Volume Index Research Articles

The incremental value of interatrial septum motion in predicting thrombus or spontaneous echo contrast in patients with non-valvular atrial fibrillation: an observational study on transesophageal echocardiography.

The thickness and motion of the Interatrial Septum (IAS) possibly serves as indicators of both structural and functional remodeling of left atrium. This study aims to use transesophageal echocardiography (TEE) to assess IAS motion in non-valvular atrial fibrillation (NVAF) and investigate its correlation with the risk of spontaneous echo contrast (SEC) and thrombus (TH). We conducted a cross-sectional study on 318 patients with NVAF who underwent transthoracic echocardiography and TEE. IAS motion was defined as the maximum displacement of IAS observed throughout the cardiac cycles using M-mode TEE. The prevalence of SEC/TH was 39.9% (127/318) in the overall group. In paroxysmal atrial fibrillation (PAF), the prevalence rate of SEC/TH was 25.3% (47/186), compared to 60.6% (80/132) in persistent atrial fibrillation (PeAF). Multivariable analyses showed that LA volume index (LAVI), mean E/e', S/D ratio, IAS motion and CHA2DS2-VASc scores were significantly associated with SEC/TH. Patients with lower IAS motion showed a higher prevalence of SEC/TH compared to those with higher IAS motion (71.3% vs. 11.6%; P < 0.001). The IAS motion under sinus rhythm could better predict risk of SEC/TH, while the predictive efficacy under AF rhythm was slightly attenuated but still had a high AUC value (0.779). A significant positive correlation was observed between the IAS motion and the LAA filling velocity (PAF r = 0.47; P<0.001 and PeAF r = 0.38; P < 0.001, respectively), LAA emptying velocity (PAF r = 0.55; P < 0.001 and PeAF r = 0.47; P < 0.001, respectively) and LAVI (PAF r = 0.59; P < 0.001 and PeAF r = 0.44; P < 0.001, respectively). The integration of the IAS motion to the CHA2DS2-VASc, LAVI and mean E/e' provided important incremental predictive value of SEC/TH (AUC = 0.859 vs. 0.826, P = 0.02). IAS motion measured by TEE correlates well with LAA flow velocity and LA size and is independently associated with SEC/TH in NVAF. Additionally, lower IAS motion is associated with a higher prevalence of SEC/TH. Furthermore, the integration of IAS motion to CHA2DS2-VASc, LAVI and mean E/e' can provide additional value for the prediction of SEC/TH.

Replacing manual planning with automatic iterative planning for locally advanced rectal cancer VMAT treatment.

To develop and implement a fully automatic iterative planning (AIP) system in the clinical practice, generating volumetric-modulated arc therapy plans combined with simultaneous integrated boost technique VMAT (SIB-VMAT) for locally advanced rectal cancer (LARC) patients. The designed AIP system aimed to automate the entire planning process through a web-based service, includingauxiliary structuregeneration,plan creation,field configuration,plan optimization,dose calculation, andplan assessment. The system was implemented based on theEclipse scriptingapplication programming interface and an efficientiterative optimization algorithm was proposed to reduce the required iterations in the optimization process. To verify the performance of the implemented AIP system, we retrospectively selected a total of 106 patients and performed dosimetric comparisons between the automatic plans (APs) and the manual plans (MPs), in terms of dose-volume histogram (DVH) metrics, homogeneity index (HI), and conformity index (CI) for different volumes of interest. The AIP system has successfully created 106 APs within clinically acceptable timeframes. The average planning time per case was 36.8±6.5 min, with an average iteration number of 6.8(±1.1) in plan optimization. Compared to MPs, APs exhibited better performance in the planning target volume conformity and hotspot control ( ). The organs at risk (OARs) sparing was significantly improved in APs, with mean dose reductions in the femoral heads, the bone marrow, and the SmallBowel-Avoid of 0.53Gy, 1.18Gy, and 1.00Gy, respectively ( ). Slight improvement was also observed in the urinary bladder and the small bowel . Additionally, quality variation between plans from different planners was observed in DVH metrics while the APs represented better plan quality consistency. An AIP system has been implemented and integrated into the clinical treatment planning workflow. The AIP-generated SIB-VMAT plans for LARC have demonstrated superior plan quality and consistency compared with the manual counterparts. In the meantime, the planning time has been reduced by the AIP approach. Based on the reported results, the implemented AIP framework has been proven to improve plan quality and planning efficiency, liberating planners from the laborious parameter-tuning in the optimization phase.

