Maternal Left Ventricular Diastolic and Systolic Function during Normal Pregnancy in Saint Bernard Dogs

This study aimed to evaluate maternal left ventricular (LV) systo-diastolic function using conventional and TDI echocardiography and included 10 healthy Saint-Bernard pregnant bitches. M-mode, peak transmitral flow velocities during early diastole (E) and atrial contraction (A), aortic and pulmonic flow, myocardial performance index (MPI), TDI studies (peak myocardial velocities during early diastole (E’), atrial contraction (A’) and peak systole (S’)), and blood pressure were measured at 21 to 28 (T1), 40 (T2) and 60 (T3) days of gestation and four to eight weeks postpartum (T4). Cardiac output and heart rate were 20% and 9% higher at T3, respectively, compared to T4 (p < 0.01). Lateral S’ was 36% higher at T3 than at T1 (p < 0.05). Changes in diastolic function were demonstrated by 10% lower E wave and 15% A wave at T1, compared to T4 (p < 0.05). E’ and A’ were 23% and 42% higher at T3 compared to T4 (p < 0.01). Both lateral E/E’ and E’/A’ were 6% and 19% lower at T3 compared to T1 (p < 0.01 and p < 0.05, respectively). At T3, MPI was 51% and 34% lower when compared to T1 or T2 (p < 0.05). The echocardiographic evaluation of maternal cardiac function is important, as structural, and functional changes occur throughout pregnancy.

AB0511 EFFECT OF SECUKINUMAB ON THE REDUCTION OF MYOCARDIAL DYSFUNCTION IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background:In ankylosing spondylitis (AS), early subclinical changes in the myocardium mostly remain undiagnosed. The impact of genetic engineering biological therapy on these changes is also unclear.Objectives:Aim: to establish the relationship between taking of secukinumab and changes in systolic and diastolic myocardial function in patients with AS.Methods:69 patients with AS were examined, of which the first group included 33 people (average age 38.8±4.74, 63.6% of men) who received the interleukin 17 inhibitor (IL17) - secukinumab, the second group - 36 people who did not receive biological therapy, average age 42.5±11 years, 66.7% of men. The control group included 40 healthy individuals, comparable in gender and age. Patients underwent tissue dopplerography of the heart and transthoracic echocardiography. The research materials were subjected to statistical processing using the program STATISTICA 10.0.Results:The patients with AS had significantly higher left ventricular mass index and ejection fraction (p<0.01) compared to the control group. Moreover, among patients who do not take biological therapy, the indicators were the highest (tabl.1).Table 1.Comparison of transthoracic echocardiography parameters in the study groups according to the Craskell-Wallis test.Показательgroup 1group 2control groupрLVMI85 [81; 100]93 [81,3; 114,2]79,5 [72; 86,5]р=0,002EF63 [62; 64]64,5 [63; 66]60 [59,5; 64,5]р=0,003LVMI – ventricular myocardial mass index, EF – ejection fraction.A comparison of tissue dopplerography of the heart between the groups established statistically higher values of peak velocity of the ring of the mitral valve in early diastole (e’L) in the 1st group (14 [9,5; 14]) and control (13 [11; 15,5]) compared with the indicator of the second group (10,5 [8,3; 13]), p<0,01; the peak speed of movement of the septum in early diastole, (e’S) in patients with secukinumab is higher (11 [9; 11]) compared to 2th (8.1 [7; 12]) and control groups 10 [8.5; 11]), p<0.05, and in the 2nd group lower than in the control (p=0.03). Significant differences in the parameters were supported by a comparison of the frequency of detection of diastolic dysfunction in the study groups. Diastolic dysfunction was diagnosed only in this group - in 38.9%. Against the background of the use of secukinumab, an increase in the systolic function of the myocardium was revealed.Conclusion:The patients with AS are characterized by a high frequency of subclinical heart dysfunction. Inhibition of IL17 can reduce diastolic dysfunction, which is confirmed by an improvement in myocardial contractility during secukinumab therapy.References:[1]ankylosing spondylitis, spondylarthritis, diastolic myocardial dysfunction, secukinumabDisclosure of Interests:None declared.

