Correlation between Volumes Determined by Echocardiography and Cardiac MRI in Controls and Atrial Fibrillation Patients

Aims: We aimed to compare cardiac volumes measured with echocardiography (echo) and cardiac magnetic resonance imaging (MRI) in a mixed cohort of healthy controls (controls) and patients with atrial fibrillation (AF). Materials and methods: In total, 123 subjects were included in our study; 99 full datasets were analyzed. All the participants underwent clinical evaluation, EKG, echo, and cardiac MRI acquisition. Participants with full clinical data were grouped into 63 AF patients and 36 controls for calculation of left atrial volume (LA Vol) and 51 AF patients and 30 controls for calculation of left ventricular end-diastolic volume (LV EDV), end-systolic volume (ESV), and LV ejection fraction (LV EF). Results: No significant differences in LA Vol were observed (p > 0.05) when measured by either echo or MRI. However, echo provided significantly lower values for left ventricular volume (p < 0.0001). The echo LA Vol of all the subjects correlated well with that measured by MRI (Spearmen correlation coefficient r = 0.83, p < 0.0001). When comparing the two methods, significant positive correlations of EDV (all subjects: r = 0.55; Controls: r = 0.71; and AF patients: r = 0.51) and ESV (all subjects: r = 0.62; Controls: r = 0.47; and AF patients: r = 0.66) were found, with a negative bias for values determined using echo. For a subgroup of participants with ventricular volumes smaller than 49.50 mL, this bias was missing, thus in this case echocardiography could be used as an alternative for MRI. Conclusion: Good correlation and reduced bias were observed for LA Vol and EF determined by echo as compared to cardiac MRI in a mixed cohort of patients with AF and healthy volunteers. For the determination of volume values below 49.50 mL, an excellent correlation was observed between values obtained using echo and MRI, with comparatively reduced bias for the volumes determined by echo. Therefore, in certain cases, echocardiography could be used as a less expensive, less time-consuming, and contraindication free alternative to MRI for cardiac volume determination.

Age- and Sex-Specific Characteristics of Right Ventricular Compacted and Non-compacted Myocardium by Cardiac Magnetic Resonance

The age and sex-specific characteristics of right ventricular compacted (RV-CMi) and RV-trabeculated myocardial mass (RV-TMi) and the determinants of RV myocardium are less well-studied; however, in different conditions, these might provide additional diagnostic information. We aimed to describe the age- and sex-specific characteristics of RV-CMi, RV-TMi, and RV volumetric and functional parameters and investigate the determinants of RV myocardial mass with cardiac magnetic resonance (CMR). Two hundred healthy Caucasian volunteers free of known cardiovascular or systemic diseases were prospectively enrolled in this study. Four different age groups were established with equal numbers of males and females: Group A (n = 50, 20-29 years, mean age: 24.3 ± 3.2 years), Group B (n = 50, 30-39 years, mean age: 33.6 ± 2.6 years), Group C (n = 50, 40-49 years, mean age: 44.7 ± 2.7 years), and Group D (n = 50, ≥50 years, mean age: 55.1 ± 3.9 years). Left ventricular (LV) and RV volumetric, functional, CMi, and TMi values were measured with a threshold-based post-processing CMR method. The volumetric parameters, RV-CMi, and RV-TMi values were larger, and the ejection fraction (EF) was lower in males. The RV-CMi did not correlate with age in either of the sexes, while the RV-TMi decreased with age in females but remained stable in males. The RV-TMi and RV-CMi correlated positively with RV volumetric parameters, the LV-CMi, the LV-TMi, and each other in both sexes. LV-TMi, LV-CMi, RV end-systolic volume, and sex were independent predictors of RV-TMi. Understanding the characteristics of RV-trabeculated and RV-compacted myocardium might have additive value in diagnosing different conditions with RV hypertrophy or hypertrabeculation.

Association of Digoxin With Preserved Echocardiographic Indices in the Interstage Period: A Possible Mechanism to Explain Improved Survival?

