Ventricular Diastolic Diameter Research Articles

Deep learning in echocardiography: real-time measurements of left ventricular wall thickness and chamber dimensions in the parasternal long-axis view

Abstract Background Accurate measurements of left ventricular (LV) wall thickness and chamber dimensions in the parasternal long-axis view (PLAX) are essential in the standard echocardiographic examination. Manual assessments introduce variability, and conducting the numerous measurements required for a comprehensive echocardiographic assessment is time-consuming. Therefore, there is potential for improving workflow. Purpose To develop a novel deep learning (DL)-based method for fully automated, real-time measurements of LV wall thickness and chamber dimensions while scanning the patient, and to validate its performance in an unselected prospective cohort. Methods PLAX recordings from 207 subjects were annotated to train DL networks for cardiac segmentation, timing of end-systole and end-diastole, measurements of LV wall thickness and chamber dimensions. The application presents results from three consecutive cardiac cycles in real-time to the operator for review (Figure 1). Agreement and correlation with reference measurements were evaluated, and the combined acquisition and measurement times for both the novel- and reference methods were recorded. Results Feasibility for real-time measurements in PLAX was 98%, with one patient excluded due to poor acoustic window. Agreement with reference measurements was good for interventricular septal diameter (IVSd) (bias - 0.7 mm, limits of agreement (LoA) -4.38 to 2.94 mm), posterior wall thickness (PWd) (bias 0.8 mm, LoA -2.32 to 3.84 mm) and left ventricular internal diastolic diameter (LVIDd) (bias 0.0 mm, LoA -7.0 to 6.9 mm, Figure 2A). Strong correlations were found for IVSd (R=0.84), PWd (R=0.66) and LVIDd (R=0.85), all significant (p <0.001). The average time for acquiring PLAX images was 53 ± 22 seconds, with an additional 42 ± 11 seconds for reference analysis, totaling 94 ± 27 seconds to complete reference PLAX measurements. In contrast, the real-time application took only 59 ± 34 seconds to obtain the same measurements (Figure 2B), resulting in a mean time reduction of 36 seconds (95% CI 24-47 seconds). Conclusion This novel DL-based method for fully automated, real-time analysis of key metrics in PLAX is time-efficient, feasible, and yields measurements in good agreement with manual reference. This method has the potential to substantially improve efficiency and precision of PLAX assessment in clinical practice.

Transcatheter edge-to-edge repair of severe tricuspid regurgitation with the pascal system. one-year results of a pioneering series in spain, with the use of the pascal system.

Abstract Background and objectives Transcatheter edge-to-edge repair (TEER) of severe tricuspid regurgitation (TR) is emerging as a lower-risk alternative to surgery. Our aim was to evaluate the safety and efficacy of treatment of severe TR with the Edwards Pascal system as well as the results at 1 year, in the longest Spanish series performed to date with this device. Methods observational study in a prospective cohort of patients from a third level referral university hospital, which included all cases of severe or major TR and persistent symptoms treated by TEER with Pascal device from December 2021 to February 2024. Baseline clinical and echocardiographic characteristics and immediate and 3-month safety and efficacy outcomes were evaluated. All-cause mortality and hospitalization for heart failure at 1 year were analyzed. Results 35 patients were included: mean age 72.5±11.5 years; 54% female, 100% with severe to torrential TR and a median Tri-score of 5(p25-75.3-6). Primary success was achieved in 97 % and 34 of 35 (97%) patients achieved moderate or lower TR, with a significant reduction in TR (p<0.0005 ). The echocardiogram at discharge showed 1 case of partial device loosening and there was a reduction in right ventricular (RV) diastolic diameter (48±10 vs 41±7mm,p<0.0005) and a reduction in the tricuspid septolateral septal annulus (44±7 vs 37±6mm,p<0.0005). At 3 months there were no deaths, strokes, device embolization or reinterventions. Mild or moderate TR persisted in 20 of 22 patients (91%, p<0.0005) and NYHA I-II in 91% (p=0.019). At one year the probability of overall and hospitalization-free survival due to heart failure according to Kaplan-Meier analysis was 100% and 84%, respectively (Figure). Conclusions The Pascal system in the treatment of severe TR demonstrated high success rate with few complications, with favorable remodeling of the tricuspid annulus and the RV and also with significant and sustained improvements in TR and functional status. At 1 year, the heart failure readmission-free survival rate was very high

Small Extracellular Vesicles from Young Healthy Human Plasma Inhibit Cardiac Fibrosis After Myocardial Infarction via miR-664a-3p Targeting SMAD4.

