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Author(s):  
Kouji Ogasawara ◽  
Shinya Shiraishi ◽  
Noriko Tsuda ◽  
Fumi Sakamoto ◽  
Seitarou Oda ◽  
...  

Abstract Purpose Wild-type transthyretin-related amyloidosis cardiomyopathy (ATTRwt-CM) is an increasingly recognized cause of heart failure especially in elderly patients. The purpose of the present study was to determine retrospectively whether the quantitative indices of 99mTc-pyrophosphate (PYP) SPECT/CT help to predict the prognosis of ATTRwt-CM patients when compared with other clinical parameters. Materials and methods Sixty-eight patients with biopsy-proven ATTRwt-CM who underwent PYP SPECT/CT were enrolled. Baseline clinical characteristics, echocardiographic parameters, and qualitative and/or quantitative indices of planar and SPECT/CT imaging in PYP scintigraphy for each patient were included. For quantitative analysis of SPECT/CT, the accumulation ratio of PYP in the septum, posterior, anterior, lateral, and apex walls to the cavity pool was calculated as the septal wall-to-cavity ratio (Se/C), lateral wall-to-cavity ratio (La/C), anterior wall-to-cavity ratio (An/C), inferior wall-to-cavity ratio (In/C), and apical wall-to-cavity ratio (Ap/C), respectively. Endpoints for prognostic accuracy evaluation were cardiac death or hospitalization due to heart failure. Event-free survival rate was evaluated through Cox proportional hazards regression analysis, providing estimated hazard ratios (HRs) with 95% confidence intervals (CIs) and Kaplan–Meier curves. Results High-sensitivity cardiac troponin T (hs-cTnT), La/C, age, interventricular septal thickness in diastole, and E/e′ ratio in the septal wall were significantly associated with event-free survival (P < 0.05). For a multivariable Cox proportional hazards analysis, hs-cTnT (HR 1.153; 95% CI 1.034–1.286; P < 0.01), La/C (HR 2.091; 95% CI 1.012–4.322; P = 0.046), and age (HR 1.116; 95% CI 1.007–1.238; P = 0.037) were significant independent prognostic factors. Conclusion This study indicated that the quantitative indices of PYP SPECT/CT can help to predict the prognosis of ATTRwt-CM patients.


2021 ◽  
Vol 8 (12) ◽  
pp. 216
Author(s):  
Michael Nguyen-Truong ◽  
Wenqiang Liu ◽  
Courtney Doherty ◽  
Kristen LeBar ◽  
Kevin Labus ◽  
...  

The interventricular septum contributes to the pumping function of both ventricles. However, unlike the ventricular wall, its mechanical behavior remains largely unknown. To fill the knowledge gap, this study aims to characterize the biaxial and transmural variation of the mechanical properties of the septum and compare it to the free walls of the left and right ventricles (LV/RV). Fresh hearts were obtained from healthy, adult sheep. The septal wall was sliced along the mid-line into two septal sides and compared to the epicardial layers of the LV- and RV-free walls. Biaxial tensile mechanical tests and constitutive modeling were performed to obtain the passive mechanical properties of the LV- and RV-side of the septum and ventricular walls. We found that both sides of the septum were significantly softer than the respective ventricular walls, and that the septum presented significantly less collagen than the ventricular walls. At low strains, we observed the symmetric distribution of the fiber orientations and a similar anisotropic behavior between the LV-side and RV-side of the septum, with a stiffer material property in the longitudinal direction, rather than the circumferential direction. At high strains, both sides showed isotropic behavior. Both septal sides had similar intrinsic elasticity, as evidenced by experimental data and constitutive modeling. These new findings offer important knowledge of the biomechanics of the septum wall, which may deepen the understanding of heart physiology.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Giulia De Santis ◽  
Lorenzo Pistelli ◽  
Marco Franzino ◽  
Claudio Nicolo ◽  
Francesca Parisi ◽  
...  

