Persistent myocardial atrophy despite LV reverse remodeling in Duchenne cardiomyopathy treated by LVAD

2020 ◽  
Author(s):  
Nicoletta Cantarutti ◽  
Rachele Adorisio ◽  
Anwar Baban ◽  
Arianna Di Molfetta ◽  
Antonio Amodeo ◽  
...  
Keyword(s):  
Reverse Remodeling ◽  
Myocardial Atrophy

Kathetertechnische Behandlung der schweren Mitralinsuffizienz: derzeitige Indikationen

Praxis ◽  
2015 ◽  
Vol 104 (18) ◽  
pp. 975-980 ◽  
Author(s):  
Barbara Naegeli ◽  
Olaf Franzen
Keyword(s):  
Reverse Remodeling ◽  
Neue Technik

Zusammenfassung. Die perkutane Mitralklappenrekonstruktion ist eine neue Technik zur Behandlung der schweren Mitralinsuffizienz (MI). Diese Methode kommt zurzeit vor allem bei betagten Patienten mit ausgeprägter Komorbidität zum Einsatz, die wegen zu hohen Operationsrisikos nicht am offenen Herzen operiert werden können. Bei den meisten Patienten kann eine deutliche Reduktion der Mitralinsuffizienz und dadurch eine klinische Verbesserung und Steigerung der Lebensqualität erreicht werden. Daneben zeigten Studien auch einen Reverse-remodeling-Prozess des linken Ventrikels. Im Vergleich zur alleinigen medikamentösen Therapie kann durch die Clip-Behandlung bei herzinsuffizienten Patienten mit relevanter MI die Rehospitalisationsrate um >50% gesenkt werden. Für Patienten mit degenerativer MI stellt die Klappenchirurgie den Goldstandard dar, für herzchirurgische Hochrisikopatienten und Patienten mit funktioneller MI ist die MitraClip®-Behandlung eine sinnvolle Alternative.

scholarly journals Implications of multiple late gadolinium enhancement lesions on the frequency of left ventricular reverse remodeling and prognosis in patients with non‐ischemic cardiomyopathy

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Shingo Ota ◽  
Makoto Orii ◽  
Tsuyoshi Nishiguchi ◽  
Mao Yokoyama ◽  
Ryoko Matsushita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Late Gadolinium Enhancement ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Cardiac Events ◽  
Gadolinium Enhancement ◽  
Systolic Volume ◽  
Linear Pattern ◽  
Multiple Lesions

Abstract Background Non-ischemic cardiomyopathy (NICM) is a heterogeneous disease, and its prognosis varies. Although late gadolinium enhancement (LGE)-cardiovascular magnetic resonance (CMR) demonstrates a linear pattern in the mid-wall of the septum or multiple LGE lesions in patients with NICM, the therapeutic response and prognosis of multiple LGE lesions have not been elucidated. This study aimed to investigate the frequency of left ventricular (LV) reverse remodeling (LVRR) and prognosis in patients with NICM who have multiple LGE lesions. Methods This single-center retrospective study included 101 consecutive patients with NICM who were divided into 3 groups according to LGE-CMR results: patients without LGE (no LGE group = 48 patients), patients with a typical mid-wall LGE pattern (n = 29 patients), and patients with multiple LGE lesions (n = 24 patients). LVRR was defined as an increase in LV ejection fraction (LVEF) ≥ 10 % and a final value of LVEF > 35 %, which was accompanied by a decrease in LV end-systolic volume ≥ 15 % at 12-month follow-up using echocardiography. The frequency of composite cardiac events, defined as sudden cardiac death (SCD), aborted SCD (non-fatal ventricular fibrillation, sustained ventricular tachycardia, or adequate implantable cardioverter-defibrillator therapies), and heart failure death or hospitalization for worsening heart failure, were summarized and compared between the groups. Results Among the 3 groups, the frequency of LVRR was significantly lower in the multiple lesions group than in the no LGE and mid-wall groups (no LGE vs. mid-wall vs. multiple lesions: 49 % vs. 52 % vs. 19 %, p = 0.03). There were 24 composite cardiac events among the patients: 2 in patients without LGE (hospitalization for worsening heart failure; 2), 7 in patients of the mid-wall group (SCD; 1, aborted SCD; 1 and hospitalization for worsening heart failure; 5), and 15 in patients of the multiple lesions group (SCD; 1, aborted SCD; 8 and hospitalization for worsening heart failure; 6). The multiple LGE lesions was an independent predictor of composite cardiac events (hazard ratio: 11.40 [95 % confidence intervals: 1.49−92.01], p = 0.020). Conclusions Patients with multiple LGE lesions have a higher risk of cardiac events and poorer LVRR. The LGE pattern may be useful for an improved risk stratification in patients with NICM.

