End-systolic Diameter Research Articles

Predicting the risk of heart failure after acute myocardial infarction using an interpretable machine learning model

Background Early prediction of heart failure (HF) after acute myocardial infarction (AMI) is essential for personalized treatment. We aimed to use interpretable machine learning (ML) methods to develop a risk prediction model for HF in AMI patients.MethodsWe retrospectively included patients initially with AMI who received percutaneous coronary intervention (PCI) in our hospital from November 2016 to February 2020. The primary endpoint was the occurrence of HF within 3 years after operation. For developing a predictive model for HF risk in AMI patients, the least absolute shrinkage and selection operator (LASSO) Regression was used to feature selection, and four ML algorithms including Random Forest (RF), Extreme Gradient Boost (XGBoost), Support Vector Machine (SVM), and Logistic Regression (LR) were employed to develop the model on the training set. The performance evaluation of the prediction model was carried out on the training set and the testing set, utilizing metrics including AUC (Area under the receiver operating characteristic curve), calibration plot, and decision curve analysis (DCA). In addition, we used the Shapley Additive Explanations (SHAP) value to determine the importance of the selected features and interpret the optimal model.ResultsA total of 1220 AMI patients were included and 244 (20%) patients developed HF during follow-up. Among the four evaluated ML models, the XGBoost model exhibited exceptional accuracy, with an AUC value of 0.922. The SHAP method showed that left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVDs) and lactate dehydrogenase (LDH) were identified as the three most important characteristics to predict HF risk in AMI patients. Individual risk assessment was performed using SHAP plots and waterfall plot analysis.ConclusionsOur research demonstrates the potential of ML methods in the early prediction of HF risk in AMI patients. Furthermore, it enhances the interpretability of the XGBoost model through SHAP analysis to guide clinical decision-making.

Occurrence of sarcopenia in elderly patients with coronary heart disease and its association with short-term prognosis

ObjectiveSarcopenia is a common complication in elderly patients with coronary heart disease (CHD). This study aims to analyse and explore the occurrence of sarcopenia in elderly patients with CHD and its associations with short-term prognosis.MethodsA total of 318 elderly patients with CHD were enrolled between March 2020 and March 2022. Sarcopenia was assessed at admission using grip strength and gait speed; subsequently, clinical data, cardiac function indicators, adverse events and mortality were compared between the two groups to explore the associations of sarcopenia with the short-term prognosis of elderly patients with CHD.ResultsAmong the 318 elderly patients with CHD included in this study, 69 developed sarcopenia, with an incidence rate of 21.70%. The sarcopenia group showed lower cardiac output and left ventricular ejection fraction levels than the non-sarcopenia group, while higher left ventricular end-diastolic diameter, left ventricular end-systolic diameter, interventricular septum thickness and left ventricular posterior wall thickness levels were greater than in the non-sarcopenia group, with p < 0.05. The sarcopenia group had higher rates of unconventional medical visits and major adverse cardiac and cerebral events compared with the non-sarcopenia group, with p < 0.05. The mortality rate in the sarcopenia group was higher than in the non-sarcopenia group, with p < 0.05.ConclusionSarcopenia is significantly associated with the short-term prognosis of elderly coronary heart disease patients, indicating the need for preventive strategies to improve clinical outcomes and extend survival.

Identifying risk factors and constructing a predictive model for heart failure combined with intracardiac thrombus in non-compaction cardiomyopathy patients

This study aims to develop a nomogram prediction model for assessing the cardiogenic composite endpoint, which includes intracardiac thrombosis (ICT) combined with heart failure (HF) in patients with non-compaction cardiomyopathy (NCM) patients. We retrospectively analyzed clinical data from NCM patients (January 2018 to May 2024), who were randomly assigned to training and validation cohorts. Independent predictors were identified using logistic regression, and a nomogram model was developed. The model’s discriminative ability, accuracy, and clinical applicability were subsequently validated. A total of 976 patients were included, of whom 54 had ICT and 191 had HF. Diabetes mellitus (DM), left ventricular end-systolic diameter (LVESD), and ejection fraction (EF) were identified as independent predictors for the composite endpoint. The nomogram demonstrated good performance, with an area under the curve (AUC) of 0.747 (95% CI: 0.707–0.787) in the training group and 0.803 (95% CI: 0.752–0.854) in the validation group. The calibration curve for the training group showed an average absolute error of 0.028, with a Hosmer-Lemeshow test P-value of 0.076. Decision curve analysis and clinical impact curves further indicated that the clinical net benefit was maximized at a threshold probability of 0.05–0.61. This study establishes and validates a nomogram for predicting cardiogenic composite endpoint in NVM patients, demonstrating robust clinical predictive value.

Effects of Metabolic Factors on Left Ventricular Diastolic Function in Patients with Obstructive Sleep Apnea.

