Ventricular Systolic Function In Patients Research Articles

Abstract 14385: The Exist of Enlarged Left Ventricular Diastolic Volume is Not a Predictor of Irreversible Left Ventricular Systolic Function in Patients With Atrial Arrhythmia

Introduction: Atrial arrhythmia (AA) and left ventricular systolic dysfunction (LVSD) frequently co-exist, which loom as burgeoning public health problems. It is difficult to determine whether a tachycardia is the indicator or consequence of LVSD in patients with tachycardia and LVSD. Tachycardia mediated cardiomyopathy (TCM) raises a “chicken or egg” question. Regardless of the etiology, the patients with severe LVSD are considered as the candidate for the implantation of cardioverter defibrillator as primary prevention. It is well known that the LVSD improves after the successful treatment of AA in TCM population. However, enlarged left ventricular end-diastolic dimension (LVDd) is considered as a parameter of irreversible LVSD. Hypothesis: Enlarged LVDd could not be a predictor for irreversible LVSD in patients with AA. Methods: We assessed patients with persistent AA and heart failure (Ejection Fraction (EF) <45%) who were received aggressive rhythm control therapy and maintained sinus rhythm with catheter ablation, electrical cardioversion and anti arhythmic drugs. Echocardiographic parameters and brain natriuretic peptide (BNP) were evaluated before and after the treatment. Results: Twenty-five patients with persistent AA and LVSD (23 men; mean age 63.8±9.3 years) were enrolled in this study. After restored and maintained SR, EF and left ventricular end-systolic volume (ESV) and BNP were improved in all patients respectively (EF 30.7±10.7 to 54.0±7.3%, ESV; 82.1±32.4 to 50.6±24.1ml, BNP; 379.2±237.9 to 48.0±29.7pg/ml P<0.001). In the other hand, there were no significant improvement of LVDd and left ventricular end-diastolic volume (EDV) (LVDd; 54.7±7.6 to 54.3±5.5mm P=0.68, EDV; 120.1±37.9 to 108.2±38.0ml P=0.16). Enlarged LVDd >60mm were observed in 5 patients (25%) before the treatment. EF was normalized in patients with severe LVSD (EF<35%, n=13; 52%). Conclusions: The unnecessary device implantation could be avoided in patients with AA and severe LVSD with aggressive rhythm control therapy. Even in the patients with severe LVSD and enlarged LVDd, LVSD is reversible when AA exists.

Evaluation of left ventricular systolic function in patients with different types of ischemic heart disease by two-dimensional speckle tracking imaging

BackgroundThe purpose of this study was to evaluate left ventricular systolic function in patients with different types of ischemic heart disease using two-dimensional speckle tracking imaging (2D-STI).MethodsWe retrospectively studied patients who were admitted to Peking University Third Hospital from January 2011 to December 2017 due to chest tightness and chest pain. Two hundred forty-two patients were divided into control group, CMD group and obstructive CAD group. The main coronary artery stenosis was confirmed by coronary angiography or coronary computed tomography and coronary flow reserve (CFR) in patients was measured by transthoracic Doppler echocardiography. Left ventricular strain and strain rate (SR) measured by 2D-STI. Cardiac structure and function were measured by conventional echocardiography.ResultsConventional echocardiography showed that there was no significant difference in cardiac structure and function among the three groups (P > 0.05). Moreover, the longitudinal strain (LS) of each ventricular wall in CMD group was notably lower than that in control group (P < 0.01). In addition, global longitudinal SR and longitudinal SR in CMD group and obstructive CAD group were obviously lower than those in control group (P < 0.01). GLS, endocardial LS and epicardial LS were negatively correlated with CFR (P < 0.01).ConclusionsEarly left ventricular systolic dysfunction was found in patients with CMD and patients with obstructive CAD, with similar degree. CFR is an independent influencing factor of GLS. GLS and stratified LS have certain diagnostic value for CMD.

The effect of intensive hemodialysis on pulmonary arterial pressure and left ventricular systolic function in patients with end-stage renal disease; a prospective clinical trial

