Cardiac Dysfunction In Patients Research Articles

Iron chelation therapy failed to improve cardiac dysfunction caused by mitochondrial injury in rats with iron overload cardiomyopathy a 7T Cardiac MR research in vivo

Abstract Purpose To assess the efficacy of iron chelation therapy in improving cardiac function in iron overload cardiomyopathy (IOC) rats by using Cardiac magnetic resonance feature-tracking (CMR-FT). Methods The IOC rat model was induced by intraperitoneal injection of iron dextran over 2 months. Subsequently, 7 rats with IOC were assigned as IOC group to receive continued intraperitoneal injections of saline for an additional 2 months, while another group of 5 rats received intraperitoneal injections of deferoxamine (DFO) for the same duration, forming the IOC+DFO group. Meanwhile, a control group consisting of 7 healthy rats received intraperitoneal injections of saline for the entire duration of 4 months. All rats underwent a 7T CMR scan to assess cardiac function, myocardial iron overload, and myocardial fibrosis via cine, T2 mapping, and late gadolinium enhancement (LGE) scanning, respectively. The cardiac function analysis included left ventricular ejection fraction (LVEF) and left ventricular global longitudinal strain (GLS) using cine images. Following CMR scans, all rats underwent open-chest blood collection to detect serum iron levels, and cardiac gross specimens were then subjected to pathological staining, including hematoxylin and eosin (HE) for cardiomyocytes injury, Prussian blue for iron deposition , and Masson staining for myocardial fibrosis. Furthermore, the ultrastructure of cardiomyocyte was examined using transmission electron microscopy (TEM). Results The T2 value, measured in the septum wall at the mid-layer of the LV, and LVEF, and GLS exhibited a significant decrease in the IOC or IOC+DFO group, compared to the control group, while there were no significant difference observed between the IOC and IOC+DFO group (Fig. 1A, B, C). Myocardial fibrosis was not detected in the LGE images in both IOC and IOC+DFO group. Compared to the control group (37.5±12.5μmol/L) , serum iron levels were significantly elevated in the IOC group (368.6±181.0μmol/L) and in chelation treatment group (106.1±32.2μmol/L). Histological examination with HE staining revealed a normal arrangement of myocardial cells in all rats, without cellular degeneration or necrosis. Prussian blue staining highlighted the presence of iron particles within the myocardial interstitium in the IOC and IOC+DFO groups. Masson staining demonstrated intact myocardial muscle bundles without any evidence of myocardial fibrosis. Transmission electron microscopy (TEM) revealed myocardial mitochondria injury, characterized by ruptured outer membranes, reduced cristae, and vacuolization. Conclusions Following iron chelation therapy, the excessive iron burden in the bloodstream was alleviated. However, myocardial iron overload persisted in IOC rats, with no significant improvement in cardiac function observed. This persistence may be attributed to mitochondrial injury. The findings underscore the importance of monitoring cardiac dysfunction in patients with iron overload.CMR parameters analysis in IOC rats

Myocardial strain analysis by feature tracking cardiac magnetic resonance to identify subclinical cardiac dysfunction in patients with MINOCA

BackgroundTo investigate whether feature tracking cardiac magnetic resonance (FT-CMR) can identify subclinical myocardial dysfunction in patients with myocardial infarction with non-obstructed coronary arteries (MINOCA).MethodsClinical data and CMR images of MINOCA patients (N = 46) and control individuals (N = 12) were compared. The infarct and edema volume to total myocardium, peak global longitudinal strain (GLS), global longitudinal strain rate (GLSR), peak global circumferential strain (GCS), global circumferential strain rate, peak global radial strain, and global radial strain rate were measured. Diagnostic performances of strain parameters for MINOCA were evaluated by logistic regression and receiver operating characteristics analysis.ResultsExcept smoking history, the two groups showed no significant differences in cardiovascular risk factors and traditional heart function. GLS (-14.67 ± 1.96% vs. -19.19 ± 2.05%), GLSR (-0.94 ± 0.16 S− 1 vs. -1.23 ± 0.14 S− 1) and GCS (-17.59 ± 1.81% vs. -19.22 ± 1.76%) were impaired in MINOCA patients compared with the control group. MINOCA patients with normal routine CMR showed abnormalities in GLS (-16.23 ± 1.16%) and GLSR (-1.04 ± 0.16 S− 1). GLS and GLSR were predictive for MINOCA diagnosis (P = 0.002 vs. P = 0.033). GLS correlated strongly with myocardial infarction and edema. The optimal diagnostic threshold for GLS was <-16.9% for MINOCA diagnosis (sensitivity 87.1%, specificity 92.9%); the area under the receiver operating characteristic curve was 0.968.ConclusionsMyocardial strain by FT-CMR may effectively detect early myocardial impairment with MINOCA, especially in patients with normal routine MRI.

