Left Atrium Research Articles

Distinct methylome profile of cfDNA in AMI patients reveals significant alteration in cAMP signaling pathway genes regulating cardiac muscle contraction

BackgroundThe role of epigenetics in cardiovascular diseases has paved the way for innovative therapeutic approaches. Investigating epigenetic changes using cell-free DNA (cfDNA) holds substantial promise beyond mere diagnostics, especially for heart-related conditions like acute myocardial infarction (AMI), where obtaining tissue samples is a challenge. This study explores the methylation patterns of cfDNA in AMI patients and compares them with genomic DNA (gDNA) from the same individuals, aiming to evaluate the effectiveness of cfDNA as a valuable resource for studying heart-related diseases.MethodologyWe generated global methylome profiles of cfDNA and gDNA from 25 AMI patients using EM-Seq. Tissue deconvolution analysis was performed to estimate tissue specificity based on the methylation patterns. Differentially methylated loci were identified and explored to understand AMI pathophysiology.ResultsComparative analysis of cfDNA and gDNA methylation patterns in AMI patients reveals cfDNA holds more significance than gDNA. Principal component analysis revealed distinct clusters for cfDNA and gDNA, indicating distinct methylome profiles. cfDNA originated from multiple sources, predominantly from neutrophils (~ 75%) and about 10% from the left atrium, highlighting cardiac-specific changes. In contrast, immune cells are the major source of gDNA, indicative of inflammatory responses. Gene set enrichment analysis (GSEA) associates cfDNA methylation patterns with pathways related to cardiac muscle contraction, inflammation, hypoxia, and lipid metabolism. The affected genes include G protein-coupled receptors (GHSR, FFAR2, HTR1A, and VIPR2) that are part of the cAMP signaling pathway.ConclusionEpigenetic changes in cfDNA are more specific to cardiac tissue compared to those in gDNA, providing better insights into the molecular mechanisms involved in AMI. Genes that are differentially methylated in cfDNA and regulate core pathways, such as cAMP signaling, could be targeted for clinical applications, including the development of effective biomarkers and therapeutic targets.

Right-to-left-shunts in patients scheduled for neurosurgical intervention in semi-sitting position – a literature review based on two case scenarios

BackgroundNeurosurgery performed in the semi-sitting position provides advantages for certain procedures. However, this approach is associated with potential complications, particularly venous air embolism. Due to typically negative venous pressure at the wound site, air can be drawn into the veins. This risk is especially high in patients presenting with an intra- or extracardiac right-to-left-shunt. Transoesophageal echocardiography can be used to detect a patent foramen ovale or other possible pulmonary-systemic shunt before placing the patient in the sitting position.Case presentationIn this report, we present two young patients undergoing scheduled microsurgical vestibular schwannoma removal in a semi-sitting position who were diagnosed with congenital heart defects during routine perioperative assessment to detect possible intracardiac right-to-left shunts, using pre- and intraoperative transesophageal echocardiography (TEE) and additionally conducting an agitated saline bubble study under Valsalva manoeuvre. Patient A was diagnosed with a persistent left superior vena cava and Patient B with an unroofed coronary sinus (UCS). These findings confronted the anesthesiological and surgical teams with difficult individual decisions regarding further perioperative management.ConclusionsPerioperative transesophageal echocardiography is a diagnostic tool to both detect intraoperative position-related air embolisms and to rule out intracardiac right-to-left shunts, e.g. a patent foramen ovale, in order to decide for or against a (semi-)sitting position. Depending on the surgical circumstances a semi-sitting positioning of patients presenting with an intracardiac right-to-left-shunt, e.g. a PFO, can be feasible in individual cases if there is an implemented therapeutic algorithm to immediately terminate significant venous air entry. However, since certain other intra- or extracardiac right-to-left-shunts, such as here presented PLSVC or UCS, are rare, there is no definitive way of estimating the amount of entered air through detected shunts or anomalous vessels. Therefore, it is recommended to avoid a (semi-)sitting position in favour of a lateral or prone position for a patient undergoing intracranial surgery, once the perioperative TEE shows air bubbles in the left atrium or ventricle whose origins cannot be defined solely through TEE for certain in order to ensure patient safety by minimizing the risk of intraoperative paradoxical air embolisms.

