Impact of Myocardial Iron Loading On Right Ventricular Function.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2012-2012
Author(s):  
John-Paul Carpenter ◽  
Francisco Alpendurada ◽  
Monica Deac ◽  
Paul Kirk ◽  
John B Porter ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Volume Index ◽  
Breath Hold ◽  
Lung Pathology ◽  
Iron Loading ◽  
Short Axis ◽  
Myocardial Iron ◽  
The Impact

Abstract Abstract 2012 Poster Board I-1034 Background: Cardiovascular magnetic resonance (CMR) is being increasingly used worldwide for monitoring chelation therapy in transfusion-dependent β-thalassemia patients. The assessment of cardiac iron loading using myocardial T2 star (T2*) is a reliable, quick and non-invasive method which can be combined with highly accurate and reproducible cardiac volume and function measurements. It has previously been noted that myocardial siderosis (T2*<20ms) is associated with progressive impairment in left ventricular (LV) function but little is known about the relation of T2* measurements to right ventricular (RV) function in these patients. This study assesses the impact of myocardial iron loading on the right ventricle. Methods: A retrospective analysis was performed of 323 consecutive β-thalassemia patients referred for their first CMR scan from 21 UK hematology centers. Only patients on a single chelating agent (deferoxamine) were included. All had received chelation from the mid-to-late 1970s or from an early age if born since then. Patients were excluded if there was significant cardiac, vascular or lung pathology (such as aortic stenosis, pulmonary artery stenosis, tetralogy of Fallot or pulmonary hypertension). All scans were performed using a 1.5T Sonata (Siemens Medical Systems, Germany). A single breath-hold multi-echo sequence with 8 different echo times (TE = 2.54-17.9ms) was used to measure T2* from a full-thickness region of interest in the septum of a mid-ventricular short axis slice. Myocardial T2* was calculated from the exponential signal intensity decay curve using a truncation method to account for background noise. RV and LV volumes and ejection fraction (EF) were calculated from a series of short axis ventricular slices (7mm thickness with 3mm gap). Results: In patients with normal T2* (>20ms), RV EF was within normal limits in 98% of cases (RV EF [mean ±SD] = 65.0 ±6.1%). In patients with myocardial siderosis (T2*<20ms), there was a progressive and significant fall in RV EF (r=0.43, p<0.001) and an increase in RV end-systolic volume index (r= -0.33, p<0.001). LV EF was within the normal range in 99% of patients with T2*>20ms (LV EF = 69.5 ±5.2%). Once again, where T2* fell below 20ms, there was a progressive decline in LV EF (r=0.40, p<0.001). 82.6% of the patients with low T2* and impaired RV ejection fraction also had an impaired LV EF and linear regression analysis showed a significant relation between RV and LV EF (r=0.69, p<0.001). Conclusions: There is a strong association between increasing myocardial iron loading and RV dysfunction which mirrors the decrease in LV ejection fraction seen with worsening myocardial siderosis. RV impairment may be a significant contributor to the syndrome of heart failure associated with severe myocardial siderosis. Disclosures: Carpenter: Swedish Orphan: Honoraria; Apotex: Honoraria. Porter:Novartis: Consultancy, Research Funding. He:Novartis: Consultancy. Smith:Novartis: Consultancy. Pennell:Siemens: Consultancy; Novartis: Consultancy; Apotex: Honoraria; Cardiovascular Imaging Solutions, London: Equity Ownership.

scholarly journals Echocardiography of right ventricular-arterial coupling predicts survival of elderly patients with heart failure and reduced to mid-range ejection fraction

2020 ◽  
Vol 90 (2) ◽  
Author(s):  
Gian Marco Rosa ◽  
Andreina D'Agostino ◽  
Stefano Giovinazzo ◽  
Giovanni La Malfa ◽  
Paolo Fontanive ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Ace Inhibitor ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
And Gender ◽  
The Impact

