RESUMEN
BACKGROUND: While left ventricular ejection fraction (LVEF) is the primary variable utilized for prognosis following myocardial infarction (MI), it is relatively indiscriminate for survival in patients with mildly reduced (> 40%) or preserved LVEF (> 50%). Improving risk stratification in patients with mildly reduced or preserved LVEF remains an unmet need, and could be achieved by using a combination approach using prognostically validated measures of left-ventricular (LV) size, geometry, and function. AIMS: The aim of this study was to compare the prognostic utility of a Combined Echo-Score for predicting all-cause (ACM) and cardiac mortality (CM) following MI to LVEF alone, including the sub-groups with LVEF > 40% and LVEF > 50%. METHODS: Retrospective data on 3094 consecutive patients with MI from 2013 to 2021 who had inpatient echocardiography were included, including both patients with ST-elevation MI (n = 869 [28.1%]) and non-ST-elevation MI (n = 2225 [71.9%]). Echo-Score consisted of LVEF < 40% (2 points) or LVEF < 50% (1 point), and 1 point each for left atrial volume index > 34 mL/m2, septal E/e' > 15, abnormal LV mass-index, tricuspid regurgitation velocity > 2.8 m/s, and abnormal LV end-systolic volume-index. Simple addition was used to derive a score out of 7. RESULTS: At a median follow-up of 4.5 years there were 445 deaths (130 cardiac deaths). On Cox proportional-hazards multivariable analysis incorporating significant clinical and echocardiographic predictors, Echo-Score was an independent predictor of both ACM (HR 1.34, p < .001) and CM (HR 1.59, p < .001). Inter-model comparisons of model ð2, Harrel's C and Somer's D, and Receiver operating curves confirmed the superior prognostic value of Echo-Score for both endpoints compared to LVEF. In the subgroups with LVEF > 40% and LVEF > 50%, Echo-Score was similarly superior to LVEF for predicting ACM and CM. CONCLUSIONS: An Echo-Score composed of prognostically validated LV parameters is superior to LVEF alone for predicting survival in patients with MI, including the subgroups with mildly reduced and preserved LVEF. This could lead to improved patient risk stratification, better-targeted therapies, and potentially more efficient use of device therapies. Further studies should be considered to define the benefit of further investigation and treatment in high-risk subgroups.
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Ecocardiografía , Ventrículos Cardíacos , Infarto del Miocardio , Volumen Sistólico , Función Ventricular Izquierda , Humanos , Femenino , Masculino , Estudios Retrospectivos , Medición de Riesgo/métodos , Ecocardiografía/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/mortalidad , Infarto del Miocardio/diagnóstico por imagen , Persona de Mediana Edad , Pronóstico , Función Ventricular Izquierda/fisiología , Anciano , Volumen Sistólico/fisiología , Tasa de Supervivencia , Valor Predictivo de las PruebasRESUMEN
OBJECTIVE: To analyze the function of the left heart in patients with different courses of gout, the independent influencing factors for left heart functional changes, and interactions between left atrial and left ventricular functions. METHODS: Patients with gout (n = 171) were selected; 87 patients with a disease course <10 years were included in Group I, and 84 patients with a disease course ≥10 years were included in Group II. Ninety-four healthy volunteers comprised the control group. RESULTS: The intergroup differences in cardiac strain parameters were statistically significant (p < .05). Moreover, the differences gradually declined with disease progression. Multivariate logistic regression analysis showed that uric acid was an independent predictor of decreased left ventricular global longitudinal strain (LVGLS). Moreover, LVGLS had a positive effect on the left atrial systolic rate (LASr) and the left atrial systolic contraction time (LASct) but no interaction with the left atrial systolic contraction duration (LAScd). CONCLUSION: The course of the disease significantly affected the function of the left heart in gout patients, and uric acid was observed to be an independent predictor of decreased LVGLS in gout patients.
