Ventricular End-diastolic Diameter Research Articles

Validation of two simple scores to identify increased risk of transthyretin amyloid cardiomyopathy in heart failure with preserved ejection fraction

Abstract Background Transthyretin Amyloid Cardiomyopathy (ATTR-CM) is an emerging underdiagnosed cause of heart failure (HF). 99mTc-3, 3-diphosphono-1,2-propanodicarboxylic acid (DPD) allows ATTR-CM diagnosis in the absence of histology. Recently two simple clinical scores to identify increased risk of ATTR-CM in patients with heart failure and preserved left ventricular ejection fraction have been developed and validated. Purpose To assess the prevalence of ATTR-CM in a Mediterranean cohort of patients at risk, and to externally validate the Mayo ATTR-CM and T-Amylo scores. We also explore its diagnostic accuracy improvement by adding N-terminal pro-B-type natriuretic peptide (NT-proBNP). Methods Retrospective cohort study of consecutive patients with suspected cardiac amyloidosis referred to DPD between March 2017 and November 2020. Scans were reported using a visual grading system (0 to 3 increasingly; 2-3 positive) on planar images. Patients with clonal dyscrasia or those without rule-out tests (serum free light chain assay, and serum and urine protein electrophoresis with immunofixation) were excluded. Discrimination was obtained using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve based on the ATTR-CM score [High risk: score ≥ 6. Components: age (60-69 = 2 points; 70-79 = 3 points; ≥80 = 4 points), male sex = 2 points, hypertension = -1 point, ejection fraction <60% = 1 point, posterior wall thickness ≥12 mm = 1 point, relative wall thickness (septal + posterior wall thickness/left ventricular end diastolic diameter) >0.57 = 2 points], and T-amylo score [High risk: score > 6. Components: age ≥ 80 years = 1 point, interventricular septum thickness ≥16 mm = 2 points, low QRS interval voltage = 2 points, male gender = 3 points, and carpal tunnel syndrome = 3 points. Calibration was assessed with the Hosmer-Lemeshow goodness-of-fit test. Results A total of 200 patients were included with a mean age of 78.5 ± 11 years, 45.5% male, left ventricular ejection fraction 58% ± 12 and a median NT-proBNP of 2310 pg/mL (Table 1). 81 (40.5%) and 10 (5.0%) patients were categorized as a high-risk group due to ATTR-CM score value ≥6 and simplified T-Amylo score >6, respectively. Prevalence of ATTR-CM was 17.5%. The AUC for the Mayo ATTR-CM and T-Amylo scores in our cohort were 0.83 (95% CI 0.75-0.90) and 0.79 (95% CI 0.69-0.88) respectively, with an appropriated calibration (Figure 1). The addition of NT-proBNP to the scores did not increase the AUC (p=0.19 and p=0.08), with a Net Reclassification Improvement (NRI) of 0.055 (95% CI - 0.110 to 0.206) and 0.033 (95% CI - 0.113 to 0.224) respectively. Conclusion These two simple clinical scores are valid and reliable tools for ATTR-CM diagnosis in our Mediterranean cohort. Added to clinical suspicion, can improve the diagnostic workup for ATTR-CM, irrespective of NT-proBNP values.

Right-sided exercise-induced cardiac remodelling is more pronounced in white than in black elite football players

Abstract Background Most echocardiography studies investigating exercise-induced cardiac remodelling (EICR) in athletes have predominantly focused on left ventricular end-diastolic volume (LVEDV) and wall thickness. Moreover, studies investigating right-sided EICR in individuals with different ethnic backgrounds are scarce, but are needed to assist clinicians in the differentiation between EICR and pathology. Purpose To investigate differences in right-sided EICR between Caucasian (white) and Sub-Saharan (black) male elite football players. Methods We included all male elite football players with echocardiography data from the Evaluation of Lifetime participation in Intensive Top-level sports and Exercise (ELITE) cohort. ELITE collects data from standardised cardiovascular screenings of elite level athletes in the Netherlands, including (but not limited to) standardised resting transthoracic echocardiograms (TTE). Athletes with known cardiovascular disease were excluded. Our primary metrics of interest were right ventricular end-diastolic diameter (RVEDD), maximal dimension of the inferior vena cava (IVC) and right atrial (RA) reservoir, conduit and contractile strain (measured using 2D-Speckle tracking). Secondary metrics of interest included LV ejection fraction (LVEF), LV mass index (LVMi) and left atrial reservoir strain. All metrics of interest were stratified by ethnicity, and indexed for body surface area (BSA) if appropriate. Results A total of 74 elite football players were included (black n = 37; white n = 37), with similar age (18 [2.0] vs 19 [3.0], p = 0.013) and BSA (2 [0.1] vs 2 [0.2] m2, p = 0.268) across ethnicities. There were no differences in indexed LA (35 [10.0] vs 33 [10.0] ml/m2, p = 0.417) and RA volumes (27 [7.4] vs 27 [6.6] ml/m2,p = 0.953). However, black athletes demonstrated smaller max IVC (18 [5.0] vs 25 [5.0] cm, p = <0.001) and RVEDD (40 [2.0] vs 43 [6.0] mm,p = 0.001). Moreover, black athletes demonstrated less RA deformation in the reservoir (31 [8.0] vs 36 [8.0] %, p = 0.003) and contractile phases (9 [4.0] vs 11 [4.0] %, p = 0.017) than white athletes. There were no ethnic-specific differences in RA conduit strain (23 [7.0] vs 25 [6.0] %, p = 0.076). We found no statistically significant differences in LVEF (55 [6.0] vs 55 [6.0] %, p = 0.914), LVMi (92 [15.0] vs 88 [26.8] g/m2, p = 0.236) or LA reservoir strain (32 [7.0] vs 33 [7.0] %, p = 0.157) in black vs white athletes. Conclusion Male elite football players with a Sub-Saharan ethnic background demonstrate less pronounced right-sided EICR than athletes with a Caucasian ethnic background. Our findings emphasize the need for ethnic-specific reference ranges for right-sided EICR to aid in the differentiation between EICR and pathology.

