Ventricular Systolic Dysfunction Research Articles

Is Conduction System Pacing a Valuable Alternative to Biventricular Pacing for Cardiac Resynchronization Therapy?

Cardiac resynchronization therapy (CRT) significantly improves clinical outcomes in patients with ventricular systolic dysfunction and dyssynchrony. Biventricular pacing (BVP) has a class IA recommendation for patients with symptomatic heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB). However, approximately 30% of patients have a poor therapeutic response and do not achieve real clinical benefit. Pre-implant imaging, together with tailored programming and dedicated device algorithms, have been proposed as possible tools to improve success rate but have shown inconsistent results. Over the last few years, conduction system pacing (CSP) is becoming a real and attractive alternative to standard BVP as it can restore narrow QRS in patients with bundle branch block (BBB) by stimulating and recruiting the cardiac conduction system, thus ensuring true resynchronization. It includes His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). Preliminary data coming from small single-center experiences are very promising and have laid the basis for currently ongoing randomized controlled trials comparing CSP with BVP. The purpose of this review is to delve into the emerging role of CSP as an alternative method of achieving CRT. After framing CSP in a historical perspective, the pathophysiological rationale and available clinical evidence will be examined, and crucial technical aspects will be discussed. Finally, evidence gaps and future perspectives on CSP as a technique of choice to deliver CRT will be summarized.

Significant disagreement between conventional parameters and 3D echocardiography-derived ejection fraction in the detection of right ventricular systolic dysfunction and its association with outcomes

AimsConventional echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) offer limited insights into the complexity of right ventricular (RV) systolic function, while 3D echocardiography-derived RV ejection fraction (RVEF) enables a comprehensive assessment. We investigated the discordance between TAPSE, FAC, FWLS, and RVEF in RV systolic function grading and associated outcomes. MethodsWe analyzed 2D and 3D echocardiography data from two centers including 750 patients followed up for all-cause mortality. RV dysfunction was defined as RVEF<45%, with guideline-recommended thresholds (TAPSE<17 mm, FAC<35%, FWLS>-20%) considered. ResultsAmong patients with normal RVEF, significant proportions exhibited impaired TAPSE (21%), FAC (33%), or FWLS (8%). Conversely, numerous patients with reduced RVEF had normal TAPSE (46%), FAC (26%), or FWLS (41%). Using ROC analysis FWLS exhibited the highest AUC of discrimination for RV dysfunction (RVEF<45%) with 59% sensitivity and 92% specificity.Over a median 3.7-year follow-up, 15% of patients died. Univariable Cox regression identified TAPSE, FAC, FWLS, and RVEF as significant mortality predictors. Combining impaired conventional parameters showed that outcomes are the worst if at least two parameters are impaired and gradually better if only one or none of them (log-rank p<0.005). ConclusionGuideline-recommended cut-off values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS showed 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.

Echocardiographic Assessment of Right Ventricular Function in Patients With Liver Cirrhosis.

In patients with chronic liver disease, the common endpoint of its course is liver cirrhosis which is a cause of cardiovascular morbidity and mortality. These abnormalities in the cardiovascular system, especially the heart, can be detected by echocardiography. Identifying and acting on these abnormalities can have an impact on their management thereby reducing morbidity and mortality of patients with liver cirrhosis. The aim of this study was to determine the prevalence of right ventricular systolic and diastolic dysfunction in liver cirrhosis patients. A hospital-based cross-sectional study was conducted among adult patients of the gastroenterology unit (ward and clinic) diagnosed with liver cirrhosis. A total of 243 patients were recruited and 210 were evaluated for this study. This study was carried out over one year. Cardiology studies, including electrocardiography and echocardiography, were conducted on patients to assess right ventricular function. Among the participants, 44.8% had right ventricular hypertrophy and 3.8% had right ventricular dilatation. Using Tricuspid Annular Plane Systolic Excursion (TAPSE), 17.1% were found to have right ventricular systolic dysfunction and 51.4% had systolic dysfunction using FAC. Diastolic dysfunction was found in 61% of the participants and grade 2 diastolic dysfunction was the commonest. From this study, a high prevalence of right ventricular systolic and diastolic dysfunction was recorded among patients with liver cirrhosis.

