Abstract 2083: Improvement in Coronary Flow Reserve is Associated With Late Recovery of Left Ventricular Function After Carvedilol Therapy in Patients with Idiopathic Dilated Cardiomyopathy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kenichi Sugioka ◽  
Takeshi Hozumi ◽  
Yasuhiko Takemoto ◽  
Shoichi Ehara ◽  
Yasushi Kono ◽  
...  
Keyword(s):  
Beta Blocker ◽  
Coronary Circulation ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Blocker Therapy ◽  
Flow Reserve ◽  
Group A ◽  
Group B ◽  
Subsequent Improvement

Background: Beta-blocker therapy reverses left ventricular (LV) remodeling in patients with idiopathic dilated cardiomyopathy (IDC). Improvement in coronary circulation by beta-blocker could play a role in theses circumstances. This study investigated the relationship between change in coronary flow reserve (CFR), as a marker of coronary circulation, and subsequent improvement in LV ejection fraction (LVEF) at follow-up during carvedilol therapy in IDC patients. Methods: We studied 20 patients with IDC (mean age 56 ± 15 years, NYHA I–II) who were scheduled to receive carvedilol therapy. All patients were stabilized using an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker and diuretic treatment. Transthoracic Doppler echocardiography with intravenous infusion of adenosine triphosphate was used to assess CFR in the left anterior descending artery at baseline and after 1 month of treatment with carvedilol. A follow-up echocardiographic assessment of LVEF was done at 12 ± 6 months of treatment. The patients were classified by the degree of improvement in LVEF in the follow-up study, as Group A (LVEF change ≥10%) and Group B (LVEF change <10%). Results: Although there was no significant difference in CFR between the 2 groups at baseline (Group A vs. Group B, 2.4 ± 1.0 vs. 2.2 ± 0.8; P =NS), CFR was significantly higher in Group A than in Group B at 1 month of therapy (3.7 ± 0.5 vs. 2.5 ± 0.9; P <0.01). The magnitude of CFR change after 1 month of therapy was significantly greater in Group A than in Group B (1.3 ± 0.6 vs. 0.4 ± 0.5; P <0.01). Logistic regression analysis revealed that CFR change predicted a significant improvement in LVEF at follow-up ( P <0.05). Furthermore, a significant correlation was found between the change in CFR after 1 month and that in LVEF on follow-up (r=0.65, P <0.01). Conclusions: This study demonstrated that early change in CFR is associated with subsequent improvement in LVEF, suggesting the potential predictive value of coronary circulation for subsequent LV reverse remodeling after beta-blocker therapy in patients with IDC.

scholarly journals AB0422 LEFT VENTRICULAR ABNORMALITIES IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS FOLLOWED BY SEQUENTIAL ECHOCARDIOGRAPHY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1510.1-1511
Author(s):  
T. Kuga ◽  
M. Matsushita ◽  
K. Tada ◽  
K. Yamaji ◽  
N. Tamura
Keyword(s):  
Lupus Erythematosus ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Monocyte Count ◽  
Lv Dysfunction ◽  
Group A ◽  
Group B ◽  
Lv Diastolic Dysfunction ◽  
Group D

