Misalignment of hemodynamic forces in the left ventricle is associated with adverse remodeling following STEMI

Abstract Funding Acknowledgements Type of funding sources: None. Background Infarct size (IS), area at risk (AAR) and microvascular obstruction (MVO) are well known predictors of adverse remodeling (aLVr) following acute myocardial infarction, while the pathogenic role of left ventricular (LV) hemodynamic forces (HDFs) is still unknown. Recent evidence suggests the role of HDFs in negative remodeling after pathogenic events. Purpose To identify LV HDFs patterns associated with aLVr in reperfused ST-segment elevation MI (STEMI) patients. Methods Forty-nine acute STEMI patients underwent CMR at 1 week (baseline) and 4 months (follow-up) after MI. The following parameters were measured: left ventricular end-diastolic and end-systolic volume index for body surface area (LVEDVi and LVESVi), left ventricular ejection fraction (LVEF) and LV mass index, AAR and IS. LV HDFs were computed at baseline from cine CMR long axis datasets using a novel method based on LV endocardial boundary tracking. LV HDFs were calculated both in apex-base (A-B) and latero-septal (L-S) directions. The distribution of LV HDFs were evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio %). All HDFs parameters are computed over the entire heartbeat, in systole and diastole. aLVr was defined as an absolute increase in LVESV of at least 15% (ΔLV-ESV ≥15%). Results Patients with aLVr (n = 18; 37%) had significant greater value of AAR (32 ± 23 vs 22 ± 18; p = 0.03) and slightly larger IS (23 ± 16 vs 15 ± 11; p= 0.07) at baseline. In patients with aLVr at FU, baseline systolic L-S HDF were lower (2.7 ± 0.9 vs 3.6 ± 1; p = 0.027) while diastolic L-S/A-B HDF ratio was significantly higher (28 ± 14 vs 19 ± 6; p = 0.03), reflecting higher grade of diastolic HDFs misalignment. At univariate logistic regression analysis, higher IS [Odd ratio (OR) 1.05; 95% confidence interval (95% CI) 1.01-1.1; p= 0.04] L-S HDFs (OR 0.41; 95% CI 0.2-0.9; p= 0.04] and higher diastolic L-S/A-B HDFs ratio (OR 1.1; 95% CI 1.01-1.2; p= 0.05) were associated with aLVr at FU (Table). At multivariate logistic regression analysis, L-S/A-B HDF ratio remained the only independent predictor of adverse LV remodeling after correction for other baseline determinants. Conclusion Misalignment of diastolic HDFs following STEMI is associated with aLVr observed after 4 months. Predictors of adverse remodeling Univariate Multivariate Parameter OR (95% CI) P OR (95% CI) P IS (%) 1.05 (1.01-1.1) 0.042 - - Systolic L-S HDF 0.41 (0.2-0.9) 0.04 - - Diastolic L-S/A-B HDF Ratio 1.1 (1.01-1.2) 0.05 1.1 (1.01-1.2) 0.04 A-B:apex-base; L-S: latero-septal; HDFs: hemodynamic forces Abstract Figure. Diastolic HDFs distribution and aLV

Impact of intraventricular haemodynamic forces misalignment on left ventricular remodelling after myocardial infarction

Aims: Altered left ventricular (LV) haemodynamic forces (HDFs) have been associated with positive and negative remodelling after pathogenic or therapeutic events. We aimed to identify LV HDFs patterns associated with adverse LV remodelling (aLVr) in reperfused segment elevation myocardial infarction (STEMI) patients. Methods and results: Forty-nine acute STEMI patients underwent cardiac magnetic resonance (CMR) at 1 week (baseline) and after 4 months (follow-up). LV HDFs were computed at baseline from cine CMR long axis data sets, using a novel technique based on endocardial boundary tracking, both in apex-base (A-B) and latero-septal (L-S) directions. HDFs distribution was evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio %). HDFs parameters were computed over the entire heartbeat, in systole and diastole. At baseline, aLVr patients had lower systolic L-S HDF (2.7 ± 0.9 vs. 3.6 ± 1%; P = 0.027) and higher diastolic L-S/A-B HDF ratio (28 ± 14 vs. 19 ± 6%; P = 0.03). At univariate logistic regression analysis, higher infarct size [odds ratio (OR) 1.05; 95% confidence interval (CI) 1.01–1.1; P = 0.04], higher L-S/A-B HDFs ratio (OR 1.1; 95% CI 1.01–1.2; P = 0.05) and lower L-S HDFs (OR 0.41; 95% CI 0.2–0.9; P = 0.04) were associated with aLVr at follow-up. In the multivariable logistic regression analysis, diastolic L-S/A-B HDF ratio remained the only independent predictor of aLVr (OR 1.1; 95% CI 1.01–1.2; P = 0.04). Conclusions: Misalignment of diastolic haemodynamic forces after STEMI is associated with aLVr after 4 months

