Optimizing radiofrequency-assisted lead penetration into swine interventricular septum using pacing leads: A systematic in vitro assessment.

Lower interventricular septal thickness from computed tomography predicts the need for pacemaker implantation after TAVR.

Despite advances in the outcomes of arterial switch operation (ASO), long-term complications such as neo-aortic regurgitation (AR), neo-aortic root dilatation (ARD), neo-pulmonary stenosis (PS), and coronary artery-related events (CARE) pose challenges. We aimed to evaluate the long-term outcomes of ASO following a consistent surgical strategy adopted since 2003. We retrospectively analyzed 133 patients who underwent ASO between January 2003 and June 2021. Consistent surgical strategies included the trap-door method for coronary artery transfer, preservation of the neo-sinotubular junction, and extensive mobilization of pulmonary artery branches. Clinical outcomes and risk factors for adverse events were assessed. Among the 133 patients, 64 had transposition of the great arteries (TGA) with intact ventricular septum (IVS), 52 had TGA with ventricular septal defect (VSD), and 17 had Taussig-Bing anomaly (TBA). Operative mortality was 5.2% (n=7), with no late mortality over a median follow-up of 7.1 years. Freedom from reoperation and the composite of reoperation and re-intervention rates at 15 years were 80.7% and 74.0%, respectively. Freedom from significant neo-AR (≥ mild-to-moderate), neo-ARD (z-score ≥3.0), neo-PS (peak velocity >3.0 m/s or requiring re-intervention), and CARE at 15 years was 91.7%, 37.1%, 77.7%, and 92.3%, respectively. Complex TGA morphological subtypes (TBA > TGA-VSD > TGA-IVS) had higher neo-ARD (log-rank p<0.001) and composite of reoperation and re-intervention rates (log-rank p=0.021). Our surgical outcomes of ASO following the standardized strategy were favorable, despite concerns regarding long-term adverse events. Complex TGA morphological subtypes demonstrated higher neo-ARD and composite of reoperation and re-intervention rates.

Failure of septation of the interventricular septum (IVS) is the most common congenital heart defect, but mechanisms for patterning the IVS are largely unknown. Here we show that a Tbx5+/Mef2cAHF+ progenitor lineage forms a compartment boundary bisecting the IVS. This coordinated population originates at a first and second heart field interface. Ablation of Tbx5+/Mef2cAHF+ progenitors causes IVS disorganization, right ventricular hypoplasia and mixing of IVS lineages. Reduced dosage of the congenital heart defect transcription factor TBX5 disrupts boundary position and integrity, resulting in ventricular septation defects and patterning defects, including misexpression of Slit2 and Ntn1, which encode guidance cues. Reducing NTN1 dosage partly rescues cardiac defects in Tbx5 mutant embryos. Loss of Slit2 or Ntn1 causes ventricular septation defects and perturbed septal lineage distributions. Thus, we identify Tbx5 as a candidate selector gene, directing progenitors and regulating essential cues, to pattern a compartment boundary for proper cardiac septation, revealing mechanisms for cardiac birth defects.

