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Cardiac Electrophysiology Clinics Jun 2024The epicardial outflow tract can be a site of origin of idiopathic ventricular arrhythmias. These arrhythmias are most commonly perivalvular and can be targeted from... (Review)
Review
The epicardial outflow tract can be a site of origin of idiopathic ventricular arrhythmias. These arrhythmias are most commonly perivalvular and can be targeted from within the coronary venous system or from other adjacent structures, such as the right ventricular and left ventricular outflow tracts or the coronary cusp region. The authors report a case of an epicardial idiopathic outflow tract premature ventricular contraction originating from the midseptal epicardial left ventricle. In this case, direct epicardial access was crucial to identify early local activation and achieve successful catheter ablation.
Topics: Adult; Female; Humans; Catheter Ablation; Electrocardiography; Heart Ventricles; Pericardium; Ventricular Premature Complexes
PubMed: 38749640
DOI: 10.1016/j.ccep.2023.10.005 -
Obesity (Silver Spring, Md.) Jul 2024Epicardial adipose tissue (EAT) is a visceral fat that has been associated with coronary artery disease and atrial fibrillation. Previous work has revealed that EAT...
OBJECTIVE
Epicardial adipose tissue (EAT) is a visceral fat that has been associated with coronary artery disease and atrial fibrillation. Previous work has revealed that EAT exhibits beige features.
METHODS
First, a new pan-genomic microarray analysis was performed on previously collected paired human EAT and thoracic subcutaneous AT (thSAT) from the EPICAR study (n = 31) to decipher a specific immune signature and its link with browning genes. Then, adaptive (T and B cells) and innate lymphoid cell (ILC1, ILC2, and ILC3) immunophenotyping assay panels, including CD127, CD117, and prostaglandin D2 receptor 2, were performed on prospectively collected paired human multiorgan donors (n = 18; INTERFACE study).
RESULTS
In the EPICAR study, a positive correlation between the T helper cell subtype Th2 immune pathway and browning genes was found in EAT versus thSAT (r = 0.82; p < 0.0001). In the INTERFACE study, this correlation was also observed (r = 0.31; p = 0.017), and a preponderance of CD4T cells, CD8T cells, and a few B cells was observed in all ATs (p < 0.0001). An increase in ILCs was observed in visceral AT (VAT) (i.e., EAT + VAT; 30 ± 5 ILCs per gram of AT) compared with subcutaneous counterparts (i.e., thSAT + abdominal SAT; 8 ± 2 ILCs per gram of AT; p = 0.001), with ILC1 being the most frequent (ILC1 > ILC3 > ILC2). Numbers of ILCs per gram of AT correlated with several Th2 or browning genes (IL-13, TNF receptor superfamily member 9 [TNFRSF9], and alkaline phosphatase, biomineralization associated [ALPL]). Interestingly, a specific increase in EAT-ILC2 compared with other ATs was observed, including a significant proportion expressing CD69 and/or CD25 activation markers (97.9% ± 1.2%; p < 0.0001). Finally, more natural killer cells were observed in EAT + VAT than in thSAT + abdominal SAT (p = 0.01). Exclusion of patients with coronary artery disease in the EPICAR and INTERFACE studies did not modify the main findings. Gene expression phenotyping confirmed specific upregulation of Th2 pathway and browning genes (IL-33 and uncoupling protein 1 [UCP-1]) in EAT.
CONCLUSIONS
This is the first study, to our knowledge, to provide a comparison between innate and adaptive lymphoid cells in human EAT. Further studies are ongoing to decipher whether these cells could be involved in EAT beiging.
Topics: Humans; Pericardium; Immunity, Innate; Male; Subcutaneous Fat; Lymphocytes; Female; Middle Aged; Adipose Tissue, Beige; Adult; Aged; Immunophenotyping; B-Lymphocytes; Th2 Cells; Epicardial Adipose Tissue
PubMed: 38747118
DOI: 10.1002/oby.24023 -
Cell Reports. Medicine May 2024Dysfunction of the sympathetic nervous system and increased epicardial adipose tissue (EAT) have been independently associated with the occurrence of cardiac arrhythmia....
