Urine Albumin to Creatinine Ratio and Echocardiographic Left Ventricular Structure and Function in Patients with Essential Hypertension

Background:Appearance of microalbuminuria, particularly in patients with hypertension, might be associated with a higher prevalence of left ventricular (LV) dysfunction and geometric abnormalities. This study was undertaken to determine whether high urine albumin to creatinine ratio (UACR) as a sensitive marker for microalbuminuria can be associated with LV hypertrophy (LVH) and systolic and diastolic LV dysfunction.Methods:The study population consisted of 125 consecutive patients with essential uncomplicated hypertension. Urine albumin and creatinine concentration was determined by standard methods. LVH was defined as a LV mass index >100 g/m2 of body surface area in women and >130 g/m2 in men. Echocardiographic LV systolic and diastolic parameters were measured.Results:The prevalence of microalbuminuria in patients with essential hypertension was 5.6 %. UACR was significantly no different in patients with LVH than in patients with normal LV geometry (21.26 ± 31.55 versus 17.80 ± 24.52 mg/mmol). No significant correlation was found between UACR measurement and systolic and diastolic function parameters, including early to late diastolic peak velocity (E/A) ratio (R=-0.192, p=0.038), early diastolic peak velocity to early mitral annulus velocity (E/E') ratio (R=-0.025, p=0.794), LV ejection fraction (R=0.008, p=0.929), and LV mass (R=-0.132, p=0.154). According to the receiver operator characteristic (ROC) curve analysis, UACR measurement was not an acceptable indicator of LVH with areas under the ROC curves 0.514 (95 % confidence interval 0.394–0.634). The optimal cut-off value for UACR for predicting LVH was identified at 9.4, yielding a sensitivity of 51.6 % and a specificity of 48.3 %.Conclusion:In patients with uncomplicated essential hypertension, abnormal systolic and diastolic LV function and geometry cannot be effectively predicted by the appearance of microalbuminuria.

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Effect of cardiosphere-derived cells on segmental myocardial function after myocardial infarction: ALLSTAR randomised clinical trial

Open Heart ◽

10.1136/openhrt-2021-001614 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001614

Author(s):

Mohammad R Ostovaneh ◽

Raj R Makkar ◽

Bharath Ambale-Venkatesh ◽

Deborah Ascheim ◽

Tarun Chakravarty ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Trial ◽

Myocardial Function ◽

Randomised Clinical Trial ◽

Scar Tissue ◽

Left Ventricular ◽

Lv Function ◽

Cardiac Events ◽

Lv Dysfunction ◽

Registration Number

BackgroundMost cell therapy trials failed to show an improvement in global left ventricular (LV) function measures after myocardial infarction (MI). Myocardial segments are heterogeneously impacted by MI. Global LV function indices are not able to detect the small treatment effects on segmental myocardial function which may have prognostic implications for cardiac events. We aimed to test the efficacy of allogeneic cardiosphere-derived cells (CDCs) for improving regional myocardial function and contractility.MethodsIn this exploratory analysis of a randomised clinical trial, 142 patients with post-MI with LVEF <45% and 15% or greater LV scar size were randomised in 2:1 ratio to receive intracoronary infusion of allogenic CDCs or placebo, respectively. Change in segmental myocardial circumferential strain (Ecc) by MRI from baseline to 6 months was compared between CDCs and placebo groups.ResultsIn total, 124 patients completed the 6-month follow-up (mean (SD) age 54.3 (10.8) and 108 (87.1%) men). Segmental Ecc improvement was significantly greater in patients receiving CDC (−0.5% (4.0)) compared with placebo (0.2% (3.7), p=0.05). The greatest benefit for improvement in segmental Ecc was observed in segments containing scar tissue (change in segmental Ecc of −0.7% (3.5) in patients receiving CDC vs 0.04% (3.7) in the placebo group, p=0.04).ConclusionsIn patients with post-MI LV dysfunction, CDC administration resulted in improved segmental myocardial function. Our findings highlight the importance of segmental myocardial function indices as an endpoint in future clinical trials of patients with post-MI.Trial registration numberNCT01458405.

