Ventricular End-diastolic Diameter Index Research Articles

The Prognostic Value of Right Ventricular End-Diastolic Basal Diameter Index by Echocardiography in Connective Tissue Diseases Associated With Pulmonary Artery Hypertension.

Right ventricular (RV) failure is a well-recognized pivotal prognostic factor of adverse outcomes in pulmonary artery hypertension (PAH), while RV dilation provides significant implications for adaptive or maladaptive changes. PAH is a predominant cause of mortality among patients with connective tissue disease (CTD). This study aims to elucidate the prognostic significance of RV morphology, as assessed by echocardiography (ECHO), in with CTD associated with PAH (CTD-PAH). In this ambispective cohort study, 143 CTD-PAH patients diagnosed by right-sided heart catheterization (RHC) from 2013 to 2023 were enrolled. Clinical characteristics, laboratory data, echocardiographic parameters (right ventricular end-diastolic basal diameter index (RVDDI), tricuspid annular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP)) and therapy were recorded. The primary endpoint was defined as clinical worsening within a five-year timeframe. Analytical methods included Kaplan-Meier survival analyses, the log-rank test, and multivariable Cox proportional hazards regression to evaluate prognostic factors. The study enrolled a total of 143 patients with CTD-PAH, with a notable female predominance (95.1%) and a median age of 41.67 years; SLE-PAH (49%) and pSS-PAH (34%) were the most common subtypes, and 94% of the participants were in WHO-FC II-III. Among the participants, 34 (23.8%) patients experienced clinical worsening during a median follow-up period of 21 months. After adjusting for confounders such as age and sex, RVDDI, as determined by ECHO was correlated with clinical worsening (HR 1.090; 95% CI: 1.019-1.166; p = 0.012). RVDDI > 25.81 mm/m2 predicts higher incidence of clinical worsening in CTD-PAH. In the subgroup of TAPSE/PASP > 0.19 mm/mmHg, patients with RVDDI > 25.81 mm/m2 had a higher incidence of clinical worsening. The estimated event-free survival rates at 1 and 3 years were 93.5% and 53.7%, respectively. The study demonstrates that RVDDI, as evaluated by ECHO, is a significant prognostic indicator for clinical worsening in CTD-PAH. Its inclusion in the assessment of RV function and risk stratification may provide valuable incremental prognostic information for this CTD-PAH population.

Association between Visit-to-Visit Ultrafiltration Volume Variability, Vascular Biomarkers and Cardiovascular Parameters in Chronic Hemodialysis Patients

Background. Cardiovascular (CV) diseases are the most common causes of morbidity and mortality in hemodialysis (HD) patients. We studied the effect of high visit-to-visit ultrafiltration (UF) variability on CV abnormalities in HD patients. Methods. Twenty-nine consecutive patients (age: 65.6 ± 10.4 years) were recruited. Samples for routine lab tests were drawn pre-HD for syndecan-1 (SDC-1) and endothelin-1 (ET-1) measurements pre-, mid- and post-HD. Applanation tonometry was performed pre-, mid- and post-HD. Visit-to-visit ultrafiltration volume variability (UVSD) was calculated as the standard deviation of the UF volume/dialysis session in the preceding 12 months. Echocardiography was performed post-HD. Results. Patients were divided into two groups based on the median of UVSD (500 mL). The average UF volume/HD was not different between the groups. Blood pressure (BP) values were similar. Pre-HD cfPWV (10.75 m/s) was lower in the high UVSD group (14.1 m/s, p = 0.03). In the high UVSD group, post-HD cfPWV (13.9 m/s) was higher than the pre-HD cfPWV (p < 0.05). Pre-HD ET-1 was lower in the high UVSD group (8.6 ± 3.9 vs. 10.8 ± 2.7 pg/mL, p < 0.05). Left ventricular end-diastolic diameter (LVEDD) and left ventricular mass index (LVMI) were higher in the high UVSD group (55.7 ± 7.3 vs. 51.0 ± 5.4 mm and 449.9 ± 180.5 vs. 350.3 ± 85.9 g/m², p < 0.005, respectively). Left ventricular ejection fraction (LVEF) was lower in the high UVSD group (53.5 vs. 60, p < 0.05). Conclusions. High UVSD was associated with increased left ventricular hypertrophy and dysfunction and decreased LVEF compared to low visit-to-visit UV variability despite similar UF volumes temporarily compensated by more elastic arteries. The observed abnormalities may increase CV risk.

