Gonzalo de la Morena

Anabolic Status and Functional Impairment in Men With Mild Chronic Heart Failure

The purpose of this study was to establish the role of hormonal anabolic deficiencies in exercise intolerance in patients with chronic heart failure One hundred four consecutive men (mean age 53.1 ± 10.6 years) with established diagnoses of chronic heart failure were included. At enrollment, blood samples were taken, and echocardiography and cardiopulmonary exercise testing were carried out. Exercise capacity was expressed as peak oxygen consumption (Vo₂), predicted peak Vo₂, and the ventilatory response to exercise (VE/Vco₂) slope. The mean left ventricular ejection fraction was 29.7 ± 11.9%, and most patients (86%) were in New York Heart Association class I or II, with a mean peak Vo₂ of 18 ml/min/kg. According to the age-adjusted reference values, hormonal deficiencies were present in 29% for total testosterone, 39% for estimated free testosterone, 34% for insulin-like growth factor-1, and 61% for dehydroepiandrosterone sulfate. Dehydroepiandrosterone sulfate showed a significant correlation with peak Vo₂ (r = 0.29, p = 0.007), predicted peak Vo₂ (r = 0.28, p = 0.006), and VE/Vco₂ slope (r = -0.39, p <0.001), whereas total testosterone, estimated free testosterone, and insulin-like growth factor-1 were not significantly correlated. After adjusting in a multivariable model, dehydroepiandrosterone sulfate remained an independent predictor of each exercise parameter. In conclusion, in a cohort of patients with mild chronic heart failure, exercise capacity objectively measured using cardiopulmonary exercise testing was related to anabolic impairment of the adrenal rather than the somatotropic or peripheral axis.

Three-Dimensional Morphology of the Left Ventricular Outflow Tract: Impact on Grading Aortic Stenosis Severity.

Background: Left ventricular outflow tract (LVOT) measurement is a critical step in the quantification of aortic valve area. The assumption of a circular morphology of the LVOT may induce some errors. The aim of this study was to assess the three‐dimensional (3D) morphology of the LVOT and its impact on grading aortic stenosis severity. Methods: Fifty‐eight patients with aortic stenosis were studied retrospectively. LVOT dimensions were measured using 3D transesophageal echocardiography at three levels: at the hinge points (HP) of the aortic valve and at 4 and 8 mm proximal to the annular plane. Results were compared with standard two‐dimensional echocardiographic measurements. Results: Three‐dimensional transesophageal echocardiography showed a funnel shape that was more circular at the HP and more elliptical at 4 and 8 mm proximal to the annular plane (circularity index = 0.92 vs 0.83 vs 0.76, P < .001). Cross‐sectional area was smaller at the HP and larger at 4 and 8 mm from the annular plane (3.6 vs 3.9 vs 4.1 cm2, P = .001). The best correlation between two‐dimensional and 3D transesophageal echocardiographic dimensions was at the HP (intraclass correlation coefficient = 0.75; 95% CI, 0.59–0.86). When the HP approach was selected, there was a reduction in the percentage of patients with low flow (from 41% to 29%). Conclusions: A large portion of patients with aortic stenosis have funnel‐shaped and elliptical LVOTs, a morphology that is more pronounced in the region farther from the annular plane. Two‐dimensional LVOT measurement closer to the annular plane has the best correlation with 3D measurements. Measurement of the LVOT closer to the annular plane should be encouraged to reduce measurement errors. Highlights:Three‐dimensional echocardiography in patients with AS shows a funnel‐shaped morphology of the LVOT in >80% of patients.The size and circularity of the LVOT differ significantly on the basis of the point of measurement.More than 70% of patients have ellipse‐shaped LVOTs at the HP of the aortic cusps.The best correlation between 2D TTE and 3D TEE dimensions is obtained when measurement occurs close to the annular plane.

Pulmonary Surfactant Protein B in the Peripheral Circulation and Functional Impairment in Patients With Chronic Heart Failure

INTRODUCTION AND OBJECTIVESnSurfactant protein B (SP-B) is a marker of damage to the alveolar-capillary barrier that could be useful for monitoring functional impairment in patients with chronic heart failure (HF).nnnMETHODSnDyspnea-limited cardiopulmonary exercise testing was carried out in 43 outpatients with chronic HF (age 51+/-10 years, 77% male, left ventricular ejection fraction [LVEF] 33+/-11%). Peripheral blood serum samples were obtained at rest and during the first minute of peak exercise. The presence and concentration of SP-B in the serum samples were determined by Western blot analysis.nnnRESULTSnAt rest, SP-B was detected in 35 (82%) patients compared with only six (23%) healthy volunteers in a control group (n=26, age 51+/-10 years, 77% male). The median circulating SP-B level was higher in HF patients, at 174 [interquartile range, 70-283] vs. 77 [41-152] (P< .001) in the control group. In HF patients, the presence of circulating SP-B was associated with a lower LVEF (31.4+/-9.6% vs. 41.8+/-15%; P=.01). Multivariate analysis showed that the resting SP-B level correlated with a greater VE/VCO2 slope (beta=1.45; P=.02). The peak-exercise SP-B level correlated almost perfectly with the resting level (r=0.980; P< .001), but there was no significant increase with exercise (P=.164). Nor was there a correlation with any other exercise parameter.nnnCONCLUSIONSnIn patients with chronic HF, the level of pulmonary surfactant protein B in the peripheral circulation is increased and is correlated with ventilatory inefficiency during exercise, as indicated by the VE/VCO2 slope.

Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study

AimsnTo obtain the normal ranges for 2D echocardiographic (2DE) measurements of left ventricular (LV) strain from a large group of healthy volunteers accounting for age and gender.nnnMethods and resultsnA total of 549 (mean age: 45.6u2009±u200913.3u2009years) healthy subjects were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. 2DE data sets have been analysed with a vendor-independent software package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire the data sets. The lowest expected values of LV strains and twist calculated asu2009±u20091.96 standard deviations from the mean were -16.7% in men and -17.8% in women for longitudinal strain, -22.3% and -23.6% for circumferential strain, 20.6% and 21.5% for radial strain, and 2.2 degrees and 1.9 degrees for twist, respectively. In multivariable analysis, longitudinal strain decreased with age whereas the opposite occurred with circumferential and radial strain. Male gender was associated with lower strain for longitudinal, circumferential, and radial strain. Inter-vendor differences were observed for circumferential and radial strain despite the use of vendor-independent software. Importantly, no intervendor differences were noted in longitudinal strain.nnnConclusionnThe NORRE study provides contemporary, applicable 2D echocardiographic reference ranges for LV longitudinal, radial, and circumferential strain. Our data highlight the importance of age- and gender-specific reference values for LV strain.

Proteína surfactante pulmonar tipo B en circulación periférica y deterioro funcional en pacientes con insuficiencia cardiaca crónica

Introduccion y objetivos La proteina surfactante tipo B (PS-B) es un marcador de dano en la barrera alveolocapilar y podria ser util en la monitorizacion del deterioro pulmonar asociado a la insuficiencia cardiaca cronica (ICC). Metodos Se estudio a 43 pacientes ambulatorios con ICC (edad, 51xa0±xa010 anos; el 77% varones; fraccion de eyeccion del ventriculo izquierdo [FEVI], 33%xa0±xa011%) a los que se realizo una prueba de esfuerzo cardiopulmonar limitada por disnea. Se obtuvieron muestras de sangre periferica en reposo y en el primer minuto tras el maximo esfuerzo. La presencia y la cantidad de PS-B en suero sanguineo se analizaron mediante analisis Western blot. Resultados En reposo, se detecto PS-B circulante en 35 (82%) pacientes, frente a solo 6 (23%) voluntarios sanos de una muestra control (nxa0=xa026; edad, 51xa0±xa010 anos; el 77% varones), con mayores concentraciones circulantes en pacientes con ICC (mediana [intervalo intercuartilico], 174 [70-283]) frente al grupo control (77 [41-152]; p Conclusiones En pacientes con ICC, la proteina surfactante pulmonar tipo B esta incrementada en la circulacion periferica y se correlaciona con la ineficiencia ventilatoria en el ejercicio expresada como pendiente VE/VCO2.

Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study

AimsnTo obtain the normal ranges for echocardiographic measurements of left atrial (LA) function from a large group of healthy volunteers accounting for age and gender.nnnMethods and resultsnA total of 371 (median age 45u2009years) healthy subjects were enrolled at 22 collaborating institutions collaborating in the Normal Reference Ranges for Echocardiography (NORRE) study of the European Association of Cardiovascular Imaging (EACVI). Left atrial data sets were analysed with a vendor-independent software (VIS) package allowing homogeneous measurements irrespective of the echocardiographic equipment used to acquire data sets. The lowest expected values of LA function were 26.1%, 48.7%, and 41.4% for left atrial strain (LAS), 2D left atrial emptying fraction (LAEF), and 3D LAEF (reservoir function); 7.7%, 24.2%, and -0.53/s for LAS-active, LAEF-active, and LA strain rate during LA contraction (SRa) (pump function) and 12.0% and 21.6% for LAS-passive and LAEF-passive (conduit function). Left atrial reservoir and conduit function were decreased with age while pump function was increased. All indices of reservoir function and all LA strains had no difference in both gender and vendor. However, inter-vendor differences were observed in LA SRa despite the use of VIS.nnnConclusionnThe NORRE study provides contemporary, applicable echocardiographic reference ranges for LA function. Our data highlight the importance of age-specific reference values for LA functions.

TWEAK and NT-proBNP levels predict exercise capacity in hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is characterized by inappropriate hypertrophy, myocyte disarray and increased interstitial fibrosis. The tumour necrosis factor‐like weak inducer of apoptosis (TWEAK) is a cell surface cytokine with biological activities including stimulation of cell growth, induction of inflammatory cytokines and stimulation of apoptosis. There are controversial data about the potential role of TWEAK in different cardiovascular pathologies. NT‐proBNP is an established biomarker of myocardial wall stress, associated with poor functional class in HCM. We hypothesized that effort capacity in patients with HCM could be related to serum levels of these biomarkers.

TCT-435 Symptomatic evaluation, exercise performance and presence of ischemia in stress echocardiography at two years after implantation of bioresorbable vascular scaffolds and metallic drug-eluting stents. The ESTROFA Ischemia BVS-mDES study

Jouke Dijkstra, Evald Christiansen, Niels Holm Aarhus University Hospital, Skejby, Viby J, Denmark; Aarhus Universitetshospital, Skejby, Aarhus, Denmark; Terumo, Aarhus, Denmark; Hospital U. Central de la Defensa Gómez Ulla; Shanghai Jiao Tong University, Shanghai, Shandong, China; Aarhus University Hospital, Aarhus N, Denmark; LUMC, Leiden, Netherlands; Aarhus University Hospital, Aarhus, Denmark; Aarhus University Hospital, Aarhus N, Denmark