ventricular dysfunction in patients undergoing mitral valve surgery for degenerative mitral regurgitation (DMR). From 2004 to 2017, 520 patients with an LVEF of 60% or more underwent mitral valve surgery (98% repair) for DMR. All patients had preoperative, predischarge, and follow-up (mean, 5.0 ± 3.6 years) echocardiograms. Speckle tracking was performed in 119 of 520 patients (22.9%) to determine LV strain, right ventricular free-wall strain, and left atrial longitudinal strain. Multivariate logistic and Cox regression models were used in this subgroup to evaluate associations with early postoperative LV dysfunction and medium-term overall survival, respectively. Median preoperative LVEF of the entire cohort was 65%. Based on predischarge echocardiogram, 449 patients (86.3%) maintained postoperative LVEF of 50% or greater. Seventy-one patients (13.7%) had a predischarge LVEF of less than 50%, 49 (9.4%) had a predischarge LVEF of 40% to 49%, and 22 (4.2% overall) had a predischarge LVEF of less than 40%. Abnormal preoperative LV, right ventricular, and left atrial strain measurements were significantly associated with the development of postoperative LV dysfunction, but preoperative hemodynamic and non-strain echo parameters did not vary enough in absolute values to be clinically useful as predictors of postoperative LV dysfunction. Preoperative strain measurements in DMR patients were significantly associated with superior capabilities of detecting underlying LV dysfunction despite preserved preoperative LVEF. Strain analysis may serve as another marker for optimal timing of surgical intervention in DMR patients.

Assessment of right ventricular dysfunction in patients with mitral stenosis: A speckle tracking study.

Although it is affected at an early stage, there is a lack of studies investigating right ventricular (RV) function in patients with mitral stenosis (MS). We aimed to investigate the correlation between conventional echocardiographic variables and tricuspid annular plane systolic excursion (TAPSE), used as an indicator of RV dysfunction. We enrolled 59 consecutive patients with MS and assigned them in group 1 if TAPSE ≤16, or group 2 if: TAPSE >16. The mean age of the patients was 42.2 ± 8 years, and 74.6% were females. In univariate analysis, maximal mitral valve gradient, mean mitral valve gradient, systolic pulmonary arterial pressure, RV strain, and RV strain rates were associated with RV dysfunction. In multivariate analysis, both strain variables were found to be independent predictors of RV dysfunction. Kaplan Maier survival analysis showed that patients with lower RV strain had more rehospitalization rate during the one-year follow-up period. RV dysfunction is common in patients with MS and is associated with higher rehospitalization rate and morbidity. Evaluation of RV strain and strain rate for early detection of RV dysfunction and prediction of rehospitalization may be an appropriate approach in mitral stenosis.

Atrial Fibrillation-Mediated Cardiomyopathy.

AF-mediated cardiomyopathy (AMC) is an important reversible cause of heart failure that is likely underdiagnosed in today's clinical practice. AMC describes AF either as the sole cause for ventricular dysfunction or exacerbating ventricular dysfunction in patients with existing cardiomyopathy or heart failure. Studies suggest that irreversible ventricular and atrial remodeling can occur in AMC, making timely diagnosis and intervention critical to optimize clinical outcome. Clinical correlation between AF onset/burden and progression of cardiomyopathy/heart failure symptoms provides strong evidence for the diagnosis of AMC. Cardiac MRI, continuous cardiac monitoring, and biomarkers are important diagnostic tools. From the therapeutic standpoint, early data suggest that AF ablation may improve long-term outcomes in AMC patients compared with medical rate and rhythm control. Patients with more AF burden and less severe underlying structural heart disease are more likely to experience left ventricle function recovery with successful AF ablation. Despite recent advances, significant knowledge gaps exist in our understanding of the epidemiology, mechanisms, diagnosis, management strategies, and prognosis of AMC.

Left Ventricular Dysfunction in Patients With Primary Aldosteronism: A Propensity Score-Matching Follow-Up Study With Tissue Doppler Imaging.

