Cardiac Chambers Research Articles

A Rare Case of Successful Device Closure of a Large Coronary CameralFistula to Right Atrium

Coronary artery anomalies are a rare group of congenital cardiac disorders with an incidence of less than 1% in general population. Coronary cameral fistula (CCF) are abnormal vascular communications between coronary artery and a cardiac chamber. These fistulae result from congenital abnormalities or are acquired as a result of trauma or cardiac surgery. We present the transcatheter closure of a large CCF from right coronary artery (RCA) to right atrium in an eight-year-old girl.

Successful clinical approach to the metastatic uterine leiomyosarcoma to the epicardium—a case report

BackgroundUterine leiomyosarcoma is a rare and aggressive tumour with a poor prognosis. Its metastases to the heart are even rarer, especially to the epicardium. The majority of reported cardiac metastases of uterine leiomyosarcoma were in the cardiac chambers or intramyocardial. Surgical resection of the uterine leiomyosarcoma in the early stages is the only definitive treatment for this disease. However, in the cases of cardiac metastasis, surgery is recommended only in emergencies and patients with expected beneficial outcomes.Case presentationOur patient was a 49-year-old female referred to the Department of Cardiac Surgery for scheduled surgery of pericardial neoplasia. The patient underwent a hysterectomy and adnexectomy three years prior owing to the uterine leiomyosarcoma. A regular follow-up magnetic resonance imaging of the abdomen and pelvis discovered neoplasia in the diaphragmic portion of the pericardium. No other signs of primary disease relapse or metastases were found. The patient was asymptomatic. The multidisciplinary team concluded that the patient is a candidate for surgery. Surgery included diastolic cardiac arrest achievement and resection of the tumour. Macroscopically, a parietal layer of the pericardium was completely free from the tumour that invaded only the apical myocardium of the left ventricle. Completed histopathology confirmed the diagnosis of leiomyosarcoma of the uterine origin. Three months after surgery, the patient received adjuvant chemotherapy with doxorubicin and dacarbazine. One year after surgery, there are no signs of new metastases.ConclusionsStrict surveillance of patients with uterine leiomyosarcoma after successful treatment of the early stage of the disease is of utmost importance to reveal metastatic disease to the heart in a timely manner and to treat it with beneficial outcomes. Surgery with adjuvant chemotherapy might be a good approach in patients with a beneficial prognosis. From a surgical point of view, it is challenging to assess the appropriate width of the resection edges to be radical enough and, at the same time, sufficiently conservative to ensure the satisfactory postoperative function of the remaining myocardium and avoid repetitive tumour growth. Therefore, intraoperative histopathology should always be performed.

Pulmonary artery thrombosis. Clinical cases

Accumulating evidence supports the need to consider pulmonary artery thrombosis the separate thrombotic complication, which requires its own treatment algorithms.
 The aim of the work is to demonstrate the pulmonary artery thrombosis clinical aspects and the effect of the standard thrombotic prophylactic algorithms with clinical examples.
 Clinical cases of patients with pulmonary artery thrombosis are presented. Pulmonary artery thrombosis is considered to be the thrombotic obstruction of the pulmonary artery branches in the absence of venous and cardiac chambers thrombosis.
 Patient S. with COVID-19 and 75% of lung involvement was treated in the accordance with the actual COVID-19 treatment recommendations. Enoxaparin sodium 6000 IE once a day followed by the increasing dosage of 8000 IE twice a day was used. To prevent exacerbation tocilizumab was infused, and systemic thrombolytic therapy was performed. On the 6th day after systemic thrombolytic therapy patient died. Examination revealed thrombi in the pulmonary artery branches.
 Patient P. with continued growth of cerebral left frontoparietal region glioblastoma was hospitalized. Surgical tumor removal was performed a year ago. Conservative therapy, dexamethasone injections and anticoagulant prophylaxis (enoxaparin sodium 4000 IE once a day) were prescribed. After the patient death thrombi were found in the pulmonary artery segmental branches.
 Outpatient D. had a history of four episodes of dyspnea during the acute respiratory diseases. Computed tomography performed at the time of the third and fourth episodes revealed thrombi in the pulmonary artery segmental branches. The fourth episode occured despite anticoagulant prophylaxis with rivaroxaban (10 mg once a day). Patient was recommended to switch to low molecular weight heparins in case of any disease. There have been no recurrent episodes over the past 8 months.
 Distinctive features of pulmonary artery thrombosis pathogenesis determine the development of the complication despite anticoagulant prophylaxis. Preventive effect of anti-inflammatory drugs on the pulmonary artery thrombosis development has not been demonstrated.

