Secondary Prevention of Potentially Life-Threatening Arrhythmia Using Implantable Cardioverter Defibrillators in Patients with Biopsy-Proven Viral Myocarditis and Preserved Ejection Fraction

Cardiology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Benjamin Sasko ◽  
Daniel Patschan ◽  
Peter Nordbeck ◽  
Lea Seidlmayer ◽  
Henrike Andresen ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Acute Phase ◽  
Viral Myocarditis ◽  
Left Ventricular ◽  
Long Term Results ◽  
Electrical Storm ◽  
Lv Function ◽  
Acute Viral Myocarditis ◽  
Life Threatening

<b><i>Background:</i></b> Arrhythmia and sudden cardiac death (SCD) are known complications of acute viral myocarditis, regardless of ejection fraction (EF) at presentation. Whether such complications confer long-term risk is unknown, especially in those who present with preserved left ventricular (LV) function. No guidelines exist to the long-term reduction of arrhythmic death in such patients. <b><i>Method:</i></b> In this retrospective study, we analyzed the long-term results of implantable cardioverter defibrillator (ICD) treatment in patients after an acute phase of myocarditis with life-threatening arrhythmia. <b><i>Results:</i></b> We identified 51 patients who had ICDs implanted following life-threatening arrhythmia presentation of confirmed acute viral myocarditis, despite preserved LVEF. Overall, 72.5% of patients had a clinical history of chest pain and viral infection with fever. Viral myocarditis was confirmed by cardiac magnetic resonance imaging (all had late enhancement) plus endomyocardial biopsies (most frequent were Epstein-Barr virus 29.4%, adenovirus 17.6%, and Coxsackie 17.6%), and 88.2% were discharged on anti-arrhythmic drugs. Overall, 12 patients (23.5%) required ICD intervention within the first 3 months, a further 7 patients (37.3% overall) between 3 and 12 months, and a further 12 patients (60.8% overall) until 58 months. During the follow-up, 3 of 51 patients (5.9%) died—deaths were due to cardiac events (<i>n</i> = 1), fatal infection (<i>n</i> = 1), and car accidents (<i>n</i> = 1). Of the 31 patients who had ventricular tachycardias after the acute phase of myocarditis, 11 needed radiofrequency ablation due to a high number of events or electrical storm. No baseline variables were identified that would serve as a basis for risk stratification. <b><i>Conclusion:</i></b> Malignant arrhythmic events due to viral myocarditis are potential predictors of future SCD in patients not only with a reduced but also with a preserved EF.

Abstract 16422: Lower Mitochondrial-derived Peptide Humanin in Young Adults Born Preterm vs. Term and Association With Left Ventricular Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daniela Ravizzoni Dartora ◽  
Adrien Flahualt ◽  
Carolina Nobre Pontes ◽  
Gabriel Altit ◽  
Alyson Deprez ◽  
...  
Keyword(s):  
Young Adults ◽  
Ejection Fraction ◽  
Experimental Models ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Mitochondrial Alterations ◽  
Increased Risk

Introduction: Preterm (PT) birth is associated with increased risk of cardiovascular diseases (CVD) and heart failure. We previously reported left ventricular (LV) mitochondrial dysfunction in a rat model mimicking the deleterious conditions associated with PT birth. Whether mitochondrial function is altered in humans born PT and associated with LV function changes is unknown. We aimed to determine if serum humanin levels, a mitochondrial-derived peptide with cytoprotective effects, are altered in humans born PT and are associated with impaired myocardial function. Methods: Data were obtained from 55 young adults born PT (<30 weeks of gestational age, GA) compared to 54 full-term (T) controls of the same age. Serum humanin levels were determined by ELISA and LV ejection fraction (LVEF) by echocardiography. Results are shown as median (interquartile range) and comparisons between groups were performed using non-parametric tests. Results: Individuals were evaluated at 23.3 (21.4, 25.3) years, and age and sex distribution were similar between groups. Median GA was 27.5 (26.2, 28.4) weeks in the PT group. Humanin levels (pg/ml) were 132.9 (105.1, 189.3) and 161.1 (123.6, 252) in the PT and the T groups, respectively (p=0.0414). LVEF was within the normal range and similar between groups. Lower LVEF was associated with lower humanin levels (p<0.001), and this association was observed both in the term (p=0.002) and the preterm (p=0.047) groups. Conclusions: Serum humanin levels are lower in adult born PT. Since lower humanin levels are also associated with lower LVEF, our results suggest that mitochondrial alterations could play a role in the long-term adverse cardiovascular consequences of PT birth. Humanin analogs improve LV function in experimental models. Our results pave the way for future studies exploring humanin as a therapeutic avenue for the prevention and treatment of CVD in individuals born PT.