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Gota , Humanos , Masculino , Femenino , Gota/fisiopatología , Gota/complicaciones , Estudios Prospectivos , Persona de Mediana Edad , Ecocardiografía/métodos , Progresión de la Enfermedad , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Ácido Úrico/sangre , Adulto , Función Ventricular Izquierda/fisiología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatologíaRESUMEN
BACKGROUND: In acute heart failure (HF), reduced cardiac output, vasoconstriction and congestion may damage the intestinal mucosa and disrupt its barrier function. This could facilitate the leakage of bacterial products into circulation and contribute to inflammation and adverse cardiac remodelling. We aimed to investigate gut leakage markers and their associations with inflammation, infarct size and cardiac function. METHODS: We examined 61 ST-elevation myocardial infarction (STEMI) patients who developed acute HF within 48 hours of successful percutaneous coronary intervention (PCI). Serial blood samples were taken to measure lipopolysaccharide (LPS), LPS-binding protein (LBP), soluble cluster of differentiation 14 (sCD14) and intestinal fatty acid binding protein (I-FABP). Cumulative areas under the curve (AUCs) from baseline to day 5 were calculated. Serial echocardiography was performed to assess left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and wall motion score index (WMSI). Single-photon emission CT (SPECT) was performed at 6 weeks to determine infarct size and LVEF. RESULTS: I-FABPAUC correlated positively with infarct size (rs=0.45, p=0.002), GLS (rs=0.32, p=0.035) and WMSI (rs=0.45, p=0.002) and negatively with LVEF measured by SPECT (rs=-0.40, p=0.007) and echocardiography (rs=-0.33, p=0.021) at 6 weeks. LPSAUC, LBPAUC and sCD14AUC did not correlate to any cardiac function marker or infarct size. Patients, who at 6 weeks had above median GLS and WMSI, and below-median LVEF measured by SPECT, were more likely to have above median I-FABPAUC during admission (adjusted OR (aOR) 5.22, 95% CI 1.21 to 22.44; aOR 5.05, 95% CI 1.25 to 20.43; aOR 5.67, 95% CI 1.42 to 22.59, respectively). The same was observed for patients in the lowest quartile of LVEF measured by echocardiography (aOR 9.99, 95% CI 1.79 to 55.83) and three upper quartiles of infarct size (aOR 20.34, 95% CI 1.56 to 264.65). CONCLUSIONS: In primary PCI-treated STEMI patients with acute HF, I-FABP, a marker of intestinal epithelial damage, was associated with larger infarct size and worse cardiac function after 6 weeks.
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Biomarcadores , Proteínas de Unión a Ácidos Grasos , Insuficiencia Cardíaca , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Función Ventricular Izquierda , Humanos , Masculino , Proteínas de Unión a Ácidos Grasos/sangre , Femenino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/diagnóstico , Persona de Mediana Edad , Biomarcadores/sangre , Anciano , Función Ventricular Izquierda/fisiología , Intervención Coronaria Percutánea/métodos , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/sangre , Volumen Sistólico/fisiología , Tomografía Computarizada de Emisión de Fotón Único , Proteínas Portadoras/sangre , Ecocardiografía/métodos , Proteínas de Fase Aguda , Glicoproteínas de Membrana/sangre , Factores de Tiempo , Receptores de Lipopolisacáridos/sangre , Enfermedad Aguda , Estudios Prospectivos , Lipopolisacáridos , Remodelación Ventricular/fisiologíaRESUMEN
Heart failure is a pediatric emergency caused by the heart's inability to adequately meet the body metabolic needs and the most common cause is congenital heart disease (CHD). The G protein is the most prominent family of membrane-bound protein known to act in major regulatory events of the cardiovascular system, one of which is heart failure. The aim of this study was to determine the level of G protein and its relationship with left ventricular systolic function in children with acyanotic CHD. A cross-sectional study was conducted in Dr. Zaionel Abidin Hospital, Banda Aceh, Indonesia. The patients aged 0 to 18 years and had acyanotic CHD diagnosis by echocardiography were included. Anthropometry measurement was performed according to standard WHO procedures and G protein level was measured using the ELISA method. The Chi-squared test was used to measure the relationship between G protein level and left ventricular systolic function. Out of a total of 38 children with acyanotic CHD, the mean level of G protein was 36.25 ng/mL and the mean of left ventricular systolic function was 73.1%. There was no relationship between G protein and left ventricular systolic function in children with acyanotic CHD. However, further study with a larger sample size and considering other variables are needed to confirm this finding.
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Cardiopatías Congénitas , Función Ventricular Izquierda , Humanos , Estudios Transversales , Preescolar , Masculino , Femenino , Lactante , Niño , Función Ventricular Izquierda/fisiología , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/fisiopatología , Adolescente , Ecocardiografía , Recién Nacido , Indonesia/epidemiología , SístoleRESUMEN
BACKGROUND: Cardiac rotational parameters in primary symptomatic left ventricular noncompaction (LVNC) with preserved left ventricular ejection fraction (LVEF) are not well understood. We aimed to analyze cardiac rotation measured with cardiac magnetic resonance feature-tracking (CMR-FT) and speckle-tracking echocardiography (Echo-ST) in LVNC morphology subjects with preserved LVEF and different genotypes and healthy controls. METHODS: Our retrospective study included 54 LVNC subjects with preserved LVEF and 54 control individuals. We evaluated functional and rotational parameters with CMR in the total study population and with echocardiography in 39 LVNC and 40 C individuals. All LVNC subjects were genotyped with a 174-gene next-generation sequencing panel and grouped into the subgroups: benign (B), variant of uncertain significance (VUS), and pathogenic (P). RESULTS: In comparison with controls, LVNC subjects had reduced apical rotational degree (p = 0.004) and one-third had negative apical rotation. While the degree of apical rotation was comparable between the three genetic subgroups, they differed significantly in the direction of apical rotation (p<0.001). In contrast to control and B groups, all four studied cardiac rotational patterns were identified in the P and VUS subgroups, namely normal rotation, positive and negative rigid body rotation, and reverse rotation. When the CMR-FT and Echo-ST methods were compared, the direction and pattern of cardiac rotation had moderate to good association (p<0.001) whereas the rotational degrees showed no reasonable correlation or agreement. CONCLUSION: While measuring cardiac rotation using both CMR-FT and Echo-ST methods, subclinical mechanical differences were identified in subjects with LVNC phenotype and preserved LVEF, especially in cases with genetic involvement.
