Search

Despite significant advances in the prevention and treatment of heart failure (HF), the prognosis in patients who have been hospitalised on at least one occasion due to exacerbation of HF is still poor. Therefore, a better understanding of the underlying pathophysiological mechanisms of HF is crucial in order to achieve better results in the treatment of this clinical syndrome. One of the areas that, for years, has aroused the interest of researchers is the activation of the immune system and the elevated levels of biomarkers of inflammation in patients with both ischaemic and non-ischaemic HF. Additionally, it is intriguing that the level of circulating pro-inflammatory biomarkers correlates with the severity of the disease and prognosis in this group of patients. Unfortunately, clinical trials aimed at assessing interventions to modulate the inflammatory response in HF have been disappointing, and the modulation of the inflammatory response has had either no effect or even a negative effect on the HF prognosis. The article presents a summary of current knowledge on the role of immune system activation and inflammation in the pathogenesis of HF. Understanding the immunological mechanisms pathogenetically associated with left ventricular remodelling and progression of HF may open up new therapeutic possibilities for HF. [ABSTRACT FROM AUTHOR]

Introduction : Left ventricular hypertrophy (LVH) is a common compensating process in the pressure overload mechanism of aortic stenosis (AS). Aim : To identify a group of patients with a LVH pattern which may alter periprocedural and 1-year outcomes after transcatheter aortic valve implantation (TAVI). Material and methods : Echocardiographic examinations of 226 patients with severe AS treated with TAVI between March 2010 and February 2016 were retrospectively analysed and correlated with echocardiographic parameters and clinical outcomes in the study group. Ultimately 208 patients were enrolled in the study. Based on left ventricular mass index (LVMI) and relative wall thickness (RWT) patients were divided into three categories: concentric remodelling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH). Most of the patients with severe AS referred for TAVI were found to have CH (n = 150, 72.8%), then EH (n = 33, 16%) and CR (n = 16, 7.8%). Results : There were no significant differences between groups in terms of periprocedural outcomes or complications. After a mean observation time of 561.8 ±239.0 days, the observed all-cause mortality rate was 19.9%. After multivariable adjustment, CR remained associated with a higher risk of mortality (HR = 4.31; 95% CI: 1.607–11.538; p = 0.004). Conclusions : Left ventricular hypertrophy is common in patients with severe AS prior to TAVI. The LVH pattern does not affect TAVI-related complications. In patients with severe AS referred for TAVI, CR seems to be the least favourable geometry of LVH, increasing the risk of 1-year all-cause death.

Purpose: Left ventricular (LV) remodelling is observed in numerous patients with hypertension and is a principal cause of heart failure in elderly patients. The aim of this study was to determine the relationships between age and structural/functional LV remodelling observed in elderly hypertensive patients. Methods: A total of 557 elderly hypertensive patients (mean age: 74.0 ± 8.6 years) with preserved LV systolic function underwent echocardiography and 24-hour blood pressure (BP) measurement. Results: Overall, 41.1% of patients had LV hypertrophy, 77.9% had increased relative wall thickness (RWT) defined as RWT >0.42, and 31.8% had both. Logistic analysis of the entire study population showed that increased RWT was associated with both 24-hour systolic BP (odds ratio (OR) 1.38, 95% confidence interval (CI) 1.12 to 1.70) and age (OR 1.32, 95%CI 1.08 to 1.61), whereas increased RWT was associated only with age (OR 1.61, 95%CI 1.23 to 2.11) after excluding patients with LV hypertrophy. Univariate and multivariate linear regression analyses of all patients showed that LV diastolic echocardiographic parameters were consistently associated with age (p ≤ .001) alone, even considering LV structural changes. Conclusions: Age was independently correlated with LV concentric/functional changes regardless of LV hypertrophy, suggesting that ageing is independently involved in the progression of LV remodelling.

Background: Coronary Heart Disease (CHD) is one of the most common types of cardiovascular disease, and Heart Failure (HF) is an important factor in its progression. We aimed to evaluate the diagnostic value and predictors of multiparametric Cardiac Magnetic Resonance (CMR) in CHD patients with HF., Methods: The study retrospectively included 145 CHD patients who were classified into CHD (HF+) (n = 91) and CHD (HF-) (n = 54) groups according to whether HF occurred. CMR assessed LV function, myocardial strain and T1 mapping. Multivariate linear regression analyses were performed to identify predictors of LV dysfunction, myocardial fibrosis, and LV remodeling., Results: CHD (HF+) group had impaired strain, with increased native T1, ECV, and LVM index. The impaired strain was associated with LVM index (p < 0.05), where native T1 and ECV were affected by log-transformed amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. ROC analysis showed the combination of global circumferential strain (GCS), native T1, and LVM had a higher diagnostic value for the occurrence of HF in CHD patients.

Meanwhile, log-transformed NT-proBNP was an independent determinant of impaired strain, increased LVM index, native T1 and ECV., Conclusion: HF has harmful effects on LV systolic function in patients with CHD. In CHD (HF+) group, LV dysfunction is strongly correlated with the degree of LV remodeling and myocardial fibrosis. The combination of the three is more valuable in diagnosing HF than conventional indicators.