Does Prosthetic Replacement Impact Right Ventricular Reverse Remodeling in Patients Undergoing Isolated Tricuspid Valve Surgery?

2021 ◽  
Vol 5 (sup1) ◽  
pp. 10-10
Author(s):  
Sri Harsha Patlolla ◽  
Hartzell V. Schaff ◽  
Juan A. Crestanello ◽  
Joseph A. Dearani ◽  
Richard C. Daly ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tricuspid Valve ◽  
Valve Surgery ◽  
Reverse Remodeling ◽  
Prosthetic Replacement ◽  
Tricuspid Valve Surgery

Left ventricular remodeling after transcatheter mitral valve replacement with Tendyne

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Fukui ◽  
P Sorajja ◽  
M Goessl ◽  
R Bae ◽  
B Sun ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Ventricular Remodeling ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Functional Changes ◽  
Transcatheter Mitral Valve Replacement ◽  
Lv Mass

Abstract Background Data on changes in left atrial (LA) and left ventricular (LV) volumes after transcatheter mitral valve replacement (TMVR) are limited. Purpose This study sought to describe the anatomical and functional changes in left-sided cardiac chambers by computed tomography angiography (CTA) from baseline to 1-month after TMVR with Tendyne prosthesis. Methods We analyzed patients who underwent TMVR with Tendyne prosthesis (Abbott Structural, Menlo Park, CA) between 2015 and 2018. Changes in LV end-diastolic volume (LVEDV), ejection fraction (LVEF), mass (LV mass), LA volume and global longitudinal strain (GLS) were assessed at baseline and at 1-month after TMVR with CTA. Specific Tendyne implant characteristics were identified and correlated with remodeling changes. Results A total of 36 patients (mean age 73±8 years, 78% men, 86% secondary MR) were studied. There were significant decreases in LVEDV (268±68 vs. 240±66ml, p<0.001), LVEF (38±10 vs. 32±11%, p<0.001), LV mass (126±37 vs. 117±32g, p<0.001), LA volume (181±74 vs. 174±70 ml, p=0.027) and GLS (−12.6±5.1 vs. −9.5±4.0%, p<0.001) from baseline to 1-month follow-up. Favorable LVEDV reverse-remodeling occurred in the majority (30 of 36 patients, or 83%). Closer proximity of the Tendyne apical pad to the true apex was predictive of favorable remodeling (pad distance: 25.0±7.7 vs. 33.5±8.8mm, p=0.02 for those with and without favorable remodeling). Conclusions TMVR with Tendyne results in favorable left-sided chamber remodeling in the majority of patients treated, as detected on CTA at 1-month after implantation. CTA identifies the favorable post-TMVR changes, which could be related to specific characteristics of the device implantation. Funding Acknowledgement Type of funding source: None

scholarly journals Distinct remodeling pattern between pediatric and adult heart failure: a focus on Ca2+ signaling pathway at proteomic level

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Zhang ◽  
U Kuzmanov ◽  
S Urschel ◽  
F Wang ◽  
S Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Signaling Pathways ◽  
Myocardial Dysfunction ◽  
Heart Defects ◽  
Systolic Dysfunction ◽  
Cellular Growth ◽  
Reverse Remodeling ◽  
Funding Source ◽  
Course Of Illness ◽  
Reduced Ejection Fraction

