RESUMEN
To investigate the safety of pancreatic body suspension (PBS) technique in laparoscopic splenectomy combined with pericardial devascularization for patients. A retrospective study inclusive of 16 patients who underwent laparoscopic splenectomy combined with pericardial devascularization from 2017 to 2022 was performed. A total of 5 patients underwent PBS technique and 11 underwent the traditional technique. There was no significant difference in age, sex, body mass index (BMI), preoperative serum white cell count (WBC), platelets (PLT), hemoglobin (HB), albumin (ALB), prothrombin time (PT), total bilirubin (TBIL), or spleen size between the 2 groups (Pâ >â .05). In the PBS group, the operation time was 280 minutes. The estimated intraoperative blood loss (EBL) was 250 mL. The mean postoperative hospitalization length was 11.2 days. There was no conversion to an open procedure or postoperative bleeding. In the traditional method group, the mean operation time was 240.91 minutes. The EBL was 290.91 mL. There were 2 cases of conversion to open, 3 cases of postoperative bleeding, and 1 reoperation. The incidence of postoperative short-term complications (postoperative bleeding, reoperation) was significantly higher in the traditional method group than in the PBS group (36.36% vs 0%, Pâ =â .034). PBS technique improved the safety of laparoscopic splenectomy combined with pericardial dissection and is worthy of clinical promotion.
Asunto(s)
Laparoscopía , Tempo Operativo , Pericardio , Esplenectomía , Humanos , Esplenectomía/métodos , Esplenectomía/efectos adversos , Masculino , Femenino , Laparoscopía/métodos , Laparoscopía/efectos adversos , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Pericardio/trasplante , Pericardio/cirugía , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Páncreas/cirugía , Páncreas/irrigación sanguínea , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Hemorragia Posoperatoria/epidemiología , Hemorragia Posoperatoria/etiología , Tiempo de Internación/estadística & datos numéricosRESUMEN
BACKGROUND: A detailed understanding of the sympathetic innervation of coronary arteries is relevant to facilitate the development of novel treatment approaches. AIMS: This study aimed to quantitatively examine periarterial innervation in human epicardial coronary arteries. METHODS: Coronary arteries with adjacent epicardial adipose tissue were excised along the left main coronary artery (LMCA), left anterior descending artery (LAD), left circumflex artery (LCx), and right coronary artery (RCA) from 28 body donors and examined histologically. Immunofluorescence staining was performed to characterise sympathetic nerve fibres. RESULTS: A total of 42,573 nerve fibres surrounding 100 coronary arteries (LMCA: n=21, LAD: n=27, LCx: n=26, RCA: n=26) were analysed. The nerve fibre diameter decreased along the vessel course (median [interquartile range]): (proximal 46 µm [31-73], middle 38 µm [26-58], distal 31 µm [22-46]; p<0.001), with the largest nerve fibre diameter along the LMCA (50 µm [31-81]), followed by the LAD (42 µm [27-72]; p<0.001). The total nerve fibre density was highest along the RCA (123 nerves/cm² [82-194]). Circumferentially, nerve density was higher in the myocardial tissue area of the coronary arteries (132 nerves/cm² [76-225]) than in the epicardial tissue area (101 nerves/cm² [61-173]; p<0.001). The median lumen-nerve distance was smallest around the LMCA (2.2 mm [1.2-4.1]), followed by the LAD (2.5 mm [1.1-4.5]; p=0.005). CONCLUSIONS: Human coronary arteries are highly innervated with sympathetic nerve fibres, with significant variation in the distribution and density. Understanding these patterns informs pathophysiological understanding and, potentially, the development of catheter-based approaches for cardiac autonomic modulation.
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Vasos Coronarios , Humanos , Vasos Coronarios/inervación , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Sistema Nervioso Simpático , Tejido Adiposo/inervación , Pericardio/inervación , Anciano de 80 o más Años , Fibras NerviosasRESUMEN
Despite being a rare phenomenon, pericardial hydatid cysts present unique diagnostic challenges and require a multimodality imaging as well as a multidisciplinary approach for a curative management. The authors here present a case of a middle aged man who was referred to them for management of new onset atrial flutter with mitral regurgitation.
