Left ventricle reverse remodeling in chronic aortic regurgitation patients with dilated ventricle after aortic valve replacement

Background Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) with a severe dilated left ventricle and dysfunction leads to left ventricle remodeling. But there are rarely reports on the left ventricle reverse remodeling (LVRR) after AVR. This study aimed to investigate the LVRR and outcomes in chronic AR patients with severe dilated left ventricle and dysfunction after AVR. Methods We retrospectively analyzed the clinical datum of chronic aortic regurgitation patients who underwent isolated AVR. The LVRR was defined as an increase in left ventricular ejection fraction (LVEF) at least 10 points or a follow-up LVEF ≥ 50%, and a decrease in the indexed left ventricular end-diastolic diameter of at least 10%, or an indexed left ventricular end-diastolic diameter ≤ 33 mm/m2. The changes in echocardiographic parameters after AVR, survival analysis, the predictors of major adverse cardiac events (MACE), the association between LVRR and MACE were analyzed. Results Sixty-nine patients with severe dilated left ventricle and dysfunction underwent isolated AVR. LV remodeling in 54 patients and no LV remodeling in 15 patients at 6–12 months follow-up. The preoperative left ventricular dimensions and volumes were larger, and the EF was lower in the LV no remodeling group than those in the LV remodeling group (all p < 0.05). The adverse LVRR was the predictor for MACE at follow-up. The mean follow-up period was 47.29 months (range 6 to 173 months). The rate of freedom from MACE was 94.44% at 5 years and 92.59% at 10 years in the remodeling group, 60% at 5 years, and 46.67% at 10 years in the no remodeling group. Conclusions The left ventricle remodeling after AVR was the important predictor for MACE. LV no remodeling may not be associated with benefits from AVR for chronic aortic regurgitation patients with severe dilated LV and dysfunction.

LEFT VENTRICLE REMODELING IN PATIENTS WITH POSTINFARCTION CARDIOSCLEROSIS AND OBESITY, TAKING INTO ACCOUNT FABP 4 AND CTRP 3 LEVELS

The objective – to study the structural-functional condition of the left ventriclemyocardium (LV) in patients with postinfarction cardiosclerosis and surplus body weighttaking into account the levels of adipokines FABP4 and CTR3.Material and methods. The study involved 189 patients. The first group consisted of60 patients with postinfarction cardiosclerosis, the second group included 68 patientswith postinfarction cardiosclerosis and excess body weight (EBW), the third groupcomprised 61 patients with postinfarction cardiosclerosis and obesity. The content ofFABP 4 and CTRP 3 was determined by enzyme-linked immunosorbent assay. Statisticalprocessing of the survey results was performed using the licensed software package“IBM SPPS Statistics 27.0”. According to the sample size and distribution of indicators,the parametric Student’s test was used. Evaluation of the significance of the differencebetween the means of multiple comparisons for quantitative traits with normaldistribution using Bonferroni correction was performed by one-way analysis of variance(ANOVA).The mean and the error of the mean were determinedThe correlations of theindicators were determined using the Pearson correlation coefficient (r). At a value ofp˂0.05, the difference was considered significant.Results. Patients with post-infarction cardiosclerosis and obesity in comparison withpatients without excess body weight were found to have an increase in end-systolicvolume (ESV), end-diastolic volume, end-diastolic size (EDS), end-systolic size (ESS),stroke volume, thickness of interventricular septum, thickness of the posterior wallof the left ventricle, size of the left atrium, mass of the left ventricular myocardium,LVMMI. A direct relationship between FABP 4 and ESS, ESV, LVMMI1in patients withpostinfarction cardiosclerosis and obesity was determined. There was a significantinverse correlation between CTRP 3 and EDS, ESS, ESV, LVMMI1 in patients withpostinfarction cardiosclerosisand obesity.Conclusions. The study showed that in patients with postinfarction cardiosclerosi 34sand obesity there was an increase in echocardiographic parameters. The influence ofFABP 4 and CTRP 3 content on the structural and functional state of the left ventricularmyocardium was determined.