Aims The Toll-like receptor 7 (TLR7) is an intracellular innate immune receptor activated by nucleic acids shed from dying cells leading to activation of the innate immune system. Since innate immune system activation is involved in the response to myocardial infarction (MI), this study aims to identify if TLR7 is involved in post-MI ischaemic injury and adverse remodelling after MI. Methods and results TLR7 involvement in MI was investigated in human tissue from patients with ischaemic heart failure, as well as in a mouse model of permanent left anterior descending artery occlusion in C57BL/6J wild type and TLR7 deficient (TLR7−/−) mice. TLR7 expression was up-regulated in human and mouse ischaemic myocardium after MI. Compared to wild type mice, TLR7−/− mice had less acute cardiac rupture associated with blunted activation of matrix metalloproteinase 2, increased expression of tissue inhibitor of metalloproteinase 1, recruitment of more myofibroblasts, and the formation of a myocardial scar with higher collagen fibre density. Furthermore, inflammatory cell influx and inflammatory cytokine expression post-MI were reduced in the TLR7−/− heart. During a 28-day follow-up after MI, TLR7 deficiency resulted in less chronic adverse left ventricular remodelling and better cardiac function. Bone marrow (BM) transplantation experiments showed that TLR7 deficiency in BM-derived cells preserved cardiac function after MI. Conclusions In acute MI, TLR7 mediates the response to acute cardiac injury and chronic remodelling probably via modulation of post-MI scar formation and BM-derived inflammatory infiltration of the myocardium. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims Cardiac resynchronization therapy (CRT) can reduce left ventricular end-systolic volume (LVESV), and a decrease of ≥15% is defined as a response. CRT can also improve LV global longitudinal strain (GLS). Changes in LVESV and LV GLS are individually associated with outcome post-CRT. We investigated LVESV and LV GLS changes and prognostic implications of improvement in LVESV and/or LV GLS, compared with no improvement in either parameter. Methods and results Baseline and 6-month echocardiograms were analysed from CRT recipients with heart failure. LV reverse remodelling was defined as a ≥15% reduction in LVESV at 6 months post-CRT. A ≥5% absolute improvement in LV GLS was defined as a change in LV GLS. A total of 1185 patients were included (mean age 65 ± 10 years, 73% male), and those with an improvement in LVESV and LV GLS (n  = 131, 11.1%) had significantly lower mortality compared with other groups. On multivariable analysis, an improvement in both LVESV and LV GLS [hazard ratio (HR): 0.47; 95% confidence interval (CI): 0.31–0.71; P  < 0.001] or an improvement in either LVESV or LV GLS (HR: 0.57; 95% CI: 0.47–0.71; P  < 0.001) were independently associated with better prognosis, compared with no improvement in either parameter. Conclusion Either a reduction in LVESV and/or an improvement in LV GLS at 6 months post-CRT are independently associated with improved long-term prognosis, compared with no change in both LVESV and LV GLS. This supports the use of LV GLS as a meaningful parameter in defining CRT response. [ABSTRACT FROM AUTHOR]

Aims: The aims of this study were to evaluate the effects of sodium tanshinone IIA sulfonate (STS) on left ventricular (LV) remodelling after for ST‐elevated myocardial infarction (STEMI). Methods and results: In this prospective, randomized clinical trial, 101 patients with the ST‐elevated MI (STEMI) and a successful reperfusion were immediately randomized to receive STS (80 mg qd for 7 days) or saline control, along with standard therapy. The primary effectiveness endpoint is the % change in LV end diastolic volumes index (%∆ LVEDVi) as measured by echocardiography from baseline to 6 months. Secondary effectiveness endpoints include 6‐month period for major adverse cardiac events (MACE), including the occurrence of recurrent myocardial infarction, death, hospitalization for heart failure and malignant arrhythmia. The 6‐month changes in %∆ LVEDVi were significantly smaller in the STS group than in the control group [−5.05% vs 3.32%; P < 0.001]. With respect to MACE, there was a significant difference between those who received STS (8.16%) and those patients on control (26.00%) (P = 0.019). Meaningfully, results of parallel tests aimed at mechanistic explanation of the reported clinical effects, revealed a significantly reduced levels of neutrophils‐derived granule components in the blood of STS treated patients. Conclusion: We found that short‐term treatment with STS reduced progressive left ventricular remodelling and subsequent better clinical outcome that could be mechanistically linked to the inhibition of the ultimate damage of infarcted myocardium by infiltrating neutrophils. [ABSTRACT FROM AUTHOR]

Myocardial infarction and post-infarction left ventricular remodelling involve a high risk of morbidity and mortality. For this reason, ongoing research is being conducted in order to learn the mechanisms of unfavourable left ventricular remodelling following a myocardial infarction. New biomarkers are also being sought that would allow for early identification of patients with a high risk of post-infarction remodelling and dysfunction of the left ventricle. In recent years, there has been ever more experimental data that confirms the significance of microRNA in cardiovascular diseases. It has been confirmed that microRNAs are stable in systemic circulation, and can be directly measured in patients' blood. It has been found that significant changes occur in the concentrations of various types of microRNA in myocardial infarction and heart failure patients. Various types of microRNA are also currently being intensively researched in terms of their usefulness as markers of cardiomyocyte necrosis, and predictors of the post-infarction heart failure development. This paper is a summary of the current knowledge on the significance of microRNA in post-infarction left ventricular remodelling and heart failure. [ABSTRACT FROM AUTHOR]

View large Download slide View large Download slide An increase in left ventricular volume after a myocardial infarction is a key component of the adverse remodelling process leading to chamber dysfunction, heart failure and an unfavourable outcome. Hence, the therapeutic strategies have been designed to reverse the remodelling process by medical therapy, devices or surgical strategies. Surgical ventricular reconstruction primarily combined with myocardial revascularization has been introduced as an optional intervention aimed to reduce the left ventricle through resection of the scar tissue and is recommended in selected patients with predominant heart failure symptoms, and with myocardial scarring and moderate left ventricular remodelling. This review outlines the rationale and the technique for reconstructing the left ventricle and the possible indications for using that technique, based on experiences from the centre with the largest international experience. The major contributions in the literature are briefly discussed. [ABSTRACT FROM AUTHOR]

