Search Results (1,159)

Background: Right ventricular (RV) strain using two-dimensional speckle tracking is a reliable and clinically significant tool for detecting RV systolic dysfunction, but it varies by age, vendor, and software. Objectives: To establish pediatric age-specific normal values and Z-score equations for biventricular strain using GE Healthcare equipment and software. Methods: Children 0–18 years with structurally and functionally normal hearts, who visited the Wilhelmina Children’s Hospital Utrecht between October 2020 and December 2023, were retrospectively included and divided into age groups: 0 years, 1–4 years, 5–9 years, 10–13 years, and 14–18 years. Left ventricular (LV) and RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWGLS) were analyzed. Results: We included 129 subjects (57% male) (0 years: n = 17; 1–4 years: n = 22; 5–9 years: n = 34; 10–13 years: n = 35; 14–18 years: n = 20). Low R² values were strain-adjusted for age, height, and body surface area (all < 0.3), and the sample size limited Z-score equation reliability. Therefore, data are presented as mean ± SD or median [IQR] stratified by age. LV GLS, RV GLS, and RV FWGLS showed a nonlinear relationship with age, peaking at the 1–4 years age group and decreasing with age. Conclusions: LV GLS, RV GLS, and RV FWGLS showed age-related differences in children using GE equipment and software, which highlights the importance of age-specific normal strain values, including Z-score equations as a function of age. Full article

Background: Takotsubo syndrome (TS) is an acute heart failure characterized by transient systolic dysfunction of the left ventricle (LV). Given the complex cardiohepatic interactions in heart failure, the purpose of this study was to examine the role of hepatic T1 mapping in TS patients as an imaging biomarker of the cardiohepatic axis and to explore its correlation with demographics, laboratory data, and cardiovascular magnetic resonance (CMR) findings. Methods: In this retrospective pilot study, CMR was performed in 62 consecutive patients with TS (54 females, 73.47 ± 9.88 years). Additionally, 24 age- and sex-matched control subjects were included (20 females, 69.67 ± 6.88 years). A dedicated CMR software (CV42 6.0, CVI42, Circle Cardiovascular Imaging Inc., Calgary, AB, Canada) was used to assess atrial and ventricular strain parameters, as well as parametric mapping, including hepatic T1 mapping. Results: TS patients exhibited significantly higher hepatic T1 mapping values compared with the age-, sex-, and cardiovascular risk factor-matched control group (499.80 ± 141.86 vs. 425.26 ± 51.91, p = 0.017). In multivariable analysis, hepatic T1 mapping was independently associated with right ventricular (RV) longitudinal strain (β coefficient = 2.936, p = 0.007) and N-terminal pro-B-type natriuretic peptide (β coefficient = 2.395, p = 0.024). Conclusions: In this pilot study, hepatic T1 mapping was elevated in TS patients, suggesting its potential role as an imaging biomarker of cardiohepatic interaction. Hepatic T1 also showed independent associations with RV longitudinal strain and N-terminal pro-B-type natriuretic peptide, both well-known markers of adverse outcomes in TS. These preliminary findings warrant validation in larger studies. Full article

Heart failure (HF) imposes a significant burden on public health, affecting over 56.19 million people worldwide. Right ventricular (RV) dysfunction may occur in HF patients due to various factors, including adverse interventricular interactions, ischemic heart disease, and HF-correlated pulmonary hypertension. Additionally, the deterioration of RV function plays a critical role in the progression of HF, regardless of left ventricular (LV) systolic function, suggesting an unfavorable outcome. Throughout the progression of HF and increasing afterload, the right ventricle undergoes adaptive remodeling to preserve adequate cardiac output. Right ventricular-pulmonary artery (RV-PA) coupling integrates the dynamic adaptation of RV systolic function to afterload and has been considered a stronger predictor of HF prognosis than other conventional parameters. Thus, accurate evaluations of RV-PA coupling are significant in the clinical diagnosis and management of HF patients, along with prognostic speculation. In this review, we summarize the basic principles and measurements of RV-PA coupling and focus on its clinical significance across each subtype of HF. Full article