Evaluation of right ventricular function in patients with Behcet's disease by four-dimensional echocardiography.

Behcet's disease (BD) is a systemic disorder characterized by vasculitis, resulting in thickened vascular walls that reduce elasticity and impair function. BD can involve the cardiovascular system in three ways: cardiac, arterial, and venous. In this study, our objective was to evaluate the efficacy of pulmonary arterial stiffness (PAS) and pulmonary pulse transit time (PPTT) measures in demonstrating right ventricular functions in asymptomatic BD patients. We aimed to objectively evaluate right ventricular function in patients with BD using four-dimensional echocardiography (4DE). This study included 40 patients diagnosed with BD and 40 healthy subjects. Demographic, clinical, laboratory, and echocardiographic parameters were compared. In addition to standard transthoracic echocardiographic evaluation, right ventricle quantification (RVQ) by using the 4DE and 2D-speckle tracking echocardiography were performed. The sPAP, 4D RVQ, and right ventricular strain values exhibited significant differences between the BD and control groups. Right ventricular end-diastolic diameter (RVDD), right ventricular end-systolic diameter (RVSD), right atrium (RA) area, right ventricular myocardial performance index (RVMPI), and PAS were increased in BD patients compared to the control group. Right ventricular ejection fraction (RVEF), right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), Tricuspid S', and PPTT were decreased in BD patients compared to control subjects. PPTT correlated with right ventricular free wall strain (RV-FWS) and PAS. In a multivariate linear regression analysis, PAS and RVFAC were found to be independent predictors of RVFWS. In addition, RVFAC and TAPSE are independent predictors for PPTT. Patients with BD may have elevated pulmonary arterial stiffness (PAS) in correlation with decreased PPTT. To ascertain the prognosis for these individuals, right ventricular (RV) functions must be evaluated. Measurements of RVFAC and RVEF via 4DE and deformation imaging techniques may be more useful in identifying subclinical impairment of RV. Individuals with BD, PAS, and PPTT may suggest a link between early pulmonary vascular remodeling and RV subclinical impairment.

Mid-term outcomes of right ventricular papillary muscle approximation for severe functional tricuspid regurgitation.

Recurrence of tricuspid regurgitation (TR) after tricuspid annuloplasty can occur in cases where a dilated right ventricle exists and subsequent leaflet tethering follows. We previously reported a new technique of the right ventricular papillary muscle approximation (RV-PMA) for functional TR associated with leaflet tethering. The objective of this study is to elucidate the mid-term outcomes and evaluate the durability of RV-PMA. Between January 2014 and March 2023, we applied RV-PMA in 20 patients of advanced functional TR with severe leaflet tethering. The indication of the technique was severe TR with leaflet tethering height >8 mm, and/or a right ventricular end-diastolic diameter >45 mm. The patients were followed up with echocardiography before discharge and at annual interval thereafter. There was no perioperative mortality. In the echocardiography performed before discharge, TR was decreased to mild or less in 85%, and a significant improvement in right ventricular end-diastolic diameter and tethering height were achieved (53-45 mm and 11.1-4.4 mm, respectively). Furthermore, during the median 3-year follow-up period, TR was kept controlled mild or less in 80% of the cases. RV-PMA is considered to be a safe, effective and durable technique as an additional approach for tricuspid annuloplasty.

