scholarly journals P929 Routine Left Atrium Strain in acute STEMI: to do or not to do

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Tadic ◽  
A Ilic ◽  
M Stefanovic ◽  
A Stojsic-Milosavljevic ◽  
S Stojsic ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Left Ventricle ◽  
Adverse Events ◽  
Left Atrium ◽  
Volume Index ◽  
Lv Function ◽  
Maximal Volume ◽  
Echocardiographic Parameters ◽  
One Year

Abstract Introduction and purpose Left atrium strain (LAS) is a very useful, modern method of establish left atrium (LA) function and rarely use in predicting adverse events (AE) in acute anterior ST-elevated myocardial infarction (STEMI). The purpose of our study was to compare LAS among other echocardiographic parameters of LA and left ventricle (LV) function, in patients that developed AE (heart failure, all cause mortality, reinfarction and rehospitalization) after acute anterior STEMI during one year follow up. Methods All 101 patients with a first acute anterior STEMI treated by primary PCI had early echocardiography in first 24 hours. After one year follow up, patients were divided in two groups: AE group (27 patients; 27%) and non-AE group (74 patients; 73%). We compared: LA size, LA maximal volume index, LAS, systolic and diastolic left ventricle parameters, between groups for the purpose of identifying early AE predictors. Results Among all left atrium parameters, LA strain was most prognostic for AE between groups (AE group vs. non-AE group): LA diameter (3,7cm vs. 3,5cm, p = 0,03), LA maximal volume index (27 ml/m2 vs. 24,5 ml/m2, p = 0,03), LAS (30% vs.37%, p < 0,0001) Statistically significant differences in systolic and diastolic LV function between AE and non-AE groups were: ejection fraction (p < 0.0001), stroke volume index (p < 0.0001), fractional shortening (p < 0.0001), cardiac index (p < 0.0001), LV systolic work (p < 0,0001), WMSI- wall motion score index (p < 0,0001), average LV peak systolic longitudinal global strain- LGSav (p < 0,001), mitral inflow peak early velocity/average mitral annular peak early velocity- E/e"av (p < 0,001). After adjustment for all echocardiographic parameters, LA strain (OR 0,91 95% CI, p = 0,04), WMSI ≥ 2 (OR 6.1 95% CI, p < 0.001), average peak systolic left ventricle LGS (OR = 15.1 95% CI, p < 0.0001) and cardiac index (OR 2.6 95% CI, p = 0.01) were independently associated with adverse outcomes. Conclusion Routine left atrium strain is very prognostic parameter of high-risk STEMI patients for adverse events and could possibly be considered as an important component of the new predictive score system for MACE and mortality of STEMI patients in the near future.

scholarly journals Minimaly invasive mitral valve repair with Neochord system in patients with degenerative mitral disease: echocardiographic assessment and predictors for mid-term outcome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Drasutiene ◽  
V Janusauskas ◽  
G Speziali ◽  
D Zakarkaite ◽  
M Budra ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Left Atrium ◽  
Beating Heart ◽  
Mean Difference ◽  
Volume Index ◽  
Term Outcome ◽  
Group A ◽  
Group B ◽  
Left Atrium Volume

