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Journal of Clinical Medicine Jun 2024: Severe aortic stenosis (AS) is the most frequent valvular heart disease. Models for stratifying cardiac damage associated with aortic stenosis have been developed to...
: Severe aortic stenosis (AS) is the most frequent valvular heart disease. Models for stratifying cardiac damage associated with aortic stenosis have been developed to predict outcomes following valve replacement. However, evidence regarding morphological and functional evolution, as well as potential changes in the degree of cardiac damage, is limited. We aim to provide information on the evolution of cardiac morphology and the function of patients undergoing transcatheter aortic valve replacement (TAVR) who have been classified using a cardiac damage staging system. : In total, 496 patients were included in the analysis, and were classified into four stages based on the extent of cardiac damage as follows: Stage 0, no cardiac damage: left ventricle global longitudinal strain (LV-GLS) < -17%; right ventricular-arterial coupling (RVAc) ≥ 0.35), and absence of significant mitral regurgitation (MR). Stage 1, left-sided subclinical damage: LV-GLS ≥ -17%. Stage 2, left-sided damage: significant MR. Stage 3, right-sided damage: RVAc < 0.35. : The mean age was 82.1 ± 5.9 years, and 53.0% were female. In total, 24.5% of patients met the criteria for Stage 0, and Stage 1 included 42.8% of patients, Stage 2 included 16.5%, and Stage 3 comprised 16.2% of patients. Mortality was 8.4% for stage 0, 17.4% for stage 1, 25.6% for stage 2, and 28.6% for stage 3 patients ( = 0.004). Diabetes mellitus (DM) ( = 0.047) and chronic kidney disease (CKD) ( = 0.024) were the only clinical predictors of no change or worsening in the stage of cardiac damage. Regarding echocardiographic variables, concomitant tricuspid, and mitral regurgitation, ≥ 2 were both significantly associated with no change or worsening, also ( < 0.001). : Cardiac damage that is secondary to severe aortic stenosis has morphological and functional repercussions that, even after valve replacement, persist and might worsen the prognosis.
PubMed: 38930068
DOI: 10.3390/jcm13123539 -
Journal of Clinical Medicine Jun 2024Modern treatments for transfusion-dependent β-thalassemia (TDβT) have allowed patients to reach high life expectancy with no iron overload. Despite survival...
Modern treatments for transfusion-dependent β-thalassemia (TDβT) have allowed patients to reach high life expectancy with no iron overload. Despite survival improvement, atrial fibrillation (AF) has emerged as a relevant issue. AF pathophysiology and characteristics in TDβT are different than in the general population. Epicardial adipose tissue (EAT) may play a role but its relationship with AF in patients with TDβT has not been explored. A monocentric, cross-sectional study, enrolling consecutive patients with TDβT. Epicardial adipose tissue (EAT) was evaluated at magnetic resonance. Characteristics of patients with and without history of AF were investigated. Factors independently associated with AF prevalence were analyzed. A total of 116 patients were enrolled. All patients were treated with regular chelation therapy. The prevalence of AF was 29.3% (34/116). Cardiac T2* and liver iron concentration were no different between patients with and without AF. EAT thickness was significantly higher in patients with AF at left atrium, right atrium and right ventricle (5.0 vs. 4.0 mm, < 0.01, 4.4 vs. 4.0, = 0.02 and 5.0 vs. 4.3, = 0.04). Patients with AF presented with older age, (53 vs. 49 years, < 0.01), more hypothyroidism (44.1 vs. 20.7%, = 0.01), pulmonary hypertension (23.5 vs. 2.4% < 0.01), splenectomy (88.2 vs. 64.6%, = 0.01), higher right and left atrial volume (61 vs. 40 and 74 vs. 43 mL, both < 0.01). At multivariable analysis, hypothyroidism, left atrial volume and left atrial EAT were independently associated with AF (odds ratio 9.95, 1.09 and 1.91, respectively). In a contemporary cohort of patients with TDβT, treated with regular chelation therapy, prevalence of AF was unrelated to iron overload. EAT was independently associated with AF.
