Abstract 4310: Chronic Effects of Surgical Ventricular Restoration on Left Ventricular Function: 6 Months Follow-Up by Pressure-Volume Loops

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ellen A ten Brinke ◽  
Robert J Klautz ◽  
Sven A Tulner ◽  
Frank H Engbers ◽  
Hariette F Verwey ◽  
...  
Keyword(s):  
Systolic Function ◽  
Nyha Class ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Lv Function ◽  
Stroke Work ◽  
Surgical Ventricular Restoration ◽  
Chronic Effects ◽  
Ventricular Restoration

Previous studies have demonstrated beneficial acute effects of surgical ventricular restoration (SVR) on mechanical dyssynchrony and left ventricular (LV) function, and improved mid- and long-term clinical parameters. However, chronic effects on systolic and diastolic LV function are still largely unknown. We studied 9 patients with ischemic dilated cardiomyopathy who underwent SVR. In all patients, invasive hemodynamic measurements by the conductance catheter (pressure-volume loops) were obtained during catheterization before and 6 months after surgery. In addition, NYHA classification, Minnesota Quality of Life (QoL)-score and 6-minute-hall-walk-test (6min-HWT) were assessed. At 6 months follow-up, all patients were alive and clinically significantly improved: NYHA class from 3.3±0.5 to 1.4±0.7, QoL-score from 46±22 to 15±15 and 6min-HWT from 302±123 to 444±78 m (all p<0.01). Hemodynamic data at fixed paced heart rate (80 bpm), showed improved cardiac output (4.8±1.4 to 5.6±1.1 L/min) (p =0.09), stroke work (6.5±1.9 to 7.1±1.4 mmHg.L) (p =0.05) and LV ejection fraction (36±10 to 46±10%) (p <0.001). LV surgical remodeling was sustained at 6 months: end-diastolic volume decreased from 246±70 to 180±48 mL and end-systolic volume from 173±77 to 103±40 mL (both p<0.001). LV mechanical dyssynchrony decreased from 29±6 to 26 ±3% (p<0.001) and ineffective internal LV flow fraction decreased from 58±30 to 42±18% (p<0.005). Early relaxation (tau, −dP/dt MIN ) was unchanged, but diastolic stiffness constant (K ED ) increased from 0.012±0.003 to 0.023±0.007 mL −1 (p<0.001) at 6 months follow-up. SVR leads to maintained LV volume reduction at 6 months follow-up. In addition, we observed improved systolic function and unchanged early diastolic function, but impaired passive diastolic properties. Clinical improvement, supported by decreased NYHA class, improved QoL-score and improved 6-min-HWT may be related to improved systolic function and reduced mechanical dyssynchrony.

scholarly journals Prognostic value of NT-proBNP for myocardial recovery in peripartum cardiomyopathy (PPCM)

2021 ◽  
Author(s):  
J. Hoevelmann ◽  
E. Muller ◽  
F. Azibani ◽  
S. Kraus ◽  
J. Cirota ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Systolic Function ◽  
Point Of Care ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Lv Function ◽  
Myocardial Recovery ◽  
End Diastolic Volume

Abstract Introduction Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure worldwide. Although a significant number of women recover their left ventricular (LV) function within 12 months, some remain with persistently reduced systolic function. Methods Knowledge gaps exist on predictors of myocardial recovery in PPCM. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the only clinically established biomarker with diagnostic value in PPCM. We aimed to establish whether NT-proBNP could serve as a predictor of LV recovery in PPCM, as measured by LV end-diastolic volume (LVEDD) and LV ejection fraction (LVEF). Results This study of 35 women with PPCM (mean age 30.0 ± 5.9 years) had a median NT-proBNP of 834.7 pg/ml (IQR 571.2–1840.5) at baseline. Within the first year of follow-up, 51.4% of the cohort recovered their LV dimensions (LVEDD < 55 mm) and systolic function (LVEF > 50%). Women without LV recovery presented with higher NT-proBNP at baseline. Multivariable regression analyses demonstrated that NT-proBNP of ≥ 900 pg/ml at the time of diagnosis was predictive of failure to recover LVEDD (OR 0.22, 95% CI 0.05–0.95, P = 0.043) or LVEF (OR 0.20 [95% CI 0.04–0.89], p = 0.035) at follow-up. Conclusions We have demonstrated that NT-proBNP has a prognostic value in predicting LV recovery of patients with PPCM. Patients with NT-proBNP of ≥ 900 pg/ml were less likely to show any improvement in LVEF or LVEDD. Our findings have implications for clinical practice as patients with higher NT-proBNP might require more aggressive therapy and more intensive follow-up. Point-of-care NT-proBNP for diagnosis and risk stratification warrants further investigation.

