Search

There is a known correlation between myocardial steatosis and heart function, but it is unclear how left ventricular diastolic function worsens over time in the myocardial steatosis setting. We sought to investigate whether intramyocardial fat deposition affects diastolic function over time. This was a retrospective analysis of patients who had undergone 1-3 echocardiography assessments between April 2011 and April 2017. Patients were divided into two groups: those with the presence of myocardial fat deposition in the left ventricular myocardium (assessed by having tissue within any 10-mm2 region with computed tomography values between - 190 and - 30 Hounsfield units; + MF), and those with absence of deposition not meeting the threshold (- MF). The rates of change of the standard early diastolic mitral annulus velocity (e') and the transmitral early peak velocity (E)/e' ratio at the second and third echocardiograph assessments were calculated relative to baseline. In total, 125 patients were eligible (+ MF, n = 39; - MF, n = 86) for inclusion. Compared with the - MF group, e' was significantly lower and E/e' was significantly higher in the + MF group at each scan timepoint, even when adjusted for body mass index and sex. A significant average decrease in e' and increase in E/e' was also observed in the + MF group across all scans compared with the - MF group. Myocardial steatosis was associated with an acceleration of decreased left ventricular diastolic function over time.

Assessment of segmental myocardial strain is a promising and relevant direction in the diagnosis of early impairments of left ventricular (LV) contractility in children with hypertrophic cardiomyopathy (HCM). Objective of the study: to assess the indicators of segmental myocardial strain in children with HCM. Materials and methods of research: prospective, open-label, nonrandomized, controlled. 61 patients with asymmetric HCM aged 7 to 17 years (median 9 [7,6; 13,2]) underwent echocardiography according to the standard technique with the determination of segmental longitudinal, radial, circular LV myocardium in 2D speckle tracking mode. 45 (74%) children had a non-obstructive form (NF) of HCM, 16 (26%) children had an obstructive form (OF). Obstruction was detected at the level of the LV outflow tract with a pressure gradient of 30-50 mm Hg. Results: when assessing segmental myocardial strain, a decrease in longitudinal strain was found less than the normative values in the antero-septal, anterior, antero-lateral segments in children with NF HCM with a compensatory increase in strain values in the contralateral segments (inferior septal, inferior lateral and lower ). In similar segments in children with OF, there was a significant decrease in deformity, while in the contralateral segments a less pronounced compensatory increase in deformity was determined, as well as a decrease in the minimum values of strain indicators. Assessment of segmental radial and circular strain, a statistically significant predominance of indicators in all segments, except for anterolateral, in the group with NF compared to the OF HCM was determined. A decrease in strain in the antero-septal, anterior, antero-lateral segments was found, but less pronounced compared to the indicators of longitudinal strain, as well as a compensatory increase in strain in the antero-septal values in the contralateral segments (inferior septal, inferior lateral and inferior). It has been found that the assessment of global strain values widely used in clinical practice might not be optimal enough, since too many segmental strain values are discarded and averaged, which are unevenly distributed, and therefore the assessment of strain in each segment of the myocardium in children with an asymmetric form of HCM acquires important diagnostic value. Conclusion: changes in the indicators of segmental myocardial strain reflect violations of LV contractile function and are most pronounced in OF compared with NF HCM. Their study in children is important for the timely initiation of therapy and improving the prognosis of the disease.

Мета. Вивчення особливостей морфофункціонального стану міокарда лівого шлуночка та загальних сонних артерій за даними ехокардіодопплерографії у дітей, хворих на муковісцидоз. Матеріали та методи. Обстежено 72 дитини, хворі на муковісцидоз. Для діагностики доклінічної стадії діастолічної дисфункції лівого шлуночка визначали функціональний індекс відповідності (ФІВ) за методикою А.Н. Розенбаума та В.Т. Коваля (2010). Результати. Результати проведеного дослідження свідчили про розвиток ремоделювання міокарда лівого шлуночка у 58 % хворих на муковісцидоз, серед варіантів якого переважала ексцентрична гіпертрофія. Виявлені зміни посилювалися при збільшенні тяжкості перебігу захворювання. Аналіз діастолічної функції лівого шлуночка за стандартною методикою в групі хворих на муковісцидоз не виявив суттєвих відмінностей від показників контрольної групи. Розрахунок ФІВ показав, що у 37,5 % дітей, хворих на муковісцидоз, відбувалося його зниження відносно значень контрольної групи. Це свідчило про формування діастолічної дисфункції лівого шлуночка, що прогресувала в динаміці захворювання. Найбільш виражені зміни ФІВ виявлялися при концентричній гіпертрофії міокарда лівого шлуночка та при тяжкому перебігу захворювання. Висновки. Встановлена морфофункціональна перебудова лівих відділів серця у дітей, хворих на муковісцидоз, відбувалася на фоні ремоделювання та гемодинамічних змін на рівні загальних сонних артерій.

