Parameters Of Ventricular Function Research Articles

The predictive value of coronary microvascular dysfunction for left ventricular reverse remodelling in dilated cardiomyopathy.

To evaluate the degree of coronary microvascular dysfunction (CMD) in dilated cardiomyopathy (DCM) patients by cardiac magnetic resonance (CMR) first-pass perfusion parameters and to examine the correlation between myocardial perfusion and left ventricle reverse remodelling (LVRR). In this study, 94 DCM patients and 35 healthy controls matched for age and sex were included. Myocardial perfusion parameters, including upslope, time to maximum signal intensity (Timemax), maximum signal intensity (SImax), baseline signal intensity (SIbaseline), and the difference between maximum and baseline signal intensity (SImax-baseline) were measured. Additionally, left ventricular (LV) structure, function parameters, and late gadolinium enhancement (LGE) were also recorded. The parameters were compared between healthy controls and DCM patients. Univariable and multivariable logistic regression analyses were used to determine the predictors of LVRR. With a median follow-up period of 12 months [interquartile range (IQR), 8-13], 41 DCM patients (44%) achieved LVRR. Compared with healthy controls, DCM patients presented CMD with reduced upslope, SIbaseline, and increased Timemax (all p < 0.01). Timemax, SImax, and SImax-baseline were further decreased in LVRR than non-LVRR group (Timemax: 60.35 [IQR, 51.46-74.71] vs. 72.41 [IQR, 59.68-97.70], p = 0.017; SImax: 723.52 [IQR, 209.76-909.27] vs. 810.92 [IQR, 581.30-996.89], p = 0.049; SImax-baseline: 462.99 [IQR, 152.25-580.43] vs. 551.13 [IQR, 402.57-675.36], p = 0.038). In the analysis of multivariate logistic regression, Timemax [odds ratio (OR) 0.98; 95% confidence interval (CI) 0.95-1.00; p = 0.032)], heart rate (OR 1.04; 95% CI 1.01-1.08; p = 0.029), LV remodelling index (OR 1.73; 95% CI 1.06-3.00; p = 0.038) and LGE extent (OR 0.85; 95% CI 0.73-0.96; p = 0.021) were independent predictors of LVRR. CMD could be found in DCM patients and was more impaired in patients with non-LVRR than LVRR patients. Timemax at baseline was an independent predictor of LVRR in DCM.

Application of Global Longitudinal Strain as a Parameter of Left Ventricular Systolic Function in Echocardiography

Global longitudinal strain (GLS) derived from speckle tracking has emerged as an important tool in assessing myocardial function, offering sensitive insights into cardiac performance. This review highlights GLS as a valuable technique for early detection and monitoring of various cardiac conditions, including heart failure, ischemic heart disease, and valvular heart disease. GLS is a measure of deformation along the longitudinal axis of the heart, providing a quantitative assessment of global left ventricular systolic function. It surpasses traditional parameters like ejection fraction in sensitivity, detecting abnormalities at earlier stages. Additionally, GLS is a robust predictor of adverse events in a wide spectrum of cardiac diseases. While GLS shows promise, it does have some drawbacks like relying on image quality and standardized guidelines. However, its high consistency and lower reliance on the operator make it more reliable in real-world clinical settings. Overall, GLS is an indispensable tool in cardiovascular imaging, empowering clinicians to detect subtle changes in cardiac function, predict adverse events, and optimize patient care and outcomes.

Impact of graft reperfusion on cardiac function assessed by transesophageal echocardiography during liver transplantation: an observational retrospective study

Cardiovascular instability is common during the reperfusion phase of orthotopic liver transplantation (OLT), and some patients experience a postreperfusion syndrome (PRS). However, there are no reports comparing the cardiac dysfunction between patients with PRS and those without. Thus, the aim of this study was to evaluate cardiac dysfunction in patients exhibiting PRS. This observational retrospective study included 34 patients who underwent OLT and were monitored with transesophageal echocardiography (TEE). The right ventricular/left ventricular (RV/LV) end diastolic area, tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF) by Simpson method, pulsed Doppler of the mitral valve, and tissue Doppler motion of the mitral annulus were determined. Echocardiographic measurements were registered at the beginning of surgery and at 1 and 30 min after vascular unclamping. Patients with PRS (PRS group) were identified, and their echocardiographic parameters of ventricular function were compared with those in patients without PRS (non-PRS group). To check the evolution of diastolic-systolic dysfunction, general linear model-repeated measures were estimated. No patient presented systolic/diastolic dysfunction on the basal echocardiogram. One minute after vascular unclamping, the incidence of RV dilation was 4.5 times greater in patients with PRS (Cramer´s V > 0.6), and the incidence of RV systolic dysfunction was 62.5% in patients with PRS compared to 15.40% in patients without PRS (Cramer´s V = 0.45). The incidence of LV systolic dysfunction was 25% in patients with PRS compared to 0% in those without (Cramer´s V = 0.45), and left ventricular diastolic dysfunction was 4.8 times greater in patients with PRS (Cramer´s V = 0.45). No patient presented diastolic dysfunction type III. There were significant differences between groups in the evolutionary pattern at 1 and 30 min after unclamping for RV dilation (p = 0.008) and for TAPSE (p = 0.014). Liver graft reperfusion may alter cardiac function. Cardiac dysfunction was more frequent in patients with PRS. These patients exhibited temporary dysfunction of the RV associated with a varying degree of LV diastolic-systolic dysfunction. Trial registration: clinicaltrials.gov (NCT05175534). January 03, 2022; “retrospectively registered”.