The Effect of Carnitine Supplementation on Cardiac Function and Ketogenic Diet Effectiveness in Patients with Drug Resistant Epilepsy on Ketogenic Diet

Abstract Background Ketogenic Diet (KD) is gaining attention as a management line in childhood drug resistant epilepsy (DRE) and it is an effective line of therapy for DRE in children. KD is a strict diet consisting of minimal carbohydrate and adequate protein intake with increased fat content. Although KD is effective for epilepsy management, it is deficient in several minerals, vitamins, and trace elements, which can lead to several early and late complications. Objective To demonstrate the effect of carnitine supplementation on cardiovascular functions in patients with DRE on KD and to highlight the effect of carnitine supplementation on efficacy of KD in seizure control. Methods This study was a clinical trial (Trial Design: Parallel 1:1) which included 52 patients with DRE on KD following up at Pediatric Neurology and Clinical Nutrition Outpatient Clinics at Ain Shams University children`s Hospital (or admitted as inpatient) in the period from March 2022 to October 2022 Results There was a statistically significant decrease in the CSSS after 6 months compared to initial presentation among the L-carnitine supplemented group. After 6 months of L-carnitine supplementation, the supplemented group showed significant increase in interventricular wall thickness diameter (IVSD) and significant increase in posterior wall thickness (PWT). Left ventricular end-diastolic diameter (LVED) and left ventricular (LV) mass index showed also increased but didn’t reach significance statistically after L- carnitine supplements. There was no statistically significant difference between carotid intima-media thickness CIMT at initial presentation and after 6 months among L-carnitine supplemented group. Conclusion After six months of L-carnitine supplementation in patients with DRE on KD, there was improvement in the frequency and duration of convulsions among L-carnitine group. Regarding ECHO finding, L-carnitine group showed increase in interventricular wall thickness diameter (IVSD) and posterior wall thickness (PWT). Left ventricular end-diastolic diameter (LVED) and left ventricular (LV) mass index also showed increases but didn’t reach statistical significance after L- carnitine supplementation. There was no statistically significant difference in carotid intima-media thickness CIMT at initial presentation and after 6 months among L-carnitine supplemented group.

Ratio of pulmonary artery diameter to ascending aortic diameter and its association with right ventricular failure after left ventricular assist device implantation

BackgroundSeveral invasive hemodynamic parameters help predict right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation. However, prediction using non-invasive parameters alone has not been established. The ratio of the diameters of the pulmonary artery (PAD) to those of the ascending aorta (AoD) may indicate past hemodynamic load and cardiac dysfunction. We aimed to investigate a predictive model for RVF after LVAD implantation using non-invasive parameters including PAD/AoD ratio. MethodsWe studied 141 patients who underwent primary LVAD implantation and 117 healthy individuals with computed tomography (CT) data. RVF was defined as the need for a subsequent right ventricular assist device or intravenous inotrope administration for more than 30 days after LVAD implantation. The PAD/AoD ratio was measured at the level of the pulmonary artery bifurcation on the CT transaxial slices. ResultsRVF was observed in 29 patients. The correlation between PAD and AoD differed among healthy individuals, patients with and without RVF. Patients with RVF had higher total bilirubin and log brain natriuretic peptide (BNP) levels, a lower left ventricular end-diastolic diameter (LVDd) index, and a higher PAD/AoD ratio than those without RVF. Decision tree analysis indicated that the subgroup with a high PAD/AoD ratio (≥1.09) and a small LVDd index (<35.4 mm/m2) showed the highest probability of RVF (100 %), while the subgroup with a low PAD/AoD ratio (<1.09) and low log BNP (<2.79) showed the lowest probability of RVF (1 %). ConclusionCombining non-invasive parameters with the PAD/AoD ratio can predict RVF with high accuracy.

Recurrence of left ventricular systolic dysfunction and its risk factors in heart failure with improved ejection fraction patients receiving guideline-directed medical therapy: A trajectory analysis based on echocardiography

BackgroundDespite the better prognosis of heart failure (HF) with improved ejection fraction (HFimpEF), remnant cardiovascular risks, including cardiovascular death, rehospitalization, and future deterioration of left ventricular (LV) systolic function, remain in HFimpEF. However, for HFimpEF patients, especially for those receiving guideline-directed medical therapy (GDMT), the recurrent LV systolic dysfunction and its risk factors is still unclear. MethodsA total of 1098 HF patients under HF follow-up management system were initially screened. Echocardiography was re-evaluated at 3-, 6-, and 12-month follow-up. After exclusion, a total of 203 HFimpEF patients on GDMT were enrolled in our final analysis. Cox regression analysis was conducted to select risk factors. ResultsDuring the 1-year follow-up, a total of 28 (13.8%) patients had recurrent LV systolic dysfunction. The trajectory analysis of echocardiographic parameters illustrated that persistent decline of left ventricular ejection fraction (LVEF) and worsening LV remodeling was observed in patients with recurrent LV systolic dysfunction. Multivariable Cox regression analysis identified that ischemic cardiomyopathy, atrial fibrillation, higher left ventricular end-diastolic diameter index (LVEDDI), elevated serum potassium, and a lack of sodium-glucose co-transporter-2 inhibitors (SGLT2i) treatment were confirmed as independent risk factors for recurrent LV systolic dysfunction. Recurrent LV systolic dysfunction was associated with higher rehospitalization rate. ConclusionIn our longitudinal cohort study, almost 14% HFimpEF receiving GDMT suffered recurrent LV systolic dysfunction. Ischemic cardiomyopathy, atrial fibrillation, higher LVEDDI, higher serum potassium, and a lack of SGLT2i therapy were tightly associated with recurrence of LV systolic dysfunction. Relapse of LV systolic dysfunction correlated with poor prognosis.