Clinical relevance of left atrial structural remodeling and non-pulmonary vein foci in atrial fibrillation.

The mechanistic role of left atrial (LA) structural remodeling as a non-pulmonary vein (PV) trigger in the initiation of atrial fibrillation (AF) remains uncertain. This study is aimed at prospectively evaluating the association between non-PV triggers and LA structural remodeling. A total of 517 patients undergoing catheter ablation for AF were included. After PV isolation, a standardized protocol was implemented to reveal non-PV triggers, which included burst pacing into AF followed by cardioversion during isoproterenol infusion. If pacing-induced atrial tachycardia (AT) was observed, mapping and catheter ablation were performed. The mean percentage of LA low-voltage area (LVA) < 0.5mV incrementally increased during right atrial pacing among the no induction (n = 470), AF (n = 21), and AT (n = 26) groups (2.6 ± 5.7%, 5.5 ± 6.4%, and 18.0 ± 21.5%, respectively; P < 0.001). In the AF induction group, non-PV foci originated from the left atrium in 13 of 25 foci (52%), and 8 of 13 LA non-PV foci (62%) were located in the septal region. All except 1 focus originated from the non-LVA < 0.5mV (8%), but 8 of the 13 LA foci originated from the LVA < 1.0mV (62%). There were no differences in AF recurrence among the groups (log-rank, P = 0.160). The majority of non-PV foci in the LA originated outside regions with advanced structural remodeling, thus suggesting the limited effectiveness of adjunctive ablation guided by the LVA < 0.5mV during sinus rhythm in eliminating non-PV triggers.

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.

A preliminary investigation of the left atrial suspended cord and its significance as revealed by coronary CT angiography: an observational study with a systematic literature review

BackgroundThe occurrence of suspended cords of the left atrium (SCLA) is rare and has seldom been described. The purpose of this study was to summarize the cases of SCLA accidentally detected by coronary CT angiography (CCTA), describe their imaging features, conduct a preliminary analysis of their clinical significance, and review relevant literature.MethodsA total of 10,796 patients who underwent CCTA examinations from July 2020 to November 2021 were consecutively selected. The original and three-dimensional reconstruction images were reviewed to identify patients with SCLA. A control group was selected in a 1:2 ratio based on age, BMI, sex, and education level. The imaging characteristics and clinical data of the two groups were collected and compared. The case group was divided into two subgroups based on the starting and ending positions of the SCLA: Group 1 with the SCLA between the free wall and free wall, and Group 2 with the SCLA between the septum wall and free wall. The clinical features of these subgroups were compared. Furthermore, a review of literature on SCLA published in the past fifteen years that includes its clinical and imaging features was conducted.ResultsIn this study, a total of 35 patients were found to have SCLA, resulting in an incidence rate of approximately 0.32%. After excluding 1 patient for whom clinical features could not be obtained, the case group included a total of 18 males and 16 females, with a male-to-female ratio of 1:1 and a median age of 57.00 (52.00–64.00) years. It was found that 19 (55.88%) cases of SCLA were located near the right superior pulmonary vein ostia, while no SCLA was found near the left lower pulmonary vein orifice. A significant difference in the incidence of atrial arrhythmia between the two groups was observed (p = 0.009). Additionally, 3 patients (8.82%) in the SCLA group had a history of transient cerebral ischemic attack (TIA), which was significantly different from that in the control group (p = 0.035). The anteroposterior and transverse diameters of the left atrium were longer in the case group than in the control group (p < 0.05), but there was no significant change in left atrial volume. Subgroup analyses found no significant difference in the incidence of cerebral infarction, atrial arrhythmia, or other intracardiac structural malformations, although there was a significant difference in cord length (p = 0.013), with the length of SCLA in Group 1 and Group 2 being 2.64 ± 0.99 cm and 3.39 ± 0.68 cm, respectively. Notably, only 1 of these 34 patients was diagnosed based on echocardiography, whereas all cases were perfectly visualized using CCTA.ConclusionSCLA is rare. CCTA can accurately detect and depict this abnormal structure as compared to echocardiography. SCLA may be linked to a higher incidence of atrial arrhythmias or transient ischemic attacks. It is important for radiologists and cardiovascular experts to recognize this structure, and further investigation is necessary to determine its clinical significance.

