Systolic Dysfunction Research Articles

The Significance of Right-Sided Precordial ECG Leads (V3R and V4R) in Assessing Right Ventricular Dysfunction: ASingle Center Cross-Sectional Study.

Right ventricular systolic dysfunction is associated with poor prognosis and increased mortality rates. Our objective was to investigate ECG changes in patients with this condition, focusing on the right-sided precordial leads. In this cross-sectional study, 60 patients with right ventricular dysfunction were included from April 2020 to April 2021. Cardiac structure and function were assessed using 2D transthoracic echocardiography. Standard 12-lead electrocardiograms and right-sided precordial ECGs (V3R-V4R) were obtained and analyzed for QRS complex configuration, ST-segment elevation, and T-wave morphology. In our study, the majority were male (70.0%) with a mean age of 58.76 years. The most common initial diagnoses were pulmonary thromboembolism (43.3%), chronic obstructive pulmonary disease (26.7%), and pulmonary hypertension (25.0%). The predominant ECG finding in the right-sided precordial leads (V3R, V4R) was a deep negative T wave (90.0%). Patients with severe right ventricular systolic dysfunction often exhibited a qR pattern (41.2%), whereas those with nonsevere dysfunction showed rS and QS patterns (55.8%). Approximately 41.0% of severe RV dysfunction cases had ST segment depression in the right-sided precordial leads, and 28.0% of patients displayed signs of right atrial abnormality. The study found that qR, rS, and QS patterns were more prevalent in V3R and V4R leads among patients with severe and nonsevere right ventricular systolic dysfunction. The most common ECG feature observed was deep T-wave inversion in these leads. The study recommends using right-sided precordial leads in all patients with RV systolic dysfunction for early detection and risk stratification.

Abstract P202: Excess of anything is detrimental - unraveling role of multiple accessory renal arteries in Pickering syndrome.

Flash pulmonary edema (FPE) appears to be more common in patients with bilateral renal artery stenosis (RAS) as compared to those with unilateral disease. The combination of bilateral RAS and recurrent FEP has been named the Pickering syndrome. Here, we present a case of Pickering syndrome caused by unilateral RAS in combination with multiple accessory renal arteries (ARA). To our knowledge, this case marks the inaugural report within the literature. A 68-year-old woman presented to ER with her third episode of FPE in two months, accompanied by hypertensive emergency, BP 232/127 mmHg. Initial evaluation, including laboratory tests and RA ultrasound, showed no abnormalities. However, a CTA of the abdomen revealed a single heavily calcified L main RA with severe atherosclerosis extending into the lumen of the aorta and the proximal L main RA. Three RAs supply R kidney with questionable stenosis of superior, smaller R RA. Atherosclerotic plaque is present at the origin of the inferior R RA, but no definitive significant stenosis is detected. Unilateral RAS and multiple ARAs were suspected to cause HTN and FPE. An aortogram with possible RA stenting was recommended by vascular surgery. It confirmed > 75% stenosis in the L RA, prompting stent deployment. However, no significant stenosis was observed in R ARAs. Post-procedure BP control was achieved with a single agent. FPE is a life-threatening syndrome. Cardiac systolic or diastolic dysfunctions usually accompany it. Recurrent FPE due to bilateral RAS was described by Pickering et al. in 1988. Although its exact mechanism is not completely understood, it is believed to result from excessive fluid volume due to decreased sodium excretion. A similar mechanism was proposed in RAS in a single functional kidney. Could the presence of an ARA mimic the pathophysiology of RAS? It has been theorized that an ARA may lead to HTN due to reduced blood flow to the kidney, caused by its longer and narrower caliber, which increases resistance and may lead to stenosis. The Poiseuille equation, rearranged to R=8μL/ΔPπR4 (where R=resistance, μ=viscosity, L=vessel's length, P=pressure, R=vessel's radius), suggests that both the radius and the length of ARAs may play a role in our patient's condition. In summary, ARAs are a common anatomical variation, and depending on their specific characteristics, they may contribute to resistant HTN and FPE through renin-dependent hyperaldosteronism.