N-terminal pro-brain natriuretic peptide (NT-proBNP) is a cardiac peptide primarily synthesized and secreted by left ventricular myocytes. It is recognized as one of the principal biochemical markers of cardiovascular disorders. Elevation of its concentration has been consistently observed in patients with heart failure. However, investigations into the association between NT-proBNP levels and electrocardiographic or echocardiographic findings in pregnancy-related pathological conditions, particularly preeclampsia, remain limited. The aim of the research. To evaluate the association between NT-proBNP concentrations and electrocardiographic and echocardiographic parameters of the heart in early-onset preeclampsia. Material and methods. A total of 90 pregnant women were enrolled in the study. All participants underwent examination between 32 and 36 weeks of gestation. The main group comprised 60 patients with pregnancies complicated by early-onset moderate preeclampsia. The control group included 30 women with uncomplicated pregnancies. NT-proBNP levels were measured using the MAGLUMI NT-proBNP assay (Shenzhen New Industries Biomedical Engineering Co., Ltd., Shenzhen, China). Venous blood samples were collected once at 08:00 after an overnight fast. Electrocardiography was performed using a Heaco ECG600G six/twelve-channel electrocardiograph. Echocardiography was conducted with a GE Voluson E8 Expert ultrasound system (serial number 3143/1144/0178; GE Healthcare, Austria). The study was approved by the Bioethics Committee of Bukovinian State Medical University (Protocol No. 2 dated 9 February 2015). Numerical data were analysed using statistical methods. The investigation was performed as part of a research project at the Department of Obstetrics and Gynecology, Bukovinian State Medical University (Chernivtsi, Ukraine). Statistical analysis was carried out on a personal computer using Statistica software (Microsoft Excel 2010, Microsoft Office 2010, and MedCalc version 16.1), with application of Student’s t-test for independent samples. This study was conducted as part of the research project entitled “Preservation and Restoration of Reproductive Health in Women and Girls with Obstetric and Gynecological Pathologies” at the Department of Obstetrics and Gynecology, Bukovinian State Medical University; state registration number 0121U110020 (2021–2025). Results. Mean NT-proBNP levels were found to be substantially higher in women with preeclampsia than in the control group (79.5 ± 37.4 pg/mL versus 32.0 ± 12.0 pg/mL; p &lt; 0.001). In patients of main group with early-onset preeclampsia, increased thickness of the left ventricular posterior wall was observed both in diastole (1.10 ± 0.05 cm versus to 0.82 ± 0.05 cm in the CG, p &lt; 0.0001), and in systole (1.30 ± 0.04 cm versus 1.10 ± 0.05 cm, p &lt; 0.0001). Comparable changes were noted for the interventricular septum thickness: 1.30 ± 0.05 cm in systole versus 1.10 ± 0.06 cm (p &lt; 0.0001) and 1.09 ± 0.05 cm in diastole versus 0.80 ± 0.04 cm (p &lt; 0.0001). Alterations in electrocardiographic parameters were identified in the MG compared with women with uncomplicated pregnancies. The duration of the P wave was increased (129.4 ± 9.0 ms versus 98.3 ± 11.4 ms; p &lt; 0.0001), as was the QRS complex (107.9 ± 9.6 ms versus 88.8 ± 10.2 ms; p &lt; 0.0001). Prolongation of the T wave was also observed (261.5 ± 9.2 ms versus 180.2 ± 10.6 ms; p &lt; 0.0001). An increase in the QT/QTc interval was noted (461.7 ± 10.0 ms versus 402.8 ± 10.2 ms; p &lt; 0.0001) Correlations between the parameters examined were established as follows: in women with preeclampsia, a weak positive correlation was observed between plasma NT-proBNP levels and interventricular septum thickness in diastole (r = 0.291; p = 0.0093), together with a weak negative correlation with the QT/QTc interval (r = −0.21; p = 0.001). In the CG, NT-proBNP levels exhibited a moderate positive correlation with left ventricular posterior wall thickness in diastole (r = 0.312; p = 0.0089) and a weak negative correlation with the QT/QTc interval (r = −0.205; p = 0.02). Conclusions. 1. Plasma levels of the cardiac peptide NT-proBNP are markedly elevated in women with pregnancies complicated by preeclampsia. 2. Electrocardiographic and echocardiographic parameters obtained in women with early-onset moderate preeclampsia are consistent with early manifestations of left ventricular hypertrophy. 3. Increased thickness of the ventricular walls and interventricular septum represents a morphological marker of myocardial remodelling in response to haemodynamic overload. 4. Electrocardiographic findings—prolongation of the PR, QRS, and QT intervals together with increased duration of the P and T waves—indicate delayed impulse conduction in the myocardium as well as potential alterations in repolarisation processes in the context of moderate preeclampsia.

Pulmonary atresia/critical stenosis with intact ventricular septum is a heterogeneous disease in which perinatal management is not exempt from controversies. We aim to understand which areas are the ones with the highest and least consensus. An online questionnaire including 30 questions was administered through a REDCap link. Invitations were sent out through the Fetal Heart Society and personal emails to the heads of fetal cardiology programs. Results were analyzed in a descriptive manner and compared among the regions with most responses (North America and Europe). A total of 72 specialists in fetal and pediatric cardiology responded, most from North-America (n = 31) and Europe (n = 29). Antenatal counselling was mainly based on the tricuspid valve z-score (43.7%), although among European responders, multivariable models were preferred (44.8%). There was a wide regional variation in the nomograms used for prenatal assessment of the tricuspid valve. More than half did not consider prenatal valvuloplasty (54.3%), and those who did diverged in selection criteria. Postnatally, in mild-moderately hypoplastic right ventricle, most opted to first assess the tricuspid valve z-score (60%) whereas others would always attempt a biventricular pathway (30.8%). The majority opted to perform cardiac catheterization in all cases to assess ventriculo-coronary connections (60.6%). If right ventricle-dependent coronary circulation was confirmed, 66.7% would opt for single ventricle palliation, whereas 15.9% would directly list for transplant. There is great heterogeneity in the management of pulmonary atresia-critical stenosis with intact ventricular septum, particularly in prenatal assessment and consideration for prenatal intervention.