Correlation Between Thyroid Autoantibodies and Cardiovascular Disease in Patients With Stages 3-5 Chronic Kidney Disease

Background: Chronic kidney disease (CKD) interacts with thyroid disease and cardiovascular disease (CVD). Our research aimed to analyze the correlation between echocardiographic parameters E / A, E / E ', E' / A ', LVEF and thyroid autoantibodies, and evaluate the role of thyroid autoimmunity in the development of CVD in patients with stages 3-5 CKD.Methods: The patients who were diagnosed as stages 3-5 CKD in our department from January 2015 to May 2019 were recruited. We collected the routine medical history, general clinical data, and laboratory test index of patients. Echocardiography is performed by a trained echocardiographer to measure mitral valve blood flow velocity (E) in early diastole and Mitral valve flow velocity (A), E / A ratio, mitral annulus velocity (E ') in early diastole, mitral annulus velocity (A') in end-diastole, E / E 'ratio, and E' / A ' ratio. The SPSS 22.0 statistical software was used to analyze the data.Results: A total of 1164 patients with stages 3-5 CKD were included. Thyroglobulin antibody (TGAb) was negatively correlated with eGFR (r = -0.287, P <0.05). Thyrotropin receptor antibody (TRAb) was significantly positively correlated with CRP (r = 0.206, P <0.001). The titers of TPOAb and TGAb in male diabetic patients were higher (r = 0.137, P = 0.023; r = 0.159, P = 0.011). In female patients, both TPOAb and TGAb are significantly negatively correlated with HGB (r = -0.213, P = 0.018; r = -0.188, P = 0.019). The E / E’ of patients with TPOAb positive was higher (r = 0.181, P ＜ 0.001). The LVEF in patients with TPOAb positive were higher (r = 0.159, P = 0.007). In addition, LVEF was significantly negatively correlated with TRAb (r = -0.112, P = 0.026).Conclusion: The prevalence of AITD in stages 3-5 CKD gradually increases with the decline of renal function, and the titers of TPOAb and TGAb also gradually increase. In patients with stages 3-5 CKD, AITD may accelerate the incidence of CVD in CKD patients by affecting TG levels, accelerating the occurrence of anemia, and promoting the micro-inflammation. Female patients with high titers of TPOAb and TGAb should be paid more attention. The average E/E' of patients with stage 5 CKD was 16. Women with low FT3 and TPOAb positive maybe more likely to develop diastolic heart failure.

Left ventricular and left atrial deformation imaging early after pPCI: does diabetes mellitus make any difference?