Background For patients with hypoplastic left heart syndrome, digoxin has been associated with reduced interstage mortality after the Norwood operation, but the mechanism of this benefit remains unclear. Preservation of right ventricular (RV) echocardiographic indices has been associated with better outcomes in hypoplastic left heart syndrome. Therefore, we sought to determine whether digoxin use is associated with preservation of the RV indices in the interstage period. Methods and Results We conducted a retrospective cohort study of prospectively collected data using the public use data set from the Pediatric Heart Network Single Ventricle Reconstruction trial, conducted in 15 North American centers between 2005 and 2008. We included all patients who survived the interstage period and had echocardiographic data post‐Norwood and pre‐Glenn operations. We used multivariable linear regression to compare changes in RV parameters, adjusting for relevant covariates. Of 289 patients, 94 received digoxin at discharge post‐Norwood. There were no significant differences in baseline clinical characteristics or post‐Norwood echocardiographic RV indices (RV end‐diastolic volume indexed, RV end‐systolic volume indexed, ejection fraction) in the digoxin versus no‐digoxin groups. At the end of the interstage period and after adjustment for relevant covariates, patients on digoxin had better preserved RV indices compared with those not on digoxin for the ΔRV end‐diastolic volume (11 versus 15 mL, P =0.026) and the ΔRV end‐systolic volume (6 versus 9 mL, P =0.009) with the indexed ΔRV end‐systolic volume (11 versus 20 mL/BSA 1.3 , P =0.034). The change in the RV ejection fraction during the interstage period between the 2 groups did not meet statistical significance (−2 versus −5, P =0.056); however, the trend continued to be favorable for the digoxin group. Conclusions Digoxin use during the interstage period is associated with better preservation of the RV volume and tricuspid valve measurements leading to less adverse remodeling of the single ventricle. These findings suggest a possible mechanism of action explaining digoxin’s survival benefit during the interstage period.

The effect of left ventricle ischemia severity on cardiac performance appeared on ejection fraction using radioactive TC 99m MIBI in comparison with echocardiography

Ischemic heart disease is a major causes of heart failure. Heart failure patients have predominantly left ventricular dysfunction (systolic or diastolic dysfunction, or both). Acute heart failure is most commonly caused by reduced myocardial contractility, and increased LV stiffness. We performed echocardiography and gated SPECT with Tc99m MIBI within 263 patients and 166 normal individuals. Left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF) were measured. For all degrees of ischemia, there was a significant difference between ejection fraction values measured by SPECT and echocardiography, and there were no significant differences among end systolic volume and end diastolic volume value calculated by two methods for all cases. The mean value for EDV (ECHO)/EDV (SPECT) was 1.07 ± 0.31 for degree (1, 2); in the degree 3 the mean value was 1.02 ± 0.08, and 1.005 ± 0.07 for degree 4. The mean value for ESV (ECHO)/ESV (SPECT) was 1.08 ± 0.34 for degree (1, 2); while 1.03 ± 0.12, 1.021 ± 0.128 for degree 3 and 4 respectively. This study was showed a good relation between left ventricular size and ejection fraction measured by SPECT with Tc99m, and echocardiography.

Đánh giá tình trạng suy tim ở bệnh nhân nhồi máu cơ tim cấp ST chênh lên trước và sau can thiệp động mạch vành

