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Journal of Cardiovascular Development... Apr 2023In the transposition of the great arteries (TGA), alterations in hemodynamics and oxygen saturation could result in fibrotic remodeling, but histological studies are...
In the transposition of the great arteries (TGA), alterations in hemodynamics and oxygen saturation could result in fibrotic remodeling, but histological studies are scarce. We aimed to investigate fibrosis and innervation state in the full spectrum of TGA and correlate findings to clinical literature. Twenty-two human postmortem TGA hearts, including TGA without surgical correction (n = 8), after Mustard/Senning (n = 6), and arterial switch operation (ASO, n = 8), were studied. In newborn uncorrected TGA specimens (1 day-1.5 months), significantly more interstitial fibrosis (8.6% ± 3.0) was observed compared to control hearts (5.4% ± 0.8, = 0.016). After the Mustard/Senning procedure, the amount of interstitial fibrosis was significantly higher (19.8% ± 5.1, = 0.002), remarkably more in the subpulmonary left ventricle (LV) than in the systemic right ventricle (RV). In TGA-ASO, an increased amount of fibrosis was found in one adult specimen. The amount of innervation was diminished from 3 days after ASO (0.034% ± 0.017) compared to uncorrected TGA (0.082% ± 0.026, = 0.036). In conclusion, in these selected postmortem TGA specimens, diffuse interstitial fibrosis was already present in newborn hearts, suggesting that altered oxygen saturations may already impact myocardial structure in the fetal phase. TGA-Mustard/Senning specimens showed diffuse myocardial fibrosis in the systemic RV and, remarkably, in the LV. Post-ASO, decreased uptake of nerve staining was observed, implicating (partial) myocardial denervation after ASO.
PubMed: 37103059
DOI: 10.3390/jcdd10040180 -
Medical Sciences (Basel, Switzerland) Apr 2023Atrial fibrillation (AF) is the most common pathological arrhythmia, and its complications lead to significant morbidity and mortality. However, patients with AF can... (Review)
Review
BACKGROUND
Atrial fibrillation (AF) is the most common pathological arrhythmia, and its complications lead to significant morbidity and mortality. However, patients with AF can often go undetected, especially if they are asymptomatic or have a low burden of paroxysms. Identification of those at high risk of AF development may help refine screening and management strategies.
METHODS
PubMed and Embase databases were systematically searched for studies looking at electrocardiographic predictors of AF from inception to August 2021.
RESULTS
A total of 115 studies were reported which examined a combination of atrial and ventricular parameters that could be electrocardiographic predictors of AF. Atrial predictors include conduction parameters, such as the PR interval, p-wave index and dispersion, and partial interatrial or advanced interatrial block, or morphological parameters, such as p-wave axis, amplitude and terminal force. Ventricular predictors include abnormalities in QRS amplitude, morphology or duration, QT interval duration, r-wave progression and ST segment, i.e., t-wave abnormalities.
CONCLUSIONS
There has been significant interest in electrocardiographic prediction of AF, especially in populations at high risk of atrial AF, such as those with an embolic stroke of undetermined source. This review highlights the breadth of possible predictive parameters, and possible pathological bases for the predictive role of each parameter are proposed.
Topics: Humans; Atrial Fibrillation; Electrocardiography; Heart Atria; Heart Rate; Heart Ventricles
PubMed: 37092499
DOI: 10.3390/medsci11020030 -
Artificial Organs Aug 2023Left ventricular assist devices (LVADs) represent an important therapeutic option for patients progressing to end-stage heart failure. LVAD has previously been shown to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Left ventricular assist devices (LVADs) represent an important therapeutic option for patients progressing to end-stage heart failure. LVAD has previously been shown to have a promising role in improving mitral regurgitation (MR). Nevertheless, the prognostic value of preoperative uncorrected MR in this population remains unclear.
METHODS
A systematic database search with meta-analysis was conducted of comparative original articles of patients with preoperative mild MR (Grade 0-I) versus moderate-severe MR (Grade II-III) undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to June 2022. Primary outcomes were overall and operative mortality. Secondary outcomes were neurological dysfunction, gastrointestinal bleeding, right heart failure, LVAD thrombosis, and driveline infection.
