Left Ventricle Function Research Articles

Role of Circulating Biomarkers in Diabetic Cardiomyopathy.

Type 2 diabetes mellitus (T2DM) is a metabolic disorder that has alarmingly increased in incidence in recent decades. One of the most serious complications of T2DM is diabetic cardiomyopathy (DCM), an often underrecognized yet severe condition that is a leading cause of mortality among diabetic patients. In the early stages of DCM, patients typically show no symptoms and maintain normal systolic and diastolic left ventricle function, making early detection challenging. Currently available clinical markers are often not specific enough to detect the early stage of DCM. Conventional biomarkers of cardiac mechanical stress and injury, such as natriuretic peptides (NPs) and cardiac troponin I (cTnI), have shown limited predictive value for patients with T2DM. NPs have proven efficacy in detecting diastolic dysfunction in diabetic patients when used alongside 2D echocardiography, but their utility as biomarkers is limited to symptomatic individuals. While cTnI is a reliable indicator of general cardiac damage, it is not specific to cardiac injury caused by high glucose levels or T2DM. This underscores the need for research into biomarkers that can enable early diagnosis and management of DCM to reduce mortality rates. Promising novel biomarkers that showed good performance in detecting diastolic dysfunction or heart failure in diabetic patients include galectin-3, ST2, FGF-21, IGFBP-7, GDF-15, and TGF-β. This review summarizes the current understanding of DCM biomarkers, aiming to generate new ideas for the early recognition and treatment of DCM by exploring related pathophysiological mechanisms.

Adverse Cardiovascular Effects of Nicotine Delivered by Chronic Electronic Cigarettes or Standard Cigarettes Captured by Cardiovascular Intrinsic Frequencies.

Electronic cigarettes have gained popularity as a nicotine delivery system, which has been recommended by some as an aid to help people quit traditional smoking. The potential long-term effects of vaping on the cardiovascular system, as well as how their effects compare with those from standard cigarettes, are not well understood. The intrinsic frequency (IF) method is a systems approach for analysis of left ventricle and arterial function. Recent clinical studies have demonstrated the diagnostic and prognostic value of IF. Here, we aim to determine whether the novel IF metrics derived from carotid pressure waveforms can detect effects of nicotine (delivered by chronic exposure to electronic cigarette vapor or traditional cigarette smoke) on the cardiovascular system. One hundred seventeen healthy adult male and female rats were exposed to purified air (control), electronic cigarette vapor without nicotine, electronic cigarette vapor with nicotine, and traditional nicotine-rich cigarette smoke, after which hemodynamics were comprehensively evaluated. IF metrics were computed from invasive carotid pressure waveforms. Standard cigarettes significantly increased the first IF (indicating left ventricle contractile dysfunction). Electronic cigarettes with nicotine significantly reduced the second IF (indicating adverse effects on vascular function). No significant difference was seen in the IF metrics between controls and electronic cigarettes without nicotine. Exposure to electronic cigarettes with nicotine significantly increased the total IF variation (suggesting adverse effects on left ventricle-arterial coupling and its optimal state), when compared with electronic cigarettes without nicotine. Our IF results suggest that nicotine-containing electronic cigarettes adversely affect vascular function and left ventricle-arterial coupling, whereas standard cigarettes have an adverse effect on left ventricle function.

Mitral Annular Plane Systolic Excursion (MAPSE): A Review of a Simple and Forgotten Parameter for Assessing Left Ventricle Function.

Mitral annular plane systolic excursion (MAPSE) was a widely used and simple M-mode echocardiographic parameter for determining the left ventricle (LV) longitudinal systolic function. The purpose of this review is to analyze the use of MAPSE as a simple LV systolic function marker in different clinical scenarios, especially given the recent paradox of choices in ultrasound markers assessing cardiac performance. Recent data on the use of MAPSE in the assessment of LV function in different settings seem to be relatively scarce, given the wide variety of possible causes of cardiovascular pathology. There remain significant possible clinical applications of MAPSE utilization. This review included all major articles on the topic of mitral annular plane systolic excursion published and indexed in the PubMed, Google Scholar, and Scopus databases. We analyzed the potential implications of using simpler ultrasonographical tools in heart failure diagnosis, prediction, and treatment. MAPSE is a dependable, robust, and easy-to-use parameter compared to ejection fraction (EF) or global longitudinal strain (GLS) for the quick assessment of LV systolic function in various clinical settings. However, there may be a gap of evidence in certain scenarios such as conventional cardiac pacing.

