Abstract 2817: The Impact of Exercise-Induced Changes in Intraventricular Dyssynchrony on the Functional Improvement in Patients with Non-Ischemic Cardiomyopathy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Soo-Jin Kang ◽  
Hong-Seok Lim ◽  
Un-Jung Choi ◽  
Byung-Joo Choi ◽  
So-Yeon Choi ◽  
...  
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Doppler Imaging ◽  
Functional Improvement ◽  
Peak Exercise ◽  
Lv Function ◽  
Functional Changes ◽  
Exercise Induced ◽  
Induced Changes ◽  
The Impact

Background: We studied whether dynamic changes in LV asynchrony may affect the functional improvement of LV in medically treated patients with non-ischemic cardiomyopathy (CMP). Methods: Supine bicycle exercise was performed in 41 patients (age 51±12 years, EF 33±8%). Using tissue Doppler imaging, the average of peak systolic velocities of 6 basal LV segments were obtained at rest (V b ) and peak exercise (V p ). ΔV was calculated by [V p -V b ], reflecting the contractile reserve. Dyssynchrony index (SD 4 ) was defined as the standard deviation of the time to peak systolic velocities at 4 basal & mid segments of septum and lateral wall on apical 4 chamber view. ΔSD 4 was calculated as [peak exercise SD 4 - resting SD 4 ]. Follow-up echocardiography was done in 35 patients after medication for 11.2±4.2 months. Functional changes of LV was assessed by ΔEF FU and %change of ESV (ΔESV FU ). Results: Baseline SD 4 was 24±17 ms. During exercise, SD 4 increased in 24 patients (ΔSD 4 =+14±12 ms), whereas decreased in 17 patients (ΔSD 4 =-17±14 ms). ΔSD 4 correlated with ΔV (r=-0.36, p=0.021) and exercise-induced increase in MR (ΔJet/LA area (%); r=0.31, p=0.05 and ΔPISA radius at 40cm/s of aliasing v; r=0.46, p=0.003). ΔV and ΔPISA were related to the follow-up change of LV function. Especially, ΔSD 4 independently correlated with ΔEF FU (β= -0.82, p<0.001) and also with ΔESV FU (β= 0.40, p=0.021)(Fig ). However, baseline SD 4 didn’t affect ΔEF FU . On ROC curve analysis, sensitivity and specificity of ΔSD 4 <4.0 ms were 82% and 78% for predicting ΔEF FU >+5% and 70% and 63% for predicting ΔESV FU <-15%. Conclusion : Exercise-induced changes in dyssynchrony (ΔSD 4 ) can predict the functional improvement in non-ischemic CMP.

scholarly journals Clinical Outcomes in Patients with Ischemic versus Non-Ischemic Cardiomyopathy after Angiotensin-Neprilysin Inhibition Therapy

2021 ◽  
Vol 10 (21) ◽  
pp. 4989
Author(s):  
Mohammad Abumayyaleh ◽  
Christina Pilsinger ◽  
Ibrahim El-Battrawy ◽  
Marvin Kummer ◽  
Jürgen Kuschyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Tachyarrhythmias ◽  
Ventricular Ejection Fraction ◽  
One Year ◽  
The Impact

Background: The angiotensin receptor-neprilysin inhibitor (ARNI) decreases cardiovascular mortality in patients with chronic heart failure with a reduced ejection fraction (HFrEF). Data regarding the impact of ARNI on the outcome in HFrEF patients according to heart failure etiology are limited. Methods and results: One hundred twenty-one consecutive patients with HFrEF from the years 2016 to 2017 were included at the Medical Centre Mannheim Heidelberg University and treated with ARNI according to the current guidelines. Left ventricular ejection fraction (LVEF) was numerically improved during the treatment with ARNI in both patient groups, that with ischemic cardiomyopathy (n = 61) (ICMP), and that with non-ischemic cardiomyopathy (n = 60) (NICMP); p = 0.25. Consistent with this data, the NT-proBNP decreased in both groups, more commonly in the NICMP patient group. In addition, the glomerular filtration rate (GFR) and creatinine changed before and after the treatment with ARNI in both groups. In a one-year follow-up, the rate of ventricular tachyarrhythmias (ventricular tachycardia and ventricular fibrillation) tended to be higher in the ICMP group compared with the NICMP group (ICMP 38.71% vs. NICMP 17.24%; p = 0.07). The rate of one-year all-cause mortality was similar in both groups (ICMP 6.5% vs. NICMP 6.6%; log-rank = 0.9947). Conclusions: This study shows that, although the treatment with ARNI improves the LVEF in ICMP and NICMP patients, the risk of ventricular tachyarrhythmias remains higher in ICMP patients in comparison with NICMP patients. Renal function is improved in the NICMP group after the treatment. Long-term mortality is similar over a one-year follow-up.