The safety and efficacy of intravenous insulin injection coupled with subsequent milk consumption was evaluated for high-quality cardiac viability F-18-fluorodeoxyglucose (18F-FDG) images. A total of 328 patients with known/suspected coronary artery disease received intravenous insulin injection with or without subsequent milk consumption for cardiac 18F-FDG imaging. When blood glucose levels had decreased by ≥ 20%, 18F-FDG was injected. Patients were scored for hypoglycemic symptoms using a 10-point scale (discomfort: 0, none; 1 to 3, mild; 4 to 6, moderate; 7 to 9, severe). An insulin-related hypoglycemic event was defined as an increased symptomatic score following insulin injection. The number of hypoglycemic events was significantly lower in the milk consumption group than in the group that did not (24/164 vs. 51/164, P

The variability of physiologic 18F-FDG uptake in the myocardium has hampered the accurate evaluation of cardiac glucose metabolism. We investigated the effects of multiple factors, including fasting duration and physical activity, on the physiologic uptake of 18F-FDG by the myocardium in healthy participants. A total of 446 participants (predominantly male, 91%) in a health screening program were included in this retrospective study. For the visual analysis of myocardial 18F-FDG uptake, the participants were categorized into three groups according to qualitative visual scales (QVS). For the quantitative analysis, the maximum SUV of the left ventricular myocardium was measured. Significant differences were observed in fasting duration (p 6% (p = 0.005) showed significant association with myocardial FDG uptake in the Chi-squared test. The median value of fasting duration decreased significantly as the QVS of the myocardium increased. Twenty-nine of the 31 participants (93.5%) who fasted for 21.5 h or more showed a suppressed FDG uptake (mean SUVmax = 2.1). In multivariate logistic regression analysis, fasting duration (OR = 0.74, 95% CI 0.69–0.80, p 6% (OR = 0.29, 95% CI: 0.12 – 0.66, p = 0.004), uric acid (OR = 0.82, 95% CI 0.68–1.00, p = 0.049) and regular exercise with vigorous activity (OR = 1.75, 95% CI 1.13–2.70, p = 0.012) were significant factors for physiologic myocardial FDG uptake. Reduced physiologic 18F-FDG uptake of the myocardium was associated with longer fasting duration, higher level of HbA1c, and less frequency of regular exercise with vigorous activity. For the preparation of cardiac 18F-FDG PET, inclusion of longer fasting duration (more than 18 h) might be necessary for the adequate suppression of physiologic 18F-FDG myocardial uptake.

Introduction . To determine the relevant indicators of strain and strain rate of the left ventricular myocardium in children and adolescents. Materials and methods. Have been examined 67 patients form aged from 7 up to 17 years old. 1-st group – 30 children from 7 to 11 years old; 2-nd group – 37 adolescents from 12 to 17 years old. Аt an echocardiographic examination the systolic function of the left ventricle was determined: ejection and shortening fractions, in 2D-speckle-tracking mode – global and segmental longitudinal, circular and radial strain and strain rates. Results . Have been studied the relevant indicators of global and segmental longitudinal, radial, circular deformities of the left ventricular myocardium and their rates in healthy children and adolescents. A statistically significant increase in global and segmental longitudinal strain, radial and circular strain rates in the 2-nd group compared with the 1-st group had revealed. Had found that the uniform distribution of indicators in the ranges of confidence intervals, noted in the assessment of global radial strain and circular strain rate, as well as a statistically significant predominance of strain indicators in the subendocardial layers compared with the subepicardial layers of the myocardium left ventricle. Conclusions. 1. In adolescents 12–17 years old, compared with children 7–11 years old, there is a statistically significant predominance of global and segmental longitudinal strain, radial and circular strain rates of the left ventricular myocardium. Radial strain and circular strain rate of the left ventricular myocardium are the most uniform in contrast to other indicators of strain. 2. In healthy children and adolescents, had observed statistically significant higher strain and strain rate in the subendocardial layer compared to the subepicardial layer of the myocardium. 3. The obtained indicators of global and segmental myocardial strain can serve as normative for children and adolescents in assessing the systolic function of the left ventricle.

