Prognostic value of NT-proBNP for myocardial recovery in peripartum cardiomyopathy (PPCM)

Abstract Introduction Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure worldwide. Although a significant number of women recover their left ventricular (LV) function within 12 months, some remain with persistently reduced systolic function. Methods Knowledge gaps exist on predictors of myocardial recovery in PPCM. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the only clinically established biomarker with diagnostic value in PPCM. We aimed to establish whether NT-proBNP could serve as a predictor of LV recovery in PPCM, as measured by LV end-diastolic volume (LVEDD) and LV ejection fraction (LVEF). Results This study of 35 women with PPCM (mean age 30.0 ± 5.9 years) had a median NT-proBNP of 834.7 pg/ml (IQR 571.2–1840.5) at baseline. Within the first year of follow-up, 51.4% of the cohort recovered their LV dimensions (LVEDD < 55 mm) and systolic function (LVEF > 50%). Women without LV recovery presented with higher NT-proBNP at baseline. Multivariable regression analyses demonstrated that NT-proBNP of ≥ 900 pg/ml at the time of diagnosis was predictive of failure to recover LVEDD (OR 0.22, 95% CI 0.05–0.95, P = 0.043) or LVEF (OR 0.20 [95% CI 0.04–0.89], p = 0.035) at follow-up. Conclusions We have demonstrated that NT-proBNP has a prognostic value in predicting LV recovery of patients with PPCM. Patients with NT-proBNP of ≥ 900 pg/ml were less likely to show any improvement in LVEF or LVEDD. Our findings have implications for clinical practice as patients with higher NT-proBNP might require more aggressive therapy and more intensive follow-up. Point-of-care NT-proBNP for diagnosis and risk stratification warrants further investigation.

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The recent advances, drawbacks, and the future directions of CMRI in the diagnosis of IHD

Scientific Reports ◽

10.1038/s41598-021-94311-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Moram A. Fagiry ◽

Ikhlas Abdelaziz ◽

Rob Davidson ◽

Mustafa Z. Mahmoud

Keyword(s):

Systolic Function ◽

Diagnostic Value ◽

Left Ventricular ◽

Lv Function ◽

Conventional Coronary Angiography ◽

Future Directions ◽

Systolic Volume ◽

End Diastolic Volume ◽

Recent Advances ◽

The Future

AbstractIschemic heart disease (IHD), also known as coronary artery disease (CAD), is a leading cause of morbidity and mortality in adults. The aims of this research were to study the recent advances on the prognostic and diagnostic value, drawbacks, and the future directions of cardiac magnetic resonance imaging (CMRI) in the diagnosis of IHD. One hundred patients with IHD who had been clinically diagnosed were enrolled in this study prospectively. CMRI; Siemens Magnetom Sola 1.5 T MRI scanner was used to examine the patients. To confirm the diagnosis, conventional coronary angiography was used. CMRI revealed that the left ventricular (LV) volumes and systolic function of male and female patients differed by age decile were 28.9 ± 3.5%; 32 ± 1.7%, 53.3 ± 11.2; 58 ± 6.6 ml, 100.6 ± 7.1; 98.3 ± 14.7 bpm, 5.4 ± 1.4; 5.8 ± 1.5 L/min, 189 ± 14.3; 180 ± 10.9 ml, and 136 ± 3.1; 123 ± 4.4 ml for the left ventricle ejection fraction (LVEF), stroke volume (SV), heart rate, cardiac output, end diastolic volume (EDV), and end systolic volume (ESV), respectively. CMRI has sensitivity, specificity, and accuracy of 97%, 33.33%, and 95.15%, respectively. Finally, CMRI provides a comprehensive assessment of LV function, myocardial perfusion, and viability, as well as coronary anatomy.

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Prognostic value of NT-pro-BNP for myocardial recovery in peripartum cardiomyopathy

European Heart Journal ◽

10.1093/ehjci/ehaa946.3185 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Hoevelmann ◽

C.A Viljoen ◽

F Azibani ◽

A Imamdim ◽

S Kraus ◽

...