Comparison between the use of one and two CT scans for attenuation correction of rest-stress myocardial perfusion SPECT with Tc-99m sestamibi

Background: The standard protocol is to use separate computed tomography (CT) scans acquired during rest and stress for attenuation correction (AC) of myocardial perfusion (MP) single photon emission computed tomography (SPECT) imaging. Recently, there have been attempts to reduce the radiation dose by using one CT instead of two CTs. Objective: To compare between the use of one and two CTs for AC of rest-stress MP SPECT with Tc-99m sestamibi in quantification of MP and left ventricle (LV) function. Materials and Methods: Gated rest-stress MP SPECT images of 107 patients were reprocessed using 3 different AC methods: 1) rest CT for AC of rest SPECT and stress CT for AC of stress SPECT (2CT); 2) rest CT for AC of both rest and stress SPECT (1CT-rest); and 3) stress CT for AC of both rest and stress SPECT (1CT-stress). SPECT images obtained from 2CT and 1CT were used for quantification of MP values and LV function values. The values from 2CT and 1CT were compared. Results: The MP values of 2CT and 1CT showed a strong correlation (r≥0.712) and they did not differ significantly (p=0.106 to 0.931). In contrast, the LV function values of 2CT and 1CT exhibited a very strong correlation (r≥0.960), but they differ significantly (p=<0.001 to 0.004). Conclusions: The use of one and two CTs for AC in rest-stress MP SPECT with Tc-99m sestamibi can be interchanged for the quantification of MP, but not for the quantification of LV function.

Effect of obesity and hypertension on left ventricular geometry and function among asymptomatic Indian adults.

Hypertension & obesity are important independent predictors of cardiovascular morbidity & mortality specifically left ventricular (LV) functions. With the Objectives to examine the effect of obesity & hypertension on echocardiographic parameters of geometry, systolic, and diastolic functions of left ventricle in asymptomatic adults the cross-sectional study was conducted with 100 individuals (60 male & 40 female). Their Blood Pressure & Body Mass Index was recorded following which they were divided into obese normotensives & non-obese hypertensive. Echocardiographic parameters indicating LV geometry and function were recorded. Data was statistically analysed with Unpaired t test considering p value <0.05 as significant. LV geometry and LV systolic function parameters were significantly altered in non-obese hypertensive. Parameters of LV diastolic functions were affected in obese normotensives. 54% of obese normotensives had LV diastolic dysfunction & 58% of non-obese hypertensive had LV diastolic dysfunction. 2% of obese non-hypertensive individuals had LV systolic dysfunction & 6% of non-obese hypertensive had LV diastolic dysfunction. Hypertension significantly affects LV geometry, LV systolic and diastolic function. Obesity affects LV geometry & diastolic functions of LV even in individuals with preserved systolic function.

EFNet: A multitask deep learning network for simultaneous quantification of left ventricle structure and function

Purpose:The purpose of this study is to develop an automated method using deep learning for the reliable and precise quantification of left ventricle structure and function from echocardiogram videos, eliminating the need to identify end-systolic and end-diastolic frames. This addresses the variability and potential inaccuracies associated with manual quantification, aiming to improve the diagnosis and management of cardiovascular conditions. Methods:A single, fully automated multitask network, the EchoFused Network (EFNet) is introduced that simultaneously addresses both left ventricle segmentation and ejection fraction estimation tasks through cross-module fusion. Our proposed approach utilizes semi-supervised learning to estimate the ejection fraction from the entire cardiac cycle, yielding more dependable estimations and obviating the need to identify specific frames. To facilitate joint optimization, the losses from task-specific modules are combined using a normalization technique, ensuring commensurability on a comparable scale. Results:The assessment of the proposed model on a publicly available dataset, EchoNet-Dynamic, shows significant performance improvement, achieving an MAE of 4.35% for ejection fraction estimation and DSC values of 0.9309 (end-diastolic) and 0.9135 (end-systolic) for left ventricle segmentation. Conclusions:The study demonstrates the efficacy of EFNet, a multitask deep learning network, in simultaneously quantifying left ventricle structure and function through cross-module fusion on echocardiogram data.

