Longitudinal strain and myocardial work in symptomatic patients having recovered from COVID-19 and possible associations with the severity of the disease.

COVID-19 may have residual consequences in multiple organs, including the cardiovascular system. The purpose of the present investigation is to quantify myocardial function in symptomatic individuals with long COVID and investigate the association between illness severity and myocardial function. A retrospective cross-sectional study was conducted in which symptomatic individuals with previous COVID-19 underwent echocardiographic analysis of left ventricle global longitudinal strain (LVGLS) and myocardial work (MW). Individuals also performed cardiopulmonary testing (CPX) to assess peak oxygen uptake (VO2peak). Differences between illness severity subgroups were analyzed by the Mann-Whitney test. Correlations were calculated using the Spearman correlation test. Multilinear regressions were performed to evaluate the influences of COVID-19 severity, body mass index, age, and sex on MW. Fifty-six individuals were included (critical subgroup: 17; moderate/severe subgroup: 39), 59% females; median age: 56 years (IQR: 43-63). CPX revealed a substantial reduction in VO2peak (median of 53% of predicted values). LVGLS were not statistically different between subgroups. Global wasted work (GWW) was higher in the critical subgroup [146 (104-212) versus 121 (74-163) mmHg%, p = 0.01], and global work efficiency (GWE) was lower in this subgroup [93 (91-95) versus 94 (93-96), p = 0.03]. Illness severity was the only independent predictor of GWW and GWE (GWW: r2 = 0.167; p = 0.009; GWE: r2 = 0.172; p = 0.005) in multilinear regressions. In our study with long COVID-19 individuals, despite having a similar LVGLS, patients had subclinical LV dysfunction, demonstrated only by an increase in GWW and a decrease in GWE.

Left ventricular global longitudinal strain and cardiorespiratory fitness in patients with heart failure: systematic review and meta-analysis.

BACKGROUND: There is no definition for strain deformation values in relation to cardiorespiratory fitness (CRF) in different heart failure (HF) phenotypes. AIM: To identify the relationship between echocardiographic systolic function measurements and CRF in HF patients. METHODS: Systematic review and meta-analysis following the PRISMA recommendations. Studies reporting echocardiographic assessments of left ventricular global longitudinal strain (LVGLS), left ventricular ejection fraction (LVEF) and direct measurement of peak oxygen uptake (VO2peak) in HF patients with reduced or preserved LVEF (HFrEF, HFpEF) were included. The patients were divided into Weber classes according to VO2peak. RESULTS: Twenty-five studies involving a total of 2,136 patients (70.5% with HFpEF) were included. Mean LVEF and LVGLS were similar in HFpEF patients in Weber Class A/B and Class C/D. In HFrEF patients, a non-significant difference was found in LVEF between Weber Class A/B (30.2% [95%CI: 29.6 to 30.9%]) and Class C/D (25.2% [95%CI: 20.5 to 29.9%]). In HFrEF patients, mean LVGLS was significantly lower in Class C/D compared to Class A/B (6.5% [95%CI: 6.0 to 7.1%] and 10.3% [95%CI: 9.0 to 11.5%], respectively). The correlation between VO2peak and LVGLS (r2 = 0.245) was nearly twofold stronger than that between VO2peak and LVEF (r2 = 0.137). CONCLUSIONS: Low LVGLS values were associated with low CRF in HFrEF patients. Although a weak correlation was found between systolic function at rest and CRF, the correlation between VO2peak and LVGLS was nearly twofold stronger than that with LVEF, indicating that LVGLS may be a better predictor of CRF in patients with HFrEF.