Proteomics-Based Machine-Learning Approach for Predicting Cardiac Dysfunction in Patients on Hemodialysis

Proteomics-Based Machine-Learning Approach for Predicting Cardiac Dysfunction in Patients on Hemodialysis

Correlation between mitral annular plane systolic excursion (MAPSE) at different degrees of ejection fraction in patients with diabetes mellitus

Background and aim. Diabetic cardiomyopathy is characterized by myocardial structure and function abnormality in the absence of other cardiovascular risk factors. Early detection of cardiac dysfunction is crucial for timely intervention and improved patient outcomes. The purpose of this study is to determine how mitral annular plane systolic excursion (MAPSE) is a sensitive marker of early cardiac dysfunction in patients with diabetes mellitus by examining the relationship between MAPSE values and different levels of ejection fraction. Methods and material. An analytical cross-sectional study was carried out at Dr. Wahidin Sudirohusodo Hospital in Indonesia's Integrated Heart Center. The sample included 79 patients with ages from 18 to 65 years old and a type 2 diabetes diagnosis. Data collected included age, gender, ejection fraction, and MAPSE. Statistical methods included descriptive analysis and Spearman correlation tests. Results. The study population was predominantly male (71%), with a mean age of 55.5 years for those without EF impairment and 59.5 years for those with impairment. The average impaired EF was 37.69%. MAPSE examination in septal, lateral, and average segments showed significant differences. There is a strong positive association between MAPSE and EF in all study samples. In patients with preserved EF (average EF 58%), MAPSE was 14.4 mm, and in those with reduced EF (average EF 29%), MAPSE was 6.31mm, with significant positive correlations. No significant results were observed in subjects with mid-range EF. Conclusions. This research revealed that mitral annular plane systolic excursion (MAPSE) is significantly associated with ejection fraction (EF) in individuals with diabetes mellitus (DM), mainly when EF is either well-maintained or diminished.

Cardiac Function and Functional Capacity in Patients with Long COVID: a Comparison to Propensity-Matched Community Controls

BackgroundCardiac impairment has been associated with acute COVID-19 since the earliest reports of the pandemic. However, its role in post-acute sequelae of COVID-19 (PASC, or “long COVID”) is undefined, and many existing observations about cardiovascular involvement in PASC are uncontrolled. ObjectiveTo compare the prevalence of cardiac dysfunction in patients with Long COVID, and non-infected controls from the same community, and explore their association with functional capacity. MethodsEchocardiography was used to assess cardiac structure and function, including the measurement of global longitudinal strain (GLS), in 190 participants with Long COVID. All underwent assessment of functional impairment by subjective (Duke Activity Status Index, DASI) and objective tests (6-minute walk test, 6MWT). The 190 participants from the Long COVID group were matched with those from 979 patients who underwent the same tests in the pre-COVID-19 era, using a propensity score. ResultsThe 190 patients with Long COVID had similar age and risk factor profiles to those of their matched controls. LV dimensions and geometry, but not diastolic parameters, were significantly altered in the Long COVID group. The Long COVID group had subclinical systolic dysfunction (GLS 18.5±2.6 vs 19.3±2.7%, p=0.005), and more Long COVID patients had abnormal (<16%) GLS (13% vs 8%, p=0.035). The association of Long COVID with abnormal GLS (OR 1.49 [1.04, 2.45]) was independent of - and had a similar or greater effect size - than age and risk factors. There was no interaction of Long COVID with the association of risk factors with GLS. As expected, the Long COVID group had significant subjective (<85% predicted METS; 72% vs 5%, p<0.001) and objective functional impairment (29% vs 24%, p=0.026), but GLS was only weakly associated with both subjective (r=0.30, p=0.005) and objective (r=0.21, p=0.05) functional impairment. The presence of Long COVID was independently associated with subjective (OR=159.7 [95% CI: 61.6-414.2]), and objective functional impairment (OR=2.8 [95% CI: 1.5-5.2]). ConclusionsImpaired GLS and LV dimensions are the echocardiographic features that are over-represented in Long COVID, and this association is similar to, and independent of other risk factors. Impaired GLS is weakly associated with functional impairment.