Background and Clinical Significance: Heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) frequently coexist, creating a complex clinical interplay that exacerbates morbidity and mortality. AF can directly precipitate or worsen HFrEF through mechanisms such as tachycardia-induced cardiomyopathy, loss of atrial contribution to ventricular filling, and irregular ventricular response. The use of evidence-based therapies improves clinical outcomes in patients with HFrEF. Case Presentation: We present a clinical case of a 58-year-old man with left bundle branch block (LBBB), tachysystolic AF, and the aforementioned induced HFrEF. The patient’s medical treatment was optimized according to recent guidelines. Subsequent to the improvements in HF treatment, the patient’s echocardiographic data showed a higher left ventricle ejection fraction (LVEF); however, it remained below 35%. Moreover, tachysystolia persisted and was not sufficiently controlled with medications. Therefore, an upgrade of the pacemaker to cardiac resynchronization therapy (CRT) following the destruction of the AV node was performed to control tachysystolic AF and worsening of HF. After the treatment adjustments, the patient’s symptoms regressed, and echocardiography showed improved LVEF up to 41%. Conclusions: This case highlights the successful identification and timely application of intensive heart rate control management and heart failure induced by AF treatment. Full article

Background/Objectives: Systemic arterial hypertension is a prevalent condition associated with adverse cardiac remodeling. Echocardiography plays a crucial role in assessing cardiac structure and function in hypertensive patients. This study aimed to evaluate the changes in echocardiographic parameters in hypertensive patients over a 3-year follow-up period and assess the impact of blood pressure control and antihypertensive medication use on these changes. Methods: This observational cohort study included 131 adult patients with systemic arterial hypertension who underwent annual echocardiographic assessments. Statistical analyses included paired and unpaired comparisons, regression modeling, and subgroup analyses by BP control and lifestyle behavior. Results: Over the 3-year follow-up, mean left ventricular mass (LVM) increased significantly from 173.99 ± 59.33 g to 183.26 ± 64.19 g (p = 0.018), and the prevalence of LV hypertrophy rose from 29.0% to 40.5% (p = 0.021). Patients with uncontrolled blood pressure at the final visit had significantly greater interventricular septum and posterior wall thicknesses (p = 0.009 and p = 0.012, respectively), but no statistically significant difference in ΔLVM. Those who adopted more healthy lifestyle behaviors showed a dose-dependent reduction in LVM progression, with each additional lifestyle improvement associated with a −3.25 g change in ΔLVM (p = 0.01). Multivariable linear regression identified baseline LVM, sex, and lifestyle score as independent predictors of 3-year LVM change (model R² = 0.318). Conclusions: Our findings indicate that long-term cardiac remodeling may continue in hypertensive patients despite treatment, particularly in the presence of suboptimal BP control. Sustained lifestyle improvements were independently associated with attenuation of LVM progression. These results underscore the importance of integrating behavioral interventions alongside pharmacologic therapy in routine hypertension management. Full article

Background: Hypertrophic cardiomyopathy (HCM) is frequently associated with preserved left ventricular ejection fraction (LVEF), yet subclinical myocardial dysfunction often escapes detection using conventional imaging. Cardiac magnetic resonance (CMR) with feature tracking (FT) enables precise assessment of myocardial deformation and mechanics. Methods: In this prospective case–control study, we evaluated 150 HCM patients and 100 age- and sex-matched healthy controls using standardized CMR protocols. Global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), and left ventricular (LV) torsion were quantified via FT-CMR. Myocardial fibrosis was assessed through late gadolinium enhancement (LGE), native T1 mapping, and extracellular volume (ECV). Results: HCM patients showed significantly impaired strain and torsion metrics compared with controls: GLS (−16% vs. −20%), GCS (−18% vs. −21%), GRS (29% vs. 38%), and global LV torsion (1.27°/cm vs. 1.95°/cm), all p < 0.001. These abnormalities were also observed in LGE-negative patients, suggesting early functional remodeling. Global LV torsion demonstrated the highest diagnostic performance for LGE detection (AUC = 0.995), surpassing those of GLS (0.877), native T1 (0.731), and ECV (0.657). A cut-off value of 0.7°/cm provided optimal sensitivity and specificity, and was associated with adverse prognosis in survival analysis. Conclusions: CMR-derived strain and torsion parameters detect early myocardial dysfunction in HCM beyond conventional markers. Global LV torsion, in particular, emerges as a sensitive and robust non-invasive marker with diagnostic and prognostic potential. Full article

