Structural Cardiac Abnormalities Research Articles

Dilated Cardiomyopathy: A Comprehensive Approach to Diagnosis and Risk Stratification

Dilated cardiomyopathy (DCM) represents one of the most common causes of non-ischemic heart failure, characterised by ventricular dilation alongside systolic dysfunction. Despite advances in therapy, DCM mortality rates remain high, and it is one of the leading causes of heart transplantation. It was recently recognised that many patients present minor structural cardiac abnormalities and express different arrhythmogenic phenotypes before overt heart-failure symptoms. This has raised several diagnostic and management challenges, including the differential diagnosis with other phenotypically similar conditions, the identification of patients at increased risk of malignant arrhythmias, and of those who will have a worse response to medical therapy. Recent developments in complementary diagnostic procedures, namely cardiac magnetic resonance and genetic testing, have shed new light on DCM understanding and management. The present review proposes a comprehensive and systematic approach to evaluating DCM, focusing on an improved diagnostic pathway and a structured stratification of arrhythmic risk that incorporates novel imaging modalities and genetic test results, which are critical for guiding clinical decision-making and improving outcomes.

CLINICAL STUDY OF STRUCTURAL AND FUNCTIONAL CARDIAC ABNORMALITIES IN CIRRHOSIS OF LIVER

BACKGROUND: Cirrhosis of liver is a hyperdynamic condition in which there may be subtle cardiac dysfunction . objective of this study was to ascertain the structural and functional cardiac abnormalities that may be present with cirrhosis of liver . AIMS AND OBJECTIVES: Ÿ To evaluate the clinical aspects of cirrhosis pertaining to cardiac abnormalities. Ÿ To ascertain the relation between cirrhosis of liver and its effect on cardiac function and structure. METHODOLGY: Ÿ 50 patients with cirrhosis of liver detected and proven by ultrasound abdomen were subjected to clinical examination and 2D echo to screen cardiac abnormalities . E/A ratio and LV mass were calculated to check for functional and structural abnormalities respectively. RESULTS: Male to female ratio 31:19, mean age 55.64±10.02 , common clinical features – Fatigue (90%) , abdominal distension (74%) , abdominal pain (74%) , icterus (76%). Mean E/A ratio 0.89±0.16 and mean LV mass 169.30±26.04 , with EF 64.53±0.97 . All patients CONCLUSION: with cirrhosis of liver must be screened for latent structural (LV mass) and functional (E/A ratio) cardiac abnormalities. Serum bilirubin >4.0 mg/dl , INR >2.0 , Serum creatinine >2.0 , associated with higher risk of cardiac abnormalities. Older age groups have a higher incidence of cardiac abnormalities

THE ASSOCIATION OF ELECTRICAL LEFT AXIS DEVIATION WITH CARDIAC STRUCTURAL ABNORMALITIES IN PATIENTS WITH ADVANCED AGE: AN OBSERVATIONAL STUDY.

THE ASSOCIATION OF ELECTRICAL LEFT AXIS DEVIATION WITH CARDIAC STRUCTURAL ABNORMALITIES IN PATIENTS WITH ADVANCED AGE: AN OBSERVATIONAL STUDY.

Abstract P588: The Association of Anthropometric Measures With Risk for Pre-HF

Introduction: Obesity is an epidemiologic challenge and a key risk factor for heart failure (HF). Pre-heart failure (pre-HF) has been recognized as an important entity to prevent progression to clinical HF. Defining the long-term effect of obesity on pre-HF is essential for understanding of HF risk and prevention. Purpose: To determine the prospective association of obesity on the incidence of pre-HF (defined as the presence of abnormal cardiac structure or function among persons without clinical HF). Methods: Data from 1580 individuals without HF and with anthropometric data from the population-based Echocardiographic-Study of Latinos were included. Pre-HF was defined as: 1) Systolic dysfunction - LV ejection fraction (LVEF) < 50% and global longitudinal strain (GLS) <15%; 2) LV diastolic dysfunction - E/e’ >10 and left atrial volume index (LAVI) >34 mL/m 2 ; or 3) LV remodeling - LV mass index (LVMI)> 115gm/m 2 , >95gm/m 2 (male and female, respectively) and relative wall thickness (RWT) >0.42. Anthropometric data were: (body mass index {BMI}, waist circumference {WC}, waist-to-hip ratio {WHR}, fat mass {FM) and free fat mass {FFM}). Echocardiographic and anthropometric data were collected twice, on average 4.3 years apart, and analyzed using survey-weighted multivariable-adjusted regression models. Incident pre-HF was determined among participants Results: Mean age of 56 (42-74) years and 1048 (66%) were female. Baseline mean BMI was 29.9 kgm 2 , FM kg 28.3, FFM kg 50.1, WC 99.7cm, and WHR 0.94. Baseline BMI, FFM, FM, WC and WHR were significantly higher in individuals with prevalent pre-HF (all p<0.007). Longitudinal data showed that WC and WHR were associated with greater probability of incident pre-HF (WC and WHR p<0.0006. Regression models showed BMI, WC, WHR and FFM were associated with increased odds of incident Pre-HF (Table 1).

