Evaluation Of Cardiac Function Research Articles

Prognostic value of global longitudinal strain in patients with preserved left ventricular systolic function: A cardiac magnetic resonance real-world study

BackgroundMyocardial strain is a more sensitive parameter for cardiac function evaluation than left ventricular ejection fraction (LVEF). This study aimed to assess the predictive value of left ventricular global longitudinal strain (LV-GLS) by feature tracking-cardiac magnetic resonance (FT-CMR) imaging in patients with known or suspected coronary artery disease (CAD) with preserved left ventricular systolic function. MethodsThis retrospective cohort analysis enrolled patients with known or suspected CAD who underwent CMR imaging during September 2017 to December 2019. LV-GLS was analyzed via feature-tracking analysis. Patients with LVEF <50% were excluded. The composite outcome comprised all-cause death, non-fatal myocardial infarction, heart failure. ResultsThere was a total of 2,613 patients. mean follow-up duration was 39.7±13.9 months. During follow-up, 194 patients (7.4%) experienced a composite outcome. The best cut off of LV-GLS in the prediction of composite outcome from Receiver-Operating-Characteristics was -14.4%. Patients were classified into 2 groups according to the LV-GLS; 1,489 (57.0%) had LV GLS <-14.4% and 1,124 (43.0%) had LV-GLS ≥-14.4%. Patients with LV-GLS ≥ -14.4% had a significantly higher rate of composite outcome than LV-GLS < -14.4% patients (3.59 vs. 1.39 per 100 person-years, respectively; p<0.001). Multivariable analysis showed that patients with LV-GLS ≥ -14.4% had a significantly higher risk of experiencing a composite outcome event compared to GLS < -14.4% patients (adjusted hazard ratio: 1.83, 95% confidence interval: 1.28-2.61; p=0.001). ConclusionLV-GLS by FT-CMR was shown to be useful for predicting the prognosis of patients with known or suspected CAD with preserved left ventricular systolic function. LV-GLS -14.4% was the identified cut-off for prognostic determination.

Transesophageal echocardiography during surgery of the thoracic aorta in adults

Thoracic aortic surgery poses significant challenges due to the complex anatomy and potential for life-threatening complications. Transesophageal echocardiography (TEE) has emerged as a crucial imaging tool in the management of patients undergoing these operations. TEE offers real-time, high-resolution imaging of the heart and aorta, enabling accurate assessment of aortic pathology, evaluation of cardiac function, and monitoring of intraoperative hemodynamics. Its semi-invasive nature, immediate availability, and ability to provide dynamic information make TEE an indispensable adjunct during these intricate procedures. One of the primary indications for TEE during thoracic aortic surgery is the assessment of aortic pathology, including aneurysms, dissections, and aortic valve diseases. TEE allows precise visualization of the extent, location, and severity of aortic lesions, facilitating decision-making regarding repair strategies, graft sizing, and intraoperative guidance. Furthermore, TEE aids in identifying associated cardiac abnormalities such as valvular or ventricular dysfunction, which may impact surgical planning and outcomes. This review aims to summarize the current evidence supporting the use of TEE during thoracic aortic surgical interventions and highlight its invaluable contributions to perioperative patient care.

Effect of Data Augmentation on Deep-Learning-Based Segmentation of Long-Axis Cine-MRI

Automated Cardiac Magnetic Resonance segmentation serves as a crucial tool for the evaluation of cardiac function, facilitating faster clinical assessments that prove advantageous for both practitioners and patients alike. Recent studies have predominantly concentrated on delineating structures on short-axis orientation, placing less emphasis on long-axis representations due to the intricate nature of structures in the latter. Taking these consideration into account, we present a robust hierarchy-based augmentation strategy coupled with the compact and fast Efficient-Net (ENet) architecture for the automated segmentation of two-chamber and four-chamber Cine-MRI images. We observed an average Dice improvement of 0.99% on the two-chamber images and of 2.15% on the four-chamber images, and an average Hausdorff distance improvement of 21.3% on the two-chamber images and of 29.6% on the four-chamber images. The practical viability of our approach was validated by computing clinical metrics such as the Left Ventricular Ejection Fraction (LVEF) and left ventricular volume (LVC). We observed acceptable biases, with a +2.81% deviation on the LVEF for the two-chamber images and a +0.11% deviation for the four-chamber images.

Navigating the Complexity: A Comprehensive Review of Managing Pregnancy in Complete Heart Block Cases.

