P5250Diastolic strain rate ratio as determined on MRI on detecting left ventricle stiffness and predict heart failure in post-STEMI patients

Abstract Background ST-elevation myocardial infarction (STEMI) Patients suffered from progressive heart failure, for which progressive and aggravated Left ventricle stiffness was one of the major culprit. Myocardial deformation in the early diastole is largely affected by the left ventricle compliance which could partly reflect chamber stiffness and potentially predict left ventricular remodeling for post-STEMI patients. Purpose To determine the value of diastolic strain rate in detecting left ventricle stiffness and early heart failure in post-STEMI patients. Methods A number of 52 (M/F: 46/6, age: 54.27 [46.8–62.3]yrs) patients with STEMI three months ago were prospectively recruited from 2016 to 2017. Follow-up was done until 2018. The primary end points were the symptoms of heart failure (NYHA II-IV). Consent was acquired from each patient and 3.0 T MRI was arranged. Imaging analysis was performed on Cvi 42 (V5.9.3 Canada). Peak radial strain (PS) and strain rate (SR) were extracted both from 2D short- and long-axis cine images, while peak circumferential parameters only from the short axis slices and longitudinal the long axis slices. The diastolic strain rate ratios (DSRRs) were calculated as the peak early diastolic SR divided by the peak late diastolic SR, which were derived from the two peak points on the corresponding curve of time-to-SR curve in the diastole (Figure 1a). Receiver-operating characteristics curve analysis and Logistic regression test were done for statistical analysis on R project and P<0.05 was considered as significant. Results Three patients were excluded due to unsatisfied cine images. Among the 52 patients, none of the patients died or had congestive heart failure. 23/52 (44.2%) patients complained of heart failure symptoms at the one-year follow-up. No significant difference was found in LVEF and three directional peak strain values or systolic peak strain rates between the patients with and without heart failure. Patients with symptoms had lower Longitudinal PS (P=0.049), early diastolic radial SR (P=0.01798), longitudinal SR (P=0.0042), and decreased DSRR in all directions (Figure 1b). Multivariate Logistic regression test showed that only DSRR in the radial direction on the short axis (DSRR-SR) was the independent predictor of the heart failure symptoms (6.59; range, 6.71–3.68; P=0.026). ROC analysis demonstrated that the DSRR-SR of 2.35 had sensitivity 91.3% and specificity 58.6% for the prediction of heart failure (Figure 1c). Figure 1 Conclusion DSRR especially DSRR-SR was more sensitive to left ventricle stiffness change and help predict the progression of heart failure for Post-STEMI patients. Further studies were needed to verify the its association with other cardiovascular clinical events. Acknowledgement/Funding the National Natural Science Foundation of China (81600299,81471721, 81471722, 81771887, and 81771897,);

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Time-Dependent Regional Myocardial Strains in Patients with Heart Failure with a Preserved Ejection Fraction

BioMed Research International ◽

10.1155/2016/8957307 ◽

2016 ◽

Vol 2016 ◽

pp. 1-13 ◽

Cited By ~ 6

Author(s):

