Left Ventricular Myocardium Research Articles

Repeatability of radiomic features in myocardial T1 and T2 mapping.

To investigate the test-retest repeatability of radiomic features in myocardial native T1 and T2 mapping. In this prospective study, 50 healthy volunteers (29 women and 21 men, mean age 39.4 ± 13.7 years) underwent two identical cardiac magnetic resonance imaging (MRI) examinations at 1.5 T. The protocol included native T1 and T2 mapping in both short-axis and long-axis orientation. For T1 mapping, we investigated standard (1.9 × 1.9 mm) and high (1.4 × 1.4 mm) spatial resolution. After manual segmentation of the left ventricular myocardium, 100 radiomic features from seven feature classes were extracted and analyzed. Test-retest repeatability of radiomic features was assessed using the intraclass correlation coefficient (ICC) and classified as poor (ICC < 0.50), moderate (0.50-0.75), good (0.75-0.90), and excellent (> 0.90). For T1 maps acquired in short-axis orientation at standard resolution, repeatability was excellent for 6 features, good for 29 features, moderate for 19 features, and poor for 46 features. We identified 15 features from 6 classes which showed good to excellent reproducibility for T1 mapping in all resolutions and all orientations. For short-axis T2 maps, repeatability was excellent for 6 features, good for 25 features, moderate for 23 features, and poor for 46 features. 12 features from 5 classes were found to have good to excellent repeatability in T2 mapping independent of slice orientation. We have identified a subset of features with good to excellent repeatability independent of slice orientation and spatial resolution. We recommend using these features for further radiomics research in myocardial T1 and T2 mapping. Question The study addresses the need for reliable radiomic features for quantitative analysis of the myocardium to ensure diagnostic consistency in cardiac MRI. Findings We have identified a subset of radiomic features demonstrating good to excellent repeatability in native T1 and T2 mapping independent of slice orientation and resolution. Clinical relevanceRadiomic features have been proposed as diagnostic and prognostic biomarkers in various heart diseases. By identifying a subset of particularly reproducible radiomic features our study serves to inform the selection of radiomic features in future research and clinical applications.

Features of infl ammatory biomarkers in patients with occupational COPD and cardiovascular comorbidity

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with over 30% of these patients dying from cardiovascular diseases. Objective: to study the pathophysiological links between echocardiography, spirometry indicators, and inflammatory biomarkers in patients with various clinical phenotypes of occupational COPD with cardiovascular comorbidity. Material and methods. The study included 111 patients with occupational COPD and cardiovascular comorbidity. Based on spirometry results, patients were divided into 4 groups (clinical phenotypes). Clinical examinations, echocardiography, and serum concentrations of troponin I, endothelin-1 (E-1), endothelial synthase (ES), hyaluronic acid (HA), and myoglobin were performed. Results. The concentrations of troponin I, myoglobin, and E-1 were normal in all groups. HA concentration was highest among phenotype “E” patients (p = 0.0008). ES concentration in phenotype “E” was more than 2.5 times higher compared to other groups (p = 0.0022). Myoglobin concentration positively correlated with left ventricular myocardium thickness, ES, eosinophil levels, and coronary heart disease (p &lt; 0.05), while ES concentration correlated positively with hypertension. HA concentration negatively correlated with spirometry and echocardiography indicators and positively correlated with eosinophil levels and exacerbations (p &lt; 0.05). Conclusion. Further research is needed to identify biomarkers reflecting the risk of exacerbations in cardiovascular comorbidities in patients with occupational COPD

Effect of magnetic field strength and segmentation variability on the reproducibility and repeatability of radiomic texture features in cardiovascular magnetic resonance parametric mapping.

Our study aims to assess the robustness of myocardial radiomic texture features (RTF) to segmentation variability and variations across scanners with different field strengths, addressing concerns about reliability in clinical practices. We conducted a retrospective analysis on 45 pairs of CMR T1 maps from 15 healthy volunteers using 1.5T and 3T Siemens scanners. Manual left ventricular myocardium segmentation and a deep learning-based model with Monte Carlo Dropout generated masks with different levels of variability and 1023 RTFs extracted from each region of interest (ROI). Reproducibility: the extent to which RTFs extracted from 1.5T and 3T images are consistent, and repeatability: the extent to which RTFs extracted from multiple segmentation runs at the same field strength agree with each other, were measured by the intraclass correlation coefficient (ICC). We categorized ICC values as excellent, good, moderate, and poor. We reported the proportion of RTFs that fell in each category. The proportion of RTFs with excellent repeatability decreased as the proportion of ROI pixels in congruence across segmentation runs decreased. Up to 31% of RTFs showed excellent repeatability, while 35% showed good repeatability across segmentation runs from the manually generated masks. Across scanners (i.e., 1.5T vs 3T), only 7% exhibited good reproducibility. While our results demonstrate RTF sensitivity to differences in field strength and segmentation variability, we identified certain preprocessing filters and feature classes that are less sensitive to these variations and, as such, may be good candidates for imaging biomarkers or building machine-learning models.