BackgroundPrimary aldosteronism is the most common cause of secondary hypertension and is associated with left ventricular hypertrophy. However, whether aldosterone excess is responsible for left ventricular (LV) diastolic dysfunction is unknown.Methods and ResultsWe prospectively enrolled 129 patients with aldosterone‐producing adenoma and 120 patients with essential hypertension, and analyzed their clinical, biochemical, and echocardiographic data, including tissue Doppler images. The patients with aldosterone‐producing adenoma were reevaluated 1 year after adrenalectomy. After propensity score matching, there were 105 patients in each group. The patients with aldosterone‐producing adenoma had worse diastolic function than the patients with essential hypertension, as reflected by lower e′ (P<0.001) and higher E/e′ (P=0.003). Multivariate analysis showed that LV diastolic function was significantly correlated with age (P<0.001), sex (P<0.001), body mass index (P=0.002), systolic blood pressure (P=0.004), creatinine (P=0.008), and log‐transformed aldosterone‐renin ratio (P=0.003). After adrenalectomy, the patients with aldosterone‐producing adenoma had significant improvements in LV diastolic function as reflected by an increase in e′ (P=0.003) and decrease in E/e′ (P=0.002). The change in E/e′ was independently correlated with baseline E/e′ (P<0.001) and change in LV mass index (P=0.006).ConclusionsThe patients with primary aldosteronism had worse LV diastolic function than the patients with essential hypertension after propensity score matching, and this could be reversed after adrenalectomy, suggesting that aldosterone excess may induce LV diastolic dysfunction.

Péptidos natriuréticos en la detección de disfunción ventricular izquierda en población de alto riesgo. Metaanálisis de pruebas diagnósticas

IntroductionThe concentration of natriuretic peptides in plasma has been proposed as a screening method for early ventricular dysfunction. ObjectiveTo compare the operative characteristics of B-type natriuretic peptide (BNP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) fraction in a population with risk factors. MethodA meta-analysis of diagnostic tests. ResultsA search strategy was applied that found 86 references, of which 12 were selected according to the inclusion criteria. The role of BNP was evaluated in 8 of these studies, that of NT-proBNP in 3, and both tests in one of them. The cut-off points for BNP varied between 8 and 169.5 pg/mL, with a grouped sensitivity of 82.1% (95% CI; 76.7-86.4%), a grouped specificity of 69% (95%CI; 61.5-75.6%), a positive likelihood ratio (LR+) of 2.65 (95% CI; 2.17-3.23) and a negative likelihood ratio (LR−) of 0.26 (95% CI; 0.21-0.32). When the data were only analysed for cut-off points below 50 pg/mL, the grouped sensitivity improved to 89.2% (95% CI; 82.6-94%), and the LR− was 0.23 (95% CI; 0.14-0.40). Only 3 studies on NT-proBNP were analysed, with cut-off points between 125 and 902 pg/mL, a grouped specificity of 97.2% (95% CI; 90.2-99.7%), a grouped sensitivity of 76.9% (95% CI; 74.5-79.1%), LR+ 3.39 (95% CI; 1.67-6.85), and LR− 0.07 (95% CI; 0.02-0.23). ConclusionBNP and NT-proBNP can be useful in ruling out asymptomatic left ventricular dysfunction in patients at risk.

Incremental Utility of Right Ventricular Dysfunction in Patients With Myeloproliferative Neoplasm–Associated Pulmonary Hypertension