Shane P. Smith ◽

Timothy W. Secomb ◽

Brian D. Hong ◽

Michael J. Moulton

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Strain Rate ◽

Speckle Tracking ◽

Circumferential Strain ◽

Normal Subjects ◽

Peak Strain ◽

Preserved Ejection Fraction ◽

Diastolic Strain Rate ◽

Patients With Heart Failure

Objectives. To better understand the etiology of HFpEF in a controlled human population, regional time-varying strains were computed using echocardiography speckle tracking in patients with heart failure with a preserved ejection fraction and normal subjects.Methods. Eleven normal volunteers and ten patients with echo-graded diastolic dysfunction and symptoms of heart failure were imaged with echocardiography and longitudinal, circumferential, and rotational strains were determined using speckle-tracking. Diastolic strain rate was also determined. Patient demographics and echo-derived flows, volumes, and pressures were recorded.Results. Peak longitudinal and circumferential strain was globally reduced in patients (p<0.001), when compared to controls. The patients attained peak longitudinal and circumferential strain at a consistently later point in systole than controls. Rotational strains were not different in most LV regions. Early diastolic strain rate was significantly reduced in the patients (p<0.001). LV mass and wall thickness were significantly increased in the patients; however ejection fraction was preserved and stroke volume was diminished (p<0.001).Conclusions. This study shows that patients with HFpEF have reduced early diastolic strain rate and reduced peak strain that is regionally homogeneous and that they also utilize a longer fraction of systole to achieve peak axial strains.

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Left ventricular and left atrial deformation imaging early after pPCI: does diabetes mellitus make any difference?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.046 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

D Trifunovic Zamaklar ◽

G Krljanac ◽

M Asanin ◽

L Savic-Spasic ◽

J Vratonjic ◽

...

Keyword(s):

Heart Failure ◽

Strain Rate ◽

Myocardial Function ◽

Radial Strain ◽

Left Ventricular ◽

Deformation Analysis ◽

Syntax Score ◽

Deformation Imaging ◽

Early Diastole

Abstract Funding Acknowledgements Type of funding sources: None. onbehalf PREDICT-VT More extensive coronary atherosclerosis in diabetes mellitu (DM) induces poorer clinical outcomes after STEMI, but there are data suggesting that impaired myocardial function in DM, even independently from epicardial coronary lesions severity, might have detrimental effect, predominately on heart failure development in DM. Aim the current study is a sub-study of PREDICT-VT study (NCT03263949), aimed to analyse LV and LA function using myocardial deformation imaging based on speckle tracking echocardiography after pPCI in STEMI patients with and without DM. Methods in 307 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done including LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec), LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strains and analysis of LV rotation mechanic. Results from 242 patients who completed 1 year follow up, 48 (20%) had DM. Pts with DM were older (60 ± 1,01 vs 57 ± 10; p = 0.067) and had insignificantly higher SYNTAX score (18.5 ± 9.2 vs 15.8 ± 9.8, p = 0.118) . However, diabetics had more severely impaired EF (44.2 ± 8.6 vs 49.2 ± 9.8, p = 0.001), E/A ratio (0.78 ± 0.33 vs 0.90 ± 0.34; p = 0.036) and MAPSE (1.18 ± 0.32 vs 1.32 ± 0.33; p = 0.001). Global LV LS on all layers (endo: -13.6 ± 4.0 vs-16.2 ± 4.7; mid: -11.9 ± 3.5 vs -14.1 ± 4.1; epi: -10.4 ± 3.1 vs -12.3 ± 3.6; p < 0.005 for all) was impaired in DM patients, as well as longitudinal systolic SR (-0.71 ± 0.23 vs -0.84 ± 0.24; p = 0.001) and SR during early diastole (0.65 ± 0.26 vs 0.83 ± 0.33, p < 0.001). Patients with DM had more pronounced longitudinal posts-systolic shortening throughout LV wall (endo: 21.4 ± 16.1 vs 13.7 ± 13.3, p = 0.005; mid: 21.9 ± 16.1 vs 14.3 ± 13.1, p = 0.006; epi: 22.4 ± 16.5 vs 15.3 ± 13.7, p = 0.010) and higher LV mechanical dispersion (MDI: 71.3 ± 38.3 vs 59.0 ± 18.9, p = 0.037). LA strain was significantly impaired in DM patients (18.9 ± 7.7 vs 22.6 ± 10.0, p = 0.011) and even more profoundly LA strain rate during early diastole (-0.73 ± 0.48 vs -1.00 ±0.58, p = 0.002). Patients with DM also had more impaired LV global (15.7 ± 9.1 vs 19.8 ± 10.4, p = 0.013) radial strain, global LV circumferencial strain, especially at the mid-wall level (-13.9 ± 4.2 vs -16.0 ± 4.3, p = 0.005) and impaired circumferential SR E (1.25± 0.44 vs 1.49 ± 0.46, p = 0.003). End-systolic rotation of the LV apex was more impaired in DM (4.7 ± 5.1 vs 6.8 ± 5.5, p= 0.022). During 1 year follow-up heart failure and all-cause mortality tend to be higher among DM pts (46.7% vs 35.2%, p = 0.153). Conclusion STEMI patients with DM have more severely impaired LV systolic and diastolic function estimated both by traditional parameter and advanced echo techniques. These results might, at least partially, explain why outcomes after STEMI in DM might be poorer, even in the absence of more complex angiographic findings, pointing to the significance of impaired myocardial function DM itself.

