Ventricular Shortening Research Articles

Unsupervised unpaired multiple fusion adaptation aided with self-attention generative adversarial network for scar tissues segmentation framework

Late gadolinium enhancement (LGE) is a specialized imaging technique used in cardiovascular magnetic resonance (CMR) imaging to detect and characterize areas of scar tissue or fibrosis within the heart muscle. After a heart attack, the affected region of the heart muscle becomes scarred due to insufficient blood supply. LGE CMR enhances the infarcted myocardium to appear with distinctive brightness compared to healthy tissues. It is primarily used to assess various heart conditions and can identify the extent and location of scar tissue, helping in risk stratification and guiding treatment decisions. Automated myocardium segmentation in LGE CMR poses challenges due to intensity heterogeneity caused by the accumulation of contrast agents in infarcted areas. Furthermore, LGE CMR images with gold standard labels are particularly scarce compared to other sequences, making the task even more demanding. Besides, the heart’s motion involves complex non-rigid deformations, including regional wall thickening, circumferential, and longitudinal ventricular shortening, making it challenging to model. This work presents an unsupervised unpaired domain adaptive scar tissue segmentation framework aided with the self-attention generative adversarial network. Besides, we proposed a novel segmentation architecture based on a parallel transformer for scar segmentation and compared the results with and without style transfer GAN and unpaired style self-supervised attention GAN. Besides, to model longitudinal changes in scare, we used eight days’ time points as a source and 1 month and 12 as a target and applied our proposed attention-generative network to transfer style from one-time point to another time. Experiments on four different LGE MICCAI datasets from 2019 to 2023 achieved significantly better performance than state-of-the-art segmentation methods.

Longitudinal echocardiographic parameters before and after pacemaker placement in congenital complete heart block

BackgroundCongenital complete heart block (CCHB) is seen in 1:15,000–1:20,000 live births, with risk of left ventricular (LV) dysfunction or dilated cardiomyopathy in 7%–23% of subjects. ObjectiveThe purpose of this study was to investigate serial changes in LV size and systolic function in paced CCHB subjects to examine the effect of time from pacemaker on echocardiographic parameters. MethodsSingle-center retrospective cohort analysis of paced CCHB subjects was performed. Echocardiographic data were collected before and after pacemaker placement. Linear mixed effect regression of left ventricular end-diastolic dimension (LVEDD) z-score, left ventricular shortening fraction (LVSF), and left ventricular ejection fraction (LVEF) was performed, with slopes compared before and after pacemaker placement. ResultsOf 114 CCHB subjects, 52 had echocardiographic data before and after pacemaker placement. Median age at CCHB diagnosis was 0.6 [interquartile range 0.0–3.5] years; age at pacemaker placement 3.4 [0.5–9.0] years; and pacing duration 10.8 [5.2–13.7] years. Estimated LVEDD z-score was 1.4 at pacemaker placement and decreased –0.08 per year (95% confidence interval [CI] –0.12 to –0.04; P = .002) to 0.2 (95% CI –0.3 to +0.3) 15 years postplacement. Estimated LVSF decreased –1.1% per year (95% CI –1.7% to –0.6%; P <.001) from 6 months prepacemaker placement to 34% (95% CI 32%–37%) 4 years postplacement. There was no significant change in LVSF between 4 and 15 years postplacement. Estimated LVEF did not change significantly after pacemaker placement, with estimated LVEF 59% (95% CI 55%–62%) 15 years postplacement. ConclusionIn 52 paced CCHB subjects, estimated LVEDD z-score decreased significantly after pacemaker placement, and estimated LVSF and LVEF remained within normal limits at 15 years postpacemaker placement.

Impact of Microvascular Disease on Changes in Left Ventricular Long-Axis Shortening with Hyperoxia

Impact of Microvascular Disease on Changes in Left Ventricular Long-Axis Shortening with Hyperoxia

Narcissin induces developmental toxicity and cardiotoxicity in zebrafish embryos via Nrf2/HO-1 and calcium signaling pathways.