Dysfunction of the sympathetic nervous system and increased epicardial adipose tissue (EAT) have been independently associated with the occurrence of cardiac arrhythmia. However, their exact roles in triggering arrhythmia remain elusive. Here, using an in vitro coculture system with sympathetic neurons, cardiomyocytes, and adipocytes, we show that adipocyte-derived leptin activates sympathetic neurons and increases the release of neuropeptide Y (NPY), which in turn triggers arrhythmia in cardiomyocytes by interacting with the Y1 receptor (Y1R) and subsequently enhancing the activity of the Na/Ca exchanger (NCX) and calcium/calmodulin-dependent protein kinase II (CaMKII). The arrhythmic phenotype can be partially blocked by a leptin neutralizing antibody or an inhibitor of Y1R, NCX, or CaMKII. Moreover, increased EAT thickness and leptin/NPY blood levels are detected in atrial fibrillation patients compared with the control group. Our study provides robust evidence that the adipose-neural axis contributes to arrhythmogenesis and represents a potential target for treating arrhythmia.
Topics: Humans; Animals; Pericardium; Adipose Tissue; Arrhythmias, Cardiac; Myocytes, Cardiac; Neuropeptide Y; Leptin; Adipocytes; Male; Calcium-Calmodulin-Dependent Protein Kinase Type 2; Neurons; Sodium-Calcium Exchanger; Female; Receptors, Neuropeptide Y; Middle Aged; Atrial Fibrillation; Sympathetic Nervous System; Mice; Epicardial Adipose Tissue
PubMed: 38744275
DOI: 10.1016/j.xcrm.2024.101559 -
Cureus Apr 2024Pericarditis is an inflammatory process that affects the pericardium, the fibrous sac surrounding the heart. Acute pericarditis accounts for approximately 0.1% of...
Re-enforcing High-Risk Acute Pericarditis Requiring Hospital Admission: An Unusual Case of Critical Idiopathic Acute Pericarditis Presenting As Tamponade and Pleuro-Pericardial Complications in a Patient Presenting With Flu-Like Symptoms.
Pericarditis is an inflammatory process that affects the pericardium, the fibrous sac surrounding the heart. Acute pericarditis accounts for approximately 0.1% of inpatient admissions and 5% of non-ischemic chest pain visits to the emergency departments (EDs). Most patients who present with acute pericarditis have a benign course and good prognosis. However, a rare percent of the patients develop complicated pericarditis. Examples of complications include pericardiac effusion, cardiac tamponade, constrictive pericarditis, effusive and constrictive pericarditis and, even more rarely, large pleural effusion The occurrence of complicated pericarditis can lead to high morbidity and mortality if not urgently managed in most patients. Our case presents a 60-year-old male that presented to the emergency room with flu-like symptoms. However, the viral panel test was negative. He initially got discharged with supportive care but was brought back to the ED by his wife in a critical, life-threatening state due to pericarditis symptoms complicated by tamponade and shock. His condition required urgent intervention and critical level of care. The patient's course was also complicated by myopericarditis and recurrent bilateral pleural effusions, which required therapeutic interventions. This unique case presents the patient group that develop multiple life-threatening complications of acute pericarditis, including cardiac tamponade and shock, affecting several end organs. This case also highlights clues to the predisposing factors to complications of acute pericarditis. Patients who present with high-risk signs and symptoms indicating poorer prognosis warrant further observation and admission. This will also add to the literature reviews regarding the risk factors associated with development of complicated acute pericarditis. This will also serve as a review of pathophysiology, etiology, current diagnosis and available novel treatment for such patients.
PubMed: 38741856
DOI: 10.7759/cureus.58147 -
The American Journal of Cardiology Jul 2024In patients with cardiac amyloidosis, pericardial involvement is common, with up to half of patients presenting with pericardial effusions. The pathophysiological... (Review)
Review
In patients with cardiac amyloidosis, pericardial involvement is common, with up to half of patients presenting with pericardial effusions. The pathophysiological mechanisms of pericardial pathology in cardiac amyloidosis include chronic elevations in right-sided filling pressures, myocardial and pericardial inflammation due to cytotoxic effects of amyloid deposits, and renal involvement with subsequent uremia and hypoalbuminemia. The pericardial effusions are typically small; however, several cases of life-threatening cardiac tamponade with hemorrhagic effusions have been described as a presenting clinical scenario. Constrictive pericarditis can also occur due to amyloidosis and its identification presents a clinical challenge in patients with cardiac amyloidosis who concurrently manifest signs of restrictive cardiomyopathy. Multimodality imaging, including echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, is useful in the evaluation and management of this patient population. The recognition of pericardial effusion is important in the risk stratification of patients with cardiac amyloidosis as its presence confers a poor prognosis. However, specific treatment aimed at the effusions themselves is seldom indicated. Cardiac tamponade and constrictive pericarditis may necessitate pericardiocentesis and pericardiectomy, respectively.
