Cardiac Function in Brain Death, Usage of Advanced Hemodynamic Monitoring

Background: This study used advanced hemodynamic monitoring along with simultaneous echocardiography to assess donated heart function of brain death patients using advanced hemodynamic monitoring and its efficacy in organ donation. Methods: Forty-eight brain death patients who were candidates of heart donation on the basis of primary standard investigations were selected with purposive and convenient sampling methods. They were investigated with advanced hemodynamic monitoring after echocardiography and primary assessments and the gleaned data were recorded. Results: Echocardiography showed that LVS (left ventricle size) and LVF (left ventricle function) were normal in %100 and %87.5 of patients, respectively. LVEF (left ventricle ejection fraction) was <%50 in %12.5 and >%50 in %87.5 of patients. SVR was smaller than 1200 at the beginning of the study that reached %54.4 at the end of the study. CI (cardiac index) was < 2.4 in %16.7 of the patients at the onset of the study that reached %25 at the end. Reduction of CI and SVR in patients with EF <%50 was significantly higher than that in patients with EF>%50. Conclusion: Given the extensive pathological changes in the cardiovascular system exerted by brain death, advanced hemodynamic monitoring, if performed continually, can greatly aid in managing inotropic drugs in these patients, decision-making for managing intravascular volume, creating hemodynamic stability, and finally, preventing deterioration of function of the donated heart and loss of a donated organ.

546 Antegrade in-stent CTO recanalization

Methods and results A 64-year-old man with prior PCI and stent of proximal LAD due to an anterior ST-elevation myocardial infarction (STEMI) presented with exertional angina (CCS III), despite optimal medical therapy (OMT). The echocardiogram showed a dilatated left ventricle with anterior and apical akinesia and a severely reduced left ventricle ejection fraction. Coronarography was performed and a chronic total occlusion was found at the proximal edge of the stent previously implanted in the proximal LAD, with a thin tapered entry (J-CTO score 1). Moderate angiographic disease was present in the circumflex (LCX) and in the right coronary artery (RCA). Interventional collaterals were absent. Dobutamine stress echocardiogram was performed to unmask myocardial viability. Indeed, during intravenous Dobutamine administration, we registered an increase in the left ventricle function, whereas only apex remained still akinetic. Accordingly, the patient underwent LAD CTO PCI using a 7 Fr EBU 4.0 guiding catheter, via right femoral artery access. The RCA ostium was engaged with a 6 Fr Judkins right 4.0 guiding catheter, via right radial artery access. Antegrade wire escalation technique was attempted. Due to scarce support, a 7 Fr Guidion guiding catheter extension and a Corsair microcatheter were placed in the proximal LAD. Antegrade crossing was very difficult due to intrastent high plaque burden. The occlusion was crossed with an Asahi Conquest Pro 9 guidewire. Subsequently, an Asahi Gaia third guidewire was advanced through the intrastent segment and then in the distal part of LAD. The advance of microcatheter was challenging but successfully achieved taking advantage of the low profile, high torqueability and trackability of the Asahi Corsair Pro microcatheter. Microcatheter tip injection confirmed the correct position in the vessel’s true lumen. An Asahi Grand Slam guidewire was placed in the distal LAD to provide extra support for delivery of interventional devices. The lesion was pre-dilated with progressively larger balloon, starting from a 1.1 mm diameter semi-compliant over-the-wire balloon (OTW). Two stents were implanted with a minimal overlap at the distal edge of the proximal stent (Resolute Onyx 3.0 × 38 mm and 2.5 × 24 mm). The result was improved with stents high-pressure post-dilatation and with selective intracoronary adenosine and nitroglycerin administration with final Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow. The total amount of contrast media used was 210 ml. The total procedure time was with 125 min with 45 min of fluoroscopy. No complications occurred. Conclusions CTO PCI still represents one of the most challenging subsets of coronary interventions despite the improvement in technology and techniques. Although data regarding percutaneous PCI CTO are still inconsistent, successful CTO recanalization has been associated with relief of angina and ischemia-related dyspnoea (Werner at al., 2018). In stable patients CTO PCI has been associated with a lower risk of death, stroke, and coronary artery bypass grafting and less recurrent angina pectoris in some registry studies (Christakopoulos et al., 2015). Additionally, CTO PCI increased left ventricle function in a subgroup of patients with LAD CTO (Henriques et al., 2016). Conversely, randomized multicentre failed to demonstrate a superiority of CTO PCI medical to OMT in terms of major adverse cardiac events (MACE) and all-cause mortality.