Keyword(s):

Heart Failure ◽

Risk Stratification ◽

Prognostic Value ◽

Prognostic Significance ◽

Left Ventricular ◽

Peripartum Cardiomyopathy ◽

Lower Probability ◽

Funding Source ◽

Myocardial Recovery

Abstract Background Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure and occurs in women towards the end of pregnancy or within the first five months post-partum. Though PPCM is mostly associated with left ventricular (LV) recovery, many affected women develop chronic heart failure with persistently reduced LV ejection fraction (LVEF). Despite recent advances in the treatment of PPCM, clinical predictors of myocardial recovery remain sparse. Purpose N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is the only clinically established biomarker with diagnostic value in PPCM. However, its prognostic value for LV recovery in PPCM remains uncertain. We aimed to establish whether NT-pro-BNP could serve as a predictor of LV recovery in PPCM, and if so, which levels would help with such risk stratification. Methods Women with PPCM seen at the Cardiomyopathy Clinic at Groote Schuur Hospital were recruited between 2012 and 2018. Clinical details and echocardiographic features were recorded at baseline and follow-up, and NT-pro-BNP was measured at baseline. LV recovery was defined as an LVEF of ≥50% at 12-month follow-up. Results This cohort of 42 women with PPCM had a mean age of 29.3±5.8 years and median parity of 2 (IQR 1–4). Almost half (45.2%) presented with a NYHA functional class III/IV. The median systolic and diastolic blood pressures were 117mmHg (IQR 105–133) and 75mmHg (IQR 68–85) respectively. The median heart was 94bpm (IQR 74–103). At diagnosis, mean LVEF was 31.1±8.4% and LV end-diastolic dimension (EDD) of 59mm (IQR 53–64), which improved to LVEF 44.5%±14.5 (p=0.001) and LVEDD 53.6mm (p=0.007) at 1 year. Median NT-pro-BNP at presentation was 915.8pg/mL (IQR 613.6–2422.5). Patients presenting with sinus tachycardia (heart rate >100 bpm) had significantly higher NT-pro-BNP values (1815 vs. 728pg/mL, p=0.009) at the time of diagnosis. At presentation, NT-pro-BNP tended to correlate with LVEDD (R 0.33, p=0.04) and was inversely correlated with LVEF (R −0.39, p=0.01). Whereas initial LVEDD and LVEF did not predict LV recovery at 1 year, NT-pro-BNP at the time of diagnosis had prognostic significance. Patients without LV recovery had a significantly higher NT-pro-BNP at diagnosis (1694.1pg/mL vs. 613.1pg/mL, p=0.02). As shown in Figure 1, NT-pro-BNP of >900pg/mL was associated with lower probability of LV recovery (OR 0.19 [95% CI 0.05–0.73], p=0.018). Conclusion We show, for the first time, that NT-pro-BNP has a prognostic value for LV recovery in PPCM. NT-pro-BNP may be useful in the risk stratification in PPCM and may be used to recommend more intensive follow-up of patients who have a NT-pro-BNP >900pg/mL at diagnosis. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the South African Medical Research Council and National Research Foundation of South Africa.

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Peripartum Cardiomyopathy Presenting with Predominant Left Ventricular Diastolic Dysfunction: Efficacy of Bromocriptine

Case Reports in Medicine ◽

10.1155/2012/476903 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Piercarlo Ballo ◽

Irene Betti ◽

Giuseppe Mangialavori ◽

Leandro Chiodi ◽

Gherardo Rapisardi ◽

...

Keyword(s):

Heart Failure ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Systolic Function ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Peripartum Cardiomyopathy ◽

Lv Function ◽

Lv Diastolic Dysfunction ◽

Lv Diastolic Function

Management of patients with peripartum cardiomyopathy (PPCM) is still a major clinical problem, as only half of them or slightly more show complete recovery of left ventricular (LV) function despite conventional evidence-based treatment for heart failure. Recent observations suggested that bromocriptine might favor recovery of LV systolic function in patients with PPCM. However, no evidence exists regarding its effect on LV diastolic dysfunction, which is commonly observed in these patients. Tissue Doppler (TD) is an echocardiographic technique that provides unique information on LV diastolic performance. We report the case of a 37-year-old white woman with heart failure (NYHA class II), moderate LV systolic dysfunction (ejection fraction 35%), and severe LV diastolic dysfunction secondary to PPCM, who showed no improvement after 2 weeks of treatment with ramipril, bisoprolol, and furosemide. At 6-week followup after addition of bromocriptine, despite persistence of LV systolic dysfunction, normalization of LV diastolic function was shown by TD, together with improvement in functional status (NYHA I). At 18-month followup, the improvement in LV diastolic function was maintained, and normalization of systolic function was observed. This paper might support the clinical utility of bromocriptine in patients with PPCM by suggesting a potential benefit on LV diastolic dysfunction.