Mục tiêu: Khảo sát sự biến đổi hình thái và chức năng thất trái của bệnh nhân nhồi máu cơ tim cấp ST chênh lên trước và sau can thiệp tại thời điểm 48 giờ và 3 tháng bằng siêu âm tim. Đối tượng nghiên cứu: Trong thời gian từ tháng 02/2020 đến 09/2020 chúng tôi đã tiến hành nghiên cứu trên 97 bệnh nhân bệnh nhồi máu cơ tim cấp ST chênh lên được can thiệp động mạch vành qua da. Phương pháp nghiên cứu: nghiên cứu tiến cứu quan sát. Kết quả: khối lượng cơ thất trái giảm từ 195,2 ± 65,8 gr xuống 170,2 ± 51,1 gr, thể tích thất trái cuối tâm trương giảm từ 105,2 ± 37,4 mm xuống 95,5 ± 41,3 mm, thể tích thất trái cuối tâm thu giảm từ 57,3 ± 45,2 mm xuống 49,8 ± 50,3 mm. Chức năng tâm thu thất trái (EF) sau 3 tháng can thiệp động mạch vành qua da của nhóm EF ≤ 45 % tăng lên đáng kể từ 39,3 ± 11,2 % lên 45,85 ± 7,56 %, (p < 0,05), ngược lại nhóm EF > 45 % cũng có sự biến đổi từ 57,7 ± 14,4% lên 60,1 ± 13,3 %, (p > 0,05). Kết luận: Sau can thiệp động mạch vành qua da ở thời điểm 3 tháng, khối lượng cơ thất trái, thể tích thất trái cuối tâm thu và cuối tâm trương có sự thay đổi đáng kể. Chức năng tâm thu thất trái (EF) sau 3 tháng can thiệp động mạch vành qua da nhóm EF ≤ 45 % tăng lên có ý nghĩa thống kê. ABSTRACT EVALUATION OF HEART FAILURE IN ST - ELEVATED MYOCADIAL INFARCTION BEFORE AND AFTER PERCUTANEOUS CORONARY INTERVENTION Objectives: Assess the function of left ventricle in ST elevation myocardial infarction before, 48 - hour and 3 - month after primary percutaneous coronary intervention by cardiac ultrasound. Patients: 97 patients who underwent PCI for ST elevated myocardial infarction from 02/2021 to 09/2020. Methods: Prospective observational study. Results: Left ventricular mass index decreased from 195.2 ± 65.8 gr/m2 to 170.2 ± 51.1 gr/m2, end - diastolic left ventricular volume decreased from 105.2 ± 37.4 mm to 95.5 ± 41.3 mm. End systolic volume decreased from 57.3 ± 45.2 mm to 49.8 ± 50.3 mm. Ejection fraction 3 month after the intervention of the EF ≤ 45 % group significantly increased from 39.3 ± 11.2 % to 45.85 ± 7.56 % (p < 0.05). In contrast, there were a rise of the ejection fraction among the EF > 45% group from 57.7 ± 14.4% to 60.1 ± 13.3 % (p > 0.05). Conclusion: 3 month after PCI, left ventricular mass, end - systolic and diastolic volume changed remarkably. The ejection fraction of EF ≤ 45 % group increased with a statical significance. Keywords: PCI, cardiac ultrasonography, ejection fraction, left ventricular mass, end systolic volume end diastolic volume.

Role of cardiac magnetic resonance in stratifying the prognosis of patients with pulmonary arterial hypertension

Background Pulmonary arterial hypertension (PAH) is a rare disease characterized by a complex remodeling of heart structures. Cardiac magnetic resonance (CMR) is the gold standard for a non-invasive evaluation of right ventricle (RV) volumes and mass. Purpose To define the relationship between clinical, functional, biochemical, haemodynamic and CMR parameters and survival in patients with PAH. Methods Consecutive patients with PAH referred to our centre underwent clinical, functional, brain natriuretic peptide (BNP) plasma levels, haemodynamic and CMR evaluation. All patients were treated according to current guidelines. Univariate Cox analysis for survival was performed. Parameters with a p-value &lt;0.1 at the univariate analysis were included in the multivariate analysis. Results One hundred forty-seven patients with PAH (mean age 49±17 years, 69% female) were included in the study. Etiology of PAH was: idiopathic/heritable (49%), associated with connective tissue disease (19%), congenital heart disease (12%), portal hypertension/HIV infection (12%) and pulmonary veno-occlusive disease (8%). Thirty-six patients died during follow-up. Parameters significantly associated with mortality at the univariate analysis were age [Hazard Ratio (95% Confidence Interval): 1.043 (1.020–1.067); p&lt;0.001], six-minute walk test (6MWT) [HR: 0.995 (0.993–0.998); p&lt;0.001], WHO-functional class [HR: 2.489 (1.025–6.041); p=0.044], idiopathic-heritable-congenital heart disease aetiology [HR: 0.182 (0.085–0.389); p&lt;0.001], connective tissue disease aetiology [HR: 2.274 (1.099–4.704); p=0.027], pulmonary veno-occlusive disease aetiology [HR: 5.864 (2.328–14.773); p&lt;0.001], right atrial pressure [HR: 1.098 (1.032–1.169); p=0.003], pulmonary artery oxygen saturation [HR: 0.947 (0.921–0.975); p&lt;0.001], BNP levels [HR: 2.214 (1.213–4.039); p=0.010], RV wall thickness [HR: 0.633 (0.399–1.006); p=0.053], RV end diastolic volume [HR: 1.012 (1.003–1.021); p=0.007], RV end systolic volume [HR: 1.014 (1.003–1.024); p=0.011]. Parameters independently associated with mortality at the multivariate analysis were age [HR: 1.035 (1.006–1.064); p=0.018], idiopathic-heritable-congenital heart disease aetiology [HR: 0.355 (0.146–0.860); p=0.022], pulmonary veno-occlusive disease aetiology [HR: 3.129 (1.071–9.143); p=0.037], pulmonary artery oxygen saturation [HR: 0.953 (0.919–0.989); p=0.011], RV wall thickness [HR: 0.527 (0.300–0.927); p=0.026], RV end systolic volume [HR: 1.016 (1.003–1.029); p=0.014]. Conclusion RV wall thickness and RV end-systolic volume are associated with prognosis in patients with PAH independently from clinical and haemodynamic characteristics. These parameters may be used in the overall risk stratification of PAH patients. FUNDunding Acknowledgement Type of funding sources: None.

