To the question of electrophysiological remodeling role in the genesis of ventricular ectopy in patients with postinfarction cardiosclerosis

Aim. To study the character and intensity of relationship between left ventricular dilatation, severity of electrophysiological myocardium remodeling and ectopic ventricular activity in patients with postinfarction cardiosclerosis. Methods. 46 patients with postinfarction cardiosclerosis were examined (males, average age 57.9 years). All patients underwent echocardiography with detection of end diastolic volume of left ventricle and its ejection fraction, Holter monitoring with determining signal-averaged electrocardiogram and severity of ventricular ectopic activity with calculation of ventricular ectopic activity index. Based on the ejection fraction the patients were divided into two groups. Group 1 included 17 patients with ejection fraction ≥45%, and group 2 - 29 patients with ejection fraction <45%. Results. Left ventricle ejection fraction in patients from group 2 was lower, and parameters of signal-averaged electrocardiogram were worse than in patients from group 1. Ventricular ectopic activity index in patients from group 2 was 5 times higher than the average index in group 1. According to correlation analysis in the combined group, signal-averaged electrocardiogram parameters more tightly correlated with end diastolic volume than with ventricular ectopic activity index. The latter more tightly correlated with end diastolic volume (r=0.67, p <0.001), than with signal-averaged electrocardiogram parameters. After calculating partial correlation coefficient and excluding the effect of end diastolic volume, correlation coefficients of ventricular ectopic activity index and signal-averaged electrocardiogram parameters became insignificant. The received data put in question the view that electrophysiological remodeling is an independent cause of severity increase of ventricular arrhythmias. More probable is that electrophysiological remodeling and ventricular ectopic activity are related pathogenetically, and correlation between them is determined by the fact that both depend on left ventricle end diastolic volume. Conclusion. Relation between electrophysiological myocardium remodeling and ectopic ventricular activity in patients with postinfarction cardiosclerosis may depend on severity of left ventricular dilatation.

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Abstract 18141: Is There Systolic Myocardial Mechanical Dysfunction in Patients With Different Degrees of Diastolic Dysfunction and Normal Ejection Fraction?

Circulation ◽

10.1161/circ.130.suppl_2.18141 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Sergio Barros-Gomes ◽

Patricia A Pellikka ◽

Angela Dispenzieri ◽

Hector R Villarraga

Keyword(s):

Ejection Fraction ◽

Diastolic Dysfunction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Al Amyloidosis ◽

Normal Ejection Fraction ◽

Group 4 ◽

Group 3 ◽

Group 2 ◽

Group 1

Introduction: Diastolic dysfunction has been characterized in relation to the relaxation and compliance properties of the left ventricle; limited information exists regarding its relationship to systolic function as assessed by deformation imaging. Objectives: To determine if there is left ventricular systolic dysfunction detected by global longitudinal strain (GLS) measured by two dimensional speckle tracking echocardiography in patients with immunoglobulin light chain (AL) amyloidosis with different degrees of diastolic dysfunction and normal ejection fraction (EF). Methods: Consecutive biopsy-proven AL patients with preserved EF (≥ 55%) who had a comprehensive echocardiogram performed and strain analysis were included. Cohort was divided into 5 groups according to the different grades of diastolic dysfunction: Group 0: normal filling pressures; Group 1: abnormal relaxation; Group 2: pseudo-normal pattern; Group 3: reversible restrictive; Group 4: fixed restrictive. Images were acquired and performed on a Vivid 9 from the 3 apical views, and analyzed on vendor-specific software (Echo-PAC, GE). GLS was averaged from the 16 segments, and their means compared by ANOVA and each pair with Student’s t test. Results: A total of 858 patients were included, mean age was 63.7 years ± 10.1, and 61.5% were male. From those, 205 (24%) were in group 0; 299 (35%) in group 1; 255 (30%) in group 2; 65 (7%) in group 3; and 34 in group 4 (4%). GLS means measurements were -18.95 ± 2.4, -16.86 ± 3.4, -15.60 ± 3.9, -12.31 ± 3.0, and -10.48 ± 3.3, respectively (P<0.0001). All individual GLS values were significantly different statistically when compared between each group (P<0.01 for all pairs; figure). Conclusions: Longitudinal systolic mechanical function is progressively impaired in AL amyloid patients as diastolic dysfunction progresses, despite normal EF. This systolic dysfunction provides insights into the intrinsic relationship between the components of the cardiac cycle.