Effect of papillary muscle and trabeculae on left ventricular function analysis via computed tomography: A cross-sectional study.

Deciding whether to include or exclude the papillary muscles and trabeculae to blood pool is essential, because quantifications of left ventricular (LV) functional parameters and myocardial mass are significantly affected. As a result, such inclusion or exclusion might produce different indices for diagnosis and therapy. Using cardiac computed tomography (CT), we obtained standard values of the portion of papillary muscle and trabeculae in normal adults, and to find out how the inclusion or exclusion of papillary muscle and trabeculae affect LV functional parameters depending on the patient group. Excluding the papillary muscles from the LV mass results in easier automated contour detection using CT. The percentage portions of papillary muscle and trabeculae to LV end-diastolic volume (EDV) and LV mass (LVM) were 11.9 ± 5.6% and 20.2 ± 4.3%, respectively, significantly affecting disease diagnosis. Imaging should be consistent at follow-up and include or exclude the papillary muscles and trabeculae to avoid introducing significant differences between measurements.

Transcatheter versus surgical aortic valve replacement in patients with aortic stenosis: molecular pathways and correlation with clinical and echocardiographic parameters

Abstract Background Transcatheter aortic valve replacement (TAVR) has reformed the management of aortic stenosis (AS), being firstly approved in high-risk patients and becoming progressively a therapeutic alternative to surgery (surgical aortic valve replacement, SAVR) for all the risk categories. Several data pointed out the role of inflammation, oxidative stress, and pathological remodeling in AS natural history. The aim of our study is to investigate the molecular pathways involved in the AS pathophysiology and in the early response to AV replacement in patients subjected to percutaneous or surgical approach. Secondary aims are to evaluate the variation in clinical and echocardiographic parameters of left ventricular (LV) function before and after procedure. Methods We enrolled 36 consecutive patients with a diagnosis of severe AS and preserved ejection fraction (17 SAVR patients and 19 TAVR patients). Biological samples, clinical and echocardiographic evaluation were gained before (T0) and 72 hours after the procedure (T1). We performed 3 gene expression arrays on pooled cDNA from peripheral blood mononuclear cells of the 2 study groups. Results SAVR patients were significantly younger (p=0.0003) and with a lower STS score (p=0.0004). After the procedure, SAVR showed a longer ICU stay (p=0.0019) and a more frequent need of inotropes/vasopressors (p=0.006). Gene expression analysis revealed a reduction of the pro-apoptotic gene CASP3 (n=13; median, IQR: 1.01, 0..89-1.62 for T0 vs 0.68, 0.58-0.85 for T1; p=0.019) and of the transcription factor MEF2C (n=13; 1.00, 0.57-1.31 for T0 vs 0.56, 0.42-0.87 for T1; p=0.028) in TAVR patients, together with significantly increased levels of the antioxidant molecule GPX1 (n=14; 1.04, 0..71-1.34 for T0 vs 1.37, 1.23-1.85 for T1;p=0.030). In SAVR patients, our data showed increased post-procedural levels of GPX1 (n=6; 0.99, 0.49-1.23 for T0 vs 1.81, 1.27-2.00 for T1; p=0.028), and of the oxidative markers CAT (n=10; 0.40, 0.27-0.69 for T0 vs 1.17, 0.59-2.06 for T1; p=0.022,) and NOX2 (n=8; 0.41, 0.31-0.63 for T0 vs 1.04, 0.73-1.54 for T1; p=0.012) (Fig.1). TAVR patients displayed a direct correlation between the gene expression of molecules involved in apoptosis (CASP3), myocardial remodeling (GTF2I, MEF2C) and oxidative stress (MPO, CAT, TXNIP) and indexed left ventricular volumes (Fig.2A), while SAVR patients showed an inverse correlation with LVEF for GTF2I, MEF2C, CAT and MPO gene expression levels (Fig.2B). Conclusions By demonstrating 1) a significant post-procedural downregulation in the expression of genes involved in oxidative stress pathways for TAVR patients if compared with SAVR patients, and 2) a significant correlation of the basal levels of genes involved in apoptosis, myocardial remodeling, and oxidative stress with post-procedural ventricular volumes and LVEF, our study provides a biological rationale to support the percutaneous approach for AS patients, independently from their class of risk.Figure 1Figure 2

Successful treatment of pulmonary hypertension and right heart failure by antibody-based functional blocking of the extra-domain A of fibronectin in a preclinical animal model