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Complete dexrazoxane cardioprotection for cardiac function but incomplete female cardioprotection for cardiac structure in doxorubicin-treated osteosarcoma survivors: Hearts too small for the body.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.10519 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 10519-10519

Author(s):

Lisa M. Kopp ◽

Mark L. Bernstein ◽

Cindy L. Schwartz ◽

David Ebb ◽

Vivian L Franco ◽

...

Keyword(s):

Heart Failure ◽

Wall Thickness ◽

Systolic Function ◽

Posterior Wall ◽

Left Ventricular ◽

The Body ◽

Lv Function ◽

Lv Systolic Function ◽

Trastuzumab Cardiotoxicity

10519 Background: Dexrazoxane is protective for lower-dose doxorubicin ( < 300 mg/m2) cardiotoxicity in childhood cancer, but the effect of dexrazoxane (DXRZ) administered with higher-dose (HD) doxorubicin (DOXO) is unknown. Methods: We evaluated patients from Children’s Oncology Group trials for localized (P9754) and metastatic (AOST0121) osteosarcoma (OS) who received HD DOXO (375-600 mg/m2) preceded by DXRZ (10:1 ratio), methotrexate, and cisplatin; some also received ifosfamide alone or ifosfamide/etoposide ± trastuzumab. Cardiotoxicity was identified by echocardiography and by serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations. Results: 81 DXRZ -treated OS patients ( age at enrollment = 13.7 years; range 3.8 - 23.7 years) had normal left ventricular (LV) systolic function as measured by LV fractional shortening and no heart failure. Female sex and longer follow-up since DOXO were associated with a significantly smaller LV dimension z-score normalized to BSA (μ = -1.20, 95%CI [-1.70, -0.70]). Similarly, in the one-third of patients treated > 81 days after minimal expected treatment (groups equally partitioned by time), significantly thinner LV posterior wall thickness for BSA (μ = -0.57, [-1.05, -0.09]) was found. Interventricular septal wall thickness (μ = -0.84, [-1.2, -0.48]) and LV mass (μ = -0.73, [-1.06, -0.40]) were significantly smaller for BSA than normal for both sexes. For females, these became significantly more abnormal with increasing length of follow-up. Females also showed progressive increases in NT-proBNP. Conclusions: DXRZ is cardioprotective for HD DOXO in terms of LV function and heart failure. Females had progressive abnormalities of LV structure, leading to smaller hearts for body size. This was associated with increasing cardiac stress, as measured by NT-proBNP. DXRZ protection was incomplete for HD DOXO effects on LV structure, resulting in higher LV stress and risk for late LV dysfunction. DXRZ should continue to be used in this population, including for females who exhibit more cardiotoxicity than males at specific cumulative DOXO doses.

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Abstract 4310: Chronic Effects of Surgical Ventricular Restoration on Left Ventricular Function: 6 Months Follow-Up by Pressure-Volume Loops

Circulation ◽

10.1161/circ.118.suppl_18.s_864-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Ellen A ten Brinke ◽

Robert J Klautz ◽

Sven A Tulner ◽

Frank H Engbers ◽

Hariette F Verwey ◽

...

Keyword(s):