Cardiac fibrosis, a key contributor to ventricular pathologic remodeling and heart failure, currently lacks effective therapeutic approaches. Small extracellular vesicles from young healthy human plasma (Young-sEVs) were characterized via protein marker, transmission electron microscopy, and nanoparticle tracking analysis, then applied in cellular models and mouse models of cardiac fibrosis. Western blotting and qRT-PCR were used to identify protective signaling pathways in cardiac fibroblasts (CFs). Young-sEVs significantly inhibited cardiac fibrosis and subsequent cardiac dysfunction post-myocardial infarction (MI) in mice. The main findings included that echocardiographic assessments four weeks post-MI indicated that Young-sEVs improved left ventricular ejection fraction (LVEF) and fractional shortening (LVFS), and reduced left ventricular internal diameter in diastole (LVIDd) and systole (LVIDs). Treatment with Young-sEVs also decreased Masson-positive fibroblast areas and collagen synthesis in cardiac tissue. However, sEVs from the old control group did not achieve the above effect. Consistent with in vivo results, Young-sEVs could also inhibit the proliferation, migration, and collagen synthesis of CFs in the TGF-β1-induced cellular fibrosis model. High-throughput microRNA (miRNA) sequencing and qRT-PCR analysis revealed that miR-664a-3p was abundant in Young-sEVs. The high expression of miR-664a-3p significantly inhibited the proliferation, migration, and collagen synthesis of TGF-β1-induced CFs. However, suppressing the expression of miR-664a-3p in Young-sEVs eliminated their therapeutic effect on cardiac fibrosis in mice. Further studies confirmed SMAD4 as a direct downstream target of miR-664a-3p, whose overexpression could reverse the anti-fibrotic effects of miR-664a-3p. In summary, these findings firstly revealed that Young-sEVs could directly bind to the 3'-untranslated region of SMAD4 mRNA through miR-664a-3p, thereby inhibiting the TGF-β/SMAD4 signaling pathway to protect heart from fibrosis and improve cardiac function. Considering the ease of obtaining plasma-derived sEVs, our study offers a promising therapeutic strategy for heart failure, with the potential for rapid clinical translation in the near future.

Pericardial Abnormalities Seen on Echocardiography in The Jos University Teaching Hospital

Introduction: A 2-D Echocardiographic manifestations of pericardial disease that are not mutually exclusive were pericardial effusion or pericardial thickening. A significant number of pericardial disease cases however are without this classical features. Methodology: In a retrospective review of pericardial echocardiography in a teaching Hospital compare the two pericardial disease syndromes. Comparism in terms of cor-morbidity and cardiac functions were carried out. Both subjective and objective assessment of echo parameters were considered for analysis. Results: A 1414retrospective records were reviewed and 169 (10%) were seen to have either pericardial effusion 91 (5.6%), thickening 78 (4.8%) or both 6 (0.3%). There was a slight female dominance and lower mean age compared to those without echo pericardial disease findings. Pericardial effusive subjectively were seen to be associated with more cor-morbidities and complications and objectively had echo parameters indicating poor cardiac functional state. Aorta, left atrium, left ventricular internal diameter in diastole and E/A ratio were statistically different. Conclusions: Routine echocardiography assessing pericardial diseases was observer dependent and pericardial effusion had a less favourable outcome than thickened pericardium.

Clinical and genetic profiles of patients with hereditary and wild type transthyretin amyloidosis: the transthyretin cardiac amyloidosis registry in the state of Sao Paulo, Brazil REACT-SP

Abstract Introduction Transthyretin amyloidosis (ATTR) is a multisystem disease caused by the deposition of fibrillar protein in organs and tissues. ATTR genotypes and phenotypes are highly heterogeneous. Purpose We designed the Transthyretin Cardiac Amyloidosis Registry in the state of São Paulo (REACT-SP), aiming to describe the demographic, genetic, clinical, and diagnostic test results and treatment of patients with ATTR. Methods We present data on physical signs and symptoms, cardiac and neurological assessments, and genetics in patients enrolled in the Transthyretin Cardiac Amyloidosis Registry in the state of São Paulo, Brazil. Results Six hundred-forty-four patients were enrolled, 505 with the variant form (ATTRv) and 139 with wild-type (ATTRwt). Sixteen different mutations were detected, the most common being Val50Met (48.3%) and V142Ile (40.8%). Overall, more than half of the patients presented cardiological involvement, and the difference in this proportion between the ATTRv and ATTRwt groups was significant (43.9 vs. 89.9%; p<0.001). The neurological phenotype also differed between ATTRv and ATTRwt (56.8 vs. 31.7%; p<0.001). The mixed phenotype was found in 25.6% of the population, without a significant difference between the forms of amyloidosis. A group of patients remained asymptomatic (10.4%), with a lower proportion of asymptomatic ATTRwt patients. The median time between the onset of symptoms and diagnosis was 1,853 (IQR 1277–2997) days, which was longer in ATTRv patients than in ATTRwt patients (p<0.001). Sinus rhythm was reported in 74.2%, atrial fibrillation in 17.0%, low voltage in 28.6%, repolarization abnormalities in 39.8%, and pseudo infarction in 27.4%. Echocardiography showed median Left Ventricular Ejection Fraction (LVEF) was 60%, Interventricular Septum (IVS) 14 mm, Posterior Wall Thickness (PWT) 13 mm, Left Atrium (LA) 41 mm, Left Ventricular Diastolic Diameter (LVDD) 45 mm, Left Ventricular Systolic Diameter (LVSD) 30 mm, basal Right Ventricular Diastolic Diameter (RVDD) 35 mm and Left Ventricle (LV) longitudinal strain 9.1%. There was some degree of LV diastolic dysfunction in 38.4%, apical sparing in 31.3%, and thrombus or masses in 1.0%. Late Gadolinium Enhancement (LGE) was absent in 29% and was subendocardial in 35.5%, transmural in 13.7%, mesocardial in 13.7%, and epicardial in 8.2%. Conclusions This study details the clinical and genetic spectrum of patients with ATTR in São Paulo, Brazil. This preliminary analysis highlights the considerable phenotypic heterogeneity of neurological and cardiac manifestations in patients with variant and wild-type ATTR.