Abstract Background Pulmonary Hypertension (PH) as heterogeneous disease group is pathogenetically accompanied by pulmonary vascular and right ventricular tissue remodelling showing similarities between the clinical groups 1 (Pulmonary Arterial Hypertension), 2 (PH associated with left heart disease) and 3 (PH associated with lung disease). Since the remodelling process entails the abundant re-expression of extra-domain A containing fibronectin (ED-A+ Fn), which is virtually absent in healthy adult organs, a potential functional role in PH development and progression has been suggested and recently proven by our group. The human recombinant antibody F8 (IgG) specifically recognises ED-A+ Fn and is capable to block its function at least in vitro. Thus, F8 might serve as a novel therapeutic agent for the treatment or even prevention of PH. Purpose Against that background, the current study was aimed to test the therapeutic efficacy of F8 after systemic administration in a well-established preclinical model of PH in comparison to a non-specific control antibody and a dual endothelin receptor antagonist as standard of care. Methods Induction of PH was realized by subcutaneous injection of Monocrotaline (MCT) in mice. In total, 41 animals were included in the study approach and were divided into the following experimental groups: sham-treated controls (controls; n=7), PH mice without a specific treatment (PH_untreated; n=12), PH mice treated with the dual endothelin receptor antagonist Macitentan (PH_MAC; n=6), PH mice treated with the F8 antibody (PH_F8; n=8) and PH mice treated with an antibody of irrelevant antigen specificity in the murine system (PH_KSF; n=8). Treatment effects were evaluated on the haemodynamic, echocardiographic and microscopic level. Results In comparison to controls, untreated PH mice showed significantly higher right ventricular systolic pressure values (RVPsys, p&amp;lt;0.05) as well as impaired echocardiographic parameters of right ventricular morphology and function, i.e., enlarged basal right ventricular (RVbasal, p=0.016) diameters and reduced tricuspid annular plane systolic excursion values (TAPSE, p=0.008). In the PH_F8 group, haemodynamic and echocardiographic parameters were significantly improved compared to the PH_untreated or the PH_KSF group (p&amp;lt;0.05 for the majority of parameters). Histological evaluation revealed significant lung tissue damage after in the PH_untreated group compared to controls (p=0.008), which were significantly attenuated in the PH_F8 (p=0.04) but not the PH_KSF group (p=n.s.). Conclusion The therapeutic efficacy of the human recombinant F8 antibody specific to ED-A+ Fn has been proven for the first time in vivo in a well-established preclinical model of PH. F8 acts as a disease-modifier by attenuating PH associated lung tissue remodelling resulting in remarkable improvements of pulmonary hemodynamics and echocardiographic parameters of right ventricular load.

Significant disagreements between conventional functional metrics and 3D echocardiography-derived ejection fraction in the detection of right ventricular systolic dysfunction

Abstract Background The conventional echocardiographic parameters of the right ventricular (RV) systolic function (e.g., tricuspid annular plane systolic excursion - TAPSE, fractional area change – FAC, free wall longitudinal strain – FWLS) only partially portray the complex functional characteristics of the RV; therefore, they may fail to capture the full spectrum of RV dysfunction and associated adverse clinical outcomes. 3D echocardiography-derived RV ejection fraction (RVEF) is a well-validated and reproducible parameter that overcomes these limitations. Purpose We aimed to investigate the discordance between TAPSE, FAC, FWLS and RVEF in RV systolic function grading and associated outcomes. Methods Two retrospective databases from different centers including consecutive patients with various cardiac diseases who underwent clinically indicated 2D and 3D echocardiography (n=750) were analysed. Patients were followed up for the occurrence of all-cause mortality. RVEF was measured by a single, commercially available 3D software package. Guideline-recommended cut-off values were used to indicate RV systolic dysfunction (TAPSE&amp;lt;17 mm, FAC&amp;lt;35%, FWLS&amp;gt;-20%). RVEF &amp;lt;45% served as the "ground truth" of RV dysfunction. Results Among patients with normal RVEF (n=511), 109 (21%) had reduced TAPSE, 168 (33%) had reduced FAC, and 42 (8%) had reduced FWLS. Among patients with reduced RVEF (n=239), 109 (46%) had normal TAPSE, 61 (26%) had normal FAC, and 98 (41%) had normal FWLS. Correspondingly, sensitivity and specificity for discrimination of RV systolic dysfunction (RVEF&amp;lt;45%) were 66% and 70% for TAPSE, 71% and 76% for FAC, and 89% and 69% for FWLS on ROC analysis, respectively (Figure 1). During the median follow-up time of 3.5 years, 112 patients (15%) died. Using univariable Cox regression, TAPSE (HR [95% CI]: 0.911 [0.881 - 0.942]), FAC (0.940 [0.924 - 0.957]), FWLS (1.101 [1.071 - 1.133], and RVEF (0.928 [0.913 - 0.944]) were all significant predictors of mortality (p&amp;lt;0.001). Interestingly, combining the conventional functional measures based on how many of them indicate dysfunction shows that outcomes are the worst if at least two parameters are impaired and gradually better if only one or none of them (Kaplan-Meier curves, Figure 2, log-rank p&amp;lt;0.001). Conclusion Guideline-recommended cut-off values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS show the closest association with the RVEF cut-off. Our results emphasize a multiparametric approach in the assessment of RV function, especially, if 3D echocardiography is not available.Figure 1.Figure 2.

Preprocedural global myocardial work index independently predicts NT-proBNP in patients undergoing transcatheter aortic valve replacement: a prospective study