PubMed: 38930000
DOI: 10.3390/jcm13123471 -
Diagnostics (Basel, Switzerland) Jun 2024Overhydration and cardiac function abnormalities are common in hemodialysis patients. The association of N-terminal prohormone for brain natriuretic peptide (NT-proBNP)...
Overhydration and cardiac function abnormalities are common in hemodialysis patients. The association of N-terminal prohormone for brain natriuretic peptide (NT-proBNP) and other fluid status biomarkers with echocardiographic parameters of heart failure with preserved ejection fraction (HFpEF) is scarcely investigated in this population. A total of 100 separate measurements performed in 50 dialysis patients (29 male, aged 60 ± 17 years) in NYHA class II/II and preserved left ventricle ejection fraction were analyzed. Plasma levels of NT-proBNP, mid-regional prohormone for atrial natriuretic peptide (MR-proANP) and copeptin (CPP) were measured. The E/e' ratio as an index of HFpEF and other echocardiographic parameters were calculated. An E/e' ratio >9 was associated with higher median right ventricular systolic pressure (RVSP) and LVMI values. Left atrium volume index (LAVI) as well as NT-proBNP and MR-proANP, but not CPP levels were significantly higher in this group. In a stepwise multivariate analysis, only CPP and IL-6 levels were found to be independently associated with the E/e' ratio in the study group, whereas NT-proBNP and MR-proANP were associated only with left heart structure parameters and LVEF. Of the analyzed biomarkers, only the CPP level was found to be independently associated with the E/e' ratio in maintenance hemodialysis patients.
PubMed: 38928725
DOI: 10.3390/diagnostics14121310 -
Diagnostics (Basel, Switzerland) Jun 2024Heart transplantation (HT) is the mainstream therapy for end-stage heart disease. However, the cardiac graft function can be affected by several factors. It is important... (Review)
Review
Heart transplantation (HT) is the mainstream therapy for end-stage heart disease. However, the cardiac graft function can be affected by several factors. It is important to monitor HT patients for signs of graft dysfunction. Transthoracic echocardiography is a simple, first-line, and non-invasive method for the assessment of cardiac function. The emerging speckle-tracking echocardiography (STE) could quickly and easily provide additive information over traditional echocardiography. STE longitudinal deformation parameters are markers of early impairment of ventricular function. Although once called the "forgotten ventricle", right ventricular (RV) assessment has gained attention in recent years. This review highlights the potentially favorable role of STE in assessing RV systolic function in clinically well HT patients.
PubMed: 38928720
DOI: 10.3390/diagnostics14121305 -
Genes May 2024Cardiac remodeling and ventricular pacing represent intertwined phenomena with profound implications for cardiovascular health and therapeutic interventions. This review... (Review)
Review
Cardiac remodeling and ventricular pacing represent intertwined phenomena with profound implications for cardiovascular health and therapeutic interventions. This review explores the intricate relationship between cardiac remodeling and ventricular pacing, spanning from the molecular underpinnings to biomechanical alterations. Beginning with an examination of genetic predispositions and cellular signaling pathways, we delve into the mechanisms driving myocardial structural changes and electrical remodeling in response to pacing stimuli. Insights into the dynamic interplay between pacing strategies and adaptive or maladaptive remodeling processes are synthesized, shedding light on the clinical implications for patients with various cardiovascular pathologies. By bridging the gap between basic science discoveries and clinical translation, this review aims to provide a comprehensive understanding of cardiac remodeling in the context of ventricular pacing, paving the way for future advancements in cardiovascular care.
Topics: Humans; Ventricular Remodeling; Animals; Heart Ventricles; Cardiac Pacing, Artificial
PubMed: 38927607
DOI: 10.3390/genes15060671 -
Journal of Cardiothoracic Surgery Jun 2024Following an acute myocardial infarction (AMI), surgery for left ventricular free wall rupture (LVFWR) and ventricular septal rupture (VSR) has a high in-hospital...
