The Relationship between QRS duration and LV systolic function in Paced Patients

Introduction: Left ventricular noncompaction (LVNC) is a rare form of cardiomyopathy in children, characterized by abnormal endocardial myofiber arrangement. This may result in an altered pattern of LV rotation depicted by a “roller pump” like motion and described as rigid body rotation (RBR). This pattern, is characterized by the apex and the base rotating in the same direction. Hypothesis: To describe the LV rotational patterns in children with LVNC using speckle tracking echocardiography and detect the relationship between the different rotational patterns and measures of LV systolic function. Methods: We prospectively studied 19 children (age 0.9 to 17.8 years) with LVNC and compared them with age-matched controls. Apical and basal rotations, peak twist and peak torsion were analyzed as indices of systolic function. Peak apical recoil rate was measured as an index of diastolic function. Results: Children with LVNC had significantly lower apical rotation (6.26°± 3.09°, 8.59°± 2.19° p=0.01) than controls. In 7 out of 19 (36.8%) patients a pattern of RBR was detected. Twelve patients exhibited the typical “wringing” motion of the LV, where the apex rotated counterclockwise and the base clockwise. Patients with LVNC and RBR had significantly lower ejection fraction than patients with LVNC without RBR (49.1 ± 9.2% vs 60.3 ± 10.2%, p<0.05). There were no significant differences in the remainder of the systolic and diastolic indices between LVNC patients and controls. Conclusions: Children with LVNC can exhibit an abnormal LV rotational pattern characterized by RBR that is associated with impaired systolic function.

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Relationship Between QRS Duration on ECG and LV Systolic Function by Echocardiography in Patients with STEMI

University Heart Journal ◽

10.3329/uhj.v15i2.42647 ◽

2019 ◽

Vol 15 (2) ◽

pp. 54-59

Author(s):

Md Billal Hossain ◽

Msi Tipu Chowdhury ◽

Md Zahidul Islam ◽

Rakhal Chandra Debnath ◽

Sajal Krishna Banerjee ◽

...

Keyword(s):

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Systolic Function ◽

Ventricular Ejection Fraction ◽

Acute Stemi ◽

St Elevation ◽

Qrs Duration ◽

Lv Systolic Function

Background: Acute STEMI patients constitute a large proportion of admissions in coronary care unit and their management and prognostic implification is of immense importance. Prolonged QRS duration on electrocardiogram (ECG) has been associated with cardiac structural and functional abnormalitiesVery few studies were performed correlating QRS duration and LV systolic function in acute STEMI patients in our country. This study assessed whether QRS duration on ECG is correlated with LV systolic function measured in patients with acute STEMI. Aim of the Study: The aim of the study is to evaluate the relationship between QRS duration on ECG with left ventricular systolic function by echocardiography in patients with acute ST elevation myocardial infarction. Methods: A cross sectional observational study was conducted in the department of Cardiology in Mymensingh Medical College Hospital from November, 2016 to February, 2018 among purposively selected 235 patients with STEMI following inclusion & exclusion criteria. After detailed history, physical examination and investigations the selected patients underwent transthoracic Echocardiography to asses left ventricular systolic function applying Teichholz method. Results: Mean age of the patients 51.84±11.74 years. 135(57.45%) patients had acute anterior MI, while 98(41.70%) had Inferior MI and only 2(0.85%) had lateral MI. Mean QRS duration was 93.3 ±10.18 ms, with maximum value 125ms and minimum value 66ms. Mean left ventricular ejection fraction was 49.71%±9.87%, with maximum value 74% and minimum value 23%. QRS duration and left ventricular ejection fraction were moderate negative correlation with r= -0.611, <P = 0.001. Conclusion: The study concluded that QRS duration is negatively correlated with Left ventricular systolic function in patients with acute ST elevation myocardial infarction. University Heart Journal Vol. 15, No. 2, Jul 2019; 54-59

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Coexistence of Cardiomyopathy and Chronic Liver Disease in Non-Moderate Drinkers

Journal of Nepal Medical Association ◽

10.31729/jnma.552 ◽

2013 ◽

Vol 52 (189) ◽

pp. 217-223 ◽

Cited By ~ 2

Author(s):

Mani Prasad Gautam ◽

Usha Ghimire ◽

Gangapatnam Subramanyam ◽

Sogunuru Guruprasad

Keyword(s):