Reduced exercise capacity occurs before intrinsic skeletal muscle dysfunction in experimental rat models of pulmonary hypertension.

Reduced exercise capacity in pulmonary hypertension (PH) significantly impacts quality of life. However, the cause of reduced exercise capacity in PH remains unclear. The objective of this study was to investigate whether intrinsic skeletal muscle changes are causative in reduced exercise capacity in PH using preclinical PH rat models with different PH severity. PH was induced in adult Sprague-Dawley (SD) or Fischer (CDF) rats with one dose of SU5416 (20 mg/kg) injection, followed by 3 weeks of hypoxia and additional 0-4 weeks of normoxia exposure. Control s rats were injected with vehicle and housed in normoxia. Echocardiography was performed to assess cardiac function. Exercise capacity was assessed by VO2 max. Skeletal muscle structural changes (atrophy, fiber type switching, and capillary density), mitochondrial function, isometric force, and fatigue profile were assessed. In SD rats, right ventricular systolic dysfunction is associated with reduced exercise capacity in PH rats at 7-weektimepoint in comparison to control rats, while no changes were observed in skeletal muscle structure, mitochondrial function, isometric force, or fatigue profile. CDF rats at 4-weektimepoint developed a more severe PH and, in addition to right ventricular dysfunction, the reduced exercise capacity in these rats is associated with skeletal muscle atrophy; however, mitochondrial function, isometric force, and fatigue profile in skeletal muscle remain unchanged. Our data suggest that cardiopulmonary impairments in PH are the primary cause of reduced exercise capacity, which occurs before intrinsic skeletal muscle dysfunction.

The Importance of Cultural Awareness in the Management of Heart Failure: A Narrative Review.

Heart failure is a commonly encountered clinical syndrome arising from a range of etiologic cardiovascular diseases and manifests in a phenotypic spectrum of varying degrees of systolic and diastolic ventricular dysfunction. Those affected by this life-limiting illness are subject to an array of burdensome symptoms, poor quality of life, prognostic uncertainty, and a relatively onerous and increasingly complex treatment regimen. This condition occurs in epidemic proportions worldwide, and given the demographic trend in societal ageing, the prevalence of heart failure is only likely to increase. The marked upturn in international migration has generated other demographic changes in recent years, and it is evident that we are living and working in ever more ethnically and culturally diverse communities. Professionals treating those with heart failure are now dealing with a much more culturally disparate clinical cohort. Given that the heart failure disease trajectory is unique to each individual, these clinicians need to ensure that their proposed treatment options and responses to the inevitable crises intrinsic to this condition are in keeping with the culturally determined values, preferences, and worldviews of these patients and their families. In this narrative review, we describe the importance of cultural awareness across a range of themes relevant to heart failure management and emphasize the centrality of cultural competence as the basis of appropriate care provision.

Prognostic value of right ventricular free wall strain in patients with sepsis.

Right ventricular systolic dysfunction (RVSD) in patients with sepsis is an area of growing interest, but its prognostic significance remains unclear and additional tools are needed to improve our understanding. Right ventricular free wall strain (RV-FWS) is a relatively new parameter to assess RV function. This study aimed to investigate the potential correlation between impaired RV-FWS and prognostic outcomes in patients with sepsis. We prospectively assessed right ventricular function in patients with sepsis within the initial 24 h of their hospital admission. RV-FWS, right ventricular global strain (RV-GS), fractional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE) were examined. RVSD was defined as impaired RV-FWS. Moreover, the association between RVSD and 30-day mortality rate was assessed. This study included 89 patients. Among them, 27 (30.3%) succumbed to their illness within 30 days. The nonsurviving patients demonstrated significantly lower absolute RV-FWS (-19.7% ± 2.4% vs. -21.1% ± 2.1%, P = 0.008) and RV-GS (-17.7% ± 1.2% vs. -18.4% ± 1.4%, P = 0.032) values than the surviving patients. However, TAPSE and FAC values were not significantly different between the two groups. The optimal cutoff values for RV-FWS, RV-GS, FAC, and TAPSE were -19.0%, -17.9%, 36.5%, and 1.55 cm, respectively. Kaplan-Meier survival curves revealed that patients with impaired RV-FWS and RV-GS demonstrated lower 30-day survival rates, and the predictive performance of RV-FWS (hazard ratio [HR]: 3.97, 95% confidence interval [CI]: 1.85-8.51, P < 0.001) was slightly higher than FAC and TAPSE. However, multivariable Cox regression analysis revealed no association between impaired RV-FWS and mortality outcomes (HR: 1.85, 95% CI: 0.56-6.14, P = 0.316). Impaired RV-FWS is not associated with short-term mortality outcomes, and RV strain imaging is of limited value in assessing the prognosis of sepsis.