Narcissin is a natural flavonoid from some edible and traditional medicinal plants. It has been proven to have multiple biological functions and exhibits potential therapeutic effects on hypertension, cancer, and Alzheimer's disease. However, the toxicity of narcissin is largely unknown. Here, we revealed that narcissin treatment led to reduced hatchability, increased malformation rate, shorter body length, and slowed blood flow in zebrafish. Furthermore, bradycardia, pericardial edema, increased SV-BA distance, diminished stroke volume, ejection fraction, and ventricular short-axis shortening rate were also found. A large accumulation of ROS, increased apoptotic cells, and histopathological changes were detected in the heart region. Moreover, the gene expression profiles and molecular docking analysis indicated that Nrf2/HO-1 and calcium signaling pathways were involved in narcissin-induced toxicity. In conclusion, here we provide the first evidence that demonstrates narcissin-induced developmental toxicity and cardiotoxicity in zebrafish via Nrf2/HO-1 and calcium signaling pathways for the first time.

Incidence and surveillance of acute cardiovascular toxicities in paediatric acute lymphoblastic leukaemia: A retrospective population-based single-centre cohort study

AimHere, we studied the incidence of acute cardiovascular toxicities in children treated for acute lymphoblastic leukaemia (ALL). MethodsWe performed a population-based single-centre longitudinal retrospective cohort study in 70 children diagnosed and treated with anthracycline-containing therapy against ALL at Karolinska University Hospital during 2015–2019 with a follow-up period of at least three months. Cardiovascular surveillance for these patients included echocardiography with measurements of left ventricular ejection fraction (LVEF) and shortening fraction (LVSF), electrocardiography and non-invasive blood pressure monitoring. ResultsNo patient experienced a significant decrease in LVEF or LVSF during or early after primary cancer treatment including anthracyclines. Surveillance with LVEF and LVSF was unable to predict the trajectory to severe clinical heart failure in one patient following treatment. Pericardial effusion prior to therapy initiation occurred in 13.6% of the patients. The incidence of intracardiac thrombosis and arterial hypertension was 8.5%, and 20%, respectively. ConclusionEarly cardiovascular toxicities were common in this paediatric ALL cohort. We confirm that early routine LVEF and LVSF assessments were insufficient to identify patients at risk of subsequent treatment-related heart failure. This underlines the unmet need of more sensitive methods for cardiovascular surveillance in children treated for cancer to reduce the burden of cardiovascular morbidity and mortality.

Stepwise application of ECG and electrogram based criteria to ensure left bundle branch pacing

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): MPL received the Catalan Society of Cardiology Research Grant in 2019 and 2020 (Catalonia, Spain); the Josep Font Grant (2019-2022) from Hospital Clínic Barcelona (Catalonia, Spain). Background Left bundle branch pacing (LBBP) has emerged as an alternative to biventricular pacing. However, lack of a systematic stepwise application of the left bundle branch (LBB) capture criteria complicates implantation. Objective To define a stepwise application of LBBP capture criteria that will simplify implantation and ensure LBB capture. Methods A cohort of 24 patients from the LEVEL-AT trial who received LBBP and had electrocardiographic imaging (ECGI) at 45 days post-implant were included. The usefulness of ECG and electrogram based criteria to predict accurate LBB capture were analyzed. A two-step approach was developed to ensure LBB capture. The gold standard used to confirm LBB capture was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI. Results Twenty-two (91.6%) patients showed LBBP capture on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120ms) resulted in 95% sensitivity and 100% specificity to predict LBB capture, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R&amp;lt;80ms (100% specificity, sensitivity 46%) ensured 100% accuracy to predict LBBP capture. Conclusions Stepwise application of ECG and electrogram criteria ensured an accurate assessment of left conduction system capture.

Analysis of bi-atrial function using CMR feature tracking and long-axis shortening approaches in patients with diastolic dysfunction and atrial fibrillation.