The impact of right atrial volume on ablation outcomes in patients with pulmonary hypertension and atrial flutter

BackgroundCatheter ablation has evolved as a safe treatment for atrial flutter (AFL) in patients with pulmonary hypertension (PH), and the recurrence of AFL may accelerate clinical decompensation. The aim of this study was to determine the recurrence rate and risk factors for recurrent AFL in PH patients after ablation.MethodsAll PH patients who underwent AFL ablation at Fuwai Hospital between May 2015 and December 2020 were followed up. The recurrence rate and risk factors for recurrence were analyzed.ResultsA total of 68 PH patients (mean age 44.0 ± 13.0 years, 36.8% male) were enrolled. The majority patients diagnosed PH had congenital heart disease-associated PH (63.2%), and 30.9% had idiopathic pulmonary arterial hypertension. At baseline, most patients (80.9%) had only cavotricuspid isthmus (CTI)-related AFL; the occurrence of non-CTI-related AFL among patients was 8.8%, and 10.3% of the patients had both types of AFL. During a median follow-up of 17.5 months, 22 patients developed at least one recurrent AFL episode (AFL-free survival: 76.5% at 1 year). The immediate success of ablation (HR 0.061, 95% CI 0.009 to 0.438; P = 0.005) and the right atrial volume index (RAVi, per 10 ml/m2; HR 1.064, 95% CI 1.011 to 1.120; P = 0.018) were associated with long-term ablation outcomes in PH patients. With 166.64 ml/m2 as a cutoff value, AFL-free survival was significantly greater in patients whose RAVi was < 166.64 ml/m2 (log-rank P = 0.024).ConclusionThe immediate success of ablation and the RAVi are associated with recurrent AFL. Patients with a RAVi ≥ 166.64 ml/m2 are likely experience recurrence.

Surgical outcome of the borderline hypoplastic left ventricle: impact of the left ventricle rehabilitation strategy.

This study aims to assess the surgical outcome of borderline hypoplastic left ventricle before and after the induction of the left ventricle rehabilitation strategy. A retrospective review investigated patients with borderline hypoplastic left ventricle who underwent surgical intervention between 2012 and 2022. The patient cohort was stratified into two groups based on the initiation of left ventricle rehabilitation: an early-era group (E group, 2012-2017) and a late-era group (L group, 2018-2022). Left ventricle rehabilitation was defined as palliation combined with other procedures aimed at promoting left ventricular growth such as restriction of atrial septal defect, relief of inflow/outflow obstructive lesions, and resection of endocardial fibroelastosis. A total of 58 patients were included. Primary diagnosis included 12 hypoplastic left heart syndromes, 11 critical aortic valve stenosis, and others. A total of 9 patients underwent left ventricle rehabilitation, 8 of whom underwent restriction of atrial septal defect. As for clinical outcomes, 9 of 23 patients achieved biventricular repair in the E group, whereas in the L group, 27 of 35 patients achieved biventricular repair (39% vs. 77%, p = 0.004). Mortality did not differ statistically between the two groups (log-rank test p = 0.182). As for the changes after left ventricle rehabilitation, left ventricular growth was observed in 8 of 9 patients. The left ventricular end-diastolic volume index (from 11.4 to 30.1 ml/m2, p = 0.017) and left ventricular apex-to-right ventricular apex ratio (from 86 to 106 %, p = 0.014) significantlyincreased after left ventricle rehabilitation. The introduction of the left ventricle rehabilitation strategy resulted in an increased proportion of patients achieving biventricular repair without a concomitant increase in mortality. Left ventricle rehabilitation was associated with enhanced left ventricular growth and the formation of a well-defined left ventricle apex. Our study underscores the significance of left ventricle rehabilitation strategies facilitating successful biventricular repair. The data suggest establishing restrictive atrial communication may be a key factor in promoting left ventricular growth.

Novel Method for Risk Stratification of Major Adverse Clinical Events Using Pre- and Post-Ablation Left Atrial Volume Index in Patients With Persistent Atrial Fibrillation.

The relationship between changes in the left atrial volume index (LAVI) post-catheter ablation (CA) and long-term prognostic events in patients with persistent atrial fibrillation (AF) remains unclear. We evaluated the incidence of major adverse clinical events (MACE), including all-cause death, unplanned heart failure hospitalization, and unplanned cardiovascular hospitalization using pre- and post-CA LAVI. We collected data retrospectively from 150 patients with persistent AF who underwent their first CA. LAVI was calculated during preprocedural echocardiography under AF rhythm (pre-CA LAVI) and 3 months post-CA under sinus rhythm (post-CA LAVI). The cumulative incidence of MACE was compared among 3 subgroups based on the cutoff values of pre-CA (45.5 mL/m2) and post-CA (46.5 mL/m2; both determined using the c-statistic) LAVI. The subgroup of a pre-CA LAVI >45.5 mL/m2 with a post-CA LAVI >46.5 mL/m2 (n=45) had a significantly higher MACE incidence compared with other subgroups (P=0.002). Multivariate analysis identified this subgroup as independently at higher risk for MACE. The subgroup of a pre-CA LAVI >45.5 mL/m2 with a post-CA LAVI ≤46.5 mL/m2 (n=49) had an incidence comparable with those with pre-CA LAVI ≤45.5 mL/m2 (n=56) and exhibited a significantly greater reduction in LAVI than other subgroups did (P<0.001). Combining pre-CA and post-CA LAVIs is valuable in stratifying long-term MACE development risk following CA.

