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Journal of Magnetic Resonance Imaging :... Jul 2024
Topics: Humans; Hypertension, Pulmonary; Magnetic Resonance Imaging; Heart Ventricles; Ventricular Dysfunction, Right
PubMed: 37905953
DOI: 10.1002/jmri.29092 -
Journal of Nuclear Cardiology :... Dec 2023The sympathetic denervation studies and the studies of microvascular involvement are the most important tools for early detection of Chagas heart disease. Especially the...
The sympathetic denervation studies and the studies of microvascular involvement are the most important tools for early detection of Chagas heart disease. Especially the 123I-123I-MIBGSPECT or 11C-meta-hydroxyephedrine-PET studies since everything starts from sympathetic denervation. Also it is advisable to insist on the assessment of other parameters of early involvement of left ventricular systolic function to understand the importance of the additional information provided by the analysis of the parameters of ventricular remodeling, synchrony, and GLS in patients with normal left ventricular ejection fraction and in the absence of ventricular dilatation for early detection of myocardial dysfunction.
Topics: Humans; Stroke Volume; Ventricular Function, Left; Heart; Cardiomyopathies; Ventricular Dysfunction, Left
PubMed: 37280386
DOI: 10.1007/s12350-023-03301-8 -
Circulation Jan 2024
Topics: Humans; Pulmonary Edema; Pulmonary Circulation; Myocardial Infarction; Ventricular Dysfunction, Left
PubMed: 38252738
DOI: 10.1161/CIRCULATIONAHA.123.066163 -
International Journal of Cardiology Oct 2023This study aims to evaluate the prevalence and the clinical significance of the right ventricular pulmonary arterial (RV-PA) uncoupling in patients with cardiac...
BACKGROUND
This study aims to evaluate the prevalence and the clinical significance of the right ventricular pulmonary arterial (RV-PA) uncoupling in patients with cardiac amyloidosis (CA).
METHODS
The study population consisted in 92 consecutive patients with CA (age 71.1 ± 12.2 years, 71% males; 47% with immunoglobulin light chain (AL), 53% with transthyretin [ATTR]). A pre-specified tricuspid anulus plane systolic excursion on pulmonary arterial systolic pressure (TAPSE/PASP) value <0.31 mm/mmHg was used to define RV-PA uncoupling and to dichotomize the study population.
RESULTS
Thirty-two patients (35%) showed RV-PA uncoupling at baseline evaluation (15/44 [34%] AL and 17/48 [35%] ATTR). Patients with RV-PA uncoupling, in both AL and ATTR, showed worse NYHA functional class, lower systemic blood pressure, and more pronounced left ventricular and RV systolic dysfunction than those with RV-PA coupling. During a median follow-up of 8 months (IQR 4-13), 26 patients (28%) experienced cardiovascular death. Patients with RV-PA uncoupling showed lower survival at 12 months follow-up than those with RV-PA coupling (42.7% [95%CI 21.7-63.7%] vs. 87.3% [95%CI 78.3-96.3%], p-value<0.001). Multivariate analysis identified high-sensitivity troponin I values (HR 1.01 [95%CI 1.00-1.02] per 1 pg/mL increase; p-value 0.013) and TAPSE/PASP (HR 1.07 [95%CI 1.03-1.11] per 0.01 mm/mmHg decrease; p-value 0.002) as independent predictors of cardiovascular death.
CONCLUSIONS
RV-PA uncoupling is common among patient with CA, and it is a marker of advanced disease and worse outcome. This study suggest that TAPSE/PASP ratio has the potential to improve risk stratification and guide management strategies in patients with CA of different etiology and advanced disease.
Topics: Male; Humans; Middle Aged; Aged; Aged, 80 and over; Female; Echocardiography, Doppler; Hypertension, Pulmonary; Prevalence; Clinical Relevance; Pulmonary Artery; Amyloidosis; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 37423570
DOI: 10.1016/j.ijcard.2023.131147 -
Cardiovascular Diabetology May 2024The association between the triglyceride-glucose (TyG) index and subclinical left ventricular (LV) systolic dysfunction in obese patients remains unclear. This study...
BACKGROUND
The association between the triglyceride-glucose (TyG) index and subclinical left ventricular (LV) systolic dysfunction in obese patients remains unclear. This study aimed to investigate the relationship between the TyG index and LV global longitudinal strain (GLS) in obese patients.
METHODS
A total of 1028 obese patients from January 2019 to January 2024 were included in the present study. Clinical parameters and biochemical and echocardiographic data were obtained from the participants. LV GLS was obtained from the GE EchoPAC workstation for evaluating subclinical LV function. The TyG index was calculated as Ln (fasting TG [mg/dL] × fasting glucose [mg/dL]/2). LV GLS was compared between obese patients with a high TyG index and those with a low TyG index.