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Regulation of components of the brain and cardiac renin-angiotensin systems by 17β-estradiol after myocardial infarction in female rats

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00497.2005 ◽

2006 ◽

Vol 291 (1) ◽

pp. R155-R162 ◽

Cited By ~ 9

Author(s):

Stephanie A. Dean ◽

Junhui Tan ◽

Roselyn White ◽

Edward R. O’Brien ◽

Frans H. H. Leenen

Keyword(s):

Myocardial Infarction ◽

Left Ventricular ◽

Female Rats ◽

Lv Function ◽

Coronary Artery Ligation ◽

Brain Nuclei ◽

Renin Angiotensin ◽

Lv Dysfunction ◽

17Β Estradiol ◽

The Brain

The present study tested the hypothesis that 17β-estradiol (E2) inhibits increases in angiotensin-converting enzyme (ACE) and ANG II type 1 receptor (AT1R) in the brain and heart after myocardial infarction (MI) and, thereby, inhibits development of left ventricular (LV) dysfunction after MI. Age-matched female Wistar rats were treated as follows: 1) no surgery (ovary intact), 2) ovariectomy + subcutaneous vehicle treatment (OVX + Veh), or 3) OVX + subcutaneous administration of a high dose of E2 (OVX + high-E2). After 2 wk, rats were randomly assigned to coronary artery ligation (MI) and sham operation groups and studied after 3 wk. E2 status did not affect LV function in sham rats. At 2–3 wk after MI, impairment of LV function was similar across MI groups, as measured by echocardiography and direct LV catheterization. LV ACE mRNA abundance and activity were increased severalfold in all MI groups compared with respective sham animals and to similar levels across MI groups. In most brain nuclei, ACE and AT1R densities increased after MI. Unexpectedly, compared with the respective sham groups the relative increase was clearest (20–40%) in OVX + high-E2 MI rats, somewhat less (10–15%) in ovary-intact MI rats, and least (<10–15%) in OVX + Veh MI rats. However, because in the sham group brain ACE and AT1R densities increased in the OVX + Veh rats and decreased in the OVX + high-E2 rats compared with the ovary-intact rats, actual ACE and AT1R densities in most brain nuclei were modestly higher (<20%) in OVX + Veh MI rats than in the other two MI groups. Thus E2 does not inhibit upregulation of ACE in the LV after MI and amplifies the percent increases in ACE and AT1R densities in brain nuclei after MI, despite E2-induced downregulation in sham rats. Consistent with these minor variations in the tissue renin-angiotensin system, during the initial post-MI phase, E2 appears not to enhance or hinder the development of LV dysfunction.

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Abstract 3435: Left Ventricular Hypertrophy is Resistant to Inhibition of Expression of the R403Q Alpha-Myosin Heavy Chain Cardiac Hypertrophy-Inducing Mutant Protein

Circulation ◽

10.1161/circ.118.suppl_18.s_423-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Leah Cannon ◽

Tadeusz Marciniec ◽

Bryony Mearns ◽

Robert M Graham ◽

Diane Fatkin

Keyword(s):

