Ischemic Cardiomyopathy Research Articles

Incremental prognostic value of late gadolinium enhancement extent, transmurality, and pattern in patients with ischemic cardiomyopathy

Incremental prognostic value of late gadolinium enhancement extent, transmurality, and pattern in patients with ischemic cardiomyopathy

Extracellular vesicles (EVs): A promising therapeutic tool in the heart tissue regeneration.

Mesenchymal stem cells (MSCs) treatment has been widely explored as a therapy for myocardial infarction, peripheral ischemic vascular diseases, dilated cardiomyopathy, and pulmonary hypertension. Latest in vitro studies suggest that MSCs can differentiate into contractile cardiomyocytes. One of the best-characterized MSCs products are MSCs-derived extracellular vesicles (EVs). EVs are crucial paracrine effectors of MSCs. Based on previous works, paracrine effects of MSCs play a primary role in the regenerative ability. Hence, in the current paper, we focused our attention on an alternative approach, exploiting products derived from human dental pulp stem cells (hDPSCs) rather than MSCs themselves, which may denote a cost-effective and safer approach. The focus has been on EVs and the bioactive molecules they contain to evaluate their ability to influence the differentiation process toward cardiomyogenic lineage. The expression of GATA4, ACTC1, CX43, and Nkx2.5 was evaluated using Immunofluorescence, real time-PCR, and Western blotting analyses. Furthermore, the expression profiling analysis of the microRNA hsa-miR-200c-3p, targeting the GATA4 gene, was studied. The hsa-miR-200c-3p was found significantly down-regulated in both c-hDPSCs + EVs-hDPSCs and c-hDPSCs + EVs-HL-1 compared to untreated c-hDPSCs underlying a possible epigenetic mechanism behind the prevalent up-regulation of its targeted GATA4 gene. The aim of the present work was to develop an in vitro model of hDPSCs able to differentiate into cardiomyocytes in order to investigate the role of EVs derived from hDPSCs and derived from HL-1 cardiomyocyte cell line in modulating the differentiation process toward cardiomyogenic lineage.

The Impact of Positive Inotropic Therapy on Hemodynamics and Organ Function in Acute Heart Failure: A Differentiated View.

Little is known about the impact of treatment with inotropic drugs on the interaction of hemodynamics, biomarkers, and end-organ function in patients with acute decompensated heart failure (HF) of different origins and heart rhythms. Fifty patients with different causes of acute decompensated HF (dilated cardiomyopathy DCM, ischemic cardiomyopathy ICM, atrial fibrillation AF, sinus rhythm/pacemaker lead rhythm SR/PM) were treated with dobutamine or levosimendan. Non-invasive hemodynamics, biomarkers, and parameters of renal organ function were evaluated at hospital admission and after myocardial recompensation (day 5 to 7). Twenty-seven patients with ICM and twenty-three patients with DCM were included. Thirty-nine patients were treated with dobutamine and eleven with levosimendan. Sixteen were accompanied by persistent AF and thirty-four presented either with SR or PM. In the overall cohort, body weight and biomarkers (NT-proBNP/ST2) significantly decreased. GFR significantly increased during therapy with either dobutamine or levosimendan. However, hemodynamic parameters seem to be only improved in patients with DCM, in the levosimendan sub-group, and in patients with SR/PM. Patients with acute decompensated HF benefit from positive inotropic therapy during short-term follow-ups. In particular, patients with DCM, those after levosimendan therapy and those with SR/PM, seem to benefit most from inotropic therapy.

Impact of repeat ablation of ventricular tachycardia in patients with structural heart disease.