Background. Cardiac fibromas (CFs) are rare primary cardiac tumors. Defining surgical indications for CF resection in early childhood represents a challenging clinical issue and varies substantially between centers. The optimal management strategy, particularly in infants and young children, requires further generalization of accumulated clinical experience.Aim. To analyze the experience of a single specialized center in managing children with CFs and to compare the outcomes of surgical treatment with the natural course of the disease. Materials and Methods. In this retrospective single-center study (2014–2023), 12 cases of CF in early childhood were analyzed: seven patients were managed conservatively, and five underwent surgical tumor resection. Results. The median age at diagnosis was 1.1 years. Asymptomatic presentation occurred in 58 % of children, arrhythmias in 33%, and signs of heart failure (HF) in 17 %. Fibromas were most commonly located in the interventricular septum (33 %), right ventricle (33 %), and left ventricle (25 %), and less frequently in the right atrium (8 %). In the observation group (median follow-up 3.6 years), an increase in absolute tumor area was noted, while the indexed area decreased (-0.94 cm²/m²/year); no deaths were recorded, and two children required antiarrhythmic therapy. In the surgical group, complications occurred in 60 % of patients (left ventricular dysfunction, ventricular septal defect, tumor recurrence, repeat surgery). Overall survival was 100 % in both groups.Conclusions. In early childhood, CFs tend to regress relatively as the child grows. In contrast, early radical surgery is frequently associated with postoperative complications. Therefore, a stratified management strategy appears optimal: urgent resection should be performed in cases of severe arrhythmia or hemodynamic obstruction, while delayed surgery is preferable for asymptomatic patients or those with medically controlled symptoms.

A bstract Background: Vitamin D has been suggested to provide benefits for maintaining left ventricular (LV) geometry, which is critical among individuals with hypertension. Objectives: To assess the association between serum vitamin D and left ventricular geometry, and the impact of supplementation on cardiac remodeling in hypertension. Materials and Methods: A systematic search was conducted across five databases up to June 7, 2024, by adhering to the PRISMA guideline. Eligible studies included observational or interventional designs reporting LV structural parameters in relation to vitamin D status or supplementation. Standardized mean differences (SMD) or mean differences (MD) were pooled using a restricted maximum-likelihood model. Heterogeneity was estimated based on I 2 -statistics. Results: Five studies met the inclusion criteria, consisting of three observational studies ( n = 349 participants) and two clinical trials ( n = 181 participants). Observational studies showed a significant association between low serum vitamin D levels and increased LV mass index (LVMI), LV end-diastolic diameter, interventricular septum thickness, and posterior wall thickness, all with P &lt; 0.001. A significant inverse correlation was found between serum vitamin D and LVMI ( r = −0.31, P &lt; 0.001). Lower vitamin D levels were linked to reduced LV ejection fraction (LVEF) (SMD = −0.38, P = 0.038). However, clinical trials showed no significant effect of vitamin D supplementation on LVMI (SMD = 0.03, P = 0.753). Conclusion: Vitamin D deficiency is significantly associated with adverse changes in left ventricular geometry and reduced cardiac function. However, current evidence from clinical trials suggests that vitamin D supplementation does not significantly improve these parameters. Protocol registration: https://osf.io/5kyfx.