SGLT2i and Primary Prevention of Cancer Therapy–Related Cardiac Dysfunction in Patients With Diabetes

SGLT2i and Primary Prevention of Cancer Therapy–Related Cardiac Dysfunction in Patients With Diabetes

The clinical relevance of the new criteria for cirrhotic cardiomyopathy and future directions.

Cardiac dysfunction in patients with liver disease has been recognized since the 1950s. Initially attributed to shared risk factors, it is now evident that cardiac dysfunction in patients with cirrhosis can occur in the absence of known cardiac, i.e., coronary artery and valvular heart disease, and across all etiologies for cirrhosis. In 1996 this myocardial dysfunction was termed cirrhotic cardiomyopathy (CCM). The pathophysiologic mechanisms underlying CCM include impaired beta-adrenergic membrane function and circulating proinflammatory and cardiotoxic substances. In 2005, the first diagnostic criteria for CCM were introduced enabling greater sensitivity and accuracy of diagnosis. Since 2005, advancements in echocardiographic methods and better understanding of the pathophysiology of cardiac dysfunction in patients with cirrhosis necessitated revision of CCM criteria. Changes in CCM criteria included removal of blunted contractile or heart rate response on stress testing and addition of global longitudinal systolic strain. Refinement of criteria for diastolic dysfunction were also incorporated into the new diagnostic approach. Since 2020, the prevalence of the disorder and clinical considerations for pre-transplant, peritransplant, and post-transplant patients with cirrhosis have been further evaluated and CCM was found to adversely impact clinical outcomes during all three phases of care. Future research considerations should address the timing of universal echocardiographic screening for patients with cirrhosis, utility of biomarkers in aiding CCM diagnosis, impact of CCM on right heart function, and role of anti-remodeling agents post-liver transplant (post-LT).

Comparison of predictive value of cardiac troponins and creatine phosphokinase MB fraction for in-hospital mortality and cardiac dysfunction in patients with AMI after thrombolysis

Comparison of predictive value of cardiac troponins and creatine phosphokinase MB fraction for in-hospital mortality and cardiac dysfunction in patients with AMI after thrombolysis

Detection of Subclinical Cardiac Dysfunction in Patients With Sickle Cell Disease Using Speckle-Tracking Echocardiography

Sickle cell disease (SCD) is characterized by chronic anemia and recurrent ischemia-reperfusion episodes, which can lead to high-output heart failure. The impact of SCD on cardiac structure and function remains underinvestigated. We conducted a single-institution retrospective analysis of clinical and echocardiographic data from patients with hemoglobin SS SCD (SCD-SS) between January 2016 and June 2022. Patients with known heart failure, left ventricular (LV) ejection fraction <50%, moderate or severe valvular heart disease, congenital heart disease, established coronary artery disease, diabetes mellitus, hypertension, or coexistent lung disease were excluded. Compared with healthy controls (n = 28), patients with SCD-SS (n = 66) had a significantly higher left atrial (LA) volume index (35.7 vs 23.9 ml/m², p <0.001) and average E/e' (7.4 vs 6.5, p = 0.003) but lower average e' (12.3 vs 13.6 cm/s, p = 0.047) and LA reservoir strain (32.9% vs 42.4%, p <0.001). Patients with SCD-SS had higher LV end-diastolic (132.5 vs 104.1 ml, p <0.001) and LV end-systolic volumes (51.0 vs 43.8 ml, p = 0.017) with reduced LV global longitudinal strain (17.6% vs 20.0%, p <0.001). In addition, patients with SCD-SS showed reduced right ventricular (RV) global longitudinal strain (19.7% vs 22.8%, p <0.001) in the setting of normal RV tricuspid annular plane systolic excursion. Maximal systolic tricuspid regurgitation velocity (231 vs 202 cm/s, p <0.001) and right atrial area (16.6 vs 12.8 cm², p <0.001) were statistically greater in SCD-SS. Hemoglobin and hematocrit negatively correlated with LA volume index, average E/e', LV end-diastolic and LV end-systolic volumes. In conclusion, patients with SCD-SS had notable differences in cardiac chamber size and impaired LV, RV, and LA strain compared with healthy controls. Further investigations are needed to assess the impact of these variables on SCD clinical course and prognosis.