Aims The effect of MitraClip implantation on left ventricular (LV) remodelling has been shown to be highly variable. The present study wants to assess patterns of LV remodelling and its relationship with outcome. Methods and results Serial echocardiography before, 1 and 6 months after MitraClip implantation was performed in 79 pts with severe mitral regurgitation (MR) (age 74 ± 10 years, New York Heart Association III/IV 80%, LV ejection fraction 38 ± 13%, logistic EuroSCORE 21 ± 15, and functional MR 81%). LV reverse/adverse remodelling was defined as a >15% decrease/>10% increase in LV end-diastolic volume (LVEDV), respectively. Patients were followed over a period of 32 ± 16 months with all-cause mortality as the primary endpoint. A sustained (6 month) reduction of MR ≤ 2 post-MitraClip implantation was observed in 83% of patients. The average decrease in LVEDV 6 months after intervention was 13% ± 16%. Reverse remodelling at 6 months occurred in 40 patients (51%), and adverse remodelling occurred in 6 patients (8%). Patients with adverse remodelling showed a 38% increase of LVEDV at 1 month vs. no early change in LVEDV in patients with reverse remodelling. During follow-up, a total of 25 patients (32%) died. Patients with adverse remodelling died more frequently than patients with reverse remodelling [67% vs. 27%, adjusted odds ratio of 5.6 (95% CI 1.5–21)]. Conclusion The majority of patients undergoing MitraClip implantation for severe MR showed LV reverse remodelling. However, there was a small group in whom afterload mismatch resulted in sustained adverse remodelling with subsequent high mortality. [ABSTRACT FROM AUTHOR]

Highlights • Vitamin D deficiency is highly prevalent among patients with myocardial infarction. • Vitamin D deficiency is associated with RAAS activation, endothelial cell and platelet function, inflammation, insulin resistance and blood pressure. • Low Vitamin D plasma levels are associated with the development of adverse LV remodelling. • Patients with adverse LV remodelling after myocardial infarction have a higher rate of events during the follow-up. [ABSTRACT FROM AUTHOR]

Aims: In a randomized trial of cardiac resynchronization therapy (CRT), a presumed optimal left ventricular (LV) lead position close to the latest mechanically activated non-scarred myocardium was achieved in 98% of patients by standard implantation. We evaluated whether inter-lead electrical delay (IED) was associated with response to CRT in these patients.Methods and results: We prospectively included 160 consecutive patients undergoing CRT. Pre-implant speckle-tracking echocardiography radial strain and 99mTc myocardial perfusion imaging determined the latest mechanically activated non-scarred myocardial segment. We measured procedural IED as the time interval between sensed signals in right ventricular and LV lead electrograms. All patients had LV pacing site concordant or adjacent to the latest mechanically activated non-scarred segment verified by cardiac computed tomography. Response to CRT was defined as ≥15% reduction in LV end-systolic volume at 6 months follow-up. Selecting a practical IED cut-off value of 100 ms, more patients with long IED than patients with short IED responded to CRT (87 vs. 68%; P = 0.004). In multivariate logistic regression analysis, IED ≥100 ms remained associated with CRT response after adjusting for baseline characteristics, including QRS duration and scar burden [odds ratio 3.19 (1.24-8.17); P = 0.01]. Categorizing IED by tertiles, CRT response improved with longer IED (P = 0.03). Comparable response rates were observed in patients with a concordant and adjacent LV lead position.Conclusion: A longer IED was associated with more pronounced LV reverse remodelling response in CRT recipients with a presumed optimal LV lead position concordant or adjacent to the latest mechanically activated non-scarred segment. [ABSTRACT FROM AUTHOR]

Aims Inhalation of nitric oxide (iNO) during myocardial ischaemia and after reperfusion confers cardioprotection in preclinical studies via enhanced cyclic guanosine monophosphate (cGMP) signalling. We tested whether iNO reduces reperfusion injury in patients with ST-elevation myocardial infarction (STEMI; NCT01398384). Methods and results We randomized in a double-blind, placebo-controlled study 250 STEMI patients to inhale oxygen with (iNO) or without (CON) 80 parts-per-million NO for 4 h following percutaneous revascularization. Primary efficacy endpoint was infarct size as a fraction of left ventricular (LV) size (IS/LVmass), assessed by delayed enhancement contrast magnetic resonance imaging (MRI). Pre-specified subgroup analysis included thrombolysis-in-myocardial-infarction flow in the infarct-related artery, troponin T levels on admission, duration of symptoms, location of culprit lesion, and intra-arterial nitroglycerine (NTG) use. Secondary efficacy endpoints included IS relative to risk area (IS/AAR), myocardial salvage index, LV functional recovery, and clinical events at 4 and 12 months. In the overall population, IS/LVmass at 48–72 h was 18.0 ± 13.4% in iNO (n  = 109) and 19.4 ± 15.4% in CON [ n  = 116, effect size −1.52 4 %, 95% confidence interval (95% CI) −5.28, 2.24; P  = 0.427]. Subgroup analysis indicated consistency across clinical confounders of IS but significant treatment interaction with NTG (P  = 0.0093) resulting in smaller IS/LVmass after iNO in NTG-naïve patients (n  = 140, P  < 0.05). The secondary endpoint IS/AAR was 53 ± 26% with iNO vs. 60 ± 26% in CON (effect size −6.8%, 95% CI −14.8, 1.3, P  = 0.09) corresponding to a myocardial salvage index of 47 ± 26% vs. 40 ± 26%, respectively, P  = 0.09. Cine-MRI showed similar LV volumes at 48–72 h, with a tendency towards smaller increases in end-systolic and end-diastolic volumes at 4 months in iNO (P  = 0.048 and P  = 0.06, respectively, n  = 197). Inhalation of nitric oxide was safe and significantly increased cGMP plasma levels during 4 h reperfusion. The Kaplan–Meier analysis for the composite of death, recurrent ischaemia, stroke, or rehospitalizations showed a tendency toward lower event rates with iNO at 4 months and 1 year (log-rank test P  = 0.10 and P  = 0.06, respectively). Conclusions Inhalation of NO at 80 ppm for 4 h in STEMI was safe but did not reduce infarct size relative to absolute LVmass at 48–72h. The observed functional recovery and clinical event rates at follow-up and possible interaction with nitroglycerine warrant further studies of iNO in STEMI. [ABSTRACT FROM AUTHOR]