Right ventricular infarction: epidemiological, clinical, and angiographic characteristics and the outcomes through the experience of a Moroccan cardiology department

Background: Acute myocardial infarction (MI) is a major cause of cardiovascular mortality, which is the leading cause of death in the world. Our objective in this study was to evaluate the epidemiological, clinical, and angiographic features of right ventricular infarction (RVI), as well as its complications and its therapeutic approaches. Patients and methods: It is a single-centered retrospective descriptive study conducted over a period of 2 years from November 2018 to October 2020. The authors included 82 patients with RVI hospitalized in the cardiovascular ICU during the initial phase of acute coronary syndrome with persistent ST segment elevation. Patients who were diagnosed with RVI at electrocardiogram and echocardiography were recruited. Results: The authors included 500 patients hospitalized for STEMI, 82 had MI extended to the RV, reflecting a rate of 16.4%. The mean age in our study was 64±12.3 years. Dyslipidemia, diabetes mellitus, and hypertension were the most common cardiovascular risk factors among these patients. RVI co-existed with inferior MI in 62.2 of cases and in 37.8% of anterior MI, while isolated RVI was seen in only one patient. Transthoracic echocardiography showed right ventricular (RV) systolic dysfunction in 24.39% of cases, while RV dilatation was seen in only 10.9% of patients. Therapeutic approach was based essentially on revascularization with thrombolysis and coronary angiography +/- PCI. The percentage of mortality was 2.4%. Conclusion: RVI is relatively rare and is mostly related to an extension of an inferior MI. Early diagnosis, prompt treatment, and appropriate are the keys to improve prognosis, and reduce complications.

Transcatheter aortic valve replacement in heart failure.

Patients with severe aortic stenosis (AS) may develop heart failure (HF), the presence of which has traditionally been deemed as a final stage in AS progression with poor outcomes. The use of transcatheter aortic valve replacement (TAVR) has become the preferred therapy for most patients with AS and concomitant HF. With its instant afterload reduction, TAVR offers patients with HF significant haemodynamic benefits, with corresponding changes in left ventricular structure and improved mortality and quality of life. The prognostic covariates and optimal timing of TAVR in patients with less than severe AS remain unclear. The purpose of this review is to describe the association between TAVR and outcomes in patients with HF, particularly in the setting of left ventricular systolic dysfunction, acute HF, and right ventricular systolic dysfunction, and to highlight areas for future research.

Cardiac Catheterization in Adults with Ebstein Anomaly: Pathophysiologic Insights Regarding Surgical Repair and Prognosis.

The underlying invasive hemodynamics and physiology in Ebstein anomaly (EA) are poorly understood. Moreover, the hemodynamic impact of tricuspid valve intervention in EA has not been well studied. Retrospective cohort of 52 adults with repaired and 36 with unrepaired EA undergoing right heart catheterization at Mayo Clinic, MN between 1993 and 2021. "Repaired" EA was defined as prior tricuspid valve repair and/or replacement (83% post-tricuspid valve replacement). Repaired patients were younger than those with unrepaired EA (41.3 ± 16.0 versus 50.6 ± 15.6years, p = 0.008) and had a lower prevalence of ≥ moderate native or prosthetic tricuspid regurgitation (67% versus 81%, p = 0.01). Right atrial (RA) pressure was higher among patients with repaired EA than in unrepaired disease [13 (11; 18) versus 10 (8; 15) mmHg; p = 0.02], but these differences were no longer present when adjusting for ≥ moderate right ventricular systolic dysfunction and ≥ moderate tricuspid regurgitation. Cardiac index (Qs) was lower among those with unrepaired EA than in repaired EA (1.9 ± 0.7 versus 2.3 ± 0.6 l/min/m2, p = 0.01), even after adjusting for similar confounders. During a follow-up of 8.6 (3.2-13.3) years, 16 (18%) patients died. Systolic pulmonary artery pressure was independently associated with all-cause mortality. In summary, highercardiac indices were found in those with repaired EA compared to those with unrepaired disease. RA hypertension was prevalent in both groups and no differences in right filling pressures were found between groups after adjusting for potential confounders. Elevation in pulmonary pressures was independently associated with survival. The use of pulmonary vasomodulators in EA requires further investigation.