Genetic Basis of Early Onset Atrial Fibrillation in Patients without Risk Factors.

Atrial fibrillation (AF) is the most common arrhythmia and typically occurs in elderly patients with other cardiovascular and extracardiac diseases. However, up to 15% of AF develops without any related risk factors. Recently, the role of genetic factors has been highlighted in this particular form of AF. The aims of this study were to determine the prevalence of pathogenic variants in early-onset AF in patients without known disease-related risk factors and to identify any structural cardiac abnormalities in these patients. We conducted exome sequencing and interpretation in 54 risk factor-free early-onset AF patients and further validated our findings in a similar AF patient cohort from the UK Biobank. Pathogenic/likely pathogenic variants were found in 13/54 (24%) patients. The variants were identified in cardiomyopathy-related and not arrhythmia-related genes. The majority of the identified variants were TTN gene truncating variants (TTNtvs) (9/13 (69%) patients). We also observed two TTNtvs founder variants in the analysed population-c.13696C>T p.(Gln4566Ter) and c.82240C>T p.(Arg27414Ter). Pathogenic/likely pathogenic variants were found in 9/107 (8%) individuals from an independent similar AF patient cohort from the UK Biobank. In correspondence with our Latvian patients, only variants in cardiomyopathy-associated genes were identified. In five (38%) of the thirteen Latvian patients with pathogenic/likely pathogenic variants, dilation of one or both ventricles was identified on a follow-up cardiac magnetic resonance scan. We observed a high prevalence of pathogenic/likely pathogenic variants in cardiomyopathy-associated genes in patients with risk factor-free early-onset AF. Moreover, our follow-up imaging data indicate that these types of patients are at risk of developing ventricular dilation. Furthermore, we identified two TTNtvs founder variants in our Latvian study population.

Renal Insufficiency Increases the Combined Risk of Left Ventricular Hypertrophy and Dysfunction in Patients at High Risk of Cardiovascular Diseases

The identification of asymptomatic structural and functional cardiac abnormalities can help us to recognize early and intervene in patients at pre-heart failure (HF). However, few studies have adequately evaluated the associations of renal function and left ventricular (LV) structure and function in patients at high risk of cardiovascular diseases (CVD). Patients undergoing coronary angiography and/or percutaneous coronary interventions were enrolled from the Cardiorenal ImprovemeNt II (CIN-II) cohort study, and their echocardiography and renal function were assessed at admission. Patients were divided into five groups according to their estimated glomerular filtration rate (eGFR). Our outcomes were LV hypertrophy and LV systolic and diastolic dysfunction. Multivariable logistic regression analyses were conducted to investigate the associations of eGFR with LV hypertrophy and LV systolic and diastolic dysfunction. A total of 5610 patients (mean age: 61.6 ± 10.6 years; 27.3% female) were included in the final analysis. The prevalence of LV hypertrophy assessed by echocardiography was 29.0%, 34.8%, 51.9%, 66.7%, and 74.3% for the eGFR categories >90, 61-90, 31-60, 16-30, and ≤15 mL/min per 1.73 m2 or for patients needing dialysis, respectively. Multivariate logistic regression analysis showed that subjects with eGFR levels of ≤15 mL/min per 1.73 m2 or needing dialysis (OR: 4.66, 95% CI: 2.96-7.54), as well as those with eGFR levels of 16-30 (OR: 3.87, 95% CI: 2.43-6.24), 31-60 (OR: 2.00, 95% CI: 1.64-2.45), and 61-90 (OR: 1.23, 95% CI: 1.07-1.42), were significantly associated with LV hypertrophy. This reduction in renal function was also significantly associated with LV systolic and diastolic dysfunction (all P for trend <0.001). In addition, a per one unit decrease in eGFR was associated with a 2% heightened combined risk of LV hypertrophy and systolic and diastolic dysfunction. Among patients at high risk of CVD, poor renal function was strongly associated with cardiac structural and functional abnormalities. In addition, the presence or absence of CAD did not change the associations. The results may have implications for the pathophysiology behind cardiorenal syndrome.