Predictive value of cardiac 18F-fluorodeoxyglucose positron emission tomography for fatal ventricular arrhythmic events in patients with cardiac sarcoidosis

Abstract Background Patients with cardiac sarcoidosis (CS) face an elevated risk of fatal ventricular arrhythmic events (FVAE), including sudden cardiac death. Late gadolinium enhancement (LGE) from contrast-enhanced cardiac magnetic resonance is used for diagnosis of CS and estimation of FVAE risk. However, its application is limited in cases with cardiac devices, renal failure or contrast agent allergies. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) emerges as a diagnostic tool for CS, even in cases where LGE is not feasible. Purpose This study aimed to investigate the potential utility of FDG-PET in predicting FVAE in patients with CS by hypothesizing that higher or lower percent FDG uptake could predict the FVAE risk. Methods Cardiac FDG-PET data from 121 patients with CS, acquired at our university hospital between March 2008 and November 2020, were analyzed. A polar-map model was used to calculate percent uptake relative to maximal cardiac FDG uptake in each of the American Heart Association (AHA) 17 segments (Figure A). Percent uptakes of the AHA 17 segments were compared between groups with and without future FVAE. LGE information was available in 82 patients and was used to assess the presence of LGE in regions where percent FDG uptake differed between the two groups. Results Among enrolled patients (mean age 59.5 ± 10.0 years, 67.8% women), 43 experienced FVAE following FDG-PET image acquisition. The group with future FVAE had a higher history of FVAE (7.7% vs. 37.2%) and beta-blocker administration (38.5% vs. 60.5%), larger left ventricular diastolic diameter (LVDd) (49.3 ± 7.3 mm vs. 57.4 ± 9.5 mm) and lower ejection fraction (LVEF) (56.6 ± 13.6% vs. 42.0 ± 15.2%) compared to the group without it (P < 0.05 all). Percent FDG uptake in the basal interventricular septum part (segment 3) (Figure A) was lower in patients with future FVAE compared to those without it (54.4 ± 13.8% vs. 41.8 ± 15.2%, P < 0.001 corrected for multiple comparisons). Kaplan-Meier analysis with a median split of percent FDG uptake in segment 3 showed that patients with lower uptake (<49%, N= 62) had lower FVAE-free survival compared to those with higher uptake (≥49%, N = 59) (P = 0.007) (Figure B). A Cox hazard model also demonstrated an association between percent FDG uptake in segment 3 and FVAE onset (hazard ratio 0.972 [95% CI 0.951, 0.995], P = 0.015) after adjusting for previous FVAE, beta-blocker administration, LVDd and LVEF. Similarly, analysis within the subgroup with LGE in the septum (N = 58) revealed a higher risk of FVAE in the group with lower percent FDG uptake compared to those with higher uptake (P = 0.020) (Figure C(a)). However, this association was not evident in patients without LGE in the septum (N = 24) (P = 0.821) (Figure C(b)). Conclusions Reduced percent FDG uptake with LGE in the basal intraventricular septum may serve as a valuable predictor of future FVAE occurrence in patients with CS.

Long-term prognosis and predictors of death in chronic Chagas cardiomyopathy in women and men