Abstract Introduction Various minimally invasive mitral valve (MV) repair techniques are available to treat degenerative mitral regurgitation (MR). Transapical implantation of artificial chordae on a beating heart is performed using the NeoChord DS1000 device with real-time TEE guidance. Purpose 1)To assess preoperative and the mid-term follow-up echocardiographic data in patients after MV repair using the NeoChord DS1000 device; 2)to investigate the changes of left ventricle (LV), left atrium (LA) and mitral annulus dimensions during the follow-up period; 3)to assess the difference of baseline echocardiographic parameters between successful and not-successful (severe residual MR) MV repair groups; 4)to identify the preoperative echocardiographic variables that may be associated with recurrence of MR at mid-term follow. Methods All patients after transapical MV repair with Neochord implantation in Vilnius University hospital were prospectively entered into the study. The acquired preoperative and follow-up echocardiographic datasets were analysed. According to the residual MR at follow-up, patients were stratified to 2 groups: group A – successful durable MV repair (residual MR ≤2); group B – MV repair failure (recurrence of severe MR or reintervention). Values were expressed as Mean±SD. Univariable regression analysis was used to identify anatomical predictors of residual MR. Results 53 (70.67%) patients had a residual MR ≤2 (Group A) and 22 (29.33%) residual MR≥2+ (Group B) at 26±6 months follow-up. At baseline, Group B patients had significantly larger left ventricle end diastolic diameter (LVEDD) (mean difference 5.67±1.29mm, p<0.0001) left ventricle end systolic diameter (LVESD) (mean difference 4.08±1.57mm, p=0.012), LA volume index (mean difference 21.57±5.003 p<0.0001) and higher systolic pulmonary pressure values (mean difference 10.46±3.34, p<0.003) compared with group A. Overall, a significant reduction in LA volume index (mean change 15.69±4.15ml/m2, p<0.001), LA diameter (mean change 3.15±1.24, p=0.012), LV diameter (mean change in LVEDD 4.78±0.88mm p<0.000) was observed at 24 months follow up. There was no significant changes in MV annular parameters at follow up. Left atrium volume (OR 1.018; 95% CI 1.006–1.035; p=0.009), left atrium volume index (OR 1.038; 95% CI 1.013–1.072; p=0.010), LVEDD (OR 1.201; 95% CI 1.088–1.353; p=0.0008), LVESD (OR 1.122; 95% CI 1.02–1.248); p=0.0236) and sPAP (OR 1.418; 95% CI 1.139–2.016; p=0.0014) were all significantly associated with the worse outcome (MR >2) after mini-invasive MV repair in univariable regression analysis. Conclusions Minimaly invasive MV repair with Neochord system on beating heart is effective in patients with degenerative MR. Baseline echocardiographic characteristics predictive for a worse middle term outcome are mainly related to LV and LA remodeling. Reverse remodeling of LV and LA is observed during the follow-up period with no significant changes in MV annulus. Funding Acknowledgement Type of funding source: None

Donation after circulatory death hearts recipients compared to donation after brain death heart recipients have comparable systolic left ventricular function and better myocardial strain at 1 year

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Ciarka ◽  
A Page ◽  
S Messer ◽  
E Pavlushkov ◽  
S Tsui ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Lv Function ◽  
Donation After Circulatory Death ◽  
Deformation Parameters ◽  
Echocardiographic Parameters ◽  
Donation After Brain Death ◽  
Circulatory Death

Abstract Purpose Cardiac transplantation from donation after circulatory death (DCD) has been implemented at our hospital since February 2015. Despite encouraging results some concerns may be raised about the impact of the warm ischemia and reperfusion injury on the myocardium status at longer follow-up. Therefore, we aimed to analyse systolic performance of the left ventricle at 1 year follow in DCD and donation after brain death (DBD) cardiac recipients, as assessed by echocardiography with myocardial deformation imaging. Methods We identified 46 consecutive DCD cardiac recipients who were transplanted from February 2015 to August 2018 and we matched them with 46 DBD cardiac recipients. Six and 7 patients from DCD and DBD group, respectively, died in the first-year post transplant. In the remaining patients we have compared the classical echocardiographic measurements as well as global longitudinal strain (GLS) and global circumferential strain (GCS) at 1-year follow-up. Results DCD and DBD patients did not present with differences in terms of classical echocardiographic parameters of left ventricular (LV) structure and systolic function at one-year follow-up. LVEDV was similar in DCD and DBD patients (101±24 vs. 95±32 ml, p=0.4 respectively), as well as LVESV (42±13 vs. 42±16 ml, p=0.9, respectively), LV ejection fraction (58±6 vs. 56±8%, p=0.22) and LV mass (156±39 vs. 163±38 gr, p=0.2, respectively). In contrast, myocardial deformation parameters, such as GLS and GCS, were better in DCD than in DBD (16.1 vs. −14.5%, p<0.01; and −25.2 vs. 22.3%, p<0.05, respectively). The diastolic LV function parameters were similar in DCD and DBD group, as evidenced by E wave velocity, A wave velocity and deceleration time of mitral inflow, however E over E prime was lower in DCD than in DBD recipients (7.7±8.7, p<0.05). Fractional area change of the right ventricle was higher in DCD in comparison with DBD (46±7 vs. 40±7%, p<0.01) while right atrial volume index was lower in DCD than in DBD (25±8 vs. 29±9 ml/m2, p<0.01). Other parameters of RV function (systolic excursion of the tricuspid annulus, TAPSE) were similar in both groups. Conclusion DCD and DBD heart recipients present with similar systolic LV function at 1-year follow, as assessed by classical echocardiographic parameters. DCD cardiac recipients have better myocardial deformation parameters as assessed by the speckle tracking, better systolic right ventricular function and lower filling pressures of the left ventricle. Funding Acknowledgement Type of funding source: None