Extracellular vesicles mediate biological information delivery: A double-edged sword in cardiac remodeling after myocardial infarction.

Acute myocardial infarction (AMI) is a severe ischemic disease with high morbidity and mortality worldwide. Maladaptive cardiac remodeling is a series of abnormalities in cardiac structure and function that occurs following myocardial infarction (MI). The pathophysiology of this process can be separated into two distinct phases: the initial inflammatory response, and the subsequent longer-term scar revision that includes the regression of inflammation, neovascularization, and fibrotic scar formation. Extracellular vesicles are nano-sized lipid bilayer vesicles released into the extracellular environment by eukaryotic cells, containing bioinformatic transmitters which are essential mediators of intercellular communication. EVs of different cellular origins play an essential role in cardiac remodeling after myocardial infarction. In this review, we first introduce the pathophysiology of post-infarction cardiac remodeling, as well as the biogenesis, classification, delivery, and functions of EVs. Then, we explore the dual role of these small molecule transmitters delivered by EVs in post-infarction cardiac remodeling, including the double-edged sword of pro-and anti-inflammation, and pro-and anti-fibrosis, which is significant for post-infarction cardiac repair. Finally, we discuss the pharmacological and engineered targeting of EVs for promoting heart repair after MI, thus revealing the potential value of targeted modulation of EVs and its use as a drug delivery vehicle in the therapeutic process of post-infarction cardiac remodeling.

P2X7 purinergic receptor: A potential target in heart diseases (Review).

The P2X7 purinergic receptor (P2X7R) is a non‑selective cation channel activated by high levels of adenosine triphosphate that are commonly present in serious conditions. Activation of this purinergic receptor is closely related to the development of various disease states including inflammatory and neurodegenerative disorders, orthopedic diseases and types of cancer. Accumulating evidence has shown that the P2X7R plays a crucial role in the development of various heart diseases. For example, activation of P2X7Rs may alleviate myocardial ischemia‑reperfusion injury by releasing endogenous cardiac protective substances. In contrast to these findings, activation of P2X7Rs can promote the development of acute myocardial infarction and myocarditis by inducing inflammatory responses. Activation of these receptors can also contribute to the development of different types of cardiomyopathies including diabetic cardiomyopathy, dilated cardiomyopathy and hypertrophic cardiomyopathy by inducing cardiac hypertrophy, fibrosis and apoptosis. Notably, inhibition of P2X7Rs can improve cardiac structure and function abnormalities following acute myocardial infarction, reduction of inflammatory responses following myocarditis and attenuation of the cardiomyopathy process. Furthermore, recent evidence has demonstrated that P2X7Rs are highly active in patients infected with coronavirus disease‑2019 (COVID‑19). Hyperactivation of P2X7Rs in COVID‑19 may induce severe myocardial injury through the activation of several signaling pathways. The present study reviewed the important role of the P2X7R in cardiac dysfunctions and discusses its use as a possible new therapeutic approach for the prevention and treatment of several myocardial diseases.

The Impact of Prenatal Diagnosis in the Evolution of Newborns with Congenital Heart Disease.

Congenital heart malformations are cardiac and/or vascular structural abnormalities that appear before birth, the majority of which can be detected prenatally. The latest data from the literature were reviewed, with reference to the degree of prenatal diagnosis regarding congenital heart malformations, as well as its impact on the preoperative evolution and implicitly on mortality. Studies with a significant number of enrolled patients were included in the research. Prenatal congenital heart malformations detection rates were different, depending on the period in which the study took place, the level of the medical center, as well as on the size of enrolled groups. Prenatal diagnosis in critical malformations such as hypoplastic left heart syndrome, transposition of great arteries and totally aberrant pulmonary venous drainage has proven its usefulness, allowing an early surgical intervention, thus ensuring improved neurological development, increasing the survival rate and decreasing the rate of subsequent complications. Sharing the experience and results obtained by each individual therapeutic center will definitely lead to drawing clear conclusions regarding the clinical contribution of congenital heart malformations prenatal detection.

