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American Journal of Physiology. Heart... Feb 2022Obesity is associated with higher risks of cardiac arrhythmias. Although this may be partly explained by concurrent cardiometabolic ill-health, growing evidence suggests... (Review)
Review
Obesity is associated with higher risks of cardiac arrhythmias. Although this may be partly explained by concurrent cardiometabolic ill-health, growing evidence suggests that increasing adiposity independently confers risk for arrhythmias. Among fat depots, epicardial adipose tissue (EAT) exhibits a proinflammatory secretome and, given the lack of fascial separation, has been implicated as a transducer of inflammation to the underlying myocardium. The present review explores the mechanisms underpinning adverse electrophysiological remodeling as a consequence of EAT accumulation and the consequent inflammation. We first describe the physiological and pathophysiological function of EAT and its unique secretome and subsequently discuss the evidence for ionic channel and connexin expression modulation as well as fibrotic remodeling induced by cytokines and free fatty acids that are secreted by EAT. Finally, we highlight how weight reduction and regression of EAT volume may cause reverse remodeling to ameliorate arrhythmic risk.
Topics: Adipose Tissue; Animals; Arrhythmias, Cardiac; Cytokines; Humans; Ion Channels; Pericardium
PubMed: 34890279
DOI: 10.1152/ajpheart.00565.2021 -
Pneumologie (Stuttgart, Germany) Oct 2019
Topics: Drainage; Humans; Pericardiocentesis; Pericardium; Practice Guidelines as Topic; Punctures
PubMed: 31622998
DOI: 10.1055/a-0863-8903 -
The Thoracic and Cardiovascular Surgeon Jan 2021Reconstruction of cardiac structures has been the goal of many surgeons even before the advent of open-heart procedures with cardiopulmonary bypass. Unsatisfactory... (Review)
Review
BACKGROUND
Reconstruction of cardiac structures has been the goal of many surgeons even before the advent of open-heart procedures with cardiopulmonary bypass. Unsatisfactory results with synthetic materials has switched the attention to biological tissues, among which pericardium, either autologous or of animal origin, has been widely used as patch material.
METHODS
We have reviewed the literature to assess the effective role of pericardial tissue in the correction of various acquired cardiac lesions. Particularly, special attention was given not only to established techniques but also to detect any peculiar and unusual application of pericardium.
RESULTS
Autologous pericardium is frequently used as patch material particularly when limited valvular lesions must be corrected, while xenograft pericardium appears particularly useful in patients with endocarditis and extensive destruction of the intracardiac structures by infection and abscesses. Pericardium is an extremely versatile material owing to its pliability and strength; however, it tends to calcify in the long term when in contact with blood, although stability of the repair is maintained in most cases.
CONCLUSIONS
Pericardium plays an important role in various cardiac and aortic pathologies. Tissues resistant to fibrosis and calcification to be used as patch material are the ideal solution for more successful cardiac reconstruction procedures and will hopefully be provided by the ongoing research.
Topics: Animals; Cardiac Surgical Procedures; Heart Diseases; Humans; Pericardium; Transplantation, Autologous; Transplantation, Heterologous; Treatment Outcome
PubMed: 31604358
DOI: 10.1055/s-0039-1697918 -
Current Cardiology Reports Dec 2023The purpose of this review is to discuss the evolving techniques and approaches for pericardiectomy, with a focus on the use of cardiopulmonary bypass (CPB) and the... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to discuss the evolving techniques and approaches for pericardiectomy, with a focus on the use of cardiopulmonary bypass (CPB) and the extent of radical pericardial resection. The review aims to highlight the benefits and considerations associated with these modifications in radical pericardiectomy.
RECENT FINDINGS
Recent studies have demonstrated that the use of CPB during pericardiectomy does not increase procedural risk or negatively impact survival. In fact, it has been shown to contribute to a more radical resection and improve postoperative outcomes, which is associated with less recurrence and better survival. The review emphasizes the importance of radical pericardiectomy and the use of CPB in achieving successful outcomes. Radical resection of the pericardium, facilitated by CPB, helps minimize the risk of recurrent constrictions and the need for reinterventions. The findings highlight the correlation between postoperative outcomes and survival, further supporting the use of CPB.