Semi-Automatic Refinement of Myocardial Segmentations for Better LVNC Detection.

Background: Accurate segmentation of the left ventricular myocardium in cardiac MRI is essential for developing reliable deep learning models to diagnose left ventricular non-compaction cardiomyopathy (LVNC). This work focuses on improving the segmentation database used to train these models, enhancing the quality of myocardial segmentation for more precise model training. Methods: We present a semi-automatic framework that refines segmentations through three fundamental approaches: (1) combining neural network outputs with expert-driven corrections, (2) implementing a blob-selection method to correct segmentation errors and neural network hallucinations, and (3) employing a cross-validation process using the baseline U-Net model. Results: Applied to datasets from three hospitals, these methods demonstrate improved segmentation accuracy, with the blob-selection technique boosting the Dice coefficient for the Trabecular Zone by up to 0.06 in certain populations. Conclusions: Our approach enhances the dataset's quality, providing a more robust foundation for future LVNC diagnostic models.

Subclinical myocardial dysfunction of the left ventricular in patients with systemic lupus erythematosus

The aim – to study the frequency of left ventricular (LV) myocardial dysfunction and its relationship with disease activity in patients with systemic lupus erythematosus (SLE).Materials and methods. The study included 100 patients with SLE who met the criteria of SLICC/ACR 2012, 87% were women, the average age was 33 [25; 40] years, the average duration of the disease was 1 [1; 9] year, patients with varying degrees of activity according to SLEDAI-2K (low/moderate/high) – 30/45/25 (30%/45%/25%). All the subjects had not previously received biological therapy and had no previously diagnosed cardiovascular diseases and other rheumatic diseases. All patients received glucocorticoids (GCs) and hydroxychloroquine therapy in different dosages depending on the severity of the disease, according to the standards recommended by the Association of Rheumatologists of Russia from 2021. Methotrexate was received by 6% of patients, azathioprine – 14%, cyclophosphamide – 3%, nonsteroidal anti-inflammatory drugs – 81.2%. The control group consisted of 20 healthy individuals, having no signs of rheumatic diseases and CVD comparable in age and gender. All the subjects underwent echocardiography (ECHO) with tissue dopplerography and left ventricle global longitudinal strain (LV GLS) assessment by speckle tracking.Results. Violation of LV GLS was observed in 65 (65%) patients with SLE. In the SLE group, compared with the control group, a significantly more damaged LV GLS was revealed. In all patients with impaired diastolic function of the left ventricular myocardium, deterioration of LV GLS parameters is observed. Impairment of LV GLS correlated with clinical and immunological parameters in patients with SLE: the degree of SLE activity according to SLEDAI-2K (r=0.219), the level of antibodies to double-stranded DNA (a/b to ds-DNA) (r=0.316), the C3 level of the complement component (r=–0.389), the C4 level of the complement component (r=–0.238), the hemoglobin level (r=–0.255), the number of red blood cells (r=–0.286), the level of C-reactive protein (r=–0.284) and CRP (r=–0.927). Also, patients with SLE with diagnosed nephritis (n=26) had a significant violation of LV GLS parameters.Conclusions. In patients with SLE, according to ECHO using the Speckle tracking technique, violation of LV GLS occurs with a high frequency (65%). Violation of LV GLS parameters is associated with SLE activity, immunological and hematological disorders. In all patients with impaired diastolic function of the left ventricular myocardium, LV GLS was obviously decreased. The presence of lupus nephritis is associated with a significant violation of the GLS parameters.

Altered Protein Kinase A-Dependent Phosphorylation of Cav1.2 in Left Ventricular Myocardium from Cacna1c Haploinsufficient Rat Hearts.