scholarly journals O06 Baseline predictors of methotrexate-related adverse events in methotrexate-naïve patients with RA

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Ahmad A Sherbini ◽  
James M Gwinnutt ◽  
Kimme L Hyrich ◽  
Suzanne M M Verstappen ◽  
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Events ◽  
Health Assessment ◽  
Prevalence Rates ◽  
Clinical Predictors ◽  
Research Support ◽  
Related Data ◽  
Increased Risk ◽  
One Year

Abstract Background/Aims  Methotrexate (MTX) is the most common treatment for rheumatoid arthritis (RA). The prevalence of adverse events (AEs) associated with MTX treatment for RA have been studied extensively, but there are limited data on the predictors of these AEs. This study aims to summarise the prevalence rates of MTX AEs, including gastrointestinal (GI), neurological, mucocutaneous, and elevated alanine transaminase (ALT) enzyme, and to identify baseline demographic and clinical predictors of these AEs. Methods  The Rheumatoid Arthritis Medication Study (RAMS) is a UK multi-centre prospective cohort study of patients with RA starting MTX for the first time. Relevant demographic, medication, clinical and disease related data were collected at baseline. AEs were reported at six and twelve months follow-ups. The prevalence rates of AEs were calculated based on the proportions of patients who reported having had an AE within one year of follow-up. The associations between candidate baseline predictors and AEs were assessed using multivariable logistic regression. Results  A total of 2,089 patients were included with a mean age of 58.4 (standard deviation: 13.5) years, 1390 (66.5%) were women. 1,814 and 1,579 patients completed the 6 and 12 months follow-up visits, respectively. The prevalence rates of the AEs within one year of follow-up were: GI = 777 (40.6%), mucocutaneous = 441 (23.1%), neurological = 487 (25.5%), elevated ALT (> upper limit of normal [ULN]) = 286 (15.5%). Younger age and being a woman were associated with increased risk of GI AEs, (age: OR 0.97 per year increase in age, 95% CI 0.98, 1.00; male sex: OR 0.58 vs female, 95% CI 0.46, 0.74) (Table 1). Higher baseline Health Assessment Questionnaire (HAQ) score was an independent predictor of GI, mucocutaneous, and neurological AEs. Furthermore, having ALT >1xULN at baseline or history of diabetes was associated with increased risk of subsequent ALT elevation during the study follow-up. Conclusion  In patients with RA starting MTX, GI AEs were the most commonly reported AEs during the first year of follow-up. The identified predictors of AEs may facilitate discussions between clinicians and patients prior to commencing MTX, and may lead to increased adherence and consequently improved effectiveness. Disclosure  A.A. Sherbini: None. J.M. Gwinnutt: Grants/research support; BMS. K.L. Hyrich: Member of speakers’ bureau; Abbvie. Grants/research support; Pfizer, UCB, BMS. S.M.M. Verstappen: Consultancies; Celltrion. Member of speakers’ bureau; Pfizer. Grants/research support; BMS.

