Early Right Heart Chambers Reverse Remodeling in Patients Operated in Adulthood for Congenital Lesions Associated with Right Heart Chambers Enlargement

Background Progressive right heart chambers dilatation is frequent in the adult congenital heart disease (ACHD) population. We evaluated the immediate and mid-term response of right heart chambers to surgery performed in adulthood for lesions associated with right heart chambers enlargement. Methods Thirty-six adult patients with lesions associated with right heart chambers enlargement submitted to surgery were studied . We collected echocardiographic data of right ventricle (RV) mid-diameter, right atrial volume indexed, RV systolic pressure, and tricuspid annular plane systolic excursion (TAPSE) prior to surgery (T0), at 2 to 5 days (T1), and 3 to 6 months (T2) after surgery. Results At T1, we observed a significant decrease of RV mid-diameter (47.2 ± 8.4 vs. 39.6 ± 7.4 mm, P < .001), right atrial volume indexed (45.6 ± 26.6 vs. 27.2 ± 11 ml/m2, P < .001), and RV systolic pressure (39 ± 14.8 vs. 32.8 ± 11.3 mm Hg, P = .03). At T2, a further significant deviation in the rate of RV diameter (39.6 ± 7.4 vs. 34.5 ± 5.1 mm, P < .001), in RV systolic pressure (32.8 ± 11.3 vs. 25.3 ± 5 mm Hg, P = .03) and TAPSE (13.9 ± 3.2 vs. 15.8 ± 2.6 mm, P < .001) was observed. Conclusions Positive right heart chambers remodeling occurs as early as in the immediate post-operative period in most ACHD patients operated for lesions associated with right heart chambers enlargement.

Cardiovascular status and echocardiographic changes in survivors of COVID-19 pneumonia three months after hospital discharge

Coronavirus disease 2019 (COVID-19) affects the function of all organs and systems. Today, studying the effect of COVID-19 on cardiovascular system, including on echocardiographic characteristics, is relevant.Aim. To study the prevalence of symptoms, cardiovascular disease and changes in echocardiographic data in persons after documented COVID-19 pneumonia 3 months after discharge from the hospital.Material and methods. The study included 106 patients after documented COVID-19 pneumonia. The patients underwent a comprehensive examination during hospitalization and 3 months±2 weeks after discharge from the hospital. The mean age of participants was 47±16 years (19-84 years); 49% of subjects were women.Results. Three months after hospital discharge, the symptoms persisted in 86% of examined patients. There were significant echocardiographic changes as follows: a decrease in LV end-diastolic, end-systolic and stroke volume (113,8±26,8 ml vs 93,5±29,4 ml; 37,7±13,0 ml vs 31,3±14,2 ml; 77,2±17,8 ml vs 62,2±18,7 ml, respectively, p<0,001 for all). The right ventricular anteroposterior dimension and the pulmonary trunk diameter decreased over time (26,0 [24,0-29,3] mm vs 25,0 [23,0-27,0] mm, p=0,004; 21,7±3,6 mm vs 18,7±2,5 mm, p<0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] m><0,001), the same as the pulmonary artery systolic pressure, estimated by tricuspid regurgitation gradient (28,0 [25,0-32,25] mm Hg vs 21,5 [17,0-25,0] mm Hg). The right atrial volume (42,0 [37,0-50,0] ml vs 31,0 [22,0-36,5] ml, p<0,001) a><0,001) and maximum width (36,1±4,6 mm vs 34,5±6,5 mm, p=0,023) decreased, while the right atrial maximum length increased (46,7±6,8 mm vs 48,6±7,1 mm, p=0,021).Conclusion. In survivors of COVID-19 pneumonia three months after hospital discharge, complaints persisted in 86% of cases. Cardiovascular diseases were detected in 52% of participants, including hypertension in 48,1% and coronary artery disease in 15,1%. Compared with in-hospital data, the echocardiographic characteristics improved, which was expressed mainly in a decrease in right heart load.

Cardiac magnetic resonance parametric mapping can detect early cardiac involvement of patients with systemic sclerosis