The effect of metabolic factors on cardiovascular risk in obstructive sleep apnea (OSA) is unclear. This study aimed to investigate the effect of metabolic factors on the left ventricular diastolic function in patients with OSA. This cross-sectional study included a total of 478 patients with OSA from September 2018 to September 2023. After propensity score matching, wherein 193 patients with OSA with metabolic syndrome (MS) were 1:1 matched to patients with OSA without MS by sex and age, data from 386 patients were ultimately analyzed. Furthermore, all patients were divided into mild, moderate, and severe OSA groups according to their sleep apnea-hypopnea index (AHI). Measurements included nocturnal polysomnography, biochemical testing, and transthoracic echocardiography data. The AHI in the MS group was higher (30.24±21.69 vs 23.19±17.65, p<0.001) and the lowest oxygen saturation at night was lower (77.67±9.23 vs 80.59±9.26, p<0.001) than those in the non-MS group. Additionally, the left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), end-diastolic ventricular septal thickness (IVST), left ventricular end-diastolic posterior wall thickness (LVPWT), left atrial internal diameter (LAD), and E peak to A peak velocity ratio (E/A) in the MS group were higher than those in the non-MS group (P<0.05). The E peak to e' peak velocity ratio (E/e') in the MS group was higher than that in the non-MS group (12.02±3.68 vs 11.13±3.12, P=0.011) and was positively correlated with the diagnosis of MS and metabolic factors (r=0.115, p=0.024; r=0.131, p=0.010, respectively). Patients with five metabolic factors had a significantly higher risk of E/e' elevation than patients in the non-MS group (odds ratio=4.238, p=0.007). MS may be related to OSA severity and left ventricular diastolic dysfunction. An increase in metabolic factors may increase the risk of diastolic dysfunction. Among metabolic factors, blood pressure may be the most important.

Mechanism of electroacupuncture at "Zusanli" (ST36) in improving cardiac function in mice with chronic heart failure

To observe the effect of electroacupuncture (EA) at "Zusanli" (ST36) on improving cardiac function in mice with chronic heart failure (CHF), so as to explore the mechanism of its regulation on the autonomic nervous system. Eighteen C57BL/6J mice were randomly divided into sham-surgery, model, and EA groups, with 6 mice in each group. The model of myocardial ischemia followed by CHF was induced by ligation of the anterior descending branch of the left coronary artery. Two weeks after modeling surgery, EA intervention (0.5 mA, 2 Hz/15 Hz) was performed bilaterally at ST36 in the EA group, 20 min each time, once every other day for 4 weeks. The left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), left ventricular end-systolic diameter (LVESD), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-diastolic volume (LVEDV) were evaluated using echocardiographic imaging. The exercise tolerance was observed in an exhaustive test. Electrocardiograms were recorded using an electrophysiological recording system to analyze heart rate (HR) changes before and after EA, and frequency domain analysis was used to analyze the heart rate variability (HRV), including low-frequency (LF) component, high-frequency (HF) component, and their ratio (LF/HF). Immunofluorescence was used to observe the number of choline acetyltransferase (ChAT)+/c-fos+ co-labeled neurons in the dorsal motor nucleus of the vagus (DMV). In terms of cardiac function, compared with the sham-surgery group, the LVEF and LVFS were decreased (P<0.001) and the LVESD, LVEDD, LVESV, and LVEDV were increased (P<0.001, P<0.01) two weeks after modeling of mice in the model group. After 2 weeks of EA intervention, the LVESD and LVESV in the EA group were significantly smaller than those in the model group (P<0.05). After 4 weeks of intervention, the LVEF and LVFS in the EA group were significantly higher than those in the model group (P<0.05), and the LVESD and LVESV were significantly reduced (P<0.05, P<0.01). Compared with the model group, EA significantly improved the exercise tolerance of CHF mice (P<0.05). Compared with the sham-surgery group, the LF/HF in the model group and EA group were significantly increased (P<0.05) 2 weeks after modeling, indicating autonomic imbalance. After 4 weeks of intervention, the LF/HF in the EA group showed lower trend than that in the model group but the difference was not statistically significant. Additionally, after immediate EA, HR decreased (P<0.05, P<0.01), HF increased (P<0.01), and both LF and LF/HF decreased significantly (P<0.05) of mice in the EA group, indicating that EA corrected the autonomic imbalance in CHF mice. The number of ChAT+/c-fos+ co-labeled neurons in the DMV of the EA group was significantly higher (P<0.001) than that in the model group. EA at ST36 significantly improved cardiac function and exercise tolerance in CHF mice. The underlying mechanism may be related to the activation of vagus efferent nerve and the regulation of autonomic nerve balance.