scholarly journals SAT0540 ONE-YEAR OUTCOMES AFTER RHEUMATIC IMMUNE-RELATED ADVERSE EVENTS FROM CHECKPOINT INHIBITORS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1227.2-1227
Author(s):  
E. Berard ◽  
T. Barnetche ◽  
L. Rouxel ◽  
C. Dutriaux ◽  
L. Dousset ◽  
...  
Keyword(s):  
Adverse Events ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Progression Free Survival ◽  
Symptomatic Treatment ◽  
Musculoskeletal Symptoms ◽  
Day Range ◽  
One Year

Background:Description and initial management of rheumatic immune-related adverse-events (irAEs) from cancer immunotherapies have been reported by several groups but to date, few studies have evaluated the long-term outcomes and management of rheumatic irAEs (1).Objectives:To describe the long-term management and assess the one-year outcomes of patients who experienced rheumatic immune-related adverse events (irAEs) due to immune checkpoint inhibitors (ICI).Methods:This was a single-centre prospective observational study including patients referred for musculoskeletal symptoms while treated with ICI. After baseline rheumatological evaluation defining the clinical entity presented, follow-up visits were organised according to the type and severity of irAE. At one year, persistence of irAE, ongoing treatment, as well as cancer outcomes were assessed.Results:63 patients were included between September 2015 and June 2018. 24 patients (38%) presented with non-inflammatory musculoskeletal conditions managed with short-term symptomatic treatment and did not require specific follow-up. 39 patients (62%) experienced inflammatory manifestations, mimicking either rheumatoid arthritis (RA, n=19), polymyalgia rheumatica (PMR, n=16), psoriatic arthritis (PsA, n=3) and one flare of a preexisting axial spondyloarthritis. Overall, 32 patients (82%) received systemic glucocorticoids, with a median rheumatic dosage of 15mg/day (range: 5-60mg/day). None of the patients had to permanently discontinue ICI therapy for rheumatic irAE. 20 patients (67%) were still receiving glucocorticoids at one year, with a median dosage of 5mg/day (range: 2-20mg/day). Glucocorticoids were more frequently discontinued for patients with RA-like condition (44%) than PMR-like condition (23%), but no other predictive factor of glucocorticoids withdrawal could be identified. At one year, overall survival and progression-free survival were comparable between patients who were still receiving glucocorticoids for rheumatic irAE and patients who have discontinued. Eight patients required csDMARDs.Conclusion:At one year, a majority of patients required long-term low-dose glucocorticoids for chronic rheumatic irAE, which seems not altering oncological control.References:[1]Braaten TJ, Brahmer JR, Forde PM, et al. Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation. Ann Rheum Dis. 2019 Sep 20.Disclosure of Interests:None declared

scholarly journals Long-term prognostic significance of three-dimensional echocardiographic parameters of the left ventricle and left atrium

2009 ◽  
Vol 11 (3) ◽  
pp. 250-256 ◽  
Author(s):  
S. Caselli ◽  
E. Canali ◽  
M. L. Foschi ◽  
D. Santini ◽  
E. Di Angelantonio ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Left Atrium ◽  
Prognostic Significance ◽  
Three Dimensional ◽  
Echocardiographic Parameters

scholarly journals Evaluation of efficacy and comparative frequency of adverse events in patients with ulcerative colitis receiving the original infliximab and its biosimilar. One year of observation

2019 ◽  
Vol 91 (8) ◽  
pp. 41-46
Author(s):  
O V Knyazev ◽  
T V Shkurko ◽  
A V Kagramanova ◽  
A A Lishchinskaya ◽  
M Yu Zvyaglova ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Adverse Events ◽  
Real Life ◽  
Fecal Calprotectin ◽  
Biologic Drugs ◽  
Real Life Data ◽  
Bowel Diseases ◽  
Significant Clinical Improvement ◽  
One Year