Myocardial tissue function and characterization in patients with idiopathic cardiac magnetic resonance myopericarditis: evolutionary analysis

Introduction The identification of prognostic markers related to the occurrence of events and recovery of ventricular function may be important in patients with acute myopericarditis (AMP). There is still a lack of data related to tissue characterization by cardiac magnetic resonance (CMR) of AMP, evolution and definition of possible long-term prognostic markers. Purpose To evaluate the myocardial tissue characterization of CMR related to the occurrence of combined events (death from all causes, heart failure and AMP recurrence) and the increase in left ventricular ejection fraction (LVEF) in patients with AMP. Methods Inclusion criteria were chest pain and/or electrocardiographic changes associated with elevated troponin (above the 99th percentile) in the absence of coronary stenosis and diagnosis of AMP by CMR &lt;48 hours of admission confirmed by the presence of edema and/or late enhancement. After a follow-up of up to 24 months, 100 patients remained and in the assessment of the increase in LVEF (increase &gt;5%), 36 cases remained, recalled for a new CMR between 6 and 18 months from the initial event. Results Significant differences in CMR were found between patients who had combined events (n=26) versus no combined events (n=74) in the following characteristics evaluated: initial LVEF (OR=0.938; CI: 0.895–0.984, p=0.008), left ventricular (LV) systolic volume index (OR=1.034; CI: 1.005–1.062, p=0.019), LV diastolic volume index (OR=1.029; CI: 1.002–1.056, p=0.038), presence of hypersignal in T2 (OR=11.325; CI: 2.247–57.075, p=0.003), presence of late anteroseptal enhancement (OR=0.160; CI: 0.037–0.685, p=0.014), basal anteroseptal (OR=0.255; CI: 0.071–0.914, p=0.036) and lateral apical (OR=5.902; CI: 1.236–28.187, p=0.026). In relation to the increase in LVEF, significant differences were found in CMR in the following characteristics evaluated: LVEF (OR=0.870; CI: 0.758–0.988, p=0.047), end systolic volume of the right ventricle (OR=1.047; CI: 1.001–1.096, p=0.047), LV systolic diameter (OR=1.283; CI: 1.034–1.593, p=0.023), LV diastolic diameter (OR=1.225; CI: 1.012–1.482, p=0.038), LV systolic volume index (OR=1.340; CI: 1.066–1.685, p=0.012), LV diastolic volume index (OR=1.111; CI: 1.017–1.213, p=0.019) and right ventricular systolic volume index (OR=1.116; CI: 1.006–1.236, p=0.037). Conclusion We observed a significant association between combined events in the long-term follow-up with initial LVEF, LV systolic and diastolic volume indexes, T2 hypersignal and the presence of mid and basal anteroseptal and lateral apical late enhancement. Already related to the increase in LVEF in evolutionary CMR, we observed a significant association with initial LVEF, end systolic volume of the right ventricle, LV systolic and diastolic diameters, LV systolic and diastolic volume indexes and right ventricle systolic volume index. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): FAPESP