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Ecocardiografía , Imagen Multimodal , Humanos , Masculino , Femenino , Persona de Mediana Edad , Ecocardiografía/métodos , Estudios Retrospectivos , Rotación , Imagen Multimodal/métodos , Adulto , Volumen Sistólico , Función Ventricular Izquierda/fisiología , Imagen por Resonancia Magnética/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Anciano , Estudios de Casos y Controles , No Compactación Aislada del Miocardio Ventricular/diagnóstico por imagen , No Compactación Aislada del Miocardio Ventricular/genética , No Compactación Aislada del Miocardio Ventricular/fisiopatologíaRESUMEN
BACKGROUND: Assessing left ventricular diastolic function (LVDF) with echocardiography as per ASE guidelines is tedious and time-consuming. The study aims to develop a fully automatic approach of this procedure by a lightweight hybrid algorithm combining deep learning (DL) and machine learning (ML). METHODS: The model features multi-modality input and multi-task output, measuring LV ejection fraction (LVEF), left atrial end-systolic volume (LAESV), and Doppler parameters: mitral E wave velocity (E), A wave velocity (A), mitral annulus e' velocity (e'), and tricuspid regurgitation velocity (TRmax). The algorithm was trained and tested on two internal datasets (862 and 239 echocardiograms) and validated using three external datasets, including EchoNet-Dynamic and CAMUS. The ASE diastolic function decision tree and total probability theory were used to provide diastolic grading probabilities. RESULTS: The algorithm, named MMnet, demonstrated high accuracy in both test and validation datasets, with Dice coefficients for segmentation between 0.922 and 0.932 and classification accuracies between 0.9977 and 1.0. The mean absolute errors (MAEs) for LVEF and LAESV were 3.7 % and 5.8 ml, respectively, and for LVEF in external validation, MAEs ranged from 4.9 % to 5.6 %. The diastolic function grading accuracy was 0.88 with hard criteria and up to 0.98 with soft criteria which account for the top two probability in total probability theory. CONCLUSIONS: MMnet can automatically grade ASE diastolic function with high accuracy and efficiency by annotating 2D videos and Doppler images.
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Aprendizaje Profundo , Diástole , Aprendizaje Automático , Función Ventricular Izquierda , Humanos , Diástole/fisiología , Femenino , Función Ventricular Izquierda/fisiología , Masculino , Persona de Mediana Edad , Anciano , Ecocardiografía/métodos , Ecocardiografía/normas , Volumen Sistólico/fisiología , AlgoritmosRESUMEN
BACKGROUND: Prematurely born adults have increased risk for cardiovascular disease. There are limited cardiac data on US-born preterm individuals. We aimed to determine whether adolescents and adults born prematurely have altered left ventricular (LV) structure and function, and to interrogate diastolic function using isometric handgrip exercise. METHODS AND RESULTS: Adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or <1500 g birth weight) were recruited from the Parkland Health Neonatal Intensive Care Unit Registry. Full-term participants were recruited from the local area. Study procedures included anthropometrics and vitals, handgrip testing, and echocardiography performed at rest and during isometric handgrip exercise. Data were reported as mean±SD. The study enrolled 107 preterm and 48 term participants. Preterm participants (gestational age: 29.5±2.5 weeks) were shorter with higher body mass index (P<0.001) compared with term participants. Preterm participants exhibited smaller LV end-diastolic volume index (50.8±10.1 versus 56.9±10.0 mL/m2, P<0.001), LV stroke volume index (29.6±6.0 versus 34.1±6.5 mL/m2, P<0.001), and LV mass index (67.2±13.1 versus 73.3±14.2 g/m2, P=0.002) compared with term individuals. Preterm participants also had subclinical reductions in LV peak systolic tissue velocity and peak early diastolic tissue velocity lateral at rest. Isometric handgrip exercise promoted a reduction in diastolic function and an increase in hemodynamic measures, but changes during isometric handgrip exercise were similar between groups. CONCLUSIONS: Adolescents and adults born preterm exhibit overall normal cardiac function despite smaller cardiac volumes and mass compared with individuals born full term. Effects are most pronounced at the lowest gestational ages.