Background:Cardiovascular disease (CVD) is detected in up to 50% of systemic lupus erythematosus (SLE) patients1and major cause of death2. Even clinically silent SLE patients can develop left ventricular (LV) diastolic dysfunction3. Proper echocardiographic follow up of SLE patients is required.Objectives:To clarify how the prevalence of LV abnormalities changes over follow-up period and identify the associated clinical factors, useful in suspecting LV abnormalities.Methods:29 SLE patients (24 females and 5 men, mean age 52.8±16.3 years, mean disease duration 17.6±14.5 years) were enrolled. All of them underwent echocardiography as the baseline examination and reexamined over more than a year of follow-up period(mean 1075±480 days) from Jan 2014 to Sep 2019. Patients complicated with pulmonary artery hypertension, deep venous thrombosis or pulmonary embolism and underwent cardiac surgery during the follow-up period were excluded. Left ventricular(LV) systolic dysfunction was defined as ejection fraction (EF) < 50%. LV diastolic dysfunction was defined according to ASE/EACVI guideline4. LV dysfunction (LVD) includes one or both of LV systolic dysfunction and LV diastolic function. Monocyte to HDL ratio (MHR) was calculated by dividing monocyte count with HDL-C level.Prevalence of left ventricular abnormalities was analysed at baseline and follow-up examination. Clinical characteristics and laboratory data were compared among patient groups as follows; patients with LV dysfunction (Group A) and without LV dysfunction (Group B) at the follow-up echocardiography, patients with LV asynergy at any point of examination (Group C) and patients free of LV abnormalities during the follow-up period (Group D).Results:At the baseline examination, LV dysfunction (5/29 cases, 13.8%), LV asynergy (6/29 cases, 21.7%) were detected. Pericarditis was detected in 7 patients (24.1%, LVD in 3 patients, LV asynergy in 2 patients) and 2 of them with subacute onset had progressive LV dysfunction, while 5 patients were normal in echocardiography after remission induction therapy for SLE. At the follow-up examination, LV dysfunction (9/29 cases, 31.0%, 5 new-onset and 1 improved case), LV asynergy (6/29 cases, 21.7%, 2 new-onset and 2 improved cases) were detected. Though any significant differences were observed between Group A and Group B at the baseline, platelet count (156.0 vs 207.0, p=0.049) were significantly lower in LV dysfunction group (Group A) at the follow-up examination. Group C patients had significantly higher uric acid (p=0.004), monocyte count (p=0.009), and MHR (p=0.003) than Group D(results in table).Conclusion:LV dysfunction is progressive in most of patients and requires regular follow-up once they developed. Uric acid, monocyte count and MHR are elevated in SLE patients with LV asynergy. Since MHR elevation was reported as useful marker of endothelial dysfunction5, our future goal is to analyse involvement of monocyte activation and endothelial dysfunction in LV asynergy of SLE patients.References:[1]Doria A et al. Lupus. 2005;14(9):683-6.[2]Manger K et al. Ann Rheum Dis. 2002 Dec;61(12):1065-70.[3]Leone P et al. Clin Exp Med. 2019 Dec 17.[4]Nagueh SF et al. J Am Soc Echocardiogr. 2016 Apr;29(4):277-314.[5]Acikgoz N et al. Angiology. 2018 Jan;69(1):65-70.Numbers are median (interquartile range), Mann-Whitney u test were performed, p value less than 0.05 was considered statistically significant.Disclosure of Interests: :None declared

scholarly journals Survival and echocardiographic evaluation of dogs with idiopathic dilated cardiomyopathy treated with carvedilol

2010 ◽  
Vol 62 (3) ◽  
pp. 555-563 ◽  
Author(s):  
E.C. Soares ◽  
G.G. Pereira ◽  
L.C. Petrus ◽  
M. Leomil Neto ◽  
F.L. Yamaki ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Ventricular Remodeling ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
P Value ◽  
Echocardiographic Evaluation ◽  
Before And After ◽  
Group A ◽  
The Stability ◽  
Group B

Sixty dogs with idiopathic dilated cardiomyopathy were randomly treated with traditional therapy - digitalis, diuretics, angiotensin-converting inhibitors - (group A) or treated with these drugs plus carvedilol (group B). Echocardiographic variables were measured before and after 3, 13, 26, and 52 weeks of treatment or until death. Comparisons between groups and time were performed. No significant differences between groups were found in the most of the echocardiographic variables. The left ventricular end-systolic diameter indexed to body surface area (LVESDi) increased significantly in the group A dogs compared to the group B animals. The survival of groups A and B dogs were not different (P-value=0.1137). In conclusion, the stability of the LVESDi observed in the group treated with carvedilol may represent the beneficial effect over the ventricular remodeling.

Prognostic value of non-ischemic ring-like left ventricular scar pattern in patients with apparently idiopathic ventricular arrhythmias: a CMR imaging study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Nucifora ◽  
D Muser ◽  
S Castro ◽  
R Casado Arroyo ◽  
D Benhayon ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Prognostic Significance ◽  
Imaging Study ◽  
Left Ventricular ◽  
High Rate ◽  
Life Threatening ◽  
History Of ◽  
Group A ◽  
Group B