Echocardiography of right ventricular (RV)-arterial coupling obtained by the estimation of the ratio of the longitudinal annular systolic excursion of the tricuspid annular plane and pulmonary artery systolic pressure (TAPSE/PASP) has been found to be a remarkable prognostic indicator in patients with HF. Our aim was to evaluate the impact of TAPSE, PASP and their ratio in the prognostic stratification of outpatients with HF aged ≥70 years and reduced to mid-range ejection fraction (EF). A complete echocardiographic examination was performed in 400 outpatients with chronic HF and left ventricular (LV) EF ≤50% who averaged 77 years in age. During a median follow-up period of 25 months (interquartile range: 8-46), there were 135 cardiovascular deaths. Two different Cox regression models were evaluated, one including TAPSE and PASP, separately, and the other with TAPSE/PASP. In the first model, LV end-systolic volume index, age, no angiotensin converting enzyme (ACE) inhibitor use, TAPSE, PASP and gender were found to be independently associated with the outcome after adjustment for demographics, clinical, biochemical, echocardiographic data. In the second model, TAPSE/PASP resulted the most important independent predictor of outcome (hazard ratio [HR]:0.07, p<0.0001) followed by LV end-systolic volume index, no ACE inhibitor use, age and gender. The use of the variable TASPE/PASP improved the predictive value of the new multivariable model (area under the curve [AUC] of 0.74 vs AUC of 0.71; p<0.05). TASPE/PASP improved the net reclassification (NRI = 14.7%; p<0.01) and the integrated discrimination (IDI = 0.04; p<0.01). In conclusion, the study findings showed that assessment of RV-arterial coupling by TAPSE/PASP was of major importance to assess the prognosis of patients with chronic HF and LV EF ≤50% aged ≥70 years.

Normalized Left Ventricular Volumes and Function in Thalassemia Major Patients with Normal Myocardial Iron.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2707-2707
Author(s):  
Mark A. Westwood ◽  
Lisa J. Anderson ◽  
Alicia M. Maceira ◽  
Emma Prescott ◽  
John B. Porter ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Ejection Fraction ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Left Ventricular ◽  
Volume Index ◽  
Iron Loading ◽  
Myocardial Iron ◽  
End Diastolic Volume

Abstract Repeated blood transfusions in Thalassemia Major (TM) may lead to myocardial iron accumulation and death. Left ventricular (LV) function is commonly used to assess for iron overload, however, the reference range in TM for these variables in the absence of myocardial iron loading is not known. We used cardiovascular magnetic resonance (CMR) in 205 TM patients and studied those (N=81) with normal myocardial T2* measurements (T2*>20ms) and by inference without excess myocardial iron. Resting LV volumes and function normalized to body surface area were compared with 40 age and gender matched healthy controls. All LV parameters were significantly different (p<0.05) in TM patients (see tables 1 and 2). The lower limit for ejection fraction was higher in TM (males 59 vs 55%, females 63 vs 59%, both P<0.001). The upper limit for end-diastolic volume index was higher in TM (males 152 vs 105 mL/m2, females 121 vs 99 mL/m2, both P<0.05). In TM the cardiac output index (P<0.001) was increased. In conclusion, at rest TM patients with normal myocardial T2* values and no excess myocardial iron loading have a hyperdynamic circulation and substantially different values for LV parameters compared with controls. Significant misdiagnosis of cardiomyopathy will result from comparison of TM patients with normal ranges. LV Parameters Normalized to Body Surface Area in Males. TM Patients (Mean±SD) Controls (Mean±SD) LV parameters normalized to body surface area for males with mean and standard deviations divided into TM patients with no myocardial iron loading and non-anemic age matched controls. The ejection fraction is not indexed to body surface area as it does not vary significantly with body habitus. LVEDVI - left ventricular end-diastolic volume index, LVESVI - left ventricular end-systolic volume index, LVSVI - left ventricular stroke volume index, LVEF - left ventricular ejection fraction, LVMI - left ventricular mass index, CO - cardiac output, COI cardiac output index. LVEDVI (mL/m 2 ) 97.2±27.2 84.1±10.5 LVESVI (mL/m 2 ) 23.1±5.2 29.6±6.1 LVSVI (mL/m 2 ) 70.8±15.8 54.4±7.1 LVEF 71.0±6.1 64.9±5.0 LVMI (g/m 2 ) 84.6±20.3 75.0±8.4 CO (L/min) 9.8±3.2 6.8±1.5 COI (L/min/m 2 ) 5.7±1.9 3.5±0.7 LV Parameters Normailzed to Body Surface Area in Females TM Patients (Mean±SD) Controls (Mean±SD) LV parameters normalized to body surface area for females with mean and standard deviations divided into TM patients with no myocardial iron loading and non-anemic age matched controls. The ejection fraction is not indexed to body surface area as it does not vary significantly with body habitus. LVEDVI - left ventricular end-diastolic volume index, LVESVI - left ventricular end-systolic volume index, LVSVI - left ventricular stroke volume index, LVEF - left ventricular ejection fraction, LVMI - left ventricular mass index, CO - cardiac output, COI cardiac output index. LVEDVI (mL/m 2 ) 87.4±16.6 79.4±9.8 LVESVI (mL/m 2 ) 20.8±7.3 26.1±4.7 LVSVI (mL/m 2 ) 66.5±12.4 53.3±7.3 LVEF 75.1±5.9 67.1±4.3 LVMI (g/m 2 ) 69.9±17.3 61.9±7.9 CO (L/min) 8.2±2.0 5.8±1.6 COI (L/min/m 2 ) 5.2±1.3 3.4±0.8