Clinical and prognostic implications of left ventricular dilatation in heart failure.

To assess the agreement between left ventricular end-diastolic diameter index (LVEDDi) and volume index (LVEDVi) to define LV dilatation and to investigate the respective prognostic implications in patients with heart failure (HF). Patients with HF symptoms and LV ejection fraction (LVEF) < 50% undergoing cardiac magnetic resonance were evaluated retrospectively. LV dilatation was defined as LVEDDi or LVEDVi above the upper normal limit according to published reference values. Patients were followed up for the combined endpoint of cardiovascular death or HF hospitalization during 5 years. A total of 564 patients (median age 64 years; 79% men) were included. LVEDDi had a modest correlation with LVEDVi (r = 0.682, P < 0.001). LV dilatation was noted in 84% of patients using LVEDVi-based definition and in 73% using LVEDDi-based definition, whereas 20% of patients displayed discordant definitions of LV dilatation. During a median follow-up of 2.8 years, patients with both dilated LVEDDi and LVEDVi had the highest cumulative event rate (HR 3.00, 95% CI 1.15-7.81, P = 0.024). Both LVEDDi and LVEDVi were independently associated with the primary outcome (hazard ratio 3.29, 95%, P < 0.001 and 2.8, P = 0.009; respectively). The majority of patients with HF and LVEF < 50% present both increased LVEDDi and LVEDVi whereas 20% show discordant linear and volumetric definitions of LV dilatation. Patients with increased LVEDDi and LVEDVi have the worst clinical outcomes suggesting that the assessment of these two metrics is needed for better risk stratification.

Sex-related differences in the association between septal wall thickness and survival

Abstract Background Septal hypertrophy is associated with increased morbidity and mortality but data regarding the effect of sex on the association between septal wall thickness and survival is limited and uniform cutoffs in men and women are often used in clinical practice and research. Objective To investigate the differences between men and women in the association between septal wall thickness and survival. Methods A retrospective analysis of consecutive unselected patients undergoing echocardiography between March 2010 and February 2021 in a large tertiary referral center. Echocardiography studies were performed according to standard protocol. Survival data was validated against the ministry of health records. Cox regression analysis was used to evaluate the association between septal thickness and mortality. Results A total of 71,965 individuals were included. There were 32,419 (46%) female and 38,546 (54%) male examinees. Females were older than males (65 + 18 vs. 62 + 18, p &amp;lt; 0.001), less likely to have diabetes (16% vs. 19%, p&amp;lt;0.001) or ischemic heart disease (11% vs. 25%, p&amp;lt;0.001) but more frequently had atrial fibrillation (11% vs. 10%, p&amp;lt;0.001). Females had lesser septal wall thickness than males (10.3 + 2 vs. 11.1 + 2, p &amp;lt; 0.001), lower left ventricular mass index (89 + 29 vs. 102 + 33, p&amp;lt;0.001), lower left ventricular end diastolic and end systolic diameter index. Men had lower ejection fraction than women (55% + 9 vs. 58% + 6, p &amp;lt; 0.001). Over a mean follow-up of 59.1 ± 37 months there were 9631 (25%) and 8429 (26%) deaths in the male and female groups, respectively. In multivariate cox regression analysis, septal thickness was an independent predictor for all-cause mortality in both sexes (Table). When using a uniform cutoff of 12mm for septal thickness for both sexes, the multivariate adjusted HR was 1.00 (CI 95%: 0.94-1.08, p=0.83) for males and 1.15 (CI 95%: 1.07-1.25, p&amp;lt;0.001) for females. The Kaplan–Meier mortality-free survival curve by septal thickness and sex is shown (figure). Septal thickness had an incremental prognostic significance in both sexes. On multivariate analysis it became statistically significant in females at 11mm with HR 1.51 (CI95%:1.06-1.24, p&amp;lt;0.001) and in males at 13mm with HR 1.21 (CI95%: 1.12-1.36, p&amp;lt;0.001). When using indexed septal thickness for BSA, the statistically significant cutoff was 6mm/BSA for women, HR 1.08 (CI 95%: 1-1.17, p=0.04) and 6.2mm/BSA for men, HR 1.07 (CI 95%: 1-1.15, p=0.05). Conclusions In an large unselected cohort of patients, septal hypertrophy had an incremental prognostic significance in both sexes and was associated with increased mortality at a lower threshold in women than in men. This may at least partially explain the delayed diagnosis and worse prognosis reported in females in many conditions characterized by septal hypertrophy. Applying a lower absolute value or using indexed measurements may facilitate early diagnosis and improve prognostication in females.

Cardiac remodeling on echocardiogram is related to contrast-associated acute kidney injury after coronary angiography: a cross-section study.