Abstract Background Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of heart failure (HF) in Latin America and carries high morbidity and mortality. Previous studies showed conflicting results in epidemiological and clinical evidence of a gender-associated risk of death in patients with HF due to CCC. Purpose This study analysed the long-term prognosis and the main predictors of death in women and men with HF due to CCC. Methods From March 2009 to January 2023, we followed a cohort of outpatients with HF due to CCC. Specific serological tests diagnosed Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) method to analyse time-to-event data and Cox proportional hazards methods to search for predictors of death. Results We studied 739 patients, with a mean age of 57.0 ± 12.1 years, 387 (52%) male. Women had a higher mean age (58.4 ± 11.7 vs. 55.8 ± 12.3 years; p=0.001), had a higher mean baseline left ventricular ejection fraction (LVEF) (44.3±14.5 % vs. 37.0±14.5%; p<0.001) and a smaller left ventricular diastolic diameter (LVDD) (56.8±8.9 vs. 62.5±9.4 mm; p<0.001). Over a median follow-up period of 10 years, 213 (56%) men and 169 (44%) women died (K-M: log-rank p=0.043; Figure). Men received more beta-blocker therapy (52.4% vs. 47.6%; p=0.040) and had a higher prevalence of chronic kidney disease (CKD) (p=0.003) and stroke (p=0.007). HFpEF was more prevalent in women and HFrEF in men (p<0.001). Device implantation and transplant were similar between women and men. Cox regression analysis for death adjusted for age, sex, myocardial infarction, diabetes, CKD, stroke, atrial fibrillation (AF), and LVEF showed LVEF (HR= 0.98;95%CL:0.97-0.98), age (HR=1.03;95%CL1.02-1.04) and CKD (HR= 1.32;95%CL:1.10-1.64) as the main predictors of death. In men, the main predictors were age (HR=1.02;95%CL:1.01-1.04), CKD (HR=1.409;95%CL:1.07-1.86), and LVEF (HR=0.98;95%CL:0.97-0.99), and in women AF (HR=1.41;95%CL:1.03-1.91), age (HR=1.03;95%CL:1.01-1.04), and LVEF (HR=0.97;95%CL:0.96 -0.98). Conclusion women had a better prognosis than men, but gender was not an independent predictor of death. Prevention of comorbidities, especially CKD in men and AF in women, and higher beta-blocker therapy can significantly reduce the death rate in women and men with HF from CCC.

Performance of the novel ANTWERP score in predicting heart function improvement after atrial fibrillation ablation in Asian patients with heart failure.

Previous research has demonstrated that atrial fibrillation (AF) ablation improves heart function variably among patients. We proposed that the ANTWERP score, which was validated in a European group of patients with low left ventricular ejection fraction (LVEF) who had AF ablation, would be valid in an Asian group as well. The purpose of the study is to examine how well a new scoring system (the ANTWERP score) can predict heart function improvement after atrial fibrillation ablation in Asian patients with heart failure. A retrospective review was conducted on patients (n = 84) undergoing AF ablation between January 2019 and June 2022. Initial diagnoses for impaired LV systolic function were confirmed by echocardiography. Patients meeting the "2021 Universal Definition of HF" criteria for LVEF recovery were classified as "responders." Similarities were observed between responders and nonresponders regarding comorbidities, AF type, and LVEF, except for the left ventricular internal diameter in diastole. A higher percentage of responders had an ANTWERP score ≤2 (87.8%) compared to those with a score >2 (55.6%). LVEF improvement was notably higher in the former group (+14.8% vs. +9.4%, p = .043). Atrial reverse remodeling and recurrent atrial arrhythmia rates were similar across groups. The conclusion of the study was that the ANTWERP score effectively predicted LVEF improvement after atrial fibrillation ablation in the Asian population and that this scoring system could be used to guide clinical decisions and prognosis prediction.

Cardiac Evaluation in Children With Chronic Renal Failure and Effect of Kidney Transplant.

Cardiovascular diseases are an important cause of mortality and morbidity in children with chronic renal failure. Cardiac evaluation and followup are crucial for these patients before and after renal transplant. Echocardiography is a noninvasive imaging modality that allows for the assessment of cardiac structure and function. We retrospectively investigated pretransplant and posttransplant echocardiography findings for 55 pediatric patients who had underwent kidney transplant. We recorded patient characteristics before and after transplant, including age, sex, follow-up period, etiology of renal failure, left ventricular systolic and diastolic diameters and the associated z scores, left ventricular mass indexes and z scores, ejection fraction and fractional shortening, aortic valve and atrioventricular valve insufficiencies, presence of pulmonary hypertension, and pericardial effusion (if any) in echocardiography. All participants underwent echocardiography at baseline and after 6 months following the transplant procedure. Posttransplant echocardiography evaluations showed that the z scores of left ventricular systolic and diastolic diameters decreased significantly, mitral regurgitation decreased, and left ventricular systolic functions and left ventricular mass index increased. Our study revealed that kidney transplant has a beneficial effect on the cardiovascular status of patients with end-stage renal disease, as shown by improvements in both structural and functional echocardiographic features. Cardiac functions must be monitored regularly before and after transplant. Transplantation is the optimal treatment option for preservation and improvement of cardiovascular functions.

Mitral valve surgery in octogenarians: long-term and hemodynamic results.