RESULTS
Our search yielded 2228 relevant studies. A total of 19 studies met the inclusion criteria with a total of 11 873 patients. LVAD caused a statistically significant decrease of 35.9% in the number of patients with moderate-severe MR (grade II-III) postoperatively. No significant difference was observed in terms of overall mortality, operative mortality, GI bleeding, LVAD thrombosis, and driveline infection rates between mild and moderate-severe MR. An increased rate of right heart failure was seen among patients with moderate-severe MR, while lower rates of neurological events were also observed.
CONCLUSION
LVAD improves the haemodynamics of the left ventricle, to promote resolution of MR. Nevertheless, the severity of preoperative mitral regurgitation in patients undergoing LVAD deployment does not seem to affect mortality.
Topics: Humans; Mitral Valve Insufficiency; Prognosis; Heart-Assist Devices; Treatment Outcome; Retrospective Studies; Heart Failure
PubMed: 37086154
DOI: 10.1111/aor.14549 -
Clinical Research in Cardiology :... Mar 2024Real-time three-dimensional echocardiography (RT3DE) is currently being developed to overcome the challenges of two-dimensional echocardiography, as it is a much cheaper... (Meta-Analysis)
Meta-Analysis Review
Validating real-time three-dimensional echocardiography against cardiac magnetic resonance, for the determination of ventricular mass, volume and ejection fraction: a meta-analysis.
INTRODUCTION
Real-time three-dimensional echocardiography (RT3DE) is currently being developed to overcome the challenges of two-dimensional echocardiography, as it is a much cheaper alternative to the gold standard imaging method, cardiac magnetic resonance (CMR). The aim of this meta-analysis is to validate RT3DE by comparing it to CMR, to ascertain whether it is a practical imaging method for routine clinical use.
METHODS
A systematic review and meta-analysis method was used to synthesise the evidence and studies published between 2000 and 2021 were searched using a PRISMA approach. Study outcomes included left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), left ventricular mass (LVM), right ventricular end-systolic volume (RVESV), right ventricular end-diastolic volume (RVEDV) and right ventricular ejection fraction (RVEF). Subgroup analysis included study quality (high, moderate), disease outcomes (disease, healthy and disease), age group (50 years old and under, over 50 years), imaging plane (biplane, multiplane) and publication year (2010 and earlier, after 2010) to determine whether they explained the heterogeneity and significant difference results generated on RT3DE compared to CMR.
RESULTS
The pooled mean differences for were - 5.064 (95% CI - 10.132, 0.004, p > 0.05), 4.654 (95% CI - 4.947, 14.255, p > 0.05), - 0.783 (95% CI - 5.630, 4.065, p > 0.05, - 0.200 (95% CI - 1.215, 0.815, p > 0.05) for LVEF, LVM, RVESV and RVEF, respectively. We found no significant difference between RT3DE and CMR for these variables. Although, there was a significant difference between RT3DE and CMR for LVESV, LVEDV and RVEDV where RT3DE reports a lower value. Subgroup analysis indicated a significant difference between RT3DE and CMR for studies with participants with an average age of over 50 years but no significant difference for those under 50. In addition, a significant difference between RT3DE and CMR was found in studies using only participants with cardiovascular diseases but not in those using a combination of diseased and healthy participants. Furthermore, for the variables LVESV and LVEDV, the multiplane method shows no significant difference between RT3DE and CMR, as opposed to the biplane showing a significant difference. This potentially indicates that increased age, the presence of cardiovascular disease and the biplane analysis method decrease its concordance with CMR.
CONCLUSION
This meta-analysis indicates promising results for the use of RT3DE, with limited difference to CMR. Although in some cases, RT3DE appears to underestimate volume, ejection fraction and mass when compared to CMR. Further research is required in terms of imaging method and technology to validate RT3DE for routine clinical use.
