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429 Impact of the Severity of End-Stage Liver Disease in Cardiac Remodeling
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The Journal of Heart and Lung Transplantation, Vol 31, No 4S, April 2012
fractional anisotropy (FA) and mean (MD), axial (DA), and transverse (DT) diffusivities, were obtained from left ventricular specimens acquired from patients with end-stage heart failure due to non-ischemic cardiomyopathy at the time of heart transplantation (n⫽17) and from normal donors (n⫽5). Basic remodeling pathologic features [fibrosis, myocyte cross sectional area (CSA), microvascular density (MD)] assessed with digital microscopy were used as the gold standard comparator. Results: Compared to the normal subjects, failing hearts specimens had lower FA and higher MD and DT while DA underwent an insignificant increase (Table). FA correlated moderately with fibrosis (r ⫽ – 0.481, p⫽0.023) while the diffusivities MD and DT had a better correlation with fibrosis (r ⫽ 0.574, p⫽ 0.005 and r ⫽ 0.640, p⫽0.001, respectively). DT-MRI parameters had no significant correlation with myocyte CSA or microvascular density. Conclusions: The DT-MRI parameters correlated well with fibrosis measured by state-of-the art digital histopathology suggesting the applicability of DT-MRI as a non-invasive complementary technique to histology in assessing myocardial fibrosis. Further investigation of DT-MRI as full heart mapping technique is warranted in order to explore its in-vivo utility in a variety of cardiac conditions associated with fibrosis or other myocardial changes such as cardiac rejection or borderline donor assessment.
430 The Role of Cardiac Biomarkers in Takotsubo Cardiomyopathy A. Lahoti,1 M. Badri,1 M. Iqbal,2 K.S. Mohammed,1 W. Saeed,2 E. Gnall,1 R. Zolty,2 M.R. Sardar.1 1Department of Cardiology, Lankenau Medical Center, Wynnewood, PA; 2Department of Cardiology, Montefiore Medical Center, New York, NY. Purpose: Takotsubo cardiomyopathy (TC), also known as stress-induced cardiomyopathy; typically has symptoms and ECG changes that mimic ST elevation myocardial infaction (STEMI). We hypothesized that STEMI should have higher Troponin T and TC should have higher pro-BNP given the nature of each disease, and evaluated the role of mean Pro-BNP to peak Troponin T ratio (BNP/TNT) in differentiating STEMI from TC. Methods and Materials: Retrospective analysis of TC patients seen in a single center in the last seven years. Inclusion criteria are a diagnosis of TC established by non-obstructive coronary artery anatomy on coronary angiography, apical ballooning with preserved base of the heart and resolution of cardiomyopathy within 4 weeks by echocardiography. Atypical TC presentations on imaging and known obstructive coronary disease were excluded. Results: 52 patients are selected with mean age 65.9, 83% females with 23% pre-menopausal and youngest is 31 years old. 66% and 25% patients have known HTN and DM respectively. Comparing TC to STEMI, mean pro-BNP 9664.4⫾2780 vs 347⫾127.4 (p⬍0.001), peak troponin T 0.73⫾0.49 vs 20.8⫾16.5 (p⬍0.001), BNP/TNT 5154⫾1891.2 vs 183⫾128.9 (p⬍0.001).
429 Impact of the Severity of End-Stage Liver Disease in Cardiac Remodeling O.M. Silvestre,1 F. Bacal,1 A.Q. Farias,2 J.L. Andrade,3 M. Furtado,3 V. Pugliese,2 W. Andraus,2 D.S. Ramos,2 E. Belleti,2 L.A.C. Albuquerque,2 F.J. Carrilho.2 1Cardiology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil; 2Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil; 3 Radiology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil. Purpose: The impact of end-stage liver disease (ESLD) in cardiac remodeling of patients with cirrhosis is unknown. Our aim was to correlate the severity of ESLD with morphologic and functional heart changes. Methods and Materials: 184 patients underwent a protocol providing data on the severity of ESLD and undergoing echocardiography to assess the diameters of the left atrium and right ventricle; the systolic and diastolic diameters of the left ventricle, interventricular septum, and posterior wall of the left ventricle; systolic pulmonary artery pressure; ejection fraction; and diastolic function. Severity of ESLD was assessed by the Model for End-Stage Liver Disease (MELD) score. Results: Left-atrial diameter (r⫽0.323; IC 95% 0.190-0.455; p⬍0.001), left-ventricular diastolic diameter (r⫽0.177; IC 95% 0.033-0.320; p⫽0.01) and systolic pulmonary artery pressure (r⫽0.185; IC 95% 0.036-0.335; p⫽0.02) significantly correlated with MELD score.