scholarly journals A Randomized, Placebo-Controlled, Double-Blind Trial of the Effect of Combined Therapy With Deferoxamine and Deferiprone on Myocardial Iron in Thalassemia Major Using Cardiovascular Magnetic Resonance

Circulation ◽  
2007 ◽  
Vol 115 (14) ◽  
pp. 1876-1884 ◽  
Author(s):  
M.A. Tanner ◽  
R. Galanello ◽  
C. Dessi ◽  
G.C. Smith ◽  
M.A. Westwood ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Endothelial Function ◽  
Thalassemia Major ◽  
Iron Chelator ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Iron Loading ◽  
Myocardial Iron

Background— Cardiac complications secondary to iron overload are the leading cause of death in β-thalassemia major. Approximately two thirds of patients maintained on the parenteral iron chelator deferoxamine have myocardial iron loading. The oral iron chelator deferiprone has been demonstrated to remove myocardial iron, and it has been proposed that in combination with deferoxamine it may have additional effect. Methods and Results— Myocardial iron loading was assessed with the use of myocardial T2* cardiovascular magnetic resonance in 167 patients with thalassemia major receiving standard maintenance chelation monotherapy with subcutaneous deferoxamine. Of these patients, 65 with mild to moderate myocardial iron loading (T2* 8 to 20 ms) entered the trial with continuation of subcutaneous deferoxamine and were randomized to receive additional oral placebo (deferoxamine group) or oral deferiprone 75 mg/kg per day (combined group). The primary end point was the change in myocardial T2* over 12 months. Secondary end points of endothelial function (flow-mediated dilatation of the brachial artery) and cardiac function were also measured with cardiovascular magnetic resonance. There were significant improvements in the combined treatment group compared with the deferoxamine group in myocardial T2* (ratio of change in geometric means 1.50 versus 1.24; P =0.02), absolute left ventricular ejection fraction (2.6% versus 0.6%; P =0.05), and absolute endothelial function (8.8% versus 3.3%; P =0.02). There was also a significantly greater improvement in serum ferritin in the combined group (−976 versus −233 μg/L; P <0.001). Conclusions— In comparison to the standard chelation monotherapy of deferoxamine, combination treatment with additional deferiprone reduced myocardial iron and improved the ejection fraction and endothelial function in thalassemia major patients with mild to moderate cardiac iron loading.

scholarly journals Impact of empagliflozin on right ventricular parameters and function among patients with type 2 diabetes

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Bradley Sarak ◽  
Subodh Verma ◽  
C. David Mazer ◽  
Hwee Teoh ◽  
Adrian Quan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Volume Index ◽  
Unique Identifier ◽  
Clinical Trial Registration ◽  
Sglt2 Inhibition ◽  
And Function ◽  
The Impact