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Aleteo Atrial , Equinococosis , Insuficiencia de la Válvula Mitral , Humanos , Masculino , Aleteo Atrial/complicaciones , Aleteo Atrial/diagnóstico , Equinococosis/complicaciones , Equinococosis/diagnóstico , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/complicaciones , Persona de Mediana Edad , Diagnóstico Diferencial , Pericardio/diagnóstico por imagen , Ecocardiografía/métodos , Quiste Mediastínico/complicaciones , Quiste Mediastínico/diagnóstico , Quiste Mediastínico/diagnóstico por imagenRESUMEN
BACKGROUND: The aim of this study (EPIDIAB) was to assess the relationship between epicardial adipose tissue (EAT) and the micro and macrovascular complications (MVC) of type 2 diabetes (T2D). METHODS: EPIDIAB is a post hoc analysis from the AngioSafe T2D study, which is a multicentric study aimed at determining the safety of antihyperglycemic drugs on retina and including patients with T2D screened for diabetic retinopathy (DR) (n = 7200) and deeply phenotyped for MVC. Patients included who had undergone cardiac CT for CAC (Coronary Artery Calcium) scoring after inclusion (n = 1253) were tested with a validated deep learning segmentation pipeline for EAT volume quantification. RESULTS: Median age of the study population was 61 [54;67], with a majority of men (57%) a median duration of the disease 11 years [5;18] and a mean HbA1c of7.8 ± 1.4%. EAT was significantly associated with all traditional CV risk factors. EAT volume significantly increased with chronic kidney disease (CKD vs no CKD: 87.8 [63.5;118.6] vs 82.7 mL [58.8;110.8], p = 0.008), coronary artery disease (CAD vs no CAD: 112.2 [82.7;133.3] vs 83.8 mL [59.4;112.1], p = 0.0004, peripheral arterial disease (PAD vs no PAD: 107 [76.2;141] vs 84.6 mL[59.2; 114], p = 0.0005 and elevated CAC score (> 100 vs < 100 AU: 96.8 mL [69.1;130] vs 77.9 mL [53.8;107.7], p < 0.0001). By contrast, EAT volume was neither associated with DR, nor with peripheral neuropathy. We further evidenced a subgroup of patients with high EAT volume and a null CAC score. Interestingly, this group were more likely to be composed of young women with a high BMI, a lower duration of T2D, a lower prevalence of microvascular complications, and a higher inflammatory profile. CONCLUSIONS: Fully-automated EAT volume quantification could provide useful information about the risk of both renal and macrovascular complications in T2D patients.
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Tejido Adiposo , Automatización , Enfermedad de la Arteria Coronaria , Aprendizaje Profundo , Diabetes Mellitus Tipo 2 , Pericardio , Valor Predictivo de las Pruebas , Calcificación Vascular , Humanos , Masculino , Femenino , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Pericardio/diagnóstico por imagen , Persona de Mediana Edad , Tejido Adiposo/diagnóstico por imagen , Anciano , Calcificación Vascular/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Angiopatías Diabéticas/diagnóstico por imagen , Angiopatías Diabéticas/etiología , Angiopatías Diabéticas/diagnóstico , Medición de Riesgo , Interpretación de Imagen Radiográfica Asistida por Computador , Angiografía por Tomografía Computarizada , Adiposidad , Angiografía Coronaria , Factores de Riesgo , Reproducibilidad de los Resultados , Pronóstico , Tejido Adiposo EpicárdicoRESUMEN
Atrial fibrillation (AF) is the most common sustained arrhythmia and carries an increased risk of stroke and heart failure. Here we investigated how the immune infiltrate of human epicardial adipose tissue (EAT), which directly overlies the myocardium, contributes to AF. Flow cytometry analysis revealed an enrichment of tissue-resident memory T (TRM) cells in patients with AF. Cellular indexing of transcriptomes and epitopes by sequencing (CITE-seq) and single-cell T cell receptor (TCR) sequencing identified two transcriptionally distinct CD8+ TRM cells that are modulated in AF. Spatial transcriptomic analysis of EAT and atrial tissue identified the border region between the tissues to be a region of intense inflammatory and fibrotic activity, and the addition of TRM populations to atrial cardiomyocytes demonstrated their ability to differentially alter calcium flux as well as activate inflammatory and apoptotic signaling pathways. This study identified EAT as a reservoir of TRM cells that can directly modulate vulnerability to cardiac arrhythmia.
