Elena Lukaschuk

Relationship between right ventricular volumes measured by cardiac magnetic resonance imaging and prognosis in patients with chronic heart failure.

The aim of this study was to investigate the prognostic impact of right ventricular (RV) size in patients with chronic heart failure.

Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value

BACKGROUNDnLeft atrial (LA) volume is an important marker of cardiac dysfunction and cardiovascular outcome in heart failure (HF), but LA function is rarely measured.nnnMETHODSnLeft atrial emptying function (LAEF), its clinical associations and prognostic value was studied in outpatients referred with suspected HF who were in sinus rhythm and had cardiac magnetic resonance imaging (CMRI). Heart failure was defined as relevant symptoms and signs with either a left ventricular ejection fraction (LVEF) <50% or amino-terminal pro-B-type natriuretic peptide (NTproBNP) >400 pg/mL (or >125 pg/mL if taking loop diuretics).nnnRESULTSnOf 982 patients, 664 fulfilled the HF criteria and were in sinus rhythm. The median (interquartile range, IQR) LAEF was 42 (31-51)% and 55 (48-61)% in patients with and without HF (P < 0.001). Patients with HF in the lowest quartile of LAEF (23%; IQR: 17-28%) had lower LV and right ventricular (RV) EF, and greater LV and RV mass and higher plasma NTproBNP than those in the highest quartile of LAEF (56%; IQR: 53-61%). Log[LAEF] and log[NTproBNP] were inversely correlated (r = -0.410, P < 0.001). During a median follow-up of 883 (IQR: 469-1626) days, 394 (59%) patients with HF died or were admitted with HF and 101 (15%) developed atrial fibrillation (AF). In a multivariable Cox model, increasing LAEF, but not LVEF, was independently associated with survival (HR for 10% change: 0.81 (95%CI: 0.73-0.90), P = <0.001). Increasing age and decreasing LAEF predicted incident AF.nnnCONCLUSIONSnIn patients with HF, LAEF predicts adverse outcome independently of other measures of cardiac dysfunction.

Prevalence of scarred and dysfunctional myocardium in patients with heart failure of ischaemic origin: A cardiovascular magnetic resonance study

BackgroundCardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) can provide unique data on the transmural extent of scar/viability. We assessed the prevalence of dysfunctional myocardium, including partial thickness scar, which could contribute to left ventricular contractile dysfunction in patients with heart failure and ischaemic heart disease who denied angina symptoms.MethodsWe invited patients with ischaemic heart disease and a left ventricular ejection fraction < 50% by echocardiography to have LGE CMR. Myocardial contractility and transmural extent of scar were assessed using a 17-segment model.ResultsThe median age of the 193 patients enrolled was 70 (interquartile range: 63-76) years and 167 (87%) were men. Of 3281 myocardial segments assessed, 1759 (54%) were dysfunctional, of which 581 (33%) showed no scar, 623 (35%) had scar affecting ≤50% of wall thickness and 555 (32%) had scar affecting > 50% of wall thickness. Of 1522 segments with normal contractile function, only 98 (6%) had evidence of scar on CMR. Overall, 182 (94%) patients had ≥1 and 107 (55%) patients had ≥5 segments with contractile dysfunction that had no scar or ≤50% transmural scar suggesting viability.ConclusionsIn this cohort of patients with left ventricular systolic dysfunction and ischaemic heart disease, about half of all segments had contractile dysfunction but only one third of these had > 50% of the wall thickness affected by scar, suggesting that most dysfunctional segments could improve in response to an appropriate intervention.

Atherosclerotic disease of the abdominal aorta and its branches: prognostic implications in patients with heart failure.

Aortic atherosclerosis reduces compliance in the systemic circulation and increases peripheral resistance, afterload and left ventricular wall stress. In patients with heart failure, these changes can impair left ventricular systolic function and energy efficiency, which could reduce exercise capacity. Though the interaction and the impact of aortic atherosclerosis on left ventricular function have been investigated, its prognostic implications in patients with heart failure are unclear. We used cardiac magnetic resonance imaging and gadolinium-enhanced abdominal aortography to investigate the prevalence and prognostic impact of atherosclerotic disease of the abdominal aorta and its side branches in 355 patients with heart failure. Sclerotic abdominal aortic disease was defined as a luminal narrowing >50% of the aorta and its side branches or the presence of abdominal aortic aneurysm. Patients with disease of the aorta and its branches were older (Pxa0<xa00.0001), had overall longer stay in hospital (Pxa0=xa00.006) and had more admissions (Pxa0=xa00.001) and worse prognosis (hazard ratio: 1.97, 95% confidence interval: 1.29–3.00, Pxa0=xa00.002) than those without. In a multivariable model, increasing age and pulse pressure, diabetes mellitus and increasing left ventricular end-diastolic volume were associated with a worse prognosis, but sclerotic abdominal aortic disease was not independently related to outcome (hazard ratio: 1.06; 95% confidence interval: 0.64–1.74; Pxa0=xa00.823). These data demonstrate that atherosclerosis of the abdominal aorta and its side branches is common and associated with increased morbidity in patients with chronic heart failure. How such disease should be managed remains uncertain, but its recognition and characterisation are the first steps in finding out.