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Edad Gestacional , Fuerza de la Mano , Ventrículos Cardíacos , Función Ventricular Izquierda , Humanos , Femenino , Masculino , Adolescente , Función Ventricular Izquierda/fisiología , Fuerza de la Mano/fisiología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Adulto , Recién Nacido , Adulto Joven , Volumen Sistólico/fisiología , Recien Nacido Prematuro , Ecocardiografía , Recien Nacido Extremadamente Prematuro , Sistema de Registros , Factores de EdadRESUMEN
BACKGROUND: This comprehensive systematic review and meta-analysis investigated the mid- to long-term efficacy and safety of stem cell therapy in patients with acute myocardial infarction (AMI). METHODS: The study encompassed 79 randomized controlled trials with 7103 patients, rendering it the most up-to-date and extensive analysis in this field. This study specifically focused on the impact of stem cell therapy on left ventricular ejection fraction (LVEF), major adverse cardiac events (MACE), and infarct size. RESULTS: Stem cell therapy significantly improved LVEF at 6, 12, 24, and 36 months post-transplantation compared to control values, indicating its potential for long-term cardiac function enhancement. A trend toward reduced MACE occurrence was observed in the intervention groups, suggesting the potential of stem cell therapy to lower the risk of cardiovascular death, reinfarction, and stroke. Significant LVEF improvements were associated with long cell culture durations exceeding 1 week, particularly when combined with high injected cell quantities (at least 108 cells). No significant reduction in infarct size was observed. CONCLUSIONS: This review highlights the potential of stem cell therapy as a promising therapeutic approach for patients with AMI, offering sustained LVEF improvement and a potential reduction in MACE risk. However, further research is required to optimize cell culture techniques, determine the optimal timing and dosage, and investigate procedural variations to maximize the efficacy and safety of stem cell therapy in this context.
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Infarto del Miocardio , Trasplante de Células Madre , Humanos , Infarto del Miocardio/terapia , Trasplante de Células Madre/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Volumen Sistólico , Resultado del Tratamiento , Función Ventricular Izquierda/fisiologíaRESUMEN
AIM: To study the relaxation structure of the left ventricle (LV) in patients who underwent ventriculography. MATERIAL AND METHODS: LV ventriculography was performed in 37 patients. Before catheterization, echocardiography was performed in each patient. In 6 patients, the LV ejection fraction (EF) was below 40%; these patients with systolic dysfunction were not included in the study. In 31 patients, the LV EF was higher than 50%. In this group, 13 patients had NYHA functional class (FC) 2-3 chronic heart failure (CHF); the rest of the patients had FC 1 CHF. Eighteen of 31 patients had stable ischemic heart disease; 50% of these patients had a history of myocardial infarction; the rest of the patients had hypertension and atrial and ventricular arrhythmias. The dynamics of the LV pressure decrease was analyzed from the moment of the maximum rate of pressure drop, which usually coincides with the closure of the aortic valves. The pressure drop curve was logarithmized with natural logarithms and divided into 4-5 sections with different degrees of curve slope. The relaxation time constant was calculated for each section. Its inverse value characterizes the relaxation time constant (tau). RESULTS: In 31 patients with LV EF 52-60%, three types of the dynamics of the relaxation rate constant were identified during the pressure decrease in the isovolumic phase: in 9 patients, the isovolumic relaxation constant (IRC) steadily increased as the pressure decreased; in 13 patients, it continuously decreased; and in 9 patients, the dynamics of IRC change was intermediate, with an initial increase followed by a decrease. CONCLUSION: In diastolic dysfunction, one group of patients had an adaptation type associated with an increase in the LV wall elasticity, while the other group had a different type of adaptation associated with its decrease. Each type has advantages and disadvantages. This is probably due to changes in the structure of the sarcomeric protein connectin (titin).
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Ecocardiografía , Ventrículos Cardíacos , Función Ventricular Izquierda , Humanos , Masculino , Femenino , Persona de Mediana Edad , Función Ventricular Izquierda/fisiología , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Ecocardiografía/métodos , Volumen Sistólico/fisiología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico , Insuficiencia Cardíaca/fisiopatología , AncianoRESUMEN
BACKGROUND: Ventricular-arterial coupling (VAC) has garnered increasing interest in critical care. The prognostic significance of left ventricular-arterial coupling (LVAC) in this context remains a topic of debate. OBJECTIVE: This study aimed to explore the association between LVAC and patient outcomes in sepsis. METHODS: Patients with sepsis or septic shock admitted to the intensive care unit (ICU) were included. LVAC was evaluated using the arterial elastance (Ea)/left ventricular end-systolic elastance (Ees) ratio. Prognostic indicators, including 30-day mortality, length of ICU stay, mechanical ventilation (MV), changes in delta lactate levels, and oxygen index were also collected. RESULTS: A total of 388 patients were enrolled in this study. A U-shaped relationship was observed between LVAC and 30-day mortality, with an optimal LVAC value of 1.19 identified. For LVAC values above 1.19, the odds ratio (OR) for 30-day mortality was 1.07 (95% confidence interval [CI] 1.01-1.14). Below this threshold, OR was 0.85 (95% CI 0.73, 0.99). Similarly, in the curve for ICU-free days, a ß value of - 8.64 (95% CI - 16.53, - 0.76) was noted for LVAC values over 1.26. For ventilator-free time, the kink point was 1.24, with significant ß values on both sides of this threshold [- 226.49 (95% CI - 411.59, - 41.38) and 147.67 (95% CI 12.40, 282.93), respectively]. CONCLUSIONS: This study established U-shaped associations between LVAC and various clinical outcomes in septic patients. Optimizing LVAC could potentially enhance patient prognosis. Given the slight variations in optimal LVAC values across different patient populations, individualized LVAC titration may be beneficial in improving clinical outcomes.