Topics: Humans; Amyloidosis; Pericardial Effusion; Cardiac Tamponade; Pericarditis, Constrictive; Cardiomyopathies; Echocardiography; Magnetic Resonance Imaging, Cine; Pericardium
PubMed: 38740164
DOI: 10.1016/j.amjcard.2024.05.007 -
Journal of Family Medicine and Primary... Mar 2024Hypothyroidism and pericardial effusion are two conditions that are associated with previous research. Nevertheless, the correlation between the severity of...
The thyroid-pericardium connection: Unveiling the influence of hypothyroidism severity on pericardial effusion in South Gujarat's patient population-A cross-sectional study.
CONTEXT
Hypothyroidism and pericardial effusion are two conditions that are associated with previous research. Nevertheless, the correlation between the severity of hypothyroidism and the occurrence of pericardial effusion remains uncertain.
AIMS
1. To explore and examine the association between the severity of hypothyroidism and the occurrence of pericardial effusion. 2. To compare clinical characteristics and demographic factors with varying degrees of hypothyroidism severity and pericardial effusion.
SETTINGS AND DESIGN
Tertiary care hospital and cross-sectional study using a pretested, semistructured questionnaire and echocardiography.
METHOD AND MATERIAL
The cross-sectional study encompassed a cohort of 60 patients diagnosed with hypothyroidism.
STATISTICAL ANALYSIS USED
Epi-info version 7.0 and Open epi version 3.1, Chi-square, mean, and standard deviation were used.
RESULTS
There were 16 male participants, accounting for 26.7% of the total, and 44 female participants, constituting 73.3% of the cohort. The participants' average age was 35.5 years. Based on TSH levels, the severity of hypothyroidism in the study was classified into three categories: mild (33.4%), moderate (43.3%), and severe (23.3%). The most common symptoms were lethargy, weight gain, and cold intolerance. Also, an association between the severity of hypothyroidism and pericardial effusion was noted.
CONCLUSION
This research established a noteworthy correlation between hypothyroidism severity and pericardial effusion incidence that is statistically significant. Nevertheless, no significant associations were detected with demographic factors or pulse rate. These results underscore the significance of monitoring and addressing pericardial effusion in patients with moderate-to-severe hypothyroidism. Further investigations are warranted to extend these findings.
PubMed: 38736801
DOI: 10.4103/jfmpc.jfmpc_1236_23 -
Clinica Chimica Acta; International... Jun 2024Pericardial Fluid (PF) is a rich reservoir of biologically active factors. Due to its proximity to the heart, the biochemical structure of PF may reflect the... (Review)
Review
BACKGROUND AND OBJECTIVE
Pericardial Fluid (PF) is a rich reservoir of biologically active factors. Due to its proximity to the heart, the biochemical structure of PF may reflect the pathological changes in the cardiac interstitial environment. This manuscript aimed to determine whether the PF level of cardiac troponins changes in patients undergoing cardiac surgery.
METHODS
This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE, Cochrane, ClinicalTrials.gov, and Google Scholar databases were electronically searched for primary studies using the keywords "pericardial fluid," "troponin," and "cardiac surgery." The primary outcome of interest was changes in troponin levels within the PF preoperatively and postoperatively. Secondary outcomes of interest included comparisons between troponin level changes in the PF compared to plasma.
RESULTS
A total of 2901 manuscripts were screened through a title and abstract stage by two independent blinded reviewers. Of those, 2894 studies were excluded, and the remaining seven studies underwent a full-text review. Studies were excluded if they did not provide data or failed to meet inclusion criteria. Ultimately, six articles were included that discussed cardiac troponin levels within the PF in patients who had undergone cardiac surgery. Pericardial troponin concentration increased over time after surgery, and levels were significantly higher in PF compared to serum. All studies found that the type of operation did not affect these overall observations.