Real - life data on the effectiveness and safety of biosimilar and biologic drugs licensed for treatment of inflammatory bowel diseases (IBD) is lacking. Aim. To investigate efficacy of original Infliximab (IFX) and its biosimilar in treating patients with ulcerative colitis (UC) and determine the frequency of adverse events during 1 year follow - up period. Materials and methods. Our cohort consisted of 98 ulcerative colitis patients, treated with original IFX and its biosimilar since December 2017 till December 2018 years. Original Infliximab was prescribed in 56 UC patients (57.1%) during 5 years and longer; 16 patients (16.3%) were switched to IFX biosimilar; 13 UC bio - naïve patients (13.3%) received original IFX, 29 (29.6%) patients - biosimilar IFX. In 14 patients (14.3%) original infliximab was rotated with biosimilar. We picked out 42 patients to assess efficacy of original IFX and biosimilar. Results and discussion. Twelve patients, received original IFX and 28 patients, treated with its biosimilar, showed significant clinical improvement by decreasing Mayo index from 9.7±0.4 and 10.2±0.2 points to 1.9±0.09 and 2.1±0.1 points, accordingly. Also we noticed positive change in laboratory markers - CRP decrease from 89.6±8.7 mg/l and 77.5±8.0 mg/l to 6.5±0.8 mg/l and 6.9±0.8 mg/l (p>0.05), albumin increase from 30.1±4.7 g/l and 29.6±3.6 g/l to 34.1±6.3 g/l and 32.8±5.9 g/l (p>0.05), increase of serum iron levels from 6.4±0.5 mcg/l and 7.1±0.65 mcg/l to 14.6±4.4 mcg/l and 15.9±5.1 mcg/l (p>0.05), hemoglobin increase from 104.7±9.8 g/l and 102.2±8.8 g/l till 124±11.3 g/l and 121±10.9 g/l (p>0.05), and fecal calprotectin decrease from 1680±134 mcg/g and 1720±126 mcg/g till 245.5±33.4 mcg/g and 230.5±29.8 mcg/g (p>0.05). During 1 year follow - up 12 UC patients, treated with original IFX and its biosimilar, developed adverse events. The majority of adverse events (n=8) were registered in patients, rotating administration of original IFX and its biosimilar. Conclusion. IFX biosimilar is effective as well as original IFX. Frequency of adverse events, occurred in patients, treated with original IFX, was comparable with adverse events frequency in patients, received biosimilar IFX. Frequency of adverse events was significantly higher in UC patients, rotating original IFX and its biosimilar.

scholarly journals P738 Association of galectin-3 and soluble ST2, and their changes, with echocardiographic parameters and development of heart failure after ST-segment elevation myocardial infarction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Tyminska ◽  
A Kaplon-Cieslicka ◽  
K Ozieranski ◽  
M Budnik ◽  
A Wancerz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Ejection Fraction ◽  
St Segment Elevation ◽  
St Segment ◽  
Lv Mass ◽  
Galectin 3 ◽  
Echocardiographic Parameters ◽  
One Year