Impact of surgical and non-surgical weight loss on echocardiographic and strain parameters in Asian patients

Surgical weight loss (SWL) improves myocardial mechanics as measured by speckle-tracking imaging. However non-surgical versus SWL and the subsequent impact on myocardial function in overweight Asian subjects has not been evaluated. 66 patients underwent a 16-week lifestyle intervention (LSI) programme consisting of dietary interventions and exercise prescription. Echocardiography with speckle tracking was performed at baseline and post-intervention. This group was compared against a group of 12 subjects who had undergone bariatric surgery and a control group of 10 lean Asian subjects. A generalised structural equation model (gSEM) was constructed to ascertain the effect of modality of weight loss on strain parameters, adjusting for BMI. Participants attained significant weight loss after LSI (28.2 ± 2.66 kg/m2 vs. 25.8 ± 2.84 kg/m2, p = 0.001). This was associated with a non-significant trend towards improvement in strain parameters. SWL participants had significant improvement in the left ventricular global longitudinal strain (− 20.52 ± 3.34 vs. − 16.68 ± 4.15, p < 0.01) and left atrium reservoir strain (44.32 ± 14.23 vs. 34.3 ± 19.31, p = 0.02). Lean subjects had significantly higher strain parameters than overweight subjects. The gSEM model demonstrated surgical modality of weight loss as an independent predictor of improvement in strain parameters. Significant improvement in echocardiographic parameters were documented in patients who underwent bariatric surgery.

Early severe paravalvular leak following mitral valve replacement with a prosthetic mechanical bileaflet valve

Abstract: A middle-aged woman developed severe breathlessness soon after mitral valve replacement for rheumatic heart disease with severe mitral stenosis and moderate mitral regurgitation. Echocardiography (two-dimensional and transesophageal) revealed a severe paravalvular leak into the left atrium between the mechanical bileaflet mitral valve and the aortic annulus. The patient was stabilized with intravenous nitroglycerin and torsemide, and the heart rate was controlled with tablet metoprolol. The patient was successfully treated with a redo surgery using a larger mechanical mitral bileaflet valve (size 29 mm) and interrupted sutures. A 25-mm mechanical bileaflet valve was used during index surgery.

Myxoma and Carotid Artery Occlusion Finding During a Stroke : The tree that hides the forest

57-year-old female patient, who is an active smoker, admitted for a left-sided ischemic stroke in whom we found an association of a chronic occlusion of the left internal carotid and a myxoma of the left atrium, who presented a new onset stroke a month after the myxoma resection.

Cystic cardiac myxoma: a rare variant of cardiac myxoma in a woman with acute stroke

BackgroundCardiac myxomas are the most common primary benign tumors of the heart usually presenting as an oval mass attached to the interatrial septum. Mild heterogenous enhancement is typically seen upon contrast administration. Myxomas are benign, however can present with embolic episodes necessitating prompt diagnosis and treatment.Case presentationA middle-aged woman presenting with acute ischemic stroke was detected to have a complex cystic mass in the left atrium on echocardiography. Further evaluation with cardiac magnetic resonance imaging narrowed a differential diagnosis to hemangioma, hemangioendothelioma, sarcoma, hydatid cysts, bronchogenic cysts, and cystic variant of cardiac myxoma. CTA demonstrated arterial supply from the left circumflex artery supplying the lesion. Following surgical excision, histopathology analysis suggested a cystic cardiac myxoma with secondary degeneration.ConclusionCystic masses in the heart are challenging to diagnose due to similar imaging characteristics, and misdiagnosis may lead to further major downstream complications such as stroke, hemorrhage, and hemodynamic alterations causing syncope. Therefore, surgical excision of a cystic cardiac mass is justified to establish a definitive histopathological diagnosis and prevent further downstream complications. We hereby report a rare case of cystic cardiac myxoma in the left atrium showing intense progressive enhancement in CMR and CTA in a middle-aged woman presenting with acute stroke. This case highlights an exceedingly rare variant of cystic cardiac myxoma.

