Ventricular Septal Thickness Research Articles

Early and mid-term results of surgical treatment of obstructive hypertrophic cardiomyopathy

Background: In this study, we aimed to investigate whether septal myectomy is an effective treatment method in the patients with obstructive hypertrophic cardiomyopathy (HCM) and to evaluate early and mid-term results. Methods: Between January 1997 and August 2008, 40 patients (23 males, 17 females; mean age 37.8±16.8 years; range 7 to 76 years) who underwent septal myectomy for HCM were retrospectively analyzed. The left ventricular outflow tract (LVOT) gradient and septum thickness were assessed using transthoracic echocardiography before and after surgery. Results: The mean preoperative functional capacity of the patients was 2.4±0.5, the mean LVOT gradient was 97.7±27.6 mmHg and the mean interventricular septum thickness was 1.7±0.3 cm. Postoperative early mortality was 5%. The mean follow-up after septal myectomy was 41.9±33.0 months (range 2-130 months). During follow-up, the mean functional capacity (1.0±0.2), the mean LVOT gradient (19.1±10.2 mmHg) and the mean interventricular septum thickness (1.3±0.2 cm) were statistically significant, compared to the preoperative values (p

Clinical and Echocardiographic Correlates of Elevated Troponin in Amyloid Light-Chain Cardiac Amyloidosis

Increased troponin is associated with poor survival in patients with amyloid light-chain (AL) amyloidosis with cardiac involvement (CAL). The purpose of this investigation was to define the relation between increased troponin and clinical, morphologic, and functional features. The comparative utility of clinical, echocardiographic, and biochemical measurements in predicting survival in CAL was also investigated. One hundred seventeen patients with CAL were divided into 2 groups: normal troponin I (<0.06 ng/ml, n = 42) or increased troponin I (≥0.06 ng/ml, n = 75). Patients in the high troponin I group were older (63 vs 58 years, p = 0.04), with higher B-type natriuretic peptide levels (1,417 vs 936 pg/ml, p = 0.0004). The high troponin I group also had higher echocardiography-determined early/late mitral inflow velocity ratio (2.2 vs 1.4, p = 0.005) and myocardial performance index (0.59 vs 0.45, p = 0.04) and lower stroke index (28 vs 38 ml/beat/m(2), p <0.0001) and left atrial systolic force (5.9 vs 8.4 k-dynes, p = 0.037) than the normal troponin group. Median survival was significantly shorter in the high troponin group (11 vs 45 months, p <0.001). At time of CAL diagnosis, univariate predictors of all-cause mortality included increased troponin, older age, male gender, New York Heart Association class III to IV, >2 organs involved, higher B-type natriuretic peptide, lower creatinine clearance, greater ventricular septal thickness, and higher myocardial performance index. However, by multivariate Cox survival analysis, only increased troponin was a significant predictor for all-cause mortality (hazard ratio 3.1, p = 0.002). In conclusion, increased troponin is associated with worse left ventricular and left atrial functions by echocardiography in patients with CAL. Among baseline variables, it is the strongest predictor of all-cause mortality in multivariate analysis. Troponin is a powerful tool in clinical and prognostic assessments of patients with CAL.

Percutaneous alcohol septal ablation for hypertrophic obstructive cardiomyopathy: Technical review and long-term clinical and echocardiographic outcomes

BackgroundPercutaneous septal ablation by alcohol-induced septal branch occlusion was introduced as a new treatment option in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Our aim was to evaluate procedural and long-term clinical and echocardiographic outcomes in patients with HOCM treated by alcohol septal ablation (ASA) at our center. MethodsThis single-center retrospective study included 14 consecutive HOCM patients undergoing percutaneous ASA (66.4±12.1 years, 71.4% female). At baseline all patients presented persistent symptoms despite optimized medical treatment, left ventricular outflow tract (LVOT) obstruction with a peak gradient >50mmHg, systolic anterior motion of the mitral valve, and ventricular septal thickness ≥15mm. ASA was considered successful when the LVOT pressure gradient fell to less than 50% of baseline value. All patients had echocardiographic evaluation at baseline, intraprocedure and at follow-up, and a long-term clinical follow-up (25±38 months) with evaluation of functional class and occurrence of symptoms or cardiovascular events. ResultsPercutaneous ASA achieved a 71.4% acute and 85.7% long-term success rate. Peak LVOT gradient decreased from 104±40mmHg at baseline to 58±30mmHg intraprocedure (p=0.03) and 35±26mmHg at follow-up (p=0.001); total gradient decrease was 75±43mmHg. Ventricular septal thickness and mitral regurgitation also presented significant decreases during follow-up (from 24±5mm to 18±4mm, p=0.02, and from grade 2.4±0.6 to 1.4±0.5, p<0.001, respectively). A tendency for long-term improvement in NYHA functional class (from 2.6±1.1 to 1.8±1.4, p=0.09) was observed. Procedural complications occurred in 6.7% of patients; two deaths and one transient ischemic attack occurred in-hospital, but no long-term clinical events were recorded. ConclusionsPercutaneous ASA is an effective treatment for symptomatic patients with HOCM, obtaining a marked decrease in LVOT pressure gradient and symptomatic improvement. Despite the occurrence of a significant number of procedural complications, the favorable long-term outcomes underline the potential of ASA as a percutaneous alternative to surgical myectomy.