Redefining left bundle branch block from high-density electroanatomical mapping

BackgroundThe existing ECG criteria for diagnosing left bundle branch block (LBBB) are insufficient to distinguish between true and false blocks accurately. MethodsWe hypothesized that the notch width of the QRS complex in the lateral leads (I, avL, V5, V6) on the LBBB-like ECG could further confirm the diagnosis of true complete left bundle branch block (t-LBBB). We conducted high-density, three-dimensional electroanatomical mapping in the cardiac chambers of 37 patients scheduled to undergo CRT. These patients' preoperative electrocardiograms met the ACC/AHA/HRS guidelines for the diagnosis of complete LBBB. If the left bundle branch potential could be mapped from the base of the heart to the apex on the left ventricular septum, it was defined as a false complete left bundle branch block (f-LBBB). Otherwise, it was categorized as a t-LBBB. We conducted a comparative analysis between the two groups, considering the clinical characteristics, real-time correspondence between the spread of ventricular electrical excitation and the QRS wave, QRS notch width of the lateral leads (I, avL, V5, V6), and the notch width/left ventricular end-diastolic diameter (Nw/LVd) ratio. We performed the ROC correlation analysis of Nw/LVd and t-LBBB to determine the sensitivity and specificity for diagnostic authenticity. ResultsTwenty-five patients were included in the t-LBBB group, while 12 patients were assigned to the f-LBBB group. Within the t-LBBB group, the first peak of the QRS notch correlated with the depolarization of the right ventricle and septum, the trough corresponded to the depolarization of the left ventricle across the left ventricle, and the second peak aligned with the depolarization of the left ventricular free wall. In contrast, within the f-LBBB group, the first peak coincided with the depolarization of the right ventricle and a majority of the left ventricle, the second peak occurred due to the depolarization of the latest, locally-activated myocardium in the left ventricle, and the trough was a result of delayed activation of the left ventricle that did not align with the usual peak timing. The QRS notch width (45.2 ± 12.3 ms vs. 52.5 ± 9.2 ms, P < 0.05) and the Nw/LVd ratio (0.65 ± 0.19 ms/mm vs. 0.81 ± 0.17 ms/mm, P < 0.05) were compared between the two groups. After conducting the ROC correlation analysis, a sensitivity of 56% and a specificity of 91.7% for diagnosing t-LBBB using Nw/LVd were obtained. ConclusionBy utilizing the current diagnostic criteria for LBBB, an increased Nw/LVd value can enhance the effectiveness of diagnosing LBBB.

Validation of the ATTR-CM score for transthyretin amyloid cardiomiopathy in a mediterranean cohort of patients at risk

Abstract Background Transthyretin Amyloid Cardiomiopathy (ATTR-CM) is an emerging underdiagnosed cause of heart failure. 99mTc-3, 3-diphosphono-1,2-propanodicarboxylic acid (DPD) allows ATTR-CM diagnosis in the absence of histology. Recently a simple clinical score to identify increased risk of ATTR-CM in patients with heart failure and preserved left ventricular ejection fraction has been developed and validated. Purpose To assess the prevalence of ATTR-CM in a Mediterranean cohort of patients at risk, and to externally validate the ATTR-CM score. We also explore its diagnostic accuracy improvement by adding N-terminal pro-B-type natriuretic peptide (NTproBNP). Methods Retrospective cohort study of consecutive patients with suspected cardiac amyloidosis referred to DPD planar test between March 2017 and November 2020. Scans were reported using a visual grading system (0 to 3 increasingly; 2-3 positive) on planar images (anterior, left oblique anterior and lateral). Patients with clonal dyscrasia or those without rule-out tests (serum free light chain assay, and serum and urine protein electrophoresis with immunofixation) were excluded. Discrimination was obtained using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve based on the ATTR-CM score [High risk: score ≥ 6. Components and punctuation: age (60-69 = 2 points; 70-79 = 3 points; ≥80 = 4 points), male sex = 2 points, hypertension diagnosis = -1 point, ejection fraction &amp;lt;60% = 1 point, posterior wall thickness ≥12 mm = 1 point, relative wall thickness (septal + posterior wall thickness/left ventricular end diastolic diameter) &amp;gt;0.57 = 2 points]. Calibration was assessed with the Hosmer-Lemeshow goodness- of-fit test. Results A total of 200 patients were included with a mean age of 78.5 ± 11 years, 45.5% male, left ventricular ejection fraction 58%±12 and a median NTproBNP of 2310 pg/ml (Figure 1). 81 (40.5%) patients were categorized as a high-risk group due to score value ≥6. Prevalence of ATTR-CM was 36%. The AUC for ATTR-CM score in our cohort was 0.82 (95% CI 0.75-0.89) with an appropriated calibration (Figure 2). The addition of NTproBNP to the score did not increase the AUC (P = 0.18), with a Net Reclassification Improvement (NRI) of 0.013 (95% CI - 0.102 to 0.210). Conclusion A simple clinical score is a valid and reliable tool for ATTR-CM diagnosis in our Mediterranean cohort. Added to clinical suspicion, it can improve the diagnostic workup for ATTR-CM, irrespective of NTproBNP values.Demographic and clinical characteristicsAUC of ATTR-CM score in our cohort

Development and validation of a nomogram for predicting hemodynamic response to balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension

BackgroundBalloon pulmonary angioplasty (BPA) can effectively alleviate pulmonary hypertension in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Identifying predictors of unfavorable hemodynamic response to BPA is essential to guide clinical practice. Therefore, our objective was to construct and validate a nomogram to facilitate clinicians predicting hemodynamic response to BPA. MethodsPatients with CTEPH and underwent BPA from May 2018 to April 2022 were retrospectively collected. Favorable hemodynamic response to BPA was defined as a mean pulmonary arterial pressure ≤30 mmHg and/or a reduction in pulmonary vascular resistance ≥30 % at follow-up. ResultsA total of 155 patients were included. At baseline, patients with favorable hemodynamic response had significantly lower proportion of occlusive lesions (11.11 % vs. 26.32 %, P = 0.017), higher diffusing capacity of the lungs for carbon monoxide (63.77 % ± 14.10 % vs. 59.11 % ± 11.78 %, P = 0.039), and better cardiac morphology than counterparts. LASSO regression and random forest were used to construct prediction models respectively. The LASSO regression model demonstrated better predictive ability and accuracy than the random forest model, as evidenced by higher area under curve (0.745 vs. 0.740) and lower Brier score (0.192 vs. 0.195). A nomogram was constructed based on the LASSO regression model, consisting of right ventricular end-diastolic diameter/left ventricular end-diastolic diameter, number of treated pulmonary vessels and proportion of occlusion lesions. High predictive ability of the LASSO model was preserved in validation (C index 0.744). ConclusionsThe current study constructed a nomogram with high accuracy in predicting BPA hemodynamic outcome, which could facilitate decision-making in clinical practice.

Xinyang tablet ameliorates sepsis-induced myocardial dysfunction by regulating Beclin-1 to mediate macrophage autophagy and M2 polarization through LncSICRNT1 targeting E3 ubiquitin ligase TRAF6

ObjectiveXinyang Tablet (XYT) has emerged as a potential intervention to counter sepsis-induced myocardial dysfunction (SMID) by influencing macrophage autophagy and M2 polarization. This study aimed to unravel the underlying mechanism of XYT in sepsis-induced myocardial dysfunction (SIMD).MethodsA microarray analysis was employed to explore sepsis-related changes, and bioinformatics analysis was used to predict lncRNAs binding to tumor necrosis factor receptor-associated factor 6 (TRAF6). This studio utilized SIMD mouse models induced by lipopolysaccharide (LPS) injection, followed by treatments involving varied doses of XYT, digoxin (positive control), or si-LncSICRNT1. After seven days, evaluations encompassing mouse hair/mental state/diet/weight were measured, and cardiac function via echocardiography were conducted. Myocardial tissue changes were observed using hematoxylin–eosin staining. Additionally, bone marrow-derived macrophages (BMDMs) subjected to LPS for M1 polarization were treated with oe-LncSICRNT1, si-TRAF6 and their negative control, XYT, or autophagy inhibitor 3-Methyladenine (3-MA) (positive control). RT-qPCR and Western blot analyses were employed to assess LncSICRNT1, TRAF6, Beclin-1, LC3II/LC3I, and p62 levels. Immunohistochemistry and flow cytometry were used for M1/M2 polarization markers, while enzyme-linked immunosorbent assay (ELISA) gauged inflammatory factor levels. Interaction between TRAF6 and LncSICRNT1 was probed using RNA pull-down and RNA immunoprecipitation (RIP) assays.ResultsChip analysis obtained 1463 differentially expressed lncRNAs, including LINC01550 (LncSICRNT1). Further prediction indicated that LncSICRNT1 was highly likely to directly bind to TRAF6. XYT treatment in LPS-induced SIMD mice led to notable enhancements in sleep/hair/diet/activity, increased weight/left ventricular end-diastolic diameter (LVEDd)/LV ejection fraction (LVEF)/LV fraction shortening (LVFS). These improvements were associated with elevated LncSICRNT1 expression and decreased TRAF6 protein levels, culminating in reduced myocardial inflammatory responses and improved cardiac function. Notably, XYT was found to suppress macrophage M1 polarization, while enhancing M2 polarization, ultimately benefitting cardiac function via LncSICRNT1 modulation. Furthermore, the study revealed LncSICRNT1 modulated Beclin-1 ubiquitination and restrained macrophage autophagy by targeting TRAF6 expression.ConclusionThe study highlights XYT’s potential to ameliorate LPS-induced SIMD by elevating LncSICRNT1 expression, influencing TRAF6 expression, and regulating Beclin-1 ubiquitination. These actions collectively inhibit macrophage autophagy and foster M1/M2 polarization, contributing to cardiac function improvement.

MicroRNA-30d and -483-3p for bi-ventricular remodelling and miR-126-3p for pulmonary hypertension in advanced heart failure.