Octogenarians are often denied mitral valve (MV) surgery secondary to concerns over increased perioperative morbidity and mortality. The objective of this study was to examine the outcomes of octogenarians undergoing mitral valve repair (MVr) and replacement (MVR). The outcomes of 139 patients between the ages of 80-90 who underwent MVR/MVr between 2004-2018 at the Mazankowski Alberta Heart Institute (Edmonton, AB, Canada) were retrospectively analyzed. Follow-up was extended to a maximum of 15.8 years. Following MVR, all-cause mortality at 30 days, 1 year, 5 years, 10 years, and the longest follow-up was 7%, 14%, 36.3%, 61.8%, and 67.7%, respectively. Post-MVr, all-cause mortality at the same time points was 1.9%, 7.6%, 22.5%, 55.5%, and 100%, respectively. During the Hospitalization Index, rates of new-onset atrial fibrillation, sepsis, acute kidney injury, superficial sternal wound infection, deep sternal wound infection, mediastinal bleeding, and permanent pacemaker insertion ranged from 22.1-34.0%, 3.8-11.0%, 7.6-22.0%, 1.9-2.4%, 0-1.2%, 0%, and 0-6.1%, respectively. Rates of overall rehospitalization, as well as readmission for heart failure, stroke, myocardial infarction, and MV reoperation ranged from 71.0-85.5%, 52.2-63.3%, 10.9-22.8%, 1.9-6.0%, and 0% during the follow-up period. There were significant reductions in peak MV gradient (P=0.042) and left ventricular internal diameter in diastole (LVIDd; P=0.008) post-MVR, as well as LVIDd (P<0.001) and Left Atrial (LA) Volume Index (P=0.019) post-MVr. Octogenarians exhibit positive left atrial and left ventricular remodeling following MVR. Perioperative morbidity is low, late survival is reasonable, and long-term morbidity is considerable. Overall, these results add to the growing literature that MV surgery is relatively safe and effective in octogenarians.

270. ANALYSIS OF THE RELATIONSHIP BETWEEN CARDIAC DIAMETER AND ANASTOMOTIC TROUBLE IN TRANS HIATAL ESOPHAGOGASTRIC JUNCTION CANCER SURGERY

Abstract Background The number of esophagogastric junction (EGJ) cancers has been increasing in recent years, and the trans hiatal lower esophagectomy is widely used for cases with shorter esophageal invasion. However, the mediastinal surgical view through the hiatus is sometimes poor due to cardiac compression, and resection and reconstruction are often difficult in these cases. We therefore retrospectively examined the influence of cardiac diameter on short-term postoperative outcomes. Methods From June 2004 to December 2022, 97 patients underwent radical surgery for EGJ cancer at our hospital, of those 67 patients underwent trans-hiatal approach. We retrospectively analyzed the relationship between cardiothoracic ratio (CTR) on preoperative chest radiographs and left ventricular diastolic diameter (LVDd) on echocardiography and postoperative complications in patients underwent trans hiatal approach. Results Patients with preoperative CTR &amp;gt;50% had a significantly higher rate of anastomotic leakage (33% v.s. 7%, p&amp;lt;0.05), and similarly for LVDd, when divided into two groups using 43 mm as cut-off, patients with larger heart diameter had significantly more anastomotic leakage (69% v.s. 24%, p&amp;lt;0.05). We performed a multivariate analysis using CTR, ASA-PS, blood loss, operative time, BMI, and tumor diameter, and defined CTR as an independent risk factor for anastomotic leakage (OR: 7.76, 95%CI: 1.45-41.4, p&amp;lt;0.05). Conclusion Trans-hiatal approach can be used for resection of EGJ cancer. However, special attention should be paid to the prevention of anastomotic leakage in patients with cardiac comorbidities or a large preoperative CTR or LVDd.

Value of Echocardiographic Evaluation of Myocardial Performance Index in Predicting Major Adverse Cardiovascular Events Within 1 Year after Percutaneous Coronary Intervention in Patients with Coronary Heart Disease

Objective: This study aimed to evaluate the predictive efficacy of the echocardiography-derived Tei index for the occurrence of major adverse cardiovascular events (MACE) within 1 year post-percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Methods: A total of 98 patients diagnosed with CHD and admitted to our hospital between January 2021 and May 2023 were retrospectively selected for this study, and the two groups were divided into good prognosis group (n = 67) and poor prognosis group (n = 31) according to whether cardiovascular adverse events occurred within 1 year after PCI. Univariate and multivariate logistic regression analyses were conducted to identify the influencing factors of adverse cardiovascular events in patients with CHD following PCI, and receiver operating characteristic (ROC) analysis was employed to evaluate the efficacy of myocardial performance index measured by echocardiography in predicting adverse cardiovascular events within 1 year post-PCI in patients with CHD. The inflammatory factors of patients with different Tei indices were compared before and 24 h after PCI. Results: The differences in general data, including preoperative Tei index, left anterior descending (LAD) level, left ventricular diameter in diastole (LVDd) level, and the number of cases with left ventricular outflow tract obstruction, were not statistically significant between two groups (p &gt; 0.05). Left ventricular ejection fraction (LVEF), maximum left ventricular thickness, postoperative Tei index, plaque score, and carotid intima–media thickness (IMT) showed statistically significant differences (p &lt; 0.05). The findings from logistic regression analysis, considering multiple factors, indicated that Tei index, plaque score, and carotid IMT were independent predictors for adverse cardiovascular events following PCI in patients with CHD (p &lt; 0.05). ROC analysis demonstrated an impressive area under the curve of 0.967 for echocardiographic assessment of myocardial performance index as a predictor for adverse cardiovascular events within 1 year after PCI in patients with CHD. The standard error was 0.017, 95% confidence interval was 0.935–0.999, optimal cut-off value was 0.88, sensitivity was 95.0%, and specificity was 93.3%. The comparison of inflammatory factors among patients with different Tei index values before PCI did not yield any statistically significant differences (p &gt; 0.05), and the comparison of inflammatory factors in patients with different Tei index 24 h after PCI. The levels of inflammatory cytokines in patients with Tei ≤0.5 were lower than those in patients with Tei &gt;0.5 (p &lt; 0.05). Conclusion: Evaluating the myocardial performance index through echocardiography holds considerable value in predicting MACE within one year following PCI in patients diagnosed with CHD.

