scholarly journals Myocardial work of the athlete's heart: the new champion of systolic function?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Tokodi ◽  
A Olah ◽  
M Ruppert ◽  
B.K Lakatos ◽  
A Fabian ◽  
...  
Keyword(s):  
Rat Model ◽  
Systolic Function ◽  
Elite Athletes ◽  
Global Longitudinal Strain ◽  
Cardiac Contractility ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Funding Source ◽  
Athlete's Heart

Abstract Background Regular, vigorous exercise induces morphological changes in the heart, including increased left ventricular (LV) volumes and mass. Although this represents a physiological adaptation to the increased cardiovascular demand, in a certain number of highly trained athletes, the LV remodelling is accompanied by decreased resting values of global longitudinal strain (GLS), exceeding even pathological limits. In this case, the differential diagnosis of overlapping pathological conditions represents a clinical challenge. Myocardial work (MW) evaluates myocardial deformation in the context of afterload; therefore, it may potentially overcome the limitations of GLS, and may better reflect the contractility of the athlete's heart. Purpose We sought to evaluate MW of elite athletes compared to sedentary volunteers. We also aimed to validate its robustness by investigating its relation to the invasively measured parameters of myocardial contractility in a rat model of the athlete's heart. Methods A total of 30 elite swimmers (19±4 years, 23±5 hours of training/week, 50% males) and 23 healthy sedentary controls (19±4 years, 40% males) were enrolled. Global MW index (GMWI) and constructive MW index (CMWI) were calculated using a vendor-specific module through the simultaneous evaluation of GLS by speckle-tracking echocardiography (STE) and the non-invasively approximated LV pressure curves (estimated from brachial cuff systolic pressure). In the rat model, LV hypertrophy was induced by swim training (n=18, 200 min/day for 12 weeks). An additional group of 17 untrained control rats were examined as well. STE was performed to assess GLS, which was followed by invasive pressure-volume (P-V) analysis to register LV pressure and to calculate cardiac contractility (slope of end-systolic P-V relationship [ESPVR]). GMWI and CMWI were assessed by evaluating the area of the LV pressure-strain loop. Results GLS was decreased in human athletes (athletes vs. controls: −18±2 vs. −19±1, p<0.05). However, athletes had higher values of CMWI (2097±293 vs. 1943±213 mmHg%, p<0.05), whereas GMWI was unchanged compared to controls (1850±299 vs. 1755±189 mmHg%, p=NS). The trained group of rats was characterized by unchanged GLS (−22±3 vs. −20±4, p=NS), however, ESPVR, GMWI, and CMWI were increased (3.64±0.70 vs. 2.55±0.38 mmHg/μL, p<0.001; 3002±488 vs. 2554±375 mmHg%, p<0.05; 3200±532 vs. 2780±591 mmHg%, p<0.05) compared to control rats. MW indices correlated with cardiac contractility measured by P-V analysis (ESPVR vs. GMWI r=0.38, p<0.05; vs. CMWI r=0.39, p<0.05). Conclusions Due to the adaptive LV remodelling, resting markers of LV systolic function may be decreased in elite athletes. Despite the reduced GLS, GMWI was preserved, and CMWI was supernormal in human athletes and the experimental model verified their correlation with contractility. Our findings indicate that MW indices in athletes may be better markers of systolic function compared to GLS. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary

scholarly journals Electrocardiographic and Echocardiographic Insights From a Prospective Registry of Asian Elite Athletes

2022 ◽  
Vol 8 ◽  
Author(s):  
Tee Joo Yeo ◽  
Mingchang Wang ◽  
Robert Grignani ◽  
James McKinney ◽  
Lay Pheng Koh ◽  
...  
Keyword(s):  
Female Athletes ◽  
Elite Athletes ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Left Ventricular Cavity ◽  
Male Athletes ◽  
Endurance Sport ◽  
Electrocardiogram Ecg ◽  
Athlete's Heart