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Sepsis , Humanos , Masculino , Femenino , Pronóstico , Persona de Mediana Edad , Estudios Prospectivos , Anciano , Sepsis/fisiopatología , Sepsis/mortalidad , Sepsis/complicaciones , Ventrículos Cardíacos/fisiopatología , Unidades de Cuidados Intensivos , Función Ventricular Izquierda/fisiología , Choque Séptico/mortalidad , Choque Séptico/fisiopatologíaRESUMEN
BACKGROUND: Increased left atrial pressure (LAP) contributes to dyspnea and heart failure with preserved ejection fraction in patients with atrial fibrillation (AF). The purpose of this study was to investigate the differences in baseline LAP and LAP response to rapid pacing between paroxysmal and persistent AF. METHODS AND RESULTS: This observational study prospectively enrolled 1369 participants who underwent AF catheter ablation, excluding those with reduced left ventricular ejection fraction. H2FPEF score was calculated by echocardiography and baseline characteristics. Patients underwent LAP measurements during AF, sinus rhythm, and heart rates of 90, 100, 110, and 120 beats per minute (bpm), induced by right atrial pacing and isoproterenol. The baseline LAP-peak in the persistent AF group consistently exceeded that in the paroxysmal AF (PAF) group across each H2FPEF score subgroup (all P<0.05). LAP-peak increased with pacing (19.5 to 22.5 mm Hg) but decreased with isoproterenol (20.4 to 18.4 mm Hg). Under pacing, patients with PAF exhibited a significantly lower LAP-peak (90 bpm) than those with persistent AF (17.7±8.2 versus 21.1±9.3 mm Hg, P<0.001). However, there was no difference in LAP-peak (120 bpm) between the 2 groups (22.1±8.1 versus 22.9±8.4 mm Hg, P=0.056) because the LAP-peak significantly increased with heart rate in the group with PAF. CONCLUSIONS: Patients with PAF exhibited lower baseline LAP with greater increases during rapid pacing compared with individuals with persistent AF, indicating a need to revise the H2FPEF score for distinguishing PAF from persistent AF and emphasizing the importance of rate and rhythm control in PAF for symptom control. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02138695.
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Fibrilación Atrial , Presión Atrial , Insuficiencia Cardíaca , Volumen Sistólico , Humanos , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Fibrilación Atrial/cirugía , Femenino , Masculino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Volumen Sistólico/fisiología , Presión Atrial/fisiología , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Frecuencia Cardíaca/fisiología , Ablación por Catéter , Ecocardiografía , Estimulación Cardíaca Artificial , Función del Atrio Izquierdo/fisiología , Función Ventricular Izquierda/fisiología , Isoproterenol/administración & dosificaciónRESUMEN
BACKGROUND: Adverse left ventricular remodeling is a significant cardiovascular predictor for patients with coronary artery disease and preserved left ventricular ejection fraction (LVEF). However, the remodeling indexes reflecting left ventricular spherization by myocardial perfusion imaging are underexplored. METHODS AND RESULTS: 727 patients (mean age 59.8±13.5 years, 329 women) diagnosed or suspected coronary artery disease with preserved LVEF who underwent resting myocardial perfusion imaging were retrospectively enrolled. The myocardial perfusion imaging findings including the total perfusion deficit and sphericity indexes (shape index (SI) and eccentricity index (EI) obtained from gated (QGS) and non-gated (QPS) images) were collected. Major adverse cardiovascular events (MACE) were followed up for 45.1±22.0 months. All patients were divided into 4 subgroups based on total perfusion deficit at 10% and LVEF at 65%. Univariable comparative analyses were performed in 5 cohorts (all patients and 4 subgroups). Patients who experienced MACE displayed higher SI and/or lower EI (all P<0.05). Kaplan-Meier survival analyses suggested significant differences for SIQPS in all 5 cohorts, for EIQPS and EIQGS in 4 cohorts, and for end-systolic and end-diastolic SIQGS in 3 cohorts (all P<0.05). Multivariate Cox analysis showed that abnormal SI and EI remained statistically significant predictors for MACE after adjusting for total perfusion deficit, LVEF, and other confounding factors. CONCLUSIONS: For patients diagnosed or suspected of coronary artery disease with preserved or supra-normal LVEF, resting sphericity indexes by myocardial perfusion imaging displayed incremental long-term prognostic value. Among these indicators, SIQPS is particularly promising across different perfusion or preserved functional conditions.