Pulse wave signal-driven machine learning for identifying left ventricular enlargement in heart failure patients

BackgroundLeft ventricular enlargement (LVE) is a common manifestation of cardiac remodeling that is closely associated with cardiac dysfunction, heart failure (HF), and arrhythmias. This study aimed to propose a machine learning (ML)-based strategy to identify LVE in HF patients by means of pulse wave signals.MethodWe constructed two high-quality pulse wave datasets comprising a non-LVE group and an LVE group based on the 264 HF patients. Fourier series calculations were employed to determine if significant frequency differences existed between the two datasets, thereby ensuring their validity. Then, the ML-based identification was undertaken by means of classification and regression models: a weighted random forest model was employed for binary classification of the datasets, and a densely connected convolutional network was utilized to directly estimate the left ventricular diastolic diameter index (LVDdI) through regression. Finally, the accuracy of the two models was validated by comparing their results with clinical measurements, using accuracy and the area under the receiver operating characteristic curve (AUC-ROC) to assess their capability for identifying LVE patients.ResultsThe classification model exhibited superior performance with an accuracy of 0.91 and an AUC-ROC of 0.93. The regression model achieved an accuracy of 0.88 and an AUC-ROC of 0.89, indicating that both models can quickly and accurately identify LVE in HF patients.ConclusionThe proposed ML methods are verified to achieve effective classification and regression with good performance for identifying LVE in HF patients based on pulse wave signals. This study thus demonstrates the feasibility and potential of the ML-based strategy for clinical practice while offering an effective and robust tool for diagnosing and intervening ventricular remodeling.

Structural and functional cardiac parameters across occupations: a cross-sectional study in differing work environments

Previous investigations have highlighted notable variations in cardiovascular risk indicators associated with various professional categories. However, only a few studies have examined structural and functional cardiac parameters using echocardiography within distinct occupational groups. Hence, this study endeavored to assess cardiac structural and functional parameters in three additional occupations: firefighters (FFs), police officers (POs), and office workers (OWs). This prospective study encompassed 197 male participants (97 FFs, 54 POs, and 46 OWs) from Germany. All participants underwent 2D and Doppler echocardiography in resting conditions; standard parasternal and apical axis views were employed to evaluate structural (diastolic and systolic) and functional (systolic and diastolic function, and strain) cardiac parameters. All three occupational groups exhibited a tendency towards septal hypertrophy. Notably, OWs exhibited the largest diastolic interventricular septum diameter (IVSd), at 1.33 ± 0.25 cm. IVSd significantly varied between POs and OWs (p = 0.000) and between POs and FFs (p = 0.025). Additionally, during diastole a substantially larger left ventricular posterior wall diameter (LVPWd) was observed in OWs compared to FFs (p = 0.001) and POs (p = 0.013). The left ventricular diastolic cavity diameter (LVIDd) and the left ventricular systolic cavity diameter (LVIDs) were significantly higher in POs than they were in FFs (LVIDd: p = 0.001; LVIDs: p = 0.009), and the LVIDd was notably higher in FFs (p = 0.015) and POs compared to OWs (p = 0.000). FFs exhibited significantly better diastolic function, indicated by higher diastolic peak velocity ratios (MV E/A ratio) and E/E’ ratios, compared to POs (E/A ratio: p = 0.025; E/E’ ratio: p = 0.014). No significant difference in diastolic performance was found between OWs and FFs. Significantly higher E’(lateral) values were noted in POs compared to FFs (p = 0.003) and OWs (p = 0.004). Ejection fraction did not significantly differ among FFs, POs, and OWs (p > 0.6). The left ventricular mass (LV Mass) was notably higher in POs than it was in FFs (p = 0.039) and OWs (p = 0.033). Strain parameter differences were notably improved in two- (p = 0.006) and four-chamber (p = 0.018) views for FFs compared to POs. Concentric remodeling was the predominant change observed in all three occupational groups. Significant differences in the presence of various forms of hypertrophy were observed in FFs, POs, and OWs (exact Fisher test p-values: FFs vs. OWs = 0.021, POs vs. OWs = 0.002). OWs demonstrated notably higher rates of concentric remodeling than FFs did (71.77% vs. 47.9%). This study underscores disparities in both functional and structural parameters in diverse occupational groups. Larger prospective studies are warranted to investigate and delineate differences in structural and functional cardiac parameters across occupational groups, and to discern their associated effects and risks on the cardiovascular health of these distinct professional cohorts.

Application of intensive management of risk awareness combined with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart failure.