Funding Acknowledgements Type of funding sources: None. onbehalf PREDICT-VT More extensive coronary atherosclerosis in diabetes mellitu (DM) induces poorer clinical outcomes after STEMI, but there are data suggesting that impaired myocardial function in DM, even independently from epicardial coronary lesions severity, might have detrimental effect, predominately on heart failure development in DM. Aim the current study is a sub-study of PREDICT-VT study (NCT03263949), aimed to analyse LV and LA function using myocardial deformation imaging based on speckle tracking echocardiography after pPCI in STEMI patients with and without DM. Methods in 307 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done including LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec), LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strains and analysis of LV rotation mechanic. Results from 242 patients who completed 1 year follow up, 48 (20%) had DM. Pts with DM were older (60 ± 1,01 vs 57 ± 10; p = 0.067) and had insignificantly higher SYNTAX score (18.5 ± 9.2 vs 15.8 ± 9.8, p = 0.118) . However, diabetics had more severely impaired EF (44.2 ± 8.6 vs 49.2 ± 9.8, p = 0.001), E/A ratio (0.78 ± 0.33 vs 0.90 ± 0.34; p = 0.036) and MAPSE (1.18 ± 0.32 vs 1.32 ± 0.33; p = 0.001). Global LV LS on all layers (endo: -13.6 ± 4.0 vs-16.2 ± 4.7; mid: -11.9 ± 3.5 vs -14.1 ± 4.1; epi: -10.4 ± 3.1 vs -12.3 ± 3.6; p &lt; 0.005 for all) was impaired in DM patients, as well as longitudinal systolic SR (-0.71 ± 0.23 vs -0.84 ± 0.24; p = 0.001) and SR during early diastole (0.65 ± 0.26 vs 0.83 ± 0.33, p &lt; 0.001). Patients with DM had more pronounced longitudinal posts-systolic shortening throughout LV wall (endo: 21.4 ± 16.1 vs 13.7 ± 13.3, p = 0.005; mid: 21.9 ± 16.1 vs 14.3 ± 13.1, p = 0.006; epi: 22.4 ± 16.5 vs 15.3 ± 13.7, p = 0.010) and higher LV mechanical dispersion (MDI: 71.3 ± 38.3 vs 59.0 ± 18.9, p = 0.037). LA strain was significantly impaired in DM patients (18.9 ± 7.7 vs 22.6 ± 10.0, p = 0.011) and even more profoundly LA strain rate during early diastole (-0.73 ± 0.48 vs -1.00 ±0.58, p = 0.002). Patients with DM also had more impaired LV global (15.7 ± 9.1 vs 19.8 ± 10.4, p = 0.013) radial strain, global LV circumferencial strain, especially at the mid-wall level (-13.9 ± 4.2 vs -16.0 ± 4.3, p = 0.005) and impaired circumferential SR E (1.25± 0.44 vs 1.49 ± 0.46, p = 0.003). End-systolic rotation of the LV apex was more impaired in DM (4.7 ± 5.1 vs 6.8 ± 5.5, p= 0.022). During 1 year follow-up heart failure and all-cause mortality tend to be higher among DM pts (46.7% vs 35.2%, p = 0.153). Conclusion STEMI patients with DM have more severely impaired LV systolic and diastolic function estimated both by traditional parameter and advanced echo techniques. These results might, at least partially, explain why outcomes after STEMI in DM might be poorer, even in the absence of more complex angiographic findings, pointing to the significance of impaired myocardial function DM itself.

Interplay between right atrial function and liver stiffness in adults with repaired right ventricular outflow obstructive lesions

Aims This study determined the associations between right atrial (RA) and right ventricular (RV) mechanics and liver stiffness in adults with repaired tetralogy of Fallot (TOF), pulmonary atresia with intact ventricular septum (PAVIS), and pulmonary stenosis (PS). Methods and results Ninety subjects including 26 repaired TOF, 24 PAIVS, and 20 PS patients and 20 controls were studied. Hepatic shear wave velocity and tissue elasticity (E), measures of liver stiffness, were assessed by two-dimensional shear wave elastography, while RA and RV mechanics were assessed by speckle tracking echocardiography. Deformation analyses revealed worse RV systolic strain and strain rate, and RA peak positive and total strain, and strain rates at ventricular systole and at early diastole in all of the patient groups compared with controls (all P &lt; 0.05). Compared with controls, all of the patient groups had significantly greater shear wave velocity and hepatic E-value (all P &lt; 0.05). Shear wave velocity and hepatic E-value correlated negatively with RV systolic strain rate, and RA positive strain, total strain, and strain rate at ventricular systole and at early diastole (all P &lt; 0.05). Multivariate analyses revealed RA strain rate at early diastole (P = 0.015, P &lt; 0.001), maximum RA size (P &lt; 0.001, P &lt; 0.001), and severity of pulmonary regurgitation (P = 0.05, Pp = 0.014) as significant correlates of shear wave velocity and hepatic E-value. Conclusion In adults with repaired TOF, PAIVS, and PS, RA dysfunction and pulmonary regurgitation are associated with liver stiffness.