Systolic Function ◽

Nyha Class ◽

Mechanical Dyssynchrony ◽

Left Ventricular ◽

Lv Function ◽

Stroke Work ◽

Surgical Ventricular Restoration ◽

Chronic Effects ◽

Ventricular Restoration

Previous studies have demonstrated beneficial acute effects of surgical ventricular restoration (SVR) on mechanical dyssynchrony and left ventricular (LV) function, and improved mid- and long-term clinical parameters. However, chronic effects on systolic and diastolic LV function are still largely unknown. We studied 9 patients with ischemic dilated cardiomyopathy who underwent SVR. In all patients, invasive hemodynamic measurements by the conductance catheter (pressure-volume loops) were obtained during catheterization before and 6 months after surgery. In addition, NYHA classification, Minnesota Quality of Life (QoL)-score and 6-minute-hall-walk-test (6min-HWT) were assessed. At 6 months follow-up, all patients were alive and clinically significantly improved: NYHA class from 3.3±0.5 to 1.4±0.7, QoL-score from 46±22 to 15±15 and 6min-HWT from 302±123 to 444±78 m (all p<0.01). Hemodynamic data at fixed paced heart rate (80 bpm), showed improved cardiac output (4.8±1.4 to 5.6±1.1 L/min) (p =0.09), stroke work (6.5±1.9 to 7.1±1.4 mmHg.L) (p =0.05) and LV ejection fraction (36±10 to 46±10%) (p <0.001). LV surgical remodeling was sustained at 6 months: end-diastolic volume decreased from 246±70 to 180±48 mL and end-systolic volume from 173±77 to 103±40 mL (both p<0.001). LV mechanical dyssynchrony decreased from 29±6 to 26 ±3% (p<0.001) and ineffective internal LV flow fraction decreased from 58±30 to 42±18% (p<0.005). Early relaxation (tau, −dP/dt MIN ) was unchanged, but diastolic stiffness constant (K ED ) increased from 0.012±0.003 to 0.023±0.007 mL −1 (p<0.001) at 6 months follow-up. SVR leads to maintained LV volume reduction at 6 months follow-up. In addition, we observed improved systolic function and unchanged early diastolic function, but impaired passive diastolic properties. Clinical improvement, supported by decreased NYHA class, improved QoL-score and improved 6-min-HWT may be related to improved systolic function and reduced mechanical dyssynchrony.

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Abstract 2180: Relationship of Left Ventricular Systolic Function to Persistence or Development of Electrocardiographic Left Ventricular Hypertrophy in Hypertensive Patients: Implications for the Development of New Heart Failure

Circulation ◽

10.1161/circ.116.suppl_16.ii_473 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Peter M Okin ◽

Kristian Wachtell ◽

Eva Gerdts ◽

Kurt Boman ◽

Markku S Nieminen ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Diastolic Pressure ◽

Systolic Function ◽

Left Ventricular ◽

Lv Function ◽

Increased Risk ◽

Cornell Product

Background : We have previously demonstrated that persistence or development of ECG left ventricular hypertrophy (LVH) by Cornell product criteria are associated with an increased risk of developing heart failure (HF) compared with regression or continued absence of LVH. We postulated that this relationship might be in part mediated via worse LV systolic function in patients with new and persistent LVH. Methods : Baseline and year-3 ECG LVH and LV midwall shortening (MWS) were examined in 725 patients in the LIFE echocardiographic substudy. MWS was measured and considered abnormal if <14.2%; stress-corrected MWS (scMWS) was considered abnormal if 2440 mm-msec. Results : Between baseline and 3 years follow-up, there was continued absence (n=260) or regression (n=167) of LVH in 427 patients and persistence (n=259) or development (n=39) of ECG LVH in 298 patients. Although there was no difference in baseline prevalence of abnormal MWS (23.4 vs 26.5%, p=0.389) or abnormal scMWS (24.6 vs 26.4%, p=0.663) between groups, after 3 years follow-up persistence or development of new LVH was associated with significantly lower mean MWS and scMWS and with higher prevalence and odds of abnormal MWS and scMWS than continued absence or regression of LVH (Table ). After controlling for differences in age, gender, race, treatment group, baseline and change from baseline to year-3 of heart rate, Sokolow-Lyon voltage, systolic and diastolic pressure and baseline severity of LVH by Cornell product, persistent or new ECG LVH remained associated with a >2-fold increased risk of abnormal MWS or scMWS at year 3. Conclusions : Persistence or development of new ECG LVH during antihypertensive therapy is associated with an increased risk of LV systolic dysfunction after 3 years of follow-up. These findings provide insight into a possible mechanism by which changes in ECG LVH are associated with changing risk of developing HF. < Midwall LV Function in Relation to Persistence or Development of ECG LVH Between Baseline and Year-3

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Abstract 15481: LV Systolic Dysfunction is Improved by TAVR: Insights From the French-American Registry

Circulation ◽

10.1161/circ.132.suppl_3.15481 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Abdulla Damluji ◽

Yahya E Alansari ◽

Michael Dyal ◽

Magdalena Murman ◽

Mohamad Kabach ◽

...