This review explores the comprehensive management of pregnancy in cases of complete heart block, a cardiac condition characterized by the dissociation between atrial and ventricular conduction. The review begins with a thorough examination of preconception counseling, emphasizing the assessment of maternal health, the evaluation of cardiac function, and the identification of potential risks. Subsequently, the medical management section delves into using beta-blockers, pacemakers, and antiarrhythmic drugs to monitor cardiac function during pregnancy and adjust medication regimens. Obstetric considerations highlight the importance of antenatal care, fetal monitoring, and thoughtful delivery planning, including the choice between vaginal delivery and cesarean section. The section on complications underscores the risks of arrhythmias, heart failure, premature birth, and neonatal cardiac issues. Looking ahead, the future directions and research section explores ongoing studies in genetics, pharmacology, and technological innovations, envisioning potential advancements in pacing technology and personalized medicine approaches. The conclusion synthesizes key findings, offering recommendations for clinical practice and reflecting on the challenges and opportunities inherent in managing pregnancy in complete heart block cases. The multidisciplinary approach emerges as paramount, with collaborative efforts paving the way for improved patient outcomes and advancements in the field.

Effect of apigenin on dynamin-related protein 1 in type 1 diabetic rats with cardiovascular complications

Background and ObjectiveCardiovascular complications cause increased mortality rates among diabetics. The molecular mechanisms of aberrant mitochondrial dynamics in diabetes mellitus (DM) are not fully understood. Dynamin-related protein 1 (Drp1) is thought to be a major regulator of mitochondrial fission. There is lack of studies that examined the relationship between apigenin and Drp1 expression in DM. Thus, the current study aimed to explore the expression of Drp1 in diabetic rats with cardiovascular complications, as well as to appraise the role of apigenin in modulating this expression. MethodsTwenty-eight adult male albino Wister rats were randomly and equally allocated into four groups: naive, streptozotocin-induced type 1 diabetic control and two apigenin-injected diabetic groups (early and late). Body weight, heart weight, blood pressure and ECG were recorded. Evaluation of blood glucose level, lipid profile and cardiac functions were measured. Determination of Drp1 mRNA expression, and histological examination of cardiac tissues from the four groups were performed. ResultsDiabetic control rats developed decrease of body weight, increase of blood pressure, deterioration of the normal ECG pattern and upregulation of Drp1 mRNA expression in cardiac tissues. There was a significant correlation between the relative expression of Drp1 and all examined parameters. Apigenin-injection improved fasting blood glucose, lipid profile and cardiac function indicators (i.e., ECG parameters, CK-MB and troponin) as well as the cardiac histological structure. The decrease of Drp1 expression was more evident with early than with late apigenin-injection, however, without statistical significance. ConclusionsIncreased level of Drp1 expression in diabetic rats may be involved in the pathogenesis of diabetic cardiovascular complications. The changes that occurred in response to apigenin injection highlight its potential ameliorative effect on the diabetic cardiovascular complications and pave the route for further investigations.

Effect of experimental periodontitis on cardiac functions: a comprehensive study using echocardiography, hemodynamic analysis, and histopathological evaluation in a rat model.

Periodontitis is a prevalent and severe dental condition characterized by the gradual degradation of the bone surrounding the teeth. Over the past two decades, numerous epidemiological investigations have suggested a potential link between periodontitis and cardiovascular disease. However, the complex mechanistic relationship between oral health issues and cardiovascular disorders remains unclear. This study aimed to explore comprehensively the cardiac function through various methods, including conventional echocardiography, intraventricular pressure gradient (IVPG) analysis, speckle tracking echocardiography (STE), and hemodynamics analysis. Ligature-induced periodontitis was established in a group of rats while the second group served as sham. The successful establishment of the periodontitis model was confirmed through staining and radiographic examination of the affected mandibles. X-ray films and methylene blue staining revealed alveolar bone resorption in the affected first molar in the model rats, confirming the successful induction of periodontitis. The rats with periodontitis displayed a decrease in ejection fraction compared to the sham group, accompanied by a decrease in mid-to-apical IVPG and mid IVPG. Lower values of strain rate were recorded in the apical segment of the septum, the middle segment of the septum, and the basal segment of the lateral free wall in the periodontitis group, which was associated with histopathological examination showing some degree of myocardial tissue damage. Conversely, rats with periodontitis showed an increase in heart rate, end-systolic volume, and arterial elastance when compared to the sham rats. However, they also exhibited a decrease in stroke work, stroke volume, cardiac output, and end-systolic pressure. This study suggests that experimental periodontitis may lead to cardiac dysfunction especially compromised systolic function and myocardial relaxation, potentially indicating an increased risk of cardiovascular events in clinical periodontitis cases. The comprehensive assessment of cardiac function, hemodynamics, and histopathological evaluation underscores the profound impact of periodontitis on heart functions within this specific experimental model.