Abstract Global myocardial work index is a novel echocardiographic parameter of the left ventricular (LV) function, which may overcome the load-sensitvity of the traditional functional measures by measuring LV deformation in the context of simultaneous pressures. This approach may gain particular importance in pressure overload states, such as patients with severe aortic stenosis. However, the longitudinal changes of this recently introduced measure are scarcely investigated in this population, and data are also lacking about its association with functional improvement following transcatheter aortic valve replacement (TAVR). Accordingly, our aim was to investigate the clinical determinants of preoperative and also postoperative GMWI in patients undergoing TAVR. Eighty-four patients (54%% male, age: 79±6 years) were enrolled. Prior to the procedure, subjects underwent echocardiographic investigation and the detailed medical history was also recorded. Serum NT-proBNP levels were also measured. We calculated LV ejection fraction and LV end-diastolic volume (EDV), and speckle-tracking analysis was performed to measure global longitudinal strain (GLS). As an accepted method of its estimation, LV pressure curve was generated by adding the mean aortic valve gradient to the systolic blood pressure. Using these measures, global myocardial work index (GMWI) was quantified by commercially available software. 12 months after the procedure, the patients underwent a follow-up echocardiographic examination, and at that time point we determined the same measures. At follow-up, GLS has significantly increased (-13.5±4.5 vs. -15.2±3.6%; p&amp;lt;0.001), while GMWI was significantly lower at the follow-up assessment (1913±786 vs. 1666±594 mmHg%, p&amp;lt;0.01). Compared to the preoperative values, LVEDV also showed a significant decrease at follow-up (115±46 vs. 105±41 mL, p&amp;lt;0.01). Using multivariable analysis, atrial fibrillation (β=0.36; p&amp;lt;0.001) ischemic heart disease (β=0.20; p&amp;lt;0.05) and also GMWI (β=-0.22; p&amp;lt;0.05) were found to be independent predictors of the postoperative NT-proBNP (R2=0.36; overall p&amp;lt;0.001). Importantly, by replacing GMWI to GLS, the latter did not enter the model as a predictor (β=0.17, p=0.11). TAVR significantly alters LV functional and morphological measures. Regarding the functional outcome of the patients, different clinical factors influence NT-proBNP after the procedure. Possibly due to its significant load dependency, preoperative GLS failed to predict NT-proBNP at follow-up, while GMWI was an independent precictor of NT-proBNP at follow up along with atrial fibrillation and ischemic heart disease. GMWI may serve as a useful imaging marker of preprocedural patient assessment before TAVR.

Relationship between the right ventricular function and MECKI score in patients with advanced heart failure

Abstract Background Three- dimensional echocardiography (3DE) is an attractive technique for assessment of RV wrapping around the conical left ventricle and MECKI score is a strong predictor of prognosis in patients with advanced heart failure. Purpose We aimed to evaluate the relationship between the right ventricular function obtained by 3DE and MECKI Score in patients with advanced heart failure. Methods The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was calculated by an online free calculator using parameters peak oxygen uptake (% predicted value) and VE/CO2 slope values obtained by CPET, blood samples such as hemoglobin, sodium, MDRD and left ventricular ejection fraction (LVEF).(1) Results The 43 patients with sinus rhythm who were candidates for heart transplantation or left ventricular assist device (LVAD) therapy between June 2022 and January 2023 were included in the study. The majority of the patients were male (% 81). The mean 3D LV EF was % 22 ± 3.8, the mean value for peak VO2 max obtained by CPET was 15 ± 5.8 ml/kg/min and the median value for VE/CO2 slope was 34 (24-99). When the right ventricular parameters were compared according to the median value of 34, the right ventricle was larger and parameters of the right ventricular systolic function were worse in patients with the higher VE/CO2 slope values. (Figure 1). The mean value for percentage of predicted peak VO2 max was % 52 ± 16 and the median for the MECKI Score was 9.3 (1.8-86). By univariate and multivariate regression analyses, only the 3D RV basal diameter was found independently associated with peak VO2 max. Also, the VECO2 slope was found independently associated only with 3D RV TAPSE. Also these two parameters, 3D RV basal diameter and 3D RV TAPSE were found independent predictors of MECKI score. In ROC analysis, the cut off value 40.9 mm for 3D RV basal diameter to predict MECKI score with sensitivity and specificity were % 90 and % 68 , respectively (AUC:0.792). Also, AUC was 0.784 for the cut off value of 7.7 mm for 3D RV TAPSE with the sensitivity % 90 and specificity % 81. (Figure 2). Conclusion The major findings in this study were RV basal diameter was an independent predictor of the peak VO2 max value and RV 3D TAPSE was an independent predictor of the VECO2 slope. These results suggest that, while the basal diameter of the right ventricle, in other words, the size of the right ventricle effects peak oxygen consumption, the O2 transport and utilization, 3D TAPSE, namely systolic function of the right ventricle effects the ability to remove C02 from the whole body. Also these two parameters were found independent predictors of the MECKI score which is a strong predictor of prognosis in patients with advanced heart failure.Figure 1Figure 2

Left atrial functional changes and its predictive value in the early period after cryoballoon ablation for paroxysmal atrial fibrillation

