Left Ventricular Remodeling Research Articles

Elevated Serum Homocysteine Associated with Left Ventricular Remodeling in Patients with IgA Nephropathy

Elevated Serum Homocysteine Associated with Left Ventricular Remodeling in Patients with IgA Nephropathy

Evaluation of cardiac remodeling in pediatric chronic kidney disease by cardiovascular magnetic resonance

BackgroundChildren with chronic kidney disease (CKD) are at high risk of cardiovascular disease. Cardiovascular magnetic resonance (CMR) is the reference method for assessing cardiac remodeling. To our knowledge, no study has reported a comprehensive analysis of left ventricular(LV) cardiac remodeling using CMR in different stages of pediatric CKD. This prospective case-control study aimed to investigate cardiac remodeling in pediatric CKD, using CMR, and determine its relationship with risk factors.MethodCMR was performed in 124 children with CKD and 50 controls. The cardiac remodeling parameters included left ventricular mass index (LVMI), LV remodeling index (LVRI), and LV wall thickness. Univariable and multivariable analyses were performed to assess the cardiac remodeling risk factors.ResultsCardiac remodeling was observed in 35.5% (44/124) of children with CKD. The LVMI, LVRI, and LV wall thickness were higher in advanced stages of CKD (P < 0.05). In the CKD stage 1–2 group, a lower in the estimated glomerular filtration rate was an independent determinant of impaired LVMI (β = −0.425, P = 0.019) and LVRI (β = −0.319, P = 0.044). A higher protein to creatinine ratio(PCR) was independently associated with impaired LVRI (β = 0.429, P = 0.022). In the CKD stage 3–5 group, higher in systolic blood pressure (SBP) (β = 0.464, P = 0.005) and PCR (β = 0.852, P = 0.031) were independent determinants of impaired LVMI. Additionally, higher SBP was positively correlated with impaired LVRI(r = 0.599, P < 0.001). There was a trend toward more abnormal cardiac remodeling in the CKD stage 3–5 group with hypertension than those without.ConclusionCardiac remodeling is prevalent in children with CKD, from an early stage. kidney markers are independently associated with cardiac remodeling. Hypertension increases the risk of cardiac remodeling in CKD stages 3–5. Strict BP control may help reverse or prevent remodeling.

Absolute coronary flow and microvascular resistance before and after transcatheter aortic valve implantation.

Severe aortic stenosis (AS) is associated with left ventricular (LV) remodelling, likely causing alterations in coronary blood flow and microvascular resistance. We aimed to evaluate changes in absolute coronary flow and microvascular resistance in patients with AS undergoing transcatheter aortic valve implantation (TAVI). Consecutive patients with AS undergoing TAVI with non-obstructive coronary artery disease in the left anterior descending artery (LAD) were included. Absolute coronary flow (Q) and microvascular resistance (Rμ) were measured in the LAD using continuous intracoronary thermodilution at rest and during hyperaemia before and after TAVI, and at 6-month follow-up. Total myocardial mass and LAD-specific mass were quantified by echocardiography and cardiac computed tomography. Regional myocardial perfusion (QN) was calculated by dividing absolute flow by the subtended myocardial mass. In 51 patients, Q and R were measured at rest and during hyperaemia before and after TAVI; in 20 (39%) patients, measurements were also obtained 6 months after TAVI. No changes occurred in resting and hyperaemic flow and resistance before and after TAVI nor after 6 months. However, at 6-month follow-up, a notable reverse LV remodelling resulted in a significant increase in hyperaemic perfusion (QN,hyper: 0.86 [interquartile range {IQR} 0.691.06] vs 1.20 [IQR 0.99-1.32] mL/min/g; p=0.008; pre-TAVI and follow-up, respectively) but not in resting perfusion (QN,rest: 0.34 [IQR 0.30-0.48] vs 0.47 [IQR 0.36-0.67] mL/min/g; p=0.06). Immediately after TAVI, no changes occurred in absolute coronary flow or coronary flow reserve. Over time, the remodelling of the left ventricle is associated with increased hyperaemic perfusion.