CACNA1C encodes the α1c subunit of the L-type Ca2+ channel, Cav1.2. Ventricular myocytes from haploinsufficient Cacna1c (Cacna1c+/-) rats exhibited reduced expression of Cav1.2 but an apparently normal sarcolemmal Ca2+ influx with an impaired response to sympathetic stress. We tested the hypothesis that the altered phosphorylation of Cav1.2 might underlie the sarcolemmal Ca2+ influx phenotype in Cacna1c+/- myocytes using immunoblotting of the left ventricular (LV) tissue from Cacna1c+/- versus wildtype (WT) hearts. Activation of cAMP-dependent protein kinase A (PKA) increases L-type Ca2+ current and phosphorylates Cav1.2 at serine-1928. Using an antibody directed against this phosphorylation site, we observed elevated phosphorylation of Cav1.2 at serine-1928 in LV myocardium from Cacna1c+/- rats under basal conditions (+110% versus WT). Sympathetic stress was simulated by isoprenaline (100 nM) in Langendorff-perfused hearts. Isoprenaline increased the phosphorylation of serine-1928 in Cacna1c+/- LV myocardium by ≈410%, but the increase was significantly smaller than in WT myocardium (≈650%). In conclusion, our study reveals altered PKA-dependent phosphorylation of Cav1.2 with elevated phosphorylation of serine-1928 under basal conditions and a diminished phosphorylation reserve during β-adrenergic stimulation. These alterations in the phosphorylation of Cav1.2 may explain the apparently normal sarcolemmal Ca2+ influx in Cacna1c+/- myocytes under basal conditions as well as the impaired response to sympathetic stimulation.

Fully Automated Assessment of Cardiac Chamber Volumes and Myocardial Mass on Non-Contrast Chest CT with a Deep Learning Model: Validation Against Cardiac MR.

Background: To validate the automated quantification of cardiac chamber volumes and myocardial mass on non-contrast chest CT using cardiac MR (CMR) as a reference. Methods: We retrospectively included 53 consecutive patients who received non-contrast chest CT and CMR within three weeks. A deep learning model created cardiac segmentations on axial soft-tissue reconstructions from CT, covering all four cardiac chambers and the left ventricular myocardium. Segmentations on CMR cine short-axis and long-axis images served as a reference. Standard estimates of diagnostic accuracy were calculated for ventricular volumes at end-diastole and end-systole (LVEDV, LVESV, RVEDV, RVESV), left ventricular mass (LVM), and atrial volumes (LA, RA) at ventricular end-diastole. A qualitative assessment noted segmentation issues. Results: The deep learning model generated CT measurements for 52 of the 53 patients (98%). Based on CMR measurements, the average LVEDV was 166 ± 64 mL, RVEDV was 144 ± 51 mL, and LVM was 115 ± 39 g. The CT measurements correlated well with CMR measurements for LVEDV, LVESV, and LVM (ICC = 0.85, ICC = 0.84, and ICC = 0.91; all p < 0.001) and RVEDV and RVESV (ICC = 0.79 and ICC= 0.78; both p < 0.001), and moderately well with LA and RA (ICC = 0.74 and ICC = 0.61; both p < 0.001). Absolute agreements likewise favored LVEDV, LVM, and RVEDV. ECG-gating did not relevantly influence the results. The CT results correctly identified 7/15 LV and 1/1 RV as dilated (one and six false positives, respectively). Major qualitative issues were found in three cases (6%). Conclusions: Automated cardiac chamber volume and myocardial mass quantification on non-contrast chest CT produced viable measurements in this retrospective sample. Relevance Statement: An automated cardiac assessment on non-contrast chest CT provides quantitative morphological data on the heart, enabling a preliminary organ evaluation that aids in incidentally identifying at-risk patients who may benefit from a more targeted diagnostic workup.

Computed Tomography Evaluation of Extracellular Volume for Predicting Prognosis in Patients with Severe Renal Dysfunction on Dialysis.

Introduction: Extracellular volume (ECV) analysis using computed tomography is recognized as a potential method for diagnostic application. It is currently the only noninvasive method for quantitatively evaluating myocardial fibrosis in dialysis patients for whom gadolinium contrast agents are contraindicated. In this study, we assessed the utility of ECV measurement via CT in the left ventricular (LV) myocardium (LVM) to predict major adverse cardiac events (MACEs) in dialysis patients. Materials and methods: We analyzed 57 dialysis patients who underwent cardiac CT and assessed the utility of LVM ECV (LV-ECV) for predicting MACEs. All the patients were followed for a median of 11 months, and MACEs occurred in 15 cases (26%). Results: LV-ECV and plasma brain natriuretic peptide levels were higher in subjects with MACEs than those without (40.29 ± 8.23% vs. 33.76 ± 4.60% and 1481 ± 997 vs. 807 ± 1109 pg/mL; both p < 0.05). Significant valvular disease was more frequently detected in patients with MACEs than those without (60% vs. 24%; p = 0.023). Serum hematocrit levels were significantly lower in patients with MACEs than those without (29 ± 5 vs. 34 ± 5; p < 0.001). The administration of statin was significantly lower in patients with MACEs than in those without (13% vs. 48%; p = 0.029). A receiver operating characteristic (ROC) curve analysis was performed using LV-ECV for predicting MACEs. The area under the curve was 0.80, and the best cut-off value of LV-ECV was 37.26% (p = 0.0003). In a Cox proportional hazards model, LV-ECV ≥ 37.26% was the only significant independent predictor of MACEs (p = 0.020). Conclusions: LV-ECV measured using CT is a useful predictor of MACEs in dialysis patients.