Background/Objectives: Dilated cardiomyopathy (DCM), defined as dilation and contractile dysfunction of the left or both cardiac ventricles, remains the most common category of primary myocardial disease worldwide. It is the most prevalent cause of chronic heart failure and the most common indication for cardiac transplantation in young subjects. Accumulating evidence increasingly highlights the substantial genetic defects underlying DCM. Nevertheless, the genetic ingredients accountable for DCM in a major percentage of patients remain indefinite. Methods: A multigenerational pedigree suffering from DCM and a total of 276 healthy volunteers employed as controls were recruited from the Chinese Han-ethnicity population. A whole-exome sequencing (WES) assay followed by a Sanger sequencing analysis of the genomic DNAs from the available family members was implemented. Functional characterization of the identified genetic variant was completed by dual-luciferase analysis. Results: A new heterozygous variation in the ETS1 (erythroblast transformation-specific 1) gene, NM_005238.4:c.447T>G;p.(Tyr149*), was identified by WES and validated by Sanger sequencing analysis to co-segregate with DCM in the whole DCM family. This nonsense ETS1 variant was not found in 276 control subjects. Functional examination elucidated that Tyr149*-mutant ETS1 lost the ability to transactivate its downstream target genes CLDN5 (claudin 5) and ALK1 (activin receptor-like kinase 1), two genes crucial for cardiovascular embryonic development and postnatal structural remodeling. Conclusions: The present investigation reveals ETS1 as a new gene predisposed to human DCM and indicates ETS1 haploinsufficiency as an alternative molecular pathogenesis underlying DCM, providing a potential molecular target for genetic counseling and early diagnosis as well as personalized prophylaxis of DCM. Full article

Background/Objectives: Heart failure (HF) with reduced ejection fraction (EF) has, in more than 50% of cases, an ischemic etiology and continues to be associated with increased mortality and morbidity despite all the progress registered in the field of medical therapy and interventional revascularization. Myocardial revascularization is extensively used in clinical practice based on the traditional concept that it can improve myocardial function and outcome in ischemic HF. This review is aimed at presenting current knowledge regarding revascularization in patients with chronic ischemic HF and reduced EF. Methods: The impact of revascularization on symptomatology, left ventricle reverse remodeling, major adverse cardiac events (MACEs), and the role of complete revascularization and of percutaneous interventional revascularization in chronic total occlusion (PCI-CTO) were analyzed. The best therapeutic strategies, revascularization and/or optimal medical therapy (OMT), are debated in different categories of patients, in order to identify who will benefit more from revascularization strategies. Results: Based on the long-term results of the STICH trial incorporated in the guidelines with a class I-b recommendation, coronary artery bypass graft (CABG) remains the main modality of revascularization for prognostic improvement in ischemic HF with multivessel disease. But real-life patients are usually old with multiple comorbidities and high surgical risk. In this category, the Heart Team opinion is required to evaluate the probability of complete revascularization and to choose between percutaneous coronary intervention (PCI) and CABG according to clinical status and coronary anatomy. Conclusions: However, until further studies are available, the results of the REVIVED-BCIS2 trial encourage OMT over PCI in patients with ischemic cardiomyopathy. The available randomized controlled trials (RCTs) showed improved angina and quality of life in PCI-CTO versus OMT, but the effect on MACEs was not demonstrated. Full article