Neuro- and immuno-modulation mediated by the cardiac sympathetic nerve: a novel insight into the anti-ischemic efficacy of acupuncture.

Communication between sympathetic nerves and the immune system is a crucial and active process during myocardial ischemia (MI), as myocardial damage and inflammatory stimuli concurrently occur. Sympathetic nerves undergo structural and functional changes after MI, leading to adverse left ventricular (LV) remodeling and heart failure (HF). The complex inflammatory response to MI, including local myocardial anti-inflammatory repair and systemic immune reactions, plays a key role in adverse LV remodeling. Here, we review the progressive structural and electrophysiological remodeling of the LV and the involvement of sympathetic tone in complex and dynamic processes that are susceptible to MI pathological conditions. Acupuncture has been reported to effectively improve cardiac function, eliminate arrhythmia, and mitigate adverse LV remodeling via somatosensory regulation after MI. Moreover, acupuncture has an anti-inflammatory effect on the pathological process of myocardial ischemia. In this Review, we aim to summarize the involvement of sympathetic nerve activation in the neuro-immune modulation of structural and functional cardiac changes after MI. As a noninvasive method for sympathetic regulation, acupuncture is an ideal option because of its anti-ischemic efficacy. A better understanding of the neural circuitry that regulates cardiac function and immune responses following MI could reveal novel targets for acupuncture treatment.

Left Ventricular Concentric Remodeling In Deployed Post 9/11 Veterans And Effects On Exercise Performance.

Left Ventricular Concentric Remodeling In Deployed Post 9/11 Veterans And Effects On Exercise Performance.

TCT-637 Early Changes of Echocardiographic Parameters Are Associated With Left Ventricular Reverse Remodeling After Mitral Transcatheter Edge-to-Edge Repair

TCT-637 Early Changes of Echocardiographic Parameters Are Associated With Left Ventricular Reverse Remodeling After Mitral Transcatheter Edge-to-Edge Repair

Cardiomyopathy characterizing and heart failure risk predicting by echocardiography and pathoanatomy in aged male mice.

Correlation between echocardiographic and pathoanatomic variables and their prognostic value in murine cardiomyopathy models remain unknown. Using echocardiography, morphometrics, and survival monitoring, we characterized transgenic (TG) mice with dilated cardiomyopathy due to cardiac overexpression of β2-adrenoceptors focusing on predicting heart failure (HF) risk and HF mortality. In 12-month-old non-TG and TG mice, echocardiography was performed to determine left ventricular (LV) dimensions (d), wall thickness (h), and fractional shortening (FS). Animals were monitored for 3 months for survival. Organ weights and pathological events indicating left HF were determined. TG mice (n = 76) had reduced FS and enlarged LV, and 79% died of HF or likely arrhythmias during the follow-up period while all non-TG mice (n = 26) survived. These mice with left HF also had pulmonary congestion and hypertrophy/dilatation of the right ventricle (RV). Weights of lungs, RV, and atria were intercorrelated (r = 0.79-0.83) and also negatively correlated with FS × (h/d) index (r = -0.502 to -0.609). By FS × (h/d) tertiles, TG mice of low tertiles were identified with the highest mortality (96%) largely due to HF (76%). In conclusion, in aged cardiomyopathy mice a good correlation existed between echocardiographic and pathoanatomic variables. Echocardiography-derived LV function and remodeling were useful in identifying a subgroup of TG mice with a high risk of HF and HF fatality.

The transition from hypertension to hypertensive heart disease and heart failure with preserved ejection fraction: a retrospective cross-sectional study of myocardial magnetic resonance strain and tissue characteristics.