Abstract Background Sodium-glucose cotransporter 2 (SGLT2) inhibition reduces cardiovascular events in type 2 diabetes (T2DM) and is associated with a reduction in left ventricular (LV) mass index. However, the impact on right ventricular (RV) remodeling is unknown. Accordingly, the objective of this study was to assess the impact of SGLT2 inhibition on RV parameters and function in T2DM and coronary artery disease (CAD). Methods In EMPA-HEART CardioLink-6, 97 patients with T2DM and CAD were randomly assigned to empagliflozin 10 mg (n = 49) once daily or placebo (n = 48). Cardiac magnetic resonance imaging was performed at baseline and after 6 months. RV mass index (RVMi), RV end-diastolic and end-systolic volume index (RVEDVi, RVESVi) and RV ejection fraction (RVEF) were assessed in blinded fashion. Results At baseline, mean RVMi (± SD) (11.8 ± 2.4 g/m2), RVEF (53.5 ± 4.8%), RVEDVi (64.3 ± 13.2 mL/m2) and RVESVi (29.9 ± 6.9 mL/m2) were within normal limits and were similar between the empagliflozin and placebo groups. Over 6 months, there were no significant differences in RVMi (− 0.11 g/m2, [95% CI − 0.81 to 0.60], p = 0.76), RVEF (0.54%, [95% CI − 1.4 to 2.4], p = 0.58), RVEDVi (− 1.2 mL/m2, [95% CI − 4.1 to 1.7], p = 0.41) and RVESVi (− 0.81 mL/m2, [95% CI − 2.5 to 0.90], p = 0.35) in the empaglifozin group as compared with the placebo group. In both groups, there was no significant correlation between RVMi and LVMi changes from baseline to 6 months. Conclusions In this post-hoc analysis, SGLT2 inhibition with empagliflozin had no impact on RVMi and RV volumes in patients with T2DM and CAD. The potentially differential effect of empagliflozin on the LV and RV warrants further investigation. Clinical Trial Registration: URL: https://www.clinicaltrials.gov/ct2/show/NCT02998970?cond=NCT02998970&draw=2&rank=1. Unique identifier: NCT02998970.

scholarly journals Effects of glossopharyngeal insufflation on cardiac function: an echocardiographic study in elite breath-hold divers

2007 ◽  
Vol 103 (3) ◽  
pp. 823-827 ◽  
Author(s):  
Ralph Potkin ◽  
Victor Cheng ◽  
Robert Siegel
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Wall Motion ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Breath Hold ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction ◽  
End Diastolic Volume

Glossopharyngeal insufflation (GI), a technique used by breath-hold divers to increase lung volume and augment diving depth and duration, is associated with untoward hemodynamic consequences. To study the cardiac effects of GI, we performed transthoracic echocardiography, using the subcostal window, in five elite breath-hold divers at rest and during GI. During GI, heart rate increased in all divers (mean of 53 beats/min to a mean of 100 beats/min), and blood pressure fell dramatically (mean systolic, 112 to 52 mmHg; mean diastolic, 75 mmHg to nondetectable). GI induced a 46% decrease in mean left ventricular end-diastolic area, 70% decrease in left ventricular end-diastolic volume, 49% increase in mean right ventricular end-diastolic area, and 160% increase in mean right ventricular end-diastolic volume. GI also induced biventricular systolic dysfunction; left ventricular ejection fraction decreased from 0.60 to a mean of 0.30 ( P = 0.012); right ventricular ejection fraction, from 0.75 to a mean of 0.39 ( P < 0.001). Wall motion of both ventricles became significantly abnormal during GI; the most prominent left ventricular abnormalities involved hypokinesis or dyskinesis of the interventricular septum, while right ventricular wall motion abnormalities involved all visible segments. In two divers, the inferior vena cava dilated with the appearance of spontaneous contrast during GI, signaling increased right atrial pressure and central venous stasis. Hypotension during GI is associated with acute biventricular systolic dysfunction. The echocardiographic pattern of right ventricular systolic dysfunction is consistent with acute pressure overload, whereas concurrent left ventricular systolic dysfunction is likely due to ventricular interdependence.

scholarly journals Left Ventricular Involvement in Arrhythmogenic Right Ventricular Cardiomyopathy – A Cardiac Magnetic Resonance Imaging Study

2014 ◽  
Vol 8s4 ◽  
pp. CMC.S18770 ◽  
Author(s):  
Soraya El Ghannudi ◽  
Anthony Nghiem ◽  
Philippe Germain ◽  
Mi-Young Jeung ◽  
Afshin Gangi ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Task Force ◽  
Previous History ◽  
Late Enhancement ◽  
Left Ventricular ◽  
Coronary Syndrome ◽  
The Impact