Keyword(s):

Systolic Function ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Lv Function ◽

Cvd Risk ◽

Hispanic Males ◽

Ventricular Ejection Fraction ◽

Lv Systolic Function

Introduction: We sought to describe changes in left ventricular ejection fraction (LVEF) after TAVR procedures. Methods: This is an observational study from 04/2008 to 06/2015 of all consecutive adults who received TAVR for severe symptomatic AS with Edwards Sapien or Medtronic CoreValve at two tertiary academic centers in USA and France. Results: Of 765 patients who received TAVR, 716 (94%) had follow-up echocardiography. Of those, 513 (72%), 143 (20%), 60 (8%) had a baseline EF>50%, EF 30-49%, and EF<30, respectively. Patients with EF < 30% were more likely to be Hispanic males. There were no differences in age, CVD risk factors, or history of multivessel coronary disease among groups. Patients with EF<30% were more likely to have AICD implantation and paced rhythm. All groups had similar rates of IABP insertion for hemodynamic support (EF≥50%: 6%, EF<30-49%: 9%, EF<30: 5%, p=0.544), procedural success (EF≥50%: 94%, EF<30-49%: 97%, EF<30: 98%, p=0.180), in-hospital mortality, procedural complications, and complete heart block. However, one-year all-cause-mortality was higher if baseline LV systolic function was abnormal (EF≥50%: 6%, EF<30-49%: 14%, EF<30: 9%, p=0.036). On 30-day follow-up echocardiography, absolute improvement in LVEF was highest among patients with EF<30% (Figure 1). If baseline LVEF was reduced, unchanged or improved mitral regurgitation were associated with improved LV function on follow-up (Figure 2). Conclusion: Transcatheter treatment of severe symptomatic AS is safe and feasible, even in patients with LVEF<30%. Most patients with LVEF<50% had increased EF after TAVR procedures.

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Prognostic Value of Left Ventricular Function and Mechanics in Pulmonary Hypertension: A Pilot Cardiovascular Magnetic Resonance Feature Tracking Study

Medicina ◽

10.3390/medicina55030073 ◽

2019 ◽

Vol 55 (3) ◽

pp. 73 ◽

Cited By ~ 5

Author(s):

Lina Padervinskienė ◽

Aušra Krivickienė ◽

Deimantė Hoppenot ◽

Skaidrius Miliauskas ◽

Algidas Basevičius ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Cardiovascular Magnetic Resonance ◽

Feature Tracking ◽

Prognostic Value ◽

Longitudinal Strain ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Lv Function ◽

Lv Systolic Function

Background and objective: Cardiovascular magnetic resonance (CMR) - based feature tracking (FT) can detect left ventricular (LV) strain abnormalities in pulmonary hypertension (PH) patients, but little is known about the prognostic value of LV function and mechanics in PH patients. The aim of this study was to evaluate LV systolic function by conventional CMR and LV global strains by CMR-based FT analysis in precapillary PH patients, thereby defining the prognostic value of LV function and mechanics. Methods: We prospectively enrolled 43 patients with precapillary PH (mean pulmonary artery pressure (mPAP) 55.91 ± 15.87 mmHg, pulmonary arterial wedge pressure (PAWP) ≤15 mmHg) referred to CMR for PH evaluation. Using FT software, the LV global longitudinal strain (GLS) and global circumferential strain (GCS), also right ventricular (RV) GLS were analyzed. Results: Patients were classified into two groups according to survival (survival/non-survival). LV GLS was significantly reduced in the non-survival group (−12.4% [−19.0–(−7.8)] vs. −18.4% [−22.5–(−15.5)], p = 0.009). By ROC curve analysis, LV GLS > −14.2% (CI: 3.229 to 37.301, p < 0.001) was found to be robust predictor of mortality in PH patients. Univariable analysis using the Cox model showed that severely reduced LV GLS > −14.2%, with good sensitivity (77.8%) and high specificity (93.5%) indicated an increase of the risk of death by 11-fold. LV GLS significantly correlated in PH patients with RV ESVI (r = 0.322, p = 0.035), RV EF (r = 0.444, p < 0.003). Conclusions: LV systolic function and LV global longitudinal strain measurements using CMR-FT correlates with RV dysfunction and is associated with poor clinical outcomes in precapillary PH patients.