Takotsubo syndrome following pericardiectomy

Background: Takotsubo cardiomyopathy (TC) is defined as a temporary and reversible systolic abnormality of the left ventricle’s apical area resembling myocardial infarction (MI) in the nonexistence of coronary artery disease (CAD)[1].Only a few cases have been reported after cardiac operations or after pericardiocentesis. Aims: To emphasize the need to be aware of the possibility of the occurrence of this potentially fatal complication after cardiac surgery. Materials and methods: A-66-year old man underwent pericardiectomy.Postoperative he endured TC and progressed exacerbation of hemodynamic instability.finally, he had to be supported by intra-aortic balloon pump（IABP),extracorporeal membrane oxygenation（ECMO). Results: Patient’s left ventricle function recovered fully in two weeks. Discussion: we discussed the pathogenesis and treatment of postoperative TC. Conclusion:TC has to be carefully considered in differential diagnosis in case of acute left ventricle dysfunction following cardiac surgery. Keywords: pericardiectomy; takotsubo cardiomyopathy.

1p36 Deletion Syndrome and Left Ventricular Non-compaction Cardiomyopathy—Two Cases Report

1p36 deletion is the most common terminal deletion syndrome in humans. Herein, we report two cases, a 5-month-old female and a 14.5-year-old female, both with 1p36 deletion and left ventricular non-compaction cardiomyopathy. They presented with severely depressed left ventricle function and underwent heart transplantation with excellent outcomes. Given the incidence of heart defects and cardiomyopathy in 1p36 deletion syndrome, it should be recommended that children with this genetic condition have screening for cardiac disease. These cases add to the current literature by demonstrating the potential therapeutic options for non-compaction in 1p36 deletion syndrome and showed the favorable outcomes.

Global Longitudinal Strain in Heart Transplantation Recipients Using Different Vendors: Reliability and Validity in a Tertiary Hospital in Colombia.

Global Longitudinal Strain (GLS) is a useful tool to follow-up heart transplant (HT) recipients. Important inter-vendor variability of GLS measurements has been reported in healthy subjects and different conditions, but there is still limited evidence among HT patients. We assessed the reliability and validity of GLS using two vendors (General Electric and Philips) in a group of consecutive and stable adult HT recipients. Patients underwent two concurrent GLS analyses during their echocardiographic follow-up. We evaluated GLS inter-vendor reliability using Bland-Altman’s limits of agreement (LOA) plots, computing its coverage probability (CP) and the intraclass correlation coefficient (ICC). Validity was assessed though receiver operating characteristics (ROC) curves, predictive values, sensitivity and specificity of GLS for each vendor to detect a normal left ventricle function. 78 pairs of GLS studies in 53 stable HT patients were analyzed. We observed a modest inter-vendor reliability with a broad LOA (less than 50% of values falling out our CP of 2% and an ICC of 0.49). ROC analyses (areas under the curve of 0.824 Vs. 0.631, p<0.05) and diagnosis test indices (Sensitivity of 0.73 Vs. 0.64; and Specificity of 0.79 Vs. 0.50) favored GE over Philips. Inter-vendor variability for GLS analysis exceeded clinically acceptable limits in HT recipients. GLS from GE software seemed to show higher validity as compared to Philips’. The present study provides evidence to consider caution for the interpretation of GLS for clinical management in the follow-up of HT patients, especially when GLS is measured by different vendors.