Single cell transcriptomics profiling of the stromal cells in the pathologic association of ribosomal proteins in the ischemic myocardium and epicardial fat.

Sustenance of ischemia in the surviving cardiac tissue following myocardial infarction (MI) elicits a proinflammatory milieu resulting in subsequent pathological episodes. Also, the activation and release of ribosomal proteins under ischemic insults have been unveiled; however, their extra ribosomal functions are unknown. We identified the ribosomal proteins including RPL10A, RPL14, RPL30, RPS18, FAU-40 (RPS30), and RPSA (Laminin Receptor, LR) in the vesicles of ischemia challenged epicardial adipose tissue derived stromal cells (EATDS). The present study aimed to assess the association of these proteins in the epicardial adipose tissues (EAT) and left ventricular (LV) myocardium and isolated stromal cells (EATDS and LVSCs) from hyperlipidemic (HL), MI and coronary artery bypass graft (CABG) swine models. The findings revealed an upregulation of RPL10A, RPL14, RPL30, RPS18, RPS30, and RPSA in the LV tissues of CABG and HL swine with a concomitant reduction in the MI group. RPS30 displayed similar upregulation in EAT, whereas the expression of other ribosomal proteins was not significantly altered. Additionally, the ischemic LVSCs and EATDS displayed altered expression status of these genes compared to the control. Also, the RPS18 + , RPL30 + and RPSA + LVSCs favored ischemia and revealed similar anti-inflammatory and regenerative sub-phenotypes reflecting the protective/survival mechanisms. Further understanding regarding the underlying molecular mechanisms and functions of these ribosomal proteins offers immense translational opportunities in the better management of ischemic cardiac complications.

Diagnosis of decreased segmental deformation of the left ventricular myocardium in a teenager at the early stage of hypertrophic cardiomyopathy (clinical observation)

The article presents a clinical observation that revealed a decrease in segmental deformation of the left ventricular myocardium in a 15-year-old teenager at the early stage of asymmetric non-obstructive hypertrophic cardiomyopathy (HCM). To assess myocardial systolic function, the following were used: ejection fraction and shortening of the left ventricle, as well as indicators of global and segmental myocardial deformation, determined by echocardiographic study using the 2D speckle-tracking method. There was no change in ejection fractions and shortening of the left ventricle, global longitudinal deformation of the myocardium, but there was a decrease in longitudinal and circular deformation in individual segments of the left ventricle, which, in general, was the basis for prescribing cardioprotective therapy.

Diagnostic capabilities of cardiac computed tomography in the preoperative diagnosis of hypertrophic cardiomyopathy

BACKGROUND: A comprehensive approach to studying hypertrophic cardiomyopathy with diagnostic equipment and the latest scanning methods will ensure quality control and effective treatment of patients with this condition. The implementation of innovative technologies and computer calculation using next-generation scanners may become relevant and promising in studying various phenotypes of left ventricular remodeling in combination with abnormalities of the chordopapillary apparatus of the mitral valve and myocardial structure. AIM: To examine the diagnostic capabilities of computed tomography in the preoperative examination of various hypertrophic cardiomyopathy phenotypes. MATERIALS AND METHODS: The retrospective data analysis included 47 patients with hypertrophic cardiomyopathy (mean age, 52±7 full years) before surgical correction. computed tomography was performed using our protocol with automatic bolus tracking in the left atrium with a 90 HU threshold and biphasic contrast injection to assess the heart chambers and coronary arteries anatomy and mitral valve morphology. Moreover, to assess myocardial structure remodeling, iodine dual-energy computed tomography maps obtained with delayed contrast enhancement were analyzed. All patients with hypertrophic cardiomyopathy were classified by morphological types. The anatomy of chordopapillary apparatus was evaluated in each case. RESULTS: This study demonstrated variability in hypertrophic cardiomyopathy phenotypes, which were conventionally divided into five morphological categories, but not restricted by them. Among the patients, 26 (55%) had diffuse septum hypertrophic cardiomyopathy, 5 (11%) had midventricular hypertrophic cardiomyopathy, 2 (4%) had midventricular obstruction and apical aneurysm, 8 (18%) had focal basal septum hypertrophic cardiomyopathy, 4 (8%) had concentric hypertrophic cardiomyopathy, and the remaining 4 (8%) had apical hypertrophic cardiomyopathy. Most patients were diagnosed with chordopapillary abnormalities of the mitral valve, categorized by papillary muscle number and position, and the ratio of chords to muscles. In 10 (21%) patients, data on the myocardial bridge of a coronary artery were obtained, whereas 3 (14%) of them had dynamic stenosis. All patients had focal iodine uptake on dual-energy computed tomography maps. An extracellular volume increase was observed in 10 out of 13 (76%) patients. As shown by dual-energy computed tomography, the mean extracellular volume of the left ventricular myocardium was 30.58% (95% confidence interval, 27–34%). CONCLUSION: Our scanning protocols developed with computed tomography scanners of various generations enable to evaluate the specific morphological patterns of hypertrophic cardiomyopathy in a single study and provide a detailed interpretation of the geometry of cardiac valves and chambers, left ventricular function, state of the coronary bed, and structural changes of the left ventricular myocardium.