The mechanisms underlying the effects of dapagliflozin in heart failure with reduced ejection fraction (HFrEF) are not yet fully understood. This study aims to evaluate the effect of the drug on cardiorespiratory function by assessing alveolar–capillary membrane characteristics, sleep apnea, pulmonary and cardiac performance in stable HFrEF patients. Seventy-three patients with stable HFrEF were enrolled, with 66 completing the six-month follow-up. Analyses included assessment of the alveolar–capillary membrane by diffusion capacity, including its membrane diffusion and capillary volume components and measurements of proSP-B in the blood, an emerging biomarker of alveolar–capillary membrane function. Pulmonary function tests, overnight respiratory monitoring, and echocardiographic parameter collection were also conducted. After 6 months, a reduction in circulating proSP-B levels was observed (32.65 ± 13.36 at baseline vs. 30.86 ± 12.45 AU at 6 months, p for trend 0.0092), accompanied by improvements in echocardiographic parameters (left ventricle ejection fraction and pulmonary pressures). Pulmonary function tests and overnight respiratory monitoring showed no significant changes in lung diffusion, spirometry, or obstructive sleep apnea (apnea hypopnea index from 5.0 [1.1–16.6] at baseline to 6.2 [0.7–13.8]/h; p = n.s.). A significant reduction in central sleep apnea (CSA) was noted in the 13 patients with at least one CSA at baseline (15 [3–48] vs. 0 [0–18.5]/h, p = 0.017). Dapagliflozin demonstrates both hemodynamic and non-hemodynamic effects, particularly improving alveolar–capillary membrane function. This study highlights the multifactorial benefits of dapagliflozin in patients with stable HFrEF and the potential of proSP-B as a sensitive marker for evaluating therapeutic response. Full article

Background/Objectives: Cardiac involvement in systemic sclerosis (SSc) ranges from subclinical to severe. While pulmonary artery hypertension (PAH) is well-documented, the mechanism of left ventricular (LV) ischemia remains unclear. Oxygen-sensitive cardiovascular magnetic resonance (OS-CMR) imaging offers a novel approach to assessing myocardial oxygenation and ischemia. This study evaluated the changes in myocardial deoxygenation in response to stress using LV OS-CMR in SSc patients without known cardiac disease. Methods: We prospectively recruited SSc patients without prior cardiac disease or risk factors, and age- and sex-matched healthy volunteers (HVs). All participants underwent transthoracic echocardiography (TTE) and 3T CMR, including native T1 mapping, rest/stress OS-CMR, stress perfusion, and late gadolinium enhancement (LGE). The primary outcome was a change in the LV OS-CMR signal intensity (SI) after adenosine stress. Results: Thirty-three participants (23 SSc, 10 HV) were enrolled. SSc patients had significantly lower global LV OS-CMR SI compared to HV (13.4 ± 6.5 vs. 19.5 ± 3.6, p = 0.011). OS-CMR SI change ≤ 10% was observed in at least one segment in 20 (87%) SSc patients and globally in 12 (52%). LGE was present in 5 (22%) patients, and 18 (78%) had ≥1 abnormal T1 mapping segment. LV global longitudinal strain (GLS) was reduced in SSc patients compared to the HVs (−19.04 ± 3.86 vs. −21.92 ± 3.72, p = 0.045). All HVs had normal CMR and TTE findings. Conclusions: SSc patients without known cardiovascular disease or PAH demonstrated subclinical LV ischemia with an impaired myocardial oxygenation response to stress. They further demonstrated LV myocardial deformation abnormalities and LV diffuse fibrosis when compared to an age-matched control group. Our findings support the presence of early coronary microvascular dysfunction and LV myocardial fibrosis in this population, which may explain the adverse cardiovascular risk seen in this population, independent of the presence of PAH. Full article