Topics: Humans; Pericarditis, Constrictive; Pericardium; Pericardiectomy; Heart Diseases
PubMed: 37938424
DOI: 10.1007/s11886-023-01986-4 -
International Journal of Molecular... Nov 2019Epicardial adipose tissue (EAT) is part of the visceral adipose tissue (VAT) that surrounds the heart and it is a quantifiable, modifiable, and multifaceted tissue that... (Review)
Review
Epicardial adipose tissue (EAT) is part of the visceral adipose tissue (VAT) that surrounds the heart and it is a quantifiable, modifiable, and multifaceted tissue that has both local and systemic effects. When EAT is enlarged, EAT contributes to atherosclerotic cardiovascular disease (ASCVD) risk and plays a role in the development of metabolic syndrome (MetS). In this review, we will discuss the role of EAT in various facets of MetS, including type 2 diabetes mellitus (T2DM) and insulin resistance. We examine the association between EAT and liver steatosis. We also address the correlations of EAT with HIV therapy and with psoriasis. We discuss racial differences in baseline EAT thickness. We conclude that EAT measurement serves as a powerful potential diagnostic tool in assessing cardiovascular and metabolic risk. Measurement of EAT is made less costly, more convenient, and yet accurate and reliable by transthoracic echocardiography. Furthermore, modification of EAT thickness has therapeutic implications for ASCVD, T2DM, and MetS.
Topics: Biomarkers; Cardiovascular Diseases; Humans; Intra-Abdominal Fat; Lipid Metabolism; Metabolic Syndrome; Pericardium
PubMed: 31795098
DOI: 10.3390/ijms20235989 -
European Heart Journal. Cardiovascular... Oct 2021Systemic autoimmune diseases are an important cause of pericardial involvement and contribute to up to ∼22% cases of pericarditis with a known aetiology. The... (Review)
Review
Systemic autoimmune diseases are an important cause of pericardial involvement and contribute to up to ∼22% cases of pericarditis with a known aetiology. The underlying mechanism for pericardial involvement varies with each systemic disease and leads to a poor understanding of its management. Multimodality imaging establishes the diagnosis and determines the type and extent of pericardial involvement. In this review, we elaborate upon various pericardial syndromes associated with different systemic autoimmune and autoinflammatory diseases and the multitude of imaging modalities that can be used to further characterize autoimmune pericardial involvement. Lastly, these forms of pericarditis have a greater likelihood of recurrence, and clinicians need to understand their unique treatment approaches to improve patient outcomes.
Topics: Humans; Multimodal Imaging; Pericardial Effusion; Pericarditis; Pericarditis, Constrictive; Pericardium
PubMed: 34333596
DOI: 10.1093/ehjci/jeab131 -
Journal of the American Society of... Aug 2023Routine echocardiography using a standard-frequency ultrasound probe has insufficient spatial resolution to clearly visualize the parietal pericardium (PP)....
BACKGROUND
Routine echocardiography using a standard-frequency ultrasound probe has insufficient spatial resolution to clearly visualize the parietal pericardium (PP). High-frequency ultrasound (HFU) has enhanced axial resolution. The aim of this study was to use a commercially available high-frequency linear probe to evaluate apical PP thickness (PPT) and pericardial adhesion in both normal pericardium and pericardial diseases.
METHODS
From April 2002 to March 2022, 227 healthy individuals, 205 patients with apical aneurysm (AA) and 80 patients with chronic constrictive pericarditis (CP) were recruited to participate in this study. All subjects underwent both standard-frequency ultrasound and HFU to image the apical PP (APP) and pericardial adhesion. Some subjects underwent computed tomography (CT).