Clinical and Sociodemographic Profile and Pattern of Echocardiographic Diagnosis of Patients Attending Outpatient Echo Department of NICVD

Background: Cardiovascular diseases (CVDs) represent a significant public health burden globally, including in Bangladesh. Echocardiography is a pivotal diagnostic tool in the assessment of cardiac function, structure, and abnormalities in patients with suspected cardiovascular conditions. Objective: This study aimed to evaluate the clinical and sociodemographic characteristics of patients attending the outpatient echocardiography department at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, and to analyze the pattern of echocardiographic findings. Methods: A cross-sectional study was conducted over six months, including [total number] patients referred for echocardiographic evaluation. Sociodemographic data, including age, gender, and clinical history, were collected. Echocardiographic assessments were performed following standard guidelines, with measurements including aortic root diameter (AO), left atrial size (LA), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and ejection fraction (EF). Descriptive statistics were used to analyze the data, and associations between demographic factors and echocardiographic findings were evaluated. Results: The mean age of the study population was 48.02 ± 14.49 years, with a majority (65.63%) aged between 31-60 years. Males constituted 86.22% of the patients, resulting in a male-to-female ratio of 6.21:1. The mean aortic root diameter was 27.81 ± 4.46 mm, and the mean left atrial diameter was 33.28 ± 4.82 mm. The mean LVEDD and LVESD were 45.28 ± 6.02 mm and 29.74 ± 5.13 mm, respectively. The average ejection fraction was 63%, indicating preserved systolic function in the majority of patients. Notably, 35.32% of patients exhibited regional wall motion abnormalities (RWMA), suggestive of ischemic heart disease. Conclusion: The study highlights that middle-aged and elderly adults, particularly males, constitute the majority of patients undergoing ...

A Systematic Review and Meta-Analysis of the Efficacy and Safety of Sodium-Glucose Cotransporter-2 Inhibitor in Patients Using Left Ventricular Assist Devices.

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) have been shown to reduce risks of clinical events in patients with heart failure (HF). However, data on the use of SGLT2-i in patients with left ventricular assist devices (LVADs) are scarce. We thought to assess the efficacy and safety of SGLT2-i in patients with LVADs. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Embase, and Cochrane from inception to November 2024. We used all relevant words for "SGLT2-i" and "LVAD" to search in databases, and we included studies and published abstracts in peer-reviewed journals of studies that assessed SGLT2-i in patients with LVAD. Results: Four studies and seven abstracts totaling 228 patients using SGLT2-i were included. Empagliflozin, Dapagliflozin, and Canagliflozin were the used SGLT2-i across the included studies. Pooled analysis showed that SGLT2-i significantly improved ejection fraction (EF) (Mean= 4.2, 95% CI [1.22, 7.19]) and hemoglobin A1c (HbA1c) (Mean = -0.44, 95% CI [-0.79, -0.09]) from baseline. However, no significant changes in B-type natriuretic peptide (BNP), or glomerular filtration rate (GFR) were noticed. Other outcomes of interest not included in the meta-analysis did not show significant changes, such as cardiac index (CI), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), mean arterial pressure (MAP), or mean pulmonary artery pressure (MPAP). The pooled percentage of people with driveline infection was 9%, 95% CI (3, 19). Conclusions: SGLT2-i effectively improves EF and HbA1c in patients using LVAD. Further adequately powered randomized studies are warranted to ascertain its clinical efficacy and safety in that unique population.

Regulation of Clusterin in the Heart and Plasma of Mice After Transverse Aortic Constriction.

Chronic pressure overload induces adverse cardiac remodelling characterised by left ventricular (LV) hypertrophy and fibrosis, leading to heart failure (HF). Identification of new biomarkers for adverse cardiac remodelling enables us to better understand this process and, consequently, to prevent HF. We recently identified clusterin (CLU) as a biomarker of cardiac remodelling and HF after myocardial infarction. The aim of this study was to investigate whether CLU expression is regulated in the heart and could be used as an indicator of adverse cardiac remodelling in response to pressure overload. We quantified CLU in the LV of mice subjected to transverse aortic constriction (TAC) and observed increased CLU mRNA levels and its mature protein form (m-CLU) compared to the sham. Interestingly, CLU mRNA levels were positively correlated with pro-hypertrophic (ANP, BNP, B-MHC), pro- and anti-fibrotic (TGFb, ColI and CILP) genes. In addition, m-CLU was positively correlated with LV hypertrophy, LV end diastolic and systolic diameters, and negatively correlated with LV ejection fraction. Finally, we observed that m-CLU levels only increased in TAC mice with severe cardiac remodelling and dysfunction without any significant difference in plasma CLU levels. This is the first study to demonstrate that cardiac expression of CLU is induced in the LV of TAC mice during adverse cardiac remodelling. However, plasma CLU levels could not be used as biomarkers of TAC-induced cardiac remodelling and dysfunction.

Efficacy of comprehensive nursing intervention on nursing outcomes and prognostic quality of life in elderly patients with chronic heart failure.