MicroRNAs play a role in pathogenic mechanisms leading to heart failure. We measured a panel of 754 miRNAs in the myocardial tissue and in the serum of patients with heart failure with reduced ejection fraction due to dilatative idiopathic cardiomyopathy (DCM, N=10) or ischaemic cardiomyopathy (N=3), referred to left ventricular assist device implant. We aim to identify circulating miRNAs with high tissue co-expression, significantly associated to echocardiographic and haemodynamic measures. We have measured a panel of 754 miRNAs in the myocardial tissue [left ventricular (LV) apex] and in the serum obtained at the same time in a well selected study population of end-stage heart failure with reduced ejection fraction due to either DCM or ischaemic cardiomyopathy, referred to continuous flow left ventricular assist device implant. We observed moderate agreement for miR-30d, miR-126-3p, and miR-483-3p. MiR-30d was correlated to LV systolic as well as diastolic volumes (r=0.78, P=0.001 and r=0.80, P=0.005, respectively), while miR-126-3p was associated to mPAP and PCWP (r=-0.79, P=0.007 and r=-0.80, P=0.005, respectively). Finally, serum miR-483-3p had an association with right ventricular end diastolic diameter (r=-0.73, P=0.02) and central venous pressure (CVP) (r-0.68 p 0.03). In patients with DCM, few miRNAs are co-expressed in serum and tissue: They are related to LV remodelling (miR-30d), post-capillary pulmonary artery pressure (miR-126-3p), and right ventricular remodelling/filling pressures (miR-483-3p). Further studies are needed to confirm their role in diagnosis, prognosis or as therapeutic targets in heart failure with reduced ejection fraction.

Analysis of relationship between P wave dispersion and diagnosis of pulmonary arterial hypertension and risk stratification

BackgroundThe aim of this study was to measure the P-wave dispersion(PWD) in the ECG of patients with pulmonary arterial hypertension(PAH). MethodsA total of 103 PAH patients were collected, including 55 patients related with congenital heart disease(CHD) and 44 patients with idiopathic pulmonary arterial hypertension(IPAH). In addition, 30 CHD patients without PAH (nPAH-CHD group) and 30 healthy controls (HCG group) were collected as control. Patients in the PAH group were categorized into the low-risk group (30 cases), moderate-risk group (53 cases) and high-risk group (20 cases), followed by comparison of PWD difference between groups. The ROC curve was used to evaluate the diagnostic efficacy of PWD on PAH-CHD and IPAH. ResultsThe levels of PWD and maximum P wave duration(Pmax) in PAH-CHD and IPAH group were significantly higher than those in nPAH-CHD and HCG group (P < 0.05). PWD level was positively correlated with right ventricular end-diastolic diameter(RVD), right atrial end-systolic diameter(RAS), mean pulmonary arterial pressure(mPAP), pulmonary vascular resistance(PVR)(r = 0.407, 0.470, 0.477, 0.423, P < 0.001), and was negatively correlated with systolic displacement of tricuspid valve annulus(TAPSE) level (r = −0.551, P < 0.001). After risk quantification in 103 PAH patients, we found that PWD was significantly different among the low-risk, moderate-risk and high-risk groups (43.89 ± 9.91 vs. 51.29 ± 6.61, 62.15 ± 10.44, P < 0.001). CHD-PAH and IPAH were identified by PWD with a cut off value of 41.5 ms (P < 0.001), and a cut off value of 41.45 ms (P < 0.001), respectively. ConclusionsPWD might be an effective ECG indicator for PAH, which might be used as a relatively economical indicator for PAH patients to assist in early diagnosis, disease severity assessment and prognosis evaluation.

The impact of invasive treatment of superficial venous insufficiency of the lower extremities on cardiac functions.

The aim of the study was to investigate the effect of invasive treatment for chronic venous insufficiency (CVI) on cardiac hemodynamics. Fifty three patients diagnosed with saphenofemoral junction or great saphenous vein insufficiency in a level above C3 according to Clinical-Etiology-Anatomy-Pathophysiology classification were included in the study. All the patients underwent 2D echocardiography before and 3months after the invasive treatment. In postinvasive treatment echocardiographic assessment, significant decreases in right ventricular end-diastolic diameter (p = 0.006), TAPSE (p = 0.006), tricuspid E wave velocity (p = 0.004), tricuspid E/A ratio (p < 0.001), sPAB (p = 0.017), tricuspid lateral s' wave velocity (p = 0.004), and right ventricular free wall longitudinal strain rate (p = 0.011) were observed. The invasive treatment of superficial venous insufficiency of the lower extremities may lead to reduction in the increased venous return in the supine position subclinically.

The long-term clinical course of moderate tricuspid regurgitation

BackgroundTo evaluate the long-term clinical outcome of a cohort of patients suffering from moderate tricuspid regurgitation (TR), regardless of its etiology. MethodsClinical and echocardiographic follow-up were assessed in 250 patients diagnosed with moderate TR between January 2016 and July 2020. TR progression at follow-up was defined as TR grade increase to at least severe. The primary endpoint was all-cause death; secondary endpoints were cardiovascular (CV) death and the composite of heart failure (HF) hospitalization plus tricuspid valve (TV) intervention. ResultsAfter a median follow-up of 3.6 years, TR progression occurred in 84 patients (34%). At multivariate analyses, atrial fibrillation (AF, OR 1.81, CI 1.01–3.29, p = 0.045) and right ventricular end-diastolic diameter (RVEDD, OR 2.19, CI 1.26–3.78, p = 0.005) were independent predictors of TR progression. The primary endpoint occurred in 59 patients (24%) and was significantly more frequent in the group with TR progression (p = 0.009). At multivariate analyses, chronic kideney disease (OR 2.80, CI 1.30–6.03, p = 0.009), left ventricular ejection fraction (OR 0.97, CI 0.94–0.99, p = 0.041) and TR progression (OR 2.32, CI 1.31–4.12, p = 0.004) were independent predictors of the primary outcome. Moreover, both the secondary endpoints of CV death and HF hospitalization plus TV intervention were more frequent in the TR progression group (p = 0.001 and p < 0.001, respectively). ConclusionsModerate TR progresses in a significant proportion of patients over a long-term follow-up, leading to a worse prognosis. TR progression is an independent determinant of hard clinical events and AF and RVEDD are associated with TR progression.