Effect of a polyherbal Unani formulation on left ventricular diastolic dysfunction in hypertensive patients- a randomized single blind placebo controlled clinical trial.

Diastolic dysfunction represents an important pathophysiological intermediate between hypertension and heart failure. In the last two decades, the prevalence of heart failure patients having normal or near normal ejection fraction (EF) has increased to around 60 %. It thus poses a great morbidity and mortality risk to the population. In view of present scenario of high prevalence, lack of evidence-based therapy, and limited clinical trials, this study aimed to evaluate how a Unani formulation affects the improvement of the left ventricular diastolic function. This clinical trial was set up as a randomized, placebo-controlled study involving 35 participants, with 18 individuals in the test group and 17 in the control group. Test group received 3.5 g of a polyherbal Unani formulation in capsule form along with 35 mL of an extract of Borago officinalis L. (Arq-e-Gaozaban), divided into two doses after meals. Meanwhile, the control group received a placebo in the same manner over an eight-week period. Follow-ups were conducted every 15days to assess both subjective and objective parameters in all participants. The test formulation shows significant improvement in dyspnea and diastolic function from baseline to the end of trial (p<0.05), slight improvement in palpitations (p>0.05) and highly significant improvement in easy fatigability (p=0.001) as compared to the control. The present study shows the effectiveness of the test drug in enhancing the diastolic function of left ventricle and alleviating other symptoms associated with ventricular diastolic dysfunction. Nevertheless, additional research with longer follow-up durations is necessary to clarify its efficacy and establish optimal treatment approaches for ventricular diastolic dysfunction in Unani medicine.

The Impact of Extracellular Histones and Absence of Toll-like Receptors on Cardiac Functional and Electrical Disturbances in Mouse Hearts.

In polymicrobial sepsis, the extracellular histones, mainly released from activated neutrophils, significantly contribute to cardiac dysfunction (septic cardiomyopathy), as demonstrated in our previous studies using Echo-Doppler measurements. This study aims to elucidate the roles of extracellular histones and their interactions with Toll-like receptors (TLRs) in cardiac dysfunction. Through ex vivo assessments of ECG, left ventricle (LV) function parameters, and in vivo Echo-Doppler studies in mice perfused with extracellular histones, we aim to provide comprehensive insights into the mechanisms underlying sepsis-induced cardiac dysfunction. Langendorff-perfused hearts from both wild-type and TLR2, TLR3, or TLR4 knockout (KO) mice were examined. Paced mouse hearts were perfused with histones to assess contractility and relaxation. Echo-Doppler studies evaluated cardiac dysfunction after intravenous histone injection. Histone perfusion caused defects in contractility and relaxation, with TLR2 and TLR3 KO mice being partially protected. Specifically, TLR2 KO mice exhibited the greatest reduction in Echo-Doppler abnormalities, while TLR4 KO exacerbated cardiac dysfunction. Among individual histones, H1 induced the most pronounced abnormalities in cardiac function, apoptosis of cardiomyocytes, and LDH release. Our data highlight significant interactions between histones and TLRs, providing insights into histones especially H1 as potential therapeutic targets for septic cardiomyopathy. Further studies are needed to explore specific histone-TLR interactions and their mechanisms.

Diagnostic and Prognostic Role of Circulating microRNAs in Patients with Coronary Artery Disease-Impact on Left Ventricle and Arterial Function.