Polygenic background modifies variant penetrance in hypertrophic (HCM) and dilated (DCM) cardiomyopathies, diseases with opposing morphologic characteristics and inversely related genetic pathways. Whether polygenic susceptibility for one disease protects against monogenic risk for the other remains uncertain. To characterize if polygenic background bidirectionally modifies pathogenicity of established rare variants associated with HCM and DCM. This cross-sectional study was conducted using data from the Penn Medicine BioBank (PMBB). Volunteers enrolled in PMBB between November 1994 and July 2022 with available electronic health record and genotyping data through September 2024 were included. Analysis was performed in June 2025. Normalized polygenic scores (PGSs) for HCM and DCM as well as carrier status of pathogenic variants in established HCM or DCM genes. HCM and DCM defined using electronic health record diagnosis and procedure codes, as well as echocardiogram measurements obtained from medical records. This study included 49 434 PMBB participants (median (IQR) age, 57 [42-67] years; 24 886 male [50.3%]). An increased HCM PGS was associated with a 1.1% increase in left ventricular ejection fraction (LVEF; 95% CI, 0.9 to 1.3; P = 7.3 × 10-31), a 0.79-mm decrease in left ventricular internal diameter at end-diastole (LVIDd; 95% CI, -0.92 to -0.67; P = 2.3 × 10-36), and a 0.18-mm increase in interventricular septal (IVS) thickness (95% CI, 0.14 to 0.22; P = 9.3 × 10-19). A 1-SD increase in DCM PGS was associated with a 2.0% decrease in LVEF (95% CI, -2.2 to -1.8; P = 3.3 × 10-83) and a 1.0-mm increase in LVIDd (95% CI, 0.93 to 1.1; P = 3.2 × 10-78) and was not significantly associated with IVS (estimate, -1.3 × 10⁻3 mm; 95% CI, -0.04 to 0.03; P = .94). A 1-SD increase in HCM PGS was associated with an increased risk of HCM (odds ratio [OR], 1.8; 95% CI, 1.6-2.0; P = 9.6 × 10-25) and decreased risk of DCM (OR, 0.69; 95% CI, 0.64-0.74; P = 4.3 × 10-22). A 1-SD increase in DCM PGS was associated with an increased risk of DCM (OR, 1.6; 95% CI, 1.5-1.7; P = 1.7 × 10-40) and decreased risk of HCM (OR, 0.69; 95% CI, 0.63-0.76; P = 3.0 × 10-13). Monogenic and polygenic risk terms had significant independent effects when combined in models of disease status and echocardiographic measurements; the inclusion of either an HCM or DCM PGS improved the discrimination (area under the receiving operating characteristic curve) of models of HCM (0.043; 95% credible interval, 0.034-0.053) and DCM (0.045; 95% credible interval, 0.039-0.051) beyond models including age, sex, and monogenic variant status. The findings in this study indicate that HCM and DCM risk were modified by polygenic background, which exists on an overlapping but opposing spectrum. Consideration of polygenic background may offer clinical value through improving understanding and prediction of these inherited cardiomyopathies.

Background:Transvenous lead implantation often faces challenges regarding venous access and lead-related complications. This study evaluated the feasibility and safety of a novel echocardiography-guided percutaneous transapical intraventricular septum (PTAIVS) pacing approach in an animal model.Methods:Twelve adult dogs underwent PTAIVS lead implantation guided by transthoracic and transoesophageal echocardiography. Leads were introduced percutaneously through the apex and fixed in the mid-to-basal septum. The first six dogs were implanted with a pacing set with a coaxial introducer needle (CareFusion) and a Model 3830 lead (Medtronic), whereas an improved pacing set with an extended helix lead was used in the next six dogs. The first three dogs were used for evaluation of acute gross pathology, with the remaining nine followed up over a period of 4–12 weeks. Pathological examinations were performed at the end of the follow-up period.Results:Successful lead placement without procedural complications was achieved in all dogs, with a mean (± SD) procedural time of 28.8 ± 4.8 min. At implantation, the median (interquartile range) capture threshold was 1.7 (0.85–2.50) V, the R-wave amplitude was 6.80 (6.13–13.00) mV and impedance was 536 (510–922) Ω. In the initial six dogs in which the unmodified pacing system was used, lead dislodgement occurred at the 1-month follow-up. Modifications to the system eliminated dislodgement at 1 month, but varying degrees of displacement were observed by 3 months.Conclusion:This study demonstrates the initial technical feasibility of echocardiography-guided PTAIVS pacing, offering a potential alternative to traditional transvenous methods. However, further refinements are essential to improve long-term lead stability.