Topics: Humans; Middle Aged; Stroke Volume; Ventricular Function, Left; Ventricular Function, Right; Echocardiography, Three-Dimensional; Heart Ventricles; Magnetic Resonance Spectroscopy
PubMed: 37079054
DOI: 10.1007/s00392-023-02204-5 -
Cardiovascular Pathology : the Official... 2023While primary cardiac tumors are rare, it has been increasingly recognized due to improvement in screening measures. However, the hamartoma of mature cardiac myocytes... (Review)
Review
BACKGROUND
While primary cardiac tumors are rare, it has been increasingly recognized due to improvement in screening measures. However, the hamartoma of mature cardiac myocytes has been underrecognized compared to other cardiac tumors, such as cardiac myxomas and papillary fibroelastomas, and is still potentially associated with critical consequences such as sudden death. This systematic review aims to summarize the evidence regarding the hamartoma of mature cardiac myocytes and characterize the presentations and symptoms for clinicians.
METHODS
Following the PRISMA statement, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "hamartoma of mature cardiac myocytes" from their inception to January 2, 2023.
RESULTS
We included 25 articles, including 34 cases, in this systematic review. Patients with hamartoma of mature cardiac myocytes commonly presented with nonspecific symptoms such as dyspnea (35.3%), although a few presented with sudden death and syncope. The left ventricle was the common site of origin (41.2%), followed by the right atrium and ventricle. Surgery was commonly pursued for diagnosis and treatment, while a few required cardiac transplants (8.8%), and 29.4% were diagnosed with autopsy or expired.
CONCLUSION
Hamartoma of mature cardiac myocytes is a potentially underrecognized primary cardiac tumor associated with treatable yet potentially critical consequences. Given the challenges of differentiating it from malignancy such as angiosarcoma, multimodal imaging needs to be utilized to pursue a diagnosis. Future studies are warranted to develop a noninvasive diagnosis mode for cardiac tumor.
Topics: Humans; Myocytes, Cardiac; Heart Neoplasms; Heart Ventricles; Hamartoma; Death, Sudden
PubMed: 37031829
DOI: 10.1016/j.carpath.2023.107538 -
International Journal of Cardiology Jun 2023A number of anterior chest wall deformities, most notably pectus excavatum (PE), may have a detrimental effect on cardiac motion and function. Interpretation of...
BACKGROUND
A number of anterior chest wall deformities, most notably pectus excavatum (PE), may have a detrimental effect on cardiac motion and function. Interpretation of transthoracic echocardiography (TTE) and speckle-tracking echocardiography (STE) results may be hampered by the possible influence of PE on cardiac kinetics.
METHODS
A comprehensive search of all articles assessing cardiac function in PE individuals was carried out. Inclusion criteria were: 1) individuals aged >10 years; 2) studies providing objective assessment of chest deformity (Haller index). Studies that measured myocardial strain parameters in PE patients were also included.
RESULTS
The search (EMBASE and Medline) yielded a total of 392 studies, 36 (9.2%) of which removed as duplicates; a further 339 did not meet inclusion criteria. The full-texts of 17 studies were then analyzed. All studies concordantly reported impaired right ventricular volumes and function. With respect to left ventricle (LV), TTE studies uniformly demonstrated a significant impairment in conventional echoDoppler indices in PE individuals, whereas STE studies provided conflicting results. Importantly, LV functional alterations promptly reverted upon surgical correction of chest defect. In subjects with PE of mild-to-moderate severity, we observed that degree of anterior chest wall deformity, as noninvasively assessed by modified Haller index (MHI), was strongly associated with myocardial strain magnitude, in heterogenous cohorts of otherwise healthy PE individuals.
CONCLUSIONS
Clinicians should be aware that in PE individuals, TTE and STE results may not always be indicative of intrinsic myocardial dysfunction, but may be, at least in part, influenced by artifactual and/or external chest shape determinants.