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.

Speckle tracking echocardiography detects subtle right ventricular systolic dysfunction in post Covid syndrome after mild severity Covid-19

Abstract Introduction Now that the global COVID-19 pandemic has come to an end, many patients seek medical help for its aftermath giving rise to post COVID syndrome. Post COVID syndrome describes individuals with a history of probable or confirmed COVID-19 infection, usually 3 months from the onset of infection with symptoms that last for at least 2 months and no alternative diagnosis can be explained. The affection of the right ventricular (RV) systolic function is a cornerstone in the pathogenesis underlying Post COVID syndrome. Many modalities were used to assess the RV with a widespread debate as to the most accurate one. However, echocardiography remains the modality of choice for the evaluation of RV systolic function, especially when using its novel features as myocardial deformation imaging by speckle tracking echocardiography (STE) to surpass the RV’s peculiar anatomy, retrosternal position and complex architecture. Purpose The aim was to assess RV systolic function by STE 3-6 months after recovery from mild severity COVID-19 disease and correlate these findings with Post COVID syndrome. Methods This study included 96 adults (above 18 years of age) who were classified into three equal groups; the first group recruited 32 subjects 3-6 months after recovery from mild severity COVID-19 disease without post COVID syndrome, the second group included 32 subjects 3-6 months after recovery from mild severity COVID-19 disease with post COVID syndrome and the third group recruited 32 gender-matched healthy subjects of similar ages without previous COVID-19 disease (control group). Each subject underwent a detailed transthoracic echocardiography including RV function assessment using 2D RV STE imaging. Results RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS) were significantly lower in patients after recovery from mild severity COVID-19 disease with post COVID syndrome (P-value= 0.010) in comparison to the other groups. There was a statistically significant negative correlation found between RV 2D STE parameters and RV end-diastolic dimension, systolic pulmonary artery pressure and RV myocardial performance index. Also, there was a statistically significant positive correlation found between RV 2D STE parameters and RV fractional area change, tricuspid annular plane systolic excursion and RV S'. The cardiac symptomatology in patients with post COVID syndrome was analyzed showing that the most common three symptoms were fatigue, palpitations and chest pain with a prevalence of 65.6%, 40.6% and 31% respectively. These three symptoms showed a significant negative relation with RV-GLS and RV-FWLS. Conclusion RV function assessed using STE occupied the lower normal ranges in patients recovering from mild severity COVID-19 disease, particularly those with post COVID syndrome. 2D STE may be used for the detection and follow-up of possible subtle long term RV dysfunction after mild severity COVID-19 disease.RV-GLS and RV-FWLS in the studied groupsRV-GLS and RV-FWLS using 2D STE

Chronic thromboembolic disease is associated with exercise-induced pulmonary hypertension and functional right ventricle deterioration