PurposeTo evaluate fetal interventricular septum (IVS) volume in pregnant women with gestational diabetes mellitus (GDM) and compare it with that of healthy pregnant women using 4D ultrasound with spatiotemporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods.Patients and MethodsThis prospective cross-sectional study was conducted at Bhumibol Adulyadej Hospital, Royal Thai Airforce, Bangkok, Thailand, from November 2024 to March 2025. Pregnant women with a gestational age (GA) between 29 and 34 weeks were enrolled and divided into two groups: GDM and healthy controls. Fetal IVS volume was measured using 4D ultrasonography with STIC and VOCAL. Maternal, fetal, and demographic data were collected and analyzed.ResultsA total of 111 participants were included: 63 in the GDM group and 48 in the control group. The GDM group was significantly older (33.0 vs 27.9 years) and had a higher BMI (31.1 vs 26.8 kg/m2). Mean fetal IVS volume was significantly greater in the GDM group (347.1 mm3 vs 221.5 mm3). Adverse neonatal outcomes were comparable. The cut-off fetal IVS volume for predicting neonatal hyperbilirubinemia (HBB) and respiratory distress syndrome (RDS) was 419.8 mm3. Sensitivity for predicting HBB and RDS was 55.0 and 56.0%, with negative predictive values of 94.0 and 95.2%, respectively.ConclusionFetal IVS volume was significantly higher in GDM pregnancies. A cut-off value of 419.8 mm3 may be useful in predicting HBB and RDS risk, with high negative predictive value, suggesting its potential as a screening tool during the early third trimester.

Objective: To examine the differences in left heart structure and function between elderly patients with primary aldosteronism (PA) and those with primary hypertension (EH), and identify factors influencing left heart structure and function in elderly PA patients. Methods: A total of 264 elderly PA patients and 266 EH patients diagnosed at Tongren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2017 to July 2023 were retrospectively included. Propensity score matching (PSM) was performed at a 1: 1 ratio based on age, gender ratio, and blood pressure. The clinical indicators and cardiac differences were compared between the two groups. Multiple linear regression model was utilized to pinpoint risk factors associated with alterations in cardiac structure and function. Results: Each group included 147 patients. PA group had 61 males and 86 females, and aged [M (Q1, Q3)] 66 (63, 69) years; EH group had 63 males and 84 females, and aged 67 (63, 70) years. Patients with PA exhibit increased left ventricular mass index (LVMI), left atrial diameter (LAD), and interventricular septum thickness (IVST) (all P<0.05). There were no statistically significant differences in the left ventricular ejection fraction (LVEF) and the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/e') between the two groups (both P>0.05). Multiple linear regression analysis revealed that plasma aldosterone concentration (β=0.162, 95%CI: 0.138 to 0.186, P=0.030), systolic blood pressure (β=0.163, 95%CI: 0.053 to 0.273, P=0.026), and plasma renin concentration (β=0.243, 95%CI: 0.039 to 0.447, P=0.002) were linked to LVMI; body mass index (β=0.260, 95%CI: 0.125 to 0.395, P=0.001), systolic blood pressure (β=0.207, 95%CI: 0.187 to 0.227, P=0.004), plasma renin concentration (β=0.155, 95%CI: 0.090 to 0.220, P=0.031), and age (β=0.212, 95%CI: 0.130 to 0.294, P=0.003) were associated with LAD; and body mass index (β=0.165, 95%CI: 0.122 to 0.208, P=0.010), HDL cholesterol (β=-0.192, 95%CI:-0.294 to -0.090, P=0.004), and plasma aldosterone concentration (β=0.151, 95%CI: 0.149 to 0.153, P=0.016) were related to IVST in PA group patients. Patients with aldosterone adenoma had a higher left ventricular mass index than those with adrenal hyperplasia [94 (81, 103) g/m2 vs 81 (70, 98) g/m2, P=0.039]. Conclusions: Elderly PA patients exhibit greater left ventricular hypertrophy and left atrial enlargement than age, gender, and blood pressure-matched elderly EH patients, though both groups show similar left ventricular function. In elderly PA patients, aldosterone and renin levels are significantly linked to changes in left ventricular structure. Patients with aldosterone adenoma exhibit more severe left heart hypertrophy than patients with adrenal hyperplasia.