The preliminary study on cardiac structure and function in Chinese patients with primary hyperparathyroidism.

Recent evidences show that primary hyperparathyroidism (PHPT) patients have a high prevalence of cardiovascular diseases. However, the reported changes in cardiac status are inconsistent in previous studies. The present work evaluated the cardiac structure and function in PHPT patients by echocardiography. PHPT patients and age- and sex-matched healthy controls were enrolled in this case-control study. Biochemical parameters were retrospectively collected from PHPT patients. Cardiac function and structure were assessed in all subjects using echocardiography. A total of 153 PHPT patients and 51 age- and sex-matched healthy controls were enrolled in this study. The mean serum calcium and parathyroid hormone (PTH) levels in PHPT patients were 2.84 ± 0.28mmol/L and 206.9 (130.0, 447.5) pg/ml, respectively. Left ventricular ejection fraction (LVEF) and early to late mitral annular velocity (E/A) were significantly lower in PHPT patients than in healthy controls (68.2 ± 6.0 vs. 70.7 ± 16.7%, 1.0 ± 0.5 vs. 1.4 ± 0.5, respectively, p both < 0.05). The left ventricular mass index (LVMI) and the relative wall thickness (RWT) were not significantly different between the two groups. However, the difference in LVEF between PHPT patients without hypertension and diabetes and the control groups disappeared. The majority of PHPT patients had normal cardiac geometry; however, a proportion of them exhibited concentric remodeling (normal LVMI, RWT≥0.42). Serum calcium, corrected calcium, ionized calcium and PTH were inversely related to E/A, whereas serum phosphorus and 24-hour urine calcium were positively related to E/A. Furthermore, biochemical parameters were not correlated with LVEF. These findings demonstrate that PHPT patients exhibit diastolic cardiac dysfunction reflected by decreased E/A, as well as possible cardiac structural abnormalities. The serum calcium, phosphorus, and parathyroid hormone levels may influence cardiac structure and function.

Cardiac structural and functional abnormalities in epilepsy: A systematic review and meta-analysis.

Epilepsy is associated with an increased risk of cardiovascular disease and mortality. Whether cardiac structure and function are altered in epilepsy remains unclear. To address this, we conducted a systematic review and meta-analysis of studies evaluating cardiac structure and function in patients with epilepsy. We searched the electronic databases MEDLINE, PubMed, COCHRANE, and Web of Science from inception to 31 December 2021. Primary outcomes of interest included left ventricular ejection fraction (LVEF) for studies reporting echocardiogram findings and cardiac weight and fibrosis for postmortem investigations. Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) assessment tools. Among the 10 case-control studies with epilepsy patients (n=515) and healthy controls (n=445), LVEF was significantly decreased in epilepsy group compared with controls (MD: -1.80; 95% confidence interval [CI]: -3.56 to -0.04; P= 0.045), whereas A-wave velocity (MD: 4.73; 95% CI: 1.87-7.60; P=0.001), E/e' ratio (MD: 0.39; 95% CI: 0.06-0.71; P= 0.019), and isovolumic relaxation time (MD: 10.18; 95% CI: 2.05-18.32; P= 0.014) were increased in epilepsy, compared with controls. A pooled analysis was performed in sudden unexpected death in epilepsy (SUDEP) cases with autopsy data (n=714). Among SUDEP cases, the prevalence of cardiac hypertrophy was 16% (95% CI: 9%-23%); cardiac fibrosis was 20% (95% CI: 15%-26%). We found no marked differences in cardiac hypertrophy, heart weight, or cardiac fibrosis between SUDEP cases and epilepsy controls. Our findings suggest that epilepsy is associated with altered diastolic and systolic echocardiogram parameters compared with healthy controls. Notably, SUDEP does not appear to be associated with a higher incidence of structural cardiac abnormalities, compared with non-SUDEP epilepsy controls. Longitudinal studies are needed to understand the prognostic significance of such changes. Echocardiography may be a useful noninvasive diagnostic test in epilepsy population.

Prevalence and prognosis of frailty in older patients with stage B heart failure with preserved ejection fraction.