Abstract Background and Aim Chronic thromboembolic pulmonary disease (CTED) is a progressive disease caused by a wall-adherent, fibrotic thrombus in the pulmonary circulation persisting despite oral anticoagulation and despite vascular remodeling of the small arteries. Despite normal pulmonary hemodynamics at rest, exercise intolerance and dyspnea have been reported. Drivers and risk factors, as well as the clinical impact of CTED, are not yet adequately characterized. We evaluated clinical factors predictive of the development of postthrombotic pulmonary disease in a cohort of patients with a history of acute pulmonary embolism on oral anticoagulant therapy. We also evaluated its impact on functional capacity, pulmonary haemodinamics at rest and after exercise and right ventricle morphology and function. Methods We compared 33 consecutive patients with a history of acute pulmonary embolism and normal pulmonary vascular imaging (group 1, n=16) or persistent defects on perfusion scan (positive P scan) despite therapeutic anticoagulation for 4 months (group 2, n=17), for the following parameters: 1. Thrombotic load (extension of pulmonary thromboembolism on CT angiography) and Pulmonary Embolism Severity Index (PESI) score at the time of admission to the Intensive Care Unit (ICU); 2. Presence of thrombophilia (factor V Leiden, prothrombin variant, lupus anticoagulant); 3. Cardiovascular risk factors; 4. Anthropometric and demographic parameters; 5. Anticoagulation treatment in ICU and at discharge. The two groups of patients were also compared for the World Health Organization functional class (WHO-FC), NT-proBNP, cardiopulmonary exercise test (CPET) and echocardiographic parameters at rest and after exercise (ESE), at 4 and after 24 months. Results Compared with group 1, patients with persisting perfusion defects (group 2) featured higher thrombotic load (p=0.004) and PESI score (p=0.02) at the time of ICU admission. At 4 months, group 2 developed exercise-induced pulmonary hypertension (Ex-PH) at CPET (p&amp;lt;0.001) and ESE (p&amp;lt;0.001). At the 24 months follow-up group 2 showed higher NT-proBNP (p&amp;lt;0.001) and WHO-FC (p&amp;lt;0.001), systolic (p&amp;lt;0.001) and diastolic (p=0.037) right ventricular (RV) dysfunction and worse echo indices of RV-Arterial Coupling (TAPSE/PAPs (p&amp;lt;0.001)), despite maintaining a low or intermediate echocardiographic probability of PH (Table 1). Conclusions Despite the low and intermediate echocardiographic probability of PH, patients with persistent positive P scan had reduced functional capacity, and developed ExPH and RV functional deterioration.

Speckle-tracking global longitudinal strain as a predictor of clinical outcomes in patients with idiopathic inflammatory myopathies

Abstract Background Idiopathic inflammatory myopathies (IIM) are systemic immune-mediated diseases that involve the skeletal muscle and several other organ systems, including the heart. Nonetheless, cardiac involvement in IIM is frequent and initially subclinical. Previous studies have demonstrated how speckle-tracking-derived global longitudinal strain (GLS), as a measurement of the subclinical systolic ventricular dysfunction, is significantly lower in IIM compared to healthy controls. Purpose To assess the progression of myocardial deformation in patients with IIM and test GLS as a prognostic marker of death and cardiovascular events. Methods We enrolled all consecutive patients with a diagnosis of IIM sent to our Cardiology Clinic. The diagnosis of definite idiopathic polymyositis or idiopathic dermatomyositis as made according to the Bohan and Peter criteria and confirmed by muscle biopsy. Patients with inclusion body myositis, necrotizing autoimmune myositis, overlap myositis, and juvenile myositis were excluded from our study. All patients underwent full evaluation, including clinical, ecg and echocardiographic assessment as well as GLS calculation both at baseline and follow up appointments. Primary endpoint was a composite of death and cardiovascular events. Results 41 consecutive patients (28 females, 58±15 years) with IIM were consecutively enrolled and followed up for a median of 8 years (4-11 years). During follow-up, a progressive worsening of LVEF (-4%; p=.03) and left GLS (LGLS: +3%; p=.04) was shown, along with an increase in atrial volumes (iLAV: +8 cm2/m2; p=.02; iRAV: +10 cm2/m2; p=0.01) and estimated filling pressures (E/e': +2; p=.01). A left GLS (LGLS) &amp;gt; -16% predicted the composite endpoint with a sensitivity of 80% and a specificity of 67% (AUC 0.74). Estimated survival from the composite endpoint was 85% for the normal LGLS group and 35% for the impaired LGLS group (Figure 1). Right GLS was not significantly associated with the primary endpoint. Conclusions Heart involvement is becoming a major cause of death in patients with myositis. Data reported that subclinical heart involvement, characterized by biochemical and instrumental modifications, is estimated to affect around 70% of patients with myositis. Cardiac involvement in IIM is often subclinical in the early stages of the disease. GLS has been proven to be an effective tool to predict heart disease. Our results show that GLS worsens over time and can be used as a possible predictor of death and cardiovascular events in this population.Figure 1

Determinants of right ventricular systolic dysfunction among patients with left heart failure in a Ghanaian hospital.