Abstract Background The presence of left ventricular (LV) late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has been correlated to life-threatening arrhythmic events in patients with apparently idiopathic ventricular arrhythmias (VAs). Aim of the present study was to investigate the prognostic significance of a specific LV-LGE phenotype characterized by a subepicardial/midmyocardial “ring-like” pattern of fibrosis. Methods Out of a total of 518 consecutive patients with apparently idiopathic VAs who underwent CMR study, 79 (15%) had evidence of LV-LGE. Of these, 23 (4%) patients had LV LGE with ring-like pattern, defined as subepicardial or midmyocardial LGE involving at least 3 contiguous segments in the same slice (group A), while 56 (11%) patients had LV LGE with no ring-like pattern (group B). The remaining 439 patients had no LGE (group C). The end-point of the study was a composite SCD, resuscitated cardiac arrest and nonfatal episodes of ventricular fibrillation or documented sustained ventricular tachycardia. Results Group A patients were more frequently males compared to groups B and C (96% vs. 79% vs. 52%; p&lt;0.01) and had more frequently a family history of SCD and/or cardiomyopathy (30% vs. 11% vs. 5%; p&lt;0.01). All patients in Group A showed VAs with a predominant RBBB morphology vs. 38 (68%) patients in Group B and 65 (15%) in Group C (p&lt;0.01). During a follow-up of 63±39 months, the composite outcome occurred in 13 patients (57%) in Group A vs. 11 (20%) in Group B and 2 (1%) in Group C (p&lt;0.01). Conclusion In patients with apparently idiopathic VAs, a nonischemic LV-LGE with a ring-like pattern at CMR is associated with a high rate of malignant arrhythmic events during follow-up. Funding Acknowledgement Type of funding source: None

Abstract 810: Impact of Elevated Plasma Matrix Metalloproteinase-2 on Prognosis in Hypertrophic Cardiomyopathy: Evidence from Long-Term Follow-Up of Genotyped Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Eiichi Masuta ◽  
Hidekazu Ino ◽  
Noboru Fujino ◽  
Katsuharu Uchiyama ◽  
Kenshi Hayashi ◽  
...  
Keyword(s):  
Matrix Metalloproteinase ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
Left Ventricular ◽  
Matrix Metalloproteinase 2 ◽  
Cardiac Events ◽  
Group A ◽  
Group B

Background: Previous studies suggest that production of matrix metalloproteinase-2 (MMP-2) which is responsible for cardiac remodeling could determine prognosis of hypertrophic cardiomyopahty (HCM). However, few data exist regarding the importance of MMP-2 production in clinical settings. Therefore, we determined MMP-2 levels correlated to prognosis in HCM with sarcomere gene mutations. Methods and Results: Echocardiography and determination of plasma MMP-2 levels by enzyme-linked immunoassay were simultaneously performed in 31 HCM patients (22 women, mean age 56±12 years) with sarcomere protein gene mutation including 22 for cardiac troponin I, 5 for cardiac myosin binding-protein C, 3 for cardiac troponin T and 1 for beta-myosin heavy chain. Major cardiac events such as hospitalization due to congestive heart failure or ventricular fibrillation and mortality were prospectively examined for follow-up period of 48.4±29.1 months. When patients were divided into two groups (Group A: MMP-2 ≥800 ng/ml n=16 and Group B: MMP-2<800ng/ml n=15), there was no differences in mean age (59.4±11.7 year vs 53.1±11.3 year, p=0.13). On echocardiograms, interventricular septal thickness in group A (11.7±4.2 mm) was smaller than that in group B (15.9±4.8 mm, p<0.05) and percent fractional shortening (FS) was significantly impaired in group A (24.8±12.5%) in comparison with that in group B (37.7±8.1%, p=0.002). There was negative correlation between the MMP-2 levels and FS (p<0.001, r=0.76). The frequency of cardiac events was significantly higher in group A (10 patients of 16 patients) than in group B (1 patient of 15 patients, p=0.0012). Importantly, 5 patients of group A died, although none of groupB patients did (p=0.018). Conclusion: These results demonstrate that the high plasma concentration of MMP-2 (≥800 ng/ml) could be a predictor of prognosis in HCM with sarcomere mutations probably through reflecting impaired left ventricular function.

scholarly journals P748 Three-year echocardiographic outcomes in MitraClip patients with chronic kidney disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Tavernese ◽  
V Cammalleri ◽  
A Sanseviero ◽  
P De Vico ◽  
S Muscoli ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systemic Hypertension ◽  
Systolic Pulmonary Artery Pressure ◽  
Kaplan Meier ◽  
Group A ◽  
Group B

