Search Results (1,321)

Background: Pulmonary hypertension (PH) is a frequent complication in patients with interstitial lung disease (ILD); its occurrence results in significant morbidity and mortality. Currently approved treatment options for PH-ILD include inhaled prostacyclin therapy, although this approach may be insufficient in patients who have developed simultaneous right ventricular failure. Moreover, there is no available treatment algorithm regarding the optimal therapy and timing of lung transplant referral for PH-ILD patients based on disease severity. Design/Methods: In this study, we created such a tool to guide PH-specific therapy in PH-ILD patients, especially as further treatment strategies are developed. We developed a 4-point PH-ILD Severity score that integrated both subjective and objective information (WHO FC, CI, TAPSE, PVR) from retrospective analysis of 57 PH-ILD patients. Results: A score of 3 or greater in the PH-ILD Severity score yielded an AUC of 0.831 (p < 0.001) for the composite endpoint of clinical worsening (hospitalization due to a cardiopulmonary indication; decrease in 6 min walk distance by >15% at 2 consecutive visits; all-cause mortality; lung transplantation). Conclusions: Further confirmation and evolution of this PH-ILD Severity score will assist in the development of optimal treatment plans in ILD patients diagnosed with concomitant PH. Full article

Background: Non-invasive diagnostic tools for the assessment of pulmonary arterial hypertension (PAH) are currently being intensively studied. Positron emission tomography (PET)/computed tomography (CT) with [18F]-fluorodeoxyglucose ([18F]-FDG) and [13N]-ammonia is the gold standard for assessing myocardial metabolism and perfusion. The relationship between right ventricle (RV) myocardial metabolism and perfusion and cardiopulmonary exercise testing (CPET) has not been studied. Objective: to evaluate correlations between the CPET parameters and RV perfusion and metabolism in IPAH patients. Methods: The study comprised 34 IPAH patients (34.2 ± 8.9 years, 4 males, 6 prevalent). Myocardial metabolism and perfusion were assessed using PET/CT with [18F]-FDG and [13N]-ammonia, respectively. CPET, cardiac MRI and invasive hemodynamics were also evaluated. Results: Significant negative correlations were registered between [18F]-FDG and [13N]-ammonia uptake by the RV (SUVmax _RV/LV) and the oxygen consumption, oxygen pulse and positive correlation with the ratio of minute ventilation to carbon dioxide production. The low-risk IPAH patients significantly differed from the intermediate-to-high-risk group in CPET indices and in SUVmax _RV/LV metabolism and SUVmax _RV/LV perfusion parameters. No reliable differences in CPET indices and [18F]-FDG and [13N]-ammonia uptake by the RV were registered between intermediate- and high-risk patients. Conclusions: CPET is a reliable non-invasive diagnostic tool that could distinguish low-risk young IPAH patients without comorbidities from those at intermediate-to-high risk. Significant correlations between CPET parameters and RV myocardial metabolism and perfusion indices, MRI, and invasive hemodynamics confirm the high diagnostic value for CPET. Full article

Background: The aim of our study is to assess the risk factors for the development of coronary artery stent thrombosis and restenosis, as well as the main localization of these processes in patients who underwent repeated coronary revascularization during the COVID-19 pandemic. Materials and Methods: Data were retrospectively analyzed from 490 patients who underwent coronary angiography and required repeat revascularization from May 2020 to May 2023. The prevalence and anatomical distribution of coronary stenosis, restenosis, and stent thrombosis were assessed. Results: Coronary artery stenosis was detected in 46.9% of patients. The most affected arteries were the left anterior descending (13.7%), right coronary artery (15.1%), and circumflex branch (9.4%). In-stent restenosis was observed in 19.0% of cases. Coronary thrombosis occurred in 22.8% of patients, while stent thrombosis was found in 11.2%. Multivariate regression revealed that leukocyte count (OR = 1.18, p < 0.05), activated partial thromboplastin time (APTP) (OR = 1.021, p = 0.025), low-density lipoproteins (LDL) (OR = 1.421, p = 0.042), and prior COVID-19 infection (OR = 2.05, p = 0.038) were significant predictors of stent thrombosis. The left ventricular ejection fraction (LVEF) (OR = 0.959, p = 0.017) and hemoglobin levels (OR = 0.975, p = 0.014) have inverse association with risk of stent thrombosis. Conclusion: COVID-19 history is a strong independent risk factor for coronary stent thrombosis, alongside inflammatory and coagulation markers. Full article