BACKGROUND
Following an acute myocardial infarction (AMI), surgery for left ventricular free wall rupture (LVFWR) and ventricular septal rupture (VSR) has a high in-hospital mortality rate, which has not improved significantly over time. Unloading the LV is critical to preventing excessive stress on the repair site and avoiding problems such as bleeding, leaks, patch dehiscence, and recurrence of LVFWR and VSR because the tissue is so fragile. We present two cases of patients who used Impella 5.5 for LV unloading following emergency surgery for AMI mechanical complications.
CASE PRESENTATION
A 76-year-old male STEMI patient underwent fibrinolysis of the distal right coronary artery. Three days later, he passed out and went into shock. Echocardiography revealed a cardiac tamponade. We found an oozing-type LVFWR on the posterolateral wall and treated it with a non-suture technique using TachoSil. Before the patient was taken off CPB, Impella 5.5 was inserted into the LV via a 10 mm synthetic graft connected to the right axillary artery. We kept the flow rate above 4.0 to 4.5 L/min until POD 3 to reduce LV wall tension while minimizing pulsatility. On POD 6, we weaned the patient from Impella 5.5. A postoperative cardiac CT scan showed no contrast leakage from the LV. However, a cerebral hemorrhage on POD 4 during heparin administration complicated his hospitalization. Case 2: A diagnosis of cardiogenic shock caused by STEMI occurred in an 84-year-old male patient, who underwent PCI of the LAD with IABP support. Three days after PCI, echocardiography revealed VSR, and the patient underwent emergency VSR repair with two separate patches and BioGlue applied to the suture line between them. Before weaning from CPB, we implanted Impella 5.5 in the LV and added venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for right heart failure. The postoperative echocardiography revealed no residual shunt.
CONCLUSIONS
Patients undergoing emergency surgery for mechanical complications of AMI may find Impella 5.5 to be an effective tool for LV unloading. The use of VA-ECMO in conjunction with Impella may be an effective strategy for managing VSR associated with concurrent right-sided heart failure.
Topics: Humans; Male; Aged; Heart-Assist Devices; Myocardial Infarction; Heart Ventricles; Heart Rupture, Post-Infarction; Ventricular Septal Rupture; Echocardiography; Postoperative Complications
PubMed: 38926884
DOI: 10.1186/s13019-024-02879-5 -
BMC Pediatrics Jun 2024Guillain‒Barre syndrome (GBS) is an acute inflammatory peripheral neuropathy caused by autoimmunity. Gangliosides and sulfatides are important components of peripheral...
BACKGROUND
Guillain‒Barre syndrome (GBS) is an acute inflammatory peripheral neuropathy caused by autoimmunity. Gangliosides and sulfatides are important components of peripheral nerves. Anti-sulfatide antibody-mediated complement is associated with acute sensorimotor peripheral neuropathy in GBS, which is characterized by pain and paresthesias.
CASE PRESENTATION
The child was a 7-year-old girl with headache and abdominal pain, followed by limb numbness and pain. Cranial imaging showed ventricular dilatation, peripheral nerve function conduction examination showed polyradiculopathy, and cerebrospinal fluid tests showed normal cell counts but elevated protein levels, all of which led to the diagnosis of GBS. After treatment with intravenous immunoglobulin (400 mg/kg × 5 days), the symptoms did not improve, and muscle strength progressively worsened, accompanied by paroxysmal complexion flushing, heart rate fluctuation, hyperhidrosis, and a progressive increase in cerebrospinal fluid protein (up to 3780.1 mg/L). On the basis of these findings combined with serum anti-sulfatide IgM positivity, anti-sulfatide antibody-related GBS was considered, and treatment with low-dose prednisolone (1 mg/kg/d) led to symptom improvement.
CONCLUSIONS
Anti-sulfatide antibody-associated GBS is associated with small fiber peripheral neuropathy. The main manifestations are pain, paresthesias and autonomic dysfunction. In addition to the dysfunction of spinal nerve root absorption caused by increased cerebrospinal fluid protein, autonomic dysfunction may be involved in pain. When the therapeutic effect of immunoglobulin is not satisfactory, a low dose and short course of corticosteroids can be considered, and the prognosis is good.