Background Systemic sclerosis (SSc) is divided into two subtypes, diffuse and limited cutaneous SSc (dcSSc and lcSSc). The dcSSc subtype has more severe internal organ fibrosis than lcSSc. It is unclear whether cardiovascular magnetic resonance (CMR) parametric mapping can detect early cardiac involvement in these two subtypes. Purpose To detect cardiac involvement and evaluate differences between the two subtypes, we examined CMR parametric mapping. Methods 57 consecutive SSc patients (27 dcSSc and 30 lcSSc) who visited our hospital from July 2018 to February 2021 and underwent CMR at 3.0T (Philips) were included. We analyzed myocardial damage using CMR parametric mapping and compared it with clinical data. Results Mean disease durations of dcSSc and lcSSc were 4.0±6.5 years and 4.4±8.3 years, respectively. Although there were no significant differences in LVEF (56.8±8.8 vs 59.6±7.2), the left and right atrial volume index were significantly larger in dcSSc compared with lcSSc (all p&lt;0.05). Focal fibrosis as evaluated by late gadolinium enhancement was found in 9 SSc patients (15.7%) and 4 patients had pulmonary hypertension. DcSSc patients had significantly higher mid-ventricular native T1 (1350.8±73.2 vs 1312.9±52.1, p=0.029) and postcontrast T1 values (640.4±59.4 vs 604.6±42.5, p=0.015) as compared to lcSSc, although there were no significant differences in ECV and T2 values. Native T1 values in mid-ventricular septum were positively correlated with E/e' ratio of echocardiography in overall SSc patients and dcSSc patients but not in lcSSc patients (r=0.320, p=0.021; r=0.505, p=0.010; r=0.195, p=0.329). Native T1 values in mid-ventricular septum were also positively correlated with plasma levels of brain natriuretic peptide (BNP) in overall SSc patients and dcSSc patients but not in lcSSc patients (r=0.353, p=0.008; r=0.484, p=0.011; r=0.113, p=0.559).The multiple regression analysis considering age and sex revealed that mid-ventricular septum native T1 was the independent predictor of E/e' in SSc patients (β=0.306, p=0.026), and dcSSc patients (β=0.553, p=0.007) but not in lcSSc patients (β=−0.282, p=0.105). The ROC curve for predicting E/e'≥14, cut-off value of native T1 in mid-ventricular septum was ≥1348.5msec (AUC 0.762; 95% CI 0.571–0.953; sensitivity 80.0%; specificity 68.1%). BNP was significantly higher in patients with native T1≥1348.5 msec compared with native T1&lt;1348.5 (102.8±112.8 vs 45.7±55.7; p=0.014). The interobserver variability of CMR parametric mapping values was excellent in this study. Conclusion DcSSc patients showed higher native T1 and larger left and right atrial volume index of CMR than lcSSc patients, suggesting that DcSSc patients had more severe myocardial involvement and left ventricular diastolic dysfunction than lcSSc patients. Early detection of the high native T1 may predict the occurrence of cardiovascular events in the future. FUNDunding Acknowledgement Type of funding sources: None. Correlation between native T1 and BNP Correlation between native T1 and E/e'

The Association of Left and Right Atrial Volume Indices with Survival Time post-Cardiac Arrest

Introduction: Left and right atrial volume indices (LAVI and RAVI) are markers of cardiac remodeling. LAVI and RAVI are associated with worse outcomes in other cardiac conditions. This study aimed to determine the association of LAVI and RAVI with survival time post-cardiac arrest. Hypothesis: Atrial volumes will be associated with survival time post cardiac arrest. Methods: This was a single academic center, retrospective study of patients with a cardiac arrest event during index hospitalization from 2014-2018. LAVI was calculated using a biplane Simpson’s method, while RAVI was calculated using a single plane summation in the 4-chamber view. Patients were further stratified into either having a Vfib/pulseless VT (pVT) event or a PEA arrest/asystole event. Survival time was measured in days from event to death date. Kaplan-Meier plots were used to evaluate differences in survival time for patients based on mean LAVI and RAVI. Results: Of 305 patients studied (64 +/- 14 years, 37% female (112 out of 305)), 162 had reliable LAVI measurements with a mean of 34.1 mL/m2 (SD=15.8) and163 had reliable RAVI measurements with a mean of 25.1 mL/m2 (SD=15.5). In patients who had sustained VFib/pVT, those with reduced LAVI (p=0.045) and RAVI (p=0.041) values below the mean had significantly improved survival time. No association was found in PEA/asystole. KM plots of patient survival for both LAVI and RAVI compared to mean are presented in figures 1a and 1b. Conclusion: Among patients presenting with a Vifb/pVT arrest, increased LAVI and RAVI were associated with decreased survival time.

Abstract 281: The Association of Left and Right Atrial Volume Indices on Survival Time Post-cardiac Arrest

Introduction: Left and right atrial volume indices (LAVI and RAVI) are markers of cardiac remodeling. LAVI and RAVI are associated with worse outcomes in other cardiac conditions. This study aimed to determine the association of LAVI and RAVI with survival time post-cardiac arrest. Hypothesis: Atrial volumes are associated with survival time post-cardiac arrest. Methods: This was a single center, retrospective study of patients with a cardiac arrest event during index hospitalization from 2014-2018. LAVI was calculated using the biplane Simpson’s method, while RAVI was calculated using a single plane summation in the 4-chamber view. Patients were further stratified into either having a Vfib/pulseless VT (pVT) event or a PEA arrest/asystole event. Survival time was measured in days from event to death date. Kaplan-Meier plots were used to evaluate differences in survival time for patients based on mean LAVI and RAVI. Results: Of 305 patients studied (64 +/- 14 years, 37% female (112 out of 305)), 162 had a reliable LAVI measurement with a mean of 34.1 mL/m 2 (SD=15.8) and 163 had a reliable RAVI measurement with a mean of 25.1 mL/m 2 (SD=15.5). In patients who had sustained a VFib/pVT event, those with reduced LAVI (p=0.045) and RAVI (p=0.041) values below the mean had significantly improved survival time. No association was found in the PEA/asystole subgroup. KM plots of patient survival for both LAVI and RAVI compared to mean are presented in figures 1a and 1b. Conclusion: Among patients presenting with Vifb/pVT arrest, increased LAVI and RAVI were associated with decreased survival time. More studies are needed to better prognosticate cardiac arrest using atrial volumes.