Surgical treatment with modified Morrow procedure in hypertrophic obstructive cardiomyopathy

To summarize the experience of ventricular septal myectomy (modified Morrow procedure) in patients with hypertrophic obstructive cardiomyopathy (HOCM). From June 2003 to March 2011, 38 patients (26 male and 12 female) with HOCM underwent modified Morrow procedure. The mean age was 36.3 years (ranging from 18 to 64 years). The diagnosis was made by echocardiography and spiral CT. The mean systolic gradient between the left ventricle and the aorta from transthoracic echocardiography (TTE) was (89±31) mmHg (ranging from 50 to 184 mmHg, 1 mmHg=0.133 kPa) before operation. There was moderate or severe systolic anterior motion (SAM) in 38 cases and mitral regurgitation in 29 cases. Ventricular septal myectomy with modified Morrow procedure was performed in all 38 cases. TEE was used intraoperatively to evaluate the results of the surgical procedures. After 1 to 2 weeks of operation, TTE was performed to evaluate the effect of operation. All patients were followed up with TTE after operation. All patients were discharged without complications. Intraoperative TEE showed that the mean systolic gradient between the left ventricle and the aorta was decreased from (95±36) mmHg before procedures to (14±11) mmHg after operation (t=13.265, P=0.000), and the thickness of ventricular septum was decreased from (28±8) mm to (12±3) mm (t=11.656, P=0.000). TTE showed that the mean systolic gradient between the left ventricle and the aorta was decreased from (89±31) mmHg preoperatively to (18±13) mmHg (t=12.729, P=0.000) in 1 to 2 weeks after operation. Mitral regurgitation and SAM were significantly improved or disappeared (t=7.930, t=5.213, both P=0.000). During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only and syncope was abolished, and TTE showed that the pressure gradient was kept on the postoperative level or slightly decreased (P=0.494). Ventricular septal myectomy with modified Morrow procedure is a mostly effective method for patients with HOCM. Good surgical exposure and the hypertrophied septum thoroughly excised are paramount for successful surgery.

Percutaneous alcohol septal ablation for hypertrophic obstructive cardiomyopathy: Technical review and long-term clinical and echocardiographic outcomes

BackgroundPercutaneous septal ablation by alcohol-induced septal branch occlusion was introduced as a new treatment option in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Our aim was to evaluate procedural and long-term clinical and echocardiographic outcomes in patients with HOCM treated by alcohol septal ablation (ASA) at our center. MethodsThis single-center retrospective study included 14 consecutive HOCM patients undergoing percutaneous ASA (66.4±12.1 years, 71.4% female). At baseline all patients presented persistent symptoms despite optimized medical treatment, left ventricular outflow tract (LVOT) obstruction with a peak gradient >50mmHg, systolic anterior motion of the mitral valve, and ventricular septal thickness ≥15mm. ASA was considered successful when the LVOT pressure gradient fell to less than 50% of baseline value. All patients had echocardiographic evaluation at baseline, intraprocedure and at follow-up, and a long-term clinical follow-up (25±38 months) with evaluation of functional class and occurrence of symptoms or cardiovascular events. ResultsPercutaneous ASA achieved a 71.4% acute and 85.7% long-term success rate. Peak LVOT gradient decreased from 104±40mmHg at baseline to 58±30mmHg intraprocedure (p=0.03) and 35±26mmHg at follow-up (p=0.001); total gradient decrease was 75±43mmHg. Ventricular septal thickness and mitral regurgitation also presented significant decreases during follow-up (from 24±5mm to 18±4mm, p=0.02, and from grade 2.4±0.6 to 1.4±0.5, p<0.001, respectively). A tendency for long-term improvement in NYHA functional class (from 2.6±1.1 to 1.8±1.4, p=0.09) was observed. Procedural complications occurred in 6.7% of patients; two deaths and one transient ischemic attack occurred in-hospital, but no long-term clinical events were recorded. ConclusionsPercutaneous ASA is an effective treatment for symptomatic patients with HOCM, obtaining a marked decrease in LVOT pressure gradient and symptomatic improvement. Despite the occurrence of a significant number of procedural complications, the favorable long-term outcomes underline the potential of ASA as a percutaneous alternative to surgical myectomy.