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Enfermedad de la Arteria Coronaria , Imagen de Perfusión Miocárdica , Volumen Sistólico , Función Ventricular Izquierda , Humanos , Femenino , Masculino , Persona de Mediana Edad , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Volumen Sistólico/fisiología , Imagen de Perfusión Miocárdica/métodos , Estudios Retrospectivos , Pronóstico , Anciano , Función Ventricular Izquierda/fisiología , Remodelación Ventricular/fisiología , Valor Predictivo de las Pruebas , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagenRESUMEN
BACKGROUND: High cognitive reserve (CR) has been related to lower dementia risk, but its association with heart disease (HD) is unknown. We aimed to explore the relation of CR to HD and cardiac structure and function. METHODS AND RESULTS: Within the UK Biobank, 349 907 HD-free participants were followed up. A composite CR indicator involving education/occupation attainment/television viewing time/confiding frequency/social connection frequency/variety of leisure activities was generated, and further categorized into low/moderate/high levels. Incident HD, including coronary HD, cardiac arrhythmia, and heart failure, was ascertained on the basis of medical records. During the follow-up, a subsample (n=31 182) underwent cardiac magnetic resonance imaging to assess ventricular structure and function. Data were analyzed using Cox regression, Laplace regression, and linear regression. Compared with low CR, the hazard ratio and 95% CI of any HD for high CR was 0.78 (0.75-0.80) (including 0.68 [0.66-0.71] for coronary HD, 0.91 [0.87-0.95] for cardiac arrhythmia, and 0.63 [0.58-0.68] for heart failure). Furthermore, high CR was associated with delayed HD onset by 1.59 (95% CI, 1.37-1.82) years compared with low CR. In cardiac magnetic resonance imaging data analysis, compared with low CR, high CR was associated with larger left ventricular end-diastolic volume (ß, 0.13 [95% CI, 0.09-0.17]), left ventricular end-systolic volume (ß, 0.05 [95% CI, 0.01-0.10]), left ventricular stroke volume (ß, 0.16 [95% CI, 0.12-0.21]), and left ventricular ejection fraction (ß, 0.08 [95% CI, 0.03-0.13]). CONCLUSIONS: High CR is associated with favorable HD health. Our findings suggest that the beneficial effect of CR is not limited to dementia but also HD.
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Reserva Cognitiva , Función Ventricular Izquierda , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios Longitudinales , Reserva Cognitiva/fisiología , Reino Unido/epidemiología , Función Ventricular Izquierda/fisiología , Cardiopatías/fisiopatología , Cardiopatías/epidemiología , Cardiopatías/diagnóstico , Volumen Sistólico/fisiología , Imagen por Resonancia Magnética , Incidencia , Adulto , Factores de Riesgo , Medición de Riesgo , Remodelación Ventricular/fisiología , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/diagnósticoRESUMEN
BACKGROUND: To determine the prognostic value of left atrial strain (LAS) using cardiac magnetic resonance for predicting death, heart failure, and ischemic stroke in patients with known or suspected coronary artery disease with preserved left ventricular systolic function and no prior history of ischemic stroke, heart failure, or atrial fibrillation. METHODS AND RESULTS: This retrospective cohort analysis included patients referred for stress cardiac magnetic resonance or myocardial viability studies between September 2017 and December 2019. Patients with impaired left ventricular systolic function (<50%) or a history of atrial fibrillation, stroke, or heart failure were excluded. A multivariable Cox model assessed the prognostic value of LAS, with the primary outcomes being the composite outcomes of all-cause death, ischemic stroke, and heart failure. A total of 2030 participants were included in the study. The average LAS was 24.1±8.5%; 928 had LAS <23%, and 1102 had LAS ≥23%. The mean follow-up duration was 39.9±13.6 months. There were 49 deaths (2.4%), 32 ischemic strokes (1.6%), and 34 heart failure events (1.7%). Patients with LAS <23% were at greater risk for composite outcome, with an adjusted hazard ratio of 2.31 (95% CI, 1.50-3.55). CONCLUSIONS: LAS by cardiac magnetic resonance has an independent and incremental prognostic value for death, ischemic stroke, and heart failure in patients with preserved left ventricular systolic function. This prognostic value is observed after adjusting for clinical and cardiac magnetic resonance parameters, including left ventricular systolic function, late gadolinium enhancement, and left atrial volume index.