Recent studies reported that circulating microRNAs (miRNAs) can target different metalloproteases (MMPs) involved in matrix remodeling and plaque vulnerability. Consequently, they might have a role in the diagnosis and prognosis of coronary artery disease. To quantify circulating miRNAs (miRNA126, miRNA146, and miRNA21) suggested to have possible cardiovascular implications, as well as levels of MMP-1 and MMP-9, and to determine their association with left ventricular (LV) function and with arterial function, in patients with either ST-segment elevation acute myocardial infarction (STEMI) or stable ischemic heart disease (SIHD). A total of 90 patients with coronary artery disease (61% men, 58 ± 12 years), including 60 patients with STEMI and 30 patients with SIHD, were assessed within 24 h of admission, by measuring serum microRNAs, and serum MMP-1 and MMP-9. LV function was assessed by measuring ejection fraction (EF) by 2D and 3D echocardiography, and global longitudinal strain (GLS) by speckle tracking. Arterial function was assessed by echo tracking, CAVI, and peripheral Doppler. Circulating levels of miRNA146, miRNA21, and MMP1 were significantly increased in patients with STEMI vs. SIHD (p = 0.0001, p = 0.0001, p = 0.04, respectively). MiRNA126 negatively correlated with LVEF (r = -0.33, p = 0.01) and LV deformation parameters (r = -0.31, p = 0.03) in patients with STEMI and negatively correlated with ABI parameters (r = -0.39, p = 0.03, r = -0.40, p = 0.03, respectively) in patients with SIHD. MiRNA146 did not have any significant correlations, while higher values of miRNA21 were associated with lower values of GLS in STEMI patients and with higher values of GLS in SIHD patients. Both MMP1 and MMP9 correlated negatively with LVEF (r = -0.27, p = 0.04, r = -0.40, p = 0.001, respectively) and GLS in patients with STEMI, and positively with arterial stiffness in patients with SIHD (r = 0.40 and r = 0.32, respectively; both p < 0.05). MiRNA126, miRNA21, and both MMP1 and MMP9 are associated with LV and arterial function parameters in patients with acute coronary syndrome. Meanwhile, they inversely correlate with arterial function in patients with chronic atherosclerotic disease. However, further studies are needed to establish whether these novel biomarkers have diagnosis and prognosis significance.

Abstract We065: Sex Differences in Autoimmune Signatures After Myocardial Infarction in Mice

Introduction: Myocardial infarction (MI) is caused by ischemic injury to the left ventricle (LV), leading to an inflammatory response, scar formation, and loss of LV function. The role of the autoimmune (AI) response during chronic MI, such as B cell activation and autoantibody production, is not well understood. As AI disease is much more prevalent in females, we hypothesized that female mice are more susceptible to MI-induced development of AI signatures. Methods: Permanent MI was induced by left coronary artery ligation in adult male and female C57BL/6J mice for 7, 28, or 56 days. LV function was tracked using echocardiography (VEVO 3100). Cytokines were measured by qPCR. LV IgG and IgM antibody deposition was measured by immunofluorescence. Plasma IgG and IgM were measured by ELISA, and plasma autoantibodies (AABs) (IgG and IgM subclasses) were measured with an autoantigen (AAN) array. Results: In both sexes, MI led to progressive LV hypertrophy, dilation, and wall thinning. MI increased spleen mass in D7, 28, and 56 females, but decreased spleen mass in D28 and 56 males. LV infarct cytokines (IL-1β, IL-6, IL-18, IFN-γ, TNF, CCL2, IL-10) were increased at D7, while IL-6 and IL-18 remained elevated at D28 and 56 to a higher degree in females. Several cytokines in the remote LV were increased in females relative to males, including TNF, IL-6, CCL2, and IL-18. Splenic cytokines were also differentially expressed between sexes, with IL-1β, IL-12a, IL-10, IFN-γ, IL-18, CCL2, and IL-4 increased in females at several time points. Infarct IgG and IgM deposition occurred in both sexes, but to a higher degree in females. Remote IgG and IgM deposition occurred at D56 in both sexes. For plasma AABs, we detected 34 AANs against which IgG AABs were significantly elevated (p&lt;0.05) at D56 in females vs 9 in males, and 30 IgM AABs vs 1 in males. Of note, anti-IL-6 IgM AABs were elevated in D56 females (9.8±0.8-fold), likely due to persistently elevated IL-6 in the female infarct and remote LV vs males. Total levels of plasma IgM were increased only in females at D56 (1.79±0.15-fold). Conclusions: MI promotes development of AI signatures which is exacerbated in females, including increased spleen mass, LV and splenic cytokines, LV infarct and remote IgG and IgM antibody deposition, increased plasma IgG and IgM AABs, and increased total levels of plasma IgM. Targeting the AI response may be a viable option for treating chronic MI outcomes, particularly in females.

Tissue-Based Predictors of Impaired Right Ventricular Strain in Coronary Artery Disease: A Multicenter Stress Perfusion Study.