Renal artery stenosis: an innocent bystander or an independent predictor of worse outcome in patients with chronic heart failure? A magnetic resonance imaging study.

To investigate the prognostic impact of atherosclerotic renovascular disease in patients with chronic heart failure.

The relationship of QRS morphology with cardiac structure and function in patients with heart failure

IntroductionThe relationship of QRS morphology with cardiac structure and function in patients with heart failure is uncertain.MethodsPatients with a clinical diagnosis of heart failure and objective evidence of cardiac dysfunction [either a left ventricular ejection fraction (LVEF) <50xa0% or an amino-terminal pro-brain natriuretic peptide (NT-proBNP) ≥400xa0pg/ml] who had been investigated by cardiac magnetic resonance imaging (CMRI) were identified. QRS duration ≥120xa0ms was grouped morphologically as left (LBBB), right bundle branch block (RBBB) or indeterminate.ResultsOf 877 patients, 320 (36xa0%) had QRSxa0≥xa0120xa0ms. Compared to patients with LBBB, those with RBBB had a lower median [inter-quartile range (IQR)] right ventricular (RV) ejection fraction [RBBB: 46 (37–57); LBBB: 52 (42–61)xa0%; pxa0=xa00.014], greater median (IQR) RV mass [RBBB: 53 (42–73); LBBB: 45 (36–56)xa0g; pxa0<xa00.001], higher median (IQR) plasma NT-proBNP [RBBB: 2013 (659–3573); LBBB: 1159 (589–2207) pg/ml, pxa0=xa00.026], more signs of peripheral congestion and higher prevalence of atrial fibrillation but had similar LVEF. During a median follow-up of 1302xa0days (IQR: 742–2237), 311 patients died. Compared with patients who had QRSxa0<xa0120xa0ms, those with RBBB [HR 1.98, 95xa0% CI (1.37–2.86); pxa0<xa00.001] had a higher mortality. Age and NT-proBNP were the strongest independent predictors of mortality; neither QRS nor CMRI variables improved prediction.ConclusionsIn patients with heart failure and QRSxa0≥xa0120xa0ms, RBBB is associated with more severe RV dysfunction and congestion and a worse prognosis. However, neither QRS morphology nor CMRI data provide independent prognostic information in a multivariable analysis including NT-proBNP.

Effect of renal artery revascularization upon cardiac structure and function in atherosclerotic renal artery stenosis: cardiac magnetic resonance sub-study of the ASTRAL trial

BackgroundnCardiac abnormalities are frequent in patients with atherosclerotic renovascular disease (ARVD). The Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial studied the effect of percutaneous renal revascularization combined with medical therapy compared with medical therapy alone in 806 patients with ARVD.nnnMethodsnThis was a pre-specified sub-study of ASTRAL (clinical trials registration, current controlled trials number: ISRCTN59586944), designed to consider the effect of percutaneous renal artery angioplasty and stenting on change in cardiac structure and function, measured using cardiac magnetic resonance (CMR) imaging. Fifty-one patients were recruited from six selected ASTRAL centres. Forty-four completed the study (medical therapy n = 21; revascularization n = 23). Full analysis of CMR was possible in 40 patients (18 medical therapy and 22 revascularization). CMR measurements of left and right ventricular end systolic (LV and RVESV) and diastolic volume (LV and RVEDV), ejection fraction (LVEF) and mass (LVM) were made shortly after recruitment and before revascularization in the interventional group, and again after 12 months. Reporting was performed by CMR analysts blinded to randomization arm.nnnResultsnGroups were well matched for mean age (70 versus 72 years), blood pressure (148/71 versus 143/74 mmHg), degree of renal artery stenosis (75 versus 75%) and comorbid conditions. In both randomized groups, improvements in cardiac structural parameters were seen at 12 months, but there were no significant differences between treatment groups. Median left ventricular changes between baseline and 12 months (medical versus revascularization) were LVEDV -1.9 versus -5.8 mL, P = 0.4; LVESV -2.1 versus 0.3 mL, P = 0.7; LVM -5.4 versus -6.3 g, P = 0.8; and LVEF -1.5 versus -0.8%, P = 0.7. Multivariate regression also found that randomized treatment assignment was not associated with degree of change in any of the CMR measurements.nnnConclusionsnIn this sub-study of the ASTRAL trial, renal revascularization did not offer additional benefit to cardiac structure or function in unselected patients with ARVD.