Assessment of Left Atrial Function in Essential Hypertension Patients With Normal Left Ventricle Function by Volume-derived Values and Two-dimensional Strain

Background: To investigate left atrial(LA) function in essential hypertension(EHT) patients by using volume-derived values, two-dimensional strain. Methods: 51 normal subjects and 95 EHT patients(without LVH: 50, and with LVH: 45) were enrolled for this research. LA Volume-derived index was measured in apical 4-, 2-chamber views by Simpson′s method. LA strain(S-reservoir, S-conduit, S-booster pump) and strain rate (SR-reservoir, SR-conduit, SR-booster pump), representing the reservoir, conduit and booster pump functions, respectively, were measured by two-dimensional speckle tracking echocardiography(STE).Results: Volume-derived values(contain Total LAEF, passive LAEF and active LAEF) and strain-derived values(S-reservoir, S-conduit, Sr-reservoir, Sr-conduit and Sr-booster pump) in EHT patients were significantly lower than normal subjects. Correlation test showed LA stiffness had a strong correlation with LA conduit function in EHT patients. The AUC values were higher for detection LA conduit function than LA reservoir and booster pump function in EHT patients. LA expansion index and LA stiffness also have the higher AUC with higher sensitivity and specificity values for detection the LA dysfunctions in EHT patients. Conclusions: In this study, we concluded that LA functions were damaged in EHT patients, which could be detect by LA volume-derived values and two-dimensional strain sensitively and reproductively. LA stiffness maybe a predictor for LV remodelling in EHT patients.

The impact of chemotheraphy and supervised high-intensity interval physical activity on left ventricle strain and myocardial work parameters – SPORT NATHY TRIAL pilot study results

Introduction Cardiotoxic effect of chemotheraphy represents known and challenging problem, thus search for potentially cardioprotective factors plays a key role in the contemporary cardio-oncology. Physical activity may allievate side effects of chemotheraphy and improve quality of live. Myocardial Work is a novel echocardiographic technique and promising tool for cancer patients assesement. Purpose The aim of this randomised pilot study was to assess left ventricle function using speckle tracking myocardial strain (2D STE) with Myocardial Work (MW) module in young women undergoing neoadjuvant chemotheraphy due to breast cancer and the impact of supervised high-intensity interval physical activity on these echocardiographic parameters. Material and methods We evaluated 24 women aged 27–41 (mean 34±4 yrs) with invasive breast cancer undergoing standard neoadjuvant chemotheraphy and randomized them into two groups: control - (CG, 15 pts) and experimental - with 6 months of supervised high-intensity interval exercise (SHIIEG, 9 pts). Every patient underwent echocardiographic examination 2D STE and MW before chemotheraphy and at 6 months follow-up. The following parameters were evaluated: Global Longitudinal Strain (GLS), Global Work Index (GWI), Global Constructive Work (GCW), Global Work Efficiency (GWE), Global Waste Work (GWW). Results Following parameters significantly decreased after chemotherapy: EF (65.4±5.7 vs 60.5±7.0%; p=0.003), GLS (20.4±2.5 vs 18.4±2.0%; p=0.001), GWI (1835.4±206.9 vs 1594.1±228.3 mmHg%; p=0.0004), GCW (2240.5±270.8 vs 1884.9±241.3 mmHg%; p=0.0001), GWE (95.9±1.5 vs 94.9±1.7%; p=0.02). No signifficant changes in GWW (78.6±36.4 vs 80.5±32.2 mmHg%; p=0.7) were found. The comparison of control (CG) and experimental group (SHIIEG) at 6 months follow-up revealed no signifficant differences in the following parameters: GLS (p=0.9), GWI (p=0.3), GCW (p=0.2), GWE (p=0.3) and GWW (p=0.5). However analysis of relative percentage change from baseline in GLS and GWW (Δ%GLS, Δ%GWW) almost reached statistical significance [for CG and SHIIEG respectively: Δ%GLS (−15.6 vs −4.4; p=0.07), Δ%GWW (+39.4 vs −7.3; p=0.06)]. Conclusions Neoadjuvant chemotherapy administered in young women with invasive breast cancer impaires the function of left ventricle after 6 month of theraphy, resulting in decrease of GLS, GWI, GCW and GWE. The supervised high-intensity interval physical activity impacts the relative change of GLS (Δ%GLS) and GWW (Δ%GWW), therefore may have cardioprotective effect on left ventricle function. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Greater Poland Cancer Centre, Poznan, Poland