Recurrences of ventricular tachycardia (VT) after initial catheter ablation is a significant clinical problem. In this study, we report the efficacy and risks of repeat VT ablation in patients with structural heart disease (SHD) in a tertiary single centre over a 7-year period. Two hundred ten consecutive patients referred for repeat VT ablation after previous ablation in our institution were included in the analysis (53% ischaemic cardiomyopathy, 91% males, median age 65 years, mean left ventricular ejection fraction 35%). After performing repeat ablation, the clinical VTs were acutely eliminated in 82% of the patients, but 46% of the cohort presented with VT recurrence during the 25-month follow-up. Repeat ablation led to a 73% reduction of shock burden in the first year and 61% reduction until the end of follow-up. Similarly, VT burden was reduced 55% in the first year and 36% until the end of the study. Fifty-two patients (25%) reached the combined endpoint of ventricular assist device implantation, heart transplantation, or death. Advanced New York Heart Association functional class, anteroseptal substrate, and periprocedural complication after repeat ablation were associated with worse prognosis independently of the type of cardiomyopathy. While complete freedom from VT after repeat ablation in SHD was difficult to achieve, ablation led to a significant reduction in VT and shock burden. Besides advanced heart failure characteristics, anteroseptal substrate and periprocedural complications predicted a worse outcome.

VT ablation based on CT imaging substrate visualization: results from a large cohort of ischemic and non-ischemic cardiomyopathy patients

IntroductionThe eradication of ventricular tachycardia (VT) isthmus sites constitutes the minimal procedural endpoint for VT ablation procedures. Contemporary high-resolution computed tomography (CT) imaging, in combination with computer-assisted analysis and segmentation of CT data, facilitates targeted elimination of VT isthmi. In this context, inHEART offers digitally rendered three-dimensional (3D) cardiac models which allow preoperative planning for VT ablations in ischemic and non-ischemic cardiomyopathies. To date, almost no data have been collected to compare the outcomes of VT ablations utilizing inHEART with those of traditional ablation approaches.MethodsThe presented data are derived from a retrospective analysis of n = 108 patients, with one cohort undergoing VT ablation aided by late-enhancement CT and subsequent analysis and segmentation by inHEART, while the other cohort received ablation through conventional methods like substrate mapping and activation mapping. The ablations were executed utilizing a 3D mapping system (Carto3), with the mapping generated via the CARTO® PENTARAY™ NAV catheter and subsequently merged with the inHEART model, if available.ResultsResults showed more successful outcome of ablations for the inHEART group with lower VT recurrence (27% vs. 42%, p < 0.06). Subsequent analyses revealed that patients with ischemic cardiomyopathies appeared to derive a significant benefit from inHEART-assisted VT ablation procedures, with a higher rate of successful ablation (p = 0.05).ConclusionOur findings indicate that inHEART-guided ablation is associated with reduced VT recurrence compared to conventional procedures. This suggests that employing advanced imaging and computational modeling in VT ablation may be valuable for VT recurrences.Graphical abstract

Circulating microRNAs as biomarkers of Chagas cardiomyopathy.

Chagas cardiomyopathy (CHCM) is the most important clinical manifestation of Chagas disease. The analysis of cardiac miRNAs may contribute to predicting the progression to CHCM in Chagas indeterminate phase and/or to the differential diagnosis for cardiomyopathy. We carried out a case-control study to identify circulating miRNAs associated with CHCM. We assigned 104 participants to four groups: healthy controls (HC), Chagas non-cardiomyopathy controls, CHCM cases, and ischemic cardiomyopathy controls. We performed a clinical, echocardiographic, and laboratory evaluation and profiled circulating miRNA in the serum samples. Differences between groups were observed in clinical variables and in the analysis of miRNAs. Compared to HC, CHCM participants had 4 over-expressed and 6 under-expressed miRNAs; miR-95-3p and miR-130b-3p were upregulated in CHCM compared with controls, Chagas non-cardiomyopathy and ischemic cardiomyopathy participants, suggesting that might be a hallmark of CHCM. Analysis of gene targets associated with cardiac injury yielded results of genes involved in arrhythmia generation, cardiomegaly, and hypertrophy. Our data suggest that the expression of circulating miRNAs identified by deep sequencing in CHCM could be associated with different cardiac phenotypes in CHCM subjects, compared with Chagas non-CHCM, ischemic cardiomyopathy controls, and healthy controls.