Icariin improves cardiac function and remodeling via the TGF-β1/Smad signaling pathway in rats following myocardial infarction

BackgroundPostinfarction cardiac remodeling presents a compensatory mechanism aimed at mitigating congestive heart failure. It is distinguished by progressive dilatation and hypertrophy of the ventricular chambers, fibrotic alterations, and prolonged apoptosis of cardiomyocytes. The primary objective of this study was to assess the effects of icariin on myocardial fibrosis and ventricular remodeling in rats subjected to myocardial infarction (MI).MethodsMale Sprague‒Dawley (SD) rats were subjected to randomization and subsequently divided into distinct groups: the control group, the sham group (undergoing sham operation), the MI group (experiencing ligation of the left anterior descending artery), and the icariin group. Within the icariin group, rats were further categorized into three different dose groups based on the administered icariin dosage: the MI30 group (30 mg/kg/day), the MI60 group (60 mg/kg/day), and the MI120 group (120 mg/kg/day). Cardiac function evaluation was carried out using echocardiography. Histological examinations, including hematoxylin and eosin (HE) staining, Masson staining, and immunohistochemistry studies, were conducted 90 days after the occurrence of MI. Additionally, Western blotting was employed to assess TGF‐β1, p-Smad2, and p-Smad3 levels.ResultsThe administration of icariin revealed a noteworthy enhancement in cardiac function among rats afflicted with left anterior descending coronary artery (LAD) ligation. In comparison to the icariin groups, the MI group exhibited reduced EF and FS, along with elevated LVEDD and LVESD. Furthermore, the cardiac fibrosis levels in the MI group rats exhibited a considerable increase compared to those in the icariin group. Notably, the levels of Collagen I, Collagen III, MMP2, and MMP9 were significantly higher in the MI group than in the icariin group, with evident distinctions. Moreover, the expression levels of TGF-β, IL-13, p-Smad2, and p-Smad3 were notably upregulated in the MI group compared to the icariin group.ConclusionsIn an experimental rat model of MI, the administration of icariin resulted in the amelioration of both cardiac function and remodeling processes, operating through the intricate TGF-β1/Smad signaling pathway.

Retracted: Evaluation of Cardiac Function before and after PAD Regimen in Patients with Multiple Myeloma by Three-Dimensional Speckle Tracking Imaging

Retracted: Evaluation of Cardiac Function before and after PAD Regimen in Patients with Multiple Myeloma by Three-Dimensional Speckle Tracking Imaging

Vascular endothelial growth factor-D plasma levels in fluid overload and cardiac function evaluation of elderly patients with cardiovascular disease.

This study aimed to investigate the clinical significance of vascular endothelial growth factor (VEGF) subtypes and growth differentiation factor-15 (GDF-15) plasma levels in evaluating the fluid overload and cardiac function of elderly patients with cardiovascular disease. The plasma levels of VEGF-C, VEGF-D, and GDF-15 were measured using ELISA. Their correlations with N-terminal pro B-type natriuretic peptide (NT-Pro BNP) and echocardiography data were analyzed. 1. Higher plasma levels of VEGF-D and GDF-15 were observed in elderly patients with cardiovascular disease and heart failure(P < .01). VEGF-D plasma levels were higher in patients with chronic heart failure than those with acute myocardial infarction (P < .01). VEGF-D plasma levels were positively correlated with amino-terminal pro-B type natriuretic peptide (NT-pro BNP) (P < .001). VEGF-D plasma levels were positively correlated with echocardiographic parameters, including left atrial diameter, left ventricular end-diastolic diameter and left ventricular ejection fraction, in patients with cardiovascular disease (P < .01). 2. VEGF-C plasma levels were higher in acute myocardial infarction group (P < .05). The plasma levels of VEGF-C were not correlated with either VEGF-D or NT-pro BNP plasma levels. VEGF-C plasma levels had no correlation with echocardiographic parameters. 3. GDF-15 plasma levels were positively correlated with sera biomarkers of cardiac injury (creatine kinase isoenzyme MB and cardiac troponin I). GDF-15 plasma levels were positively correlated with urinary biomarkers of tubular injury (N-acetyl-β-galactosidase and α1-microglobulin). Both GDF-15 and NT-pro BNP plasma levels were correlated with age, estimated glomerular filtration rate (eGFR), and nutritional biomarkers (albumin and hemoglobin plasma levels). VEGF-D plasma levels is a potential biomarker of fluid overload and cardiac function in elderly patients with cardiovascular disease. Age, nutrition, and kidney injury are factors influencing both GDF-15 and NT-pro BNP plasma levels in estimating cardiac function and fluid overload.