Contribution of Computed Tomography in the Diagnosis of Multifocal Non-Hodgkin’s Lymphoma at the Mother-Child University Hospital the ‘’Luxembourg’’ About a Case

Lymphoma is a malignant proliferation of lymphoid tissue cells. We report a case of multi-focal lymphoma of lymph node, pharyngeal, cardiac and splenic sites. This was a 19-year-old patient received in February 2023, at the radiology and medical imaging department of the Mother and Child University Hospital Center ''Luxembourg'' as part of the CT exploration of a lateral mass. -left cervical. On admission, the clinical examination found a patient with an altered general condition, moderately colored conjunctiva, normal blood pressure and temperature. Examination of the lymph node areas revealed a left latero-cervical swelling, and fixed bilateral axillary swellings, of firm consistency and irregular contours. Palpation revealed hepatosplenomegaly. Cardiopulmonary auscultation was normal. A cervico-thoraco-abdominal CT scan revealed irregular thickening of the left lateral wall of the oropharynx, a hypodense tissue mass in the right cardiac chambers, heterogeneous splenomegaly, cervical, mediastinal, axillary and abdominal ADP. The histological examination carried out after lymph node biopsy revealed a histological appearance of small cell lymphoma. Conclusion: Lymphoma is a very common malignant tumor that can occur at any age. This tumor can affect all organs, however its cardiac location is rare. The positive diagnosis remains histological. Imaging plays an important role in the initial assessment, extension and surveillance.

The Influence of Anthropometrics on Cardiac Mechanics in Healthy Women With Opposite Obesity Phenotypes (Android vs Gynoid).

The possible influence exerted by mechanical factors and/or compressive phenomena on myocardial strain parameters in healthy individuals with opposite obesity phenotypes (android vs gynoid) has never been previously investigated. Accordingly, we aimed at evaluating the relationship between anthropometrics, such as the waist-to-hip ratio (WHR), modified Haller index (MHI, the ratio of chest transverse diameter over the distance between sternum and spine), and epicardial adipose tissue (EAT), and left ventricular (LV)-global longitudinal strain (GLS), in healthy women with opposite obesity phenotypes (android vs gynoid). Forty healthy women with obesity (body mass index (BMI) ≥30 Kg/m2)and WHR ≥0.85 ("android group") (52.5±13.2 yrs), 40 age- and BMI-matched healthy women with obesityand WHR <0.78 ("gynoid group") (49.8±13.4 yrs) and 40 age-matched healthy women without obesity (BMI <30 Kg/m2) (controls) (50.3±12.5 yrs) were retrospectively analyzed. All women underwent transthoracic echocardiography implemented with echocardiographic strain analysis of all cardiac chambers. Correlation between LV-GLS and anthropometrics (WHR, MHI, and EAT) was assessed in both groups of obese women. Age, WHR, homeostasis model assessment for insulin resistance (HOMA-IR), and left ventricular mass index (LVMi) were included in the logistic regression analysis performed for evaluating the independent predictors of reduced LV-GLS magnitude (less negative than -20%) in women with android obesity. Compared to the other groups of women, those with android obesity were found with significantly greater LVMi, higher LV filling pressures, and lower biventricular and biatrial deformation indices. A strong inverse correlation between LV-GLS and all anthropometrics (WHR, MHI, and EAT) was demonstrated in both groups of women with obesity. Univariate logistic regression analysis revealed that WHR (OR 1.58, 95%CI 1.22-2.03, p<0.001) and LVMi (OR 1.09, 95%CI 1.02-1.16, p=0.006) were independently correlated with LV-GLS impairment in women with android obesity. On multivariate logistic regression analysis, the WHR maintained a statistically significant association with the above-mentioned outcome (OR 1.68, 95%CI 1.14-2.48, p=0.009). Receiver operating characteristic (ROC) curve analysis showed that a WHR value ≥1.01 had 93% sensitivity and 100% specificity for detecting LV-GLS impairment in women with android obesity (AUC=0.98; 95%CI 0.96-1.00). Anthropometrics may strongly influence cardiac mechanics in healthy women with obesity. The WHR is associated with reduced LV-GLS magnitude in healthy women with android obesity, independent of age, glycometabolic status, and LV size.