Insight on Exercise-Induced Heart Remodeling in Different Track and Field Disciplines.

Background: The foot racing disciplines include sprints, middle distances, and long distances, which vary in terms of intensities, duration of training, and metabolic demands. The aim of our study was to evaluate the differences in morpho-functional parameters describing cardiac remodeling in a large cohort of Olympic athletes practicing the different track subspecialties. Methods: We evaluated 140 track and field (52.1% males, mean age 26.3 ± 4.3 years) Olympic athletes divided into four groups according to the distance performed: Group A (46, 32.9%): 100 and 200 mt; Group B (34, 24.3%): 400 mt; Group C (25, 17.9%): 800, 1500, and 3000 mt; Group D (35, 24.9%): 5000, 10,000 mt, and marathon distance. The athletes underwent a pre-participation screening, which included transthoracic echocardiography and exercise stress testing. Results: In Group A and in Group B, most athletes presented normal cardiac geometry (41/46, 89.1% in Group A and 31/34, 91.2% in Group B, p < 0.0001). Instead, in Groups C and D, more than half presented eccentric cardiac remodeling (13\25, 52% in Group C and 23\35, 65.7% in Group D). No significant differences were found between subspecialties in LVEF (p = 0.587), diastolic function (p = 0.431), and training hours/week (p = 0.078). Conclusions: In conclusion, the presence and extent of cardiac remodeling vary according to the distance of the discipline practiced, with the largest dimensional increase in both left and right ventricles and atria in mid- and long-distance runners and the lowest in sprinters.

Rhythm and rate control strategies in patients with long-standing persistent atrial fibrillation treated with cardiac resynchronization: the results of the randomized Pilot-CRAfT study.

Atrial fibrillation (AF) is common in cardiac resynchronization therapy (CRT) recipients. It is a marker of impaired CRT response mainly mediated by the reduction of effectively captured biventricular paced beats (BiVp). There are no randomized trials comparing strategies to maintain high BiVp percentage. To compare the efficacy of rhythm vs rate control strategies in CRT recipients with long-standing persistent AF. We performed a randomized trial including CRT recipients with persistent AF resulting in low BiVp%. All patients received amiodarone, the rhythm control group received external electrical cardioversion (EC), and the rate control group received atrioventricular node ablation, if needed. The primary end-point was 12-month BiVp% (NCT). 43 patients were included in the analysis. The mean age was 68.4 (SD: ± 8.3) years and the mean BiVp% 82.4% ± 9.7%. AF lasted 25 ± 19 months. The mean baseline left ventricular ejection fraction (LVEF), left atrium area, and the maximal oxygen uptake (VO2max) were: 30 ± 8%, 33 ± 7 cm2, and 14 ± 5 mL/(kg*min), respectively. The EC success rate was 58%. 38% patients remained in sinus rhythm (SR) after 12 months. BiVp% increased similarly in both arms reaching 99% [95% CI 97.3-99.8] and 98% [94.0-99.0], P = 0.14 in rhythm and rate control groups, respectively. LVEF raised significantly only in the rhythm control group (ΔLVEF 4.1 (± 7.3), P = 0,018) which was driven by the patients who maintained SR. No differences in VO2max, QoL, clinical and safety end-points were observed. Despite comparable BiVp% in both groups, only restoration of SR led to improved left ventricular ejection fraction in CRT patients with long-standing AF. NCT01850277 registered on 22/04/2013.