Liver Disease ◽

Chronic Liver Disease ◽

Heart Muscle ◽

Systolic Function ◽

Chronic Liver ◽

Muscle Disease ◽

Moderate Drinking ◽

Echo Features ◽

Lv Systolic Function ◽

The Relationship

Introduction: The dose-response relationship suggests a toxic effect of alcohol on heart and liver and the possibility of a correlation between alcohol-induced liver and heart disease. The present study was aimed to look into the relationship between chronic liver and heart muscle disease among the non-moderate drinkers in our context.Methods: An observational study on non-moderate chronic drinkers was carried out. Clinical evaluation along with detail sonographic study of heart and liver was conducted.Results: Fifty-eight percent had echocardiographic features consistent with heart muscle disease, either as a dilated cardiomyopathy, categorized by the presence of echo features of impaired LV systolic function and dilated left ventricle or as a possible cardiomyopathy categorized by the presence of any of these two echo features. Similarly, 56 of the total recruits showed ultrasonographic evidence of chronic liver disease as cirrhosis or early cirrhosis. Approximately, 86% of these 56 non-moderate drinkers with chronic liver disease also had echocardiographic features of heart muscle disease and 83% of the 58 non-moderate drinkers showing echo features of heart muscle disease had ultrasonographic features of chronic liver disease.Conclusions:Our study showed a strongly positive relationship on the coexistence of chronic liver disease and cardiomyopathy among the non-moderate drinkers. Non-moderate drinkers with chronic liver disease have a high likelihood of having a concurrent clinical or sub-clinical heart muscle disease and vice versa.Keywords: alcohol; chronic liver disease; heart muscle disease; non-moderate drinking.

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The Relationship Between EF and Strain Permits a More Accurate Assessment of LV Systolic Function

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2019.03.019 ◽

2019 ◽

Vol 12 (9) ◽

pp. 1893-1895 ◽

Cited By ~ 6

Author(s):

Gianni Pedrizzetti ◽

Tomas Lapinskas ◽

Giovanni Tonti ◽

Lukas Stoiber ◽

Remigijus Zaliunas ◽

...

Keyword(s):

Systolic Function ◽

Accurate Assessment ◽

Lv Systolic Function ◽

The Relationship

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Abstract 14295: Increasing QRS Duration Over Time Is Associated With Mortality and Morbidity in an Outpatient Heart Failure Population

Circulation ◽

10.1161/circ.132.suppl_3.14295 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Hassan Alfraidi ◽

William F McIntyre ◽

Lindsay Torbiak ◽

Shelley Zieroth ◽

Colette M Seifer

Keyword(s):

Heart Failure ◽

Systolic Function ◽

Nyha Class ◽

Tertiary Care ◽

Left Ventricular ◽

Conduction Delay ◽

Mortality And Morbidity ◽

Qrs Duration ◽

Lv Systolic Function ◽

Over Time

Introduction: Heart failure is a leading cause of morbidity and mortality. Prolonged QRS duration (QRSd), a marker of intra-ventricular conduction delay, has been shown to be associated with worse left ventricular (LV) systolic function, LV dilation and mitral regurgitation as well as with mortality. There are minimal data in the literature on the progression of QRSd over time, and the association with clinical outcomes. Hypothesis: We hypothesized that the progression of QRSd over time would be associated with mortality and hospitalizations in an outpatient heart failure population. Methods: Retrospective study of consecutive new adult referrals to a tertiary heart failure clinic over a 1 year period (2012). All patients with a narrow QRSd (defined as <130 ms) were included. Data were collected on demographics, ejection fraction (EF), clinical course and major clinical events. Primary endpoint was mortality and secondary endpoint was heart failure hospitalization. Results: A total of 147 patients were included, 90 were males (61%). Mean age was 66 years (+/-15), mean EF was 33% (+/- 15) and mean NYHA class 2.2 (+/- 0.9) at baseline. An ischemic aetiology accounted for 50% of the patients. Mean QRSd was 100 ms (+/- 13) at baseline and 119 ms (+/- 25) at last follow-up, which was a mean of 2.5 years from baseline. Death occurred in 27 patients (18%) and there were 114 hospitalizations in 54 patients. Results of univariate regression analysis are presented in the table. Conclusion: An increase in QRSd over time is associated with increased heart failure hospitalizations and all cause mortality in a tertiary care outpatient heart failure population.

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Acute coronary syndromes in chronic kidney disease patients: the good, the bad or the ugly?

