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Alotaibi MM, Alrashdi NZ, Almutairi Pt MK, Alqahtani MM, Almutairi AB, Alqahtani SM, Alajel HM, Bajunayd AK. Association of adipose tissue infiltration with cardiac function: scoping review. Adipocyte 2025; 14:2489467. [PMID: 40207777 PMCID: PMC11988230 DOI: 10.1080/21623945.2025.2489467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 03/27/2025] [Accepted: 04/01/2025] [Indexed: 04/11/2025] Open
Abstract
Evidence suggests that adipose tissue (AT) infiltration in skeletal muscles may negatively influence cardiac function, yet its use as a biomarker remains unclear. This scoping review examined the relationship between AT infiltration and cardiac function in adults. A systematic search of PubMed, CINAHL and SCOPUS identified peer-reviewed studies reporting AT infiltration and cardiac function measures. Excluded were review-type studies, animal studies, abstracts and case series. Study quality was assessed using the Study Quality Assessment Tool (SQAT). Three good-quality studies were included. Findings demonstrated a negative association between AT infiltration and cardiac function parameters, including exercise capacity, left ventricular ejection fraction (LVEF) and heart failure events, in cancer survivors and healthy individuals. There is evidence supporting an association between increased AT infiltration of skeletal muscles and impaired cardiac function, highlighting the need for further research to validate AT infiltration as a potential biomarker. Despite the limited available studies, our findings highlight a distinct association between skeletal muscle AT infiltration and cardiac dysfunction, independent of general obesity.
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Affiliation(s)
- Mansour M. Alotaibi
- Department of Rehabilitation, Faculty of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia
- Center for Health Research, Northern Border University, Arar, Saudi Arabia
| | - Naif Z. Alrashdi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, Saudi Arabia
- Health and Basic Sciences Research Center, Majmaah University, Majmaah, Saudi Arabia
| | - Marzouq K. Almutairi Pt
- Department of Physical Therapy, College of Applied Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Mohammed M. Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Anwar B. Almutairi
- Department of Physical Therapy, Faculty of Allied Health, Kuwait University, Jabriya, Kuwait
| | | | - Hamoud M. Alajel
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Amani K. Bajunayd
- Department of Internal Medicine, Western University, Ontario, Canada
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Zhu W, Lai Z, Xue M, Feng S, Feng P, Pan X, Ke X, Chen X, Li Z, Mao H, Yang X, Huang F, Chen W, Xu Y, Li S, Guo Q. Elevated concentrations of cardiac troponin T are associated with thoracic aortic calcification in non-dialysis chronic kidney disease patients of stage G3 to G5. Ren Fail 2025; 47:2440512. [PMID: 39694530 DOI: 10.1080/0886022x.2024.2440512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 11/30/2024] [Accepted: 12/05/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Vascular calcification (VC), especially coronary artery calcification (CAC), serves as a robust predictor of cardiovascular mortality in chronic kidney disease (CKD) patients. Recent studies have revealed that the presence of extra-coronary calcifications (ECCs) contributes to cardiovascular disease (CVD). Elevated myocardial injury markers predict mortality risk in CKD patients and are associated with CVD. Nevertheless, the relationship between VC, including CAC and ECCs, and myocardial injury markers remain unexplored in non-dialysis CKD patients. METHODS In 278 non-dialysis CKD patients of stage G3 to G5, we assessed calcified scores in CAC (Agatston score) and ECCs including thoracic aortic calcification (TAC), abdominal aortic calcification (AAC), carotid artery calcification, and valvular calcification. We analyzed the relationships between VC and myocardial injury markers of cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB). RESULTS A total of 278 non-dialysis CKD patients (median age 52.4 ± 13.2; male 65.1%; diabetes 33.5%) were enrolled. A total of 71.8% (227) of patients had cTnT levels above the upper limit of normal (> 0.014 ng/mL). Moderate to severe (calcified score ≥100 vs. <100), CAC (OR 6.39; 95% CI 1.03-39.61) and TAC (OR 6.16; 95% CI 1.76-21.55) were significantly associated with higher cTnT concentrations after adjustment for confounders. Additionally, male sex and a lower eGFR were also associated with cTnT elevation. However, when we included CAC and TAC in one model, only moderate to severe TAC (OR 4.85; 95% CI 1.38-16.96) was a risk factor for cTnT elevation, but not CAC. Furthermore, patients with severer TAC presented lower diastolic blood pressure (DBP), wider pulse pressure (p < 0.001) and higher prevalence of left ventricular hypertrophy (LVH). CONCLUSION Moderate to severe thoracic aortic calcification (TAC score ≥ 100) is significantly associated with elevated cTnT concentrations in non-dialysis CKD patients of stage G3 to G5. The linkage may result from decreased coronary perfusion and relative myocardial ischemia.
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Affiliation(s)
- Wenjiao Zhu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Zhiman Lai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Miaorong Xue
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Shaozhen Feng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Pinning Feng
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiantian Pan
- Department of Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaojie Ke
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Xionghui Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Zhijian Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Yuanwen Xu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
| | - Shurong Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qunying Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
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Chen QF, Lu Y, Katsouras CS, Peng Y, Sun J, Li M, Liu C, Yao H, Lian L, Feng X, Lin WH, Zhou XD. Characteristics, outcomes and the necessity of continued guideline-directed medical therapy in patients with heart failure with improved ejection fraction. Ann Med 2025; 57:2442535. [PMID: 39687932 PMCID: PMC11654040 DOI: 10.1080/07853890.2024.2442535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 09/12/2024] [Accepted: 11/14/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND Much remains to be learned about patients with heart failure with improved ejection fraction (HFimpEF). OBJECTIVE This study sheds light on the characteristics and clinical outcomes of HFimpEF patients, including the consequences of halting guideline-directed medical therapy (GDMT). METHODS This retrospective study was conducted on patients diagnosed with heart failure with reduced ejection fraction (HFrEF) who underwent a second echocardiogram at least 6 months apart between January 2009 and February 2023. The primary outcomes were major adverse cardiovascular events (MACEs), including all-cause mortality and heart failure hospitalization. The second outcome was recurrent HFrEF. RESULTS Of 4,560 HFrEF patients were included, 3,289 (72.1%) achieved HFimpEF within a median follow-up period of 3.4 years (IQR: 1.8 - 5.9 years). Among these HFimpEF patients, recurrent HFrEF was observed in 941 (28.6%) patients during a median follow-up period of 2.3 years (IQR: 0.8-4.6 years). The proportion of patients who halted GDMT was 70.4%, 53.2%, 59.8% and 63.8% for MRA, beta-blockers, ACEI/ARB/ARNI and SGLT-2 inhibitors. Multivariable Cox analysis revealed ischemic heart disease, chronic kidney disease, coronary heart disease, lower left ventricular ejection fraction, larger left ventricular diastolic dimension and non-use GDMT are associated with recurrent HFrEF. Individuals without GDMT use exhibited lower chances of persistently recovering ejection fraction and high risks of MACEs compared to those who continue use. CONCLUSIONS HFimpEF is a common condition across all clinical follow-ups. Prevalent discontinuation of GDMT medications may contribute significantly to recurrent HFrEF, placing patients at a higher risk for poor prognosis.
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Affiliation(s)
- Qin-Fen Chen
- Medical Care Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Institute of Aging, Key Laboratory of Alzheimer’s Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou Medical University, Wenzhou, China
| | - Yindan Lu
- Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Christos S. Katsouras
- Second Department of Cardiology, University Hospital of Ioannina Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Yangdi Peng
- Department of Respiratory Medicine, Yongjia County Traditional Chinese Medicine Hospital, Wenzhou, China
| | - Junfang Sun
- Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mingming Li
- Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenyang Liu
- Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongxia Yao
- Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liyou Lian
- Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaofang Feng
- Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei-Hong Lin
- Medical Care Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao-Dong Zhou
- Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Abou Kamar S, van Ommen AM, Dal Canto E, Valstar G, Akkerhuis KM, Cramer MJ, Umans V, Rutten F, Teske AJ, Menken R, Geleijnse ML, Hofstra L, Verhaar MC, de Boer RA, Boersma E, Asselbergs FW, van Dalen BM, den Ruijter HM, Kardys I. The plasma proteome is linked to echocardiographic parameters and stages of diastolic dysfunction, across the ejection fraction spectrum. Int J Cardiol 2025; 434:133329. [PMID: 40311691 DOI: 10.1016/j.ijcard.2025.133329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 04/03/2025] [Accepted: 04/28/2025] [Indexed: 05/03/2025]
Abstract
INTRODUCTION This study investigates the interplay between the circulating plasma proteome and echocardiographic parameters in patients across the spectrum of heart failure (HF) (ranging from patients at risk of/with preserved (HFpEF) to reduced (HFrEF) ejection fraction). METHODS Data from two cohort studies, HELPFul and Bio-SHiFT, were analyzed. We measured 4210 circulating plasma proteins in a total of 750 patients using SomaScan® proteomics. Echocardiographic parameters in both studies included left ventricular ejection fraction (LVEF) and the ratio of the peak early left ventricular (LV) filling velocity and early diastolic mitral annular velocity (E/e'). In further analyses, we classified patients in left ventricular diastolic dysfunction (LVDD) groups according to the prevailing guidelines. RESULTS Out of the 4210 plasma proteins, 21 proteins were significantly associated with E/e' in patients at risk of/with HFpEF, whereas 9 proteins were associated with LVEF. Approximately 43 % (n = 1822) of the proteins showed significant interactions between E/e' and HF subtype. All of these proteins showed weaker associations with E/e' in patients at risk of/with HFpEF compared to the ones with HFrEF. These proteins were related to the extracellular matrix, cellular processes, insulin-like growth factor (IGF) transport, metabolic and catabolic processes. Furthermore, comparisons between LVDD groups and those with normal diastolic function identified 40 proteins associated with grade 2 (top 5: Cystatin C, TMEDA, NT-proBNP, GDF-15 and PXDN) and 198 with grade 3 LVDD (top 5: NT-proBNP, Cystatin C, PXDN, RNasa1, and Factor D). CONCLUSION In patients at risk of/with HFpEF, biological processes and pathways showed weaker associations with E/e' compared to patients with HFrEF. Varying pathways identified through proteomics were associated with deterioration of LVDD across the ejection fraction spectrum. Our results are in line with the mechanistic frameworks currently thought to underlie the various types of HF.
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Affiliation(s)
- Sabrina Abou Kamar
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Anne-Mar van Ommen
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Elisa Dal Canto
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gideon Valstar
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J Cramer
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Victor Umans
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department oF Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Frans Rutten
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arco J Teske
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roxana Menken
- Cardiology Centers of the Netherlands, The Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Leonard Hofstra
- Cardiology Centers of the Netherlands, The Netherlands; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Amsterdam, Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Folkert W Asselbergs
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Amsterdam, Netherlands; The National Institute for Health Research University College London Hospitals Biomedical Research Center, University College London, London, London, United Kingdom; Institute of Health Informatics, University College London, London, London, United Kingdom
| | - Bas M van Dalen
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Baracchini N, Capovilla TM, Rossi M, Carriere C, De Luca A, Tavcar I, Barbati G, Merlo M, Sinagra G. Unveiling the limitations of non-metabolic thresholds in assessing maximal effort: The role of cardiopulmonary exercise testing. Int J Cardiol 2025; 433:133292. [PMID: 40262699 DOI: 10.1016/j.ijcard.2025.133292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Revised: 04/12/2025] [Accepted: 04/18/2025] [Indexed: 04/24/2025]
Abstract
INTRODUCTION Maximal effort, defined by a respiratory exchange ratio (RER) ≥ 1.10, is crucial for accurate interpretation of cardiopulmonary exercise testing (CPET). Standard tests rely on non-metabolic thresholds, such as peak predicted heart rate (ppHR) ≥ 85 %, double product (DP) ≥ 20,000 bpm*mmHg and peak metabolic equivalent of task (MET) ≥ 5.0. This study aimed to assess the effectiveness of non-metabolic thresholds in detecting maximal effort, compared with the RER ≥ 1.10 criterion. METHODS We retrospectively analyzed stable patients who underwent CPET from 2022 to 2023, regardless of test indication, history of heart failure (HF), or medication use. All patients also performed transthoracic echocardiography. RESULTS Among 239 middle-aged patients (53 ± 14 years, 67 % male), 86 % achieved a RER ≥ 1.10, and 65 % had a diagnosis of HF. Non-metabolic thresholds correctly identified maximal efforts (RER ≥ 1.10) in 75 % of the cases (AUC < 0.600). Misclassified cases were more likely to have a history of atrial fibrillation (AF), paced rhythm, HF, and beta-blockers or RAAS inhibitors use. These patients exhibited lower VO2 peak and higher VE/VCO2 slope. Multivariable analysis identified HF history (OR 4.8, CI 95 % 1.6-15.6, p: 0.005), low resting DP (≤ 7500 mmHg*bpm), and ramp protocol as independent predictors of discordant tests. CONCLUSION Non-metabolic thresholds misclassified up to 25 % of tests with RER ≥ 1.10 as non-maximal, potentially leading to inaccurate interpretation. In patients with HF, poor expected functional capacity and low DP, direct referral to CPET-equipped facilities may provide more accurate assessment than relying on non-metabolic thresholds.
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Affiliation(s)
- Nikita Baracchini
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy.
| | - Teresa Maria Capovilla
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy
| | - Maddalena Rossi
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy
| | - Cosimo Carriere
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy
| | - Antonio De Luca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy
| | - Irena Tavcar
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Italy
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Yang X, Sun W, Chen K, Wang X. Establishment and validation of a critical care echocardiography-based predictive model for sepsis-induced cardiomyopathy: A prospective cohort study. J Crit Care 2025; 88:155066. [PMID: 40132344 DOI: 10.1016/j.jcrc.2025.155066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 02/28/2025] [Accepted: 03/11/2025] [Indexed: 03/27/2025]
Abstract
BACKGROUND Integrating echocardiographic parameters for a comprehensive and precise evaluation of sepsis-induced cardiomyopathy (SIC) presents a significant challenge. RESEARCH QUESTION To develop a nomogram for the echocardiographic diagnosis of SIC. STUDY DESIGN AND METHODS A cohort of 181 septic patients was prospectively enrolled for critical care echocardiography assessments. The cohort was randomly divided into a training dataset (70 %, n = 126) and a validation dataset (30 %, n = 55). The LASSO regression analysis was used to identify key echocardiographic predictors, which were then analyzed using multivariate logistic regression to determine the final diagnostic predictors and establish an echocardiographic model for SIC. A nomogram was developed based on the model, which was evaluated and verified for discrimination, calibration, and clinical utility. RESULTS Three key predictors, including left ventricular global longitudinal strain (GLS), early diastolic mitral flow velocity (E), and tricuspid annular plane systolic motion amplitude (TAPSE), were selected from 14 variables to develop a SIC echocardiographic predictive model. The model exhibited a strong discrimination with an area under the curve (AUC) value of 0.879 in the training dataset and 0.888 in the validation dataset. The results of the Hosmer-Lemeshow test further validated the consistency between predicted probabilities and actual outcomes in both datasets. Decision curve analysis (DCA) indicated a substantial net clinical benefit within risk threshold ranges of 5-100 % in the training dataset and 21-100 % in the validation dataset. CONCLUSION The nomogram, incorporating GLS, E, and TAPSE, emerged as a reliable non-invasive tool for assessing the risk of SIC. CLINICAL TRIAL REGISTRATION The study protocol was registered in the ChiCTR database (Registration No. ChiCTR2200066966; Date of Registration: December 22, 2022).
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Affiliation(s)
- Xiaojuan Yang
- Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China; Ningxia Medical University, Yinchuan 750004, China
| | - Wanqi Sun
- Ningxia Medical University, Yinchuan 750004, China
| | - Kai Chen
- Ningxia Medical University, Yinchuan 750004, China
| | - Xiaohong Wang
- Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
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Gao Z, Qian XH, Ke JY, Lin K, Zhu JH, Zhou X, Zhou H, Wang LG. Angiography-derived index of microcirculatory resistance as a novel tool to assess coronary microvascular dysfunction in patients with diabetic cardiomyopathy. Int J Cardiol 2025; 431:133220. [PMID: 40188960 DOI: 10.1016/j.ijcard.2025.133220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 03/05/2025] [Accepted: 03/28/2025] [Indexed: 04/10/2025]
Abstract
BACKGROUNDS Coronary microvascular dysfunction (CMD) has been proposed as a major mechanism and a potential therapeutic target for diabetic cardiomyopathy (DbCM); however, it has not been fully investigated in a clinical setting. The angiography-derived index of microcirculatory resistance (AMR) is a novel non-invasive measurement of CMD that exhibits promising clinical applications. METHODS AMR was measured in hospitalized patients with DbCM and in control patients. The incidence, clinical characteristics, risk factors, and effects of pharmacological interventions on CMD were investigated. RESULTS AMR was significantly higher in patients who met the DbCM-2B diagnostic criteria. The independent risk factors for abnormal AMR included diabetes, body mass index (BMI), and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). Patients with elevated NT-pro-BNP had high AMR, and those grouped by medication indicated that ACEI/ARB, sacubitril/valsartan, and trimetazidine might lower AMR in patients with elevated NT-pro-BNP. CONCLUSIONS The DbCM-2B diagnostic criteria demonstrated a strong correlation with CMD. ACEI/ARB, sacubitril/valsartan, and trimetazidine might improve CMD in patients with DbCM.