Frailty in older patients with stage B heart failure with preserved ejection fraction (HFpEF) has not been fully explored. We evaluated the prevalence and prognostic significance of frailty in older patients diagnosed with stage B HFpEF. Our prospective cohort study included inpatients aged ≥65years who were followed up for 3years. Stage B HFpEF was defined as cardiac structural or functional abnormalities with a left ventricular ejection fraction (LVEF)≥50% without signs or symptoms. Frailty was assessed using the Fried phenotype. The primary outcome was 3-year all-cause mortality or readmission. Overall, 520 older inpatients diagnosed with stage B HFpEF [mean±standard deviation age: 75.5±6.25years, male: 222 (42.7%)] were included in the study. Of these, 145 (27.9%) were frail. Frail patients were older (78.5±6.23 vs. 74.3±6.22years, P<0.001), with a lower body mass index (24.6±3.60 vs. 25.7±3.27kg/m2 , P=0.001), higher level of N-terminal pro-B-type natriuretic peptide [279 (interquartile range: 112.4, 596) vs. 140 (67.1, 266) pg/mL, P<0.001], longer timed up-and-go test result (19.9±9.71 vs. 13.3±5.08s, P<0.001), and poorer performance in the short physical performance battery (4.1±3.26 vs. 8.2±2.62, P<0.001), basic activities of daily living (BADL, 4.7±1.71 vs. 5.7±0.57, P<0.001), and instrumental activities of daily living (IADL, 4.4±2.73 vs. 7.4±1.33, P<0.001). Frail patients were more likely to have a Mini-Mental State Examination (MMSE) score <24 (55.9% vs. 28.8%, P<0.001) and take more than five medications (64.1% vs. 47.2%, P=0.001). Frail patients had a higher incidence of all-cause mortality or readmission (62.8% vs. 47.7%, P=0.002), all-cause readmission (56.6% vs. 45.9%, P=0.029), and readmission for non-heart failure (55.2% vs. 41.3%, P=0.004) during the 3-year follow-up, with a 1.53-fold (95%CI 1.11-2.11, P=0.009) higher risk of all-cause mortality or readmission, a 1.52-fold (95%CI 1.09-2.11, P=0.014) higher risk of all-cause readmission, and a 1.70-fold (95%CI 1.21-2.38, P=0.002) higher risk of readmission for non-clinical heart failure, adjusted for sex, age, polypharmacy, Athens Insomnia Scale, MMSE, LVEF, BADL, and IADL. Frailty is common in elderly patients with stage B HFpEF. Physical frailty, particularly low physical activity, can independently predict the long-term prognosis in these patients.

Abnormal electrocardiogram or echocardiogram as interim measures for CVD risk stratification in pregnancy and postpartum

Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States. The diagnosis of CVD is challenging as signs and symptoms of normal pregnancy may mimic CVD. The California Maternal Quality Care Collaborative (CMQCC) CVD risk assessment algorithm was used to help stratify pregnant and postpartum patients into low or high risk for CVD and guide further cardiac testing. We sought to evaluate the intermediate outcomes, i.e., abnormal electrocardiogram (EKG) and echocardiogram, as surrogates for CVD to assess the positive predictive value of the CMQCC tool in patients determined to be at high risk for CVD. Retrospective medical record review of 1,399 patients that underwent CVD risk stratification using the CMQCC algorithm over an 18-month period at a major hospital network in California. The primary outcome was the rate of abnormal EKG or echo, defined as abnormal cardiac structure and/or function, among patients who were determined to be at increased risk for CVD. Of 29 patients identified to be at increased risk, 20 received follow-up testing with EKG or echo within 60 days of the risk assessment. Over half (65%) of the patients were found to have underlying EKG or echo abnormality. Abnormal cardiovascular testing results included findings such as sinus tachycardia (HR > 100 bpm), conduction delays, Wolff Parkinson-White syndrome, left ventricular hypertrophy/diastolic dysfunction, and chamber dilation. Using these results as a surrogate for CVD, the CMQCC risk assessment tool identified 13 cases of previously undiagnosed cardiovascular dysfunction in the study population (Table 1). Use of the CMQCC CVD risk assessment tool provides an opportunity for early diagnosis of CVD that may allow for prompt clinical intervention in addition to patient education and promotion of healthy lifestyle changes. EKG and echo results may be used as intermediate outcomes to assess the positive predictive value of the tool. Future long-term studies should evaluate the benefits of obstetric CVD risk assessment on the prevention of CVD over the life course.