Cardiac dysfunction is a well-established risk factor for contrast-associated acute kidney injury (CA-AKI). Nevertheless, the relationship between cardiac remodeling, as assessed by echocardiography, and CA-AKI remains uncertain. A total of 3,241 patients undergoing coronary angiography (CAG) with/without percutaneous coronary intervention (PCI) were enrolled in this retrospective study. Collected echocardiographic parameters were normalized by body surface area (BSA) and divided according to quartile, including the left ventricular internal end-diastolic diameter index (LVIDDI), left ventricular internal end-systolic diameter index (LVIDSI), and left ventricular mass index (LVMI). Logistic regression analysis was conducted to ascertain the association between structural parameter changes and CA-AKI. Further investigation was performed in different subgroups. The mean age of the participants was 66.6 years, and 16.3% suffered from CA-AKI. LVIDSI [≥22.9 mm/m2: OR = 1.953, 95%CI (1.459 to 2.615), P < 0.001], LVIDDI [≥33.2 mm/m2: OR = 1.443, 95%CI (1.087 to 1.914), P = 0.011], and LVMI [≥141.0 g/m2: OR = 1.530, 95%CI (1.146 to 2.044), P = 0.004] in quartile were positively associated with CA-AKI risk in general (all P for trend <0.05). These associations were consistent when stratified by age, left ventricular ejection fraction, estimated glomerular filtration rate, and N-terminal brain natriuretic peptide (all P for interaction >0.05). The presence of eccentric hypertrophy [OR = 1.400, 95%CI (1.093 to 1.793), P = 0.008] and the coexistence of hypertrophy and dilation [OR = 1.397, 95%CI (1.091 to 1.789), P = 0.008] carried a higher CA-AKI risk. The presence of cardiac remodeling, assessed by echocardiography, is associated with a higher risk of CA-AKI.

Association between greenery and health indicators in urban patients with symptomatic heart failure: a retrospective cohort study in Lithuania

ABSTRACT Urban green spaces benefit physical, mental health, and reduses the risk of cardiovascular disease. A study in Kaunas, Lithuania collected health data from 100 patients with symptomatic heart failure (HF) during 2006–2009. Residential greenness was measured by the normalized difference vegetation index (NDVI). We assessed the impact of greenness on health indicators and on changes in health markers after 6 months. Higher greenness levels based on the NDVI 1-km radius were related to higher mean values of heart rate (HR) and ejection fraction and lower left ventricular (LV) end-diastolic diameter index (LV EDDI), LV end-systolic volume (ESV), left atrium size (LAS), and right atrium size (RAS) at baseline. After 6 months, a decrease in DBP and HR and an improvement in spiroergometric parameters were associated with exposure to high levels of greenness. The long-term rehabilitation group experienced significant changes in spiroergometric indicators. The results confirm that the greenness of the residential environment can improve health indicators in patients with HF.

Outcome and prognostic value of N-terminal pro-brain natriuretic peptide and high-sensitivity C-reactive protein in mildly dilated cardiomyopathy vs. dilated cardiomyopathy.

AimsMildly dilated cardiomyopathy (MDCM) was characterized as a subset of dilated cardiomyopathy (DCM) with systolic dysfunction and modest ventricular dilatation, of which the prognostic studies were limited. We aimed to compare the prognostic value of the N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) and high‐sensitivity C‐reactive protein (hs‐CRP) between MDCM and DCM.Methods and resultsWe retrospectively included hospitalized patients diagnosed with DCM and a left ventricular ejection fraction ≤ 50% at Fuwai Hospital from 2006 to 2017. MDCM was defined as left ventricular end‐diastolic diameter index (LVEDDi) ≤ 33 mm/m2 in males and ≤34 mm/m2 in females. A total of 640 patients (median age 49 years, 24.8% female) were included in this study. At baseline, 110 cases (17%) were categorized as MDCM and 529 cases (83%) as DCM. Of 282 patients who had follow‐up echocardiograms ≥ 6 months, 7 MDCM patients (11.1%) evolved to DCM and 70 DCM patients (32.0%) recovered to MDCM by the change of LVEDDi. Compared with DCM, patients with baseline MDCM had lower composite risks of all‐cause mortality, heart transplantation, and heart failure rehospitalization [adjusted hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.43–0.93, P = 0.019]. Both hs‐CRP and NT‐proBNP were independently associated with the composite endpoint in the overall cohort (hs‐CRP: adjusted HR 1.07, 95% CI 1.00–1.15, P = 0.036; NT‐proBNP: adjusted HR 1.11, 95% CI 1.02–1.22, P = 0.019). After a propensity‐score matching between MDCM and DCM, higher NT‐proBNP (above the median) was significantly associated with the outcome in DCM patients (HR 1.83, 95% CI 1.05–3.20, P = 0.034), but not in MDCM patients (HR 1.54, 95% CI 0.76–3.11, P = 0.227). On the contrary, higher hs‐CRP (above the median) showed prognostic value for adverse events in MDCM patients (HR 3.19, 95% CI 1.52–6.66, P = 0.002), but not in DCM patients (HR 1.04, 95% CI 0.61–1.79, P = 0.88).ConclusionsIn patients with MDCM, although no evidence suggested the prognostic role of NT‐proBNP, higher level of hs‐CRP was associated with outcome, supporting the use of hs‐CRP in risk stratification for patients with MDCM.