Abstract Introduction/Purpose In patients with paroxysmal atrial fibrillation (PAF), functional changes are observed in the left atrium (LA) after the pulmonary vein isolation (PVI) procedure. Although previous studies have investigated the altered mechanical functions of the LA with radiofrequency (RF) ablation, changes in the LA functions in the early period after cryoablation (CB-2) and the relationship between early period serial echocardiographic follow-ups after cryoablation and recurrence of atrial fibrillation/atrial tachycardia (AF/AT) have not been clearly demonstrated. This study aims to determine changes in the mechanical functions of LA in patients with PAF during the early period after cryoablation and whether these changes are effective in predicting the risk of recurrence by using echocardiographic parameters including Doppler and strain parameters. Methods Consecutive seventy-seven patients (mean age: 57.5±11.2 years; 57% men) with PAF underwent CB-2 and were prospectively analyzed. All patients were in sinus rhythm before and after the procedure. The LA dimensions, the LA reservoir strain (LASr), the LA atrial contractile strain (LASct), the LA conduit strain (LAScd) and left ventricular diastolic function parameters were evaluated by Doppler echocardiography before and 3 months after the procedure. Patients were monitored with 48-hour Holter at 1-3-6-12th months after the procedure to evaluate for recurrence. Results Acute procedural success was achieved in all cases. No major complications were observed. LASr and LASct showed significant recovery after the procedure (28.3±12.8% vs 34.6±13.8%, p&amp;lt;0.001 and -10.8±7.9% vs -13.9±9.3%, p=0.014 respectively). No significant change was demonstrated in other echocardiographic parameters. During the one-year follow-up after the procedure late recurrence (&amp;gt;3 months) of AF/AT was observed in 9 (11.7%) patients. Although the power of echocardiographic parameters in predicting recurrence was found to be not statistically significant, a downward trend especially in the values of LASr (p=0.068) and LASct (p=0.058) was observed at the 3rd month control echocardiographic results in patients with recurrence. Conclusion Significant improvement in mechanical functions may occur even in the early period after cryoballoon ablation in patients with PAF. In addition, as our study points out strain parameters, indicators of mechanical function tend to decline in patients with late term recurrence.

Preoperative predictors of recurrent tricuspid regurgitation after annuloplasty: insights into the role of 3D echocardiography

Abstract Introduction There is a growing concern regarding the recurrence of tricuspid regurgitation (TR) after tricuspid annuloplasty (TA) in patients with functional tricuspid regurgitation (FTR). While TA is an effective treatment option, understanding the echocardiographic factors contributing to recurrent TR can help in developing more effective preventive measures to reduce the rate of recurrent TR after TA. Aim The aim is to investigate the relationship between tricuspid valve (TV) and right ventricular geometry and function parameters with recurrent TR after TA. Methods This study was designed as a prospective observational cohort study to investigate factors contributing to recurrent TR following surgical TV repair in patients with moderate or severe functional TR caused by left heart valvular disease, with severe mitral regurgitation as the dominant pathology. Patients with ischemic heart disease were excluded from the analysis. The study included 65 patients who underwent preoperative 2D and 3D echocardiographic assessments, which included the quantification of right ventricular (RV) and right atrial (RA) geometry, functional and TV parameters. The severity of TR was measured according to the recent ESC guidelines, and patients were divided into two groups based on the outcomes of TA: effective TA (43 patients) and recurrent TR group (22 patients). Effective TA was defined as mild TR one year after surgery, while recurrent TR group was defined as moderate or severe TR. Statistical analysis was conducted using SPSS statistical software. Results Of the patients, 54% were male, and the mean age was 68±9 years. The distribution of echocardiography parameters among the study groups are shown in Table 1. Analysis revealed that gender, left ventricular and atrial geometrical and functional parameters, or preoperative effective regurgitant TV orifice area did not differ between the groups (recurrent TR vs. effective TA: 33 [28] mm2 vs. 29 [18] mm2, p=0.113 respectively). However, recurrent TR was associated with dilated RV and RA parameters and an increased septal-lateral diameter of tricuspid annulus. RV functional parameters did not show significant associations. Of all preoperative parameters, RV middle (sensitivity 82%, specificity 63%; AUC 0.731) and basal (sensitivity 73%, specificity 65%; AUC 0.725) diameters, tricuspid annulus sphericity index (sensitivity 59%, specificity 70%; AUC 0.718), septal-lateral systolic (sensitivity 59%, specificity 76%; AUC 0.686) diameter, have the highest predictive value for recurrent TR. Conclusion Recurrent moderate or severe functional TR after TA is associated with preoperative tricuspid annulus size, RA and RV geometry, but not with changes of RV function. This information can guide surgical decision-making. To conclude with, improving our understanding of the factors contributing to recurrent TR after TA can improve patient outcomes and reduce the need for reoperations.

Prevalence and risk factors of left ventricular diastolic dysfunction in systemic sclerosis patients: insights from new echocardiographic parameters

Abstract Background Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by excessive extracellular matrix deposition and fibrosis that can affect the skin, blood vessels, and internal organs, including the heart. Primary heart involvement in SSc refers to the presence of cardiac fibrosis, inflammation, and dysfunction in the absence of pulmonary hypertension (PH). Although PH is usually considered the major risk factor for death in SSc patients, diastolic dysfunction has been proposed as an independent predictor of mortality, which may be more robust than PH. Purpose Early identification and management of heart complications in SSc patients are crucial to prevent further deterioration and improve treatment outcomes. However, myocardial damage caused by SSc is often poorly understood, and the long-term effects and prognosis remain unknown. Methods We conducted a cross-sectional study of 69 patients (p) with SSc diagnosis evaluated between February 2022 and February 2023. We analyzed the prevalence of left ventricular diastolic dysfunction (LVDD) as recommended by the 2016 ASE/EACVI guidelines. We compared the presence of risk factors associated with LVDD and its association with other echocardiographic findings. Of the 69p, 24 (34.8%) had LVDD, 41 (59.4%) had normal diastolic function, and 4 (5.8%) had undetermined diastolic dysfunction. Older age (mean age 69.7 ± 11.2 vs 57 ± 12.8; p &amp;lt; 0.01), arterial hypertension (50% vs 22%; p = 0.02), higher body mass index (28.3 ± 8 vs 24.6 ± 4.5; p = 0.02), and higher NTproBNP levels (131 [64-403] vs 97 [45-163]; p = 0.047) were significantly associated with LVDD. The absence of antitopoisomerase (scl70 0% vs 22.2%; p = 0.021) and the presence of anticentromere (CENP-A 81% vs 55.6%; p = 0.05) and (CENP-B 85.7% vs 55.6%; p = 0.02) antibodies were also significantly associated with LVDD. Additionally, classical parameters of ventricular function, such as left ventricular ejection fraction (LVEF 63.5 ± 4.2 vs 63.4 ± 3.7; p = 0.9) or tricuspid annular plane systolic excursion (TAPSE 20.6 ± 2.3mm vs 21.2 ± 2.4mm; p = 0.32), were not associated with LVDD. However, impairment of the right ventricular free wall strain (-23.8 ± 4 vs -27 ± 2.8; p = 0.017), and lower left atrial strain reservoir function (27.7 ± 10 vs 38.4 ± 12.7; p = 0.05) were significantly associated with LVDD. Conclusion LVDD is highly prevalent in patients with systemic sclerosis, particularly in elderly patients with a higher body mass index and those affected by arterial hypertension. These patientes have higher values of NTproBNP. Futhermore, antitopoisomerases antibodies are less likely to be expressed and anticetromere antibodies are more likely to be expressed . These findings highlight the importance of regular cardiovascular monitoring in SSc patients and the potential value of using new echocardiographic parameters to identify those at risk for LVDD.