Complete dexrazoxane cardioprotection for cardiac function but incomplete female cardioprotection for cardiac structure in doxorubicin-treated osteosarcoma survivors: Hearts too small for the body.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10519-10519
Author(s):  
Lisa M. Kopp ◽  
Mark L. Bernstein ◽  
Cindy L. Schwartz ◽  
David Ebb ◽  
Vivian L Franco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Wall Thickness ◽  
Systolic Function ◽  
Posterior Wall ◽  
Left Ventricular ◽  
The Body ◽  
Lv Function ◽  
Lv Systolic Function ◽  
Trastuzumab Cardiotoxicity

10519 Background: Dexrazoxane is protective for lower-dose doxorubicin ( < 300 mg/m2) cardiotoxicity in childhood cancer, but the effect of dexrazoxane (DXRZ) administered with higher-dose (HD) doxorubicin (DOXO) is unknown. Methods: We evaluated patients from Children’s Oncology Group trials for localized (P9754) and metastatic (AOST0121) osteosarcoma (OS) who received HD DOXO (375-600 mg/m2) preceded by DXRZ (10:1 ratio), methotrexate, and cisplatin; some also received ifosfamide alone or ifosfamide/etoposide ± trastuzumab. Cardiotoxicity was identified by echocardiography and by serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations. Results: 81 DXRZ -treated OS patients ( age at enrollment = 13.7 years; range 3.8 - 23.7 years) had normal left ventricular (LV) systolic function as measured by LV fractional shortening and no heart failure. Female sex and longer follow-up since DOXO were associated with a significantly smaller LV dimension z-score normalized to BSA (μ = -1.20, 95%CI [-1.70, -0.70]). Similarly, in the one-third of patients treated > 81 days after minimal expected treatment (groups equally partitioned by time), significantly thinner LV posterior wall thickness for BSA (μ = -0.57, [-1.05, -0.09]) was found. Interventricular septal wall thickness (μ = -0.84, [-1.2, -0.48]) and LV mass (μ = -0.73, [-1.06, -0.40]) were significantly smaller for BSA than normal for both sexes. For females, these became significantly more abnormal with increasing length of follow-up. Females also showed progressive increases in NT-proBNP. Conclusions: DXRZ is cardioprotective for HD DOXO in terms of LV function and heart failure. Females had progressive abnormalities of LV structure, leading to smaller hearts for body size. This was associated with increasing cardiac stress, as measured by NT-proBNP. DXRZ protection was incomplete for HD DOXO effects on LV structure, resulting in higher LV stress and risk for late LV dysfunction. DXRZ should continue to be used in this population, including for females who exhibit more cardiotoxicity than males at specific cumulative DOXO doses.

Abstract 3255: Left ventricular stroke volume reduction after Surgical Ventricular Restoration: a diastolic dysfunction?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Marisa Di Donato ◽  
Fabio Fantini ◽  
Serenella Castelvecchio ◽  
Claudio Bussadori ◽  
Francesca Giacomazzi ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Diastolic Dysfunction ◽  
Nyha Class ◽  
Experimental Studies ◽  
Left Ventricular ◽  
Volume Reduction ◽  
Diastolic Filling ◽  
Surgical Ventricular Restoration ◽  
Post Surgery ◽  
Ventricular Restoration