Topics: Humans; Funnel Chest; Heart Ventricles; Echocardiography; Myocardium; Ventricular Function, Left
PubMed: 37003372
DOI: 10.1016/j.ijcard.2023.03.058 -
The American Journal of Cardiology May 2023Neuroendocrine tumors (NETs) are a rare group of malignancies which are aggressive and widely metastatic. Cardiac metastases (CMs) are rarely reported because of NET. We... (Meta-Analysis)
Meta-Analysis
Neuroendocrine tumors (NETs) are a rare group of malignancies which are aggressive and widely metastatic. Cardiac metastases (CMs) are rarely reported because of NET. We aim to analyze the available literature to study the proportional prevalence of CM because of NET and its location and effect on the ejection fraction (EF) and survival rate. Our search strategy and meta-analysis are in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) AMSTAR-2 (Assessing the methodological quality of systematic Reviews-2) Guidelines. A literature search was conducted on MEDLINE (EMBASE and PubMed) for randomized clinical trials, pilot trials, and retrospective and prospective studies. Statistical analysis was performed using the CRAN-R software (https://CRAN.R-project.org/doc/FAQ/R-FAQ.html). The quality assessment of the included articles was performed using the Cochrane Risk of Bias and Newcastle-Ottawa Scale. A total of 16,685 patients were included in the study. The mean age of patients included in the study was 61.28 ± SD 9.89 years. Of these, 257 patients had a total of 283 CM. Metastasis was mainly located in the left ventricle with a pooled proportion of 0.48, 95% confidence interval (CI) 0.4 to 0.56, pericardium: 0.34, 95% CI 0.19 to 0.53, right ventricle 0.28, 95% CI 0.16 to 0.44, interventricular septum 0.25, 95% CI 0.16 to 0.37, left atrium 0.1, 95% CI 0.03 to 0.26 and right atrium 0.05, 95% CI 0.01 to 0.20. Decrease in EF at the time of CM diagnosis was the effect most consistently reported in patients with CM. Pooled mean survival was 35.89, 95% CI 8.27 to 155.68 months after the diagnosis of CM. CM due to NET was <2% and the left ventricle is the most common metastatic location, followed by the pericardium. Decreased EF was the most common clinical picture observed. Further studies are needed to analyze the clinical impact of NET CM.
Topics: Humans; Middle Aged; Prospective Studies; Prevalence; Retrospective Studies; Melanoma; Melanoma, Cutaneous Malignant
PubMed: 36996525
DOI: 10.1016/j.amjcard.2023.02.011 -
Cardiology in Review Mar 2023This study reviews the published data comparing the efficacy and safety of apical and septal right ventricle defibrillator lead positioning at 1-year follow-up. Systemic...
This study reviews the published data comparing the efficacy and safety of apical and septal right ventricle defibrillator lead positioning at 1-year follow-up. Systemic research on Medline (PubMed), ClinicalTrials.gov, and Embase was performed using the keywords "septal defibrillation," "apical defibrillation," "site defibrillation," and "defibrillation lead placement," including implantable cardioverter-defibrillator and cardiac resynchronization therapy devices. Comparisons between apical and septal position were performed regarding R-wave amplitude, pacing threshold at a pulse width of 0.5 ms, pacing and shock lead impedance, suboptimal lead performance, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter, readmissions due to heart failure and mortality rates. A total of 5 studies comprising 1438 patients were included in the analysis. Mean age was 64.5 years, 76.9% were male, with a median LVEF of 27.8%, ischemic etiology in 51.1%, and a mean follow-up period of 26.5 months. The apical lead placement was performed in 743 patients and septal lead placement in 690 patients. Comparing the 2 placement sites, no significant differences were found regarding R-wave amplitude, lead impedance, suboptimal lead performance, LVEF, left ventricular end-diastolic diameter, and mortality rate at 1-year follow-up. Pacing threshold values favored septal defibrillator lead placement (P = 0.003), as well as shock impedance (P = 0.009) and readmissions due to heart failure (P = 0.02). Among patients receiving a defibrillator lead, only pacing threshold, shock lead impedance, and readmission due to heart failure showed results favoring septal lead placement. Therefore, generally, the right ventricle lead placement does not appear to be of major importance.