Abstract Background The occurrence of HF (heart failure) with preserved ejection fraction (HFpEF) has risen significantly over the past decade. Galectin-3 (Gal-3) and soluble ST2 (sST2) are involved in inflammatory processes and fibrosis and might be useful in estimation of the risk of HFpEF development after myocardial infarction (MI).Purpose: To investigate the association of Gal-3 and sST2, and their follow-up changeswith echocardiographic parameters of systolic and diastolic dysfunctionin patients (pts) with ST-segment elevation MI (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods:A prospective, observational study, BIOSTRAT (NCT03735719), enrolled 117 pts. Gal-3 and sST2 serum collection and echocardiography were performed twice (during index hospitalization and on a control visit at one-year follow-up). Assessedat baseline and at one-year echocardiographic indices included left ventricular ejection fraction (LVEF), atrial and ventricular size, LV posterior wall and septal thickness, LV hypertrophy based on LV mass index, mitral inflow velocities, and early diastolic tissue velocities at the lateral and medial mitral annulus. Results:Mean baseline concentrations of Gal-3 and sST2 (7.5 and 26.4 ng/mL, respectively) were increased at one-year follow-up (8.5 ng/mL, p < 0.001 and 31.4 ng/mL, p = 0.001, respectively). Fifty of 105 pts (48%) developed HF and 30% of the study population had LVEF <50% at one-year. There were no significant differences between pts with LVEF <50% and ≥50% in terms of baseline, follow-up, nor changes in Gal-3 and sST2 concentrations from baseline to the one-year visit. Gal-3 and sST2 concentrations at baseline, after one-year, and their changes were correlated with echocardiographic parameters. Correlation analysis revealed that higher baseline Gal-3 concentrations correlated inversely only with LV end-diastolic volume at one-year. There were no other significant correlations of baseline, follow-up, nor changes in Gal-3 concentration with echocardiographic parameters. Baseline sST2 values correlated positively with LV end-diastolic diameter, LV end-systolic volume, LV mass index, and inversely with LVEF at one-year, but not with baseline echocardiographic parameters. Changes in sST2 concentration correlated positively only with LVEF at one-year. There were no significant correlations of sST2 concentrations at follow-up with echocardiographic parameters. Only pts with a higher sST2 baseline level had lower LVEF at baseline and after one-year, and pts with higher concentrations of both Gal-3 and sST2 at baseline were more likely to have LV hypertrophy initially and after one-year. There was no clear association of rising biomarkers’ quartiles with other echocardiographic parameters. Conclusions:There was no clear association between both biomarkers and echocardiographic parametersof diastolic dysfunction. Increasing levels of Gal-3 and sST2 do not reflect the HFpEF development in pts after STEMI.

scholarly journals 1028 Early response to a low- dose acubitril/valsartan (ARNI) therapy among stable symptomatic patients with HFrEF

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
W Sacharczuk ◽  
R Dankowski ◽  
A Baszko ◽  
A Sowinska ◽  
S Ozegowski ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Low Dose ◽  
Global Longitudinal Strain ◽  
Early Response ◽  
Lv Function ◽  
Echocardiographic Evaluation ◽  
Heart Failure Questionnaire ◽  
Echocardiographic Parameters ◽  
The Mean

Abstract Funding Acknowledgements no financial support Background Sacubitril/valsartan (S/V) has shown to improve outcomes, that is related to reverse remodeling of the left ventricle (LV) with improved ejection fraction (LVEF) and mitral regurgitation (MR) during long-term therapy. There are limited data on early effects of S/V treatment with respect to the left ventricle function and echocardiographic evaluation of this phenomenon. Aim of the study was to evaluate the early effect of a starting-dose of S/V administered in patients (pts) with stable symptoms of heart failure on clinical symptoms, laboratory tests and echocardiographic parameters using global longitudinal strain (GLS) as a sensitive parameter detecting improvement of LV function. Methods Twenty pts (mean age 60 years, 2 female), with HFrEF (NYHA class II-III) on optimal medical treatment with ICM (75%) or NICM (35%) were included to low-dose S/V treatment (24/26mg) after excluding contraindications. Clinical and echocardiographic evaluation was performed at baseline and after 30 days. The following parameters have been measured: 6-Minutes Walking Test (6MWT) and Minnesota Living with Heart Failure questionnaire, laboratory results and echocardiographic assessment with speckle tracking technique (STE). Results All pts completed 30 days treatment period without complications and no change to medication. During this period the mean values of RR decreased significantly (SBP 129,4mmHg vs 121,25mmHg and DBP 81,6mmHg vs 79,2mmHg respectively). Other clinical parameters did not change. There were no differences NT-pro BNP and TNT levels (respectively 1726 vs 1930 pg/ml and 26 vs 22 ng/ml). After 30days, the mean 6MWT distance increased by 50m (349,5 vs 401,5m p < 0.01), and a positive response was observed in Minnesota Living with Heart Failure Questionnaire (p < 0.001). Echocardiographic parameters revealed positive remodeling of LV and left atrium (LA). There was a significant improvement in LVEDd (67,9mm vs 64,9mm, p < 0.01), LVESd (61,6mm vs 58,8mm, p < 0.01) and stroke volume (40,5 to 45,8ml, p < 0.01). There was no significant increase in LVEF (30% vs 31,5%, p = 0.052). The diastolic parameters of LV function didn’t change during the study. The LA volumes significantly decreased (110 vs 92ml, p < 0.01) during the treatment period as well as the degree of MR (ERO 0.51 vs 0,37 p < 0.01). Out of several LV deformation parameters, only global longitudinal strain has changed significantly (GLS-6,1% vs -7,0%, p = 0,02). The improvement in symptoms and 6MWT correlated only with global systolic radial (RS) and longitudinal (GLS) strain correlated positively after 30 days treatment. Conclusion:Thirty days treatment with low-dose S/V in stable, symptomatic HFrEF patients leads to symptomatic and clinical improvement which correlates with positive remodeling of the left ventricle and reduces the degree of mitral regurgitation. The GLS is a sensitive indicator of LV function improvement after short time S/V treatment and may be used to assess early response.