Abstract Background Chronic kidney disease (CKD) has been shown to impact negatively the prognosis of patients with heart failure, coronary artery or valvular heart disease and emerged as predictor of poor outcomes in mitraclip population. Purpose Aim of our study was to evaluate three-year echocardiographic outcomes in CKD patients with severe mitral regurgitation (MR) treated with mitraclip. Methods This in an observational study including patients treated with mitraclip in our institution, who completed three years of follow up. Patients population was divided into two groups according to basal creatinine clearance (CrCl): group A, including patients with normal/mild decline of renal function (CrCl &gt; 60 ml/min) and group B, including patients with CKD (CrCl &lt; 60 ml/min). Demographic and procedural characteristics were compared, as well as echocardiographic data, including grade of MR, left ventricular ejection fraction (LVEF), mean transmitral gradient and systolic pulmonary artery pressure (sPAP). Kaplan-Meier survival curves were obtained. Results The study population consists of 107 patients (mean age 71 ± 9 years, 69% male): 57 belonging to group A and 50 to group B. Patients of group B had higher values of LogEuroScore (22 ± 10 vs.15 ± 9 p = 0,0002), systemic hypertension (92% vs. 74%, p = 0,026), complicated diabetes (46% vs. 24% p = 0,034) and NYHA IV before the procedure (24% vs 9 %, p = 0,059). Additionally, patients of group B had lower baseline LVEF (35 ± 11 vs. 41 ± 13; p = 0,012). Procedural success was similar between the two groups without significant difference in degree of MR reduction after mitraclip implantation. Echocardiographic follow-up showed that in group B, the LVEF did not improve after the treatment (more than 50% had LVEF &lt; 35% at 1,2 and 3 years) while in the group A it improved significantly (LVEF &lt; 35% from 47,6% at discharge to 29%, 32% and 31% at 1, 2 and 3 years, respectively). In comparison to group A, in group B a progressive increase in residual MR grade was observed (moderate-to-severe MR from 2% at discharge to 14%, 15%, and 27% at 1, 2 and 3 years, respectively) as well as in the mean transmitral gradient (from 3,90 ±1,6 mmHg after the mitraclip implantation to 5,28 ± 1,7; 5,73 ± 1,75; 6,06 ±1,75 at 1, 2 and 3 years, respectively) and sPAP (from 47 ± 12 mmHg at discharge to 49 ± 21; 51 ± 20; 48 ± 22 at 1, 2 and 3 years, respectively). Kaplan Meier estimate of survival free from in-hospital readmission was 77% in group A and 61% in group B (Log-Rank 4.563, p = 0,033) and survival free from cardiovascular death was 95% and 81,5%, in group A and B, respectively (Log-Rank 4.806, p = 0,028). Conclusion Our results suggest that CKD patients have poorer outcomes after mitraclip implantation with worsening of some echocardiographic parameters, particularly for residual MR degree, mean transmitral gradient and sPAP, without improvement in LVEF at one, two and three years of follow-up.

scholarly journals 614 Implantable cardiac monitors predict arrhythmic events in post-infarction patients with mildly reduced left ventricular ejection fraction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vincenzo Riverso ◽  
Antonio Curcio ◽  
Alessia Tempestini ◽  
Emilia De Luca ◽  
Sabrina La Bella ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Cardiac Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment ◽  
Group A ◽  
Group B

