scholarly journals PATTERN OF MYOCARDIAL FIBROSIS IN ISCHEMIC AND NON ISCHEMIC CARDIOMYOPATHY

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Chaman Lal Kaushal ◽  
Danquale Vance Kynshikhar ◽  
Anupam Jhobta ◽  
Dimple Kaushal
Keyword(s):  
Myocardial Fibrosis ◽  
Ischemic Cardiomyopathy ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
Heterogenous Group ◽  
One Year

Background: The cardiomyopathies are defined as “heterogenous group of diseases of the myocardium associated with mechanical or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and are due to variety of causes that frequently are genetic. Methods: The cross sectional hospital based study was conducted in the Department of Radiodiagnosis in patients with heart failure with LVEF (Left Ventricular Ejection Fraction) of <45% without RWM (Regional Wall Motion) abnormality on echocardiography evaluated in department of cardiology at IGMC, Shimla over a period of one year. Demographics: Demographics Overall Group Male Female Mean Age (year ) ± SD 53.86  ± 16.34  54.45  ± 19.41 53.94  ± 16.36 Gender (n) 38 17 (44.73%) 21(55.26%) Results: Myocardial fibrosis was seen in 4 (100%) patients of ischemic cardiomyopathy and 3 (18.75%) patients of non ischemic cardiomyopathy with significant P value of 0.01 and odd ratio of 1.67.  The subendocardial myocardial fibrosis was seen in 3 (75%) patients of ischemic cardiomyopathy while it was not seen in non ischemic cardiomyopathy with significant P value of < 0.01 and odd ratio of 3.59. Conclusion: Cardiac MRI has important role in dilated cardiomyopathies for distinguishing ischemic and non ischemic types as well as in evaluation of various etiological types. Keywords: MRI, Myocardial, Cardiomyopathies

scholarly journals ASSOCIATION OF PATTERN OF MYOCARDIAL FIBROSIS WITH ADVANCED AND EARLY HEART FAILURE

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Chaman Lal Kaushal ◽  
Danquale Vance Kynshikhar ◽  
Anupam Jhobta ◽  
Dimple Kaushal
Keyword(s):  
Heart Failure ◽  
Myocardial Fibrosis ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
Coronary Territory

Background: The cardiomyopathies are defined as “hetrogenous group of diseases of the myocardium associated with mechanical or electrical dysfunction that usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation and are due to variety of causes that frequently are genetic. They usually present clinically with heart failure. Methods: The cross sectional hospital based study was conducted in the Department of Radiodiagnosis in patients with heart failure with LVEF (Left Ventricular Ejection Fraction) of <45% without RWM(Regional Wall Motion)  abnormality on echocardiography evaluated in department of cardiology at IGMC, Shimla over a period of one year. Results: The myocardial fibrosis was seen in the 10 (47.62%) patients of advanced heart failure and 6(35.29%) patients of early heart failure with insignificant P value of 0.52 and odd ratio of 1.64.The subendocardial myocardial fibrosis in coronary territory was seen in the 3(14.29%) patients of advanced heart failure and 2(11.76%) patients of early heart failure with insignificant P value of 1.00 and odd ratio of 1.24. Conclusion: The association of pattern of myocardial fibrosis with advanced and early heart failure was found statistically Insignificants Keywords: MRI, Myocardial,  Heart failure.

scholarly journals Clinical Outcomes in Patients with Ischemic versus Non-Ischemic Cardiomyopathy after Angiotensin-Neprilysin Inhibition Therapy

2021 ◽  
Vol 10 (21) ◽  
pp. 4989
Author(s):  
Mohammad Abumayyaleh ◽  
Christina Pilsinger ◽  
Ibrahim El-Battrawy ◽  
Marvin Kummer ◽  
Jürgen Kuschyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Tachyarrhythmias ◽  
Ventricular Ejection Fraction ◽  
One Year ◽  
The Impact