Background. Experimental studies and theoretical considerations suggest that reduction of left ventricle (LV) stroke volume (SV) following Surgical Ventricular Restoration (SVR) is a consequence of diastolic dysfunction. Aim. To analyze changes in SV following SVR and assess if SV reduction is related to diastolic dysfunction. Patients. 134 consecutive patients submitted to SVR for symptoms of HF and/or angina. Patients with mitral regurgitation were excluded. Results. SV improved in 43 patients (54 ± 13 to 60 ± 15 ml; p 0.0001)-G1- and decreased in 91 patients (69 ± 19 to 48 ± 13 ml, p 0.0001)-G2-. The greater EDV reduction, the greater SV reduction (r = 0.609) and the greater EF improvement (r = 0.402)(Graph). Preoperatively, EF and SV were lower in G1 (31 ± 8 vs 35 ± 8%, p 0.002 and 54 ± 13 vs 69 ± 19 ml, respectively); no differences in LV volumes and Diastolic Filling Pattern (DP). Post surgery G2 shows smaller EDV and ESV and lower SV. DP significantly increased in G1 (from 1.42 ± 0.8 to 1.7 ± 0.7, p 0.01) and was higher than in G2, after surgery (p 0.008). NYHA class at FUP improved (2.4 ± 0.6 to 1.6 ± 0.6 in G1 and 2.4 ± 0.7 to 1.7 ± 0.6 in G2, p 0.001) Post-operative data Conclusions. Post-SVR stroke volume reduction is not related to diastolic dysfunction; paradoxically, diastolic function is more impaired in patients with SV improvement and larger residual volumes.

Abstract 2180: Relationship of Left Ventricular Systolic Function to Persistence or Development of Electrocardiographic Left Ventricular Hypertrophy in Hypertensive Patients: Implications for the Development of New Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Peter M Okin ◽  
Kristian Wachtell ◽  
Eva Gerdts ◽  
Kurt Boman ◽  
Markku S Nieminen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Diastolic Pressure ◽  
Systolic Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Increased Risk ◽  
Cornell Product

Background : We have previously demonstrated that persistence or development of ECG left ventricular hypertrophy (LVH) by Cornell product criteria are associated with an increased risk of developing heart failure (HF) compared with regression or continued absence of LVH. We postulated that this relationship might be in part mediated via worse LV systolic function in patients with new and persistent LVH. Methods : Baseline and year-3 ECG LVH and LV midwall shortening (MWS) were examined in 725 patients in the LIFE echocardiographic substudy. MWS was measured and considered abnormal if <14.2%; stress-corrected MWS (scMWS) was considered abnormal if 2440 mm-msec. Results : Between baseline and 3 years follow-up, there was continued absence (n=260) or regression (n=167) of LVH in 427 patients and persistence (n=259) or development (n=39) of ECG LVH in 298 patients. Although there was no difference in baseline prevalence of abnormal MWS (23.4 vs 26.5%, p=0.389) or abnormal scMWS (24.6 vs 26.4%, p=0.663) between groups, after 3 years follow-up persistence or development of new LVH was associated with significantly lower mean MWS and scMWS and with higher prevalence and odds of abnormal MWS and scMWS than continued absence or regression of LVH (Table ). After controlling for differences in age, gender, race, treatment group, baseline and change from baseline to year-3 of heart rate, Sokolow-Lyon voltage, systolic and diastolic pressure and baseline severity of LVH by Cornell product, persistent or new ECG LVH remained associated with a >2-fold increased risk of abnormal MWS or scMWS at year 3. Conclusions : Persistence or development of new ECG LVH during antihypertensive therapy is associated with an increased risk of LV systolic dysfunction after 3 years of follow-up. These findings provide insight into a possible mechanism by which changes in ECG LVH are associated with changing risk of developing HF. < Midwall LV Function in Relation to Persistence or Development of ECG LVH Between Baseline and Year-3

Abstract 15481: LV Systolic Dysfunction is Improved by TAVR: Insights From the French-American Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Abdulla Damluji ◽  
Yahya E Alansari ◽  
Michael Dyal ◽  
Magdalena Murman ◽  
Mohamad Kabach ◽  
...  
Keyword(s):  
Systolic Function ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Cvd Risk ◽  
Hispanic Males ◽  
Ventricular Ejection Fraction ◽  
Lv Systolic Function