Background Few studies evaluated left ventricular (LV) involvement in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). The aim of this study is to determine the frequency, clinical presentation, and pattern of LV involvement in ARVD/C (LV-ARVD/C). Methods We retrospectively evaluated the cardiac magnetic resonance (CMR) in 202 patients referred between 2008 and 2012 to our institution, and we determined the presence or the absence of CMR criteria in the revised task force criteria 2010 for the diagnosis of ARVD/C. A total of 21 patients were diagnosed with ARVD/C according to the revised task force criteria 2010. All included patients had no previous history of myocarditis, acute coronary syndrome, or any other cardiac disease that could interfere with the interpretations of structural abnormalities. The LV involvement in ARVD/C was defined by the presence of one or more of the following criteria: LV end-diastolic volume (LVEDV; >95 mL/m2), LV ejection fraction (LVEF; <55%), LV late enhancement of gadolinium (LVLE) in a non-ischemic pattern, and LV wall motion abnormalities (WMAs). In the follow-up for the occurrence of cardiac death, ventricular tachycardia (VT) was obtained at a mean of 31 ± 20.6 months. Results A total of 21 patients had ARVD/C. The median age was 48 (33-63) years. In all, 11 patients (52.4%) had LV-ARVD/C. The demographic characteristics of patients with or without LV were similar. There was a higher frequency of left bundle-branch block (LBBB) VT morphology in ARVD/C ( P = 0.04). In CMR, regional WMAs of right ventricle (RV) and RV ejection fraction (RVEF; <45%) were strongly correlated with LV-WMAs ( r = 0.72, P = 0.02, r = 0.75, P = 0.02, respectively). RV late enhancement of gadolinium (RVLE) was associated with LV-WMs and LVLE ( r = 0.7, P = 0.03; r = 0.8, P = 0.006). LVLE was associated with LV-WMAs, LVEF, and LVEDV ( r = 0.9, P = 0.001; r = 0.8, P = 0.001; r = 0.8, P = 0.01). Conclusion LV involvement in ARVD/C is common and frequently associated with moderate to severe right ventricular (RV) abnormalities. The impact of LV involvement in ARVD/C on the prognosis needs further investigations.

Improved Endothelial Function with Combined Chelation Therapy in Thalassaemia Major.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1770-1770 ◽  
Author(s):  
Mark A. Tanner ◽  
Renzo Galanello ◽  
Carlo Dessi ◽  
Annalisa Agus ◽  
Gillian C. Smith ◽  
...  
Keyword(s):  
Placebo Group ◽  
Ejection Fraction ◽  
Endothelial Function ◽  
Chelation Therapy ◽  
Combined Treatment ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Iron Loading ◽  
Myocardial Iron ◽  
Ventricular Ejection Fraction

Abstract Background: In β-thalassemia major (TM) myocardial iron toxicity is the dominant cause of ventricular dysfunction, with heart failure responsible for the majority of deaths. Abnormal endothelial function has also been described in these patients and could further contribute to cardiovascular complications. Endothelial function can be determined by measurement of flow mediated dilatation of the brachial artery (FMD). This can be assessed reproducibly by cardiovascular magnetic resonance (CMR). Aims: To report the changes in endothelial function, LV ejection fraction and ferritin from a randomized placebo controlled trial comparing combined chelation therapy (deferiprone and deferoxamine) with deferoxamine monotherapy. Methods: 65 patients (male 27, female 38, age 28.7+/−4.8years) with mild-moderate myocardial iron loading (heart T2* 8–20ms) were randomized to receive either deferoxamine with placebo (placebo group), or deferoxamine with deferiprone (combined group). FMD was assessed at baseline and after 12 months. Results: There were significant improvements in endothelial function in the combined treatment group compared with the placebo group (+8.8% vs 3.1% p=0.013). This was in accord with improvements in the combined group in left ventricular ejection fraction (+2.4% vs +0.6%, p=0.02), and serum ferritin (−870 vs −194 μg/L; p<0.001). These findings were in accord with improved myocardial T2* in the combined group (+43% vs +23%, p=0.017), Conclusion: In patients with mild-moderate cardiac iron loading, the combined therapy of deferiprone and deferoxamine is superior to deferoxamine alone in improving endothelial function, cardiac function and ferritin, as well as reducing myocardial iron.

P4507Left atrial conduit function modulates functional capacity in heart failure patients acting through the pulsatile component of right ventricular afterload

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Zanaboni ◽  
A Giubertoni ◽  
C Piccinino ◽  
A Panizza ◽  
A Degiovanni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Right Ventricular ◽  
Real Time ◽  
Functional Capacity ◽  
Left Ventricular ◽  
Lv Volumes ◽  
The Impact ◽  
Conduit Function

