Background Left ventricular remodeling following ST-elevation myocardial infarction (STEMI) is associated with poor outcome, including heart failure (HF). Neprilysin inhibition leads to improved outcome in patients with altered left ventricular ejection fraction (LVEF). Methods We aimed to assess the association between serum levels of neprilysin and left ventricular (LV) volumes, function and remodeling in STEMI patients with successful myocardial reperfusion and no clinical sign of HF. Sixty-eight patients were admitted for STEMI and had both plasma neprilysin measurement at baseline and 3D transthoracic echocardiogram at baseline and after a median follow-up of 7 months. We compared 3 groups: a group with a low-level of plasma neprilysin (< 125 pg/mL, i.e. the lower limit of detection of the assay) and the two other groups were defined as being below or above the median value of the remaining samples. Results Median age was 58.5 ± 12.8 years and 56 (82.4%) were men. Median LVEF was 45.0 ± 8.5%. Baseline characteristics were comparable between groups (low-level of neprilysin group [≤125 pg/mL, n = 38], medium-level of neprilysin group [126–450 pg/mL, n = 15] and a high-level group [> 450 pg/mL, n = 15]). At baseline there was a non-significant trend towards lower end-diastolic volume (p = 0.07) but significantly lower LVEF in the high neprilysin group (46.4 ± 8.3%, 47.1 ± 8.1% and 39.1 ± 6.9%, p < 0.01). At follow-up, the magnitude of LVEF increase was significantly more important in the high neprilysin group compared to the other groups (p = 0.022 for relative change in LVEF and 6.6 ± 7.3%, 3.6 ± 9.0% and 11.3 ± 8.4%, p = 0.031 for absolute change in LVEF) resulting in similar LVEF levels at follow-up between all groups (53.0 ± 8.9%, 50.6 ± 9.7% and 50.4 ± 9.9%, p = 0.55). Conclusions Initial high neprilysin levels may identify patients with stunned myocardium early after STEMI, with a recovery of contractility leading to improved LVEF at follow-up. Future studies will have to assess the role of neprilysin in the setting of STEMI and the potential benefit of its blockade.

ObjectivesThe objectives of this study were to examine left atrial (LA) function and compliance using two-dimensional (2D) strain analysis in adult patients with corrected Tetralogy of Fallot (c-ToF) and to investigate the relationships between LA function and patient characteristics, especially history of life-threatening arrhythmia (h-LTA).MethodsFifty-one c-ToF patients (34 males; age, 39 ± 15 years; h-LTA, n = 13) were included in this retrospective monocenter study. In addition to a 2D standard echocardiography examination, 2D strain analysis was performed to assess left ventricular (LV) and LA functions, including peak-positive LA strain (LAS—reservoir function) and LA compliance [defined as the ratio LAS/(E/Ea)].ResultsPatients with h-LTA were older and exhibited a longer QRS duration. LV ejection fraction, LAS and LA compliance were significantly lower in the group of patients with h-LTA. Indexed LA and RA volumes, RV end-diastolic area was significantly higher and RV fractional area change significantly lower in the h-LTA group. LA compliance was the best echocardiographic predictor for h-LTA (AUC: 0.839; p &lt; 0.001). Moderate inverted correlations were found between LA compliance and age and QRS duration. Among the echocardiographic parameters, LA compliance was moderately inversely correlated with RV end-diastolic area (r = −0.40, p = 0.01).ConclusionWe documented abnormal LAS and LA compliance values in adult c-ToF patients. Further study is needed to determine how best to incorporate LA strain, particularly LA compliance, into multiparametric predictive models for LTA in c-ToF patients.

Background/Introduction Left ventricular remodeling following ST-elevation myocardial infarction (STEMI) is associated with poor outcome. Neprilysin inhibition leads to improved outcome in patients with altered left ventricular ejection fraction (LVEF). Purpose We aimed to assess the association between serum levels of neprilysin and left ventricular (LV) volumes, function and remodeling in STEMI patients with successful myocardial reperfusion. Methods Sixty-eight patients were admitted for STEMI and had both plasma neprilysin measurement at baseline and 3D transthoracic echocardiogram at baseline and at follow-up (7 months). We compared 3 groups: a group with a low-level of plasma neprilysin (&lt;125 pg/mL, i.e. the lower limit of detection of the assay, 38 patients) and the two other groups were defined as being below or above the median value of the remaining samples (15 patients each). Results Median age was 58.5±12.8 years and 56 (82.4%) were men. Median LVEF was 45.0±8.5%. Baseline characteristics were comparable among groups. At baseline there was a non-significant trend towards lower end-diastolic volume (p=0.07) but significantly lower LVEF in the high neprilysin group (46.4±8.3%, 47.1±8.1% and 39.1±6.9%, p&lt;0.01). At follow-up, the magnitude of LVEF increase was significantly more important in the high neprilysin group compared to the other groups (p=0.022 for relative change in LVEF and 6.6±7.3%, 3.6±9.0% and 11.3±8.4%, p=0.031 for absolute change in LVEF) resulting in similar LVEF levels at follow-up between all groups (53.0±8.9%, 50.6±9.7% and 50.4±9.9%, p=0.55). Conclusion(s) Initial high neprilysin levels may identify patients with stunned myocardium early after STEMI, with a recovery of contractility leading to improved LVEF at follow-up. Funding Acknowledgement Type of funding source: None