Introduction: End-stage renal disease (ESRD) requires hemodialysis or kidney transplantation for the patients to survive. Objectives: The present study was conducted to examine whether intensive hemodialysis and hemoglobin (Hb) concentration correction can improve left ventricular (LV) function and pulmonary arterial hypertension in ESRD patients? Patients and Methods: This prospective clinical trial was designed to examine patients referring to public hospitals in Ahvaz, Iran, in 2016-2017. All the patients treated with intensive hemodialysis for two months were included in the study. The Hb concentration was corrected by the subcutaneous injection of erythropoietin at the dose of 50-150 IU/kg three times per week. Results: Thirty-one ESRD patients with high pulmonary arterial pressure participated in this study. After the intervention, blood Hb levels increased significantly in the ESRD patients from 9.20±1.39 g/dL to 10.96±1.01 g/dL (P&lt;0.0001). Pulmonary arterial pressure decreased significantly from 53.52±10.63 mmHg to 43.32±10.92 mm Hg (P&lt;0.0001). Left ventricular ejection fraction increased significantly based on the visual assessment and Simpson’s method (2D echocardiography) from 41.06±10.76 to 43.00±11.28 and 46.26±13.72 to 48.36±13.90, respectively (P&lt;0.0001). Absolute value of two dimensional global longitudinal strain (GLS) increased significantly from 13.99±5.05 to 15.14±5.32 (P&lt;0.0001) after the intervention. Conclusion: Intensive hemodialysis for two months resulted in a significant increase in Hb concentrations, improved the LV systolic function and decreased pulmonary hypertension in ESRD patients. Trial registration: The trial protocol was approved in the Iranian Registry of Clinical Trials (identifier: IRCT20180212038705N1, https://www.irct.ir/trial/29593; Ethic code: IR.AJUMS. REC.1396.911).

Four-Dimensional Echocardiographic Evaluation of Left Ventricular Systolic Functions in Patients with Chronic Myeloid Leukaemia Receiving Tyrosine Kinase Inhibitors.

Tyrosine kinase inhibitors (TKIs) are established treatment for haematological malignancies. However, cardiac adverse effects, including the reduction in left ventricular ejection fraction and symptomatic heart failure remain clinical problems. The purpose of this study was to evaluate the left ventricular systolic functions in patients with chronic myeloid leukaemia receiving TKIs. A cross-sectional and observational study was conducted of 37 patients with chronic myeloid leukaemia receiving dasatinib or nilotinib after imatinib failure. Left ventricular systolic functions were evaluated using four-dimensional speckle tracking echocardiography derived global longitudinal (GLS), circumferential (GCS), radial (GRS), and area (GAS) strain indices. Mean ejection fraction, stroke volume, cardiac output and left ventricular mass index were similar between control and patient groups and within normal limits. GLS (- 16.7% vs - 20.8%, p < 0.001), GCS (- 13.0% vs - 15.6%, p = 0.002), and GAS (- 26.2% vs - 31.0, p < 0.001) values were significantly higher in the patient population than those of the controls. Dasatinib and nilotinib groups did not show differences regarding strain indices. In multivariate regression analysis, only the usage of dasatinib or nilotinib was found to be an independent risk factor for diminished GAS (β = 4.406, p = 0.016), GLS (β = 3.797, p = 0.001), and GCS (β = 2.404, p = 0.040). Although imatinib, nilotinib, and dasatinib seem to be clinically safe in terms of cardiac function, monitoring of systolic functions using strain imaging, and long-term observation of patients may provide early detection of the possible cardiac toxicity.

Subclinical Left Ventricular Systolic Dysfunction in Patients with Septic Shock Based on Sepsis-3 Definition: A Speckle-Tracking Echocardiography Study.

Introduction Left ventricular dysfunction is quite common in septic shock. Speckle-tracking echocardiography (STE) is a novel, highly sensitive method for assessing left ventricular function, capable of detecting subclinical myocardial dysfunction, which is not identified with conventional echocardiography. We sought to evaluate subclinical left ventricular systolic function in patients with septic shock using speckle-tracking echocardiography. Methods From May 2017 to December 2018, patients aged ≥18 years admitted to the intensive care unit with the diagnosis of sepsis and septic shock based on the sepsis-3 definition were included. Patients with other causes of cardiac dysfunction were excluded. Transthoracic echocardiography was performed for all the patients within 24 hours of diagnosis. Left ventricular systolic function was assessed using conventional echocardiography and speckle-tracking echocardiography. Results Patients with septic shock (n = 90) (study group) and 37 matched patients with sepsis but no septic shock (control group) were included. Left ventricular ejection fraction (LVEF) by conventional echocardiography showed no significant difference between two groups (58.2 ± 9.9 vs. 58.6 ± 8.3, p=0.804). The global longitudinal strain (GLS) by STE was significantly reduced in patients with septic shock compared with that in the control (−14.6 ± 3.3 vs. −17.1 ± 3.3, p < 0.001). Based on the cutoff value of GLS ≥ −15% for the definition of subclinical left ventricular systolic dysfunction, this dysfunction was detected in 50 patients with septic shock (55.6%) and in 6 patients in the control group (16.2%) (p < 0.05). Conclusions Speckle-tracking echocardiography can detect early subclinical left ventricular systolic dysfunction via the left ventricular global longitudinal strain compared with conventional echocardiographic parameters in patients with septic shock.