European Heart Journal ◽

10.1093/ehjci/ehaa946.1514 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Saleiro ◽

D De Campos ◽

J Lopes ◽

R Teixeira ◽

J.P Sousa ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Systolic Function ◽

Lv Function ◽

Angiotensin Ii Antagonist ◽

All Cause Mortality ◽

Group A ◽

Lv Ejection Fraction ◽

Group B ◽

Lv Systolic Function

Abstract Background Patients with chronic kidney disease (CKD) are at increased risk of composite cardiovascular (CV) events and all-cause mortality. However, current aggressiveness of therapeutic strategies may minimize the course of the disease. Aim To assess the prognostic impact of optimized medical treatment in a CKD population with acute coronary syndrome (ACS). Methods 355 ACS patients admitted to a single coronary care with CKD who were discharged from hospital were included. Those with end-stage renal disease were excluded. Three groups were created based on the KDIGO classification: Group A (Stage 3A, eGFR [estimated glomerular filtration rate] 45–59mL/min/1.73 m2) N=190; Group B (Stage 3B, eGFR 30–44mL/min/1.73 m2) N=113; and Group C (Stage 3B, eGFR 15–29mL/min/1.73 m2) N=52. The primary endpoint was long-term all-cause mortality. Kaplan-Meyer survival curves and Cox regression were done. The median of follow-up was 32 (IQ 15–70) months. Results Groups were similar regarding demographics, CV risk factors, ACS type, heart failure diagnosis, left ventricular (LV) systolic function, peak troponin, multivessel disease, treatment option (PCI, CABG or OMT) and medical therapy at discharge. More advance renal failure patients had a higher prevalence of diabetes mellitus (DM), a lower haemoglobin, a higher NT-proBNP and were less likely to receive ACE inhibitors/angiotensin II antagonist at discharge. 170 patients met the primary outcome. Kaplan-Meyer curves showed decreased survival with worse renal function (Group A 68% vs Group B 57% vs Group C 37%, Log Rank P=0.006 – Figure 1). After adjustment for age, DM, haemoglobin, NT-proBNP, LV systolic function and ACE inhibitors/angiotensin II antagonist at discharge, eGFR was not associated with increased death (HR 1.00, 95% CI 0.98–1.01). In this model, only age (HR 1.04, 95% CI 1.01–1.07), haemoglobin (HR 0.86, 95% CI 0.979–0.94), Nt-proBNP (HR 1.00, 95% CI 1.00–1.00) and impaired LV function (LV ejection fraction 40–49%: HR 2.95, 95% CI 1.89–4.81; LV ejection fraction <40%: HR 2.15, 95% CI 1.44–3.21) remained associated with the outcome. Conclusion The worse outcome attributed to CKD after an ACS seems to be related not the eGFR itself but to associated comorbidities such as age, anaemia, fluid overload and impaired LV function. The fact that some of these comorbidities may be altered by intensive therapy indicates that CKD patients should also be candidates to optimized medical treatment. Funding Acknowledgement Type of funding source: None

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Improved risk-stratification in heart failure patients with mid-range to severe abnormalities of QRS duration and systolic function using mechanical dyssynchrony assessed by myocardial perfusion-gated SPECT

Journal of Nuclear Cardiology ◽

10.1007/s12350-021-02554-5 ◽

2021 ◽

Cited By ~ 2

Author(s):

Takahiro Doi ◽

Tomoaki Nakata ◽

Takahiro Noto ◽

Tomohiro Mita ◽

Satoshi Yuda ◽

...

Keyword(s):

Heart Failure ◽

Myocardial Perfusion ◽

Risk Stratification ◽

Gated Spect ◽

Systolic Function ◽

Mechanical Dyssynchrony ◽

Heart Failure Patients ◽

Qrs Duration

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Acute recoordination rather than functional hemodynamic improvement determines reverse remodelling by cardiac resynchronisation therapy

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02174-7 ◽

2021 ◽

Author(s):

Philippe C. Wouters ◽

Geert E. Leenders ◽

Maarten J. Cramer ◽

Mathias Meine ◽

Frits W. Prinzen ◽

...