The impact of high-altitude migration on cardiac structure and function: a 1-year prospective study.

The trend of human migration to terrestrial high altitudes (HA) has been increasing over the years. However, no published prospective studies exist with follow-up periods exceeding 1month to investigate the cardiac change. This prospective study aimed to investigate the changes in cardiac structure and function in healthy young male lowlanders following long-term migration to HA. A total of 122 Chinese healthy young males were divided into 2 groups: those migrating to altitudes between 3600m and 4000m (low HA group, n = 65) and those migrating to altitudes between 4000m and 4700m (high HA group, n = 57). Traditional echocardiographic parameters were measured at sea level, 1month and 1year after migration to HA. All 4 cardiac chamber dimensions, areas, and volumes decreased after both 1month and 1year of HA exposure. This reduction was more pronounced in the high HA group than in the low HA group. Bi-ventricular diastolic function decreased after 1month of HA exposure, while systolic function decreased after 1year. Notably, these functional changes were not significantly influenced by altitude differences. Dilation of the pulmonary artery and a progressive increase in pulmonary artery systolic pressure were observed with both increasing exposure time and altitude. Additionally, a decreased diameter of the inferior vena cava and reduced bicuspid and tricuspid blood flow velocity indicated reduced blood flow following migration to the HA. 1year of migration to HA is associated with decreased blood volume and enhanced hypoxic pulmonary vasoconstriction. These factors contribute to reduced cardiac chamber size and slight declines in bi-ventricular function.

Using CT to Evaluate Cardiac Function

A comprehensive evaluation of cardiac function includes information in relation to cardiac output and systemic venous return. The heart is composed of four chambers: two atria and two ventricles, each with its own unique mechanical function. These four cardiac chambers, their valves, and the pulmonary circulation system are inter-related as they preload or afterload on each other. Cardiac dysfunction is a failure of global cardiac function, resulting in typical clinical manifestations. To investigate the underlying cause of cardiac dysfunction, a step-by-step evaluation of cardiac blood flow tracks is necessary. In this context, imaging markers showing details of the cardiac structures have an important role in assessing cardiac function. An image-based evaluation allows for investigation of function in terms of individual cardiac components. Evaluation of cardiac function using cardiac CT has recently been validated. This review aimed to discuss cardiac CT-based imaging markers for comprehensive and detailed cardiac function assessment.

Autopsy Pathology of Heart and Coronary Vessels in Sudden Death: A Cross-sectional Study from Southern India