Fibroblast-specific SOCS3 deficient mice exhibits decreased myocardial fibrosis and increased cardiomyocyte survival after acute myocardial infarction

Abstract Background Left ventricular (LV) remodeling after acute myocardial infarction (AMI) results in poor cardiac performance leading to heart failure. LV remodeling after AMI is characterized by infarct expansion, LV dilation, and fibrosis of viable myocardium. Suppressor of cytokine signaling-3 (SOCS3) is an endogenous negative-feedback regulator of the STAT3 signaling pathway. We previously reported that myocardial SOCS3 plays a detrimental role in LV remodeling after AMI; however, the role of STAT3 and SOCS3 within fibroblast in LV remodeling after AMI remains elusive. Objective The aim of this study is to clarify the role of STAT3 and SOCS3 within fibroblasts in LV remodeling during AMI in mice. Methods To investigate the role of STAT3 signaling and SOCS3 within fibroblast, we generated tamoxifen-induced fibroblast-specific SOCS3-deficient (fib-SOCS3 KO) mice. AMI was induced by permanent ligation of the left anterior descending artery in mice. After 2 weeks of induction with tamoxifen, histological evaluation by Hematoxylin Eosin staining and Picro-Sirius Red staining, cardiac function evaluation by echocardiography using a Vevo 3100 Echo Imaging System (Visual Sonics), and protein expression using Western blot analysis were performed. Results There was no significant difference in 2-week survival rate between fib-SOCS3 KO group and wild type (WT). Two weeks after AMI, ventricular weight was less in fib-SOCS3 KO mice compared to WT mice (p&amp;lt;0.05). In terms of cardiac function, LV ejection fraction was predominantly increased in fib-SOCS3 KO mice compared with WT mice, as measured by the Area method (p&amp;lt;0.05). There was no difference in LV end-diastolic area, but LV end-systolic area was significantly less in fib-SOCS3 KO mice than in WT mice. Histologically, residual viable myocardium in the infarcted area was greater in fib-SOCS3 KO mice compared with WT mice. The percentage of fibrotic area in the LV short-axis plane was significantly less in fib-SOCS3 KO mice than in WT mice. Western blot analysis revealed that phosphorylated-STAT3 tended to be elevated in fib-SOCS3 KO mice than in WT mice. Conclusions Our data suggest that STAT3 and SOCS3 within fibroblast may play an important role in the prevention of LV remodeling after AMI.

Risk prediction model of cardiotoxicity in breast cancer patients; the multicenter prospective CHECK HEART-BC (comprehensive heart imaging to evaluate cardiac damage linked with chemotherapy in breast