Effect of low-dose norepinephrine combined with goal-directed fluid therapy on postoperative pulmonary complications in lung surgery: A prospective randomized controlled trial

Study objectivePostoperative pulmonary complications (PPCs), the predominant complications following lung surgery, are closely associated with intraoperative fluid therapy. This study investigates whether continuous low-dose norepinephrine infusion combined with goal-directed fluid therapy (GDFT) reduced the risk of PPCs after lung surgery relative to either GDFT alone or standard fluid treatment. DesignA prospective, randomized controlled trial. SettingThe First Affiliated Hospital of Anhui Medical University, Anhui, China. PatientsThe study included 184 patients undergoing elective thoracoscopic lung resection surgery. InterventionsPatients were randomized into three groups based on different fluid treatment regimens: Group C received standard fluid treatment, Group G received GDFT, and Group N received continuous low-dose norepinephrine infusion combined with GDFT. MeasurementsThe primary outcome was the incidence of PPCs, including respiratory infection, atelectasis, pneumothorax, pleural empyema, respiratory failure, pulmonary embolism and bronchopleural fistula, during the postoperative hospital stay. Secondary outcomes were hemodynamic variables and arterial blood gases. Additional recorded parameters included other postoperative complications such as bleeding, postoperative re-intubation, re-hospitalization within 30 days, and the length of hospital stay. Main resultsGroup N showed a significantly lower PPCs incidence during hospitalization compared to Group C (11.5 % vs 27.9 %; odds ratio, 2.98; 95 % confidence interval, 1.17–8.31; P = 0.023). No significant difference in PPCs was found between Group N and Group G (11.5 % vs 14.5 %; odds ratio, 1.31; 95 % confidence interval, 0.46–3.91; P = 0.616). Additionally, there were no significant differences among the three groups in the components of PPCs. Group N showed higher mean arterial pressure and stroke volume index intraoperatively compared to Group C. ConclusionsContinuous low-dose norepinephrine infusion combined with GDFT reduced PPCs incidence in elective lung surgery patients compared with standard fluid management, but showed no difference compared to GDFT alone. Clinical trial registrationChiCTR2200064081.

Surge in Eye Drop Safety Concerns and Interest in Alternative Dry Eye Disease Therapy Following Eye Drop Recalls: A Cross-Sectional Google Trends Analysis.

Beginning in January 2023, numerous eye drops were recalled following reports of contamination. To investigate hesitancy in topical therapies for dry eye disease (DED), we analyzed trends in Internet search traffic for alternative DED therapies and eye drop safety concerns following initial recalls. Google Trends (GT) was used to measure the popularity of specific search terms during a given time period. The main GT output metric for gauging interest in a search term is the Search Volume Index (SVI). We collected worldwide SVI data for terms "dry eye vitamin," "are eye drops safe," "stop eye drops," "lipiflow," "ilux treatment," "dry eye mask," "dry eye warm compress," "omega-3 for dry eyes," "dry eye plugs," "dry eye humidifier," "itear," and "IPL dry eye" from April 24, 2022, to October 29, 2023. Statistical analysis was performed with Microsoft Excel v.16.77.1, and comparisons between groups were performed using paired t tests. A significant increase in SVI was observed for most keywords. When comparing the 40-week period before and after the initial recall, 7/10 alternative DED therapies demonstrated a statistically significant surge in Internet search traffic after recall (P < 0.05). Furthermore, 2/2 keywords pertaining to eye drop safety concerns demonstrated an increase in SVI (P < 0.0001). We identified a significant surge in Internet search activity for eye drop safety and alternative DED therapies following eye drop recalls. Public health agencies and physicians may find this information valuable while attempting to address safety concerns and navigating noncompliance of routine eye drop therapy.