Pathophysiology of High Output Arteriovenous Fistula with Heart Failure: A Systematic Review and Meta-analysis

Introduction: Arteriovenous Fistula (AVF) is extensively used as vascular access for haemodialysis patients. It induces a high output state, which is associated with cardiac remodeling. With High Output Heart Failure (HOHF), the AVF occupies a low pressure; reduced vascular resistance and increased venous return. The High Output Arteriovenous Fistula with Heart Failure (HOHF-AVF) patients often undergo a comprehensive assessment of type of underlying diseases, the degree of vasodilatation along with laboratory investigations and cardiac imaging. Hence identification of the pathophysiological determinants of HOHF-AVF is intriguing. Aim: To identify the pathophysiological determinants of HOHF-AVF. Materials and Methods: This systematic review was conducted from May 2021 to December 2021 at the Department of Cardiovascular Surgery, Imperial College, United Kingdom. Randomised Controlled Trials (RCTs), cohort, case-control, cross-sectional and descriptive studies, conducted on adult patients who underwent AVF creation or ligation and addressed the pathophysiological determinants of HOHFAVF were included. Studies conducted among Paediatric cases, case reports, and case series were excluded. Medline (PubMed), EMBASE, ProQuest, and the Cochrane database were searched, by utilising the key words {[(“HOHF” OR “High output heart failure”) AND (“AVF” OR “Arteriovenous fistula”)] AND (“LV parameters” OR “Structural Characteristics” OR “Echocardiographic indices)}. The searches were restricted from January 2000 to October 2021 with studies published in the English language. All the included studies were subjected to critical appraisal using the “Cochrane risk of bias assessment tool” for RCTs, and the “Joanna Briggs Institute (JBI) checklist” for cohort, case-control, cross-sectional and descriptive studies. For meta-analysis Mantel-Haenszel Odds Ratio (M.H. O.R.) with its 95% Confidence Interval (C.I), Mean Difference (M.D) with its 95 % C.I were computed. The Review Manager Software (Rev Man 5, Cochrane collabouration, Oxford, England) was used for data analytics. Results: Overall, 115 citations were identified from the initial search, of which 29 studies were retrieved. Later, 14 studies were excluded. Of the remaining 15 studies, 12 were subjected to meta-analysis. There was a change in Left Ventricular (LV) end diastolic diameter (M.D=2.0; p&lt;0.001; 95% C.I=1.13 to 2.86), and cardiac index (M.D=0.63; p&lt;0.001, 95% C.I=0.46 to 0.79) from baseline to atleast three months of postsurgery among HOHF-AVF patients. According to the AVF flow, there was a change in LV systolic diameter (M.D=-18.90; p&lt;0.01; 95% C.I=-22.84 to-14.96), cardiac index (M.D=0.50; p=0.007; 95% C.I=0.14 to 0.86) and tricuspid annular plane systolic excursion (M.D=3.90; p=0.03; 95% C.I=0.30 to 7.50). Conclusion: Left ventricular end diastolic diameter and cardiac index were found to be the major determinants for a HOHFAVF. The left ventricular mass index, ejection fraction, posterior wall thickness, interventricular septum were not associated with HOHF-AVF. Left ventricular systolic diameter, cardiac index and tricuspid annular plane systolic excursion were the determinants of AVF flow.

Correlations between Gatectin 3 and clinical echocardiographic parameters during ST elevation myocardial infarction

The circulating Galectin 3 (Gal-3) emerged as a new biomarker involved in fibrosis and left ventricular remodeling. The aim of our study was to investigate correlations of Gal-3 levels with cardiac function and remodeling parameters evaluated by echocardiography, and with clinical, biological and angiographic parameters in patients hospitalized for ST elevation myocardial infarction (STEMI) We conducted a prospective longitudinal study, including consecutive patients hospitalized for STEMI at the Cardiology Department of the Charles Nicoll Hospital in Tunis. A Gal-3 assay and an echocardiography were performed at four times: admission (T0), one month (T1), three months (T2), and six months (T3). Our study collected 45 patients aged 58 + 12 years. The sex ratio was 10, 2. We found a significant correlation between Gal–3 assayed at T0 with age (r = 0.311; P = 0.037), ALAT (r = 0.4; P = 0.009) and CPK (r = 0.384; P = 0.019); and between Gal-3 assayed at T3 and the infarction localization ( P = 0.007). At one month, Gal-3 correlated with the left ventricular ejection fraction (r = 0.308; P= 0.042), left ventricular end-diastolic volume index (LVEDVi) (r = 0.324; P = 0.032), and left ventricular end-systolic volume index (LVESVi) (r = 0.378; P = 0.012). In addition, it had a predictive value on evolution. In fact, Gal-3 assayed at T1 was found to be significantly correlated with LVEDVi measured at T2 (r = 0.O312; P = 0.039) and with left ventricular end-diastolic diameter index (LVEDDi) measured at T2 (r = 0.372; P = 0.014) and at T3 (r = 0.372; P = 0.032). Gal-3 correlates with remodeling parameters and cardiac function, and predicts structural changes when measured at one month of the acute episode of STEMI.