The presence of right ventricular dysfunction affects outcomes in patients with left heart failure. We assessed the determinants of right ventricular systolic dysfunction (RVSD) among patients with left heart failure presenting to the Korle Bu Teaching Hospital of Ghana. Consecutive patients with left heart failure who were 18 years and above were prospectively enrolled and assessed for evidence of RVSD by measuring the tricuspid annular plane systolic excursion, the peak velocity of the tricuspid annulus in systole (RV S'), the two-dimensional right ventricular fractional area change (RV FAC) and the right ventricular myocardial performance index (RV MPI). Two hundred and seventy participants were enrolled, of whom 75.2% had at least one abnormal index of right ventricular systolic function. The prevalence of RVSD was significantly higher among those with non-hypertensive heart failure (85.3 vs 66.0%, p < 0.001). The left ventricular outflow tract velocity-time integral (LVOT VTI) was strongly correlated with the RV FAC and an LVOT VTI < 9.8 cm predicted the presence of an RV FAC < 35% with a sensitivity of 81.5% and specificity of 81.9% [area under the curve 0.882; 95% confidence interval (CI): 0.838-0.926, p < 0.001]. Independent predictors of the presence of RVSD included a transmitral E/A > 2 [odds ratio (OR) = 4.684, 95% CI: 1.521-14.428, p = 0.007), left ventricular ejection fraction < 40% (OR = 4.205, 95% CI: 1.643-10.760, p = 0.003), pulmonary artery systolic pressure (PASP) ≥ 35 mmHg (OR = 2.434, 95% CI: 1.012-5.852, p = 0.047) and systemic systolic blood pressure (SBP) < 140 mmHg (OR = 2.631, 95% CI: 1.152-6.011, p = 0.022). RVSD was common in these Ghanaian patients with left heart failure. Left ventricular function, SBP and PASP were independent predictors of the presence of RVSD. Pending further validation, the LVOT VTI may serve as a useful surrogate or screening tool for RVSD in these patients.

Abstract 18819: Detection of Systolic Dysfunction in Pediatric Patients Using an Artificial Intelligence-Enabled Electrocardiogram

Introduction: Left and right ventricular systolic dysfunction (LVSD and RVSD respectively) contribute to considerable pediatric morbidity. Both LVSD and RVSD can occur in children before symptom onset, emphasizing the need for early detection. Existing deep-learning algorithms can identify LVSD in adults using 12-lead ECG; however, their efficacy in children is uncertain. Aims: We aimed to create a deep-learning model for LVSD and RVSD detection in pediatric patients using an AI-enabled ECG and compare novel pediatric models to a previously validated adult LVSD model. Methods: We identified 10,214 pediatric patients at the Mayo Clinic with a transthoracic echocardiogram (TTE) and a 10-second, 12-lead surface ECG within 14 days of TTE, performed from 2002 -2022. Our cohort comprised the first TTE-ECG pair from each patient, totaling 138 with EF ≤ 35%, 312 with EF ≤ 50%, 482 with RVSD, and 9,567 without any LVSD or RVSD. The cohort was split into training, validation, and testing datasets to develop neural networks for systolic dysfunction detection. Results: The cohort was 52.3% male, with an average age of 10.3 years. Novel models generated in the pediatric cohort demonstrated excellent performance in systolic dysfunction detection (Figure 1). Pediatric models for EF ≤ 35% and EF ≤ 50% achieved test AUCs of 0.92 (95% CI 0.89, 0.95) and 0.89 (95% CI 0.85, 0.94) respectively. The RVSD model reached a test AUC of 0.91 (95% CI 0.88, 0.94). A combined model for EF ≤ 35% or RVSD exhibited a test AUC of 0.90 (95% CI 0.87, 0.93), sensitivity 0.88, specificity 0.82, PPV 0.20, and NPV 0.95. A combined model for EF ≤ 50% or RVSD exhibited a test AUC of 0.88 (95% CI 0.85, 0.91). The previously validated adult data-derived model achieved an AUC of 0.86 (95% CI 0.83, 0.89) for EF ≤ 50% in children. Conclusions: AI-enabled ECGs demonstrate efficient detection of both LVSD and RVSD in pediatric patients. Future multi-site validation is needed to further establish the reliability of these models.