scholarly journals Chronic Mitral Regurgitation: When the Optimal Timing of Surgical Intervention?

1970 ◽  
Vol 1 (2) ◽  
pp. 142-147
Author(s):  
H Oemar ◽  
K Yusoff ◽  
HB Abdulgani
Keyword(s):  
Mitral Regurgitation ◽  
Surgical Intervention ◽  
Clinical Symptoms ◽  
Left Ventricular ◽  
Long Term Results ◽  
Lv Function ◽  
Optimal Timing ◽  
Pathophysiological Mechanism ◽  
Lv Dysfunction

Optimal timing of surgery in mitral regurgitation (MR) is a complex problem that has been studied widely. The pathophysiological mechanism and hemodynamic changes whereby MR exerts its deleterious effects on survival is well recognized. Early reports in the literatures and newer prospective studies suggest that severe MR is not a benign state and it has a high morbidity and eventually mortality. Thus, it is obviously rationale in understanding pathophysiological construct and be able to identify disease condition in choosing the golden moment for surgical intervention. Surgical intervention has been exposed to be the only efficient management, but its optimal timing remains a matter of controversy. The ultimate goal of patient care is obviously no longer the relief of limiting symptoms but the achievement of an optimal long-term outcome with regard to mortality and morbidity. Preoperative developments of severe symptoms, left ventricular (LV) dysfunction, LV enlargement, chronic atrial fibrillation, or progressive pulmonary hypertension were found to be associated with an unfavorable outcome. The timing of surgical correction for MR depends chiefly on three factors: clinical symptoms, LV function and the severity of MR. In term of waiting symptoms, the surgery has changed considerably from a relatively passive response to the development of severe symptoms, to an early surgery concept preceding the signs of LV dysfunction. This because clinical symptoms can remain absent or minimal despite severe regurgitation caused by adaptive remodeling of LV and left atrium, or because of patient adaptation of the disease. Thus, in chronic severe MR, there should be no waiting for LV function to decline before intervening, because the long-term results of that approach are not gratifying. Recent data underscored that mitral surgery is associated with a considerably decreased subsequent risk of mortality and heart failure. The reduction in the risk of death associated with surgery is greater among patients with a larger effective regurgitant orifice (ERO) assessed echocardiographically than among those with a smaller ERO and results in normalization of the life expectancy. These data provide a firm basis for considering surgery in patients with asymptomatic chronic mitral regurgitation who have an ERO of at least 40 mm². Key words: Mitral regurgitation; Mitral valve surgery; Echocardiography. DOI: http://dx.doi.org/10.3329/cardio.v1i2.8120 Cardiovasc. j. 2009; 1(2) : 142-147

scholarly journals Initial Effects of the Left Ventricular Repair by Plication May Not Last Long in a Rat Ischemic Cardiomyopathy Model

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
Takeshi Nishina ◽  
Kazunobu Nishimura ◽  
Sadatoshi Yuasa ◽  
Senri Miwa ◽  
Takuya Nomoto ◽  
...  
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Sham Group ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Long Term Results ◽  
Lv Function ◽  
Long Term Effects ◽  
Second Surgery