Trans-Thoracic Echocardiographic Parameters for Prognostic Assessment Across the Spectrum of Heart Failure

Heart failure with increasing life expectancy has become the leading cause of morbidity and mortality in modern day world, begetting great economic burden. Usually diagnosed by specific criteria, Framingham’s being the most commonly employed, heart failure has been classified on the basis of left ventricular ejection fraction measured by transthoracic echocardiography as heart failure with preserved ejection fraction (HFpEF, LVEF ≥ 50%), heart failure with mid-range EF (HFmrEF, LVEF 41-49%) and heart failure with reduced EF (HFrEF, LVEF ≤ 40%), constituting the “spectrum”. For the diagnosis of HFpEF, elevated biochemical markers and presence of cardiac structural abnormalities or diastolic dysfunction are also required whereas for the other types only ejection fraction, with appropriate symptoms/signs are needed. It is quite clear that echocardiography plays a central role in diagnosis and classification of heart failure. Mostly, of the prognostic markers mortality and hospitalization have been assessed in clinical trials. Here also echocardiography plays a prominent role and every modality of it (with numerous parameters) including M-mode, 2D, color, spectral and tissue Doppler along with recent addition of strain imaging provide important clues. These clues not only work for heart failure as a whole but also for the individual classes. Many studies have provided insights into the comparative efficacy of these markers across the spectrum. The prognostic power of these echo parameters has been assessed either individually or in combination. Various scoring systems have also been formulated. An individual patient can transit through the classes of heart failure over time and certain echo parameters provide an indication in this regard as well. Structural parameters of both sides of the heart along with functional and hemodynamic assessment provide prognostic insights with strain measures showing superiority. No large-scale clinical trial has yet been done in which all the parameters across the spectrum of heart failure have been studied. An appraisal of clinically important echo markers for prognostic assessment across the spectrum is the subject of this descriptive review.

Revisiting the role of electrocardiography for screening of congenital heart disease in young adults

Introduction: Congenital heart disease (CHD) is the most prevalent congenital disability found in newborns. Many cases remain unknown until complications occur, usually in young adults. Transthoracic and Doppler echocardiography are modalities of choice for CHD detection, but these are limited in Indonesia. Electrocardiography (ECG) is a widely available and low-cost test. This study investigated the role of ECG as a screening modality for CHD. Methods: A cross-sectional study was held at Atma Jaya School of Medicine and Health Science from August to November 2019. Participants were students aged 18 years old or more. Exclusion criteria was previously detected for CHD. Data were collected through history taking, anthropometrics, blood pressure measurement, and 12 leads ECG. ECG results were interpreted independently by two cardiologists to minimize observer bias. Results: A total of 193 students, 78 male and 115 female, participated. The mean age was 19.22±1.85 years. ECG abnormalities were discovered in 57 (29.5%) participants:15 with crochetage sign, 13 right axis deviation, three left axis deviation, nine right ventricle hypertrophy, and nine left ventricle hypertrophy, six left bundle branch block, and two defective T wave. Further evaluation was done with echocardiography in 20 participants, which resulted in one participant having mitral valve prolapsed (MVP). Conclusion: ECG could detect the characteristic patterns suggestive of CHD, but ECG alone is insufficient to confirm cardiac structural abnormalities.

Echocardiographic Study Among Traffic Police Personnel in Central Nepal

Background: Echocardiographic studies among traffic police personnel are lacking in the world including in Nepal. So, this study is planned to detect any structural cardiac abnormalities in this specific group population. Methods: This is a cross-sectional descriptive study conducted among fifty traffic police personnel working in the Chitwan district of Nepal. All underwent two-dimensional transthoracic echocardiography in Chitwan Mutu Aspatal. Results: The age ranged from 21 to 55 years, with a mean age of 35 years. Males were predominant (46/50) and 14(28%) were diagnosed as hypertensives. Mild MR was detected on 11(22%) participants. Conclusion: This is the first reported observational study so far among the traffic police personnel in Nepal. There is a high incidence of systemic hypertension among these populations though no major cardiac structural abnormalities were detected.