Echocardiographic red flags of ATTR cardiomyopathy A single center validation

Abstract Aims Echocardiography plays an important role in suspecting the presence of transthyretin cardiomyopathy (ATTR-CM) in patients with heart failure, based on parameters proposed as “red flags” for the diagnosis of ATTR-CM. We aimed to validate those measurements in a group of patients with ATTR-CM including ATTRv and ATTRwt. Methods We tested a number of echocardiographic red flags in 118 patients with confirmed diagnosis of ATTR-CM. These variables were validated against healthy controls and patients with heart failure with left ventricular hypertrophy (LVH) but not ATTR-CM. The red flag measures outside the proposed cut-off values were also revalidated. Results In ATTR-CM, all conventional echocardiographic parameters were significantly abnormal compared to controls. Comparing ATTR-CM and LVH, LV wall thickness, LV diameter, E velocity, and relative apical sparing (RELAPS) were all different. Eighty-three % of ATTR-CM patients had RELAPS &amp;gt;1.0, 73% had RWT &amp;gt;0.6, 72% had LVEF &amp;gt;50%, 24 % had GLS &amp;gt;-13%, 33% had LVEF/GLS &amp;gt;4 and 54% had increased left atrial volume index (LAVI) (&amp;gt;34ml/m2). Forty % of ATTR-CM patients had SVI &amp;lt;30 ml/m2 and 52% had CI &amp;lt; 2.5 L/min/m2. RELAPS, LVEF and RWT, in order of accuracy, were the three best measures for the presence ATTR-CM in the patient cohort, who all had thick myocardium. The concomitant presence of the three disturbances was found in only 50% but the combination of RELAPS &amp;gt;1.0 and RWT &amp;gt;0.6 was found in 72% of the patient cohort. Conclusion Increased relative apical sparing proved the most accurate independent marker of the presence of ATTR-CM followed by normal LV ejection fraction and then increased relative wall thickness. The other proposed red flags for diagnosing ATTR-CM did not feature as reliable disease predictors.

The role of E-wave velocity in predicting early left ventricular dysfunction and significant decline in left ventricular ejection fraction after mitral valve repair for severe chronic primary mitral regurgitation.

Preoperative left ventricular (LV) ejection fraction (LVEF) and LV end-systolic dimension (LVESD) are established predictors of LV dysfunction (LVD) after mitral valve repair (MVr) for mitral regurgitation (MR). Although elevated estimated right ventricular systolic pressure (eRVSP) indicating pulmonary hypertension is the best proposed additional predictor, we hypothesized that transthoracic echocardiography (TTE) parameters more directly reflecting left atrial pressure (LAP) would more accurately predict LVD than eRVSP. Furthermore, predictors of a significant decline in LVEF remain unknown. We retrospectively studied 622 patients, aged 20-87years, who underwent MVr for severe chronic primary MR. As previously reported predictors of postoperative LVD, we collected seven preoperative TTE parameters, including LVESD, LVEF, eRVSP, LV end-diastolic dimension, left atrial volume index (LAVI), early transmitral annular (e') velocity, and atrial fibrillation. Furthermore, as LAP-related TTE parameters, we collected left atrial dimension, E-wave velocity, and E/e' ratio, in addition to eRVSP and LAVI. Using multivariate logistic regression and receiver operating characteristic curve analyses, we explored predictors of early postoperative LVD, defined as LVEF < 50% measured on postoperative day 7. We further explored predictors of a significant decline in LVEF, defined as an absolute decline in LVEF of > 12 percentage points, the third quintile of the data. Incidences of postoperative LVD and a significant LVEF decline were 12.9% and 23.2%, respectively. In addition to LVESD and LVEF, E-wave velocity, but not eRVSP, remained a significant predictor of postoperative LVD. E-wave velocity, LVESD, and LVEF had additive effects in risk prediction. Furthermore, E-wave velocity was the strongest predictor of a significant LVEF decline. E-wave velocities > 121.5cm/s and > 101.5cm/s were associated with increased risks of postoperative LVD (odds ratio [OR], 2.896; 95% confidence interval [95%CI], 1.792-4.681; p < 0.001) and a significant LVEF decline (OR, 6.345; 95%CI, 3.707-10.86; p < 0.001), respectively. After adjustment for multiple TTE parameters, E-wave velocity, but not eRVSP, remained significant predictors of postoperative LVD and a significant LVEF decline after MVr. These results were reproducible in 461 patients who underwent follow-up TTE at 1year, suggesting an important role of E-wave velocity in risk prediction.