Heart Failure Readmissions: A Deep Dive into Patient Demographics, Comorbidities, and Systemic Challenges

Background: Heart failure (HF) is a leading cause of hospital readmissions, presenting significant challenges in healthcare. Comorbid conditions like diabetes and hypertension are prevalent among HF patients and may complicate disease management. Understanding these dynamics is crucial for developing effective intervention strategies. Objective: This study aims to analyze the factors contributing to HF readmissions, focusing on patient demographics, comorbidities, and systemic healthcare challenges. Methods: A comprehensive, retrospective cohort analysis was conducted at a tertiary care cardiac center. The study included 1,000 patients with a documented history of HF and instances of hospital readmissions. Patient selection was based on age (≥18 years), a diagnosis of HF, and readmission within six months post-discharge. Exclusion criteria included planned readmissions for elective procedures and cognitive impairments impeding consent. Data collection encompassed patient demographics, clinical history, comorbidity details, initial hospitalization, and readmission information. Descriptive statistics were employed to analyze and summarize the data. Results: The cohort comprised 80% male (n=800) and 20% female (n=200) with a mean age of 58 years. The median hospital stay was 6 days. Comorbidities included diabetes (78%, n=780) and hypertension (56%, n=560). The primary cause of HF was ischemic cardiomyopathy (82%, n=820). The leading reasons for readmission were lack of counseling (42%, n=420), underdosage of medication (16%, n=160), and non-compliance to medication (13%, n=130). Other factors included volume overload (11%, n=110), secondary hypertensive failure (9%, n=90), infections (6%, n=60), anemia (2%, n=20), and progressive renal failure (1%, n=10). Conclusion: The study highlights the complexity of managing HF, emphasizing the need for comprehensive approaches addressing patient education, medication management, and comorbidity control. Improved patient counseling and adherence to treatment regimens could significantly reduce HF readmissions.

Ischemic cardiomyopathy: epidemiology, pathophysiology, outcomes, and therapeutic options.

Ischemic cardiomyopathy (ICM) is the most prevalent cause of heart failure (HF) in developed countries, with significant morbidity and mortality, despite constant improvements in the management of coronary artery disease. Current literature on this topic remains fragmented. Therefore, this review aimed to summarize the most recent data on ICM, focusing on its definition, epidemiology, outcomes, and therapeutic options. The most widely accepted definition is represented by a left ventricular dysfunction in the presence of significant coronary artery disease. The prevalence of ICM is largely influenced by age and sex, with older individuals and males being more affected. Its pathophysiology is characterized by plaque buildup, thrombus formation, hypoperfusion, ischemic cell death, and left ventricular remodeling. Despite improvements in therapy, ICM still represents a public health burden, with a 1-year mortality rate of 16% and a 5-year mortality rate of approximately 40% in the USA and Europe. Therefore, optimization of cardiovascular function, prevention of progressive remodeling, reduction of HF symptoms, and improved survival are the main goals of treatment. Therapeutic options for ICM include lifestyle changes, optimal medical therapy, revascularization, device therapy, mechanical circulatory support, and cardiac transplantation. Personalized management strategies and tailored patient care are needed to improve the outcomes of patients with ICM.

Mortality Associated With Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair: North American Mitraclip for Functional Mitral Regurgitation Registry

The association, if any, between the effective regurgitant orifice area (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients who undergo mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, CA). This study's objective was to determine the association between EROA/LVEDV and 1-year mortality in patients who undergo m-TEER with MitraClip. In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. We studied 525 patients with secondary MR who underwent m-TEER. Most patients were male (63%) and were New York Heart Association class III (61%) or IV (21%). Mitral regurgitation was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely, with median=0.19 mm2/ml, interquartile range [0.12,0.28] mm2/ml, and 187 patients (36%) had values <0.15 mm2/ml. Postprocedural mitral regurgitation severity was substantially alleviated, being 1+ or less in 74%, 2+ in 20%, 3+ in 4%, and 4+ in 2%; 1-year mortality was 22%. After adjustment for confounders, the logarithmic transformation (Ln) of EROA/LVEDV was associated with 1-year mortality (odds ratio 0.600, 95% confidence interval 0.386 to 0.933, p=0.023). A higher Society of Thoracic Surgeons risk score was also associated with increased mortality. In conclusion, lower values of Ln(EROA/LVEDV) were associated with increased 1-year mortality in this multicenter registry. The slope of the association is steep at low values but gradually flattens as Ln(EROA/LVEDV) increases.