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Affiliation(s)
- Zhan Gao
- The Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Xue Hua Qian
- The Department of Information, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Jia Yu Ke
- The Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Ken Lin
- The Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Jian Han Zhu
- The Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Xi Zhou
- The Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Hao Zhou
- The Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Liang Guo Wang
- The Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
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Holcman K, Rubiś P, Ćmiel B, Szot W, Stępień-Wroniecka A, Graczyk K, Mróz K, Dziewięcka E, Mateusz W, Szczepara S, Kurek M, Kęska M, Podolec P, Kostkiewicz M. [ 99mTc]Tc-DPD SPECT/CT evaluation of right and left ventricular involvement in cardiac transthyretin amyloidosis. Int J Cardiol 2025; 431:133227. [PMID: 40185370 DOI: 10.1016/j.ijcard.2025.133227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 03/10/2025] [Accepted: 03/31/2025] [Indexed: 04/07/2025]
Abstract
BACKGROUND Accurate assessment of ventricular involvement in transthyretin cardiac amyloidosis (ATTR-CA) is essential for diagnosis and management. This study evaluated left and right ventricular (LV and RV) involvement in patients with ATTR-CA using single-photon emission computed tomography/computed tomography (SPECT/CT) witch Technetium-99m and 3,3-diphosphono-1,2-propanodicarboxylic acid ([99mTc]Tc-DPD). METHODS This prospective, single-centre study enrolled 100 adults from 2020 to 2024 (NCT05814380). Participants underwent clinical assessment, genetic testing, electrocardiography, echocardiography, and [99mTc]Tc-DPD SPECT/CT. Volumetric and regional analyses of LV and RV amyloid burden were conducted. Patients were prospectively observed for 5 years to assess all-cause mortality. RESULTS Overall, RV uptake was observed in 91 % of patients with ATTR-CA. Radiotracer uptake was detected in the interventricular septum of all ATTR-CA patients, with apical involvement being less common (24 % hereditary ATTR vs. 31 % wild-type ATTR, p = 0.62). Notably, RV uptake was associated with RV thickness, LV global longitudinal strain, and N-terminal pro-brain natriuretic peptide levels (p = 0.00007, p = 0.00022, p = 0.00007; respectively). Multivariate analysis identified increased LV mass index and NYHA class as predictors of RV involvement (area under curve: 0.96). Volumetric LV and RV SPECT uptake measurements and apical sparing correlated with all-cause mortality (p < 0.001). CONCLUSIONS The presented findings confirm that SPECT/CT evaluation provides insights into both LV and RV involvement in patients with ATTR-CA and is associated with prognosis. Detailed assessment of RV involvement, through SPECT/CT, reveals significant structural and functional changes associated with disease severity. The presence of RV uptake is associated with advanced cardiac involvement, emphasising the importance of comprehensive biventricular evaluation in this patient population.
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Affiliation(s)
- Katarzyna Holcman
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Institute of Cardiology, St. John Paul II Hospital, Krakow, Poland; St. John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland.
| | - Paweł Rubiś
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Institute of Cardiology, St. John Paul II Hospital, Krakow, Poland
| | - Bogdan Ćmiel
- AGH University of Science and Technology, Faculty of Applied Mathematics, Krakow, Poland
| | - Wojciech Szot
- St. John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland; Jagiellonian University Medical College, Department of Hygiene and Dietetics, Krakow, Poland
| | - Agnieszka Stępień-Wroniecka
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Institute of Cardiology, St. John Paul II Hospital, Krakow, Poland; Jagiellonian University Medical College, Doctoral School of Medical and Health Sciences, Krakow, Poland
| | - Katarzyna Graczyk
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Institute of Cardiology, St. John Paul II Hospital, Krakow, Poland; Jagiellonian University Medical College, Doctoral School of Medical and Health Sciences, Krakow, Poland
| | - Krystian Mróz
- Jagiellonian University Medical College, Department of Interventional Cardiology, Institute of Cardiology St. John Paul II Hospital, Krakow, Poland
| | - Ewa Dziewięcka
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Institute of Cardiology, St. John Paul II Hospital, Krakow, Poland
| | - Winiarczyk Mateusz
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Institute of Cardiology, St. John Paul II Hospital, Krakow, Poland; Jagiellonian University Medical College, Doctoral School of Medical and Health Sciences, Krakow, Poland
| | - Sylwia Szczepara
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Institute of Cardiology, St. John Paul II Hospital, Krakow, Poland
| | - Maria Kurek
- Students Scientific Group of Cardiovascular Imaging, Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Kęska
- Students Scientific Group of Cardiovascular Imaging, Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Podolec
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Institute of Cardiology, St. John Paul II Hospital, Krakow, Poland
| | - Magdalena Kostkiewicz
- Jagiellonian University Medical College, Department of Cardiac and Vascular Diseases, Institute of Cardiology, St. John Paul II Hospital, Krakow, Poland; St. John Paul II Hospital, Department of Nuclear Medicine, Krakow, Poland
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9
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Oda R, Izumo M, Miyahara D, Yamaga M, Shoji T, Murata R, Okuno T, Sato Y, Kuwata S, Akashi YJ. Diastolic Stress Echocardiography Using the Six-Minute Walk Test in Asymptomatic Patients With Aortic Stenosis. Am J Cardiol 2025; 246:71-79. [PMID: 40107334 DOI: 10.1016/j.amjcard.2025.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2025] [Revised: 03/01/2025] [Accepted: 03/05/2025] [Indexed: 03/22/2025]
Abstract
Diastolic stress echocardiography is useful in patients with heart failure with preserved ejection fraction (EF); however, its utility in asymptomatic patients with aortic stenosis (AS) remains unexplored. We investigated the value of diastolic stress echocardiography using a 6-minute walk test (6-MWT) in elderly AS patients. This retrospective observational study included 96 consecutive asymptomatic patients (82 years, 39.6% male) with at least moderate AS (mean pressure gradient (MPG) ≥ 20 mm Hg or aortic valve area < 1.5 cm2) and preserved left ventricular EF. All underwent diastolic stress echocardiography using the 6-MWT. Patients were classified into a post-exercise impaired relaxation pattern (pIR) and a post-exercise pseudo-normalised/restrictive pattern (pPN) groups, based on transmitral flow velocity post-6-MWT. The primary endpoint was the time to first occurrence of the composite endpoint (all-cause mortality, aortic valve replacement due to AS-related symptoms, and hospitalization for heart failure).22 patients (23%) changed from baseline IR pattern at rest to the pPN pattern after the 6-MWT.The pPN group demonstrated lower %predicted walking distance than the pIR group. Additionally, the pPN group exhibited greater dyspnea after the 6-MWT. During a median follow-up of 536 days (interquartile range, 106-720 days), 46 patients experienced AS-related events. Multivariable Cox regression analysis indicated that the pPN group was independently associated with increased event risk (hazard ratio: 5.37, p < 0.001). In conclusion, this study suggests that the diastolic stress echocardiography using the 6-MWT is useful for risk stratification in asymptomatic elderly AS patients.
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Affiliation(s)
- Ryutaro Oda
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Daisuke Miyahara
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mitsuki Yamaga
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tatsuro Shoji
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Risako Murata
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Taishi Okuno
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yukio Sato
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shingo Kuwata
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
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10
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Delestri LFU, Abed AA, Dokos S, Mokhtarudin MJM, Kok FN, Bressloff NW, Sengers BG, Bakir AA. Modelling of cardiac biventricular electromechanics with coronary blood flow to investigate the influence of coronary arterial motion on coronary haemodynamic. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2025; 267:108800. [PMID: 40319840 DOI: 10.1016/j.cmpb.2025.108800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 04/11/2025] [Accepted: 04/20/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND AND OBJECTIVE Coronary flow is strongly influenced by the geometry and motion of coronary arteries, which change periodically in response to myocardial contraction throughout the cardiac cycle. However, a computational framework integrating cardiac biventricular electromechanics with dynamic coronary artery flow using a simplified, yet comprehensive mathematical approach remains underexplored. This study aims to develop a coupled 3D model of cardiac biventricular electromechanics and coronary circulation, enabling simulation of the interplay between cardiac electrical activity, mechanical function and coronary flow. METHODS A patient-specific biventricular electromechanical model encompasses the fibre orientation, electrophysiology, mechanical properties and an open-loop heart circulation is developed. The electromechanical model is simulated independently from the coronary circulation model. The model provides an input for the Navier-Stokes-based coronary flow model. A one-way coupling approach maps the biventricular motion to the coronary arteries, linking both components. To evaluate the influence of coronary arterial motion on coronary haemodynamic, simulations are performed for two scenarios: a moving and a non-moving (static) coronary artery model. RESULTS Cardiac-induced coronary motion alters the pressure, velocity and flow profiles. Non-moving coronary arteries produce stable counter-rotating Dean-like vortices due to steady flow dominated by centrifugal forces, while the moving arteries disrupt these vortices as arterial curvature changes disturb the flow. Coronary motion significantly affects the wall shear stress, highlighting the necessity of incorporating arterial dynamics to investigate atherosclerosis. CONCLUSION The integrated biventricular-coronary model emphasizes the significance of background cardiac motion in coronary haemodynamic. The model offers a foundation for exploring myocardial perfusion mechanisms in realistic physiological settings.
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Affiliation(s)
- Laila Fadhillah Ulta Delestri
- Smart Manufacturing and Systems Research Group, University of Southampton Malaysia, 79100 Iskandar Puteri, Johor, Malaysia
| | - Amr Al Abed
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Mohd Jamil Mohamed Mokhtarudin
- Centre for Research in Advanced Fluid and Processes (Fluid Centre), Universiti Malaysia Pahang Al-Sultan Abdullah, Lebuhraya Tun Razak, 26300 Kuantan, Pahang, Malaysia
| | - Foo Ngai Kok
- Carbon Neutrality Research Group, University of Southampton Malaysia, 79100 Iskandar Puteri, Johor, Malaysia
| | - Neil W Bressloff
- School of Mechanical Engineering, Faculty of Engineering and Physical Sciences, University of Leeds, Leeds, United Kingdom
| | - Bram G Sengers
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Azam Ahmad Bakir
- Smart Manufacturing and Systems Research Group, University of Southampton Malaysia, 79100 Iskandar Puteri, Johor, Malaysia.
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11
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Di Gioia G, Ferrera A, Maestrini V, Monosilio S, Serdoz A, Nenna A, Mango F, Squeo MR, Pelliccia A. Correlation between workload-indexed blood pressure response to exercise (SBP/MET slope) and clinical and echocardiographic parameters among normotensive Olympic athletes. Int J Cardiol 2025; 429:133171. [PMID: 40107386 DOI: 10.1016/j.ijcard.2025.133171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Revised: 02/23/2025] [Accepted: 03/14/2025] [Indexed: 03/22/2025]
Abstract
INTRODUCTION The workload-indexed systolic blood pressure response to exercise (SBP/MET slope) has been proposed as a novel parameter for evaluating abnormal blood pressure response to exercise (ABPR) and its potential risks. Aim of our study was to assess the association between SBP/MET slope and clinical and cardiac dimensional parameters in normotensive athletes. METHODS A cohort of 292 normotensive Olympic athletes (155 male, 53.1 %) underwent a pre-participation evaluation that included clinical, echocardiographic, and exercise-stress test parameters. The SBP/MET slope was calculated as the increase in systolic blood pressure indexed to metabolic equivalents achieved during maximal exercise. Athletes were stratified into quartiles based on their SBP/MET slope, and comparisons across quartiles were made. RESULTS Athletes in the highest SBP/MET slope quartile exhibited increased left ventricular wall thickness, i.e., interventricular septum (IVS) compared to those in lower quartiles (10.3 ± 0.9 vs. 9.5 ± 1.1, p = 0.014). Male athletes predominated in higher quartiles (p = 0.047), and endurance athletes were absent in the higher groups (p = 0.006). No differences were observed for systolic or diastolic function across quartiles. At multivariate analysis, SBP/MET slope was indipendently correlated to IVS (p = 0.040; R2 = 0.566, standardized beta coefficient = 0.368) and inversely correlated to W/Kg (p = 0.014; R2 = 0.566, standardized beta coefficient = -0.507). After a follow-up of 10.3 ± 2.6 years, 13.6 % of athletes in the highest quartile developed hypertension. CONCLUSION Athletes with higher SBP/MET slope exhibited increased wall thickness and lower exercise capacity and showed higher risk for late-onset hypertension. Long-term follow-up studies are warranted to further elucidate its prognostic implications.
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Affiliation(s)
- Giuseppe Di Gioia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis, 15, 00135 Rome, Italy.
| | - Armando Ferrera
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; Clinical and Molecular Medicine Department, Sapienza University of Rome, 00198 Rome, Italy
| | - Viviana Maestrini
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | - Sara Monosilio
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy; Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | - Andrea Serdoz
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Antonio Nenna
- Fondazione Policlinico Universitario Campus Bio-Medico University, Unit of Cardiothoracic Surgery, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Federica Mango
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Maria Rosaria Squeo
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Antonio Pelliccia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy
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12
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Sugiyama Y, Tahara N, Honda A, Koga Y, Yoshimura-Takubo H, Bekki M, Tahara A, Maeda-Ogata S, Igata S, Mizushima Y, Murotani K, Kuromatsu R, Kawaguchi T, Fukumoto Y. Utility of liver stiffness for the classification of portopulmonary hypertension in precapillary pulmonary hypertension. Int J Cardiol 2025; 429:133126. [PMID: 40058610 DOI: 10.1016/j.ijcard.2025.133126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 12/15/2024] [Accepted: 03/05/2025] [Indexed: 03/17/2025]
Abstract
BACKGROUND Invasive right heart catheterization plays a central role in identifying pulmonary hypertension (PH) disorders. However, non-invasive biomarkers of portopulmonary hypertension (PoPH) are required. Liver stiffness evaluated by FibroScan® is useful for the assessment of liver fibrosis in patients with chronic liver diseases. This study sought to investigate the utility of liver stiffness for the classification of PoPH among precapillary PH patients. METHODS A total of 46 patients [38 females, median (interquartile range) age 63.0 (50.8-72.0) years old] with precapillary PH were divided into a PoPH group (N = 6) and a non-PoPH group (N = 40) based on the presence of portosystemic shunts and/or portal hypertension with hepatic venous pressure gradient >5 mmHg. RESULTS The PoPH group showed higher cardiac index and lower pulmonary vascular resistance than the non-PoPH group. Other hemodynamic variables and liver fibrosis biomarkers such as fibrosis-4 index and albumin-bilirubin score were comparable between the 2 groups. Liver stiffness measurements in the PoPH group were significantly higher than those in the non-PoPH group [12.8 kPa (9.4-17.3 kPa) vs 4.15 kPa (3.30-5.50 kPa), p < 0.001]. The cut-off value for the classification of PoPH was 8.50 kPa from the receiver operating characteristic curve (area under curve 0.979, 95 % Confidence interval 8.50 kPa - 11.00 kPa). CONCLUSIONS Liver stiffness evaluated by transient elastography may be a non-invasive biomarker to detect the liver status that caused PoPH among precapillary PH patients.
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Affiliation(s)
- Yoichi Sugiyama
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, 67 Asahi-Machi, Kurume 830-0011, Japan.
| | - Nobuhiro Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, 67 Asahi-Machi, Kurume 830-0011, Japan.
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, 67 Asahi-Machi, Kurume 830-0011, Japan
| | - Yuki Koga
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, 67 Asahi-Machi, Kurume 830-0011, Japan
| | - Harumi Yoshimura-Takubo
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, 67 Asahi-Machi, Kurume 830-0011, Japan
| | - Munehisa Bekki
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, 67 Asahi-Machi, Kurume 830-0011, Japan
| | - Atsuko Tahara
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, 67 Asahi-Machi, Kurume 830-0011, Japan
| | - Shoko Maeda-Ogata
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, 67 Asahi-Machi, Kurume 830-0011, Japan
| | - Sachiyo Igata
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, 67 Asahi-Machi, Kurume 830-0011, Japan
| | - Yasuko Mizushima
- Ultrasound Diagnostic Center, Kurume University Hospital, 67 Asahi-Machi, Kurume 830-0011, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University, 67 Asahi-Machi, Kurume 830-0011, Japan; School of Medical Technology, Kurume University, 67 Asahi-Machi, Kurume 830-0011, Japan
| | - Ryoko Kuromatsu
- Ultrasound Diagnostic Center, Kurume University Hospital, 67 Asahi-Machi, Kurume 830-0011, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology Medicine, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume 830-0011, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume, 67 Asahi-Machi, Kurume 830-0011, Japan
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13
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Cai Y, Ou M, Li Y, Zhang X, Huang T, Zeng D, Chang S, Xie X, Lu W, Cai X, Song H, Li Y, Wu B, Zheng B, Wu J. Parameters of speckle tracking echocardiography in right atrial fibrosis of patients with rheumatic mitral stenosis: Focusing on right atrial stiffness. Int J Cardiol 2025; 429:133170. [PMID: 40101856 DOI: 10.1016/j.ijcard.2025.133170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 02/25/2025] [Accepted: 03/14/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND In rheumatic mitral stenosis (RMS), left atrial pressure elevation can lead to right heart dysfunction and fibrosis. The relationship between speckle-tracking echocardiography (STE) right-heart parameters, right atrial fibrosis, and its histological confirmation, remains unclear. METHODS 46 RMS patients (mean age of 53.0 ± 8.9 years, 67 % females) were enrolled. The exclusion criteria were the presence of moderate or severe aortic valve diseases, rheumatic tricuspid lesions and poor acoustic windows. RA tissue specimens were collected during the operation in RMS patients to analyze the degree of myocardial fibrosis. Echocardiographic evaluations and histological analysis of right atrial (RA) tissue were performed. Correlations between parameters and RA fibrosis were analyzed. RESULTS RA fibrosis was strongly correlation with RAsr (r = -0.860, P < 0.001). ROC analysis confirmed that RA stiffness (E/e'/RAsr) (AUC = 0.934, 95 %CI: 0.843-1.000) and STREI index (2 × RVFLWS + RAsr) (AUC = 0.802, 95 %CI: 0.672-0.933) had good diagnostic efficacy. RA fibrosis was verified histologically. CONCLUSION To a certain degree, RAsr serves as an indicator mirroring the extent of right atrial fibrosis. In the context of RMS patients, both RA stiffness and the STREI index emerge as potential harbingers of RA fibrosis, playing a significant role in unravelling the underlying mechanisms of disease progression and informing the formulation of efficacious treatment strategies.
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Affiliation(s)
- Yongzhi Cai
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Mengqian Ou
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Yue Li
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Xiaofeng Zhang
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tongtong Huang
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Decai Zeng
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Shuai Chang
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Xiaoyong Xie
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Wei Lu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Xiongwei Cai
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Haitao Song
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Yugui Li
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Binling Wu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China
| | - Baoshi Zheng
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China.
| | - Ji Wu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Shuangyong Road 6, Nanning 530021, China.
