Long-term Heart Research Articles

Prolonged Impella 5.0/5.5 support within different pathways of care for cardiogenic shock: the experience of a referral center.

Impella 5.0 and 5.5 are promising low-invasive left ventricle (LV) temporary mechanical circulatory supports (tMCS) for cardiogenic shock due to LV mechanical unloading and are paired with powerful hemodynamic support. This study aimed to analyze data and destinies of patients supported with Impella 5.0/5.5 at a national referral center for cardiogenic shock and to assess the parameters associated with myocardial recovery and successful weaning. A single-center observational study was conducted on all patients treated with Impella 5.0 or 5.5 from March 2018 to July 2023. A total of 59 patients underwent Impella 5.0/5.5 implantation due to profound cardiogenic shock, with acute myocardial infarction being the most frequent cause of shock (42 patients, 71%). The median duration of Impella support was 13 days (maximum duration of 52 days). Axillary cannulation was feasible in almost all patients, and 36% were mobilized during support. A total of 44 patients (75%) survived to the next therapy/recovery: 21 patients experienced recovery and 15 and 8 were bridged to long-term LVAD and heart transplantation, respectively. The global survival rate was 66%. The predictors of native heart recovery at multivariate analysis were the number of days on tMCS before upgrade to Impella 5.0/5.5 [hazard ratio (HR) 0.68 (0.51-9) p = 0.0068] and improvement of LVEF within the first 7-10 days of support [HR 4.72 (1.34-16.7), p = 0.016]. Transcatheter systems such as Impella 5.0/5.5 revolutionized the field of tMCS. Myocardial recovery is the primary clinical target. Its prognostication and promotion are key to ensure the most proficuous course for each patient from cardiogenic shock to long-term event-free survival.

Balloon atrial septostomy: a weapon to challenge right heart failure after cardiac surgery

Right heart failure is a common complication after cardiac surgery, and its mortality remains high. The medical management and veno-arterial extracorporeal membrane oxygenation has shown significant improvement in the majority of cases. However, a minority of patients may still require long-term mechanical circulatory support or heart transplantation. Balloon atrial septostomy is a new method for the prevention and treatment of right heart failure, which may avoid the patient’s dependence on mechanical circulatory support. We used this method to try to treat patients with right heart failure after cardiac surgery, and all received good benefits. Therefore, we selected several representative cases to report, in order to guide other qualified cardiac surgeons to carry out relevant clinical practice.

Quality-Aware Signal Processing Mechanism of PPG Signal for Long-Term Heart Rate Monitoring.

Photoplethysmography (PPG) is widely utilized in wearable healthcare devices due to its convenient measurement capabilities. However, the unrestricted behavior of users often introduces artifacts into the PPG signal. As a result, signal processing and quality assessment play a crucial role in ensuring that the information contained in the signal can be effectively acquired and analyzed. Traditionally, researchers have discussed signal quality and processing algorithms separately, with individual algorithms developed to address specific artifacts. In this paper, we propose a quality-aware signal processing mechanism that evaluates incoming PPG signals using the signal quality index (SQI) and selects the appropriate processing method based on the SQI. Unlike conventional processing approaches, our proposed mechanism recommends processing algorithms based on the quality of each signal, offering an alternative option for designing signal processing flows. Furthermore, our mechanism achieves a favorable trade-off between accuracy and energy consumption, which are the key considerations in long-term heart rate monitoring.