Imatinib Mesylate Causes Potential Cardiac Dysfunction in Patients With Chronic Myeloid Leukemia: the Results of a Case-control Study.

Unlike second-generation tyrosine kinase inhibitors, effects of imatinib on the cardiovascular (CV) system are debatable. The current case-control study aimed to evaluate the CV effects of imatinib in patients with chronic myeloid leukemia (CML) using non-invasive 2D-echocardiography testing. Patients with CML ≥ 13 years attending the adult haematology clinic of a tertiary care hospital in north India were prospectively enrolled over 1.5 years. The study population (n = 110) consisted of 35 newly diagnosed patients (treatment-naïve group) and 75 patients under imatinib therapy ≥ 1 year (treated group). All the eligible patients were subjected to 2D-echocardiography to calculate pulmonary artery systolic pressure (PASP), left ventricular ejection fraction (LVEF) and deceleration time (DT). These parameters were compared between the two groups. P-value < 0.05 was considered statistically significant. The median age of study population was 40 years (range, 13-73) and M:F ratio was 1.14:1. Both the groups had similar demographics at the diagnosis including CV risk factors. The median PASP of the treated group was 2 mm Hg higher than the treatment-naïve group (25 vs 23 mm Hg, p-value = 0.919). The median LVEF of the treated group was 3.2% lower than the treatment-naïve group (58.5% vs 61.72%, p-value = 0.577). The median DT of the treated group was 7 ms shorter than treatment-naïve group (211 vs 204 ms, p-value = 0.411). Imatinib causes potential cardiac dysfunction in patients with CML. Large scale prospective follow-up trials in the same cohort of patients are needed to validate the findings of our study.

Cardiomyocyte PANX1 Controls Glycolysis and Neutrophil Recruitment in Hypertrophy.

PANX1 (pannexin 1), a ubiquitously expressed ATP release membrane channel, has been shown to play a role in inflammation, blood pressure regulation, and myocardial infarction. However, the possible role of PANX1 in cardiomyocytes in the progression of heart failure has not yet been investigated. We generated a novel mouse line with constitutive deletion of PANX1 in cardiomyocytes (Panx1MyHC6). PANX1 deletion in cardiomyocytes had no effect on unstressed heart function but increased the glycolytic metabolism and resulting glycolytic ATP production, with a concurrent decrease in oxidative phosphorylation, both in vivo and in vitro. In vitro, treatment of H9c2 (H9c2 rat myoblast cell line) cardiomyocytes with isoproterenol led to PANX1-dependent release of ATP and Yo-Pro-1 uptake, as assessed by pharmacological blockade with spironolactone and siRNA-mediated knockdown of PANX1. To investigate nonischemic heart failure and the preceding cardiac hypertrophy, we administered isoproterenol, and we demonstrated that Panx1MyHC6 mice were protected from systolic and diastolic left ventricle volume increases as a result of cardiomyocyte hypertrophy. Moreover, we found that Panx1MyHC6 mice showed decreased isoproterenol-induced recruitment of immune cells (CD45+), particularly neutrophils (CD11b+ [integrin subunit alpha M], Ly6g+ [lymphocyte antigen 6 family member G]), to the myocardium. Together, these data demonstrate that PANX1 deficiency in cardiomyocytes increases glycolytic metabolism and protects against cardiac hypertrophy in nonischemic heart failure at least in part by reducing immune cell recruitment. Our study implies PANX1 channel inhibition as a therapeutic approach to ameliorate cardiac dysfunction in patients with heart failure.