Arrest of atherosclerosis progression after interruption of GH replacement in adults with congenital isolated GH deficiency

GH replacement therapy (GHRT) in adult-onset GH deficiency (AOGHD) reduces carotid intima-media thickness (IMT) and increases myocardial mass, with improvement of systolic and diastolic function. These observations have reinforced the use of GHRT on AOGHD. Conversely, we have previously reported that in adults with lifetime congenital and severe isolated GH deficiency (IGHD) due to a mutation in GHRH receptor gene (GHRHR), a 6-month treatment with depot GH increased carotid IMT, caused the development of atherosclerotic plaques, and an increase in left ventricular mass index (LVMI), posterior wall, and septal thickness and ejection fraction. Such effects persisted 12 months after treatment (12-month washout - 12 mo). We have studied the cardiovascular status (by echocardiography and carotid ultrasonography) of these subjects 60 months after completion of therapy (60-month washout - 60 mo). Carotid IMT reduced significantly from 12 to 60 mo, returning to baseline (pre-therapy) value. The number of individuals with plaques was similar at 12 and 60 mo, remaining higher than pre-therapy. LVMI, relative posterior wall thickness, and septum thickness did not change between 12 and 60 mo, but absolute posterior wall increased from 12 to 60 mo. Systolic function, evaluated by ejection fraction and shortening fraction, was reduced at 60 mo in comparison with 12 mo returning to baseline levels. The E/A wave ratio (expression of diastolic function) decreased at 60 mo compared with both 12 mo and baseline. In adults with lifetime congenital IGHD, the increase in carotid IMT elicited by GHRT was transitory and returned to baseline 5 years after therapy discontinuation. Despite this, the number of subjects with plaques remained stable at 60 mo and higher than at baseline.

094 Long-term follow-up after alcohol septal ablation for hypertrophic obstructive cardiomyopathy in young adults

Results: During the study period, 21 patients (15 males) aged between 18 and 40 years old (mean age 33.1±5.6, range 18-39 years) underwent ASA. Among them, 76% were treated with beta-blockers, 33% calcium-channel antagonists and 5% disopyramide. There were 6 patients (29%) with prior pacemaker, 1 patient (5%) with history of sudden death and prior implantable cardioverter-defibrillator (ICD) and 1 patient (5%) with prior myectomy. At baseline, mean New York Heart Association (NYHA) functional class was 2.4±0.5. Mean left ventricular outflow tract (LVOT) peak gradient and septal thickness were 89±37 mmHg and 24.9±5.1 mm, respectively. All procedures were performed with myocardial contrast echocardiography guidance. During ASA, 2.2±0.7 ml of absolute alcohol was injected in 1.4±0.5 septal perforators. Final procedural LVOT peak gradient was 20±16mmHg. Procedural success (defined as immediate LVOT peak gradient reduction >50%) was achieved in 20 patients (95%). There were no major complications. One patient (5%) required a temporary pacemaker for second-degree atrioventricular block. Mean peak CK was 934±468 IU/L. At a mean follow-up of 3.0±2.0 years after the procedure (range 0.3-8.4), repeat ASA was performed in two patients (10%) and a new ICD was needed in 1 patient (5%), while there were no fatalities reported. Mean NYHA class was improved to 1.6±0.7.

Assessment of left atrial function by strain rate imaging in patients with hypertension

ObjectiveTo compare strain and strain rate in primary hypertensive patients with different configuration of left ventricular (LV) by Strain Rate Imaging (SRI), analysis the dependability of strain rate and traditional...