Background: Arteriovenous fistulas (AVFs) may contribute to cardiac remodeling and consequently to an increased risk of heart failure and cardiovascular mortality in patients with end-stage kidney disease (ESKD). We aimed to assess cardiac changes following AVF creation and identify potential parameters associated with cardiac remodeling. Methods: In our prospective, single-center study, ESKD patients without significant pre-existing cardiac disease underwent 2D and 3D echocardiographic evaluation before and after AVF creation, along with AVF flow measurement. Cardiac remodeling was assessed using 3D indexed left and right ventricular end-diastolic volumes (LVEDVi, RVEDVi), while systolic function was assessed using longitudinal strain and 3D ejection fraction. Results: We included 20 patients (18 men; median age 73.5 years [IQR: 67–77]) with a mean AVF flow of 1140 ± 345 mL/min. At a median of 8.2 months (IQR: 7.3–9.3) following AVF creation, significant biventricular dilatation was observed: LVEDVi increased from 89 ± 14 to 97 ± 21 mL/m² (p < 0.05) and RVEDVi from 80 ± 15 to 91 ± 18 mL/m² (p < 0.05), while the systolic function of both ventricles did not change significantly. The right ventricle showed the most pronounced remodeling and it was independently associated with volume overload (p = 0.003) and elevated left ventricular filling pressure (p = 0.030), but not with AVF flow. Conclusions: Moderate AVF flow was associated with cardiac remodeling, primarily affecting the right ventricle. Fluid overload and left ventricular filling pressure were key factors associated with right ventricular remodeling, underscoring the need for careful fluid management and vascular access planning in ESKD patients. Full article

Background and Objectives: Risk stratification in acute heart failure (AHF) remains challenging, particularly in settings where biomarker availability is limited. Echocardiography offers valuable hemodynamic insights, but no single parameter fully captures the complexity of biventricular dysfunction and pressure overload. This study aimed to evaluate a novel echocardiographic index (ViRTUE Index–VTI-RVRA-TAPSE Unified Evaluation) integrating a peak systolic gradient between the right ventricle and right atrium (RV-RA gradient), tricuspid annular plane systolic excursion (TAPSE), the velocity–time integral in the left ventricular outflow tract (VTI LVOT), NT-proBNP (N-terminal pro–B-type Natriuretic Peptide) levels, and in-hospital mortality among patients with AHF. Materials and Methods: We retrospectively analyzed 123 patients admitted with AHF. Echocardiographic evaluation at admission included TAPSE, VTI LVOT, and the RV-RA gradient. An index was calculated as ${\displaystyle \frac{RV-RA gradient }{TAPSE x VTI LVOT}}$. NT-proBNP levels and in-hospital outcomes were recorded. Statistical analysis included correlation, logistic regression, and ROC curve evaluation. Results: The proposed index showed a significant positive correlation with NT-proBNP values (r = 0.543, p < 0.0001) and good discriminative ability for elevated NT-proBNP (AUC = 0.79). It also correlated with in-hospital mortality (r = 0.193, p = 0.032) and showed moderate prognostic performance (AUC = 0.68). Higher index values were associated with greater mortality risk. Conclusions: This novel index, based on standard echocardiographic measurements, reflects both systolic dysfunction and pressure overload in AHF. Its correlation with NT-proBNP and in-hospital mortality highlights its potential as a practical, accessible bedside tool for early risk stratification, particularly when biomarker testing is unavailable or delayed. Full article

Background/Objectives: Nelumbo nucifera Gaertn. (lotus) seeds have traditionally been used to treat hypertension, though their mechanisms remain unclear. This study investigated the antihypertensive effects of lotus seed extract (LSE) and its mechanisms in rats with N^ω-nitro-L-arginine methyl ester (L-NAME)-induced hypertension. Methods: Male Sprague Dawley rats received L-NAME (40 mg/kg/day) in drinking water and were treated orally with LSE (5, 10, or 100 mg/kg/day), captopril (5 mg/kg/day), or a combination of LSE and captopril (2.5 mg/kg/day each) for 5 weeks. Hemodynamic parameters and histological changes in the left ventricle and aorta were assessed. Mechanistic studies included measurements of plasma nitric oxide (NO) metabolites, malondialdehyde (MDA), superoxide dismutase (SOD) activity, angiotensin II (Ang II), angiotensin-converting enzyme (ACE) activity, and protein expression via western blot. Results: L-NAME elevated systolic blood pressure and induced cardiovascular remodeling, oxidative stress, and renin-angiotensin system activation. LSE treatment reduced blood pressure, improved antioxidant status, increased NO bioavailability, and downregulated gp91^phox and AT₁R expression. The combination of low-dose LSE and captopril produced stronger effects than LSE alone, with efficacy comparable to captopril. Conclusions: These findings suggest that LSE exerts antihypertensive effects via antioxidant activity and inhibition of the renin-angiotensin system, supporting its potential as an adjunct therapy for hypertension. Full article