The value of 2D speckle-tracking strain echocardiography in evaluating the relationship between carotid elasticity and left ventricular systolic function in patients with diabetic nephropathy

ObjectiveTo investigate the relationship between the elasticity of the carotid artery and the LV (left ventricle) systolic function in patients with diabetic nephropathy (DN) by using two-dimensional speckle-tracking strain echocardiography (2D-STE).MethodsDN patients (n = 108) and control subjects (n = 112), all of whom underwent echocardiography and carotid ultrasound. Analysis of LV GLS (global longitudinal strain) from the apical two-chamber (2C), three-chamber (3C), and four-chamber (4C) views. Meanwhile, the circumferential strain (CS) of the carotid artery was obtained from the view of the short-axis right common carotid artery. The differences between the two groups were compared, and a correlation analysis between CS and GLS was performed.ResultsThe 4CGLS, 2CGLS, 3CGLS, and CS of the DN group were significantly lower at significant levels in contrast to the control group (p < 0.05). There was a significantly positive correlation of CS with 4CGLS, 2CGLS, and 3CGLS in all subjects (r = 0.809, p = 0.000; r = 0.830, p = 0.000; r = 0.830, p = 0.000, respectively).Conclusion2D-STE is a relatively new technique for assessing the mechanical characteristics of the carotid artery in patients with DN. Reduced values of CS correlate with reduced LV systolic function as evaluated by strain measurements, which can predict the risk of systolic dysfunction of LV.

Circulating CD34+VEGFR-2+ endothelial progenitor cells correlate with revascularization-mediated long-term improvement of cardiac function in patients with coronary chronic total occlusions

BackgroundEndothelial progenitor cells (EPCs) participate in angiogenesis and neocollateralization. This study assessed if circulating EPCs can predict long-term improvement of global left ventricular systolic function in patients with coronary chronic total occlusions (CTOs) underwent successful percutaneous coronary intervention (PCI). MethodsIn this single-center, prospective, observational study, 115 consecutive patients with CTOs were evaluated by standard transthoracic echocardiography (ECHO) before and 9–12 months after PCI. Numbers of circulating putative EPCs were determined by flow cytometry analysis of mononuclear cells isolated from peripheral blood samples drawn before and 72 h after PCI. ResultsAt mean 11.3 ± 2.5 months post vs. before PCI (all P < .05): by SAQ-7 summary scores, angina frequency, physical limitation and quality of life scores were greater; by ECHO, LVEDd decreased and LVEF increased, which were more significant in patients with Rentrop grades 2/3 vs. 0/1. At 72 h post vs. before PCI, CD34+VEGFR-2+CD133− (0.82 ± 0.32 × 106/L vs. 1.00 ± 0.39 × 106/L, P = .003), CD34+VEGFR-2+CD133+ (0.24 ± 0.12 × 106/L vs. 0.27 ± 0.14 × 106/L, P = .028), and CD14+Tie2+VEGFR-2+ (6.60 ± 3.32 × 106/L vs. 7.82 ± 3.91 × 106/L, P = .006) cell numbers were lower. The baseline levels of CD34+VEGFR-2+cells (P = .001) and CD14+Tie2+VEGFR-2+cells (P < .001) were association with the grade of collateralization. In addition, the baseline and peri-procedural decrease of circulating CD34+VEGFR-2+ cells correlated with the increase of LVEF (P < .001, P < .001, respectively) and the decrease of LVEDd (P = .022, P = .029, respectively) at follow-up. ConclusionsIn this small study, the baseline levels of circulating CD34+VEGFR-2+ EPCs and its reduction after successful revascularization of CTOs correlated with long-term improvement in global LV systolic function.

Automated Quantitative Technique of 3D Cardiac Anatomical Model for Evaluating Left Ventricular Systolic Function in Patients with Myocardial Infarction

This study intends to use 3D cardiac anatomical model automatic quantitative technique Heart Model (HM) to assess left ventricular systolic function in patients with myocardial infarction. Thirty patients with myocardial infarction (case group) and 32 healthy individuals (control group) were enrolled in this study.M-mode echocardiography (MME), two-dimensional echocardiography (2DE), 3D cardiac anatomical model (HM) and real-time 3D echocardiography (3DE) were used to collect echocardiographic images. Left ventricular systolic function parameters (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) were obtained from two post-surgical analysis of more than 5 years of experience. Compared to control group, MME, 2DE, HM, and 3DE were significantly higher in the LVEDV and LVESV cases and lower in the LVEF (P &lt; 0 05). MME, 2DE, HM and 3DE were correlated and best correlation as found between HM and 3DE (P &lt; 0 05). For the consistency of MME, 2DE, HM and 3DE, the best consistency was observed in the LVEF of HM and 3DE, and case group was lower than control (P &lt; 0 05). In terms of repeatability of MME, 2DE, HM and 3DE, HM showed the best repeatability followed by MME. In comparison of the time of MME, 2DE, HM and 3DE, HM had shortest time (&lt; 0 05). HM automatic quantitative technique can evaluate left ventricular systolic function in myocardial infarction patients, and it is simple, rapid and reproducible.

