Abstract 13767: Cardiac MRI Predictors of Good Long-term Outcomes in Patients With Repaired TOF

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Amara Majeed ◽  
Tal Geva ◽  
Julia Graf ◽  
Minmin Lu ◽  
Sonya Babu-Narayan ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Course ◽  
Systolic Function ◽  
Volume Ratio ◽  
Left Ventricular ◽  
Volume Index ◽  
Good Outcome ◽  
Intermediate Outcomes ◽  
Lv Mass ◽  
Mass Volume

Introduction: Good outcomes in adults with repaired tetralogy of Fallot (rTOF) are not well explored. Identifying markers of a benign clinical course late after TOF repair can guide resource utilization in this growing population. Methods: Clinical and CMR data were analyzed from the International Multicenter TOF Registry (INDICATOR). The clinical outcome was a composite of death, aborted sudden death, sustained ventricular and atrial arrhythmia, non-sustained ventricular tachycardia, and New York Heart Association functional class>II. Multinomial regression explored predictors of the 3-category outcome-Good and intermediate outcomes; defined as freedom from clinical outcome at 50 and <50 years respectively; and bad outcome; defined as having an adverse event at <50 years. Results: The cohort had 1088 patients-good outcome, n=96; intermediate, n=747; bad, n=245 with median age at last CMR 44 (40, 47); 21 (15, 28); 31 (20, 39) years respectively. Median follow-up was 8 (5, 11) years after CMR in event-free patients. Right ventricular (RV) parameters associated with a good outcome were smaller RV end-systolic volume index, higher RV ejection fraction (EF), lower RV mass index, and lower RV mass/volume ratio. Left ventricular (LV) parameters associated with a good outcome were lower LV mass index and LV mass/volume ratio. Multivariable models showed RV EF (OR 1.56 per 10% increase, p=.009) and RV mass index (OR 1.51, per 10 g/m 2 decrease, p=.002) as independently associated with good outcome after adjusting for age at CMR. Important thresholds identified in older patients (age ≥37 years) were RVEF ≥42% and RV mass index <39 g/m 2 . Combined, this subgroup had a 56% likelihood of a good outcome. Conclusions: Adults with rTOF and CMR findings of adequate RV systolic function and no significant ventricular hypertrophy are likely to have a benign clinical course by age 50 years. Frequency of cardiac testing in such patients may be lower than in those not fulfilling these criteria.

Do Pediatric Sickle Cell Disease Patients Develop Diastolic Dysfunction?.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3195-3195
Author(s):  
Mark V. Zilberman ◽  
Wei Du ◽  
Wanda J. Whitten-Surney ◽  
Sharada A. Sarnaik
Keyword(s):  
Mitral Valve ◽  
Sickle Cell Disease ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Volume Index ◽  
Cell Disease ◽  
Mitral Inflow ◽  
Lv Mass ◽  
Z Scores ◽  
Mass Volume

Abstract Sickle cell disease (SCD) is a known cause of chronic volume overload. Although systolic dysfunction is rare, as many as 80% of adult patients with SCD have an echocardiographic mitral valve inflow pattern suggestive of abnormal left ventricular (LV) diastolic function (DF). DF has not been studied in pediatric SCD patients. Therefore, the objective of this study was to evaluate DF in pediatric SCD patients using echocardiographic velocities of mitral inflow and tissue Doppler (TDI) indices. Echocardiograms were performed in 79 SCD patients (ages 2 – 18 years), and 84 controls matched for age and race. LV and left atrial (LA) volumes, LV mass, early (E) and late (A) mitral inflow velocities, and TDI velocities at the septal and lateral aspects of the mitral valve were obtained. LV dilatation was defined as LV end-diastolic dimension more then 2 standard deviations above the median (z-value &gt;2). LV hypertrophy was defined as LV mass/volume index&gt;1.15 g/ml. For SCD patients, average hemoglobin (Hb) levels for the year prior to the study were recorded. Data were analyzed using t-test and Spearman correlation analysis. Of 79 SCD subjects, 32 (43%) had LV dilatation, 11(14.9%) had LV hypertrophy and 3 had both. LV z-scores were inversely related to Hb (r −0.62, p&lt;0.0001) but unrelated to age. The early mitral inflow velocities E were negatively correlated with Hb levels(r − 0.34, p&lt;0.04) and were positively correlated with LV z-scores (r 0.41, p&lt;0.04) reflecting pre-load dependency of mitral inflow indices. DTI diastolic velocities were unrelated to Hg or LV size reflecting pre-load independent nature of these indices. DTI systolic velocities S’ correlated positively with LV mass/volume index (r 0.28, p&lt;0.02). SCD patients had significantly larger LV and LA volumes than controls (p&lt;0.01). The early E and late A mitral inflow velocities were higher in the SCD group than the control, although the differences were not statistically significant. DTI indices did not differ between SCD patients and the control. Conclusion: Despite high incidence of left ventricular dilatation, pediatric SCD patients don’t demonstrate diastolic dysfunction when evaluated using pre-load independent echocardiographic tissue Doppler indices.