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14
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Cejka V, Riepl H, Schwegel N, Kolesnik E, Zach D, Santner V, Höller V, Schweighofer N, Obermayer‐Pietsch B, Pieber T, Morbach C, Frantz S, Zirlik A, von Lewinski D, Störk S, Posch F, Ablasser K, Verheyen N. Prognostic impact of gait speed, muscle strength and muscle mass in chronic heart failure-A prospective cohort study. ESC Heart Fail 2025; 12:2113-2124. [PMID: 39904947 PMCID: PMC12055347 DOI: 10.1002/ehf2.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 12/09/2024] [Accepted: 01/05/2025] [Indexed: 02/06/2025] Open
Abstract
AIMS Heart failure (HF) impairs skeletal muscle mass and function, which contributes to reduced physical performance. We investigated the prognostic impact of gait speed (GS), handgrip strength (HG) and appendicular skeletal muscle index (ASMI) on cardiovascular outcomes in a prospective HF cohort. METHODS This single-centre prospective cohort study included adults with stable chronic HF with a previous diagnosis of overtly reduced left ventricular ejection fraction (LVEF) <40% and LVEF < 50% at enrolment. GS was measured by the 4 m GS test, maximal HG was measured with a hydraulic dynamometer, and ASMI was measured by dual-energy X-ray absorptiometry. The primary combined outcome was cardiovascular death or worsening HF. Fine and Gray regression models were calculated, treating non-cardiovascular death as the competing event. RESULTS Two hundred five patients (78% male) were analysed. The median age was 66 (quartiles: 58-74) years, 31% had diabetes mellitus, and the median LVEF was 37 (30-43) %. Median GS was 1.0 (0.8-1.0) m/s, median HG was 32 (24-40) kg, and median ASMI was 8.0 (7.2-8.9) kg/m2. During a median follow-up of 4.7 (4.0-5.3) years, the primary outcome was observed in 52 patients. In models adjusted for key clinical covariates, lower GS predicted a higher risk of cardiovascular death or worsening HF [subdistribution hazard ratio (SHR) per 0.1 m/s increase = 0.81, 95% confidence interval (CI) 0.68-0.95], whereas HG (SHR per 5 kg increase = 0.97, 95% CI 0.84-1.10) and ASMI (SHR per 1 kg/m2 increase = 1.17, 95% CI 0.94-1.44) did not. In the analysis of effect modification, these associations were consistent across key clinical subgroups. CONCLUSIONS Higher GS was independently associated with a lower risk of cardiovascular death or worsening HF, whereas HG and ASMI were not. We prospectively confirm GS as a physical performance measure with clear prognostic significance for patients with HF.
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Affiliation(s)
- Vladimir Cejka
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
| | - Hermann Riepl
- Division of Cardiology, Department of Internal Medicine, University Heart CenterMedical University of GrazGrazAustria
| | - Nora Schwegel
- Division of Cardiology, Department of Internal Medicine, University Heart CenterMedical University of GrazGrazAustria
| | - Ewald Kolesnik
- Division of Cardiology, Department of Internal Medicine, University Heart CenterMedical University of GrazGrazAustria
| | - David Zach
- Division of Cardiology, Department of Internal Medicine, University Heart CenterMedical University of GrazGrazAustria
| | - Viktoria Santner
- Division of Cardiology, Department of Internal Medicine, University Heart CenterMedical University of GrazGrazAustria
| | - Viktoria Höller
- Division of Cardiology, Department of Internal Medicine, University Heart CenterMedical University of GrazGrazAustria
| | - Natascha Schweighofer
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Barbara Obermayer‐Pietsch
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Thomas Pieber
- Division of Endocrinology and Diabetology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Caroline Morbach
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
- Division of Cardiology, Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Stefan Frantz
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
- Division of Cardiology, Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Andreas Zirlik
- Division of Cardiology, Department of Internal Medicine, University Heart CenterMedical University of GrazGrazAustria
| | - Dirk von Lewinski
- Division of Cardiology, Department of Internal Medicine, University Heart CenterMedical University of GrazGrazAustria
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure CenterUniversity Hospital WürzburgWürzburgGermany
- Division of Cardiology, Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Florian Posch
- Division of Hematology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Klemens Ablasser
- Division of Cardiology, Department of Internal Medicine, University Heart CenterMedical University of GrazGrazAustria
| | - Nicolas Verheyen
- Division of Cardiology, Department of Internal Medicine, University Heart CenterMedical University of GrazGrazAustria
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15
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Gao Y, Liu H, Bi X, Sun J, Zhu Y, Zhou W, Fan Y, Cheng X, Huang P, Liu Y, Deng Y. H 2FPEF and HFA-PEFF scores for heart failure risk stratification in hypertrophic cardiomyopathy patients. ESC Heart Fail 2025; 12:2225-2238. [PMID: 40022558 PMCID: PMC12055370 DOI: 10.1002/ehf2.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 01/06/2025] [Accepted: 02/04/2025] [Indexed: 03/03/2025] Open
Abstract
AIMS H2FPEF and HFA-PEFF scores have demonstrated prognostic value in heart failure (HF) with preserved ejection fraction. This study aimed to explore the value of the H2FPEF and HFA-PEFF scores for HF risk stratification in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS In this cohort study, 1068 HCM patients were included. Then the H2FPEF and HFA-PEFF scores were calculated to categorize patients into low, intermediate, and high score groups. The primary endpoint was a composite of the first HF hospitalization and all-cause death. 594 (55.6%) patients were classified discordantly. After a follow-up period of 3.1 ± 2.1 years, 85 (8.0%) patients were admitted for HF for the first time, and 62 (5.8%) patients died. Rates of first HF hospitalization and all-cause death per 1000 person-years for the low, intermediate, and high H2FPEF score groups were 25.0 (95% confidence interval [CI]: 14.5-35.4), 52.0 (95% CI: 41.6-62.3), and 148.1 (95% CI: 77.7-218.5), respectively. For the low-intermediate and high HFA-PEFF score groups, rates were 19.3 (95% CI: 11.6-27.0) and 69.3 (95% CI: 56.4-82.1), respectively. Intermediate H2FPEF score (hazard ratio [HR]: 1.820, 95% CI: 1.135-2.919; P = 0.013), high H2FPEF score (HR: 3.464, 95% CI: 1.774-6.765; P < 0.001), and high HFA-PEFF score (HR: 2.414, 95% CI: 1.501-3.882; P < 0.001) were each independently associated with an increased risk of the primary endpoint. Intermediate-high H2FPEF score demonstrated an equal risk for the primary endpoint compared to the high HFA-PEFF score (HR: 0.826, 95% CI: 0.636-1.072; P > 0.05). Obesity (HR: 1.958, 95% CI: 1.140-3.363; P = 0.015), atrial fibrillation (HR: 1.686, 95% CI: 1.071-2.654; P = 0.024), pulmonary hypertension (HR: 1.613, 95% CI: 1.032-2.521; P = 0.036) of the H2FPEF score, and the morphological major criterion (HR: 1.601, 95% CI: 1.084-2.364; P = 0.018) and functional major criterion (HR: 2.340, 95% CI: 1.442-3.797; P < 0.001) of the HFA-PEFF score were independent predictors of the primary endpoint. A new algorithm was constructed using the independent predictors from both scores, with the functional major criterion weighted as 2 points and the others as 1 point. The H2FPEF score, HFA-PEFF score, and the new algorithm demonstrated C-indices of 0.594, 0.651, and 0.681, respectively. CONCLUSIONS There is discordance in the classification of patients with HCM using the H2FPEF and HFA-PEFF scores. Both scores demonstrated prognostic value in risk stratification for HF hospitalization and all-cause death in HCM patients. Future studies should develop and validate a new algorithm integrating both scores.
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Affiliation(s)
- Yi‐Peng Gao
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Hong‐Yun Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xiao‐Jun Bi
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jie Sun
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Ying Zhu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Ya‐Ting Fan
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xue‐Qing Cheng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Pei‐Na Huang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Ya‐Ni Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - You‐Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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16
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Sasaki H, Takaoka H, Yoshida K, Matsumoto M, Nishikawa Y, Noguchi Y, Aoki S, Suzuki K, Yashima S, Kinoshita M, Suzuki-Eguchi N, Takanashi S, Matsumiya G, Kobayashi Y. Preoperative mitral valve annulus area size is an important factor in avoiding functional mitral stenosis after mitral valve repair. J Echocardiogr 2025; 23:123-132. [PMID: 39572515 PMCID: PMC12103365 DOI: 10.1007/s12574-024-00671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 10/14/2024] [Accepted: 11/10/2024] [Indexed: 05/25/2025]
Abstract
BACKGROUND Functional mitral stenosis (FMS) following mitral valve (MV) repair for degenerative mitral regurgitation (DMR) is known as a poor prognostic factor. The parameters for avoiding postoperative FMS in MV repair for DMR have not been established. METHODS Two-hundred-and-twenty patients (mean age 61.1 ± 13.3 years, 144 males) who underwent MV repair for DMR were analyzed. MV annulus area was measured pre- and postoperatively using three-dimensional transesophageal echocardiography (TEE). Trans-mitral pressure gradient (TMPG) was evaluated by postoperative transthoracic echocardiography and FMS was defined as a mean TMPG ≥ 5 mmHg. RESULTS FMS was present in 14 patients (6.4%). Pre- versus postoperative MV annulus area change ratio was greater in the FMS group than in the non-FMS group (62.5 ± 7.2% vs. 48 ± 11.2%, p < 0.0001). On multivariate logistic regression analysis, MV annulus area change ratio was an independent predictor of FMS (odds ratio 1.19, 95% confidence interval 1.09-1.33, p < 0.0001), while receiver operating characteristics analysis showed that the optimal threshold for MV annulus area change ratio to predict FMS was 56.2% (area under the curve, 0.87; p < 0.0001). CONCLUSION The preoperative MV annulus area on TEE can be used to determine the postoperative MV annulus area to avoid FMS after MV repair.
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Affiliation(s)
- Haruka Sasaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan.
- Kawasaki Heart Center, Kawasaki Saiwai Hospital, Kawasaki, Japan.
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan
| | - Kazuki Yoshida
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan
| | - Moe Matsumoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan
| | - Yusei Nishikawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan
| | - Yoshitada Noguchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan
| | - Shuhei Aoki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan
| | - Katsuya Suzuki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan
| | - Satomi Yashima
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan
| | - Makiko Kinoshita
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan
| | - Noriko Suzuki-Eguchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan
| | | | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba-City, Chiba, 260-8677, Japan
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17
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Sumiyoshi H, Hayashi H, Yoshida K, Sakata A, Mizukami A, Minamino T, Tasaka H. The HFA-PEFF score and outcomes in patients with sick sinus syndrome and preserved ejection fraction after pacemaker implantation. J Arrhythm 2025; 41:e70088. [PMID: 40357358 PMCID: PMC12067048 DOI: 10.1002/joa3.70088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2025] [Revised: 04/22/2025] [Accepted: 04/29/2025] [Indexed: 05/15/2025] Open
Abstract
Background Sick sinus syndrome (SSS) is associated with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). However, diagnosing HFpEF in patients with SSS and determining its prognosis are challenging. The European Society of Cardiology has recommended the HFA-PEFF score for HFpEF diagnosis. In this study, we utilized the HFA-PEFF score to diagnose HFpEF in patients with SSS and preserved ejection fraction, comparing the prognosis and AF burden between those diagnosed with HFpEF and those without. Methods We identified 131 patients with symptomatic SSS and preserved ejection fraction who underwent pacemaker implantation between January 2019 and December 2021. Of these, 52 (39.7%) had an HFA-PEFF score ≥5 and met the diagnostic criteria for HFpEF. Results Patients with HFpEF experienced more cardiovascular events (28.8% vs. 11.4%; p = .009) within 3 years than those without HFpEF. The median duration of AF per day during the first year was significantly longer in the HFpEF group (10 vs. 30 min/day, p < .001). Additionally, these patients had a higher incidence of AF lasting for ≥7 days (32.9% vs. 16.9%; p = .038) within 3 years. A simplified HFA-PEFF score incorporating E/e', tricuspid regurgitation peak gradient, left atrial volume index, and brain natriuretic peptide predicted cardiovascular events and AF burden. Conclusions Patients diagnosed with HFpEF using the HFA-PEFF score have a higher incidence of cardiovascular events and a greater AF burden within 3 years after pacemaker implantation for SSS. The HFA-PEFF score may be useful for risk stratification in these patients.
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Affiliation(s)
- Hironobu Sumiyoshi
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Kenta Yoshida
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | - Atsushi Sakata
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
| | | | - Tohru Minamino
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Hiroshi Tasaka
- Department of Cardiovascular MedicineKurashiki Central HospitalKurashikiJapan
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18
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Sadasivan C, Gagnon LR, Hazra D, Wang K, Youngson E, Thomas J, Chan AY, Paterson DI, McAlister FA, Dzwiniel T, Tymchak W, Christian S, Oudit GY. Early genetic screening and cardiac intervention in patients with cardiomyopathies in a multidisciplinary clinic. ESC Heart Fail 2025; 12:1942-1955. [PMID: 39740200 PMCID: PMC12055407 DOI: 10.1002/ehf2.15202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 10/19/2024] [Accepted: 12/13/2024] [Indexed: 01/02/2025] Open
Abstract
AIMS Patients with cardiomyopathies are a heterogeneous group of patients who experience high morbidity and mortality. Early cardiac assessment and intervention with access to genetic counselling in a multidisciplinary Cardiomyopathy Clinic may improve outcomes and prevent progression to advanced heart failure. METHODS AND RESULTS Our prospective cohort study was conducted at a multidisciplinary Cardiomyopathy Clinic with 421 patients enrolled (42.5% female, median age 58 years), including 224 patients with dilated cardiomyopathy (DCM, 42.9% female, median age 57 years), 72 with hypertrophic cardiomyopathy (HCM, 43.1% female, median age 60 years), 79 with infiltrative cardiomyopathy (65.8% female, median age 70 years) and 46 who were stage A/at risk for genetic cardiomyopathy (54.3% female, median age 36 years). Patients were seen in follow-up at a median of 18 months. A pathogenic/likely pathogenic variant was identified in 28.5% of the total cohort, including 33.3% of the DCM cohort (28% TTN mutations) and 34.1% of the HCM cohort (60% MYBPC3 and 20% MYH7) who underwent genetic testing. The use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitor (48.3-69.5% of total cohort, P < 0.001), β-blockers (58.4-72.4%, P < 0.001), mineralocorticoid receptor antagonists (33.9-41.4%, P = 0.0014) and sodium/glucose cotransporter-2 inhibitors (5.3-27.9%, P < 0.001) all increased at follow-up. Precision-based therapies were also implemented, including tafamidis for transthyretin amyloidosis (n = 21), enzyme replacement therapy for Fabry disease (n = 14) and mavacamten (n = 4) for HCM. Optimization of medications and devices resulted in improvements in left ventricular ejection fraction (LVEF) from 27% to 43% at follow-up for DCM patients with reduced LVEF at baseline (P < 0.001) and reduction in left ventricular mass index (LVMI) from 156 g/m2 to 128 g/m2 at follow-up for HCM patients with abnormal LVMI at baseline (P = 0.009). Optimization of therapies was associated with stable plasma biomarkers in stage B patients while lowering levels of BNP (619-517.5 pg/mL, P = 0.048), NT-proBNP (777.5-356 ng/L, P < 0.001) and hsTropT (31-22 ng/L, P = 0.005) at follow-up relative to baseline values for stage C patients. Despite stage B patients having overt cardiomyopathy at baseline, stage A and B patients had a similarly high probability of survival (χ2 = 0.204, P = 0.652). The overall cardiovascular mortality rate was low at 1.7% for the cohort (0.5% for stage B and 3.3% for stage C) over a median of 34-month follow-up. CONCLUSION Our study demonstrates that a multidisciplinary cardiomyopathy clinic can improve the clinical profiles of patients with diverse genetic cardiomyopathies.
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Affiliation(s)
- Chandu Sadasivan
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - Luke R. Gagnon
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - Deepan Hazra
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - Kaiming Wang
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - Erik Youngson
- The Alberta Strategy for Patient Oriented Research Support Unit (AbSPORU)EdmontonABCanada
- Provincial Research Data ServicesAlberta Health ServicesEdmontonABCanada
| | - Jissy Thomas
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - Anita Y.M. Chan
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | | | - Finlay A. McAlister
- The Alberta Strategy for Patient Oriented Research Support Unit (AbSPORU)EdmontonABCanada
- Division of General Internal Medicine, Department of Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - Tara Dzwiniel
- Department of Medical Genetics, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - Wayne Tymchak
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - Susan Christian
- Department of Medical Genetics, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | - Gavin Y. Oudit
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
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Poledniczek M, Kammerlander A, Jansen C, Feser D, Ehrengruber S, Steinacher E, Hengstenberg C, Niessner A, Lang I, Binder T, Richter B. Right ventricular strain and tricuspid annular plane systolic excursion are associated with mortality in inferior ST-elevation myocardial infarction. Eur J Clin Invest 2025; 55:e70014. [PMID: 39996559 PMCID: PMC12066937 DOI: 10.1111/eci.70014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 02/12/2025] [Indexed: 02/26/2025]
Abstract
BACKGROUND Patients with inferior ST-segment elevation myocardial infarction face a substantial risk for cardiovascular death. While left ventricular function is known to be associated with clinical outcomes in these patients, we evaluated the prognostic impact of tricuspid annular plane systolic excursion (TAPSE) and advanced measures of right ventricular function (free wall strain [FWS] and global longitudinal strain [RVGLS]). METHODS Consecutive patients presenting with acute inferior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention between 01/2012 and 08/2015 were retrospectively analysed. Associations between RV strain measurements and all-cause mortality were evaluated using Cox regression analysis. RESULTS 207 patients (69.6% male, median 59.0 [IQR: 52.1-70.7] years) were followed for 8.3 (IQR: 7.4-9.3) years, during which 49 patients (23.7%) deceased. Median right ventricular function parameters were significantly better in surviving patients (RVGLS: -17.5% vs. -13.3%, p < .001; FWS: -20.5% vs. -14.8%, p < .001; TAPSE 1.8 cm vs. 1.3 cm, p < .001). All 3 parameters were associated with mortality in univariate and multivariable analysis adjusted for age, sex and the number of comorbidities (chronic kidney disease, hypercholesterinaemia, diabetes mellitus) (adj. hazard ratio [HR] per 1 standard deviation: RVGLS: 1.68 [95% CI: 1.27-2.23, p < .001], FWS: 1.56 [95% CI: 1.56-2.00, p < .001], TAPSE: 1.55 [95% CI: 1.17-2.05, p = .002]). Additionally, right ventricular function was inversely associated with peak troponin T and creatine kinase levels. CONCLUSIONS Among patients with inferior ST-segment myocardial infarction, RVGLS, FWS and TAPSE convey crucial prognostic information and might help to identify patients at increased risk requiring intensified monitoring and therapy.