Difficulties in diagnosing and predicting possible complications in patients after heart transplantation: single-center experience in the Krasnodar region

Aim. To evaluate the early and long-term outcomes of heart transplantation (HT) at the Research Institute of the S. V. Ochapovsky Regional Clinical Hospital № 1.Material and methods. On the basis of the Research Institute of the S. V. Ochapovsky Regional Clinical Hospital № 1 from March 2010 to March 2023, 230 HTs were carried out. Among the patients, men predominated 86% (n=198), women — 14% (n=32). The mean age was 48,3±11,7 years. The reason for HT in 42,6% (n=98) was ischemic cardiomyopathy (ICM), in 40% (n=92) — dilated cardiomyopathy (DCM), while 17,4% were operated on for another cardiac pathology (n=40). All recipients underwent immunological examination, endomyocardial biopsy (EMB), 2D-speckle-tracking echocardiography (2D-STE), transthoracic echocardiography (TTE), coronary angiography (CAG), as well as a number of studies for early diagnosis of possible cancer complications.Results. Acute rejection during the first three years was detected in 77 recipients (42,5%), of which cellular rejection (grade ≥2, 3) and humoral rejection was verified in 49 and 28 recipients, respectively. During the entire follow-up period, de novo anti-human leukocyte antigen (HLA) antibodies were detected in 34 recipients in the posttransplantation period, of which 50% (n=17) and 35% (n=12) were diagnosed with humoral and cellular rejection, respectively. Of the 34 patients with anti-HLA antibodies, 11 (32%) died. All of them died due to a humoral rejection. The survival rate of patients with antibodies was lower (59%) than in patients without antibodies (66%), p=0,023. The annual survival rate of all patients after transplantation in our center was 83,1% (during the first year after transplantation, 30 and 9 patients died due to an acute rejection and infectious complications, respectively).Conclusion. Since the introduction and modification of immunosuppressive therapy regimens, tremendous progress has occurred, and the incidence of acute cellular rejection has decreased. However, the risk of humoral rejection and long-term complications remains one of the main reasons for graft failure.

Chronic kidney disease is related to impaired left ventricular strain as assessed by cardiac magnetic resonance imaging in patients with ischemic cardiomyopathy

IntroductionChronic kidney disease (CKD) is an important cardiovascular risk factor. However, the relationship between CKD and myocardial strain as a parameter of myocardial function is still incompletely understood, particularly in patients with ischemic cardiomyopathy (ICM). Cardiac magnetic resonance imaging (CMR) feature tracking allows to analyze myocardial strain with high reproducibility. Therefore, the aim of the present study was to assess the relationship between CKD and myocardial strain as described by CMR in patients with ICM.MethodsWe retrospectively performed CMR-based myocardial strain analysis in 89 patients with ICM and different stages of CKD, classified according to the KDIGO stages. In all patients, global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) analysis of left ventricular myocardium were performed. Furthermore, segmental longitudinal (SLS), circumferential (SCS) and radial strain (SRS) according to the AHA 16/17-segment model was determined.ResultsCreatinine levels (GLS: r = 0.46, p < 0.001; GCS: r = 0.34, p = 0.001; GRS: r = − 0.4, p < 0.001), urea levels (GLS: r = 0.34, p = 0.001; GCS: r = 0.30, p = 0.005; GRS: r = − 0.31, p = 0.003) as well as estimated glomerular filtration rate (GLS: r = -0.40, p < 0.001; GCS: r = − 0.27, p = 0.012; GRS r = 0.34, p < 0.001) were significantly associated with global strains as determined by CMR. To further investigate the relationship between CKD and myocardial dysfunction, segmental strain analysis was performed: SLS was progressively impaired with increasing severity of CKD (KDIGO-1: − 11.93 ± 0.34; KDIGO-5: − 7.99 ± 0.38; p < 0.001 for KDIGO-5 vs. KDIGO-1; similar data for SCS and SRS). Interestingly, myocardial strain was impaired with CKD in both segments with and without scarring. Furthermore, in a multivariable analysis, eGFR was independently associated with GLS following adjustment for LV-EF, scar burden, diabetes, hypertension, age, gender, LV mass or LV mass index.ConclusionCKD is related to impaired LV strain as assessed by CMR in patients with ICM. In our cohort, this relationship is independent of LV-EF, the extent of myocardial scarring, diabetes, hypertension, age, gender, LV mass or LV mass index.

