Prognostic role of left ventricular late gadolinium enhancement (LV-LGE) in patients who received implantable cardioverter defibrillator (ICD) for secondary prevention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Mattesi ◽  
E Baldi ◽  
F Guerra ◽  
M Toniolo ◽  
A Cipriani ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Left Ventricular ◽  
Prognostic Role ◽  
Multicentric Study ◽  
Icd Therapy ◽  
Bystander Cardiopulmonary Resuscitation ◽  
St Elevation ◽  
Made In

Abstract Introduction LV myocardial fibrosis detected as LGE on cardiac magnetic resonance (CMR) is a predictor of arrhythmic risk in primary prevention both in ischaemic and non-ischaemic cardiomyopathy. However, we still do not know the prognostic role of LV-LGE in patients who suffered cardiac arrest (CA). Purpose To evaluate the prognostic role of CMR, and in particular of LV-LGE suggesting myocardial scar, in predicting appropriate ICD interventions in secondary prevention patients. Methods Ninety-seven consecutive patients 1) aged ≥14 years 2) hospitalized for CA because of ventricular arrhythmias from 2009/01/01 3) who underwent/undergoing a CMR within one month from the event 4) who received/receiving an ICD for secondary prevention and 5) with at least 1 year-follow-up, were enrolled for this multicentric study. Results 97 patients (68 males, 70%), mean age 46±16 years, were enrolled. Seventy-six percent of patients received bystander cardiopulmonary resuscitation (CPR) and ventricular fibrillation (VF) was the first rhythm in 86% of cases. ST elevation was present in 18% of cases at the admission; however, angiography was found negative in 80% of patients. Myocardial oedema and LGE were identified in 26% and 64% of patients respectively. A diagnosis was made in 83.5% of cases, while in the remaining 16.5% CA was considered idiopathic. During a four-year-follow-up, 25% of patients had appropriate ICD therapy (10% of which ATP only). A significant correlation between LGE and appropriate ICD intervention was not found (p=0.89). Conclusions One fourth of patients who received ICD for secondary prevention had appropriate ICD therapy during a four-year-follow-up. In this setting, LV-LGE does not provide a prognostic value. Funding Acknowledgement Type of funding source: None

Cardiomyopathies

2016 ◽  
Author(s):  
Patrizio Lancellotti ◽  
Bernard Cosyns
Keyword(s):  
Mitral Valve ◽  
Dilated Cardiomyopathy ◽  
Coronary Arteries ◽  
Takotsubo Cardiomyopathy ◽  
Fatty Infiltration ◽  
Left Ventricular ◽  
Prognostic Role ◽  
Echocardiographic Findings

This chapter focuses on the role of echocardiography in dilated cardiomyopathy, showing diagnostic and associated findings along with the prognostic role of echocardiography. Primary myocardial disease is inadequate hypertrophy, independent of loading conditions and often other affected structures such as mitral valve apparatus, small coronary arteries, and cardiac interstitium. Arrhythmogenic RV cardiomyopathy is fatty or fibro-fatty infiltration of the RV with apoptosis and hypertrophied trabeculae of the RV. This chapter also details diagnostic findings and progression of this condition alongside relevant echocardiographic findings. Previously known as ‘spongy heart syndrome’, left ventricular non compaction is characterized by the absence of involution of LV trabeculae during the embryogenic process. This chapter demonstrates the diagnostic findings of this condition, and looks at the diagnostic findings and complications of Takotsubo cardiomyopathy, illustrating typical, RV apical and variant views. It also shows diagnostic findings in myocarditis in both the acute phase and follow-up.

scholarly journals Prognostic role of cardiac magnetic resonance in left ventricular noncompaction

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
G Casas ◽  
J Limeres ◽  
R Barriales-Villa ◽  
P Garcia-Pavia ◽  
E Zorio ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricular ◽  
Left Ventricular Noncompaction ◽  
Prognostic Role ◽  
End Points ◽  
Ventricular Noncompaction

Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular noncompaction (LVNC) is a heterogeneous entity with a wide phenotypic expression. Risk factors have not been well established and prognostic stratification remains challenging. Purpose Describe prognostic role of CMR on long term outcomes of LVNC patients.  Methods   Retrospective multicentric longitudinal cohort study of consecutive patients fulfilling imaging diagnostic criteria for LVNC (Jenni echo criteria and Petersen and Jacquier CMR criteria). Demographic, ECG, genetic, family and treatment variables were recorded. Baseline CMR was used for the analysis. LV ejection fraction (LVEF) was categorized according to heart failure (HF) guidelines and late gadolinium enhancement (LGE) was visually assessed in a binary way. End points were HF, ventricular arrhythmias (VA), systemic embolisms (SE) and all-cause death. Major adverse cardiovascular events (MACE) were the combination of the four previous end points. In patients with initially preserved LVEF (≥ 50%), LV adverse remodelling (LVAR) was defined as an LVEF < 50% and/or absolute decrease of ≥10% in LVEF at last follow-up. Results 585 patients from 12 referral centres were included from 2000 to 2018. Age at diagnosis was 45 ± 20 years, 334 (57%) were male, baseline LVEF was 48 ± 17% and 18% presented LGE. During a median follow-up of 5.1 years (IQR 2.3-8.1), 110 (19%) patients presented HF, 87 (15%) VA, 18 (3%) SE and 34 (6%) died. MACE occurred in 223 (38%) patients. LVEF was independently associated with HF, VA, SE and MACE: HR were 1.08, 1.02, 1.04 and 1.02 respectively (all p < 0.05). LGE was more frequent in patients with reduced LVEF (39 Vs 53%, p < 0.001) and was associated with higher HF and VA risk in patients with an LVEF > 35% (HR 2.69 and 2.48 respectively, p < 0.05) (Figure 1). No MACE (0%) occurred during long-term follow-up in patients with preserved LVEF, no LGE as well as no ECG abnormalities and no family aggregation. 305 (52%) patients presented with initially preserved LVEF, and 230 (75%) of those had LVEF available at last follow-up. LVAR occurred in 50 (22%) patients: 22 (10%) had an LVEF < 50% and 41 (18%) an absolute ≥ 10% decrease in LVEF. LGE was independently associated with LVAR (HR 3.51, p = 0.045) (Figure 2).  Conclusions Cardiac magnetic resonance has an important prognostic role in LVNC. LVEF is the most powerful predictor of events. Myocardial fibrosis is associated with worse outcomes in patients without severe systolic dysfunction, as well as with left ventricular adverse remodelling in those with initially preserved LVEF. Besides, CMR may identify a low-risk subgroup of LVNC patients. Therefore, CMR should be used in risk stratification in LVNC.

Prognostic role of Pro-BNP levels in left ventricular hypertrabeculation/non-compaction and neuromuscular disorders: results of a pilot study

2019 ◽  
Vol 67 (3) ◽  
Author(s):  
Norbert Malli ◽  
Nastasia Wilfinger-Lutz ◽  
Walter Krugluger ◽  
Claudia Stöllberger ◽  
Maria Winkler-Dwora K ◽  
...  
Keyword(s):  
Pilot Study ◽  
Neuromuscular Disorders ◽  
Left Ventricular ◽  
Prognostic Role

The role of inflammation in recent-onset dilated cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Chaloupka ◽  
J Krejci ◽  
H Poloczkova ◽  
P Hude ◽  
E Ozabalova ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Pcr Analysis ◽  
Myocardial Inflammation ◽  
Gene Variants ◽  
Absolute Increase ◽  
Recent Onset ◽  
Cardiotropic Viruses