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Affiliation(s)
- Michael Poledniczek
- Department of Internal Medicine II – Division of CardiologyMedical University of ViennaViennaAustria
| | - Andreas Kammerlander
- Department of Internal Medicine II – Division of CardiologyMedical University of ViennaViennaAustria
| | - Caroline Jansen
- Department of Internal Medicine II – Division of CardiologyMedical University of ViennaViennaAustria
| | - Daniel Feser
- Department of Internal Medicine II – Division of CardiologyMedical University of ViennaViennaAustria
| | | | - Eva Steinacher
- Department of Internal Medicine II – Division of CardiologyMedical University of ViennaViennaAustria
| | - Christian Hengstenberg
- Department of Internal Medicine II – Division of CardiologyMedical University of ViennaViennaAustria
| | - Alexander Niessner
- Department of Internal Medicine II – Division of CardiologyMedical University of ViennaViennaAustria
| | - Irene Lang
- Department of Internal Medicine II – Division of CardiologyMedical University of ViennaViennaAustria
| | - Thomas Binder
- Department of Internal Medicine II – Division of CardiologyMedical University of ViennaViennaAustria
| | - Bernhard Richter
- Department of Internal Medicine II – Division of CardiologyMedical University of ViennaViennaAustria
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20
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Tian Z, Li X, Li L, Zhang Q, Wang J, Shi Y, Peng D, Yang P, Ma W, Wang F, Jin W, Cheng X, Chen YM, Zhong Y, Barrett YC, Zheng J, Zhang S. Effect of Mavacamten on Echocardiographic Features in Chinese Patients with Obstructive Hypertrophic Cardiomyopathy: Results from the EXPLORER-CN Study. Cardiol Ther 2025; 14:267-282. [PMID: 40299193 PMCID: PMC12084482 DOI: 10.1007/s40119-025-00409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Accepted: 03/31/2025] [Indexed: 04/30/2025] Open
Abstract
INTRODUCTION Mavacamten, a cardiac myosin inhibitor, has demonstrated positive outcomes in left ventricular outflow tract (LVOT) gradient reduction and improvements of symptoms and function in Chinese patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM) in EXPLORER-CN. This exploratory analysis aimed to evaluate the effect of mavacamten on echocardiographic measures of cardiac structure and function and its relationship with other clinical biomarkers. METHODS Key echocardiographic parameters acquired over 30 weeks from 81 patients (n = 54 on mavacamten and n = 27 on placebo) were assessed in a central laboratory. RESULTS At 30 weeks, greater improvements in measures of diastolic function were observed with mavacamten versus placebo, including lateral E/e' (least-squares mean [LSM] change from baseline [CFB] - 5.1 vs. 0.6; between-group LSM difference - 5.7; 95% confidence interval [CI] - 7.6 to - 3.7), septal E/e' (LSM CFB - 6.0 vs. - 0.3; between-group LSM difference - 5.7; 95% CI - 7.8 to - 3.7), and left atrial volume index (LAVI) (LSM CFB - 11.7 vs. - 3.5 ml/m2; between-group LSM difference - 8.2; 95% CI - 12.0 to - 4.4) (nominal p < 0.001 for all). Twelve patients (23.1%) treated with mavacamten had complete resolution of mitral valve systolic anterior motion (SAM) versus two patients (7.4%) receiving placebo. Among mavacamten-treated patients, reductions in resting and Valsalva LVOT gradients, left ventricular (LV) mass index, LAVI, and lateral and septal E/e' were associated with reduced N-terminal pro-B-type natriuretic peptide levels (nominal p < 0.0001 for all). In the mavacamten group, reductions in LVOT gradients and LV end-diastolic interventricular septal thickness were associated with improved patient-reported Kansas City Cardiomyopathy Questionnaire Overall Summary Score (nominal p < 0.05 for all). CONCLUSIONS Clinically meaningful improvements were evident in Chinese patients treated with mavacamten compared with placebo in several hallmarks of obstructive HCM, including measures of LV diastolic function, SAM, and LVOT gradient. These results add further evidence to support the positive effects of mavacamten in cardiac remodeling. REGISTRATION ClinicalTrials.gov identifier: NCT05174416.
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Affiliation(s)
- Zhuang Tian
- Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, China
| | - Xiaoyan Li
- Renmin Hospital of Wuhan University, Hubei General Hospital, Wuhan, China
| | - Liwen Li
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Qing Zhang
- West China Hospital, Sichuan University, Chengdu, China
| | - Jian'an Wang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yunqi Shi
- The People's Hospital of Liaoning Province, Shenyang, China
| | - Daoquan Peng
- The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ping Yang
- China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wei Ma
- Peking University First Hospital, Beijing, China
| | | | - Wei Jin
- Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiang Cheng
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Yue Zhong
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | - Shuyang Zhang
- Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing Dongcheng District, Beijing, China.
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Faillé M, Bourdel-Marchasson I, Lafargue A, Lafitte S, Ternacle J, Roubaud-Baudron C, Guerville F. Hand-carried ultrasound for volaemia assessment in older adults: A prospective observational study. Arch Cardiovasc Dis 2025; 118:348-355. [PMID: 40180860 DOI: 10.1016/j.acvd.2025.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 01/22/2025] [Accepted: 01/27/2025] [Indexed: 04/05/2025]
Abstract
BACKGROUND Clinical assessment of volaemia is a daily challenge in geriatric care. Access to standard transthoracic echocardiography may be limited. Right atrial pressure is influenced by volaemia and can be estimated from inferior vena cava (IVC) diameter and collapsibility measured by hand-carried ultrasound (HCU). These pocket-size devices enable rapid bedside evaluation. AIMS To determine the added value of HCU performed by geriatricians in addition to clinical and biological data for assessing volaemia (hypovolaemia, euvolaemia or hypervolaemia). METHODS This single-centre prospective observational cross-sectional study included patients hospitalized in geriatric care units whose extracellular volume status was in doubt, based on clinical and biological data. IVC diameter and collapsibility index were assessed by geriatricians using HCU. RESULTS Overall, 102 patients were included (median [interquartile range] age 89 [84-94] years, 58% women). Volaemia based on clinical and biological data was different from that assessed by HCU in 54 patients (53%, 95% confidence interval [CI] 43-63%; Cohen's κ=0.15). This discordance was associated with the absence of clinically detectable jugular vein distension (P=0.014). The most frequent discordance (n=37) was clinical-biological suspicion of hypervolaemia in euvolaemic patients according to HCU. This led to a therapeutic impact (stopping or starting drugs) in 36 patients (35%, 95% CI 26-44%). CONCLUSION HCU performed during hospitalization for a suspicion of volaemia imbalance provides an assessment that differs from clinical-biological assessment in approximately 50% of cases. HCU could be a useful tool in geriatric care units to improve the diagnosis and management of volaemia.
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Affiliation(s)
- Mathilde Faillé
- Univ. Bordeaux, 33000 Bordeaux, France; CHU Bordeaux, Cardiology Unit, Hôpital Saint-André, 33000 Bordeaux, France
| | - Isabelle Bourdel-Marchasson
- CRMSB, UMR 5536, CNRS/Univ. Bordeaux, 33000 Bordeaux, France; CHU Bordeaux, Pôle de Gérontologie Clinique, 33000, Bordeaux, France
| | - Aurélie Lafargue
- CHU Bordeaux, Pôle de Gérontologie Clinique, 33000, Bordeaux, France
| | - Stéphane Lafitte
- Univ. Bordeaux, 33000 Bordeaux, France; CHU Bordeaux, Echocardiography and Valvular Heart Disease Units, 33600 Pessac, France
| | - Julien Ternacle
- Univ. Bordeaux, 33000 Bordeaux, France; CHU Bordeaux, Echocardiography and Valvular Heart Disease Units, 33600 Pessac, France
| | - Claire Roubaud-Baudron
- CHU Bordeaux, Pôle de Gérontologie Clinique, 33000, Bordeaux, France; Univ. Bordeaux, UMR INSERM 1312 BRIC, 33000 Bordeaux, France
| | - Florent Guerville
- CHU Bordeaux, Pôle de Gérontologie Clinique, 33000, Bordeaux, France; Univ. Bordeaux, ImmunoConcEpT lab, CNRS UMR 5164, INSERM ERL 1303, 33000 Bordeaux, France.
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22
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Matsuda J, Takano H, Imori Y, Ishihara K, Sangen H, Kubota Y, Nakata J, Miyachi H, Hosokawa Y, Tara S, Tokita Y, Yamamoto T, Kitamura M, Takayama M, Asai K. Long-term clinical outcomes after alcohol septal ablation for hypertrophic obstructive cardiomyopathy in Japan: a retrospective study. Heart Vessels 2025; 40:496-508. [PMID: 39580779 DOI: 10.1007/s00380-024-02489-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 11/13/2024] [Indexed: 11/26/2024]
Abstract
Hypertrophic cardiomyopathy is characterized by significant left ventricular wall thickening, often leading to obstructive symptoms. Alcohol septal ablation (ASA) has emerged as an effective treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite maximal medical therapy. However, the detailed long-term effects of ASA in Japanese patients with HOCM remain unclear. Therefore, this study aimed to investigate the long-term effects of ASA for HOCM by evaluating changes in symptoms, pressure gradient, hemodynamics, prognosis, and predictive factors for cardiovascular events over time. In this retrospective study, we examined 239 highly symptomatic patients (age, 64 ± 13 years; median follow-up, 6.9 years) treated with ASA for drug-refractory HOCM between 1998 and 2021. Patients were assessed using transthoracic echocardiography, magnetic resonance imaging, and cardiac catheterization. Follow-up evaluations included clinical assessments, electrocardiography, and echocardiography. Data analysis included descriptive statistics, Kaplan-Meier analysis, and multivariate regression. ASA reduced the left ventricular outflow tract gradient from 90.5 ± 52.8 to 14.4 ± 17.1 mmHg (P < 0.01) and New York Heart Association (NYHA) class from 3 [2.5-3] to 1 [1-2] at 10 years after ASA (P < 0.01). The 30-day mortality rate following ASA was 1%. Overall, 31 patients (13%) died during the follow-up period. The survival rates at 1, 5, 10, and 15 years after ASA were 97.4%, 89.9%, 83.7%, and 77.6%, respectively. Multivariable analysis revealed NYHA functional class before ASA (odds ratio [OR], 3.09; 95% confidence interval [CI], 1.40-6.82; P = 0.005), beta-blocker use (OR, 0.25; 95% CI, 0.07-0.91; P = 0.036), and class Ia agent use (OR, 0.31; 95% CI, 0.13-0.75; P = 0.009) as independent predictors of all-cause mortality. This study demonstrated low periprocedural and long-term mortality rates following ASA in patients with HOCM, suggesting that ASA provides durable symptomatic relief and reduces left ventricular outflow tract obstruction in selected highly symptomatic patients with HOCM.
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Affiliation(s)
- Junya Matsuda
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kakeru Ishihara
- Division of Cardiovascular Intensive Care, Nippon Medical School, Tokyo, Japan
| | - Hideto Sangen
- Division of Cardiovascular Intensive Care, Nippon Medical School, Tokyo, Japan
| | - Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Nippon Medical School, Tokyo, Japan
| | - Hideki Miyachi
- Division of Cardiovascular Intensive Care, Nippon Medical School, Tokyo, Japan
| | - Yusuke Hosokawa
- Division of Cardiovascular Intensive Care, Nippon Medical School, Tokyo, Japan
| | - Shuhei Tara
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yukichi Tokita
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School, Tokyo, Japan
| | | | | | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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23
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Hintz MO, Ahmad Zamri AS, Erickson EW, Barlev F, Coffey S, Lamberts RR. Associations between heart size and anthropometric and cardiovascular indicators: an undergraduate physiology teaching laboratory. ADVANCES IN PHYSIOLOGY EDUCATION 2025; 49:508-516. [PMID: 40139244 DOI: 10.1152/advan.00254.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 01/10/2025] [Accepted: 03/25/2025] [Indexed: 03/29/2025]
Abstract
Heart size is a critical indicator of cardiovascular health, is influenced by various anthropometric measures such as age, sex, body height, body weight, and fat-free mass, and associates with hand palm diameter. Understanding the relationship between heart size and these anthropometric indicators is vital for clinical practice and for understanding and exploring the anatomy and physiology of the heart. We designed a physiology teaching laboratory for second-year undergraduate students to facilitate this understanding. The laboratory had three primary learning objectives: 1) to observe heart size measurement with ultrasound by a professional cardiac sonographer; 2) to measure anthropometric parameters (age, sex, body height, body weight, body fat percentage, and hand palm diameter) alongside cardiovascular measures (heart rate and blood pressure); 3) to comprehend the basic qualitative and quantitative relationships between heart size and both the anthropometric and cardiovascular measurements.NEW & NOTEWORTHY Heart size is a key indicator of cardiovascular health, influenced by various factors such as sex and body height. We developed a physiology laboratory for second-year undergraduates to support learning of these relationships, which are crucial for understanding cardiac physiology. First, students observed heart size measurements with ultrasound by a professional. Second, they measured anthropometric and cardiovascular parameters. Finally, they explored the basic associations between heart size and the anthropometric and cardiovascular indicators.
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Affiliation(s)
- Madyson O Hintz
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Aisya S Ahmad Zamri
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Elizabeth W Erickson
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Frosina Barlev
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sean Coffey
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Medicine, Dunedin Hospital, Te Whatu Ora, Dunedin, New Zealand
- HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Regis R Lamberts
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
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24
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Yu C, Jiang L, Long L, Yu H. Atrial fibrillation in cancer patients: Epidemiology, identification and management. Semin Cancer Biol 2025; 111:39-47. [PMID: 39993515 DOI: 10.1016/j.semcancer.2025.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 02/05/2025] [Accepted: 02/11/2025] [Indexed: 02/26/2025]
Abstract
Cancer and cardiovascular disease (CVD) are among the leading causes of death globally, and the rate of coexistence of the two diseases has been increasing in recent years, with the elevation of the susceptible population base in aging societies and the improvement of therapeutic approaches. Atrial fibrillation (AF), as a common type of cancer-related cardiovascular toxicity (CTR-CVT) in oncology patients, is a serious threat to patients' health and may lead to other cardiovascular complications. Therefore, early detection, timely recognition, and effective intervention of AF are essential to maintain long-term survival of tumor survivors. However, the causal mechanisms regarding its association are still inconclusive, and there is no consensus in the clinic on the optimal treatment. In this review, we will integrate existing guidelines and studies to summarize the current state of research on atrial fibrillation in oncology patients in terms of epidemiology, pathophysiological mechanisms, predictive diagnostics, and therapeutic measures, and propose some research directions to be improved. We hope to provide a more comprehensive review and provide assistance in clinical response.
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Affiliation(s)
- Chengqi Yu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Leilei Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Liuhua Long
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Huiming Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
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25
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Jakstaite AM, Mueller‐Leisse J, Hillmann HA, Hohmann S, Eiringhaus J, Bavendiek U, Kempf T, Veltmann C, Bauersachs J, Duncker D, Berliner D. Right ventricular dysfunction for prediction of long-term recovery in de novo HFrEF : a PROLONG-II substudy. ESC Heart Fail 2025; 12:2166-2176. [PMID: 39905162 PMCID: PMC12055338 DOI: 10.1002/ehf2.15236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 12/21/2024] [Accepted: 01/18/2025] [Indexed: 02/06/2025] Open
Abstract
AIMS To analyse the predictive value of advanced markers of right ventricular (RV) function and RV-pulmonary arterial (PA) coupling in forecasting long-term left ventricular (LV) improvement in de novo heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS 260 patients (mean age 57 years, 68% men) from the PROLONG-II study were included. PROLONG-II analysed patients with new-onset HFrEF receiving a wearable cardioverter-defibrillator. For this substudy, RV free wall longitudinal strain (RVFWS), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and right ventricular-pulmonary artery (RV-PA) coupling ratios [RVFWS/systolic pulmonary artery pressure (PASP), TAPSE/PASP and FAC/PASP] at baseline and 3-month follow-up (early follow-up) were examined. LV improvement and non-improvement were defined as an LV ejection fraction (LVEF) of >35% or ≤35% at last available (long-term) follow-up. The median follow-up was 31.5 months (IQR: 18.2-45.4), and 151 (58%) patients experienced LV improvement in the long term. No significant differences of RV function and markers of RV-PA coupling were observed at baseline; however, the subgroup of patients with long-term LVEF improvement showed better RV function at early follow-up (RVFWS -20.9 ± 4.3 vs. -18.5 ± 5.1%, TAPSE 19.7 ± 5.1 vs. 17.4 ± 4.9 mm, FAC 39.7 ± 8.5 vs. 35.2 ± 9.4%, all P < 0.01). In multivariable analysis, RVFWS at early follow-up was shown to be an independent predictor of later LV recovery [odds ratio 1.078 (95% confidence interval 1.010-1.150), P < 0.05]. The non-improvers exhibited worse RV-PA coupling at early follow-up [RVFWS/PASP 0.82 ± 0.35 vs. 0.65 ± 0.35%/mmHg, TAPSE/PASP 0.71 (0.55-1.00) vs. 0.54 (0.35-0.75) mm/mmHg, FAC/PASP 1.54 ± 0.61 vs. 1.24 ± 0.75%/mmHg, all P < 0.01]. RVFWS/PASP identified RV-PA uncoupling was associated with a higher risk of all-cause mortality (hazard ratio 4.64, 95% confidence interval 1.34-16.09, P = 0.033). CONCLUSIONS Persistent RV dysfunction, as indicated by both standard and advanced echocardiographic markers during the early follow-up period, implies a reduced potential for long-term LV recovery in patients with newly diagnosed HFrEF.