Topics: Humans; Female; Child; Guillain-Barre Syndrome; Abdominal Pain; Headache; Sulfoglycosphingolipids; Autoantibodies; Prednisolone
PubMed: 38926645
DOI: 10.1186/s12887-023-04287-5 -
Three-Dimensional Feature Tracking Study of Healthy Chinese Ventricle by Cardiac Magnetic Resonance.Cardiovascular Engineering and... Jun 2024Myocardial strain, as a crucial quantitative indicator of myocardial deformation, can detect the changes of cardiac function earlier than parameters such as ejection...
PURPOSE
Myocardial strain, as a crucial quantitative indicator of myocardial deformation, can detect the changes of cardiac function earlier than parameters such as ejection fraction (EF). It has reported that cardiac magnetic resonance(CMR) and post-processing software possess the ability to obtain the stability and repeatability strain values. Recently, the normal strain values range of people are debatable, especially in the Chinese population. Therefore, we aim to explore the ventricular characteristics and the myocardial strain values of the Chinese people by using the cardiac magnetic resonance feature tracking (CMR-FT). Additionally, we attempted to use the myocardial and chordae tendineae contours to calculate the ventricular volumes by the CMR-FT. This study may provide valuable insights into the application of CMR-FT in tracking the ventricular characteristics and myocardial strain for Chinese population, especially in suggesting an referable myocardial strain parameters of the Chinese.
METHODS
A total of 109 healthy Chinese individuals (age range: 18 to 58 years; 52 males and 57 females) underwent 3.0T CMR to acquire the cardiac images. The commercial post-processing software was employed to analyse the image sequence by semi-automatic processing, then the biventricular morphology (End-Diastolic Volume, EDV; EDV/Body Surface Area, EDV/BSA), function(EF; Cardiac Output, CO; Cardiac Index, CI) and strain(Radial Strain, RS; Circumferential Strain, CS; Longitudinal Strain, LS) values were obtained.The biventricular myocardial strain values were stratified according to the age and gender. The Left Ventricular( LV base, mid, apex) and myocardial strain values of three coronary artery areas were calculated based on the the strain value of LV American Heart Association(AHA) 16 segments.
RESULTS
It was shown that the females had larger LV globe strain values compared with the males (LVGPRS: 42.0 ± 8.5 versus 33.6 ± 6.2%, P < 0.001; LVGPCS: -21.2 ± 2.1 versus - 19.7 ± 2.3%, P < 0.001; LVGPLS: -16.4 ± 2.6 versus - 14.6 ± 2.2%, P < 0.001;). Moreover, the differences in RS, CS, and LS among the LV myocardium 16 segments were obvious. However, the right ventricle (RV) strain values showed non-normal distribution in the volunteers of this research.
CONCLUSIONS
Here, we successfully tracked the characteristics of bilateral ventricles in healthy Chinese populations through using the 3.0T CMR. We confirmed that there was a gender difference in LV Globe Strain values. In addition, we obtained strain values for each myocardial segment of the LV and different coronary artery regions based on the AHA 16 segments method, Our results also showed that the RV strain values with a non-normal distribution, and RV global strain values were not related to the gender and age. Furthermore, LVGPRS, LVGPLS, and RVGPRS were significantly correlated with BMI, CO, CI, and EDV in the Chinese population.
PubMed: 38926238
DOI: 10.1007/s13239-024-00736-z -
JACC. Cardiovascular Interventions Jun 2024Right ventricular impairment is common among patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation (SMR). Adherence to... (Observational Study)
Observational Study
BACKGROUND
Right ventricular impairment is common among patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation (SMR). Adherence to guideline-directed medical therapy (GDMT) for heart failure is poor in these patients.
OBJECTIVES
The aim of this study was to evaluate the impact of GDMT on long-term survival in this patient cohort.
METHODS
Within the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) international registry, we selected patients with SMR and right ventricular impairment (tricuspid annular plane systolic excursion ≤17 mm and/or echocardiographic right ventricular-to-pulmonary artery coupling <0.40 mm/mm Hg). Titrated guideline-directed medical therapy (GDMT) was defined as a coprescription of 3 drug classes with at least one-half of the target dose at the latest follow-up. The primary outcome was all-cause mortality at 6 years.