CARDIAC ULTRASOUND ALTERATIONS IN INDIVIDUALS WITH PNEUMONIA RELATED TO COVID-19 INFECTION

A wide range of cardiac effects are observed during the acute phase of COVID-19. Interestingly, troponin levels are raised in 8–28% of instances, while systolic myocardial dysfunction symptoms are not always evident. Subclinical myocardial dysfunction is more common and is commonly defined as a decrease in the left ventricle's global longitudinal strain (LV GLS). Up to 80% of individuals exhibit this alteration while they are in the hospital. LV GLS is a crucial component in risk assessment for follow-up care and a strong independent predictor of in-hospital mortality. The first results on the long-term cardiovascular effects of COVID-19 one year after hospitalization are presented in this study. One year after discharge, we found that patients with COVID-19 pneumonia had a negative trend in LV GLS and deformation metrics in the apical and certain middle segments of the LV myocardium, as compared to data collected three months after discharge. The purpose of the study is to look at the prevalence and clinical significance of long-term heart injury following COVID-19. In order to do this, we examined patient data and categorized patients a year following hospital discharge according to their LV GLS values. This method aids in comprehending the clinical ramifications of long-term cardiac injury after COVID-19.

Non-invasive assessment of left ventricular contractility by myocardial work index in veno-arterial membrane oxygenation patients: rationale and design of the MIX-ECMO multicentre observational study.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an increasingly utilized therapeutic choice in patients with cardiogenic shock, however, high complication rate often counteracts with its beneficial cardiopulmonary effects. The assessment of left ventricular (LV) function in key in the management of this population, however, the most commonly used measures of LV performance are substantially load-dependent. Non-invasive myocardial work is a novel LV functional measure which may overcome this limitation and estimate LV function independent of the significantly altered loading conditions of VA-ECMO therapy. The Usefulness of Myocardial Work IndeX in ExtraCorporeal Membrane Oxygenation Patients (MIX-ECMO) study aims to examine the prognostic role of non-invasive myocardial work in VA-ECMO-supported patients. The MIX-ECMO is a multicentric, prospective, observational study. We aim to enroll 110 patients 48-72 h after the initiation of VA-ECMO support. The patients will undergo a detailed echocardiographic examination and a central echocardiography core laboratory will quantify conventional LV functional measures and non-invasive myocardial work parameters. The primary endpoint will be failure to wean at 30 days as a composite of cardiovascular mortality, need for long-term mechanical circulatory support or heart transplantation at 30 days, and besides that other secondary objectives will also be investigated. Detailed clinical data will also be collected to compare LV functional measures to parameters with established prognostic role and also to the Survival After Veno-arterial-ECMO (SAVE) score. The MIX-ECMO study will be the first to determine if non-invasive myocardial work has added prognostic value in patients receiving VA-ECMO support.

The impact of permanent pacemaker implantation on long-term survival after cardiac surgery: A systematic review and meta-analysis

ObjectivesThe long-term impact of permanent pacemaker (PPM) implantation on survival after cardiac surgery remains ill defined. We aimed to investigate the effect of PPM on survival and explore factors driving outcomes using meta-regression according to the type of surgery. MethodsMEDLINE, EMBASE, and the Cochrane Library Central Register of Controlled Trials were searched through October 2023 to identify studies reporting the long-term outcomes of PPM implantation. The primary outcome was all-cause mortality during follow-up. The secondary outcome was heart failure rehospitalization. The subgroup analysis and meta-regression analysis were performed according to the type of surgery. ResultsA total of 28 studies met the inclusion criteria. 183,555 patients (n = 6298; PPM, n = 177,257; no PPM) were analyzed for all-cause mortality, with a weighted median follow-up of 79.7 months. PPM implantation was associated with increased risks of all-cause mortality during follow-up (hazard ratio, 1.22; confidence interval, 1.08-1.38, P < .01) and heart failure rehospitalization (hazard ratio, 1.24; confidence interval, 1.01-1.52, P = .04). Meta-regression demonstrated the adverse impact of PPM was less prominent in patients undergoing mitral or tricuspid valve surgery, whereas studies with a greater proportion with aortic valve replacement were associated with worse outcomes. Similarly, a greater proportion with atrioventricular block as an indication of PPM was associated with worse survival. ConclusionsPPM implantation after cardiac surgery is associated with a greater risk of long-term all-cause mortality and heart failure rehospitalization. This impact is more prominent in patients undergoing aortic valve surgery or atrioventricular block as an indication than those undergoing mitral or tricuspid valve surgery.