Association of QRS Duration with Echocardiographic Left Ventricular Dimensions

Background: QRS duration (QRSd) is used to diagnose left bundle branch block (LBBB) and is important for determining cardiac resynchronization therapy eligibility. Others have reported associations of left bundle branch block (LBBB) and interventricular conduction delay with left ventricular (LV) systolic and diastolic dysfunction in patients without clinical HF. Individualized QRSd thresholds may improve diagnosis and intervention strategies. The goal of this study was to assess the relations of QRS duration to echocardiographic left ventricular (LV) dimensions in individuals. Methods: This was a hospital-based cross-sectional analytical study. A total of 134 purposively selected respondents were included in the study from the patients attending the outpatient or inpatient department of cardiology, Dhaka Medical College Hospital, advised for an echocardiogram. They were divided into two groups depending on their QRS complex duration (Group I≤100 ms and Group II>100 ms). After taking informed written consent, a case record form was filled and Echo measurements were taken following standard procedure with confidentiality. Results: Among the respondents, the mean age was found 52.68 ± 14.24 years. The majority were male (68%), and around 1/3rd of the respondents were overweight or obese. Males were found to have less QRS duration than females (p<0.001) but there was no difference in age (p=0.814) between the groups. All the risk factors considering obesity, diabetes mellitus, hypertension, family history, smoking status, and dyslipidemia were found in similar proportions in both groups (p>0.05). The study found that the interventricular septum thickness and inferolateral wall thickness were higher among those having a QRS duration of more than 100 ms (Group II), but this difference was not significant (p > 0.05). On the other hand, left ventricular diastolic dimension, systolic dimension, and left ventricular mass were found to be increased significantly (p<0.05) with a reduction in ejection fraction in Group II (p<0.05). Conclusion: Left ventricular diastolic and systolic dimensions along with left ventricular mass significantly increase according to QRS duration among the patients. Meanwhile, a reduction in ejection fraction was also evident. (Bangladesh Heart Journal 2024; 39(2): 144-150

Association of Multiple Nonhypertrophic Cardiomyopathy-Related Genetic Variants and Outcomes in Patients With Hypertrophic Cardiomyopathy.

Approximately 10% of hypertrophic cardiomyopathy (HCM) patients have left ventricular systolic dysfunction (end-stage HCM) leading to severe heart-failure; however, risk stratification to identify patients at risk of progressing to end-stage HCM remains insufficient. In this study, the authors sought to elucidate whether the coexistence of other cardiovascular disease (CVD)-related variants is associated with progression to end-stage HCM in patients with HCM harboring pathogenic or likely pathogenic (P/LP) sarcomeric variants. The authors performed genetic analysis of 83 CVD-related genes in HCM patients from a Japanese multicenter cohort. P/LP variants in 8 major sarcomeric genes (MYBPC3, MYH7, TNNT2, TNNI3, TPM1, MYL2, MYL3, and ACTC1) definitive for HCM were defined as "sarcomeric variants." In addition, P/LP variants associated with other CVDs, such as dilated cardiomyopathy and arrhythmogenic cardiomyopathy, were referred to as "other CVD-related variants." Among 394 HCM patients, 139 carried P/LP sarcomeric variants: 11 (7.9%) carried other CVD-related variants, 6 (4.3%) multiple sarcomeric variants, and 122 (87.8%) single sarcomeric variants. In a multivariable Cox regression analysis, presence of multiple sarcomeric variants (adjusted HR [aHR]: 3.35 [95%CI: 1.25-8.95]; P = 0.016) and coexistence of other CVD-related variants (aHR: 2.80 [95%CI: 1.16-6.78]; P = 0.022) were independently associated with progression to end-stage HCM. Coexisting other CVD-related variants were also associated with heart failure events (aHR: 2.75 [95%CI: 1.27-5.94]; P = 0.010). Approximately 8% of sarcomeric HCM patients carried other CVD-related variants, which were associated with progression to end-stage HCM and heart failure events. Comprehensive surveillance of CVD-related variants within sarcomeric HCM patients contributes to risk stratification and understanding of mechanisms underlying end-stage HCM.