8647 Reversal Of Left Atrial Dilation In Heart Failure With Preserved Ejection Fraction (HFpEF) Treated With A GLP-1 Receptor Agonist And A Mineralocorticoid Receptor Antagonist

Abstract Disclosure: M. Marino: None. L.S. Phillips: Advisory Board Member; Self; Diasyst, Inc.. Research Investigator; Self; Abbvie, Research Support, Jansen Pharmaceuticals, Research Support, Novo Nordisk, Research Support, Abbott Laboratories, Research Support, GlaxoSmithKline, Research Support, Sanofi-Aventis, Research Support, Pfizer, Inc.. Background: HFpEF is a major public health problem, since contributors include age, hypertension, hyperglycemia, and inactivity - and the US population is aging, hypertension and hyperglycemia are often inadequately treated, and inactivity is common. Moreover, management is difficult, since few medications have improved outcomes, and there is little long-term experience with sodium-glucose co-transporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and mineralocorticoid receptor antagonists. Clinical Case: In October 2010, a 69-year-old male with a history of lung adenocarcinoma with left lower lobe segmentectomy, prostate cancer post prostatectomy, and well-managed hypertension and hyperglycemia experienced severe shortness of breath while running on a track as part of his routine exercise. A left heart catheterization was performed to determine if the symptoms reflected inadequate perfusion, revealing only 30% stenosis in the left anterior descending coronary artery, ruling out coronary disease as the primary etiology. However, the left ventricular end diastolic pressure (LVEDP) was elevated (25 mmHg vs. normal &amp;lt;12), indicating heart failure. A transthoracic echocardiogram (TTE) in December 2010 revealed a normal left ventricular ejection fraction (EF 65%), a severely dilated left atrium [left atrial volume index (LAVI) 57 mL/m2 vs. normal &amp;lt;34], and diastolic dysfunction [flow velocity across the mitral valve (E/A ratio 1.61 and E/e’ 7.26). The patient was given pioglitazone 30mg daily before and nebivolol 2.5mg BID after the TTE, but in March 2011, a TTE showed an EF of 57% with persistent left atrial dilation (LAVI 50 mL/m2). A dipeptidyl peptidase-4 (DPP-4) inhibitor (sitagliptin 100mg daily) was begun August 2011, changed to liraglutide 1.8mg daily in December 2011, and eplerenone 75mg daily was begun February 2012. In June 2012, the LAVI was markedly improved (39 mL/m2). The nebivolol was switched to irbesartan 225mg daily in August 2012, and canagliflozin 300mg daily was added September 2013. A repeat TTE in March 2014 found an EF of 60%, and showed that the LAVI had returned to normal (34 mL/m2). During this period, mean blood pressure was 111/67 mmHg, LDL cholesterol 57 mg/dL, and HbA1c 5.4%, indicating that inadequate risk factor management was unlikely to be contributing to the diastolic dysfunction. Presently, the patient takes semaglutide, pioglitazone, telmisartan, empagliflozin, and eplerenone, continues to exercise vigorously, and a recent TTE showed an EF of 62% with mild left atrial dilation (LAVI 36.6). Conclusion: Left atrial dilation was improved after addition of a GLP-1 receptor agonist and a mineralocorticoid receptor antagonist, prior to use of an SGLT-2 inhibitor. Future investigations are needed to further understand the cardiovascular utility of these medications - beyond glycemic control and electrolyte balance. Presentation: 6/3/2024

A Collection of Wisdom in Predicting Sector Returns: The Use of Google Search Volume Index

This study investigates whether the aggregate investor information demand for all stocks in a sector demonstrated in the Google search volume index (SVI) can predict the sector’s performance. The evidence shows that a sector’s abnormal SVI can predict the sector’s performance next month, even after controlling for the sector’s contemporaneous standardized unexpected earnings and lagged returns on both the market and the sector. Also found is a partial reversal in the sector’s long-run performance that is not completely consistent with the price pressure hypothesis. This indicates that some fundamental information about a sector can be captured by the sector’s abnormal SVI on a timely basis.

Clinical and echocardiographic parameters associated with outcomes in patients with moderate secondary mitral regurgitation

BackgroundSignificant secondary mitral regurgitation (SMR) is known to be associated with worse prognosis. However, data focusing specifically on moderate SMR and associated risk factors are lacking. In the present study,...

Equol Nonproducing Status as an Independent Risk Factor for Acute Cardioembolic Stroke and Poor Functional Outcome.