Due to the variability of symptoms and signs associated with heart failure, along with the lack of specific tests for definitive diagnosis, the noninvasive diagnosis of heart failure with preserved ejection fraction (HFpEF) continues to pose significant clinical challenges. This investigation was designed to elucidate the clinical manifestations of HFpEF and to analyze cardiac magnetic resonance (CMR)-derived myocardial strain metrics and tissue characteristics in a cohort exhibiting HFpEF with hypertension (HFpEF-HTN). This retrospective analysis consisted of 128 patients diagnosed HFpEF-HTN, 78 individuals with hypertensive heart disease (HHD), 89 individuals with hypertension (HTN), and 60 normotensive healthy controls and was conducted from August 2021 to February 2024. All participants were recruited from The First Hospital of Lanzhou Universityand underwent laboratory examinations and 3.0 T CMR. The study compared clinical features and CMR-derived structural and functional parameters across different groups. Logistic regression was employed to determine the association between CMR parameters and HFpEF-HTN. Spearman correlation coefficient analysis was used to clarify the relationship between myocardial strain parameters and left ventricular (LV) ejection fraction and right ventricular (RV) ejection fraction. Additionally, the area under the curve (AUC) from receiver operating characteristic (ROC) analysis was used to compare the diagnostic performance of different CMR parameters for HFpEF-HTN. Patients diagnosed with (HFpEF-HTN) were characterized by an older demographic profile, a higher prevalence of smoking history, elevated systolic and diastolic blood pressure, increased levels of N-terminal pro-brain natriuretic peptide, and more advanced New York Heart Association functional class as compared to other studied groups. In terms of myocardial deformation, individuals with HFpEF-HTN exhibited pronounced impairments in both LV and RV function, as evidenced by significantly reduced longitudinal strain (LS), circumferential strain (CS), and radial strain (RS), relative to HTN, HHD, the control cohorts (all P values <0.001). Patients with HFpEF-HTN showed significantly elevated levels of late gadolinium enhancement, native T1, and extracellular volume fraction (ECV) indicative of myocardial interstitial fibrosis as compared to patients with HHD. Additionally, as compared to ECV, LV GCS emerged as a superior diagnostic indicator, demonstrating greater diagnostic accuracy in differentiating HFpEF-HTN patients from those with HHD (AUC =0.85; P<0.001). Moreover, LVEF showed a mild correlation with CMR-derived LV GLS (R=-0.43; P<0.001), LV GCS (R=-0.42; P<0.001), and LV GRS, (R=0.56; P<0.001) in all patients. Myocardial strain, T1 mapping, and ECV can be used for the quantitative evaluation of LV and RV ventricular remodeling, dysfunction, and tissue characteristics in patients with HFpEF-HTN and thus hold significant potential for the diagnosis of these patients.

Effect of Optimal Heart Rate on Left Ventricular Remodeling in Patients with Systolic Heart Failure Following Acute Coronary Syndrome.

The optimal therapeutic approach to facilitate reverse remodeling is desired in patients with systolic heart failure following acute coronary syndrome (ACS). The association between heart rate (HR) and reverse remodeling in this cohort has remained elusive.Patients with left ventricular ejection fraction (LVEF) < 50% who received echocardiography assessments following ACS were retrospectively included. Theoretically ideal HR was calculated using a previously established formula: 93 - 0.13 × (deceleration time [msec]). Impacts of HR on echocardiographic left ventricular (LV) reverse remodeling during the 2-year observational period were compared between 2 groups stratified by the HR difference between theoretically ideal and actual values: optimal HR group (HR difference ≤ 10 bpm) versus sub-optimal HR group (HR difference > 10 bpm).A total of 27 patients (median 72 years old, 23 males) were included. There were no significant differences in the baseline characteristics including maximum serum creatinine kinase level and the dose of beta-blocker between the 2 groups. LV ejection fraction increased significantly only in the optimal HR group at follow-up (from 42% to 54%; P = 0.001). The optimal HR group exhibited a more pronounced decrease in LV end-diastolic diameter (from 57 to 52 mm) compared to the sub-optimal HR group (from 58 to 56 mm).Optimal HR, which was calculated using a previously proposed formula, was associated with more substantial post-infarct LV reverse remodeling. The implications of aggressive HR modulation targeting theoretically ideal HR among those with systolic heart failure following ACS are the focus of our investigation here.

Cardiac Resynchronization Therapy with Defibrillator in Ischemic Versus Nonischemic Cardiomyopathy.