The image represents the post-mortem heart of a 28-year-old female patient, diagnosed in childhood with complete common atrioventricular canal defect. At time of diagnosis, the family refused surgery, as did the patient during her adulthood. Despite being advised against pregnancy, she became pregnant. On presentation to hospital, she was cyanotic, with clubbed fingers, and hemodynamically unstable, in sinus rhythm, with Eisenmenger syndrome and respiratory failure partially responsive to oxygen. During pregnancy, owing to systemic vasodilatation, the right-to-left shunt is increased, with more severe cyanosis and low cardiac output. Echocardiography revealed the complete common atrioventricular canal defect, with a single atrioventricular valve with severe regurgitation, right ventricular hypertrophy, pulmonary artery dilatation, severe pulmonary hypertension and a hypoplastic left ventricle. The gestational age at delivery was 38 weeks. She gave birth to a healthy boy, with an Apgar score of 10. The vaginal delivery was chosen by an interdisciplinary team. The cesarean delivery and the anesthesia were considered too risky compared to vaginal delivery. Three days later, the patient died. The autopsy revealed hepatomegaly, a greatly hypertrophied right ventricle with a purplish clot ascending the dilated pulmonary arteries and a hypoplastic left ventricle with a narrowed chamber. A single valve was observed between the atria and ventricles, making all four heart chambers communicate, also insufficiently developed interventricular septum and its congenital absence in the cranial third. These morphological changes indicate the complete common atrioventricular canal defect, with right ventricular dominance, which is a rare and impressive malformation that requires mandatory treatment in early childhood in order for the condition to be solved. Full article

Background/Objectives: While aldosterone excess has a detrimental impact on the left ventricle, no data exist concerning right ventricular (RV) function in primary aldosteronism (PA) patients. We aimed to assess RV structure and function in patients with PA using cardiac magnetic resonance imaging. Methods: Thirty PA patients and 30 age- and sex-matched healthy volunteers were studied. All patients underwent cardiac magnetic resonance with the assessment of RV structure and function. Results: Neither the RV mass index (RVMi) nor the RV ejection fraction (RVEF) correlated with the aldosterone levels (p = 0.36 and p = 0.37, respectively). On the contrary, we found a weak positive correlation between the RV end-diastolic volume index (RVEDVi) and aldosterone concentration (rho = 0.5, p = 0.005). Neither the RVEDVi nor the RVEF differed between the PA patients and the control group (p = 0.077 and p = 0.93, respectively). The RVMi was higher in the PA group, at 18.9 (4.9) g/m², versus 13.6 (3.2) g/m² (SD) in the control group (p < 0.0001). The RVEDVi was positively correlated with the duration of hypertension (rho = 0.4, p = 0.03), and the latter was correlated inversely with the RVEF (rho = −0.47, p = 0.009). The RV global longitudinal strain was impaired in PA patients in comparison with the controls (−16.8 (2.5%) versus −19.6 (2.7%), p = 0.0001). Conclusions: The PA patients exhibited larger RVMi values than the controls. The higher the aldosterone levels were, the higher the observed RVEDVi. Additionally, the longer the duration of hypertension, the higher the observed RVEDVi and the lower the noted RVEF. The PA patients exhibited subclinical RV systolic dysfunction, expressed as impaired RV global longitudinal strain. Full article