Objective Forward-projected Model-based Iterative Reconstruction SoluTion (FIRST) is a novel reconstruction method. We investigated the improvement in the diagnostic performance for the detection of abnormal late enhancement (LE) in left ventricular myocardium (LVM) using a new-generation 320-slice computed tomography (CT) device with FIRST. Methods This is a retrospective study that included 100 adult patients who underwent cardiac CT including a late phase scan and magnetic resonance imaging (MRI) within 3 months. The first 50 consecutive patients (first-generation group) underwent first-generation 320-slice CT without FIRST, and the next 50 consecutive patients (second-generation group) underwent second-generation 320-slice CT with FIRST. We compared the diagnostic performance of the first- and second-generation 320-slice CT with FIRST with MRI as a reference standard to detect LE in LVM. Results In the patient-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of detection of LE on CT were 79%, 90%, 92%, 76%, and 84%, respectively, in the first-generation group and 97%, 84%, 91%, 94%, and 92%, respectively, in the second-generation group. The sensitivity was significantly higher in the second-generation group than in the first-generation group (p=0.049). In the segment-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of detection of LE on CT were 69%, 96%, 83%, 92%, and 90%, respectively, in the first-generation group and 87%, 94%, 84%, 95%, and 92%, respectively, in the second-generation group. The sensitivity and negative predictive value were significantly higher in the second-generation group than in the first-generation group (p

The aim was to determine the pathogenetic features of the NO system in the myocardium of the left ventricle in the rats with endocrine-salt hypertension.Material and methods. The experiment was conducted on 20 male rats 220-290 g weight, 6–10 months old which were divided into 2 experimental groups: 1st – the control group (10 intact normotensive male Wistar rats); 2nd – 10 male Wistar rats with endocrine-salt arterial hypertension. Systolic and diastolic BP levels were measured in all the rats using a system of non-invasive arterial pressure measurement BP-2000. The objects of study in the experimental animals were blood plasma in which the nitrotyrosine level was measured, and the fragment of left ventricle, which was divided into two parts, one of which was homogenized using a Silent Crusher S homogenizer (Heidolph, Germany), in which nitrites level was determined. Concentration of immunoreactive material to NOS isoforms was detected with immunofluorescence method. The study of NOS mRNA isoforms expression in the left ventricular myocardium homogenates was carried out using a real-time polymerase chain reactionResults. In the experiment, an increase in all 3 isoforms and their mRNA was obtained. In the study, a decrease in nitrites concentration and a significant increase in nitrotyrosine levels, indicates the development of nitroso-oxidative stress.Conclusions. The development of experimental endocrine-salt hypertension in the Wistar rats leads to a stable increase in mean blood pressure by 65 % compared to control. Endocrine-salt arterial hypertension in Wistar rats is characterized by an increased mRNA content of all three isoforms of nNOS, eNOS and iNOS by 2.7, 2.8 and 5.7 times, respectively, compared to the control; increased expression of immunoreactive material to isoforms in transverse fibers by 14.3 %, 16.2 % and 18.5 %, respectively; in longitudinal fibers IRM to nNOS was higher by 8.3 %, to iNOS - by 8. 5%, but to eNOS it was lower by 7.6 %. At the same time, nitrites level decreased by 11.7 % and nitrotyrosine concentration was significantly higher, exceeding the control value by 88.5 %.

Purpose. The aim of this study was to identify the signifi cance of myocardial viability indicators calculated based on cardiac magnetic resonance imaging (MRI) with delayed contrast, as predictors of the adverse course of postoperative period in the surgical treatment of patients with ischemic cardiomyopathy.Material and Methods. A total of 178 patients underwent surgical treatment for ischemic cardiomyopathy from March, 2013 to December, 2017. All patients underwent preoperative cardiac MRI scan with paramagnetic contrast.Results. The logistic regression analysis showed that the left ventricular volumetric indicators and the amount of residual viable myocardium, calculated using delayed contrast-enhanced MRI, were the essential predictors of favorable and complicated course of postoperative period in ischemic cardiomyopathy patients. In patients with a residual viable left ventricular myocardium amount over 64.5%, surgical ventricular reconstruction procedure may be performed with a low risk of early postoperative complications (OR 8.25, 95% CI 1.45-46.8, p = 0.017).Conclusion. Cardiac MRI with delayed paramagnetic contrasting is a valuable method contributing to the preoperative identifi cation of a cohort of ischemic cardiomyopathy patients who can benefi t the most from surgical left ventricular reconstruction.