RESULTS
Obese patients with a high TyG index had greater incidences of hypertension, diabetes mellitus and hyperlipidaemia. The LV GLS was significantly lower in the high TyG index group than in the low TyG index group (P = 0.01). After adjusting for sex, age, body mass index, heart rate, hypertension, diabetes mellitus, dyslipidaemia, blood urea nitrogen, serum creatinine, LV mass and LV hypertrophy, the TyG index remained an independent risk indicator related to an LV GLS < 20% (OR: 1.520, 95% CI: 1.040 to 2.221; P = 0.031).
CONCLUSIONS
We concluded that an increase in the TyG index is independently associated with subclinical LV systolic dysfunction in obese patients.
Topics: Humans; Male; Female; Ventricular Dysfunction, Left; Obesity; Middle Aged; Triglycerides; Ventricular Function, Left; Blood Glucose; Biomarkers; Adult; Risk Factors; Asymptomatic Diseases; Risk Assessment; Systole; Aged; Cross-Sectional Studies; Predictive Value of Tests; Retrospective Studies
PubMed: 38715070
DOI: 10.1186/s12933-024-02253-8 -
The International Journal of... Nov 2023The myocardial performance index (MPI) is an index that shows both systolic and diastolic functions of the ventricle. Presystolic wave (PSW) is a late diastolic wave...
The myocardial performance index (MPI) is an index that shows both systolic and diastolic functions of the ventricle. Presystolic wave (PSW) is a late diastolic wave encountered in the left ventricular outflow tract (LVOT) and is associated with increased left ventricular stiffness and decreased left ventricular compliance. In our study, MPI was compared between patients with metabolic syndrome and normal patients, and we also investigated whether PSW could predict subclinical left ventricular dysfunction (SCLVD) in patients with metabolic syndrome. A total of 119 patients, 59 with metabolic syndrome and 60 healthy volunteers, were included in our study. Our study is a two-center prospective study. The patient groups were compared in terms of demographic, laboratory and echocardiographic parameters. Univariate and multivariate regression analyzes were performed to detect predictors of SCLVD. Higher MPI and PSW were found in patients with metabolic syndrome compared to the normal population (0.56 ± 0.11 vs. 0.46 ± 0.07, p < 0.001, 34 (57.6%) vs. 19 (31.7%), p = 0.004, respectively). MPI was found to be higher in patients with metabolic syndrome with PSW ( +) (0.59 ± 0.13 vs. 0.52 ± 0.05, p = 0.005). Smoking and PSW were found as Independent Predictors of Subclinical Left Ventricular Dysfunction in the Multivariate Logistic Regression Analysis Model (OR 0.146, 95%CI 0.028-0.767, p = 0.023 and OR 10.689, 95%CI 2.176-52.515, p = 0.004, respectively). Higher MPI and SCLVD were detected in patients with metabolic syndrome compared to the normal population. In addition, PSW positivity was associated with SCLVD in this patient group.
Topics: Humans; Metabolic Syndrome; Prospective Studies; Predictive Value of Tests; Ventricular Dysfunction, Left; Heart; Ventricular Function, Left
PubMed: 37594699
DOI: 10.1007/s10554-023-02929-4 -
American Journal of Obstetrics &... Dec 2023Peripartum cardiomyopathy, one of the most fatal conditions during delivery, results in heart failure secondary to left ventricular systolic dysfunction. Left...
BACKGROUND
Peripartum cardiomyopathy, one of the most fatal conditions during delivery, results in heart failure secondary to left ventricular systolic dysfunction. Left ventricular dysfunction can result in abnormalities in electrocardiography. However, the usefulness of electrocardiography in the identification of peripartum cardiomyopathy in pregnant women remains unclear.
OBJECTIVE
This study aimed to evaluate the effectiveness of a 12-lead electrocardiography-based artificial intelligence/machine learning-based software as a medical device for screening peripartum cardiomyopathy.
STUDY DESIGN
This retrospective cohort study included pregnant women who underwent transthoracic echocardiography between a month before and 5 months after delivery and underwent 12-lead electrocardiography within 30 days of echocardiography between December 2011 and May 2022 at Seoul National University Hospital. The performance of 12-lead electrocardiography-based artificial intelligence/machine learning analysis (AiTiALVSD software; version 1.00.00, which was developed to screen for left ventricular systolic dysfunction in the general population) was evaluated for the identification of peripartum cardiomyopathy. In addition, the performance of another artificial intelligence/machine learning algorithm using only 1-lead electrocardiography to detect left ventricular systolic dysfunction was evaluated in identifying peripartum cardiomyopathy. The results were obtained under a 95% confidence interval and considered significant when P<.05.