The first experience of intraoperative myocardial elastography in cardiac surgery patients

The goal the work was to study the possibility of using elastography on an open heart to determine the stiffness of the left ventricular myocardium. Material and methods. Intraoperative elastography was performed in 6 patients with isolated aortic stenosis and dissecting aneurysm of the ascending aorta with aortic insufficiency. Three patients underwent surgery to replace the aortic valve with mechanical prostheses (SIM-19) and three were operated to replace the ascending aorta with an artificial prosthesis with aortic valve replacement (David’s operation). The average age of the patients was 42±9 years (42–53) years. All patients underwent surgery under conditions of artificial blood circulation. Initially, elastography was evaluated on a working heart, and then on full artificial circulation. The study was performed on a VK 5000 ultrasound device with an intraoperative «stick» type sensor at a frequency of 7.5–15 Mhz, gain of 1.6 Db, resolution of 127 hz. The deformation coefficient was evaluated. The imaging program was exposed as for neurosurgery with a frequency of 15 Mhz. Visualization was performed in B-mode, followed by obtaining shear wave elastography with calculation of the deformation coefficient. Results. Wave elastography was evaluated for various heart pathologies with different myocardial thickness. It was found that the stiffness in the studied areas of the myocardium is different. Thus, in patients with atherosclerotic aortic stenosis and a pressure gradient of more than 100 mmHg, the deformation coefficient was increased, in accordance with the thickness of the myocardium and amounted to 3.81–4.06, and in patients with aortic root dilation and aortic insufficiency, the deformation coefficient was 1.64–2.9. Conclusion. Intraoperative assessment of the left ventricular myocardial deformation coefficient is possible only on a stopped heart and gives an idea of the state of the heart muscle with the possibility of soft and hard areas. Shear wave elastography provides information about the elasticity and hardness of the tissue, which indirectly reflects the viscosity of the myocardium. This study was aimed at verifying the methodology for assessing the characteristics of the elasticity of the left ventricular myocardium for myocardial overload by pressure (aortic stenosis) and volume in case of a dissecting aortic aneurysm with aortic insufficiency.

Shock wave-pretreated ADMSCs of cell-sheet scaffold (CSS) patched on the left ventricular wall (LVW) inhibited LVW remodeling in mini-pig MI: role of CSS on counteracting Laplace's Law of LVW stress - experimental study.

We investigated whether shock wave (SW)-pretreated autologous adipocyte-derived mesenchymal stem cells (ADMSCs) seeded in the cell-sheet scaffold (CSS) could inhibit left ventricular (LV) remodeling and improve LV ejection fraction (LVEF) in old myocardial infarction (MI). Mini-pigs ( n =20) were divided into group 1 (sham-operated control), group 2 (old MI), group 3 (old MI + autologous ADMSCs/1.0×10 7 in CSS on LV myocardium), and group 4 [old MI + SW (0.12mJ/mm 2 for total 140 shots)-pretreated ADMSCs in CSS on LV myocardium]. Treatments started on day 28 after MI induction. In-vivo and in-vitro studies were conducted. Cell viability/relative mitochondria DNA expression/mitochondrial cytochrome C/adenosine triphosphate concentration in ADMCSs and protein expressions of angiogenesis factors [vascular endothelial growth factor (VEGF)/stromal cell-derived factor-1 (SDF-1)/mitochondrial respiratory chain complexes I-IV/oxygen consumption rate] were higher in group 4 than in group 3 ( P <0.001). By day 180, LVEF and small vessel numbers in the peri-infarct or infarct area were highest in group 1, lowest in group 2, and significantly lower in group 3 than in group 4. In contrast, the LV dimension was opposite to the pattern of change in LVEF in all groups ( P <0.0001). The basal/middle/apical infarct and fibrotic areas were inversely related to LVEF in all groups (all P <0.0001). Protein levels of angiogenetic markers (SDF-1α/C-X-C chemokine receptor type 4/VEGF/angiopoietin-1) were significantly and persistently increased from groups 1 to 4. In contrast, protein levels of endothelial cell markers (von Willebrand factor or endothelial nitric oxide synthase) showed an identical pattern to LVEF in all groups (all P <0.0001). SW pretreatment of ADMSCs seeded in CSS offered significant benefits in preserving LV performance and ameliorating LV remodeling in mini-pigs with old MI.