Abstract Background Dilated cardiomyopathy (DCM) is among the most common causes leading to end-stage heart failure with reduced ejection fraction (HF-rEF) in adult and pediatric patients. Despite similar phenotypes characterized as systolic dysfunction and eccentric ventricular dilation, pediatric DCM are biologically distinct entities with age- and development-specific features in the heart. Though underlying mechanisms may vary between the two populations, it's largely unexplored with few studies conducted to date. Purpose HF-rEF typically results from impaired myocardial contractility, triggered by defective cellular Ca2+ handling and cytoskeletal remodeling. Hence, we aim to integrate clinical profile and experimental data from human explanted hearts: 1) to unravel the age-dependent disparate Ca2+ signaling pathways; and 2) to identify pediatric-specific HF signatures or potential cures for precision managements. Methods Non-ischemic failing hearts (n=6 adult and n=6 pediatric) were procured immediately after excision via Human Explanted Heart Program. Age-matched adult non-failing control hearts (NFC, n=6) were obtained from deceased donors without cardiovascular history, while pediatric NFC (n=6) were collected from children with congenital heart defects but no primary myocardial dysfunction constituting relatively reasonable controls. Myocardial metabolic and oxidative profile were evaluated spectrophotometrically, and tissue remodeling was assessed immunohistochemically. Global proteomics and phosphoproteomics were performed on a Q-Exactive mass spectrometer, followed by network biology pathway analyses. Expression of screened proteins and kinases was validated by gel electrophoresis. Apoptosis and cellular growth signaling pathways were also incorporated into analysis. Results Both HF groups had remarkably lower LVEF (26.6±10.7% in pediatric vs. 26.5±9.1% in adult DCM) while compared to the NFC (both ≥60%) respectively. Histologically, adult-DCM demonstrated significantly worse fibrosis than pediatric-DCM (p<0.01). It was consistent with excessive reactive oxygen species (ROS) production and perturbed anti-ROS defense noted in adult-DCM, indicative of possible reverse remodeling in the pediatric failing hearts with shorter course of illness till transplant. Mechanistically, NCX1 was elevated with SERCA2 decreased in adult-DCM versus adult-NFC (p<0.05), while both pediatric groups exhibited comparable levels. Reduced p-/t-phospholamban and p-/t-CaMK in adult-DCM, unlike in pediatric-DCM, also illustrated altered phosphorylation patterns. Moreover, GSK-3β and AMPK pathways were inhibited while AKT-473 was activated in adult-DCM. Conclusions Pediatric DCM exhibited less adverse remodeling partially mediated by divergent Ca2+ handling and downstream signaling pathways, illustrating the fundamental differences between adult and pediatric DCM. Our findings may provide a scientific basis for the development of specific therapies for pediatric DCM. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes for Health Research (CIHR); Heart & Stroke Foundation (HSF)

scholarly journals Evaluation of the morphology and mechanics of the right ventricle using echocardiography before and after transcatheter balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
KIRILL Malikov ◽  
MARINA Kirichkova ◽  
MARIA Simakova ◽  
NARECK Marukyan ◽  
OLGA Moiseeva
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Pulmonary Artery Pressure ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Reverse Remodeling ◽  
Free Wall ◽  
Artery Pressure ◽  
Balloon Pulmonary Angioplasty ◽  
Before And After ◽  
The Right