CONCLUSION
Our review of the literature suggest that the PF level of cardiac troponins increases in patients undergoing cardiac surgery, irrespective of the procedure type. However, these changes' exact pattern and clinical significance remain undefined.
Topics: Humans; Pericardial Fluid; Cardiac Surgical Procedures; Troponin
PubMed: 38734224
DOI: 10.1016/j.cca.2024.119722 -
Cell Transplantation 2024
Topics: Myocardial Infarction; Animals; Pericardium; Tissue Scaffolds; Peptides; Stem Cells; Humans; Stem Cell Transplantation
PubMed: 38733311
DOI: 10.1177/09636897241255859 -
Scientific Data May 2024The Sparsely Annotated Region and Organ Segmentation (SAROS) dataset was created using data from The Cancer Imaging Archive (TCIA) to provide a large open-access CT...
The Sparsely Annotated Region and Organ Segmentation (SAROS) dataset was created using data from The Cancer Imaging Archive (TCIA) to provide a large open-access CT dataset with high-quality annotations of body landmarks. In-house segmentation models were employed to generate annotation proposals on randomly selected cases from TCIA. The dataset includes 13 semantic body region labels (abdominal/thoracic cavity, bones, brain, breast implant, mediastinum, muscle, parotid/submandibular/thyroid glands, pericardium, spinal cord, subcutaneous tissue) and six body part labels (left/right arm/leg, head, torso). Case selection was based on the DICOM series description, gender, and imaging protocol, resulting in 882 patients (438 female) for a total of 900 CTs. Manual review and correction of proposals were conducted in a continuous quality control cycle. Only every fifth axial slice was annotated, yielding 20150 annotated slices from 28 data collections. For the reproducibility on downstream tasks, five cross-validation folds and a test set were pre-defined. The SAROS dataset serves as an open-access resource for training and evaluating novel segmentation models, covering various scanner vendors and diseases.
Topics: Female; Humans; Male; Image Processing, Computer-Assisted; Tomography, X-Ray Computed; Whole Body Imaging
PubMed: 38729970
DOI: 10.1038/s41597-024-03337-6 -
Current Medical Imaging May 2024Hydatidosis, a distinctive parasitic ailment, exhibits a broad range of imaging characteristics influenced by the growth stage, resultant complications, and tissue...
Hydatidosis, a distinctive parasitic ailment, exhibits a broad range of imaging characteristics influenced by the growth stage, resultant complications, and tissue involvement. Its occurrence throughout the human anatomy underscores its ubiquitous propensity. Despite its relatively infrequent manifestation as diffuse hydatosis, the disease assumes particular significance in rural regions. Given its detrimental complications and resemblance to other cystic conditions, vigilance towards the potential presence of this ailment becomes imperative.
Case Presentation: In 2022, a 12-year-old female patient residing in a village sought medical assistance for left flank pain. During the evaluation, an incidental discovery of a pancreatic cyst through sonography prompted further investigation. Subsequent abdominopelvic computed tomography (CT) scans identified multiple lesions consistent with hydatid cysts in various anatomical locations, including the pancreas, right atrium, ventricle of the heart, pericardium, and lung. Confirmation of the hydatid cysts was obtained through pathology examination and consideration of the patient's medical history, which included a previously diagnosed brain hydatid cyst. Treatment with albendazole was initiated, and the patient underwent cardiac surgical intervention. Unfortunately, the condition of the patient deteriorated, leading to septic shock and subsequent mortality. Conclusion: In areas with a high prevalence of hydatid cysts, the presence of diverse lesions on radiologic assessments, despite negative serologic tests, should raise suspicion for this condition. Furthermore, understanding the importance of timely detection and intervention is crucial, as it greatly impacts patient prognosis,. In the advanced stages of the disease, particularly when cardiac involvement occurs, surgical excision of the cysts remains the sole therapeutic approach, albeit accompanied by certain complications. Through the utilization of various imaging modalities and early recognition and treatment, the need for more complex interventions can be minimized.PubMed: 38726784
DOI: 10.2174/0115734056295104240506101317