The effect of blood pressure rhythm on the left ventricular structure and function in elderly systolic hypertensive patients

Objective: The aim of this study was to investigate the effects of blood pressure rhythm on the left ventricular structure and function in elderly systolic hypertensive patients. Methods: 94 elderly systolic hypertensive patients were evaluated by echocardiography and ambulatory 24-h blood pressure monitoring, and 84 patients with non-dipper blood pressure pattern and reverse dipper blood pressure pattern are included into our further research. All the patients received fixed antihypertensive drug therapy for at least 3 months prior to the evaluation. The systolic and diastolic parameters derived from the tissue Doppler examination were compared between non-dipper group and reverse dipper group. Results: Abnormal blood pressure rhythm was found in 93% elderly systolic hypertensive patients, including 55 non-dipper blood pressure patterns (58%) and 22 reverse blood pressure patterns (35%). Compared with non-dipper blood pressure pattern, reverse dipper patients had significant difference for aortic diameter (mm) (31.36±5.12, 26.57±4.49), left ventricular septum thickness (mm) (1.21±2.50, 9.66±1.13), left ventricular posterior wall thickness (mm) (9.76±1.41, 9.02±1.02), and stroke volume (ml) (45.05±17.36, 61.10±16.24) (P<0.01). There was a difference between reverse dipper group and non-dipper group for ejection fraction (%) (46.26±12.66, 55.21±10.53), left ventricular mass (g) (224.89±43.32, 192.72±61.02), and left ventricular mass index (g/m2) (124.13±22.54, 105.39±32.62). Conclusion: Blood pressure rhythm is one of the most important effect factors on target organ in elderly systolic hypertensive patients. Reverse dipper blood pressure patterns influence more on left ventricular structure and functions than non-dipper group.

33-Year-Old Man With Syncope

33-Year-Old Man With Syncope

Long-Term Efficacy of Deferasirox in Preventing Cardiovascular Complications in the Iron-Overloaded Gerbil

Iron-induced cardiovascular disease is the leading cause of death in iron-overloaded patients. Deferasirox is a novel tridentate oral chelator that exhibits a half-life suitable for once-daily dosing; however, little is known regarding the effectiveness of this agent in preventing iron-induced cardiovascular disease. Adult male Mongolian gerbils were randomly divided into 3 groups: control, iron overload, and iron overload followed by deferasirox treatment. Iron-overloaded animals received iron dextran 100 mg/kg intraperitoneally (ip)/5 days for 10 weeks, while deferasirox was given 100 mg/kg per d orally (po) for 9 months post iron loading. Cardiac and aortic iron levels were determined by inductively coupled plasma atomic emission spectrometry. Gerbil electro- and echocardiograms were obtained in anesthetized animals at regular intervals. Compared to control animals, iron concentration was 3.3- and 2.4-fold higher in iron-overloaded heart and aorta, respectively (P < .05). Deferasirox treatment reduced cardiac and aortic iron levels by 32% and 35%, respectively (P < .05). These results were consistent with the decrease in cellular iron deposition observed with Prussian Blue iron staining. Iron-overloaded gerbils were found to exhibit frequent arrhythmias including premature ventricular contractions, supraventricular tachycardia, and recurrent ventricular tachycardia. In addition, echocardiographic assessment demonstrated iron overload-associated increase in left ventricular dimensions including left ventricular posterior wall dimension (LVPWd: 49%), left ventricular internal dimension (LVIDd: 26%), and left ventricular septum thickness (LVSd: 42%). These parameters were significantly reduced with deferasirox treatment (LVPWd: 23%, LVIDd: 24%, and LVSd: 27%). Iron overload was also associated with reduced ejection fraction (EF: by 30%) and fractional shortening (FS: by 23%) in comparison with controls (P < .05). With deferasirox treatment, these values were higher (EF: by 30%, FS: by 28%) compared to iron-overloaded group. These findings suggest that deferasirox may be useful for attenuating iron-induced changes in cardiac structure and function.