To explore the effect of comprehensive nursing intervention on nursing outcomes, self-efficacy, and quality of life in elderly patients with chronic heart failure (CHF). A retrospective analysis was conducted on the clinical data from 120 elderly patients with CHF admitted to Baoding No.1 Central Hospital from June 2019 to June 2022. Patients were divided into a control group and an observation group based on different nursing methods (n= 60 each group). The clinical data of the two groups were analyzed, comparing changes in heart function, psychological status, and quality of life before and after intervention. After intervention, both groups exhibited decreased scores on the Hamilton Anxiety Scale and the Hamilton Depression Rating Scale compared to the pre-intervention levels, with the observation group showing a significantly lower degree of decline compared to the control group during the same period (P<0.05, respectively). The overall compliance rate of medical adherence in the observation group was 85.00%, significantly higher than the 70.00% in the control group (P<0.05). After intervention, both groups exhibited improvement in left ventricular ejection fraction, left ventricular end-systolic diameter, and left ventricular end-diastolic diameter compared to the pre-intervention levels, with the observation group showing a more significant improvement than the control group (P < 0.05, respectively). For elderly patients with CHF, comprehensive nursing intervention may reduce negative emotions, improve sleep quality, self-care ability, and self-efficacy, and enhance patient compliance, quality of life, and heart function.

Long-Term Outcomes After Aortic Valve Replacement for Aortic Valve Regurgitation - Importance of Left Ventricular End-Systolic Diameter.

We determined the left ventricular end-systolic diameter (LVDs) cut-off value for risk of major adverse cardiac and cerebrovascular events (MACCE) in Japanese asymptomatic or mildly symptomatic patients undergoing aortic valve replacement (AVR) for aortic valve regurgitation (AR), and investigated the effect of left ventricular dilation on long-term postoperative outcomes.Methods and Results: The 168 patients who underwent surgical AVR for AR at Shiga University of Medical Science between January 2002 and December 2022 were included in this study. Receiver operating characteristic curve analysis showed that the cut-off value of preoperative LVDs for the incidence of MACCE was 42.8 mm (area under the curve 0.616). Postoperative outcomes were compared between patients with preoperative LVDs >42.8 mm (n=77) and those with preoperative LVDs ≤42.8 mm (n=91) using propensity score matching. The 10-year estimated rates of freedom from MACCE in those with LVDs >42.8 and ≤42.8 mm were 59.9% and 85.7%, respectively; the curves differed significantly (P=0.004). In multivariable Cox proportional hazard regression analyses, preoperative LVDs >42.8 mm was an independent predictor of MACCE (hazard ratio 2.485; 95% confidence interval 1.239-4.984; P=0.010). Preoperative LVDs >42.8 mm is associated with an increased risk of MACCE in Japanese patients undergoing AVR for AR.

Prognostic Value of Pre-Operative Transthoracic Echocardiography in Patients with Primary Mitral Regurgitation.

Mitral regurgitation is the second most prevalent valvular disease, with primary mitral regurgitation (PMR) accounting for 61%-67% of cases. Chronic PMR can result in progressive left ventricular remodeling and dysfunction, ultimately leading to heart failure or other adverse cardiac events. This, in turn, necessitates frequent referrals, hospitalizations, and cardiac surgeries. The optimal timing for PMR surgery has been a subject of ongoing debate and remains a controversial issue. Presently, it is recommended that patients with chronic PMR undergo earlier mitral valve surgery to enhance post-operative outcomes. For example, the recommendation of European and American guidelines about left ventricular end-systolic diameter for surgery has been altered from 45 mm to 40 mm. Echocardiographic parameters are regarded as noteworthy indicators for intervention in patients with PMR. Extensive research has been undertaken in the field of echocardiography to identify more effective indicators that can propose the optimal timing for surgery, encompassing both conventional and novel echocardiography parameters. However, some parameters are not known to clinicians and the cut-off values for these parameters have shown some variations. Furthermore, a comprehensive review of this topic is currently missing. Consequently, this review aims to provide a thorough summary and elucidation of the prognostic significance of various echocardiographic measurements and their corresponding cut-off values, to help the clinical decision-making and further improve the outcomes of patients with PMR.

Catheter ablation for atrial tachycardia in pediatric patients: a single-center experience.

Atrial tachycardia is an uncommon supraventricular tachycardia in children. It is often drug-resistant and likely to occur concomitantly with tachycardia-induced cardiomyopathy, making radiofrequency catheter ablation the preferred treatment. The aim of this study was to assess the feasibility, safety, and effectiveness of radiofrequency catheter ablation for the treatment of different types of atrial tachycardia in children, particularly in those with drug-resistant and tachycardia-induced cardiomyopathy. A total of 28 children with atrial tachycardia (including focal atrial tachycardia and atrial flutter) who underwent atrial radiofrequency ablation at the Children's Hospital Affiliated to Chongqing Medical University from May 2018 to December 2023 were included. The baseline characteristics, preoperative medication, surgical information, and postoperative follow-up data of these children were analyzed statistically. The mean age patients at ablation was 10.24 ± 3.40 years. A total of 78.6% of the patients (22/28) who received preoperative pharmacological treatment had intermittent or persistent atrial tachycardia. Of the 28 children who underwent radiofrequency ablation, 24 (85.7%) were diagnosed with focal atrial tachycardia, three (10.7%) with atrial flutter, and one (3.6%) with both. No postoperative complications occurred in any patient. The immediate ablation success rate in the 25 patients with focal atrial tachycardia was 96.0% (24/25). After 26.89 ± 18.17 months of follow-up, only three patients had recurrence. The ablation difficulty of focal atrial tachycardia originating in the appendage was higher than that originating in the non-atrial appendage (44.4% vs. 6.3%, p = 0.01). The success rate of ablation for atrial flutter was 100%, except in one child with underlying cardiomyopathy who experienced recurrence. Final success was achieved in 25 of the 28 patients (89.2%) at the end of the follow-up period. In addition, eight children (28.6%) in this study were diagnosed with tachycardia-induced cardiomyopathy, with significantly increased ejection fraction and shortening rate after radiofrequency ablation (p < 0.01), whereas the left ventricular end-systolic diameter were not significantly reduced during the follow-up period (p > 0.05). Radiofrequency catheter ablation is safe and effective for the treatment of atrial tachycardia in children in the short- and long-term.It can be used as the first treatment option for children with medically refractory atrial tachycardia and tachycardia-induced cardiomyopathy.