Mean pBNP/pTNT ⬎2500 yields 90 % specificity and sensitivity for TC diagnosis. Conclusions: BNP/TNT ratio was significantly higher in patients with TC compared to STEMI, and therefore can potentially be used to differentiate the two conditions early on. Further studies will need to evaluate the use of this ratio in different patient populations presenting with TC. 431 Is Improvement in Pulmonary Vascular Hemodynamics in Patients Supported with Continuous-Flow Left Ventricular Assist Devices Sustained after Heart Transplantation? A. Saidi, O. Wever-Pinzon, M. Labedi, M. Barakat, J. Stehlik, S. Drakos, C. Selzman, B. Reid, R. Alharethi, A.G. Kfoury, F. Bader. Cardiology, Utah Transplant Affiliated Hospitals, Salt Lake City, UT.
Patients with MELD ⬎16 had significantly higher left-atrial diameter and systolic pulmonary artery pressure, compared with patients with MELD scores ⬍16 points. Conclusions: Changes in cardiac structure and function correlate with the severity of ESLD.
Purpose: Pulmonary hypertension (PHT) is common in patients with advanced heart failure (HF) and is also a risk factor for mortality after heart transplantation (HTx). Severe PHT is a contraindication for HTx. Continuous-flow left ventricular assist devices (CF-LVADs) are widely used as a bridge to HTx in these patients. Several studies have shown that reversal of PHT after LVAD placement allows for HTx in these patients. However, it is debatable whether CF-LVADs are as effective as pulsatile LVADs in
The Journal of Heart and Lung Transplantation, Vol 31, No 4S, April 2012
fractional anisotropy (FA) and mean (MD), axial (DA), and transverse (DT) diffusivities, were obtained from left ventricular specimens acquired from patients with end-stage heart failure due to non-ischemic cardiomyopathy at the time of heart transplantation (n⫽17) and from normal donors (n⫽5). Basic remodeling pathologic features [fibrosis, myocyte cross sectional area (CSA), microvascular density (MD)] assessed with digital microscopy were used as the gold standard comparator. Results: Compared to the normal subjects, failing hearts specimens had lower FA and higher MD and DT while DA underwent an insignificant increase (Table). FA correlated moderately with fibrosis (r ⫽ – 0.481, p⫽0.023) while the diffusivities MD and DT had a better correlation with fibrosis (r ⫽ 0.574, p⫽ 0.005 and r ⫽ 0.640, p⫽0.001, respectively). DT-MRI parameters had no significant correlation with myocyte CSA or microvascular density. Conclusions: The DT-MRI parameters correlated well with fibrosis measured by state-of-the art digital histopathology suggesting the applicability of DT-MRI as a non-invasive complementary technique to histology in assessing myocardial fibrosis. Further investigation of DT-MRI as full heart mapping technique is warranted in order to explore its in-vivo utility in a variety of cardiac conditions associated with fibrosis or other myocardial changes such as cardiac rejection or borderline donor assessment.