Differential Effects of Nebivolol and Metoprolol on Central Aortic Pressure and Left Ventricular Wall Thickness

The aim of this study was to investigate the effects of the vasodilating β-blocker nebivolol and the cardioselective β-blocker metoprolol succinate on aortic blood pressure and left ventricular wall thickness. We conducted a randomized, double-blind study on 80 hypertensive patients. The patients received either 5 mg of nebivolol or 50 to 100 mg of metoprolol succinate daily for 1 year. Their heart rate, central and brachial blood pressures, mean arterial pressure, augmentation index, carotid-femoral pulse wave velocity, and left ventricular wall thickness were measured at baseline and at the end of the study. Nebivolol and metoprolol significantly reduced heart rate, brachial blood pressure, and mean arterial pressure to the same degree. However, reductions in central systolic and diastolic blood pressures, central pulse pressure, and left ventricular wall thickness were significant only in the nebivolol group. The change in left ventricular septal wall thickness was significantly correlated with central systolic blood pressure change (r=0.41; P=0.001) and with central pulse pressure change (r=0.32; P=0.01). No significant changes in augmentation index or carotid-femoral pulse wave velocity were detected in either treatment group. This proof-of-principle study provides evidence to suggest that β-blockers with vasodilating properties may offer advantages over conventional β-blockers in antihypertensive therapy; however, this remains to be tested in a larger trial.

Long-Term Follow-Up of Children and Adolescents Diagnosed with Hypertrophic Cardiomyopathy: Risk Factors for Adverse Arrhythmic Events

Our aim was to identify prognostic factors for an arrhythmic event (AE) in children with hypertrophic cardiomyopathy (HCM) without a previous AE. One hundred thirty-one nonconsecutive patients (≤ 20 years) with HCM but no previous AE were evaluated at the NIH Clinical Center from 1980 to 2001. At a median follow-up of 6.4 years, 22 patients experienced an AE [sudden death (SD) (n = 12), resuscitated cardiac arrest (n = 3), clinical sustained ventricular tachycardia (VT) (n = 2), and implantable cardiac defibrillator discharge (n = 5)], resulting in a 2% annual AE rate. Baseline factors that were most predictive in univariate risk analysis included ventricular septal thickness (ST) (P = 0.01), VT induction by programmed ventricular stimulation (PVS) (P = 0.01), age (P = 0.05), and presyncope/syncope (P = 0.05). In multivariate analysis, ST, age, presyncope/syncope, and PVS were not independently predictive of risk for an AE. However, the 5-year event rates for AE was 15% (95% CI: 5-23%) if ST ≥ 20 mm, 19% (95% CI: 6-31%) when age ≥ 13 years and ST ≥ 20 mm were combined together, and 23% (95% CI: 3-39%) when PVS and ST ≥ 20 mm were combined together. Of the various risk factors that were considered in our pediatric HCM cohort, ST and inducible VT were the most significant univariate predictors of risk for an AE. More traditional risk factors identified in older patients (family history of SD, VT on Holter, and exercise-induced hypotension) were not predictive of an AE in patients age under 21 years.

N-terminal pro-atrial natriuretic peptide reflects cardiac remodelling in stage 1 hypertension

Early detection of left ventricular hypertrophy (LVH) is beneficial, since treatment-induced regression of LVH has been unequivocally associated with a better prognosis. Our aim was to study the relation of cardiac remodelling and natriuretic peptides (NPs) in stage 1 hypertension. We studied 175 (46±7 years, 87 women and 88 men) apparently healthy middle-aged that had never been treated for hypertension. Left ventricular and atrial parameters were determined by magnetic resonance imaging. Systolic blood pressure (BP) correlated with left ventricular mass index (LVMI) (r=0.23, P<0.01) and ventricular septum thickness index (IVSI) (r=0.29, P<0.001). N-terminal pro-B-type NP (NT-proBNP) or N-terminal pro-atrial NP (NT-proANP) did not correlate with BP, LVMI or IVSI. NT-proANP correlated with left atrial area index (LAAI) (r=0.38, P<0.001), and subjects with LVH had higher LAAI than subjects with normal left ventricular geometry and no LVH (11.2±0.3 vs 10.0±0.2 cm(2) m(-2), P<0.001). In conclusion, measurement of NT-proBNP or NT-proANP does not appear to discriminate LVH in middle-aged, never treated and apparently healthy hypertensives. NT-proANP, but not NT-proBNP, reflects early cardiac remodelling in hypertensive heart disease.