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Tejido Adiposo , Fibrilación Atrial , Células T de Memoria , Pericardio , Fibrilación Atrial/inmunología , Fibrilación Atrial/genética , Fibrilación Atrial/patología , Fibrilación Atrial/metabolismo , Humanos , Pericardio/metabolismo , Pericardio/patología , Pericardio/inmunología , Tejido Adiposo/metabolismo , Tejido Adiposo/inmunología , Tejido Adiposo/patología , Células T de Memoria/inmunología , Células T de Memoria/metabolismo , Masculino , Linfocitos T CD8-positivos/inmunología , Linfocitos T CD8-positivos/metabolismo , Transcriptoma , Miocitos Cardíacos/metabolismo , Miocitos Cardíacos/patología , Miocitos Cardíacos/inmunología , Femenino , Persona de Mediana Edad , Perfilación de la Expresión Génica , Anciano , Fenotipo , Señalización del Calcio , Apoptosis , Memoria Inmunológica , Transcripción Genética , Estudios de Casos y Controles , Atrios Cardíacos/patología , Atrios Cardíacos/inmunología , Atrios Cardíacos/metabolismo , Fibrosis/patología , Tejido Adiposo EpicárdicoRESUMEN
Diabetic cardiomyopathy (DCM) represents one of the typical complications associated with diabetes. It has been described as anomalies in heart function and structure, with consequent high morbidity and mortality. DCM development can be described by two stages; the first is characterized by left ventricular hypertrophy and diastolic dysfunction, and the second by heart failure (HF) with systolic dysfunction. The proposed mechanisms involve cardiac inflammation, advanced glycation end products (AGEs) and angiotensin II. Furthermore, different studies have focused their attention on cardiomyocyte death through the different mechanisms of programmed cell death, such as apoptosis, autophagy, necrosis, pyroptosis and ferroptosis. Exosome release, adipose epicardial tissue and aquaporins affect DCM development. This review will focus on the description of the mechanisms involved in DCM progression and development.
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Tejido Adiposo , Cardiomiopatías Diabéticas , Exosomas , Fibrosis , Pericardio , Humanos , Exosomas/metabolismo , Cardiomiopatías Diabéticas/metabolismo , Cardiomiopatías Diabéticas/patología , Tejido Adiposo/metabolismo , Tejido Adiposo/patología , Animales , Pericardio/metabolismo , Pericardio/patología , Muerte Celular , Miocitos Cardíacos/metabolismo , Miocitos Cardíacos/patología , Tejido Adiposo EpicárdicoRESUMEN
In treating aortic root diseases, the Bentall procedure offers reliable and stable results. However, it requires a prosthetic valved conduit, which presents inherent challenges due to the need for anticoagulation. The Ozaki procedure, which uses pericardium for aortic valve neocuspidization, is an alternative to prosthetic valves and does not need anticoagulation. We developed a surgical technique combining the Bentall and Ozaki procedures to treat patients with aortic root disease, which we describe in this article. Because the risk of bleeding due to anticoagulation after prosthetic valve replacement was a concern, we combined the Bentall and Ozaki procedures with a graft conduit using bovine pericardial patch neocuspidization. Postoperative echocardiography showed a competent aortic valve with no regurgitation. We believe that this novel procedure provides hope for a more adaptable and patient-friendly option.
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Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas , Bovinos , Pericardio/trasplante , Masculino , Implantación de Prótesis Vascular/métodos , Bioprótesis/efectos adversos , Femenino , Resultado del Tratamiento , Animales , Persona de Mediana EdadRESUMEN
Background: Heterogenous deposition and homeostasis roles of physiologic and ectopic adipose tissues underscore the impact of fat compartmentalization on cardiometabolic risk. We aimed to characterize the distribution of abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), epicardial adipose tissue (EAT), and liver fat on magnetic resonance imaging (MRI), and evaluate their associations with anthropometric indices and adverse cardiac remodeling. Methods: In this cross-sectional observational study, 149 Asian adults (57.0 ± 12.8 years; 65% males) with at least one cardiometabolic risk factor underwent multiparametric fat and cardiovascular MRI. Anthropometric indices included body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and bioimpedance body fat mass (BFM). Associations between fat depots and anthropometric measures as well as cardiac remodeling features were examined as a single cohort and stratified by type 2 diabetes mellitus (T2DM) status. Results: VAT and SAT had opposing associations with liver fat and EAT. Therefore the VAT/SAT ratio was explored as an integrated marker of visceral adiposity. VAT/SAT was positively associated with EAT (ß=0.35, P<0.001) and liver fat (ß=0.32, P=0.003) independent of confounders. Of the anthropometric measurements assessed, only WHR was independently associated with VAT/SAT (ß=0.17, P=0.021). Individuals with T2DM had higher VAT and lower SAT compared to those without T2DM, translating to a significantly higher VAT/SAT ratio. EAT volume was independently associated with adverse features of cardiac remodeling: increased left ventricular (LV) mass (ß=0.24, P=0.005), larger myocyte volume (ß=0.26, P=0.001), increased myocardial fibrosis (ß=0.19, P=0.023), higher concentricity (ß=0.18, P=0.035), and elevated wall stress (ß=-0.18, P=0.023). Conclusion: Multiparametric MRI revealed abdominal VAT and SAT have differential associations with anthropometric indices and ectopic fats in a single cohort of Asians at risk of cardiometabolic disease. People with T2DM have expanded VAT and diminished SAT, endorsing the VAT/SAT ratio beyond usual anthropometric measurements as a marker for multiorgan visceral fat composition. Among the fat depots examined, EAT is uniquely associated with adverse cardiac remodeling, suggesting its distinctive cardiometabolic properties and implications.