RESULTS
Apical PPT was measured using HFU and found to be 0.60 ± 0.01 mm (0.37-0.87 mm) in normal control subjects, 1.22 ± 0.04 mm (0.48-4.53 mm) in patients with AA, and 2.91 ± 0.17 mm (1.13-9.01 mm) in patients with CP. Tiny physiologic effusions were observed in 39.2% of normal individuals. Pericardial adhesion was detected in 69.8% of patients with local pericarditis due to AA and 97.5% of patients with CP. Visibly thickened visceral pericardium was observed in six patients with CP. Apical PPT measurements obtained by HFU correlated well with those obtained by CT in those patients with CP. However, CT could clearly visualize the APP in only 45% of normal individuals and 37% of patients with AA. In 10 patients with CP, both HFU and CT demonstrated equal ability to visualize the very thickened APP.
CONCLUSIONS
Apical PPT measured using HFU in normal control subjects ranged from 0.37 to 0.87 mm, consistent with previous reports from necropsy studies. HFU had higher resolution in distinguishing local pericarditis of the AA from normal individuals. HFU was superior to CT in imaging APP lesions, as CT failed to visualize the APP in more than half of both normal individuals and patients with AA. The fact that all 80 patients with CP in our study had significantly thickened APP raises doubt regarding the previously reported finding that 18% of patients with CP had normal PPT.
Topics: Humans; Pericardium; Pericarditis, Constrictive; Ultrasonography; Pericarditis; Echocardiography
PubMed: 37019343
DOI: 10.1016/j.echo.2023.03.010 -
International Journal of Surgery... Oct 2021Valve disease carries a huge burden globally and the number of heart valve procedures are projected to increase from the current 300 000 to 800 000 annually by 2050.... (Review)
Review
Valve disease carries a huge burden globally and the number of heart valve procedures are projected to increase from the current 300 000 to 800 000 annually by 2050. Since its genesis 50 years ago, pericardial heart valve has moved leaps and bounds to ever more ingenious designs and manufacturing methods with parallel developments in cardiology and cardiovascular surgical treatments. This feat has only been possible through close collaboration of many scientific disciplines in the fields of engineering, material sciences, basic tissue biology, medicine and surgery. As the pace of change continues to accelerate, we ask the readers to go back with us in time to understand developments in design and function of pericardial heart valves. This descriptive review seeks to focus on the qualities of pericardial heart valves, the advantages, successes and failures encapsulating the evolution of surgically implanted pericardial heart valves over the past five decades. We present the data on comparison of the pericardial heart valves to porcine valves, discuss structural valve deterioration and the future of heart valve treatments.
Topics: Animals; Aortic Valve; Bioprosthesis; Forecasting; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Pericardium; Prosthesis Design; Swine
PubMed: 34543742
DOI: 10.1016/j.ijsu.2021.106121 -
Circulation Research Jan 2020The heart is lined by a single layer of mesothelial cells called the epicardium that provides important cellular contributions for embryonic heart formation. The... (Review)
Review
The heart is lined by a single layer of mesothelial cells called the epicardium that provides important cellular contributions for embryonic heart formation. The epicardium harbors a population of progenitor cells that undergo epithelial-to-mesenchymal transition displaying characteristic conversion of planar epithelial cells into multipolar and invasive mesenchymal cells before differentiating into nonmyocyte cardiac lineages, such as vascular smooth muscle cells, pericytes, and fibroblasts. The epicardium is also a source of paracrine cues that are essential for fetal cardiac growth, coronary vessel patterning, and regenerative heart repair. Although the epicardium becomes dormant after birth, cardiac injury reactivates developmental gene programs that stimulate epithelial-to-mesenchymal transition; however, it is not clear how the epicardium contributes to disease progression or repair in the adult. In this review, we will summarize the molecular mechanisms that control epicardium-derived progenitor cell migration, and the functional contributions of the epicardium to heart formation and cardiomyopathy. Future perspectives will be presented to highlight emerging therapeutic strategies aimed at harnessing the regenerative potential of the fetal epicardium for cardiac repair.
Topics: Animals; Heart Diseases; Humans; Myocardium; Paracrine Communication; Pericardium; Regeneration
PubMed: 31999538
DOI: 10.1161/CIRCRESAHA.119.315857 -
Journal of Cardiovascular... Jun 2020
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Pericardium; Pulmonary Veins
PubMed: 32202011
DOI: 10.1111/jce.14453