430 The Role of Cardiac Biomarkers in Takotsubo Cardiomyopathy A. Lahoti,1 M. Badri,1 M. Iqbal,2 K.S. Mohammed,1 W. Saeed,2 E. Gnall,1 R. Zolty,2 M.R. Sardar.1 1Department of Cardiology, Lankenau Medical Center, Wynnewood, PA; 2Department of Cardiology, Montefiore Medical Center, New York, NY. Purpose: Takotsubo cardiomyopathy (TC), also known as stress-induced cardiomyopathy; typically has symptoms and ECG changes that mimic ST elevation myocardial infaction (STEMI). We hypothesized that STEMI should have higher Troponin T and TC should have higher pro-BNP given the nature of each disease, and evaluated the role of mean Pro-BNP to peak Troponin T ratio (BNP/TNT) in differentiating STEMI from TC. Methods and Materials: Retrospective analysis of TC patients seen in a single center in the last seven years. Inclusion criteria are a diagnosis of TC established by non-obstructive coronary artery anatomy on coronary angiography, apical ballooning with preserved base of the heart and resolution of cardiomyopathy within 4 weeks by echocardiography. Atypical TC presentations on imaging and known obstructive coronary disease were excluded. Results: 52 patients are selected with mean age 65.9, 83% females with 23% pre-menopausal and youngest is 31 years old. 66% and 25% patients have known HTN and DM respectively. Comparing TC to STEMI, mean pro-BNP 9664.4⫾2780 vs 347⫾127.4 (p⬍0.001), peak troponin T 0.73⫾0.49 vs 20.8⫾16.5 (p⬍0.001), BNP/TNT 5154⫾1891.2 vs 183⫾128.9 (p⬍0.001).
429 Impact of the Severity of End-Stage Liver Disease in Cardiac Remodeling O.M. Silvestre,1 F. Bacal,1 A.Q. Farias,2 J.L. Andrade,3 M. Furtado,3 V. Pugliese,2 W. Andraus,2 D.S. Ramos,2 E. Belleti,2 L.A.C. Albuquerque,2 F.J. Carrilho.2 1Cardiology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil; 2Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil; 3 Radiology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil. Purpose: The impact of end-stage liver disease (ESLD) in cardiac remodeling of patients with cirrhosis is unknown. Our aim was to correlate the severity of ESLD with morphologic and functional heart changes. Methods and Materials: 184 patients underwent a protocol providing data on the severity of ESLD and undergoing echocardiography to assess the diameters of the left atrium and right ventricle; the systolic and diastolic diameters of the left ventricle, interventricular septum, and posterior wall of the left ventricle; systolic pulmonary artery pressure; ejection fraction; and diastolic function. Severity of ESLD was assessed by the Model for End-Stage Liver Disease (MELD) score. Results: Left-atrial diameter (r⫽0.323; IC 95% 0.190-0.455; p⬍0.001), left-ventricular diastolic diameter (r⫽0.177; IC 95% 0.033-0.320; p⫽0.01) and systolic pulmonary artery pressure (r⫽0.185; IC 95% 0.036-0.335; p⫽0.02) significantly correlated with MELD score.
Mean pBNP/pTNT ⬎2500 yields 90 % specificity and sensitivity for TC diagnosis. Conclusions: BNP/TNT ratio was significantly higher in patients with TC compared to STEMI, and therefore can potentially be used to differentiate the two conditions early on. Further studies will need to evaluate the use of this ratio in different patient populations presenting with TC. 431 Is Improvement in Pulmonary Vascular Hemodynamics in Patients Supported with Continuous-Flow Left Ventricular Assist Devices Sustained after Heart Transplantation? A. Saidi, O. Wever-Pinzon, M. Labedi, M. Barakat, J. Stehlik, S. Drakos, C. Selzman, B. Reid, R. Alharethi, A.G. Kfoury, F. Bader. Cardiology, Utah Transplant Affiliated Hospitals, Salt Lake City, UT.
Patients with MELD ⬎16 had significantly higher left-atrial diameter and systolic pulmonary artery pressure, compared with patients with MELD scores ⬍16 points. Conclusions: Changes in cardiac structure and function correlate with the severity of ESLD.
Purpose: Pulmonary hypertension (PHT) is common in patients with advanced heart failure (HF) and is also a risk factor for mortality after heart transplantation (HTx). Severe PHT is a contraindication for HTx. Continuous-flow left ventricular assist devices (CF-LVADs) are widely used as a bridge to HTx in these patients. Several studies have shown that reversal of PHT after LVAD placement allows for HTx in these patients. However, it is debatable whether CF-LVADs are as effective as pulsatile LVADs in