Abstract Background The aetiology of recent-onset dilated cardiomyopathy (RODCM) includes inflammatory, genetic, toxic and metabolic causes. Delineating the role of inflammation on the genetic background could improve risk stratification. Purpose We aimed to ascertain the role of inflammation evaluated by serum CRP immunohistochemical and PCR analysis of endomyocardial biopsy (EMB) in conjunction with genetic testing in left ventricular reverse remodelling (LVRR) in 12-month follow-up. Methods 83 RODCM patients enrolled in this prospective observational study underwent 12-month echocardiographic follow up whole-exome sequencing, and EMB. Presence of cardiotropic viruses was determined by PCR analysis of the EMB samples. Inflammation was defined according to TIMIC immunohistochemical criteria as the presence of >7 CD3+ lymphocytes/mm2 and/or >14 infiltrating leukocytes (LCA+ cells/mm2). LVRR was defined as an absolute increase in LV ejection fraction > +10% and a relative decrease of LV end-diastolic diameter >−10% at 12 months. Results LVRR occurred in 28 (34%) of all cases. PCR analysis uncovered cardiotropic viruses in 55 (66%) patients, with highest prevalence of parvovirus B19 (47%). (Figure 1) EMB analysis detected inflammation in 28 (34%) cases and inflammation significantly positively predicted LVRR (P=0.019). Sequencing identified disease-related gene variants (ACMG class 3–5) in 45 (54%) patients. Carriers of non-titin gene variants showed a lowest probability of 12-month LVRR (19%) P=0.041. Combination of genetic findings and inflammation did not improve the prediction of LVRR in 12 months. (Table 1) Conclusion Both myocardial inflammation and disease-causing variants can be identified in a large proportion of RODCM cases. Prognostic value of CRP and virus detection is low. Non-titin disease-related variants carriers of are less likely to reach LVRR. In contrast, myocardial inflammation detected by EMB predicts favourable remodelling in 12 months. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Tumor Heterogenity in Gastro-Entero-Pancreatic Neuroendocrine Neoplasia

Endocrines ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 28-36
Author(s):  
Ludovica Magi ◽  
Maria Rinzivillo ◽  
Francesco Panzuto
Keyword(s):  
Functional Imaging ◽  
Clinical Heterogeneity ◽  
Therapeutic Approaches ◽  
Prognostic Role ◽  
Neuroendocrine Neoplasia ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Owing to the rarity and the biological and clinical heterogeneity of gastroenteropancreatic neuroendocrine neoplasia (GEP NEN), the management of these patients may be challenging for physicians. This review highlights the specific features of GEP NEN with particular attention on the role of Ki67 heterogeneity, the potential prognostic role of novel radiological techniques, and the clinical usefulness of functional imaging, including 68Ga-DOTA-SST PET/CT and 18F-FDG PET/CT. Understanding these specific features may help to plan proper and tailored follow-up programs and therapeutic approaches.

scholarly journals Clinical significance of late diastolic tissue doppler parameters after onset of STEMI: from the view point of the timing of the echocardipography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Iwahashi ◽  
J Kirigaya ◽  
M Horii ◽  
T Abe ◽  
E Akiyama ◽  
...  
Keyword(s):  
Tissue Doppler ◽  
Atrial Function ◽  
Diastolic Velocity ◽  
Long Time ◽  
Group A ◽  
St Elevation ◽  
Group B ◽  
First Time

Abstract Background The early transmitral flow velocity (E) divided by the early diastolic velocity of the mitral valve annulus (e') is referred to as the “E/e' ratio,” is useful even for ST elevation acute myocardial infarction (STEMI). However, the role of late diastolic velocity (a') which reveals the atrial function for STEMI is still unclear. Objectives We evaluated the clinical usefulness of tissue Doppler including atrial function for a first-time STEMI by long time follow up. Furthermore, we evaluated the meaning of each parameters by performing immediately after PCI or 2 weeks later. Methods We treated consecutive 571 first-time STEMI patients by immediate PCI within 12 hours after onset, and we examined 270 patients at immediately after PCI (GroupA, 65 years, 250 male) and 301 patients at 2 weeks after onset (GroupB, 64 years, 243 male). We examined trans mitral flow and TDI, then defined E/e' as LV filling pressure and A/a' as left atrial function. We followed them for a long time (>5 years). The primary end point (PE) was cardiac death or re-admission for heart failure (HF). Results We followed the patients in Group A for 10 years, Group B for 5 years. PE occurred in 64 patients in GroupA during 10 years, and 45 patients in GroupB during 5 years. We analyzed the univariate and multivariate Cox hazard analyses and we compared e' and a', E/e' and A/a' (Table). In GroupA, a' and A/a' were the independent predictors, on the other hand neither a' nor A/a' were the predictors in GroupB. E/e' was an independent predictor both in GroupA and B. Conclusion TDI parameters have different meanings by the timing of echocardiography after onset of a first-time STEMI. These results demonstrated that atrial dysfunction immediately after onset of STEMI suggests the poor prognosis after STEMI. Cox Hazard Proportional Analysis Funding Acknowledgement Type of funding source: None

