Ventricle Systolic Dysfunction Research Articles

Effect of SGLT2 Inhibitors on Post-PCI Outcomes after Acute Myocardial Infarction in Diabetic Patients: A Systematic Review and Meta-Analysis

Background: Acute myocardial infarction (AMI) is related with poor outcomes in patients with diabetes mellitus (DM). Whether diabetic patients with AMI undergoing percutaneous coronary intervention (PCI) benefit from sodium–glucose cotransporter 2 inhibitors (SGLT2i) in terms of cardiovascular mortality, myocardial damage, and left ventricular function is unclear. Methods: Through a comprehensive search in PubMed, EMBASE, and Web of science databases from January 2018 to September 2023, randomized controlled trials were performed to compare SGLT2i with other oral antidiabetic medications in diabetic patients with AMI undergoing PCI. Cardiovascular mortality constituted the primary outcome. Secondary outcomes were high-sensitivity troponin I (hs-TnI) levels, left ventricular ejection fraction (LVEF), and contrast-induced acute kidney injury (CI-AKI). Results: SGLT2i significantly reduced cardiovascular mortality risk versus other antidiabetic agents (hazard ratio (HR): 0.35, 95% confidence interval (CI): 0.21–0.58, p < 0.0001). SGLT2i also lowered hs-TnI levels across all time points (mean difference: –2931 ng/L, p < 0.001). After adjustment for publication bias, this difference was no longer significant. However, peak hs-TnI levels remained significantly lower with SGLT2i (mean difference: –3836 ng/L, p < 0.001). Finally, SGLT2i improved LVEF versus comparators, with a mean difference of –5.00% (95% CI: –6.69 to –3.31, p < 0.001) at hospital discharge. SGLT2i was also associated with 60% lower odds of CI-AKI (odds ratio (OR): 0.40, 95% CI: 0.22–0.75, p = 0.004). Conclusions: Compared with other antidiabetic medications, SGLT2i may lower cardiovascular mortality, infarct size, and prevent left ventricle (LV) systolic dysfunction in diabetic patients with AMI undergoing PCI. The use of SGLT2i in this high-risk group is supported by these findings.

Treatment strategy for heart failure complicated with complete left bundle branch block and atrial tachycardia: a case report

BackgroundFor patients with heart failure combined with complete left bundle branch block, cardiac resynchronization therapy is an important therapeutic method. If these patients also have atrial tachycardia, how to choose a treatment strategy deserves discussion.Case presentationA Chinese woman in her early 70s was admitted due to recurrent episodes of chest distress and asthma for 1 year. Physical and laboratory examinations showed filling of the jugular vein, lung rales, left enlargement of the heart boundary, edema of the lower limbs and elevation of N-terminal pro b-type natriuretic peptide. An electrocardiogram showed atrial tachycardia and a left bundle branch block. An echocardiography revealed enlargement of the left ventricle and left ventricular systolic dysfunction. After obtaining informed consent, the treatment strategy decided upon by the team was to use biventricular cardiac resynchronization therapy treatment and to not intervene for the atrial tachycardia, with left bundle branch area pacing as a backup. Due to twisted and narrow coronary vein branches, traditional biventricular pacing failed, and then, left bundle branch area pacing was attempted successfully. A follow-up echocardiography at 1 year showed improved systolic function. The outcomes for this patient are favorable, but the choice of interventional strategy is worthy of discussion in this case.ConclusionFor patients with heart failure combined with left bundle branch block and atrial tachycardia, left bundle branch area pacing can replace traditional biventricular pacing for cardiac resynchronization therapy treatment, and the therapeutic effect is significant. However, multiple factors need to be considered when formulating strategies, including whether there is bundle branch block under sinus rhythm, the success and recurrence rate of atrial tachycardia ablation, the response of cardiac resynchronization therapy, the costs of different strategies, and instrument implantation issues.

Cardiac miRNA expression during the development of chronic anthracycline-induced cardiomyopathy using an experimental rabbit model.