Background: The angiotensin receptor-neprilysin inhibitor (ARNI) decreases cardiovascular mortality in patients with chronic heart failure with a reduced ejection fraction (HFrEF). Data regarding the impact of ARNI on the outcome in HFrEF patients according to heart failure etiology are limited. Methods and results: One hundred twenty-one consecutive patients with HFrEF from the years 2016 to 2017 were included at the Medical Centre Mannheim Heidelberg University and treated with ARNI according to the current guidelines. Left ventricular ejection fraction (LVEF) was numerically improved during the treatment with ARNI in both patient groups, that with ischemic cardiomyopathy (n = 61) (ICMP), and that with non-ischemic cardiomyopathy (n = 60) (NICMP); p = 0.25. Consistent with this data, the NT-proBNP decreased in both groups, more commonly in the NICMP patient group. In addition, the glomerular filtration rate (GFR) and creatinine changed before and after the treatment with ARNI in both groups. In a one-year follow-up, the rate of ventricular tachyarrhythmias (ventricular tachycardia and ventricular fibrillation) tended to be higher in the ICMP group compared with the NICMP group (ICMP 38.71% vs. NICMP 17.24%; p = 0.07). The rate of one-year all-cause mortality was similar in both groups (ICMP 6.5% vs. NICMP 6.6%; log-rank = 0.9947). Conclusions: This study shows that, although the treatment with ARNI improves the LVEF in ICMP and NICMP patients, the risk of ventricular tachyarrhythmias remains higher in ICMP patients in comparison with NICMP patients. Renal function is improved in the NICMP group after the treatment. Long-term mortality is similar over a one-year follow-up.

P6456Role of cardiac imaging in the prediction of ventricular arrythmias, heart failure and death in dilated non-ischemic cardiomyopathy with severe left ventricular systolic disfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Travieso Gonzalez ◽  
F Islas ◽  
M Ferrandez Escarabajal ◽  
T S Luque-Diaz ◽  
J Palacios-Rubio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Myocardial Fibrosis ◽  
Predictive Value ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Predictive Tool ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Background and purpose Dilated non-ischemic cardiomyopathy (DCM) is associated with an increased risk of cardiac events. Implantable Cardioverter Defibrillator (ICD) is recommended in DCM with severe left ventricular ejection fraction impairment, but the evidence of its usefulness is somewhat controversial. We evaluated the predictive value of myocardial fibrosis measured by cardiac magnetic resonance (CMR) and of global longitudinal strain (GLS) in the incidence of adverse cardiac events. Methods From 2009 to 2019, sixty-six patients with DCM were evaluated. CMR with a 1.5 Tesla scanner was performed, and the presence and extent of late gadolinium enhancement (LGE) was blindly assessed. GLS was measured using speckle-tracking 2D echocardiography. We examined the incidence of sustained ventricular arrhythmias (SVA, including appropriate anti-tachycardia pacing and shocks), admissions due to heart failure (HF) and all-cause mortality. Results 62.1% of the patients were male, with a median age of 63.8 years. 50.0% had cardiac resynchronization therapy and 73.9% had ICD as primary prevention therapy. Median LVEF was 25.7%. Median follow-up was 32 months. In that period, 10.6% of patients died, 25.8% had hospital admissions due to HF, and 9.2% had SVA. A burden of LGE over 14% was independently associated with higher risk of SVA (3.0% vs 19.2%, p=0.041). This cut-off value had a sensitivity of 83.3% and a negative predictive value of 97.0%. LGE was not associated with higher risk of HF admissions (27.3% vs 23.1%, p=0.731) or death (9.1% vs 11.5%, p=0.757). On the other hand, GLS was not associated with higher risk of SVA (8.7% vs 4.55% for a cut-off value of −10.6%, p=0.577), HF admissions (26.1% vs 30.4%, p=0.743) or death (8.7% vs 8.7%, p=1.00). Table 1. Main etiologies of DCM Causes N (%) Idiopathic 43 (65.2) Alcoholic 6 (9.1) Chemotherapy 4 (6.1) Non-compaction 4 (6.1) Familiar 3 (4.6) Thoracic radiotherapy 2 (3.0) Chagas disease 2 (3.0) Conclusions The burden of myocardial fibrosis measured by LGE is a high sensitive marker for the development of SVA. However, is not a predictive tool for HF admissions or all-cause mortality. GLS was not associated with the incidence of cardiac events in this population.