Background: Asian representation in sport is increasing, yet there remains a lack of reference values for the Asian athlete's heart. Consequently, current guidelines for cardiovascular screening recommend using Caucasian athletes' norms to evaluate Asian athletes. This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athlete's heart using a Singaporean prospective registry of Southeast (SE) Asian athletes.Methods and Results: One hundred and fifty elite athletes, mean age of 26.1 ± 5.7 years (50% males, 88% Chinese), were evaluated using a questionnaire, 12-lead electrocardiogram (ECG) and transthoracic echocardiogram. All ECGs were analyzed using the 2017 International Recommendations. Echocardiographic data were presented by gender and sporting discipline. The prevalence of abnormal ECGs among SE Asian athletes was 6.7%—higher than reported figures for Caucasian athletes. The abnormal ECGs comprised mainly anterior T wave inversions (ATWI) beyond lead V2, predominantly in female athletes from mixed/endurance sport (9.3% prevalence amongst females). None had echocardiographic structural abnormalities. Male athletes had reduced global longitudinal strain compared to females (−18.7 ± 1.6 vs. −20.7 ± 2.1%, p < 0.001). Overall, SE Asian athletes had smaller left ventricular cavity sizes and wall thickness compared to non-Asian athletes.Conclusion: SE Asian athletes have higher abnormal ECG rates compared to Caucasian athletes, and also demonstrate structural differences that should be accounted for when interpreting their echocardiograms compared to athletes of other ethnicities.

Evaluation of cardiac titin expression after long-term exercise in a rat model

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Kellermayer ◽  
A Olah ◽  
M Ruppert ◽  
B.A Barta ◽  
A.A Sayour ◽  
...  
Keyword(s):  
Cardiac Muscle ◽  
Rat Model ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Control Group ◽  
Funding Source ◽  
Passive Stiffness ◽  
Functional Changes ◽  
Athlete's Heart

Abstract Introduction The main role of the giant elastic protein titin is to provide passive stiffness to striated (i.e. cardiac and skeletal) muscles. The adult cardiac muscle contains two titin isoforms: the more compliant N2BA and the stiffer N2B isoforms. Titin reduces passive stiffness in cardiac muscle by increased expression of the more compliant N2BA isoform (elevated N2BA:N2B ratio). Moreover, decreased passive stiffness is associated with increased exercise tolerance. Long-term exercise induces physiological adaptation of the heart, termed athlete's heart. Currently, there is limited data of titin's role in the athlete's heart. Aims Our aim is to evaluate exercise-induced morphological and functional changes of the heart. Furthermore, to determine the N2BA:N2B ratio in the rat model of athlete's heart. Methods Rats were divided into exercised (n=12) and control (n=12) groups. Athlete's heart was induced by a 12-week-long swim training (200min/day). The control group swam 5 min/day. Following the training period cardiac changes were assessed by echocardiography. In vivo cardiac function was examined by left ventricular (LV) pressure-volume (P-V) analysis. Titin isoform expressions were detected by sodium-dodecyl-sulfate (SDS)-agarose gel electrophoresis. Results Echocardiography and post-mortem measured cardiomyocyte diameters confirmed athlete's heart and LV hypertrophy in exercised rats. P-V analysis showed improved contractility, active relaxation and mechanoenergetics in the exercised group. The N2BA:N2B titin ratio was significantly increased in exercised rats compared to controls (0.28 vs. 0.21, p<0.05). Conclusions Our results confirm the morphological and functional changes of the athlete's heart. The increased ratio of N2BA:N2B titin corresponds to a more compliant heart in the exercised rats. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): National Research, Development and Innovation Office of Hungary (K 120277) and the ÚNKP-19-3-I New National Excellence Program of The Ministry For Innovation and Technology.

scholarly journals Detailed Hemodynamic Characterization of Athlete's Heart using Left Ventricular Pressure-Volume Analysis in a Rat Model

2014 ◽  
Vol 106 (2) ◽  
pp. 344a
Author(s):  
Dalma Kellermayer ◽  
Attila Oláh ◽  
Árpád Lux ◽  
Balázs Tamás Németh ◽  
László Hidi ◽  
...  
Keyword(s):  
Rat Model ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Ventricular Pressure ◽  
Volume Analysis ◽  
Athlete's Heart

scholarly journals Morphological changes and myocardial function assessed by traditional and novel echocardiographic methods in preadolescent athlete’s heart