Abstract Aims Complications of acute myocardial infarction (MI) can be life-threatening leading to sudden cardiac death. While guidelines recommend prompt revascularization and prolonged intensive care hospitalization, predictors of major adverse cardiovascular outcomes are yet poorly understood. The role of implantable cardioverter-defibrillators, even in cases of non-sustained arrhythmias is still debated. To date, it is unknown how to follow-up patients with mild cardiac dysfunction after MI. Implantable cardiac monitors (ICMs) can be helpful for stratifying patients in the early discharge period, and remote monitoring might speed up arrhythmia recognition and treatment. We investigated the role of remote monitoring of ICMs to detect arrhythmic events in post-MI patients without overt cardiac dysfunction. Methods and results We enrolled 13 patients (9 males; 69.8 years) after either ST-segment (N = 7) or non-ST-segment elevation (N = 6) MI with a left ventricular ejection fraction (LVEF) &gt;35%, admitted to our coronary care unit for urgent revascularization between September 2019 and September 2021. Twelve patients underwent percutaneous myocardial revascularization, whereas one was treated with medical therapy only. All patients received an ICM during hospitalization according to echo and EKG parameters. We considered LVEF ≤ 40% as sole risk factor or LVEF between 40% and 50% in addition to either PQ length prolongation, or QRS widening, or pathologic heart rate variability, or non-sustained ventricular tachycardia/paroxysmal advanced second degree atrioventricular block. Patients with multiple revascularization procedures and several hospital admissions were excluded. Implanted ICM were frequently monitored both remotely and in-office when required. During follow-up, brady- and tachy-arrhythmias were recorded in four patients (30.8%). The remote monitoring of the ICM documented new-onset atrial fibrillation, high-degree atrioventricular block, severe bradycardia, and sustained ventricular tachycardia. Three patients required hospitalization and upgrade of the implanted device with pacemakers and cardioverter/defibrillator. For arrhythmic risk stratification, patients were divided into two subgroups; group A included patients with LVEF 40% associated with heart rate &gt; 60 b.p.m., PQ length &gt;160 ms and QRS width &gt;86 ms (N = 4); group B included patients with EF 41%/50%, PQ length &lt;159 and QRS width &lt;85 ms (N = 10). First group experienced more advanced rhythm disorders than group B (P &lt; 0.05). Device implantation was significantly higher in group A (P &lt; 0.05%). Conclusions OFF-label implementation of ICMs coupled with remote device monitoring may be effective for early detection of serious adverse cardiac rhythm alterations in patients after MI and LVEF higher than 35%. Further monitoring is ongoing for assessing the occurrence of multiple arrhythmias or their increased occurrence.

P497Arrhythmic burden in patients with filamin C (FLNC) truncating variant associated cardiomyopathy

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Zupan Meznar ◽  
D Zizek ◽  
U D Breskvar Kac ◽  
K Writzl ◽  
M Jan ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Optimal Timing ◽  
Icd Implantation ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
Current Guidelines

Abstract Background Truncating variants in FLNC gene are associated with an overlapping phenotype of arrhythmogenic and dilated cardiomyopathy. There are reports of high arrhythmia propensity with sudden cardiac death (SCD) often being the first symptom of the disease. It has been suggested that the current European guidelines primary prevention (PP) recommendation about implantable cardioverter-defibrillator (ICD) implantation might not be applicable in these patients and that earlier intervention should be considered. Purpose We sought to investigate the arrhythmic burden in FLNC truncation carriers in our centre. Methods Adult FLNC truncation carriers diagnosed in our centre between the years 2018 and 2019 were included in the study. We retrospectively analysed clinical data, and ICD follow-up reports in the cohort. Patients implanted with an ICD were divided in 3 groups: group A (secondary prevention ICD implantation), group B (PP indication according to the current guidelines – left ventricular ejection fraction (LVEF) below 35%) and group C (early PP– FLNC truncation carrier, LVEF &lt; 50% and late gadolinium enhancement on cardiac magnetic resonance). We report the number of patients experiencing SCD and the number of appropriate and inappropriate ICD therapies per group. Results Twenty-four adult patients from 3 different families with three distinct FLNC truncating variants were identified. Ten (42%) were male; the average age was 45 ± 14 years. There were 3 (13%) SCDs in one family (2 male and one female, 29-42 years old) and two (8%) aborted SCDs in the remaining two families (one male and one female, 66 and 51 years old). Altogether eleven (46%) patients were implanted with an ICD. There were three patients in group A (2 aborted SCDs and 1 sustained ventricular tachycardia (VT)), two patients in group B and six patients in group C. Average ICD follow-up times were 42, 48 and 6 months for groups A, B and C, respectively. Eight appropriate ICD therapies occurred in 3 patients (27%). In group A, there were four sustained VT episodes successfully converted with an anti-tachycardia pacing (ATP) in two patients (67%); the average time to first therapy was 33 months. In group B, there was one appropriate shock for ventricular fibrillation (VF), and three sustained VT episodes in one patient (50%), time to first therapy was 60 months. After six months follow-up, there were no appropriate therapies registered in group C. Two patients (18%) experienced inappropriate shocks due to sinus tachycardia, one in group A and one in group C. Conclusion One-fifth of FLNC truncation carriers in our cohort experienced SCD. When patients received an ICD according to the current guidelines, majority experienced appropriate ICD therapy. Further clinical studies with longer follow-up will be needed to define appropriate risk stratification and optimal timing for prophylactic ICD intervention in these patients.

Sign in / Sign up

Export Citation Format

Share Document