Strain-based staging classification of left bundle branch block-induced cardiac remodeling predicts reverse remodeling after cardiac resynchronization therapy

Background Left bundle branch block (LBBB)-induced adverse remodeling is a gradual but largely unknown process, causing a variable degree of left ventricular (LV) dysfunction and response to cardiac resynchronization therapy (CRT). In LBBB patients with septal flash (SF), an electro-mechanical continuum of different speckle-tracking strain patterns was observed, with each pattern tightly correlating with the degree of LV remodeling and dysfunction (1) (Figure 1). Purpose In this study, we investigated the relationship between the staged LBBB strain patterns in CRT-eligible patients and their prediction with respect to reverse remodeling and clinical outcome. Methods This study enrolled CRT patients from the PREDICT-CRT study population (2). Inclusion criteria were LV ejection fraction (LVEF) ≤35%, QRS duration ≥120 ms, NYHA class II–IV, absence of right ventricular pacing and availability of speckle tracking strain imaging. All patients underwent an echocardiographic examination before and 12 months after CRT implant. LV volumes, strain and dyssynchrony were assessed. Mid-septal longitudinal strain curves were classified into 5 patterns (LBBB-0 through LBBB-4; Figure 1). Primary endpoint was all-cause mortality. Results The study involved 250 patients (mean age 64±10 years; 79% men) with a mean LVEF of 26±7%. LBBB was present in 220 (89%) patients and 206 (82%) patients had SF. Prior to CRT implant, a LBBB-0 pattern was observed in 33 (13%), LBBB-1 in 33 (13%), LBBB-2 in 39 (16%), LBBB-3 in 44 (18%) and LBBB-4 in 101 (40%) patients. Patients with LBBB-3 and -4 patterns more frequently had LBBB, lower LVEF, increased mechanical dyssynchrony and more prominent SF (p&lt;0.001 for all) compared with patients with LBBB-0, -1 and -2 patterns. Across the stages, CRT resulted in a gradual volumetric response, ranging from no response in stage LBBB-0 patients (ΔLV end-systolic volume +7±33%; ΔLVEF −2±9%) to super-response in stage LBBB-4 patients (ΔLV end-systolic volume −40±29%; ΔLVEF +15±13%) (p&lt;0.001 for all). Interestingly, following reverse remodeling, the LV function of stage LBBB-2, -3 and -4 patients improved to a similar LVEF of 38% (p=1.000) in this cohort. Patients in stage LBBB-0 had a significantly less favorable five-year outcome compared to those in stage LBBB≥1 (log-rank p=0.003). There was no difference in long-term outcome between stage LBBB-1 to −4 patients (log-rank p=0.510). Conclusion Strain-based LBBB staging predicts the extent of LV reverse remodeling in CRT patients. CRT did not translate into improved absolute survival in the more advanced stages, but the observed gradual volumetric response suggests that CRT corrects the LBBB-induced mortality. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Effect of Sacubitril/Valsartan on left ventricular longitudinal strain in patients with hematologic malignancies after bone marrow transplantation