Introduction: Cardiac diseases emerge as the primary culprits behind sudden and unexplained deaths. Morphological evaluation through autopsy is invaluable in establishing the prevalence of cardiac lesions and coronary atherosclerosis within the general population. It provides healthcare researchers with valuable insights to develop preventive measures and early detection strategies crucial for improving survival rates. Aim: To estimate the prevalence of cardiac lesions in postmortem specimens of the heart from autopsies of sudden and unexplained deaths. Materials and Methods: The present cross-sectional study was conducted in the Department of Pathology, Government Medical College (a public sector hospital), Cochin, Kerala, India, from January to December 2021 on 140 specimens of the heart. Medicolegal autopsies were performed in the Department of Forensic Medicine, with specimens forwarded to the Pathology Department for histopathological examination. Hearts dissected by the modified Virchow’s method were examined for gross pathology in the cardiac wall, chambers, valves, coronaries and aorta. Microscopy findings were documented and the grading of coronary atherosclerosis was done using the Modified American Heart Association (AHA) criteria. Proportions were analysed from the compiled data using a Chi-square test. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21.0 software. Results: In the study encompassing 140 adult autopsies, the mean age of the study population was 45.98 with a Standard Deviation (SD) of 15.82 years and the male to female ratio was 3.5:1. The prevalence of cardiac lesions was as follows: coronary artery atherosclerosis (80.70%), Ischaemic Heart Disease (IHD) (44.28%), cardiac hypertrophy and hypertension (10%), pericarditis (6.42%) and myocarditis (3.50%). The male- to-female ratio for coronary atherosclerosis was 4.4:1, with triple vessel disease observed in 42.90% of cases. Atherosclerosis severity grades included early non atheromatous lesions (19.3%), Pathological Intimal Thickening (PIT) (23.6%), and advanced atherosclerotic lesions (37.80%). Among cases associated with Coronavirus Disease 2019 (COVID-19)-related deaths (10.7%), changes noted included myocarditis, microhaemorrhages, oedema, capillary dilatation, fibrin deposition and inflammatory infiltrates. Conclusion: The present study revealed a high prevalence of coronary atherosclerosis affecting all three vessels, particularly among the younger population. This underscores the significance of screening for cardiovascular risk factors and implementing preventive measures from an early age.

Fístula cardiocutânea com corpo estranho em ventrículo direito: complicação tardia e rara do uso de cateter venoso central de inserção periférica

INTRODUCTION: Foreign bodies in the heart are rare and a small number of cases are reported about this event. There are different mechanisms by which objects can reach a cardiac chamber and cause myocardial perforation, so an individualized diagnostic approach must be taken to define the management of these cases. OBJECTIVES: To report the case of a five-year-old pediatric patient with a cardiocutaneous fistula caused by a caused by a fragment of a peripherally inserted central catheter (PICC) in the right ventricle (RV). CASE REPORT: A 5-year-old male patient with a history of blunt chest trauma due to a fall from his own height a year ago, followd by a chest wall abscess, after 20 days. After drainage, a recurrent outflow of serous and bloody secretion from the lesion persisted. Eleven months after the event, the patient started to present daily high fever, local hyperemia, and increased drainage secretion. The diagnostic investigation showed an Intracardiac foreign body with the presence of a cardiocutaneous fistula. Due to the past of peripherally inserted central catheter (PICC) during the neonatal period, it is believed that the catheter fragmented and remained asymptomatically lodged in the RV, with exteriorization through the skin after 5 years. CONCLUSION: Cardiocutaneous fistula caused by a foreign body in the heart is a rare event and may be caused by fracture and migration of a PICC. The diagnosis must be made through a detailed clinical history, aligned with adequate imaging exams.

Influence of chest wall conformation on reproducibility of main echocardiographic indices of left ventricular systolic function.