Introduction: We sought to describe changes in left ventricular ejection fraction (LVEF) after TAVR procedures. Methods: This is an observational study from 04/2008 to 06/2015 of all consecutive adults who received TAVR for severe symptomatic AS with Edwards Sapien or Medtronic CoreValve at two tertiary academic centers in USA and France. Results: Of 765 patients who received TAVR, 716 (94%) had follow-up echocardiography. Of those, 513 (72%), 143 (20%), 60 (8%) had a baseline EF>50%, EF 30-49%, and EF<30, respectively. Patients with EF < 30% were more likely to be Hispanic males. There were no differences in age, CVD risk factors, or history of multivessel coronary disease among groups. Patients with EF<30% were more likely to have AICD implantation and paced rhythm. All groups had similar rates of IABP insertion for hemodynamic support (EF≥50%: 6%, EF<30-49%: 9%, EF<30: 5%, p=0.544), procedural success (EF≥50%: 94%, EF<30-49%: 97%, EF<30: 98%, p=0.180), in-hospital mortality, procedural complications, and complete heart block. However, one-year all-cause-mortality was higher if baseline LV systolic function was abnormal (EF≥50%: 6%, EF<30-49%: 14%, EF<30: 9%, p=0.036). On 30-day follow-up echocardiography, absolute improvement in LVEF was highest among patients with EF<30% (Figure 1). If baseline LVEF was reduced, unchanged or improved mitral regurgitation were associated with improved LV function on follow-up (Figure 2). Conclusion: Transcatheter treatment of severe symptomatic AS is safe and feasible, even in patients with LVEF<30%. Most patients with LVEF<50% had increased EF after TAVR procedures.

P5545Predictors of 10-year mortality and re-intervention in patients with multivessel coronary disease, reduced systolic left ventricular function, after complete revascularization by PCI or CABG

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Popov ◽  
J Dejanovic ◽  
M Petrovic ◽  
I Srdanovic ◽  
S Tadic ◽  
...  
Keyword(s):  
Left Ventricular Function ◽  
Ventricular Function ◽  
Coronary Disease ◽  
Systolic Function ◽  
Nyha Class ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Complete Revascularization ◽  
Systolic Left Ventricular Function

Abstract Introduction In patients with multivessel coronary disease, the decision on revascularization should be made through a heart team. Whether there is an optimal method and what are the predictors of mortality and repeated interventions is the subject of numerous studies. Purpose To determine what are the predictors of 10-year mortality and repeated interventions in patients with multivessel coronary disease and reduced systolic left ventricular function in which complete revascularization is done through percutaneous coronary intervention (PCI) and surgical aortocoronary bypass (CABG). Methods The survey included 178 patients who underwent elective revascularization of multivessel coronary disease in one center during 2008 through PCI or bypass, according to the heart team's decision. All subjects had a reduced left ventricular systolic function, ejection fraction less than 50%. The study excluded patients with acute coronary syndrome. The basic demographic and clinical characteristics of the subjects and risk factors were analyzed. Results Ten-year mortality was 31.4%, without a significant difference between the examined groups (in the PCI group 25 patients (30.5%) in the bypass group 30 (32.3%), p>0.05). In subjects with letal outcome during 10-year follow-up, lower hemoglobin levels in discharge, enlarged cardiac cavities, increased internal diameter of left ventricle in systole (LVIDs) and enlarged left atrium, lower systolic left ventricular function, higher EUROscore and higher NYHA class in discharge. The enlarged left ventricular diameter in systole (OR 2.28 (1.27–4.11), p=0.006) and the NYHA class (OR 2.49 (1.22–5.08), p=0.012) are independent predictors ten-year mortality. In the group of patients undergoing surgical revascularization, independent predictors of 10-year mortality are higher levels of uric acid (OR 1,006 (1,000–1,011), P=0,047) and lower serum hemoglobin at discharge (OR 0,959 (0,919–0,999), P=0.046), while in PCI group LVIDs (OR 2.89 (1.351–6.196), p=0.006). During the 10-year follow-up, repeated PCI was performed in 12 (14.5%) patients in the PCI group and in 3 (3.2%) patients in the CABG group, p=0.012. No surgical revascularization was performed during follow up. Diabetes mellitus is an independent predictor of reintervention in the PCI group (OR 4.12 (1.153–14.703), p=0.029). Conclusion Mortality predictors during ten years of follow-up in subjects following a revascularization of multivessel coronary disease, and with reduced left ventricular systolic function, are increased systolic left ventricular diameter and higher NYHA class in discharge. Reintervention is more commonly performed after PCI and the presence of diabetes mellitus is an independent predictor.

scholarly journals Analysis of patient-specific surgical ventricular restoration: importance of an ellipsoidal left ventricular geometry for diastolic and systolic function