Comportamento hemodinâmico e da função cardíaca de recém-nascidos com encefalopatia hipóxico-isquêmica submetidos a hipotermia terapêutica, avaliados pelas técnicas ecocardiográficas convencionais e avançadas / Hemodynamic behavior and cardiac function of newborns with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia, evaluated by conventional and advanced echocardiographic techniques

INTRODUÇÃO: a encefalopatia hipóxico-isquêmica (EHI) corresponde a uma das maiores causas de morbidade e mortalidade neonatal. Ocorre em consequência à asfixia perinatal aguda, representada por baixo escore de Apgar e evidências de distúrbios neurológicos ao nascimento. A hipotermia terapêutica (HT) tem mostrado benefícios relevantes no prognóstico neurológico a longo prazo. Os efeitos da HT no sistema cardiovascular são pouco estudados, suscitando questionamentos quanto a adequada interpretação dos achados ecocardiográficos nesta condição terapêutica. OBJETIVO: avaliar o comportamento hemodinâmico e da função cardíaca de recém-nascidos (RN) com EHI submetidos a HT, utilizando-se técnicas ecocardiográficas convencionais e avançadas. MÉTODO: trata-se de um estudo observacional prospectivo desenvolvido em três instituições que avaliou 22 RN com EHI nas duas fases da HT (durante a hipotermia e após o reaquecimento) e 22 RN saudáveis. Os bebês foram submetidos a HT seguindo critérios do protocolo de hipotermia de cada um dos serviços. RESULTADOS: houve redução da frequência cardíaca durante a hipotermia (p < 0,001) com significativa elevação após o reaquecimento (p < 0,001). Os valores do débito cardíaco direito e esquerdo foram maiores após a fase de reaquecimento (p = 0,005 e p < 0,001 respectivamente). A pressão sistólica da artéria pulmonar estava mais elevada nas duas fases da HT (p = 0,02 e p = 0,01). As frações de ejeção e encurtamento ficaram estáveis durante a HT, porém foram maiores após o reaquecimento comparados ao grupo controle (p = 0,003 e p = 0,002 respectivamente). Não se observou diferença no comportamento do strain longitudinal global, circunferencial e radial, twist e torção do ventrículo esquerdo durante o processo terapêutico. Observou-se aumento da velocidade da onda s´ do ventrículo direito (VD) após o reaquecimento comparado ao período de hipotermia e ao grupo controle (p < 0,001 para ambos). Houve queda da variação fracional das áreas do VD após o reaquecimento em relação ao grupo controle (p = 0,03). O strain longitudinal global do ventrículo direito (STLGVD) foi pior no grupo estudo. CONCLUSÃO: a função ventricular esquerda permanece estável nas duas fases da HT, demonstrando o baixo comprometimento cardíaco esquerdo do resfriamento induzido. Disfunção ventricular direita foi observada nos momentos em que a pressão pulmonar estava elevada. O STLGLVD foi a única ferramenta capaz de identificar comprometimento da função sistólica durante a HT. (AU)

Prospective comparison between three TAVR devices: ACURATE neo vs. CoreValve vs. SAPIEN XT. A single heart team experience in patients with severe aortic stenosis.

OBJECTIVE: We sought to compare the new transcatheter aortic valve replacement (TAVR) device ACURATE neo (ACT) with the already established CoreValve (MCV) and SAPIEN XT (SXT) for the treatment of severe aortic stenosis (AS). BACKGROUND: Very few data on TAVR devices are available beyond MCV and SAPIEN and there is no previous study comparing ACT with MCV and SXT. METHODS: We prospectively evaluated consecutive patients who underwent transfemoral TAVR for the treatment of severe AS. Clinical outcomes were reported following Valve Academic Research Consortium 2 (VARC-2) criteria. RESULTS: A total of 162 patients (ACT n = 49, MCV n = 56, SXT n = 57), were included. MCV group had higher valve embolization/migration rates (ACT none; MCV 9%; SXT 2%; P = 0.034) causing lower device success rates (ACT 98%; MCV 86%; SXT 95%; P = 0.043). At 30 days, there was no significant difference in all-cause mortality (P = 0.22), cardiovascular mortality (P = 0.20), periprocedural myocardial infarction (P = 0.40), stroke (P = 0.64), major vascular complications (P = 0.48), life-threatening bleeding (P = 0.29), acute kidney injury stage 2/3 (P = 0.69), or VARC-2 composite early safety endpoints (P = 0.21). MCV group had higher rates of new permanent pacemaker implantation (ACT 6%; MCV 25%; SXT 11%; P = 0.013). Follow-up echocardiography showed no significant difference in aortic valve mean pressure gradient (P = 0.73) or moderate/severe aortic regurgitation (P = 0.19) between groups. CONCLUSIONS: In a "real world" registry, ACT compared favorably against the well-studied SXT and MCV devices in both safety and efficacy. MCV implantation was associated with lower device success rates and higher rates of new permanent pacemaker implantation. © 2016 Wiley Periodicals, Inc.