The purpose. To determine the efficacy, safety, and potential advantages of two variants of cardiac resynchronization therapy–biventricular pacing CRT(D) and selective left bundle branch pacing (LBBP) – in patients with left bundle branch block (LBBB) and heart failure. Materials and Methods. In the first group, cardiac resynchronization therapy devices (CRT-(D)) were implanted in 24 patients using the standard biventricular pacing technique. The patients were aged 36 to 72 years; 20 were male and 4 were female. Three leads were positioned in the heart chambers: the atrial lead in the right atrial appendage, ventricular leads in the interventricular septum or apex, and in a lateral cardiac vein to stimulate the left ventricle in the region of maximal electromechanical delay. In the second group, 26 patients aged 16 to 75 years (21 males, 5 females) underwent selective left bundle branch pacing (LBBP). Transseptal selective LBBP was performed using an active-fixation lead (Selekt Secure, 69 cm) and a C315HIS delivery system. Central cardiohemodynamic parameters–end-systolic volume (ESV), end-diastolic volume (EDV), and left ventricular ejection fraction (LVEF) by Simpson’s method, as well as pulmonary artery pressure–were assessed by transthoracic echocardiography (TTE). The effectiveness of ventricular resynchronization was evaluated using speckle-tracking echocardiography. The following parameters were calculated: left ventricular longitudinal strain (4-chamber view), circular strain at the basal and apical segments, and the time to peak systolic contraction of LV segments (MOWD). Changes in QRS morphology after resynchronization therapy in both groups were assessed using standard ECG. A 6-minute walk test was performed before surgery and at 3, 6, and 12 months post-procedure to evaluate the distance covered at a comfortable walking pace on a flat surface. Results. The observation period lasted 12 months. After standard biventricular resynchronization pacing, QRS duration decreased by 21%, from 158 ± 7.1 ms to 125.3 ± 5.1 ms (St–R interval 115 ± 5.1 ms). After selective LBBP, the St–R interval was 82.3 ± 7.1 ms, representing a 47% reduction in QRS duration compared with baseline. Changes in central hemodynamic parameters over 12 months were as follows: in the first group (CRT-D), LVEF increased from 27.3 ± 3.8% to 45.2 ± 4.3%; in the second group (LBBP), LVEF increased from 39.3 ± 3.8% to 48.5 ± 3.2%. This corresponds to a 40% and 18% increase in LVEF in the first and second groups, respectively. A reduction in EDV of 28% (from 265.2 ± 14.7 to 191.3 ± 14.4 ml) was observed in the first group, and an 11.8% reduction (from 203.2 ± 13.4 to 179.3 ± 12.9 ml) in the second group. Hemodynamic improvements also included reductions in ESV: 36.5% (from 148.2 ± 3.4 to 94.2 ± 3.37 ml) and in systolic pulmonary artery pressure by 43.3% (from 30.3 ± 4.1 to 23.2 ± 3.8 mmHg) in the first group. In the second group, ESV decreased by 25.2% (from 127.5 ± 2.7 to 95.4 ± 3.1 ml), and systolic pulmonary artery pressure decreased by 14% (from 37.4 ± 3.9 to 32.4 ± 3.5 mmHg). Speckle-tracking echocardiography demonstrated significant improvement in left ventricular deformation patterns–both longitudinal and circumferential–in both groups. Conclusion. Both techniques are effective in restoring left ventricular contractility and can be used in this group of patients. However, there are inherent advantages of direct bundle branch block pacing: it significantly shortens QRS duration, as our results showed, there were no failed electrode placement attempts, which even required thoracotomy with biventricular pacing. Left bundle branch block pacing offers several potential advantages over biventricular pacing , including lower pacing thresholds, no atrial capture, and less technical complexity.