2013 ◽  
Vol 115 (1) ◽  
pp. 136-144 ◽  
Author(s):  
Lik Chuan Lee ◽  
Jonathan F. Wenk ◽  
Liang Zhong ◽  
Doron Klepach ◽  
Zhihong Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Negative Impact ◽  
Systolic Function ◽  
Left Ventricular ◽  
Magnetic Resonance Images ◽  
Left Ventricular Geometry ◽  
Patient Specific ◽  
Surgical Ventricular Restoration ◽  
Ventricular Restoration

Surgical ventricular restoration (SVR) is a procedure designed to treat heart failure by surgically excluding infarcted tissues from the dilated failing left ventricle. To elucidate and predict the effects of geometrical changes from SVR on cardiac function, we created patient-specific mathematical (finite-element) left ventricular models before and after surgery using untagged magnetic resonance images. Our results predict that the postsurgical improvement in systolic function was compromised by a decrease in diastolic distensibility in patients. These two conflicting effects typically manifested as a more depressed Starling relationship (stroke volume vs. end-diastolic pressure) after surgery. By simulating a restoration of the left ventricle back to its measured baseline sphericity, we show that both diastolic and systolic function improved. This result confirms that the increase in left ventricular sphericity commonly observed after SVR (endoventricular circular patch plasty) has a negative impact and contributes partly to the depressed Starling relationship. On the other hand, peak myofiber stress was reduced substantially (by 50%) after SVR, and the resultant left ventricular myofiber stress distribution became more uniform. This significant reduction in myofiber stress after SVR may help reduce adverse remodeling of the left ventricle. These results are consistent with the speculation proposed in the Surgical Treatment for Ischemic Heart Failure trial ( 20 ) for the neutral outcome, that “the lack of benefit seen with surgical ventricular reconstruction is that benefits anticipated from surgical reduction of left ventricular volume (reduced wall stress and improvement in systolic function) are counter-balanced by a reduction in diastolic distensibility.”

scholarly journals Clinical outcome after MitraClip procedure: role of right ventricle

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Barosi ◽  
E Gherbesi ◽  
S Colombo ◽  
A Giavarini ◽  
I Cusmano ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcome ◽  
Nyha Class ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Mitraclip System

Abstract Background MitraClip system is a device for percutaneous edge-to-edge repair of the mitral valve in symptomatic patients with severe mitral regurgitation (MR) not eligible for surgery, but frequently heart failure symptoms remain substantial on mid-term follow-up. Recently, right ventricular (RV) to pulmonary arterial (PA) coupling has emerged as a relevant prognostic predictor in heart failure but little is known about its prognostic role in patients after MitraClip implantation. Purpose To identify echocardiographic predictors of clinical outcome after MitraClip procedure, with a particular focus on RV-PA coupling. Methods We retrospectively analyzed the data of patients with severe MR who underwent MitraClip implantation between April 2015 and October 2019 at our Institution. Echocardiographic data were assessed at baseline, 3 and 12 months after the procedure; RV to PA coupling was assessed using the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). Functional class was assessed at 12 months of follow-up. Significance level was set to 0.05 and SPSS was used for statistical analysis. Results 41 patients were included (age 77.1±7.3, 71% male, BMI 25.8±5.5). MR was primary, functional and mixed in 22, 76 and 2% of patients, respectively. 1/2/3 mitraclips were implanted in 39/56/5% of patients, respectively. Echocardiographic data at baseline, at 3 and 12 months follow-up are shown in Table. NYHA class at 12 months significantly correlated with TAPSE and PASP at 3 months follow-up echocardiogram (beta coefficient −0.83 and 0.78 respectively). On the contrary, NYHA class did not show a correlation with left ventricular ejection fraction (LVEF) or residual MR grade. At 12 months 44% of patients showed an improvement in NYHA class; these patients had a better TAPSE (22.7±1.3 vs 19.4±4.6 mm), a lower PASP (37.9±10.2 vs 48.5±12.9 mmHg) and a better TAPSE/PASP (0.61±0.2 vs 0.42±0.2) compared to patients who did not improve their functional class, while LVEF and residual MR did not differ. Conclusion In this sample of significant MR undergoing repair with MitraClip System, patients with functional class improvement at 12 months follow-up showed a better RV-coupling without difference in LV function and residual MR. FUNDunding Acknowledgement Type of funding sources: None. Table 1

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