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Adiposidad , Grasa Intraabdominal , Pericardio , Remodelación Ventricular , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Transversales , Adiposidad/fisiología , Pericardio/diagnóstico por imagen , Pericardio/patología , Grasa Intraabdominal/diagnóstico por imagen , Grasa Intraabdominal/patología , Anciano , Diabetes Mellitus Tipo 2/patología , Diabetes Mellitus Tipo 2/fisiopatología , Pueblo Asiatico , Hígado/diagnóstico por imagen , Hígado/patología , Antropometría , Imagen por Resonancia Magnética , Adulto , Grasa Abdominal/diagnóstico por imagen , Grasa Abdominal/patologíaRESUMEN
BACKGROUND: Obesity increases the risk of atrial fibrillation (AF). We hypothesize that 'obese' epicardial adipose tissue (EAT) is, regardless of comorbidities, associated with markers of AF vulnerability. METHODS: Patients >40y of age undergoing bariatric surgery and using <2 antihypertensive drugs and no insulin were prospectively included. Study investigations were conducted before and 1y after surgery. Heart rhythm and p-wave duration were measured through ECGs and 7-d-holters. EAT-volume and attenuation were determined on non-enhanced CT scans. Serum markers were quantified by ELISA. RESULTS: Thirty-seven patients underwent surgery (age: 52.1 ± 5.9y; 27 women; no AF). Increased p-wave duration correlated with higher BMI, larger EAT volumes, and lower EAT attenuations (p < 0.05). Post-surgery, p-wave duration decreased from 109 ± 11 to 102 ± 11ms. Concurrently, EAT volume decreased from 132 ± 49 to 87 ± 52ml, BMI from 43.2 ± 5.2 to 28.9 ± 4.6kg/m2, and EAT attenuation increased from -76.1 ± 4.0 to -71.7 ± 4.4HU (p <0.001). Adiponectin increased from 8.7 ± 0.8 to 14.2 ± 1.0 µg/ml (p <0.001). However, decreased p-wave durations were not related to changed EAT characteristics, BMI or adiponectin. CONCLUSION: In this explorative study, longer p-wave durations related to higher BMIs, larger EAT volume, and lower EAT attenuations. P-wave duration and EAT volume decreased, and EAT attenuation increased upon drastic weightloss. However, there was no relation between decreased p-wave duration and changed BMI or EAT characteristics.
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Tejido Adiposo , Fibrilación Atrial , Pericardio , Pérdida de Peso , Humanos , Fibrilación Atrial/metabolismo , Fibrilación Atrial/fisiopatología , Femenino , Persona de Mediana Edad , Masculino , Tejido Adiposo/metabolismo , Pericardio/metabolismo , Pericardio/patología , Obesidad/metabolismo , Estudios Prospectivos , Adiponectina/metabolismo , Adiponectina/sangre , Cirugía Bariátrica , Índice de Masa Corporal , Tejido Adiposo EpicárdicoRESUMEN
LMNA-related dilated cardiomyopathy (DCM) is an autosomal-dominant genetic condition with cardiomyocyte and conduction system dysfunction often resulting in heart failure or sudden death. The condition is caused by mutation in the Lamin A/C (LMNA) gene encoding Type-A nuclear lamin proteins involved in nuclear integrity, epigenetic regulation of gene expression, and differentiation. The molecular mechanisms of the disease are not completely understood, and there are no definitive treatments to reverse progression or prevent mortality. We investigated possible mechanisms of LMNA-related DCM using induced pluripotent stem cells derived from a family with a heterozygous LMNA c.357-2A>G splice-site mutation. We differentiated one LMNA-mutant iPSC line derived from an affected female (Patient) and two non-mutant iPSC lines derived from her unaffected sister (Control) and conducted single-cell RNA sequencing for 12 samples (four from Patients and eight from Controls) across seven time points: Day 0, 2, 4, 9, 16, 19, and 30. Our bioinformatics workflow identified 125,554 cells in raw data and 110,521 (88%) high-quality cells in sequentially processed data. Unsupervised clustering, cell annotation, and trajectory inference found complex heterogeneity: ten main cell types; many possible subtypes; and lineage bifurcation for cardiac progenitors to cardiomyocytes (CMs) and epicardium-derived cells (EPDCs). Data integration and comparative