Clinical and prognostic relationships of pulmonary artery to aorta diameter ratio in patients with heart failure: a cardiac magnetic resonance imaging study

The pulmonary artery (PA) distends as pressure increases.

011 QT PEAK DISPERSION CORRELATED WITH LV SIZE AND MASS IN PATIENTS WITH CHRONIC HEART FAILURE, BUT NOT TO THE AMOUNT OF SCAR PRESENT

Introduction In middle aged men with a normal QT interval on a resting 12-lead ECG, increased QT peak dispersion is an independent risk factor for sudden cardiac death. QT peak prolongation is associated with left ventricular (LV) hypertrophy in hypertensive subjects, stroke survivors, and patients with suspected coronary artery disease. However, young footballers with LVH characterised by myocyte hypertrophy (with no fibrosis) do not have QT peak prolongation. We wondered if increased left ventricular mass and scar burden were associated with QT peak dispersion in patients with heart failure (HF). Methods 121 consecutive patients with chronic heart failure in sinus rhythm were studied. LV mass was determined on cardiac MRI. Scar mass was assessed using late gadolinium enhancement. The ECGs were analysed by a single observer who was blind to the results of the cardiac MRI and to clinical findings. QT peak (QTp) was measured from onset of the Q-wave to the peak of T-wave in every ECG lead of the 12-lead ECG, and heart rate corrected (QTpc) using Bazetts formula. QTpc dispersion was defined as QTpc Max—QTpc Min. Results are presented as mean±SD, unless stated otherwise. Results 121 patients (17 female) were aged 66±10.9u2005years. LV ejection fraction was (EF) 36±11%, end-diastolic volume (EDV) 239±72u2005ml, end-systolic volume (ESV) 159±67u2005ml, LV mass 146±30.9u2005g, scar mass was 27±10u2005g and formed 19±7% of the LV mass. The QTpc dispersion was 76±40u2005ms. QTpc dispersion correlated with total LV mass (r=0.3, p=0.01) and size (EDV r=0.4, p=0.002; ESV 0.4, p=0.001). There was no correlation between QTpc dispersion and scar size, either expressed in absolute units or as a percentage of total LV mass. Conclusions QTpc dispersion correlated with the total LV mass and LV size. However, there was no correlation between QTpc dispersion and scar size as determined by cardiac MR with late gadolinium enhancement imaging.

2053 Age and sex related changes in right ventricular dimensions and systolic function

30 ± 8 ml/m2) and RVMI (22 ± 5 gr/m2 vs. 19 ± 4 gr/m2) and a lower RVEF (46 ± 7% v 52 ± 8%) compared to women <60 years old (n = 25). No statistical significant differences were found in the indexed right ventricular volumes, mass and function between men and women ≥ 60. In men, RVEDVI (71 ± 13 ml/m2 vs. 57 ± 14 ml/m2), RVESVI (38 ± 9 ml/m2 vs. 28 ± 6 ml/m2) and RVMI (22 ± 5 gr/m2 vs. 18 ± 3 gr/m2) decreased with age while RVEF (46 ± 7 ml/m2 vs. 51 ± 8%) and M/V ratio (0.38 ± 0.06 gr/ mlvs. 0.42 ± 0.07 gr/ml) increased but similar changes were not observed in women. In men, Pearson correlation analysis demonstrated an age related decrease in RVEDVI (r = -0.41, p < 0.05), RVESVI (r = -0.45, p < 0.05) and RVMI (r = -0.29, p < 0.05) while the M/V increased (r = 0.29, p < 0.05). Similar relationships were not observed in women. Conclusion These data suggest that ageing has a different impact on RV morphology in men and women. The mechanism responsible for the gender related changes are unclear.