Genetic polymorphisms and cardiovascular outcomes in Chinese patients undergoing PCI and treated with clopidogrel and aspirin

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Xu ◽  
L Ying ◽  
J Chen ◽  
L Xu ◽  
J Li ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Genetic Polymorphisms ◽  
Light Transmission ◽  
Left Ventricular ◽  
Cardiovascular Outcomes ◽  
Chinese Patients ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Ventricular Ejection Fraction ◽  
One Year

Abstract Background Genetic polymorphisms of key proteins involved in clopidogrel absorption, metabolism, and action may contribute to variability in platelet inhibition in patients undergoing percutaneous coronary intervention (PCI), but their impacts on cardiovascular outcomes remain unclear. Purpose To examine the associations between genetic polymorphisms and cardiovascular outcomes in Chinese patients undergoing PCI and treated with clopidogrel and aspirin. Methods This prospective cohort study consecutively enrolled 2,453 post-PCI patients treated with clopidogrel and aspirin. Adenosine diphosphate-induced platelet aggregation was measured by light transmission aggregometry. A total of 40 single nucleotide polymorphisms (SNPs) of 18 genes selected according to published studies were investigated using an improved multiplex ligation detection reaction technique. The primary outcome was major adverse cardiovascular event (MACE), the composite of cardiovascular death, non-fatal myocardial infarction (MI), and ischemic stroke within one year after PCI. Results We restricted the analyses to the first 1,452 patients who had finished one-year follow-up and complete data on genotyping and platelet aggregation. 44 (3.03%) patients suffered MACE. Among the 40 SNPs, only the A-allele carriers of CYP2C19*2 had a significant higher risk of MACE (adjusted HR 2.05; 95% CI, 1.01–4.19; p=0.048) and platelet aggregation than non-A-carriers after adjusting age, sex, MI presentation, and left ventricular ejection fraction. CYP2C19*3, CYP2B6 rs3745274, and PEAR1 rs12041331 variants were also significantly associated with platelet aggregation (all p&lt;0.05) but not with MACE at 1 year. Conclusion About 54.2% of Chinese patients with PCI were A-allele carriers of CYP2C19*2, who face a two-fold higher risk of MACE than non-A-allele carriers in Chinese patients after PCI. It would help identify low clopidogrel responders and optimize antiplatelet therapy before drug administration. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Funding of China

Bendopnea as a risk factor for the incidence of COVID-19 in patients with CHF

2021 ◽  
Vol 2 (2) ◽  
pp. 26-34
Author(s):  
Dmitry O. Dragunov ◽  
Anna V. Sokolova ◽  
Aminat D. Gasanova ◽  
Timofey V. Latyshev ◽  
Grigoriy P. Arutyunov
Keyword(s):  
Risk Factor ◽  
Left Ventricular Ejection Fraction ◽  
Statistical Processing ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Chronic Patients ◽  
Software Environment ◽  
Ventricular Ejection Fraction ◽  
R Language

Purpose. Analysis of the incidence of COVID-19 in patients from the register «Management of chronic patients with multiple diseases» with a previously established CHF diagnosis, depending on the presence or absence of a symptom of bendopnea. Materials and methods. Retrospective analysis of electronic outpatient records of 121 patients with CHF with and without bendopnea symptom, with an assessment of the incidence of COVID-19. For statistical processing of the data obtained, we used the R language and the RStudio software environment. Results. The average age of the patients was 74.38±9.83 years. Bendopnea symptom occurred in 60,3% (n = 73) of the studied patients. The incidence of COVID-19 was 14% (n = 17), of which 88% were patients with the symptom of bendopnea (p-value = 0.023, Х2 = 5.17). The chance of COVID-19 in patients with bendopnea was higher than in patients without symptom of bendopnea (OR 5.8 (1.2; 26.7), p = 0.013). Conclusion. The presence of a symptom of bendopnea in patients with CHF increases the risk of COVID-19. A statistically significant relationship was established between the presence of a symptom of bendopnea, the level of left ventricular ejection fraction and the incidence of COVID-19.