An atrial septal defect (ASD) is the most common congenital heart defect (CHD) diagnosed in adulthood. It is characterized by significant anatomical heterogeneity and complications that evolve over time. While often asymptomatic in children, the signs of adverse effects of ASD increase with age, including a greater risk of heart failure, stroke, atrial fibrillation (AF), and reduced life expectancy. ASD is traditionally considered a right-heart lesion due to long-term complications such as arrhythmias, right-sided heart failure, thromboembolism, and, in a subset of patients, pulmonary arterial hypertension (PAH). The pathophysiology of atrial shunts also affects the left heart due to volume overload and adverse ventriculo-ventricular interaction. Early diagnosis of interatrial septal anomalies is essential to prevent hemodynamic consequences and/or thromboembolic events. Electrocardiographic (ECG) findings play a crucial role in this early diagnosis. This narrative review aims to update clinicians on the latest evidence regarding the pathophysiological link between ASD and cardiac rhythm disorders, the nuances of optimal diagnostics, treatment options (surgical, interventional, pharmacological), and the need for long-term follow-up for patients with ASD. The review will determine the risk of conduction disorders compared to a healthy population and to compare the prevalences of conduction disorders, mortality, and pacemaker use in patients with closed ASDs versus those with open ASDs. Full article

Pulmonary arterial hypertension (PAH) is a rare condition characterized by high pulmonary artery pressure leading to right ventricular dysfunction and potential life-threatening consequences. It primarily affects the pre-capillary pulmonary vascular system. The exact pathophysiological mechanisms underlying PAH are not entirely known. Environmental factors; genetic predisposition; mitochondrial and microRNA dysfunction; and inflammatory, metabolic, and hormonal mechanisms may be involved. A central role is played by the dysfunction of the pulmonary vascular endothelium. This alteration is characterized by a reduction in vasodilatory and antiproliferative factors such as prostacyclin and nitric oxide and an increase in vasoconstrictive and mitogenic substances such as endothelin and thromboxane A2. Such imbalance leads to a progressive increase in pulmonary vascular resistance. The aim of the present review is to focus on the vascular endothelium and its role as a potential therapeutic target in PAH. Full article

Background/Objectives: This study aimed to investigate the association between right ventricular (RV) structure and function and established markers of alcohol septal ablation (ASA) efficacy in patients with hypertrophic cardiomyopathy (HCM). We hypothesized that RV characteristics may serve as predictors of left ventricular outflow tract gradient (LVOT_G) in the early period following ASA. Methods: A retrospective analysis was performed in 50 HCM patients who underwent ASA. Correlations between echocardiographic RV parameters and standard indicators of ASA success were assessed at 3 months, 1 year, 3 years, and 5 years post-procedure. Results: Echocardiographic measurements of RV wall thickness (RVWT) at 3 months and 1 year after ASA showed significant correlations with maximum LVOT_G (p < 0.001), NYHA functional class, and left ventricular end-diastolic dimension (LV_D) (both p < 0.01). At 3 and 5 years, these correlations were no longer statistically significant (p = ns). No associations were observed for other parameters. Conclusions: Echocardiographic assessment of RVWT may serve as an early predictor of subsequent LVOT_G development as soon as 3 months after ASA. RVWT could therefore provide an estimate of long-term treatment effects. Further studies are needed to confirm these findings. Full article