Predicting long-term survival after de novo cardioverter-defibrillator implantation for primary prevention: A population based study

BackgroundImplantable cardioverter-defibrillators (ICDs) reduce the risk of sudden cardiac death in patients with left ventricular dysfunction. While short-term mortality benefit of ICD insertion has been established in landmark randomized controlled trials, little is known about the long-term outcomes of patients with ICDs in clinical practice. In this paper, we describe the long-term survival of patients following de novo ICD implantation for primary prevention in clinical practice and determine the factors which help predict survival after ICD implant. MethodsRetrospective population-based study of all patients receiving a de novo ICD for primary prevention in Ontario, Canada from 2007 to 2011 using the Ontario ICD Database housed within ICES. Simple random selection was used to split the population into a derivation and internal validation cohort in a ratio of 2:1. Cox proportional hazards regression was used to determine predictors of interest and predict 10-year survival, model performance was assessed using calibration and validation. ResultsIn the derivation cohort (n = 3399), mean age was 65.3 years (standard deviation [SD] = 11.0), 664 patients were female (19.5 %) and 2344 patients (69.0 %) had ischemic cardiomyopathy. Ten year survival was 45.7 % (95 % confidence interval [CI] 44.0 %–47.4 %). The final prediction model included age, sex, disease factors (ischemic vs nonischemic cardiomyopathy, left ventricular ejection fraction) and patient factors (symptoms, comorbidities), and biomarkers at the time of ICD assessment. This model had good discrimination and calibration in derivation (0.79, 95 % CI 0.77, 0.81) and validation samples (0.78, 95 % CI 0.76, 0.79). ConclusionsA combination of demographic and clinical factors determined at baseline can be used to predict 10-year survival in patients with implantable cardioverter-defibrillators with good accuracy. Our findings help to identify individuals at risk of long-term mortality and may be useful in targeting future prevention strategies to enhance longevity in this high-risk population.

Post-transplant survival with pre-transplant durable continuous-flow mechanical circulatory support in a Swiss cohort of heart transplant recipients.

Worldwide, almost half of all heart transplantation candidates arrive today at their transplant operation with durable continuous-flow mechanical circulatory support (CF-MCS). This evolution is due to a progressive increase of waiting list time and hence an increased risk of haemodynamic worsening. Longer duration of CF-MCS is associated with a higher risk of device-related complications with potential adverse impact on post-transplant outcome as suggested by recent results from the United Network of Organ Sharing of the United States. A 2-centre Swiss heart transplantation programme conducted a retrospective observational study of consecutive patients of theirs who underwent a transplant in the period 2008-2020. The primary aim was to determine whether post-transplant all-cause mortality is different between heart transplant recipients without or with pre-transplant CF-MCS. The secondary outcome was the acute cellular rejection score within the first year post-transplant. The study participants had a median age of 54 years; 38/158 (24%) were females. 53/158 study participants (34%) had pre-transplant CF-MCS with a median treatment duration of 280 days. In heart transplant recipients with pre-transplant CF-MCS, the prevalence of ischaemic cardiomyopathy was higher (51 vs 32%; p = 0.013), the left ventricular ejection fraction was lower (20 vs 25; p = 0.047) and pulmonary vascular resistance was higher (2.3 vs 2.1 Wood Units; p = 0.047). Over the study period, the proportion of heart transplant recipients with pre-transplant CF-MCS and the duration of pre-transplant CF-MCS treatment increased (2008-2014 vs 2015-2020: 22% vs 45%, p = 0.009; increase of treatment days per year: 34.4 ± 11.2 days, p = 0.003; respectively). The primary and secondary outcomes were not different between heart transplant recipients with pre-transplant CF-MCS or direct heart transplantation (log-rank p = 0.515; 0.16 vs 0.14, respectively; p = 0.81). This data indicates that the strategy of pre-transplant CF-MCS with subsequent orthotopic heart transplantation provides post-transplant outcomes not different to direct heart transplantation despite the fact that the duration of pre-transplant assist device treatment has progressively increased.