Prognostic value of systemic inflammatory response syndrome after transcatheter aortic valve implantation

AIMS: Systemic inflammatory response syndrome (SIRS) could affect mortality after transcatheter aortic valve implantation (TAVI) up to 12 months of follow-up. The aim of this study was to evaluate the prevalence of SIRS after TAVI and its impact on all-cause mortality up to 24 months follow-up. METHODS: We retrospectively enrolled 132 patients with symptomatic severe aortic stenosis undergoing TAVI. SIRS development during the first 72 h after the intervention was evaluated. Other postoperative complications were defined according to the Valve Academic Research Consortium 2 (VARC2). All patients underwent follow-up at 30 days and 24 months. Endpoints were 30-days and 24-months mortality. RESULTS: Post-TAVI SIRS developed in 27 patients (20%). At 30-day follow-up, all-cause death occurred in 10 (8%) patients and SIRS occurred more frequently in patients with adverse short-term outcome (60 vs. 17%; P = 0.001). Twenty-four months all-cause death occurred in 25 (19%) patients. SIRS resulted as an independent predictor of long-term outcome [hazard ratio 3.7; 95% confidence interval (95% CI) 1.5-9; P = 0.004], along with major vascular complications (hazard ratio 4; 95% CI 1.6-9.9; P = 0.003), relevant bleedings (hazard ratio 6.4; 95% CI 1.5-28; P = 0.013) and baseline pulmonary hypertension (hazard ratio 2.4; 95% CI 1.05-5.6; P = 0.039). CONCLUSION: Postoperative SIRS was more frequent in patients who died at 30 days follow-up. Moreover, SIRS resulted as a predictor of 24-month mortality along with vascular complications, relevant bleedings and baseline pulmonary hypertension

Myocardial contractility recovery following acute pressure unloading after transcatheter aortic valve intervention (TAVI) in patients with severe aortic stenosis and different left ventricular geometry: a multilayer longitudinal strain echocardiographicanalysis

none11noAim of the present study was to describe the left ventricular longitudinal strain (LS) in all myocardial layers in patients with severe aortic stenosis (AS), preserved left ventricular ejection fraction (LVEF) in different LV geometry and to compare LS analysis before and early after acute LV unloading provided by transcatheter aortic valve implantation (TAVI). 68 patients were enrolled. LS was measured from the endocardial layer (Endo-LS), epicardial layer (Epi-LS) and full thickness of myocardium (Transmural-LS) before and after TAVI. Patients were divided in two groups accordingly with relative wall thickness (RWT): concentric LV hypertrophy (cLVH) vs eccentric LV hypertrophy (eLVH). Less impaired values of LS at baseline were observed, in all layers, in patients with cLVHas compared to patients with eLVH (Endo-LS was − 13.2 ± 2 vs − 11.1±3 %, p = 0.041; Epi-LS was − 11.8 ± 1.8 vs − 9.9 ± 3 %, p = 0.043; Transmural-LS was − 12.3 ± 1.8 vs − 10.49 ± 3.3 %, p = 0.02, respectively). A significant improvement in endocardial LS (Endo-LS) after TAVI was detected only in cLVH(− 13 ± 2 vs − 14 ± 2, p = 0.011). Our findings documented that concentric LVH had better basal strain function and showed a better myocardial recovery after TAVI compared to eLVH.restrictedCimino S.; Monosilio S.; Luongo F.; Neccia M.; Birtolo L.I.; Salvi N.; Filomena D.; Mancone M.; Fedele F.; Agati L.; Maestrini V.Cimino, S.; Monosilio, S.; Luongo, F.; Neccia, M.; Birtolo, L. I.; Salvi, N.; Filomena, D.; Mancone, M.; Fedele, F.; Agati, L.; Maestrini, V

Prognostic role of pre- and post-interventional myocardial injury in patients undergoing transcatheter aortic valve implantation

Background: Chronic pre-procedural and acute post-procedural myocardial injury are frequently observed in patients with aortic stenosis undergoing trans-catheter aortic valve implantation (TAVI). The aim of our study was to investigate the prognostic role of high sensitivity cardiac troponins (hs-cTns) elevation before and after TAVI. Methods: 106 patients with severe aortic stenosis who underwent TAVI were enrolled. High sensitivity cardiac troponin T (hs-cTnT) was measured before and after TAVI (6, 24, 48, 72 hours). Post-procedural myocardial damage was defined as a 15-fold rise in hs-cTnT upper reference limit (URL) after TAVI. The clinical endpoints were all cause death, cardiovascular death and rehospitalization at 24 months follow-up. Results: Before TAVI, hs-cTnT median value was 0.03 μg/L (2.3 ± 2.1 fold over URL). After TAVI procedure, myocardial damage (MD), as defined by VARC-2 criteria, was observed in 40 patients (38%) (MD group). In our population, logarithmically transformed hs-cTnTs were independently associated with all-cause mortality at 24 months F/U (pre-TAVI hs-cTnT: Hazard ratio [HR] 2.2, 95% confidence interval [CI]: 1.1 to 4.4, p=0.027). No significant differences were observed between the MD and non-MD groups for the three endpoints of all cause death (p log rank: 0.15), cardiovascular death (p log rank: 0.86) and re-hospitalization (p log rank: 0.87). Conclusions: Only baseline hs-cTnT levels correlated with outcomes at 24 months of follow-up. Chronic pre-procedural myocardial injury significantly affects prognosis after TAV