Cardiac resynchronization therapy with implantable cardioverter defibrillators (CRT-Ds) are established therapy options for patients suffering from heart failure (HF). Several aspects of HF modification have yet to be described regarding etiology-dependent outcome differences in the long-term.The Mannheim CArdiac Resynchronization TherApy RetrospeCtive ObservAtioNAl (MARACANA) Registry retrospectively included all patients provided with CRTs in our center from 2013 to 2021. CRT-D recipients (n = 380) were grouped to either ischemic cardiomyopathy (ICM, n = 206) or nonischemic cardiomyopathy (NICM, n = 174). Both groups were compared regarding survival, left ventricular ejection fraction (LVEF), hospitalizations due to HF, intrinsic and paced QRS width, NYHA classification, and several further aspects of HF modification in the long-term (59.1 ± 4.81 months).Patients with ICM were older (73.3 ± 8.4 versus 67.7 ± 10.8 years) and predominantly male (86.4 versus 74.7%) and presented with higher creatinine values (1.57 ± 0.92 versus 1.31 ± 0.66 mg/dL, each P < 0.05) at baseline. The mean survival for patients with NICM was better (51.9 ± 1.2 versus 54.4 ± 1.1 months, P = 0.03). Improvements in NYHA (2.93 ± 0.4 versus 2.79 ± 0.5-2.19 ± 0.7 versus 1.79 ± 0.7) and LVEF (26.4 ± 6.8 versus 27% ± 6.9% to 35.7 ± 9.6 versus 44 ± 11%, each P < 0.05) were similar for both groups after 5 years. Patients with ICM experienced more hospitalizations due to HF within the first year (odds ratio 1.9, P < 0.05), whereas electrical remodeling was more impressive for NICM (QRS width 157.1 ± 19.4 milliseconds versus intrinsic 116.6 ± 12.7 milliseconds and paced 131.9 ± 21 milliseconds after 5 years, both P < 0.05).Patients with HF might experience long-term improvements in functional status and left ventricular reverse remodeling following CRT-D, regardless of underlying etiology. Alterations in some aspects of HF modification could be influenced by time- and etiology-associated comorbidities.

Обратное ремоделирование левого желудочка у пациентов с многососудистым поражением при инфаркте миокарда после реваскуляризации

The role of factors leading to reverse LV remodeling in patients with multivessel ischemic heart disease after percutaneous coronary intervention (PCI) has not been sufficiently studied. The purpose of this article is to provide a brief and concise review of the current understanding of the pathophysiology, clinical predictors, and studies of LV reverse remodeling after complete and incomplete revascularization in patients with multivessel coronary disease. Materials and methods. A systematic review and meta-analysis was conducted in the search systems: eLIBRARY.RU, PubMed, Medline, ResearchGate, Connected papers and Google Scholar mainly from 2019 to 2024 (85.7 %). Results. The cumulative evidence suggests that key factors that can initiate and maintain remodeling processes include myocardial ischemic injury, chronic inflammation, neurohormonal activation, and oxidative stress. A decrease in all these factors can lead to reverse myocardial remodeling. This is possible with complete revascularization during primary PCI, which leads to improved clinical course and reduced 30-day, 1-year and 3-year mortality rates. A combination of biomarkers from different groups may be suitable for predicting reverse remodeling (brain natriuretic peptide precursor-N-terminal natriuretic hormone propeptide, high-sensitivity troponins, C-reactive protein and creatinine kinase), as well as echocardiographic findings, especially 3D-echocardiographic assessments of ventricular volumes, mass and ejection fraction. Conclusion. Complete revascularization is feasible and has great advantages over revascularization of only one infarct-related coronary artery.

Kynurenines in heart failure with preserved ejection fraction: an influence of type 2 diabetes.