Preoperative and postoperative administration of vitamin C in cardiac surgery patients – settings, dosages, duration, and clinical outcomes: a narrative review

Vitamin C or ascorbic acid is a water-soluble vitamin capable of directly donating electrons to reactive oxygen species, attenuating electrical remodeling, and cardiac dysfunction in patients undergoing cardiac surgery (CS), considered one of the most effective defenses against free radicals in the blood, thus being one of the first antioxidants consumed during oxidative stress. The aim of this review is to assess the effects of perioperative administration of vitamin C in CS patients. A comprehensive literature search was conducted in order to identify prospective cohort studies and/or randomized controlled trials reporting on the perioperative effects of vitamin C among adult patients undergoing CS. Studies published between January 1980 to December 2022 were included in our search, resulting in a total of 31 articles that met all our inclusion criteria. There seems to be a beneficial effect of vitamin C supplementation in arrhythmias such as in postoperative atrial fibrillation, reduction of ICU length of stay, and hospital length of stay, reduction in postoperative ventilation time, in inotropic demand, and in postoperative fatigue. Vitamin C can act as a scavenger of free radicals to decrease the peroxidation of the lipids present in the cell membrane, and to protect the myocardium postoperatively from ischemia/reperfusion injury, thus attenuating oxidative stress and inflammation. It represents a readily available and cost-effective strategy that could improve the outcome of patients undergoing CS, by reducing the risk of serious cardiovascular adverse events, both perioperatively and postoperatively.

FRI-243 Echocardiography-based markers of subclinical cardiac dysfunction in patients with MASLD and preserved ejection fraction: prospective data from the Turin cohort

FRI-243 Echocardiography-based markers of subclinical cardiac dysfunction in patients with MASLD and preserved ejection fraction: prospective data from the Turin cohort

Cardiac dysfunction in patients with cirrhosis and acute decompensation.

The prevalence of cirrhotic cardiomyopathy (CCM) has been reported as high as 60%-70% in patients with liver cirrhosis and is associated with various negative outcomes. There has been a growing understanding of CCM over recent years. Indeed, the development of imaging techniques has enabled new diagnostic criteria to be proposed by the Cirrhotic Cardiomyopathy Consortium. However, important unanswered questions remain over pathophysiological mechanisms, optimal diagnostic modalities and potential treatment options. While there has been an increasing volume of literature evaluating CCM, there is a lack of clarity on its implications in acute decompensation, acute-on-chronic liver failure and following interventions such as transjugular intrahepatic portosystemic shunt insertion and liver transplantation. This review aims to summarise the literature in these challenging domains and suggest where future research should focus. We conclude that systemic inflammation and structural myocardial changes are likely to be crucial in the pathophysiology of the disease, but the relative contribution of different components remains elusive. Furthermore, future studies need to use standardised diagnostic criteria for CCM as well as incorporate newer imaging techniques assessing both myocardial structure and function. Finally, while specific treatments are currently lacking, therapeutics targeting systemic inflammation, microbial dysbiosis and bacterial translocation are promising targets and warrant further research.

Assessment of Native Myocardial T1 Mapping for Early Detection of Anthracycline-Induced Cardiotoxicity in Patients with Cancer: a Systematic Review and Meta-analysis

Anthracycline antibiotic is one of the most effective anti-tumor drugs used to manage certain types of breast cancers, lymphomas, and leukemias. However, anthracyclines induce a dose-dependent cardiotoxicity that may progress to heart failure. Thus, using a sensitive predictor of early cardiac dysfunction in patients treated with anthracyclines can help detect subclinical cardiac dysfunction early and help initiate interventions to protect these patients. Among parameters of myocardial measure, cardiac magnetic resonance (CMR)-measured native myocardial T1 mapping is considered a sensitive and accurate quantitative measure of early subclinical cardiac changes, particularly cardiac inflammation and fibrosis. However, to understand the quality and the validity of the current evidence supporting the use of these measures in patients treated with anthracyclines, we aimed to conduct a systematic review of clinical studies of this measure to detect early myocardial changes in cancer patients treated with anthracyclines. The primary outcome was the level of native T1 mapping. We performed fixed-effects meta-analyses and assessed certainty in effect estimates. Of the 1780 publications reviewed (till 2022), 23 were retrieved, and 9 articles met the inclusion criteria. Our study showed that exposure to anthracycline was associated with a significant elevation of native myocardial T1 mapping from baseline (95% CI 0.1121 to 0.5802; p = 0.0037) as well as compared to healthy control patients (95% CI 0.2925 to 0.7448; p < 0.0001). No significant publication bias was noted on the assessment of the funnel plot and Egger’s test. According to the Q test, there was no significant heterogeneity in the included studies (I2 = 0.0000% versus healthy controls and I2 = 14.0666% versus baseline). Overall, our study suggests that native myocardial T1 mapping is useful for detecting anthracycline-induced cardiotoxicity in patients with cancer.