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Affiliation(s)
- Aiste Monika Jakstaite
- Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverGermany
| | - Johanna Mueller‐Leisse
- Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverGermany
| | - Henrike A.K. Hillmann
- Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverGermany
| | - Stephan Hohmann
- Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverGermany
| | - Jörg Eiringhaus
- Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverGermany
| | - Udo Bavendiek
- Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverGermany
| | - Tibor Kempf
- Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverGermany
| | - Christian Veltmann
- Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverGermany
- Electrophysiology BremenHeart Center BremenSenator‐Wessling‐Str. 1BremenGermany
| | - Johann Bauersachs
- Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverGermany
| | - David Duncker
- Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverGermany
| | - D. Berliner
- Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverGermany
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26
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Wu X, Li J, Xu Z, Feng Y. Prognostic value of the HFA-PEFF and H(2) FPEF scores for clinical outcomes in patients with coronary artery disease and preserved ejection fraction. IJC HEART & VASCULATURE 2025; 58:101655. [PMID: 40207301 PMCID: PMC11979905 DOI: 10.1016/j.ijcha.2025.101655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 03/08/2025] [Accepted: 03/14/2025] [Indexed: 04/11/2025]
Abstract
Background Coronary artery disease (CAD) is a significant risk factor for heart failure with preserved ejection fraction (HFpEF). While the HFA-PEFF and H2FPEF scoring systems were developed to aid in the diagnosis of HFpEF, their predictive performance in patients with CAD remains underexplored. Methods This single-center retrospective cohort study included patients who underwent drug-eluting stent implantation between January 2018 and October 2022. The study's primary endpoint was a composite outcome of all-cause mortality and heart failure hospitalization during follow-up. Kaplan-Meier survival curves were used to evaluate time to adverse events, and differences between groups were analyzed using the log-rank test. Cox proportional hazards regression was applied to assess the independent predictive value of the HFA-PEFF and H2FPEF scores for adverse outcomes. Results The HFA-PEFF score categorized 65.7 % of patients as intermediate, 25.1 % as high, and 9.2 % as low probability for HFpEF. The H2FPEF score placed 77.3 % in the intermediate group, 19.3 % in the low, and 3.4 % in the high-probability group. The median follow-up period was 29 months. Adjusted Cox proportional hazard regression revealed the HFA-PEFF score was significantly associated with the composite endpoint of all-cause mortality and heart failure hospitalization (HR: 1.33, 95 % CI:1.07-1.65). Each point increase in the HFA-PEFF score raised heart failure hospitalization risk by 26 % (HR:1.26, 95 % CI: 1.05-1.51). In contrast, the H2FPEF score did not show a significant association with adverse events. Conclusions The HFA-PEFF score demonstrated superior prognostic value for predicting adverse outcomes in CAD patients with preserved ejection fraction compared to the H2FPEF score.
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Affiliation(s)
- Xuefeng Wu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Department of Cardiology, The First People’s Hospital of Foshan, Foshan, China
| | - Jianming Li
- Department of Cardiology, The First People’s Hospital of Foshan, Foshan, China
| | - Zhaoyan Xu
- Department of Cardiology, The First People’s Hospital of Foshan, Foshan, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Nguyen Duy T, Pham Phuong TA, Nguyen Lan H, Luong Cong T. Changes in the Right Ventricular Diameters and Systolic Function After Successful Percutaneous Coronary Intervention in Patients With First Acute Myocardial Infarction. Cardiol Res 2025; 16:212-224. [PMID: 40370618 PMCID: PMC12074680 DOI: 10.14740/cr2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Accepted: 03/14/2025] [Indexed: 05/16/2025] Open
Abstract
Background Right ventricular (RV) diameters and systolic function are strong predictors of outcomes and major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI). This study evaluated RV parameters via echocardiography in AMI patients and assessed their changes 1 month after discharge. Methods A prospective observational study was conducted on 133 consecutive patients with their first AMI. RV diameters and systolic function were evaluated with echocardiography within 24 h after successful percutaneous coronary intervention (PCI) and again 1 month after discharge. MACEs were evaluated during hospitalization and at 1 month post discharge. Results Men accounted for 69.92% of the participants, with a mean age of 68 years. Reduced right ventricular free wall longitudinal strain (RVFWSL) and right ventricular four-chamber longitudinal strain (RV4CSL) were observed in 62.4% (mean -18.28±8.77%) and 83.34% (mean -14.78±6.94%) of patients, respectively. Right ventricular longitudinal strain (RVLS) was significantly lower in the ST-elevation myocardial infarction (STEMI) group and Killip III-IV patients. RV basal and mid diameters (RVD1, RVD2) were larger in right coronary artery (RCA) and left main artery (LM) lesions than in left anterior descending artery (LAD) and left circumflex artery (LCx) ones (P < 0.05). RVLS correlated significantly with body mass index (BMI), troponin I, and left ventricular ejection fraction (LVEF). After 1 month, RVFWSL and RV4CSL improved significantly, especially in patients without MACEs, Killip III-IV, and single-vessel lesions. Conclusions RV diameters varied with the culprit lesion and remained stable after 1 month. RVLS was significantly reduced in AMI, especially in STEMI and Killip III-IV, correlating with LVEF. After 1 month, RVLS improved faster, particularly in patients without MACEs, Killip III-IV, or single-vessel lesions.
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Affiliation(s)
- Toan Nguyen Duy
- Cardiovascular Center, Military Hospital 103, Hanoi, Vietnam
- Cardiovascular Department, Vietnam Military Medical University, Hanoi, Vietnam
| | - Thao Anh Pham Phuong
- Cardiovascular Center, Military Hospital 103, Hanoi, Vietnam
- Cardiovascular Department, Vietnam Military Medical University, Hanoi, Vietnam
| | - Hieu Nguyen Lan
- Cardiovascular Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Thuc Luong Cong
- Cardiovascular Center, Military Hospital 103, Hanoi, Vietnam
- Cardiovascular Department, Vietnam Military Medical University, Hanoi, Vietnam
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28
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van Oort MJ, Oliveri F, de Lange FW, Regeer MV, Bingen B, Jukema J, van der Kley F, Al Amri I, Montero-Cabezas JM. Association of indexed aortic dimensions with the presence and extent of coronary artery ectasia in patients with acute coronary syndrome. IJC HEART & VASCULATURE 2025; 58:101654. [PMID: 40170954 PMCID: PMC11960637 DOI: 10.1016/j.ijcha.2025.101654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 03/10/2025] [Accepted: 03/12/2025] [Indexed: 04/03/2025]
Abstract
Background Conflicting findings have been reported on the potential association between CAE and aortic dilatation. This study aimed to investigate the relationship between CAE extent and aortic dimensions in patients with acute coronary syndrome (ACS). Methods This retrospective cohort study included 448 adult patients who underwent coronary angiography for ACS between 2004 and 2015. The cohort was divided into 224 patients with CAE and 224 control patients without CAE, matched for age, sex, and hypertension. Aortic dimensions at the annulus, sinus of Valsalva (SOV), sinotubular junction (STJ), and ascending aorta were measured using transthoracic echocardiography and indexed to body surface area (BSA). The extent of CAE was classified using the Markis and Markis-Harirkrishnan systems. Statistical analysis included ANOVA to assess differences in aortic dimensions and their correlation with CAE extent. Results Patients with CAE had significantly larger non-indexed aortic dimensions compared to those without CAE (e.g., ascending aorta diameter: 35.2 ± 4.0 mm vs. 33.6 ± 3.7 mm, p < 0.0001). However, when indexed to BSA, these differences were not significant. No significant correlation was found between CAE extent and aortic dimensions (e.g., indexed ascending aorta: F = 1.161, p = 0.325). The incidence of bicuspid aortic valve was similar between both groups (0.9 % vs. 0.4 %, p = 0.554). Conclusion In patients with ACS, there were no significant differences in indexed aortic diameters in those with and without CAE. Additionally, no correlation was found between CAE extent and aortic dimensions and the incidence of bicuspid aortic valve was comparable in both groups.
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Affiliation(s)
| | - Federico Oliveri
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Madelien V. Regeer
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - B.O. Bingen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J.Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Heart Institute. Utrecht, The Netherlands
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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29
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Giaquinto A, Abate V, Vergatti A, Muscariello R, Iervolino A, Pucci M, Cavati G, Pirrotta F, De Filippo G, Esposito R, D'Elia L, Merlotti D, Gennari L, Rendina D. Standard and advanced echocardiographic study of patients with Paget's disease of bone: Evidence of a pagetic heart disease? J Intern Med 2025; 297:630-641. [PMID: 40342188 PMCID: PMC12087814 DOI: 10.1111/joim.20069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2025]
Abstract
BACKGROUND Paget's disease of the bone (PDB) is a metabolic bone disorder involving one or more skeletal sites. Cardiovascular diseases (CVDs) have been described in patients with PDB but have not been systematically analysed. OBJECTIVES This study aimed to compare standard and advanced (speckle-tracking) echocardiographic parameters measured in patients with PDB and controls matched for age, weight, height and history of hypertension but without metabolic bone disorders. METHODS This multicentre case-control study included all patients with PDB referred to the Federico II and Siena Universities, Italy, from March 2019 to October 2022. During the same time, we enrolled at least one control for each patient, matched for age, sex, body mass index (BMI) and history of hypertension. RESULTS Sixty-nine patients with PDB and 115 healthy controls were enrolled in this study. All patients with PDB were treated with zoledronic acid at the time of diagnosis. Compared with controls, on standard echocardiography, patients with PDB showed a high prevalence of aortic and mitral valve calcifications and/or sclerosis, reduced left ventricular (LV) ejection fraction, stroke volume, cardiac output, increased interventricular septum thickness, posterior wall thickness, LV mass index, relative wall thickness, relative diastolic wall thickness, E/e' ratio and systemic vascular resistance. Using speckle-tracking echocardiography, patients with PDB showed a lower global longitudinal strain and global myocardial work efficiency than controls. There was no relationship between the PDB activity and extent and severity of cardiac abnormalities. CONCLUSION Overall, the myocardial function and structure were impaired in patients with PDB. Additionally, PDB was associated with early subclinical myocardial damage.
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Affiliation(s)
- Alfonso Giaquinto
- Department of Clinical Medicine and SurgeryFederico II UniversityNaplesItaly
| | - Veronica Abate
- Department of Clinical Medicine and SurgeryFederico II UniversityNaplesItaly
| | - Anita Vergatti
- Department of Clinical Medicine and SurgeryFederico II UniversityNaplesItaly
| | | | - Adelaide Iervolino
- Department of Clinical Medicine and SurgeryFederico II UniversityNaplesItaly
| | - Martina Pucci
- Department of Clinical Medicine and SurgeryFederico II UniversityNaplesItaly
| | - Guido Cavati
- Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
| | - Filippo Pirrotta
- Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
| | - Gianpaolo De Filippo
- Assistance Publique‐Hôpitaux de Paris, Hôpital Robert‐DebréService d'Endocrinologie‐DiabétologieParisFrance
| | - Roberta Esposito
- Department of Clinical Medicine and SurgeryFederico II UniversityNaplesItaly
| | - Lanfranco D'Elia
- Department of Clinical Medicine and SurgeryFederico II UniversityNaplesItaly
| | - Daniela Merlotti
- Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
| | - Luigi Gennari
- Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
| | - Domenico Rendina
- Department of Clinical Medicine and SurgeryFederico II UniversityNaplesItaly
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Gao S, Li D, Qiao B, Gong Y, Xu X, Wang Y, Jia L, Du J. Association of elevated levels of soluble transferrin receptor with left ventricular remodeling and mortality in patients with heart failure: Evidence from observational and genetic investigations. Int J Cardiol 2025; 428:133133. [PMID: 40056940 DOI: 10.1016/j.ijcard.2025.133133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 02/25/2025] [Accepted: 03/05/2025] [Indexed: 03/17/2025]
Abstract
BACKGROUND Iron deficiency (ID) is prevalent in heart failure (HF) patients and correlates with adverse outcomes. Serum soluble transferrin receptor (sTfR) levels reflect bone marrow and myocardial iron stores, potentially impacting HF prognosis. However, the specific role of sTfR in the progression of HF remains unclear. METHODS In a retrospective cohort of 391 patients with HF and left ventricular ejection fraction (LVEF) < 50 %, multivariate logistic regression and Cox proportional hazard regression identified mortality-associated factors. The receiver operating characteristic (ROC) curve determined sTfR cut-off value based on the area under the curve. Kaplan-Meier curves were used to compare the cumulative survival rates. Spearman's rank correlation assessed sTfR's relation to left ventricular (LV) parameters. Mendelian randomization (MR) analysis explored causal associations. RESULTS High sTfR levels (≥1.96 mg/L) predicted worse survival and were associated with increased LV volume and lower LVEF. sTfR correlated significantly with LV end-diastolic volume (LVEDV) (r = 0.09, P = 0.0152), LV end-systolic volume (LVESV) (r = 0.16, P = 0.0018), body surface area-indexed LVEDV (LVEDVI) (r = 0.12, P = 0.0140), body surface area-indexed LVESV (LVESVI) (r = 0.14, P = 0.0058), and negatively with LVEF (r = -0.20, P = 0.0001). MR analysis showed a causal link between elevated sTfR and increased LVEDV (β = 0.092; 95 % CI: 1.031-1.162; P = 0.0056) and LVESV (β = 0.089; 95 % CI: 1.027-1.058; P = 0.0079). CONCLUSIONS Elevated sTfR levels identify HF patients at higher risk of mortality and are linked to detrimental LV structural and functional changes, particularly enlargement of LVEDV and LVESV.
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Affiliation(s)
- Shan Gao
- Beijing Anzhen Hospital, Capital Medical University; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Center for Cardiovascular Disorders; Beijing Institute of Heart, Lung & Blood Vessel Disease, Beijing 100029, China
| | - Dehui Li
- Beijing Anzhen Hospital, Capital Medical University; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Center for Cardiovascular Disorders; Beijing Institute of Heart, Lung & Blood Vessel Disease, Beijing 100029, China
| | - Bokang Qiao
- Beijing Anzhen Hospital, Capital Medical University; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Center for Cardiovascular Disorders; Beijing Institute of Heart, Lung & Blood Vessel Disease, Beijing 100029, China
| | - Yanyan Gong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Xuan Xu
- Beijing Anzhen Hospital, Capital Medical University; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Center for Cardiovascular Disorders; Beijing Institute of Heart, Lung & Blood Vessel Disease, Beijing 100029, China
| | - Yuan Wang
- Beijing Anzhen Hospital, Capital Medical University; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Center for Cardiovascular Disorders; Beijing Institute of Heart, Lung & Blood Vessel Disease, Beijing 100029, China
| | - Lixin Jia
- Beijing Anzhen Hospital, Capital Medical University; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Center for Cardiovascular Disorders; Beijing Institute of Heart, Lung & Blood Vessel Disease, Beijing 100029, China; Institute for Biological Therapy, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan 450052, China.
| | - Jie Du
- Beijing Anzhen Hospital, Capital Medical University; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education; Beijing Collaborative Innovation Center for Cardiovascular Disorders; Beijing Institute of Heart, Lung & Blood Vessel Disease, Beijing 100029, China.
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31
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Cefalo CMA, Riccio A, Fiorentino TV, Succurro E, Perticone M, Cassano V, Sciacqua A, Andreozzi F, Sesti G. The triglyceride glucose (TyG) index is associated with decreased myocardial mechano-energetic efficiency in individuals with different glucose tolerance status. Eur J Clin Invest 2025; 55:e70013. [PMID: 40007083 PMCID: PMC12066897 DOI: 10.1111/eci.70013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Accepted: 02/11/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND This investigation had two main objectives: (1) to compare the triglyceride-glucose (TyG) index with the homeostasis model assessment of insulin resistance (HOMA-IR) in relation to insulin-stimulated myocardial glucose metabolic rate (MrGlu), measured by a dynamic positron emission tomography (PET) scan using 18F-fluorodeoxyglucose (18F-FDG) coupled with a euglycemic-hyperinsulinemic clamp; and (2) to assess whether the TyG index correlates with myocardial mechano-energetic efficiency (MEE). METHODS We evaluated MrGlu in 46 participants who had no prior diagnosis of coronary heart disease. Myocardial MrGlu was quantified by 18F-FDG PET during a euglycemic-hyperinsulinemic clamp. In a larger cohort of 1820 individuals, myocardial MEE per gram of left ventricular mass (MEEi) was measured echocardiographically. The TyG index was computed as the Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. RESULTS When compared to HOMA-IR, the TyG index exhibited a stronger correlation with myocardial MrGlu (Pearson's r = -.566 for TyG vs. -.471 for HOMA-IR). Within the larger cohort, individuals in the highest TyG quartile showed significantly reduced MEEi compared to those in the lowest quartile (p < .001). Stepwise multivariate linear regression confirmed that the TyG index was the most significant determinant of MEEi, independent of traditional cardio-metabolic risk factors. CONCLUSIONS Our findings suggest that the TyG index is superior to HOMA-IR as an indicator of cardiac insulin resistance and that it independently correlates with MEEi. Thus, the TyG index may serve as a valuable, readily available tool to identify subjects at elevated cardiovascular risk.