RESULTS
Among 1,213 patients with SMR and right ventricular impairment, 852 had complete data on medical therapy. The 123 patients who were on GDMT showed a significantly higher long-term survival vs the 729 patients not on GDMT (61.8% vs 36.0%; P < 0.00001). Propensity score-matched analysis confirmed a significant association between GDMT and higher survival (61.0% vs 43.1%; P = 0.018). GDMT was an independent predictor of all-cause mortality (HR: 0.61; 95% CI: 0.39-0.93; P = 0.02 for patients on GDMT vs those not on GDMT). Its association with better outcomes was confirmed among all subgroups analyzed.
CONCLUSIONS
In patients with right ventricular impairment undergoing transcatheter edge-to-edge repair for SMR, titration of GDMT to at least one-half of the target dose is associated with a 40% lower risk of all-cause death up to 6 years and should be pursued independent of comorbidities.
Topics: Humans; Female; Male; Mitral Valve Insufficiency; Registries; Aged; Treatment Outcome; Time Factors; Ventricular Dysfunction, Right; Ventricular Function, Right; Risk Factors; Practice Guidelines as Topic; Guideline Adherence; Cardiac Catheterization; Cardiovascular Agents; Europe; Aged, 80 and over; Risk Assessment; Echocardiography, Transesophageal; Mitral Valve; Middle Aged; Recovery of Function
PubMed: 38925749
DOI: 10.1016/j.jcin.2024.04.025 -
Journal of the American College of... Jul 2024Whereas medical practice stems from Hippocrates, cardiovascular science originates with Aristotle. The Hippocratic philosophy was championed by Galen (129-216 CE), whose... (Review)
Review
Whereas medical practice stems from Hippocrates, cardiovascular science originates with Aristotle. The Hippocratic philosophy was championed by Galen (129-216 CE), whose advocacy of a tripartite soul found favor in the early Christian Church. In contrast, Aristotle's works were banned as heresy by ecclesiastical authority, only to survive and prosper in the Islamic Golden Age (775-1258 CE). Galen theorized that the circulation consisted of separate venous and arterial systems. Blood was produced in the liver and traveled centrifugally through veins. When arriving in the right ventricle, venous blood passed through tiny pores in the ventricular septum into the left ventricle, where it became aerated by air passing from the lungs through the pulmonary veins to the left side of the heart. Following arrival at distal sites, arterial blood disappeared, being consumed by the tissues, requiring that the liver needed to continually synthesize new blood. The heart was viewed as a sucking organ, and the peripheral pulse was deemed to result from changes in arterial tone, rather than cardiac systole. Galen's framework remained undisputed and dominated medical thought for 1,300 years, but the reintroduction of Aristotelian principles from the Islamic world into Europe (through the efforts of the Toledo School of Translators) were nurtured by the academic freedom and iconoclastic environment uniquely cultivated at the University of Padua, made possible by Venetian rebellion against papal authority. At Padua, the work of Andreas Vesalius, Realdo Colombo, Hieronymus Fabricius ab Acquapendente, and William Harvey (1543-1628) methodically destroyed Galen's model, leading to the modern concept of a closed-ended circulation. Yet, due to political forces, Harvey was ridiculed, as was James Lind, who performed the first prospective controlled trial, involving citrus fruits for scurvy (1747); it took nearly 50 years for his work to be accepted. Even the work of William Withering (1785), the father of cardiovascular pharmacology, was tarnished by professional jealously and the marketing campaign of a pharmaceutical company. Today's cardiovascular investigators should understand that major advances are routinely derided by the medical establishment for political or personal reasons; and it may take decades or centuries for important work to be accepted.
Topics: Humans; Cardiology; History, Ancient; History, Medieval; Physicians; History, 17th Century; Biomedical Research; History, 16th Century
PubMed: 38925728
DOI: 10.1016/j.jacc.2024.03.420