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NT-pro-BNP levels in patients with acute pulmonary embolism are correlated to right but not left ventricular volume and function

Thrombosis and Haemostasis ◽

10.1160/th11-12-0901 ◽

2012 ◽

Vol 108 (08) ◽

pp. 367-372 ◽

Cited By ~ 9

Author(s):

Frederikus A. Klok ◽

Noortje van der Bijl ◽

Albert de Roos ◽

Lucia J. M. Kroft ◽

Menno V. Huisman ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Systolic Function ◽

Ventricular Volume ◽

Left Ventricular ◽

Lv Function ◽

Relative Contribution ◽

End Diastolic Volume ◽

The Right ◽

Enddiastolic Volume

SummaryN-terminal pro-Brain Natriuretic Peptide (NT-pro-BNP) is primarily secreted by left ventricular (LV) stretch and wall tension. Notably, NT-pro-BNP is a prognostic marker in acute pulmonary embolism (PE), which primarily stresses the right ventricle (RV). We sought to evaluate the relative contribution of the RV to NT-pro-BNP levels during PE. A posthoc analysis of an observational prospective outcome study in 113 consecutive patients with computed tomography (CT)-proven PE and 226 patients in whom PE was clinically suspected but ruled out by CT. In all patients RV and LV function was established by assessing ECG-triggered-CT measured ventricular end-diastolic-volumes and ejection fraction (EF). NT-pro-BNP was assessed in all patients. The correlation between RV and LV end-diastolic-volumes and systolic function was evaluated by multiple linear regression corrected for known con-founders. In the PE cohort increased RVEF (β-coefficient (95% confidence interval [CI]) –0.044 (± –0.011); p<0.001) and higher RV enddiastolic-volume (β-coefficient 0.005 (± 0.001); p<0.001) were significantly correlated to NT-pro-BNP, while no correlation was found with LVEF ( β-coefficient 0.005 (± 0.010); p=0.587) and LV end-diastolic-volume (β-coefficient –0.003 (± 0.002); p=0.074). In control patients without PE we found a strong correlation between NT-pro-BNP levels and LVEF ( β-coefficient –0.027 (± –0.006); p<0.001) although not LV enddiastolic-volume (β-coefficient 0.001 (± 0.001); p=0.418). RVEF (β-co-efficient –0.002 (± –0.006); p=0.802) and RV end-diastolic-volume (β-coefficient <0.001 (± 0.001); p=0.730) were not correlated in patients without PE. In PE patients, lower RVEF and higher RV end-diastolic-volume were significantly correlated to NT-pro-BNP levels as compared to control patients without PE. These observations provide patho-physiological ground for the well-known prognostic value of NT-pro-BNP in acute PE.

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Abstract 15512: Predictors of Normalization of Left Ventricular Systolic Function After Acute Myocarditis -multicenter Observational Study

Circulation ◽

10.1161/circ.142.suppl_3.15512 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ayano Yoshida ◽

Kentaro Jujo ◽

Eiji Shibahashi ◽

Takuma Takada ◽

Yuichiro Minami ◽

...

Keyword(s):

Observational Study ◽

Systolic Function ◽

Acute Myocarditis ◽

Area Under The Curve ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Lv Function ◽

Multicenter Observational Study ◽

Recovery Group

Introduction: The clinical presentation of acute myocarditis is highly variable, and its prognosis is occasionally unpredictable. Even the patients discharge alive, left ventricular (LV) remodeling occurs during the follow-up period in some cases, which causes the progression of dilated cardiomyopathy or sudden cardiac death. Purpose: We aimed to investigate the predictors of the recovery of LV ejection fraction (LVEF) in patients with acute myocarditis. Methods: This multicenter observational study included 20 patients [average age 38 years, 18 (90%) male] suffering acute myocarditis who were urgently hospitalized between 2007 and 2019. Enrolled patients were assigned into 2 groups depending on a recovery of LV function that was defined as LVEF ≥55% by transthoracic echocardiography (TTE) within 12 months after the onset; the Recovery group (n=8) and Non-recovery group (n=12). Results: Overall, LVEF increased from 37% to 52% (p<0.001) during the follow-up period (median interval: 180 (IQR: 42-332) days). There was no statistically differences in baseline clinical profiles or medications at discharge between the groups. However, LVEF at admission was significantly higher in the Recovery group than Non-recovery group (47±13% vs. 31±13%, p=0.014). The univariate logistic regression analysis showed that baseline LVEF was related to a recovery of LV function (odds ratio, 1.12; 95% confidence interval, 1.00-1.26). The ROC curve for a recovery of LV function revealed that the cut-off value of LVEF at admission was 42% (sensitivity: 75%, specificity: 83%, area under the curve: 0.83, Figure A ). Patients with baseline LVEF ≥42% achieved significantly higher rates of LV functional recovery after acute myocarditis than those with LVEF <42% (17% vs 75%, p=0.019, Figure B ). Conclusions: Baseline LVEF could predict a normalization of LV function in patients with acute myocarditis. Close observation and TTE follow-up should be considered in such a refractory population.

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