Macitentan in the Young-Mid-term Outcomes of Patients with Pulmonary Hypertensive Vascular Diseasetreated in a Pediatric Tertiary Care Center.

Pulmonary hypertension (PH) is a severe hemodynamic condition with high morbidity and mortality. Approved targeted therapies are limited for pediatric subjects, and treatments are widely adopted from adult algorithms. Macitentan is a safe and effective drug used for adult PH, but data on pediatric patients are limited. In this prospective single-center study, we investigated mid- and long-term effects of macitentan in children with advanced pulmonary hypertensive vascular disease. Twenty-four patients were enrolled in the study for treatment with macitentan. Efficacy was determined by echo parameters and brain natriuretic peptide levels (BNP) at 3months and 1year. For detailed analysis, the entire cohort was subgrouped into patients with congenital heart disease-related PH (CHD-PH) and non-CHD-PH patients, respectively. Mean age of the patients was 10.7±7.6 years; median observation period was 36months. Twenty of 24 patients were on additional sildenafil and/or prostacyclins. Two of 24 patients discontinued because of peripheral edema. Within the entire cohort, BNP levels and all echo measures such as right ventricular systolic pressure (RVSP), right ventricular end-diastolic diameter (RVED), tricuspid annular plane systolic excursion (TAPSE), pulmonary velocity time integral (VTI), and pulmonary artery acceleration time (PAAT) improved significantly after 3months (p ≤ 0.01), whereas in the long term significant improvement persisted for BNP levels (-16%), VTI (+14%) and PAAT (+11%) (p<0.05). By subgroup analysis, non-CHD PH patients showed significant improvements in BNP levels (-57%) and all echo measures (TAPSE +21%, VTI +13%, PAAT +37%, RVSP -24%, RVED -12%) at 3months (p≤0.01), whereas at 12months, improvements persisted (p<0.05) except for RVSP and RVED (nonsignificant). In CHD-PH patients, none of the measures changed (nonsignificant). 6-MWD (distance walked in 6 minutes)slightly increased but was not statistically evaluated. Data presented herein account for the largest cohort of severely affected pediatric patients receiving macitentan. Overall, macitentan was safe and associated with significant beneficial effects and sustained positive signals after 1year, albeit in the long term disease progression remains a major concern. Our data suggest limited efficacy in CHD-related PH, whereas favorable outcomes were mainly driven by improvements in patients with PH not related to CHD. Larger studies are needed to verify these preliminary results and to prove efficacy of this drug in different pediatric PH entities.

Predictors and clinical implications of residual mitral regurgitation following left ventricular assist device therapy

BackgroundCorrection of mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation remains controversial. There is conflicting evidence regarding the clinical impact of residual MR, and studies...

Transcatheter tricuspid valve edge-to-edge repair after a heart transplant: a single-centre experience with a novel therapy†.

Tricuspid regurgitation (TR) in patients who had heart transplants is associated with poor outcome. The increased risk for surgical and postoperative complications might be reduced in these vulnerable patients by transcatheter therapies. All patients with a prior heart transplant (HTX) undergoing transcatheter edge-to-edge repair in the tricuspid position (T-TEER) were prospectively enrolled in an institutional registry. Seven patients who had heart transplants (5/7 female) at a mean age of 53 [48; 64] and median TRI-SCORE of 14 [7; 22] underwent T-TEER to treat symptomatic TR ≥ IV in an elective (n = 6) and urgent (n = 1) setting, respectively. The median time from HTX to T-TEER was 13 years. A total of 2 (n = 4) and 3 (n = 3) clips were implanted with a technical success in 6/7 (one single- device detachment). TR reduction was effective and durable within a median echocardiographic follow-up time of 10 months (TR baseline vs last follow-up: P = 0.03). Further, significant right ventricular remodelling (right ventricular end-diastolic diameter: 50 mm-36 mm, P = 0.02), decrease in the inferior vena cava diameter (24 mm-18 mm, P = 0.04) and in the gamma-glutamyl-transferase (255 U/l-159 U/l, P = 0.04) was found. Four of 7 patients were free of cardiovascular death (n = 1, 267 days after T-TEER), cardiac redo surgery (n = 1) and heart failure hospitalization (n = 2) and had no further clinical signs of right heart failure. T-TEER after HTX is feasible and effective regarding TR reduction in a short-term follow-up. The initial results may pave the way for a novel approach in TR management in patients having HTX.

Tissue Doppler Echocardiography As A Predictor Of Early Subclinical Right Ventricular Diastolic Dysfunction In Asthmatic Children.