Effect of Left Ventricular Geometric Remodeling on Restrictive Filling Pattern and Survival in Patients with Post Myocardial Infarction LV Dysfunction.

Effect of Left Ventricular Geometric Remodeling on Restrictive Filling Pattern and Survival in Patients with Post Myocardial Infarction LV Dysfunction.

ПОСЛЕРОДОВАЯ ПЕРИПАРТАЛЬНАЯ КАРДИОМИОПАТИЯ КАК РЕДКАЯ ПРИЧИНА СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ: СЛУЧАЙ ИЗ ПРАКТИКИ

Abstract. Introduction. Peripartum cardiomyopathy is a rare, idiopathic myocardial disease occurring during pregnancy or within 5 months after delivery and characterized by the decreased contractility of the left ventricular myocardium. Insufficient awareness of physicians about this rare pathology creates prerequisites for the description of interesting clinical observations. This article presents a case follow-up (for 5 months) of female patient R. with diagnosed peripartum cardiomyopathy at the age of 31 years after childbirth. Before and during pregnancy, no risk factors or pathology of cardiovascular system, or myocardium exposure to toxic substances were identified. Patient R. first sought medical attention 3 months after her fourth delivery (in total, there were 5 pregnancies and 4 deliveries without pathologies) and prolonged breastfeeding, symptoms of heart failure appeared and rapidly progressed. Aim. To present a clinical case of peripartum cardiomyopathy developed in the postpartum period. Materials and Methods. A clinical case of peripartum cardiomyopathy of patient R. was analzed, who voluntarily signed the informed consent for examination and permission to anonymously publish personal medical information. Results and Discussion. Peripartum cardiomyopathy is a diagnosis of exclusion; therefore, an important stage is differential diagnosis with manifestations of pre-eclampsia and myocarditis. Untimely diagnosis of peripartum cardiomyopathy, in some cases, is due to lack of physicians’ awareness. An important criterion for diagnosing peripartum cardiomyopathy is the absence of any previously diagnosed cardiovascular diseases; therefore, the first priority is to exclude heart valve defects and dilated cardiomyopathy. In addition, it is necessary to exclude pregnancy-mediated hemodynamic changes, as well as differential diagnosis with such conditions as myocarditis, Takotsubo syndrome, pulmonary embolism, acute coronary syndrome, and human immunodeficiency virus. Conclusions. Thus, the factors contributing to the development of peripartum cardiomyopathy in patient R. were as follows: Age over 30 years, 4 childbirths, iron deficiency anemia. Three diagnostic criteria have formed the basis for the diagnosis of peripartum cardiomyopathy: 1) debut of heart failure within 5 months after delivery; 2) no newly diagnosed heart disease more than 1 month before delivery or any other causes of chronic heart failure; and 3) left ventricular dysfunction according to the findings of echocardioscopy and magnetic resonance imaging with the ejection fraction decreased down to 13 %.

Potential use of radiomics analysis of cine-mode cardiac MRI to detect post-infarction lesions in the left ventricular myocardium

BACKGROUND: The size and location of an infarct lesion and its clear differentiation from normal tissue are important for clinical diagnosis and precision medicine. This paper is based on the study of radiomic attributes for differentiation of infarct and non-infarct tissue using non-contrast-enhanced cine-mode cardiac magnetic resonance imaging (MRI) data. AIM: The aim of the study was to evaluate the potential use and informative value of radiomics analysis to identify post-infarction lesions in the left ventricular myocardium in patients with ischemic cardiomyopathy (ICM) using non-contrast-enhanced cine-mode cardiac MRI. MATERIALS AND METHODS: Results of contrast-enhanced cardiac MRI were evaluated in 33 patients following surgical treatment for ICM. Texture analysis was performed on 66 lesions in cine-mode cardiac MRI images, and 105 texture attributes were determined for each lesion. Cardiac MRI was performed according to a standard technique using a Vantage Titan 1.5 T MRI scanner (Toshiba). For texture analysis, 3D Slicer version 5.2.2 (Pyradiomics) was used. RESULTS: During the study, attribute collinearity diagrams were plotted, zero-significance attributes were identified, and attribute significance was determined using a gradient boosting algorithm, and the cumulative significance of attributes was estimated as a function of their total number. By identifying low-significance attributes, the least significant parameters that did not affect the overall significance level were determined. When single-valued attributes were extracted, no corresponding attributes were found. Based on the analysis results, an ROC curve was constructed for Lasso logistic regression (Se=57.14%, Sp=71.43%, AUC=0.76). The main result of this study was to determine radiomic attributes that characterized lesions corresponding to post-infarction cardiosclerosis and intact left ventricular wall based on cine-mode cardiac MRI images. CONCLUSIONS: This study demonstrated that radiomics analysis of non-contrast-enhanced cine-mode cardiac MRI images is a promising approach to identify lesions corresponding to myocardial infarction and intact wall. This method may potentially be used to identify lesions of post-infarction cardiosclerosis in patients with ICM without contrast enhancement.