Background/Objectives: Mechanical circulatory support (MCS) is increasingly utilized for the management of acute decompensated heart failure (HF) and cardiogenic shock (CS). The primary goals of MCS are to restore systemic perfusion, reduce cardiac workload, and support end-organ function. A thorough understanding of cardiovascular physiology in patients supported by MCS is essential for clinical decision-making. This review summarizes current evidence on the physiological effects of various MCS devices, key monitoring techniques, patient management, and explores the emerging role of artificial intelligence (AI) in this field. Main Text: Short-term MCS devices include intra-aortic balloon pumps (IABP), percutaneous left-sided devices such as Impella (Abiomed, Danvers, MA, USA) and TandemHeart (LivaNova, London, UK), percutaneous right-sided support devices like Protek Duo (LivaNova, London, UK) and Impella RP Flex (Abiomed, Danvers, MA, USA), and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Long-term support is mainly provided by left ventricular assist devices (LVADs), including the HeartMate 3 (Abbott Laboratories, Chicago, IL, USA). Optimal MCS application requires an understanding of device-specific cardiovascular interactions and expertise in appropriate monitoring tools to assess device performance and patient response. The choice of device, timing of initiation, and patient selection must be individualized, with careful consideration of ethical implications. The integration of AI offers significant potential to advance clinical care by improving complication prediction, enabling real-time optimization of device settings, and refining patient selection criteria. Conclusions: MCS is a rapidly evolving field that requires a comprehensive understanding of cardiovascular interactions, careful selection of monitoring strategies, and individualized clinical management. Future research should address current device limitations, clarify device-specific clinical applications, and assess the validity of AI-driven technologies. Full article

Introduction: Sepsis-induced cardiac dysfunction (SICD) is a transient cardiac disfunction, with variable described prevalence and uncertain prognostic. This study aimed to characterize the laboratory and microbiological findings in critically ill patients with sepsis who developed left ventricular (LV) or biventricular systolic dysfunction. Methods: Patients who required intensive care unit hospitalization for sepsis were screened retrospectively. Only patients with positive cultures and echocardiography performed within 24 h from admission were included. The exclusion criteria were infective endocarditis, acute coronary syndrome, history of cardiomyopathy, severe valve disease, end-stage organ or oncological disease. Cardiac function was appreciated on transthoracic echocardiography, using LV ejection fraction for the left ventricle and tricuspid annular plane systolic excursion (TAPSE) for the right ventricle. SICD was confirmed if the systolic dysfunction found upon admission was reversible within 7–10 days. Results: A total of 100 patients with positive cultures were included. The median age was 73 and 55% were male. SICD was diagnosed in 14% of patients. Patients with SICD were more likely to develop septic shock and had longer hospital and intensive care unit stay. In-hospital mortality was 44% with no significant difference between SICD and non-SICD patients. Laboratory markers upon hospital admission showed that SICD patients had significantly higher values of lactate and transaminases. Cardiac (troponin and NT-proBNP) and inflammation markers (leukocytes, neutrophils, NLR, C-reactive protein, procalcitonin) had higher values in patients with SICD but the difference did not reach statistical significance. Streptococcal infections and polymicrobial cultures were risk factors for developing SICD. Higher rates of infections with Enterobacterales were seen in the SICD group but the difference was not significant. Conclusions: SICD patients had higher lactate, inflammation, and cardiac biomarkers levels upon admission and significantly higher rates of streptococcal infections and polymicrobial cultures. Full article

Objective: This study sought to examine the relationships between right ventricular (RV) parameters and function, and body composition in adolescents and young adult individuals with overweight and obesity. We hypothesized that abnormal body composition is linked to RV dysfunction and subclinical changes in the ventricle. Methods: The study prospectively included 80 young adult individuals, with 55 being overweight or obese and 25 having a normal body weight. We examined differences in RV echocardiographic parameters between these groups and their relationship with body composition parameters. Results: Adolescents and young adults with overweight or obesity had greater RV pressure load, and larger RV diameter. Significant differences in RV size and strain were noted between groups. Across the cohort, lean body mass positively correlated with RV strain, while fat mass and total serum protein negatively correlated with RV strain (both p < 0.01 or lower). Conclusions: This study found that RV function and body composition are often linked and improving body composition could prevent RV dysfunction, while addressing wasting might enhance RV function. Overweight or obese young adults show decreased RV strain in the absolute value compared to those with normal body weight. Full article