Abstract Background Cardiotoxicity due to cancer therapy has been emerging as an important issue along with the improvement in prognosis of breast cancer patients. Although the usefulness of global longitudinal strain and biomarker analysis was previously reported separately, there are few studies based on systematic evaluation of cardiotoxicity. Furthermore, large prospective cohort studies regarding cardiotoxicity and its prediction in breast cancer patients were also limited. Purpose Multicenter prospective study was performed to reveal the current characteristics of cardiotoxicity and develop a robust prediction model for cardiotoxicity using systematic evaluation of cardiac function. Methods and results Breast cancer patients who were scheduled for neoadjuvant and/or adjuvant chemotherapy were prospectively screened at the 25 participating institutions from August 2017 and March 2020. As a study protocol, follow-up visits were planned every 3 months from pre-treatment to 12 months after chemotherapy (median follow-up of 366 days). To evaluate their cardiac function, echocardiography, high-sensitive cardiac troponin, natriuretic peptide, and 12-lead ECG were acquired at every follow-up visit. cardiotoxicity was defined as a reduction in LVEF &amp;gt;10% point from baseline and to a value &amp;lt;53% in LVEF. Results 542 chemotherapy-naïve patients were included for analysis from 25 institutions. cardiotoxicity developed in 46 (8.5%) during follow-up period. The HEART2 score based on pre-treatment data (model A) was composed of 6 variables including heart rate &amp;gt;64 bpm, LV end-systolic volume index &amp;gt;36.0 mL/m2, treatment with anthracycline, with radiation, with trastuzumab, and TAPSE &amp;lt;26 mm. The receiver-operating characteristic (ROC) curve showed acceptable accuracy (an area under curve (AUC) 0.74 [95%confidence interval 0.66-0.81], P&amp;lt;0.01). Furthermore, the ROC curve of the HEART2 score adding variables of 3 months after chemotherapy (model B) (difference in heart rate from pre-treatment, LV end-systolic volume index &amp;gt;42.0 mL/m2) showed a greater AUC than the model based on only pre-treatment data (AUC 0.81 [95%confidence interval 0.73-0.90], P&amp;lt;0.01). No patient with low-risk group in the HEART2 score based on variables of pre-treatment and 3 months after chemotherapy developed cardiotoxicity, while 28.1% developed cardiotoxicity in patients with high-risk group in both models. Conclusions CHECK HEART-BC study revealed current clinical characteristics of cardiotoxicity and developed the HEART2 score which showed good accuracy and consistency. The HEART2 score can provide an efficient and effective strategy for early detection of cardiotoxicity.The HEART2 scoreThe combination of model A and B

Melatonin attenuates an impairment of metabolic reprogramming in doxorubicin-induced cardiotoxicity: insights from metabolomics study in rats

Abstract Background Doxorubicin is an effective chemotherapeutic agent. Unfortunately, the clinical utilization of doxorubicin is limited due to cardiotoxicity. It was previously shown that doxorubicin caused the changes in glycolysis metabolome levels, fatty acid levels, and genes involving lipid metabolism in the heart. However, the pattern of metabolic reprogramming in doxorubicin-induced heart failure remains unknown. Moreover, the benefit of melatonin in attenuating doxorubicin-induced heart failure was previously revealed. Nonetheless, the potential benefits of melatonin on metabolic reprogramming in doxorubicin-induced heart failure has never been determined. Purposes Using liquid chromatography coupled with mass spectrometry-based targeted metabolomics, we identified the pattern of metabolic reprogramming in rats with doxorubicin-induced heart failure. In addition, the effects of melatonin on metabolic reprogramming in doxorubicin-induced heart failure were investigated. Methods Male Wistar rats (n=18) were divided into 3 groups (n=6/group) to receive either 1) normal saline solution as a vehicle, 2) 3 mg/kg/day of doxorubicin at days 0, 4, 8, 15, 22, and 29, and 3) 3 mg/kg/day of doxorubicin at days 0, 4, 8, 15, 22, and 29 plus 10 mg/kg/day of melatonin at days 0-29. At day 30, echocardiography and heart rate variability were done for an evaluation of cardiac function. The rats were then euthanized to collect ventricular cardiac tissues for metabolomics study. Results Comparing to vehicle-treated rats, the heart of rats treated with doxorubicin alone exhibited cardiac dysfunction, increased glucose and ketone body utilization, decreased fat utilization, decreased succinate oxidation, and decreased adenosine triphosphate (ATP) production. The co-treatment with melatonin effectively restored cardiac function, glucose and ketone body utilization, and ATP production in the heart. Interestingly, the co-treatment with melatonin also increased cardiac fatty acid oxidation, branched-chain amino acid catabolism, and anaplerosis (Figure). Conclusions Our findings highlighted the potential benefits of melatonin on cardiac metabolic reprogramming impaired by doxorubicin. These findings also suggested that melatonin could be considered as an adjunctive treatment for doxorubicin-induced heart failure in clinical settings.