Background Long term effects of left ventricle (LV) repair surgery (LVR) for ischemic cardiomyopathy are not well understood. Methods and Results Sixty-nine rats developed ischemic cardiomyopathy with large akinetic LV area 4 weeks after the left anterior descending artery was ligated. In a second surgery 4 weeks later, 33 rats underwent LVR by plication of the akinetic LV area (LVR group), and 36 underwent rethoracotomy alone (sham group). No medication was used in either group. All rats survived the second surgery. LV end-diastolic dimension as measured by echocardiography, LV fractional shortening, and the maximal end-systolic pressure-volume relationship (E max ) as calculated from the data by catheter-tipped manometer and echocardiography improved in the LVR group after the second surgery, but LV end-diastolic dimension and E max gradually deteriorated as time passed. LV end-diastolic pressure improved 1 week after LVR but rose significantly 4 weeks after LVR. Brain natriuretic peptide mRNA was lower in the LVR group than in the sham group 1 week after LVR but not 4 weeks postoperatively. Conclusions Initial improvement in LV function and neurohormonal status after LVR did not last for 4 weeks in this rat model when untreated medically. The mechanism of deterioration should be elucidated to improve long-term results of LVR.

scholarly journals 528 Advanced echocardiographic assessment in outpatients with advanced heart failure undergoing periodical levosimendan infusion

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Matteo Morello ◽  
Emilio Miglierina ◽  
Michele Golino ◽  
Francesca Ceriani ◽  
Carlo Oliva ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Lv Function ◽  
Clinical Effects ◽  
Non Invasive ◽  
Vasodilatory Effect ◽  
Before And After ◽  
Echocardiographic Assessment

Abstract Aims The long-term clinical effects of Levosimendan in patients (pts) with heart failure and reduced ejection fraction (HFrEF) are mainly mediated by its long-acting metabolite, OR-1896, whose half-life is much longer (81 h vs. 1–1.5 h), although with similar inotropic and vasodilatory effect. Echocardiographic data are still lacking, expecially in the chronic setting. Global longitudinal strain (GLS) and left ventricular myocardial work index (LVMWI) are novel non-invasive methods for left ventricle (LV) function evaluation that consider myocardial deformation and afterloads using LV strain combined with the non-invasive estimation of LV pressure. The aim of this study was to perform an echocardiographic assessment in pts with advanced HFrEF before and after infusion of Levosimendan in a chronic setting, using GLS and LVMWI. Methods and results 6 pts with ischaemic HFrEF were prospectively enrolled in the study. Echo-data were collected from all patients using a Vivid E95 system (GE Healthcare), before and after the end of infusion (24–48 h). Moreover, 4 pts underwent another echo evaluation 96 h after the infusion to assess the long term effect of OR-1896. Although mean end-diastolic volume decreased after 24–48 h, increased after 96 h, as reported in Table 1. As to the Ejection Fraction (EF), strain-parameters and stroke volume (SV) remain unchanged before and after the infusion. Similarly LVMWI-derived parameters also remain overall unchanged (Table 1). Conclusions In pts with ischaemic HFrEF undergoing periodical infusion of Levosimendan, we very preliminary observed a reduction of LV size short after the infusion, which interestingly do not persist after 96 h. The other considered echocardiographic parameters (EF, SV, strain-derived parameters) did not show significant differences before and after the infusion. An explanation is that Levosimendan improves LV congestion but not the contractile force in pts with advanced HFrEF, whose myocardial performance is too compromised. Therefore the haemodynamic benefits observed chronically in pts with Levosimendan might be due to the initial decongestion and its vasodilatory effect, and it may not persist in mid-term, depending on basal myocardial conditions. Larger studies should be conducted to conferm these findings.

scholarly journals Assessment of 10-Year Left-Ventricular-Remodeling by CMR in Patients Following Aortic Valve Replacement