analyses of Patient and Control cells found cell type and lineage-specific differentially expressed genes (DEGs) with enrichment, supporting pathway dysregulation. Top DEGs and enriched pathways included 10 ZNF genes and RNA polymerase II transcription in pluripotent cells (PP); BMP4 and TGF Beta/BMP signaling, sarcomere gene subsets and cardiogenesis, CDH2 and EMT in CMs; LMNA and epigenetic regulation, as well as DDIT4 and mTORC1 signaling in EPDCs. Top DEGs also included XIST and other X-linked genes, six imprinted genes (SNRPN, PWAR6, NDN, PEG10, MEG3, MEG8), and enriched gene sets related to metabolism, proliferation, and homeostasis. We confirmed Lamin A/C haploinsufficiency by allelic expression and Western blot. Our complex Patient-derived iPSC model for Lamin A/C haploinsufficiency in PP, CM, and EPDC provided support for dysregulation of genes and pathways, many previously associated with Lamin A/C defects, such as epigenetic gene expression, signaling, and differentiation. Our findings support disruption of epigenomic developmental programs, as proposed in other LMNA disease models. We recognized other factors influencing epigenetics and differentiation; thus, our approach needs improvement to further investigate this mechanism in an iPSC-derived model.
Asunto(s)
Cardiomiopatía Dilatada , Diferenciación Celular , Haploinsuficiencia , Células Madre Pluripotentes Inducidas , Lamina Tipo A , Miocitos Cardíacos , Transcriptoma , Células Madre Pluripotentes Inducidas/metabolismo , Células Madre Pluripotentes Inducidas/patología , Humanos , Cardiomiopatía Dilatada/genética , Cardiomiopatía Dilatada/patología , Cardiomiopatía Dilatada/metabolismo , Lamina Tipo A/genética , Lamina Tipo A/metabolismo , Miocitos Cardíacos/metabolismo , Miocitos Cardíacos/patología , Diferenciación Celular/genética , Haploinsuficiencia/genética , Femenino , Transcriptoma/genética , Pericardio/patología , Pericardio/metabolismo , Linaje de la Célula/genética , Análisis de la Célula Individual , Regulación de la Expresión Génica , Mutación/genética , AdultoRESUMEN
INTRODUÇÃO: A agenesia do pericárdio é uma patologia rara, com prevalência de 1:14.000 casos pela literatura. Seu diagnóstico é habitualmente incidental, visto que a maioria dos casos são assintomáticos. Pode ocorrer de forma total ou parcial, sendo três vezes mais prevalente entre indivíduos do sexo masculino. DESCRIÇÃO DO CASO: Paciente do sexo feminino, 28 anos de idade com história de derrame pleural à esquerda recorrente desde 2012 associada a dor ventilatório-dependente em hemitórax esquerdo. Ao exame físico apresentava desvio de ictus para linha axilar posterior, sem outros achados. Eletrocardiograma com desvio extremo do eixo para a direita e distúrbio de condução pelo ramo direito, Holter 24h com ausência de ectopias ou pausas, Ecocardiograma com desvio extremo do ápice cardíaco (ambos os ventrículos) para região axilar posterior e hipermobilidade cardíaca durante o exame, além de Ressonância Magnética Cardíaca evidenciando levoposição excessiva do coração, hipermobilidade ventricular e interposição de parênquima pulmonar entre o tronco pulmonar e a aorta ascendente, todos achados sugestivos de agenesia de pericárdio. DISCUSSÃO: A agenesia de pericárdio, embora frequentemente assintomática, pode manifestar-se com sintomas variados como dor torácica, dispneia, tonturas ou síncope, decorrentes de um defeito congênito no desenvolvimento da membrana pleuropericárdica esquerda. Em casos de defeitos parciais, onde os sintomas são mais prevalentes, pode ocorrer herniação e encarceramento do apêndice atrial esquerdo ou do ventrículo esquerdo, situações que demandam reparo cirúrgico urgente utilizando materiais sintéticos ou pericárdio bovino. No caso relatado, os achados de desvio extremo do ápice cardíaco e interposição de parênquima pulmonar entre o tronco pulmonar e a aorta ascendente indicam agenesia total. A decisão contra a intervenção cirúrgica foi baseada na ausência de risco iminente de morte súbita, sublinhando a importância de uma avaliação criteriosa dos riscos versus benefícios da cirurgia em casos de agenesia completa.