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Ultraviolet Exposure and Photokeratitis Complaints among Informal Welding Workers in Depok, West Java, Indonesia

Kesmas National Public Health Journal ◽

10.21109/kesmas.v15i4.3283 ◽

2020 ◽

Vol 15 (4) ◽

Author(s):

Maria K I J Yustheresani ◽

Fajaria Nurcandra ◽

Azizah Musliha Fitri ◽

Annisa Ika Putri ◽

Dyah Utari

Keyword(s):

Logistic Regression ◽

Uv Radiation ◽

Education Level ◽

Epithelial Tissue ◽

West Java ◽

Eye Protection ◽

Regression Test ◽

Safety Knowledge ◽

Logistic Regression Test ◽

Uv Rays

One of the photokeratitis risk factors is acute reversible radiation of ultraviolet (UV) rays, which injure the cornea's epithelial tissue. Informal welding workers are susceptible populations to UV rays exposure. This study aimed to confirm the influence of UV radiation exposure on photokeratitis complaints in welding workers in Cimanggis, Depok, West Java. A cross-sectional study was conducted from February to June 2019 and used to select 100 welding workers purposively. A semi-structured questionnaire was used to determine photokeratitis complaints, age, education level, eye protection, safety knowledge, and work period; the UV radiation measured by A UV meter. Data were analyzed using a logistic regression test. We found the proportion of photokeratitis to be 84.0%, with 76.0% of UV radiation exceeding the Threshold Limit Values (TLV). The logistic regression test showed a significant effect of UV radiation on photokeratitis after controlling confounding variables (education level, eye protection, safety knowledge, and welding distance) (p-value = 0.006; AdjOR = 7.236; 95% CI: 1.74–30.07). It can be concluded that UV radiation, more than TLV, constitutes the primary risk factor for photokeratitis complaints. Risks for photokeratitis were influenced by low education level, poor eye protection, limited safety knowledge, and welding distance ≤ 45 cm.

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PRESEPSIN AND PROCALCITONIN VALUES TO DETERMINE THE PROGNOSIS OF UROSEPSIS

Indonesian Journal of Urology ◽

10.32421/juri.v25i2.463 ◽

2018 ◽

Vol 25 (2) ◽

Author(s):

Sofyan Rais Addin ◽

Tarmono Djojodimedjo ◽

Fikri Rizaldi

Keyword(s):

Logistic Regression ◽

Statistical Analysis ◽

Prospective Study ◽

Prognostic Value ◽

Observational Prospective Study ◽

Regression Test ◽

The Difference ◽

Logistic Regression Test ◽

First Admission

Objective: To evaluate the prognostic value of presepsin and procalcitonin in patient with urosepsis. Material & Method: This is an observational prospective study. Patients who fulfilled the criteria for urosepsis at Soetomo Hospital Surabaya were enrolled. Presepsin and procalcitonin were measured at first admission. All patients were managed according to standard urosepsis therapy. At the 28th day of treatment, patients were evaluated and classified into survivor and non-survivor. The statistical analysis were tested with logistic regression test using software SPSS 23. Results: 30 urosepsis patients were included in this study with average age was 48.3 years (range 21-77 years). There were 23 survivor and 7 non-survivor. Mean presepsin values were higher in non-survivor than in survivor but the difference was not significant (4405 ± 4664 vs 4042 ± 2643, p=0.259). Mean procalcitonin value was significantly higher in non-survivor than in survivor (7.68 ± 6.81 vs 3.27 ± 2.74, p=0.013). Using the cut off value ≥2.24 ng/ml, procalcitonin can predict mortality in 28 days with sensitivity 71.4% and specificity 47.8%. Conclusion: Presepsin can not be used to determine the prognosis of urosepsis patients. Procalcitonin showed a significant correlation with outcome of urosepsis patients so it can be use to determine the prognosis of urosepsis.