Sodium glucose cotransporter-2 inhibitor was associated with an improvement in left ventricular systolic function in patients with type 2 diabetes mellitus with impaired left ventricular systolic function.

AimsRecent studies indicated that sodium glucose cotransporter‐2 inhibitors (SGLT2i) reduced heart failure hospitalization in patients with type 2 diabetes mellitus (T2DM). However, whether SGTL2i can improve left ventricular (LV) systolic and diastolic function remained unclear. This study aimed to compare the change in echocardiographic parameters in T2DM patients receiving SGLT2i with a different baseline LV ejection fraction (LVEF). The change in echocardiographic parameters was also compared between T2DM patients treated with SGLT2i and those treated with dipeptidyl peptidase‐4 inhibitor (DPP4i).Methods and resultsThis multicentre cohort study consecutively enrolled 665, 119, and 132 T2DM patients treated with SGLT2i with a preserved (≥50%), moderately reduced (40–50%), and reduced baseline LVEF (<40%), respectively, with paired baseline and post‐treatment echocardiographic data available between 1 June 2016 and 31 May 2018. There were 212 patients treated with DPP4i with paired baseline and post‐treatment echocardiographic data available at the same time. For those patients treated with DPP4i, 45 patients had impaired baseline LVEF of <50%. Echocardiographic parameters, including LVEF, LV end‐diastolic volume, LV end‐systolic volume (LVESV), and LV diastolic function, were analysed at baseline and after treatment. After a median SGLT2i treatment period of 230 days, patients with reduced LVEF were associated with an improvement in LVEF from 29.4 ± 7.4% to 42.2 ± 15.2% (P < 0.0001) and decrease in LVESV from 133.2 ± 49.2 to 117.4 ± 60.1 mL (P = 0.0002). Patients with moderately reduced LVEF were associated with an improvement in LVEF from 44.8 ± 2.9% to 49.7 ± 12.4% (P < 0.0001) and decrease in LVESV from 90.7 ± 31.1 to 80.0 ± 36.2 mL (P = 0.0017). Patients with preserved LVEF did not show an improvement in LVEF and LVESV after SGLT2i treatment. There were no significant changes of LV end‐diastolic volume, LV diastolic function, and LV wall thickness in three study groups after SGLT2i treatment. In contrast, patients with impaired baseline LVEF (<50%) did not show any change in LVEF and LVESV after DPP4i treatment.ConclusionsSodium glucose cotransporter‐2 inhibitor was associated with an improvement in LV systolic function in patients with T2DM with reduced and moderately reduced LVEF. In contrast, DPP4i treatment was not associated with any improvement in LVEF among patients with impaired LVEF.

Left Ventricular Systolic Function in Patients with Systemic Lupus Erythematosus and Its Association with Cardiovascular Events

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with potential cardiovascular involvement. The aim of this study was to assess left ventricular (LV) systolic function in a large cohort of patients with SLE using standard echocardiographic measurements and global longitudinal strain (GLS) by two-dimensional speckle-tracking analysis. Furthermore, the association between echocardiographic parameters and the occurrence of cardiovascular events was assessed. A total of 102 patients with SLE (88% women; mean age, 43±14years) undergoing a dedicated multidisciplinary assessment were analyzed, including echocardiography, at the time of their first visit. A control group consisted of 50 age- and sex-matched healthy subjects. Compared with control subjects, patients with SLE showed impaired LV systolic function on the basis of LV ejection fraction (51±6% vs 62±6%, P<.001) and by LV GLS (-15±3% vs -19±2%, P<.001). During a median follow-up period of 2years (interquartile range, 1-6years), 38 patients (37%) developed cardiovascular events. Kaplan-Meier survival curves showed that patients with SLE with more impaired LV GLS (on the basis of the median value of -15%) experienced higher cumulative rates of cardiovascular events compared with those with less impaired LV GLS (χ2=8.292, log-rank P=.004). On multivariate Cox regression analysis, LV GLS demonstrated an independent association with cardiovascular events (hazard ratio, 2.171; 95% CI, 1.015-4.642; P=.046), whereas LV ejection fraction was not significantly associated with the outcome. In patients with SLE, LV systolic function as measured by LV GLS is significantly impaired and associated with cardiovascular events, potentially representing a new tool to improve risk stratification in these patients.