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Epicardial Adipose Tissue Role as a Marker of Higher Vulnerability in Patients with Coronary Artery Disease

Journal of Interdisciplinary Medicine ◽

10.2478/jim-2018-0018 ◽

2018 ◽

Vol 3 (2) ◽

pp. 77-83 ◽

Cited By ~ 1

Author(s):

Tiberiu Nyulas ◽

Mirabela Morariu ◽

Nora Rat ◽

Emese Marton ◽

Victoria Ancuta Rus ◽

...

Keyword(s):

Adipose Tissue ◽

Left Ventricular Ejection Fraction ◽

Left Ventricle ◽

Epicardial Adipose Tissue ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

The Mean ◽

Group 2 ◽

Group 1

Abstract Background: Epicardial adipose tissue (EAT) has been recently identified as a major player in the development of the atherosclerotic process. This study aimed to investigate the role of EAT as a marker associated with a higher vulnerability of atheromatous coronary plaques in patients with acute myocardial infarction (AMI) as compared to patients with stable angina. Material and methods: This analysis enrolled a total of 89 patients, 47 with stable angina (SA) and 42 with AMI, who underwent echocardiographic investigations and epicardial fat measurement in 2D-parasternal long axis view. The study lot was divided as follows: Group 1 included patients with prior AMI, and Group 2 included patients with SA. Results: There were no significant differences between the two groups regarding cardiovascular risk factors, excepting smoking status, which was recorded more frequently in Group 1 as compared to Group 2 (36.17% vs. 11.63%, p = 0.02). The mean epicardial fat diameter was 9.12 ± 2.28 mm (95% CI: 8.45–9.79 mm) in Group 1 and 6.30 ± 2.03 mm (95% CI: 5.675–6.93 mm) in Group 2, the difference being highly significant statistically (p <0.0001). The mean value of left ventricular ejection fraction was significantly lower in patients with AMI (Group 1 – 47.60% ± 7.96 vs. Group 2 – 51.23% ± 9.05, p = 0.04). EAT thickness values showed a weak but significant positive correlation with the level of total cholesterol (r = −0.22, p = 0.03) and with the value of end-systolic left ventricle diameter (r = 0.33, = 0.001). Conclusions: The increased thickness of EAT was associated with other serum- or image-based biomarkers of disease severity, such as the left ventricular ejection fraction, end-systolic diameter of the left ventricle, and total cholesterol. Our results indicate that EAT is significantly higher in patients with acute coronary syndrome, proving that EAT could serve as a marker of vulnerability in cardiovascular diseases.

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1409Use of phenomapping to determine response of treatment by sacubitril/valsartan in patients with heart failure with reduced ejection fraction

European Heart Journal ◽

10.1093/eurheartj/ehz748.0057 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Godet ◽