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Interstitial Fibrosis ◽

Myocardial Dysfunction ◽

Left Ventricular ◽

Familial Hypertrophic Cardiomyopathy ◽

Lv Function ◽

Dependent Manner ◽

Cardiovascular Morbidity And Mortality ◽

Lv Mass

Left ventricular hypertrophy (LVH) develops as a compensatory response to myocardial dysfunction due to diverse causes, but is nonetheless a major risk factor for premature cardiovascular morbidity and mortality. It is thus unclear if regressing LVH is beneficial or may worsen patient outcome. To evaluate the effects of LVH regression, we developed a transgenic mouse model in which the expression of a familial hypertrophic cardiomyopathy (FHC)-inducing mutation (R403Q alpha-MHC) can be regulated in a temporal and dose-dependent manner. In this model, transgene expression can be shut off by feeding with a tetracycline analogue (doxycycline). Serial echocardiography and histology studies were performed in a cohort of mice expressing the FHC mutant (“gene-on”) and in wildtype (WT) littermates. A second cohort of WT and 403/+ mice was randomised to placebo or doxycycline (“gene off”) from 6 (Dox6) or 20 weeks (Dox20) and evaluated at 40 weeks of age. Compared to WT littermates, “gene on” 403/+ mice showed increased LV mass, LV end-diastolic diameter (LVDD) and left atrial diameter (LAD), and reduced fractional shortening (LVFS), with changes evident from 12 weeks of age. LV sections from 403/+ mice showed typical features of FHC: myofibre disarray and interstitial fibrosis. LV mass, LV function and myocardial histology were unchanged in both male and female placebo- vs Dox6 or Dox20 mice at 40 weeks (Table 1 ). Thus, consistent with the major LV thickening in FHC humans occurring in adolescence, overexpression of R403Q for only 6 weeks is sufficient to trigger the complete LVH phenotypic response. Moreover, switching off the genetic trigger for LVH in 403/+ mice at 6 weeks (prior to overt disease manifestation) or 20 weeks (established disease) does not induce regression of LVH or exacerbate contractile dysfunction. Interventions to induce LVH regression may, therefore, need to be directed at downstream factors in hypertrophic pathways. Table 1. Echo data for male WT and 403/+ mice aged 40 weeks

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Abstract 12952: Global Longitudinal Strain is Simple, Effective & Sensitive Assessment of Cardiac Chamber Function in Patients With Acute-phase Myocarditis

Circulation ◽

10.1161/circ.142.suppl_3.12952 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Shaun Khanna ◽

Aditya Bhat ◽

Henry H Chen ◽

Kennith Gu ◽

Gary Gan ◽

...

Keyword(s):

Acute Phase ◽

Longitudinal Strain ◽

Myocardial Dysfunction ◽

Global Longitudinal Strain ◽

Disease Process ◽

Left Ventricular ◽

Lv Function ◽

Lv Mass ◽

Echocardiographic Parameters ◽

Cardiac Therapy

Introduction: Myocarditis is an inflammatory disease process with growing clinical relevance in the current COVID-19 pandemic. Acute-phase myocarditis is known to result in subclinical changes in left ventricular (LV) function despite normal LV ejection fraction (LVEF), as assessed by myocardial deformation indices. The presence of right ventricular (RV) and left atrial (LA) subclinical dysfunction however has not been well described in current literature. Hypothesis: Myocarditis patients have subclinical impairment of LV, RV and LA function as assessed by global longitudinal strain (GLS) on speckle tracking echocardiography. Methods: Consecutive patients with clinical diagnosis of myocarditis admitted to our institution during 2013-2018 were assessed (n=76). Patients who did not meet appropriate diagnostic criteria (n=14), had impaired LVEF or prior cardiac disease (n=8) or poor transthoracic echocardiogram images (n=14) were excluded from analysis. Clinical and echocardiographic parameters were compared to age- , gender- and risk factor- matched controls. GLS was performed by two independent observers using vendor independent software (TomTec Arena, Germany v4.6). Results: The final cohort consisted 40 patients with myocarditis (age 44.3±16.7, 60% male) and 40 matched controls (44.5±16.6, 60% male). No significant differences in baseline clinical characteristics were observed between groups. No differences in LVEF, indexed LV mass, RV fractional area change, indexed LA volume or TR pressure gradient (p>0.05 for all) were demonstrated between the two groups. Patients with myocarditis had a lower mean LV strain (GLS%: -16.4±2.9 vs -19.7±2.7, p=0.0001), a lower mean RV Free Wall Strain (FWS) (GLS%: -22.1±4.1 vs -26.2±6.9, p=0.03) and a lower mean LA reservoir strain (GLS%: 27.5±4.6 vs. 33.7±6.3, p<0.0001) when compared to controls. Conclusions: Our results demonstrate the presence of significant subclinical global myocardial dysfunction despite normal traditional echocardiographic indices, in patients with acute-phase myocarditis. Routine assessment of GLS may identify such patients for early targeted cardiac therapy.

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Impact of Valve Surgery on Serum Osteopontin Levels in Patients with Mitral Regurgitation

Cardiology ◽

10.1159/000368299 ◽

2015 ◽

Vol 130 (2) ◽

pp. 82-86

Author(s):

H.M. Gunes ◽

G.B. Guler ◽

E. Guler ◽

G.G. Demir ◽

S. Hatipoglu ◽

...