Right ventricular (RV) dysfunction is known to impact prognosis, but its determinants in coronary artery disease are poorly understood. Stress cardiac magnetic resonance (CMR) has been used to assess ischemia and infarction in relation to the left ventricle (LV); the impact of myocardial tissue properties on RV function is unknown. Vasodilator stress CMR was performed in patients with known coronary artery disease at 7 sites between May 2005 and October 2018. Myocardial infarction was identified on late gadolinium enhancement-CMR, and infarct transmurality was graded on a per-segment basis. Ischemia was assessed on stress CMR based on first-pass perfusion and localized by using segment partitions corresponding to cine and late gadolinium enhancement analyses. RV function was evaluated by CMR-feature tracking for primary analysis with a global longitudinal strain threshold of 20% used to define impaired RV strain (RVIS); secondary functional analysis via RV ejection fraction was also performed. A total of 2604 patients were studied, among whom RVIS was present in 461 patients (18%). The presence and magnitude of RVIS were strongly associated with LV dysfunction, irrespective of whether measured by LV ejection fraction or wall motion score (P<0.001 for all). Regarding tissue substrate, regions of ischemic and dysfunctional myocardium (ie, hibernating myocardium) and infarct size were each independently associated with RVIS (both P<0.001). During follow-up (median, 4.62 [interquartile range, 2.15-7.67] years), 555 deaths (21%) occurred. Kaplan-Meier analysis for patients stratified by presence and magnitude of RV dysfunction by global longitudinal strain and RV ejection fraction each demonstrated strong prognostic utility for all-cause mortality (P<0.001). RVIS conferred increased mortality risk (hazard ratio, 1.35 [95% CI, 1.11-1.66]; P=0.003) even after controlling for LV function, infarction, and ischemia. RVIS in patients with known coronary artery disease is associated with potentially reversible LV processes, including LV functional impairment due to ischemic and predominantly viable myocardium, which confers increased mortality risk independent of LV function and tissue substrate.

Single Center Retrospective Evaluation of Coronary Artery Fistula Outcomes.

There is a paucity of literature describing long-term outcomes of patients with coronary artery fistula with most manuscripts focusing on those requiring interventions. We describe single-center outcomes of coronary artery fistulas including those not requiring intervention. We performed a retrospective review of the electronic medical record and identified all patients with a diagnosis of coronary artery fistula over the last 10years. 158 patients were identified with a coronary artery fistula. The mean age at diagnosis was 5.8years (SD ± 5.9). There was a male (55%, n = 87) predominance. Concomitant congenital heart lesion was present in 49% (n = 77) and a genetic anomaly was found in 18% (n = 29). No ischemic changes on electrocardiogram or ECG-stress test were observed. The mean follow-up was 5.0 (SD ± 3.8) years. Most patients (94%, n = 149) did not undergo an intervention. Of those 63% (n = 94) had at least one follow-up echocardiogram. There was spontaneous coronary artery fistula closure in 44% (n = 41), 8% (n = 8) decreased in size, and 48% (n = 45) were unchanged. No patient had enlargement of the coronary artery fistula over time. Additionally, tiny and small coronary artery fistulas showed no significant clinical changes in coronary artery dimensions, left ventricle dimensions and function over time. Seven patients required intervention; two patients underwent surgical ligation and five underwent catheter-based intervention. Most patients with coronary artery fistula in our cohort did not require intervention and over half either closed spontaneously or decreased in size with routine follow-up.

Myocardial work and risk stratification in patients with severe aortic valve stenosis referred for transcatheter aortic valve replacement

BackgroundTranscatheter aortic valve replacement(TAVR) has shown clear survival benefits in severe aortic valve stenosis(AS). However, patients unable to recover left ventricle function remain at risk with poor long-term survival. This single-center prospective study aims to analyze the supplementary benefits of myocardial work(MW) assessment for baseline risk stratification in patients with severe AS referred for TAVR. MethodsA total of 110 patients with severe AS referred for TAVR were included in the study. Baseline ECG data, transthoracic echocardiographic(TTE) images and blood samples were obtained. The TTE examination was repeated one day and one month after valve replacement. The primary outcome of the study was a composite endpoint consisting of all-cause mortality and HF hospitalization. ResultsDuring a mean follow-up period of 521 ± 343 days, 29patients(26.4 %) reached the composite endpoint. Baseline troponins, NT-proBNP, sST2, GWI and GCW showed statistically significant differences between groups. Patients with a baseline GWI<2323 mmHg% (sensitivity 0.63 and specificity 0.76)had significantly worse outcome following TAVR. A basic predictive model included QRS-length, TAPSE, LAVI and E/e’. The addition of biomarkers did not yield any further advantages whereas incorporating the GWI cut-off value of 2323 mmHg% significantly enhanced the predictive value. Although there were no significant changes in LVEF and GLS, all patients exhibited a significant reduction in GWI and GCW immediately after TAVR. ConclusionOur findings provide evidence for the enhanced usefulness of MW analysis in the initial risk stratification of patients with severe AS referred for TAVR. Specifically, a baseline GWI<2323 mmHg% demonstrates an independent predictor associated with increased incidence of all-cause mortality and HF hospitalization following TAVR.