Given their association with inflammatory processes and oxidative stress, tryptophan metabolites involved in the kynurenine pathway (KP) play a role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes (T2D). The study aimed to examine the relationship between the parameters of HFpEF, as determined by transthoracic echocardiography, and metabolites of the KP. We prospectively included 120 patients with HFpEF, 60 with and 60 without T2D, and 55 controls. High‑performance liquid chromatography was used to quantify the serum metabolites of KP. Echocardiography was used to assess left ventricular systolic and diastolic function. The patients with HFpEF and T2D showed an increase in tryptophan, kynurenine, and anthranilic acid concentrations (P = 0.001, P <0.001, and P <0.001, respectively) with a concomitant decrease in 3‑hydroxykynurenine (P <0.001) and quinolinic acid (P = 0.003), as compared with those with HFpEF without T2D. Left ventricular and left atrial remodeling was more pronounced in the group with T2D, but differences between these parameters did not reach statistical significance. Left ventricular global longitudinal strain was lower in the subgroup of patients with HFpEF and T2D than in the subgroup without T2D (P = 0.003). The study showed altered tryptophan metabolism in patients with HFpEF, highlighting a possible connection. The findings suggest potential implications for targeted therapeutic strategies focusing on tryptophan metabolism and cardiac function in patients with HFpEF and T2D.

NT-proBNP and Cardiac Troponin I, but Not Cardiac Troponin T, Are Associated With 7-Year Changes in Cardiac Structure and Function in Older Adults: The ARIC Study.

Higher circulating concentrations of NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) are associated with left ventricular remodeling and with incident heart failure. The associations of these cardiac biomarkers with changes in cardiac structure and function over time are uncharacterized. Among 2006 participants in the ARIC prospective cohort study (Atherosclerosis Risk in Communities) who were free of overt cardiovascular disease and underwent echocardiography at study visits 5 (2011- 2013) and 7 (2018-2019), we assessed the associations of NT-proBNP, hs-cTnT, and hs-cTnI concentrations at visit 5 with changes in left ventricular structure and function between visits 5 and 7 (≈7-year change) using multivariable linear regression with the biomarkers modeled as restricted cubic splines. Models were adjusted for age, sex, race, body mass index, smoking, diabetes, hypertension, and renal function at visit 5; blood pressure and heart rate at both visits; and the baseline value of the echocardiographic parameter of interest. Mean±SD age was 74±4 years at visit 5; 61% were women; and 23% were Black adults. Median (25th-75th percentile) concentrations at visit 5 of NT-proBNP, hs-cTnT, and hs-cTnI were 87 ng/L (50-157 ng/L), 9 ng/L (6-12 ng/L), and 2.6 ng/L (1.9-3.9 ng/L). In adjusted models, elevated baseline concentrations of NT-proBNP and hs-cTnI were significantly associated with 7-year decline in left ventricular systolic function (ejection fraction, longitudinal and circumferential strain) and worsening diastolic indices. In contrast, elevated baseline concentrations of hs-cTnT were not significantly associated with 7-year changes in cardiac structure, systolic function, or diastolic function (all P>0.05). Higher concentrations of NT-proBNP and hs-cTnI, but not hs-cTnT, were associated with greater declines in left ventricular function over ≈7 years in late life independently of traditional cardiovascular risk factors.AQ.

CMR native T1 and T2 Mapping in Olympic athletes: the influence of sport discipline and sex

Abstract Background Cardiac Magnetic Resonance (CMR) has a growing role in evaluating athletes’ hearts. Mapping techniques provide added value for tissue characterisation, but data on athletes and sports disciplines are lacking. Aim To describe native mapping values in a cohort of Olympic Athletes and evaluate the influence of sports discipline and sex. Methods A group of 300 Olympic athletes (13% skill, 20% power, 25% mixed, 42% endurance, 58% male) with unremarkable cardiovascular screening and a control group of 42 sedentary subjects (52% male) underwent CMR without contrast administration. Athletes were divided based on sex and sports categories according to the ESC classification. Results Among athletes of different sports categories and controls, endurance presented the lowest value of T1 mapping (p&amp;lt;0.001). No differences in T2 mapping were observed (p=0.472). Female athletes had higher values of T1 native myocardial mapping compared to males (p=0.001), while there were no differences in T2 mapping (p=0.817). Male athletes with higher left ventricular mass indexed (LV-Massi) had lower values of T1 mapping (p=0.006) and slightly higher values of T2 mapping, even if not significant (p=0.150). Female athletes with higher LV-Massi did not show significant differences in T1 and T2 mapping (p=0.053 and p=0.438) Conclusions T1 native myocardial mapping showed significant differences related to sports disciplines and gender. Athletes with the largest LV remodelling, mostly endurance and mixed, showed the lowest values of T1 mapping. Male athletes showed lower values of T1 mapping than females. No significant differences were observed in T2 mapping related to sports disciplines and gender.