The Significance of Echocardiographic Evaluation in Atrial Fibrillation

The echocardiographic examination has emerged as an essential part in the evaluation of atrial fibrillation (AF) patients. When evaluating and treating patients with atrial fibrillation, transthoracic echocardiography continues to be important. TEE gives an excellent view of the atrium and amply illustrates or rules out thrombus. For the purpose of determining the dimensions and function of the left atrium and left ventricle, as well as the various conditions that may predispose to atrial fibrillation, such as cardiomyopathy, pericardial disease, and congenital heart defects, transthoracic echocardiography (TTE) must be used in conjunction with two-dimensional (2D) and Doppler studies in the initial evaluation of all patients with atrial fibrillation.

Impact of anisotropic conduction and premature atrial contraction on the fractionated atrial potentials

AbstractBackgroundFractionated atrial potential (FAP) during sinus rhythm (SR) may be a new target for ablation of atrial fibrillation (AF). However, the effects of the direction of activation and premature atrial contraction (PAC) on FAP is unknown. Therefore, we examined the impact of anisotropic conduction and PAC on the distribution and areas of FAP.MethodsFAP map in the left atrium was created in 40 patients with AF before ablation. The distribution and areas of FAP were compared during SR, distal coronary sinus (CS) pacing (S1) and extrastimulus (S2), and paced PAC after SR. FAP was defined as a potential with four or more fragmented deflections.ResultsFAPs during SR were found in the right and mid‐anterior walls and septum in most patients. During S1 compared to SR, FAPs significantly decreased in the right and mid‐anterior walls, appendage, septum, and right inferior wall, while significantly increased in the lateral wall. During S2 compared to S1, FAPs significantly increased in the mid anterior and right and mid posterior walls. During PAC compared to SR, FAPs significantly decreased in the right and mid anterior walls and roof, while significantly increased in the left anterior, left inferior and lateral walls. A rotational activation pattern at the FAP area during CS pacing was observed in 12 patients (30%), mostly in the left inferior wall.ConclusionsThe distribution and areas of FAP vary with anisotropic conduction and extrastimulus. Therefore, FAP should be evaluated not only during SR but also during extrastimulus from the distal CS.

Senescent CD8+ T cells: a novel risk factor in atrial fibrillation.

Immune cell alterations may play a role in the development of atrial fibrillation (AF). Our objective was to comprehensively characterize immune cells in AF, and investigate the potential mechanisms. Single-cell RNA sequencing and multicolor flow cytometry revealed that T cells constituted the most significant subset alterations in AF, and senescent CD8+ T cells were AF-associated subset. Senescent CD8+ T cells increased in both peripheral veins (p < 0.0001) and the left atria (p < 0.05) in patients with AF compared to non-AF control. Senescent CD8+ T cells were independently associated with AF prevalence (odds ratio = 2.876, p < 0.05) and postprocedural recurrence (hazard ratio = 22.955, p < 0.0001) using a cross-sectional study and a subsequent prospective cohort study. Senescent CD8+ T cells secreted an increased amount of interferon (IFN)-γ, which induces Ca2+ handling abnormalities in human induced pluripotent stem cell-derived atrial cardiomyocytes, and translated into an increased susceptibility to AF assessed by heart optical mapping. An increased amount of senescent CD8+ T cells may be a hallmark of the immune senescence phenotype in AF and potentially serve as a valid biomarker for assessing prevalence and postprocedural recurrence of AF. By connecting immune senescence with electrophysiological disturbances in AF, this research provides a potential mechanism for the involvement of senescent CD8+ T cells in proarrhythmic calcium disorders and suggests novel avenues for developing new immune-modulatory and senolytic therapies for AF.