scholarly journals Distributed changes of the functional connectome in patients with glioblastoma

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Karl-Heinz Nenning ◽  
Julia Furtner ◽  
Barbara Kiesel ◽  
Ernst Schwartz ◽  
Thomas Roetzer ◽  
...  
Keyword(s):  
Tumour Recurrence ◽  
Local Network ◽  
Distributed Network ◽  
Focal Lesions ◽  
Functional Changes ◽  
Functional Connectome ◽  
Neural Organization ◽  
Tumour Location ◽  
The Impact

Abstract Glioblastoma might have widespread effects on the neural organization and cognitive function, and even focal lesions may be associated with distributed functional alterations. However, functional changes do not necessarily follow obvious anatomical patterns and the current understanding of this interrelation is limited. In this study, we used resting-state functional magnetic resonance imaging to evaluate changes in global functional connectivity patterns in 15 patients with glioblastoma. For six patients we followed longitudinal trajectories of their functional connectome and structural tumour evolution using bi-monthly follow-up scans throughout treatment and disease progression. In all patients, unilateral tumour lesions were associated with inter-hemispherically symmetric network alterations, and functional proximity of tumour location was stronger linked to distributed network deterioration than anatomical distance. In the longitudinal subcohort of six patients, we observed patterns of network alterations with initial transient deterioration followed by recovery at first follow-up, and local network deterioration to precede structural tumour recurrence by two months. In summary, the impact of focal glioblastoma lesions on the functional connectome is global and linked to functional proximity rather than anatomical distance to tumour regions. Our findings further suggest a relevance for functional network trajectories as a possible means supporting early detection of tumour recurrence.

Improvement in left ventricular mechanics following medical treatment of constrictive pericarditis

Heart ◽  
2021 ◽  
pp. heartjnl-2020-317304
Author(s):  
Kimi Sato ◽  
Ayman Ayache ◽  
Arnav Kumar ◽  
Paul C Cremer ◽  
Brian Griffin ◽  
...  
Keyword(s):  
Constrictive Pericarditis ◽  
Clinical Symptoms ◽  
Heart Association ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Clinical Resolution ◽  
Ventricular Mechanics ◽  
Anti Inflammatory ◽  
The Impact

ObjectivePatients with constrictive pericarditis (CP) with active inflammation may show resolution with anti-inflammatory therapy. We aimed to investigate the impact of anti-inflammatory medications on constrictive pathophysiology using echocardiography in patients with CP.MethodsWe identified 35 patients with CP who were treated with anti-inflammatory medications (colchicine, prednisone, non-steroidal anti-inflammatory drugs) after diagnosis of CP (mean age 58±13; 80% male). Clinical resolution of CP (transient CP) was defined as improvement in New York Heart Association class during follow-up. We assessed constrictive pathophysiology using regional myocardial mechanics by the ratio of peak early diastolic tissue velocity (e’) at the lateral and septal mitral annulus by tissue Doppler imaging (lateral/septal e’) or the ratio of the left ventricular lateral and septal wall longitudinal strain (LSlateral/LSseptal) by two-dimensional speckle-tracking echocardiography. Longitudinal data were analysed using a mixed effects model.ResultsDuring a median follow-up of 323 days, 20 patients had transient CP, whereas 15 patients had persistent CP. Transient CP had higher baseline erythrocyte sedimentation rates (ESR) (p=0.003) compared with persistent CP. There were no significant differences in LSlateral/LSseptal and lateral/septal e’. During follow-up, only transient CP showed improvement in lateral/septal e’ (p<0.001) and LSlateral/LSseptal (p=0.003), and recovery of inflammatory markers was similar between the two groups. In the logistic model, higher baseline ESR and greater improvement in lateral/septal e’ and LSlateral/LSseptal were associated with clinical resolution of CP using anti-inflammatory therapy.ConclusionsImprovement of constrictive physiology detected by lateral/septal e’ and LSlateral/LSseptal was associated with resolution of clinical symptoms after anti-inflammatory treatment. Serial monitoring of these markers could be used to identify transient CP.