To assess the effect of asthma in children on systolic and diastolic functions of the heart, and to explore the relationship between the two. The case-controlstudy was conducted at Kafrelsheikh University Hospital, Egypt, from September 2019 to May 2022, and comprised asthmatic children of either gender aged 5-15 years and healthy controls matched for age and gender. The participants were subjected to detailed history, complete examination, spirometry evaluation and conventional and tissue Doppler echocardiography. Myocardial performance index was calculated and compared. Data was analysed using SPSS 22. Of the 120 subjects, 60(50%) were cases; 33(55%) boys and 27(45%) girls with mean age 9.4±2.9 years(range: 5-15 years). The remaining 60(50%)subjects were controls; 34(56.6%) boys and 26(43.3%) girls with mean age 9.7±2.9 years (range: 5-15 years). Left ventricular dimensions, estimated pulmonary artery pressure, and right ventricular dimensions showed no significant inter-group differences (p>0.05), but right ventricular end diastolic diameter was significantly higher in the cases than the controls (p=0.046). Tissue Doppler showed that lateral annular peak Ê, Â, isovolumetric relaxation time and myocardial performance index values were significantly different between the groups (p<0.05). Tissue Doppler echocardiography could detectsubtle right ventricular diastolic dysfunction in asthmatic children even with no clinical symptoms and normal findings on conventional echocardiography.

Comparison of echocardiographic pulmonary flow Doppler markers in patients with massive or submassive acute pulmonary embolism and control group: A cross-sectional study.

Computed tomography angiography (CTA) is the gold standard for the diagnosis of massive (MPE) and submassive pulmonary embolism (SMPE). Ultrasound has not been accepted as a diagnostic tool. We aim to evaluate the pattern of pulmonary Doppler echocardiography in patients with pulmonary embolism (PE). From 2020 to 2022, 30 patients with acute MPE or SMPE confirmed by CTA and normal pulmonary pressures were selected. A control group was created with 30 individuals without PE. All patients had an echocardiography Doppler study of the pulmonary flow with a focus on early systolic notching (ESN), McConnell's (MC) sign, Right ventricular outflow tract velocity time integral (RVOTVTI), segmental thickness variability (STV), right ventricular end-diastolic diameter (RVEDD), tricuspid regurgitation (TR) gradient, pulmonary artery pressure (PAP), and acceleration (AT) or ejection time (ET). ESN was identified in 96.6% of PE patients and 0% of the control group (p < 0.001). In comparison with the control group, STV (p < 0.001), RVOT VTI (p < 0.001), ET (p = 0.04), and AT (p < 0.001) values were lower in patients with PE while RVEDD, TR gradient, PAP, ESN, MC sign, and d-shape were higher (p < 0.001). Identification of the ESN pattern and AT/ET < 0.4 showed excellent predictive ability for MPE and SMPE with a sensitivity of 97.0% and 100%, specificity of 99.0% and 97%, and an area under the ROC curve of 0.967 (95% CI 0.914-1.00) and 0.933 (95% CI 0.844-1.00), respectively. Doppler echocardiography with particular attention to ESN, may be a suitable noninvasive method for the diagnosis of MPE and SMPE. Further studies with more sample sizes are needed to confirm its diagnostic benefit.

A mid- and long-team follow-up study of the application of single-valved bovine pericardium patches in right ventricular outflow tract reconstruction.

Pulmonary regurgitation following right ventricular outflow tract (RVOT) reconstruction may cause right heart dysfunction and even right heart failure. Installation of a single valve at this time point can effectively reduce pulmonary regurgitation, thereby protecting right heart function. Here, we analyzed the outcomes and mid- and long-term follow-up data of patients undergoing single-valved bovine pericardium patch (svBPP) placement for reconstruction and explored the effectiveness and gaps of svBPP in preventing right heart failure. A retrospective analysis was performed on patients undergoing RVOT reconstruction using BalMonocTM svBPP from October 2010 to August 2020. The follow up procedures included outpatient visits and collection of outcomes. The cardiac ultrasound-related indicators during the follow-up visits included ejection fraction (EF), right ventricular end-diastolic diameter (EDD), pulmonary regurgitation, and pulmonary artery stenosis. The survival rates and reoperation-free rate were analyzed by Kaplan-Meier method. Patients includes tetralogy of Fallot, pulmonary atresia and other complex congenital heart disease. A total of 5 patients (5.7%) died during the perioperative period. Early complications included pleural effusion, cardiac insufficiency, respiratory insufficiency, chylothorax, and atelectasis, all of which were cured. After discharge, 83 patients (94.3%) were effectively followed up. During follow-up, 1 patient died and 1 patient underwent reoperation. The 1-, 5-, and 10-year survival rates were 98.8%, 98.8%, and 98.8%, respectively, and the reintervention-free rates for the same intervals were 98.8%, 98.8%, and 98.8%, respectively. The last follow-up ultrasound revealed severe pulmonary stenosis in 0 cases, moderate stenosis in 2 cases, mild stenosis in 7 cases, and no stenosis in 73 cases. Pulmonary regurgitation was not found in 12 patients; however, there were 2 cases of severe pulmonary regurgitation, 20 cases of moderate pulmonary regurgitation, and 48 cases of mild pulmonary regurgitation. As shown in the mid- and long-term follow-up studies, BalMonocTM svBPP has good performance in RVOT reconstruction. It can effectively eliminate or reduce pulmonary valve regurgitation and protect right heart function. Both réparation à l'Etage ventriculaire (REV) and the modified Barbero-Marcial procedure can bring growth potential and reduce reoperation rate.