RESULTS
Among the 14,557 women who delivered during the study period, 204 (1.4%) underwent transthoracic echocardiography a month before and 5 months after delivery. Among them, 12 (5.8%) were diagnosed with peripartum cardiomyopathy. The results showed that AiTiALVSD for 12-lead electrocardiography was highly effective in detecting peripartum cardiomyopathy, with an area under the receiver operating characteristic of 0.979 (95% confidence interval, 0.953-1.000), an area under the precision-recall curve of 0.715 (95% confidence interval, 0.499-0.951), a sensitivity of 0.917 (95% confidence interval, 0.760-1.000), a specificity of 0.927 (95% confidence interval, 0.890-0.964), a positive predictive value of 0.440 (95% confidence interval, 0.245-0.635), and a negative predictive value of 0.994 (95% confidence interval, 0.983-1.000). In addition, a 1-lead (lead I) artificial intelligence/machine learning algorithm showed excellent performance; the area under the receiver operating characteristic, area under the precision-recall curve, sensitivity, specificity, positive predictive value, and negative predictive value were 0.944 (95% confidence interval, 0.895-0.993), 0.520 (95% confidence interval, 0.319-0.801), 0.833 (95% confidence interval, 0.622-1.000), 0.880 (95% confidence interval, 0.834-0.926), 0.303 (95% confidence interval, 0.146-0.460), and 0.988 (95% confidence interval, 0.972-1.000), respectively.
CONCLUSION
The 12-lead electrocardiography-based artificial intelligence/machine learning-based software as a medical device (AiTiALVSD) and 1-lead algorithm are noninvasive and effective ways of identifying cardiomyopathies occurring during the peripartum period, and they could potentially be used as highly sensitive screening tools for peripartum cardiomyopathy.
Topics: Humans; Female; Pregnancy; Ventricular Function, Left; Stroke Volume; Retrospective Studies; Artificial Intelligence; Deep Learning; Peripartum Period; Electrocardiography; Cardiomyopathies; Ventricular Dysfunction, Left
PubMed: 37863197
DOI: 10.1016/j.ajogmf.2023.101184 -
Archives of Cardiovascular Diseases 2023Current guidelines recommend aortic valve replacement for symptomatic or selected asymptomatic high-risk patients with severe aortic stenosis. Conversely, a watchful... (Review)
Review
Current guidelines recommend aortic valve replacement for symptomatic or selected asymptomatic high-risk patients with severe aortic stenosis. Conversely, a watchful waiting attitude applies to patients with moderate aortic stenosis, regardless of their risk profile and symptoms, until the echocardiographic thresholds of severe aortic stenosis are reached. This strategy is based on data reporting high mortality in untreated severe symptomatic aortic stenosis, whereas moderate aortic stenosis has always been perceived as a non-threatening condition, with a benefit-risk balance against surgery. Meanwhile, numerous studies have reported a worrying event rate in these patients, surgical techniques and outcomes have improved significantly and the use of transcatheter aortic valve replacement has become more widespread and extended to lower-risk patients, leaving this strategy open to question, especially for patients with moderate aortic stenosis and left ventricular dysfunction. In this review, we summarize the current state of knowledge about moderate aortic stenosis progression and prognosis. We also discuss the particular case of moderate aortic stenosis associated with left ventricular dysfunction, and the ongoing trials that that might change our paradigm for the management of this "moderate" valvular heart disease.
Topics: Humans; Heart Valve Prosthesis Implantation; Aortic Valve Stenosis; Aortic Valve; Transcatheter Aortic Valve Replacement; Ventricular Dysfunction, Left
PubMed: 37230916
DOI: 10.1016/j.acvd.2023.04.006 -
Diabetes, Obesity & Metabolism Oct 2023To compare clinical outcomes among patients with heart failure and reduced ejection fraction (HFrEF) according to body mass index (BMI) after initiating treatment with...
AIM
To compare clinical outcomes among patients with heart failure and reduced ejection fraction (HFrEF) according to body mass index (BMI) after initiating treatment with an angiotensin-receptor neprilysin inhibitor (ARNI).
METHODS
We gathered data from 2016 to 2020 at the University Medical Center Mannheim; 208 consecutive patients were divided into two groups according to BMI (< 30 kg/m ; n = 116, ≥ 30 kg/m ; n = 92). Clinical outcomes, including mortality rate, all-cause hospitalizations and congestion, were systematically analysed.