S100A8/A9 as a prognostic biomarker with causal effects for post-acute myocardial infarction heart failure

Heart failure is the prevalent complication of acute myocardial infarction. We aim to identify a biomarker for heart failure post-acute myocardial infarction. This observational study includes 1062 and 1043 patients with acute myocardial infarction in the discovery and validation cohorts, respectively. The outcomes are in-hospital and long-term heart failure events. S100A8/A9 is screened out through proteomic analysis, and elevated circulating S100A8/A9 is independently associated with heart failure in discovery and validation cohorts. Furthermore, the predictive value of S100A8/A9 is superior to the traditional biomarkers, and the addition of S100A8/A9 improves the risk estimation using traditional risk factors. We finally report causal effect of S100A8/A9 on heart failure in three independent cohorts using Mendelian randomization approach. Here, we show that S100A8/A9 is a predictor and potentially causal medicator for heart failure post-acute myocardial infarction.

Diagnostic and prognostic markers of morphofunctional heart state impairment and long-term persistence of heart failure in patients with myocarditis

The problem of myocarditis, has gained special relevance in recent years, therefore, the search for new diagnostic and prognostic markers of the disease unfavorable course is expedient for the timely appointment of optimal drug therapy, strengthening of regimen measures and adequate monitoring of the patient’s clinical condition. The purpose of the study: to establish laboratory and instrumental markers of morphofunctional heart state impairment and to develop a mathematical model for early prediction of long-term heart failure persistence in patients with myocarditis. We included 80 patients with acute myocarditis with a severe course and reduced left ventricular ejection fraction (LVEF) – ≤40 %. Assessment of laboratory and instrumental indicators was carried out in the 1st month from the onset of symptoms, after 6 and after 12 months of observation. All patients underwent for immunological studies, 24-hour ECG monitoring, echocardiography with speckle-tracking and cardiac magnetic resonance imaging. After 12 months of follow-up frequency of adverse cardiovascular events (ACE) was assessed. Statistical processing included Student’s t-test for comparison of mean values, binary logistic regression and ROC analysis, discriminant analysis. A set of morphofunctional instrumental indicators determined during the 1st month from the onset of myocarditis, which can serve as predictors of cardiovascular events during the next 12 months, was established: left ventricular ejection fraction ≤30 %; indicator of longitudinal global strain ≤7.0 %; the presence of paroxysms of non-sustained ventricular tachycardia; the presence of inflammatory changes in ≥6 segments and delayed contrast enhancement in ≥5 segments of the left ventricle. A mathematical model has been created, with the help of which it is possible to predict the adverse course of the disease with long-term (at least 12 months) persistence of heart failure already within the 1st month from the onset of myocarditis.

Routine screening for HLA Antibodies in Heart Transplant patients-Does it affect clinical decision making?

We aimed to assess outcomes in patients with and without donor specific antibodies (DSA) and to evaluate the relationship between DSA presence and graft function, cardiac allograft vasculopathy (CAV), and mortality. The study population comprises 193 consecutive long-term heart transplanted (HTx) patients who underwent DSA surveillance between 2016 and 2022. The patients were prospectively screened for CAV through serial coronary angiograms, graft function impairment through serial echocardiograms, and cardiac biomarkers. The patients were followed from the first DSA measurement until death, 5 years follow-up or right censuring on the 30th of June 2023. DSAs were detected in 50 patients using a cut-off at MFI ≥1000 and 45 patients using a cut-off at ≥2000 MFI. The median time since HTx was 9.0 years [3.0-14.4]. DSA positive patients had poorer graft function and higher values of NT-proBNP and troponin T, and more prevalent CAV than DSA negative patients. In total, 25 patients underwent endomyocardial biopsies due to DSA presence while another eight patients underwent endomyocardial biopsies for other reasons. Histological antibody mediated rejection (AMR) signs were seen in three biopsies. During a median follow-up of five years [4.7-5], a total of 41 patients died. Mortality rates did not differ between DSA positive and DSA negative patients (HR 1.2, 95% CI.6-2.4). DSA positive patients were more likely to experience CAV progression than DSA negative patients (HR 2.7, 95% CI 1.5-4.8) CONCLUSIONS: Routine screening reveals DSA in approximately 25% of long-term HTx patients but is rarely related to histopathological AMR signs. DSA presence was associated with poorer graft function and more prevalent and progressive CAV. However, DSA positive patients had similar survival rates to DSA negative patients.