O Raitiere ◽

H Chopra ◽

P Guignant ◽

C Fauvel ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Hypertension ◽

Ejection Fraction ◽

Left Ventricular ◽

Heat Map ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Group 3 ◽

Group 2 ◽

Group 1

Abstract Background Treatment by sacubitril/valsartan decreases mortality, improves KCCQ score and ejection fraction in patients with heart failure with reduced ejection fraction (HF REF), but there is currently no data to predict response to treatment. Purpose The purpose of our work was to assess whether unbiased clustering analysis, using dense phenotypic data, could identify phenotypically distinct HF-REF subtypes with good or no response after 6 months of sacubitril/valsartan administration. Methods A total of 78 patients in NYHA functional class 2–3 and treated by ACE inhibitor or AAR2, were prospectively assigned to equimolar sacubitril/valsartan replacement. We collected demographic, clinical, biological and imaging continuous variables. Phenotypic domains were imputed with 5 eigenvectors for missing value, then filtered if the Pearson correlation coefficient was >0.6 and standardized to mean±SD of 0±1. Thereafter, we used agglomerative hierarchical clustering for grouping phenotypic variables and patients, then generate a heat map (figure 1). Subsequently, participants were categorized using Penalized Model-Based Clustering. P<0,05 was considered significant. Results Mean age was 60.4±13.4 yo and 79.0% patients were males. Mean ejection fraction was 29.3±7.0%. Overall, 16 phenotypic domains were isolated (figure 1) and 3 phenogroups were identified (Table 1). Phenogroup 1 was remarkable by isolated left ventricular involvement (LVTDD 64.3±5.9mm vs 73.9±8.7 in group 2 and 63.8±5.7 in group3, p<0.001) with moderate diastolic dysfunction (DD), no mitral regurgitation (MR) and no pulmonary hypertension (PH). Phenogroups 2 and 3 corresponded to patients with severe PH (TRMV: 2.93±0.47m/s in group 2 and 3.15±0.61m/s in groupe 3 vs 2.16±0.32m/s in group 1), related to severe DD (phenogroup 2) or MR (phenogroup 3). In both phenogroups, the left atrium was significantly enlarged and the right ventricle was remodeled, compared with phenogroup 1. Despite more severe remodeling and more compromised hemodynamic in phenogroups 2 and 3, the echocardiographic response to sacubitril/valsartan was comparable in all groups with similar improvement of EF and reduction of cardiac chambers dimensions (response of treatment, defined by improvement of FE +15% and/or decreased of indexed left ventricule diastolic volume −15% = group 2: 22 (76%); group 3: 18 (60%); group 1: 9 (50%); p=0.17; OR group 2 vs 1: OR=3.14; IC95% [0.9–11.03]; p=0.074; OR group 3 vs 1: OR=1.5; IC95% [0.46–4.87]; p=0.5)). The clinical response was even better in phenogroups 2 and 3 (Group 2: 19 (66%); group 3: 21 (78%) vs group 1: 9 (50%); p=0.05). Heat map Conclusion HF-REF patients with severe diastolic dysfunction, significant mitral regurgitation and elevated pulmonary hypertension by echocardiographic had similar reverse remodeling but better clinical improvement than patients with isolated left ventricular systolic dysfunction.

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The prognostic value of the NT-proBNP biomarkers and Fas ligand in assessing the risk of cardiotoxicity of anthracycline chemotherapy

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2019-1-127-133 ◽

2019 ◽

Vol 18 (1) ◽

pp. 127-133

Author(s):

A. T. Teplyakov ◽

S. N. Shilov ◽

A. A. Popova ◽

E. N. Berezikova ◽

M. N. Neupokoeva ◽

...

Keyword(s):

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Fas Ligand ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Group 2 ◽

Anthracycline Chemotherapy ◽

Group 1

Aim. To study the mechanisms, features of clinical manifestations and predicting of cardiotoxicity resulting from anthracycline chemotherapy.Material and methods. We examined 176 women with breast cancer who received anthracycline antibiotics as part of polychemotherapeutic (PCT) treatment. Patients were divided into 2 groups: with the development of cardiotoxic remodeling — group 1 (n=52) and with preserved heart function — group 2 (n=124). We conducted echocardiographic (EchoCG) tests before the start, during and after anthracycline chemotherapy. In the serum after the termination of PCT treatment, the concentrations of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and soluble Fas ligand (sFas-L) were determined.Results. Analysis of EchoCG parameters in patients after 12 months of PCT finish, showed a significant difference in the final systolic and end diastolic sizes, as well as a significant decrease in the left ventricular ejection fraction in group 1 compared with those before the start of treatment. A direct correlation was found between the end-systolic and end-diastolic volumes and inverse correlation between left ventricular ejection fraction and the resulting summary dose of doxorubicin. EchoCG changes in women of group 1 after the first course of PCT treatment were recorded in 49% of cases and 11% of cases — in group 2. The concentrations of sFas-L and NT-proBNP after PCT therapy finish in group 1 were significantly higher compared with group 2. Patients with significantly elevated NT-proBNP levels were had a high risk of heart disease developing during 12 months follow-up. A high concentration of NT-proBNP is a predictor of cardiovascular complications, which is more sensitive than EchoCG.Conclusion. Fas-associated apoptosis plays an important role in the pathogenesis of anthracycline cardiotoxicity. NT-proBNP may be an important biomarker for cardiotoxicity development, which already effective when EchoCG or clinical signs is absent.