Cardiac Function and Functional Capacity in Patients with Long COVID: a Comparison to Propensity-Matched Community Controls

BackgroundCardiac impairment has been associated with acute COVID-19 since the earliest reports of the pandemic. However, its role in post-acute sequelae of COVID-19 (PASC, or “long COVID”) is undefined, and many existing observations about cardiovascular involvement in PASC are uncontrolled. ObjectiveTo compare the prevalence of cardiac dysfunction in patients with Long COVID, and non-infected controls from the same community, and explore their association with functional capacity. MethodsEchocardiography was used to assess cardiac structure and function, including the measurement of global longitudinal strain (GLS), in 190 participants with Long COVID. All underwent assessment of functional impairment by subjective (Duke Activity Status Index, DASI) and objective tests (6-minute walk test, 6MWT). The 190 participants from the Long COVID group were matched with those from 979 patients who underwent the same tests in the pre-COVID-19 era, using a propensity score. ResultsThe 190 patients with Long COVID had similar age and risk factor profiles to those of their matched controls. LV dimensions and geometry, but not diastolic parameters, were significantly altered in the Long COVID group. The Long COVID group had subclinical systolic dysfunction (GLS 18.5±2.6 vs 19.3±2.7%, p=0.005), and more Long COVID patients had abnormal (<16%) GLS (13% vs 8%, p=0.035). The association of Long COVID with abnormal GLS (OR 1.49 [1.04, 2.45]) was independent of - and had a similar or greater effect size - than age and risk factors. There was no interaction of Long COVID with the association of risk factors with GLS. As expected, the Long COVID group had significant subjective (<85% predicted METS; 72% vs 5%, p<0.001) and objective functional impairment (29% vs 24%, p=0.026), but GLS was only weakly associated with both subjective (r=0.30, p=0.005) and objective (r=0.21, p=0.05) functional impairment. The presence of Long COVID was independently associated with subjective (OR=159.7 [95% CI: 61.6-414.2]), and objective functional impairment (OR=2.8 [95% CI: 1.5-5.2]). ConclusionsImpaired GLS and LV dimensions are the echocardiographic features that are over-represented in Long COVID, and this association is similar to, and independent of other risk factors. Impaired GLS is weakly associated with functional impairment.

Incidentally Induced Atrial Fibrillation During Programmed Electrical Stimulation in Patients With Depressed Left Ventricular Systolic Function After an Acute Myocardial Infarction.

The aim of this study was to investigate the clinical implication of incidentally induced atrial fibrillation (AF) during programmed electrical stimulation (PES) in patients with left ventricular systolic dysfunction (≤40%) after an acute myocardial infarction (MI). In this study, we included 231 patients from the Cardiac Arrhythmias and RIsk Stratification after Myocardial InfArction (CARISMA) study with left ventricular ejection fraction ≤40% and no prior history of AF. These patients underwent PES 6 weeks post-MI as part of the study protocol. Patients all received an implantable cardiac monitor (ICM) 3-21 days post-MI and were continuously monitored for cardiac arrhythmias for 2 years. Induction of AF was unwanted but reported if this incidentally occurred. A total of 61 patients (26%) developed AF within 2 years of follow-up, in which n = 10 (29%) had incidental AF during PES at baseline. The overall risk of AF was not significantly increased in patients with incidental AF (n = 34) during PES compared to patients without incidental AF (n = 197) (HR 1.6 [0.9-3.0], p = 0.14). The risk of bradyarrhythmia (HR = 0.2 [0.0-1.2], p = 0.07), ventricular arrhythmias (HR = 0.7 [0.1-5.8], p = 0.77), and major cardiovascular events (MACE) (HR 0.5 [0.2-1.7], p = 0.28) was not significantly different in patients with versus without incidental AF. Incidentally induced AF during PES in post-MI patients with reduced LVEF was not significantly associated with a higher risk of long-term atrial fibrillation, other cardiac arrhythmias, or major cardiac events. NCT00145119.