The aim of this study is to assess the impact of intensive risk awareness management along with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart failure. We selected 101 elderly patients with acute myocardial infarction and heart aging treated from January 2022 to March 2023. They were divided into control and observation groups based on hospitalization numbers. The control group (n = 50) received routine nursing, while the observation group (n = 51) received intensive risk awareness management and cardiac rehabilitation nursing. We compared medication possession ratio (MPR), cardiac function, self-care ability scale scores, quality-of-life, incidents, and satisfaction between the 2 groups. Before intervention, there was no significant difference in MPR values between the 2 groups (P > .05). After intervention, MPR values increased in both groups, with a greater increase in the observation group (P < .05). Cardiac function showed no significant difference before intervention (P > .05), but after intervention, the observation group had lower left ventricular end-systolic and diastolic diameters and higher left ventricular ejection fraction compared to the control group (P < .05). Self-care skills, health knowledge, self-responsibility, and self-concept scores improved in both groups after intervention, with higher scores in the observation group (P < .05). The observation group had higher scores in various quality-of-life domains (P < .05). The total incidence of adverse events was lower in the observation group (5.88%) compared to the control group (20.00%) (P < .05). Patient satisfaction was significantly higher in the observation group (96.08%) than in the control group (84.00%) (P < .05). Intensive risk awareness management combined with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart aging can enhance medication compliance, improve quality-of-life, enhance self-care abilities, boost cardiac function, reduce incidents, and increase patient satisfaction.

Cardiac screening in pediatric patients with neurofibromatosis type 1: similarities with Noonan syndrome?

Both Neurofibromatosis type 1 (NF1) and Noonan syndrome (NS) are RASopathies. Characteristic cardiac phenotypes of NS, including specific electrocardiographic changes, pulmonary valve stenosis and hypertrophic cardiomyopathy have not been completely studied in NF1. Purpose: The aims of this study were to assess: (1) similarities in the prevalence and types of ECG and conventional echocardiographic findings described in NS in asymptomatic patients with NF1, and (2) the presence of discrete myocardial dysfunction in NF1 patients using myocardial strain imaging. Methods: Fifty-eight patients with NF1 (ages 0–18 years), and thirty-one age-matched healthy controls underwent cardiac assessment including blood pressure measurements, a 12-lead ECG, and detailed echocardiography. Quantification of cardiac chamber size, mass and function were measured using conventional echocardiography. Myocardial strain parameters were assessed using 2-Dimensional (2D) Speckle tracking echocardiography. Results: Asymptomatic patients with NF1 had normal electrocardiograms, none with the typical ECG patterns described in NS. However, patients with NF1 showed significantly decreased calculated Z scores of the left ventricular internal diameter in diastole and systole, reduced left ventricular mass index and a higher incidence of cardiac abnormal findings, mainly of the mitral valve, in contrast to the frequently described types of cardiac abnormalities in NS. Peak and end systolic global circumferential strain were the only significantly reduced speckle tracking derived myocardial strain parameter. Conclusions: Children with NF1 demonstrated more dissimilarities than similarities in the prevalence and types of ECG and conventional echocardiographic findings described in NS. The role of the abnormal myocardial strain parameter needs to be explored.

The impact of intravenous medetomidine and vatinoxan on echocardiographic evaluation of dogs with stage B1 mitral valve disease

Introduction/objectiveThe purpose of this study was to investigate the echocardiographic effects of intravenous medetomidine and vatinoxan in dogs with stage B1 mitral valve disease. We hypothesised medetomidine-vatinoxan would reduce the need for manual restraint during echocardiography without producing detrimental cardiovascular effects or echocardiographic changes. AnimalsTwelve client-owned dogs with stage B1 mitral valve disease. MethodsA transthoracic echocardiographic examination was performed before and after sedation with intravenous medetomidine (10 μg/kg) and vatinoxan (200 μg/kg). Vital parameters were also recorded, and the level of sedation was assessed subjectively. The data were analysed with Student’s t-tests with an alpha level of <0.05. ResultsEnd-systolic volume and left ventricular systolic diameter increased (from 0.89 ± 0.19 mL/kg to 1.13 ± 0.29 mL/kg and 0.96 ± 0.12 cm to 1.10 ± 0.10 cm, respectively) and ejection fraction (from 66.33 ± 4.0% to 56.23 ± 9.54%) and fractional shortening (from 36.13 ± 5.42% to 27.24 ± 5.6%) decreased significantly after sedation. End diastolic volume, left ventricular diastolic diameter, and left atrial size remained statistically unchanged, while aortic (from 1.34 ± 0.2 m/s to 0.99 ± 0.14 m/s) and pulmonic (from 0.94 ± 0.16 m/s to 0.66 ± 0.15 m/s) velocities decreased significantly. No dogs had a mean arterial pressure below 65 mmHg. Sedation enabled echocardiographic examination without manual restraint. No adverse effects were observed with the dose studied. ConclusionsEchocardiographic parameters were not completely comparable with the baseline values, which should be taken into consideration when evaluating dogs sedated with intravenous medetomidine-vatinoxan.