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Affiliation(s)
- Chiara M. A. Cefalo
- Department of Clinical and Molecular MedicineUniversity of Rome‐SapienzaRomeItaly
| | - Alessia Riccio
- Department of Clinical and Molecular MedicineUniversity of Rome‐SapienzaRomeItaly
| | | | - Elena Succurro
- Department of Medical and Surgical SciencesUniversity Magna Graecia of CatanzaroCatanzaroItaly
| | - Maria Perticone
- Department of Medical and Surgical SciencesUniversity Magna Graecia of CatanzaroCatanzaroItaly
| | - Velia Cassano
- Department of Medical and Surgical SciencesUniversity Magna Graecia of CatanzaroCatanzaroItaly
| | - Angela Sciacqua
- Department of Medical and Surgical SciencesUniversity Magna Graecia of CatanzaroCatanzaroItaly
| | - Francesco Andreozzi
- Department of Medical and Surgical SciencesUniversity Magna Graecia of CatanzaroCatanzaroItaly
| | - Giorgio Sesti
- Department of Clinical and Molecular MedicineUniversity of Rome‐SapienzaRomeItaly
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32
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Coppi F, Cavalletti A, Pagnoni G, Campani C, Grossule F, Maini A, Macripò P, Zanini G, Sinigaglia G, Giuggioli D, Nasi M, Fedele F, Mattioli AV, Boriani G, Pinti M. Pulmonary hypertension in patients with Sjögren's syndrome: Gender differences in cardiovascular risk factors and instrumental data. Int J Cardiol 2025; 428:133131. [PMID: 40058609 DOI: 10.1016/j.ijcard.2025.133131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 02/14/2025] [Accepted: 03/05/2025] [Indexed: 03/15/2025]
Abstract
BACKGROUND Pulmonary hypertension (pH) is a well-documented complication in patients with connective tissue diseases, including Sjögren's syndrome (SS). However, the prevalence of PH in SS varies considerably across studies, likely due to differences in diagnostic methods. AIM OF THE STUDY This study aims to assess the prevalence of PH in a cohort of SS patients and to examine potential differences in age, cardiovascular risk factors, autoimmunity, pulmonary function tests, and echocardiographic parameters between male and female SS patients. PATIENTS AND METHODS Sixty-three patients diagnosed with primary SS were included in this study. Male patients were compared to females regarding age, cardiovascular risk factors, autoimmunity, pulmonary function tests, and echocardiographic parameters. All patients underwent comprehensive cardiac echo-color-Doppler evaluations during their most recent follow-up. RESULTS The prevalence of PH in the study cohort was 1.6 %. Respiratory function tests revealed significantly lower values in male patients compared to females. Echocardiographic assessments also indicated more pronounced alterations in males in pulmonary artery diameter and TVI-RVOT. In left-sided heart parameters, males showed greater dilatation and signs of diastolic dysfunction. Mass 2D and ejection fraction FE2D were also altered in males. DISCUSSION AND CONCLUSION The low prevalence of PH (1.6 %) in SS patients when diagnosed with RHC emphasizes the importance of using accurate diagnostic methods. As male patients demonstrated a greater predisposition to developing PH, as evidenced by altered respiratory function, and early diastolic dysfunction, regular echocardiographic monitoring is recommended for male SS patients, particularly those exhibiting early structural or functional cardiac changes.
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Affiliation(s)
- Francesca Coppi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy
| | - Alessia Cavalletti
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Gianluca Pagnoni
- Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Cecilia Campani
- Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Francesca Grossule
- Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Arianna Maini
- Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Pierluca Macripò
- Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Giada Zanini
- Department of Life Sciences, University of Modena and Reggio Emilia, Via G. Campi 287, 41125 Modena, Italy
| | - Giorgia Sinigaglia
- National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy
| | - Dilia Giuggioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Milena Nasi
- Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Francesco Fedele
- National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy
| | - Anna Vittoria Mattioli
- National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy
| | - Giuseppe Boriani
- Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Marcello Pinti
- National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy; Department of Life Sciences, University of Modena and Reggio Emilia, Via G. Campi 287, 41125 Modena, Italy.
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Papangelopoulou K, Kuznetsova T, Orlowska M, Cauwenberghs N, Voigt JU, D'hooge J. Strain rate during isovolumic relaxation as a prognostic biomarker for long-term cardiovascular morbidity and mortality: an exploratory study on a general population. J Echocardiogr 2025; 23:86-98. [PMID: 39405011 DOI: 10.1007/s12574-024-00662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 08/07/2024] [Accepted: 09/23/2024] [Indexed: 05/25/2025]
Abstract
AIMS Left ventricular (LV) strain rate (SR) during early relaxation correlates with LV filling pressures and has been assessed as a prognostic biomarker in several cardiac diseases. Conversely, even though LV SR during isovolumic relaxation (SRIVR) is more strongly related to invasive measurements of LV diastolic function, to date, studies on the role of SRIVR in the long-term prognosis assessment are lacking. Thus, the goal of this study was to assess the potential additive prognostic value of SRIVR on top of conventional cardiovascular risk factors in a general population. METHODS 657 subjects (mean age 51.6y; 47.6% males) were included in this study and, besides clinical and standard echocardiographic assessment, tissue Doppler imaging (TDI)-based SR was measured during IVR (SRIVR), early diastole (SRe), and atrial contraction (SRa) in the mid-segment of the inferior, inferolateral, lateral, and septal wall of the LV. RESULTS During the follow-up period (median 12.1 years), the total number of major adverse cardiac events was 85 (13.4%). Overall, after adjustment for known cardiovascular risk factors and important echocardiographic indices in a multivariable-adjusted Cox regression model, SRIVR of the inferolateral wall (SRIVRinflat) remained an independent predictor of fatal and nonfatal cardiac events (HR: 1.49, p = 0.016), along with GLS (HR: 1.35, p = 0.027), age (HR: 1.09, p < 0.001), and male sex (HR: 2.06, p = 0.037). None of SRIVR measured in the other myocardial walls were associated with cardiac outcome. CONCLUSION SRIVRinflat predicted adverse outcome in the general population, on top of conventional cardiovascular factors. However, its incremental value as a prognosticator remained limited.
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Affiliation(s)
- Konstantina Papangelopoulou
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Oude Markt 13, 3000, Louvain, Belgium.
| | - Tatiana Kuznetsova
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Oude Markt 13, 3000, Louvain, Belgium
| | - Marta Orlowska
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Oude Markt 13, 3000, Louvain, Belgium
| | - Nicholas Cauwenberghs
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Oude Markt 13, 3000, Louvain, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Oude Markt 13, 3000, Louvain, Belgium
- Department of Cardiovascular Diseases, Division of Cardiology, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Jan D'hooge
- Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Oude Markt 13, 3000, Louvain, Belgium
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Thiel JN, Gestrich J, Steinseifer U, Friehs I, Diaz-Gil D, Neidlin M. Quantifying the impact of mitral valve anatomy on clinical markers using surrogate models and sensitivity analysis. Comput Biol Med 2025; 192:110265. [PMID: 40347797 DOI: 10.1016/j.compbiomed.2025.110265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Revised: 04/03/2025] [Accepted: 04/22/2025] [Indexed: 05/14/2025]
Abstract
Blood flow studies within the left ventricle have proven to be promising for future clinical decision-making. However, accurate segmentation of heart valves, particularly the mitral valve, is still challenging. The mitral valve has a significant impact on local flow phenomena within the ventricle and assumptions about its anatomy and position introduce uncertainties that are not yet fully understood. The overall aim of this study is to quantify the impact of uncertainty in defining mitral valve anatomy and position on local and global hemodynamic markers, such as kinetic energy, energy loss, transventricular pressure gradient and locally resolved wall shear stresses. A combination of computational fluid dynamics moving mesh simulations of cardiac blood flow, reduced order modeling and variance-based global sensitivity analysis is used. The influence of annular displacement, angular orientation and long-axis radius is assessed using echocardiographic imaging data from an infant. A non-linear relationship between geometric uncertainties and flow biomarkers is uncovered, with mitral valve size and angle identified as the most important parameters. Uncertainty quantification of echocardiography measurements reveals a standard deviation between 5-32% for the different clinical markers. This study highlights the importance of robust surrogate models and global sensitivity analysis, as their choice can drastically affect both predicted clinical markers and identified key parameters most relevant for model personalization. The presented pipeline is summarized in the open source tool SASQUATCH - a framework for sensitivity analysis and uncertainty quantification in cardiac hemodynamics.
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Affiliation(s)
- Jan-Niklas Thiel
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Joel Gestrich
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Ingeborg Friehs
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Daniel Diaz-Gil
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Pediatric Heart Medicine and Adults with Congenital Heart Disease, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany.
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Vera A, Lanaspa A, Jiménez O, Navarro A, Basurte MT, Beunza M, Ciriza M, Basterra N, Sadaba R, Ruiz-Quevedo V, Álvarez V. Reduced left atrial strain is associated with worse outcomes in coronary embolism. Heart Vessels 2025:10.1007/s00380-025-02561-3. [PMID: 40434417 DOI: 10.1007/s00380-025-02561-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2025] [Accepted: 05/14/2025] [Indexed: 05/29/2025]
Abstract
Coronary embolism (CE) is an uncommon cause of acute myocardial infarction (AMI), representing around 3% of cases. Left atrial strain (LAS) has emerged as a promising tool for assessing atrial function, however its prognosis role in CE remains unsettled. We retrospectively analyzed 100 consecutive patients with CE that was diagnosed based on criteria encompassing clinical, angiographic and diagnostic imaging findings. We evaluated in-hospital and long-term outcomes. Among the 100 patients, 28 experienced adverse in-hospital events. In the univariate analysis, lower estimated glomerular filtration rate, peak troponin I, lower LAS reservoir, atrial fibrillation (AF), right ventricular dysfunction (RVD), mitral regurgitation and reduced left ventricular ejection fraction were associated with in-hospital events. Multivariate analysis confirmed reduced LAS reservoir (OR 0.88, 95%CI 0.81-0.95; p = 0.03), AF (OR 15, 95%CI 1.4-168; p = 0.02), and RVD (OR 18, 95% CI 1.2-275; p = 0.04) as independent predictors of adverse in-hospital outcomes. After a median follow-up of 26 months, 21 patients (23%) experienced adverse long-term events. In the univariate analysis chronic kidney disease, STEMI presentation, RVD and lower LAS reservoir were associated with worse long-term outcomes. In multivariate analysis, reduced LAS reservoir (HR 0.9 (95%CI 0.84-0.98; p = 0.02)) remained a significant predictor of long-term adverse outcomes. On the log-rank test using the discriminatory cutoff value of LASr < 17.5%, LASr was associated with higher risk of long-term outcomes (p < 0.001). Reduced LAS is associated with worse in-hospital and long-term outcomes in patients with CE. These findings highlight the potential role of LAS as a valuable prognostic tool in CE.
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Affiliation(s)
- Alberto Vera
- Cardiology Department, Hospital Universitario de Navarra, c/Irunlarrea 3 Pamplona, 31008, Pamplona, Navarra, Spain.
| | - Arturo Lanaspa
- Cardiology Department, Hospital Universitario de Navarra, c/Irunlarrea 3 Pamplona, 31008, Pamplona, Navarra, Spain
| | - Octavio Jiménez
- Cardiology Department, Hospital Universitario de Navarra, c/Irunlarrea 3 Pamplona, 31008, Pamplona, Navarra, Spain
| | - Adela Navarro
- Cardiology Department, Hospital Universitario de Navarra, c/Irunlarrea 3 Pamplona, 31008, Pamplona, Navarra, Spain
| | - María Teresa Basurte
- Cardiology Department, Hospital Universitario de Navarra, c/Irunlarrea 3 Pamplona, 31008, Pamplona, Navarra, Spain
| | - Maite Beunza
- Cardiology Department, Hospital Universitario de Navarra, c/Irunlarrea 3 Pamplona, 31008, Pamplona, Navarra, Spain
| | - Mercedes Ciriza
- Radiology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Nuria Basterra
- Cardiology Department, Hospital Universitario de Navarra, c/Irunlarrea 3 Pamplona, 31008, Pamplona, Navarra, Spain
| | - Rafael Sadaba
- Cardiac Surgery Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Valeriano Ruiz-Quevedo
- Cardiology Department, Hospital Universitario de Navarra, c/Irunlarrea 3 Pamplona, 31008, Pamplona, Navarra, Spain
| | - Virginia Álvarez
- Cardiology Department, Hospital Universitario de Navarra, c/Irunlarrea 3 Pamplona, 31008, Pamplona, Navarra, Spain
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Brown K, Xu K, Hahn RT, Pibarot P, Leipsic J, Ma Y, Clavel MA, Elmariah S, Weissman NJ, Asch FM, Khalique O, Leon MB, Cremer P, Lindman BR, Alu MC, Douglas PS, Daubert MA. Impact of Coronary Artery Disease on Cardiovascular Outcomes Differs Between Men and Women With Severe Aortic Stenosis. Circ Cardiovasc Interv 2025:e014999. [PMID: 40421543 DOI: 10.1161/circinterventions.124.014999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Accepted: 04/30/2025] [Indexed: 05/28/2025]
Abstract
BACKGROUND There is heterogeneity in coronary artery disease (CAD) severity among individuals with severe aortic stenosis (AS), but whether this differentially influences prognosis is unknown. METHODS Patients with severe AS in the PARTNER 1, 2, and 3 trials and registries (Placement of Aortic Transcatheter Valves) were stratified by obstructive CAD (coronary stenosis ≥50%, prior myocardial infarction, or revascularization) or no obstructive CAD (all stenoses <50%). Multivariable Cox proportional-hazards models examined the association between CAD severity groups and clinical outcomes. The primary composite end point was death, heart failure hospitalization, or stroke at 5 years. Interaction between sex and CAD severity was evaluated. RESULTS Among 7505 patients with severe AS, 2062 (27.5%) had no obstructive CAD and were more likely to be women (60.5%) with fewer CAD risk factors. After multivariable adjustment, the primary end point was significantly lower among patients with no obstructive CAD compared with those with obstructive CAD (adjusted hazard ratio, 0.92 [CI, 0.84-1.00]; P=0.04), irrespective of AS treatment. However, there were significant differences by sex (Pinteraction=0.0002). Men with no obstructive CAD had a 16% lower event rate compared with men with obstructive CAD (adjusted hazard ratio, 0.84 [CI, 0.73-0.96]; P=0.01). In contrast, women with no obstructive CAD did not have a significantly lower rate of death, stroke, or heart failure hospitalization compared with women with obstructive CAD (adjusted hazard ratio, 0.95 [CI, 0.85-1.07]; P=0.41). Women with no obstructive CAD had a more advanced heart failure phenotype and higher event rates compared with men with no obstructive CAD. CONCLUSIONS Obstructive CAD was associated with a higher risk of long-term adverse events after treatment for severe AS, but there was a significant sex disparity in clinical outcomes among men and women with no obstructive CAD. Further study is needed to optimize the evaluation and management of women with severe AS.
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Affiliation(s)
- Kayla Brown
- Duke University, Durham, NC (K.B., P.S.D., M.A.D.)
| | - Ke Xu
- Edwards Lifesciences, Irvine, CA (K.X., Y.M.)
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, NY (R.T.H., M.B.L., M.C.A.)
- Cardiovascular Research Foundation, New York, NY (R.T.H., M.B.L., M.C.A.)
| | | | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.)
| | - Ying Ma
- Edwards Lifesciences, Irvine, CA (K.X., Y.M.)
| | | | | | - Neil J Weissman
- MedStar Health Research Institute, Washington, DC (N.J.W., F.M.A.)
| | - Federico M Asch
- MedStar Health Research Institute, Washington, DC (N.J.W., F.M.A.)
| | | | - Martin B Leon
- Columbia University Irving Medical Center, New York, NY (R.T.H., M.B.L., M.C.A.)
- Cardiovascular Research Foundation, New York, NY (R.T.H., M.B.L., M.C.A.)
| | | | | | - Maria C Alu
- Columbia University Irving Medical Center, New York, NY (R.T.H., M.B.L., M.C.A.)
- Cardiovascular Research Foundation, New York, NY (R.T.H., M.B.L., M.C.A.)
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Zaroui A, Lafont C, Kharoubi M, Audureau E, Bézard M, Hentati M, Chadha GDS, Teiger E, Itti E, Lellouche N, Fellahi S, Broussier A, Canoui-Poitrine F, Damy T. Men and women differ with regard to the prevalence, phenotype, and prognosis of wild-type transthyretin amyloid cardiomyopathy. Amyloid 2025:1-12. [PMID: 40421897 DOI: 10.1080/13506129.2025.2507921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 05/10/2025] [Accepted: 05/13/2025] [Indexed: 05/28/2025]
Abstract
BACKGROUND We explored sex differences in wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) and determined survival and prognostic factors. METHODS In a retrospective cohort study at a reference centre in France from 1 January 2008 to 31 December 2022, multiple regression analyses, supervised clustering, Cox models, and a Kaplan-Meier analysis were used to compare women and men in each age quartile (Q1: ≤77 years; Q2: 78-82; Q3: 83-86; Q4 > 86). RESULTS We included 1062 patients with ATTRwt-CM (180 women, 16%). The women had a higher median [IQR] left ventricular ejection fraction (LVEF; 52% [45-60] vs. 50 [43-58] in men) and a thinner interventricular septum. 12% of women and 4.1% of men had a septum thickness <12 mm (p = 0.004). The women in Q1 had lower LVEF and global longitudinal strain values and a higher prevalence of a septum <12 mm (15.8%, vs 2.0% in men) than men and older women (Q2-Q3-Q4). Women had a greater risk of sudden death than men (13.8% vs. 4.6%, respectively; odds ratio [95% confidence interval]: 3.24 [1.56-6.64]; p = 0.001). CONCLUSIONS In women, the ATTRwt-CM phenotype and prognosis are related to age at diagnosis. Decreasing the septum thickness cut-off would increase the frequency of ATTR-CM diagnosis in women.