Abstract 15275: Cardiac Magnetic Resonance Ventricular Function and Hemodynamic Multivariable Model Predictors of Exercise Performance in Tetralogy of Fallot Using Machine Learning and Multivariable Modelling: A Substudy of the Single Center Cardiac Magnetic Resonance Outcomes Registry-Tetralogy of Fallot

Background: There are no robust predictors of exercise performance in repaired tetralogy of Fallot (rTOF) using both ventricular function and hemodynamics. Aim: To utilize machine learning and multivariable modeling to determine cardiac magnetic resonance (CMR) and other metrics predictive of exercise performance. Methods: We retrospectively reviewed data of all rTOF pts undergoing CMR from 2005-2020. Those who had cardiopulmonary exercising testing (CPET) within 6 months of CMR were analyzed using the machine learning technique LASSO to choose candidate variables for subsequent testing with multivariable modeling. CMR parameters included right (RV) and left ventricular (LV) function and hemodynamics. Significance P&lt;0.05. Results: 266 of 761 pts with rTOF met the inclusion criteria (age at CMR 16.1 + 9.7 years old, age at repair 0.36 years old, 56% male). Higher RV mass, RV global function index and lower pulmonary regurgitant fraction (PR) were independently associated with higher % predicted (%P) maximum oxygen consumption (VO 2 max). In addition, females and non-syndromic pts were also associated with higher %P VO 2 max (table). Those with a higher LV end-diastolic volume (EDV), females and pts without pulmonary atresia performed better at %P work. Those with a higher RV mass/volume demonstrated a worse ventilatory equivalent of carbon dioxide (VE/VCO 2 ). See table. Conclusion: RV ventricular functional parameters, PR (hemodynamics), gender and syndromic status are all independently associated with %P VO 2 max. Those with larger LV volumes were able to perform more work and those with a higher RV mass/volume had a worse VE/VCO 2 . Our findings shed some light into the etiology of poor rTOF exercise performance.

Longitudinal analysis left ventricular chamber responses under durable LVAD support

Left ventricular assist device (LVAD) support offers remodelling potential in some patients. Our goal was to use non-invasively derived pressure-volume (PV) loops to understand the effect of demographic and device variables on serial changes in cardiac function under pump support. Thirty-two consecutive Medtronic HVAD patients (mean 55.9±12.3 years, 81.3% male) were prospectively recruited. Single-cycle ventricular pressure and volume were estimated using a validated algorithm. PV loops (n=77) and corresponding cardiac chamber dynamics were derived at predefined post-implant timepoints (1, 3, 6 months). Changes in PV loop parameters sustained across the 6-month period were characterised using mixed-effects modelling. The influence of demographic and device variables on the observed changes were assessed. Across a 6-month period, the mean ventricular function parameters remained stable. Significant predictors of monthly improvement of stroke work include: lower pump speeds (2400rpm vs 2500-2800rpm) [0.0.051mmHg/L/month (p=0.001)], high pulsatility index (>1.0 vs <1.0) [0.052mmHg/L/month (p=0.012)], and ischemic cardiomyopathy indication for LVAD implantation (vs non-ischemic) [0.0387mmHg/L/month (p=0.007)]. Various other cardiac chamber function parameters including cardiac power, peak systolic pressure and LV elastance also showed improvements in these cohorts. Factors associated with improvement in ventricular energetics and hemodynamics under LVAD support can be determined with non-invasive PV loops. Understanding the basis of increasing ventricular load to optimise myocardial remodelling may prove valuable in selecting eligible recovery candidates.