Echocardiographic assessment of cardiac function abnormalities and related risk factors in Thai overweight and obese children

ABSTRACT Background: Childhood obesity has become a global concern, with its prevalence steadily increasing over the past decade. This condition negatively impacts the cardiovascular system, increasing the risk of morbidity and mortality in adulthood. This study aimed to identify cardiac function abnormalities and related risk factors among overweight and obese Thai children. Materials and Methods: A cross-sectional observational study of 70 children with body mass index (BMI) &gt;1 standard deviation above the mean for Thai children was conducted at Naresuan University Hospital. Body fat percentage (%Fat) was measured, and standard transthoracic echocardiography was performed. Metabolic profiles were collected from medical records. Results: The thickness and diameter of the Left ventricle (LV) wall, including the LV posterior wall, LV internal diameter, and interventricular septum (IVS), were significantly increased in both systolic and diastolic phases in obese children. LV concentric hypertrophy and an abnormal E/E’ ratio were found in 27% and 34.3% of participants, respectively. Right ventricular systolic dysfunction indicated by abnormal tricuspid annular plane systolic excursion values was found in 55.7% of all participants. In addition, 27.1% of all obese children had pulmonary hypertension. Significant differences in BMI and %Fat were detected between children with abnormal and normal IVS diastolic (IVSd) (P = 0.016). Our univariate and multivariate correlation analyses revealed a significant positive association between abnormal IVSd and %Fat, with an odd ratio (OR) of 1.13 (95% confidence interval [CI]: 1.01–1.27; P = 0.047) and an adjusted OR of 1.17 (95% CI: 1.01–1.36; P = 0.04). Conclusions: Cardiac function abnormalities in childhood obesity exhibit a significant positive correlation with BMI and various cardiac dimensions, including ventricular wall thickness. One important related risk factor for increased IVS thickness is %Fat. Therefore, multidisciplinary management of obesity should be initiated as early as possible to prevent future cardiovascular morbidity and mortality.

Prognostic Value of Right Ventricular Longitudinal Shortening Fraction in Patients With ST-Elevation Myocardial Infarction: A Prospective Echocardiography Study

Background: Right ventricular systolic dysfunction (RVsD) frequently occurs in patients with ST-elevation myocardial infarction (STEMI). However, the diagnosis depends on the echocardiographic parameters to define RVsD. Right ventricle longitudinal shortening fraction (RV-LSF) is an accurate and reproducible two-dimensional speckle tracking parameter associated with clinical events in various pathologies.Objective: The aim of the study is to evaluate the association between RVsD and major adverse cardiovascular events (MACE) occurrence in a cohort of STEMI patients.Methods: Adult STEMI patients admitted to Amiens University Hospital's cardiovascular intensive care unit between May 2021 and November 2022, who underwent coronary angiography and TTE within 48 hours of admission, were included. RVsD was defined as RV-LSF < 20%. The primary outcome was MACE occurrence, including heart failure, myocardial infarction, stroke, and death within six months of admission. Multivariable Cox regression analysis with proportional hazard ratio (HR) models assessed the association between RVsD and MACE.Results: Among the 164 included patients, 72 (44%) had RVsD, and 92 (56%) did not. The RVsD group had a significantly higher proportion of MACE during the six-month follow-up (n = 23/72, 33%) than the no-RVsD group (n = 8/92, 9%; P = 0.001). RVsD showed an independent association with MACE at six months (HR=3.1, 95% CI [1.35-7.30], P=0.008). Left ventricular ejection fraction < 40 % and TIMI score > 4 were independently associated with RVsD (odds ratio = 2.80, 95% CI [1.34-5.98] and OR=2.15, 95% CI [1.18-4.39 respectively]; P = 0.015). The cumulative risk of MACE at six months was 33% for RV-LSF < 20% and 9% for RV-LSF ≥ 20% (log-rank test P < 0.001).Conclusion: RVsD, defined by RV-LSF < 20%, is associated with an increased risk of MACE after STEMI.