Impact of a New Preoperative Stratification Based on Cardiac Structural Compromise in Patients with Severe Aortic Stenosis Undergoing Valve Replacement Surgery

Introduction and objectives: Aortic valve replacement surgery (SAVR) remains a recommended indication, though its pre-surgical stratification is an ongoing challenge. Despite the widespread use of scores like the STS and EuroSCORE II, they have a number of limitations, while often neglecting structural parameters like left ventricular hypertrophy or left atrium volume. This study aimed to evaluate whether a new adaptation of the Généreux classification in the preoperative risk stratification of severe aortic stenosis (AS) is associated with the primary outcome, and to compare it with the original classification versus the traditional scores in short- and long-term follow-up. Methods: We conducted a retrospective, single-center study involving patients with confirmed severe AS who underwent SAVR. The new stratification categorized patients into three stages. Cox regression analyses were conducted to identify factors associated with mortality, with survival analysis performed using Kaplan–Meier curves. A p-value &lt; 0.05 was considered statistically significant. Results: A total of 508 patients were included. Stage 3 patients had a lower median age (67 years). The median EuroSCORE II and STS scores were 2.75 and 2.62%, respectively (p ≤ 0.001). Over a median follow-up of 81 months, 56 deaths occurred (11%). Kaplan–Meier curve analysis revealed significant differences in all-cause mortality among the three groups (HR 4.073, log-rank p ≤ 0.001). Multivariable analysis identified the three preoperative stages (HR 3.22, [95% CI 1.44–7.20], p = 0.004) and mean transaortic gradient (HR 0.96, [95% CI 0.92–0.99], p = 0.021) as independent variables of mortality. The original Généreux scale AUC was higher (AUC: 0.760, 95% CI: 0.692–0.829) compared to the modified Généreux scale (AUC: 0.758, 95% CI: 0.687–0.829). However, no statistical differences were found between the different scales. Conclusions: Preoperative three-stage classification and low transaortic gradient are factors associated with increased all-cause mortality in patients undergoing SAVR. The proposed staging system performed better in the mortality analysis than EuroSCORE II and STS and was similar to the original classification.

Causes and Diagnostic Significance of Coughing in Dogs with Endocardiosis

Introduction. Endocardiosis is the most widespread acquired cardiac disease in small dog breeds, characterised by the valvular degeneration leading to mitral insufficiency. Progression of mitral regurgitation leads to cardiac remodeling, increased left ventricular filling pressures, pulmonary hypertension and, eventually, myocardial dysfunction. Decreased exercise tolerance, dyspnea, anorexia, and coughing are the most often reported signs in dogs with endocardiosis. Coughing is often reported as the primary clinical sign of congestive heart failure in dogs with endocardiosis. The concomitant respiratory tract disease and compression of the left mainstem bronchus by the giant left atrium have also been suggested as the potential causes of coughing in these patients. However, the absence of relief from cough in dogs with endocardiosis when treated with calcium sensitizers and the registered improvement in systolic cardiac function makes doubtful the cardiogenic nature of coughing in endocardiosis. In other words, the clinical and diagnostic significance of coughing in dogs with endocardiosis has not been sufficiently studied. The aim of the present research is to determine the frequency of cough incidence in dogs with endocardiosis and to establish the pathognomonic nature of this symptom in endocardiosis, its clinical significance.Materials and Methods. The medical records of 49 dogs that have attended to the veterinary clinics of the “Vita” network (Rostov region) for cardiological examination in the period from September 1, 2021 to July 31, 2024 were analysed. The research was carried out using the following equipment: premium ultrasound scanner with improved image quality on the ZST+ Mindray Vetus 9 platform, Maxivet 400 veterinary X-ray digital DR system, and Poli-Spectrum–8/V computerassisted electrocardiograph.Results. The research allowed us to find out the following: although the cardiomegaly and the increase in the size of the left ventricle in endocardiosis can aggravate and intensify the clinical manifestation of coughing in dogs with degenerative diseases of the upper respiratory tract, they are not the necessary condition for the occurrence of coughing. Coughing in dogs with endocardiosis should be considered as a clinical sign of the concomitant inflammatory or degenerative disease of the upper respiratory tract, which should be taken into account in therapy and in the attempt to improve the quality of life of these animals.Discussion and Conclusion. We have found that only 57% of the dogs with clinically evident endocardiosis suffer from coughing, whereas it does not have the uniform nature. In dogs with cardiogenic pulmonary edema, a cough is not loud, is usually acute and is associated with the flow of fluid into the medium and large-sized bronchi. The chronic loud, hoarse cough, intensifying in the morning, is typical for dogs with endocardiosis and chronic bronchitis: these animals at the same time have the non-specific inflammatory lesion of the bronchial tree and lesion of the mitral valves. Most severe coughing, with the characteristic loud sound, is observed in dogs suffering from the elements of the upper respiratory tract collapse and cardiomegaly due to endocardiosis.