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High level of growth differentiation factor 15 and lower left ventricular ejection fraction as predictors of left atrial thrombosis in patients with nonvalvular atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0488 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A.V Belokurova ◽

T.P Gizatulina ◽

N.Y.U Khorkova ◽

L.U Martyanova ◽

T.I Petelina ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ejection Fraction ◽

Left Atrial ◽

Roc Analysis ◽

Left Ventricular ◽

Growth Differentiation Factor 15 ◽

Differentiation Factor ◽

Group 2 ◽

High Level ◽

Group 1

Abstract Background The presence of left atrial/left atrial appendage (LA/LAA) thrombus is used as a surrogate marker of potential stroke in patients (pts) with atrial fibrillation (AF). Purpose To assess the role of growth differentiation factor 15 (GDF-15) level, clinical and echocardiographic (EchoCG) data as predictors of LA/LAA thrombus in pts with nonvalvular AF. Methods Out of 158 pts with nonvalvular AF admitted to Cardiology Center for radiofrequency ablation or elective cardioversion in 2019–2020 2 groups were formed according to transesophageal EchoCG results: group 1 included pts without LA/LAA thrombus (n=102, mean age 59.5±6.0 years) and group 2 (n=42, mean age 60.9±8.8 years) – pts with LA/LAA thrombus. Arterial hypertension was found in 93 pts of group 1 (91%) and in 40 pts of group 2 (95%, p=0.42), coronary artery disease - in 53 pts (52%) and 29 pts (69%), respectively (p=0.06). Both groups did not differ in frequency and spectrum of oral anticoagulants administration. General clinical assessment, EchoCG, and laboratory tests were performed, including GDF-15 (pg/ml) levels using Human GDF-15/MIC-1 ELISA kit and NT-proBNP (pg/ml) in blood. Results Pts with LA/LAA thrombus more often had persistent AF, while paroxysmal AF was more common in pts without thrombus. There was a tendency to more significant congestive heart failure in group 2. Mean CHA2DS2-VASc score was higher in pts with LA/LAA thrombus, also there was a tendency to a larger proportion of pts with scores ≥3. According to EchoCG data, sizes and volumes of both atria, right ventricle, end-systolic volume, left ventricular (LV) size, pulmonary artery systolic pressure and LV mass index were higher in group 2; LV ejection fraction (LVEF) was normal in both groups, but it was significantly lower in pts with LA/LAA thrombus: 59.1±5.1 and 64.0±7.3, respectively (p<0.001). GDF-15 and NT-proBNP levels were significantly higher in group 2 compared to group 1: p=0.00025 and p=0.ehab724.048801 respectively. According to ROC analysis cut-off were set at level >935.0 pg/ml for GDF-15 (AUC=0.705, 95% CI 0.609–0.800, p<0.001) and >143 pg/ml for NT-proBNP (AUC=0.759, 95% CI 0.670–0.849, p<0.001). Multivariate logistic regression revealed the following variables as independent predictors of LAAT: GDF-15 >935.0 pg/ml (OR=4.132, 95% CI 1.305–13.084) and LVEF (OR=0.859, 95% CI 0.776–0.951). According to ROC analysis, the model had a good quality: AUC=0.776 (p<0.001), sensitivity was 78.3%., specificity - 78.3%. Conclusion High level of GDF-15 (>935.0 pg/ml) along with lower LVEF are independent predictors of LA/LAA thrombus in pts with nonvalvular AF. FUNDunding Acknowledgement Type of funding sources: None.