Left ventricular diastolic dysfunction and transmitral blood flow parameters in patients after COVID-19

Background. People who previously had COVID-19 infection have an increased risk of developing cardiovascular diseases. Left ventricular diastolic dysfunction is an early marker of the development of cardiac pathology. Its early detection is important for the adequate therapy order and dynamic monitoring of patients. In this regard, it seems relevant to study the effect of a recent COVID-19 infection on the left ventricular diastolic function and transmitral blood flow parameters in apparently healthy individuals without clinical and instrumental signs of cardiovascular pathology. The aim of the study. To assess the changes in the diastolic and systolic function of the left ventricle, its anatomical parameters and transmitral blood flow parameters in two groups of apparently healthy individuals: those who had and those who had not COVID-19 infection. Materials and methods. Transthoracic echocardiography was performed according to the standard technique and its results were analyzed in 66 examined patients who were recognized as apparently healthy according to the results of regular comprehensive clinical and instrumental studies. The first group included 30 individuals who underwent an echocardiographic study before or during the COVID-19 pandemic, but did not have a coronavirus infection; the second group consisted of 36 people who recovered from COVID-19. The indicators of the presence of left ventricular diastolic dysfunction and the transmitral blood flow parameters were assessed. The study was approved at a meeting of the Medical Ethics Committee under the Ministry of Health of the Republic of Karelia and of Petrozavodsk State University (Minutes No. 47 of 01.11.2023). Results. The frequency of the left ventricular diastolic dysfunction did not differ in the first and second groups of patients. Statistically significant differences were recorded in the average flow deceleration time for both early and late filling of the left ventricle in people who had and did not have COVID-19 infection. A change in the phase structure of the transmitral blood flow may be an early manifestation of intracardiac hemodynamic disorders in people who have recovered from COVID-19.

The influence of arm positions on mechanical dyssynchrony measured by gated myocardial perfusion imaging.

In routine procedures, patient's arms are positioned above their heads to avoid potential attenuation artifacts and reduced image quality during gated myocardial perfusion imaging (G-MPI). However, it is difficult to achieve this action in the acute period following pacemaker implantation. This study aimed to explore the influence of arm positioning on myocardial perfusion imaging (MPI) in different types of heart disease. This study was conducted retrospectively. A total of 123 patients were enrolled and underwent resting G-MPI using a standard protocol with arms positioned above their heads and again with their arms at their sides. All individuals were divided into 3 groups: the normal group, the obstructive coronary artery disease (O-CAD) group, and the dilated cardiomyopathy (DCM) group. The G-MPI data were measured by QGS software and Emory Reconstruction Toolbox, including left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), end-systolic volume (ESV), extent, total perfusion deficit (TPD), summed rest score (SRS), scar burden, phase standard deviation (SD), and phase histogram bandwidth (BW). In total, extent, TPD, EDV, ESV, LVEF, systolic SD, systolic BW, diastolic SD, and diastolic BW were all significantly different between the 2 arm positions (all P<0.01). On the Bland-Altman analysis, both EDV and ESV with the arm-down position were significantly underestimated (P<0.001). Meanwhile, TPD, extent, and LVEF with the arm-down position were significantly overestimated (P<0.05). Systolic SD, systolic BW, diastolic SD, and diastolic BW were systematically overestimated (P<0.001). In the DCM group (n=52), EDV, ESV, systolic SD, systolic BW, diastolic SD, and diastolic BW were identified as significantly different by the paired t-test between the 2 arm positions (P<0.05). In the O-CAD group (n=32), scar burden, ESV, LVEF, and diastolic BW were significantly different between the 2 arm positions (P<0.05). Systolic and diastolic dyssynchrony parameters and most left ventricular (LV) functional parameters were significantly influenced by arm position in both normal individuals and patients with heart failure (HF) with different pathophysiologies. More attention should be given to LV dyssynchrony data during clinical evaluation of cardiac resynchronization therapy (CRT) implantation procedure.

Integration of ventricular remodeling, synchrony and filling rate parameters to improve the assessment of left ventricular systolic function

Introduction and objectivesThe aim of this study is to assess the relationship between structural, remodeling, synchrony, and systolic left ventricular (LV) function parameters using gated-SPECT myocardial-perfusion-images (gSPECT-MPI). In addition, obtaining the cut-off values for end-diastolic LV-shape-index (EDLVsi), end-systolic LV-shape-index (ESLVsi), ECC (eccentricity-index) and PER, and developing a new index to evaluate different patterns of the LV systolic function. MethodsThe study was approved by the Hospital’s Ethical-Committee (PR[AG]168.2010), and all patients gave their informed consent. We analyzed prospectively 238 patients (age 63.4 ± 13 years) who underwent stress-rest gSPECT-MPI (control-group, n = 148; patients with previous myocardial infarction [MI], n = 90). ResultsIn the control group, with regard to remodeling parameters: the end-diastolic-volume-index (EDV) and the ECC were the parameters that influenced the EDLVsi (r2: 0.52, p < 0.001). EDV, PER, men, and the ECC were the parameters (r2: 0.44; p < 0.001) which influenced the ESLVsi. EDLVsi, ESLVsi, LVEF and the stroke-volume were the parameters (r2: 0.62; p < 0.001) which influenced the ECC. With regards to PER: LVEF, heart-rate, bandwidth, and the standard-deviation were the influencing parameters (r2: 0.76; p < 0.001). The cut-off values for EDLVsi, ESLVsi, ECC, and PER were 0.59, 0.42, 0.87, and 3.3, respectively. The PER, the ESLVsi and the bandwidth were the parameters related to patients with previous MI (AUC: 0.89); and they allow the assessment of different patterns of systolic function (PERRS-index: peak-emptying-rate, left ventricular-remodeling and synchrony). ConclusionsThe remodeling, synchrony and the systolic function parameters of the LV should be interpreted together (PERRS-index). In this way, we obtain different patterns of LV systolic function.