P1752 Prognostic role of Multilayer Strain Speckle Tracking Echocardiography in patients with severe aortic stenosis treated with Transcatheter Aortic Valve Implantation

Abstract Background Myocardial Strain evaluation helps to assess the efficacy of therapeutic interventions and to predict the prognosis and clinical outcomes. The aim of the present study was to assess whether Multilayer Global longitudinal Strain (GLS) can be useful in estimation of left ventricle (LV) function in patients with severe symptomatic aortic stenosis (AS) who have undergone transcatheter aortic valve implantation (TAVI). Methods 35 patients with severe AS who successfully underwent TAVI, were enrolled in the study. GLS was measured from the endocardial layer (Endo-LS), epicardial layer (Epi-LS) and full thickness of myocardium before the procedure. Analysis included other parameters such as age, sex, LV volumes and ejection fraction (LVEF), type of prosthesis implanted, right ventricular (RV) dimension and function. Occurrence of cardiovascular (CV) events (rehospitalization for HF or CV death) were collected after 24 months follow-up.Results: CV events occurred in 7 patients (20%). Patients were divided in two groups accordingly with CV events occurrence. No differences in baseline, demographic, echocardiographic and procedural characteristics were found. Patients who developed CV events had a more impaired pre-procedural GLS (-10.2 \ub1 2.4% vs -12.6 \ub1 2.2%, p\u2009=\u20090.029), mostly due to his subendocardial layer (Endo-LS -10.8 \ub1 2 vs -13.9 \ub1 2, p\u2009=\u20090.003). Moreover, by ROC curve analysis, a cut-off value of -12.4% of endo LS was associated with CV events (sensitivity of 83% and specificity of 65 %, AUC 0.8, p\u2009=\u20090.024), with a log-rank p value assessed by survival analysis of 0.044. Conclusion Multilayer GLS analysis could provide additional information for prognosis stratification in patients with severe symptomatic AS before TAVI, above and beyond assessment of LVEF alone. Parameter Event-group (7/35 pz= 20%) Non-event group (28/35 pz= 80%) p Age (y.o) 86 \ub1 4 80 \ub1 7 NS LVEDV (ml) 112 \ub1 34 94 \ub1 32 NS LVESV (ml) 51.2 \ub1 6 56.9 \ub1 6 NS LVEF(%) 55.7 \ub1 6 56.9 \ub1 6 NS AVA (cm2) 0.77 \ub1 0.2 0.73 \ub1 0.2 NS GLS (%) -10.2 \ub1 2.4 -12.6 \ub1 2.2 0.029 Endo-LS (%) -10.8 \ub1 2 -13.9 \ub1 2 0.003 Epi-LS (%) -10.2 \ub1 2 -11.9 \ub1 2 NS Abstract P1752 Figure

Periodic health evaluation in athletes competing in Tokyo 2020: from SARSCoV-2 to Olympic medals

Background The Tokyo Olympic games were the only games postponed for a year in peacetime, which will be remembered as the COVID-19 Olympics. No data are currently available on the effect on athlete’s performance. Aim To examine the Italian Olympic athletes who have undergone the return to play (RTP) protocol after COVID-19 and their Olympic results. Methods 642 Potential Olympics (PO) athletes competing in 19 summer sport disciplines were evaluated through a preparticipation screening protocol and, when necessary, with the RTP protocol. The protocol comprised blood tests, 12-lead resting ECG, transthoracic echocardiogram, cardiopulmonary exercise test, 24-hour Holter-ECG monitoring and cardiovascular MR based on clinical indication. Results Of the 642 PO athletes evaluated, 384 participated at the Olympic Games, 254 being excluded for athletic reasons. 120 athletes of the total cohort of 642 PO were affected by COVID-19. They were evaluated with the RTP protocol before resuming physical activity after a mean detraining period of 30±13 days. Of them, 100 were selected for Olympic Games participation, 16 were excluded for athletic reasons and 4 were due to RTP results (2 for COVID-19-related myocarditis, 1 for pericarditis and 1 for complex ventricular arrhythmias). Among athletes with a history of COVID-19 allowed to resume physical activity after the RTP and selected for the Olympic Games, no one had abnormalities in cardiopulmonary exercise test parameters, and 28 became medal winners with 6 gold, 6 silver and 19 bronze medals. Conclusions Among athletes with COVID-19, there is a low prevalence of cardiac sequelae. For those athletes allowed to resume physical activity after the RTP evaluation, the infection and the forced period of inactivity didn’t have a negative impact on athletic performance