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Coronary Artery Bypass Grafting for Patients with Poor Left Ventricular Function

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230301100107 ◽

2003 ◽

Vol 11 (1) ◽

pp. 23-27 ◽

Cited By ~ 1

Author(s):

Hitoshi Hirose ◽

Atsushi Amano ◽

Syuichirou Takanashi ◽

Akihito Takahashi

Keyword(s):

Ejection Fraction ◽

Left Ventricular Function ◽

Ventricular Function ◽

Bypass Surgery ◽

Artery Bypass ◽

Coronary Bypass ◽

Left Ventricular ◽

Poor Left Ventricular Function ◽

Group 2 ◽

Group 1

Patients undergoing isolated first-time elective coronary bypass surgery were classified according to their preoperative ejection fraction: group 1 comprised 131 patients with poor left ventricular function (ejection fraction < 40%); group 2 was 1,496 control patients. The mean number of distal anastomoses was not significantly different in the 2 groups, however, clamp time, pump time, and operative time were longer in group 1. Patient recovery was significantly slower in group 1. Morbidity (14.5% in group 1 versus 7.4% in group 2, p < 0.005) and mortality (2.3% versus 0.1%, p < 0.0001) were higher in group 1. During late follow-up, the 5-year survival rate (70.1% versus 90.5%) and 5-year event-free rate (65.6% versus 81.9%) were significantly inferior in group 1 compared to group 2. The results of bypass surgery in cases of decreased left ventricular function were poor, and such patients need to be carefully followed up.

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Is It Possible for Children in Duchenne Muscular Dystrophy to Preserve Cardiac Function with Medical Assistance?

Children ◽

10.3390/children7110249 ◽

2020 ◽

Vol 7 (11) ◽

pp. 249

Author(s):

Han Geul Kim ◽

Lucy Youngmin Eun ◽

Han Ki Park

Keyword(s):

Duchenne Muscular Dystrophy ◽

Muscular Dystrophy ◽

Ejection Fraction ◽

Linear Mixed Model ◽

Left Ventricular ◽

Internal Diameter ◽

Septal Thickness ◽

Group 2 ◽

Cardiac Medication ◽

Group 1

In patients with Duchenne muscular dystrophy (DMD), death secondary to cardiac or respiratory failure typically occurs in the second or third decade without treatment. Although cardiac dysfunction is treated with standard heart-failure strategies, it remains insufficient in DMD children. The purpose of this study was to evaluate the efficiency of cardiac medication and noninvasive ventilator support in DMD cardiomyopathy children with analyzing echocardiographic data. Forty-eight DMD children patients were included and divided into 2 groups by left ventricular (LV) ejection fraction (EF) at the time of initial treatment. Group 1: LV EF ≥ 45% and Group 2: LV EF < 45%. p-values were calculated using a Linear mixed model to estimate the association between cardiac medications and echocardiographic measurements. Before and after cardiac medications, the change values were significantly different in interventricular septal thickness at end diastole (IVSd), interventricular septal thickness at end systole (IVSs), left ventricular internal diameter end systole (LVIDs), left ventricular posterior wall thickness end diastole (LVPWd), ejection fraction (EF), fractional shortening (FS), deceleration time (DT), DT slope, Lat A’ and Lat E/E’ (p < 0.05). Group 2 patients revealed to take more kinds of cardiac medications than Group 1 (p < 0.05) including ACEIs, beta-blocker, and inotropics, then LV EF was better preserved in Group 2 than Group 1. It is certainly helpful to take individualized medical combination therapy including inotropic agents for cardiomyopathy in DMD children patients with EF < 45%.

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Extend of coronary lesion, in-hospital complications in patients with STEMI, treated with PCI and high levels of CD14++CD16+ monocytes subpopulation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1567 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

O.V Dovhan ◽

A.N Parkhomenko ◽

T.V Talayeva ◽

I.V Tretyak ◽

O Shumakov ◽

...