Background and aims Chemotherapy is known for its potential adverse effects on myocardium. Optimal medical treatment for heart failure may reverse myocardial dysfunction in the early stages of toxicity development. We hypothesized that early initiation of treatment with sacubitril valsartan could prevent cardiotoxicity. Patients and methods 40 patients (mean age 45,3±13,1 years old, 23 male) with preserved ejection fraction, who suffered from hematologic malignancies (lymphoma, leukemia) and underwent bone marrow transplantation and were randomized to receive sacubitril/valsartan 24/26 mg bid daily or placebo. We measured at baseline, before transplantation, and after three months: i) Global Longitudinal Strain of left ventricle (LV) (GLS), ii) Left Ventricular Epicardial Strain (GLSepi), iii) Left Ventricular Endocardial Strain GLSendo), by speckle tracking imagind iv) Left Ventricular End Diastolic Volume, Left Ventricular End Systolic Volume and Left Ventricular Ejection Fraction (LVEF-Simpson's Method). Results The two treatment groups had similar age, sex atherosclerotic risk factors and cardiotoxic medication before and after bone marrow transplantation. Compared to baseline, patients treated with sacubitril/valsartan did not show a deterioration of LV GLS and GLSepi [(GLS = −20,2±3,1% vs −19,8±3,1%, p=0,551), (GLSepi = −17,9±2,8% vs −17,8±3,1%, p=0,855), (GLSendo = −23,02±3,6% vs −22,6±3,5%, p=0,572)], Conversely, patients treated with placebo group, presented a significant impairment of LV GLS and GLSepi [(GLS = −20,5±1,9% vs 18,5±2,3%, p=0,006, GLSepi = −18,1±1,5% vs −16,1±2,1%, p=0,003), (GLSendo = −23,4±2,2% vs −21,4±2,6%, p=0,008)] six months after bone marrow transplantation. No significant changes were found in LVEF after treatment with sacubitril/valsartan (57,9±5,6% vs 57,6±6,1%, p=0,733) or the placebo (60,1±5,6% vs 57,8±6,6%, p=0,166). However, in the sacubitril valsartan group, we noticed a significant reduction of left ventricular end diastolic and end-systolic volume [(103,1±27,01 ml vs 89,2±21,1 ml, p=0,012), (44,65±15,83 ml vs 36.4±8.3 ml, p=0,003), respectively]. Conclusions Treatment with sacubitril/valsartan prevented deterioration of myocardial deformation three months after bone marrow transplantation in patients with hematologic malignancies and preserved ejection fraction. FUNDunding Acknowledgement Type of funding sources: None.

Normal values for indexed left atrial end-systolic volume by two- and three-dimensional echocardiography. A cross-sectional population study

Background The left atrium volume and function gives important prognostic and diagnostic information. Normal values for left atrial end-systolic volume index (LASVI) is derived from 4-chamber and 2-chamber views or three-dimensional (3D) imaging. In current recommendations LASVI above 34 ml/m2 has been regarded dilated when assessing diastolic function and left ventricular filling pressures. It is not known if improved image quality by new scanners or more dedicated atrial focused views provide the same normal reference ranges. Material and methods We examined a large sub-population participating in a population based health study by high-end echocardiographic scanners. LA volume was assessed at end-systole in two-dimensional (2D) recordings focusing on the left atrium to avoid foreshortening. Additionally, 3D full volume recordings were acquired stitching 2–4 cardiac cycles when feasible using breath hold. All echocardiograms were analyzed offline using dedicated commercial software with manual tracing of the endocardial border and calculation of volume by the summation of discs method in 2D recordings. Results 2462 of 5763 invited persons was examined by echocardiography. 1048 persons were excluded due to known heart disease, atrial fibrillation, antihypertensive treatment, diabetes mellitus or findings of clear pathology on echocardiography leaving 1414 persons presumed free of cardiovascular disease or major risk factors for the analyses. Mean ± SD age was 57.9±12.4, and 55.8% was females. Mean (SD) LASVI in females and males were 27.6±9.7 ml/m2 and 30.7±11.1 ml/m2 by 2D imaging, respectively. Similarly, mean ± SD LASVI in females and males were 29.1±6.8 ml/m2 and 30.5±7.9 ml/m2 by 3D. The distribution of LASVI by age is showed in figure 1. The mean ± SD difference between 2D and 3D intra-individual measurements were 0.31±9.0 ml/m2 corresponding to 1.1%. By 2D assessment 24.1% of this presumed healthy cohort had a LASVI over 34 ml/m2, with more males than females had enlarged left atria by this definition (32.7% vs 20.1%, p&lt;0.001). Conclusion New reference ranges for left atrial size is provided for 2D and 3D recordings. By dedicated 2D recordings normal values are larger than previously recorded, and the difference between 2D and 3D recordings are less than previously reported. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): NTNU and the HUNT study Figure 1. Indexed left atrial end-systolic volume, summation of discs method using adjusted left atrial view vs age. The red line denotes 34 ml/m2 used as the cut-off value in present guidelines.