Background: Mitral annular plane systolic excursion (MAPSE) is a simple and widely used M-mode echocardiographic marker of left-ventricular longitudinal function that correlates well with left ventricular ejection fraction (LVEF). Conventional chronic right ventricle (RV) pacing is associated with left ventricle (LV) dysfunction, inducing heart failure (HF) and leading to the development of pacing-induced cardiomyopathy (PiCM). The aim of this study is to ascertain the clinical usefulness of MAPSE in the assessment of LV function in patients with permanent RV pacing. Methods: We performed a cross-sectional association analysis, enrolling consecutive patients with pacemakers and chronic RV pacing burdens over 20% (Vp > 20%) from 2021 to 2024. All patients were assessed by standard transthoracic echocardiography (TTE) with LVEF and MAPSE among other parameters being assessed. We performed a correlation test using linear regression and plotted an ROC curve. Results: 409 patients (mean age = 68.7 year) were included, 225 men (55%) and 245 (59.9%) with dual-chamber pacemakers. The mean follow-up period was 18 ± 2 months, with HF incidence in the study group being 23.2%. The results showed that average, septal, and lateral MAPSE all correlate well with LVEF, but septal values seemed to provide the strongest correlation (r = 0.90, p < 0.001), and that a septal MAPSE cut off value of <10 mm (sensitivity 99.4, specificity 42.1, AUC = 0.89) was associated with impaired LVEF (<50%). Conclusions: MAPSE seems to corelate well with LVEF across the spectrum of HF in pts with chronic RV conventional pacing. Septal MAPSE shows the strongest correlation with LVEF, and a value of <10 mm is a cut-off for altered LVEF, making it a potentially useful marker of cardiac function in these pts. Full article

Tricuspid valve diseases are an increasing cause of cardiovascular mortality, peaking in the eighth decade of life. More than 75% of severe tricuspid regurgitations are recognized via functional mechanisms, often secondary to left heart disease and pulmonary hypertension. Surgical risk for isolated correction of tricuspid regurgitation, both repair or replacement, is associated with prohibitive risk mainly in elderly patients, with several comorbidities and right ventricular dysfunction. In the past decade, different percutaneous devices have been developed to treat a large group of high-surgical-risk patients. Early diagnosis and careful patient selection are essential to improving prognosis in severe TR. Potential treatment options may vary in different stages of disease. The current available results from present studies have proven the safety and effectiveness of these devices under proper clinical indications, although selection bias and non-randomization in most investigations at present do not allow for definite indications. Ideal anatomic and clinical parameters to predict interventional success are in continuous evolution and need definite standardization. We report three cases in which different percutaneous techniques were employed for treatment when surgery was not suitable. The literature is discussed for each condition. Despite promising results in terms of safety and success rate, further randomized studies are needed to better understand which patients may be subject to long-term effects on survival and quality of life. Full article

Right heart failure (RHF) remains an under-recognized yet devastating condition in critically ill and chronic patients, frequently complicating cardiac surgery, pulmonary embolism, advanced heart failure, sepsis and left ventricular assist device (LVAD) implantation. Despite growing awareness, clinical decision making is still hampered by the complex pathophysiology, limitations in diagnosis and a fragmented therapeutic landscape. In recent years, progress in hemodynamic phenotyping, advanced echocardiographic and biomarker-based assessment, and the development of mechanical circulatory support (MCS) systems, including percutaneous and surgical right ventricle assist devices (RVAD), veno-arterial extracorporeal membrane oxygenation (V-A ECMO), Impella RP (right percutaneous) or BiPella (Impella CP/5.0/5.5 + Impella RP) has expanded the armamentarium for managing RHF. This review synthetizes current evidences on the anatomical, physiological and molecular underpinnings of RHF, delineates the distinction and continuum between acute and chronic forms and provides a comparative analysis of diagnostic tools and MCS strategies. By integrating mechanistic insights with emerging clinical frameworks, the review aims to support earlier recognition, tailored management and innovative therapeutic approaches for this high-risk population. Full article