Keyword(s):

Left Ventricle ◽

Ejection Fraction ◽

Population Analysis ◽

Analysis Data ◽

Lesion Group ◽

Systolic Volume ◽

End Systolic Volume ◽

Lv Ejection Fraction ◽

Group 2 ◽

Group 1

Abstract Aims Acute myocardial infarction with the ST elevation (STEMI) is accompanied by the development of an inflammatory reaction, in particular, activation of monocytes. To date, the relationship between the levels and dynamics of monocyte populations in patients with STEMI and the prevalence of coronary atherosclerosis on the one hand (and with the clinical course of the disease, on the other hand) is not well understood. Methods and results The 50 STEMI patients (pts) were studied prospectively. All the pts underwent the PCI (alone, or followed by angioplasty/stenting) and have the monocytes (Mc) population analysis data obtained at 1st and 7th–10th days. According to the angiography data, pts were divided into three groups: “single-vessel lesion” (group 1, n=13), “two-vessel lesion” (group 2, n=14) and “three-vessel lesion” (group 3, n=23). There was an in-hospital increase in CD14++CD16-, CD14++CD16+ and CD14+CD16++ populations of Mc in 3rd group (+5%, +43% and +44%, respectively, p<0.05 for all), whereas in subgroups 1 and 2 there was an increase in CD14+CD16++ population (+70% in group 1, p<0.05 and +90% in group 2, p<0.001), without significant dynamics of CD14++CD16− and CD14++CD16+ populations. In addition, there was an increase in the CD14+CD16++ population only in pts with 1–3 coronary lesions (+72%, p<0.001 versus −12% of decrease in pts with more than 3 lesions, p>0.1). The number of CD14++CD16+ Mc on day 1 of STEMI correlated positively with levels of C-reactive protein (C-RP, r=0.34, p<0.05), erythrocyte sedimentation rate (ESR, r=0.39, p<0.01), and with left ventricle (LV) end-systolic volume (r=0.33, p<0.05) and negatively – with LV ejection fraction (r=−0.22, p<0.1), while there were only slight correlations of CD14++CD16- Mc levels with left ventricle (LV) end-systolic volume (r=0.28, p<0.05) and with LV ejection fraction (r=−0.23, p<0.1). According to the hospital follow-up, the 1st day count of CD14++CD16+ Mc was higher in patients with in-hospital complications (mean 42.9±6.9x106/L vs 26.6±5.3x106/L in uncomplicated cases, p<0.05), and was correlated with number of in-hospital complications per patient (r=0.25, p=0.05). Conclusion Higher baseline number of CD14++CD16+ Mc correlates with other “pro-inflammatory” indices (C-RP, ESR) and indicates the worse baseline cardio-hemodynamic and unfavorable course of in-hospital period in pts with STEMI, treated with PCI. Incremental in-hospital dynamic of all Mc populations was observed in multi-vessel lesion cases. Funding Acknowledgement Type of funding source: None

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Comorbidities Associated with One-Year Mortality in Patients with Atrial Fibrillation and Heart Failure

Healthcare ◽

10.3390/healthcare9070830 ◽

2021 ◽

Vol 9 (7) ◽

pp. 830

Author(s):