Atrial function can be assessed using advancing cardiovascular magnetic resonance (CMR) post-processing methods: atrial feature tracking (FT) strain analysis or a long-axis shortening (LAS) technique. This study aimed to first compare the two FT and LAS techniques in healthy individuals and cardiovascular patients and then investigated how left (LA) and right atrial (RA) measurements are related to the severity of diastolic dysfunction or atrial fibrillation. Sixty healthy controls and 90 cardiovascular disease patients with coronary artery disease, heart failure, or atrial fibrillation, underwent CMR. LA and RA were analyzed for standard volumetry as well as for myocardial deformation using FT and LAS for the different functional phases (reservoir, conduit, booster). Additionally, ventricular shortening and valve excursion measurements were assessed with the LAS module. The measurements for each of the LA and RA phases were correlated (p < 0.05) between the two approaches, with the highest correlation coefficients occurring in the reservoir phase (LA: r = 0.83, p < 0.01, RA: r = 0.66, p < 0.01). Both methods demonstrated reduced LA (FT: 26 ± 13% vs 48 ± 12%, LAS: 25 ± 11% vs 42 ± 8%, p < 0.01) and RA reservoir function (FT: 28 ± 15% vs 42 ± 15%, LAS: 27 ± 12% vs 42 ± 10%, p < 0.01) in patients compared to controls. Atrial LAS and FT decreased with diastolic dysfunction and atrial fibrillation. This mirrored ventricular dysfunction measurements. Similar results were generated for bi-atrial function measurements between two CMR post-processing approaches of FT and LAS. Moreover, these methods allowed for the assessment of incremental deterioration of LA and RA function with increasing left ventricular diastolic dysfunction and atrial fibrillation. A CMR-based analysis of bi-atrial strain or shortening discriminates patients with early-stage diastolic dysfunction prior to the presence of compromised atrial and ventricular ejection fractions that occur with late-stage diastolic dysfunction and atrial fibrillation. • Assessing right and left atrial function with CMR feature tracking or long-axis shortening techniques yields similar measurements and could potentially be used interchangeably based on the software capabilities of individual sites. • Atrial deformation and/or long-axis shortening allow for early detection of subtle atrial myopathy in diastolic dysfunction, even when atrial enlargement is not yet apparent. • Using a CMR-based analysis to understand the individual atrial-ventricular interaction in addition to tissue characteristics allows for a comprehensive interrogation of all four heart chambers. In patients, this could add clinically meaningful information and potentially allow for optimal therapies to be chosen to better target the dysfunction.

PO-03-012 STEPWISE APPLICATION OF ECG AND ELECTROGRAM BASED CRITERIA TO ENSURE ELECTRICAL RESYNCHRONIZATION WITH LEFT BUNDLE BRANCH PACING

Left bundle branch pacing (LBBP) has emerged as an alternative to biventricular pacing. However, a systematic stepwise approach to ensure electrical resynchronization is lacking. To define a stepwise application of LBBP criteria that will simplify implantation and guarantee electrical resynchronization. A cohort of 24 patients from the LEVEL-AT trial (NCT04054895) who received LBBP and had electrocardiographic imaging (ECGI) (CardioinsightTM Medtronic, USA) at 45 days post-implant were included. The usefulness of ECG and electrogram based criteria to predict accurate electrical resynchronization with LBBP were analyzed. A two-step approach was developed. The gold standard used to confirm resynchronization was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI. Twenty-two (91.6%) patients showed electrical resynchronization on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120ms) resulted in 95% sensitivity and 100% specificity to predict LBBP resynchronization, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R<80ms (100% specificity, sensitivity 46%) ensured 100% accuracy to predict resynchronization by LBBP. Stepwise application of ECG and electrogram criteria ensured accurate assessment of electrical resynchronization with left bundle branch pacing.

Activation of Kir2.1 improves myocardial fibrosis by inhibiting Ca 2+ overload and the TGF-β1/Smad signaling pathway.

The inwardly rectifying potassium channel Kir2.1 is closely associated with many cardiovascular diseases. However, the effect and mechanism of Kir2.1 in diabetic cardiomyopathy remain unclear. In vivo, we use STZ to establish the model, and ventricular structural changes, myocardial inflammatory infiltration, and myocardial fibrosis severity are detected by echocardiography, histological staining, immunohistochemistry, and western blot analysis, respectively. In vitro, a myocardial fibrosis model is established with high glucose. The Kir2.1 current amplitude, intracellular calcium concentration, fibrosis-related proteins, and TGF-β1/Smad pathway proteins are detected by whole-cell patch clamp, calcium probes, western blot analysis, and immunofluorescence, respectively. The in vivo results show that compared to diabetic cardiomyopathy, zacopride (a Kir2.1 selective agonist) significantly reduces the left ventricular systolic diameter and diastolic diameter, increases the left ventricular ejection fraction and left ventricular short-axis shortening, improves the degree of cell necrosis, and reduces the expression of myocardial interstitial fibrosis protein and collagen fibre deposition area. The in vitro results show that the current amplitude and protein expression of Kir2.1 are both decreased in the high glucose-induced myocardial fibrosis model. Additionally, zacopride significantly upregulates the expression of Kir2.1 and inhibits the expressions of the fibrosis-related proteins α-SMA, collagen I, and collagen III. Activation of Kir2.1 reduces the intracellular calcium concentration and inhibits the protein expressions of TGF-β1 and p-Smad 2/3. Activation of Kir2.1 can improve myocardial fibrosis induced by diabetic cardiomyopathy, and the possible mechanism may be related to inhibiting Ca 2+ overload and the TGF-β1/Smad signaling pathway.