Abstract 14223: Vector Analysis for Left Ventricular Wall Motion by Optical Flow With Echocardiographic Images in Myocardial Infarction Rat Model

Background/Research Questions: Alternative evaluation of cardiac function may be established in echocardiography-based vector analysis of the ventricular wall motion property. Vector acceleration and direction have the potential to assess cardiac kinetic energy and dynamics. Optical flow is suitable for vector analysis, because ventricular wall motion can be estimated as visible and quantitative vectors by optical flow from 2D echocardiographic images. Aims: This study aimed to establish a vector analysis for ventricular wall motion via optical flow with echocardiography. Methods: Coronary artery ligation rat model was used in this study. Before surgery (Pre) and four weeks after surgery (MI), short axis echocardiographic images in mid portion were obtained and analyzed by optical flow for left ventricular regional wall motion. Vector accelerations and directions were measured in both systolic and diastolic phases. Vector directions were classified into inward (ID), outward (OD), and circumferential direction (counterclockwise: CC, clockwise: CW). Following echocardiography, a rat was sacrificed for histological evaluation. Results: Pathological myocardial infarction was noted in the anterolateral lesion. Comparing average vector accelerations, MI had significantly smaller acceleration vectors in both systolic and diastolic phase (Pre vs. MI in systolic: 0.006±0.002 vs. 0.002±0.001 mm/s 2 , P&lt;0.001, Pre vs. MI in diastolic: 0.007±0.002 vs. 0.002±0.001 mm/s 2 , P&lt;0.001). Regarding total vector direction, CC and CW significantly increased in MI (P&lt;0.01). In the anterolateral lesion, ID and OD were the main vector directions in Pre. In contrast, CC and CW vectors significantly increased in MI (P&lt;0.0001). Conclusions: Optical flow effectively visualized cardiac wall motions and quantify them as vectors in echocardiographic images. The technique clarified left ventricular wall vector property alterations between healthy and infarcted hearts.

Abstract 12897: Automated Assessment of Left Ventricular Function in Tetralogy of Fallot - A Machine Learning Approach

Introduction: Congenital heart disease (CHD) is associated with significant cardiac anatomic and functional variability. This study tests the implementation and validation of a convolutional neural network algorithm (EchoNet-Dynamic) on a pediatric dataset via a transfer learning approach. We compare the echocardiographic systolic function measure, left ventricular ejection fraction (LVEF), with CMR as the gold standard. Methods: Patients ages 1-18 (44% female) who underwent a transthoracic echocardiographic evaluation and CMR for repaired Tetralogy of Fallot (TOF) were divided into 2 groups of EF &lt; and &gt;40%. 406 (2D-A4C views) videos with LVEF calculated using Bullet and Simpson method were identified. MRI EF as a ground truth label was compared with predicted EF data. Inference weights were derived from EchoNet-Dynamic and the weights from re-training the model on pediatric data. Correlation statistics were computed. The metrics included mean absolute error (MAE), root mean squared error (RMSE), and coefficient of determination (R2). Results: The R2 of actual vs predicted was 0.83 (0.71-0.89) with an MAE of 3.55. The predicted EF vs MRI EF resulted in an R2 of 0.48 and an MAE of 6.39 (Figure 1 a-c). Bland-Altman analysis between actual vs predicted EF estimates LVEF (bias = 1.64%) with 95% limits of agreement of -7.80% to 11.09%. MRI EF vs predicted values, the model estimates LVEF (bias = -3.12%) with 95% limits of agreement of -18.71% to 12.48%. The smaller body surface area and ages correlated with better model performance in both groups. Conclusions: EchoNet-Dynamic trained on a pediatric data set can accurately predict EF and this validates the model’s performance on a distinct CHD population. The predicted EF accurately compares with the MRI assessment. EchoNet Dynamic can be employed via a transfer learning method for automated real-time evaluations of cardiac function in CHD patients with compromised ventricular function and complex anatomical phenotypes.

Echocardiographic Evaluation of Fetal Cardiac Structure and Function in Pregnant Women with Hyperglycemia

Echocardiographic Evaluation of Fetal Cardiac Structure and Function in Pregnant Women with Hyperglycemia

Decades of Improvement in Cardiovascular Morbidity and Mortality in Leukemia Patients Reversed in 2020: Covid? Novel Agents? Neither?

