Huan P. Loh

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.

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.

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.