2018 ◽  
Vol 25 (9) ◽  
pp. 1000-1007 ◽  
Author(s):  
Anders W Bjerring ◽  
Hege EW Landgraff ◽  
Svein Leirstein ◽  
Anette Aaeng ◽  
Hamza Z Ansari ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Left Ventricular Mass ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Right Atrial ◽  
End Diastolic Volume ◽  
Ventricular Mass ◽  
Athlete's Heart

Background Athlete’s heart is a term used to describe the morphological and functional changes in the hearts of athletes. Recent studies suggest that these changes may occur even in preadolescent athletes. This study aims to improve our understanding of the changes occurring in the preadolescent athlete’s heart. Design and methods Cardiac morphology and function in 76 preadolescent cross-country skiers (aged 12.1 ± 0.2 years) were compared with 25 age-matched non-competing preadolescents. Echocardiography was performed in all subjects, including 2D speckle-tracking strain echocardiography and 3D echocardiography. All participants underwent cardiopulmonary exercise testing to assess oxygen uptake and exercise capacity. Results Athletes had greater indexed VO2 max (62 ± 7 vs. 44 ± 5 mL/kg per min, p < 0.001), indexed left ventricular end-diastolic volume (79 ± 7 vs. 68 ± 7 mL/m2, p < 0.001), left ventricular mass (69 ± 12 vs. 57 ± 13 g/m2, p < 0.001), indexed right ventricular basal diameter (28.3 ± 3.0 vs. 25.4 ± 3.5 mm/m2, p < 0.001) and right atrial area (10.6 ± 1.4 vs. 9.7 ± 1.2 cm2/m2, p < 0.01). There was no difference in left ventricular ejection fraction, global longitudinal strain, and global circumferential strain and right ventricular fractional area change between the groups. Controls had higher right ventricular global longitudinal strain (−28.1 ± 3.5 vs. −31.1 ± 3.3%, p < 0.01). VO2 max was highly correlated to left ventricular end-diastolic volume ( r = 0.76, p < 0.001). Conclusion Athletes had greater left ventricular mass and greater left and right ventricular chamber dimensions compared with controls, while left ventricular function did not differ. Interestingly, right ventricular deformation was significantly lower compared with controls. This supports the notion that there is physiological, adaptive remodelling in preadolescent athlete’s heart.

scholarly journals Cardiac magnetic resonance T2 mapping and feature tracking in athlete’s heart and HCM

2020 ◽  
Author(s):  
Mareike Gastl ◽  
Vera Lachmann ◽  
Aikaterini Christidi ◽  
Nico Janzarik ◽  
Verena Veulemans ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
T2 Mapping ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Deformation Imaging ◽  
Athlete's Heart

Abstract Objectives Distinguishing hypertrophic cardiomyopathy (HCM) from left ventricular hypertrophy (LVH) due to systematic training (athlete’s heart, AH) from morphologic assessment remains challenging. The purpose of this study was to examine the role of T2 mapping and deformation imaging obtained by cardiovascular magnetic resonance (CMR) to discriminate AH from HCM with (HOCM) or without outflow tract obstruction (HNCM). Methods Thirty-three patients with HOCM, 9 with HNCM, 13 strength-trained athletes as well as individual age- and gender-matched controls received CMR. For T2 mapping, GRASE-derived multi-echo images were obtained and analyzed using dedicated software. Besides T2 mapping analyses, left ventricular (LV) dimensional and functional parameters were obtained including LV mass per body surface area (LVMi), interventricular septum thickness (IVS), and global longitudinal strain (GLS). Results While LVMi was not significantly different, IVS was thickened in HOCM patients compared to athlete’s. Absolute values of GLS were significantly increased in patients with HOCM/HNCM compared to AH. Median T2 values were elevated compared to controls except in athlete’s heart. ROC analysis revealed T2 values (AUC 0.78) and GLS (AUC 0.91) as good parameters to discriminate AH from overall HNCM/HOCM. Conclusion Discrimination of pathologic from non-pathologic LVH has implications for risk assessment of competitive sports in athletes. Multiparametric CMR with parametric T2 mapping and deformation imaging may add information to distinguish AH from LVH due to HCM. Key Points • Structural analyses using T2 mapping cardiovascular magnetic resonance imaging (CMR) may help to further distinguish myocardial diseases. • To differentiate pathologic from non-pathologic left ventricular hypertrophy, CMR including T2 mapping was obtained in patients with hypertrophic obstructive/non-obstructive cardiomyopathy (HOCM/HNCM) as well as in strength-trained athletes. • Elevated median T2 values in HOCM/HNCM compared with athlete’s may add information to distinguish athlete’s heart from pathologic left ventricular hypertrophy.