Prognostic impact of diagnosis-to-ablation time on outcomes following catheter ablation in persistent atrial fibrillation and left ventricular systolic dysfunction

BackgroundThe optimal timing of catheter ablation in individuals with atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD) remains uncertain. ObjectiveWe examined whether AF diagnosis to ablation time (DAT) influences outcomes following catheter ablation (CA) in patients with persistent AF (PsAF) and LVSD from the CAMERA-MRI and CAPLA randomized studies. MethodsWe evaluated clinical outcomes according to DAT < 1 year (“shorter DAT”) and ≥1 year (“longer DAT”), comparing AF recurrence, AF burden, left ventricular ejection fraction (LVEF), and LV recovery (LVEF ≥ 50%) at 12 months. DAT was also compared according to the median (24 months). ResultsTwo hundred and ten individuals with AF and LVSD were identified, with a median DAT of 24 months. Shorter DAT was associated with lower LA global and posterior wall scar (<0.05 mV; both P < .05). At 12 months, 69.4% with shorter DAT (<1year) were free from recurrent atrial arrhythmias vs 53.6% in longer DAT (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.01–2.65, P = .040). Median AF burden was 0% in both groups (shorter DAT: interquartile range [IQR] 0.0–2.0% vs longer DAT: IQR 0.0–7.3%, P = .017). At 12 months, shorter DAT was associated with higher LVEF (55.3% vs 51.0%, P = .009), greater LVEF improvement (+20.8 ± 13.0% vs +13.9 ± 13.2% longer DAT, P < .001) and LV recovery (75.0% vs longer DAT: 57.2%, P = .011). Shorter DAT was associated with fewer hospitalizations and electrical cardioversions at 12 months. ConclusionIn individuals with AF and LVSD, shorter DAT was associated with greater LVEF improvement and arrhythmia-free survival with lower AF burden and rehospitalization at 12 months, highlighting the prognostic benefit of early CA in AF and LVSD.

Revisiting Peripartum Cardiomyopathy: A Case Report and Review

Peripartum cardiomyopathy (PPCM) is a rare and idiopathic disease characterized by left ventricular dilation and systolic dysfunction, that occurs late in pregnancy or during the postpartum period. Diagnosis is typically achieved through transthoracic echocardiography and cardiac magnetic resonance imaging (MRI). Management includes standard heart failure therapies such as beta-blockers, ACE inhibitors, and diuretics, with the addition of bromocriptine to target the prolactin pathway involved in PPCM pathophysiology. This report presents a case of a 31-year-old female with a history of acute lymphoblastic leukemia who, following an uncomplicated pregnancy, presented with acute heart failure symptoms. Initial evaluations suggested pulmonary embolism, but further diagnostic workup, including echocardiography and cardiac MRI, confirmed PPCM. The patient was treated with diuretics, ACE inhibitors, and beta blockers. Significant improvement was observed, with complete resolution and normal cardiac function at the 6-month follow-up.

A systematic review and meta-analysis of Nordic walking for chronic heart failure with low left ventricular ejection fraction.