Assessing Left Ventricular Pathology in Patients with Ebstein Anomaly Using Cardiovascular Magnetic Resonance: Looking Past the Right Heart.

Ebstein Anomaly (EA) is a malformation of the right heart, but there is data to suggest that the left ventricle (LV) can suffer from intrinsic structural and functional abnormalities which affect surgical outcomes. The LV in patients with EA is hypertrabeculated with abnormalities in LV function and strain. In this retrospective single-center study, patients with EA who underwent pre-operative cardiac MRI (CMR) between the periods of 2014-2024 were included along with a group of healthy-age-matched controls. Left ventricular and right ventricular volume, function and strain analyses were performed on standard SSFP imaging. LV noncompacted: compacted (NC/C) ratio and the displacement index of the tricuspid valve were measured. Forty-seven EA patients were included with mean age of 21.0 ± 17.6years. Seventeen EA patients (36%) had mild pre-operative LV dysfunction on CMR and 1 (2.1%) had moderate LV dysfunction. Out of these 18 patients with LV dysfunction, only 2 were detected to have dysfunction on Echocardiogram. The global circumferential and longitudinal strain were significantly lower in the reduced LVEF group compared to those with preserved LVEF (-14.8% vs. -17%, p = 0.02 and - 11.9% vs. - 15.0%; p = 0.05; respectively) on CMR. A single EA patient met criteria for LVNC with a maximal NC/C ratio > 2.3. There was no statistically significant difference in NC/C ratio in the EA population (1.4 ± 0.6) vs. controls (1.1 ± 0.2), p = 0.17. There was an inverse correlation of LV ejection fraction with right ventricular end-diastolic volume and displacement index. All patients underwent the Da Silva Cone procedure at our center. Patients with preoperative LV dysfunction had longer duration of epinephrine use in the immediate postoperative period (33.7 ± 21.4 vs 10.2 ± 25.6h, p = 0.02) and longer length of hospital stay (6.3 ± 3.2 vs 4.4 ± 1.2days, p = 0.01). This is the largest study to date to evaluate preoperative LV structure and function in EA patients by CMR. In this cohort of 47 patients, preoperative LV dysfunction is fairly common and CMR has high sensitivity in detecting LV dysfunction as compared to Echo. True LV non-compaction was rare in this cohort. The presence of LV dysfunction is relevant to perioperative management and further study with larger cohorts and longer follow up are necessary.

Causal relationship between inflammatory markers and left ventricle geometry and function: A 2-sample Mendelian randomization study.

Studies have shown that some inflammatory markers can predict the risk of cardiovascular disease (CVD) and affect the structure and function of the heart. However, a causal relationship between inflammatory markers and the cardiac structure and function has not yet been established. Thus, we conducted a 2-sample Mendelian randomization (MR) study to explore the potential causal relationship between inflammatory markers and prognostically-related left ventricular (LV) parameters. Instrumental variables (IVs) for C-reactive protein (CRP), interleukin-6 (IL-6), and myeloperoxidase (MPO) levels were selected from the databases of large genome-wide association studies (GWAS). Summary statistics for LV parameters, including LV mass, ejection fraction, end-diastolic and systolic volumes, and the ratio of LV mass to end-diastolic volume, were obtained from cardiovascular magnetic resonance studies of the UK Biobank (n = 16923). The inverse-variance weighted (IVW) method was the primary analytical method used, and was complemented with the MR-Egger, weighted median, simple mode, weighted mode, and MR pleiotropy residual sum and outlier (MR-PRESSO) methods. Sensitivity analysis was performed to evaluate the robustness of the results. CRP was significantly associated with the LV mass in the IVW method (β = -0.13 g [95% confidence interval [CI], 0.78 g-1.00 g], P = .046). A higher standard deviation of genetically-predicted CRP levels was associated with a 0.13 ± 0.06 g lower LV mass. No causal relationships of IL-6 and MPO with LV parameters were found. No evidence of heterogeneity and pleiotropy was detected. Sensitivity analyses confirmed the robustness of the results. Two-sample MR analysis revealed a causal association between increased CRP level and decreased LV mass, whereas IL-6 and MPO levels did not influence the LV parameters. However, further research is required to validate our findings.