Evaluation of Systolic Function of the Right Ventricle in Patients with Chronic Obstructive Pulmonary Disease: A Cross Sectional Study about 30 Cases

Introduction: Chronic pulmonary heart is the main cardiovascular complication of chronic obstructive pulmonary disease. The aims of our study were to evaluate the right ventricular systolic function in patients with chronic obstructive pulmonary disease and to investigate the relationship between parameters of right ventricular function and pulmonary function testing data. Methodology: A multicenter cross-sectional study was conducted between January 2013 and July 2013 in cardiology and pulmonology department in Dakar. Was included all in or outpatient diagnosed for chronic obstructive pulmonary disease. Results: 30 patients were evaluated in this cohort. The mean age was 62.4 years. Male predominance was noted (sex ratio of 9). Right heart failure was found in 7 patients (23.3%) had. Right ventricule enlargement was noted in 12 patients (40%). Mean sPAP was 58.58 ± 23.59 mmHg. Pulmonary arterial hypertension was found in 16 (53.3%) patients. TAPSE was impaired in 7 patients (23.3%). Reduction of right ventricule fractional area change was present in 14 (46.6%) patients. S’ of the tricuspid annulus velocity was reduced in 11 (33%) patients. Parameters correlated with the severity of chronic obstructive pulmonary disease were: TAPSE (p= 0.0099), right ventricule fractional area change (p = 0.0095), S’ of the annular tricuspid (p= 0.0173) TEI index (p= 0.038) and Pulmonary arterial hypertension (p= 0,023). Conclusion: Evaluation of right ventricular systolic function in chronic obstructive pulmonary disease is fundamental and must use multiple parameters.

Left Ventricular Systolic Function in Patients with Rheumatic Mitral Stenosis: Speckle Tracking Study

Left Ventricular Systolic Function in Patients with Rheumatic Mitral Stenosis: Speckle Tracking Study

Characteristics and Prognostic Associations of Echocardiographic Pulmonary Hypertension With Normal Left Ventricular Systolic Function in Patients ≥90 Years of Age

The high prevalence of pulmonary hypertension (PH) in elderly patients is well known. However, much remains unknown about those population. We sought to find the clinical characteristics of echocardiographic PH and the prognostic factors in patients ≥90 years of age. We retrospectively reviewed 310 patients ≥90 years of age (median age 92 years, 64% women) diagnosed as echocardiographic PH (peak systolic pulmonary arterial pressure ≥40 mm Hg) with normal left ventricular systolic function. We defined left heart disease (LHD) as significant left-sided valve diseases, left ventricular hypertrophy and left ventricular diastolic dysfunction by using echocardiography. The endpoint was all-cause death at 2,000 days after diagnosis. LHD was found in 92% of patients. During the median follow-up of 367 days (interquartile range, 39-1,028 days), 151 all-cause deaths (49%) occurred. Multivariable Cox regression analysis demonstrated that right ventricular fraction area change <35% (adjusted hazard ratio [HR]: 2.31; p <0.001), pericardial effusion (adjusted HR: 2.28; p <0.001), serum albumin <3.5 g/dL (adjusted HR: 1.76; p = 0.001), chronic obstructive pulmonary disease (adjusted HR: 1.93; p = 0.001) and New York Heart Association (NYHA) class ≥II (adjusted HR: 1.73; p = 0.004) were associated with mortality after adjusted for age. In conclusion, LHD was significantly associated with echocardiographic PH in most patients ≥90 years of age. Also, the co-morbid factors at diagnosis (right ventricular systolic dysfunction, pericardial effusion, hypoalbuminemia, chronic obstructive pulmonary disease, and NYHA class ≥II) were independently associated with mortality.

Self-care and related factors associated with left ventricular systolic function in patients under follow-up after myocardial infarction.

Recent advances in treatment have led to long-term survival after myocardial infarction (MI), but subsequent complications such as heart failure have also increased, and, therefore, the relationship between prognosis and self-care needs to be investigated. This study aimed to confirm the relationship of potential variables affecting self-care of patients after MI and to determine whether self-care predicts left ventricular systolic function. Using a descriptive study design, a hypothetical model was constructed based on previous studies, and 191 post-MI patients were recruited from three university hospital outpatient clinics in Korea. The modified model was verified by constructing a structural equation model using AMOS version 24.0. The exogenous variables were illness perception, social support, and depression symptoms. The endogenous variables were self-efficacy, self-care compliance, and changes in left ventricular ejection fraction (LVEF). The average patient age and disease duration were 66.3 (±11.5) years and 62.1 (±56.6) months, respectively. Self-care compliance was directly influenced by self-efficacy and indirectly affected by social support. Self-care compliance had a direct effect on LVEF changes, which was indirectly associated with illness perception, social support, and self-efficacy. This study confirmed the direct effect of self-care compliance on changes in LVEF in patients under follow-up after MI. It is necessary to periodically monitor the degree of self-care in outpatients who are undergoing follow-up after MI to prevent a decrease in cardiac function. Counseling and education may be effective forms of social support to improve disease awareness and self-efficacy among patients with low self-care compliance.