Advances in the Insulin-Heart Axis: Current Therapies and Future Directions.

The insulin-heart axis plays a pivotal role in the pathophysiology of cardiovascular disease (CVD) in insulin-resistant states, including type 2 diabetes mellitus. Insulin resistance disrupts glucose and lipid metabolism, leading to systemic inflammation, oxidative stress, and atherogenesis, which contribute to heart failure (HF) and other CVDs. This review was conducted by systematically searching PubMed, Scopus, and Web of Science databases for peer-reviewed studies published in the past decade, focusing on therapeutic interventions targeting the insulin-heart axis. Studies were selected based on their relevance to insulin resistance, cardiovascular outcomes, and the efficacy of pharmacologic treatments. Key findings from the review highlight the efficacy of lifestyle modifications, such as dietary changes and physical activity, which remain the cornerstone of managing insulin resistance and improving cardiovascular outcomes. Moreover, pharmacologic interventions, such as metformin, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors, have shown efficacy in reducing cardiovascular risk by addressing metabolic dysfunction, reducing inflammation, and improving endothelial function. Furthermore, emerging treatments, such as angiotensin receptor-neprilysin inhibitors, and mechanical interventions like ventricular assist devices offer new avenues for managing HF in insulin-resistant patients. The potential of these therapies to improve left ventricular ejection fraction and reverse pathological cardiac remodeling highlights the importance of early intervention. However, challenges remain in optimizing treatment regimens and understanding the long-term cardiovascular effects of these agents. Future research should focus on personalized approaches that integrate lifestyle and pharmacologic therapies to effectively target the insulin-heart axis and mitigate the burden of cardiovascular complications in insulin-resistant populations.

Severe Mitral Regurgitation in Paradoxical Low-Flow Low-Gradient Severe Aortic Stenosis.

Patients with paradoxical low-flow, low-gradient severe aortic stenosis (LFLGAS) exhibit low transvalvular flow rate (Q), while maintaining preserved left ventricular ejection fraction (LVEF). Concomitant severe mitral regurgitation (MR) contributes to the low flow state, adding complexity to diagnosis and management. This study aimed to examine the impact of severe MR on outcomes in paradoxical LFLGAS. Data from an institutional echo database identified 1,189 patients with adjudicated severe aortic stenosis (AVA≤1.0 cm 2 ), low transaortic gradients (mean gradient<40 mmHg), preserved LVEF (≥50%), and low flow rate (Q≤210 ml/sec), to confirm paradoxical LFLGAS. Subgroups were based on MR severity (severe and non-severe). Clinical outcomes included all-cause mortality, aortic valve replacement (AVR), heart failure hospitalizations, and a composite outcome. In the severe MR group (n=80), patients had lower flow rates, increased LV dimensions and a more eccentric hypertrophy pattern compared to non-severe MR (n=1,109). Over a median 5-year follow-up, severe MR correlated with higher all-cause mortality (p=0.02) and AVR rates (p=0.012). After adjustment, severe MR was independently associated with increased all-cause mortality risk (HR=1.43, p=0.011) and composite outcome (HR=1.64, p<0.001). AVR significantly reduced mortality at every MR degree, with the most substantial impact in severe MR (HR=0.18, p<0.001). Propensity-adjusted models demonstrated a stronger AVR impact with increasing MR degree (p-for-interaction=0.044). Severe MR in paradoxical LFLGAS is associated with adverse outcomes and distinctive LV remodeling. Aortic valve replacement improves survival across all MR grades, with greater impact in severe MR.