scholarly journals EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
C Rios-Navarro ◽  
J Gavara ◽  
J Nunez ◽  
C Bonanad Lozano ◽  
E Revuelta-Lopez ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Microvascular Obstruction ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Ventricular Ejection Fraction ◽  
Systolic Volume

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” Bachground. Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in endothelium adhesion, is an understudied area in the MVO setting. Purpose. We aimed to evaluate whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI. Methods. We prospectively included 106 patients with a first STEMI treated with primary percutaneous coronary intervention, quantifying serum levels of EpCAM 24 hours post-reperfusion. All patients underwent CMR imaging 1 week and 6 months post-STEMI. The independent correlation of EpCAM with MVO, systolic volume indices, and left ventricular ejection fraction (LVEF) was evaluated. Results. The mean age of the sample was 59 ± 13 years and 76% were male. Patients were dichotomized according to EpCAM median (4.48 pg/mL). At 1-week CMR, lower EpCAM was related to extensive MVO (p-value = 0.02) and greater infarct size (p-value = 0.02). At presentation, only EpCAM values were significantly associated with the presence of MVO in univariate (Odds Ratio [95% confidence interval] (OR [95% CI]): 0.58 [0.38-0.88], p-value = 0.01) and multivariate logistic regression models (OR [95% CI]: 0.54 [0.34-0.85], p-value = 0.007). Although MVO tends to resolve at chronic phases, decreased EpCAM was associated with worse systolic function: depressed LVEF (p-value = 0.009) and higher left ventricular end-systolic volume (p-value = 0.04). Conclusions. EpCAM is associated with occurrence of CMR-derived MVO at acute phases and long-term adverse ventricular remodeling post-STEMI. Future studies are needed to confirm EpCAM as biomarker, and eventually biotarget in STEMI pathophysiology.

scholarly journals AUTOLOGICAL CELL THERAPY AND ITS ROLE IN THE TREATMENT OF REFRACTORY ANGINA

2021 ◽  
Vol 19 (4) ◽  
Author(s):  
S.I. Эстрин ◽  
T.V. Kravchenko ◽  
A.R. Pechenenko
Keyword(s):  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Medical Science ◽  
State Institution ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Cell Transplant ◽  
Refractory Angina ◽  
Ventricular Ejection Fraction

