Nhola, Lara F.

Abstract Background The left ventricle (LV) undergoes different types of remodeling to normalize its wall stress. There has been an increase in the trend in research regarding the process of remodeling but little is known about how LV volumes and global longitudinal strain (GLS) may vary depending upon the type of remodeling. Purpose To define the values of LV volumes and GLS in patients with different types of LV remodeling with normal ejection fraction (EF). Methods Single center retrospective study conducted from 2008 to 2018. We selected 10,356 subjects >18 years (5808 females, 4548 males) with normal EF and who underwent 2D echocardiography (2DE) at Mayo clinic, Rochester. They were categorized into 4 groups (Figure) i.e., group 1 = normal geometry, group 2 = concentric remodeling, group 3 = concentric hypertrophy, group 4 = eccentric hypertrophy based on their LV mass index (102 g/m2 in males, 88 g/m2 in females) and relative wall thickness (0.42) values measured by 2DE (figure). The patterns of LV GLS, end diastolic and end systolic volumes (EDV, ESV) indexed to body surface area were analyzed in these four groups by gender and body mass index (BMI). Mean±SD, One-way Anova, two sample t-test and Tukey- Kramer HSD were applied. Results The mean age of the selected population is 57.9 years ±14.9 (females=57.7±14.7, males=58.2±15.1) and the body surface area of 1.9 m2±0.2 (females=1.8±2 and males=2.1±0.2). The LV GLS values (Figure) of groups 1, 2, 3 and 4 were −20.7, −18.9, −17.5 and −19.9 and their EDV cc/m2 values were 63.6, 58.5, 61.2 and 68.2 respectively. LV GLS and Biplane EF values were higher in females while Biplane EDV and ESV were higher in males. When each gender is sub-divided based on their BMI (<25 and ≥25), the LV GLS, EDV and ESV values were higher in all groups with BMI<25 except in males with concentric remodeling and females with concentric hypertrophy where they were low. Remodeling distribution Conclusion To our knowledge, this is the biggest single center study to evaluate LV GLS and volumes based on type of remodeling by gender and BMI. When compared with normal geometry, LV volumes and GLS values were statistically different among each type of remodeling as well as for gender and BMI. These results can be used as reference values in patient population studies where remodeling is being analyzed in subjects with normal LV EF. Acknowledgement/Funding None

Abstract Background: Aortic valve stenosis (AS) commonly causes left ventricular (LV) pressure overload; thus, identifying patients with adverse remodeling/early LV dysfunction is critical. We compared 2-dimensional (2D) to 3-dimensional (3D) echocardiographic measures of LV myocardial deformation in patients with severe AS and studied the relation of LV preload and afterload (Zva) to myocardial deformation. Methods: We prospectively included 168 symptomatic patients (72±12 years) with severe AS and ejection fractions ≥50%. Strain parameters from those patients were compared with normal values found in the literature. 3D full-volume and 2D images were analyzed for global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), systolic strain rate (SRs), basal rotation (Rotmax-B), apical rotation (Rotmax-A), and peak systolic twist (Twistmax). Results: 2D–GLS and 2D–GCS decreased significantly compared with normal values (P˂.001 and P=.02, respectively); 2D Rotmax-B and Twistmax increased (P˂.001 vs normal values). Agreement between 2D–GLS and 3D–GLS by concordance correlation coefficient was 0.49 (95% CI, 0.39-0.57) in patients with AS. Both 2D– and 3D–GLS correlated with valvulo-arterial impedance (Zva) (r=0.34, P<.001; and r=0.23, P=.003, respectively). Conclusion: In patients with severe AS, GLS and GCS decreased, and basal rotation and twist increased to maintain LV ejection fraction. 2D– and 3D–GLS had a relatively fair agreement. Both 2D– and 3D–GLS correlated modestly with Zva.