Assessing cardiac contractility in hypertension with heart failure with preserved ejection fraction: the value of left ventricular strain

Aim: Hypertension (HTN) is a major cause of heart failure but the precise pathways by which HTN leads to heart failure are not resolved. Newer echocardiographic techniques permit assessment of myocardial contraction in different orientations defining left ventricular (LV) shortening as percentage longitudinal, circumferential and radial strain. Methods: A systematic search was conducted of Medline and Embase. The search was conducted from the inception of each database on June 30, 2022. Search terms “left ventricular strain” or speckle tracking AND heart failure with preserved ejection fraction or diastolic dysfunction AND HTN. Results: Six studies were identified and subject to detailed review. LV ejection fraction (LVEF) was not significantly different in patients with heart failure with preserved ejection fraction (HFpEF) and HTN compared to individuals with or without HTN. Global longitudinal strain (GLS) and global circumferential strain (GCS) were significantly (P &lt; 0.0001) different (lower) in patients with HFpEF and HTN compared to patients with HTN without HFpEF and control individuals without HTN or other conditions. In contrast, global radial strain (GRS) was not significantly (P &lt; 0.054) different in patients with HFpEF and HTN compared to individuals without HTN or other conditions. GRS was significantly (P &lt; 0.01) different in individuals with HFpEF and HTN compared to individuals with HTN. Conclusions: Assessment of LV strain is an important advance in the assessment of LV function in patients with HTN and HFpEF as it identifies patients with reduced LV strain while there was no difference in LVEF. GLS and GCS provide the best separation between patients with HFpEF and HTN compared to individuals with HTN without HFpEF. This study advances the possibility of redefining the classification of heart function and heart failure for patients with HTN by either classifying patients mainly by LV strain or sub-classifying patients with HTN and HFpEF by LV strain.

Transverse and longitudinal right ventricular fractional parameters derived from four-chamber cine MRI are associated with right ventricular dysfunction etiology

Studies of the usefulness of transverse right ventricular (RV) shortening are limited. We retrospectively analyzed the CMR images of 67 patients (age: 50.8 ± 19.0 years; men: 53.7%; Control: n = 20, Overloaded RV (atrial septal defect): n = 15, Constricted RV (pericarditis): n = 17, Degenerated RV (arrhythmogenic right ventricular cardiomyopathy): n = 15) (all enrolled consecutively for each disease) in a single center. We defined RV longitudinal (fractional longitudinal change: FLC) and transverse (fractional transverse change: FTC) contraction parameters. We assessed the FTC/FLC (T/L) ratio on four-chamber cine CMR views and compared the four groups regarding the fractional parameters. FTC had a stronger correlation (R2 = 0.650; p < 0.001) with RV ejection fraction than that with FLC (R2 = 0.211; p < 0.001) in the linear regression analysis. Both FLC and FTC were significantly lower in the Degenerated RV and Constricted RV groups compared with those in the Control and Overloaded RV groups. The T/L ratio was significantly lower in the Degenerated RV group (p = 0.008), while the Overloaded RV (p = 0.986) and Constricted RV (p = 0.582) groups had preserved T/L ratios, compared with the Control group. Transverse shortening contributes to RV function more significantly compared with longitudinal contraction. Impaired T/L ratios may reflect RV myocardial degeneration. RV fractional parameters may help precisely understand RV dysfunction.

Abstract TMP112: CD133+Exosome Treatment Improves Neuro-cognitive And Cardiac Function After Stroke In Female Adult Type 2 Diabetic Mice