Flow mapping of Intraventricular velocity behaviour along the early diastolic filling streamline in patients with atrial fibrillation: implication for HFpEF

Aims Intraventricular velocity distribution reflects left ventricular (LV) diastolic function and can be measured non-invasively by flow mapping technologies. We sought to compare intraventricular velocity gradient during early diastole – obtained by vector flow mapping (VFM) technology – in consecutive patients with normal ejection fraction (EF &gt;55%) and atrial fibrillation (AF) with and without clinical evidence of heart failure (HFpEF), and controls in sinus rhythm. We hypothesised that the VFM-derived Intraventricular Velocity Gradient over e' ratio (GrIV/e') would discriminate between the groups beyond conventional echocardiographic markers of elevated LV filling pressure. Methods and results Two-dimensional streamline fields were obtained using VFM technology in 120 subjects, i) 60 in sinus rhythm with normal systolic and diastolic function, ii) 29 out-patients with AF and no signs or symptoms of heart failure, and iii) 31 patients in AF hospitalized with signs of HFpEF. We compared the intraventricular gradient along the early diastolic streamline between groups, and correlated it with conventional echocardiographic parameters. GrIV/e' was the lowest in control group, followed by AF without HFpEF and the highest in AF HFpEF groups (GrIV/e' = 0.5±0.2, vs 0.9±0.4 vs. 2.0±1.2, p&lt;0.001, Figure, left). Conversely, LV filling pressure as determined by E/e', while lowest in the control group, failed to discriminate between patients with AF with and without (E/e' = 10.0±3.7 vs. 9.5±2.1, p=0.456, Figure, right). Conclusion The novel VFM parameter – reflecting early-diastole intraventricular dynamics – may discriminate between patients with AF with and without HFpEF beyond conventional echocardiography. While further studies are need to validate its clinical impact, GrIV/e' has the potential to become a novel parameter for diastolic function assessment in this population. VFM vs. Conventional echo parameter Funding Acknowledgement Type of funding source: None

Additional Heart Sounds—Part 1 (Third and Fourth Heart Sounds)

S3 is a low-pitched sound (25–50Hz) which is heard in early diastole, following the second heart sound. The following synonyms are used for it: ventricular gallop, early diastolic gallop, protodiastolic gallop, and ventricular early filling sound. The term “gallop” was first used in 1847 by Jean Baptiste Bouillaud to describe the cadence of the three heart sounds occurring in rapid succession. The best description of a third heart sound was provided by Pierre Carl Potain who described an added sound which, in addition to the two normal sounds, is heard like a bruit completing the triple rhythm of the heart (bruit de gallop). The following synonyms are used for the fourth heart sound (S4): atrial gallop and presystolic gallop. S4 is a low-pitched sound (20–30 Hz) heard in presystole, i.e., shortly before the first heart sound. This produces a rhythm classically compared with the cadence of the word “Tennessee.” One can also use the phrase “A-stiff-wall” to help with the cadence (a S4, stiff S1, wall S2) of the S4 sound.

A case report of a coronary myocardial bridge with impaired full-cycle ratio during dobutamine challenge

Background A myocardial bridge (MB) is a coronary variant in which an epicardial coronary artery tunnels through the myocardial band. Although MBs have been reported to cause ischaemia, physiological assessment of an MB has not been fully established. Case summary We encountered a case with exertional chest pain who underwent coronary angiography showing an MB at the mid-left anterior descending artery with systolic compression. Optical coherence tomography showed an MB defined as a homogeneous intermediate intensity surrounding the epicardial artery. The full-cycle ratio, defined as the lowest ratio of distal coronary pressure (Pd) to aortic pressure (Pa) during the entire cardiac cycle, measured 0.89 at rest and 0.73 with intravenous dobutamine of 20 µg/kg/min with a distinctive waveform pattern (early diastolic Pd drop) during a dobutamine challenge. Metoprolol succinate dosage was increased. The patient has been free from chest pain for 7 months after the discharge. Discussion Optical coherence tomography may contribute to anatomical detections of MBs. Because a systolic compression of the MB and release of the vascular lumen during early diastole leads to an early steep pressure loss, early diastolic Pd drop should be one of the specific haemodynamic characteristics of MBs. On the other hand, in a severe atherosclerotic stenosis, Pd drop is typically observed in late diastole, which could be differentiated from that of MBs. Because full-cycle ratio reflects the whole cardiac cycle including early diastole, this might be more useful than other physiological indices for detection of MB-related ischaemia induced by a dobutamine challenge.