Abstract Aims Distribution of wall motion abnormalities (WMA) in young patients presenting with acute coronary syndrome (ACS) is not well described. Methods and results We included 91 consecutive young patients (≤45 years at presentation) with ACS with obstructive or without obstructive coronary artery disease referred from October 2013 until March 2021 to our clinic. Wall motion abnormalities, wall motion score index (WMSI) and left ventricle ejection fraction (LVEF) were evaluated. A wall motion abnormality in at least one segment was present in 78.7% of patients. Mean LVEF was 50.9 ± 8.8% and mean WMSI was 1.38 ± 0.37%. Akinesia of at least one segment was present in 49.4%, dyskinesia and aneurysm were rare (1.1%, respectively). Ventricular thrombus was observed in 4.7%. Distribution of wall motion abnormalities is presented in Figure A. Most frequently WMA affected the apex and the basal inferior wall. The severity of WMA for each segment is presented in Figure B. The mean highest severity of WMA affected the apex, and the inferior and infero-septal wall. In the subgroup of patients presenting without obstructive coronary artery disease, WMA were less prevalent (37.5%), LVEF was higher (57.1% vs. 50.4% P = 0.032), and WMSI was lower (1.16% vs. 1.40% P = 0.07), but similarly affected with higher frequency the apex area. Conclusions In conclusion, WMA are frequent in young patients presenting with ACS, mostly affecting the apex. More severe abnormalities of wall kinesis affect the apex and the inferior and infero-septal wall.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Nunzia Borrelli ◽  
Giovanni Di Salvo ◽  
Giovanni Domenico Ciriello ◽  
Nicola Grimaldi ◽  
Rosaria Barracano ◽  
...  

Abstract Aims Wolff–Parkinson–White syndrome (WPW) is a clinical condition characterized by pre-excitation on electrocardiogram (ECG) and symptoms of arrhythmias. It has been described that premature ventricular activation induces septal wall motion abnormalities and ventricular dyssynchrony, causing detrimental effects on cardiac performance. The new speckle-tracking-based technique, blood speckle imaging (BSI), has been previously used to evaluate blood flow characteristics in normal and dysfunctional hearts in patients with normal atrio-ventricular (AV) conduction. We aimed to study the features of left ventricle blood vortices in patients with WPW and short AV conduction by using BSI. Methods and results Nineteen paediatric patients (age 7 ± 2.9 years) were included in the study: 13 patients with manifest WPW (WPW group) and 6 age and sex -matched controls with normal AV conduction (CTR group). A complete echocardiographic evaluation with 2D, color Doppler, and BSI was performed in all the included patients. BSI was recorded in apical 3-chamber view with a 6S-D probe. Vortices characteristics were analysed during the filling phase of the left ventricle. We focused on the anterior vortex generated by the mitral valve, which persisted longer during the cardiac cycle and is assumed to contribute to optimizing cardiac function. For each child in the WPW group, Arruda criteria were used to esteem accessory pathway localization from a 12-lead surface ECG. All patients in the WPW group manifested the accessory pathway in the septal region. All patients in the CTR group presented one major anterior vortex along the septal wall during the filling phase (Figure A), while in the WPW group, 10 patients out of 13 (P = 0.009) lacked this main anterior vortex, showing instead fragmented vortices (Figure B). Interestingly, the main differences in blood vortices pattern were showed in the last part of filling phase, when blood flow could be affected by premature activation of the septal wall. There were no differences in terms of left ventricle function (WPWg 59.8 ± 4.02% vs. CTRg 59.0 ± 2.5%, P = 0.6) and global longitudinal strain (WPWg −18.6 ± 1.0% vs. CTRg −19.6 ± 3.1%, P = 0.5) between the two groups. 136 Figure A and B  Conclusions In our preliminary study, patients with WPW showed a fragmented pattern of diastolic blood vortices that adapted to septal dyssynchrony. We speculate this fragmentation may contribute to impair the performance of the left ventricle.


2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alexios S. Kotinas ◽  
Mauro Gitto ◽  
Riccardo Terzi ◽  
Angelo Oliva ◽  
Jorgele Zagoreo ◽  
...  