The interaction of choline and one-carbon / folate metabolism derangements on the cardiac remodeling process with or without diabetes

Proper nutrition helps protect from illness and disease. Choline (Ch), an essential molecule of substantial importance for the optimal development and function of several biological systems, plays a crucial role in the pathway of one-carbon metabolism. On the other hand, Ch-deprivation (CD) has been linked with abnormal fat metabolism, insulin resistance, and myocardial dysfunction. The Ch-deficiency setting is an established experimental model of non-alco¬holic steatohepatitis that resembles the human non-alcoholic fatty liver disease (NAFLD); a disease with constantly increasing incidence and prevalence. NAFLD, commonly associated with metabolic comorbidities such as obesity and type 2 diabetes mellitus, consists a high risk for cardiovascular disease. Experimental data of dietary CD through the administration of a Ch-deficient diet to rodents have revealed myocardial monocyte infiltration along with cardiac interstitial oedema and fibrosis, as well as a deleterious effect on cardiac valves that could lead to impaired heart mechanical properties which resemble to a restrictive pattern of cardiomyopathy characterised mainly by diastolic dysfunction. In a Ch-deprived diabetic experimental model, the diastolic heart failure has been characterized by a concentric hypertrophied myocardium, a left ventricular cavity with a thinner wall, and an increased left ventricular diastolic diameter, in addition to a left atrial dilatation that could also exert functional derangement and provoke arrhythmogenesis, thereby jeopardising cardiac output.

Effect of Butorphanol-Medetomidine and Butorphanol-Dexmedetomidine on Echocardiographic Parameters during Propofol Anaesthesia in Dogs.

This study compared the effects of butorphanol-medetomidine and butorphanol-dexmedetomidine combinations on echocardiographic parameters during propofol anaesthesia in dogs. The dogs were randomly divided into two groups. In the butorphanol-medetomidine (BM) group, butorphanol (0.2 mg/kg) and medetomidine (15 μg/kg) were intravenously administered; in the butorphanol-dexmedetomidine (BD) group, butorphanol (0.2 mg/kg) and dexmedetomidine (7.5 μg/kg) was used. Anaesthesia was induced with propofol and maintained with a constant-rate infusion of propofol (0.2 mg/kg/min). The echocardiographic parameters were assessed in conscious dogs (T0). Echocardiography was conducted again at 10 min post premedication (T1), followed by assessments at 30 (T2), 60 (T3), and 90 (T4) mins. The dogs were subjected to diagnostic procedures (radiography, computed tomography) under anaesthesia. A significant reduction in heart rate and cardiac output was noted in both groups at T1. There was no significant difference in the stroke volume between the BM and BD groups. The application of butorphanol-dexmedetomidine caused a significant increase in the left ventricular internal diameter in diastole and the diameter of the left atrium compared to that caused by butorphanol-medetomidine. This study documented that butorphanol-medetomidine and butorphanol-dexmedetomidine combinations caused similar reductions in heart rate and cardiac output in both groups. 'New´ valvular regurgitation occurred following their administration.

CARDIOVASCULAR OUTCOMES IMPROVE IN CHILDREN WITH RENOVASCULAR HYPERTENSION FOLLOWING ENDOVASCULAR AND SURGICAL INTERVENTIONS

Objective: Renovascular hypertension (RVH) is a common cause of hypertension in children. It is caused by renal artery stenosis reducing the blood supply to the renal parenchyma and activating the renin-angiotensin-aldosterone axis, often leading to cardiac remodelling. This is a longitudinal observational study that aims to describe the occurrence of hypertensive changes and their severity and also any improvement in cardiac remodelling after successful endovascular and/or surgical intervention in children with RVH. Design and method: All patients with RVH referred to our centre, who had received at least one endovascular intervention, were included. Data was collected by retrospective database review over a 22-year period. We assessed oscillometric blood pressure as well as eight echocardiographic parameters pre- and post-intervention: intraventricular septal diameter (IVSD), posterior wall diameter (PWD), left ventricular internal diastolic diameter (LVIDD), fractional shortening (FS), Relative Wall Thickness (RWT), Left Ventricular Mass (LVM) and Left Ventricular Ejection Fraction (LVEF). Results: 152 patients met inclusion criteria and had on average two endovascular interventions. Six children presented in frank heart failure. 54.4% achieved normal blood pressure (BP) control after intervention. Average z-scores improved in IVSD, PWD and FS; LVMI and RWT also improved. PWD saw the greatest reduction in mean difference in children with an abnormal (z-score reduction of 0.25, p&lt;0.001) and severely abnormal (z-score reduction of 0.23, p&lt;0.001) z-scores between pre- and post-intervention echocardiograms. 45.9% of children had a reduction in prescribed antihypertensive medications. Conclusions: Our study reports improvement in cardiac outcomes after either endovascular or surgical intervention. This is evidenced on BP control and echocardiogram changes in which almost half achieved normalisation in systolic BP readings and reduction in the number of children with abnormal echocardiographic parameters.