Background Cardiac rehabilitation (CR) exercise training is beneficial after myocardial infarction (MI). Whilst the peripheral adaptations to training are well defined, little is known regarding the effect on left ventricular (LV) remodelling, particularly LV function. Efficient LV ejection and filling is achieved through deformation and rotation of the myocardium in systole and diastole – LV mechanics. The response of LV mechanics to CR exercise training in MI patients is unknown. Methods In this observational exploratory study, 36 (of 40 enrolled) male, MI patients completed either 10-weeks of twice-weekly gym based cardiovascular exercise at 60–80% VO 2peak ( n = 18), or a non-exercise control period ( n = 18). Cardiopulmonary exercise testing and speckle tracking echocardiography were performed at baseline and 10 weeks. Results Compared to the non-exercise group, VO 2peak improved with CR exercise training (Difference: +4.28 [95% CI: 1.34 to 7.23] ml.kg −1 .min −1 , P = 0.01). Neither conventional LV structural or functional indices, nor LV global longitudinal strain, significantly changed in either group. In contrast, LV twist and twist velocity decreased in the exercise group and increased in the non-exercise group (Difference: −3.95° [95% CI: −7.92 to 0.03°], P = 0.05 and −19.2°.s −1 [95% CI: −35.9 to −2.7°.s −1 ], P = 0.02, respectively). Conclusion In MI patients who completed CR exercise training, LV twist and twist velocity decreased, whereas these parameters increased in patients who did not exercise. These preliminary data may indicate reverse LV functional remodelling and improved functional reserve. The assessment of LV twist may serve as an indicator of the therapeutic benefit of CR exercise training and should be investigated in larger trials. [ABSTRACT FROM AUTHOR]

Post-myocardial infarction (MI) patients has varied outcome despite successful reperfusion. Our study aimed to use cardiac magnetic resonance imaging (CMR) to explore parameters that may influence outcome in successfully reperfused post-MI patients. We used left ventricular (LV) remodelling and major adverse cardiovascular event (MACE) at 6 months as a pooroutcome indicator. Consecutive patients admitted to Sarawak Heart Centre from Dec 2012 to Nov 2014 with acute anterior or inferior ST elevation MI were screened. A total of 101 patients with TIMI-3 flow were recruited. Patients underwent CMR imaging during the index admission, and another between 3 to 6 months later. LV remodelling occurred in 21.8% while microvascular obstruction (MVO) in 38.6% of patients. LV infarct size and MVO were significant in those who developed LV remodelling, while door-to-perfusion time and total-ischaemic time were not significantly different. MACE was significant in patients with larger infarcts but not significant in patients with MVO. LV infarct size was also significant in those who had reverse LV remodelling. These results suggest that early CMR measurement of infarct size and detection of MVO has the potential to predict LV improvement or deterioration at 6 months. [ABSTRACT FROM AUTHOR]

Introduction: Left ventricular hypertrophy (LVH) is a common compensating process in the pressure overload mechanism of aortic stenosis (AS). Aim: To identify a group of patients with a LVH pattern which may alter periprocedural and 1-year outcomes after transcatheter aortic valve implantation (TAVI). Material and methods: Echocardiographic examinations of 226 patients with severe AS treated with TAVI between March 2010 and February 2016 were retrospectively analysed and correlated with echocardiographic parameters and clinical outcomes in the study group. Ultimately 208 patients were enrolled in the study. Based on left ventricular mass index (LVMI) and relative wall thickness (RWT) patients were divided into three categories: concentric remodelling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH). Most of the patients with severe AS referred for TAVI were found to have CH (n = 150, 72.8%), then EH (n = 33, 16%) and CR (n = 16, 7.8%). Results: There were no significant differences between groups in terms of periprocedural outcomes or complications. After a mean observation time of 561.8 ±239.0 days, the observed all-cause mortality rate was 19.9%. After multivariable adjustment, CR remained associated with a higher risk of mortality (HR = 4.31; 95% CI: 1.607-11.538; p = 0.004). Conclusions: Left ventricular hypertrophy is common in patients with severe AS prior to TAVI. The LVH pattern does not affect TAVI-related complications. In patients with severe AS referred for TAVI, CR seems to be the least favourable geometry of LVH, increasing the risk of 1-year all-cause death. [ABSTRACT FROM AUTHOR]

Purpose:Left ventricular (LV) remodelling is observed in numerous patients with hypertension and is a principal cause of heart failure in elderly patients. The aim of this study was to determine the relationships between age and structural/functional LV remodelling observed in elderly hypertensive patients. Methods:A total of 557 elderly hypertensive patients (mean age: 74.0 ± 8.6 years) with preserved LV systolic function underwent echocardiography and 24-hour blood pressure (BP) measurement. Results:Overall, 41.1% of patients had LV hypertrophy, 77.9% had increased relative wall thickness (RWT) defined as RWT >0.42, and 31.8% had both. Logistic analysis of the entire study population showed that increased RWT was associated with both 24-hour systolic BP (odds ratio (OR) 1.38, 95% confidence interval (CI) 1.12 to 1.70) and age (OR 1.32, 95%CI 1.08 to 1.61), whereas increased RWT was associated only with age (OR 1.61, 95%CI 1.23 to 2.11) after excluding patients with LV hypertrophy. Univariate and multivariate linear regression analyses of all patients showed that LV diastolic echocardiographic parameters were consistently associated with age (p ≤ .001) alone, even considering LV structural changes. Conclusions:Age was independently correlated with LV concentric/functional changes regardless of LV hypertrophy, suggesting that ageing is independently involved in the progression of LV remodelling. [ABSTRACT FROM AUTHOR]