Prognostic Role of Left Ventricular Intramyocardial Fatty Metaplasia in Patients With Previous Myocarditis (MYOFAT Study)

2021 ◽  
Author(s):  
Gianluca Di Bella ◽  
Giovanni Gentile ◽  
Flaviano Irsuti ◽  
Romano Giuseppe ◽  
Francesco Clemenza ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Prognostic Role

Abstract 2838: Sequential Changes of Left Ventricular Systolic and Diastolic Synchronicity in Acute ST-Elevation Myocardial Infarction after Primary Coronary Intervention

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Seong-Mi Park ◽  
Yong-Hyun Kim ◽  
Soon-Jun Hong ◽  
Do-Sun Lim ◽  
Wan-Joo Shim
Keyword(s):  
Myocardial Infarction ◽  
Wall Motion ◽  
Chronic Phase ◽  
Regional Wall Motion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Regional Wall ◽  
St Elevation

The aims of this study were to assess the sequential changes of left ventricular (LV) systolic and diastolic synchronicity in patients with acute myocardial infarction (AMI) and to assess their relation with LV recovery and remodeling. Forty-patients with acute ST-elevation MI were examined within 2days, 6weeks and 6months after primary coronary intervention. Fifteen-age matched subjects were enrolled for normal control. The time from the onset of QRS complex to peak systolic velocity (Ts) and to peak early diastolic velocity (Te) were measured on color-coded tissue Doppler imaging. To assess LV synchronicity, SDs of Ts (Ts-SD) and Te (Te-SD) of all 12 segments were calculated (within 2days, at 6weeks and 6months; SD1, SD2 and SD3, respectively). LV recovery was defined as the improvement of wall motion at least more than two segments at 6 weeks. In all AMI patients, the wall motion score index was 1.72±0.27 and LV ejection fraction was 45.9±9.9%. The Ts-SD1 was higher in AMI patients than in controls (45.4±13.5 vs 29.4±13.3ms, p<0.05), but Te-SD1 was not different (18.7±6.9 vs 16.2±10.0). Twenty-two patients (group1) showed a recovery and 18 patients (group2) showed no recovery. The Ts-SD1 was smaller in group1 than in group2 (43.4±12.6 vs 47.9±11.7 ms, p<0.05). In group1, Ts-SD were much decreased as follow up (Ts-SD2, 3; 36.6±14.0 and 31.1±9.5, respectively, p<0.05). In contrast, in group2, Ts-SD was not significantly changed (Ts-SD2,3; 46.7±13.2 and 43.7±8.8, respectively) but Te-SD was increased as follow up (Te-SD1,2,3; 17.8±5.5, 20.4±4.3 and 25.0±3.8, respectively, p<0.05). The LV end-diastolic and systolic volume were increased and the deceleration time of early diastolic mitral inflow velocity was shortened in group2 (p<0.05). This clinical study shows: 1) in acute phase, the regional wall motion abnormalities of AMI had an impact on LV systolic synchronicity; 2) the AMI patients with LV recovery showed better LV systolic synchronicity; 3) the LV systolic synchronicity became better as regional wall motion was improved; and 4) in chronic phase, the LV diastolic synchronicity became worse in AMI patients with no recovery, which might be related to LV remodeling and worsening of LV diastolic function.

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