Gynecologic Care of Black Breast Cancer Survivors.

Black patients suffer from breast cancer-related racial health disparities, which could have implications on their gynecologic care. This review explores considerations in the gynecologic care of Black breast cancer survivors. Black people have a higher risk of leiomyoma and endometrial cancer, which could confound bleeding patterns such as in the setting of tamoxifen use. As Black people are more likely to have early-onset breast cancer, this may have implications on long-term bone and heart health. Black patients may be more likely to have menopausal symptoms at baseline and as a result of breast cancer treatment. Furthermore, Black patients are less likely to utilize assisted reproductive technology and genetic testing services. It is important for healthcare providers to be well-versed in the intersections of breast cancer and gynecologic care. Black breast cancer survivors may have unique considerations for which practitioners should be knowledgeable.

Short-Term Effects of Heart Rate Variability Biofeedback on Working Memory.

Drawing upon the well-documented impact of long-term heart rate variability biofeedback (HRVB) on psychophysiological responses, this study seeks to explore the short-term effects arising from a single HRVB session during and after paced breathing exercise. The research aligns with the neurovisceral integration model, emphasizing the link between heart rate variability (HRV) levels and cognitive performance. Therefore, a randomized controlled trial employing a between-subjects design was conducted with 38 participants. Each participant was assigned to either the paced breathing intervention group or the spontaneous breathing control group. The study assessed various parameters such as cardiac vagal tone, evaluated through vagally mediated HRV measures, and working memory, measured using the N-back task. Additionally, participants' affective states were assessed through self-reported questionnaires, specifically targeting attentiveness, fatigue, and serenity. The results notably reveal enhancements in the working memory task and an elevated state of relaxation and attention following the HRVB session, as evidenced by higher averages of correct responses, serenity and attentiveness scores. However, the findings suggest that this observed improvement is not influenced by changes in cardiac vagal tone, as assessed using a simple mediation analysis. In conclusion, this study presents promising insights into the impact of a single HRVB session, laying the foundation for future research advancements in this domain.

Effect of a transitional care model following hospitalization for heart failure: 3-year outcomes of the Patient-Centered Care Transitions in Heart Failure (PACT-HF) randomized controlled trial.

Patients are at high risk of death or readmission following hospitalization for heart failure (HF). We tested the effect of a transitional care model that included month-long nurse-led home visits and long-term heart function clinic visits - with services titrated to estimated risk of clinical events - on 3-year outcomes following hospitalization. In a pragmatic, stepped-wedge cluster randomized trial, 10 hospitals were randomized to the intervention versus usual care. The primary outcome was a composite of all-cause death, readmission, or emergency department (ED) visit. Secondary outcomes included components of the primary composite outcomes, HF readmissions and healthcare resource utilization. There were 2494 patients (50.4% female) with mean age of 77.7 years. The primary outcome was reached in 1040 (94.2%) patients in the intervention and 1314 (94.5%) in the usual care group at 3 years. The intervention did not reduce the risk of the primary composite outcome (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.81-1.05) nor the component outcomes overall, although numerically reduced the risk of ED visits in women but not men (HR 0.79, 95% CI 0.63-1.00 vs. HR 0.98, 95% CI 0.80-1.19; sex-treatment interaction p = 0.23). The uptake of guideline-directed medical therapy was no different with the intervention than with usual care, with the exception of sacubitril/valsartan, which increased with the intervention (3.3% vs 1.5%; relative risk 6.2, 95% CI 1.92-20.06). More than 9 of 10 patients hospitalized for HF experienced all-cause death, readmission, or ED visit at 3 years. A transitional care model with services titrated to risk did not improve the composite of these endpoints, likely because there were no major differences in uptake of medical therapies between the groups. ClinicalTrials.gov Identifier NCT02112227.