Background Novel biomarkers representing different pathobiological pathways and their role in patients with acute myocardial infarction ( AMI) were studied. Methods We retrospectively analysed serum levels of soluble suppression of tumorigenicity ( sST2), growth-differentiation factor-15 ( GDF-15), soluble urokinase plasminogen activator receptor (su PAR), heart-type fatty acid-binding protein (H- FABP) and plasma fetuin A in blood of patients with AMI ( STEMI, n = 61; NSTEMI, n = 57) compared to controls with excluded coronary artery disease ( n = 76). Furthermore, detailed correlation analysis was performed. Results Compared with controls, in patients with STEMI and NSTEMI higher levels expressed as median of sST2 in pg/mL ( STEMI: 13210·9, NSTEMI: 11989·1, control: 5248; P < 0·001), GDF-15 in pg/mL ( STEMI: 818·8, NSTEMI 677·5, control 548·6; P < 0·001), su PAR in pg/mL ( STEMI: 3461·1, NSTEMI: 3466·7, control: 2463·6; P < 0·001), H- FABP in ng/mL ( STEMI: 5·8, NSTEMI: 5·4, control: 0·0; P < 0·001) and lower plasma fetuin A levels in μg/mL ( STEMI: 95, NSTEMI: 54, control: 116·6; P < 0·001) were detected. Correlation analysis found clinical and biochemical parameters such as ejection fraction, length of hospital stay, creatine kinase, NT-pro BNP and hs Troponin T levels as well as inflammatory markers ( CRP, leucocytes) to be significantly correlated with novel biomarkers. Conclusion Plasma levels of novel biomarkers were significantly elevated ( sST2, GDF-15, H- FABP, su PAR) or inversely downregulated (fetuin A) in patients with AMI compared to a control group with excluded coronary artery disease. Significant correlations with various clinical parameters and standard biochemical markers were found. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the impact of the interaction of QRS duration and morphology on left ventricular (LV) reverse remodelling and LV functional improvement in heart failure (HF) patients treated with cardiac resynchronization therapy (CRT).Methods and Results: From an ongoing registry of HF patients treated with CRT according to contemporary guidelines, demographic, clinical, electrocardiographic (ECG) and echocardiographic characteristics were analysed. Patients were divided according to QRS duration and morphology: <150 ms vs. ≥150 ms and left bundle branch block (LBBB) vs. non-LBBB, respectively. Echocardiographic measurements were performed at baseline and at 6 months' follow-up. The effect of the interaction between QRS duration and morphology on LV reverse remodelling and LV ejection fraction (LVEF) was analysed using linear, mixed models. Of 1467 patients (mean age 65 ± 10 years, 77% male), 884 (60%) had a QRS ≥150 ms and 814 (55%) showed LBBB. The group with QRS ≥150 ms demonstrated larger LV reverse remodelling (mean reduction in LV end-systolic volume 34.3 mL vs. 14.8 mL; P < 0.001) and improvement in LVEF (mean increase 6.8% vs. 5.2%; P < 0.001) compared with their counterparts. Similarly, patients with LBBB QRS morphology showed greater LV reverse remodelling (mean reduction in LV end-systolic volume 30.8 mL vs. 17.4 mL; P < 0.001) and improvement in LVEF (mean increase 6.9% vs. 3.7%; P < 0.001) than those with non-LBBB QRS morphology.Conclusions: Left ventricular reverse remodelling and LV functional improvement are greater among HF patients with LBBB morphology and increasing QRS duration who receive CRT. [ABSTRACT FROM AUTHOR]

Left bundle branch block (LBBB) results in an altered pattern of left ventricular (LV) activation and subsequent contraction, causing remarkable changes in LV mechanics, perfusion and workload and ultimately leading to pathologic cardiac remodelling. Clinical and diagnostic notions about the LBBB phenomenon had evolved from just an electrocardiographic pattern to a critically important finding affecting diagnostic and clinical management of many patients and adversely influencing their outcomes. Recent advances in imaging techniques significantly improved the assessment of patients with LBBB and provided additional insights into pathophysiological mechanisms of LV remodelling. In the current review we summarized currently available data on the LBBB epidemiology, diagnosis, its impact on clinical management and prognosis, and the role and place of various imaging modalities in assessing cardiac mechanics and perfusion abnormalities, as well as their potential implications for diagnostic and treatment strategies. [ABSTRACT FROM AUTHOR]

Background & objectives: The clinical benefit of optimization (OPT) of atrioventricular delay (AVD) and interventricular delay (VVD) in cardiac resynchronization therapy (CRT) remains debatable. This study was aimed to determine the influence of AVD and VVD OPT on selected parameters in patients early after CRT implantation and at mid-term follow up (FU). Methods: Fifty two patients (61±10 yr, 23 males) with left bundle branch block, left ventricular ejection fraction (LVEF) ≤35 per cent and heart failure were selected for CRT implantation. Early on the second day (2DFU) after CRT implantation, the patients were assigned to the OPT or the factory setting (FS) group. Haemodynamic and electrical parameters were evaluated at baseline, on 2DFU after CRT and mid-term FU [three-month FU (3MFU)]. Echocardiographic measures were assessed before implantation and at 3MFU. The AVD/VVD was deemed optimal for the highest cardiac output (CO) with impedance cardiography (ICG) monitoring. Results: On 2DFU, the AVD was shorter in the OPT group, LV was paced earlier than in FS group and CO was insignificantly higher in OPT group. At 3MFU, improvement of CO was observed only in OPT patients, but the intergroup difference was not significant. At 3MFU in OPT group, reduction of LV in terms of LV end-diastolic diameter (LVeDD), LV end-systolic diameter, LV end-diastolic and systolic volume with the improvement in LVEF was observed. In FS group, only a reduction in LVeDD was present. In OPT group, the paced QRS duration was shorter than in FS group patients. Interpretation & conclusions: CRT OPT of AVD and VVD with ICG was associated with a higher CO and better reverse LV remodelling. CO monitoring with ICG is a simple, non-invasive tool to optimize CRT devices. [ABSTRACT FROM AUTHOR]