Myeloproliferative neoplasm (MPN) has been associated with pulmonary hypertension (PH) on the basis of small observational studies, but the mechanism and clinical significance of PH in MPN are not well established. The aims of this study were to expand understanding of PH in a well-characterized MPN cohort via study of PH-related symptoms, mortality risk, and cardiac remodeling sequalae of PH using quantitative echocardiographic methods. The population comprised a retrospective cohort of patients with MPN who underwent transthoracic echocardiography: Doppler-derived pulmonary arterial systolic pressure applied established cutoffs for PH (≥35mm Hg) and advanced PH (≥50mm Hg); right ventricular (RV) performance was assessed via conventional indices (tricuspid annular plane systolic excursion [TAPSE], S') and global longitudinal strain. Symptoms and mortality were discerned via standardized review. Three hundred one patients were studied; 56% had echocardiography-demonstrated PH (20% advanced) paralleling a high prevalence (67%) among patients with invasively quantified PASP. PH was associated with adverse left ventricular (LV) remodeling indices, including increased myocardial mass and diastolic dysfunction (P≤.001 for all): LV mass and filling pressure (P<.01) were associated with PH independent of LV ejection fraction. RV dysfunction by strain and TAPSE and S' increased in relation to PH (P≤.001) and was about threefold greater among patients with advanced PH compared with those without PH. Patients with RV dysfunction were more likely to report dyspnea, as were those with advanced PH (P<.05). During median follow-up of 2.2years, all-cause mortality was 27%. PH grade (hazard ratio, 1.9; 95% CI, 1.1-3.0; P=.012) and TAPSE- and S'-demonstrated RV dysfunction (hazard ratio, 3.3; 95% CI, 1.3-8.2; P=.01) were independently associated with mortality; substitution of global longitudinal strain for TAPSE and S' yielded similar associations of RV dysfunction with death (hazard ratio, 3.2; 95% CI, 1.5-6.7; P=.003) independent of PH. PH is highly prevalent in patients with MPN and is linked to LV diastolic dysfunction; echocardiography-quantified RV dysfunction augments risk for mortality independent of PH.

P4553Clinical and prognostic value of right ventricular dysfunction in patients with chagas heart disease during acute decompensated heart failure

Abstract Introduction The occurrence of right ventricular disfunction (RVD) is common in heart failure (HF) patients due to Chagas' disease (ChD). However, its clinical and prognostic value has not been studied during episodes of acute decompensated heart failure (ADHF). Purpose Evaluate the prognostic value of RVD in ADHF patients with ChD during hospitalization and after 180 days of discharge compared to other etiologies. Methods We analysed a prospective cohort of consecutive 768 patients admitted for ADHF between March 2013 and October 2018; 490 (63.7%) patients were male and the median age was 58 (48.3–66.8) years and left ventricular ejection fraction was 26% (median) (IQR 22–35%). We compared the clinical characteristics and the prognosis of ChD patients according to the presence of RVD in the echocardiogram to other etiologies. Results RVD was presented in 289 (37.6%) patients. Among patients with non-chagasic etiologies, those with RVD were younger [53 (41–62) vs 61 (52–70) years, p&lt;0.0001], had high levels of BNP in the moment of hospitalization [1195 (606–2209) vs 886 (366– 555) pg/mL], p&lt;0,0001], received more inotropes (79.2% vs 57.9%, p&lt;0,0001), had longer hospitalization [35 (17–51) vs 21 (10–37) days, p&lt;0.001] and more clinical signs of congestion as hepatomegaly (49% vs 28.6%, p&lt;0.0001); jugular venous distension (68.3% vs 41.2%, p&lt;0.0001) and leg edema (65.4% vs 49.2%, p=0.001). Among patients with ChD, those with RVD were older [61 (48- 66) vs 58 (48 - 67) years, p=0.017], and had more frequently signs of hypoperfusion (56.8% vs 36.5%, p=0.029), jugular venous distension (72.8% vs 52.8%, p=0.01) and hepatomegaly (56.8% vs 31.1%, p=0.011), higher BNP levels [1288 (567–2180) vs 1066 (472–2007) pg/mL, p=0.006] and more frequent use of intravenous inotropes (88.9% vs 67.1%, p=0.003); additionally ChD patients with RVD had a higher rate of death and transplant during hospitalization (51.2% vs 38.3%, p=0.001). When all groups were compared together, ChD patients with RVD had the highest rate of death, transplant and readmissions at 180-days of follow-up (Figure). Figure 1 Conclusion Patients with RVD demonstrated a distinct clinical presentation, biomarkers and worse prognosis in all etiologies. ChD patients with RVD in ADHF had the worst prognosis with the highest rate of death, heart transplant e rehospitalization in follow-up.