Nordic walking (NW) has been reported to be beneficial in various chronic diseases. To determine whether NW improves function in patients with heart failure (HF) with low left ventricular ejection fraction more than conventional cardiac rehabilitation or usual care. Systematic literature searches in PubMed, ScienceDirect, and Web of Science were conducted. According to patient, intervention, comparison, and outcome (PICO) principles, a stepwise selection process was completed to identify eligible studies. Only randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. Pooled effects were determined using a random effect analysis model for the meta-analysis. A total of 282 participants from four RCTs were included. The improvement of peak oxygen consumption (peak VO2) was greater in the NW group than in the control group (mean difference [MD] = 2.18 mL/kg/min; 95% confidence interval [CI] = 1.35-3.01; p < .01). The improvement of the 6-minute walk test (6MWT) distance was also greater in the NW group than in the control group (MD = 16.51 meters; 95% CI = 3.23-29.80; p = .01). This systematic review highlights the benefits of NW training in patients with chronic HF, particularly those with systolic dysfunction. Specifically, NW walking was associated with increased peak VO2 and 6MWT improvement compared to conventional cardiac rehabilitation or usual care. These results suggest that NW may be a useful component of cardiac rehabilitation. However, additional larger studies with a wider range of patients are needed.

Diabetic Cardiomyopathy: Role of Cell Death, Exosomes, Fibrosis and Epicardial Adipose Tissue.

Diabetic cardiomyopathy (DCM) represents one of the typical complications associated with diabetes. It has been described as anomalies in heart function and structure, with consequent high morbidity and mortality. DCM development can be described by two stages; the first is characterized by left ventricular hypertrophy and diastolic dysfunction, and the second by heart failure (HF) with systolic dysfunction. The proposed mechanisms involve cardiac inflammation, advanced glycation end products (AGEs) and angiotensin II. Furthermore, different studies have focused their attention on cardiomyocyte death through the different mechanisms of programmed cell death, such as apoptosis, autophagy, necrosis, pyroptosis and ferroptosis. Exosome release, adipose epicardial tissue and aquaporins affect DCM development. This review will focus on the description of the mechanisms involved in DCM progression and development.

The Structure of Left Ventricular Relaxation in Case of Ventriculography.

To study the relaxation structure of the left ventricle (LV) in patients who underwent ventriculography. LV ventriculography was performed in 37 patients. Before catheterization, echocardiography was performed in each patient. In 6 patients, the LV ejection fraction (EF) was below 40%; these patients with systolic dysfunction were not included in the study. In 31 patients, the LV EF was higher than 50%. In this group, 13 patients had NYHA functional class (FC) 2-3 chronic heart failure (CHF); the rest of the patients had FC 1 CHF. Eighteen of 31 patients had stable ischemic heart disease; 50% of these patients had a history of myocardial infarction; the rest of the patients had hypertension and atrial and ventricular arrhythmias. The dynamics of the LV pressure decrease was analyzed from the moment of the maximum rate of pressure drop, which usually coincides with the closure of the aortic valves. The pressure drop curve was logarithmized with natural logarithms and divided into 4-5 sections with different degrees of curve slope. The relaxation time constant was calculated for each section. Its inverse value characterizes the relaxation time constant (tau). In 31 patients with LV EF 52-60%, three types of the dynamics of the relaxation rate constant were identified during the pressure decrease in the isovolumic phase: in 9 patients, the isovolumic relaxation constant (IRC) steadily increased as the pressure decreased; in 13 patients, it continuously decreased; and in 9 patients, the dynamics of IRC change was intermediate, with an initial increase followed by a decrease. In diastolic dysfunction, one group of patients had an adaptation type associated with an increase in the LV wall elasticity, while the other group had a different type of adaptation associated with its decrease. Each type has advantages and disadvantages. This is probably due to changes in the structure of the sarcomeric protein connectin (titin).

Discontinuation of β-blocker therapy in stabilised patients after acute myocardial infarction (SMART-DECISION): rationale and design of the randomised controlled trial

IntroductionThere is a lack of evidence to support the effectiveness of prolonged β-blocker therapy after stabilisation of patients with acute myocardial infarction (AMI) without heart failure (HF) or left ventricular...