Prognostic implications of myocardial work in patients with reduced left ventricular ejection fraction: a preliminary study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Strada ◽  
G Casas Masnou ◽  
V Gonzalez Fernandez ◽  
J Lozano Torres ◽  
L La Mura ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cardiovascular Events ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Funding Source ◽  
Ventricular Ejection Fraction ◽  
Prognostic Implications

Abstract Background Myocardial work (MW) is a new imaging technique to assess left ventricular (LV) systolic function. It incorporates both deformation parameters (global longitudinal strain -GLS-) and loading conditions and gives information on global constructive work (GCW), global wasted work (GWW), global LV myocardial work index (GWI) and global LV myocardial work efficiency (GWE). Purpose The aim of this study was to describe the prognostic role of MW in predicting major adverse cardiovascular events (MACE) in patients with reduced LV ejection fraction (LVEF), and to compare it with GLS and LVEF. Methods We retrospectively included consecutive patients from 2012 to 2019 with dilated LV and LVEF &lt;50% of any aetiology. Clinical variables were collected and LVEF, GLS and MW were evaluated from baseline echocardiogram. MACE was defined as heart failure (HF) and/or ventricular arrhythmia (VA) and/or cardiac arrest and/or all cause death. Results 99 patients were included, 26 were women (26.3%), mean age at diagnosis was 57 years (SD 23). Mean LVEF was 32.5% (SD 10.3). Baseline patients characteristics are described in Table 1. During a median follow-up of 25 months (IQR 12), 24 MACE were recorded (24.4%). Patients with MACE had worse MW parameters: significantly lower MWI (805±360% vs 638±277%, p=0.04) and lower GCW (1116±535 mmHg vs 874±458 mmHg, p=0.05), and a tendency to lower GWE (83±11% vs 77±16%, p=0.084). Of note, both LVEF (33±10% vs 29±9%, p=0.123) and GLS (−9.99±3.7% vs −8.8±3.0, p=0.170) showed a trend but were not significantly associated with outcomes. This might suggest that MW variables are stronger prognostic predictors than traditional imaging parameters. Conclusions In patients with reduced LVEF, MW parameters including global MWI and GCW were associated with major adverse cardiovascular events. Of note, both EF and GLS seem to have less prognostic implications in this cohort when compared with MW. Our results are preliminary and larger studies are needed in order to fully understand the clinical utility of MW beyond traditional parameters. Results Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Universitary Hospital Vall d'Hebron

scholarly journals Associations of the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet with cardiac remodelling in the community: the Framingham Heart Study

2021 ◽  
pp. 1-9
Author(s):  
Maura E. Walker ◽  
Adrienne A. O’Donnell ◽  
Jayandra J. Himali ◽  
Iniya Rajendran ◽  
Debora Melo van Lent ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Root Diameter ◽  
Left Ventricular ◽  
Cardiac Remodelling ◽  
Lv Function ◽  
The Mediterranean ◽  
Diet Score ◽  
Mind Diet

Abstract Normal cardiac function is directly associated with the maintenance of cerebrovascular health. Whether the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet, designed for the maintenance of neurocognitive health, is associated with cardiac remodelling is unknown. We evaluated 2512 Framingham Offspring Cohort participants who attended the eighth examination cycle and had available dietary and echocardiographic data (mean age 66 years; 55 % women). Using multivariable regression, we related the cumulative MIND diet score (independent variable) to left ventricular (LV) ejection fraction, left atrial emptying fraction, LV mass (LVM), E/e’ ratio (dependent variables; primary), global longitudinal strain, global circumferential strain (GCS), mitral annular plane systolic excursion, longitudinal segmental synchrony, LV hypertrophy and aortic root diameter (secondary). Adjusting for age, sex and energy intake, higher cumulative MIND diet scores were associated with lower values of indices of LV diastolic (E/e’ ratio: logβ = −0·03) and systolic function (GCS: β = −0·04) and with higher values of LVM (logβ = 0·02), all P ≤ 0·01. We observed effect modification by age in the association between the cumulative MIND diet score and GCS. When we further adjusted for clinical risk factors, the associations of the cumulative MIND diet score with GCS in participants ≥66 years (β = −0·06, P = 0·005) and LVM remained significant. In our community-based sample, relations between the cumulative MIND diet score and cardiac remodelling differ among indices of LV structure and function. Our results suggest that favourable associations between a higher cumulative MIND diet score and indices of LV function may be influenced by cardiometabolic and lifestyle risk factors.