Abstract 12153: Gender Differences in Patients with Val122ile Hereditary Transthyretin Cardiac Amyloidosis

Introduction: Hereditary Transthyretin Cardiac Amyloidosis (hATTR-CA) of the Valine 122 Isoleucine (Val122Ile) variant is prevalent among 3.4% African Americans. More commonly diagnosed in men, there is limited data on sex differences in clinical characteristics and outcomes in patients with Val122Ile hATTR-CA. Methods: Retrospective chart review identified a total of 90 patients with a genetic confirmation of Val122Ile hATTR-CA and either positive technetium pyrophosphate (PYP) scanning or endomyocardial biopsy. Cohorts were divided based on sex and clinical and demographic data was collected from time of diagnosis. Results: Among our cohort, 64 (71%) were males and 26 (28%) were females. All were African Americans. Women were significantly older at the time of diagnosis compared to men, 76 ± 6 vs 71 ± 7, p=0.001. New York Heart Association (NYHA) Functional Classification scores were similar between sexes with the majority presenting with NYHA class II and III symptoms. Men had significantly higher rates of coronary artery disease compared to women, 17 (26.6%) vs 2 (7.7%), p=0.047, but all other comorbidities and extra-cardiac manifestations were similar. Troponin I, BNP, eGFR, and prealbumin did not differ significantly between sexes. Electrocardiographic variables, arrhythmia rates, and cardiac implantable electronic distribution were also similar between gender. However, several echocardiographic variables at diagnosis significantly differed: left ventricular ejection fraction (LVEF, %) was lower in men compared to women (41 ±17 vs 33 ± 15, p=0.024) whereas left ventricular end-diastolic diameter (LVeDd, mm) and mass index (LVMI, g/m2) were both higher in men (44.3 ± 6.7 vs 38.4 7.6, p = 0.001 and 168 ± 63 vs 131 ± 38, p = 0.009 respectively). There was no difference in time to diagnosis or survival between men and women in our cohort. Conclusions: Consistent with prior data, women with Va1122Ile hATTR-CA were significantly older with higher LVEF at diagnosis when compared to men. Despite this, women were found to have similar NYHA classification, extra-cardiac manifestation rates, biomarkers, and survival. These findings support a delayed, but equally infiltrative phenotype that should be considered in women with preserved heart failure.

Intrinsic left ventricular impairment in Marfan syndrome: A systematic review and meta‐analysis

Intrinsic cardiac impairment in Marfan syndrome (MFS) has been explored in many clinical studies; however, their results have been inconsistent. This meta-analysis aimed to assess the difference in cardiac structure and function between Marfan patients and healthy individuals, and to verify the hypothesis of intrinsic cardiac impairment in MFS. Electronic searches for studies were performed in the PubMed, Embase, and Cochrane Library databases. Nine studies with 490 patients with MFS and 478 controls were included in the analysis. Age and sex were strictly matched between Marfan patients and healthy controls in every study. There was no difference in the left ventricular end systolic diameter index (mean difference [MD]: 0.33; 95% confidence interval [CI]: (-0.24, 0.89); p = 0.26) and left ventricular end diastolic diameter index (MD: 0.18; 95% CI: [-0.47, 0.83]; p = 0.58) between Marfan patients and controls. Marfan patients showed larger left ventricular end systolic volume index (MD: 2.62; 95% CI: [0.27, 4.97]; p = 0.03) and left ventricular end diastolic volume index (MD: 4.16; 95% CI: [2.70, 5.63]; p < 0.01) than the control group. Furthermore, Marfan patients showed a lower left ventricular ejection fraction than healthy people (MD: -2.59%; 95% CI: [-4.64%, -0.54%]; p = 0.01). Intrinsic cardiac impairment was observed in MFS. MFS patients showed the larger left ventricular volume and poorer left ventricular function than matched controls. Considering the potentially adverse impact on cardiac function, intrinsic cardiac impairment in MFS should be considered during the cardiac surgery.