The possible influence of chest wall conformation, as noninvasively assessed by Modified Haller Index (MHI, the ratio of chest transverse diameter over the distance between sternum and spine), on reproducibility of both left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) has never been previously investigated. Two equal groups of healthy individuals, matched by age, sex, and cardiovascular risk factors and categorized according to MHI in those with concave-shaped chest wall (MHI>2.5) and those with normal chest shape (MHI≤2.5), who underwent transthoracic echocardiography implemented with echocardiographic deformation imaging between June 2018 and May 2019, were retrospectively analyzed. LVEF and GLS were measured twice by the two echocardiographers in a double blinded manner. Intra-class correlation coefficients (ICCs), bias and limits of agreement determined with Bland-Altman analysis were calculated for repeated measurements of both LVEF and GLS. Thirty-four healthy individuals with MHI>2.5 (54.9±6.4 years, 58.8% females) and 34 matched controls with MHI≤2.5 (52.5±8.1 years, 50% females) were separately analyzed. In comparison to MHI≤2.5 group, the MHI>2.5 group was found with significantly smaller cardiac chambers and significantly lower GLS magnitude (-15.8±2.5 vs. -22.2±1.3%, P<0.001), despite similar LVEF (61.3±6.4 vs. 61.1±3.6%, P=0.87). In the MHI>2.5 group, intra-rater and inter-rater ICCs were ≤0.5 for both LVEF and LV-GLS, whereas in the MHI≤2.5 group intra-rater and inter-rater ICCs values indicated good reliability for LVEF and excellent reliability for GLS. The greatest bias and largest limits of agreement were detected for LVEF assessment (bias ranging from -1.09 to 2.94%, with the 95% limits of agreement ranging from -13.9 to 21.3%) in individuals with MHI>2.5. On the other hand, the smallest bias and narrowest limits of agreement were obtained for GLS measurement (bias ranging from -0.26 to 0.09%, with the 95% limits of agreement ranging from -1.4 to 1.4%) in participants with normal chest wall conformation (MHI≤2.5). The test reliability of LVEF and GLS is strongly influenced by the chest wall conformation. MHI might represent an innovative approach for selecting the best echocardiographic method for LV systolic function estimation in the individual case.

Multimodality Imaging in Cardiomyopathies.

Cardiomyopathy, which is shortly defined as a disease of the myocardium, has a broad definition that includes many different diagnoses. Recent advances in cardiac imaging techniques, including basic and advanced echocardiography, computed tomography, nuclear medicine, and cardiac magnetic resonance, allow for a more accurate evaluation of volumes and thickness of cardiac chambers, systolic and diastolic function of the ventricules, and tissue structure. Multimodality imaging often provides the first clinical suspicion for specific etiologies, especially when the medical and family history is unclear, by identification of red flags of underlying systemic diseases. In this review, we aimed to evaluate the role of multimodality imaging in diagnosis of cardiomyopathies with key images and discussed the effects of genetics on the diagnostic, prognostic, and therapeutic guidance of cardiomyopathies.

Meta-analysis of the correlation between pulmonary hypertension and echocardiographic parameters in patients with chronic kidney disease.

To investigate the correlation between pulmonary hypertension (PH) and echocardiographic parameters in patients with chronic kidney disease (CKD). PubMed, Embase, Web of Science, Cochrane, VIP, CNKI, and Wanfang databases were systematically searched for articles published from inception to 19 May 2023. Study quality was estimated using the Quality Assessment of Case-Control Studies tool. Forest plots were drawn using R language software. The "metacor" function in the "meta" package was utilized for meta-analysis of the r-values and their standard errors. Heterogeneity and sensitivity analyses were carried out, with the main outcomes as r-value, p-value, and I2 value. Eleven studies were included, with 1,809 CKD patients. The correlations between 12 echocardiographic parameters and PH were analyzed. Except for FS and LVEF which were negatively correlated with CKD-PH, the other 10 parameters were positively correlated with CKD-PH. Among them, LA was highly correlated with CKD-PH (0.70 < r < 0.89); LVDD, RA, RV, LVMI, and LVDS were moderately correlated with CKD-PH (0.40 < r < 0.69); while PA, IVS, LVPW, SV, FS, and LVEF were lowly correlated with CKD-PH (0.20 < r < 0.39). The synthesized estimates were stable against heterogeneity. CKD-PH patients may have large cardiac chambers, thickened septal tissue on both sides of the chambers, reduced pulmonary artery flow rates, and decreased left ventricular function.