Epicardial adipose tissue and subclinical incident atrial fibrillation as detected by continuous monitoring: a cardiac magnetic resonance imaging study

Epicardial adipose tissue (EAT) has endocrine and paracrine functions and has been associated with metabolic and cardiovascular disease. This study aimed to investigate the association between EAT, determined by cardiac magnetic resonance imaging (CMR), and incident atrial fibrillation (AF) following long-term continuous heart rhythm monitoring by implantable loop recorder (ILR). This study is a sub-study of the LOOP study. In total, 203 participants without a history of AF received an ILR and underwent advanced CMR. All participants were at least 70 years of age at inclusion and had at least one of the following conditions: hypertension, diabetes, previous stroke, or heart failure. Volumetric measurements of atrial- and ventricular EAT were derived from CMR and the time to incident AF was subsequently determined. A total of 78 participants (38%) were diagnosed with subclinical AF during a median of 40 (37–42) months of continuous monitoring. In multivariable Cox regression analyses adjusted for age, sex, and various comorbidities, we found EAT indexed to body surface area to be independently associated with the time to AF with hazard ratios (95% confidence intervals) up to 2.93 (1.36–6.34); p = 0.01 when analyzing the risk of new-onset AF episodes lasting ≥ 24 h. Atrial EAT assessed by volumetric measurements on CMR images was significantly associated with the incident AF episodes as detected by ILR.

DATA ANALYTICS FOR HEALTH-RELEVANT EVENTS DETECTION BASED UPON LONGITUDINAL FITBIT HEART RATE DATA

Abstract The increasing prevalence of wearable devices enables low-cost, long-term collection of health relevant data such as heart rate, exercise, and sleep signals. Currently these data are used to monitor short term changes with limited interpretation of their relevance to health. These data provide an untapped resource to monitor daily and long-term activity patterns. Changes and trends identified from such data can provide insights and guidance to the management of many chronic conditions that change over time. In this study we conducted a machine learning based analysis of longitudinal heart rate data collected over multiple years from Fitbit devices. We built a multi-resolutional pipeline for time series analysis, using model-free clustering methods inspired by statistical conformal prediction framework. With this method, we were able to detect health relevant events, their interesting patterns (e.g., daily routines, seasonal differences, and anomalies), and correlations to acute and chronic changes in health conditions. We present the results, lessons, and insights learned, and how to address the challenge of lack of labels. The study confirms the value of long-term heart rate data for health monitoring and surveillance, as complementary to extensive yet intermittent examinations by health care providers.

Modifications of long-term heart rate variability produced in an experimental model of diet-induced metabolic syndrome.

Metabolic syndrome (MetS) has been linked to a higher prevalence of cardiac arrhythmias, the most frequent being atrial fibrillation, but the mechanisms are not well understood. One possible underlying mechanism may be an abnormal modulation of autonomic nervous system activity, which can be quantified by analysing heart rate variability (HRV). Our aim was to investigate the modifications of long-term HRV in an experimental model of diet-induced MetS to identify the early changes in HRV and the link between autonomic dysregulation and MetS components. NZW rabbits were randomly assigned to control (n = 10) or MetS (n = 10) groups, fed 28 weeks with high-fat, high-sucrose diet. 24-hour recordings were used to analyse HRV at week 28 using time-domain, frequency-domain and nonlinear analyses. Time-domain analysis showed a decrease in RR interval and triangular index (Ti). In the frequency domain, we found a decrease in the low frequency band. Nonlinear analyses showed a decrease in DFA-α1 and DFA-α2 (detrended fluctuations analysis) and maximum multiscale entropy. The strongest association between HRV parameters and markers of MetS was found between Ti and mean arterial pressure, and Ti and left atrial diameter, which could point towards the initial changes induced by the autonomic imbalance in MetS.