scholarly journals Left Ventricular Global Function Index and Left Ventricular Mass Volume Ratio By CMR: Relation with Heart Failure in Thalassemia Major Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2688-2688
Author(s):  
Antonella Meloni ◽  
Lucia De Franceschi ◽  
Domenico Maddaloni ◽  
Sabrina Carollo ◽  
Roberto Sarli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Iron Overload ◽  
Volume Ratio ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
Myocardial Iron ◽  
Global Function ◽  
Function Index ◽  
Lv Mass ◽  
Mass Volume

Abstract Introduction: Recently two novels indicators of left ventricular (LV) performance assessed by Cardiovascular Magnetic Resonance (CMR) have been introduced: the LV global function index (LVGFI) and the LV mass/volume ratio (LVMVR). The LVGFI combines LV stroke volume, end-systolic and end diastolic volumes, as well as LV mass, integrating structural as well as mechanical behaviour. Elevated LVMVR is indicative of concentric remodelling. A LVGFI <37% and a LVMVR>1 were shown to be associated with the occurrence of cardiovascular events in no-thalassemic populations. This retrospective cohort study aimed to systematically evaluate in a large historical cohort of thalassemia major (TM) in the CMR era whether the LVGFI and the LVMVR were associated with a higher risk of heart failure. Methods: We considered 812 TM patients (391 M, 30.4±8.6 years), consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network. LVGFI and LVMRI were quantitatively evaluated by SSFP cine images. The T2* value in all the 16 cardiac segments was evaluated and a global heart T2* value <20 ms was considered indicative of myocardial iron overload (MIO). Results: Eighty (9.9%) patients had a LVGFI<37% and, compared to the patients with a normal LVGFI, they showed a significant higher frequency of heart failure (43.8% vs 4.2%; P<0.0001). Patients with a LVGFI<37% had a significant higher risk of heart failure (odds-ratio-OR=17.59, 95%CI=9.95-21.09; P=<0.001). The risk remained significant also adjusting for the presence of MIO (OR=15.54, 95%CI=8.05-26.27; P=<0.001). Thirty (3.7%) patients had a LVMVR≥1% and, compared to the patients with a normal LVMRI, they showed a significant higher frequency of heart failure (20.0% vs 7.7%; P=0.015). Patients with a LVMVR≥1% had a significant higher risk of heart failure (OR=3.01, 95%CI=1.18-7.64; P=0.021). The risk remained significant also adjusting for the presence of MIO (OR=3.44, 95%CI=1.31-9.01; P=0.012). In a multivariate model including LVGFI, LVMVR and heart iron, the significant predictors of heart failure were a LVGFI<37% (OR=14.05, 95%CI=7.66-25.77; P=<0.001) and a global heart T2*<20 ms (OR=1.94, 95%CI=1.08-3.47; P=0.026). Conclusions: In TM patients a LVGFI<37% was associated with an higher risk of heart failure, independent by the presence of MIO. A widespread program using CMR exploiting its multi-parametric potential can have considerable power for the early identification and treatment of patients at risk for heart failure. Disclosures No relevant conflicts of interest to declare.

Abstract 5160: Obesity is Related to Concentric Left Ventricular Hypertrophy: Results from the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Evrim B Turkbey ◽  
Robyn L McClelland ◽  
Richard A Kronmal ◽  
Diane Bild ◽  
Gregory L Burke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiac Output ◽  
Ejection Fraction ◽  
Fat Mass ◽  
Volume Ratio ◽  
Left Ventricular ◽  
Additive Models ◽  
Lv Mass ◽  
Mass Volume