Objective: In patients with aortic regurgitation (AR), the effect of static exercise (SE) on global ventricular function and AR severity has not been previously studied.Methods: Resting and SE cardiovascular magnetic resonance (CMR) were prospectively performed in 23 asymptomatic patients with AR.Results: During SE, we observed a decrease in regurgitant volume in both end-diastolic (EDV) and end-systolic (ESV) volume in both ventricles, as well as a slight decrease in LV ejection fraction (EF). Interestingly, responses varied depending on the degree of LV remodelling. Among patients with a greater degree of LV remodelling, we observed a decrease in LVEF (56 ± 4 % at rest vs 48 ± 7 % during SE, p = 0.001) as a result of a lower decrease in LVESV (with respect to LVEDV. Among patients with a lower degree of LV remodelling, LVEF remained unchanged. RVEF remained unchanged in both groups.Conclusions: In patients with AR, SE provoked a reduction in preload, LV stroke volume, and regurgitant volume. In those patients with higher LV remodelling, we observed a decrease in LVEF, suggesting a lower LV contractile reserve.Key Points: • In patients with aortic regurgitation, static exercise reduced preload volume. • In patients with aortic regurgitation, static exercise reduced stroke volume. • In patients with aortic regurgitation, static exercise reduced regurgitant volume. • In patients with greater remodelling, static exercise unmasked a lower contractile reserve. • Effect of static exercise on aortic regurgitation was assessed by cardiac MR. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: In clinical practice, left ventricular hypertrophy (LVH) is defined by physical findings and electrocardiographic criteria, which are useful but imperfect tools, echocardiographic criteria and cardiac magnetic resonance imaging. In echocardiography, LVH is defined not by left ventricular wall thicknesses but by left ventricular mass. The latter is calculated according to Devereux's formula, and is increased by insulin resistance/hyperinsulinaemia. It is however unclear whether insulin resistance, hyperinsulinaemia, or both, is actually causative and what their collective or individual influence is on the components of Devereux's formula and parameters of left ventricular diastolic function. This study evaluated the associations of the homeostatic model assessment for insulin resistance (HOMAIR) and fasting plasma insulin levels with components of Devereux's formula and parameters of left ventricular diastolic function., Methods: Relevant clinical data were collected from 220 hypertensive patients recruited between January and December 2019. The associations of components of Devereux's formula and parameters of diastolic function with insulin resistance were tested using binary ordinal, conditional and classical logistic regression models., Results: Thirty-two (14.5%) patients (43.9 ± 9.1 years), 99 (45%) patients (52.4 ± 8.7 years) and 89 (40.5%) patients (53.1 ± 9.8 years) had normal left ventricular geometry, concentric left ventricular remodelling and concentric left ventricular hypertrophy, respectively. In multivariable adjusted analysis, 46.8% of variation in interventricular septum diameter (R ² = 0.468; overall p = 0.001) and 30.9% of E-wave deceleration time (R ² = 0.309; overall p = 0.003) were explained by insulin level and HOMAIR, 30.1% of variation in left ventricular end-diastolic diameter (R ² = 0.301; p = 0.013) by HOMAIR alone, and 46.3% of posterior wall thickness (R ² = 0.463; p = 0.002) and 29.4% of relative wall thickness (R ² = 0.294; p = 0.007) by insulin level alone., Conclusions: Insulin resistance and hyperinsulinaemia did not have the same influence on the components of Devereux's formula. Insulin resistance appeared to act on left ventricular end-diastolic diameter, while hyperinsulinaemia affected the posterior wall thickness. Both abnormalities acted on the interventricular septum and contributed to diastolic dysfunction via the E-wave deceleration time.

Aim. Mitral valve surgery results in the left ventricular (LV) remodelling and adjustment to the new preload and afterload. This study evaluated the dynamics ofLVgeometry and function immediately after surgical correction of mitral valve (MV) degenerative prolapse. Material and methods. This prospective study included 40 patients: 25 after MV surgery and 15 after coronary artery bypass graft surgery. The latter group served as controls, in order to assess potential impact of cardiopulmonary bypass and cardioplegic arrest onLV function. All participants underwent intraoperative transesophageal echocardiography, before and after cardiopulmonary bypass, after protamine infusion and hemodynamic stabilisation. Simultaneous pulmonary catheterisation ensured that the echocardiographic data were obtained in similar hemodynamic conditions. Results. Immediately after MV surgery,LV fractional area change decreased from 65±7% to 52±% (p

Aim. To study left ventricular (LV) remodelling types and their association with age, gender, duration of arterial hypertension (AH), and cardiac arrhythmias in elderly patients with Stage II–III AH. Material and methods. The study included 80 AH patients (23 men, 57 women) with different levels of cardiovascular risk (age 60–86 years; mean age 72,4±6,5 years). The mean AH duration was 19,6±6,8 years. All participants underwent echocardiography and long-term ECG monitoring. Statistical analyses were performed using “Statistica-6.0” software (StatSoft Inc., 1984–2001). Results. In the study sample of elderly AH patients, the following geometricLV models were registered: concentricLV remodelling (n=30, 37,5%), concentricLV hypertrophy (n=36, 45,0%), and eccentricLV hypertrophy (n=36, 45,0%). The most prevalent cardiac arrhythmia was the combination of supraventricular (SVE) and ventricular (VE) extrasystoles, particularly in patients with concentricLV hypertrophy. In this group, atrial fibrillation was also prevalent. The second most prevalent cardiac arrhythmia was SVE, with the highest prevalence in patients with concentricLVremodelling. Conclusion. Elderly patients with Stage II–III AH were characterised by the high prevalence of concentricLV hypertrophy. This clinical group had the highest levels of cardiovascular risk, as well as the highest prevalence of cardiac arrhythmias, including arrhythmias with poor prognosis. Echocardiographic parameters ofLV remodelling were similar in patients aged 60–74 vs. 75+ years. There was a weak, albeit statistically significant, association betweenLV remodelling type and AH duration.