Abstract PO4-12-07: INSTITUTIONAL EXPERIENCE IN PATIENTS WITH EARLY BREAST CANCER WHO RECEIVED CARDIOTOXIC THERAPY IN CARDIONCOLOGY UNIT

Abstract Introduction: Early breast cancer (eBC) is the most frequent malignancy diagnosed in women worldwide; fortunately, survival is increasing related to early diagnosis and the incorporation of new drugs. In this scenario, preventing long-term toxicities become essential. Cardiac adverse events related to anthracyclines or trastuzumab such as reduction in left ventricular (LV) systolic function and clinical heart failure (HF), are well known and are the leading cause of morbidity in breast cancer survivors. Cardioprotective strategies and early diagnoses of asymptomatic cardiac dysfunction are essential to optimized management and prevention of overt cardiovascular (CV) disease. We made a specific cardiac assessment within an Oncocardiology multidisciplinary Unit in patients receiving anticancer therapies. We present the experience in patients with eBC treated with anthracyclines, trastuzumab or both in the past five years. Materials and Methods: We conducted an institutional, interventional, prospective study in patients who received anthracyclines, trastuzumab or both according to the standard of care (SoC) in eBC. Basal CV risk stratification included lipid profile, glycated haemoglobin, high-sensitive troponin T (hs-TnT) and N-terminal ProB-type natriuretic peptide (NT-ProBNP) was done. Image assessment was done by echocardiogram (echo), including myocardial deformation assessed by speckle tracking (STRAIN). Follow-up was done according to anthracycline or trastuzumab therapy with echo and cardiac biomarkers during the systemic therapy and at the end of anticancer treatment, 1, 2 and 5 years after. Patients with uncontrolled CV risks factors according to local protocol, asymptomatic cardiac dysfunction defined as decreased strain (&amp;gt;15% compared with baseline) or increased cardiac biomarkers (Hs-TnT &amp;gt;14 at baseline or x3 basal value during the follow-up; NT-ProBNP &amp;gt; 300 in patients with &amp;lt; 50y; &amp;gt; 600 in patients between 50-75-y or &amp;gt;900 in patients &amp;gt; 75 years or older) or patients who develop heart failure during the treatment or follow-up were referred to cardiologist. Results: between 2018 and 2022, 1125 patients were diagnosed with eBC in our institution, and 435 patients received systemic treatment with anthracyclines, trastuzumab or both. During the study period, 165 of these patients were referred to the cardio-oncologist. 60% received treatment with anthracyclines, 36% with trastuzumab and 4.1% with both. The median age was 58(±23.2), 60% had previous CV risk factors. The main reason to refer patients to the cardio-oncologist was asymptomatic cardiac dysfunction and uncontrolled CV risk factors. (Table 1). 60% of patients initiated angiotensin-converting-enzyme inhibitors or Beta-blockers, and only two patients stopped anticancer therapy due to severe cardiac dysfunction. The period of high risk of developing cardiotoxicity was the first year after the end of treatment. Conclusion: multidisciplinary evaluation within a cardio-oncology unit is useful to optimize CV risk factors and to detect asymptomatic cardiac dysfunction in patients receiving cardiotoxic drugs. Table 1. Main reasons to refer patients to cardiologist. Citation Format: Tamara Martos, Laia Carla Belarte-Tornero, Mireia Ble, Eva Gimeno, Laura Sanhauja, Felicidad Martines-Medina, Maria Martinez-García, Maria Castro-Henriques, Joan Albanell, Sonia Servitja. INSTITUTIONAL EXPERIENCE IN PATIENTS WITH EARLY BREAST CANCER WHO RECEIVED CARDIOTOXIC THERAPY IN CARDIONCOLOGY UNIT [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-12-07.