Obesity is a risk factor for cardiovascular disease but its association with left ventricular (LV) morphologic adaptations is debated because of obesity-associated co-morbidities. We evaluated the relationship of obesity to ventricular size and remodeling independent of other risk factors for LV hypertrophy. 5004 participants (age 45– 84 years; 52% female) of the MESA study free of clinical cardiovascular disease underwent cardiac MRI to assess LV size and function. The association of LV indices with measures of obesity, including fat mass (FM), body mass index (BMI) and waist circumference (WC), was determined using generalized additive models adjusted for established risk factors for LV hypertrophy and fat-free mass (FFM). FFM of participants was estimated based on height-weight models derived from bioelectrical impedance studies and FM was obtained by subtracting FFM from weight. LV mass and end diastolic volume were positively associated with FM, BMI and WC after adjustment for risk factors and FFM. For a given FFM, LV mass/volume ratio increased with FM up to approximately 50 kg FM (Figure ). Cardiac output and stroke volume were also positively associated with FM (slopes: CO 0.02 L/min per kg FM, SV 0.16 ml per kg FM, p<0.001 for each). Ejection fraction showed no significant association with FM. The associations of fat mass to increased LV mass and LV mass/volume were similar in patients with and without obesity associated co-morbidities. Obesity is associated with concentric LV hypertrophy, marked by increased LV mass/volume ratio, increased cardiac output and preserved ejection fraction.

scholarly journals Differential left ventricular and left atrial remodelling in heart failure with preserved ejection fraction patients with and without diabetes

2019 ◽  
Vol 10 ◽  
pp. 204201881986159 ◽  
Author(s):  
Gaurav S. Gulsin ◽  
Prathap Kanagala ◽  
Daniel C. S. Chan ◽  
Adrian S. H. Cheng ◽  
Lavanya Athithan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Preserved Ejection Fraction ◽  
Cox Regression Analysis ◽  
Markers Of Inflammation ◽  
Lv Mass ◽  
Mass Volume

Background: Attempts to characterize cardiac structure in heart failure with preserved ejection fraction (HFpEF) in people with type 2 diabetes (T2D) have yielded inconsistent findings. We aimed to determine whether patients with HFpEF and T2D have a distinct pattern of cardiac remodelling compared with those without diabetes and whether remodelling was related to circulating markers of inflammation and fibrosis and clinical outcomes. Methods: We recruited 140 patients with HFpEF (75 with T2D and 65 without). Participants underwent comprehensive cardiovascular phenotyping, including echocardiography, cardiac magnetic resonance imaging and plasma biomarker profiling. Results: Patients with T2D were younger (age 70 ± 9 versus 75 ± 9y, p = 0.002), with evidence of more left ventricular (LV) concentric remodelling (LV mass/volume ratio 0.72 ± 0.15 versus 0.62 ± 0.16, p = 0.024) and smaller indexed left atrial (LA) volumes (maximal LA volume index 48 ± 20 versus 59 ± 29 ml/m2, p = 0.004) than those without diabetes. Plasma biomarkers of inflammation and extracellular matrix remodelling were elevated in those with T2D. Overall, there were 45 hospitalizations for HF and 22 deaths over a median follow-up period of 47 months [interquartile range (IQR) 38–54]. There was no difference in the primary composite endpoint of hospitalization for HF and mortality between groups. On multivariable Cox regression analysis, age, prior HF hospitalization, history of pulmonary disease and LV mass/volume were independent predictors of the primary endpoint. Conclusions: Patients with HFpEF and T2D have increased concentric LV remodelling, smaller LA volumes and evidence of increased systemic inflammation compared with those without diabetes. This suggests the underlying pathophysiology for the development of HFpEF is different in patients with and without T2D. ClinicalTrials.gov identifier: NCT03050593.

scholarly journals Blood pressure in athletic preparticipation evaluation and the implication for cardiac remodelling

Heart ◽  
2019 ◽  
Vol 105 (16) ◽  
pp. 1223-1230 ◽  
Author(s):  
Kristofer Hedman ◽  
Kegan J Moneghetti ◽  
Jeffrey W Christle ◽  
Shadi P Bagherzadeh ◽  
Myriam Amsallem ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Volume Ratio ◽  
Left Ventricular ◽  
Lv Function ◽  
Sports Cardiology ◽  
Hypertension Guidelines ◽  
Lv Mass ◽  
Male Sex ◽  
Mass Volume ◽  
The Relationship