Background: Anthracycline cardiotoxicity is a well-known complication of cancer treatment, and miRNAs have emerged as a key driver in the pathogenesis of cardiovascular diseases. This study aimed to investigate the expression of miRNAs in the myocardium in early and late stages of chronic anthracycline induced cardiotoxicity to determine whether this expression is associated with the severity of cardiac damage. Method: Cardiotoxicity was induced in rabbits via daunorubicin administration (daunorubicin, 3mg/kg/week; for five and 10weeks), while the control group received saline solution. Myocardial miRNA expression was first screened using TaqMan Advanced miRNA microfluidic card assays, after which 32 miRNAs were selected for targeted analysis using qRT-PCR. Results: The first subclinical signs of cardiotoxicity (significant increase in plasma cardiac troponin T) were observed after 5weeks of daunorubicin treatment. At this time point, 10 miRNAs (including members of the miRNA-34 and 21 families) showed significant upregulation relative to the control group, with the most intense change observed for miRNA-1298-5p (29-fold change, p < 0.01). After 10weeks of daunorubicin treatment, when a further rise in cTnT was accompanied by significant left ventricle systolic dysfunction, only miR-504-5p was significantly (p < 0.01) downregulated, whereas 10 miRNAs were significantly upregulated relative to the control group; at this time-point, the most intense change was observed for miR-34a-5p (76-fold change). Strong correlations were found between the expression of multiple miRNAs (including miR-34 and mir-21 family and miR-1298-5p) and quantitative indices of toxic damage in both the early and late phases of cardiotoxicity development. Furthermore, plasma levels of miR-34a-5p were strongly correlated with the myocardial expression of this miRNA. Conclusion: To the best of our knowledge, this is the first study that describes alterations in miRNA expression in the myocardium during the transition from subclinical, ANT-induced cardiotoxicity to an overt cardiotoxic phenotype; we also revealed how these changes in miRNA expression are strongly correlated with quantitative markers of cardiotoxicity.

TAKOTSUBO SYNDROME

Takotsubo syndrome, also known as Takotsubo cardiomyopathy, stress-induced cardiomyopathy, transient apical ballooning and broken heart syndrome, is a disease characterized by transient regional left ventricular systolic dysfunction. It is usually determined by emotional or physical stress. Even though it was thought to be a self-limiting condition, Takotsubo syndrome is now known to be associated with important short and long-term morbidity and mortality. Takotsubo syndrome affects 2-3% of all patients and 5-6% of female patients presenting with acute coronary syndrome (frequently women in the sixth decade). The Takotsubo syndrome cases are mostly preceded by acute emotional or physical triggers such as: family death, financial loss, anxiety, excessive work, domestic abuse, anxiety, fear for medical procedures, severe pain, sepsis, post surgeries, and cancer. Diagnosis of Takotsubo syndrome can sometimes be difficult due to clinical manifestations similar to acute myocardial infarction. Myocardial necrosis biomarkers (Troponin I, Troponin T and Creatinin kinase) are elevated, with values comparable to those in patients with acute myocardial infarction. Transthoracic echocardiography usually shows akinetic or dyskinetic apical and mid-ventricular segments of the left ventricle compared to the hyperkinetic basal segments (“apical ballooning” aspect) and left ventricle systolic dysfunction. The positive diagnosis of Takotsubo syndrome is made on coronary angiography, normal or non-obstructive coronary artery disease

Performance of handheld ultrasound devices in diagnosis of pulmonary hypertension and right heart dysfunction in ICU patients.

The use of handheld ultrasonography devices (HHUD) has increased recently but there are limited data about their performance in the evaluation of right heart dysfunction (RHD) and pulmonary hypertension (PHT). The aim of the study is to compare the performance of a HHUD with a conventional ultrasound device (CUD) in assessing PHT and RHD. This single-center prospective study was performed in a seven-bed teaching hospital intensive care unit (ICU). PHT and RHD criteria were compared by HHUD and CUD. Additional PHT criteria and right ventricle (RV) systolic and diastolic dysfunction criteria were also measured. Forty-six patients were included in the study. There was no significant difference between the imaging rates and mean values of the parameters measured by both devices. When the positivity rates for additional PHT parameters and RHD criteria were compared, there were no significant differences between the devices. In Bland-Altman's analysis, there was good agreement and there was no bias between the measurements of the two devices but left ventricular end-systolic eccentricity index (LVSEI), right atrium area (RAA), and pulmonary artery diameter (PAD). Ninety percent of the patients had PHT probability, of whom 43% had a low, 37% had intermediate and 10% had a high probability of PHT. Ninety-two percent of the patients had RHD and there was no significant difference between the devices in the diagnosis of RHD (p=.212). When RV systolic and diastolic dysfunction evaluations of the devices were compared according to the British Society of Echocardiography (BSE) criteria there was no significant difference between the devices' measurements in the evaluation of systolic and diastolic function. The imaging and measurement capabilities of the HHUDs for PHT and RHD parameters were similar to CUDs, and considering the inconsistent parameters, the HHUD can be useful in diagnosing these problems.

Cardiac damage extent in patient with isolated severe aortic stenosis referred to surgical aortic valve replacement: is it reversible after surgery?