Efficacy of Information-Motivation-Behavioral Skills ModelBased nursing care intervention in management of patients with Heart Failure: A retrospective cohort study.

Self-care practices are integral part of heart failure (HF) management. Information-Motivation-Behavioral skills (IMB) model has shown promise in fostering better self-care behaviors, but its efficacy in management of HF patients remains underexplored. This retrospective study investigated the value of IMB model-based nursing intervention for improving self-care, hemodynamic indicators, and quality of life (QOL) of HF patients. This retrospective study involved 308 HF patients treated at a tertiary care hospital from January 2021 to January 2023. Patients were grouped based on the received nursing care. The intervention group contained patients who received IMB model-based nursing intervention (n=151), and a control group included patients who got routine nursing care (n=157). IMB intervention comprised information delivery, motivation enhancement, and behavioral skills training. Key outcomes included self-care behavior measured by the Self-Care of HF Index (SCHFI), quality of life, assessed by the Minnesota Living with HF Questionnaire (MLHFQ), and hemodynamic parameters including Left Ventricular End-Systolic Diameter (LVESD), Left Ventricular End-Diastolic Diameter (LVEDD), and Left Ventricular Ejection Fraction (LVEF). IMB model-based nursing intervention was significantly more effective in improving the condition of HF patients than the routine nursing care, including better SCHFI and MLHFQ scores and improved hemodynamic parameters (LVESD, LVEDD, and LVEF) (P<0.05). Variation in different analysis further confirmed the efficacy of the IMB model-based nursing intervention. IMB model-based nursing intervention significantly improved self-care behavior, QOL, and hemodynamic parameters in HF patients. This mode of nursing care has a potential as a valuable strategy for enhancing HF management.

Off-Pump Revascularization in Moderate Ischemic Mitral Regurgitation.

Ischemic mitral regurgitation (IMR) is associated with high mortality and poor outcomes. The surgical management of moderate IMR is still an object of debate. Patients with moderate IMR who underwent isolated off-pump coronary bypass grafting (OPCAB) with facile stabilization between January 2015 and February 2022 were analyzed. The primary endpoint was the remaining IMR and echocardiographic findings while the secondary outcomes were defined as mortality, major adverse events, and postoperative functional status. Of 541 patients who underwent isolated OPCAB in this period, there were 62 patients with concomitant moderate IMR. The mean follow-up period was 19.4 ± 21.6 months. The median number of the coronary anastomosis was 4. In 58.06% (n = 36), the regurgitation regressed. Left atrial (LA) diameter significantly decreased postoperatively (p = 0.040). Increased LA diameter was associated with increased major adverse events (p = 0.010). Rehospitalization rates were higher in low ejection fraction (EF). The postoperative poor functional status (New York Heart Association [NYHA] III-IV) was correlated with an increased postoperative left ventricular end-systolic diameter (LVESD; 41.75 ± 6.13 vs. 34.79 ± 6.8 mm, p = 0.05). Mortality (4.8%, n = 3) was associated with older age and increased preoperative systolic pulmonary artery pressure (PAP; p = 0.050 and p = 0.046, respectively). LA diameter, LVESD, mean systolic PAP, left ventricular ejection fraction (LVEF), and age are important predictors for outcomes in IMR. Remaining IMR per se is not directly correlated with increased mortality and major adverse cardiac and cerebrovascular events. The facile stabilization technique we used appears to be advantageous due to the feasibility of full revascularization of all intended vessels, particularly of the inferoposterior wall by providing excellent vision without compression of the heart.