Abstract Background It has been suggested that left atrial (LA) characteristics modulate the functional capacity in heart failure (HF) patients through the impact that LA cavity exerts on the pulmonary circulation and the pulsatile component of right ventricular (RV) afterload, as represented by pulmonary arterial compliance (PAC). Purpose Thus, we hypothesized that, in a HF patients' population, a larger relative contribution of LA phasic conduit function (PCF) to the left ventricular (LV) stroke volume would be associated with a heavier right ventricular hemodynamic burden and a reduced functional capacity. Methods 60 sinus rhythm HF subjects (42 males, 67±11 years, ejection fraction [EF] 39±11%, range 20% - 62%) underwent 6 minute walking test (6MWT) and routine transthoracic echocardiography, plus real time 3D acquisitions analyzed with a dedicated echo software package. LV ejection fraction (EF) was obtained from 3D echo acquisitions. LV diastolic dysfunction (DD) was assessed according to current guidelines. Computation of PCF was made by simultaneous gathering real time 3D multibeats (6 cycles) LA and LV volumes, using the formula: PCF(time) = [LV(time) − LV minimum] − [LA maximum − LA(time)] as proposed by Bowman & Kovacs (2004), with PCF expressed as % of LV stroke volume. Atrioventricular compliance (Cn) was also assessed, as proposed by Flachskampf et al. (1992): 1270*(mitral valve area/E wave downslope) and expressed in ml/mmHg. Finally, PAC was obtained as the ratio between RV stroke volume (pulmonary velocity time integral*pulmonary valve annulus area measured from the RV outflow tract diameter) and pulse pressure (obtained from pulmonary and tricuspid regurgitant envelopes) and expressed in ml/mmHg. Results Maximal LA and LV volumes averaged 69±21 ml and 147±47 ml, respectively. The mean value of PCF was 33±12% (range 7% - 58%). Mean 6MWT was 397±162 m. Mean PAC was (3.1±1.1 ml/mmHg). DD grade I, II and III were detected in 38 (63%), 18 (30%) and 4 (7%) of the patients' population, respectively. PCF was independent of LA or LV volumes and EF, but showed a strong direct relation with DD (r=0.62; p<0.0001) and a relevant inverse dependence on Cn (r=−0.48; p=0.0001). For a comparable Cn, dividing patients into tertiles according to 6MWT, it was clear that highest PCF was significantly associated with lowest functional capacity (ANCOVA, figure left). Similarly, dividing patients into tertiles according to PAC, it emerges that highest PCF is significantly associated with most deranged PAC (ANCOVA, figure right), suggesting outmost RV hemodynamic burden. Conclusion PCF is an important parameter to be quantified in HF patients that is dependent on global left heart compliance, being affected by DD, but not LV EF. Furthermore, at a given Cn, PCF is increased in HF patients with lowest functional capacity, likely because RV pulsatile afterload is highest in these subjects.

scholarly journals Effects on the left ventricular diastolic dysfunction of a cardiac rehabilitation program in chronic heart failure patients

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Chaveles ◽  
L Karatzanos ◽  
S Nanas
Keyword(s):  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Diastolic Dysfunction ◽  
Left Atrium ◽  
Left Atrial Volume ◽  
Rehabilitation Program ◽  
Left Ventricular ◽  
Volume Index ◽  
Cardiac Rehabilitation Program ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. PURPOSE The aim of the present study is to evaluate the impact of a cardiac rehabilitation program on the diastolic dysfunction, the ejection fraction (EF) of left ventricular and the volume index of the left atrium comparing 2 groups: those with restricted EF (&lt;40%) and those with intermediate and preserved EF (≥ 40%). METHODS In the present study 41 stable CHF patients (N = 41; 56 ±10 years [mean ± SD], 34 males and 7 females) with diastolic dysfunction, participated in an exercise rehabilitation program (3 sessions a week). Only 38 of them completed the rehabilitation program in the form of circuit-interval aerobic training, adjusted according to 70–80% of heart rate reserve, for a period of 3 months. A detailed echocardiogram was performed before and immediately after the rehabilitation program, focusing on the diastolic dysfunction assessment of the left ventricular. RESULTS At the end of the three months rehabilitation program, the diastolic dysfunction stage was significantly decreased (from 1.45+/- 0.72 to 1.08 +/-0.67, p = .000). The LV ejection fraction was significantly increased (from 34.97+/-10.66 to 36.68 +/-10.52, p = .002). In addition, there was a significant decrease in E/E" and RVSP (from 9.37+/-3.54 to 8.47+/-3.34 and from 28.44+/-6.86mmHg to 27.38+/-5.87 mmHg, p =.033 and p =.030, respectively). Finally, the left atrial volume and the average e" had no significant decrease. CONCLUSIONS Circuit training improved both diastolic and systolic dysfunction but had no significant repercussion on the left atrium volume. From this study it was concluded that a rehabilitation cardiac program can have an impact in the improvement in the diastolic dysfunction, especially in the restricted EF group, a mechanism that is essential in the pathophysiology of the CHF. Table 1 PairedDifferences t df Sig. (2-tailed) Mean Std. Deviation Std. ErrorMean 95% Confidence Interval of the Difference Lower Upper Diast.stage b-a 0.368 .589 .096 .175 .562 3.855 37 .000 A b - A a ( m/sec) -.03816 .21084 .03420 -.10746 .03114 -1.116 37 .272 Ε/Α b - Ε/Α a .11039 .44705 .07252 -.03655 .25734 1.522 37 .136 mean e" b - a(cm/sec) .19395 2.56304 .41578 -.64850 1.03640 .466 37 .644 Ε/e "b - Ε/e "a .90026 2.50613 .40655 .07652 1.72401 2.214 37 .033 DTeb -DTe a (msec) 8.500 44.324 7.190 -6.069 23.069 1.182 37 .245 T-Test for the measured diastolic parameters (diastolic stage, E, A, E/A, mean e", E/E", DTe) for all groups (b = before, a = after). Abstract Figure. Linear scatter plot for EF