Anomalies cardiaques associées à l'hyperthyroïdie : étude clinique, structurelle et rythmique

IntroductionThe prevalence and nature of cardiac complications associated with hyperthyroidism vary considerably in the literature depending on the population studied and the means of investigation used to detect them. The aim of this study was to determine the structural, functional, and rhythmic cardiac abnormalities associated with hyperthyroidism and to identify their risk factors. MethodsIt is a cross-sectional study conducted in thirty adult patients with overt or subclinical hyperthyroidism. Each patient underwent a clinical cardiovascular examination, a cardiac Doppler ultrasound, a pulmonary ultrasound and a 24-hours rhythm holter. The diagnosis of cardiothyreosis (thyrotoxic heart disease) was retained if an arrhythmia, heart failure (HF) and/or pulmonary arterial hypertension (PAH) were noted following the investigations carried out. ResultsThe mean age of the patients was 44.8 ± 14.4 years. The sex ratio (M/F) was 0.3. Five patients (17%) had subclinical hyperthyroidism and 25 (83%) had overt hyperthyroidism. Thirteen patients (43%) had cardiothyreosis. It consisted of a rhythm disorder in three patients (10%), PAH in twelve patients (40%) and HF in eight patients (27%). An age over 50 years and toxic nodular etiology were associated with atrial fibrillation (AF), p = 0.041 and p = 0.004 respectively. Tachycardia and a higher number of atrial extrasystoles were associated with HF, p = 0.039 and p = 0.007 respectively. A lower TSH, tachycardia and a higher number of atrial extrasystoles were associated with the presence of PAH, p = 0.004, p = 0.011 and p = 0.007 respectively. ConclusionCardiac complications should be sought in all patients with hyperthyroidism, especially in elderly and tachycardic patients. Specialized investigations such as echocardiography or 24 hours rhythmic holter should be requested in these cases.

Dynamic Evolution of Cardiac Function and Glucose and Lipid Metabolism in Ovariectomized Rats and the Intervention Effect of Erxian Decoction.

Abnormal changes in cardiac function have been reported in menopausal women, but there are few clinical studies on this topic. Erxian decoction (EXD) is a classic prescription that is widely used in the treatment of female menopausal diseases. The purpose of this study was to investigate the dynamic evolution of cardiac function and glucose and lipid metabolism in ovariectomized (OVX) rats and the intervention effect of EXD. The OVX climacteric rat model was established by bilateral ovariectomy. After successful modeling, the rats were randomly divided into four groups: the sham operation (SHAM) group (equal volumes of purified water), OVX group (equal volumes of purified water), estradiol (E2) group (1.8 × 10-4 g/kg), and EXD group (9 g/kg). Each group of rats was treated for 16 weeks. At the 4th, 8th, 12th, and 16th weeks after treatment, the cardiac function of the rats in each group was evaluated by ultrasound. The coaxial method was used to measure blood pressure (BP). Serum endothelin-1 (ET-1) and angiotensin-2 (Ang II) levels were determined by the enzyme-linked immunosorbent assay (ELISA). The strip method was used to measure fasting blood glucose (FBG). The serum total cholesterol (TC) and triglyceride (TG) levels of rats were measured with the oxidase method. Direct methods were used to measure serum high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) levels. At week 16 of dosing, serum E2 levels were determined by E2 radioimmunoassay. The myocardium and uterus of the rats in each group were stained with HE (hematoxylin-eosin). The ultrastructure of the rat myocardium was observed by electron microscopy. After the 16th week of treatment, the serum E2 level decreased (P < 0.05), and the uterus was atrophied in OVX rats. The cardiac ejection fraction (EF%) decreased at 4 weeks after treatment, and systolic and diastolic function decreased after 12 weeks. After the 16th week, the EF%, which reflects the "pump" function of the heart, decreased significantly (P < 0.05 or P < 0.01). At the 4th, 8th, 12th, and 16th weeks of treatment, the systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean pressure (MBP) of the rats in the OVX group increased with time (P < 0.05 or P < 0.01). The serum ET-1 and Ang II levels of rats in the OVX group increased (P < 0.05 or P < 0.01). In the OVX group, FBG was increased (P < 0.05 or P < 0.01), and blood lipids, especially LDL-C, were significantly increased (P < 0.05 or P < 0.01). After the 16th week of treatment, the myocardial tissue of OVX rats showed obvious pathological changes. EXD significantly increased serum E2 levels (P < 0.01), decreased ET-1 and Ang II levels (P < 0.01), reduced the cardiac function risk factors BP, FBG, and blood lipids, and significantly improved cardiac function and structural changes in OVX rats (P < 0.05 or P < 0.01). EXD can improve abnormal cardiac structure and function in OVX rats.