Once universally considered a rapidly fatal condition, cancer has increasingly become a chronic medical condition and comorbidities and adverse effects of cancer therapies have become increasingly significant. One of the leading advancements that has gained traction for the treatment of a variety of malignancies is the class of small molecule tyrosine kinase inhibitors (TKIs). Although, in many aspects revolutionary, TKIs have their own profile of side effects, including cardiovascular side effects, the most common being hypertension (HTN), congestive heart failure, corrected QT (QTc) prolongation, and instances of premature coronary heart disease. Herein, we describe the mechanisms of small TKI‐induced cardiovascular toxicity and related intracellular signaling. In particular, systems‐based approaches to the understanding of small TKI‐induced cardiovascular toxicity are addressed. The pathophysiology of synergic cardiovascular toxicity from TKIs, anthracyclines, and monoclonal antibodies (e.g., trastuzumab, bevacizumab) is illustrated. Finally, recommendations are made for implementing systems medicine in clinical practice, for individualized cardiovascular wellness after cancer therapy.

PurposeInfarct mass as assessed by myocardial‐delayed enhancement imaging on cardiac magnetic resonance (CMR) and myocardial blood flow as assessed by real time myocardial perfusion echocardiography (RT‐MPE) have been shown to predict adverse events following ST elevation myocardial infarction (STEMI). There has been no published comparison of quantitative assessment using these modalities as predictors of clinical outcomes to date. We compared RT‐MPE with CMR for prediction of cardiac events in reperfused STEMI patients.Materials and MethodsConsecutive STEMI patients with early reperfusion were studied. RT‐MPE and CMR were performed. Perfusion score indices (PSIRT‐MPE and PSICMR) were calculated [sum of segmental perfusion scores/number of segments]. CMR infarct mass (g) and RT‐MPE myocardial blood flow (MBF dB/s) were quantified. Patients were followed for cardiac events (death, nonfatal MI, revascularization, angina, and heart failure).ResultsAll 27 patients (age 62±14; follow‐up 3.5±2.6 years) had thrombolysis in myocardial infarction (TIMI) grade 3 flow of infarct vessel. Cardiac events occurred in 17 (63%). Cardiac event patients had higher PSIRT‐MPE, PSICMR, infarct mass, and lower MBF. PSIRT‐MPE cutoff of 0.3 had an AUC of 0.856 (82% sensitivity, 70% specificity), while a PSICMR cutoff of 0.2 had an AUC of 0.765 (76% sensitivity, 60% specificity). Infarct mass and MBF were independent predictors of cardiac events after adjusting for risk factors (hazard ratios: 20.9 [95% CI 1.8–256] P=.02 and 8.1 [95% CI 1.5–78] P=.01, respectively).ConclusionsQuantitative RT‐MPE performed comparably to CMR for prediction of MACE in STEMI patients supporting a prognostic role for this noninvasive, bedside imaging method.

To study the relationship between glycosylated hemoglobin (HgbA1c) and myocardial perfusion in type 2 diabetes mellitus (T2DM) patients, we prospectively enrolled 24 patients with known or suspected coronary artery disease (CAD) who underwent adenosine stress by real-time myocardial perfusion echocardiography (RTMPE). HgbA1c was measured at time of RTMPE. Microbubble velocity (β min−1), myocardial blood flow (MBF, mL/min/g), and myocardial blood flow reserve (MBFR) were quantified. Quantitative MCE analysis was feasible in all patients (272/384 segments, 71%). Those with HgbA1c > 7.1% had significantly lowerβreserveand MBFR than those with HgbA1c ≤ 7.1%(P<0.05). In patients with suspected CAD, there was a significant inverse correlation between MBFR and HgbA1c (r=-0.279,P=0.01); however, in those with known CAD, this relationship was not significant (r=-0.117,P=0.129). Using a MBFR cutoff value > 2 as normal, HgbA1c > 7.1% significantly increased the risk for abnormal MBFR, (adjusted odds ratio: 1.92, 95% CI: 1.12–3.35,P=0.02). Optimal glycemic control is associated with preservation of MBFR as determined by RTMPE, in T2DM patients at risk for CAD.