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Affiliation(s)
- Amira Zaroui
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiac Amyloidosis Referral Center, Cardiogen Network, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Medical Center, Créteil, France
- Ecole Doctorale Santé Publique, Université de Paris-Est Creteil, Créteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Henri Mondor University Medical Center, Créteil, France
| | - Charlotte Lafont
- Ecole Doctorale Santé Publique, Université de Paris-Est Creteil, Créteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Department, Henri Mondor University Medical Center, Créteil, France
| | - Mounira Kharoubi
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiac Amyloidosis Referral Center, Cardiogen Network, Henri Mondor University Medical Center, Créteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Henri Mondor University Medical Center, Créteil, France
| | - Etienne Audureau
- Ecole Doctorale Santé Publique, Université de Paris-Est Creteil, Créteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Department, Henri Mondor University Medical Center, Créteil, France
| | - Mélanie Bézard
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiac Amyloidosis Referral Center, Cardiogen Network, Henri Mondor University Medical Center, Créteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Henri Mondor University Medical Center, Créteil, France
| | - Mouna Hentati
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiac Amyloidosis Referral Center, Cardiogen Network, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Medical Center, Créteil, France
| | - Gagan Deep Singh Chadha
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiac Amyloidosis Referral Center, Cardiogen Network, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Medical Center, Créteil, France
| | - Emmanuel Teiger
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiac Amyloidosis Referral Center, Cardiogen Network, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Medical Center, Créteil, France
| | - Emmanuel Itti
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiac Amyloidosis Referral Center, Cardiogen Network, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Medical Center, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hopitaux de Paris), Nuclear Medicine Department, Henri Mondor University Medical Center, Creteil, France
| | - Nicolas Lellouche
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiac Amyloidosis Referral Center, Cardiogen Network, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Medical Center, Créteil, France
| | - Soraya Fellahi
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiac Amyloidosis Referral Center, Cardiogen Network, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hopitaux de Paris), Biology Department, Henri Mondor University Medical Center, Creteil, France
| | - Amaury Broussier
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hopitaux de Paris), Geriatric Department, Henri Mondor University Medical Center, Creteil, France
| | - Florence Canoui-Poitrine
- Ecole Doctorale Santé Publique, Université de Paris-Est Creteil, Créteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Public Health Department, Henri Mondor University Medical Center, Créteil, France
| | - Thibaud Damy
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiology Department, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), Cardiac Amyloidosis Referral Center, Cardiogen Network, Henri Mondor University Medical Center, Créteil, France
- AP-HP (Assistance Publique-Hôpitaux de Paris), GRC Amyloid Research Institute, Henri Mondor University Medical Center, Créteil, France
- Ecole Doctorale Santé Publique, Université de Paris-Est Creteil, Créteil, France
- Clinical Epidemiology and Ageing (CEpiA) Geriatrics, Primary Care and Public Health, Henri Mondor University Medical Center, Créteil, France
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Balata M, Tanaka T, Sugiura A, Kavsur R, Vogelhuber J, Öztürk C, Zimmer S, Luetkens J, Nickenig G, Weber M. Association between psoas muscle area and outcomes after transcatheter tricuspid valve repair. Cardiovasc Interv Ther 2025:10.1007/s12928-025-01136-3. [PMID: 40423763 DOI: 10.1007/s12928-025-01136-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Accepted: 04/30/2025] [Indexed: 05/28/2025]
Abstract
Transcatheter tricuspid valve repair (TTVR) might be an alternative option to reduce tricuspid regurgitation (TR) in patients with sarcopenia. Psoas muscle area (PMA) measured using computed tomography (CT) is known as a marker of sarcopenia. We investigated the association of PMA with procedural and clinical outcomes following TTVR. We retrospectively measured left and right PMA using pre-procedural CT in patients undergoing TTVR. Low PMA was defined as the total PMA < 20.3 cm2 for men and < 11.8 cm2 for women. The primary outcome was a composite of all-cause mortality and heart failure hospitalization within one year after TTVR. Of 163 patients, 47 (29%) were considered as having low PMA. Procedural success, defined as residual TR of ≤ 2 + at discharge, and in-hospital mortality were comparable between patients with low and high PMA. Patients with low PMA had a higher incidence of the composite outcome than those with high PMA (49% vs. 21%; p = 0.001) This association was consistent after adjusting for baseline characteristics (adjusted hazard ratio 0.43; 95% confidence interval: 0.23-0.80; p = 0.008). In contrast, the New York Heart Association functional class improved from baseline to three-month follow-up, regardless of PMA. Approximately 30% of patients undergoing TTVR were found to have low PMA. Although TTVR may be a safe therapeutic option to reduce TR and improve heart failure symptoms in patients with sarcopenia, the prognosis after TTVR remains poor in this population. Pre-procedural CT-based assessment of PMA may enhance risk stratification and support better clinical decision-making for TTVR.
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Affiliation(s)
- Mahmoud Balata
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian Luetkens
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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39
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Di Gioia G, Ferrera A, Mango F, Maestrini V, Monosilio S, Pelliccia A, Squeo MR. The spectrum of eccentric left ventricular hypertrophy in endurance sports disciplines. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2025:10.1007/s10554-025-03430-w. [PMID: 40419828 DOI: 10.1007/s10554-025-03430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Accepted: 05/17/2025] [Indexed: 05/28/2025]
Abstract
Endurance sports disciplines largely differ in terms of specific training and event modalities, likely resulting in diverse morpho-functional cardiac changes. Our study aims to assess elite athletes engaged in different endurance disciplines and describe cardiac remodelling in each. We enrolled 282 Olympic athletes (58.5% males, mean age 26.7 ± 4.7) practising long-distance running (57, 20.2%), triathlon (18, 6.4%), canoeing/rowing (76, 26.9%), cycling (65, 23%), long-distance swimming (21, 7.4%), cross-country skiing & biathlon (45, 16%). athletes underwent ECG, echocardiogram and exercise stress-test. Eccentric LV hypertrophy (EH) was present in 73.8% of athletes, without gender differences (p = 0.847), varying greatly among disciplines (p = 0.0005). Triathlon (94.4%) and cycling (87.7%) showed the highest prevalence. The largest LV volumes were observed in triathlon-athletes and cyclists (LVEDVi: males, p = 0.009, females, p = 0.002). The lowest LV dimensions were found in rowing/canoeing (males: p < 0.0001; females: p < 0.0001). Long-distance runners and swimmer presented intermediate extent of LV remodelling. Positive correlation between hours of training and LVMi (p = 0.0004) and LVEDVi (p = 0.048) was observed among cyclists. Indeed, cyclists with the highest EH (i.e., lowest LVMi\LVEDVi ratio) achieved the highest workload at exercise stress-test (p = 0.045) and better athletic achievements. Among endurance athletes, cyclists and triathletes present the most marked extent of LV EH, while canoeists and rowers the lowest degree, with major increase in LV mass. Intra-group analysis showed an association between eccentric hypertrophy and superior exercise capacity and higher athletic performances that may be related to an increased stroke volume and cardiac output, which improve cardiovascular efficiency during endurance exercise. These findings could be useful both for clinicians in identifying potential health issues in athletes and for coaches when assessing athletes' training status.
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Affiliation(s)
- Giuseppe Di Gioia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy.
- Department of Cardiology, Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy.
| | - Armando Ferrera
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
| | - Federica Mango
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
| | - Viviana Maestrini
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Sara Monosilio
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Antonio Pelliccia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
| | - Maria Rosaria Squeo
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
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40
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Wernhart S, Fiorentini C, Glowka S, Madl B, Grill S, Kiechle M, Mueller S, Schmid V, Foulkes S, Haykowsky MJ, Halle M. Evaluating cardiovascular risk factors in breast cancer survivors: The role of echocardiography and cardiopulmonary exercise testing in the Munich Cardio-Oncology-Exercise retrospective Registry. Int J Cardiol 2025; 436:133421. [PMID: 40425074 DOI: 10.1016/j.ijcard.2025.133421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2025] [Revised: 05/21/2025] [Accepted: 05/23/2025] [Indexed: 05/29/2025]
Abstract
BACKGROUND Breast cancer survivors (BCS) have an increased risk of developing cardiovascular disease risk factors (CVDRF). However, the role of cardiopulmonary fitness, echocardiography and treatment regimen e.g. anthracycline, HER2-targeted therapy (AC/H) or endocrine therapy (ET) are uncertain. METHODS This single-center, retrospective study included BCS without visceral metastases, who had been treated with either AC/H or ET and assessed by echocardiography, cardio-pulmonary exercise testing (CPET) and the H2FPEF score at baseline. We included BCS with a left ventricular ejection fraction ≥50 % and absence of CVDRF at baseline. The primary outcome was the incidence of CVDRF. RESULTS A total of 112 BCS were included (mean age of 54.6 ± 9.9 years, BC stage I-III). After a median follow-up of 21 months new-onset arterial hypertension was the most common CVDRF observed (n = 17). New onset hypertension was related to higher baseline resting systolic blood pressure (127.4 ± 9.2 mmHg vs. 117.3 ± 13.1 mmHg, p = 0.002) and H2FPEF scores (1.2 ± 0.8 vs. 0.8 ± 1.1, p = 0.043). Echocardiographic and CPET findings associated with new-onset arterial hypertension included greater left ventricular mass index (77.3 ± 24.2 g/m2 vs. 65.6 ± 15.5 g/m2, p = 0.007), higher peak systolic blood pressure (193.1 ± 19.5 mmHg vs. 173.3 ± 21.2 mmHg, p = 0.017) and ventilatory power (6.4 ± 1.3 mmHg vs. 5.7 ± 1.2 mmHg, p = 0.022). Treatment regimen had no influence on the development of CVDRF. CONCLUSIONS The most common CVDRF among BCS is hypertension, underscoring the importance of monitoring this outcome irrespective of breast cancer treatment regimens. The H2FPEF score, CPET and echocardiography may help identify BCS at risk of developing hypertension. Strain and biomarkers were not available, impeding detection of cardiotoxicity.
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Affiliation(s)
- Simon Wernhart
- Department for Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich (TUM), Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
| | - Caterina Fiorentini
- Department for Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich (TUM), Munich, Germany
| | - Simon Glowka
- Department for Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich (TUM), Munich, Germany
| | - Bernadine Madl
- Department for Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich (TUM), Munich, Germany
| | - Sabine Grill
- Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Stephan Mueller
- Department for Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich (TUM), Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Veronika Schmid
- Department for Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich (TUM), Munich, Germany
| | - Stephen Foulkes
- Integrated Cardiovascular and Exercise Physiology and Rehabilitation (iCARE) Laboratory, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Heart, Exercise and Research Trials Lab, St Vincent's Institute of Medical Research, Melbourne, Victoria, Australia
| | - Mark J Haykowsky
- Integrated Cardiovascular and Exercise Physiology and Rehabilitation (iCARE) Laboratory, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Halle
- Department for Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich (TUM), Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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41
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Wang R, Gao W, Che X, Shen R, Dai C, Xia Y, Chen A, Lu D, Ma J, Chen H, Li C, Chen Z, Qian J, Ge J. Clinical factors associated with severe coronary stenosis in patients undergoing cardiac surgery. BMC Cardiovasc Disord 2025; 25:395. [PMID: 40413436 DOI: 10.1186/s12872-025-04835-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/08/2025] [Indexed: 05/27/2025] Open
Abstract
BACKGROUND Many cardiovascular patients undergoing valve surgeries require coronary angiography (CAG). Positive results may lead to bypass surgery, while negative results require no treatment. Although informative, CAG is costly and exposes patients to significant radiation. This study aimed to develop a model to reduce unnecessary procedures. METHODS A retrospective cohort study was conducted on 5,086 patients who underwent valve repair/replacement or other cardiac surgeries at Zhongshan Hospital between 2016 and 2021 and received CAG. Patients treated between 2016 and 2020 formed the training set, while those treated in 2021 constituted the validation set. Severe coronary stenosis was defined as a ≥ 50% reduction in luminal diameter. Logistic regression analysis identified independent predictors in the training set, and a scoring system (Coronary Angiography Positivity Prediction Score) was constructed based on the β-coefficients of each variable. The model was evaluated for discrimination and calibration. RESULTS Among 4,049 patients, 536 (13.2%) had severe coronary stenosis. Independent predictors included age ≥ 60 years, male sex, hypertension, diabetes, hyperlipidemia, and left ventricular ejection fraction ≤ 58%. The scoring system ranged from 0 to 11 points and demonstrated good discrimination, with an area under the receiver operating characteristic curve of 0.715 (95% confidence interval: 0.694-0.740) in the training set. In the high-risk group (≥ 6 points), the probability of severe coronary stenosis was 23.1%, compared to 8% in the low-risk group (< 6 points). The scoring system also performed well in the validation set with the curve of 0.740 (95% CI, 0.695-0.784). CONCLUSION We developed and validated a scoring system based on six clinical variables to predict severe coronary stenosis in patients undergoing valve surgeries. This tool may help optimize individual treatment strategies and reduce unnecessary CAG procedures.
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Grants
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 2023YFC2506500 National Key Research and Development Program of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- 82470338, 82170338 National Natural Science Foundation of China
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
- ZSLCYJ202330 Grant of Zhongshan Hospital Affiliated to Fudan University
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Affiliation(s)
- Rui Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Wei Gao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- State Key Laboratory of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xinyu Che
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Ruopei Shen
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Chunfeng Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- State Key Laboratory of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yan Xia
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- State Key Laboratory of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Ao Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- State Key Laboratory of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Danbo Lu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- State Key Laboratory of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jiaqi Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- State Key Laboratory of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hungju Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- State Key Laboratory of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhangwei Chen
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China.
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
- State Key Laboratory of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Juying Qian
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China.
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
- State Key Laboratory of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
- State Key Laboratory of Cardiovascular Diseases, Key Laboratory of Viral Heart Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
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Tian F, Hu C, Liu W, Zhang B, Chen H, Shu X. Noninvasive right ventricular myocardial work by pressure-strain loop: a new perspective on right ventricular function and cardiac resynchronization therapy. Am J Cardiol 2025:S0002-9149(25)00332-7. [PMID: 40414269 DOI: 10.1016/j.amjcard.2025.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 04/25/2025] [Accepted: 05/21/2025] [Indexed: 05/27/2025]
Abstract
BACKGROUND Myocardial work (MW) by noninvasive pressure-strain loop (PSL) is a novel echocardiographic tool that provides a more precise estimation of right ventricular (RV) performance by accounting for the RV loading conditions. The study sought to investigate the impact of cardiac resynchronization therapy (CRT) on RV function and explore the role of RV MW indices in predicting CRT response. METHODS AND RESULTS Ninety-one CRT-candidates were prospectively enrolled. left ventricular (LV) MW parameters, RV global longitudinal strain (RV GLS) and RV free wall strain (RV FWS) were obtained. RV MW indices, including RV global work index (RV GWI), RV global constructive work (RV GCW), RV global wasted work (RV GWW), and RV global work efficiency (RV GWE), were measured by PSL analysis. Response to CRT was defined as a reduction in left ventricular end-systolic volume of ≥15% at follow-up. RV GWI significantly increased in responders. CRT caused significant improvements in RV GWI, RV GCW, and RV GWE (P < 0.05). In multivariate analysis, RV GWI (adjusted odds ratio (OR): 1.010; 95% CI: 1.003-1.017; P < 0.05), and LV GCW (adjusted OR: 1.002; 95% CI: 1.000-1.003; P < 0.05) were associated with CRT response. Adding RV GWI to the basal model yielded a significant improvement in continuous net reclassification improvement at 0.284 (p=0.032), while other function parameters failed to improve reclassification. CONCLUSION RV MW indices provide a new reference for the quantitative evaluation of RV myocardial performance before and after CRT. Although both RV GWI and LV GCW have prognostic value, RV GWI may better predict the response to CRT.
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Affiliation(s)
- Fangyan Tian
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang 550002, China; Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Chunqiang Hu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Wen Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Bei Zhang
- Department of Ultrasound Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang 550002, China
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China.
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Pinchuk A, Adam V, Biehler P, Hägele P, Hanger S, Löbig S, Ausbuettel F, Waechter C, Seizer P, Weyand S. Impact of functional mitral regurgitation on outcomes of high-power short-duration pulmonary vein isolation in patients with atrial fibrillation. Herz 2025:10.1007/s00059-025-05318-w. [PMID: 40410581 DOI: 10.1007/s00059-025-05318-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Revised: 04/12/2025] [Accepted: 04/22/2025] [Indexed: 05/25/2025]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia with significant health implications. Mitral regurgitation (MR) frequently coexists with AF and may affect treatment outcomes. METHODS This study aimed to analyze the impact of MR severity on the outcomes of high-power short-duration pulmonary vein isolation (PVI) in patients with AF. This observational cohort study involved 255 patients undergoing their first PVI. A total of 83 patients with moderate or severe MR were propensity score-matched with 83 controls based on age, sex, and body mass index (BMI). Procedural parameters, complication rates, AF recurrence within 1 year of PVI, and MR progression were analyzed. RESULTS Patients with moderate or severe MR demonstrated a higher percentage of atrial low-voltage areas (23.06% vs. 15.42%, p = 0.04) and more frequently required additional ablations (18.07% vs. 6.02%, p = 0.02). The 1‑year AF recurrence rates were identical between the groups (19.28% each, p = 1.00). The MR grade remained stable without significant differences between the groups after 1 year. However, among patients without AF recurrence, a statistically significant reduction in MR grade was observed after 1 year (1.54 ± 0.64 vs. 1.37 ± 0.53, p < 0.01). By contrast, patients with AF recurrence exhibited a trend toward worsening MR, although this change was not statistically significant (1.53 ± 0.57 vs. 1.75 ± 0.51, p = 0.09). CONCLUSION High-power short-duration PVI is safe and effective in AF patients, even among those with moderate or severe MR. Patients with moderate or severe functional MR exhibit more LA low-voltage areas and require more extensive ablations, especially cavotricuspid isthmus CTI ablation, reflecting a more complex disease profile. Maintaining a stable sinus rhythm can contribute to a reduction in MR grade.
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Affiliation(s)
- A Pinchuk
- Department of Cardiology, Ostalb-Klinikum Aalen, Im Kaelblesrain 1, 73430, Aalen, Germany
| | - V Adam
- Department of Cardiology, Ostalb-Klinikum Aalen, Im Kaelblesrain 1, 73430, Aalen, Germany
| | - P Biehler
- Department of Cardiology, Ostalb-Klinikum Aalen, Im Kaelblesrain 1, 73430, Aalen, Germany
| | - P Hägele
- Department of Cardiology, Ostalb-Klinikum Aalen, Im Kaelblesrain 1, 73430, Aalen, Germany
| | - S Hanger
- Department of Cardiology, Ostalb-Klinikum Aalen, Im Kaelblesrain 1, 73430, Aalen, Germany
| | - S Löbig
- Department of Cardiology, Ostalb-Klinikum Aalen, Im Kaelblesrain 1, 73430, Aalen, Germany
| | - F Ausbuettel
- Department of Cardiology, Angiology and internal Intensive Care, University Clinic of Gießen and Marburg, 35043, Marburg, Germany
| | - C Waechter
- Department of Cardiology, Angiology and internal Intensive Care, University Clinic of Gießen and Marburg, 35043, Marburg, Germany
| | - P Seizer
- Department of Cardiology, Ostalb-Klinikum Aalen, Im Kaelblesrain 1, 73430, Aalen, Germany
- University of Ulm, 89069, Ulm, Germany
| | - S Weyand
- Department of Cardiology, Ostalb-Klinikum Aalen, Im Kaelblesrain 1, 73430, Aalen, Germany.