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Función del Atrio Izquierdo , Atrios Cardíacos , Insuficiencia Cardíaca , Accidente Cerebrovascular Isquémico , Imagen por Resonancia Cinemagnética , Humanos , Masculino , Femenino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/diagnóstico , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Accidente Cerebrovascular Isquémico/mortalidad , Accidente Cerebrovascular Isquémico/fisiopatología , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Pronóstico , Función del Atrio Izquierdo/fisiología , Imagen por Resonancia Cinemagnética/métodos , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/diagnóstico por imagen , Valor Predictivo de las Pruebas , Medición de Riesgo/métodos , Función Ventricular Izquierda/fisiología , Factores de Riesgo , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnósticoRESUMEN
Over half of patients with heart failure have a preserved ejection fraction (>50%, called HFpEF), a syndrome with substantial morbidity/mortality and few effective therapies1. Its dominant comorbidity is now obesity, which worsens disease and prognosis1-3. Myocardial data from patients with morbid obesity and HFpEF show depressed myocyte calcium-stimulated tension4 and disrupted gene expression of mitochondrial and lipid metabolic pathways5,6, abnormalities shared by human HF with a reduced EF but less so in HFpEF without severe obesity. The impact of severe obesity on human HFpEF myocardial ultrastructure remains unexplored. Here we assessed the myocardial ultrastructure in septal biopsies from patients with HFpEF using transmission electron microscopy. We observed sarcomere disruption and sarcolysis, mitochondrial swelling with cristae separation and dissolution and lipid droplet accumulation that was more prominent in the most obese patients with HFpEF and not dependent on comorbid diabetes. Myocardial proteomics revealed associated reduction in fatty acid uptake, processing and oxidation and mitochondrial respiration proteins, particularly in very obese patients with HFpEF.
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Insuficiencia Cardíaca , Mitocondrias Cardíacas , Miocardio , Volumen Sistólico , Humanos , Insuficiencia Cardíaca/patología , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/metabolismo , Masculino , Femenino , Anciano , Persona de Mediana Edad , Miocardio/patología , Miocardio/metabolismo , Miocardio/ultraestructura , Mitocondrias Cardíacas/ultraestructura , Mitocondrias Cardíacas/patología , Mitocondrias Cardíacas/metabolismo , Microscopía Electrónica de Transmisión , Función Ventricular Izquierda/fisiología , Sarcómeros/ultraestructura , Sarcómeros/metabolismo , Sarcómeros/patología , Biopsia , Proteómica , Obesidad/patología , Obesidad/metabolismo , Gotas Lipídicas/metabolismo , ComorbilidadRESUMEN
BACKGROUND: Indexed left ventricular end-diastolic volume (LVEDVi) is a left ventricle (LV) size marker. The "Recommendations for Chamber Quantification" guideline was published in 2006 and updated in 2015. Although the previous guideline maintained uniform cutoff points for both men and women, the latest revision introduced new thresholds that vary between genders. We evaluated the extent of change in labeled indexed LV diastolic volumes in men and women following the adoption of the 2015 guideline. METHODS: Data were extracted from a web-based registry from March 2020 to October 2022. LV indexed volume variables were categorized on the basis of the 2006 and 2015 guidelines. RESULTS: Among the 7598 individuals, the classification of LVEDVi differed in 910 (12.0%) individuals. In 213 (5.5%) female subjects, substantial reclassification (i.e., transitioning from normal to moderate LV enlargement to mild to severe LV enlargement) occurred on the basis of the 2015 guideline. All females classified as having moderately abnormal LVEDVi according to the 2006 guideline were reclassified as having severely abnormal LVEDVi according to the 2015 guideline. Age, LV ejection fraction (LVEF), and significant aortic regurgitation (AR) were common factors contributing to the observed discrepancy in both men and women. Significant mitral regurgitation (MR) and regional or global motion abnormality were correlated with the reclassification of LVEDVi to higher abnormal partitions only in women. CONCLUSION: The observed disparities underscore the importance of ongoing dedicated research to reassess the range of indexed echocardiographic parameters, considering various outcomes and differences in countries.
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Ecocardiografía , Ventrículos Cardíacos , Guías de Práctica Clínica como Asunto , Volumen Sistólico , Función Ventricular Izquierda , Humanos , Femenino , Masculino , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Anciano , Persona de Mediana Edad , Ecocardiografía/métodos , Estudios Retrospectivos , Sistema de Registros , Diástole , Factores SexualesRESUMEN
In this systematic review and meta-analysis, we aim to evaluate the efficacy and safety of catheter ablation as the first-line treatment of ventricular tachycardia (VT) in patients with structural heart disease (SHD) and preserved left ventricular ejection fraction (LVEF). Patients with SHD are particularly susceptible to VT, a condition that increases the risk of sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICDs) can terminate VT and prevent SCD but do not prevent VT recurrence. The efficacy and safety of CA as a first-line treatment in SHD patients with preserved LVEF remain unclear. We searched PubMed/Medline, EMBASE, Web of Science, and Cochrane CENTRAL for studies reporting the outcomes of CA therapy in patients with VT and preserved LVEF, published up to January 19, 2023. The primary outcome was the incidence of SCD following catheter ablation as the first-line treatment of VT in patients with SHD and preserved LVEF. Secondary outcomes included all-cause mortality, VT recurrence, procedural complications, CA success rate, and ICD implantation after catheter ablation. We included seven studies in the meta-analysis, encompassing a total of 920 patients. The pooled success rate of catheter ablation was 84.6% (95% CI 67.2-93.6). Complications occurred in 6.4% (95% CI 4.0-9.9) of patients, and 13.9% (95% CI 10.1-18.8) required ICD implantation after ablation. VT recurrence was observed in 23.2% (95% CI 14.8-34.6) of patients, while the rate of sudden cardiac death (SCD) was 3.1% (95% CI 1.7-5.6). The overall prevalence of all-cause mortality in this population was 5% (95% CI 1.8-13). CA appears promising as a first-line VT treatment in patients with SHD and preserved LVEF, especially for monomorphic hemodynamically tolerated VT. However, due to the lack of direct comparisons with ICDs and anti-arrhythmic drugs, further research is needed to confirm these findings.