Abstract Background Aortic stenosis (AS) may lead to progressive and adverse cardiac remodeling. A recently-proposed staging classification regarding extravalvular cardiac damage in AS patients undergoing aortic valve intervention was shown to have significant prognosis implications. However, cardiac damage evolution and reversibility after intervention remain unknown. Aims to assess extravalvular cardiac damage evolution after surgical aortic valve replacement (SAVR) in patients with isolated severe AS. Methodology we performed a single-center, prospective cohort study enrolling consecutive patients with severe aortic stenosis undergoing SAVR. Those with previous cardiomyopathy or concomitant severe valve dysfunction beyond AS were excluded. All patients performed transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) within 3 months before SAVR as well as at the 3rd to 6th post-operative month. Patients were classified according to the extent of cardiac damage into 4 groups: stage 0: no damage; stage 1: left ventricle (LV) hypertrophy (indexed LV mass &amp;gt;95 g/m2 [women] or &amp;gt;115 g/m2 [men]), LV diastolic (E/e′ &amp;gt; 14) or systolic (ejection fraction &amp;lt;50%) dysfunction; stage 2: dilated left atrium (&amp;gt;34mL/m2) or atrial fibrillation; stage 3: pulmonary hypertension (systolic pulmonary artery pressure ≥60mmHg); stage 4: significant right ventricle (RV) dysfunction. Global longitudinal strain (GLS) was also assessed to further characterize the extent of LV damage – a GLS &amp;gt; -14.7% was considered abnormal. Due to the impact of on-pump cardiac surgery on RV systolic longitudinal function, RV ejection fraction assessed by CMR (&amp;lt;45%) was used to define significant post-operative RV dysfunction. Results A total of 67 patients were included (mean age 71 ± 8 years; 50% male; mean valvular transaortic gradient 60 ± 19 mmHg; mean indexed aortic valve area 0.4 ± 0.01 cm2/m2; mean LV ejection fraction by TTE 58 ± 9%). Overall, a significant number of patients still showed sign of structural cardiac damage after surgery – 14 vs. 10 on stage 1, 44 vs. 39 on stage 2, 1 vs. 1 on stage 3 and 4 vs. 4 on stage 4 after AVR- figure 1. However, a statistically significant improvement in the number of patients at stage 0 after surgery (4 vs. 11, paired McNemar test p=0.016) was observed, as well as a significant improvement in GLS (mean GLS pre and post AVR -14.8 ± 3.6% vs. -16.6 ± 3.3%, respectively; 45 vs. 21% patients with abnormal GLS before and after AVR, p=0.001). Conclusion Extravalvular cardiac damage is common in a selected cohort of severe AS and potentially reversible after SAVR. A significant improvement in GLS, although not a part of the previously established staging system, was observed after AVR. Whether or not these findings may correlate with long-term patient prognosis or if additional favorable cardiac remodeling is seen on a longer-term follow-up remains to be determined.

Left atrial functional assessment a prime clue in solving the puzzle of stable angina symptoms in suspected coronary artery disease patients

Abstract Background Assessing clinically for significant coronary artery disease (CAD) in stable angina patients presents a formidable task. Routinely performed echocardiography is limited in diagnosing CAD with provision for the regional wall motion abnormality (RWMA) for left ventricle (LV) systolic dysfunction and altered mitral inflow velocities for LV diastolic dysfunction. However, the advent of two-dimensional (2D) speckle-tracking technique has established the era of strain imaging, opening new possibilities in echocardiography. It is now possible to have a detailed functional assessment of left atrium (LA). We utilised speckle tracking imaging to obtain strain parameters for LA function. Combining these strain parameters with the doppler myocardial velocities and mitral inflow velocities, may prove useful mode of imaging to diagnose significant CAD in stable angina patients. Purpose To study the parameters of left atrial functions utilising echocardiographic strain imaging and evaluate their correlation with the syntax score-II in patients with symptoms of stable angina. Methods 103 patients with symptoms of stable angina undergoing coronary angiography for suspected coronary artery disease(CAD), were considered for LA function assessment and compared with their syntax-II score. Results The LA reservoir function parameters, peak atrial longitudinal strain (PALS) and peak global systolic strain rate (LAsSR), decreased with increasing syntax-II score (p values 0.011 and 0.001 respectively) and the parameter of LA conduit function, peak global early diastolic strain rate (LAeSR) increased (p value &amp;lt;0.001). The LA filling pressures reflected by E/e`, also increased with more severe syntax-II score (p value &amp;lt;0.001). We, further, configured cut off values of &amp;lt; 23.56 for PALS, &amp;lt; 1.15 for LAsSR, &amp;gt; -1.09 for LAeSR, and E/e` ratio &amp;gt; 10.39 as predictors of significant CAD, with good sensitivity and specificity. Therefore, stable angina patients who had significant CAD on coronary angiogram represented by severe syntax score-II, had higher LA filling pressures and deranged LA function with transition from more of reservoir chamber to merely a conduit. Conclusion Our study shows a significant association between LA strain parameters (PALS, LAsSR, and LAeSR) and LA filling pressures (E/e`), with the presence of significant CAD in these patients. The stable angina patients with more severe CAD as quantified by their severe syntax score-II, have an impaired LA reservoir and LA functions more as a conduit, with elevated filling pressures. This study establishes a significant association between LA deformation strain variables and severity of CAD and hence LA strain imaging can be a useful tool to diagnose significant CAD in stable angina patients.