Pre-implantation screening is a crucial step in preventing inappropriate sensing in patients with subcutaneous implantable cardioverter defibrillators (S-ICDs). Paced QRS-T morphology may influence screening outcomes. We aimed to explore the impact of pacing rhythm and different pacing sites on pre-implantation screening of S-ICD. This prospective, single-center study enrolled patients referred for radiofrequency ablation, with both left and right-heart access. A contact-force ablation catheter was used to mimic ventricular pacing at different sites. Automatic screening tests for S-ICD eligibility were performed during pacing and sinus rhythm. The impact of pacing sites on S-ICD eligibility was assessed. Thirty patients (age 54.0 ± 15.0 years, 73.3% male) were enrolled. The overall passing rate during intrinsic sinus rhythm was 86.7%. Compared with sinus rhythm, conduction system pacing from His bundle or left bundle branch demonstrated comparable pass rates and the number of passed vectors, whereas right ventricular septum (RVS) pacing exhibited significantly lower pass rates and less pass vectors. Among all RVS pacing sites, the lowest pass rate was observed at the apical portion, followed by middle and basal portion (p < 0.001 for all comparisons). Conduction system pacing preserves patient eligibility for S-ICD comparable to sinus rhythm, while RVS pacing significantly impairs sensing performance, with the greatest deterioration observed in apical pacing. These findings underscore the advantages of conduction system pacing in optimizing sensing function for patients eligible for both S-ICDs and pacemakers.

In Wilson's disease (WD), copper accumulation in the organs and/or damage caused by oxygen free radicals occurs due to disturbances in copper excretion. In our study, we aimed to evaluate cardiac involvement with advanced echocardiographic modalities (tissue Doppler echocardiography, strain and strain-rate echocardiography). Twenty WD patients and 20 healthy children from the Pediatric Gastroenterology Department of Diyarbakır Children's Hospital were included in the study between 2022 and 2023. The mean age of the WD patients was 12.89 ± 3.79 years. Left ventricular wall thicknesses and diameters (diastolic interventricular septum thickness, diastolic left ventricular posterior wall thickness, left ventricular end-diastolic diameter), left ventricular diastolic function parameters (E, A, E/A, deceleration time) and left ventricular ejection fraction and tricuspid annular plane systolic excursion were similar and not statistically significantly different in the WD and control groups. Mitral lateral e', mitral septal e' and tricuspid lateral e' velocities were lower in the WD patients and statistically significantly different from the controls (p = 0.02, 0.04 and 0.005, respectively), as assessed by tissue Doppler echocardiography. Global longitudinal systolic strain was similar in the WD and control groups and no statistically significant difference was detected. Longitudinal early diastolic strain rate was lower in the WD patients and statistically significantly different (p = 0.002). Subclinical early diastolic dysfunction and segmental systolic dysfunction were detected in WD patients with advanced echocardiographic modalities, in addition to normal cardiac function as assessed by conventional echocardiography. Advanced echocardiographic modalities can be used in the follow up of WD patients.

Prolonged Tp-Te interval is strongly associated with fatal ventricular arrhythmias and mortality. This association has been demonstrated in various diseases. However, the current literature does not give any information on Tp-Te interval in cardiac amyloid light-chain (AL) amyloidosis. We retrospectively screened 116 cardiac AL amyloidosis patients and 35 patients were included in the study. Demographic, laboratory, 12-lead electrocardiographic (QTc, Tp-Te V1-V6) and transthoracic echocardiographic data of the patients were analysed and compared with 35 healthy controls. QTc and Tp-Te V2-V5 were significantly prolonged in the cardiac AL amyloidosis group (p < 0.05). Also, there was a positive and statistically significant correlation between the parameters of QTc and Tp-Te V3-V6, and also between the parameters of interventricular septum thickness at enddiastole and Tp-Te V2-V5. We present the first strong evidence of prolonged Tp-Te intervals in patients with cardiac AL amyloidosis. There may also be a relationship between prolonged Tp-Te interval and the development of arrhythmia in this patient group, as in some other groups. There is a need for prospective studies examining the relationship of prolonged Tp-Te interval with arrhythmias and its prognostic significance in cardiac AL amyloidosis.