MYELOPROLIFERATIVE HYPEREOSINOPHILIC SYNDROME A RARE CAUSE OF DILATED CARDIOMYOPATHY WITH A REVIEW

Hypereosinophilic syndrome (HES) is aheterogenous group of rare haematological disorders, the majority of which are idiopathic. Cardiac manifestations of HES are rare and the myeloproliferative HES (M-HES) is very rare. Eosinophilic myocarditis and endomyocardial fibrosis are a typical course of morbidity and mortality in hypereosinophilic syndrome. We present a case of idiopathic eosinophilia who presented with dyspnea, abdominal distention and edema with peripheral eosinophilia (82%) in a complete blood count test done before presentation to us. Echocardiography showed enlarged cardiac chambers, global hypokinesia,moderate to severe tricuspid regurgitation, with reduced left ventricular ejection fraction &lt;40% suggestive of dilated cardiomyopathy (DCM). Parasitic disease, autoimmune disease and drug induced cardiomyopathy were excluded as possibilities. He was treated with steroids, imatinib, and anti failure therapy. Cardiac function improved with therapy and the eosinophilic count reduced. Monitoring chest radiography and electrocardiogram and echocardiography according to fluctuations in eosinophils may enable early detection and treatment of cardiac involvement in patients with HES.

Understanding Diastolic Heart Failure

This paper analyzes the concepts of systolic function, diastolic function, heart failure, diastolic dysfunction, and diastolic heart failure. Reference is made to the historical evolution of the concept of heart failure and the origin of the term diastolic heart failure. In light of current knowledge of the physiology of the heart and its pathophysiology, the inappropriate terms for heart failure with preserved systolic function (is there heart failure? or is ventricular function normal?). The clinical picture of pulmonary and systemic venous congestion in patients with obliteration of the cardiac chambers by endocardial thrombi or cardiac tamponade and finally pulmonary edema, caused by tight mitral stenosis, are they in diastolic heart failure? or do they have heart failure with preserved systolic function? This confusion has originated in clinical practice, since numerous research papers have called it "diastolic heart failure". It is concluded that there is a growing and increasingly urgent need to clearly identify the concepts of heart failure, diastolic dysfunction or diastolic heart failure. This paper attempts to conceptualize the aforementioned concepts by analyzing the pathology, pathophysiology, clinical picture, prognosis, and treatment in an attempt to conceptualize the clinical picture of the entities that can lead to heart failure as opposed to the diastolic dysfunction and diastolic heart failure.

Myocardial strain changes over a 1-month follow-up in Takotsubo syndrome: a case report

Among various diagnostic methods, echocardiography (EchoCG) is most often used to identify Takotsubo syndrome. Left ventricular apical ballooning and the absence of permanent local contractility disturbances makes it possible to confirm the diagnosis. Currently, the available literature provides insufficient data on longitudinal strain (LS) of various cardiac chambers in this condition. The current case report demonstrates complete restoration of left heart LS within 1 month with its initial significant decrease.

Effect of Vascular Lumen Reduction on the Performance and Energy Consumption of an Innovative Implantable LVAD

This paper presents the results of a study on the effect of vascular lumen reduction on the performance of an innovative implantable LVAD (left ventricular assist device). It details the pressures in the individual cardiac chambers as a function of device frequency. In addition, mass flow rates and energy consumption of the device are examined, varying with lumen reduction and operating frequency. While the lumen reduction of the vessels has little effect on energy consumption, the mass flow rates vary considerably, i.e., above 140 cyc/min, the mass flow rate increment is no longer achieved for specified initial conditions. There are also differences regarding the pressures in the heart; namely, it was found that the pressure plots look similar in all cases, leading to the conclusion that the reduction of the vessel lumen does not affect their shape, but does affect the maximum values of the left ventricular and aortic pressures. Importantly, the innovative device in the form of an intra-cardiac balloon assembly for circulatory support is based on a pulsatile flow strategy and is synchronized with the ECG signal. Other advantages of the proposed solution include a minimally invasive method of implantation, which is important for patients with end-stage heart failure. The design of the device is portable and the device itself is battery-powered, allowing for shorter hospitalization times and faster recovery, even in patients with end-stage heart failure associated with mitral regurgitation and pulmonary hypertension.