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

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

Evaluation of subclinical left ventricular systolic dysfunction in patients with type 2 diabetes mellitus by combining myocardial work and triglyceride-glucose index.

Type 2 diabetes mellitus (T2DM) frequently presents subclinical left ventricular systolic dysfunction. The TyG index is a surrogate indicator of insulin resistance and is closely related to heart failure (HF). This study aimed to evaluate subclinical systolic dysfunction in T2DM by combining myocardial work (MW) and the TyG index and to investigate the risk factors for MW. This study included 102 diabetic patients and 78 healthy control subjects, and the diabetic group was divided into three subgroups based on the TyG index. LV global longitudinal strain (GLS), global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global myocardial work efficiency (GWE) were measured in all subjects. GLS and MW were compared between the diabetic and control groups and between subgroups. Regression models were applied to analyze the risk factors for MW in diabetic patients. GLS, GWI, GCW, and GWE significantly increased, and GWW significantly decreased in the diabetic group (all p<.01). GWI and GCW were significantly lower in the T3 subgroup than in the T1 and T2 subgroups (all p<.05). The TyG index, sex (female), BMI, systolic blood pressure (SBP), and total cholesterol (TC) were independent risk factors for GWI and GCW, and HbA1c was an independent risk factor for GWI. MW accurately revealed subtle changes in subclinical LV systolic dysfunction in T2DM patients. An elevated TyG index was strongly associated with decreased GWI and GCW. The TyG index, sex (female), BMI, SBP, and TC were independent risk factors for GWI and GCW, and HbA1c was an independent risk factor for GWI.

Erbin alleviates sepsis-induced cardiomyopathy by inhibiting RIPK1-dependent necroptosis through activating PKA/CREB pathway

Sepsis is a systemic inflammatory disease that can cause multiple organ damage. Septic patients with cardiac dysfunction have a significantly higher mortality. Based on the results of bioinformatics analysis, weighted gene co-expression network analysis (WGCNA), we found that Erbin is vital in cardiomyocyte. However, the function of Erbin in sepsis-induced cardiomyopathy (SIC) has not been explicitly studied. We discussed the role of Erbin in SIC by employing the Erbin−/− mice and HL-1 cardiomyocyte. An in vitro model of inflammation in HL-1 was used to confirm stimulation with lipopolysaccharide (LPS) and a mouse model of cecal ligation and puncture (CLP) to study the molecular mechanisms under SIC. Transmission electron microscopy (TEM) was used to characterize the morphological characteristics at the ultrastructural level. The expressions of Erbin, p-RIPK1, RIPK1, p-RIPK3, RIPK3, p-MLKL, MLKL, p-PKA, PKA, p-CREB and CREB were detected by western blot. qPCR analysis was applied to detect TNF-α, IL-1β, IL-6, RIPK1 and MLKL mRNA expression. Cell survival was detected by CCK-8 assay and the levels of c TnI concentration were detected by ELISA kit. Our study revealed that necroptosis and inflammation were activated in cardiomyocytes during sepsis and deficiency of Erbin aggravated them. Furthermore, deficiency of Erbin exacerbated systolic dysfunction including the decline of LVEF and LVFS induced by CLP. Overexpression of Erbin alleviated necroptosis and inflammation by activating PKA/CREB pathway. Our research elucidates a noval mechanism whereby Erbin participates in SIC, providing a promising therapeutic target for myocardial dysfunction during sepsis.