Keyword(s):

Mitral Regurgitation ◽

Left Ventricular ◽

Valve Surgery ◽

Lv Function ◽

Vena Contracta ◽

Atherosclerotic Lesions ◽

Lv Dysfunction ◽

Echocardiographic Parameters ◽

Artery Disease ◽

The Impact

Objective: Osteopontin (OPN), a sialoprotein present within atherosclerotic lesions, especially in calcified plaques, is linked to the progression of coronary artery disease and heart failure. We assessed the impact of valve surgery on serum OPN and left ventricular (LV) function in patients with mitral regurgitation (MR). Methods: Thirty-two patients with severe MR scheduled for surgery were included in the study. Echocardiography markers were assessed preoperatively and at 3 months following the surgery and matched with the serum OPN levels. Results: Valve surgery was associated with a reduction of the ejection fraction (EF) from 55.2 ± 6.3 to 48.8 ± 7.1% after surgery, p < 0.001. Following surgery, the OPN level was significantly higher than preoperatively (mean 245, range 36-2,284 ng/ml vs. 76, 6-486 ng/ml, p = 0.007). Preoperative OPN exhibited a slight negative correlation with the EF (r = -0.35, p = 0.04), and a moderate correlation with vena contracta (r = -0.38, p = 0.02). There were no other meaningful correlations between conventional echocardiographic parameters and OPN. Conclusion: Following valve surgery due to severe MR, patients exhibited a decrease in EF and an increase in OPN levels. The assessment of preoperative OPN failed to strongly predict probable LV dysfunction.

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Abstract 14119: Contrasting Effects of Exercise Training After Acute Myocardial Infarction versus Aortic Stenosis Depend Critically on the Regulation of Endothelial Nitric Oxide Synthase

Circulation ◽

10.1161/circ.132.suppl_3.14119 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yanti Octavia ◽

Elza D van Deel ◽

Monique de Waard ◽

Martine de Boer ◽

Dirk J Duncker

Keyword(s):

Nitric Oxide ◽

Myocardial Infarction ◽

Exercise Training ◽

Wheel Running ◽

Left Ventricular ◽

Lv Function ◽

Enhanced Chemiluminescence ◽

Lv Dysfunction ◽

Enos Uncoupling ◽

Endothelial Nitric Oxide

Introduction: The cardiovascular benefits of exercise training (EX) are widely appreciated. Previously we found that the cardiac effects of EX critically depend on the underlying cause of heart disease. Hypothesis: The underlying etiology determines how EX affects the endothelial nitric oxide (NO) synthase (eNOS)-mediated balance between NO and superoxide (O2-). Methods: Mice were subjected to sham surgery, myocardial infarction (MI) or transverse aortic constriction (TAC), and subsequently exposed to 8 weeks of voluntary wheel running or sedentary housing. Left ventricular (LV) function was assessed by echocardiography and hemodynamic measurements; fibrosis by Picro-sirius Red staining; peroxynitrite (ONOO-) and O2- production by luminol- and lucigenin-enhanced chemiluminescence respectively, with or without the NOS inhibitor L-NAME; eNOS uncoupling and eNOS S-glutathionylation by western blot and coimmunoprecipitation, respectively; cardiac NO by the Griess reaction. Results: EX ameliorated LV dysfunction and fibrosis in MI but not TAC (Table 1). Strikingly, O2- generation was blunted by EX in MI, but exacerbated by EX in TAC, which was largely NOS-dependent. Accordingly, eNOS uncoupling and eNOS S-glutathionylation were corrected by EX in MI but aggravated in TAC mice. In parallel, ONOO- levels was attenuated by EX in MI but aggravated by EX in TAC. Cardiac NO levels were reduced in MI and TAC and normalized by EX in MI. Conclusions: The contrasting effects of EX in MI vs TAC can be explained by the highly divergent effects of EX on eNOS regulation, resulting in blunted vs aggravated oxidative stress by EX in MI vs TAC.