The Use of Extracorporeal Membrane Oxygenation in a Patient with Septic Myocarditis in the Postpartum Period

Introduction. Septic myocarditis is a rare disease (from 10 to 22 cases per 100 000 people). The cause of death is usually acute heart failure, hemodynamically significant cardiac arrhythmias, or thromboembolism. Patients in critical condition suffering from infectious myocarditis require massive cardiotonic support to maintain the necessary cardiac output with reduced myocardial contractile function, which leads to an increase in the need for cardiomyocytes for oxygen and aggravates their damage. Veno-arterial extracorporeal membrane oxygenation (ECMO) allows partial or complete replacement of cardiac function and reduces the dose of inotropic drugs, improve oxygen delivery and thereby contribute to the rapid restoration of cardiac function.The purpose of this publication is to demonstrate in a clinical case the successful experience of ECMO in the treatment of a patient with septic myocarditis in the early postpartum period.Materials and methods. A 28-year-old patient, data from medical records at the previous stages of treatment and at the Sverdlovsk Regional Clinical Hospital No. 1.Results. On the third day of treatment, the patient’s condition worsened due to the progression of cardiovascular and respiratory failure. A veno-arterial ECMO procedure was initiated, which lasted 6 days.Discussion. Positive dynamics in the patient’s condition were observed during six days of ECMO (normalization of echocardiography parameters, levels of cardiac enzymes and natriuretic peptide).Conclusion. Veno-arterial ECMO as a temporary method of mechanical support of the left ventricle and prosthetic pulmonary function can be successfully used until their recovery in patients with septic myocarditis in the postpartum period.

Chronic Partial Sleep Deprivation Increased the Incidence of Atrial Fibrillation by Promoting Pulmonary Vein and Atrial Arrhythmogenesis in a Rodent Model.

Sleep deprivation (SD) is a recognized risk factor for atrial fibrillation (AF), yet the precise molecular and electrophysiological mechanisms behind SD-induced AF are unclear. This study explores the electrical and structural changes that contribute to AF in chronic partial SD. We induced chronic partial SD in Wistar rats using a modified multiple-platform method. Echocardiography demonstrated impaired systolic and diastolic function in the left ventricle (LV) of the SD rats. The SD rats exhibited an elevated heart rate and a higher low-frequency to high-frequency ratio in a heart-rate variability analysis. Rapid transesophageal atrial pacing led to a higher incidence of AF and longer mean AF durations in the SD rats. Conventional microelectrode recordings showed accelerated pulmonary vein (PV) spontaneous activity in SD rats, along with a heightened occurrence of delayed after-depolarizations in the PV and left atrium (LA) induced by tachypacing and isoproterenol. A Western blot analysis showed reduced expression of G protein-coupled receptor kinase 2 (GRK2) in the LA of the SD rats. Chronic partial SD impairs LV function, promotes AF genesis, and increases PV and LA arrhythmogenesis, potentially attributed to sympathetic overactivity and reduced GRK2 expression. Targeting GRK2 signaling may offer promising therapeutic avenues for managing chronic partial SD-induced AF. Future investigations are mandatory to investigate the dose-response relationship between SD and AF genesis.

Phosphodiesterase 9A inhibition improves aging-related increase in pulmonary vascular resistance in mice.