Clinical and echocardiographic impact of physiological estimulation in patients with preserved ejection fraction: a randomized clinical trial

Abstract Introduction Right ventricular stimulation in the apex (RVAS) produce dysynchrony, leading to left ventricle systolic dysfunction (LVSD) in some cases. Circumstances that can worsen the LVSD are a high burden of RVAS, and the presence of previous LVSD and/or intraventricular conduction disease (IVCD). Direct activation of the specialized conduction system with physiological stimulation (PS) can preserve this physiological pattern and shorten de QRS when the impairment is proximal to the pacing site. Most of the studies with PS has been focused on patients with LVSD, with few and scarce evidences regarding pacients without LVSD. Objectives and methods: This is a parallel, single blinded, unicentric, randomized trial of patients with preserved of mild reduced left ventricular ejection fraction (LVEF) submitted to a pacemaker implantation due to atrioventricular block (AVB), with previous IVCD (wide QRS) an anticipated high rate of ventricular pacing. Patients were randomized 1:1 to RVAS vs PS and followed for 6 months. Clinical, ECG, echocardiography and analytic parameters were compared. The primary endpoint was the change in the LVEF at 6 months in each group. The secondary endpoints were the changes in the left ventricular end-diastolic diameter (LVEDD), the QRS duration, the pro–B-type natriuretic peptide (NT-proBNP), the NYHA class, and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) in each group. Results The study included 57 patients of 77±9,6 years. Of all patients, 53% were treated with RVAS and 47% with PS. There were 2 patients with crossover to RVAS for technical difficulties and 1 patient with crossover to PS due to apical scar. There were no differences in the basal QRS duration (142.08±20,2 ms), LVEF (58.87±7,2%), NT-proBNP (3336,03±7258,68 pg/ml), or MLWHFQ (22,19±14,68), between both groups (Table 1). Acutely significant differences were observed in the change of QRS duration among groups (+16±29 ms in the RVAS group vs -17±25 ms in the PS group, p&amp;lt;0,001). At 6 months follow-up LVEF showed a non-significant reduction of 0.8±1.1% in the PS group compared to a significant reduction of 5.1±1.7% in the RVAS group (difference 4,26% IC 0,1-8,43 p=0,022). No differences were observed regarding the values of the NT-ProBNP and the MLWHFQ between groups at 6 months (Table 2). Conclusions In patients with preserved LVEF requiring pacemaker implantation for AVB, PS shorten the QTS duration and preserves the LVEF compared to RVAS.Basal characteristics of groupsDifferences in outcomes between groups

Arrhythmic variant of post-covid myocarditis: spectrum of rhythm and conduction disorders, treatment approaches

Aim. To study the spectrum of rhythm and conduction disorders in patients with arrhythmic variant of postcovid myocarditis and determine the treatment approaches.Methods. The study included 23 patients with post-COVID-19 по абстракту разное написание. Post-COVID arrhythmias who had at least two of the three Lake-Louise criteria for myocarditis on magnetic resonance imaging of the heart and/or elevated anticardiac antibody (ACA) titers. The period of occurrence of post-COVID arrhythmias was 4.0 [2.0; 8.0] months, from 2 to 34 months. Echocardiography, Holter monitoring, and ACA study were performed. Cardiac magnetic resonance imaging was performed in 70% of patients (n=16). Coronary artery disease was excluded in 9 patients with risk factors.Results. In all patients’ arrhythmias were associated with COVID-19. Rhythm and conduction disturbances occurred within 2 to 34 months after infection. Echocardiography revealed no left ventricle systolic dysfunction. In all patients, an increase in ACA by 3 or more times was noted, in 65.2% (n=15) a specific antinuclear factor (ANF) was detected, reflecting the high immunological activity of myocarditis. Ventricular arrhythmias in most cases were represented by frequent ventricular extrasystole. Among supraventricular arrhythmias, frequent extrasystoles, non-sustained tachycardia, paroxysmal form of atrial fibrillation were detected. In one case, a transient atrioventricular block II-III degree developed. Treatment approaches included antiarrhythmic and immunosuppressive therapy. All patients underwent Holter monitoring, which showed regression of arrhythmias. Patients with high immunological activity of myocarditis underwent immunosuppressive therapy with methylprednisolone 8-16 mg/day (n=13), with moderate - mild immune-suppressive therapy with hydroxychloroquine 200 mg/day (n=10). When controlling the ACA titers, their decrease was noted. The decrease in the specific ANF titer was close to statistically significant (p=0.057). Interventional treatment of arrhythmias was performed in three patients.Conclusions. Arrhythmias that first developed after COVID-19 require the exclusion of subacute/chronic myocarditis that develops 2-8 months after COVID-19. The spectrum of arrhythmias in patients with post-COVID myocarditis is mostly represented by frequent symptomatic extrasystoles. Basic therapy of the arrhythmic variant of post-COVID myocarditis with methylprednisolone and/or hydroxychloroquine makes it possible to increase the effectiveness of antiarrhythmic drugs with the opportunity of their complete withdrawal in some patients.