Aim. To identify the criteria of early left ventricular (LV) remodelling; to assess the baseline structure and function of left and right cardiac chambers, as well as their dynamics during adequate antihypertensive therapy (AHT), in patients with Stage 2 arterial hypertension (AH). Material and methods. In total, the study included 79 individuals: 35 patients with Stage 2 AH and 44 healthy volunteers. All participants underwent echocardiography (EchoCG), with the assessment of standard structural and functional remodelling parameters, as well as the original linear parameters “a”, “b”, and “c”, proposed by the authors. Twenty five AH patients were re-examined 1,5 years after the start of adequate AHT. Results. Even early stages of AH are characterised by left and right ventricular dysfunction, as a manifestation of complex heart reaction to pressure overload. Simple, accessible EchoCG criteria, specifically, linear parameters of LV geometry “a”, “b”, and “c”, have been proposed to assess LV remodelling at earlier stages, compared to traditional parameters and spherical index. Adequate AHT resulted in improvement of left and right heart structure and function, with geometric parameters “a” and “b” being the most sensitive criteria.Conclusion. In AH patients, the proposed linear parameters could be used as diagnostic criteria for earlyLV remodelling, as well as indicators of AHT effectiveness, considering their higher sensitivity, compared to traditional EchoCG parameters.

Aim. To investigate the variants of left ventricular (LV) remodelling in men aged 18-25 years, with and without arterial hypertension (AH). Material and methods. In total, the study included 211 men aged 18-25 years (mean age 21,1±0,14 years), with random blood pressure (BP) elevation at previous clinical examinations. All participants underwent repeat BP measurements, 24-hour BP monitoring (BPM), echocardiography with calculation of LV myocardial mass index (LVMMI) and relative wall thickness (RWT), and evaluation of LV diastolic function (DF). Results. According to the results of clinical BP measurements and 24-hour BPM, normal BP levels were observed in 36 participants (17 %), stable AH — in 124 (58,7 %), and unstable AH — in 51 (24,3 %). In patients with stable AH, LVMMI was significantly higher than in individuals with normal BP. Among participants with stable AH, 43 (34,7 %) had normal LV geometry, 75 (60,5 %) had concentric LV remodelling, and 6 (4,8 %) — concentric LV hypertrophy. Among participants with unstable AH, 14 (27,5 %) had concentric LV remodelling. Comparing to normotensive individuals, patients with stable and unstable AH had lower transmitral flow ratio E/A, and significantly higher peak A velocity. Conclusion. In young 18-25-year-old men with stable AH, the typical LV remodelling variant was concentric remodelling, with a tendency towards LV diastolic dysfunction development.

Aim. To investigate left ventricular (LV) remodelling variants in patients with chronic renal disease.Material and methods. The study included 150 patients with primary renal parenchymal disease, various stages of chronic kidney failure (CKF), and secondary arterial hypertension (AH). General clinical examination, laboratory tests, and renal function assessment were performed. LV remodelling was assessed by echocardiography.Results. LV concentric and eccentric hypertrophy (LVCH and LVEH) were more prevalent in more advanced stages of CKF, and were often combined with rigid and pseudo-normal types of diastolic dysfunction. In patients on hemodialysis, LVEH was associated with restrictive and pseudo-normal types of diastolic dysfunction. In hemodialysis patients, the symptoms of chronic heart failure (CHF) were explained by systolic and diastolic dysfunction, while early CKF stages were associated with diastolic HF only.Conclusion. In chronic renal disease, structural and functional LV changes require active drug therapy, delaying the progression of myocardial remodelling and HF.

Aim: To study the specifics of heart pathology in patients with Stage I-III arterial hypertension (AH) and present or absent metabolic syndrome (MS).Material and methods: The study included 303 patients with Stage I-III AH and MS, aged 25-70 years (mean age 52±18 years); 110 men and 193 women. All patients were divided into 2 groups (AH+MS and AH-MS) by MS presence or absence, respectively. The groups were comparable by sex and age distribution. Each group was also divided into three subgroups by AH stage (I-III). Left ventricular (LV) diastolic dysfunction (DD) was assessed by transmitral flow dopplerography (TFD), pulmonary vein dopplerography (PVD), and impulse-wave myocardial tissue dopplerography (MTD).Results: In patients with AH and MS, LV myocardial mass increase and LV remodelling were observed at earlier AH stage, comparing to MS-free hypertensive patients. MTD demonstrated early LV diastolic dysfunction in 85 % and 88 % of the Stage I and Stage II AH patients, respectively. For TFD method, these figures were 33 % and 44 %, respectively.Conclusion. The combination of MS and Stage I-III AH, comparing to AH only, was characterized by more severe LV diastolic dysfunction and LV remodelling at early stages of the disease.

Cardiac resynchronisation therapy (CRT) has an established role in the management of patients with heart failure, reduced left ventricular ejection fraction (LVEF < 35%) and widened QRS (>130 msec). Despite the complex pathophysiology of left ventricular (LV) dyssynchrony and the increasing evidence supporting the identification of specific electromechanical substrates that are associated with a higher probability of CRT response, the assessment of LVEF is the only imaging-derived parameter used for the selection of CRT candidates. This review aims to (1) provide an overview of the evolution of cardiac imaging for the assessment of LV dyssynchrony and its role in the selection of patients undergoing CRT; (2) highlight the main pitfalls and advantages of the application of cardiac imaging for the assessment of LV dyssynchrony; (3) provide some perspectives for clinical application and future research in this field., Conclusion: the road for a more individualized approach to resynchronization therapy delivery is open and imaging might provide important input beyond the assessment of LVEF., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Galli, Galand, Le Rolle, Taconne, Wazzan, Hernandez, Leclercq and Donal.)