scholarly journals Right ventricular insertion site fibrosis in a dilated cardiomyopathy referral population: phenotypic associations and value for the prediction of heart failure admission or death

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Yoko Mikami ◽  
Aidan Cornhill ◽  
Steven Dykstra ◽  
Alessandro Satriano ◽  
Reis Hansen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Dilated Cardiomyopathy ◽  
Primary Outcome ◽  
Left Ventricular ◽  
Volume Index ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
Heart Failure Admission

Abstract Background Dilated cardiomyopathy (DCM) is increasingly recognized as a heterogenous disease with distinct phenotypes on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging. While mid-wall striae (MWS) fibrosis is a widely recognized phenotypic risk marker, other fibrosis patterns are prevalent but poorly defined. Right ventricular (RV) insertion (RVI) site fibrosis is commonly seen, but without objective criteria has been considered a non-specific finding. In this study we developed objective criteria for RVI fibrosis and studied its clinical relevance in a large cohort of patients with DCM. Methods We prospectively enrolled 645 DCM patients referred for LGE-CMR. All underwent standardized imaging protocols and baseline health evaluations. LGE images were blindly scored using objective criteria, inclusive of RVI site and MWS fibrosis. Associations between LGE patterns and CMR-based markers of adverse chamber remodeling were evaluated. Independent associations of LGE fibrosis patterns with the primary composite clinical outcome of heart failure admission or death were determined by multivariable analysis. Results The mean age was 56 ± 14 (28% female) with a mean left ventricular (LV) ejection fraction (LVEF) of 37%. At a median of 1061 days, 129 patients (20%) experienced the primary outcome. Any abnormal LGE was present in 306 patients (47%), inclusive of 274 (42%) meeting criteria for RVI site fibrosis and 167 (26%) for MWS fibrosis. All with MWS fibrosis showed RVI site fibrosis. Solitary RVI site fibrosis was associated with higher bi-ventricular volumes [LV end-systolic volume index (78 ± 39 vs. 66 ± 33 ml/m2, p = 0.01), RV end-diastolic volume index (94 ± 28 vs. 84 ± 22 ml/m2 (p < 0.01), RV end-systolic volume index (56 ± 26 vs. 45 ± 17 ml/m2, p < 0.01)], lower bi-ventricular function [LVEF 35 ± 12 vs. 39 ± 10% (p < 0.01), RV ejection fraction (RVEF) 43 ± 12 vs. 48 ± 10% (p < 0.01)], and higher extracellular volume (ECV). Patient with solitary RVI site fibrosis experienced a non-significant 1.4-fold risk of the primary outcome, increasing to a significant 2.6-fold risk when accompanied by MWS fibrosis. Conclusions RVI site fibrosis in the absence of MWS fibrosis is associated with bi-ventricular remodelling and intermediate risk of heart failure admission or death. Our study findings suggest RVI site fibrosis to be pre-requisite for the incremental development of MWS fibrosis, a more advanced phenotype associated with greater LV remodeling and risk of clinical events.

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