Arterial Hypertension in Aortic Valve Stenosis: A Critical Update

Aortic stenosis (AS) is a very common valve disease and is associated with high mortality once it becomes symptomatic. Arterial hypertension (HT) has a high prevalence among patients with AS leading to worse left ventricle remodeling and faster degeneration of the valve. HT also interferes with the assessment of the severity of AS, leading to an underestimation of the real degree of stenosis. Treatment of HT in AS has not historically been pursued due to the fear of excess reduction in afterload without a possibility of increasing stroke volume due to the fixed aortic valve, but most recent evidence shows that several drugs are safe and effective in reducing BP in patients with HT and AS. RAAS inhibitors and beta-blockers provide benefit in selected populations based on their profile of pharmacokinetics and pharmacodynamics. Different drugs, on the other hand, have proved to be unsafe, such as calcium channel blockers, or simply not easy enough to handle to be recommended in clinical practice, such as PDE5i, MRA or sodium nitroprusside. The present review highlights all available studies on HT and AS to guide antihypertensive treatment.

Post Infarction left ventricle remodeling surgical treatment, different ways to get same result

The surgical ventricular restoration is an evolution of treatment of left ventricle aneurysm. The aetioloy of left ventricle aneurysm and the dilated post AMI cardiomiopaty is the same; the difference is in the extension of scarred tissue and in the quality of remote zone. Because in this anatomical situation the geometry of left left ventricle can be deeply affected, it can very difficult to have point of reference as position of apex or papillary mussles. Using a sizer and combine different surgical thecniques allow to rebuilt a ventricle with appropriate volume and shape.

Aortic regurgitation and left ventricle remodeling in cardiac magnetic resonance and transthoracic echocardiography

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Medical University of SIlesia Background Transthoracic echocardiography (TTE) is the main imaging modality used to assess patients with chronic aortic regurgitation (AR). However, it is not possible to provide a precise quantification in all patients. Our aim was to compare TTE and cardiovascular magnetic resonance (CMR) measurements in grading AR and left ventricle (LV) remodeling. Methods A total of 51 consecutive patients with isolated AR in TTE were enrolled into the study and finally forty nine individuals (age: 57.1 (14); 61% males) underwent a non-contrast CMR (2 pts excluded for CMR contraindications). AR severity grading and LV remodeling were assessed according to the current ASE guidelines, including a semi-quantitative and quantitative parameters. All CMR studies were obtained on ecg-gated cine images acquired on 1.5T system (GE Optima MR450w, GE Healthcare, Wisconsin, USA) with a dedicated cardiac coil using a non-contrast protocol, including a quantitative approach (phase-contrast velocity encoded imaging). Results Most of the study patients showed mild symptoms (NYHA I/II/III – 55%/38%/7%; CCS 0/I/II/III/IV – 79%/2%/12%/6%) and typical cardiovascular risk factors: hypertension (83%), dyslipidemia (91%), diabetes (12%) and obesity (16%). Twenty patients (40%) showed combined AV disease and 14 patients (28,5%) had a bicuspid AV. The AR jets were central (53%) or eccentric (47%) and multiple in 7 cases (14%). The inter-modality agreement (TTE-CMR) in AR grading was high in mild AR (91%) and low in mild-to-moderate (12%), moderate-to-severe (10%) and severe (20%) AR. The comprehensive quantitative grading with AR volume (AR vol) and regurgitant fraction (RF) were measurable in TTE in 24 cases and showed a significant association with CMR parameters (AR vol: r = 0.75; p &lt; 0.001 and RF: r = 0.55; p &lt; 0.01). Moreover, CMR revealed significantly larger LV end-diastolic volumes (EDV) (185,5 ± 61ml vs 158,4 ± 61ml; p = 0.03) and a trend towards higher left ventricle ejection fraction (59 ± 8 vs 56 ± 8%; p = 0.08). The association of AR vol and LV EDV was stronger in CMR (r = 0.85; p &lt; 0.0001) compared to TTE (r = 0.6; p = 0.001). Conclusions CMR provides a comprehensive assessment of AR severity and LV remodeling with a moderate agreement with TTE.