Comparison between compressed sensing and segmented cine cardiac magnetic resonance: a meta-analysis

PurposeHighly accelerated compressed sensing cine has allowed for quantification of ventricular function in a single breath hold. However, compared to segmented breath hold techniques, there may be underestimation or overestimation of LV volumes. Furthermore, a heterogeneous sample of techniques have been used in volunteers and patients for pre-clinical and clinical use. This can complicate individual comparisons where small, but statistically significant differences exist in left ventricular morphological and/or functional parameters. This meta-analysis aims to provide a comparison of conventional cine versus compressed sensing based reconstruction techniques in patients and volunteers.MethodsTwo investigators performed systematic searches for eligible studies using PubMed/MEDLINE and Web of Science to identify studies published 1/1/2010-3/1/2021. Ultimately, 15 studies were included for comparison between compressed sensing cine and conventional imaging.ResultsCompared to conventional cine, there were small, statistically significant overestimation of LV mass, underestimation of stroke volume and LV end diastolic volume (mean difference 2.65 g [CL 0.57–4.73], 2.52 mL [CL 0.73–4.31], and 2.39 mL [CL 0.07–4.70], respectively). Attenuated differences persisted across studies using prospective gating (underestimated stroke volume) and non-prospective gating (underestimation of stroke volume, overestimation of mass). There were no significant differences in LV volumes or LV mass with high or low acceleration subgroups in reference to conventional cine except slight underestimation of ejection fraction among high acceleration studies. Reduction in breath hold acquisition time ranged from 33 to 64%, while reduction in total scan duration ranged from 43 to 97%.ConclusionLV volume and mass assessment using compressed sensing CMR is accurate compared to conventional parallel imaging cine.

Non-Alcoholic Fatty Liver Disease and Echocardiographic Parameters of Left Ventricular Diastolic Function: A Systematic Review and Meta-Analysis.

The cardiovascular implications of non-alcoholic fatty liver disease (NAFLD) have been associated with heart failure with preserved ejection fraction (HFpEF). The purpose of this review was to conduct a bibliographic search regarding the correlation between NAFLD and the echocardiographic parameters of left ventricular diastolic function. A systematic literature search was conducted in PubMed and Embase for original research data reporting on the association of NAFLD with diastolic function markers [E/e', left atrial volume index (LAVi), left ventricular mass index (LVMi)]. Meta-analysis was performed using the meta and dmetar packages in R studio v.1.4.1106, with p < 0.05 values being considered significant. Results are expressed as the standardized mean difference (SMD) for continuous variables and as the odds ratio (OR) for categorical variables, with respective 95% confidence intervals (CI). Heterogeneity between studies was expressed with index Ι2. From the preliminary search, 2619 articles were found from which 31 studies were included in the final statistical analysis. The meta-analysis of 8 studies which reported on the prevalence of diastolic dysfunction showed that it was increased in patients with NAFLD (OR: 2.07, 95% CI 1.24-3.44 with p = 0.01, I2: 80% with p < 0.01). The meta-analysis of 21 studies showed significantly higher E/e' in NAFLD patients (SMD 1.02, 95% CI 0.43-1.61 with p < 0.001, I2: 97% with p < 0.001). Individuals with NAFLD had increased LAVi (SMD: 0.87, 95% CI 0.38-1.37 with p < 0.001, I2: 96% with p < 0.001) and LVMi (SMD: 0.89, 95% CI 0.31-1.48 with p = 0.003, I2: 100% with p < 0.001). To conclude, in the meta-analysis of 31 observational studies, NAFLD patients were found to have affected left ventricular diastolic function, supporting the hypothesis of NAFLD being associated with HFpEF.

Evaluation of right ventricular longitudinal strain in pediatric patients with pulmonary hypertension by two-dimensional speckle-tracking echocardiography.

We aimed to investigate the association between right ventricular longitudinal strain measured by two-dimensional speckle-tracking echocardiography (2D-STE) and right heart catheterization data in pediatric patients with pulmonary hypertension (PH). Two groups were evaluated, each consisting of 58 patients. Group 1, patients with PH; Group 2, normal matched controls. Data were collected from 58 patients with PH who underwent invasive hemodynamic evaluation. Standard transthoracic echocardiographic assessment was performed in all patients under the same circumstances. All patients underwent 2D-STE, and off-line analysis generated right ventricle longitudinal strain (RVLS) and right ventricular free wall strain (RVFW) and collected echocardiographic conventional parameters of right ventricular function, including the control group. The relationship between invasive characteristics and right ventricular function parameters was analyzed. In all, 58 PH patients were included in our study. The mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) were strongly correlated with right ventricular free wall strain (RVFW) and right ventricular longitudinal strain (RVLS), moderately correlated with the right ventricle myocardial performance index (Tei index), weakly correlated with the transverse diameter of the right ventricle (RV) and the transverse diameter of the right atrium (RA), and moderately negatively correlated with right ventricular fractional area change (RVFAC). In terms of segments of the right ventricular free wall, the basal segment had the highest correlation coefficient with mPAP and PVR (r = 0.413, 0.523, 0.578, r = 0.421, 0.533, 0.575, p < 0.05, respectively). Tricuspid annular plane systolic excursion (TAPSE), main pulmonary artery diameter (MPA), peak systolic velocity of the right ventricle (RV-S'), and RA area parameters were not associated with mPAP and PVR (p > 0.05). Right ventricular longitudinal strain is a reliable indicator to evaluate right ventricular function in pediatric patients with PH. It can provide valuable reference information for the clinical judgment of the status and severity of the disease in children.