scholarly journals Time saving, simple and reproducible method to quantify left ventricular function in patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.V Bunting ◽  
S Gill ◽  
A Sitch ◽  
S Mehta ◽  
K O'Connor ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Controlled Trial ◽  
Global Longitudinal Strain ◽  
Intraclass Correlation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Ventricular Ejection Fraction

Abstract Introduction Echocardiography is essential for the management of patients with atrial fibrillation (AF), but current methods are time consuming and lack any evidence of reproducibility. Purpose To compare conventional averaging of consecutive beats with an index beat approach, where systolic and diastolic measurements are taken once after two prior beats with a similar RR interval (not more than 60 ms difference). Methods Transthoracic echocardiography was performed using a standardized and blinded protocol in patients enrolled into the RAte control Therapy Evaluation in permanent AF randomised controlled trial (RATE-AF; NCT02391337). AF was confirmed in all patients with a preceding 12-lead ECG. A minimum of 30-beat loops were recorded. Left ventricular function was determined using the recommended averaging of 5 and 10 beats and using the index beat method, with observers blinded to clinical details. Complete loops were used to calculate the within-beat coefficient of variation (CV) and intraclass correlation coefficient (ICC) for Simpson's biplane left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and filling pressure (E/e'). Results 160 patients (median age 75 years (IQR 69–82); 46% female) were included, with median heart rate 100 beats/min (IQR 86–112). For LVEF, the index beat had the lowest CV of 32% compared to 51% for 5 consecutive beats and 53% for 10 consecutive beats (p&lt;0.001). The index beat also had the lowest CV for GLS (26% versus 43% and 42%; p&lt;0.001) and E/e' (25% versus 41% and 41%; p&lt;0.001; see Figure for ICC comparison). Intra-operator reproducibility, assessed by the same operator from two different recordings in 50 patients, was superior for the index beat with GLS bias −0.5 and narrow limits of agreement (−3.6 to 2.6), compared to −1.0 for 10 consecutive beats (−4.0 to 2.0). For inter-operator variability, assessed in 18 random patients, the index beat also showed the smallest bias with narrow confidence intervals (CI). Using a single index beat did not impact on the validity of LVEF, GLS or E/e' measurement when correlated with natriuretic peptides. Index beat analysis substantially shortened analysis time; 35 seconds (95% CI 35 to 39 seconds) for measuring E/e' with the index beat versus 98 seconds (95% CI 92 to 104 seconds) for 10 consecutive beats (see Figure). Conclusion Index beat determination of left ventricular function improves reproducibility, saves time and does not compromise validity compared to conventional quantification in patients with heart failure and AF. After independent validation, the index beat method should be adopted into routine clinical practice. Comparison for measurement of E/e' Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research UK

Implication of anti-angiogenic VEGF-A165b in angiogenesis and systolic function after reperfused myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Marcos Garces ◽  
C Rios-Navarro ◽  
L Hueso ◽  
A Diaz ◽  
C Bonanad ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Adjuvant Therapy ◽  
Ejection Fraction ◽  
Infarct Size ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Coronary Reperfusion ◽  
Ventricular Ejection Fraction