Introduction: The incidence of many types of leukemia increases with age. Intensive induction chemotherapy containing cytarabine and an anthracycline has been part of the upfront and salvage treatment of AML for decades. Regimens for the treatment of ALL are also often anthracycline-based. Anthracyclines are associated with a significant risk of cardiotoxicity including anthracycline-related left ventricular dysfunction. Comprehensive baseline evaluation of cardiac function and risk may lead to better risk stratification and selection of patients who are best suited to anthracycline-based therapy. With the advent of more effective, yet less chemo-intense regimens for the management of older or unfit adults with leukemia, for example hypomethylator and venetoclax-based combinations, which gained widespread use with their accelerated approval in November 2018, one would hypothesize decreased rates of cardiovascular complications associated with the treatment of adult leukemia. To further investigate this hypothesis, we performed a nationwide analysis for adults age 25 and older with leukemia of all types and their associated cardiovascular disease related mortality. Methods: We utilized the Wide-ranging Online Data for Epidemiologic Research from the CDC. Patients were identified using ICD codes: C91 (Lymphoid leukaemia, C92 (Myeloid leukaemia), C93 (Monocytic leukaemia), C94 (Other leukaemias of specified cell type), and C95 (Leukaemia of unspecified cell type) with an underlying cause of death I00-I99 (Diseases of the circulatory system). Data was reviewed between 1999 to 2020 and included patients who were aged ≥25. We analyzed the age adjusted mortality rate (AAMR) per 100,000 people and stratified the data by sex, race/ethnicity, and geographical location within the USA by census region. Results: There were a total of 19,368 cardiovascular related deaths in leukemia patients between 1999 and 2020. There has been a decreasing trend in overall mortality associated with cardiovascular diseases from 1999 to 2019, falling from 4.6 to 3.9 deaths per 100,000 people, with an annual percent change of -2.89% (Figure 1). Both sexes mirrored this trend, with female mortality rates improving from 3.4 to 2.7 (APC -3.26%) and male rates from 6.5 to 5.6 (APC -3.07%) between 1999 and 2019. In 2020, it was observed that leukemia patients had an increased cardiovascular related mortality: 4.5 AAMR overall, 3.0 AAMR in females, and 6.5 AAMR in males . There was not a statistically significant difference in mortality changes by race (Table 1). Conclusion: Our study reveals a decrease in mortality rates from cardiovascular disease in leukemia patients from 1999 to 2018 followed by a relatively sharp increase noted in 2020. The steady improvements noted from the early 2000s to the 2010s may be attributable to awareness of known toxicities that led to enhanced screening and active monitoring for cardiovascular complications. Electrocardiograms, echocardiograms, and cardiotoxic markers including troponins and natriuretic peptides have served as diagnostic and risk-stratification tools. In 2020 leukemia patients exhibited a sudden increase in mortality across all sub-groups. One may postulate that this is related to COVID-19-related complications/delays in treatment, however, another possible explanation may be incompletely recognized toxicities of novel therapeutics. Interestingly, preclinical data have demonstrated that venetoclax treatment resulted in cardiac damage as evidenced by major changes in histopathology and markedly elevated cardiac enzymes and hypertrophic genes markers. Moreover, a drastic increase in oxidative stress, as well as inflammatory and apoptotic markers, with a remarkable decline in the levels of Bcl-2 has been observed (AlAsmari et al Int J Mol Sci 2022). Clearly, continued monitoring and further exploration is needed to identify the reason or reasons for the noted 2020 phenomenon. Continued data collection in the post-Covid vaccine era is likely to help to further elucidate the reasons for the unexpected uptick in cardiovascular-related morbidity and mortality in our leukemia patients.

Artificial intelligence technology applied to an unoccluded catheter for recognition of hemodynamic changes

This study seeks to provide a reliable means for physicians to diagnose hemorrhagic complications associated with patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. We employ the YOLOv4 algorithm to analyze cardiac parameters from the echocardiography device's ultrasonic wave, such as left ventricular ejection time (LVET), left ventricular internal dimension-diastole (LVIDd), left ventricular internal dimension-systole (LVIDs), posterior wall thickness at end-systole (HES), and RR interval. The proposed model has achieved an impressive average detection accuracy of 89.4% for these five parameters. Additionally, the further evaluation of cardiac function can be done by deriving the end-systolic wall stress (ESWS) and left ventricle rate-corrected mean velocity of circumferential fiber shortening (mVcFc) values from these parameters. As a result, it indicates that the accuracy of ESWS and mVcFc values is 88.7% and 90.3%, respectively. With this deep learning-based approach, physicians can confidently evaluate the cardiac function of ELBW infants and diagnose PDA-related hemorrhagic complications.

The Importance of Tissue Doppler Imaging and M-Mode Ultrasonography in Fetuses With Preterm Premature Rupture of Membranes: A Case-Control Study.