Impact of extract of cryopreserved pig heart fragments in alginate hydrogel on electrophysiological indicators of rat hearts with myocardial cryonecrosis

Background. The issue of stimulating reparative myocardial regeneration in ischemic heart disease (IHD) is a pressing one, requiring in-depth experimental and clinical research. Consequently, considerable attention is currently being paid to studies on the effectiveness and mechanisms of action of regenerative plastic therapy for pathological conditions of the cardiovascular system. To prevent cardiac aneurysms in the early post-infarction period and to treat progressive chronic heart failure, biodegradable polymer hydrogels, including alginate polysaccharide hydrogels, are used as surgical implants. Purpose – analysis of electrophysiological indicators of the heart during the development of necrosis and organ remodeling in a myocardial cryodestruction model and the introduction of an alginate implant saturated with an extract of cryopreserved pig heart fragments to determine the cardioprotective effect of these factors. Materials and Methods. Electrocardiograms (ECGs) were recorded in three standard leads (I, II, III) and three additional leads (aVR, aVL, aVF) using the «PolySpectrum/8V» hardware-software complex («Poly-Spectrum», Ukraine). The «PolySpectrum-Analysis» software allows for contour analysis of the averaged cardiocomplex. Initially, we conducted an experiment to assess the impact of sodium alginate hydrogel alone on electrocardiographic parameters without heart cryoinjury. Subsequently, the experimental animals were divided into three groups: 1 – control group, animals with myocardial necrosis (MN) without treatment; 2 – rats with MN and an implant (sodium alginate hydrogel) introduced into the cryonecrosis area; 3 – rats with MN and an alginate implant saturated with cryopreserved pig heart extract (CPHE) introduced into the cryonecrosis area. The normal group consisted of 7 rats. Results. The use of an extract from cryopreserved heart fragments of piglets, delivered via an alginate carrier, in the context of myocardial infarction induced by local cryodestruction of the heart, significantly accelerates the recovery of the left ventricular myocardium compared to both the control group and the experimental groups receiving alginate hydrogel alone. This is supported by electrocardiographic evidence: a positive P wave on the first day indicates the preservation of the myocardial excitation source at the sinoatrial node level; recovery of the R wave to normal levels by the seventh day reflects the restoration of myocardial contractile function; and on the 30th day, the group treated with the ECP in alginate gel shows a QRS complex shape that conforms to normal standards, with minimal cardiac remodeling as evidenced by the absence of a Q wave in the ECG. In contrast, up to 40% of animals in other groups exhibit signs of transmural myocardial necrosis, indicated by the persistent presence of the Q wave. Conclusions. Analysis of the electrocardiograms (ECGs) of healthy rats after the introduction of the alginate hydrogel into the heart muscle showed that the correct sinus rhythm is maintained, and the QRS-T complexes retain their shape and duration, indicating that the alginate implant does not cause pathological changes in the ECG. It was demonstrated that the alginate implant, when introduced into the myocardial infarction area, is an indifferent substance that does not exacerbate destructive and inflammatory processes and can be used as a carrier for biologically active substances or drugs for delivery to the damaged area. On the 30th day of observation, in the group with CPHE in the alginate gel, the shape of the QRS complex corresponds to the norm, and signs of heart remodeling are minimal, as evidenced by the absence of animals with a registered Q wave. In contrast, up to 40% of animals in other groups show signs of previous transmural myocardial necrosis with the persistence of the Q wave on the ECG.

Abstract 4137339: Application of PLGA-PEG-PLGA Thermosensitive Hydrogel Loaded with Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes and Ginsenoside Rb3 in the Treatment of Acute Myocardial Infarction