Long-term structural right heart remodeling following transcatheter annuloplasty for treating severe tricuspid regurgitation assessed by CT scan

Abstract Background Transcatheter tricuspid annuloplasty has emerged as an attractive percutaneous therapy for patients with severe symptomatic tricuspid regurgitation. Cardioband (Edwards) was the first dedicated CE marked percutaneous device for tricuspid regurgitation. Despite mid-long-term clinical safety and efficacy demonstrated in early feasibility trials and registries, there is no data about its impact on right heart structural remodeling using computed tomography (CT). Our aim was to assess right heart remodeling and changes in the tricuspid annulus (TA) one year after Cardioband implantation. Methods A total of 30 patients were prospectively included in the study; 21 of them had baseline and at least 1-year follow-up CT analysis. The average time from the basal CT scan and the procedure was 118±136 days, and from the intervention to follow-up CT scan was 468±251 days. 2D and 3D analyses were performed with 3mensio version 10.3 at baseline and at least 12 months after Cardioband implantation. Results There was a significant decrease in right ventricular dimensions at follow-up (right ventricular basal diameter was 53.65 ± 8.45 mm at baseline Vs 48.54 ± 9.12 mm at 1-year follow-up; right ventricular mid cavity diameter was 40.30 ± 9.10 mm at baseline Vs 34.22 ± 9.22 at the end of follow-up, and right ventricular longitudinal diameter was 75.43 ± 9.85 mm at baseline Vs 69.95 ± 9.96 mm at the end of follow-up, all of them were statistically significant). A reduction in right atrial dimension was also observed (longitudinal diameter 66.86 ± 7.63 mm at baseline Vs 64.89 ± 9.99 mm at the end of follow-up; transverse diameter of 61.62 ± 8.38 mm at baseline Vs 60.59 ± 8.3 mm at the end of follow-up, p&amp;lt;0.001). There was a significant decrease in the area and diameters of the dilated TA (area at baseline 16.51 ± 3.06 cm2 vs 8.90 ± 2.71 cm2 at the end of follow-up, p=0.02; septolateral diameter 45.42 ± 5.02 mm at baseline vs 33.87 ± 5.09 mm at the end of follow-up, p=0.01). Conclusions Long-term favorable right ventricular chambers and TA remodeling was observed following Cardioband implantation assessed by CT scan. This finding could explain the long-term clinical benefit demonstrated in feasibility studies.Right heart remodeling after Cardioband

Metabolic syndrome and long-term heart rate variability: a systematic review and meta-analysis