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Survival of COVID-19 with Multimorbidity Patients

Healthcare ◽

10.3390/healthcare9111423 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1423

Author(s):

E. Bustos-Vázquez ◽

E. Padilla-González ◽

D. Reyes-Gómez ◽

M. C. Carmona-Ramos ◽

J. A. Monroy-Vargas ◽

...

Keyword(s):

Descriptive Analysis ◽

Survival Rates ◽

Hospitalized Patients ◽

Sample Population ◽

Mechanical Ventilators ◽

Number Of Patients ◽

Regression Test ◽

Main Variable ◽

Logistic Regression Test

Background: The outbreak of SARS-CoV-2 abruptly disseminated in early 2020, overcoming the capacity of health systems to respond the pandemic. It was not until the vaccines were launched worldwide that an increase in survival was observed. The objectives of this study were to analyse the characteristics of survivors and their relationship with comorbidities. We had access to a database containing information on 16,747 hospitalized patients from Mexico, all infected with SARS-CoV-2, as part of a regular follow-up. The descriptive analysis looked for clusters of either success or failure. We categorized the samples into no comorbidities, or one and up to five coexisting with the infection. We performed a logistic regression test to ascertain what factors were more influential in survival. The main variable of interest was survival associated with multimorbidity factors. The database hosted information on hospitalized patients from Mexico between March 2020 through to April 2021. Categories 2 and 3 had the largest number of patients. Survival rates were higher in categories 0 (64.8%), 1 (57.5%) and 2 (51.6%). In total, 1741 (10.5%) patients were allocated to an ICU unit. Mechanical ventilators were used on 1415 patients, corresponding to 8.76%. Survival was recorded in 9575 patients, accounting for 57.2% of the sample population. Patients without comorbidities, younger people and women were more likely to survive.

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Use of Sacubitril/valsartan in patients with cardio toxicity and heart failure due to chemotherapy

Cardio-Oncology ◽

10.1186/s40959-020-00078-4 ◽

2020 ◽

Vol 6 (1) ◽

Cited By ~ 1

Author(s):

Vanesa Gregorietti ◽

Teresa Lopez Fernandez ◽

Diego Costa ◽

Elías Ortega Chahla ◽

Andrés J. Daniele

Keyword(s):

Heart Failure ◽

Left Ventricle ◽

Serum Creatinine ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Internal Diameter ◽