The first clinical studies dedicated to the use of autological mesenchymal stem сells(MSCs) for the treatment of angina by means of their intravenous and transendocardialinjection is carried out in State Institution «Institute of Urgent and Recovery Surgerynamed after V.K. Gusak of National Academy of Medical Science of Ukraine» since 2007.The effectiveness of autological mesenchymal stem cells (MSCs) was researched in 60patients, and it was established that injection of 50 million of cells per a person withrefractory angina is an effective and a safe method of treatment. The results of clinicalresearch have shown that the delivery of MSCs to the lesion provides restoring ofmyocardial function and influences on the left ventricular remodeling.Objective – to substantiate the effectiveness of autological MSCs in the treatment ofrefractory angina.Material and methods. The results of examination, treatment and observation of 60patients with refractory angina (52 men and 8 women aged from 46 to 70 years) since2007 to 2012 are performed in the article.Results. We obtained the following data while studying of the dynamics of left ventricularend diastolic volume (LVEDV), which is a prognostic factor of the course of heart failure(HF). The decrease of LVEDV from 248.5 ± 22.3 to 194.3 ± 26.4 ml was observed inthe group of patients 3 months later after endocardial injection. This rate was stable 6months later after an injection, but lower than the initial one (p value > 0.05). A similartrend was observed in the group of intravenous injection . LVEDV decreased from 244.1± 24.3 to 193.4 ± 18.9 ml within 3 months and remained stable up to 6 months but lowerto the rate that was observed before the treatment with a trend to increasing to the initiallevel. Ultrasound studying of the left ventricular ejection fraction (LVEF) in patients of transendocardial injection of cell transplant showed an increasing of LVEF from 41.3 ±3.2 to 49.3 ± 4.6% 3 months later after the procedure and it was stable up to 6 months ofthe posttransplant period. LVEF is also increased in the group of intravenous transplantadmission (from 33.8 ± 3.6 to 42.8 ± 4.8%) after procedure, with its gradually decreasingin terms of 3 months, LVEF approaches the starting values up to 6 months after celltransplantation.Conclusions. The received clinical data have shown that MSCs facilitate the restoringof mechanical myocardial function and influence left ventricular remodeling aftertheir admission to the lesion zone. This effect has been confirmed according to cardiacechocardiography, treadmill-test, electromechanical mapping of the LV. The positiveeffect was remaining for 6 months. The received data allows to recommend the clinicaluse of biotechnology in ischemic heart disease treatment.

scholarly journals Indicators of the left ventricular-arterial coupling interaction in chronic forms of ischemic heart disease: relationships of the protradenomedullin and N-terminal probrain natriuretic peptide

Kardiologiia ◽  
2019 ◽  
Vol 59 (6S) ◽  
pp. 41-50
Author(s):  
E. I. Myasoedova ◽  
L. P. Voronina ◽  
O. S. Polunina ◽  
Yu. G. Shvarts
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coupling Interaction ◽  
Left Ventricular Arterial Coupling

Purpose of the study. Analyze the parameters of the interaction between the left ventricle and the arterial system in patients with chronic forms of coronary heart disease and to identify relationships with levels of proadrenomedullin (MR‑proADM) and N‑terminal precursor of the brain natriuretic peptide B (NT‑proBNP).Materials and methods.240 patients with chronic forms of coronary heart disease (median – 55,9 [43; 63] years) and Q‑forming myocardial infarction in the past were examined. Of these, 110 patients with myocardial infarction and preserved lef ventricular ejection fraction and 130 patients with ischemic cardiomyopathy. All patients were calculated parameters of lef ventricular‑arterial interaction and the determination in blood serum levels of MR‑proADM and NT‑proBNP.Results.In patients with ischemic cardiomyopathy, an increase in the lef ventricular‑arterial interaction index was detected (2,51 [1,18; 5,00]), which reflects a decrease in the functional abilities and efficiency of the heart. In patients with myocardial infarction and a preserved left ventricular ejection fraction, this indicator was in the range of normal values (0,78 [0,55; 1,07]), which indicates an effective cardiac work. A study of MR‑proADM and NT‑proBNP levels demonstrated an increase in both groups (1,72 [1,56; 1,98] nmol/l and 779,3 [473; 2193] pg/ml in the group of patients with ischemic cardiomyopathy; 0,89 [0,51; 1,35] nmol/l and 246 [118; 430] pg/ml in the group of patients with myocardial infarction and preserved left ventricular ejection fraction), and the correlation analysis with left ventricular‑arterial coupling interaction parameters allowed identify statistically significant connections (in the group of patients with ischemic cardiomyopathy: with the level of MR‑proADM ‑ r=0,67, p=0,006, with the level of NT‑proBNP ‑ r=0,78, p<0,001; in the group of patients with myocardial infarction and preserved left ventricular ejection fraction: with MR‑proADM level ‑ r=‑0,52, p=0,024, with NT‑proBNP level ‑ r =‑0,38, p=0,037).Conclusion.The findings suggest a pathogenetic association between the biomarkers under study and the parameters of left ventricular‑arterial coupling interaction.

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