Asunto(s)
Humanos , Femenino , Adulto , Pericardio/anomalías , Derrame Pleural , EcocardiografíaRESUMEN
Development of the heart is a very intricate and multiplex process as it involves not only the three spatial dimensions but also the fourth or time dimension. Over time, the heart of an embryo needs to adapt its function to serve the increasing complexity of differentiation and growth towards adulthood. It becomes even more perplexing by expanding time into millions of years, allocating related species in the tree of life. As the evolution of soft tissues can hardly be studied, we have to rely on comparative embryology, supported heavily by genetic and molecular approaches. These techniques provide insight into relationships, not only between species, but also between cell populations, signaling mechanisms, molecular interactions and physical factors such as hemodynamics. Heart development depends on differentiation of a mesodermal cell population that - in more derived taxa - continues in segmentation of the first and second heart field. These fields deliver not only the cardiomyocytes, forming the three-dimensionally looping cardiac tube as a basis for the chambered heart, but also the enveloping epicardium. The synchronized beating of the heart is then organized by the conduction system. In this Review, the epicardium is introduced as an important player in cardiac differentiation, including the conduction system.
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Evolución Biológica , Sistema de Conducción Cardíaco , Hemodinámica , Pericardio , Vertebrados , Animales , Pericardio/fisiología , Pericardio/embriología , Vertebrados/fisiología , Sistema de Conducción Cardíaco/fisiología , Corazón/fisiología , Corazón/embriologíaRESUMEN
OBJECTIVE: Epicardial adipose tissue (EAT) quantity is associated with poor cardiovascular outcomes. However, the quality of EAT may be of incremental prognostic value. Cardiac magnetic resonance (CMR) is the gold standard for tissue characterization but has never been applied for EAT quality assessment. We aimed to investigate EAT quality measured on CMR T1 mapping as a predictor of poor outcomes in an all-comer cohort. METHODS: We investigated the association of EAT area and EAT T1 times (EAT-T1) with a composite endpoint of nonfatal myocardial infarction, heart failure hospitalization, and all-cause death. RESULTS: A total of 966 participants were included (47.2% female; mean age: 58.4 years) in this prospective observational CMR registry. Mean EAT area and EAT-T1 were 7.3 cm2 and 268 ms, respectively. On linear regression, EAT-T1 was not associated with markers of obesity, dyslipidemia, or comorbidities such as diabetes (p > 0.05 for all). During a follow-up of 57.7 months, a total of 280 (29.0%) events occurred. EAT-T1 was independently associated (adjusted hazard ratio per SD: 1.202; 95% CI: 1.022-1.413; p = 0.026) with the composite endpoint when adjusted for established clinical risk. CONCLUSIONS: EAT quality (as assessed via CMR T1 times), but not EAT quantity, is independently associated with a composite endpoint of nonfatal myocardial infarction, heart failure hospitalization, and all-cause death.
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Tejido Adiposo , Imagen por Resonancia Magnética , Infarto del Miocardio , Pericardio , Humanos , Femenino , Persona de Mediana Edad , Masculino , Pericardio/diagnóstico por imagen , Pericardio/patología , Tejido Adiposo/diagnóstico por imagen , Estudios Prospectivos , Imagen por Resonancia Magnética/métodos , Anciano , Infarto del Miocardio/diagnóstico por imagen , Insuficiencia Cardíaca/diagnóstico por imagen , Pronóstico , Hospitalización/estadística & datos numéricos , Obesidad , Enfermedades Cardiovasculares/diagnóstico por imagen , Factores de Riesgo , Tejido Adiposo EpicárdicoRESUMEN
Injectable extracellular matrix (iECM) is a versatile biological material with beneficial properties such as good degradability, promotion of cell survival, immunomodulation, and facilitation of vascular formation. However, intravenous injection of iECM faces challenges like a short retention time in vivo and low concentration at the lesion site. To address these issues, we prepared a composite hydrogel composed of sodium alginate and iECM and administered it via intrapericardial injection, forming a structure akin to cardiac patches within the pericardium. Compared with intramyocardial injection, intrapericardial injection avoids direct myocardial injury and ectopic tumor formation, offering less invasiveness and better biocompatibility. This study demonstrates that the sodium alginate/infusible extracellular matrix (SA/iECM) composite hydrogel can effectively prolong the local retention time of iECM in the heart, enhance electrical conduction between cardiomyocytes, promote angiogenesis at ischemic myocardial sites, inhibit apoptosis in the infarcted region, mitigate left ventricular remodeling postmyocardial infarction (MI), and improve cardiac function after infarction. Precise coordination of cardiomyocyte contraction and relaxation depends on the rhythmic occurrence of calcium-dependent action potentials. Cardiac dysfunction is partially attributed to the disruption of the excitation-contraction coupling (ECC) mechanism, which is associated with prolonged intracellular Ca2+ transients and alterations in contraction and relaxation Ca2+ levels. Our results show that the SA/iECM composite hydrogel improves electrical conduction, as evidenced by increased Cx43 expression and enhanced intercellular electrical connectivity. This research establishes that intrapericardial injection of a SA/iECM composite hydrogel is a safe and effective treatment modality, providing a theoretical basis for the use of biomaterials in MI therapy.