Walk Test ◽

Aldosterone Antagonists ◽

Treatment Standard

Abstract Background Cancer therapy-related cardiac dysfunction (CTRCD) is a critical problem with an impact on both oncological and cardiovascular prognosis, especially when it prevents patients from receiving cancer treatment. Standard therapy for heart failure (HF) is recommended for CTRCD, but there is no well-established evidence on how sacubitril/valsartan may help cancer patients with cardiotoxicity. Objectives The aim of this trial was to study the effectiveness of sacubitril-valsartan in patients with CTRCD treated in cardio-oncology units. Methods We enrolled 635 patients with breast cancer and followed them with echocardiography and NT- proBNP. Patients who developed left ventricular dysfunction and heart failure were treated with angiotensin-converting enzyme inhibitors (ACEI) (enalapril) or angiotensin receptor blockers (ARB) (valsartan), aldosterone antagonists (eplerenone), digitalis and diuretics (furosemide), as needed. When patients remained symptomatic and met the PARADIGM-HF inclusion criteria, sacubitril/valsartan was started instead of enalapril or valsartan. We analyzed clinical, laboratory and echocardiographic variables to determine the beneficial effects of sacubitril/valsartan on left ventricular remodeling (improvement of left ventricular ejection fraction (LVEF), left ventricle internal diameter in diastole), diastolic dysfunction (E/e’ ratio), reduction in NT-proBNP levels, New York Heart Association (NHYA) class and improvement in the 6-min walk test. Also, we analyzed serum creatinine and potassium levels to determine treatmentsafety in this population. Median follow-up was 20 months. Results Twenty-eight patients developed cardiotoxicity and were treated with sacubitril/valsartan. The sacubitril/valsartan dose was 100 mg (sacubitril 49 mg/valsartan 51 mg) in 12 patients (42.85%) and 200 mg (sacubitril 97 mg/valsartan 103 mg) in 16 patients (57.15%). No deaths were reported, and one patient underwent heart transplantation. Baseline median NT-proBNP was 997.5 pg/ml (IQR 663.8 — 2380.8), which decreased to a median of 416.5 pg/ml (IQR 192.0–798.2) on follow-up with p < 0.001. Baseline NYHA functional class was III (78.6%) or IV (21.4%), and it improved to I (57.1%) or II (42.9%) on follow-up. LVEF increased with treatment from 26.7 ± 5.4% to 32.3 ± 5.5% (p < 0.001). There were also significant improvements in left ventricle internal diameter in diastole (LVIDD), diastolic function, 6-min walk test, and mitral valve regurgitation. There were no differences between basal and follow-up levels of serum creatinine or potassium. Conclusion Sacubitril/valsartan might be a promising treatment option in patients with refractory CTRCD.

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P1573 Late recovery of left ventricular function in patients with non-severe ischemic mitral regurgitation and multivessel disease qualified to cardiosurgery treatment

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.993 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

R Piatkowski ◽

J Kochanowski ◽

M Budnik ◽

M Grabowski ◽

P Scislo ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Left Ventricle ◽

Mitral Regurgitation ◽

Odds Ratio ◽

Left Ventricular ◽

Ischemic Mitral Regurgitation ◽

Multivariable Logistic Regression Analysis ◽

Late Recovery

Abstract Late recovery of left ventricular function in patients with non-severe ischemic mitral regurgitation and multivessel disease qualified to cardiosurgery treatment. Purpose In patients (pts) after myocardial infarction (MI) with chronic left ventricle (LV) dysfunction, the presence and degree of ischemic mitral regurgitation (IMR) are predominantly related to LV remodelling and mitral valvular deformation. The aim of this study was to compare functional recovery (LVFR) as well as reverse remodelling of the left ventricle (LVRR) in pts with non-severe IMR qualified for cardiosurgical treatment - coronary artery bypass grafting alone (CABGa) or CABG with mitral repair (CABGmr in the 12-month follow-up. Materials and methods A total of 100 pts (mean age 64,4 ± 7,9 years) after MI, eligible for CABG, were included in a prospective study. Echo and clinical assessment were performed before and 12-months after surgery. Pts were referred for CABG a(gr.1; n = 74) or CABGmr (gr.2; n = 26) based on clinical assessment, 2D echo at rest and exercise and myocardial viability assessment (low dose dobutamine - dbx). Effective regurgitation orifice area (EROA) was used for quantitative IMR assessment. An increase in EF≥ 5% (ΔEF) from baseline value was considered as LVFR. A decrease in LV end-systolic volume > 15% from baseline value was considered as LVRR. Multivariable logistic regression analysis was used to identify the strongest factors of lack of LVFR and LVRR. Results An LVFR was observed, at late control, in 35 (49%) of pts in the CABGa group and in 11 (48%) of pts in CABGmr group (p = 0,948). LVRR was observed in 41 (56%) of pts in the CABGa group and in 16 (70%) of pts in CABGmr group 12 months follow-up (p = 0,5). In pts with LVFR, there was a lower incidence of at least moderate IMR at follow-up (ΔEF dbx≥5% vs ΔEFdbx < 5%:11% vs 30% pts; p = 0,05). Multivariable logistic regression analysis revealed that in both CABGa and CABGmr group only preoperative age and EF changes during stress echo remained the independent predictors of the lack of LVFR in 12 months follow-up (table 1). Conclusions 1. LVFR and LVRR were reported in most of the pts in both analyzed groups. 2. Preoperative assessment of changes EF during dbx (ΔEFdbx)can be used to identify pts with IMR at increased risk of lack of improvement in LV function and risk of residual IMRin 12-month f-up after surgery. Parameters Odds ratio (OR) Odds ratio (OR) p CABGa vs CABGmr 0,644 0,215 - 1,927 0,432 Age (increase by every 5 years) 1,11 1,039 - 1,879 0,003 ΔEF dbx (increase by every 5%) 0,21 0,096 - 0,46 <0,001 Table 1. Prognostic factors lack improvement in left ventricle function.