Myocardial infarct size for predicting improvements in cardiac function in patients with ischemic cardiomyopathy following coronary artery bypass grafting.

This study used late gadolinium enhancement-cardiac magnetic resonance (LGE-CMR) to assess myocardial infarct size, with the data being employed to predict whether patients with ischemic cardiomyopathy (ICM) would experience improvements in left ventricular function at 6 months following coronary artery bypass grafting (CABG). The data of patients with ICM with left ventricular ejection fraction (LVEF) ≤40% who underwent CABG were retrospectively analyzed. All patients underwent preoperative LGE-CMR imaging. Echocardiography results from 6 months post-CABG were used to assess improvements in LVEF, with improvement being defined as ΔLVEF ≥5%. The value of myocardial infarction segments and infarct size as predictors of improved cardiac function following CABG was analyzed. Of the included patients, 66.7% (52/78) exhibited improved cardiac function at 6 months post-CABG. LGE-CMR imaging data revealed that compared to improved group, the improved group had significantly more myocardial infarct segments [improved group: median 1.0, interquartile range (IQR) 0-3; nonimproved group: median 4.0, IQR 3.0-6.0; P<0.001] and significantly greater myocardial infarct size (improved group: 22.4%±8.2%; nonimproved group: 34.7%±5.9%; P<0.001). The area under the receive operating characteristic curve values for myocardial infarct size in predicting cardiac function improvement were significantly higher than those of myocardial infarct segments (0.88 vs. 0.81; P=0.041). The respective sensitivity and specificity values for using a myocardial infarct size cutoff of 26.4% in differentiating between these 2 patient groups were 92.3% and 71.2%, respectively. According to logistic regression analysis, myocardial infarct size was an independent predictor of nonimprovement in cardiac function [odds ratio (OR) =1.244; 95% confidence interval (CI): 1.114-1.389; P<0.001]. A median 1.6-year follow-up interval (range, 0.5-4.1 years) revealed that the incidences of major adverse cerebrovascular events and cardiovascular events were significantly higher in the nonimproved group (5.8% vs. 26.9%; P<0.001), with these individuals having a higher New York Heart Association grading than patients with improved cardiac function (P=0.019). Myocardial infarct size can be measured to reliably predict improvements in cardiac function in patients with ICM following CABG. These results can guide clinicians in their efforts to identify those patients most likely to achieve positive outcomes following CABG.

Prediction of left ventricular ejection fraction improvement in patients with ischemic cardiomyopathy after coronary artery bypass grafting based on cardiac magnetic resonance.

To investigate the risk factors of left ventricular ejection fraction (LVEF) improvement in patients with ischemic cardiomyopathy (ICM) after coronary artery bypass grafting (CABG), and to construct a model that predicts LVEF improvement. A retrospective analysis was performed on 106 ICM patients who received CABG and underwent cardiac magnetic resonance (CMR) at Beijing Anzhen Hospital, Capital Medical University from January 2017 to June 2022. Patients were divided into two groups with improved LVEF and no improved LVEF based on the results of postoperative 6-month transthoracic echocardiography. To analyze the risk factors affecting the LVEF non-improvement after CABG and establish a prediction model. There was LVEF non-improvement in 30.2% (32/106) of patients. Multivariate analysis showed that the number of transmural scar segments and left ventricular end-systolic volume index (LVESVI) were independent risk factors in LVEF non-improvement after CABG [odds ratio (OR) =2.398, 95% confidence interval (CI): 1.607-3.579, P<0.001; OR =1.036, 95% CI: 1.009-1.063, P=0.008]. The model is built and internally verified. ROC showed that the area under the curve (AUC) was 0.866 (95% CI: 0.792-0.940), calibration curve showed that the probability predicted by the model matched well with the clinical results, and decision curve analysis (DCA) showed that the model had good clinical applicability. During the mean follow-up time of 1.5 years, the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the LVEF non-improvement group was higher (5.4% vs. 25.0%, P=0.009), and the NYHA grading was higher (P=0.016), when compared to the LVEF improvement group. The prediction model based on the number of transmural scar segments and LVESVI has good diagnostic efficacy. Our findings help to identify patients with improved LVEF and thus guide the selection of clinical treatment strategies.