As individuals age, there is a gradual decline in cardiopulmonary function, often accompanied by cardiac pump dysfunction leading to increased pulmonary vascular resistance (PVR). Our study aims to investigate the changes in cardiac and pulmonary vascular function associated with aging. Additionally, we aim to explore the impact of phosphodiesterase 9A (PDE9A) inhibition, which has shown promise in treating cardiometabolic diseases, on addressing left ventricle (LV) dysfunction and elevated PVR in aging individuals. Young (3 months old) and aged (32 months old) male C57BL/6 mice were used. Aged mice were treated with the selective PDE9A inhibitor PF04447943 (1 mg/kg/day) through intraperitoneal injections for 10 days. LV function was evaluated using cardiac ultrasound, and PVR was assessed in isolated, ventilated lungs perfused under a constant flow condition. Additionally, changes in PVR were measured in response to perfusion of the endothelium-dependent agonist bradykinin or to nitric oxide (NO) donor sodium nitroprusside (SNP). PDE9A protein expression was measured by Western blots. Our results demonstrate the development of LV diastolic dysfunction and increased PVR in aged mice. The aged mice exhibited diminished decreases in PVR in response to both bradykinin and SNP compared to the young mice. Moreover, the lungs of aged mice showed an increase in PDE9A protein expression. Treatment of aged mice with PF04447943 had no significant effect on LV systolic or diastolic function. However, PF04447943 treatment normalized PVR and SNP-induced responses, though it did not affect the bradykinin response. These data demonstrate a development of LV diastolic dysfunction and increase in PVR in aged mice. We propose that inhibitors of PDE9A could represent a novel therapeutic approach to specifically prevent aging-related pulmonary dysfunction.

3D Echocardiographic Assesment of Left Ventricle Size and Function with Automated Adaptive Software in Patients with Right Heart Dominant

Introduction : Echocardiography is a fundamental tool for assessing cardiac chamber size and function, with evolving technologies like real-time three-dimensional echocardiography (3DE) and automated quantification software offering new possibilities. This study aims to validate left ventricular (LV) measurements obtained through automated quantification software against manual 3DE and 2D measurements, explore the relationship between these measurement techniques, and compare their reproducibility and analysis time. Methods : A total of 60 patients with uncorrected severe mitral stenosis (MS) and atrial septal defect (ASD) underwent echocardiography. Automated and manual 3DE measurements were compared, with subgroup analysis for software performance. Analysis times were also assessed. Results : The automated quantification software did not work in 16 patients, with notable differences in tricuspid regurgitation parameters. Automated 3DE measurements yielded larger LV volumes than manual 3DE measurements, while LV ejection fraction (LVEF) measurements were smaller. Good correlations were observed, but agreement analysis revealed significant differences between the two methods. The use of automated software significantly reduced analysis time. Conclusions : Automated quantification software can effectively measure LV parameters in patients with MS and ASD, significantly reducing analysis time. However, manual methods may still be necessary in cases with structural changes or unique anatomical conditions, emphasizing the importance of selecting the appropriate measurement technique for specific patient populations. Keywords: 3D Echocardiography, Automated Adaptive Software, Cardiac Imaging

Left Ventricular Remodeling after Percutaneous Coronary Intervention in Acute Myocardial Infarction Complicated by Acute Heart Failure

The aim. To establish the relationship between structural-functional and laboratory parameters in patients with myocardial infarction (MI) and heart failure (HF) undergoing percutaneous coronary intervention (PCI). Materials and methods. We examined 308 MI patients who were divided into 3 groups: 161 patients without signs of acute heart failure (AHF) (group I), 99 with Killip class II-III AHF (group II) and 48 with Killip class IV (cardiogenic shock) (group III). All the patients underwent general clinical examinations: complete blood count, lipid profile, creati-nine, quantitative determination of troponin I, D-dimer, creatine kinase-MB, electrocardiography, coronary angiography with PCI, focused cardiac ultrasound and standard echocardiography over 3-5 days. Results. According to the focused cardiac ultrasound, the majority of MI patients with signs of AHF had preserved left ventricle function, and only 8.2% of patients had left ventricle ejection fraction (LVEF) ˂40%. The most significant structural and functional changes were observed in group II. After PCI, a significant increase in left ventricle contractility was found in all groups, but in the group II, the increase in LVEF was more pronounced. The severity of HF manifestations increased depending on the severity of diastolic dysfunction. Many correlations were established: an inverse relationship between LVEF and the presence of HF, the number ofaffected vessels, proximal left anterior descending artery lesions, low-density lipoprotein cholesterol, and atrium fibrilla-tion; a direct relationship between LVEF and hemoglobin levels and glomerular filtration rate. Conclusions. The vast majority of patients with MI and signs of AHF had preserved left ventricle contractile function. High-grade HF manifestations increase depending on the severity of diastolic dysfunction. Myocardial revascularization in MI pa-tients significantly improves functional and volumetric parameters of myocardial function. Numerous correlations between structural-functional and laboratory parameters in patients with MI and HF who underwent PCI have been established.