Angiotensin-(1–7) reduces doxorubicin-induced cardiac dysfunction in male and female Sprague-Dawley rats through antioxidant mechanisms

Doxorubicin (Dox) is an effective chemotherapeutic for a variety of pediatric malignancies. Unfortunately, Dox administration often results in a cumulative dose-dependent cardiotoxicity that manifests with marked oxidative stress, leading to heart failure. Adjunct therapies are needed to mitigate Dox cardiotoxicity and enhance quality of life in pediatric patients with cancer. Angiotensin-(1–7) [Ang-(1–7)] is an endogenous hormone with cardioprotective properties. This study investigated whether adjunct Ang-(1–7) attenuates cardiotoxicity resulting from exposure to Dox in male and female juvenile rats. Dox significantly reduced body mass, and the addition of Ang-(1–7) had no effect. However, adjunct Ang-(1–7) prevented Dox-mediated diastolic dysfunction, including markers of decreased passive filling as measured by reduced early diastole mitral valve flow velocity peak ( E) ( P < 0.05) and early diastole mitral valve annulus peak velocity ( e′; P < 0.001) and increased E/e′ ( P < 0.001), an echocardiographic measure of diastolic dysfunction. Since Dox treatment increases reactive oxygen species (ROS), the effect of Ang-(1–7) on oxidative by-products and enzymes that generate or reduce ROS was investigated. In hearts of male and female juvenile rats, Dox increased NADPH oxidase 4 ( P < 0.05), a major cardiovascular NADPH oxidase isozyme that generates ROS, as well as 4-hydroxynonenal ( P < 0.001) and malondialdehyde ( P < 0.001), markers of lipid peroxidation; Ang-(1–7) prevented these effects of Dox. Cotreatment with Dox and Ang-(1–7) increased the antioxidant enzymes SOD1 (male: P < 0.05; female: P < 0.01) and catalase ( P < 0.05), which likely contributed to reduced ROS. These results demonstrate that Ang-(1–7) prevents diastolic dysfunction in association with a reduction in ROS, suggesting that the heptapeptide hormone may serve as an effective adjuvant to improve Dox-induced cardiotoxicity. NEW & NOTEWORTHY Ang-(1–7) is a clinically safe peptide hormone with cardioprotective and antineoplastic properties that could be used as an adjuvant therapy to improve cancer treatment and mitigate the long-term cardiotoxicity associated with doxorubicin in pediatric patients with cancer.

Acute impact of changes to hemodynamic load on the left ventricular strain-volume relationship in young and older men

Chronic changes in left ventricular (LV) hemodynamics, such as those induced by increased afterload (i.e., hypertension), mediate changes in LV function. This study examined the proof of concept that 1) the LV longitudinal strain (ε)-volume loop is sensitive to detecting an acute increase in afterload, and 2) these effects differ between healthy young versus older men. Thirty-five healthy male volunteers were recruited, including 19 young (24 ± 2 yr) and 16 older participants (67 ± 5 yr). Tests were performed before, during, and after 10-min recovery from acute manipulation of afterload. Real-time hemodynamic data were obtained and LV longitudinal ε-volume loops were calculated from four-chamber images using two-dimensional echocardiography. Inflation of the anti-gravity (anti-G) suit resulted in an immediate increase in heart rate, blood pressure, and systemic vascular resistance and a decrease in stroke volume (all P < 0.05). This was accompanied by a decrease in LV peak ε, slower slope of the ε-volume relationship during early diastole, and an increase in uncoupling (i.e., compared with systole; little change in ε per volume decline during early diastole and large changes in ε per volume decline during late diastole) (all P < 0.05). All values returned to baseline levels after recovery (all P > 0.05). Manipulation of cardiac hemodynamics caused comparable effects in young versus older men (all P > 0.05). Acute increases in afterload immediately change the diastolic phase of the LV longitudinal ε-volume loop in young and older men. This supports the potency of the LV longitudinal ε-volume loop to provide novel insights into dynamic cardiac function in humans in vivo.