Multiple Implantable Cardioverter-Defibrillator Shocks in Ischemic Cardiomyopathy Compels Coronary Vascularization Reassessment

Abstract The increasing number of patients with heart failure and implantable cardioverter-defibrillators (ICD) has led to a growing of the emergency presentations for ICD internal shocks. Appropriate shocks are sometimes caused by acute events in the course of disease and could be one of the earliest symptoms contributing to the diagnosis and timely treatment of these acute conditions. We present the case of a 64-year-old male patient with ischemic cardiomyopathy, ICD carrier, who presented to the emergency department for recurrent appropriate ICD shocks caused by episodes of polymorphic ventricular tachycardia and ventricular fibrillation. Even if he did not have chest pain, he was referred to cath lab, where the coronary angiography has shown a severe stenosis at the origin of the left anterior descending artery and a moderate stenosis at the proximal left circumflex artery. The percutaneous revascularization of both lesions resulted in the eradication of the sustained ventricular arrhythmias and the improvement of the clinical status. The case argues for the need for coronary vascularization assessment in ICD carrier patients with ischemic heart failure and adequate recurrent shocks, also emphasizing the importance of remote monitoring in early diagnosis of acute conditions in these patients.

Parameters of the mitral apparatus in patients with ischemic and nonischemic dilated cardiomyopathy.

The mitral valve apparatus is a complex structure consisting of several coordinating components: the annulus, two leaflets, the chordae tendineae, and the papillary muscles. Due to the intricate interplay between the mitral valve and the left ventricle, a disease of the latter may influence the normal function of the former. As a consequence, valve insufficiency may arise despite the absence of organic valve disease. This is designated as functional or secondary mitral regurgitation, and it arises from a series of distortions to the valve components. This narrative review describes the normal anatomy and the pathophysiology behind the mitral valve changes in ischemic and non-ischemic dilated cardiomyopathies. It also explains the value of a complete multiparametric assessment of this structure. Not only must an assessment include quantitative measures of regurgitation, but also various anatomical parameters from the mitral apparatus and left ventricle, since they carry prognostic value and are predictors of mitral valve repair success and durability.

A Powerful Tool in the Treatment of Myocardial Ischemia-Reperfusion Injury: Natural and Nanoscale Modified Small Extracellular Vesicles Derived from Mesenchymal Stem Cells.

Myocardial ischemia-reperfusion injury (MI/RI) constitutes a pivotal determinant impacting the long-term prognosis of individuals afflicted by ischemic cardiomyopathy subsequent to reperfusion therapy. Stem cells have garnered extensive application within the realm of MI/RI investigation, yielding tangible outcomes. Stem cell therapy encounters certain challenges in its application owing to the complexities associated with stem cell acquisition, a diminished homing rate, and a brief in vivo lifespan. Small extracellular vesicles (sEV) originating from mesenchymal stem cells (MSCs) have been demonstrated to possess the benefits of abundant availability, reduced immunogenicity, and a diminished tumorigenic incidence. They can exert their effects on damaged organs, improving injuries by transporting a lot of constituents, including proteins, RNA, lipid droplets, and more. This phenomenon has garnered substantial attention in the context of MI/RI treatment. Simultaneously, MSC-derived sEV (MSC-sEV) can exhibit enhanced therapeutic advantages through bioengineering modifications, biomaterial incorporation, and natural drug interventions. Within this discourse, we shall appraise the utilization of MSC-sEV and their derivatives in the context of MI/RI treatment, aiming to offer valuable insights for future research endeavors related to MI/RI.