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Alginatos , Matriz Extracelular , Hidrogeles , Infarto del Miocardio , Neovascularización Fisiológica , Pericardio , Alginatos/química , Alginatos/farmacología , Animales , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/patología , Infarto del Miocardio/fisiopatología , Hidrogeles/química , Hidrogeles/farmacología , Matriz Extracelular/efectos de los fármacos , Matriz Extracelular/metabolismo , Matriz Extracelular/química , Pericardio/efectos de los fármacos , Ratones , Neovascularización Fisiológica/efectos de los fármacos , Miocitos Cardíacos/efectos de los fármacos , Miocitos Cardíacos/metabolismo , Masculino , Ratas , AngiogénesisRESUMEN
BACKGROUND: One of the special anatomical structures in sturgeons is the pericardioperitoneal canal (PPC), which has not been studied much. Considering that the presence and absence of this channel and its morphometry have not been investigated in this type of fish, this study was conducted. OBJECTIVE: The purpose of present study was to obtain a complete understanding about anatomical features and ultrasonography of PPC in the heart of immature beluga species in order to provide standard approaches for performing sonography and echocardiography on this sturgeon species. METHODS: Ten immature belugas (Huso huso) were used to perform ultrasonography with Sonosite MicroMaxx ultrasonography machine of ventral approach between two pectoral fins. After performing the steps of ultrasonographic study, gross anatomical studies were also performed, and the morphometric measurement of the canal was also performed. RESULTS: A small PPC was observed, which communicated between the pericardial cavity, and the peritoneal (coelomic) cavity. The cranial part of this channel, which was located immediately after the transverse septum, was on the midline of the body and was seen in midsagittal ultrasonograms. On average, the length of this canal was 3.23 ± 0.05 cm, and its diameter (cranial part) was 0.24 ± 0.04 cm. CONCLUSIONS: In the present study on immature beluga, it was observed that the canal is located behind the sinus venosus and is caudoventral to it, though behind the transverse septum. It has been mentioned that this PPC establishes a connection between the pericardial cavity and the peritoneal cavity, so this connection is between the peritoneal cavity and the space between the two layers of the pericardium and has no connection with the pericardial sac (the space where the heart is located). In this study, the anatomical structure and morphometry of the PPC in immature beluga were investigated, and some approaches were presented to observe the canal in ultrasonography.
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Peces , Animales , Peces/anatomía & histología , Ultrasonografía/veterinaria , Pericardio/diagnóstico por imagen , Pericardio/anatomía & histologíaRESUMEN
BACKGROUND: Cushing's syndrome (CS) is associated with increased risk for heart failure, which often initially manifests as left ventricular diastolic dysfunction (LVDD). In this study, we aimed to explore the potential risk factors of LVDD in CS by incorporating body composition parameters. METHODS: A retrospective study was conducted on patients diagnosed with endogenous CS no less than 18 years old. The control group consisted of healthy individuals who were matched to CS patients in terms of gender, age, and BMI. LIFEx software (version 7.3) was applied to measure epicardial adipose tissue volume (EATV) on non-contrast chest CT, as well as abdominal adipose tissue and skeletal muscle mass at the first lumbar vertebral level. Echocardiography was used to evaluate left ventricular (LV) diastolic function. Body compositions and clinical data were examined in relation to early LVDD. RESULTS: A total of 86 CS patients and 86 healthy controls were enrolled. EATV was significantly higher in CS patients compared to control subjects (150.33 cm3 [125.67, 189.41] vs 90.55 cm3 [66.80, 119.84], p < 0.001). CS patients had noticeably increased visceral fat but decreased skeletal muscle in comparison to their healthy counterparts. Higher prevalence of LVDD was found in CS patients based on LV diastolic function evaluated by E/A ratio (p < 0.001). EATV was proved to be an independent risk factor for LVDD in CS patients (OR = 1.015, 95%CI 1.003-1.026, p = 0.011). If the cut-point of EATV was set as 139.252 cm3 in CS patients, the diagnostic sensitivity and specificity of LVDD were 84.00% and 55.60%, respectively. CONCLUSION: CS was associated with marked accumulation of EAT and visceral fat, reduced skeletal muscle mass, and increased prevalence of LVDD. EATV was an independent risk factor for LVDD, suggesting the potential role of EAT in the development of LVDD in CS.