Historical Left Atrial Myxoma Causing an Obstructive Shock

Learning Objectives: - Explore the clinical presentation and diagnosis of cardiac myxoma. -Find out the potential complications of cardiac myxoma, such as embolic events and heart failure. -Understanding the role of echocardiography in the diagnosis and management of cardiac myxoma. Background: Cardiac myxoma, an uncommon tumor forming in the heart, tends to occur in the left atrium and is generally non-cancerous in nature. The composition, size, and position of the tumor can lead to a range of varied signs and symptoms. These symptoms can range from barely noticeable to severe and may include heart ailments, pulmonary hypertension, and even strokes. The usual course of treatment involves surgical removal of the tumor to resolve the issue. Case Presentation: This manuscript presents a case report of a 33-year-old male patient who presented with sudden dyspnea and was diagnosed with an extraordinarily large left atrial myxoma causing cardiogenic shock. Despite plans for surgery, the patient's condition rapidly deteriorated and he eventually died due to persistent intracardiac obstruction. The article discusses the rarity of primary tumors in the heart, with myxoma being the most prevalent, and the non-specific symptoms that can manifest in a variety of ways, including cardiac, embolic, and systemic symptoms. The importance of echocardiography in diagnosing cardiac tumors and the potential complications of atrial myxomas, including mitral valve obstruction, congestive heart failure, and sudden death, are also discussed. Conclusion: The presence of a giant left atrial myxoma, although benign, can cause severe symptoms and even be life-threatening. Diagnosis is made through echocardiography, and surgical removal of the tumor is the recommended treatment, which should be performed promptly upon diagnosis.

Inhaled Argon Dilates Pulmonary Vasculature in Rat Isolated Lungs.

During cardiopulmonary resuscitation, pulmonary vasoconstriction due to hypoxia and hypercarbia restricts blood flow from the right to the left heart, resulting in reduced cardiac output that further inhibits adequate oxygenation and the ability to distribute oxygenated blood and medications. An inhaled pulmonary vasodilator could attenuate vasoconstriction and, therefore, increase cardiac output. We used rat isolated lungs to test if inhaled Argon leads to pulmonary vasodilation in phenylephrine-treated lungs. Lungs of 13 adult male Sprague Dawley rats were isolated, ventilated, and perfused. Pulmonary artery and left atrium were cannulated and lungs perfused at constant flow with 4% albumin physiological saline solution. Controls (n=6) were ventilated with 65% N2, 5% CO2, 30% O2 and Argon lungs (n=7) with 65% Argon, 5% CO2, 30% O2. Pulmonary mean arterial pressure (pMAP) and airway pressure (AWP) were recorded continuously, and pulmonary vascular resistance (PVR) was calculated. Following baseline readings, phenylephrine, a pulmonary vasoconstrictor, was perfused at increasing concentrations from 10-7 M to 10-3 M every 5 min. Statistics: Student's t-Test, α=0.05. Argon led to significantly lower pMAPs and PVRs, independent of AWP. Thus, it significantly dilated pre-constricted pulmonary vessels in an ex-vivo lung model. When given during resuscitation, this might aid to increase cardiac output.

ABLE-SCORE, a simplified risk score for major adverse cardiovascular outcomes in left ventricular hypertrabeculation: a multicenter longitudinal cohort study.