Abstract Aims Heart failure (HF) is a pandemic and despite improvements in therapy, the mortality rate has remained unacceptably high. Sodium glucose cotransporter-2 inhibitors (SGLT2i) have emerged as a promising new class of glucose-lowering drugs, reducing HF-related outcomes across all ejection fraction ranges in clinical trials. However, few studies have assessed their efficacy using echocardiography imaging in a real-world setting. Methods and results Type 2 diabetes mellitus (T2DM) patients treated with SGLT2i from 2015 to 2020 were enrolled in a retrospective observational study. Clinical, biochemical, and echocardiographic data at baseline and 6 and 12 months after treatment initiation were collected. Of the 459 patients screened, 312 (68%) patients completed 1 year of SGLT2i therapy. Side effects were developed in 92 (20%) patients leading them to stop treatment pre-maturely, while 55 (12%) were lost to follow-up. From the 312 patients who completed 1 year of treatment, 83 patients had echocardiography data before initiation and after either 6 or 12 months of treatment and were included in the data analysis. Sample’s average age was 65.78 ± 8.53 years, 23 (27.7%) were females, and the mean BMI was 32.10 ± 6.29 kg/m2. At baseline patients had Hb1Ac 7.94 ± 1.80% and the mean duration of diabetes was 11.19 ± 8.54 years. 59 (71.1%) patients were asymptomatic (NYHA I) at baseline. The mean left ventricular ejection fraction (LVEF) at baseline was 48.40 ± 10.89%, while mean left ventricular end-diastolic volume (LVEDV) was 127.96 ± 41.84 ml. Mean pulmonary artery systolic pressure (PASP) was 33.63 ± 7.89 mmHg and mean tricuspid annular plane systolic excursion (TAPSE) was 20.18 ± 4.17 mm before treatment started. Mean E/e′ ratio at baseline was 9.75 ± 3.50. Mean septal wall thickness before therapy was initiated was 12.05 ± 1.80 mm while mean anterior wall thickness was 11.22 ± 1.52 mm. Almost all of the patients had at least one cardiovascular risk factor, hypertension being the most common (77, 92.8%), while 53 (63.9%) patients had a history of coronary artery disease (CAD), of which 42 (50.6%) had suffered a myocardial infarction. All-cause HF was present in 31 (37.3%) patients (19 HFrEF, 7 HFmrEF, 5 HFpEF). After a mean of 12.94 ± 7.91 months of SGLT2i treatment, left ventricular function was improved as LVEF was increased to 50.62 ± 10.04% (+2.22%, P = 0.018), while LVEDV was reduced to 123.24 ± 41.41 ml (−4.72 ml, P = 0.052). A trend towards improvement of the right ventricular function was also observed as TAPSE increased to 21.45 ± 3.92 mm (+1.27 mm, P = 0.076). PASP remained rather stable (−0.83 mm, P = 0.620), as well as the E/e′ ratio (−0.11, P = 0.857). Septal wall thickness was found unchanged (−0.16 mm, P = 0.449), as well as the anterior wall thickness (−0.63 mm, P = 0.143). After 1 year of treatment the number of asymptomatic patients remained stable (60, P = 0.863). Conclusions SGLT2i improved left ventricular systolic function in a sample of real-world diabetic patients, as shown by the changes in LVEF and LVEDV. A trend towards right ventricular function improvement was also recorded, demonstrated by the TAPSE increase. These findings highlight SGLT2i action on ventricular function and might be hypothesis generating to further elucidate their cardiovascular mechanism of action, beyond their already noted diuretic effect.


2021 ◽  
Author(s):  
Fulufhelo Nemavhola ◽  
Harry Ngwangwa ◽  
Thanyani Pandelani ◽  
Neil Davies ◽  
Thomas Franz