Prospective comparison between three TAVR devices: ACURATE neo vs. CoreValve vs. SAPIEN XT. A single heart team experience in patients with severe aortic stenosis

OBJECTIVE: We sought to compare the new transcatheter aortic valve replacement (TAVR) device ACURATE neo (ACT) with the already established CoreValve (MCV) and SAPIEN XT (SXT) for the treatment of severe aortic stenosis (AS). BACKGROUND: Very few data on TAVR devices are available beyond MCV and SAPIEN and there is no previous study comparing ACT with MCV and SXT. METHODS: We prospectively evaluated consecutive patients who underwent transfemoral TAVR for the treatment of severe AS. Clinical outcomes were reported following Valve Academic Research Consortium 2 (VARC-2) criteria.RESULTS:A total of 162 patients (ACT n = 49, MCV n = 56, SXT n = 57), were included. MCV group had higher valve embolization/migration rates (ACT none; MCV 9%; SXT 2%; P = 0.034) causing lower device success rates (ACT 98%; MCV 86%; SXT 95%; P = 0.043). At 30 days, there was no significant difference in all-cause mortality (P = 0.22), cardiovascular mortality (P = 0.20), periprocedural myocardial infarction (P = 0.40), stroke (P = 0.64), major vascular complications (P = 0.48), life-threatening bleeding (P = 0.29), acute kidney injury stage 2/3 (P = 0.69), or VARC-2 composite early safety endpoints (P = 0.21). MCV group had higher rates of new permanent pacemaker implantation (ACT 6%; MCV 25%; SXT 11%; P = 0.013). Follow-up echocardiography showed no significant difference in aortic valve mean pressure gradient (P = 0.73) or moderate/severe aortic regurgitation (P = 0.19) between groups...

Serial assessment of arterial structure and function in patients with coarctation of the aorta undergoing stenting.

Stenting for CoA has become an acceptable treatment modality in the last 20 years. However little is known about arterial changes after this procedure. To assess arterial structure and function including peripheral reactivity and stiffness and intima-media thickness (IMT) pre and post stenting for coarctation of the aorta (CoA). Twenty-one patients [median age: 15 years (8-39)] were studied at baseline, 1 day, 6 months and 1 year after stenting. Twenty-one healthy subjects (1:1 matched) were used as controls. Left ventricular (LV) mass, ejection fraction, flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) of left brachial artery, common carotid (CC) and right subclavian artery (RSCA) IMT and pulse wave velocity (PWV) were assessed by echocardiography and vascular ultrasound. CoA patients had higher LV indexed mass (p < 0.0001), impaired FMD (p < 0.0001) and NMD (p < 0.0001), increased PWV (p < 0.0001), carotid and RSCA IMT (both p < 0.0001). All procedures were successful and resulted in significant gradient reduction (p < 0.001). One year after stenting there was improvement in LV function (p = 0.034) and although there was significant reduction of LV mass (103.29 ± 24.77 vs. 74.39 ± 22.07 g/m(2), p < 0.0001) values did not normalize. There was no significant change in FMD, NMD, PWV and CC or RSCA IMT. In patients with CoA, arterial reactivity is impaired and LV mass, arterial stiffness and thickness are increased. Although stenting is successful to relieve the obstruction resulting in better LV function and mass reduction, arterial structure and function remains abnormal after 1 year of follow-up.