Compressed SENSE accelerated 3D single-breath-hold late gadolinium enhancement cardiovascular magnetic resonance with isotropic resolution: clinical evaluation

AimThe purpose of this study was to investigate the clinical application of Compressed SENSE accelerated single-breath-hold LGE with 3D isotropic resolution compared to conventional LGE imaging acquired in multiple breath-holds.Material &amp;amp; MethodsThis was a retrospective, single-center study including 105 examinations of 101 patients (48.2 ± 16.8 years, 47 females). All patients underwent conventional breath-hold and 3D single-breath-hold (0.96 × 0.96 × 1.1 mm3 reconstructed voxel size, Compressed SENSE factor 6.5) LGE sequences at 1.5 T in clinical routine for the evaluation of ischemic or non-ischemic cardiomyopathies. Two radiologists independently evaluated the left ventricle (LV) for the presence of hyperenhancing lesions in each sequence, including localization and transmural extent, while assessing their scar edge sharpness (SES). Confidence of LGE assessment, image quality (IQ), and artifacts were also rated. The impact of LV ejection fraction (LVEF), heart rate, body mass index (BMI), and gender as possible confounders on IQ, artifacts, and confidence of LGE assessment was evaluated employing ordinal logistic regression analysis.ResultsUsing 3D single-breath-hold LGE readers detected more hyperenhancing lesions compared to conventional breath-hold LGE (n = 246 vs. n = 216 of 1,785 analyzed segments, 13.8% vs. 12.1%; p &amp;lt; 0.0001), pronounced at subendocardial, midmyocardial, and subepicardial localizations and for 1%–50% of transmural extent. SES was rated superior in 3D single-breath-hold LGE (4.1 ± 0.8 vs. 3.3 ± 0.8; p &amp;lt; 0.001). 3D single-breath-hold LGE yielded more artifacts (3.8 ± 1.0 vs. 4.0 ± 3.8; p = 0.002) whereas IQ (4.1 ± 1.0 vs. 4.2 ± 0.9; p = 0.122) and confidence of LGE assessment (4.3 ± 0.9 vs. 4.3 ± 0.8; p = 0.374) were comparable between both techniques. Female gender negatively influenced artifacts in 3D single-breath-hold LGE (p = 0.0028) while increased heart rate led to decreased IQ in conventional breath-hold LGE (p = 0.0029).ConclusionsIn clinical routine, Compressed SENSE accelerated 3D single-breath-hold LGE yields image quality and confidence of LGE assessment comparable to conventional breath-hold LGE while providing improved delineation of smaller LGE lesions with superior scar edge sharpness. Given the fast acquisition of 3D single-breath-hold LGE, the technique holds potential to drastically reduce the examination time of CMR.

Association of SGLT2is with cardiovascular and reproductive diseases: a meta-analysis based on 14 large-scale randomized trials.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) can improve long-term cardio-renal outcomes in patients with diabetes, heart failure (HF), or renal failure. We aimed to investigate the association of SGLT2is with the risks of various cardiovascular and reproductive diseases. Large-scale randomized trials enrolling more than 1000 participants and assessing SGLT2is were included. Outcomes of interest were the various serious adverse events related to cardiovascular or reproductive diseases. Meta-analysis was done to generate pooled risk ratio (RR) and 95% confidence interval (CI). We included 14 large trials and evaluated 169 types of cardiovascular and reproductive diseases. SGLT2is were significantly associated with the lower risks of 13 types of cardiovascular diseases, e.g., cardiac failure chronic (RR 0.70, 95% CI 0.57-0.87), cardiac failure congestive (RR 0.74, 95% CI 0.66-0.83), acute cardiac failure (RR 0.72, 95% CI 0.60-0.86), coronary artery disease (RR 0.75, 95% CI 0.58-0.97), ischemic cardiomyopathy (RR 0.72, 95% CI 0.52-0.99), atrial fibrillation (RR 0.88, 95% CI 0.78-0.99), bradycardia (RR 0.72, 95% CI 0.53-0.99), and hypertension (RR 0.70, 95% CI 0.54-0.91). SGLT2is were not significantly associated with 18 types of reproductive diseases, e.g., adenomyosis, endometrial hyperplasia, and metrorrhagia. Although SGLT2is were observed to have a significant association with a higher risk of uterine prolapse, the 95% CI of RR for this outcome was relatively wide. This meta-analysis confirms the benefits of SGLT2is against chronic congestive HF again; reveals the possible benefits of SGLT2is against acute HF, myocardial infarction, arrhythmias, and hypertension; and identifies that SGLT2is are safe in general for the reproductive system.