scholarly journals Adverse remodeling of the subpulmonary left ventricle in patient with systemic right ventricle is associated with clinical outcome

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
B Santens ◽  
F Helsen ◽  
A Van De Bruaene ◽  
P De Meester ◽  
A Budts ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Clinical Outcome ◽  
Right Ventricle ◽  
Prognostic Markers ◽  
Volume Index ◽  
Short Term ◽  
Systemic Right Ventricle ◽  
Adverse Remodeling

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This research received project funding by KU Leuven Background – Early recognition of adverse remodeling is important since outcome is unfavorable once patients with a systemic right ventricle (sRV) become symptomatic. We aimed assessing prognostic markers linked to short-term clinical evolution in this population.  Purpose - We aimed assessing short-term clinical evolution and early prognostic markers of cardiac complications in adults with sRV (atrial switch repair for D-transposition of the great arteries (D-TGA) and congenitally corrected transposition of the great arteries (ccTGA)) based on detailed phenotyping.  Methods– Thirty-three patients with sRV underwent detailed phenotyping including exercise CMR. Adverse outcome was a composite of heart failure episode and tachyarrhythmia. Descriptive statistics and univariate cox regression analyses were performed.  Results - Thirty-three patients (76% male) with sRV were followed over mean follow-up time of 3 years. Mean age was 40 ± 8 (range 26-57) years at latest follow-up. When compared to baseline, (I) most patients remained in NYHA functional class I (76%),  (II) the degree of severity of the SAVV regurgitation rose and (III) more electrical instability was documented at latest follow-up. Six (18%) of a total of nine events were counted as first cardiovascular events (9% heart failure, 9% arrhythmia). NTproBNP (HR 11.02 (95%CI 1.296-93.662), p= 0.028), oxygen pulse (HR 1.202 (95% CI 1.012-1.428), p = 0.037), left ventricle end diastolic volume index (LVEDVi) in rest (HR 1.046 (95% CI 1.002-1.092), p = 0.041) and during exercise (HR 1.035 (95% CI 1.002-1.069), p = 0.038), stroke volume index (SVi) of the subpulmonary left ventricle (LV) in rest (HR 1.154 (95% CI 1.005-1.322), p = 0.038) and at peak exercise (HR 1.065 (95% CI 1.007-1.125), p = 0.026) were significantly associated with the first cardiovascular event (Figure 1A and B).  Conclusion – NTproBNP was by far the best prognostic marker for clinical outcome. Adverse remodelling with increase of LVEDVi and SVi of the subpulmonary LV at rest and during exercise were associated with worse clinical outcome. We theorize that remodeling of the subpulmonary ventricle might be an early sign of a failing sRV circulation (Figure 2).

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