Serial assessment of arterial structure and function in patients with coarctation of the aorta undergoing stenting

Stenting for CoA has become an acceptable treatment modality in the last 20 years. However little is known about arterial changes after this procedure. To assess arterial structure and function including peripheral reactivity and stiffness and intima-media thickness (IMT) pre and post stenting for coarctation of the aorta (CoA). Twenty-one patients [median age: 15 years (8-39)] were studied at baseline, 1 day, 6 months and 1 year after stenting. Twenty-one healthy subjects (1:1 matched) were used as controls. Left ventricular (LV) mass, ejection fraction, flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) of left brachial artery, common carotid (CC) and right subclavian artery (RSCA) IMT and pulse wave velocity (PWV) were assessed by echocardiography and vascular ultrasound. CoA patients had higher LV indexed mass (p < 0.0001), impaired FMD (p < 0.0001) and NMD (p < 0.0001), increased PWV (p < 0.0001), carotid and RSCA IMT (both p < 0.0001). All procedures were successful and resulted in significant gradient reduction (p < 0.001). One year after stenting there was improvement in LV function (p = 0.034) and although there was significant reduction of LV mass (103.29 ± 24.77 vs...

Early improvement in left atrial remodeling and function after mitral valve repair or replacement in organic symptomatic mitral regurgitation assessed by three-dimensional echocardiography.

BACKGROUND: Left atrial (LA) dilation is associated with worse prognosis in various clinical situations including chronic mitral regurgitation (MR). Real time three-dimensional echocardiography (3DE) has allowed a better assessment of LA volumes and function. Little is known about LA size and function in early postoperative period in symptomatic patients with chronic organic MR. We aimed to investigate these aspects. METHODS: By means of 3DE, 43 patients with symptomatic chronic organic MR were prospectively studied before and 30 days after surgery (repair or bioprosthetic valve replacement). Twenty subjects were studied as controls. Maximum (Vol-max), minimum, and preatrial contraction LA volumes were measured and total, passive, and active LA emptying fractions were calculated. RESULTS: Before surgery patients had higher LA volumes (P < 0.001) but smaller LA emptying fractions than controls (P < 0.01). After surgery there was a reduction in all 3 LA volumes and an increase in active atrial emptying fraction (AAEF). Multivariate analysis showed that independent predictors of early postoperative Vol-max reduction were preoperative diastolic blood pressure (coefficient = -0.004; P = 0.02), lateral mitral annular early diastolic velocity (e') (coefficient = 0.023; P = 0.008), and the mean transmitral diastolic gradient increment (coefficient = -0.035; P < 0.001). Furthermore, e' was also independently associated with AAEF increase (odds ratio = 1.66, P = 0.027). CONCLUSION: Early LA reverse remodeling and functional improvement occur after successful surgery of symptomatic organic MR regardless of surgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variables negatively related to Vol-max reduction. Besides, e' is positively correlated with both Vol-max reduction and AAEF increase.

Early Improvement in Left Atrial Remodeling and / Function after Mitral Valve Repair or Replacement in / Organic Symptomatic Mitral Regurgitation Assessed / by Three-Dimensional Echocardiography

Left atrial (LA) dilation is associated with worse prognosis in various clinical situationsincluding chronic mitral regurgitation (MR). Real time three-dimensional echocardiography (3DE) hasallowed a better assessment of LA volumes and function. Little is known about LA size and function inearly postoperative period in symptomatic patients with chronic organic MR. We aimed to investigatethese aspects. Methods: By means of 3DE, 43 patients with symptomatic chronic organic MR were prospectivelystudied before and 30 days after surgery (repair or bioprosthetic valve replacement). Twentysubjects were studied as controls. Maximum (Vol-max), minimum, and preatrial contraction LA volumeswere measured and total, passive, and active LA emptying fractions were calculated. Results: Before surgerypatients had higher LA volumes (P < 0.001) but smaller LA emptying fractions than controls(P < 0.01). After surgery there was a reduction in all 3 LA volumes and an increase in active atrial emptyingfraction (AAEF). Multivariate analysis showed that independent predictors of early postoperativeVol-max reduction were preoperative diastolic blood pressure (coefficient = 0.004; P = 0.02), lateralmitral annular early diastolic velocity (e0) (coefficient = 0.023; P = 0.008), and the mean transmitral diastolicgradient increment (coefficient = 0.035; P < 0.001). Furthermore, e0 was also independentlyassociated with AAEF increase (odds ratio = 1.66, P = 0.027). Conclusion: Early LA reverse remodelingand functional improvement occur after successful surgery of symptomatic organic MR regardless ofsurgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variablesnegatively related to Vol-max reduction. Besides, e0 is positively correlated with both Vol-max reductionand AAEF increase.