Intracoronary Injection of Autologous CD34+ Cells Improves One-Year Left Ventricular Systolic Function in Patients with Diffuse Coronary Artery Disease and Preserved Cardiac Performance—A Randomized, Open-Label, Controlled Phase II Clinical Trial

This phase II randomized controlled trial tested whether intracoronary autologous CD34+ cell therapy could further improve left ventricular (LV) systolic function in patients with diffuse coronary artery disease (CAD) with relatively preserved LV ejection fraction (defined as LVEF >40%) unsuitable for coronary intervention. Between December 2013 and November 2017, 60 consecutive patients were randomly allocated into group 1 (CD34+ cells, 3.0 × 107/vessel/n = 30) and group 2 (optimal medical therapy; n = 30). All patients were followed for one year, and preclinical and clinical parameters were compared between two groups. Three-dimensional echocardiography demonstrated no significant difference in LVEF between groups 1 and 2 (54.9% vs. 51.0%, respectively, p = 0.295) at 12 months. However, compared with baseline, 12-month LVEF was significantly increased in group 1 (p < 0.001) but not in group 2 (p = 0.297). From baseline, there were gradual increases in LVEF in group 1 compared to those in group 2 at 1-month, 3-months, 6-months and 12 months (+1.6%, +2.2%, +2.9% and +4.6% in the group 1 vs. −1.6%, −1.5%, −1.4% and −0.9% in the group 2; all p < 0.05). Additionally, one-year angiogenesis (2.8 ± 0.9 vs. 1.3 ± 1.1), angina (0.4 ± 0.8 vs. 1.8 ± 0.9) and HF (0.7 ± 0.8 vs. 1.8 ± 0.6) scores were significantly improved in group 1 compared to those in group 2 (all p < 0.001). In conclusion, autologous CD34+ cell therapy gradually and effectively improved LV systolic function in patients with diffuse CAD and preserved LVEF who were non-candidates for coronary intervention (Trial registration: ISRCTN26002902 on the website of ISRCTN registry).

Systolic function of the left ventricle in patients with pulmonary hypertension on the background of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) greatly affects the quality of life, significantly limiting the physical capabilities of people suffering from it. The prevalence of COPD worldwide is about 7,6 %, and it is one of the main causes of morbidity and mortality in today’s society. An urgent medical and social problem of our time is the development of pulmonary hypertension (PH) in patients with COPD. Transthoracic echocardiography is important for PH screening. It has the highest sensitivity and specificity among non-invasive examinations, and unlike catheterization of the right heart, it does not require special equipment and centers for dynamic monitoring of patients with PH. When pulmonary hypertension, there is a pronounced remodeling of the heart. At the first stage, it occurs in the right parts of the heart, and in the future, as a consequence, it is accompanied by a violation of systolic inter-ventricular interactions.&#x0D; Purpose of the study. To determine the characteristics of left ventricular systolic function in patients with pulmonary hypertension on the background of COPD.&#x0D; Materials and methods. Results of the study are based on data from a comprehensive survey of 170 COPD patients aged 40 to 65 years, 123 of which had pulmonary hypertension and 47 ones had no pulmonary hypertension.&#x0D; Results and discussion. In the group of patients with PH on the background of COPD, the shock volume was 74,72 cm3 (64,60–83,09) and it was significantly lower compared to the level of 82,04 cm3 (75,20–87,76) of the COPD group without PH (p &lt; 0,05). Such echocardiographic index as left ventricular ejection fraction in groups of patients with COPD with PH and without it, was 57,59% (53,84–62,19) and 59,44% (56,67–61,88), respectively, and it was significantly lower compared to the level of 64,62% (62,86–67,91) of healthy individuals (p &lt; 0,05).&#x0D; There was a straight increase in end-diastolic volume and end-systolic volume in the subgroup of patients with COPD duration &gt; 12 years compared to the subgroup  12 years, 134,17 cm3 (117,00–150,15) versus 125,52 cm3 (105,20–139,60) and 57,37 cm3 (51,70–65,60) versus 51,40 cm3 (43,08–59,84),&#x0D; respectively (p &lt; 0,05). The impact volume had no significant differences between subgroups depending on the duration of COPD (p &gt; 0,05). The level of LV ejection fraction was significantly lower in the subgroup of COPD duration &gt; 12 years 56,64% (52,65–59,73) against the subgroup  12 years (p &lt; 0,05). There were no significant differences between the levels of systolic heart function indicators: end-diastolic volume, end-systolic volume, shock volume, and LV EF depending on the stage of COPD (p &gt; 0,05). Correlation analysis revealed significant relationships between the following indicators: duration of COPD and ESV (R = +0,24, p = 0,008); duration of COPD and LV EF (R = –0,25, p = 0,006); MPAP and EDV (R = –0,22, p = 0.02); MPAP and SV (R = –0,26, p = 0,004); MPAP and LV EF (R = –0,21, p = 0,02).