ObjectivesTo explore blood pressure (BP) in athletes at preparticipation evaluation (PPE) in the context of recently updated US and European hypertension guidelines, and to determine the relationship between BP and left ventricular (LV) remodelling.MethodsIn this retrospective study, athletes aged 13–35 years who underwent PPE facilitated by the Stanford Sports Cardiology programme were considered. Resting BP was measured in both arms; repeated once if ≥140/90 mm Hg. Athletes with abnormal ECGs or known hypertension were excluded. BP was categorised per US/European hypertension guidelines. In a separate cohort of athletes undergoing routine PPE echocardiography, we explored the relationship between BP and LV remodelling (LV mass, mass/volume ratio, sphericity index) and LV function.ResultsIn cohort 1 (n=2733, 65.5% male), 34.3% of athletes exceeded US hypertension thresholds. Male sex (B=3.17, p<0.001), body mass index (BMI) (B=0.80, p<0.001) and height (B=0.25, p<0.001) were the strongest independent correlates of systolic BP. In the second cohort (n=304, ages 17–26), systolic BP was an independent correlate of LV mass/volume ratio (B=0.002, p=0.001). LV longitudinal strain was similar across BP categories, while higher BP was associated with slower early diastolic relaxation.ConclusionIn a large contemporary cohort of athletes, one-third presented with BP levels above the current US guidelines’ thresholds for hypertension, highlighting that lowering the BP thresholds at PPE warrants careful consideration as well as efforts to standardise measurements. Higher systolic BP was associated with male sex, BMI and height and with LV remodelling and diastolic function, suggesting elevated BP in athletes during PPE may signify a clinically relevant condition.

scholarly journals The prognostic importance of left ventricular geometry in uremic cardiomyopathy.

1995 ◽  
Vol 5 (12) ◽  
pp. 2024-2031 ◽  
Author(s):  
R N Foley ◽  
P S Parfrey ◽  
J D Harnett ◽  
G M Kent ◽  
D C Murray ◽  
...  
Keyword(s):  
Relative Risk ◽  
Systolic Function ◽  
Prognostic Significance ◽  
Volume Ratio ◽  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Cavity Volume ◽  
Late Mortality ◽  
Normal Systolic Function ◽  
Lv Mass

The objective of this study was to determine the effect of left ventricular (LV) mass, volume, and mass-to-volume ratio on mortality in chronic dialysis patients. The Design was a multicenter, prospective inception cohort study with a median follow-up of 41 months. The Setting was three university-affiliated nephrology units. A total of 433 patients who (1) survived > 6 months from the start of ESRD therapy and (2) had a technically satisfactory baseline echocardiogram were studied. Measurements included a baseline clinical, laboratory and echocardiographic assessment. LV hypertrophy was present in 74% and LV dilation was present in 36% of patients. In patients with normal cavity volume (< or = 90 mL/m2) and normal systolic function, high LV mass index (> 120 g/m2) and mass-to-volume ratios (> 2.2 g/mL) were independently associated with late mortality (> 2 yr after starting dialysis therapy). After adjusting for baseline age, diabetes, and ischemic heart disease, the relative risk for the former was 3.29 and for the latter was 2.24. Cavity volume was of no prognostic significance in this group. In patients with LV dilation and normal systolic function, high cavity volume (> 120 mL/m2) and low mass-to-volume ratio (< 1.8 mL/m2) were independently associated with late mortality, the relative risk in the former being 17.14 and the latter being 4.27. LV mass index was of no prognostic significance in this group. The baseline echocardiographic classification, based on LV mass and cavity volume, was the strongest predictor of late mortality, after adjusting for age, gender, diabetes mellitus, coronary artery disease, angina pectoris, chronic hypertension, and hemoglobin and serum albumin levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract 4329: Myocardial Protein Kinase G Activity Differs in Heart Failure with Normal and Reduced Ejection Fraction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Loek van Heerebeek ◽  
Nazha Hamdani ◽  
Martin L Handoko ◽  
Jolanda van der Velden ◽  
Ger J Stienen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Protein Kinase ◽  
Ejection Fraction ◽  
Volume Ratio ◽  
Left Ventricular ◽  
Protein Kinase G ◽  
Reduced Ejection Fraction ◽  
Lv Mass ◽  
Lv Remodeling ◽  
Mass Volume

Concentric left ventricular (LV) remodeling and cardiomyocyte (CM) hypertrophy characterize heart failure with normal ejection fraction (HFNEF) whereas eccentric LV remodeling and low myofilamentary density characterize heart failure with reduced ejection fraction (HFREF). In rodents, low myocardial protein kinase G (PKG) activity has been implicated in the development of pathological CM hypertrophy induced by LV pressure-overload. The present study therefore compared LV remodeling, CM hypertrophy and myocardial PKG activity in patients (pts) with HFNEF (n=36) and HFREF (n=43). All pts had been admitted to hospital for worsening heart failure (NYHA 3–4) and were free of coronary artery disease. HFNEF pts had a LVEF > 50% and a LV end-diastolic pressure > 16 mmHg. HFREF pts had a LVEF <45%. LV remodeling was measured by LV mass/volume ratio derived from biplane LV angiograms and 2D-echocardiograms. CM hypertrophy and myocardial PKG activity were assessed in LV endomyocardial biopsies by histomorphometry of CM diameter and by immunohistochemistry using antibodies against the specific PKG substrate vasodilator stimulated phosphoprotein (VASP) and against phosphorylated VASP ((P)-VASP). Myocardial PKG activity corresponded to the ratio of (P)-VASP/VASP. LV mass/volume ratio and CM diameter were significantly larger in HFNEF than in HFREF (Table ). As evident from (P)-VASP/VASP ratio, PKG activity was lower in HFNEF than in HFREF (Table ). Conclusion: HFNEF patients have lower myocardial PKG activity than HFREF patients. This low myocardial PKG activity could contribute to CM hypertrophy and concentric LV remodeling observed in HFNEF. Raising myocardial PKG activity by phosphodiesterase 5A inhibition could be useful to limit CM hypertrophy and concentric LV remodeling in HFNEF.