Background: Cardiac complications post-stroke are common, and diabetes exacerbates post-stroke cardiac injury. In this study, we tested whether treatment with exosomes harvested from human umbilical cord blood derived CD133+ cells (CD133+Exo) improve neuro-cognitive and cardiac function in female type 2 diabetes mellitus (T2DM) mice subjected to ischemic stroke. Methods: Female, adult non-DM and T2DM mice were randomized to: 1) Non-DM (n=6), 2) Non-DM-stroke (n=15), 3) T2DM (n=8), 4) T2DM-stroke (n=12) and 5) T2DM-stroke+Exo (n=13). CD133+Exo (20μg/200μl PBS, i.v.) was administered 3 days after stroke. Evaluation of neurological function (mNSS, adhesive removal test), cognitive function (novel object recognition (NOR) test, odor test) and cardiac function (echocardiography) was performed, and mice were sacrificed at 28 days after stroke. Results: Stroke induces severe neurological deficits and significant short-term and long-term memory deficits which were worse in T2DM mice compared to non-DM mice. CD133+Exo treatment in T2DM-stroke mice significantly improves neurological function and cognitive outcome indicated by improved discrimination index in NOR test and odor test compared to control T2DM-stroke mice. T2DM-stroke induces significant cardiac dysfunction indicated by reduced left ventricular ejection fraction (LVEF) and shortening fraction (LVSF) compared to T2DM-control and non-DM-stroke mice. CD133+Exo treatment significantly improves LVEF, LVSF and heart rate and reduces left ventricular dimension compared to T2DM-stroke mice. T2DM-stroke mice exhibit significantly increased cardiomyocyte hypertrophy, cardiac fibrosis and inflammation compared to T2DM-control and non-DM-stroke mice. Treatment of T2DM-stroke with CD133+Exo significantly reduced cardiomyocyte hypertrophy, cardiac fibrosis and inflammation compared to T2DM-stroke mice. T2DM-stroke increases while CD133+Exo treatment reduces expression of serum inflammatory factors such as MMP-2, DKK-1, CRP, VCAM, CXCL5 and Cystatin-C. Conclusions: In T2DM-stroke mice, CD133+Exo treatment significantly improves neurological, cognitive, and cardiac function, and reduces cardiac pathological remodeling compared to T2DM-stroke control mice.

Exercise Training Does Not Attenuate Cardiac Atrophy or Loss of Function in Individuals With Acute Spinal Cord Injury: A Pilot Study

ObjectiveTo investigate the effects of 2 modes of exercise training, upper-body alone, and the addition of electrical stimulation of the lower body, to attenuate cardiac atrophy and loss of function in individuals with acute spinal cord injury (SCI). DesignRandomized controlled trial. SettingRehabilitation Hospital. ParticipantsVolunteers (N=27; 5 women, 22 men) who were <24 months post SCI. InterventionsVolunteers completed either 6 months of no structured exercise (Control), arm rowing (AO), or a combination of arm rowing with electrical stimulation of lower body paralyzed muscle (functional electrical stimulation [FES] rowing). Main Outcome MeasuresTransthoracic echocardiography was performed on each subject prior to and 6 months after the intervention. The relations between time since injury and exercise type to cardiac structure and function were assessed via 2-way repeated-measures analysis of variance and with multilevel linear regression. ResultsTime since injury was significantly associated with a continuous decline in cardiac structure and systolic function, specifically, a reduction in left ventricular mass (0.197 g/month; P=.049), internal diameter during systole (0.255 mm/month; P<.001), and diastole (0.217 mm/month; P=.019), as well as cardiac output (0.048 L/month, P=.019), and left ventricular percent shortening (0.256 %/month; P=.027). These associations were not differentially affected by exercise (Control vs AO vs FES, P>.05). ConclusionsThese results indicate that within the subacute phase of recovery from SCI there is a linear loss of left ventricular cardiac structure and systolic function that is not attenuated by current rehabilitative aerobic exercise practices. Reductions in cardiac structure and function may increase the risk of cardiovascular disease in individuals with SCI and warrants further interventions to prevent cardiac decline.

Interchangeability of right ventricular longitudinal shortening fraction assessed by transthoracic and transoesophageal echocardiography in the perioperative setting: A prospective study.