Mineralocorticoid receptor blockade improves diastolic function independent of blood pressure reduction in a transgenic model of RAAS overexpression

There is emerging evidence that aldosterone can promote diastolic dysfunction and cardiac fibrosis independent of blood pressure effects, perhaps through increased oxidative stress and inflammation. Accordingly, this investigation was designed to ascertain if mineralocorticoid receptor blockade improves diastolic dysfunction independently of changes in blood pressure through actions on myocardial oxidative stress and fibrosis. We used young transgenic (mRen2)27 [TG(mRen2)27] rats with increases in both tissue ANG II and circulating aldosterone, which manifests age-related increases in hypertension and cardiac dysfunction. Male TG(mRen2)27 and age-matched Sprague-Dawley rats were treated with either a low dose (∼1 mg·kg(-1)·day(-1)) or a vasodilatory, conventional dose (∼30 mg·kg(-1)·day(-1)) of spironolactone or placebo for 3 wk. TG(mRen2)27 rats displayed increases in systolic blood pressure and plasma aldosterone levels as well as impairments in left ventricular diastolic relaxation without changes in systolic function on cine MRI. TG(mRen2)27 hearts also displayed hypertrophy (left ventricular weight, cardiomyoctye hypertrophy, and septal wall thickness) as well as fibrosis (interstitial and perivascular). There were increases in oxidative stress in TG(mRen2)27 hearts, as evidenced by increases in NADPH oxidase activity and subunits as well as ROS formation. Low-dose spironolactone had no effect on systolic blood pressure but improved diastolic dysfunction comparable to a conventional dose. Both doses of spironolactone caused comparable reductions in ROS/3-nitrotryosine immunostaining and perivascular and interstitial fibrosis. These data support the notion mineralocorticoid receptor blockade improves diastolic dysfunction through improvements in oxidative stress and fibrosis independent of changes in systolic blood pressure.

Elastic properties of the vascular wall in patients with rheumatoid arthritis and changes in blood pressure levels

Objective. To evaluate the elastic properties of the vascular wall in patients with rheumatoid arthritis (RA) as applied to the course of the underlying disease and the changes in blood pressure (BP) from one-year follow-up results. Subjects and methods. Therapeutic effectiveness was evaluated in 52 patients with RA according to the EULAR and ACR criteria; pulse wave propagation velocity (PWPV) along the vessels of elastic and muscular types was measured on an apparatus (OOO Neurosoft) at baseline and after one-year follow-up. Results. PWPV values were found to correlate with age, functional class of RA, risk level by the Framingham model, ventricular septal thickness, left ventricular relative wall thickness, erythrocyte sedimentation rate, and the presence of C-reactive protein. After one-year follow-up, the diminished elasticity of vessels correlated with the baseline duration of morning stiffness, the number of swollen joints, and ineffective therapy for RA. The RA patients in whom BP increased to the upper normal range or who developed essential hypertension (EH) had significantly higher values of vascular wall rigidity at the beginning of the follow-up. BP elevation was also associated with age, baseline clinical activity, the systemic manifestations of RA, the cardiovascular risk by the Framingham model. There was an association of vascular elastic properties in RA patients with the magnitude and uncontrolled activity of inflammation and with elevated BP. Conclusion. The findings show it important to reduce the elastic properties of vessels in the emergence of EH in RA.

Regression of Left Ventricular Mass after Aortic Valve Replacement in Isolated Aortic Regurgitation

Background: The aim of our study was to assess the extent of regression of left ventricular mass after aortic valve replacement in isolated aortic regurgitation. Material and Method: Retrospective analysis of echocardiographic data was collected preoperative and postoperative 1 year. There were 20 patients (12 males, 8 females, mean age 55.8±11.8 years, mean body surface area 1.64±0.19 ㎡) with aortic regurgitation from 2002 through 2007. We studied the change of left ventricular ejection fraction, ventricular septum and left ventricular posterior wall thickness, and left vemtricular muscle index (LVMI). The control group was age matched with normal echocardiographic study results. Patients with combined surgery or infective endocarditis were excluded. Result: Seven cases of tissue valves and thirteen cases of mechanical valve were used. The valve sizes were 21 mm (3 cases), 23 ㎜ (13 cases) and 25 ㎜ (4 cases). The postoperative (125.5±42 g/㎡) LVMI has decreased than preoperative LVMI (212.3±80 g/㎡, p=0.000) but higher than that of control group (80.5±15.9 g/㎡, p=0.000). Postoperative septal wall (systolic/diastolic: 13.5±3.4 ㎜/17.1±4.1 ㎜) and left ventricular posterior wall (systolic/diastolic: 12.9±3.4 ㎜/16.7±3.4 ㎜) thickness were slightly decreased after the valve replacement but was not significantly different than preoperative levels. And postoperative interventricular septal wall and left ventricular posterior wall thickness (systolic/diastolic: 8.6±1.4 ㎜/12.1±1.7 ㎜, systolic/diastolic: 8.4±1.4/13.2±1.9) were higher than that of the control group (p＜0.001). Conclusion: The significant regression of LVMI after aortic valve replacement developed at postoperative one year but the level was higher than control group. The main cause of decreased LVMI is decreased in left ventricular dimension.