Algorithm for diagnosis and typing of ALCAPA syndrome

ALCAPA syndrome was characterized by anomalous origin of left coronary artery from pulmonary artery. Its clinical presentation is varied and although it is an anomaly of congenital origin, it is not exclusive to pediatric ages. Its epidemiological documentation is difficult. We aimed to make the non-invasive diagnosis of the ALCAPA syndrome and its variants. An observational, prospective and cross-sectional study was conducted with 31 patients with a positive echocardiographic diagnosis of ALCAPA syndrome at Pediatric Cardio Center “William Soler” from 2005 to 2018. The variables with significance for diagnosis were the echocardiographic visualization of the anomalous connection and the reversed flow in the left coronary artery. The variables with significance for typing were age at diagnosis, ischemia in the electrocardiogram, echocardiographic visualization of left ventricle papillary muscles fibrosis, presence of severe mitral regurgitation, left ventricle spheroidal remodeling, left ventricle ejection fraction, left ventricular end-diastolic volume index, and left ventricular end-diastolic diameter index. An algorithm integrated by various diagnostic modalities associated with echocardiography as a tool for the detection of ALCAPA was developed. The documentation of the diagnostic and classificatory aspects of the syndrome is possible by detecting echocardiographic elements in conjunction with electrocardiographic and radiological aspects.

Are exercise-induced changes of fatty acids associated with cardiac hypertrophy in athletes? A pilot study

Abstract Study aim: In this study, we evaluated the effects of acute and chronic exercise on the plasma FAs and their association with cardiac hypertrophy indices. Material and methods: In this pilot study, 15 sedentary and 15 athlete women underwent acute and long-term water aerobic exercise and their plasma FA levels and a number of electrocardiographic parameters, such as left ventricular end-diastolic diameter index (LVEDDI), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), and wall thickness were evaluated before and after the exercise program. Results: The acute exercise significantly increased palmitic and oleic acid levels in non-athletes and stearic acid in both groups. However, the same type of exercise decreased linoleic acid only in non-athlete women (p &lt; 0.05). The water aerobics training caused a significant decrease in the levels of palmitic, stearic, and arachidonic acid, SFA/UFA, and ω3/ ω6 ratios and also an increase in α-Linolenic acid and MUFA in non-athletes. We found positive and negative correlations between LVEF with ω3 and SFA/UFA ratio in both groups, respectively. In the non-athlete group, the ω3/ω6 ratio showed negative correlations with LVMI and LVEDDI. Conclusions: The study indicated that the 12-week exercise by sedentary women could make their plasma FAs composition similar to athlete women. Moreover, the plasma FA levels were associated with cardiac hypertrophy indices, showing the importance of FAs in physiological hypertrophy.

Correlations between Gatectin 3 and clinical echocardiographic parameters during ST elevation myocardial infarction

The circulating Galectin 3 (Gal-3) emerged as a new biomarker involved in fibrosis and left ventricular remodeling. The aim of our study was to investigate correlations of Gal-3 levels with cardiac function and remodeling parameters evaluated by echocardiography, and with clinical, biological and angiographic parameters in patients hospitalized for ST elevation myocardial infarction (STEMI). We conducted a prospective longitudinal study, including consecutive patients hospitalized for STEMI at the Cardiology Department of the Charles Nicolle Hospital in Tunis. A Gal-3 assay and an echocardiography were performed at four times: admission (T0), one month (T1), three months (T2), and six months (T3). Our study collected 45 patients aged 58 + 12 years. The sex ratio was 10, 2. We found a significant correlation between Gal-3 assayed at T0 with age ( r = 0.311; P = 0.037), ALAT ( r = 0.4; P = 0.009) and CPK ( r = 0.384; P = 0.019); and between Gal-3 assayed at T3 and the infarction localization ( P = 0.007). At one month, Gal-3 correlated with the left ventricular ejection fraction ( r = 0.308; P = 0.042), left ventricular end-diastolic volume index (LVEDVi) ( r = 0.324; P = 0.032), and left ventricular end-systolic volume index (LVESVi) ( r = 0.378; P = 0.012). In addition, it had a predictive value on evolution. In fact, Gal-3 assayed at T1 was found to be significantly correlated with LVEDVi measured at T2 ( r = 0.312; P = 0.039) and with left ventricular end-diastolic diameter index (LVEDDi) measured at T2 ( r = 0.372; P = 0.014) and at T3 ( r = 0. 372; P = 0.032). Gal-3 correlates with remodeling parameters and cardiac function, and predicts structural changes when measured at one month of the acute episode of STEMI. Gal-3 can contribute to tissue repair, but excessive activation of its repair mechanisms may became harmful at a distance from the acute phase, it could then be a prognostic marker and a therapeutic target.

The Role of False Tendons in Left Ventricular Remodeling and Secondary Mitral Regurgitation After Acute Myocardial Infarction.