A retrospective analysis of clinical characteristics and outcomes of pediatric fulminant myocarditis

BackgroundThe study aimed to explore clinical indicators that can predict the prognosis of children with acute fulminant myocarditis (AFM) through a retrospective analysis.MethodsA retrospective analysis was conducted on the clinical indices of 79 children diagnosed with AFM and hospitalized from March 2013 to March 2023. Relevant demographic and clinical data, including symptoms at admission, laboratory results, and outcomes were extracted to identify factors associated with in-hospital mortality.ResultsA total of 79 children with AFM were analyzed. The survival group (n = 61) had a longer median hospital stay and higher medical expenses compared to the death group (n = 18). Significant differences in the levels of left ventricular ejection fraction (LVEF)(P < 0.001), myoglobin (MYO)(P < 0.001), aspartate aminotransferase (AST)(P < 0.001), lactate dehydrogenase (LDH)(P = 0.004), B-type natriuretic peptide (BNP)(P = 0.005), arterial potential hydrogen (PH)(P < 0.001), bicarbonate (HCO3-)(P = 0.003), serum lactate (Lac)(P = 0.001), peripheral oxygen saturation (SpO2)(P = 0.008), and white blood cell count (WBC)(P = 0.007) were observed between the two groups. Additionally, there were significant differences in the incidences of multi-organ failure (P = 0.003) and respiratory failure (P = 0.001) between the two groups.ConclusionsSevere myocardial injury (AST > 194.00 U/L, LDH > 637.50 U/L, MYO > 265.75 µg/L, BNP > 1738.50 ng/L), acidosis (PH < 7.29, HCO3− <18.45 mmol/L, Lac > 12.30 mmol/L), hypoxia (SpO2 < 97.50%), inflammatory response (WBC > 9.69*109/L), left ventricular systolic dysfunction (LVEF < 28.25%), multi-organ failure, and respiratory failure are significantly associated with higher mortality rates. These factors can accurately identify AFM children at an increased risk of death.

Myocardial Strain Imaging: Theory, Current Practice, and the Future.

Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter. Several CMR-based modalities are available and are ready to be implemented clinically. Clinical applications of strain include global longitudinal strain as a more sensitive method than ejection fraction for diagnosing mild systolic dysfunction. This applies to patients suspected of having heart failure with normal LV ejection fraction, to early systolic dysfunction in valvular disease, and when monitoring myocardial function during cancer chemotherapy. Segmental LV strain maps provide diagnostic clues in specific cardiomyopathies, when evaluating LV dyssynchrony and ischemic dysfunction. Strain imaging is a promising modality to quantify right ventricular function. Left atrial strain may be used to evaluate LV diastolic function and filling pressure.

Characteristics of electrocardiogram in fulminant myocarditis

Objective: To investugate the unique electrocardiogram (ECG) characteristics of fulminant myocarditis (FM) patients and provide important clues for the diagnosis of FM. Methods: This was a retrospective study. Patients diagnosed with acute myocarditis at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from February 2017 to April 2022 were enrolled and divided into fulminant myocarditis group (FM) and non-fulminant myocarditis group (NFM) according to clinical diagnosis. A total of 246 healthy people who underwent physical examination in the Health examination Center of Tongji Hospital at the same period were selected as the control group. The clinical data and ECG characteristics of the above 3 groups were analyzed and compared. Logistic regression model was used to analyze the influence of ECG parameters on left ventricular ejection fraction in FM patients. Receiver operating curves were constructed to evaluate the predictive value of different ECG parameters for FM. Results: A total of 180 patients were included in this study (FM group: n=123; NFM group: n=57), with an age of (35.0±16.2) years and 106 males (58.89%). Compared with NFM group, ECG was significantly abnormal in FM group, with a higher incidence of sinus tachycardia, ventricular tachycardia or ventricular fibrillation, escape rhythm, right bundle branch block, third degree atrioventricular block, ST-segment elevation, low voltage, prolonged QTc interval, and widened QRS wave in the FM group (all P<0.05). The ECG parameters showed that the amplitude of the full lead QRS wave in FM group was lower than that in NFM group (P<0.01). The average heart rate and QTc interval of FM group were significantly higher than those of NFM and control groups (all P<0.05). Although ST-segment elevation had a higher incidence in the FM group, ECG parameters showed that except for leads Ⅲ and aVF, the ST segment levels in all leads in the FM group were lower than those in the control group (all P<0.05). There was a statistically significant difference in some ST segment changes between FM and NFM groups, while there was no statistical difference between the NFM and control groups. Multivariate regression analysis showed that widened QRS wave and increased heart rate were the influencing factors for left ventricular systolic dysfunction in FM patients (OR=16.914, 95%CI: 1.367-209.224, P=0.028; OR=1.026, 95%CI: 1.010-1.042, P=0.001). Receiver operating curve analysis showed that heart rate>86.90 beat/min, QTc>431.50 ms, and RV5+SV1<1.72 mV had certain predictive value for FM diagnosis. Conclusions: FM patients displayed marked and severe ECG abnormalities, and characteristic changes in ECG can provide important first clues for the diagnosis of FM.