Background: Ginsenoside Rb3 (GSRb3) is a traditional Chinese medicine monomer. We aim to investigate the effects of GSRb3 on the proliferation of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and the reparative effects of PLGA-PEG-PLGA thermosensitive hydrogel loaded with hiPSC-CMs and GSRb3 (NP GSRb3 @Gel+iCM) on myocardial infarction (MI). Methods: 1. Western Blot, RT-qPCR, cell immunofluorescence staining, and CCK-8 assays were employed to assess the proliferative effects of different concentrations of GSRb3 on neonatal mouse primary cardiomyocytes (NCMs) and hiPSC-CMs. 2. Transcriptomic gene sequencing technology was utilized to investigate the mRNA expression changes of hiPSC-CMs induced by GSRb3; The NP GSRb3 @Gel+iCM was injected into the left ventricular myocardium of the MI mice; the same volume injections of hiPSC-CMs (iCM group) and PLGA-PEG-PLGA thermosensitive hydrogel loaded with GSRb3 (NP GSRb3 @Gel group) served as control; Additionally, MI model group without additional treatment and sham group were established. 3. At 4 weeks post-MI, echocardiography, Sirius Red/Fast Green staining and immunofluorescence staining were utilized to evaluate the heart function, infarction size and survival rate of transplanted hiPSC-CMs. Results: GSRb3 inhibit the apoptosis of NCMs while promote proliferation of NCMs and hiPSC-CMs significantly. After 4 weeks of treatment, the engraftment rate of hiPSC-CMs in NP GSRb3 @Gel+iCM group (36.7%) was 4.8 times that of iCM group (7.7%); Compared to the MI group, NP GSRb3 @Gel group and iCM group, NP GSRb3 @Gel+iCM group showed significant improvement in cardiac function; The myocardial repair effect in NP GSRb3 @Gel+iCM group was significantly superior to NP GSRb3 @Gel group and iCM group, with a 47% reduction in infarct size compared to MI group, and further reduction in left ventricular anterior wall thickness compared to NP GSRb3 @Gel group and iCM group. Conclusion: GSRb3 promotes the proliferation of hiPSC-CMs both in vitro and in vivo. NP GSRb3 @Gel+iCM significantly increase the engraftment of hiPSC-CMs, promote angiogenesis, reduce infarction size, inhibit left ventricular remodeling and improve cardiac function.

Abstract 4129974: Increased Expression of Histone Deacetylases-2 and -6 in Left Ventricular Myocardium of Dogs with Chronic Heart Failure

Background: Histone deacetylases (HDACs) -2 and -6 are localized in the nucleus and cytoplasm of cells and have been implicated in the development of left ventricular (LV) hypertrophy, cardiac interstitial fibrosis, inflammation and worsening of LV systolic and diastolic function thus contributing to progressive worsening of heart failure (HF) with reduced ejection fraction (HFrEF) as well as HF with preserved ejection fraction (HFpEF). There is considerable interest in the application of small molecules that inhibit the activity of HDAC proteins in HF in the hope of fostering clinical benefit. Purpose: In the present study we examined the expression of HDAC-2 and -6 in LV tissue from normal (NL) dogs and dogs with chronic HF (LVEF &lt;35%) produced by multiple sequential intracoronary microembolizations. Methods: Studies were performed in LV tissue from 7 NL dogs and 7 HF dogs. HDAC-2 and -6 protein levels were determined by Western blotting in the lysate of homogenate and 9000g supernatant (cytosolic) fractions prepared from powder of approximately 200 mg frozen LV tissue. After determining the protein by Lowry method, approximately 30 μg homogenate and 15 μg supernatant for HDAC-2 and 8 μg protein for both homogenate and supernatant for HDAC-6 were separated on 4%-20% SDS-PAGE and transferred on PVDF membrane. Band intensities were quantified in densitometric units (du). All data were normalized to glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Results: HDAC-2 proteins levels normalized to GAPDH were higher in the cytosol (0.59 ± 0.10 vs. 0.17 ± 0.04, p&lt;0.05 vs. NL) and homogenate (0.75 ± 0.12 vs. 0.55 ± 0.10, not statistically significant) of LV tissue of dogs with HF compared to NL dogs. HDAC-6 protein levels were higher in the homogenate (2.54 ± 0.36 vs. 0.57 ± 0.19, p&lt;0.05 vs. NL) and the cytosol (0.96 ± 0.15 vs. 0.78 ± 0.13, not statistically significant) of LV tissue of dogs with HF compared to NL dogs. Conclusions: These findings indicate upregulation of protein levels of HDAC-2 and -6 isoforms in LV myocardium of dogs with chronic HF. These abnormalities are likely to contribute to worsening HF. Selective inhibition of HDAC-2 and -6 represents a potential therapeutic approach for the treatment of both HFrEF and HFpEF.

Reducing the Сardiotoxicity of Daunorubicin by Conjugation with Natural Sesquiterpene Lactones

We present the results of a histological study into the cardiotoxicity of conjugates of daunorubicin with dehydrocostus lactone and epoxyisoalantolactone in mature male mice of the C57BL/6 line. The effect of conjugates on the morphology of cardiomyocytes and the structure of the left ventricular myocardium in mice was studied.