Abstract Background: Availability of biaxial mechanical data for heart myocardia remains high in demand for the development of accurate and detailed computational models. Lack of accurate mechanical data for myocardia may delay the understanding of heart diseases mechanisms. Therefore, the aim of this study is to develop understanding of the regional difference of wall mechanics using rat heart in the left ventricle (LV), septal wall (STW) and right ventricle (RV). This was achieved by conducting a biaxial test on three rat heart myocardia (i.e LV, RV and STW). To select the best hyperelastic model that may be utilised for the development of computational models of the heart, the Fung, Choi-Vito, Polynomial (Anisotropic), Four-Fiber family, Holzapfel (2000) and Holzapfel (2005) hyperelastic models were selected and fitted on the biaxial data of the LV, RV and STW. Results: The best hyperelastic model was selected based on evaluation index (EI) which utilises the Coefficient of Determination (R2). All the six hyperelastic constitutive models were then compared in all three rat heart myocardia. The results show that the Polynomial (Anisotropic) model outperforms the other five models in all myocardial tissues with EI’s above 90 %. The Four-fiber-family and the two Holzapfel models perform equally in the LV and STW myocardial tissue with EI of 50 and 70 %, respectively. Conclusions: The Fung and Choi-Vito models yielded poor goodness of fit in the LV and STW myocardial tissues. The results presented here will be useful for detailed development of accurate computational models studying mechanisms of cardiovascular diseases.


2021 ◽  
Author(s):  
Fulufhelo Nemavhola ◽  
Harry Ngwangwa ◽  
Thanyani Pandelani ◽  
Neil Davies ◽  
Thomas Franz

Abstract Availability of biaxial mechanical data for heart myocardia remains high in demand for the development of accurate and detailed computational models. The aim of this study is to study the regional difference of wall mechanics using rat heart in the left ventricle (LV), septal wall (STW) and right ventricle (RV). This was achieved by conducting a biaxial test on three rat heart myocardia (i.e LV, RV and STW). Fung, Choi-Vito, Polynomial (Anistropic), Four-Fiber family, Holzapfel (2000) and Holzapfel (2005) hyperelastic models were selected and fitted on the bixial data of the LV, RV and STW. The best hyperelastic model was the selected based on evaluation index (EI) determined from the coefficient of determination (R2). All the six models were then compared in all three rat heart myocardia. The results show that the Polynomial (Anisotropic) model outperforms the other five models in all myocardial tissues with EI’s above 90 % goodness of fit. The Four-fiber-family and the two Holzapfel models perform equally in the LV and STW myocardial tissue between 50 and 70 % goodness of fit. The Fung and Choi-Vito models yielded poor goodness of fit in the LV and STW myocardial tissues. Parameter fitting is useful method in advancing reliable data to be used in the development of accurate computational models.


Author(s):  
Faiza Nafees Khan ◽  
Imtiaz Begum ◽  
Syed Ali Raza ◽  
Sohail Hussain ◽  
Santosh Kumar Sidhwani ◽  
...  

Objective: To determine the left ventricular hypertrophy (LVH) prevalence in patients admitted with advanced stage of Chronic kidney disease at Ziauddin hospital. Methodology: This was a cross-sectional study conducted in department of Nephrology of Ziauddin University Hospital, Karachi from January to July 2016. The inclusion criteria involved patients with CKD stages 3-5 undergoing two-dimensional M mode Doppler echocardiography. The sample size of the study was 147. LVH was considered as positive when Inter-ventricular-septal-wall-thickness in diastole (IVSd) >11 mm, Left-Ventricular-Septal-Wall-Thickness in diastole (LVPWd) >11 mm and Left-Ventricular-Mass-Index (LVMi) >131 g/m2 for men and > 100 g/m2 for women. The exclusion criteria included patients with terminal illness, on mechanical ventilator support, valvular heart diseases and congenital heart diseases, liver diseases and patients with acute kidney injury on chronic kidney disease. Results: 88 male and 59 female patients were included. The mean duration of CKD was 7.02±1.60 years. 94(63.9%) study subjects were observed with left ventricular hypertrophy. A significant association of LVH was observed with gender and CKD Stages. Conclusion: LVH can be easily diagnosed and assessed by M-mode or 2D echocardiography. The prevalence was high (60.5%) in stage 3–5 CKD patients.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Duchenne ◽  
S Calle ◽  
A Puvrez ◽  
F Rega ◽  
F Timmermans ◽  
...  