Abstract Introduction Metabolic syndrome (MS) is defined as the convergence over time of a group of non-communicable chronic diseases (hypertension, diabetes, dyslipidemia, obesity). There is agreement that MS is related to pathological changes in the behavior of the autonomic nervous system (ANS). Heart rate variability (HRV) is a very useful tool for assessing autonomous behavior, widely used and that could be useful for the diagnosis and monitoring of MS. However, to date, there are no quantitative analyses using meta-analysis (MA) that have addressed the changes that MS causes on the ANS. Therefore, the objective of this systematic review and MA is to evaluate changes in long-term HRV in patients with MS, in order to characterize the cardiac autonomic dysfunction induced by this pathological condition and the most frequently reported explanatory variables. Methods We searched PubMed, Web of Science and Scopus electronic databases for original works with long-term HRV recordings (24-h holter) that compared people with MS (MS+) versus healthy people as a control group (MS-). The search was carried out between June 25th, 2022 and September 1st, 2022. In the databases selected, the terms used were "metabolic syndrome" linked to "heart rate variability" (HRV), "cardiac autonomic control", "cardiac autonomic function", or "cardiac autonomic modulation". This systematic review and MA was performed according with PRISMA guidelines and registered at the International Prospective Register of Systematic Reviews (CRD42022358975). Results are reported as standard mean difference [95% CI]. Results Thirteen articles were included in the qualitative synthesis and seven of them met required criteria to be included in the MA. MS decreased SDNN (-0.33 [-0.57, -0.09], p=0.008), LF (-0.40 [-0.51, -0.28], p&amp;lt;0.0001), VLF (-0.35 [-0.50, -0.21], p p&amp;lt;0.0001)) and TP (-0.24 [-0.43, -0.05], p=0.01). The MA did not find significant differences in rMSSD (-0.09 [-0.31, 0.13], p=0.41), HF (-0.29 [-0.61, 0.03], p=0.07) and LF/HF (-0.04 [-0.45, 0.36], p=0.84). No article reported information by gender. In the case of the non-linear variables, the information reported was not enough to carry out the MA, but the qualitative analyses showed no change in SD1 of the Poincare plot and a decrease in the multiscale entropy. For the SD2 of the Poincare plot and alfa-1 of the detrended fluctuation analyses, the results are not conclusive. Conclusions The analysis of HRV (time-domain) in long recording periods showed that patients with MS have lower values in the SDNN and no significant changes in rMSSD. Regarding the frequency domain analysis, we found that MS induced a significant decrease in LF, VLF and TP. The MA did not show changes in HF and LF/HF, and quantitative analyses of non-linear parameters could not be performed.

Abstract 16488: Sestrin2 Protects Against Long-Term Cardiac Injury and Remodeling by Modulating mTORC1 Activation in Myocardial Ischemia/Reperfusion

Introduction: Myocardial ischemia/reperfusion (I/R) injury can lead to long-term cardiac dysfunction and heart failure with reduced ejection fraction (HFrEF) in aged hearts. However, young hearts may exhibit some resistance to this process and retain better cardiac function. Our previous studies have identified a novel protein called Sestrin2 (Sesn2), which is downregulated in aged hearts. Hypothesis: Sesn2 may protect hearts from progressing to HFrEF following myocardial I/R. Methods: We induced myocardial I/R injury by ligation/release of the left anterior descending coronary arteries (LAD) in both C57BL/6J mice and mice with cardiac-specific Sesn2 knockout (Sesn2 cKO ). Cardiac function was assessed, and samples were collected at baseline, one day post I/R, seven days post I/R, and 28 days post I/R. Results: In wild-type (WT) hearts (12-18 weeks), cardiac function showed a slight decrease 28 days post I/R (IR28D), but the ejection fraction (EF) remained above 50%. However, Sesn2 cKO mice exhibited a significant reduction in cardiac function at IR28D, with an about 27.5% decrease in EF compared to WT hearts. We also observed a significant increase in volume at diastole in Sesn2 cKO mice at IR28D compared to their baseline and corresponding WT. Furthermore, when comparing mitochondrial respiration in the area at risk (AAR) of the left ventricles between the two groups, we found a significant decrease in oxygen consumption rate (OCR) and a significant increase in H 2 O 2 production in Sesn2 cKO hearts. Additionally, the mammalian target of rapamycin complex 1 (mTORC1) was significantly upregulated in Sesn2 cKO mice compared to WT hearts. Conclusions: Sesn2 exerts a cardiac protective effect by downregulating mTORC1 activation, thereby reducing long-term cardiac injury following I/R, attenuating cardiac remodeling, and improving mitochondrial respiration in the AAR of the heart.