Previous studies have reported positive late gadolinium enhancement (LGE) rates ranging from 30% to 72% in dilated cardiomyopathy (DCM). There is no unified consensus on the relationship between different LGE features and left ventricular (LV) function. This study aimed to demonstrate the LGE characteristics in patients with DCM and to further investigate the relationship between LGE distribution, location and load and LV function. A total of 193 patients diagnosed with DCM were enrolled from February 2018 to May 2020 in the First Affiliated Hospital of Nanjing Medical University. All patients underwent cardiac magnetic resonance (CMR). The parameters of LV function, volume, and global LGE burden were obtained. According to the myocardial level of LGE distribution, stage of LGE distribution, and LGE load, the grouping included 3 types. A total of 127 patients (80.9%) were enrolled with LGE positive. The median LV LGE load was 15.5%. The proportion of midmyocardial and subepicardial myocardial involvement was significantly higher than that of subendocardial myocardial involvement (60.6%, 50.4% vs. 10.2%, P < 0.001). LGE distributed more often in the ventricular septum, which was significantly higher than in the free-wall segments. Left ventricular ejection fraction and global radial strain in the midmyocardial LGE group and the multilayer LGE group were lower than in the LGE(-) group (p < 0.005). Kaplan-Meier survival analysis revealed that compared to the LGE-negative group, both the midmyocardial LGE group and the multilayer LGE group exhibited significantly elevated risks of long-term MACE (Log-rank p < 0.05). Dilated cardiomyopathy LGE most commonly involves the septal myocardium of the basal and intermediate segments of the left ventricle, and predominantly involves the middle layer and subepicardium. LGE involvement of the LV midmyocardium is associated with poorer LV function and higher risks of long-term MACE.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-27411-0.

BackgroundUnderstanding the molecular mechanisms underlying cardiac aging may uncover novel therapeutic targets for age-related cardiovascular disease. Long non-coding RNAs (lncRNA), which regulate cell differentiation and disease progression, are emerging as promising diagnostic biomarkers and therapeutic candidates. However, their expression profiles and functional roles in the aging heart remain poorly characterized.MethodsMale C57BL/6 wild type mice aged 20 months (aged group) and 3 months (young group) underwent transthoracic echocardiography to evaluate cardiac function. Myocardial aging phenotypes were assessed using hematoxylin-eosin, Masson’s trichrome, terminal deoxynucleotide transferase dUTP nick end labeling (TUNEL), and senescence-associated β-galactosidase staining. Transcriptomic profiling was performed using a lncRNA-focused microarray platform to identify differentially expressed lncRNAs and mRNAs in heart tissues.ResultsAged mice showed increased heart weight/body weight and heart weight/tibia length ratios. Both interventricular septum in systole and left ventricular posterior wall in diastole were elevated, while ejection fraction and fractional shortening remained unchanged. The Tei index was significantly higher, suggesting impaired myocardial performance. Histological staining revealed enlarged cardiomyocytes, increased myocardial fibrosis, enhanced apoptosis, and greater senescence-associated β-galactosidase activity. Microarray analysis identified distinct age-related expression patterns of lncRNAs and mRNAs in the heart.ConclusionsCardiac aging is characterized by structural and functional remodeling, accompanied by transcriptional reprogramming involving both lncRNAs and mRNAs. These changes offer insights into potential molecular mechanisms and provide candidate regulatory targets for diagnosis and intervention in age-related heart disease.

Morbity and mortality in Texel sheep following feed-based monensin overdose in Brazil.

Early diagnosis of transthyretin-amyloid cardiomyopathy (ATTR-CM) is key to early treatment initiation. Recent guidelines recommend using both single-photon emission computed tomography (SPECT) and planar imaging. However, whether combined use of planar imaging and SPECT improves diagnostic accuracy compared with histological confirmation is unclear. We assessed the significance of using both planar imaging and SPECT with bone-seeking tracer cardiac scintigraphy for diagnosing endomyocardial biopsy (EMB)-proven ATTR-CM. This retrospective observational study included 117 consecutive patients with suspected ATTR-CM who underwent bone-seeking tracer cardiac scintigraphy, among whom 42 underwent EMB based on positive planar imaging (Perugini grade ≥2) and/or positive SPECT results (uptake score ≥1). Of these 42 patients, 38 (91%) were histologically diagnosed with ATTR-CM. Among patients with concordantly positive planar imaging and SPECT, 36/37 (97%) were diagnosed with ATTR-CM. Among patients with discordant findings, 2/2 (100%) with negative planar but positive SPECT findings were diagnosed with ATTR-CM, whereas 0/3 (0%) with positive planar but negative SPECT findings were diagnosed with ATTR-CM. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SPECT for detecting transthyretin amyloid deposition on EMB were 100%, 75%, 97%, 100%, and 98%, respectively. On SPECT, tracer uptake was consistently and maximally observed in the interventricular septum in all cases of EMB-proven ATTR-CM (P < 0.001). SPECT has a high diagnostic ability in detecting EMB-proven ATTR-CM and effectively complements planar imaging by mitigating its limitations, reducing both false-positive and false-negative findings of planar imaging alone.