Abstract Introduction Recent cross-sectional studies suggest a relationship between persisting left bundle branch block (LBBB) and the extent of left ventricular (LV) electro-mechanical alterations over time. When patients are referred for cardiac resynchronization therapy (CRT), temporal data during the sub-clinical phase of disease is often missing. A longitudinal study using an animal model would provide a better understanding of the relationship between the onset of LBBB and the electro-mechanical changes. Purpose To investigate the sequential alterations in LV structure and function that develop over time in an animal model of LBBB. Methods Thirteen sheep were subjected to rapid DDD pacing (180 bpm; leads on right atrium and right ventricular free wall) in order to induce a LBBB-like conduction delay. All animals underwent an 8-week pacing protocol, whereas 4 of them were subjected to 16 weeks of pacing in total. Echocardiographic speckle tracking was used to assess circumferential strain of the septal and lateral wall. Septal and lateral wall thickness were measured at end-diastole. Cardiac magnetic resonance imaging was used to determine LV volumes and ejection fraction (LVEF). Examinations took place at baseline (before and after start of pacing), and after 8 and 16 weeks of pacing. All examinations were performed at a physiologic heart rate of 110 bpm. Results At baseline, DDD pacing induced an increase in QRS duration (+85%, p&lt;0.0001) and LBBB-like mechanical dyssynchrony, with mild early-systolic notching and preserved systolic shortening of the septal wall. The lateral wall demonstrated early pre-stretch followed by increasing systolic shortening. No acute changes in LV end-diastolic volume, LVEF or septal or lateral wall thickness were observed (all p&gt;0.05). After 8 weeks of DDD pacing, mechanical dyssynchrony worsened: septal notching increased, followed by reduced systolic shortening. After 16 weeks, the initial septal shortening was followed by profound stretching throughout systole. Lateral wall systolic shortening was reduced compared to baseline. QRS duration increased further by +12% (week 8) and +20% (week 16) (all p&lt;0.001). End-diastolic volumes had increased by +39% (week 8) and +72% (week 16), whereas LVEF had decreased by −48% (week 8) and −56% (week 16) (all p&lt;0.001). Septal wall thickness had reduced by −24% (week 8) and −33% (week 16), while lateral wall thickness had increased by +21% (week 8) and +30% (week 16) (all p&lt;0.05). Conclusion A persisting LBBB-like conduction delay induces sequential changes in LV deformation patterns, and triggers morphological and electrical remodelling. These changes are similar to those observed in patients with LBBB and different degrees of LV dysfunction. Our data suggest a continuum due to the progression of LBBB-induced LV disease. In the clinic, patients with mild dysfunction should be closely monitored in order to treat dyssynchrony as soon as guideline indications are reached. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): This work was supported by a KU Leuven research grant


Author(s):  
Muhammad Umer Butt ◽  
Anas Alameh ◽  
Hanad Bashir ◽  
Ahmad Jabri

Abstract Background Hypertrophic cardiomyopathy is estimated to affect 1 out of every 500 adults in the United States. One of its main complications is left ventricular outflow obstruction, which may require surgical septal myectomy in severe cases. We report a rare complication of postoperative septal akinesis leading to thrombus formation presenting as an acute ischaemic stroke. Case summary A 48-year-old woman presented with acute stroke two years after surgical septal myectomy for hypertrophic obstructive cardiomyopathy. Diagnostic workup identified an intraventricular thrombus arising in the left ventricular outflow tract. After comprehensive evaluation, it was determined that the thrombus development was a complication of the prior septal myectomy causing focal septal akinesis. Treatment with anticoagulation resulted in improvement of neurological symptoms and resolution of the intraventricular thrombus. Discussion This case illustrates the rarity and unusual presentation of an intracardiac thrombus that arises from septal myectomy site. A thrombus arising in the left ventricular outflow tract, which is characterized by high gradient laminar flow, is highly unusual. This suggests microscopic and macroscopic alteration in the ventricular septal wall structure, as evident by the septal wall akinesis seen on echocardiography. Recognition of this complication is critical to the selection of appropriate anticoagulation as secondary stroke prevention in these patients.


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