Echocardiographic parameters in COVID-19 patients and their association with ICU mortality: a prospective multicenter observational study

BackgroundEchocardiography has become an integral part of the management of critically ill patients. It helps to diagnose and treat various conditions. COVID-19 patients can develop cardiac dysfunction. We planned to study the echocardiographic parameters in COVID-19 patients.MethodsWe conducted a prospective observational multicenter study after institutional ethical committee approval. COVID-19 pneumonia patients admitted to the intensive care unit (ICU) were enrolled. The echocardiographic evaluation was done within 24–48 hours of admission. Assessment of the left and right heart with systolic and left ventricular diastolic function evaluation was done. The primary outcome was ICU mortality. The secondary outcomes were the length of ICU stay and duration of mechanical ventilation.ResultsAmong 573 patients mean age was 57.17 (14.67) with 68.60% being males. On day 1 of ICU, invasive mechanical ventilation was used in 257 (45%) patients. One hundred and forty-eight (25.83%) patients were on vasopressors when echocardiography was performed. Severe left ventricle (LV) systolic dysfunction was seen in 8.7% of patients and had higher odds of mortality [2.48(1.058–5.807), p = 0.037] followed by E and e′ with odds ratio of [0.984(0.971–0.998), p = 0.021] and 0.897 (0.805–0.998), p = 0.046], respectively. E/e′ indicative of filling pressure of the LV was not found to be significant. Troponin I, E/A, and RV dilatation were similar among survivors and non-survivors.ConclusionEchocardiographic evaluation in COVID-19 patients showed severe LV systolic dysfunction was associated with ICU mortality. E/e′ was not found to be significant but lower e′ was associated with higher mortality.Trial registration IEC 131/2020, CTRI/2020/06/025858 date 13th June 2020

Early Coronary Artery Disease in a Female Patient with Discoid Lupus Erythematosus and Hashimoto’s Thyroiditis

BACKGROUND: Atherosclerosis is a chronic inflammatory condition involving the endothelium of the blood vessels, predominant the coronary arteries. Main risk factors are dyslipidemia, hypertension, diabetes, smoking, obesity, and lack of physical activity. Patients with autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis etc., have a twofold increased risk of developing CAD at younger age, compared with the general population. CASE REPORT: A 41-year-old female patient, with history of smoking and dyslipidemia, was admitted to our hospital with acute inferoposterior myocardial infarction. Initially, coronary reperfusion therapy per protocol was administrated and primary percutaneous coronary intervention (PCI) was performed. Multivessel CAD was found, and two stents were implanted on obtuse marginal and circumflex artery. Transthoracic echocardiography (TTE) revealed left ventricle systolic and diastolic dysfunction with segmental hypokinesis. Additionally, the patient was first diagnosed with DLE at the age of 15, but the disease was uncontrolled in the last 7 years. She also has hypothyroidism, regularly treated with hormone replacement therapy. The patient was discharged with medicamentous therapy including dual antiplatelet agents, statin, beta-blocker, angiotensin-receptor blocker, potassium sparing diuretic and proton pump inhibitor. One month later, recoronarography was performed with stenting of left anterior descending artery. TTE showed improvement of the left ventricle systolic function with preserved ejection fraction. The blood test showed elevated levels of antithyroid antibodies. A rheumatologist was consulted, who recommended therapy with hydroxychloroquine and regular follow-ups. CONCLUSION: In younger patients with chronic inflammatory diseases, inflammatory mediators play a significant role in the development of the atherosclerotic plaques, regardless of co-existing risk factors. Therefore, an early cardiovascular assessment is required in these patients for preventing severe or life-threatening cardiovascular events.