Background/Objectives: Equol has protective effects against coronary artery disease and dementia by strongly binding to estrogen receptor beta, whereas the intake of soy isoflavone alone does not always confer such protective effects. Equol production is completely dependent on the existence of equol-producing gut microbiota. The effects of equol-producing status on the cerebrovascular diseases remain unclear. The current study was aimed to investigate the association of equol-producing status with the development of stroke and its neurological prognosis. Methods: Frequencies of equol producers were compared between healthy subjects (HS) registered in the Suita Study and patients with acute stroke admitted to our stroke center from September 2019 to October 2021 in a retrospective cohort study. Results: The proportion of HSs and patients with ischemic stroke who were equol producers did not significantly differ (50/103 [48.5%] vs. 60/140 [42.9%], p = 0.38). However, cardioembolic stroke was significantly associated with low a prevalence of equol producers (adjusted odds ratio [aOR] 0.46, 95% confidence interval [CI] 0.21-0.99, p = 0.05). A higher left atrial volume index was observed in equol nonproducers (46.3 ± 23.8 vs. 36.0 ± 11.6 mL/m2, p = 0.06). The equol nonproducers had a significantly higher prevalence of atrial fibrillation than the equol producers (27.5% vs. 13.3%, p = 0.04). Furthermore, the equol producers exhibited a significantly favorable functional outcome upon discharge (aOR 2.84, 95% CI 1.20-6.75, p = 0.02). Conclusions: Equol is a promising candidate for interventions aiming to reduce the risk of CES and atrial dysfunction, such as atrial fibrillation and improve neurological prognosis after ischemic stroke.

Obesity-related indices as predictors of lower extremity arterial disease in type 2 diabetes mellitus.

The aim of this study was to investigate the relationship between obesity and lower extremity arterial disease (LEAD) in patients with type 2 diabetes mellitus (T2DM). This retrospective study included 1821 patients with type 2 diabetes: 364 patients with LEAD and 1457 patients without LEAD. The patients were divided into training and internal test cohorts in a 7:3 ratio. LASSO regression analysis was used in the training cohort to filter relevant variables. Univariate and multivariate regression analyses were conducted to assess independent risk factors. A diagnostic nomogram was constructed and its discrimination was evaluated using the area under the ROC curve (AUC). The consistency was assessed using a calibration plot. The clinical application of the nomogram was evaluated by performing a decision curve analysis (DCA) and validated by an internal test cohort of the training cohorts. The LEAD group exhibited significantly higher values in obesity-related indices compared to the non-LEAD group, including waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), conicity index (CI), body adiposity index (BAI), and abdominal volume index (AVI). Multivariate analysis identified BMI, CI, BAI, and other parameters as independent risk factors for LEAD. A nomogram was constructed, and the AUC value of the nomogram was 0.746 in the training cohort and 0.663 in the internal test cohort. Obesity-related indices are associated with LEAD in patients with T2DM. Therefore, it is important to manage waist circumference and weight to reduce the risk of LEAD in patients with T2DM.

Expression of HMGB1, TGF-β1, BIRC3, ADAM17, CDKN1A, and FTO in Relation to Left Ventricular Remodeling in Patients Six Months after the First Myocardial Infarction: A Prospective Study.

Background: After myocardial infarction (MI), adverse left ventricular (LV) remodeling may occur. This is followed by LV hypertrophy and eventually heart failure. The remodeling process is complex and goes through multiple phases. The aim of this study was to investigate the expression of HMGB1, TGF-β1, BIRC3, ADAM17, CDKN1A, and FTO, each involved in a specific step of LV remodeling, in association with the change in the echocardiographic parameters of LV structure and function used to assess the LV remodeling process in the peripheral blood mononuclear cells (PBMCs) of patients six months after the first MI. The expression of selected genes was also determined in PBMCs of controls. Methods: The study group consisted of 99 MI patients, who were prospectively followed-up for 6 months, and 25 controls. Cardiac parameters, measured via conventional 2D echocardiography, were evaluated at two time points: 3-5 days and 6 months after MI. The mRNA expression six-months-post-MI was detected using TaqMan® technology (Applied Biosystems, Thermo Fisher Scientific, Waltham, MA, USA). Results:HMGB1 mRNA was significantly higher in patients with adverse LV remodeling six-months-post-MI than in patients without adverse LV remodeling (p = 0.04). HMGB1 mRNA was significantly upregulated in patients with dilated LV end-diastolic diameter (LVEDD) (p = 0.03); dilated LV end-diastolic volume index (LVEDVi) (p = 0.03); severely dilated LV end-systolic volume index (LVESVi) (p = 0.006); impaired LV ejection fraction (LVEF) (p = 0.01); and LV enlargement (p = 0.03). It was also significantly upregulated in PBMCs from patients compared to controls (p = 0.005). TGF-β1 and BIRC3 mRNA were significantly lower in patients compared to controls (p = 0.02 and p = 0.05, respectively). Conclusions: Our results suggest that HMGB1 is involved in adverse LV remodeling six-months-post-MI, even on the mRNA level. Further research and validation are needed.