Conventional transthoracic (TTE) and transoesophageal echocardiography (TEE) parameters assessing right ventricle (RV) systolic function are daily used assuming their clinical interchangeability. RV longitudinal shortening fraction (RV-LSF) is a two-dimensional speckle tracking parameter used to assess RV systolic function. RV-LSF is based on tricuspid annular displacement analysis and could be measured with TTE or TEE. The aim of the study was to determine if RV-LSFTTE and RV-LSFTEE measurements were interchangeable in the perioperative setting. Prospective perioperative TTE and TEE echocardiography were performed under general anesthesia during scheduled cardiac surgery in 90 patients. RV-LSF was measured by semi-automatic software. Comparisons were performed using Pearson correlation and Bland-Altman plots. RV-LSF clinical agreement was determined as a range of -5 to 5%. Of the 114 patients who met the inclusion criteria, 90 were included. The mean preoperative RV-LSFTTE was 20.4 ± 4.3 and 21.1 ± 4.1% for RV-LSFTEE. The agreement between RV-LSF measurements was excellent, with a bias at -0.61 and limits of agreement of -4.18 to 2.97 %. All measurements fell within the determined clinical agreement interval in the Bland-Altman plot. Linear regression analysis showed a high correlation between RV-LSFTTE and RV-LSFTEE measurement (r = 0.9; confidence interval [CI] 95%: [0.87-0.94], p < 0.001). RV-LSFTTE and RV-LSFTEE measurements are interchangeable, allowing RV-LSF to be a helpful parameter for assessing perioperative changes in RV systolic function. NCT05404737. https://www.clinicaltrials.gov/ct2/show/NCT05404737.

Novel grading system for ischemia‒reperfusion injury manifestations in patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

To establish a simple myocardial ischemia‒reperfusion injury (MIRI) manifestation grading system based on clinical manifestations and coronary angiography during primary percutaneous coronary intervention (PPCI). All STEMI patients treated with PPCI from June 2018 to November 2019 were included. According to the MIRI manifestation grade, patients were divided into four grades (I–IV). Laboratory and clinical indicators of the patients and the occurrence of major adverse cardiac events (MACEs) within one year of follow-up were analyzed. A total of 300 patients were included. The higher the MIRI manifestation grade, the lower was the high-density lipoprotein cholesterol (HDL-C); the higher were the C-reactive protein (CRP), lipoprotein(a) [LP(a)], and peak levels of high-sensitivity troponin T (hs-cTnT), creatine kinase (CK-MB), and N-terminal pro-B-type natriuretic peptide (NT-proBNP); and the higher were the proportions of right coronary artery (RCA) and multivessel lesions (P < 0.05). The left ventricular end-diastolic dimension (LVEDD) and E/e′ values of patients with higher grades were significantly increased, while the LVEF, left ventricular short-axis functional shortening (LVFS) and E/A values were significantly decreased (P < 0.05). The one-year cumulative incidence of major adverse cardiac events (MACEs) in patients with grade I–IV disease was 7.7% vs. 26.9% vs. 48.4% vs. 93.3%, respectively, P < 0.05. The higher the MIRI manifestation grade, the more obvious is the impact on diastolic and systolic function and the higher is the cumulative incidence of MACEs within one year, especially in patients with multivessel disease, low HDL-C, high CRP, high LP(a) levels, and the RCA as the infarction-related artery.

Two-dimensional speckle tracking echocardiography, a powerful method for the evaluation of anthracyclines induced left ventricular insufficiency.

Anthracyclines have been one of the most important therapeutic methods in breast cancer therapy for decades. However, serious long-term toxicities, especially cardiotoxicity limits the continuous usage of anthracyclines, hence affects long term prognosis. Early detection of myocardial dysfunction during treatment is critical but challenging. Two-dimensional speckle tracking echocardiography (2D-STE) is a non-Doppler technique that can assess deformation and strain by tracking displacement of acoustic markers in the myocardium. This study aims to compare the sensitivity and precision between 2D-STE and traditional echocardiography on monitoring the left ventricular function in patients with breast cancer after anthracyclines therapy, which is the key indicator for evaluating myocardial changes. Thirty-three patients with breast cancer were recruited from February 2019 to December 2019. All patients were treated with 4 cycles anthracycline. 2D-STE and conventional echocardiography were performed on each patient. Two-dimensional echocardiographic examination was used to collect data interventricular septum diameter (IVSD), end-diastolic left ventricular posterior wall diameter (LVPWD), left ventricular end-diastolic diameter (LVEDD) and left ventricular systole on the parasternal left ventricular long axis view. The final diameter (left ventricular end-systolic diameter [LVESD]) and the left ventricular short axis shortening rate (LVFS) was measured by M-type. The two-plane Simpson’s method was used to measure left ventricular end-diastolic volume (LVEDV) and end-systolic volume (left ventricular end-systolic volume [LVESV]) to obtain left ventricular ejection fraction (LVEF). Two-dimensional speckle tracking imaging technical indicator includes left ventricular global longitudinal strain (LVGLS), subendocardial myocardial longitudinal strain (LVGLS-Endo) and epicardial myocardial longitudinal strain (LVGLS-Epi). The correlation between 2-dimensional speckle tracking imaging and conventional ultrasound parameters were analyzed. Compared with baseline (T0), the systolic function parameter LVEF was significantly changed after four cycle chemotherapy (T4) (P < .05). However, the conventional echocardiographic parameters including IVSD, LVPWD, LVEDD, LVESD, LVEDV, and LVESV were not statistically significant (P > .05). Meanwhile, the two-dimensional strain parameters LVGLS, LVGLS-Endo, and LVGLS-Epi were statistically significant after T2 and T4 cycle chemotherapy (P < .01).The two-dimensional strain parameter GLS has higher accuracy and sensitivity for monitoring left ventricular insufficiency caused by anthracycline therapy when compared with traditional echocardiography.