Construction and validation of a nomogram prediction model for the risk of new-onset atrial fibrillation following percutaneous coronary intervention in acute myocardial infarction patients

ObjectiveThe objective of this study was to investigate risk factors for new-onset atrial fibrillation (NOAF) post-percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), aiming to develop a predictive nomogram for NOAF risk.MethodsA retrospective cohort study involving 397 AMI patients who underwent PCI at a tertiary hospital in Anhui, China, from January 2021 to July 2022 was performed. Patients were divided into NOAF (n = 63) and non-NOAF (n = 334) groups based on post-PCI outcomes. Clinical data were extracted from the hospital information system (HIS) and analyzed using univariate and multivariate logistic regression to identify independent risk factors. A nomogram was generated utilizing R software (version 3.6.1), with its performance evaluated through receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and Bootstrap resampling.ResultsIndependent risk factors for NOAF included age, left atrial diameter (LAD), Gensini score, N-terminal pro-B-type natriuretic peptide (NT-proBNP), alanine transaminase (ALT), low-density lipoprotein cholesterol (LDL-C), left ventricular end-systolic diameter (LVESD), and ventricular rate (P < 0.05). The nomogram’s ROC curve demonstrated an area under the curve (AUC) of 0.925 (95% CI: 0.887–0.963), supported by a Bootstrap-verified AUC of 0.924 (95% CI: 0.883–0.954), reflecting strong discriminative capability. The calibration curve indicated a mean absolute error (MAE) of 0.031 and 0.017 prior to and following Bootstrap verification, respectively, signifying robust calibration. The DCA curve illustrated that the nomogram offered optimal clinical net benefit for patients with a threshold probability of NOAF ranging from 0.01 to 0.99.ConclusionThe nomogram developed from independent risk factors for NOAF exhibits significant predictive accuracy and clinical relevance for evaluating the risk of NOAF in AMI patients following PCI, thereby enabling the identification of high-risk individuals for targeted interventions.

An explainable deep learning model to predict partial anomalous pulmonary venous connection for patients with atrial septal defect

BackgroundPatients with partial anomalous pulmonary venous connection (PAPVC) usually present asymptomatic and accompanied by intricate anatomical types, which results in missed diagnosis from atrial septal defect (ASD). The present study aimed to explore the predictive variables of PAPVC from patients with ASD and constructed an explainable prediction model based on deep learning.MethodsThe retrospective study included 834 inpatients with ASD in Women and Children's Hospital, Qingdao University from January 2018 to January 2023. They were separated into two groups based on the presence of PAPVC. Propensity score matching and SMOTE were used to balance the baseline data between groups. The differential variables between the two groups were determined by univariate logistic regression. The patients were randomly divided into the training set and the validation set in a ratio of 8:2. Support vector machines (SVM), Random forest, Decision tree, XGBoost, and LightGBM were used to build models by differential variables. The classification performance of models was compared. Split, gain and SHAP were used to measure the importance of differential variables and improve the interpretability of the model. Moreover, a portion of the patients was included in the validation set to test the performance of the selected models.ResultsThree hundred twenty-eight patients with ASD and patients with 82 PAPVC were included in the training set and the validation set, respectively. The selection of 10 differential variables was based on univariate logistic regression, including right atrial diameter (longitudinal axis and transverse axis), right ventricular diameter, left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, P-wave voltage, P-wave interval PR interval, and QRS-wave voltage. In the classification model established based on differential variables, the LightGBM model achieved the highest performance on the validation set (AUC = 0.93). Based on variables importance analysis, the LightGBM-Clinic model was retrained by P-wave voltage, P-wave interval, PR interval, QRS wave interval, and right ventricular diameter, and performed excellently (AUC = 0.90). The AUC of the LightGBM-Clinic model was 0.87 in the test set.ConclusionIn this study, the LightGBM model performs excellently in determining whether patients with ASD are accompanied by PAPVC. ECG parameters such as P-wave voltage were important to predictive value and enhance the explainability of the model.

Early Right Heart Remodeling in Patients With Mitral Valve Prolapse.

Mitral valve prolapse (MVP) has been associated with left heart remodeling. This study explored cardiac remodeling in patients with MVP without significant regurgitation, focusing on the right heart. This single-center study enrolled consecutive patients referred to trans-thoracic-echocardiography (TTE) with MVP, excluding those with significant regurgitation or known cardiovascular or pulmonary diseases. A group of healthy controls was included. Forty-nine patients with MVP and 54 controls were finally selected (mean age of 62, 52-71; 52% males), and echocardiographic parameters were compared among groups. Twenty-nine (41%) patients with MVP showed tricuspid valve prolapse (TVP). Patients with MVP, irrespective of TVP, showed greater tricuspid annulus (systolic annulus: 31±6 vs. 32±5 vs. 27±3mm for MVP+/TVP-, MVP+/TVP+, and controls, respectively; all p < 0.01) and greater minimum right atrial volume indexed (13, 12-15mL/m2vs. 15, 12-20mL/m2 vs. 11, 10-14mL/m2; all p < 0.05). Right ventricular dimensions and systolic indexes did not differ among groups, except TAPSE, which was significantly greater in MVP+/TVP+ patients compared to controls (25±4vs. 22±3mm, p = 0.004). A significant correlation (ρ = 0.43; p < 0.001) and an independent association at multivariate analysis (ß = 0.28; 95% CI 0.09-0.47; p = 0.004) were observed between end-systolic tricuspid diameter and TAPSE. In patients with MVP with less-than-moderate mitral or tricuspid regurgitation, dilation of the right atrium and tricuspid annulus was found. The latter finding was associated with increased values of TAPSE, which should then be used with caution, while other indexes may be preferred when assessing the systolic function of these patients.