Right Ventricle Systolic Dysfunction: A Rare Cause of Right-To-Left Interatrial Shunt with Normal Pulmonary Artery Pressure

There is little information about right-to-left shunting with normal pulmonary artery pressure, which is produced as a consequence of right ventricle systolic dysfunction. We presented a case of unexpected transesophageal echocardiography findings of right-to-left shunting through an atrial septal defect despite normal pulmonary artery pressure, related to right ventricle systolic dysfunction in a 27-year-old young woman. Transesophageal echocardiography imaging revealed right ventricular systolic dysfunction and normal pulmonary artery pressure.

A randomized controlled trial to compare ramipril and sacubitril/valsartan in post-acute coronary syndrome patients with left ventricular systolic dysfunction in terms of improvement in ejection fraction

Background: Ramipril and sacubitril/valsartan are used in the management of ACS patients with left ventricle systolic dysfunction. The objective of the study was to compare ramipril and sacubitril/valsartan in improving LVEF in post ACS patients with LVEF &lt;40%. Methods: A randomized, prospective, open label, comparative study was carried out in department of pharmacology and cardiology at Dr. R. P. G. M. C. Kangra at Tanda, Himachal Pradesh. The study was carried for a period of one and a half year. Out of 80 patients, 38 patients were in ramipril group and 42 were in sacubitril/valsartan group. Data was presented as mean±SD, frequency and percentage. Student’s t test and chi square test were used and p value&lt;0.05 was considered significant. Results: In both the groups, a statistically significant improvement was observed in terms of improvement in LVEF at 6th month when compared to baseline, however, at 6th month both the groups were comparable in terms of LVEF improvement with p value of 0.275. Conclusions: The study concluded that both the drugs have same efficacy in improving LVEF in post ACS patients at 6th month.

Physiological stimulation in preserved ejection fraction: A randomized trial

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Right ventricular stimulation in the apex (RVAS) produce dysynchrony, leading to left ventricle systolic dysfunction (LVSD) in some cases. Circumstances that can worsen the LVSD are a high burden of RVAS, and the presence of previous LVSD and/or intraventricular conduction disease (IVCD). Direct activation of the specialized conduction system with physiological stimulation (PS) can preserve this physiological pattern and shorten de QRS when the impairment is proximal to the pacing site. Most of the studies with PS has been focused on patients with LVSD, with few and scarce evidences regarding pacients without LVSD. Objectives and methods This is a parallel, single blinded, unicentric, randomized trial of patients with preserved of mild reduced left ventricular ejection fraction (LVEF) submitted to a pacemaker implantation due to atrioventricular block (AVB), with previous IVCD (wide QRS) an anticipated high rate of ventricular pacing. Patients were randomized 1:1 to RVAS vs PS and followed for 6 months. Clinical, ECG, echocardiography and analytic parameters were compared. The primary endpoint was the change in the LVEF at 6 months in each group. The secondary endpoints were the changes in the left ventricular end-diastolic diameter (LVEDD), the QRS duration, the pro–B-type natriuretic peptide (NT-proBNP), the NYHA class, and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) in each group. Results The study included 57 patients of 77±9,6 years. Of all patients, 53% were treated with RVAS and 47% with PS. There were 2 patients with crossover to RVAS for technical difficulties and 1 patient with crossover to PS due to apical scar. There were no differences in the basal QRS duration (142.08±20,2 ms), LVEF (58.87±7,2%), NT-proBNP (3336,03±7258,68 pg/ml), or MLWHFQ (22,19±14,68), between both groups (Table 1). Acutely significant differences were observed in the change of QRS duration among groups (+16±29 ms in the RVAS group vs -17±25 ms in the PS group, p&amp;lt;0,001). At 6 months follow-up LVEF showed a non-significant reduction of 0.8±1.1% in the PS group compared to a significant reduction of 5.1±1.7% in the RVAS group (difference 4,26% IC 0,1-8,43 p=0,022). No differences were observed regarding the values of the NT-ProBNP and the MLWHFQ between groups at 6 months (Table 2). Conclusions In patients with preserved LVEF requiring pacemaker implantation for AVB, PS shorten the QTS duration and preserves the LVEF compared to RVAS.

The world upside down - after 20 years of follow-up of dextro-transposition of the great arteries.