High salt intake damages myocardial viability and induces cardiac remodeling via chronic inflammation in the elderly.

BackgroundThe heart is an important target organ for the harmful effects of high dietary salt intake. However, the effects and associations of high salt intake on myocardial viability, cardiac function changes, and myocardial remodeling are unclear.MethodsA total of 3,810 participants aged 60 years and older were eligible and enrolled from April 2008 to November 2010 and from August 2019 to November 2019 in the Shandong area of China. Salt intake was estimated using 24-h urine collection consecutively for 7 days. Myocardial strain rates, cardiac function and structure, and serum high-sensitivity C-reactive protein (hsCRP) levels were assessed. Participants were classified into low (n = 643), mild (n = 989), moderate (n = 1,245), and high (n = 933) groups, corresponding to < 6, 6–9, 9–12, and >12 g/day of salt intake, respectively, depending on the salt intake estimation.ResultsThe global early diastolic strain rate (SRe) and late diastolic strain rate (SRa) in the high group were 1.58 ± 0.26, 1.38 ± 0.24. respectively, and significantly lower compared with the low, mild, and moderate groups (all P < 0.05). The global systolic strain rate (SRs) in the high group was −1.24 ± 0.24, and it was higher than those in the low, mild, and moderate groups (all P < 0.05). Salt intake was independently and positively correlated with global SRs, Tei index, and the parameters of left ventricular structure separately; negatively correlated with global SRe and SRa, left ventricular short axis shortening rate, left ventricular ejection fraction after adjusting for confounders (all Padjusted < 0.001). Hayes process analyses demonstrated that the mediating effects of hsCRP on global SRe, SRa, and SRs; Tei index; and left ventricular remodeling index were −0.013 (95% CI: −0.015 to −0.010), −0.010 (−0.012 to −0.008), 0.008 (0.006–0.010), 0.005 (0.003–0.006), and 0.010 (0.009–0.012), respectively (all Padjusted < 0.001).ConclusionOur data indicate that excess salt intake is independently associated with the impairment in myocardial viability and cardiac function, as well as myocardial remodeling. Chronic inflammation might play a mediating role in the association between high salt intake and cardiac function damage and myocardial remodeling.

Safety of heart radiotherapy for malignant cardiac tumors: a short and long term study

Abstract Background Radiotherapy (RT) may be used as a complementary or palliative treatment for selected cases of malignant cardiac tumors, and improves the overall and relapse-free survival in cardiac sarcomas (1–3). Its use is limited by the risk of radiation injury on the cardiac structures (4). Only few data about the safety of cardiac RT are available. Purpose This study aimed to assess the short and long term adverse cardiac effects in a cohort of patients with cardiac malignancies treated with RT directly on the heart. Methods We reviewed the clinical and echocardiographic data of 25 patients (pts) treated with cardiac RT from 2002 to 2021, using Intensity Modulated RT or Tomotherapy at doses of 25–59 Gy over 5–25 fractions for primary or metastatic tumors (21 sarcomas). The patients had ECG and echocardiogram (ECHO) before RT and weekly during the treatment. After RT, the cardiac surveillance included a visit with ECG and ECHO every 3 months for the first 2 years, every 6 months for 3 years, and yearly thereafter. We compared the left ventricular ejection fraction (LVEF) before RT and at the last available follow-up for all patients; for 12 pts whose radiation field included the right chambers, we analyzed also the right ventricular shortening fraction (RVSF) at the last available follow-up. Results The pts were 14 males, 11 females, aged 22 to 75 (median 54) when treated. The intent was adiuvant after R1 surgery in 12 pts, preoperative in 3, palliative or curative for metastatic or unresectable tumors or in patients refusing redo surgery or chemotherapy (10 pts). Anthracyclines chemotherapy was used in 19 pts. The radiation field included the left atrium and/or ventricle in 11 pts, the right heart in 9, both left and right structures in 3. Two pts were lost to follow-up after 36 and 50 months; 17 died, 3 to 175 months after RT (median 12), all for non-cardiac causes; 6 are alive (with complete local remission) 15 to 126 months (median 79) after completing RT. Acute toxicities were: atrial fibrillation in 2 pts, pericarditis in 2 (both reverted in one week with medical therapy) and temporary worsening of ventricular arrhythmias in one pt with myocardial metastases. At last follow-up no significant valvular or pericardial disease was evident; the LVEF was &amp;gt;50% in all pts (5–10% decreased -compared to baseline- in 2 pts, improved in 3, stable in the others) and the RVSF was &amp;gt;35%. Conclusions In our experience, RT may be used in the treatment of cardiac malignancies with little adverse effects both on short term and at a median follow-up of 13 months (and lasting up to &amp;gt;10 years). Funding Acknowledgement Type of funding sources: None.