Cardiac output drop reflects circulatory attrition after Fontan completion: serial cardiac magnetic resonance study

Abstract Aims Cardiac magnetic resonance (CMR) imaging is a main diagnostic tool in the follow-up of Fontan patients. However, the value of serial CMR for the evaluation of Fontan attrition is unknown. The aim of this prospective study of serial CMR is to describe the analysis of time-dependent evolution of blood flow distribution, ventricular volumes, and function in patients after Fontan completion. Methods and results In this prospective single-centre study, between 2012 and 2022, 281 CMR examinations were performed in 88 Fontan patients with distribution of blood flows, measurements of ventricular volumes, and ejection fraction. Linear mixed model regression for repeated measurements was used to analyse changes of measurements across serial CMR examinations. During a time interval of 10 years, the median number of CMR per patient was 3 (range 1–5). Indexed flow of ascending aorta, caval veins, and pulmonary arteries decreased significantly across serial CMR examinations. Although a decrease of mean indexed aortic flow (3.03 ± 0.10 L/min/m2 at first CMR vs. 2.36 ± 0.14 L/min/m2 at fourth CMR, P &amp;lt; 0.001) was observed, ejection fraction did not decline (50 ± 1% at first CMR vs. 54 ± 2% at fourth CMR, P = 0.070). Indexed ventricular volumes did not differ significantly across serial CMR examinations. Conclusion The decrease of indexed aortic and cavopulmonary flows reflects the attrition of univentricular circulation and can be detected by means of serial CMR. Ventricular systolic dysfunction does not contribute significantly to this attrition. In order to detect significant change of indexed aortic flow, we recommend performing serial CMR as routine practice in the Fontan population.

Right Ventricle Systolic Dysfunction: A Rare Cause of Right-To-Left Interatrial Shunt with Normal Pulmonary Artery Pressure

There is little information about right-to-left shunting with normal pulmonary artery pressure, which is produced as a consequence of right ventricle systolic dysfunction. We presented a case of unexpected transesophageal echocardiography findings of right-to-left shunting through an atrial septal defect despite normal pulmonary artery pressure, related to right ventricle systolic dysfunction in a 27-year-old young woman. Transesophageal echocardiography imaging revealed right ventricular systolic dysfunction and normal pulmonary artery pressure.

Abstract P3030: Reduced Exercise Capacity Occurs Before Intrinsic Changes In Skeletal Muscle In Experimental Rat Models Of Pulmonary Hypertension

Background: Pulmonary Hypertension (PH) is defined with mean pulmonary arterial pressure greater than 20 mmHg at rest. Reduced exercise capacity in PH significantly impacts quality of life. While the cause of reduced exercise capacity in PH remains unclear, it is suggested that regional skeletal muscle adaptions may play a role. The objective of this study was to investigate whether intrinsic changes in skeletal muscle determine exercise capacity in PH using preclinical PH rat models with different PH severity. Methods and Results: PH was induced in adult Sprague-Dawley (SD) or Fischer (CDF) rats with one dose of SU5416 (20 mg/kg) injection, followed by 3 weeks of hypoxia and additional 1-4 weeks of normoxia exposure. Rats injected with vehicle and housed in normoxia were used as controls. Echocardiography and hemodynamics were performed to assess PH and cardiac function. Exercise capacity was assessed by VO 2 max. Skeletal muscle structural changes (atrophy, fiber type switch, and capillary density), mitochondrial function, isometric force, and fatigue profile were assessed in soleus muscles. In SD rats, right ventricular systolic dysfunction is associated with reduced exercise capacity in PH rats at 7 weeks timepoint in comparison to control rats, while no changes were observed in skeletal muscle structure, mitochondrial function, isometric force, or fatigue profile. CDF rats at 4 weeks timepoint developed a more severe PH and, in addition to right ventricular dysfunction, the reduced exercise capacity in these rats is associated with skeletal muscle atrophy; however, mitochondrial function, isometric force, and fatigue profile in skeletal muscle remain unchanged. Conclusions: Our study demonstrated that reduced exercise capacity in PH occurs before intrinsic changes in skeletal muscle, suggesting that alterations in skeletal muscle are not causative to exercise intolerance in PH, while they may worsen exercise capacity collaboratively with primary factors in the late stage of PH. In addition, our study supports the notion that improving central cardiopulmonary impairments at the early stage of PH may be critical in preventing or delaying the occurrence of exercise limitation in settings of PH.