There are many contradictory opinions, and the role of TGF-β1 in the vascular effects of atherosclerosis remains unclear. This study aims to verify whether plasma TGF-β1 concentrations are correlated with changes in echocardiographic and vascular parameters in individuals with early coronary artery disease (CAD), including those with type 2 diabetes mellitus (T2DM). The study group consisted of 100 patients with early-onset CAD. Patients underwent echocardiography and electrocardiography. The thickness of the internal and middle membrane complex of the carotid and brachial arteries, the ankle-brachial index, and the atherosclerotic plaques present were assessed via Doppler ultrasound. No statistically significant correlation of TGF-β1 with diabetes, hypertension, metabolic syndrome, or myocardial infarction was observed, only weak associations with impaired ventricular function. The positive correlations between right and left ventricular parameters and TGF-β1 level, as well as the negative correlations fractional shortening and deceleration time, were found. The last correlation was strong. There is a strong positive correlation between TGF-β1 and QRS II width and QRS V5 width. The positive correlation was found between TGF-β1 and PLA density and thickness of the intima-media. These associations are very weak. In patients with early-onset CAD, high TGF-β1 concentrations are not associated with heart attacks or the associated risk factors. However, these cases are potentially those with stable plaques. Our study indicates a significant association between TGF-β1 levels and left ventricular diastolic dysfunction and arrhythmia risk in these patients. Full article

Background/Objectives: After pneumonectomy, the right ventricular stroke volume is pumped into pulmonary vessels whose volume has been reduced by approximately 50%. To sustain conditions for pulmonary flow, the flow reserve is increased in the remaining lung, which is conducive to the development of pulmonary hypertension symptoms. This study sought to examine pulmonary flow in one lung and the size of the right atrium (RA), right ventricle (RV) and pulmonary artery (PA) in patients who had undergone pneumonectomy and to establish the influence of time since pneumonectomy on these parameters, as well as their potential mutual dependencies. Methods: The retrospective analysis included 34 patients who had undergone pneumonectomy. Pulmonary flow was measured by means of perfusion scintigraphy. The diameters of the RA, RV and PA were evaluated based on computed tomography with contrast. Results: We observed complete or near-complete utilization of flow reserve in 38.2% (13/34) of patients, enlarged transversal and longitudinal dimensions of the RA in 17.6% (6/34) and 32.3% (11/34) of patients, respectively, and enlarged transversal and longitudinal dimension of the RV in 67.6% (23/34) and 44.1% (15/34) of patients, respectively. Dilatation of the PA was discovered in 23.5% (8/34) to 26.5% (9/34) of patients, as well as the presence of an extensive complex of radiographic features of pulmonary hypertension (PH) syndrome in 23.5% (8/34) of cases. Conclusions: Radiological features of PH were present in a significant number of patients. These features developed at varying rates but were present in all patients followed >10 years after the procedure. Full article

Bedside echocardiography stands as a cornerstone diagnostic tool in internal medicine, offering rapid, real-time evaluation of cardiac structure and function across a wide spectrum of acute and chronic conditions. Its application, particularly when combined with lung and inferior vena cava (IVC) ultrasound, significantly enhances diagnostic accuracy for fluid balance assessment, dyspnea, and hypotensive states, guiding timely therapeutic decisions. Focused cardiac ultrasound (FoCUS) enables internists to assess left ventricular function, right atrial pressure, valvular abnormalities, and pericardial effusion, facilitating differentiation between cardiac and non-cardiac causes of symptoms such as dyspnea, chest pain, and hemodynamic instability. While operator-dependent, echocardiography can be effectively integrated into internal medicine practice through structured training programs that combine theoretical knowledge with supervised hands-on experience. This integration enhances clinical decision-making, optimizes patient management, and reduces the need for immediate specialist consultation. Widespread adoption of focused ultrasound techniques in internal medicine wards promises not only improved patient outcomes but also more efficient utilization of healthcare resources. Continued education and institutional support are fundamental to embedding echocardiography into routine care, ensuring internists are equipped to leverage this powerful bedside modality. This narrative review aims to underscore the transformative impact of bedside echocardiography in internal medicine, demonstrating its capacity, when combined with lung and IVC ultrasound, to optimize diagnostic pathways and treatment decisions across diverse acute and chronic settings. Full article