Echocardiographic assessment of felines sedated with dexmedetomidine or xylazine associated with butorphanol

This prospective cohort study aimed to evaluate by echocardiogram the cardiovascular effects of α2 agents associated with butorphanol in cats. A group of 18 mixed-breed cats with a mean weight of 3.65 + 0.7 kg, with an approximate age of 6 months. The cats were assigned in three groups, XB (Xylazine/butorphanol group) sedation with 0.5 mg/kg of xylazine and 0.5 mg/kg of butorphanol IM; DB (Dexmedetomidine/butorphanol group): sedation with 20 µg/kg of dexmedetomidine and 0.5 mg/kg of butorphanol IM; C: control group which received saline solution in volume approximated to those used in the other groups, IM. Echocardiographic variables as ejection fraction (Simpson's method and M-mode) and left ventricular shortening fraction (M-mode), ejection volume, end-systolic volume and cardiac output (Teichholz), tissue Doppler E' and A' wave velocities and cardiac index were evaluated. There was a reduction in echocardiographic variables compared with the control group, being statistically significant for heart rate, ejection fraction (% by Simpson), shortening fraction (% in M-mode) and end-systolic volume in XB and DB groups, and tissue Doppler E' and A' wave velocity (m/s), E'/A' ratio, cardiac output and cardiac index only in XB group. When compared to each other, XB and DB differed significantly in the tissue Doppler E' and A' wave velocity (m/s), and E'/A' ratio. Xylazine was more deleterious than dexmedetomidine in most of the variables evaluated, leading to a significant reduction in cardiac output and cardiac index at the doses used in this study.

Effects of Isoprenaline on ventricular myocyte shortening and Ca2+ transport in the Zucker rat

Obesity is an important risk factor for diabetes mellitus (DM) which is a major global health problem. Electro-mechanical dysfunction has been extensively described in diabetic heart and cardiovascular complications are an important cause of mortality and morbidity in diabetic patients. ObjectivesTo examine the effects of Isoprenaline (ISO) in obesity and diabesity on ventricular myocyte shortening and Ca2+ transport in Zucker fatty (ZF), Zucker diabetic fatty (ZDF) in comparison to Zucker lean (ZL) rats. MethodsMyocyte shortening and intracellular Ca2+ were investigated with video imaging and fluorescence photometry, respectively. ResultsThe amplitude of Isoprenaline stimulated shortening was significantly (p < 0.05) decreased in ZDF and ZF compared to ZL myocytes. The amplitude of Isoprenaline stimulated Ca2+ transient was also significantly (p < 0.05) reduced in ZF compared to ZL and modestly reduced in ZDF compared to ZL myocytes. Mean Isoprenaline stimulated time to peak along with time to half relaxation of shortening were unchanged in ZDF and ZF compared to ZL myocytes. Mean Isoprenaline stimulated time to peak Ca2+ transient was significantly shortened in ZF compared to ZL myocytes. Time to half decay of the Ca2+ transient was considerably prolonged in ZDF compared to ZL myocytes. Amplitude of Isoprenaline stimulated caffeine-evoked Ca2+ transients were significantly reduced in ZDF and ZF in comparison to ZL myocytes. ConclusionIsoprenaline was less effective at generating an increase in the amplitude of shortening in ZDF and ZF in comparison to ZL myocytes and defects in Ca2+ signaling, and in particular SR Ca2+ transport, might partly underlie these abnormalities.