This study explored the potential risk factors of LVDD in endogenous CS by incorporating body composition parameters. EATV was identified as an independent risk factor for LVDD. Targeted therapeutic interventions to reduce excessive cortisol-induced EAT accumulation may be promising to mitigate the risk of LVDD development in patients with CS.
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Tejido Adiposo , Síndrome de Cushing , Ecocardiografía , Pericardio , Disfunción Ventricular Izquierda , Humanos , Masculino , Síndrome de Cushing/fisiopatología , Síndrome de Cushing/complicaciones , Síndrome de Cushing/epidemiología , Femenino , Estudios Retrospectivos , Adulto , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/etiología , Pericardio/diagnóstico por imagen , Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/fisiopatología , Persona de Mediana Edad , Diástole , Factores de Riesgo , Estudios de Casos y Controles , Tomografía Computarizada por Rayos X , Tejido Adiposo EpicárdicoRESUMEN
Pericardial diseases have gained renewed clinical interest, leading to a renaissance in the field. There have been many recent advances in pericardial diseases in both multimodality cardiac imaging of diagnoses, such as recurrent, transient constrictive and effusive-constrictive pericarditis, and targeted therapeutics, especially anti-interleukin (IL)-1 agents that affect the inflammasome as part of autoinflammatory pathophysiology. There remains a large educational gap for clinicians, leading to variability in evaluation and management of these patients. The latest pericardial imaging (American Society of Echocardiography, European Association of Cardiovascular Imaging) and clinical guidelines (European Society of Cardiology) are >8-10 years of age and may not reflect current practice. Recent clinical trials involving anti-IL-1 agents in recurrent pericarditis, including anakinra (AIRTRIP), rilonacept (RHAPSODY), and goflikicept have demonstrated their efficacy. The present document represents an international position statement from world leaders in the pericardial field, focusing on novel concepts and emphasizing the role of multimodality cardiac imaging as well as new therapeutics in pericardial diseases.
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Consenso , Imagen Multimodal , Pericardio , Valor Predictivo de las Pruebas , Humanos , Imagen Multimodal/normas , Pericardio/diagnóstico por imagen , Difusión de Innovaciones , Pronóstico , Pericarditis/diagnóstico por imagen , Pericarditis/terapia , Pericarditis/fisiopatología , Pericarditis/tratamiento farmacológico , Pericarditis Constrictiva/diagnóstico por imagen , Pericarditis Constrictiva/fisiopatología , Pericarditis Constrictiva/terapia , Técnicas de Imagen Cardíaca/normasRESUMEN
INTRODUCTION: Rheumatoid arthritis (RA) is a chronic inflammatory disease that primarily affects the joints. RA is associated with high cardiovascular mortality and morbidity. One of the new markers of cardiometabolic risk is epicardial fat thickness, the study of EFT in patients with RA and its association with echocardiographic parameters may provide valuable insight into the potential cardiac involvement and overall cardiovascular risk in these patients. METHOD: The present study is a cross-sectional study with a comparison group conducted in 2024. The study population included 66 RA patients and 66 healthy participants. Echocardiographic parameters, laboratory data including lipid profile and inflammatory markers, were obtained from the medical record. RESULTS: Comparison of echocardiographic parameters between RA and healthy participants showed that E parameter and EFT were statistically significant in RA patients. (EFT was 5.22 ± 2.6 in RA patients which in comparison with healthy participant (5.22 ± 2.06) was statistically significant (p-value: <.001)). Also, EFT was correlated with RF, Anti-CCP, ESR, and systolic blood pressure. CONCLUSION: To the best of our knowledge, ours is the first EFT study on RA patients in Iran, which shows a higher EFT in RA patients. High EFT is correlated with more cardiovascular events and is an early sign and independent predictor of atherosclerosis in RA patients, which greatly underlines the importance of cardiovascular assessment in RA patients.