BACKGROUNDLeft ventricular false tendons (LVFT) are common structures visualized on transthoracic echocardiography (TTE). The present study tested the hypothesis that LVFT, via a possible ‘constraint’ mechanism, attenuate left ventricular (LV) remodeling and secondary mitral regurgitation after acute myocardial infarction.METHODSSeventy-one patients admitted to the Coronary Care Unit following an ST-elevation (n = 63) or non-ST-elevation (n = 8) myocardial infarction were analyzed; 29 (41%) had LVFT, and 42 (59%) did not (no-LVFT). All had a TTE and at least 1 follow-up study after revascularization. The χ2 analysis, Student's t-test, and Mann Whitney U test were used for the statistical analyses.RESULTSThe mean age (64 vs. 66 years), left ventricular ejection fraction (LVEF) (41% vs. 39%), left ventricular end-diastolic diameter (LVEDd) index (23 mm/m2 for both), and prevalence of ≥ moderate secondary/functional mitral regurgitation (MR) (17% vs. 14%) were similar between the LVFT and no-LVFT groups. At 1-year follow-up, there was no significant difference in chamber remodeling amongst the LVFT versus no-LVFT group when assessed by: 1) ≥ 10% decrease in the relative LVEF (24% vs. 26%; p = 0.83); 2) ≥ 10% increase in the LVEDd index (41% vs. 38%, p = 0.98); and, 3) ≥ 10% increase in the LV mass index (48% vs. 41%, p = 0.68). There was no difference in the prevalence of ≥ moderate secondary/functional MR (17% vs. 12%, p = 0.77). Outcomes remained similar when stratifying by LVFT morphology or ischemic territory.CONCLUSIONSIn patients with mild to moderate LV dysfunction and normal chamber size, LVFT do not affect the development of LV remodeling or secondary/functional MR post-myocardial infarction.

Response to ECG, August 2020

A prophylactic implantable cardioverter defibrillator (ICD) in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) is only indicated when left ventricular ejection fraction (LVEF) reassessment remains ≤35% after 3–6 months on optimal pharmacological therapy. However, LVEF may not improve during this period and the patient may be exposed to an unnecessary risk of sudden cardiac death. This study aimed to determine the incidence and predictors of the absence of left ventricular reverse remodeling (LVRR) after pharmacological treatment optimization in patients with HFrEF to design a risk score of absence of LVRR.Consecutive outpatients with LVEF ≤35% were included in this observational prospective study. Up-titration of angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradine was performed in our Heart Failure (HF) Unit. The absence of LVRR was defined as the persistence of an LVEF ≤35% at the 6-month follow-up.One hundred and twenty patients were included. At the 6-month follow-up, 64%, 76%, 72%, and 7% of patients were at 100% of the target dose of ACE inhibitors/ARBs, beta-blockers, MRAs, and ivabradine, respectively. LVRR was observed in 48% of the patients. Ischemic cardiomyopathy, prolonged HF duration, and larger left ventricular end-diastolic diameter index (LVEDDI) were independent predictors of the absence of LVRR. The risk score based on these predictors showed a c-statistic value of 0.81.Pharmacological treatment optimization is associated with LVRR in approximately half of cases, reducing potential ICD indications in parallel. However, ischemic cardiomyopathy, prolonged HF duration, and larger LVEDDI predict the absence of LVRR and favor ICD implantation without delay. The risk score based on the former predictors may help the clinician with the timing of ICD implantation.

Serum Prealbumin and Echocardiography Parameters Predict Mortality in Peritoneal Dialysis Patients

Aim: Protein-energy malnutrition and cardiovascular (CV) disease predisposes patients with end-stage renal disease (ESRD) on dialysis to a high risk of early death, but the prognostic value of prealbumin (PAB) and echocardiographic indices in ESRD patients treated with maintenance peritoneal dialysis (PD) remains unclear. Methods: A total of 211 PD patients (mean age 49.2 ± 15.4 years, 51.7% male) were prospectively studied. PAB and echocardiography parameters were recorded at baseline. Follow-up (mean ± SD: 33.7 ± 17.3 months) was conducted based on hospital records, clinic visits, and telephone reviews, to record death events and their causes. Results: In the Cox proportional hazards model, PAB and the echocardiographic parameters listed below were found to be optimal predictors of all-cause mortality: PAB (p = 0.003), aortic root diameter (ARD) (p = 0.004), interventricular septum end-diastolic thickness (IVSd) (p = 0.046), and left ventricular end-diastolic diameter index (LVEDDI) (p = 0.029). Of the above-mentioned factors, PAB (p = 0.018), ARD (p = 0.031), and IVSd (p = 0.037) were independent predictors of CV mortality in PD patients. Of note, malnutrition, degradation of the aorta, and myocardial hypertrophy are also known death risk factors in the general population. The all-cause mortality and CV death rate significantly increased as the number of risk factors increased, reaching values as high as 40 and 22% in patients who had all of the risk factors, i.e., abnormal PAB, ARD, and IVSd (p < 0.001 and p = 0.011). Conclusion: In PD patients, low serum PAB and abnormal echocardiographic parameters together were significantly associated with all-cause mortality and CV death, independently of other risk factors. These risk factors for death in PD are similar to those in the general population. Noticeably, the combination of echocardiographic parameters and PAB could provide additional predictive value for mortality in PD patients. In light of these findings, more studies in an optimal model containing PAB and echocardiographic parameters for the prediction of outcomes in ESRD are required.