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Dourado IM, Goulart CDL, Santos-de-Araújo AD, Marinho RS, Garcia-Araujo AS, Roscani MG, Trimer R, da Silva ALG, Mendes RG, Borghi-Silva A. Distance travelled in the six-minute walk test in patients with chronic obstructive pulmonary disease as a predictor of mortality. BMC Pulm Med 2025; 25:258. [PMID: 40410785 PMCID: PMC12102868 DOI: 10.1186/s12890-025-03721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 05/12/2025] [Indexed: 05/25/2025] Open
Abstract
BACKGROUND Exercise intolerance in patients with COPD has significant implications for quality of life, hospitalization rates, and survival. OBJECTIVE To assess functional capacity using the six-minute walk test (6MWT) by categorizing the distance walked in six minutes (6MWD) into tertiles and to assess the impact of this functional capacity on predictors of survival over a 24-month follow-up in patients with Chronic Obstructive Pulmonary Disease (COPD). METHODS This prospective cohort study followed 118 patients with COPD for 24 months. Participants were stratified based on the 6MWD: Group 1 (mean distance 590-424 m); Group 2 (mean distance 423-337 m); and Group 3 (mean distance < 336 m). Symptoms and disease severity were assessed using CAT scores. Kaplan-Meier was used to determine the association between 6MWD and all-cause mortality. RESULTS The 6MWD, stratified by functional performance, was a significant predictor of survival in patients with COPD, despite heterogeneity in disease severity between groups. The 6MWD, stratified by functional performance, was a significant predictor of survival in patients with COPD, despite heterogeneity in disease severity between groups. Furthermore, in regression analysis for mortality, it was identified for 6MWD (CI 0.994; p = 0.043) and peripheral oxygen saturation (SpO₂) (CI 0.735; p < 0.001). Kaplan-Meier survival analysis revealed that patients who walked less than 336 m in the 6MWD had the lowest probability of survival at 24 months (log-rank p < 0.05). CONCLUSION The 6MWD is a robust predictor of mortality over a 2-year period in patients with COPD, reflecting a broad spectrum of disease severity. Poorer 6MWD performance is associated with increased desaturation, impaired heart rate recovery, and greater symptom burden during exercise, as indicated by CAT scores. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Izadora Moraes Dourado
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | - Cássia da Luz Goulart
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | | | - Renan Shida Marinho
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | - Adriana Sanches Garcia-Araujo
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | - Meliza Goi Roscani
- Department of Medicine, Federal University of Sao Carlos, São Carlos, Brazil
| | - Renata Trimer
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | | | - Renata Gonçalves Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil.
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Lu R, Skoll D, Gasmelseed AY, Rubin GA, Wan EY, Saluja AS, Dizon JM, Biviano AB, Garan H, Yarmohammadi H. Chronic obstructive pulmonary disease is associated with higher recurrence rates of atrial fibrillation following catheter ablation. Indian Pacing Electrophysiol J 2025:S0972-6292(25)00050-6. [PMID: 40412516 DOI: 10.1016/j.ipej.2025.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2025] [Revised: 04/13/2025] [Accepted: 05/20/2025] [Indexed: 05/27/2025] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular mortality compared to patients with AF alone. Consequently, employing rhythm control strategies such as AF catheter ablation could offer substantial benefits to patients with COPD. However, the impact of COPD on AF ablation outcomes is not well established. METHODS In this single-center case control study, we retrospectively analyzed 200 patients with AF and COPD, 52 of whom underwent AF catheter ablation. Those who underwent ablation were matched with a control group of patients with AF but without COPD who underwent ablation. Ablation outcomes were compared between the groups. Univariate and multivariable analysis were conducted for prediction of AF recurrence. RESULTS Compared to the controls, cases with COPD were more likely to have AF recurrence following catheter ablation (OR 13.42, P-value = 0.0001). Multivariable analysis revealed predictors of AF recurrence following catheter ablation included decreased use of loop diuretics and amiodarone. Patients with severe or very severe COPD were more likely to have left atrial enlargement than patients with mild or moderate COPD (OR 2.28, P-value = 0.026). CONCLUSION Patients with AF and COPD were more likely than patients with AF but without COPD to experience AF recurrence following catheter ablation. Predictors of AF recurrence included decreased use of loop diuretics and amiodarone. Our study demonstrates that while ablation in patients with COPD is safe, ablation in patients with COPD is associated with higher AF recurrence rates.
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Affiliation(s)
- Ree Lu
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Devin Skoll
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ahmed Y Gasmelseed
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Geoffrey A Rubin
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Amardeep S Saluja
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jose M Dizon
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Angelo B Biviano
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
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Elsanan MAHA, Soliman MH, Meawad BMN, Kandeel NT, Elshora A, Shehata IE. Cardiovascular risks in non-dipper OSA patients: insights from ABPM, echocardiography, and Holter monitoring. Sleep Breath 2025; 29:193. [PMID: 40402329 DOI: 10.1007/s11325-025-03365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Revised: 04/13/2025] [Accepted: 05/14/2025] [Indexed: 05/23/2025]
Abstract
BACKGROUND A high prevalence of non-dipping diastolic blood pressure (DBP) patterns has been observed in Obstructive Sleep Apnea (OSA), suggesting that diminished circadian blood pressure variability may significantly contribute to hypertensive end-organ damage. OBJECTIVES This study aimed to evaluate cardiovascular complications in non-dipper OSA patients using a combination of 24-hour Ambulatory Blood Pressure Monitoring (ABPM), Holter electrocardiography, and transthoracic echocardiography (TTE). METHODS This cross-sectional study assessed 64 adult non-dipper OSA patients. The patients, with an average age of 46.5 years, underwent clinical assessments via sphygmomanometer, resting electrocardiogram (ECG), TTE, 24-hour ABPM, and 24-hour Holter ECG. The average age of the patients was 46.5 years, with 50% exhibiting grade 2 obesity. OSA severity was classified as follows: 42.2% moderate; 32.8% severe; and 25% mild. A positive correlation was identified between OSA severity and body mass index (BMI), diabetes, and hypertension. ABPM revealed masked hypertension in 45% of participants. TTE showed that severe OSA was linked to regional wall motion abnormalities, ischemic changes, and increased interventricular septal thickness. Elevated pulmonary artery systolic pressure is predominantly observed in patients with severe OSA. Holter monitoring detected intermittent atrial fibrillation in 15.6% and infrequent extrasystoles in 31.2%. The multivariate logistic regression analysis identified BMI, age, male gender, and the presence of hypertension and diabetes mellitus as significant risk factors for severe OSA. Higher BMI, age, male gender, and these comorbidities increased the likelihood of severe OSA, with odds ratios of 1.22, 1.03, 2.80, and 1.85, respectively. CONCLUSIONS The 24-hour ABPM is an effective tool for detecting masked hypertension in non-dipper OSA patients. Additionally, the severity is directly associated with an increased risk of cardiovascular disease (CVD). Regular cardiovascular assessments are recommended for patients with OSA to mitigate potential complications. TRIAL REGISTRATION ZUIRB#9417/2042022 Registered 20 April 2022, email IRB_123@medicine.zu.edu.eg.
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Affiliation(s)
| | - Mohammad Hassan Soliman
- Department of Cardiovascular Medicine, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Bishoy Meawad Nicola Meawad
- Department of Cardiovascular Medicine, 15 May Hospital, Ministry of Health, 15 May city, Helwan, 14531, Egypt
| | - Nader Talat Kandeel
- Department of Cardiovascular Medicine, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Ashraf Elshora
- Department of Chest, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Islam Elsayed Shehata
- Department of Cardiovascular Medicine, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
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Qin S, Zhang L, Ji M, Wu Z, Lin Y, He Q, Xie M, Li Y. Clinical Utility of Atrioventricular Coupling Index in Cardiovascular Disease. J Am Heart Assoc 2025:e041392. [PMID: 40401599 DOI: 10.1161/jaha.125.041392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2025]
Abstract
Atrioventricular coupling refers to the synchronized interaction between the atrial and ventricular phases of contraction and relaxation within the cardiac cycle. Atrioventricular coupling can be assessed by the left atrioventricular coupling index and right atrioventricular coupling index. These indices provide a comprehensive assessment of the functional interdependence between the atrial and ventricular chambers, and offer insights into cardiac performance beyond traditional markers. Atrioventricular coupling indices are critical for aiding in risk stratification and clinical decision-making, ultimately improving patient outcomes. This review focuses on the clinical utility of atrioventricular coupling in various cardiac pathologies.
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Affiliation(s)
- Shuxuan Qin
- Department of Ultrasound Medicine Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
- Clinical Research Center for Medical Imaging in Hubei Province Wuhan China
- Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Li Zhang
- Department of Ultrasound Medicine Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
- Clinical Research Center for Medical Imaging in Hubei Province Wuhan China
- Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Mengmeng Ji
- Department of Ultrasound Medicine Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
- Clinical Research Center for Medical Imaging in Hubei Province Wuhan China
- Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Zhenni Wu
- Department of Ultrasound Medicine Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
- Clinical Research Center for Medical Imaging in Hubei Province Wuhan China
- Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Yixia Lin
- Department of Ultrasound Medicine Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
- Clinical Research Center for Medical Imaging in Hubei Province Wuhan China
- Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Qing He
- Department of Ultrasound Medicine Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
- Clinical Research Center for Medical Imaging in Hubei Province Wuhan China
- Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Mingxing Xie
- Department of Ultrasound Medicine Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
- Clinical Research Center for Medical Imaging in Hubei Province Wuhan China
- Hubei Province Key Laboratory of Molecular Imaging Wuhan China
| | - Yuman Li
- Department of Ultrasound Medicine Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
- Clinical Research Center for Medical Imaging in Hubei Province Wuhan China
- Hubei Province Key Laboratory of Molecular Imaging Wuhan China
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Kittipibul V, Cyr DD, Harrington J, Lala A, Fudim M, Ward JH, Sarwat S, Solomon SD, Hernandez AF, Zieroth S, Starling RC, Mentz RJ. Structural Abnormalities and Effects of Sacubitril/Valsartan in Patients with Mildly Reduced or Preserved Ejection Fraction and Worsening Heart Failure: The PARAGLIDE-HF Trial. Am Heart J 2025:S0002-8703(25)00161-9. [PMID: 40412494 DOI: 10.1016/j.ahj.2025.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 05/06/2025] [Accepted: 05/08/2025] [Indexed: 05/27/2025]
Abstract
BACKGROUND PARAGLIDE-HF showed significantly greater reduction in NT-proBNP in patients with LVEF>40% and worsening HF with sacubitril/valsartan (sac/val) vs. valsartan (val). The impact of structural abnormalities on the effects of sac/val in this context is unknown. This study aimed to evaluate the impact of left ventricular hypertrophy (LVH) and left atrial enlargement (LAE) on sac/val in patients with LVEF>40% and worsening HF. METHODS PARAGLIDE-HF patients were classified into 3 groups according the degree of structural abnormalities using LVH and LAE. The primary endpoint was time-averaged proportional change in NT-proBNP from baseline to Weeks 4 and 8. Secondary endpoints were recurrent cardiovascular composite events (HF hospitalizations, urgent HF visits, cardiovascular death) and adverse events (symptomatic hypotension, hyperkalemia, worsening renal function). RESULTS Of 454 (97.4%) patients with LVH and LAE data, 157 (34.5%) had both LVH and LAE, 178 (39.2%) had either LVH or LAE, and 119 (26.2%) had neither LVH nor LAE. Greater reduction in NT-proBNP with sac/val vs. valsartan was consistent across groups (p interaction=0.705). There was no significant interaction between treatment and degree of structural abnormalities for other efficacy endpoints. Patients with both LVH and LAE had significantly higher odds of hyperkalemia with sac/val (OR 2.41, p interaction=0.024). CONCLUSION Patients with LVEF>40% and recent WHF had greater reduction in NT-proBNP with sac/val vs. val, regardless of the degree of structural abnormalities. There was no difference in the effects of sac/val on efficacy endpoints across structural abnormality group. Patients with both LVH and LAE had higher odds for hyperkalemia with sac/val.
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Affiliation(s)
- Veraprapas Kittipibul
- Duke Clinical Research Institute, Durham, NC, USA; Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
| | - Derek D Cyr
- Duke Clinical Research Institute, Durham, NC, USA
| | - Josephine Harrington
- University of Colorado, Aurora, CO, USA; Colorado Prevention Center, Aurora, CO, USA
| | - Anuradha Lala
- Mount Sinai Fuster Heart Hospital and Department of Population Health Science and Policy, Mount Sinai, New York, NY, USA
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, NC, USA; Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | | | - Samiha Sarwat
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, NC, USA; Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Randall C Starling
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, NC, USA; Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
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Cersosimo A, Arabia G, Cerini M, Calvi E, Mitacchione G, Aboelhassan M, Giacopelli D, Inciardi RM, Curnis A. Predictive value of left and right atrial strain for the detection of device-detected atrial fibrillation in patients with cryptogenic stroke and implantable cardiac monitor. Int J Cardiol 2025:133368. [PMID: 40409500 DOI: 10.1016/j.ijcard.2025.133368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2025] [Revised: 05/04/2025] [Accepted: 05/09/2025] [Indexed: 05/25/2025]
Abstract
BACKGROUND AND OBJECTIVE Device-detected atrial fibrillation (DDAF) is frequently identified using implantable cardiac monitors (ICMs) following cryptogenic stroke (CS). While left atrium (LA) echocardiographic parameters have been linked to DDAF risk, right atrial (RA) parameters remain underexplored. This study aimed to assess the relationship between speckle-tracking echocardiography parameters and the occurrence of DDAF detected via ICM in patients with CS. METHODS We retrospectively analyzed consecutive CS patients who received an ICM at our institution. All underwent transthoracic echocardiography to evaluate LA, RA, left and right ventricle (LV, RV) function using standard and strain-derived parameters. The primary endpoint was the first DDAF episode lasting >6 min recorded by ICM. RESULTS Between May 2013 and July 2022, 204 patients (82 % males, median age 69 years) received an ICM. Over a median follow-up of 15.3 months [interquartile range: 7.4-23.5], DDAF was detected in 96 patients (47.0 %). LA peak longitudinal strain (adjusted-hazard ratio [HR] 0.87, 95 %CI 0.84-0.89, p < 0.001), peak conduit strain (adjusted-HR 1.17, 95 %CI 1.13-1.22, p < 0.001), and peak contraction strain (adjusted-HR 1.17, 95 % CI 1.11-1.22, p < 0.001) significantly predicted DDAF. RA peak longitudinal strain (adjusted-HR 0.89, 95 % CI 0.83-0.95, p < 0.001) and peak contraction strain (adjusted-HR 1.39, 95 % CI 1.26-1.53, p < 0.001) were also predictive, but peak conduit strain was not (p = 0.103). No significant associations were found for LV or RV parameters. CONCLUSIONS LA and RA strain analyses are valuable for predicting DDAF detection following CS and can aid in risk stratification before ICM insertion.
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Affiliation(s)
- Angelica Cersosimo
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Gianmarco Arabia
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy.
| | - Manuel Cerini
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | - Emiliano Calvi
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
| | | | - Mohamed Aboelhassan
- Cardiology Department, Assiut University Heart Hospital, Assiut University, Asyut, Egypt
| | | | | | - Antonio Curnis
- Cardiology Department, Spedali Civili Hospital, University of Brescia, Italy
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50
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Velmeden D, Söhne J, Schuch A, Zeid S, Schulz A, Troebs SO, Müller F, Heidorn MW, Buch G, Belanger N, Dinh W, Mondritzki T, Lackner KJ, Gori T, Münzel T, Wild PS, Prochaska JH. Role of Heart Rate Recovery in Chronic Heart Failure: Results From the MyoVasc Study. J Am Heart Assoc 2025; 14:e039792. [PMID: 40371587 DOI: 10.1161/jaha.124.039792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 03/11/2025] [Indexed: 05/16/2025]
Abstract
BACKGROUND Cardiac autonomic dysfunction is associated with heart failure (HF). Reduced heart rate recovery (HRR) indicates impaired parasympathetic reactivation after physical activity. Heart rate recovery 60 seconds after peak effort (HRR60) is linked to autonomic dysfunction, but data on its relevance across HF phenotypes are scarce. This study aimed to identify clinical determinants of HRR60 in an HF cohort and assess its relationship with clinical outcomes. METHODS Data from the MyoVasc study (NCT04064450; N=3289) were analyzed. Participants underwent standardized clinical phenotyping including cardiopulmonary exercise testing. HRR60 was defined as the heart rate decline 60 seconds after exercise termination. Clinical determinants of HRR60 were evaluated using multivariate regression, whereas Cox regression analyses assessed all-cause death and worsening of HF. RESULTS The analysis sample comprised 1289 individuals (median age, 66.0 [interquartile range {IQR}, 58.0-73.0] years, 30.4% women) ranging from stage B to stage C/D according to the universal definition of HF. Age, sex, smoking, obesity, peripheral artery disease, and chronic kidney disease were identified as determinants of HRR60. HRR60 showed a strong association with all-cause death (hazard ratio [HR]HRR60 [10 bpm], 1.56 [95% CI, 1.32-1.85]; P<0.0001) and worsening of HF (HRHRR60 [10 bpm], 1.36 [95% CI, 1.10-1.69]; P=0.0052) independent of age, sex, and clinical profile. Sensitivity analysis showed a stronger association with worsening HF in HF with preserved left ventricular ejection fraction (Pinteraction=0.027). CONCLUSIONS HRR60 was associated with clinical outcome in chronic HF. Because it showed a stronger association with outcomes in HF with preserved ejection fraction, future research should consider phenotype-specific differences.
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Affiliation(s)
- David Velmeden
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
- Department of Cardiology - Cardiology I University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Jakob Söhne
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
- Department of Cardiology - Cardiology I University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Alexander Schuch
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
- Department of Cardiology - Cardiology I University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Silav Zeid
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Sven-Oliver Troebs
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
| | - Felix Müller
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
- Department of Cardiology - Cardiology I University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Marc W Heidorn
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
- Department of Cardiology - Cardiology I University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Gregor Buch
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Noémie Belanger
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
| | - Wilfried Dinh
- Bayer AG, Research and Development, Translational Clinical Medicine, Experimental Medicine 1 Wuppertal Germany
- School of Medicine University Witten/Herdecke Witten Germany
| | - Thomas Mondritzki
- Research & Early Development, Clinical Experimentation CV, BAYER AG Wuppertal Germany
| | - Karl J Lackner
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
- Institute for Clinical Chemistry and Laboratory Medicine University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Tommaso Gori
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
- Department of Cardiology - Cardiology I University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
- Department of Cardiology - Cardiology I University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (CTH) University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- Institute for Molecular Biology (IMB), Mainz, Working Group Systems Medicine Mainz Germany
| | - Jürgen H Prochaska
- Preventive Cardiology and Preventive Medicine, Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main Mainz Germany
- Clinical Epidemiology and Systems Medicine, Center for Thrombosis and Hemostasis (CTH) University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
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