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Ablación por Catéter , Volumen Sistólico , Taquicardia Ventricular , Humanos , Ablación por Catéter/métodos , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables , Taquicardia Ventricular/etiología , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/terapia , Resultado del Tratamiento , Función Ventricular Izquierda/fisiologíaRESUMEN
PURPOSE: Coronavirus disease-2019 (COVID-19) affects the cardiovascular system even after the acute phase of the disease. Cardiopulmonary rehabilitation may improve post-COVID-19 symptoms. This study aims to evaluate the impact of a cardiopulmonary rehabilitation program after acute COVID-19 on arterial stiffness, left ventricular function, and ventriculoarterial coupling (VAC). METHODS: Forty-eight adults were examined 1 (T0) and 3-mo (T1) following recovery from COVID-19 and randomized 1:1 to participate or not in a 3-mo rehabilitation program. Matched subjects were enrolled as a non-COVID-19 group. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (PWV). Left ventricular (LV) systolic performance was evaluated with global longitudinal strain (GLS). The PWV/LV-GLS ratio was calculated as an index of VAC. High-sensitivity C reactive protein (hs-CRP) was measured. RESULTS: At T0, convalescent patients with COVID-19 had impaired PWV ( P = .001) and reduced VAC ( P = .001) compared to non-COVID-19 subjects. PWV (8.15 ± 1.37 to 6.55 ± 0.98 m/sec, P < .001) and LV-GLS (-19.67 ± 1.98 to -21.3 ± 1.93%, P < .001) improved only in convalescent patients with COVID-19 undergoing rehabilitation. Similarly, VAC was only improved in the rehabilitation group (-0.42 ± 0.11 to -0.31 ± 0.06 m · sec -1 ·% -1 , P < .001). A significant improvement in VO 2max was noted after rehabilitation (15.70 [13.05, 21.45] to 18.30 [13.95, 23.75] ml · kg -1 · min -1 , P = .01). Finally, hs-CRP was improved in both groups with a significantly greater improvement in the rehabilitation group. CONCLUSION: A 3-mo rehabilitation program in convalesced patients with COVID-19 enhances the recovery of arterial stiffness, left ventricular function, and VAC, highlighting the beneficial mechanisms of rehabilitation in this patient population.
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COVID-19 , Rehabilitación Cardiaca , Rigidez Vascular , Humanos , COVID-19/rehabilitación , COVID-19/complicaciones , COVID-19/fisiopatología , Masculino , Femenino , Persona de Mediana Edad , Rigidez Vascular/fisiología , Rehabilitación Cardiaca/métodos , Función Ventricular Izquierda/fisiología , SARS-CoV-2 , Análisis de la Onda del Pulso/métodos , AncianoRESUMEN
OBJECTIVES: This study is aimed to compare the effectiveness of modern therapy including angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) with conventional heart failure treatment in the real world. BACKGROUND: Since ARNI and SGLT2i were introduced to treat heart failure (HF), its therapeutic regimen has modernized from previous treatment with beta-blocker (BB) and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) with mineralocorticoid receptor antagonist (MRA) as added-on in HF with reduced ejection fraction (HFrEF). However, a comparison between conventional and modern treatment strategies with drugs in combination has not been performed. METHODS: This observational study (2013-2020), using the Swedish HF Registry, involved 20,849 HF patients. Patients received either conventional (BB, ACEi/ARB, with/without MRA, n = 20,140) or modern (BB, ACEi/ARB, MRA, SGLT2i or BB, ARNI, MRA with/without SGLT2i, n = 709) treatment at the index visit. The endpoints were all-cause and cardiovascular (CV) mortality. RESULTS: Modern HF therapy was associated with a significant 28% reduction in all-cause mortality (adjusted HR [aHR], 0.72 (0.54-0.96); p = 0.024) and a significant 62% reduction in CV mortality (aHR, 0.38 (0.21-0.68); p = 0.0013) compared to conventional HF treatment. Similar results emerged in a sensitivity analysis using propensity score matching. The interaction analyses did not reveal any trends for EF (< 40% and ≥ 40%), sex, age (< 70 and ≥ 70 years), eGFR (< 60 and ≥ 60 ml/min/1.73 m2), and etiology of HF subgroups. CONCLUSION: In this nationwide study, modern HF therapy was associated with significantly reduced all-cause and CV mortality, regardless of EF, sex, age, eGFR, and etiology of HF.