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Abstract 2280: Urine Albumin/creatinine Ratio, Cardiac Structure And Diastolic Function In Patients With Hypertension And Diastolic Dysfunction: The Validd Study

Circulation ◽

10.1161/circ.116.suppl_16.ii_497-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Anil Verma ◽

Rajesh Janardhanan ◽

William L Daley ◽

Susan Ritter ◽

William A Kaye ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Dysfunction ◽

Diastolic Function ◽

Organ Damage ◽

Left Ventricular ◽

Creatinine Ratio ◽

Albumin Creatinine Ratio ◽

End Organ Damage ◽

Urine Albumin ◽

Urine Albumin Creatinine Ratio

Background: Increasing urine albumin/creatinine ratio (ACR) is associated with systemic microvascular damage and increased cardiovascular morbidity and mortality. However, the relationship between albuminuria and left ventricular (LV) diastolic function, an early measure of myocardial end-organ damage in hypertension, has not been well defined. Methods: Urine ACR and echocardiographic measures of LV structure and function were assessed in 384 patients enrolled in the VALsartan In Diastolic Dysfunction (VALIDD) trial with mild hypertension and no heart failure and evidence of diastolic dysfunction based on Doppler assessment of myocardial relaxation velocities. Results: Urine ACR was undetected in 151 (39.3%) subjects, between 1 to 30 mg/g in 194 (50.5%), and > 30mg/g in 39 (10.2%). The mean blood pressure in the cohort was 143.8 ± 16.1/86.2 ± 10.3 mmHg and LV hypertrophy was present in < 4% of enrolled patients. Higher urine ACR was associated with lower annular relaxation velocity (E′), higher E/E′ (Figure ), higher prevalence of concentric LV remodeling and higher NT-ProBNP even after adjusting for age, diabetes, systolic BP, eGFR and LV mass index (LVMi) (p < 0.02 for all associations). Conclusion: Albuminuria is associated with worsening diastolic function in patients with hypertension, and both measures may represent important and modifiable markers of early end-organ damage even in patients with mild blood pressure elevation. E′ stratified by urine albumin creatinine ratio E/E′ stratified by urine albumin creatinine ratio

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Association between Serum Ferritin Level and Left Ventricular Function by Speckle Tracking Echocardiography in Patients with Thalassemia

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.09.12096 ◽

2021 ◽

Vol 104 (9) ◽

pp. 1421-1427

Keyword(s):

Serum Ferritin ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Early Stage ◽

Ferritin Level ◽

Left Ventricular ◽

Lv Function ◽

Lv Dysfunction ◽

Spearman's Rho ◽

Spearman’S Rho

Background: Thalassemia is a common disease in Thailand. Most patients with thalassemia receive regular blood transfusion, resulting in iron accumulation in the body. Ferritin levels are associated with iron accumulation in vital organs of patients with thalassemia. The relationship between the ferritin levels and left ventricular (LV) function in these patients showed no relationship in most data, but all data were measured by conventional echocardiography. Currently, LV function can be measured by more advanced methods, such as the speckle tracking echocardiography, which demonstrates high accuracy in detecting early-stage LV dysfunction. Objective: To investigate the association between the serum ferritin level and LV function by speckle tracking echocardiography in patients with thalassemia. Materials and Methods: The present study was a cross-sectional analytic study that enrolled patients with thalassemia in the Faculty of Medicine, Vajira Hospital, between January and December 2019. Each participants provided an informed consent. Serum ferritin, conventional echocardiography, and speckle tracking echocardiography using global longitudinal strain [GLS] parameters were collected. Results: Among 45 participants, 33 had transfusion-dependent thalassemia (TDT), and 12 had non-transfusion-dependent thalassemia (NTDT). Female participants accounted for 64.4% with 29 patients. The mean age was 35.51±13.81 years, and participants had no other systemic diseases. The median serum ferritin was 1,159 ng/dL with a range of 638 to 1,983. The mean values for GLS and LVEF by biplane were −22.97±2.20% and 63.90±7.62%, respectively. Serum ferritin was not significantly related to GLS (Spearman’s rho 0.164, 95% CI −0.136 to 0.437, p=0.280). In the TDT group, ferritin was significantly related to GLS (Spearman’s rho 0.405, 95% CI 0.072 to 0.657, p=0.019), whereas in the NTDT group, such relationship was insignificant (Spearman’s rho −0.394, 95% CI 0.790 to 0.232, p=0.205). Conclusion: Serum ferritin and speckle tracking echocardiography in patients with thalassemia are not significantly associated. Therefore, serum ferritin should not be a single candidate for detecting early-stage LV dysfunction. As a result, using various measurements remains the best option. Keywords: Ferritin; Speckle tracking echocardiography; Thalassemia; Echocardiography