Cardiac Effects of Dexamethasone in Very Low Birth Weight Infants

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 818-821 ◽  
Author(s):  
Andrew S. Bensky ◽  
Jamanadas M. Kothadia ◽  
Wesley Covitz
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Wall Thickness ◽  
Very Low Birth Weight ◽  
Systolic Function ◽  
Left Ventricular ◽  
Low Birth Weight Infants ◽  
Cardiac Effects ◽  
Significant Prolongation ◽  
Lv Mass

Objective. To characterize the cardiac effects of dexamethasone in very low birth weight infants. Design. Prospective, randomized, placebo-controlled, double-blind trial. Enrolled subjects were randomized to receive either a 42-day tapering course of dexamethasone or a saline placebo. Echocardiographic measurements were obtained on days 0, 7, 14, 28, and 42. Subjects. Thirteen infants received dexamethasone and 13 a saline placebo. The two groups were similar in birth weight, gestational age, age at enrollment, and sex/race composition. Results. Patients receiving dexamethasone had a significantly larger increase in septal thickness on days 7, 14, and 28 and left ventricle (LV) posterior wall thickness on day 14. A significantly lower left ventricular enddiastolic dimension in the dexamethasone group was initially noted on day 7 and persisted until day 42. With the reduced left ventricular end-diastolic dimension, no significant differences in LV mass were noted, despite the increased wall thickness. No differences in LV systolic function, as assessed by area shortening, were seen. Assessment of diastolic function showed a significant increase in the atrial portion of mitral inflow in dexamethasone patients on day 14, as well as a significant prolongation in isovolumic relaxation time on days 7, 14, and 28. Conclusions. Infants receiving dexamethasone developed evidence for impaired LV filling with a larger increase in wall thickness but no increase in LV mass, asymmetric septal hypertrophy, or augmented systolic function. This suggests that alterations in left ventricular filling play an important role in the development of hypertrophy seen with dexamethasone administration.

Effect of endurance training on cardiac morphology in Alaskan sled dogs

1998 ◽  
Vol 85 (4) ◽  
pp. 1368-1375 ◽  
Author(s):  
R. L. Stepien ◽  
K. W. Hinchcliff ◽  
P. D. Constable ◽  
J. Olson
Keyword(s):  
Endurance Training ◽  
Morphological Changes ◽  
Left Ventricular ◽  
Volume Index ◽  
Heart Weight ◽  
Wall Thickening ◽  
Cardiac Morphology ◽  
End Diastolic Volume ◽  
Sled Dogs ◽  
Lv Mass

The cardiac morphology of 77 conscious Alaskan sled dogs before and after 5 mo of endurance training (20 km/day team pulling a sled and musher) was studied using two-dimensional and M-mode echocardiography. Subgroups included dogs with at least one season of previous training (“veterans”) and dogs undergoing their first season of training (“rookies”). Training resulted in a significant ( P< 0.05) decrease in resting heart rate (−15%) and significant increases in interventricular septal thickness (systole, 15%; diastole, 13%), left ventricular (LV) internal dimension in diastole (LVIDd, 4%), LV free wall thickness in systole (9%) and diastole (LVWd, 9%), and left atrial diameter (5%) in all dogs, but the increase in LVWd was greater in rookies (16%) than in veterans (7%). Training increased end-diastolic volume index (8%), LV mass index (24%), and heart weight index (24%) and decreased the LVIDd-to-LVWd ratio (−6%) but did not alter cardiac index. We conclude that increased LV mass attributable to LV dilation and hypertrophy is associated with endurance training in Alaskan sled dogs. Disproportionate LV wall thickening accompanying LV dilation suggests that cardiac morphological changes are due to volume and pressure loading. These training-induced changes are similar to those documented in human athletes undergoing combined isometric and isotonic training and differ from studies of dogs trained on treadmills.

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