Keyword(s):

Systolic Function ◽

Cardiac Resynchronisation Therapy ◽

Left Ventricular ◽

Lv Function ◽

Peak Strain ◽

Cardiac Resynchronisation ◽

Reverse Remodelling ◽

Resynchronisation Therapy ◽

Lv Systolic Function

AbstractPurpose: Cardiac resynchronisation therapy (CRT) improves left ventricular (LV) function acutely, with further improvements and reverse remodelling during chronic CRT. The current study investigated the relation between acute improvement of LV systolic function, acute mechanical recoordination, and long-term reverse remodelling after CRT. Methods: In 35 patients, LV speckle tracking longitudinal strain, LV volumes & ejection fraction (LVEF) were assessed by echocardiography before, acutely within three days, and 6 months after CRT. A subgroup of 25 patients underwent invasive assessment of the maximal rate of LV pressure rise (dP/dtmax,) during CRT-implantation. The acute change in dP/dtmax, LVEF, systolic discoordination (internal stretch fraction [ISF] and LV systolic rebound stretch [SRSlv]) and systolic dyssynchrony (standard deviation of peak strain times [2DS-SD18]) was studied, and their association with long-term reverse remodelling were determined. Results: CRT induced acute and ongoing recoordination (ISF from 45 ± 18 to 27 ± 11 and 23 ± 12%, p < 0.001; SRS from 2.27 ± 1.33 to 0.74 ± 0.50 and 0.71 ± 0.43%, p < 0.001) and improved LV function (dP/dtmax 668 ± 185 vs. 817 ± 198 mmHg/s, p < 0.001; stroke volume 46 ± 15 vs. 54 ± 20 and 52 ± 16 ml; LVEF 19 ± 7 vs. 23 ± 8 and 27 ± 10%, p < 0.001). Acute recoordination related to reverse remodelling (r = 0.601 and r = 0.765 for ISF & SRSlv, respectively, p < 0.001). Acute functional improvements of LV systolic function however, neither related to reverse remodelling nor to the extent of acute recoordination. Conclusion: Long-term reverse remodelling after CRT is likely determined by (acute) recoordination rather than by acute hemodynamic improvements. Discoordination may therefore be a more important CRT-substrate that can be assessed and, acutely restored.

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Intracoronary Injection of Autologous CD34+ Cells Improves One-Year Left Ventricular Systolic Function in Patients with Diffuse Coronary Artery Disease and Preserved Cardiac Performance—A Randomized, Open-Label, Controlled Phase II Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm9041043 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1043 ◽

Cited By ~ 2

Author(s):

Pei-Hsun Sung ◽

Yi-Chen Li ◽

Mel S. Lee ◽

Hao-Yi Hsiao ◽

Ming-Chun Ma ◽

...

Keyword(s):

Systolic Function ◽

Coronary Intervention ◽

Left Ventricular ◽

Diffuse Coronary Artery Disease ◽

Cd34 Cells ◽

Group 2 ◽

Artery Disease ◽

One Year ◽

Lv Systolic Function ◽

Group 1

This phase II randomized controlled trial tested whether intracoronary autologous CD34+ cell therapy could further improve left ventricular (LV) systolic function in patients with diffuse coronary artery disease (CAD) with relatively preserved LV ejection fraction (defined as LVEF >40%) unsuitable for coronary intervention. Between December 2013 and November 2017, 60 consecutive patients were randomly allocated into group 1 (CD34+ cells, 3.0 × 107/vessel/n = 30) and group 2 (optimal medical therapy; n = 30). All patients were followed for one year, and preclinical and clinical parameters were compared between two groups. Three-dimensional echocardiography demonstrated no significant difference in LVEF between groups 1 and 2 (54.9% vs. 51.0%, respectively, p = 0.295) at 12 months. However, compared with baseline, 12-month LVEF was significantly increased in group 1 (p < 0.001) but not in group 2 (p = 0.297). From baseline, there were gradual increases in LVEF in group 1 compared to those in group 2 at 1-month, 3-months, 6-months and 12 months (+1.6%, +2.2%, +2.9% and +4.6% in the group 1 vs. −1.6%, −1.5%, −1.4% and −0.9% in the group 2; all p < 0.05). Additionally, one-year angiogenesis (2.8 ± 0.9 vs. 1.3 ± 1.1), angina (0.4 ± 0.8 vs. 1.8 ± 0.9) and HF (0.7 ± 0.8 vs. 1.8 ± 0.6) scores were significantly improved in group 1 compared to those in group 2 (all p < 0.001). In conclusion, autologous CD34+ cell therapy gradually and effectively improved LV systolic function in patients with diffuse CAD and preserved LVEF who were non-candidates for coronary intervention (Trial registration: ISRCTN26002902 on the website of ISRCTN registry).

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