Exercise is Associated With Impaired Left Ventricular Systolic Function in Patients With Lamin A/C Genotype.

BackgroundLamin A/C cardiomyopathy is a malignant and highly penetrant inheritable cardiomyopathy. Competitive sports have been associated with adverse events in these patients, but data on recreational exercise are lacking. We aimed to explore associations between exercise exposure and disease severity in patients with lamin A/C genotype.Methods and ResultsLamin A/C genotype positive patients answered a questionnaire on exercise habits from age 7 years until genetic diagnosis. We recorded exercise hours >3 metabolic equivalents and calculated cumulative lifetime exercise. Patients were grouped in active or sedate based on lifetime exercise hours above or below median. We performed echocardiography, 12‐lead ECG, Holter monitoring, and biomarkers including NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide). We defined left ventricular ejection fraction <45% as a clinically significant impairment of left ventricular function. We included 69 patients (age 42±14 years, 41% probands, 46% women) with median lifetime exercise 4160 (interquartile range 1041–6924) hours. Active patients were more frequently probands (53% versus 29%, P=0.04), had lower left ventricular ejection fraction (43±13% versus 51±11%, P=0.006), and higher NT‐proBNP (78 [interquartile range 32–219] pmol/L versus 30 [interquartile range 13–64] pmol/L, P=0.03) compared with sedate, while age did not differ (45±13 years versus 40±16 years, P=0.16). The decrease in left ventricular ejection fraction per tertile increment in lifetime exercise was 4% (95% CI −7% to −0.4%, P=0.03), adjusted for age and sex and accounting for dependence within families. Left ventricular ejection fraction <45% was observed at a younger age in active patients (log rank P=0.007).ConclusionsActive lamin A/C patients had worse systolic function compared with sedate which occurred at younger age. Our findings may improve exercise recommendations in patients with lamin A/C.

415 The Immediate Impact of Electrical Cardioversion on Right Ventricular Systolic Function in Patients With Non-Valvular Atrial Fibrillation

Successful electrical cardioversion (ECV) for atrial fibrillation (AF) is often followed by a transient period of atrial stunning, where depressed mechanical atrial function persists despite reversion to sinus rhythm (SR). Left ventricular (LV) changes following ECV are well characterised, but knowledge of early changes to right ventricular (RV) function is lacking. We aimed to assess the immediate impact of ECV on right heart function. Patients referred for ECV with non-valvular AF between Jan 2017 to Jan 2018 were assessed. Patients without history of heart failure, normal left ventricular ejection fraction, and who successfully reverted to SR following ECV were prospectively recruited. RV metrics of systolic function including 2-dimensional RV free wall longitudinal strain (RV-FWLs) was measured offline from transthoracic echocardiogram images obtained prior to and immediately following ECV (TomTec Imaging system). Of 50 patients (64.14±11.01yrs, 60% male) assessed, 28% had a history of ischaemic heart disease and 5% had obstructive sleep apnoea. Paired T-test analysis showed a significant improvement in RV-FWLs (pre-ECV: 14.18±4.42 vs post-ECV: 21.02±6.80; p<0.01) and RV-FAC (pre-ECV: 36.77±8.85 vs post-ECV: 40.80±10.16; p=0.02) following ECV. Based on a cut-off value of ≥23% for RV-FWLs, 10% of the cohort had normal RV-FWLs pre-ECV which significantly increased to 36% post-ECV (p<0.01). A similar trend was observed with RV-FAC (cut-off value of ≤35%), although not statistical significant (pre-ECV: 60% normal RV-FAC, post-ECV: 74% normal RV-FAC; p=0.17). Improvements in RV-FWLs and RV-FAC was observed following ECV, suggesting that there are immediate improvements in RV function in this population.