Triphasic diastolic transmitral and intraventricular blood flows and their relationship with LV diastolic dysfunction according to echocardiography

An acceleration of blood flow in the diastasis phase with the formation of the so-called L-wave may be found in some patients. The transmitral blood flow is transformed into a triphasic in the presence of L-wave.Objective: to assess the frequency of L-wave presence and to evaluate the relationship between the presence of L-wave in Doppler imaging of left ventricular blood flow, transmitral blood flow at the level of the mitral valve leaflets, and modern criteria for assessing left ventricular diastolic function.Material and methods. The study included 105 patients (age 62.21 ± 11.97 (29–91) years, 61 men) with sinus rhythm. From a total of examined patients, 30 were conditionally healthy, 64 patients suffered from coronary heart disease, and 11 suffered from arterial hypertension. Pulsed-wave Doppler ultrasound of transmitral flow was performed in the apical 4-chamber view with the sample volume located at the level of the ends of the mitral valve leaflets, as well as at the level of the basal and middle segments of the left ventricle. The distinct positive wave on the spectrogram during the diastasis phase with a speed exceeding 20 cm/s was considered an additional L-wave, and such blood flow in diastole was considered triphasic.Results. Triphasic transmitral blood flow was found in 9 patients (8.5%), and triphasic intraventricular blood flow in another 30 patients (28.5%). Patients with triphasic transmitral blood flow were older, with a greater left atrial volume index, and LV diastolic dysfunction was more often detected compared to patients with triphasic intraventricular blood flow (66.7% compared to 23.3%, p = 0.042).Conclusion. Triphasic transmitral blood flow is revealing significantly less frequently than triphasic intraventricular blood flow (8.5% compared to 28.5%, p &lt; 0.001). Triphasic transmitral blood flow is more often observed in patients with left ventricular diastolic dysfunction.

Clinical significance of echocardiographic left ventricular hypertrophy for predicting left atrial appendage thrombotic milieu in patients with atrial fibrillation and CHA2DS2-VASc scores of 0–2

BackgroundThe clinical significance of echocardiographic left ventricular hypertrophy (LVH) in risk stratification of left atrial appendage (LAA) thrombogenic milieu, as a surrogate for cardioembolic risk, in patients with atrial fibrillation (AF) and HA2DS2-VASc scores of 0–2 is unknown. Methods and resultsWe enrolled 707 consecutive patients with AF and CHA2DS2-VASc scores of 0–2 who underwent transesophageal echocardiography. LAA thrombogenic milieu was defined as the presence of a thrombus, severe spontaneous echo contrast, sludge in the LAA, or LAA flow velocity ≤ 20 cm/s. Alongside conventional parameters, longitudinal strain values for the left ventricle (LV) and left atrium were obtained using transthoracic echocardiography. Among the 707 patients, 77 (10.9 %) exhibited LVH. The LVH group exhibited a significantly higher prevalence of LAA thrombogenic milieu than the non-LVH group (32.5 % vs. 2.5 %, p < 0.001). LVH independently associated with LAA thrombogenic milieu after adjusting for clinical factors (including CHA2DS2-VASc score, AF type, and serum brain natriuretic peptide levels) and conventional echocardiographic parameters (including LV ejection fraction, LV end-diastolic volume index, and left atrium volume index) (odds ratio [OR]: 7.54, 95 % confidence interval [CI]: 3.49–16.29, p < 0.001 and OR: 7.16, 95 % CI: 3.26–15.73, p < 0.001, respectively). Moreover, LVH provided incremental value for predicting LAA thrombogenic milieu, even when added to the longitudinal strain of the LV and left atrium reservoir strains (p < 0.001). ConclusionEchocardiographic LVH significantly improves the prediction of LAA thrombogenic milieu, offering potential utility in further cardioembolic risk stratification for patients with AF and CHA2DS2-VASc scores of 0–2.

Impact of left ventricular rehabilitation on surgical outcomes in patients with borderline left heart hypoplasia