To compare the cardiac functions of fetuses with preterm premature rupture of membranes (PPROM) between their control groups and investigate its relationship with perinatal outcomes. This prospective study was conducted with 102 pregnant women. Pregnant women with PPROM were divided into two subgroups Group A, between 26 and 30 weeks, and Group B, between 30 and 34 weeks. A control group was formed by randomly including one healthy pregnant woman for each study patient. Sociodemographic, obstetric data, tissue Doppler imaging, and M-mode imaging results were compared. The relationship between echocardiographic parameters and perinatal outcomes was also investigated. Tricuspid annular plane systolic excursion (TAPSE), S', and ET' of systolic cardiac parameters were shortened in both groups compared with their controls. Diastolic function indicator E'/A', and global function indicator myocardial performance index' increased in both groups. Isovolumetric contraction time' did not change between groups. A correlation was found between myocardial performance index', and the length of neonatal intensive care unit stay in Group A and TAPSE and duration of respiratory support and length of neonatal intensive care unit stay in Group B. The fetal cardiac function seems to be affected by PPROM, and these changes are associated with neonatal outcomes. Therefore, administering fetal cardiac function evaluation in pregnancies complicated by PPROM may help physicians establish more appropriate clinical management protocols in this special population.

Maternal Hyperglycemia Induces Autonomic Dysfunction and Heart Failure in Older Adult Offspring.

Offspring exposed to an adverse fetal environment, such as gestational diabetes, may manifest increased susceptibility to several chronic diseases later in life. In the present study, the cardiovascular function of three different ages of offspring from diabetic rats was evaluated. Diabetes mellitus was induced in pregnant rats by a single dose of streptozotocin (50 mg/kg). The offspring from diabetic (OD) and control rats (OC) were evaluated at three different ages: 6, 12 or 18 months. In the corresponding OC groups, fasting glycemia, baseline mean arterial pressure, and sympathetic tonus increased in the OD rats at 12 (OD12) and 18 (OD18) months of age, while cardiac hypertrophy was observed in all OD groups. Cardiac function evaluation in vivo showed low left ventricular systolic pressure and+dP/dt in the OD18 rats, suggesting a systolic dysfunction. OD12 and OD18 groups showed high left ventricle end-diastolic pressure, suggesting a diastolic dysfunction. OD groups showed an age-related impairment of both baroreflex-mediated tachycardia and baroreflex-mediated bradycardia in OD12 and OD18 rats. In isolated hearts from OD18 rats, both inotropic and tachycardiac responses to increasing isoproterenol were significantly reduced compared to the corresponding OC group. These results suggest that gestational diabetes triggers the onset of hyperglycemia hypertension with impaired baroreflex sensitivity and heart failure in older age of offspring, representing important risk factors for death. Therefore, ensuring optimal glycemic control in diabetic pregnancy is important and serves as a key to preventing cardiovascular disease in the offspring in their older age.

The evaluation of cardiac functions in deep Trendelenburg position during robotic-assisted laparoscopic prostatectomy.

This study aimed to demonstrate the reliability of the cardiac cycle efficiency value through its correlation with longitudinal strain by observing the effect of the deep Trendelenburg position. A prospective, observational study. Single center. Between May and September 2022, the hemodynamic parameters of 30 patients who underwent robotic assisted laparoscopic prostatectomy under general anesthesia were prospectively evaluated. All invasive cardiac monitoring parameters and longitudinal strain achieved transesophageal echocardiography were recorded in pre-deep Trendelenburg position (T3) and 10th minute of deep Trendelenburg position (T4). Delta values were calculated for the cardiac cycle efficiency and longitudinal strain (values at T4 minus values at T3). The estimated power was calculated as 0.99 in accordance with the cardiac cycle efficiency values at T3 and T4 (effect size: 0.85 standard deviations of the mean difference: 0.22, alpha: 0.05). At T4, heart rate, pulse pressure variation, cardiac cycle efficiency, dP/dt and longitudinal strain were significantly lower than those at T3 (p = 0.009, p < 0.001, p < 0.001, and p < 0.001, respectively). There was a positive correlation between the delta-cardiac cycle efficiency and delta-longitudinal strain (R2 = 0.36, p < 0.001). Although the absence of significant changes in mean arterial pressure and cardiac index after Trendelenburg position suggests that cardiac workload has not changed, changes in cardiac cycle efficiency and longitudinal strain indicate increased cardiac workload due to increased ventriculo-arterial coupling.