P5561MicroRNA-208b gene expression levels as a biomarkers of left ventricular dysfunction in patients with acute myocarditis

Abstract Purpose MicroRNAs (miRs) play a major role in protein regulation by post-transcriptional gene expression and cell to cell interaction. Recently, they have been emerged as important modulators in cardiovascular development and disease. Our aim was to determine whether cardiac related miRs such as miR-208b was differentially expressed in peripheral blood mononuclear cells from patients with acute myocarditis. We also evaluated their expression levels in peripheral blood mononuclear cells in relation with left ventricular global longitudinal peak strain (GLPS) in those patients. Methods We assessed the expression levels of miR-208b in 45 patients with acute myocarditis (38 men, mean age 31±10 years) and 22 healthy individuals (18 men, mean age 33±9 years). Blood samples were taken on admission and miR expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. All patients were also underwent an assessment with standard conventional transthoracic and a two-dimensional speckle tracking echocardiography. Results GLPS was significantly reduced in the group of myocarditis compared to healthy individuals (from −13.7 ± −7.9% versus −22.2±6.7%, p&lt;0.05). Myocarditis patients showed significantly higher miR-208b (28.5±6.6 versus 6.40±1.1, p&lt;0.001) expression levels compared to control group. miR-208b gene expression levels at baseline revealed a significant negative correlation with GLPS on admission (r=−0.51, p&lt;0.05). This correlation was independent of the patients' clinical parameters. Conclusions Our data reveal that miR-208b gene expression levels are upregulated in peripheral blood mononuclear cells from patients with acute myocarditis relative to healthy individuals. In addition, miR-208b levels have a prognostic value in the deterioration of left ventricular GLPS in those patients. Thus, miR-208b may represent a promising biomarkers in myocarditis or a potential therapeutic target in the future.

Detecting right ventricular dysfunction in patients diagnosed with low-risk pulmonary embolism: is routine computed tomographic pulmonary angiography sufficient?

Detecting right ventricular dysfunction in patients diagnosed with low-risk pulmonary embolism: is routine computed tomographic pulmonary angiography sufficient?

Response to 'Detecting right ventricular dysfunction in patients diagnosed with low-risk pulmonary embolism: is routine computed tomographic pulmonary angiography sufficient?'

Response to 'Detecting right ventricular dysfunction in patients diagnosed with low-risk pulmonary embolism: is routine computed tomographic pulmonary angiography sufficient?'

The Association between Neutrophil to Lymphocyte Ratio and Systolic Right Ventricular Dysfunction in Patients with Acute Inferior ST- Segment Elevation Myocardial Infarction

AbstractBackground: Ischemic heart disease is considered the most common cause of death worldwide. Inflammation and oxidative stress play an important role in the pathogenesis of all phases of atherosclerosis and atherosclerotic plaque rupture which are the main mechanisms in the pathophysiology of acute ST-segment Elevation Myocardial Infarction (STEMI). Acute inferior STEMI is associated with increased in-hospital morbidity and mortality particularly among patients with coexisting Right Ventricular (RV) involvement. High Neu-trophil to Lymphocyte Ratio (NLR) is an independent predictor of major adverse cardiac events and mortality in patients with myocardial infarction.Aim of Study: To study the relationship between the NLR and RV Dysfunction (RVD) in patients with inferior STEMI who underwent primary Percutaneous Coronary Intervention (PCI) or received fibrinolytic therapy. RVD measured by Tricuspid Annular Plane Systolic Excursion (TAPSE) Patients and Methods: This study was conducted on sixty patients diagnosed with acute inferior STEMI and underwent primary PCI or received fibrinolytic therapy in Tanta University Hospitals, Cardiovascular Department, from December 2017 to June 2018. The cases were divided into two groups according to the presence of RVD or not. The groups were compared according to NLR and Receiver Operating Characteristic (ROC) analysis was performed to access the predictability of high NLR in patients with RVD.Results: The NLR was significantly higher in the group with RVD compared to that without RVD (p=0.002). In ROC analysis, NLR >3.2 predicted RVD with sensitivity of 82.16% and specificity of 89.19%. In a multivariate regression analysis, NLR remained an independent predictor of RVD (95% C.I 0.787-0.976, p=0.002).Conclusion: NLR was an independent predictor of RVD in patients with acute inferior STEMI who underwent primary PCI or received fibrinolytic therapy.