Aims To investigate the influence of cardiovascular risk factors (CV-RFs) on infarct severity and post-infarction left ventricular (LV) remodelling in acutely reperfused ST-segment elevation myocardial infarction (STEMI) patients studied with cardiovascular magnetic resonance (CMR). Methods and results Four-hundred seventy-one patients were included in the study. Baseline CMR was performed at 4+1 days after STEMI to assess area-at-risk, infarct size (IS), myocardial salvage index (MSI), microvascular obstruction (MVO), intramyocardial haemorrhage (IMH), LV volumes, and function. Cardiovascular magnetic resonance was repeated 4 months after STEMI (n = 383) to assess adverse LV remodelling (increase of LV end-diastolic volume .20% between baseline and follow-up). Smoking was associated with IMH at baseline even after correction for other factors associated with ischaemia- reperfusion injury including MVO, IS, and MSI (OR: 2.17, 95% CI: 1.17-4.00, P = 0.01). Unexpectedly, smoking was an independent protective predictor against adverse LV remodelling (OR: 0.43, 95% CI: 0.24-0.77, P = 0.005), consistent with the 'smoker's paradox'. However, the presence of IMH at baseline abolished the paradoxical, beneficial effects of smoking with respect to IS, baseline LV function, and post-infarction LV remodelling. No association between other CV-RFs, infarct severity, or post-infarction LV remodelling was observed. Conclusion In patients with reperfused STEMI, smoking is strongly and independently associated with IMH at baseline. Nonetheless, consistent with the 'smoker's paradox', smoking was an independent predictor of more favourable post-infarction LV remodelling. However, the paradoxical beneficial effects of smoking were lost in patients with IMH. [ABSTRACT FROM AUTHOR]

Aim: Dilated cardiomyopathy (DCM) has a variety of causes, and no useful approach to predict left ventricular (LV) remodelling and long-term outcome has yet been established. Myocardial tenascin-C (TNC) is known to appear under pathological conditions, possibly to regulate cardiac remodelling. The aim of this study was to clarify the significance of myocardial TNC expression in LV remodelling and the long-term outcome in DCM.Methods and Results: One hundred and twenty-three consecutive DCM patients who underwent endomyocardial biopsy for initial diagnosis were studied. Expression of TNC in biopsy sections was analysed immunohistochemically to quantify the ratio of the TNC-positive area to the whole myocardial tissue area (TNC area). Clinical parameters associated with TNC area were investigated. The patients were divided into two groups based on receiver operating characteristic analysis of TNC area to predict death: high TNC group with TNC area ≥2.3% (22 patients) and low TNC group with TNC area <2.3% (101 patients). High TNC was associated with diabetes mellitus. Comparing echocardiographic findings between before and 9 months after endomyocardial biopsy, the low TNC group was associated with decreased LV end-diastolic diameter and increased LV ejection fraction, whereas the high TNC group was not. Survival analysis revealed a worse outcome in the high TNC group than in the low TNC group (P < 0.001). Multivariable Cox regression analysis revealed that TNC area was independently associated with poor outcome (HR = 1.347, P = 0.032).Conclusions: Increased myocardial TNC expression was associated with worse LV remodeling and long-term outcome in DCM. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Persistent left ventricular (LV) hypertrophy after surgery is frequent, but its clinical relevance is controversial. We evaluated if residual LV hypertrophy (LVH) is associated with clinical outcomes after aortic valve replacement (AVR) for severe aortic stenosis (AS). METHODS: We analysed clinical and echocardiographic parameters before and after AVR, in a prospective cohort of 132 patients with severe AS. The mean follow-up was 6.0 ± 1.5 years. Clinical endpoints were all-cause death and combination of as in all-cause death and non-fatal cardiovascular hospitalization. At AVR, myocardial biopsies for collagen volume fraction (CVF) evaluation were done in 56 random patients. RESULTS: Residual LVH was present in 44% of patients after AVR. Patients with residual LVH were older, more frequently women and had hypertension (HT). Preoperatively, they had higher LV mass indices (LVMI), higher E/e0 and left atrial volume indices, as well as lower peak systolic annular velocity. Female gender, HT, LVMI and E/e0 were independent predictors of persistent LVH. CVF at the time of surgery was higher in those with residual LVH (20.0 ± 14.6 vs 13.2 ± 11.5%, P = 0.027). The risk of all-cause death and non-fatal cardiovascular hospitalization was higher in patients with residual LVH [OR 2.89 (95% CI 1.12-7.44); P = 0.035], but there were no differences in all-cause mortality. Residual LVH was associated with a worse outcome in women but not in men. CONCLUSIONS: Residual LVH after AVR is common and is associated with worse prognosis, particularly in women. In addition, HT, higher baseline LVM and worse diastolic dysfunction can help to identify patients at risk for incomplete normalization of LVM. [ABSTRACT FROM AUTHOR]

Aims We sought to determine whether peri-infarct pacing prevents left ventricular (LV) remodelling and improves functional and clinical outcomes in patients with large first myocardial infarction (MI). Methods and results A total of 126 patients at 27 international sites within 10 days of onset of anterior or non-anterior MI with creatine phosphokinase >3000 U/L and QRS duration ≤120 ms were randomized 1:1:1 to dual-site biventricular pacing vs. single- site LV only pacing vs. non-implanted control. The primary endpoint was the echocardiographic core laboratoryassessed change in LV end-diastolic volume (ΔLVEDV) from baseline to 18 months between the pooled pacing therapy groups and the control group. ΔLVEDV increased by 15.3±28.6 mL in the control group and by 16.7±0.5 mL in the pooled pacing groups during follow-up (adjusted mean difference (95% CI) = 0.6 (-12.3, 13.5) mL, P = 0.92). There were also no significant between-group differences in the change in LV end-systolic volume or ejection fraction over time. Quality of life, as assessed by the Minnesota Living with Heart Failure (HF) and European Quality of Life-5 Dimension questionnaires and New York Heart Association class, was also similar between groups during 18-month follow-up. Six-minute walk distance improved during follow-up to an equal degree between groups, and there were no significant differences in the 18-month rates of death or HF hospitalization between the pooled pacing therapy vs. control groups (17.4 vs. 21.7% respectively, P = 0.59). Conclusions In the present multicentre, randomized trial, peri-infarct pacing did not prevent LV remodelling or improve functional or clinical outcomes during 18-month follow-up in patients with large first MI. [ABSTRACT FROM AUTHOR]