2021 ◽  
Vol 8 ◽  
Author(s):  
Nina Rank ◽  
Lukas Stoiber ◽  
Mithal Nasser ◽  
Radu Tanacli ◽  
Christian Stehning ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Aortic Valve ◽  
Ejection Fraction ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Lv Function ◽  
Close Monitoring ◽  
Gadolinium Enhancement

Aims: Aortic valve replacement (AVR) may result in reverse cardiac remodeling. We aimed to assess long-term changes in the myocardium following AVR by Cardiac Magnetic Resonance Imaging (CMR).Methods: We prospectively observed the long-term left ventricular (LV) function and structure of 27 patients with AVR [n = 19 with aortic stenosis (AS); n = 8 with aortic regurgitation (AR)] by CMR. Patients underwent CMR before, as well as 1, 5, and 10 years after AVR. We evaluated clinical parameters, LV volumes, mass, geometry, ejection fraction (EF), global myocardial longitudinal strain (MyoGLS), global myocardial circular strain (MyoGCS), hemodynamic forces (HemForces), and Late Gadolinium Enhancement (LGE).Results: The median of LVMI, EDVI, and ESVI decreased in both groups. Patients with AR had higher initial values of EDVI and ESVI and showed a more prominent initial reduction. In AS, MyoGLS improved already after 1 year and remained constant afterward, whereas, in AR no improvement of MyoGLS was found. MyoGCS remained unchanged in the AS group but deteriorated in the AR group over 10 years. Ejection fraction (EF) was higher in AS patients compared to AR 10 years post-AVR. Late gadolinium enhancement (LGE) could be found more frequently in AS patients.Conclusion: CMR was well suited to investigate myocardial changes over a 10-year follow up period in patients with aortic valve disease. Regarding the long-term functional changes following AVR, patients with AR seemed to benefit less from AVR compared to AS patients. Fibrosis was more common in AS, but this did not reflect functional evolution in these patients. Close monitoring seems indispensable to avoid irreversible structural damage of the heart and to perform AVR at an appropriate stage.

scholarly journals Immediate and Long-Term Results of Coronary Angioplasty in Patients Aged 80 Years and Older

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Bo Chen ◽  
Dingguo Zhang ◽  
Tiebing Zhu ◽  
Liansheng Wang ◽  
Chunjian Li ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Left Ventricular ◽  
Long Term Results ◽  
Lv Function ◽  
Cardiac Events ◽  
Vessel Disease ◽  
Triple Vessel Disease ◽  
Procedural Success ◽  
One Year

Objectives. To observe the short- and long-term outcomes after percutaneous coronary intervention (PCI) in octogenarians (>80y.o.) at our institution.Method. All octogenarians who underwent PCI during the study period were retrospectively retrieved from our database and clinically followed. Major adverse cardiac (and cerebral) events (MAC(C)E) was considered as primary outcome.Results. From January 2003 to December 2007, 140 octogenarians (mean age: 85±3y.o., 79% of male) underwent PCI and were clinically followed 14±11months. Procedural success was obtained in 100 percent of patients with single vessel disease, in 96 percent of patients with double vessel disease, and in 75 percent of patients with triple vessel disease. In-hospital, 30 days, and one year MACE rates were 5%, 5%, and 10.7%, respectively. Impaired left ventricular (LV) ejection fraction (hazard ratio(HR)=0.909, 95% confidence interval(CI)=0.856to 0.964,P=.002), diabetes mellitus (HR=5.792, 95%  CI=1.785to 18.796,P=.003), and low GFR (HR=2.943, 95%  CI=1.161, to 7.464,P=.023) were independently associated with an increase risk of MACE at long-term followup.Conclusion. Coronary angiography can be successfully performed in elderly patients with single and double vessel disease. The results in triple vessel disease are encouraging. Low LV function, diabetes, and impaired renal function increase the risk of long-term major adverse cardiac events.