Abstract Background Angiogenesis participates in re-establishing microcirculation after myocardial infarction (MI). Purpose In this study, we aim to further understand the role of the anti-angiogenic isoform vascular endothelial growth factor (VEGF)-A165b after MI and explore its potential as a co-adjuvant therapy to coronary reperfusion. Methods Two mice MI models were formed: 1) permanent coronary ligation (non-reperfused MI), 2) transient 45-min coronary occlusion followed by reperfusion (reperfused MI); in both models, animals underwent echocardiography before euthanasia at day 21 after MI induction. Serum and myocardial VEGF-A165b levels were determined. In both experimental MI models, functional and structural implication of VEGF-A165b blockade was assessed. In a cohort of 104 ST-segment elevation MI patients, circulating VEGF-A165b levels were correlated with cardiovascular magnetic resonance-derived left ventricular ejection fraction at 6-months and with the occurrence of adverse events (death, heart failure and/or re-infarction). Results In both models, circulating and myocardial VEGF-A165b presence was increased 21 days after MI induction. Serum VEGF-A165b levels inversely correlated with systolic function evaluated by echocardiography. VEGF-A165b blockage increased capillary density, reduced infarct size, and enhanced left ventricular function in reperfused, but not in non-reperfused MI experiments. In patients, higher VEGF-A165b levels correlated with depressed ejection fraction and worse outcomes. Conclusions In experimental and clinical studies, higher serum VEGF-A165b levels associates with a worse systolic function. Its blockage enhances neoangiogenesis, reduces infarct size, and increases ejection fraction in reperfused, but not in non-reperfused MI experiments. Therefore, VEGF-A165b neutralization represents a potential co-adjuvant therapy to coronary reperfusion. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” (Exp. PIE15/00013, PI17/01836, PI18/00209 and CIBERCV16/11/00486).

Presence of adipose tissue in aortic valves from aortic regurgitation patients: pathophysiological role and clinical implications

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Sadaba Cipriain ◽  
A.M Navarro Echeverria ◽  
C.R Tiraplegui Garjon ◽  
A Garcia De La Pena Urtasun ◽  
V Arrieta Paniagua ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Systolic Function ◽  
Statistical Significance ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Funding Source ◽  
Matrix Remodeling ◽  
Aortic Valves

Abstract Introduction Adipose tissue is a common constituent of the heart and it is located, without great clinical relevance, frequently in the pericardium. The presence of adipose tissue in the aortic valve is rare, with unknown significance on valve structural properties and function. Aortic regurgitation (AR) is the third most prevalent valve disease, although it is uncommon to find it in isolation. Myxoid degeneration may be the cause or result of AR, although the pathophysiology remains poorly understood. Purpose To describe and characterize the presence of adipose tissue in the aortic valves from a cohort of AR patients. Methods 116 patients undergoing aortic valve replacement due to severe AR were enrolled. We classified them in two groups according to the histological results showing presence or absence of adipose tissue in the aortic valves. In the valve tissue molecular analysis were performed by RT-PCR, Western Blot and ELISA to analyze markers of adipocytes (leptin, adiponectin, resistin), inflammation (Rantes, interleukin-6, interleukin-1β), extracellular matrix remodeling (metalloproteinases-1, -2 and -9), proteoglycans (aggrecan, hyaluronan, lumican, syndecan-1, decorin) and fibrosis (collagens, fibronectin). Results Adipose tissue was found in 63% of the aortic valves analyzed. Baseline characteristics (age, hypertension, dyslipidemia, diabetes, smoking, left ventricular telediastolic diameter, left ventricular systolic function, ascending aorta) were similar in patients presenting valve adipose tissue as compared with patients without valve adipose tissue. Valves containing adipocytes exhibited a higher leptin content (p&lt;0.001), fibronectin (p&lt;0.01), decorin (p&lt;0,0001), hyaluronan (p=0.03), aggrecan (p=0.04) and metalloproteinase 1 (p=0.03). Interestingly, the presence of adipocytes in the valve was positively correlated with valve thickness measured by echocardiogram (Pearson chi2 statistical significance = 26.3345 p&lt;0.001). Conclusion To our knowledge, this is the first study that describes the presence of adipose cells in aortic valves from a cohort of AR patients. Aortic valves containing adipocytes were thicker and exhibited significant higher levels of proteoglycans, suggesting that adipocytes could contribute to the myxomatous degeneration process. Our results propose that the valve adipose tissue could play a role in the pathophysiology of AR. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Gobierno de Navarra

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