Rationale and design of the PACIFIC-PRESERVED (PhenomApping, ClassIFication and Innovation for Cardiac dysfunction in patients with heart failure and PRESERVED left ventricular ejection fraction) study

BackgroundHeart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome that is poorly defined, reflecting an incomplete understanding of its pathophysiology. AimTo redefine the phenotypic spectrum of HFpEF. MethodsThe PACIFIC-PRESERVED study is a prospective multicentre cohort study designed to perform multidimensional deep phenotyping of patients diagnosed with HFpEF (left ventricular ejection fraction≥50%), patients with heart failure with reduced ejection fraction (left ventricular ejection fraction≤40%) and subjects without overt heart failure (3:2:1 ratio). The study proposes prospective investigations in patients during a 1-day hospital stay: physical examination; electrocardiogram; performance-based tests; blood samples; cardiac magnetic resonance imaging; transthoracic echocardiography (rest and low-level exercise); myocardial shear wave elastography; chest computed tomography; and non-invasive measurement of arterial stiffness. Dyspnoea, depression, general health and quality of life will be assessed by dedicated questionnaires. A biobank will be established. After the hospital stay, patients are asked to wear a connected garment (with digital sensors) to collect electrocardiography, pulmonary and activity variables in real-life conditions (for up to 14 days). Data will be centralized for machine-learning-based analyses, with the aim of reclassifying HFpEF into more distinct subgroups, improving understanding of the disease mechanisms and identifying new biological pathways and molecular targets. The study will also serve as a platform to enable the development of innovative technologies and strategies for the diagnosis and stratification of patients with HFpEF. ConclusionsPACIFIC-PRESERVED is a prospective multicentre phenomapping study, using novel analytical techniques, which will provide a unique data resource to better define HFpEF and identify new clinically meaningful subgroups of patients.

Echocardiographic assessment of cardiovascular involvements in children with cystic fibrosis

BackgroundOver the past four decades, numerous case reports and clinical studies have highlighted the presence of heart disease in individuals with cystic fibrosis. Given the limited information in this field and the imperative to identify early changes during childhood, our study aims to explore cardiac dysfunction in patients with cystic fibrosis using echocardiography. MethodsIn this case-control study, we examined echocardiographic findings from thirty-three patients with cystic fibrosis and sixty healthy children. Demographic information for both groups was recorded, and the disease severity in patients was assessed using the Schawachman criterion. M-mode, Doppler flow velocity, and Tissue Doppler Imaging echocardiography were performed for all participants, with subsequent data analysis using SPSS 24. ResultsOur study encompassed thirty-three CF patients and sixty healthy children. The estimated pulmonary artery blood pressure (systolic and mean) in patients with cystic fibrosis was significantly higher than in the control group (P < 0.05). Additionally, the mean trans-tricuspid peak early to late diastolic flow velocity (E/A) was significantly lower in the case group than the control group (P < 0.05), along with a significantly lower mean tricuspid valve deceleration time (DT) (P < 0.05). Similarly, the mean TAPSE in the case group was notably lower than in the control group (P < 0.05). No significant difference in Mean left ventricular Ejection Fraction (EF) and Fractional Shortening (FS) existed between the two groups (P > 0.05). Furthermore, Trans-mitral peak early to late diastolic flow velocity (E/A) in the case group was significantly lower than in the control group (P < 0.05), and the mean mitral valve DT in the case group was also significantly lower (P < 0.05). ConclusionOur study findings indicate the presence of some degree of right ventricular dysfunction in children with cystic fibrosis. This finding may have implications for the development or modification of clinical guidelines for managing cystic fibrosis in children. Further investigations are recommended to elucidate the underlying mechanisms and contributing factors, providing valuable insights for clinical management.

Cardiac effects of deferasirox in transfusion-dependent patients with myelodysplastic syndromes: TELESTO study.