scholarly journals Impact of exercise capacity on the long-term incidence of atrial arrhythmias in heart failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tetsuri Sakai ◽  
Atsuhiko Yagishita ◽  
Masahiro Morise ◽  
Susumu Sakama ◽  
Takeshi Ijichi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Arrhythmias ◽  
Maximal Exercise ◽  
Peak Exercise ◽  
Atrial Arrhythmias ◽  
Patients With Heart Failure ◽  
The Impact ◽  
New Onset

AbstractWe sought to demonstrate the impact of improved peak exercise oxygen consumption (V̇O2) during maximal exercise testing after cardiac rehabilitation (CR) on the incidence of arrhythmias in patients with heart failure (HF). The present study comprised of 220 patients with HF, and peak V̇O2 was examined at 2 and 5 months after CR. Of the 220 patients, 110 (50%) had a low peak V̇O2 of < 14 mL/min/kg at 2 months. The peak V̇O2 improved in 86 of these 110 (78%) patients at 5 months after CR. During a median follow-up of 6 years, the patients with improvement in peak V̇O2, compared to those without peak V̇O2 improvement, had a lower rate of mortality (4% vs. 29%, log-rank, P < 0.001) and HF hospitalization (6 vs. 17%, log-rank, P = 0.044) and a lower incidence of new-onset atrial arrhythmias (9 vs. 27%, log-rank, P = 0.013), with no difference in the incidence of ventricular arrhythmias between groups (1 vs. 4%, log-rank, P = 0.309). The majority of deaths in the patients without an improved peak V̇O2 were because of cardiovascular events (73%), particularly progressive HF (55%). Early detection and management of atrial arrhythmias may improve outcomes in patients without peak V̇O2 improvement after CR.

scholarly journals The Short Term Influence of RV Pacing Burden on Numerous Echocardiographic and Spiroergometric Parameter In Patients With Preserved LVEF - The Mechanism of The Worsened Clinical Outcome Due To High RV Pacing Burden Remains Unclear.

2021 ◽  
Author(s):  
Akram Youssef ◽  
Karim Ibrahim ◽  
Michael Günther ◽  
Steffen Kolschmann ◽  
Utz Richter ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Exercise Capacity ◽  
Time Course ◽  
Maximal Oxygen Consumption ◽  
Pacemaker Implantation ◽  
Peak Exercise ◽  
Pacemaker Therapy ◽  
Rv Pacing ◽  
The Impact

Abstract Background: The cause of worsened clinical outcome due to high RV pacing burden remains unclear.Objective: To investigate the impact of RV pacing on several echocardiographic and spiroergometric parameter Methods: In 60 pacemaker patients with preserved LVEF serial echocardiographies and spiroergometries were performed over a time course of 12 months. Additionally in 50 patients retrospective echocardiographic analyses of the LV- and RV function were carried out up to 24 months after pacemaker implantation.Results: The patients were divided into two groups: The high RV pacing burden group (hRVP: ≥ 40%) and the low RV pacing group (lRVP <40%) according to the definitions in previous randomized MOST and DAVID trials. After a period of 12 month pacemaker therapy there could not revealed any changes LVEDD, LVESD, LVEF, E/A-ratio; E/E’-ratio and TAPSE independently of the RV pacing burden. Additionally, after 24 month long term follow-up there were no changes in LVEF and TAPSE in both groups. Accordingly to these echo data no relevant changes of peak exercise capacity, ventilatory anaerobic threshold and maximal oxygen consumption could be revealed independently of the RV pacing. Conclusions: In pacemaker patients with preserved LVEF the burden of RV pacing has no adverse influence, neither to several echocardiographic parameters nor to the clinical exercise capacity after a follow-up of 12 to 24 month. Therefore, the mechanism of the worsened clinical outcome due to high RV pacing burden in patients without a relevant structural heart disease remains unclear.

scholarly journals Functional Recovery and Serum Angiogenin Changes According to Intensity of Rehabilitation Therapy After Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Nicolás Garcia-Rodriguez ◽  
Susana Rodriguez ◽  
Pedro Ignacio Tejada ◽  
Zuberoa Maite Miranda-Artieda ◽  
Natalia Ridao ◽  
...  
Keyword(s):  
Inflammatory Diseases ◽  
Biological Effects ◽  
Functional Improvement ◽  
Rehabilitation Process ◽  
Rehabilitation Therapy ◽  
Significant Difference ◽  
The Impact ◽  
Intensive Rehabilitation ◽  
Final Cohort