Predictors and outcomes associated with right ventricular function in patients with acute respiratory distress syndrome treated with Veno-venous extracorporeal membrane oxygenation.

Right ventricular dysfunction is associated with mortality in patients with acute respiratory distress syndrome (ARDS) but information in veno-venous extracorporeal membrane oxygenation (ECMO) settings is limited. Study objectives were to examine factors associated with right ventricular (RV) systolic dysfunction (RVSD) and RV dilation in ECMO patients with ARDS, to compare outcomes in those with and without RVSD and RV dilation defined by qualitative and quantitative parameters, and to describe RVSD evolution during ECMO. Retrospective observational study of adult ARDS patients supported with ECMO at a tertiary care hospital. Of a total of 62 patients, 56% had RVSD and 61% had RV dilation by qualitative assessment. Male gender, COVID-19, hypercarbia, and pneumothorax were associated with RVSD and RV dilation. In-hospital mortality was significantly higher in patients with RV dilation vs. no dilation (42% vs. 17%, p = .05) but comparisons for patients with and without RVSD (37% vs. 26%, respectively) did not reach statistical significance. Findings were similar when RV size and function were quantified by right to left ventricle end-diastolic area ratio and fractional area change (39% vs. 21% and 36% vs. 20% respectively; p = NS). Of 39 patients with multiple echocardiograms, 9 of 18 with initially normal RV function developed RVSD while RV function normalized in 10 of 21 patients who began ECMO with RVSD. Study results suggest an association of RV dilation and RVSD with worse outcomes and a dynamic nature of RV function necessitating close monitoring during the ECMO course.

Comparison Between Heart Failure Without Left Ventricular Systolic Dysfunction and Progression to End-Stage in Hypertrophic Cardiomyopathy.

The incidence and prognostic predictors of heart failure (HF) without left ventricular systolic dysfunction (LVSD) in hypertrophic cardiomyopathy (HCM), particularly their differences in terms of developing LVSD (progression to end-stage) or sudden cardiac death (SCD), are not fully elucidated. This study included 330 consecutive HCM patients with left ventricular ejection fraction (LVEF) ≥50%. HF hospitalization without LVSD and development of LVSD were evaluated as main outcomes. During a median follow-up of 7.3 years, the incidence of HF hospitalization without LVSD was 18.8%, which was higher than the incidence of developing LVSD (10.9%) or SCD (8.8%). Among patients who developed LVSD, only 19.4% experienced HF hospitalization without LVSD before developing LVSD. Multivariable analysis showed that predictors for HF hospitalization without LVSD (higher age, atrial fibrillation, history of HF hospitalization, and higher B-type natriuretic peptide concentrations) were different from those of developing LVSD (male sex, lower LVEF, lower left ventricular outflow tract gradient, and higher tricuspid regurgitation pressure gradient). Known risk factors for SCD did not predict either HF without LVSD or developing LVSD. In HCM with LVEF ≥50%, HF hospitalization without LVSD was more frequently observed than development of LVSD or SCD during mid-term follow-up. The overlap between HF without LVSD and developing LVSD was small (19.4%), and these 2 HF events had different predictors.