Evaluation of fetal cardiac function in fetal growth restriction via fetal HQ analysis based on two-dimensional STI.

Abnormalities of the fetal cardiovascular system caused by fetal growth restriction (FGR) may lead to adverse outcomes. The fetal cardiac function assessment is of great significance for treatment selection and prognostic evaluation of fetuses with FGR. This study aimed to explore the value of fetal HQ analysis based on speckle tracking imaging (STI) to evaluate the global and regional cardiac function of fetuses with early-onset or late-onset FGR. From June 2020 to November 2022, 30 pregnant women with early-onset FGR (21-38 gestational weeks) and 30 pregnant women with late-onset FGR (21-38 gestational weeks) in the Department of Ultrasound, Shandong Maternal and Child Health Hospital were enrolled. Also, 60 healthy volunteer pregnant women were enrolled as two control groups according to the principle of matching gestational weeks (21-38 gestational weeks). The fetal cardiac functions, including fetal cardiac global spherical index (GSI), left ventricular ejection fraction (LVEF), fractional area change (FAC) of both ventricles, global longitudinal strain (GLS) of both ventricles, 24-segmental fractional shortening (FS), 24-segmental end-diastolic ventricular diameter (EDD), and 24-segmental spherical index (SI), were assessed using fetal HQ. The standard biological values of fetuses and Doppler blood flow parameters of fetuses and mothers were measured. The estimated fetal weight (EFW) measured by the last prenatal ultrasound was calculated, and the weights of newborns were followed up. Among early FGR, late FGR and total control group, significant differences were found in global cardiac indexes of right ventricle (RV), left ventricle (LV) and GSI. For the segmental cardiac indexes, there are significant differences in three groups except parameter of LVSI. Compared with the control group at the same gestational week, the Doppler indexes including MCAPI and CPR in both the early-onset FGR group and the late-onset FGR group were significantly different. The intra- and inter-observer correlation coefficients of RV FAC, LV FAC, RV GLS, and LV GLS were good. Further, the intra- and inter-observer variability in FAC and GLS was small, as analyzed using the Bland-Altman scatter plot. Fetal HQ software based on STI showed that FGR affected the global and segmental cardiac function of both ventricles. FGR no matter early-onset or late-onset altered Doppler indexes significantly. The FAC and the GLS had satisfactory repeatability in evaluating fetal cardiac function.

Prognostic significance of pulmonary arterial wedge pressure estimated by deep learning in acute heart failure.

Acute decompensated heart failure (ADHF) presents with pulmonary congestion, which is caused by an increased pulmonary arterial wedge pressure (PAWP). PAWP is strongly associated with prognosis, but its quantitative evaluation is often difficult. Our prior work demonstrated that a deep learning approach based on chest radiographs can calculate estimated PAWP (ePAWP) in patients with cardiovascular disease. Therefore, the present study aimed to assess the prognostic value of ePAWP and compare it with other indices of haemodynamic congestion. We conducted a post hoc analysis of a single-centre, prospective, observational heart failure registry and analysed data from 534 patients admitted for ADHF between January 2018 and December 2019. The deep learning approach was used to calculate ePAWP from chest radiographs at admission and discharge. Patients were divided into three groups based on the ePAWP tertiles at discharge, as follows: first tertile group (ePAWP≤11.2mm Hg, n=178), second tertile group (11.2<ePAWP<13.5mm Hg, n=170), and third tertile group (ePAWP≥13.5mm Hg, n=186). The third tertile group had a higher prevalence of atrial fibrillation and lower systolic blood pressure at admission; a lower platelet count and higher total bilirubin at both admission and discharge; and a higher left atrial diameter, peak early diastolic transmitral flow velocity, right ventricular end-diastolic diameter, and maximal inferior vena cava diameter at discharge. During the median follow-up period of 289days, 223 (41.7%) patients reached the primary endpoint (a composite of all-cause mortality or rehospitalization for heart failure). Kaplan-Meier analysis revealed a significantly higher composite event rate in the third tertile group (log-rank test, P=0.006). Even when adjusted for clinically relevant factors, a higher ePAWP at discharge and a smaller decrease in ePAWP from admission to discharge were significantly associated with higher event rates [ePAWP at discharge: hazard ratio, 1.10; 95% confidence interval (CI), 1.02-1.19; P=0.010; and size of ePAWP decrease: hazard ratio, 0.94; 95% CI, 0.89-0.99; P=0.038]. Our study suggests that ePAWP calculated by a deep learning approach may be useful for identifying and monitoring pulmonary congestion during hospitalization for ADHF.