Experimental study on the treatment of diabetic cardiomyopathy in rats by using ultrasound-targeted microbubble destruction combined with coenzyme Q10 loaded long-circulating nanoliposomes

Objective: To investigate the therapeutic effects and mechanisms of Ultrasound-targeted microbubble destruction (UTMD) technology combined with CoQ10 loaded PEGylated nanoliposomes (CoQ10-PEG-lips) on diabetic cardiomyopathy (DCM) in rats. Methods: CoQ10-PEG-lips were prepared using the thin-film dispersion method combined with ultrasonic hydration, followed by quality assessment. Sixty healthy and clean male SD rats were selected, and 50 were randomly chosen using a random number table to establish a type 1 diabetes mellitus (DM) model via a single intraperitoneal injection of streptozotocin. The remaining 10 rats were assigned as the normal control group. A total of 47 rats successfully developed the DM model, and 40 were selected using the random number table method. Based on different intervention methods, these rats were then randomly divided into DM model group, CoQ10 solution group, CoQ10-PEG-Lips group, and CoQ10-PEG-Lips+UTMD group (n=10 per group). Normal control group and DM model group rats were injected with 1 ml of normal saline through caudal vein. CoQ10 solution group and CoQ10-PEG-Lips group were injected with 1 ml of CoQ10 solution or CoQ10-PEG-Lips solution containing 10 mg/kg of CoQ10 through caudal vein, respectively. Rats in the CoQ10-PEG-Lips+UTMD group were injected with 1 ml of CoQ10-PEG-Lips solution containing 10 mg/kg of CoQ10+100 mg of freeze-dried ultrasound microbubble powder through caudal vein and were given UTMD treatment at the same time, with the intervention given twice a week. After 12 weeks of intervention, cardiac function indexes [left ventricular end-systolic diameter (LVEDs), left ventricular end-diastolic diameter (LVEDd), and left ventricular ejection fraction (LVEF)]of each group were measured by ultrasonic cardiac function detection in vivo. Simultaneously, ex-vivo histopathological examination was conducted to assess myocardial cell morphology, cross-sectional area, collagen volume fraction (CVF), and apoptosis index (AI) in each group. Additionally, molecular biology techniques were employed to measure oxidative stress-related indicators and the expression of apoptosis-related pathway proteins. Results: The prepared CoQ10-PEG-lips had a well-rounded morphology, good dispersibility, and a high encapsulation efficiency of 87.45%±3.23%. After 12 weeks of intervention, the myocardial cell morphology in the CoQ10-PEG-Lips+UTMD group was intact, with orderly arrangement, closely resembling that of the normal control group. There were no statistically significant differences between the two groups in terms of LVEDs [(1.53±0.07) mm vs (1.42±0.04) mm], LVEDd [(2.93±0.15) mm vs (2.81±0.05) mm], or LVEF (80.76%±3.42% vs 84.60%±2.10%) (all P>0.05). Similarly, there were no significant differences between the two groups in myocardial cell cross-sectional area, CVF, or AI (all P>0.05). The CoQ10-PEG-Lips+UTMD group showed statistically significant differences in the above-mentioned indicators compared to the DM group, CoQ10 solution group, and CoQ10-PEG-Lips group (all P<0.05). In the CoQ10-PEG-Lips+UTMD group, the levels of myocardial superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and the expression of the anti-apoptotic protein B-cell lymphoma-2 (Bcl-2) were significantly higher compared to the DM model group, CoQ10 solution group, and CoQ10-PEG-Lips group (all P<0.05), while malondialdehyde levels and the expression of Bcl-2-associated X protein (Bax) and caspase-3 were lower (all P<0.05). Conclusions: Using PEG-lips to encapsulate the poorly soluble drug CoQ10 in combination with UTMD technology enables targeted delivery of the drug to the myocardium, which can help reduce myocardial cell damage, fibrosis, and apoptosis caused by diabetes mellitus (DM) by inhibiting oxidative stress damage and the Bcl-2/Bax/caspase-3 apoptosis signaling pathway, ultimately improving cardiac function in DCM rats.