Prolonged QTc Interval Is Common In Patients with Sickle Cell Disease and Has An Inverse Relationship to Hemoglobin and Hematocrit: Results From CSSCD

AbstractAbstract 2675 Background:Sudden unexplained premature cardiac death is common among patients with sickle cell disease (SCD). Prolonged QTc (Corrected QT interval) on electrocardiogram (EKG) is an established marker for higher risk of sudden cardiac death. There are limited data on the prevalence of prolonged QTc in SCD patients. Aim:We studied the prevalence, EKG and echocardiographic characteristics correlated with prolonged QTc in SCD patients and assessed for any predictors of prolonged QTc interval in the study subjects. Methods:Data from the National Institutes of Health sponsored Cooperative Study of Sickle Cell Disease (CSSCD), a multi-center, prospective study of the clinical course of SCD were analyzed. HbSS patients > 5 years of age from four clinical centers participated in the study. Each patient underwent a standard 12 lead EKG and echocardiogram and laboratory testing at a steady state. Bazett's square root formula was used for rate correction to calculate QTc. QTc> 440msec was considered as prolonged. Patients with a known diagnosis of congenital prolonged QTc syndrome or those on any medications with a known association with prolonged QTc were excluded from the analysis.Multivariate logistic regression was used for statistical analysis. P value of <0.05 was considered statistically significant. Results:Data from 240 patients (62% females, 100% African American with mean age 22.3 +−10.3 years were analyzed. Of these, 33.1% were women. Prolonged QTc, per the above specified definition was seen in 31.3% of the study patients.Mean serum hemoglobin (7.9 vs. 8.6; p<0.001) and hematocrit value (23.4 vs. 25.1; p = 0.002) were lower in those with prolonged QTc interval. Subjects with prolonged Qtc had slightly higher ventricular septal wall thickness (end diastole 1.23 vs. 1.12 cm, p = 0.03; end systole 1.54 vs. 1.45 cm, p = 0.09). Pericardial effusion (seen in 8.8%) was associated with higher odds of prolonged QTc (odds ratio (95% CI): 3.24 (1.24, 8.46).In a multivariable model with age, gender, venticular septal thickness, pericardial effusion and hemoglobin%, only hemoglobin% was associated with prolonged QT interval: odds ratio (SD) per unit increase in Hb% = 0.65 (0.49, 0.87).Age, gender, echocardiography determined left ventricular hypertrophy, X-ray determined cardiomegaly, PR interval, ventricular or atrial thickness or dimensions were not related to prolonged QTc interval. Conclusions:These data suggest that prolonged QTc is common among patients with sickle cell disease and that hemoglobin and hematocrit are independent and inverse predictors of prolonged QTc interval.The mechanism of prolonged QTc interval and its role if any, in sudden cardiac deaths in patients with sickle cell disease is unknown. We speculate that chronic anemia and resulting sub-acute cardiac ischemia may be associated with ventricular repolarization defects leading to prolonged QTc interval. These data provide the rationale for mechanistic studies of prolonged QTc interval and its potential relationship to sudden cardiac death in patients with sickle cell disease. Disclosures:No relevant conflicts of interest to declare.

E0233 Late gadolinium-enhanced MRI in restrictive cardiomyopathy

ObjectiveTo evaluate the diagnostic value of MRI in combination of late gadolinium-enhanced imaging in the identification of restrictive cardiomyopathy (RCM).Methods116 patients with RCM underwent ECG, x-ray, Echocardiography and MRI. The...

E0699 Late gadolinium-enhanced cardiac MRI in restrictive cardiomyopathy

ObjectiveTo evaluate the diagnostic value of MRI in combination of late gadolinium-enhanced imaging in the identification of restrictive cardiomyopathy (RCM).Methods116 patients with RCM underwent ECG, X-ray, Echocardiography and MRI. The...