ObjectiveClinical significance of left ventricular (LV) rehabilitation for borderline left ventricular (LV) hypoplasia is controversial. This study aimed to review the surgical results of patients with borderline LV hypoplasia, and to evaluate the impact of the LV rehabilitation on outcomes. MethodsPatients diagnosed with borderline LV hypoplasia and surgically treated from 2018 to 2022 were included. Overall surgical outcomes were evaluated and the changes in LV volumes calculated using angiography and zlog-NT-proBNP levels were analyzed in patients who underwent LV rehabilitation. ResultsThirty-three patients were included. Sixteen patients underwent primary biventricular repair, three patients underwent primary single ventricle palliation, and the remaining 14 patients underwent LV rehabilitation, including nine bilateral pulmonary artery banding (PAB) and ductal stenting, four central PAB, and one ductal stenting. Among fourteen patients who received LV rehabilitation, one died, one underwent single ventricle palliation, one was waiting for further procedure, and 11 underwent biventricular repair. After biventricular repair, 2 patients died, and 1 patient developed hemodynamic failure. As a result, only 8 patients were alive and in good condition. In patients who underwent LV rehabilitation, LV end-diastolic/end-systolic volume index, and LV stroke volume index increased over time after LV rehabilitation (p=0.001, p=0.007, and p=0.009, respectively). The zlog-NT-proBNP levels were stable until biventricular repair, but significantly higher in patients who presented with hemodynamic failure following biventricular repair compared to patients who did not exhibit hemodynamic failure. ConclusionsIn patients with borderline left heart hypoplasia, LV rehabilitation procedure promoted an increase in LV volume and contributed to establishing a biventricular circulation. The short-term results of this strategy are satisfactory, but further studies are essential to determine the long-term outcomes.

Low birth weight associations with cardiac structure and function in adults after arterial switch for transposition of the great arteries

Background and aimsThe objective of this study was to assess the associations of birth weight with cardiac structure and function in adults with dextro-transposition of the great arteries (D-TGA) who underwent the arterial switch operation (ASO). Methods and resultsThirty-nine ASO patients (age 24.4 ± 3.3 years) were included during routine clinical follow-up from July 2019 to December 2021. All patients underwent cardiopulmonary exercise testing and cardiac magnetic resonance imaging at rest and during exercise. Early-life characteristics, including birth weight, were extracted from electronic medical health records. Linear regression analysis showed that lower birth weight was associated with smaller left ventricular (LV) and right ventricular (RV) end-diastolic volume index (LV: −14.5 mL/m2 [95 % confidence interval, CI: −26.5 to −2.5] per 1-kg decrease in birth weight, p = 0.04; RV: −11.2 mL/m2 [-20.7 to −1.7] per 1-kg decrease in birth weight, p = 0.03). Lower birth weight was associated with greater LV and RV ejection fraction at rest (LV: +8.5 % [+4.4 to +12.5] per 1-kg decrease in birth weight, p < 0.001); RV: +8.1 % [+2.8 to +13.4] per 1-kg decrease in birth weight, p = 0.005). Furthermore, lower birth weight was associated with an attenuated increase in LV stroke volume index from rest to peak exercise (−5.2 mL/m2 [-9.3 to −1.2] per 1-kg decrease in birth weight, p = 0.02). ConclusionsBirth weight may be a novel risk factor for adverse cardiac remodeling in adult ASO patients. Further research is needed to delineate the mechanisms underlying the associations between birth weight and cardiac remodeling ASO patients as well as the broader adult CHD population.

Differential Cardiac Responses after Passive Leg Raising.

This study retrospectively examined the hemodynamic effects of passive leg raising (PLR) in mechanically ventilated patients during fluid removal before spontaneous breathing trials. In previous studies, we noticed varying cardiac responses after PLR completion, particularly in positive tests. Using a bioreactance monitor, we recorded and analyzed hemodynamic parameters, including stroke volume and cardiac index (CI), before and after PLR in post-acute ICU patients. We included 27 patients who underwent 60 PLR procedures. In preload-unresponsive patients, no significant CI changes were observed (CI_t-6 = 3.7 [2.6; 4.7] mL/min/m2 vs. CI_t9 = 3.3 [2.5; 3.4] mL/min/m2; p = 0.306), while in preload-responsive patients, two distinct CI response types to PLR were identified: a transient peak with immediate return to baseline (CI_t-6 = 2.7 [2.5; 3.1] mL/min/m2 vs. 3.3 [2.6; 3.8] L/min/m2; p = 0.119) and a sustained CI elevation lasting beyond the PLR maneuver (CI_t-6 = 2.8 [2.3; 2.9] L/min/m2 vs. 3.3 [2.8; 3.9] ml/min/m2; p = 0.034). The latter was particularly noted when ΔCI during PLR exceeded 25%. Our findings suggest that in certain preload-responsive patients, PLR can induce a more sustained increase in CI, indicating a possible persistent hemodynamic effect. This effect could be due to a combination of autotransfusion and sympathetic activation affecting venous return and vascular tone. Further research in larger cohorts and more comprehensive hemodynamic assessments are warranted to validate these observations and elucidate the possible underlying mechanisms.The Fluid unLoading On Weaning (FLOW) study was prospectively registered under the ID NCT04496583 on 2020-07-29 at ClinicalTrials.gov.