Structural and functional remodeling of the heart in hypertensive patients with COVID-19: assessmentof changes at the end of hospitalization period and during a 1-month follow-up

COVID-19 is often accompanied by the long-term persistence of symptoms, the risk of which depends on the severity and duration of the acute phase, as well as existing comorbidities. Cardiac dysfunction is one of the possible mechanisms of impaired functional status of patients. While clinically manifest systolic heart failure is a rare phenomenon in such a situation, minor alterations in the structural and functional state of the heart may be contributing to persistence of general symptoms such as dyspnea, fatigue, and reduced work capacity.The aim – to study the role of hypertension in the formation of structural and functional changes of the heart during hospitalization for COVID-19, and the dynamics of detected changes in the early period after discharge.Materials and methods. 221 hospitalized patients with COVID-19 (age 53.4±13.6 years, 53 % female) underwent a comprehensive transthoracic echocardiographic examination 1-2 days before discharge and after 31 days of follow-up. The control group included 88 subjects matched by age, sex, height, weight, and existing comorbidities. The studied parameters included morphometry of the cardiac chambers, indices of longitudinal systolic function and diastolic filling of the ventricles; the participants were also performing a 6-minute walk test.Results. Geometric changes of the heart in hospitalized patients with COVID-19 at the time of discharge included an increase in absolute (10.1±1.5 vs 9.1±0.9 mm, p&lt;0.001) and relative LV walls thickness (0.45±0,07 vs 0.39±0.04, p&lt;0.001), indices of LV myocardial mass (38.1±8.9 vs 33.9±5.8 g/m2.7, p&lt;0.001) and left atrial volume index (28.6±6.6 vs 25.1±4.9 ml/m2, p&lt;0.001), as well as a decrease in LV global longitudinal strain (-17.5±2.4 vs -18.6±2.2 %, p&lt;0.001) and diastolic filling parameters (e’ – 9.2±2.2 vs 11.3±2.6 cm/s, p&lt;0.001; E/e’ – 7.5±1.8 vs 6.8±1.7, p=0.002). The observed changes were more pronounced in the cohort of hypertensive participants, but also persisted in normotensive patients, resulting in a high prevalence of concentric LV geometry (78 % and 43 %, respectively, p&lt;0.001 between groups and vs controls), mainly type I diastolic dysfunction (51 % and 25 %, p&lt;0.001 between groups and vs control), as well as abnormal values of global longitudinal strain (32 % and 19 %, p=0.027 between groups, p&lt;0.001 vs control), which persisted during a short observation period. The increase in the reached % of individually predicted 6-minute walk distance was 11.2±7.5 in hypertensive participants vs 12.8±7.6 in normotensives, p&gt;0.05.Conclusions. Patients with COVID-19 at the end of hospitalization period were characterized by a high prevalence of LV concentric geometry and diastolic dysfunction, as well as minor decrease in its longitudinal systolic function, which were more pronounced in the presence of concomitant hypertension and did not improve during the first month after discharge.