The Structural-Functional Peculiarities of Heart in Patients with Acute Coronary Syndrome

Acute coronary syndrome (ACS) is associated with very high morbidity and mortality. The American Heart Association estimates – approximately every 40 seconds an American has a myocardial infarction. The aim of this study was to evaluate the structural-functional peculiarities of heart remodeling in patients with acute coronary syndrome. Material and Methods. In this observational cohort trial there were observed 184 patients with ACS. Coronary angiography was performed at admission, and lesions that reduced the lumen area at 50% or more were considered angiographically significant. Transthoracic echocardiography was performed in accordance with recommendations of the American Society of Echocardiography. Results. The mean age of all observed patients with ACS was 64.6±11.9 years; 93 (50.5%) were males. ACS with persistent ST segment elevation more often was presented as the anterior-lateral myocardial infarction with persistent ST segment elevation (STEMI) – in 70 (50.0%) cases. Among patients with STEMI the left anterior descending coronary artery (LAD) was mostly affected as infarction-related artery (IRA): in 74 (52.9%) cases at initial urgent coronary angiography. Multivessel disease (MVD) was identified in 22 (15.7%) patients with STEMI. The most significant variations of EchoCG parameters were observed in STEMI patients with MVD on coronary angiography (Table 2): dilatation of left atrium and left ventricle (increased of End-diastolic volume (EDV), End-systolic volume (ESV), End-diastolic diameter (EDD) and End-systolic diameter (ESD)) and low ejection fraction (EF) of left ventricle. Low EF of left ventricle was observed in 6 patients with culprit of LAD, 3 patients with culprit of LCx and in 6 patients with MVD (φ=0.244; p<0.05). Conclusion. Acute STEMI is caused by significant left ventricle remodeling (dilatation and ejection fraction decrease) in case of multivessel disease in coronary angiography.

Combined influence of diabetes mellitus and obesity on left ventricle remodeling in hypertensive patients

The aim of the study was to evaluate the effect of type 2 diabetes mellitus (T2DM) and obesity influence on the left ventricular (LV) remodeling peculiarities in hypertensive patients. Materials and methods. In total, 327 patients, aged 38–74 years, were comprehensively examined. The enrolled patients were divided into 4 groups in dependence of the presence of associated disease: the 1st group – n = 87 hypertensive patients with T2DM combined with obesity, the 2nd group – n = 71 hypertensive patient with T2DM and the 3rd group – n = 65 hypertensive patients with obesity; the comparison group consisted of 74 patients with essential hypertension (EH) but without obesity or diabetes. Echocardiography was performed according to the standard method of H. Feigenbaum to estimate the LV parameters. HbA1c was determined by turbidimetric method. Serum glucose levels were determined by ELISA. Results. When comparing the three patient groups with those who had only EH, the most significant influence was found in combined influence of T2DM and obesity on the development of unfavorable type of LV remodeling with values of χ2 = 29.371 and Pearson's contingency coefficient (C) ‒ 0.393 (P < 0.05). The presence of concomitant T2DM without obesity had a significant moderate relationship with the development of unfavorable LV geometry, χ2 = 11.029 and C ‒ 0.266 (P < 0.05), which indicates a much smaller impact on the process compared to the polymorbid effect of T2DM with obesity. Comparison of patients with a combination of EH and obesity with those who had only EH did not show a significant effect of concomitant obesity on the development of unfavorable types of LV geometry with values of χ2 and C: 0.529 and 0.062, respectively (P > 0.05). Conclusions. Essential hypertension with type 2 diabetes mellitus and obesity polymorbidity, but not in combination with type 2 diabetes mellitus or obesity alone, has the most significant association with hypertrophic types of LV remodeling. The co-existence of type 2 diabetes mellitus and obesity in hypertensive patients leads to the development of predominantly LV concentric hypertrophy.