Left ventricular hypertrabeculation (LVHT) is a heterogeneous entity with life-threatening complications and variable prognosis. However, there are limited prediction models available to identify individuals at high risk of adverse outcomes, and the current risk score in LVHT is comparatively complex for clinical practice. This study aimed to develop and validate a simplified risk score to predict major adverse cardiovascular events (MACE) in LVHT. This multicenter longitudinal cohort study consecutively enrolled morphologically diagnosed LVHT patients between January 2009 and December 2020 at Fuwai Hospital (derivation cohort, n = 300; internal validation cohort, n = 129), and between January 2014 and December 2022 at two national-level medical centers (external validation cohort, n = 95). The derivation/internal validation cohorts and the external validation cohort were followed annually until December 2022 and December 2023, respectively. MACE was defined as a composite of all-cause mortality, heart transplantation/left ventricular assist device implantation, cardiac resynchronization therapy, malignant ventricular arrhythmia, and thromboembolism. A simplified risk score, the ABLE-SCORE, was developed based on independent risk factors in the multivariable Cox regression predictive model for MACE, and underwent both internal and external validations to confirm its discrimination, calibration, and clinical applicability. A total of 524 LVHT patients (43.5 ± 16.6years, 65.8% male) were included in the study. The ABLE-SCORE was established using four easily accessible clinical variables: age at diagnosis, N-terminal pro-brain natriuretic peptide levels, left atrium enlargement, and left ventricular ejection fraction ≤ 40% measured by echocardiography. The risk score showed excellent performance in discrimination, with Harrell's C-index of 0.821 [95% confidence interval (CI), 0.772-0.869], 0.786 (95%CI, 0.703-0.869), and 0.750 (95%CI, 0.644-0.856) in the derivation, internal validation, and external validation cohort, respectively. Calibration plots of the three datasets suggested accurate agreement between the predicted and observed 5-year risk of MACE in LVHT. According to decision curve analysis, the ABLE-SCORE displayed greater net benefits than the existing risk score for LVHT, indicating its strength in clinical applicability. A simplified and efficient risk score for MACE was developed and validated using a large LVHT cohort, making it a reliable and convenient tool for the risk stratification and clinical management of patients with LVHT.

'Color Doppler stripes’ make it difficult to diagnose the severity of valvular heart diseases: a report of two cases

BackgroundEchocardiography remains the reference-standard imaging technique for assessing valvular heart disease (VHD), but artifacts like the ‘color Doppler stripe’ can complicate diagnosis. This artifact is not widely recognized and can mimic severe VHD, leading to potential misdiagnoses. We present two cases where color Doppler stripes mimicked severe VHD, highlighting the need for awareness and accurate interpretation in echocardiographic assessments.Case presentationsCase 1: An 85-year-old patient was referred for mitral valve surgery due to suspected severe mitral regurgitation (MR). Upon evaluation, transthoracic echocardiography (TTE) showed mitral valve prolapse (P3) and a high-echoic, vibrating structure attached to the mitral valve, indicative of chordal rupture. Color Doppler echocardiography revealed strong systolic signals in the left atrium, mimicking severe MR. Transesophageal echocardiography (TEE) also detected the vibrating structure and color Doppler stripes in the left atrium, left ventricle, and outside the cardiac chambers. The PISA method on TEE indicated moderate MR and left ventriculography showed Sellers grade II MR. The artifact was identified as color Doppler stripes caused by the vibrating high-echoic structure from the ruptured chorda. Case 2: A 64-year-old patient with severe aortic stenosis, end-stage kidney disease requiring hemodialysis, and a history of coronary bypass grafting presented for routine follow-up. B-mode echocardiography showed a severely calcified tricuspid aortic valve with a vibrating calcified nodule and restricted opening, corresponding to severe aortic stenosis. During systole, color Doppler signals were observed around the aortic, pulmonary, and tricuspid valves, mimicking significant pulmonary stenosis and tricuspid regurgitation. However, pulmonary stenosis was ruled out as the pulmonary valve opening was normal. Mild tricuspid regurgitation was confirmed in the apical view.ConclusionsThese cases highlight the diagnostic challenges posed by color Doppler stripes. Recognizing and understanding this artifact are crucial for the accurate diagnosis and management of VHD, ensuring appropriate treatment and patient outcomes.