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Evaluation of diastolic LV function

The ESC Textbook of Cardiovascular Imaging ◽

10.1093/med/9780198703341.003.0024 ◽

2015 ◽

pp. 323-335

Author(s):

Johan De Sutter ◽

Jean-Louis J. Vanoverschelde

Keyword(s):

Diastolic Function ◽

Daily Practice ◽

Tissue Doppler ◽

Left Ventricular ◽

Doppler Imaging ◽

Lv Function ◽

Prognostic Information ◽

Heart Failure Patients ◽

Lv Mass ◽

Deformation Measurements

The evaluation of diastolic function in patients with reduced (HFREF) or preserved (HFPEF) left ventricular (LV) ejection fraction is important as it carries both diagnostic and prognostic information. In daily practice, this is most frequently done by standard echocardiographic techniques, including the evaluation of LV mass and LA volumes, as well as transmitral and pulmonary venous PW Doppler, CW Doppler for evaluation of the IVRT, and tissue Doppler imaging of the septal and lateral annular velocities. This permits grading the severity of diastolic dysfunction, which is related to outcome and may be used to estimate LV filling pressures. The latter needs further validation, especially in patients with HFPEF. Newer echocardiographic and cardiac magnetic resonance techniques, including myocardial deformation measurements during diastole, LV twist and untwisting, and parameters of left atrial function, are promising and will hopefully in the future help clinicians to make a more precise evaluation of diastolic function and filling pressures in heart failure patients.

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Bridge to recovery with Berlin Heart EXCOR in children <10 kg with dilated cardiomyopathy: a histological analysis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa033 ◽

2020 ◽

Vol 58 (2) ◽

pp. 253-260 ◽

Cited By ~ 1

Author(s):

Yuji Tominaga ◽

Takayoshi Ueno ◽

Takashi Kido ◽

Tomomitsu Kanaya ◽

Jun Narita ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Left Ventricular ◽

Lv Function ◽

Vascular Density ◽

Bridge To Recovery ◽

High Power Field ◽

Lv Dysfunction ◽

Paediatric Patients ◽

Berlin Heart ◽

Recovery Group

Abstract OBJECTIVES This study aimed to identify the histological characteristics associated with bridge to recovery using Berlin Heart EXCOR® (BHE) in paediatric patients <10 kg with dilated cardiomyopathy. METHODS Of the 10 consecutive patients <10 kg with dilated cardiomyopathy who underwent BHE implantation between 2013 and 2018, 4 patients showed improvement in left ventricular (LV) function, resulting in successful BHE explantation (recovery group). The remaining 6 patients showed persistent LV dysfunction and underwent heart transplantation (non-recovery group). The following variables were compared between the 2 groups: (i) histological findings in LV myocardium obtained at BHE implantation and (ii) LV function after BHE implantation assessed with echocardiography and cardiac catheterization. RESULTS The degree of myocardial fibrosis was significantly lower, and the capillary vascular density was significantly higher in the recovery group than in the non-recovery group [16% (standard deviation 5.9%) vs 28% (5.9%), P = 0.021, and 65 (11) vs 43 (18) units/high-power field, P = 0.037, respectively]. The changes during 3 months after BHE implantation in LV diastolic dimension (z-score) and ejection fraction were significantly greater in the recovery group than in the non-recovery group [−9.6 (3.5) vs −3.6 (4.5), P = 0.045, and 36% (13%) vs 13% (13%), P = 0.032, respectively]. CONCLUSIONS In paediatric patients <10 kg with dilated cardiomyopathy, bridge to recovery with BHE implantation was achieved in patients with less injured LV myocardial histology at BHE implantation.

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