PECULIARITIES OF HEMODYNAMICS IN PATIENTS WITH CHRONIC HEART FAILURE CONSIDERING SEX DIMORPHISM

Introduction. Heart failure is an important factor in the development of pathological processes and pathophysiological manifestations; it can be modified at all stages of its development, regardless of sex and age, and be accompanied by arterial hypertension, heart ischemia, tachycardia, bradycardia, etc. The purpose of this study is to investigate the peculiarities of central hemodynamics in cases of chronic heart failure considering sex dimorphism. Materials and methods. The research comprised 149 individuals, aged between 18 and 75, with long-term heart failure, who received inpatient treatment at the Heart Failure Department of the National Centre of Cardiology "Acad. M.D. Strazhesko Institute of Cardiology” of the National Academy of Sciences of Ukraine for 2020 – 2022. Objective criteria such as heart rate, systolic and diastolic blood pressure, pulse pressure, systolic blood volume, and minute blood volume were used to assess the state of the cardiovascular system. All patients underwent an echocardiogram in M- and B-modes to assess the structural and functional state of the heart and to establish an accurate diagnosis. Results. Analyzing the obtained results, it should be noted that there is a certain sexual dimorphism in the indicators of central hemodynamics in patients with chronic heart failure: for instance, women with chronic heart failure demonstrates significantly higher values of blood pressure and pulse pressure than men with the same diagnosis. The values of minute blood volume in patients with chronic heart failure of both sexes were within the reference values. More pronounced changes in central hemodynamic parameters under chronic heart failure were observed in women compared to men. It should be noted that all investigations were conducted while individuals were receiving medical therapy for heart failure. It is note worthy that the results of the echocardiographic examination indicate profound changes in the heart structure in the patients with chronic heart failure. In particular, the set of the evaluated indicators point out left ventricle hypertrophy. The degree of hypertrophy provides unquestionable predictive value. Remodelling of the myocardium is a possible occurrence linked to arterial hypertension. Conclusion. Central hemodynamic indicators reveal sex dimorphism, with greater distinction observed in the patients with chronic heart failure, particularly among women. Despite this, the main indicators of hemodynamics in patients with chronic heart failure were within the reference values, which can be explained by the fact that the patients received drug therapy. However, the analysis of indicators obtained by echocardiographic study indicates profound changes in the heart structure in patients with chronic heart failure, which are more pronounced in male patients compared to their female counterparts.

Association between the neutrophil-to-lymphocyte ratio and risk of in-hospital heart failure and arrhythmia in patients with acute myocardial infarction.

This study was to probe into the relationship between the neutrophil-to-lymphocyte ratio (NLR) and both in-hospital and long-term heart failure risk in patients with acute myocardial infarction (AMI). 990 patients with AMI, including 386 with non-ST-segment elevation myocardial infarction (NSTEMI) and 604 with segment elevation myocardial infarction (STEMI) were recruited between January 2019 and March 2022. The in-hospital acute heart failure (AHF) and arrhythmia events were recorded. The NLR was significantly greater in the AHF group in STEMI and NSTEMI patients, with a higher frequency of arrhythmia in comparison to the non-AHF group. A high NLR was related to a high level of myocardial injury markers, accompanied with more AHF and arrhythmia events. Multivariate logistic regression analyses revealed that high NLR is independently linked with increased in-hospital AHF and arrhythmia risk. Receiver operating characteristic curve analyses revealed that the prognostic value of NLR for in-hospital AHF was 0.704 in STEMI patients and 0.766 in NSTEMI patients. However, during a median follow-up of 28 months with 32 heart failure patients, there was no significant difference between the low NLR group (n = 18) and the high NLR group (n = 14). Further analysis showed that the two groups did not significantly differ in the occurrence of heart failure within 12 months of discharge. Our results indicate that NLR is an independent risk factor of in-hospital AHF in AMI patients. However, NLR has no value in predicting long-term heart failure.