Background: Rehabilitation is still the only treatment available to improve functional status after the acute phase of stroke. Most clinical guidelines highlight the need to design rehabilitation treatments considering starting time, intensity, and frequency, according to the tolerance of the patient. However, there are no homogeneous protocols and the biological effects are under investigation.Objective: To investigate the impact of rehabilitation intensity (hours) after stroke on functional improvement and serum angiogenin (ANG) in a 6-month follow-up study.Methods: A prospective, observational, longitudinal, and multicenter study with three cohorts: strokes in intensive rehabilitation therapy (IRT, minimum 15 h/week) vs. conventional therapy (NO-IRT, &lt;15 h/week), and controls subjects (without known neurological, malignant, or inflammatory diseases). A total of seven centers participated, with functional evaluations and blood sampling during follow-up. The final cohort includes 62 strokes and 43 controls with demographic, clinical, blood samples, and exhaustive functional monitoring.Results: The median (IQR) number of weekly hours of therapy was different: IRT 15 (15–16) vs. NO-IRT 7.5 (5–9), p &lt; 0.01, with progressive and significant improvements in both groups. However, IRT patients showed earlier improvements (within 1 month) on several scales (CAHAI, FMA, and FAC; p &lt; 0.001) and the earliest community ambulation achievements (0.89 m/s at 3 months). There was a significant difference in ANG temporal profile between the IRT and NO-IRT groups (p &lt; 0.01). Additionally, ANG was elevated at 1 month only in the IRT group (p &lt; 0.05) whereas it decreased in the NO-IRT group (p &lt; 0.05).Conclusions: Our results suggest an association of rehabilitation intensity with early functional improvements, and connect the rehabilitation process with blood biomarkers.

Abstract 2341: Myocardial Ultrasound Tissue Characterisation in Children after Kawasaki disease

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Benedetta Leonardi ◽  
Vincenzo Giglio ◽  
Vincenzo Pasceri ◽  
Andrea de Zorzi ◽  
Stephen P Sanders
Keyword(s):  
Kawasaki Disease ◽  
Myocardial Dysfunction ◽  
Subsequent Development ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Cellular Damage ◽  
Lv Function ◽  
Integrated Backscatter ◽  
Ultrasound Tissue Characterization

Background: Reports of late follow-up of patients with Kawasaki Disease (KD), even with no epicardial coronary artery disease, have demonstrated abnormal vascular reactivity and myocardial perfusion. Left ventricular (LV) function is usually normal in KD patients during long-term follow-up. However, data regarding the myocardial properties of these children are lacking. Ultrasound tissue characterization (UTC), under some circumstances, appears to be predictive of subsequent development of myocardial dysfunction. Methods and Results: We performed UTC analysis in 22 asymptomatic KD patients, mean age 6.6±3.4 years, 17 males, with a mean follow-up of 4.8±3.4 years after the illness. Coronary aneurysms were present in 8 patients (mean age 7.8±5.3 years). Cyclic variation of integrated backscatter (cvIBS) and calibrated integrated backscatter (cIBS) were assessed in 16 LV myocardial segments. Tissue Doppler imaging (TDI) at the mitral annulus was performed to assess LV diastolic function. All UTC and TDI data were compared to 22 age-matched controls, mean age 6.6±3.4 years. All patients had normal LV systolic function and wall motion score index (WMSI) compared to controls (EF 60.3±4.0% vs 60.8±4.4%, p=0.64, WMSI 1 vs 1, p=NS respectively). Myocardial velocities in systole and diastole by TDI did not differ significantly between patients and controls. CvIBS and cIBS mean values showed significant differences, for all segments sampled, between patients and controls (7.8±0.8 dB vs 8.9±0.6 dB, p<0.001, and 28.6±3.2 dB vs 25.2±1.0 dB p< 0.001 respectively). Neither cvIBS nor cIBS differed significantly between patients with and without aneurysms (7.9±0.8 dB vs 7.8±0.8 dB, p=0.84, and 30.3±4.3 dB vs 27.7±2.3 dB, p=0.20 respectively). Conclusions: We detected widespread differences in myocardial physical properties between KD patients and controls late after the acute disease, despite normal LV function and independent of demonstrable coronary abnormalities. These differences could be related to cellular damage induced by occult myocardial ischemia or could represent abnormalities of small myocardial vessels. Further studies are needed to confirm these findings in a larger group of patients and to determine the clinical significance.

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