Echocardiographic and clinical features of patients developing prosthesis-patient mismatch after TAVI: insights from an international multicenter registry

Abstract Background The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) is controversial. Purpose Our study aims to evaluate the impact of PPM on mortality and clinical-echocardiographic progression of cardiac damage in a "real world" cohort of patients at intermediate and low surgical risk and to characterize its main predictors. Methods 963 patients who underwent TAVI procedure between 2017 and 2021, from an international multicenter observational registry, were included in this analysis. Multiparametric echocardiographic data were analyzed at 1-year follow-up (FU). Clinical and echocardiographic features were stratified by presence of PPM and PPM severity, as per the most current international recommendations (VARC-3 criteria). Results 18% of patients developed post-TAVI PPM, (7.7% of the whole cohort severe). At baseline, 50.3% of patients with PPM were male (vs 46.2% in the cohort without PPM, p=0.33), aged 82y (interquartile range (IQR) 79-85y) vs 82y (IQR 78-86y; p=0.46), and 55.6% had Balloon-Expandable valves implanted (vs 46.8% of patients without PPM, p=0.04); they had smaller left ventricular outflow tract (LVOT) diameter (20mm, IQR 19-21 vs 20mm, IQR 20-22, p=0.02), reduced Stroke Volume index (SVi) (34.2 vs 38 ml/m2, p&amp;lt;0.01) and transaortic flow rate (190.6 vs 211 ml/s, p&amp;lt;0.01). At pre-discharge FU patients with PPM had more paravalvular aortic regurgitation (AR) (moderate/severe AR 15.8% vs 9.2%, p&amp;lt;0.01). At a median FU of 1.46 years (IQR 1-4), there was no evidence of a significant impact of PPM on overall mortality (15.3% vs 13.1%, p=0.46) nor on rehospitalization rate for heart failure (4.3% vs 8.0%, p=0.10). At 1-year FU, maladaptive alterations of left ventricular parameters were found in patients with PPM, with a significant increase in endsystolic diameter (ESD) (33 vs 28mm, p=0.03) and a statistically non-significant increase in LV mass index (121 vs 106g/m2, p=0.07). Interestingly, trajectory parameters of patients with PPM from baseline to 1-year FU showed a reduced cardiac remodeling compared to patients without PPM, including no LVEF improvement (p=0.88), absent reduction of LV end-diastolic volume (p=0.70), indexed LV mass (p=0.31), ESD (p=0.48) and pulmonary artery systolic pressure (p=0.82), and an increase of basal RV diameter (p&amp;lt;0.001). Patients with moderate/severe PPM had worse NYHA functional class at 1 year (NYHA III-IV 13% vs 7.8%, p=0.03). Independent predictor of PPM at multivariable logistic regression was male gender (OR=1.93, p=0.04); while SVi (OR=0.86, p&amp;lt;0.001), prosthetic size &amp;gt;23mm (OR=0.62, p=0.03) and LVOT diameter (OR=0.79, p=0.02) had protective effect. Conclusions There was no evidence of a short- or medium-term impact of PPM on mortality. However, clinical-echocardiographic evaluations demonstrated a PPM-related pattern of early ventricular maladaptive alterations associated with a significant deterioration in NYHA class at 1 year.

Echocardiographic associates of impaired sleep quality in patients with anxiety and depression

Abstract Objective Sleep health, mental health and cardiovascular health are multidimensional constructs that are strongly associated with each other. Anxiety and depression are the most common psychiatric diseases in the community and frequently comorbid in routine clinical practice. This study sought to investigate whether there is an association between sleep quality and echocardiographic parameters in patients with anxiety and/or depression. Methods The clinical and instrumental find­ings of consecutive patients diagnosed with either of anxiety disorders and/or depressive disorders and underwent cardiac examination in our tertiary center on the same day were retrospectively reviewed. The diagnosis was made by a psychiatrist according to the criteria listed in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders. Afterwards, Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) were applied to patients to assess symptom severity and sleep quality, respectively. Subsequent to psychiatric examination, the patients underwent echocardiographic examination that includes two-dimensional conventional echocardiography, tissue doppler imaging (TDI) echocardiography, atrial conduction times, and left atrium (LA) volumes and functions. Results The final study population consisted of 167 patients and divided into two groups according to their PSQI score: PSQI&amp;lt;5 (normal sleep quality) (n=32) and PSQI≥5 (impaired sleep quality) (n=135). Aortic diameter, left ventricular (LV) end-systolic diameter, LV end-diastolic and -systolic volume, LV stroke volume and LV stroke volume index, LV outflow tract velocity–time integral (LVOT-VTI), and LA conduit volume calculations were significantly lower in patients with impaired sleep quality compared to patients with normal sleep quality. The other echocardiographic parameters including LV systolic functions, doppler and TDI echocardiography indices, atrial conduction times, atrial mechanical functions including LA function index (LAFI) were similar among groups. Correlation analysis yielded a negative, weak but statistically significant correlation between LAFI and PSQI score (r=-0.17, p=.030) (Figure 1A). Left intra-AEMD positively and significantly correlated with PSQI score at a weak level (r=0.16, p=.043) (Figure 1B). Aortic diameter, LV stroke volume index, LVOT-VTI and conduit volume were determined as echocardiographic parameters significantly associated with impaired sleep quality in univariate analysis. Among these parameters, only conduit volume remained as significant and independent associate of impaired sleep quality in multivariate logistic regression analysis (Odds ratio:0.91, 95% Confidence interval:0.85-0.98, p=.018) (Table 1). Conclusion There is an independent association between LA conduit volume and impaired sleep quality in patients suffering from anxiety and/or depressive disorders.Figure 1Table 1