scholarly journals Differing effects of beta-blockers on long-term clinical outcomes following percutaneous coronary intervention between patients with mid-range and reduced left ventricular ejection fraction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jun Shitara ◽  
Ryo Naito ◽  
Takatoshi Kasai ◽  
Hirohisa Endo ◽  
Hideki Wada ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Abstract Background The aim of this study was to determine the difference in effects of beta-blockers on long-term clinical outcomes between ischemic heart disease (IHD) patients with mid-range ejection fraction (mrEF) and those with reduced ejection fraction (rEF). Methods Data were assessed of 3508 consecutive IHD patients who underwent percutaneous coronary intervention (PCI) between 1997 and 2011. Among them, 316 patients with mrEF (EF = 40–49%) and 201 patients with rEF (EF < 40%) were identified. They were assigned to groups according to users and non-users of beta-blockers and effects of beta-blockers were assessed between mrEF and rEF patients, separately. The primary outcome was a composite of all-cause death and non-fatal acute coronary syndrome. Results The median follow-up period was 5.5 years in mrEF patients and 4.3 years in rEF patients. Cumulative event-free survival was significantly lower in the group with beta-blockers than in the group without beta-blockers in rEF (p = 0.003), whereas no difference was observed in mrEF (p = 0.137) between those with and without beta-blockers. In the multivariate analysis, use of beta-blockers was associated with reduction in clinical outcomes in patients with rEF (hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.36–0.97; p = 0.036), whereas no association was observed among those with mrEF (HR 0.74; 95% CI 0.49–1.10; p = 0.137). Conclusions Our observational study showed that use of beta-blockers was not associated with long-term clinical outcomes in IHD patients with mrEF, whereas a significant association was observed in those with rEF.

scholarly journals Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

2021 ◽  
Author(s):  
Philippe C. Wouters ◽  
Geert E. Leenders ◽  
Maarten J. Cramer ◽  
Mathias Meine ◽  
Frits W. Prinzen ◽  
...  
Keyword(s):  
Systolic Function ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Lv Function ◽  
Peak Strain ◽  
Cardiac Resynchronisation ◽  
Reverse Remodelling ◽  
Resynchronisation Therapy ◽  
Lv Systolic Function

AbstractPurpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.

scholarly journals Peripheral Blood MicroRNAs as Potential Biomarkers of Myocardial Damage in Acute Viral Myocarditis

Genes ◽  
2021 ◽  
Vol 12 (3) ◽  
pp. 420
Author(s):  
Maria Marketou ◽  
Joanna Kontaraki ◽  
Alexandros Patrianakos ◽  
George Kochiadakis ◽  
Ioannis Anastasiou ◽  
...  
Keyword(s):  
Peripheral Blood ◽  
Mononuclear Cells ◽  
Troponin I ◽  
Left Ventricular Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Viral Myocarditis ◽  
Myocardial Damage ◽  
Left Ventricular ◽  
Cardiovascular Development ◽  
Acute Viral Myocarditis

Background: microRNAs (miRs) have emerged as important modulators of cardiovascular development and disease. Our aim was to determine whether cardiac-related miRs such as miR-21-5p and miR-1-3p were differentially expressed in acute viral myocarditis and whether any of them was related with the extent of myocardial damage and left ventricular dysfunction. Methods: We enrolled 40 patients with acute viral myocarditis. Blood samples were taken on admission and miRs expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. Results: miR-21-5p, miR-1-3p were significantly elevated in acute myocarditis. miR-21-5p levels showed a strong correlation with global longitudinal strain (r = 0.71, p < 0.01), while miR-1-3p had significant correlations with troponin I (r = 0.79, p < 0.01). Conclusions: The expression of miR-21-5p and miR-1-3p in peripheral blood is increased in acute viral myocarditis, and this increase is correlated with myocardial damage and indicative of left ventricular systolic dysfunction in these patients.

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