Dextro-transposition of the great arteries (D-TGA) is a congenital heart disease (CHD) classically palliated with atrial switch (ATR-S) and nowadays corrected with arterial switch (ART-S). Our aim was to observe a group of D-TGA patients followed in an adult CHD outpatient clinic. We analyzed a group of D-TGA patients born between 1974 and 2001. Adverse events were defined as a composite of death, stroke, myocardial infarction or coronary revascularization, arrhythmia, and ventricular, baffle, or significative valvular dysfunction. A total of 79 patients were enrolled, 46% of whom were female, with a mean follow-up of 27±6 years after surgery. ATR-S was performed in 54% and ART-S in 46%; the median age at procedure was 13 months and 10 days, respectively. During follow-up, almost all ART-S remained in sinus rhythm versus 64% of ATR-S (p=0.002). The latter group had a higher incidence of arrhythmias (41% versus 3%, p<0.001), mostly atrial flutter or fibrillation; the median time to first arrhythmia was 23 years. Systemic ventricle systolic dysfunction (SVSD) was more frequent in ATR-S (41% versus 0%, p<0.001); the mean time to SVSD was 25 years. In ART-S, the most frequent complication was significant valvular regurgitation (14%). Regarding time-to-event analysis, 80% and 40% of ATR-S maintained adverse events-free after 20 and 30 years, respectively; the time-to-first adverse event was 23 years, and there was no difference compared to ART-S (Log-rank=0.596). ART-S tended to maintain more preserved biventricular function than ATR-S (Log-rank=0.055). After a long term free of adverse events, ATR-S patients experienced more arrhythmias and SVSD. ART-S complications were predominantly anastomosis-related; SVSD or arrhythmias were rare.

Structural and functional state of postinfarction myocardium and vascular endothelial growth factor: is there a connection?

Purpose of the study. To reveal the relationship between the serum concentration of vascular endothelial growth factor and the structural and functional state of the myocardium in patients in the post-infarction period at the stage of rehabilitation.Materials and methods. We examined 94 patients at the outpatient stage of rehabilitation after ad hoc stenting 6 weeks after myocardial infarction, 10 healthy volunteers without somatic pathology. All participants in the study underwent standard transthoracic echocardiography with assessment of thickness of epicardial fat, assessment of the concentration of vascular endothelial growth factor (VEGF) in peripheral blood by ELISA.Results and discussion. VEGF values above the median values were associated with lower left ventricular ejection fraction and left ventricular fraction shortening, which indirectly may indicate a more pronounced expression of VEGF in patients with left ventricular systolic dysfunction. Assessing the parameters of LV diastolic dysfunction in groups with different levels of VEGF, no significant differences were found in patients after myocardial infarction. Correlation relationships between the content of VEGF and the thickness of epicardial adipose tissue were not found either among patients or in the control group.Conclusions. Elevated VEGF values in patients with coronary artery disease at the 6th week of rehabilitation were accompanied by left ventricle systolic dysfunction, in contrast to diastolic dysfunction. There was no direct correlation between the thickness of epicardial fat and the concentration of VEGF in the blood serum in patients with coronary artery disease.

Potential protective role of apelin-13 in the doxorubicin-induced cardiotoxicity in the rat

Due to its unselective action, chemotherapy affects not only cancer cells but also a variety of normal human cells causing several toxicities, thus leading to decreased anticancer efficacy. One of such toxicities is cardiotoxicity caused by anthracyclines, mainly doxorubicin (DOX). Doxorubicin-induced cardiotoxicity (DIC) generally occurs as a chronic process and resembles chronic heart failure with reduced ejection fraction. Based on the data about the role of the apelinergic system in the pathogenesis of cardiovascular diseases like heart failure, we hypothesize that it can be also involved in the DIC. Dysregulation of the apelinergic system has been observed in heart failure or myocardial infarction, which was confirmed in studies when apelinergic stimulation resulted in a cardioprotective effect.The aim of the present study was to investigate the role of apelin-13 on echocardiographic parameters in the DIC in the rat.The study was performed in a rat model (male Sprague Dawley, 12 weeks old) of cardiotoxicity. The animals were randomly divided on 3 groups (control, DOX, apelin 40 μg/kg). The cardiotoxicity was induced by 4 intraperitoneal injections of DOX in a dose of 3,5 mg/kg every 7 days with control group receiving saline. All animals were implanted with osmotic pumps to receive a continuous infusion of apelin-13 or saline (control) for 4 weeks, concomitantly with DOX. Immediately before the first dose echo examination was performed. The same procedure was repeated on day 28 days after the last dose of DOX. Later, animals were euthanized and heart samples were collected.Echocardiographic parameters in DOX group compered to control group showed left ventricle (LV) systolic dysfunction, with significant deterioration of LV ejection fraction (LVEF) (66±2.55% vs. 90±4.88), fractional shortening (%FS) (31,67±2.2% vs 55,33±4.45), stroke volume/tibial length ratio (0.041±0.008ml/cm vs 0.064±0.02), and cardiac output/tibial length ratio (10.35±2.12ml/min/cm vs 17.04±4.08). Apelin-13 at a dose of 40 μg/kg reduced the toxic effects of DOX. Furthermore, the heart weight in the group with DOX was significantly smaller than in the control group, while in the group receiving continuous infusion of apelin-13 at a dose 40 μg/kg the heart weight was very similar to control group.The results indicate that continuous exposure to apelin-13 in dose 40 μg/kg has a cardioprotective effect in echocardiographic and clinical parameters. Evaluating the role of the apelinergic system will help us to better understand the pathomechanisms of cardiotoxicity and in the future may result in the development of protective or curative therapies. Acknowledgments: This study was supported by the Grant No UMO-2020/37/B/NZ5/02529 from the National Science Center (Poland). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Current perspectives of cardio-oncology: Epidemiology, adverse effects, pre-treatment screening and prevention strategies.