Surface engineering enhances the therapeutic potential of systemically delivered extracellular vesicles following acute myocardial infarction.

The objective of the study was to assess the therapeutic efficacy of targeting remote zone cardiomyocytes with cardiosphere-derived cell (CDC) extracellular vesicles (EVs) delivered via intramyocardial and intravenous routes following acute myocardial infarction (MI). Cardiomyocyte (CM) cell death plays a significant role in left ventricular (LV) remodeling and cardiac dysfunction following MI. While EVs secreted by CDCs have shown efficacy in promoting cardiac repair in preclinical models of MI, their translational potential is limited by their biodistribution and requirement for intramyocardial delivery. We hypothesized that engineering the surface of EVs to target cardiomyocytes would enhance their therapeutic efficacy following systemic delivery in a model of acute MI. CDC-derived EVs were engineered to express a CM-specific binding peptide (CMP) on their surface and characterized for size, morphology, and protein expression. Mice with acute MI underwent both intramyocardial and intravenous delivery of EVs, CMP-EVs and placebo in a double-blind study. LVEF was assessed by echo at 2- and 28-days post-MI and tissue samples processed for assessment of EV biodistribution and histological endpoints. CMP-EVs demonstrated superior cardiac targeting and retention when compared with unmodified EVs 24 h post-MI. Mice treated with IV delivered CMP-EVs demonstrated a significant improvement in LVEF and a significant reduction in remote zone cardiomyocyte apoptosis when compared with IV delivered non-targeted EVs at 28-day post-MI. Systemic administration of CMP-EVs improved cardiac function and reduced remote zone cardiomyocyte apoptosis compared with IV-administered unmodified EVs, demonstrating a strategy to optimize therapeutic EV delivery post-MI.

The differential effects of dyslipidemia status and triglyceride-glucose index on left ventricular global function and myocardial microcirculation in diabetic individuals: a cardiac magnetic resonance study

BackgroundIt remains unclear whether the association between dyslipidemia status and triglyceride-glucose (TyG) index with myocardial damage varies in the context of type 2 diabetes mellitus (T2DM). This study aimed to determine the differential effects of dyslipidemia status and TyG index on left ventricular (LV) global function and myocardial microcirculation in patients with T2DM using cardiac magnetic resonance (CMR) imaging.MethodsA total of 226 T2DM patients and 72 controls who underwent CMR examination were included. The T2DM group was further categorized into subgroups based on the presence or absence of dyslipidemia (referred to as T2DM (DysL+) and T2DM (DysL-)) or whether the TyG index exceeded 9.06. CMR-derived LV perfusion parameters, remodeling index, and global function index (GFI) were assessed and compared among groups. A multivariable linear regression model was employed to evaluate the effects of various variables on LV myocardial microcirculation, remodeling index, and GFI.ResultsThe LV GFI sequentially decreased in controls, T2DM (DysL-), and T2DM (DysL+) groups (p < 0.001), and was lower (p = 0.003) in T2DM with higher TyG index group than in lower TyG index group. The LV remodeling index was higher in higher TyG index group than in lower TyG index group (p = 0.002), but there was no significant difference in whether the subgroup was accompanied by dyslipidemia. Multivariable analysis revealed that the TyG index, but not dyslipidemia status, was independently associated with LV remodeling index (β coefficient[95% confidence interval], 0.152[0.025, 0.268], p = 0.007) and LV GFI (− 0.159[− 0.281, − 0.032], p = 0.014). For LV myocardial microcirculation, perfusion index, upslope, and max signal intensity sequentially decreased in controls, T2DM (DysL-), and T2DM (DysL+) groups (all p < 0.001). Dyslipidemia status independently correlated with perfusion index (− 0.147[− 0.272, − 0.024], p = 0.02) and upslope (− 0.200[− 0.320, 0.083], p = 0.001), while TyG index was independently correlated with time to maximum signal intensity (0.141[0.019, 0.257], p = 0.023).ConclusionsBoth dyslipidemia status and higher TyG index were associated with further deterioration of LV global function and myocardial microvascular function in the context of T2DM. The effects of dyslipidemia and a higher TyG index appear to be differential, which indicates that not only the amount of blood lipids and glucose but also the quality of blood lipids are therapeutic targets for preventing further myocardial damage.