PubMed: 36883833
DOI: 10.1097/CRD.0000000000000527 -
Experimental and Therapeutic Medicine Mar 2023The current review aimed to assess the effect of obstructive sleep apnea (OSA) on the severity and outcomes of pulmonary embolism (PE). PubMed, Embase, ScienceDirect,...
The current review aimed to assess the effect of obstructive sleep apnea (OSA) on the severity and outcomes of pulmonary embolism (PE). PubMed, Embase, ScienceDirect, CENTRAL and Google Scholar were searched for studies assessing the impact of OSA on severity and outcomes of PE. A total of 12 studies were included. Meta-analysis revealed that simplified PE severity index of >1 and pulmonary artery obstruction index score was significantly higher in patients with OSA as compared with controls, but there was no difference in right ventricle to left ventricle short-axis diameter. The need for non-invasive ventilation was significantly higher in patients with OSA but there was no difference in the need for mechanical ventilation. Patients with OSA had a significantly higher incidence of recurrence of PE. Meta-analysis also showed a statistically significantly lower risk of in-hospital mortality in patients with OSA as compared with controls, but without any difference in the risk of late mortality. Adjusted data on mortality indicated a significantly lower risk of mortality in PE patients with comorbid OSA. Limited data shows that comorbid OSA increases the severity of PE but has no effect on right ventricular function. OSA may increase the risk of recurrent PE. Paradoxically, the presence of OSA may also reduce the risk of in-hospital mortality. Results must be interpreted with caution owing to high inter-study heterogeneity and lack of matching of baseline characteristics. Current evidence needs to be confirmed by high-quality prospective studies.
PubMed: 36815968
DOI: 10.3892/etm.2023.11819 -
BMJ Open Feb 2023Cardiac involvement in patients with systemic sclerosis (SSc) is associated with poor prognosis. Early detection of myocardial impairment is essential for treatment. The... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Cardiac involvement in patients with systemic sclerosis (SSc) is associated with poor prognosis. Early detection of myocardial impairment is essential for treatment. The present study aimed to systematically review the value of detecting subclinical myocardial impairment in SSc patients using myocardial strain obtained from speckle tracking echocardiography (STE).
DESIGN
A systematic review and meta-analysis.
DATA SOURCES
The PubMed, Embase and Cochrane library databases were searched in the period from the earliest available indexing date to 30 September 2022.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Studies evaluating myocardial function in SSc patients comparison with healthy controls based on myocardial strain data obtained from STE were included.
DATA EXTRACTION AND SYNTHESIS
Ventricle and atrium data on myocardial strain were extracted to assessing the mean difference (MD).
RESULTS
A total of 31 studies were included in the analysis. Left ventricular global longitudinal strain (MD: -2.31, 95% CI -2.85 to -1.76), left ventricular global circumferential strain (MD: -2.93, 95% CI -4.02 to -1.84) and left ventricular global radial strain (MD: -3.80, 95% CI -5.83 to -1.77) was significantly lower in SSc patients than in healthy controls. Right ventricular global wall strain (MD: -2.75, 95% CI -3.25 to -2.25) was also decreased in SSc patients. STE revealed significant differences in several atrial parameters including left atrial reservoir strain (MD: -6.72, 95% CI -10.09 to -3.34) and left atrial conduit strain (MD: -3.26, 95% CI -6.50 to -0.03), as well as right atrial reservoir strain (MD: -7.37, 95% CI -11.20 to -3.53) and right atrial conduit strain (MD: -5.44, 95% CI -9.15 to -1.73). There were no differences in left atrial contractile strain (MD: -1.51, 95% CI -5.34 to 2.33).
CONCLUSION
SSc patients have a lower strain than healthy controls for the majority of STE parameters, indicating the presence of an impaired myocardium involving both the ventricle and atrium.
Topics: Humans; Atrial Fibrillation; Echocardiography; Heart Atria; Heart Ventricles; Scleroderma, Systemic; Reproducibility of Results; Ventricular Function, Left
PubMed: 36797018
DOI: 10.1136/bmjopen-2022-063364