Cancer and cardiac diseases are the most prevalent causes of death in most developed countries. Due to the earlier detection and higher effectiveness of treatment, more patients survive the disease and have a long life expectancy. As the post-cancer population is growing, an increasing number of patients will be diagnosed with sequelae of those therapies, most often affecting the cardiovascular system. Although the risk of cancer recurrence decreases within years, the risk of cardiac complications-for example left ventricle (LV) systolic and diastolic dysfunction, arterial hypertension, arrhythmias, pericardial effusion and premature coronary artery disease remains elevated for decades after the completion of the therapy. The most common anticancer therapies that can cause adverse cardiovascular effects include chemotherapy-in particular anthracyclines, human epidermal growth receptor 2 targeted drugs and radiation therapy. A new field of research, cardio-oncology, addresses this increasing risk, screening, diagnosis and prevention. This review aims to present the most relevant reports regarding the adverse cardiac effects of oncological therapy, including the most prevalent types of cardiotoxicity, methods of pre-treatment screening and indications for prevention therapy.

Isolated Subclinical Right Ventricle Systolic Dysfunction in Patients after Liver Transplantation.

Although hemodynamic alterations in end-stage liver disease (ESLD) and its association with porto-pulmonary hypertension have been well-established, the long-term effects of ESLD on RV systolic function in patients without porto-pulmonary hypertension remain disregarded. Here we aimed to assess the long-term effect of ESLD on RV function and its relationship with the use of NSBBs and clinical, laboratory and imaging parameters in end-stage liver disease. The use of NSBBs is still controversial due to concerns about reduced cardiac contractility and the possibility of increased mortality. Thirty-four liver transplant recipients were included. Demographic characteristics, laboratory and baseline echocardiography measures were obtained. Patients were recalled for transthoracic echocardiographic evaluation after transplantation. Right ventricle dysfunction was identified by having at least one value below the reference levels of RV S', or TAPSE. Isolated subclinical RV dysfunction was observed at 20.6% of the sample population. The present study demonstrates hemodynamic circulation in cirrhosis and increased preload and afterload might have long-term effects on RV function, even the lack of porto-pulmonary hypertension. These findings underline the significance of cardiac function follow-up in cirrhotic patients after transplantation. In this study, patients treated with propranolol seemed to have better RV function and less gastrointestinal bleeding. We speculated that preoperative propranolol treatment might help preserve RV function by providing RAS suppression, improving endothelial function and hyperdynamic circulation seen in ESLD. This potential protective relationship between the use of propranolol and RV function might improve mortality or graft-failure during OLT and after liver transplantation in patients with cirrhosis.

The systemic deletion of interleukin-1α reduces myocardial inflammation and attenuates ventricular remodeling in murine myocardial infarction

Myocardial inflammation following myocardial infarction (MI) is crucial for proper myocardial healing, yet, dysregulated inflammation may promote adverse ventricular remodeling and heart failure. IL-1 signaling contributes to these processes, as shown by dampened inflammation by inhibition of IL-1β or the IL-1 receptor. In contrast, the potential role of IL-1α in these mechanisms has received much less attention. Previously described as a myocardial-derived alarmin, IL-1α may also act as a systemically released inflammatory cytokine. We therefore investigated the effect of IL-1α deficiency on post-MI inflammation and ventricular remodeling in a murine model of permanent coronary occlusion. In the first week post-MI, global IL-1α deficiency (IL-1α KO mice) led to decreased myocardial expression of IL-6, MCP-1, VCAM-1, hypertrophic and pro-fibrotic genes, and reduced infiltration with inflammatory monocytes. These early changes were associated with an attenuation of delayed left ventricle (LV) remodeling and systolic dysfunction after extensive MI. In contrast to systemic Il1a-KO, conditional cardiomyocyte deletion of Il1a (CmIl1a-KO) did not reduce delayed LV remodeling and systolic dysfunction. In conclusion, systemic Il1a-KO, but not Cml1a-KO, protects against adverse cardiac remodeling after MI due to permanent coronary occlusion. Hence, anti-IL-1α therapies could be useful to attenuate the detrimental consequences of post-MI myocardial inflammation.