Cardiac myosin motor deficits are associated with left ventricular dysfunction in human ischemic heart failure.

During ischemic heart failure (IHF), cardiac muscle contraction is typically impaired, though the molecular changes within the myocardium are not fully understood. Thus, we aimed to characterize the biophysical properties of cardiac myosin in IHF. Cardiac tissue was harvested from 10 age-matched males, either with a history of IHF or nonfailing (NF) controls that had no history of structural or functional cardiac abnormalities. Clinical measures before cardiac biopsy demonstrated significant differences in measures of ejection fraction and left ventricular dimensions. Myofibrils and myosin were extracted from left ventricular free wall cardiac samples. There were no changes in myofibrillar ATPase activity or calcium sensitivity between groups. Using isolated myosin, we found a 15% reduction in the IHF group in actin sliding velocity in the in vitro motility assay, which was observed in the absence of a myosin isoform shift. Oxidative damage (carbonylation) of isolated myosin was compared, in which there were no significant differences between groups. Synthetic thick filaments were formed from purified myosin and the ATPase activity was similar in both basal and actin-activated conditions (20 µM actin). Correlation analysis and Deming linear regression were performed between all studied parameters, in which we found statistically significant correlations between clinical measures of contractility with molecular measures of sliding velocity and ELC carbonylation. Our data indicate that subtle deficits in myosin mechanochemical properties are associated with reduced contractile function and pathological remodeling of the heart, suggesting that the myosin motor may be an effective pharmacological intervention in ischemia.NEW & NOTEWORTHY Ischemic heart failure is associated with impairments in contractile performance of the heart. This study revealed that cardiac myosin isolated from patients with ischemic heart failure had reduced mechanical activity, which correlated with the impaired clinical phenotype of the patients. The results suggest that restoring myosin function with pharmacological intervention may be a viable method for therapeutic intervention.

872 ENDOTHELIAL AND CARDIAC AUTONOMIC FUNCTION IN PATIENTS WITH A RECENT SARS-COV-2 INFECTION

Abstract Background A significant proportion of patients recovering from SARS-CoV-2 infection (Covid-19) complain a wide variety of bothersome symptoms, including symptoms potentially related to cardiac involvement, that may significantly impair their quality of life (post-Covid or long-Covid syndrome). However, full diagnostic investigation usually does not reveal significant structural or functional cardiac abnormalities. Whether cardiac autonomic dysfunction and/or endothelial dysfunction may play a role in post-COVID-19 symptoms, however, has poorly been investigated. Methods We prospectively enrolled 63 young adult patients (age 18-55 years) without any previous cardiovascular disease, referred to our “Post-COVID-19” Day Hospital ward for a clinical follow-up after 3 months from SARS-CoV-2 infection. In all patients endothelium-dependent vasodilator function was assessed non-invasively by measuring the change of brachial artery diameter in response to hyperaemia after 5 minutes of forearm ischemia (flow-mediated dilatation, FMD); furthermore, endothelium-independent vasodilator function was assessed by measuring the change of brachial artery diameter in response to sublingual nitro-glycerine (25 µg) (nitrate-mediated dilatation, NMD). A 24-hour ECG Holter monitoring (HM) was performed to assess cardiac autonomic function by obtaining time-domain and frequency-domain parameters of heart rate variability (HRV). Results Symptoms of potential cardiac origin (dyspnoea on exertion, chest pain, arrhythmic symptoms) were referred by 47 patients (74.6%, Group 1), whereas 16 (25.4%, Group 2) were free from any possible cardiac symptom. The two groups did not differ in age, sex and cardiovascular risk factors. FMD was 7.29±3.4% and 7.01±2.3% in Group 1 and 2, respectively (p=0.77), whereas NMD was 11.1±3.8% and 14.2±4.9 in the two groups, respectively (p=0.013). No significant differences were observed for HRV parameters between the two groups (see Table). Conclusions Our data do not support a role for both endothelial dysfunction and cardiac autonomic dysfunction in the persistence of symptoms of potential cardiac origin in patients with a recent SARS-CoV-2 infection. The lower endothelium-independent arterial vasodilator found in these patients, however, deserves further investigation.