RESULTS
At the 12-month follow-up, the mortality rate was similar in both groups (7.9% in BMI < 30 kg/m vs. 5.6% in BMI ≥ 30 kg/m ; P = .76). All-cause hospitalization before ARNI treatment was comparable in both groups (63.8% in BMI < 30 kg/m vs. 57.6% in BMI ≥ 30 kg/m ; P = .69). After ARNI treatment, the hospitalization rate was also comparable in both groups at the 12-month follow-up (52.2% in BMI < 30 kg/m vs. 53.7% in BMI ≥ 30 kg/m ; P = .73). Obese patients experienced more congestion compared with non-obese patients at follow-up, without statistical significance (6.8% in BMI < 30 kg/m vs. 15.5% in BMI ≥ 30 kg/m ; P = .11). Median left ventricular ejection fraction (LVEF) improved in both groups, but significantly more in non-obese compared with obese patients at the 12-month follow-up (from 26% [3%-45%] [min.-max.] vs. 29% [10%-45%] [min.-max.] [P = .56] to 35.5% [15%-59%] [min.-max.] vs. 30% [13%-50%] [min.-max.] [P = .03], respectively). The incidence of atrial fibrillation (AF), non-sustained (ns) and sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) was less in non-obese than in obese patients after initiation of sacubitril/valsartan at the 12-month follow-up (AF: 43.5% vs. 53.7%; P = .20; nsVT: 9.8% vs. 28.4%; P = .01; VT: 14.1% vs. 17.9%; P = .52; VF: 7.6% vs. 13.4%; P = .23).
CONCLUSIONS
The incidence of congestion in obese patients was higher compared with non-obese patients. LVEF improved significantly more in non-obese compared with obese HFrEF patients. Furthermore, AF and the ventricular tachyarrhythmia rate were revealed more in obesity compared with those without obesity at the 12-month follow-up.
Topics: Humans; Heart Failure; Stroke Volume; Ventricular Function, Left; Atrial Fibrillation; Incidence; Tetrazoles; Treatment Outcome; Valsartan; Biphenyl Compounds; Ventricular Dysfunction, Left; Drug Combinations; Obesity; Angiotensin Receptor Antagonists
PubMed: 37417372
DOI: 10.1111/dom.15198 -
ESC Heart Failure Jun 2024Heart failure is the final stage of several cardiovascular diseases, and the key to effectively treating heart failure is to reverse or delay ventricular remodelling.... (Meta-Analysis)
Meta-Analysis Review
Heart failure is the final stage of several cardiovascular diseases, and the key to effectively treating heart failure is to reverse or delay ventricular remodelling. Levosimendan is a novel inotropic and vasodilator agent used in heart failure, whereas the impact of levosimendan on ventricular remodelling is still unclear. This study aims to investigate the impact of levosimendan on ventricular remodelling in patients with left ventricular systolic dysfunction. Electronic databases were searched to identify eligible studies. A total of 66 randomized controlled trials involving 7968 patients were included. Meta-analysis results showed that levosimendan increased left ventricular ejection fraction [mean difference (MD) = 3.62, 95% confidence interval (CI) (2.88, 4.35), P < 0.00001] and stroke volume [MD = 6.59, 95% CI (3.22, 9.96), P = 0.0001] and significantly reduced left ventricular end-systolic volume [standard mean difference (SMD) = -0.52, 95% CI (-0.67, -0.37), P < 0.00001], left ventricular end-diastolic volume index [SMD = -1.24, 95% CI (-1.61, -0.86), P < 0.00001], and left ventricular end-systolic volume index [SMD = -1.06, 95% CI (-1.43, -0.70), P < 0.00001]. In terms of biomarkers, levosimendan significantly reduced the level of brain natriuretic peptide [SMD = -1.08, 95% CI (-1.60, -0.56), P < 0.0001], N-terminal pro-brain natriuretic peptide [SMD = -0.99, 95% CI (-1.41, -0.56), P < 0.00001], and interleukin-6 [SMD = -0.61, 95% CI (-0.86, -0.35), P < 0.00001]. Meanwhile, levosimendan may increase the incidence of hypotension [risk ratio (RR) = 1.24, 95% CI (1.12, 1.39), P < 0.0001], hypokalaemia [RR = 1.57, 95% CI (1.08, 2.28), P = 0.02], headache [RR = 1.89, 95% CI (1.50, 2.39), P < 0.00001], atrial fibrillation [RR = 1.31, 95% CI (1.12, 1.52), P = 0.0005], and premature ventricular complexes [RR = 1.86, 95% CI (1.27, 2.72), P = 0.001]. In addition, levosimendan reduced all-cause mortality [RR = 0.83, 95% CI (0.74, 0.94), P = 0.002]. In conclusion, our study found that levosimendan might reverse ventricular remodelling when applied in patients with left ventricular systolic dysfunction, especially in patients undergoing cardiac surgery, decompensated heart failure, and septic shock.
Topics: Simendan; Humans; Ventricular Dysfunction, Left; Ventricular Remodeling; Ventricular Function, Left; Stroke Volume; Cardiotonic Agents; Systole
PubMed: 38419326
DOI: 10.1002/ehf2.14714