INCREASED LEVELS OF PROINFLAMMATORY CYTOKINES IN BLOOD PLASMA IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION

HighlightsIL-8 and MCP-1 have a significant role in the CTEPH pathogenesis, which indicates the importance of nonspecific immunity in the formation and progression of CTEPH. The coupling between cytokines and hemodynamic parameters, cardiac structural changes and plasma biochemical parameters were determined. AbstractBackground. Chronic thromboembolic pulmonary hypertension (CTEPH) pathogenesis is complex and not fully understood. Particular attention to the microvascular damage genesis in CTEPH is given to aseptic inflammation, which in turn could be mediated through various molecular mechanisms. According to the conflicting and incomplete data on changes in the profile of factors controlling inflammation in CTEPH, research in this field would identify new therapeutic targets for the prevention and treatment of CTEPH.Aim. To study the profile of plasma proinflammatory cytokines in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and evaluate the coupling of these cytokines with the main morphofunctional and laboratory values of the disease severity.Methods. 34 patients with CTEPH were included in this study. To characterize the group, the following methods were used: echocardiographic examination, catheterization of the right cardiac chambers. Biomarkers of heart failure, systemic inflammation, as well as erythropoiesis and iron metabolism were assessed in all patients. The control group included 10 donors. To study the proinflammatory cytokine profile in plasma, interleukins (IL) 6, 8, 18, monocyte chemoattractant protein-1 (MCP-1) and matrix metalloproteinase 9 were determined using standard enzyme-linked immunosorbent assay (ELISA) kits.Results. Hemodynamic and morphofunctional changes in the pulmonary circulation specific to pulmonary hypertension were determined with catheterization of the right cardiac chambers and echocardiography. During plasma proinflammatory cytokines analysis, a significant increase in the level of IL-8 (p = 0.030) and MCP-1 (p = 0.031) in CTEPH group compared to the control group was observed. No significant differences for other analyzed markers were found. In the elaboration of the correlation analysis, moderate inverse coupling between proinflammatory markers and hemodynamic parameters characterizing the CTEPH severity were revealed, as well as positive correlations with parameters of remodeling of the right cardiac chambers and iron metabolism.Conclusion. The increased levels of IL-8 and MCP-1 in patients with CTEPH identified in the present study indicate a significant role of nonspecific immunity in the formation and progression of CTEPH. The coupling between cytokines and hemodynamic parameters, structural cardiac changes and plasma biochemical parameters were determined. Based on the obtained data, it is possible to develop new medicinal substances, targeting towards proinflammatory cytokines, their receptors and signaling pathways.

The shape of the mitral annulus: A hypothesis of mechanical morphogenesis

This paper investigates the role of mechanics in the morphogenesis of the annulus of the mitral valve. We represent the annulus in its embryonic stage as an elastic ring and we perform a mechanical simulation of the development process applying a distributed torque on the rod: because of the mechanical action of the other growing cardiac chambers on the atrio-ventricular region, it departs from a planar circular shape. The numerical integration of the mathematical rod model subject to a bending load yields a shape very near to the one reported in the medical literature as anatomical reference for healthy patients. To make the comparison quantitative, we illustrate a numerical approach to match two curves in 3D defining their distance in a proper mathematical way. Such a methodology is first applied to compare the annular shape resulting from the mechanical model with an anatomical reference “master” shape and it is then applied to set to clinical data extracted from MRI for a cohort of healthy patients. The good agreement among anatomical master description, numerical mechanical model, and clinical data supports our speculation about a possible role of mechanics in determining the shape of the mitral valve.

Enhancement of intra-cardiac flow-field data using adaptive Kernel filtering

A method of determining the optimal kernel size for filtering noise in vortex dominated flow-fields, as found in the cardiac chambers is presented in this paper. Using synthetic flow fields generated using harmonic functions and perturbed using Gaussian noises of different amplitudes and spreads, the effect of kernel size on noise removal using the Median filter is tested systematically. It is shown that there exists an optimal kernel size at which the Median filter works best. The size of the optimal kernel is shown to be related to the vortex size. When applied to MRI generated cardiac flow-fields, the approach is seen to reveal underlying vortex patterns thereby aiding as an effective tool in the diagnosis and prognosis of cardiac diseases based on vortices as clinical biomarkers. The behavior of the restored cardiac flow fields which are filtered with the optimal kernel size and also with some values preceding and succeeding it are similar to that observed in studies with synthetic flow fields. This confirms that the optimal size of the kernel is related to the cardiac vortex size as is observed in the case of synthetic flow fields.