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P5272Right versus Left Ventricular Remodelling after Surgical myectomy for HOCM

European Heart Journal ◽

10.1093/eurheartj/ehz746.0243 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Abdelkhalek ◽

A El Sawy ◽

R Doss ◽

A Samaan ◽

M Donia ◽

...

Keyword(s):

Left Ventricle ◽

Nyha Class ◽

Left Ventricular ◽

P Value ◽

Peak Strain ◽

Functional Changes ◽

Septal Myectomy ◽

Surgical Myectomy ◽

The Right

Abstract Background Surgical myectomy for (HOCM) results in complex structural and functional changes. “Remodelling” in different cardiac chambers. To date, changes in the Right versus the left Ventricle have not been studied. Methods Fourty five patients (mean age = 32±16, 68% males) who underwent extended septal myectomy for LVOTO and Fourty “normal” controls (mean age = 32±12 years, 52% males) were studied by cardiac magnetic resonance imaging (CMR). The patients were studied pre-operatively and 6–18 months post-operatively (median = 9 months). The images were analysed by both commercial and in-house software. Results After myectomy. Follow up CMR showed changes in RV mass (21±5 to 23±7) g/m2, volume (60±15 to 66±12) ml/m2 and shape using 3 different methods. RV deformation parameters showed significant changes with circumferential strain (−8±2 to −14±4), filling (38±16 to 62±19) ml/s/m2 and ejection rate (−44±17 to −75±22). Changes in RV were substantially higher than those observed in the LV (Figure. 1, Table. 1). All patients reported significant symptomatic improvement with 31 (78%) patients in NYHA class I and 9 (22%) in class II at follow up. Significant reduction in peak gradient across the LVOT by 75%. Table 1. Summary of reported parameters related to RV Shape for pre and post operation HOCM patients and Normal Healthy Volunteers LV RV Pre Post Normal P-value Pre Post Normal P-value EDV ml/m2 75±18 81±14 73±10 0.005 60±15 66±12 71±12 0.002 ESV ml/m2 20±9 24±8 26±6 0.008 16±7 19±9 26±7 0.02 SV ml/m2 56±13 57±10 51±13 0.38 44±11 48±10 49±14 0.009 EF 74±7 70±7 65±5 0.001 74±8 72±7 64±6 0.228 Mass g/m2 74±33 62±29 27±8 0.0456 21±5 23±7 18±5 0.2100 PFR ml/m2 173±48 141±48 141±40 <0.0001 38±16 62±19 55±24 <0.0001 PER ml/m2 −179±35 −172±42 −144±42 0.29 −44±17 −75±22 −57±22 <0.0001 Peak Strain −20±3 −20±3 −20±3 0.49 −8±2 −14±4 −12±3 <0.0001 Conclusion LV septal myectomy is followed by structural and functional remodelling which is more extensive in the right than the left ventricle. The clinical significance of these findings needs further study.

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