Preoperative left ventricular ejection fraction and left atrium reverse remodeling after mitral regurgitation surgery.

BACKGROUND: Left atrium enlargement has been associated with cardiac events in patients with mitral regurgitation (MR). Left atrium reverse remodeling (LARR) occur after surgical correction of MR, but the preoperative predictors of this phenomenon are not well known. It is therefore important to identify preoperative predictors for postoperative LARR. METHODS: We enrolled 62 patients with chronic severe MR (prolapse or flail leaflet) who underwent successful mitral valve surgery (repair or replacement); all with pre- and postoperative echocardiography. LARR was defined as a reduction in left atrium volume index (LAVI) of ≥ 25%. Stepwise multiple regression analysis was used to identify independent predictors of LARR. RESULTS: LARR occurred in 46 patients (74.2%), with the mean LAVI decreasing from 85.5 mL/m2 to 49.7 mL/m2 (p <0.001). These patients had a smaller preoperative left ventricular systolic volume (p =0.022) and a higher left ventricular ejection fraction (LVEF) (p =0.034). LVEF was identified as the only preoperative variable significantly associated with LARR (odds ratio, 1.086; 95% confidence interval, 1.002-1.178). A LVEF cutoff value of 63.5% identified patients with LARR of ≥ 25% with a sensitivity of 71.7% and a specificity of 56.3%. CONCLUSIONS: LARR occurs frequently after mitral valve surgery and is associated with preoperative LVEF higher than 63.5%.

Early improvement in left atrial remodeling and function after mitral valve repair or replacement in organic symptomatic mitral regurgitation assessedby three dimensional echocardiography

Left atrial (LA) dilation is associated with worse prognosis in various clinical situationsincluding chronic mitral regurgitation (MR). Real time three-dimensional echocardiography (3DE) hasallowed a better assessment of LA volumes and function. Little is known about LA size and function inearly postoperative period in symptomatic patients with chronic organic MR. We aimed to investigatethese aspects. Methods: By means of 3DE, 43 patients with symptomatic chronic organic MR were prospectivelystudied before and 30 days after surgery (repair or bioprosthetic valve replacement). Twentysubjects were studied as controls. Maximum (Vol-max), minimum, and preatrial contraction LA volumeswere measured and total, passive, and active LA emptying fractions were calculated. Results: Before surgerypatients had higher LA volumes (P < 0.001) but smaller LA emptying fractions than controls(P < 0.01). After surgery there was a reduction in all 3 LA volumes and an increase in active atrial emptyingfraction (AAEF). Multivariate analysis showed that independent predictors of early postoperativeVol-max reduction were preoperative diastolic blood pressure (coefficient = 0.004; P = 0.02), lateralmitral annular early diastolic velocity (e0) (coefficient = 0.023; P = 0.008), and the mean transmitral diastolicgradient increment (coefficient = 0.035; P < 0.001). Furthermore, e0 was also independentlyassociated with AAEF increase (odds ratio = 1.66, P = 0.027). Conclusion: Early LA reverse remodelingand functional improvement occur after successful surgery of symptomatic organic MR regardless ofsurgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variablesnegatively related to Vol-max reduction. Besides, e0 is positively correlated with both Vol-max reductionand AAEF increase.