Impact of different techniques for mitral valve repair on left ventricular function: a 2D/3D echocardiographic analysis

Different surgical techniques are available for mitral valve (MV) repair in patients with degenerative severe mitral regurgitation (MR). Leaflet resection (LR) and neochordoplasty (NP), both including ring annuloplasty (RA), are the most frequently performed techniques for posterior mitral leaflet prolapse/flail repair. Despite NP technique is supposed to preserve LV physiology more than LR, it is unclear which technique provides the best haemodynamic pattern. In the present study, the results of the two different surgical techniques in terms of left ventricular (LV) dimension and function are investigated

CMR Mapping: The 4th-Era Revolution in Cardiac Imaging

Cardiac magnetic resonance (CMR) imaging has witnessed substantial progress with the advent of parametric mapping techniques, most notably T1 and T2 mapping. These advanced techniques provide valuable insights into a wide range of cardiac conditions, including ischemic heart disease, cardiomyopathies, inflammatory cardiomyopathies, heart valve disease, and athlete’s heart. Mapping could be the first sign of myocardial injury and oftentimes precedes symptoms, changes in ejection fraction, and irreversible myocardial remodeling. The ability of parametric mapping to offer a quantitative assessment of myocardial tissue properties addresses the limitations of conventional CMR methods, which often rely on qualitative or semiquantitative data. However, challenges persist, especially in terms of standardization and reference value establishment, hindering the wider clinical adoption of parametric mapping. Future developments should prioritize the standardization of techniques to enhance their clinical applicability, ultimately optimizing patient care pathways and outcomes. In this review, we endeavor to provide insights into the potential contributions of CMR mapping techniques in enhancing the diagnostic processes across a range of cardiac conditions

P1365 Different response of myocardial contractility by layer following acute pressure unloading after transcatheter aortic valve implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) is an effective therapeutic option for severe symptomatic aortic stenosis (AS) with intermediate/high surgical risk. Aim of this study was to examine the acute effect of TAVI in terms of pressure unloading, on left ventricular (LV) mechanics using multilayer global longitudinal strain (GLS) by 2D speckle-tracking echocardiography (ST-E). Methods A total of 44 patients (mean age 81.8\u2009\ub1\u20092, 34% male) with severe symptomatic AS and preserved LV ejection fraction (LVEF) underwent 2D echocardiography at baseline and 5\u2009\ub1\u20092 days after TAVI. GLS was measured from the endocardial layer (Endo-LS), epicardial layer (Epi-LS) and full thickness of myocardium before and after the procedure. Analysis included other parameters such as age, sex, LV volumes and ejection fraction (LVEF), type of prosthesis implanted, right ventricular (RV) dimension and function. Results By dividing patients in two groups accordingly with LV geometry assessed with regional wall thickness measurement (concentric vs eccentric hypertrophy), better values of Endo-LS were recorded at baseline, in patients with concentric hypertrophy (-12.9\u2009\ub1\u20092 vs -11\u2009\ub1\u20093, p\u2009=\u20090.048). After TAVI, a significant improvement in Endo-LS was observed, but only in patients with concentric hypertrophy (-12.9\u2009\ub1\u20092 vs -14.2\u2009\ub1\u20092, p\u2009=\u20090.003). Conclusion The improvement in LS was more prominent in the endocardium, which was evident even immediately after TAVI only in patients with concentric hypertrophy. Evaluation of multilayer strain may provide new insights into the positive effects of unloading in patients with AS and may be potentially useful to predict patients with better outcome after TAVI. Parameter RWT > 0.42 31 pz (70%) RWT 64 0.42 13 pz (30%) p Male sex (n, %) 8 (25%) 7 (53%) NS Age (y.o) 81 \ub1 6 83 \ub1 7 NS CAD (n, %) 3 (9%) 8 (61%) NS LVEDV (ml) 97 \ub1 29 134 \ub1 14 0.002 LVESV (ml) 43 \ub1 15 72 \ub1 38 0.001 LVEF(%) 56.2 \ub1 6 50 \ub1 12 NS AVA (cm2) 0.8 \ub1 0.2 0.8 \ub1 0.3 NS GLS (%) -11.4 \ub1 3 -10.5 \ub1 3 NS Endo-LS (%) -12.9 \ub1 2 -11 \ub1 3 0.048 Epi-LS (%) -10.8 \ub1 4 -9.9 \ub1 3 NS Abstract P1365 Figure