Ruxandra Nicoleta Horodinschi ◽

Camelia Cristina Diaconu

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Group 3 ◽

Group 2 ◽

One Year ◽

Group 1

Background: Heart failure (HF) and atrial fibrillation (AF) commonly coexist and patients with both diseases have a worse prognosis than those with HF or AF alone. The objective of our study was to identify the factors associated with one-year mortality in patients with HF and AF, depending on the left ventricular ejection fraction (LVEF). Methods: We included 727 patients with HF and AF consecutively admitted in a clinical emergency hospital between January 2018 and December 2019. The inclusion criteria were age of more than 18 years, diagnosis of chronic HF and AF (paroxysmal, persistent, permanent), and signed informed consent. The exclusion criteria were the absence of echocardiographic data, a suboptimal ultrasound view, and other cardiac rhythms than AF. The patients were divided into 3 groups: group 1 (337 patients with AF and HF with reduced ejection fraction (HFrEF)), group 2 (112 patients with AF and HF with mid-range ejection fraction (HFmrEF)), and group 3 (278 patients with AF and HF with preserved ejection fraction (HFpEF)). Results: The one-year mortality rates were 36.49% in group 1, 27.67% in group 2, and 27.69% in group 3. The factors that increased one-year mortality were chronic kidney disease (OR 2.35, 95% CI 1.45–3.83), coronary artery disease (OR 1.67, 95% CI 1.06–2.62), and diabetes (OR 1.66, 95% CI 1.05–2.67) in patients with HFrEF; and hypertension in patients with HFpEF (OR 2.45, 95% CI 1.36–4.39). Conclusions: One-year mortality in patients with HF and AF is influenced by different factors, depending on the LVEF.

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Correlation of the Myocardial Viability Score with Left Ventricular Ejection Fraction in Patients after Revascularization

Ukrainian journal of cardiovascular surgery ◽

10.30702/ujcvs/21.4512/kb063-3642 ◽

2021 ◽

pp. 36-42

Author(s):

Viktoriia V. Kundina ◽

Tetiana M. Babkina

Keyword(s):

Coronary Artery ◽

Ejection Fraction ◽

Myocardial Viability ◽

Systolic Dysfunction ◽

Myocardial Scintigraphy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Before And After ◽

Group 2 ◽

Group 1

Background. Coronary artery disease (CAD) is one of the main causes of cardiovascular death. The severity of CAD is determined by the left ventricular (LV) dysfunction which is caused by coronary atherosclerosis. The possibility of restoring functional capacity of the heart (ejection fraction (EF)) depends on hibernating volume of the myocardium which is a pitfall in revascularization. The aim. To assess the correlation between the score of the viable myocardium (VM) and EF with systolic dysfunction and preserved LVEF in patients after coronary artery bypass grafting (CABG). Material and methods. To implement the set clinical tasks, 62 patients with CAD with preserved systolic function and systolic dysfunction were examined, 35 (56%) patients had heart failure with an EF of 49% (group 2) and less. Twenty-seven (44%) patients had preserved ventricular function of 50% or more (group 1). The mean age of the subjects was 59.6 ± 8.2 years. Five (8.0%) patients denied myocardial infarction. Myocardial scintigraphy was performed on Infinia Hawkeye all purpose imaging system (GE, USA) with integrated CT. The studies were performed in SPECT and SPECT/CT with ECG synchronization (gated SPECT) modes. 99mTc-MIBI with an activity of 555–740 MBq was used. Myocardial scintigraphy was performed in the course of treatment (before CABG and after CABG) according to the One Day Rest protocol. A total of 124 scintigraphic studies were performed. Results and discussion. Samples of the studied patients “before” and “after” treatment were compared using Wilcoxon matched-pairs test. In group 1 in patients with EF ≥ 50% the score of VM increased after CABG with values from 81.7 CI 95% [78.5; 84.9] to 86.9 CI 95% [84.4; 89.3]. However, the EF itself before and after treatment remained the same or slightly decreased amounting to 54.9 CI 95% [50.8; 59.1] and 52.5 CI 95% [48.6; 56.3]. In group 2 in patients with EF ≤ 49% the amount of VM increased after CABG with values from 59.9 CI 95% [54.9; 64.8] to 65.9 CI 95% [60.2; 71.6] (p = 0.00005). However, the EF itself before and after treatment remained the same, amounting to 28.9 CI 95% [24.8; 32.9] and 31.1 CI 95% [26.8; 35.5] (p = 0.19). Conclusions. Myocardial viability in both study groups significantly improved, given the high statistical reliability of the results, although LVEF either remained unchanged or changed slightly. Improvement of static parameters (wall perfusion) also confirms positive effect of revascularization with constant dynamic parameters (EF, end-diastolic volume) or statistically insignificant changes thereof. There is no direct correlation between VM and EF.

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