Iron overload from repeated transfusions has a negative impact on cardiac function, and iron chelation therapy may help prevent cardiac dysfunction in transfusion-dependent patients with myelodysplastic syndromes (MDS). TELESTO (NCT00940602) was a prospective, placebo-controlled, randomised study to evaluate the iron chelator deferasirox in patients with low- or intermediate-1-risk MDS and iron overload. Echocardiographic parameters were collected at screening and during treatment. Patients receiving deferasirox experienced a significant decrease in the composite risk of hospitalisation for congestive heart failure (CHF) or worsening of cardiac function (HR = 0.23; 95% CI: 0.05, 0.99; nominal p = 0.0322) versus placebo. No significant differences between the arms were found in left ventricular ejection fraction, ventricular diameter and mass or pulmonary artery pressure. The absolute number of events was low, but the enrolled patients were younger than average for patients with MDS, with no serious cardiac comorbidities and a modest cardiovascular risk profile. These results support the effectiveness of deferasirox in preventing cardiac damage caused by iron overload in this patient population. Identification of patients developing CHF is challenging due to the lack of distinctive echocardiographic features. The treatment of iron overload may be important to prevent cardiac dysfunction in these patients, even those with moderate CHF risk.

THE CORRELATION PARAMETERS OF CARDIAC DYSFUNCTION ON THE BACKGROUND OF STEATOHEPATOSIS

Introduction. Coronary heart disease (CHD) and its complications in the modern world are one of the main causes of disability and mortality of people of different ages [1-3]. Fatty liver disease - steatohepatosis - is an important factor in the development and progression of CAD and increases the risk of developing type 2 diabetes. On the other hand, information on cardiac dysfunction in patients with coronary heart disease with manifestations of steatohepatosis is insufficient and contradictory, the diagnosis, clinical features and treatment of this pathology are not accurate enough.&#x0D; The aim of the study. Determination of the correlations of the studied indicators in patients with coronary artery disease complicated by fatty liver disease.&#x0D; Research methods. Fatty infiltration of the liver was diagnosed using ultrasound of the abdominal cavity (EUB-6000 scanner; Hitachi Medical Corporation, Japan). The content of NT-proBNP was determined on StatFax-303, the activity of enzymes and indicators of carbohydrate and lipid metabolism were determined using the CRPLX "Roche Diagnostics" reagent set on the COBAS INTEGRA 400 plus automatic analyzer.&#x0D; In order to identify correlations, the coefficient of linear correlation |r| was determined between all studied indicators. The strength of the relationship was estimated by the absolute value of the Pearson linear correlation coefficient, considering that at r &lt;0.25 the relationship is weak, 0.25 &lt;r&lt; 0.75 - a relationship of medium strength, r ˃ 0.75 - correlation the bond is strong. We used the STATISTICA 6.0 software package (StatSoft, USA) [8].&#x0D; Results and discussion. Strong probable positive correlations were found between glucose concentration and the content of triacylglycans, glycated hemoglobin, atherogenicity coefficient, and lipase activity.&#x0D; Strong probable positive correlations were found between the activity of pancreatic amylase and the concentration of creatinine, C-reactive protein, interleukin 1β, NT-proBNP, and ALT activity.&#x0D; Strong probable positive correlations were found between the concentration of NT-proBNP and the content of uric acid, glucose, C-reactive protein, apoprotein A, interleukin 10, LDH activity, and alkaline phosphatase.&#x0D; Strong probable positive correlations were found between the concentration of creatinine and the content of total cholesterol, the content of HDL-cholesterol, LDL-cholesterol, and lipase activity.&#x0D; Strong probable positive correlations were found between the concentration of total cholesterol and the content of HDL-cholesterol, creatinine, and lipase activit&#x0D; Conclusions. Steatohepatosis is a factor in the development and progression of coronary heart disease and probably increases the risk of developing type 2 diabetes. In the group of patients with steatohepatosis, reliable strong correlation links of carbohydrate metabolism with other parameters were revealed. In the group of patients with on the background of steatohepatosis, significant strong correlation of the level of NT-proBNP, cholesterol and creatinine with other parameters was found.