P664 Relationship of left atrial function assessed by 2D speckle tracking echocardiography with left ventricular systolic function in patients with degenerative mitral regurgitation

Abstract Funding Acknowledgements none Background In degenerative mitral regurgitation (DMR), left ventricle (LV) and left atrium (LA) undergo progressive volume overload leading to chamber remodelling and dysfunction in advanced stages. Speckle tracking echocardiography (STE) is an estabilished technique able in detecting subclinical LA and LV dysfunction in this setting. However data are lacking on the relationship of LA and LV function in DMR patients. Purpose Our aim was to assess LA function in patients with DMR and to explore its possible correlations with LV dimensions and systolic function. Methods We enrolled 95 patients with mild to severe DMR, dichotomizing them on the basis of mitral regurgitation severity (DMR 1-2: mild and mild-to-moderate MR; DMR 3-4: at least moderate to severe MR). LA function was assesed with 2D speckle tracking echocardiography. Results The two groups were well matched. DMR 3-4 group (n= 48) showed higher LA and LV volumes, lower right ventricle longitudinal systolic function and higher values of systolic pulmonary pressure. There was not significant difference in LV ejection fraction (LVEF) and global longitudinal strain (GLS). Among LA function indexes, only peak systolic reservoir strain was significantly reduced in DMR 3-4 group (21,9± 6,2% vs 24,7± 7,2% ; p= 0,04). Then population study was further divided in two groups according to the presence (LA dys+) or absence (LA dys-) of LA dysfunction, defined as reservoir strain values below the median [median 23.7%; LAdys- group (n. 49), LAdys+ group (n.46) ]. At the comparison of continuous variables (Tab.1), LAdys+ group showed larger LV end systolic diameter and more impaired LVEF (60,9± 9,8% vs 65,4± 4,8%; p: 0,004) and GLS (20,04 ± 3,7% vs 23,53 ± 2,7%; p &amp;lt;0,001). Conclusions Our data showed that LA reservoir strain was impaired in patients with moderate to severe DMR. Furthermore, patients with LA dysfunction showed reduced LVEF and GLS values. Consequently, LA dysfunction assessed with STE may be a novel marker of early LV systolic dysfunction in patients with degenerative mitral regurgitation. Tab.1 LAdysf- (n = 49) LAdysf+ (n = 46) P value LVESD (mm) 31.78 ± 4.1 34.74 ± 7.6 0.020 LAVI (mL/mq) 44.5 ± 15.1 55.6 ± 25.6 0.015 TAPSE (mm) 26.30 ± 3.96 24.02 ± 3.31 0.004 sPAP (mmHg) 31.4 ± 7.0 36.4 ± 10.9 0.009 LVEF (%) 65.4 ± 4.8 60.9 ± 9.8 0.004 GLS (%) 23.5 ± 2.7 20.0 ± 3.7 &amp;lt;0.001 Comparison of continuous variables between patients with and without LA dysfunction.

Use of the Left Ventricular Internal Dimension at End-Diastole and the E-Point Septal Separation Ratio in the Prediction of the Left Ventricular Systolic Function in Patients with Midrange and Reduced Ejection Fractions: A Pilot Study

Background: The aim of this study was to investigate the ability of a new index, namely the left ventricular internal dimension at end-diastole/mitral valve E-point septal separation (LVIDd/EPSS), to predict the left ventricular (LV) systolic function and to compare its performance with that of the EPSS index and to investigate the correlation between the LVIDd/EPSS and the left ventricular ejection fraction (LVEF). Methods: The current study recruited 142 patients who presented to the Cardiology Clinic of Sakarya University Education and Research Hospital and were followed for heart failure (HF).M-mode measurements of the EPSS and the LVIDd were recorded in the parasternal long-axis view. Results: Totally, 142 HF patients with midrange ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF) were enrolled in the study. There was a significantly correlation both between the EF and the EPSS and between the EF and the LVIDd/EPSS (P<0.001). In both HFmrEF and HFrEF groups, the correlation between the LVIDd/EPSS and the EF was more significant than was the correlation between the EPSS and the EF (P<0.001). The results of the linear regression analysis indicated that the LVIDd/EPSS was an independent predictor of the HFmrEF and the HFrEF (P<0.001). In the patients with EPSS≤12, there was a significant association between the EF and the LVIDd/EPSS (P<0.001) but not between the EF and the EPSS(P>0.05). The receiver operating characteristic curve analysis showed that the LVIDd/EPSS predicted advanced HF with 87% sensitivity and 72% specificity, using a cutoff value of 3.35,and it predicted the HFrEF (EF<40%) with 84% sensitivity and 81% specificity, using a cutoff value of 3.75. Conclusion: The LVIDd/EPSS may allow certain clinicians, especially beginners and emergency department physicians, to assess the LVEF when other methods are not available or questionable.