Implications of Myocardial Strain in Primary Mitral Regurgitation - A Cardiovascular Magnetic Resonance Study.

Chronic primary mitral regurgitation (MR) results in progressive left ventricular (LV) remodeling. Abnormal myocardial deformation (strain) can be present despite preserved ejection fraction. Cardiovascular magnetic resonance (CMR) feature-tracking techniques allow assessment of global longitudinal strain (GLS) from routine cine-images. The aim of this study was to evaluate the prognostic value of CMR feature-tracking derived GLS in patients with primary MR. Consecutive patients undergoing CMR for chronic MR from January 2012 to June 2018 were enrolled. Patient with LV ejection fraction <50% were excluded. The composite primary outcome aiming to detect decompensation related to MR comprised of 1) referral for mitral surgery due to symptoms or LV systolic dysfunction or 2) cardiovascular death. The secondary outcome was all-cause death. A total of 422 patients were followed for a median of 2.7 years, the primary endpoint was met in 93 patients (34 patients reported symptoms at baseline). On multivariable analysis, GLS≥ -16.6% was associated with primary outcome (hazard ratio 1.90,p=0.01). In moderate MR cohort, patient with GLS≥ -16.6% had worse event-free survival while no significant different in mild or severe MR groups. GLS≥ -16.0% remained associated with all-cause death after adjusting for other covariates including the MR severity (hazard ratio 2.24,p=0.02). In primary MR patients with preserved systolic function, GLS was associated with our composite outcomes and all-cause death. GLS may serve as a marker of cardiac dysfunction in primary MR patients with preserved systolic function allowing identification of patients likely to decompensate during observation.

Ambulatory blood pressure is associated with left ventricular geometry after 10 years in hypertensive patients with continuous antihypertensive treatment.

Both aging and high blood pressure (BP) are associated with a risk of left ventricular concentricity and hypertrophy. We hypothesized that optimal BP management improves left ventricular remodeling beyond aging. Among 558 hypertensive patients on continuous antihypertensive treatment and without concurrent heart disease who were referred to a cardiology clinic with echocardiography and ambulatory BP monitoring data, 142 patients' echocardiographic data was available after 10 years. Baseline BP and changes in left ventricular geometry were evaluated. Mean age at baseline was 71.0 years old. Baseline daytime BP was 129.9/72.4 ± 17.1/10.2 mmHg and nighttime BP was 122.5/67.1 ± 16.9/9.1 mmHg. After 10 years, left ventricular mass index (LVMI) and relative wall thickness (RWT) significantly decreased from 104.5 ± 26.3 to 97.9 ± 26.4 g/m2, p = 0.003 and 0.51 ± 0.09 to 0.47 ± 0.09, p < 0.001, consecutively. Among patients with hypertrophic geometry at baseline, 17.2% reverted to normal geometry at follow-up. Daytime systolic BP (136.9 ± 18.5 mmHg vs 126.2 ± 16.5 mmHg, p = 0.03), nighttime systolic BP (126.2 ± 17.7 mmHg vs 116.3 ± 16.0 mmHg, p = 0.038) and daytime pulse pressure (63.5 ± 17.3 mmHg vs 53.1 ± 14.9 mmHg, p = 0.022) at baseline were higher in patients who remained hypertrophic than those without hypertrophy at follow-up. On logistic regression analysis, daytime, nighttime systolic BP, and daytime pulse pressure were significantly related to the regression of hypertrophy adjusted for age, sex, eGFR, BMI, LVMI, and RWT at baseline. For conclusion, antihypertensive treatment for 10 years improved LV geometry despite aging. Ambulatory BP and pulse pressure at baseline predicted the change of LV geometry after 10 years.