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) leads to a progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) with the development of severe dysfunction of the right heart and heart failure. Mortality for three years with an average pressure in the pulmonary artery (PA) of more than 50 mmHg is more than 90%. Balloon pulmonary angioplasty (BPA) has a significant advantage over other methods of surgical treatment, but it requires the determination of additional non-invasive markers of effectiveness. Transthoracic echocardiography (TTE) remains the main method for assessing the morphology and function of the heart. Purpose Compare different indicators reflecting the severity of CTEPH with TTE indicators before and after BPA. To evaluate the effectiveness of using BPA for the treatment of patients with CTEPH using routine TTE and speckle tracking mode. Materials and methods For 18 months 30 patients without concomitant cardiovascular pathology were subjected to several BPA sessions. Before treatment, 50% of patients belonged to the 3 CTEPH functional class (FC), 40% to 2 FC, 10% to 1 FC. The average number of sessions was 4.7 ± 1.3. Before the first BPA and after the last, all the patients were performed: six-minute walk test (6MWT, metres), Borg scale (in points), test for NT-proBNP (pg/ml); TTE with assessment of the right ventricle (RV) and left ventricle (LV) including areas of the right atrium (aRA, cm2), mean pulmonary artery pressure (PUPM,mmHg),RV free wall strain (GLSFW, %), RV free wall strain rate (GLSRFW, sm/sec), RV free wall postsystolic shortening (PSSFW, %), tricuspid annular plane systolic excursion (TAPSE, sm), tricuspid annulus systolic velocity (TASV, sm/sec). Results. Before the first BPA session, the 6MWT in the patient group averaged 315.9 ± 9.08 metres, after - 439.5 ± 11.45 m; the Borg from 5.4 ± 0.94 points decreased to 4 ± 1.01 points; NT-proBNP before the treatment was 1513 ± 13.01 pg/ml, after - 171 ± 6.09; according to TTE the ratio of RV/ LV before and after treatment was 1.31 ± 0.02 and 0.97 ± 0.04; aRA was 29.3 ± 4.87 and 22.3 ± 3.53 cm2; basal RV - 52 ± 5.11 and 44 ± 7.26 mm; PUPM decreased from 76.6 ± 7.65 to 31.3 ± 3.78 mmHg; GLSFW from -14.69 ± 2.33 came to 17.5 ± 3.45 %; GLSRFW with -0.9 ± 0.09 to -1.7 ± 0.11 cm/sec; TAPSE from 16.7 ± 1.87 to 18.2 ± 2.34 cm; TASV from 10.11 ± 1.45 to 12.25 ± 1.98 cm/s, PSSFW before treatment was -18.4 ± 1.2%, after treatment in 66% of patients disappeared, in 34% became an average of 17.4 ± 0.9% The distribution of STEPH FC has also changed. Conclusion. BPA leads to an improvement in the tolerance of physical activity, clinical indicators, and parameters of central hemodynamics in the pulmonary circulation, evaluated according to direct manometry, and leads to reverse remodeling of the RV in the long term. Performing a staged BPA leads to an improvement in the functional parameters of contractility of the RV.

scholarly journals The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement —Meta-Analysis

2020 ◽  
Vol 17 (19) ◽  
pp. 7335
Author(s):  
Ilija Bilbija ◽  
Milos Matkovic ◽  
Marko Cubrilo ◽  
Nemanja Aleksic ◽  
Jelena Milin Lazovic ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Meta Analysis ◽  
Reverse Remodeling ◽  
Term Survival ◽  
Long Term Survival

Aortic valve replacement for aortic stenosis represents one of the most frequent surgical procedures on heart valves. These patients often have concomitant mitral regurgitation. To reveal whether the moderate mitral regurgitation will improve after aortic valve replacement alone, we performed a systematic review and meta-analysis. We identified 27 studies with 4452 patients that underwent aortic valve replacement for aortic stenosis and had co-existent mitral regurgitation. Primary end point was the impact of aortic valve replacement on the concomitant mitral regurgitation. Secondary end points were the analysis of the left ventricle reverse remodeling and long-term survival. Our results showed that there was significant improvement in mitral regurgitation postoperatively (RR, 1.65; 95% CI 1.36–2.00; p < 0.00001) with the average decrease of 0.46 (WMD; 95% CI 0.35–0.57; p < 0.00001). The effect is more pronounced in the elderly population. Perioperative mortality was higher (p < 0.0001) and long-term survival significantly worse (p < 0.00001) in patients that had moderate/severe mitral regurgitation preoperatively. We conclude that after aortic valve replacement alone there are fair chances but for only slight improvement in concomitant mitral regurgitation. The secondary moderate mitral regurgitation should be addressed at the time of aortic valve replacement. A more conservative approach should be followed for elderly and high-risk patients.

Sign in / Sign up

Export Citation Format

Share Document