The left main coronary artery (LMCA) supplies majority of the left ventricular myocardium and atherosclerotic obstruction is associated with significant myocardial jeopardy. Coronary artery bypass surgery (CABG) has been the gold standard for LMCA disease in the past. The LMCA has special characteristics anatomically, poses different challenges with regard to percutaneous coronary intervention (PCI), and is often associated with multivessel disease. However, advancements in technology have established PCI to be a standard, safe, and reasonable alternative to CABG with comparable outcomes. Contemporary PCI of LMCA disease includes proper selection of the patients and correct technique, and is aided by intravascular ultrasound, optical coherence tomography, and physiological assessment with fractional flow reserve. In this review article, we discuss the anatomy, plaque characteristics of LMCA, current evidence from registries and randomized trials comparing with CABG, technical aspects of stent implantation, adjuvant technologies, mechanical circulatory supports, and triumph of PCI.

Adrenaline damage to the myocardium is an important element in the pathogenesis of myocardial infarction in humans. Despite the use of modern methods of treatment of myocardial infarction, the issue of cardioprotection of reperfusion myocardial damage remains open. Promising in this direction is the use of quinazolone derivatives, which have already shown cardioprotective properties in other models of myocardial infarction. The aim of the study was to establish morphological changes in the conditions of adrenaline myocardiodystrophy (AMD) against the background of the introduction of the compound PC-66 and amiodarone in rats. The study was performed on 100 nonlinear rats of both sexes weighing 165-220 g, divided into four groups of 25 animals each: 1 – intact rats; 2 – rats with a model of adrenaline myocardial infarction without treatment (control); 3 – rats with AMD treated with amiodarone (10 mg/kg, intraperitoneally); 4 – rats with AMD treated with compound PC-66 (10 mg/kg, intraperitoneally). It was found that control rats under conditions of cardiotoxic dose of adrenaline in the left ventricular myocardium for up to 8 days of the experiment does not fully restore the myocardial structure, dystrophic and necrobiotic changes were found in both cardiomyocytes and walls of vessels of a blood microcirculatory channel of a myocardium. Course intraperitoneal administration to rats of the compound PC-66 in the conditions of adrenaline myocardial infarction as well as amiodarone, contributes to the attenuation of signs of dystrophic and destructive processes. The degree of protective effect on the myocardium under conditions of cardiotoxic dose of adrenaline compound PC-66 was not lower to the reference drug – amiodarone. Thus, it is morphologically confirmed that in adrenaline myocardial infarction the compound PC-66, similar to the action of amiodarone, has a cardioprotective effect.

Objective To evaluate the accuracy of a deep learning-based automated segmentation of the left ventricle (LV) myocardium using cardiac CT. Materials and methods To develop a fully automated algorithm, 100 subjects with coronary artery disease were randomly selected as a development set (50 training / 20 validation / 30 internal test). An experienced cardiac radiologist generated the manual segmentation of the development set. The trained model was evaluated using 1000 validation set generated by an experienced technician. Visual assessment was performed to compare the manual and automatic segmentations. In a quantitative analysis, sensitivity and specificity were calculated according to the number of pixels where two three-dimensional masks of the manual and deep learning segmentations overlapped. Similarity indices, such as the Dice similarity coefficient (DSC), were used to evaluate the margin of each segmented masks. Results The sensitivity and specificity of automated segmentation for each segment (1-16 segments) were high (85.5-100.0%). The DSC was 88.3 ± 6.2%. Among randomly selected 100 cases, all manual segmentation and deep learning masks for visual analysis were classified as very accurate to mostly accurate and there were no inaccurate cases (manual vs. deep learning: very accurate, 31 vs. 53; accurate, 64 vs. 39; mostly accurate, 15 vs. 8). The number of very accurate cases for deep learning masks was greater than that for manually segmented masks. Conclusion We present deep learning-based automatic segmentation of the LV myocardium and the results are comparable to manual segmentation data with high sensitivity, specificity, and high similarity scores.

To date, it has been established that in the progression of coronary artery disease (CAD) and its complications, an increase in the level of homocysteine and hypovitaminosis D are essential. However, medical publications do not adequately cover the study of the effects of hyperhomocysteinemia and vitamin D deficiency on the course of atherosclerosis and the functional state of the myocardium, and requires more detailed research of this problem. Objective. To study the functional state of the myocardium depending on the degree of hyperhomocysteinemia and hypovitaminosis D in patients with CAD. Materials and methods. The study analyzed data from 69 diagnosed with CAD. Depending on the degree of hyperhomocysteinemia and the level of vitamin D, patients were divided into 3 groups. Results. In all patients, speckle-tracking echocardiography revealed a decrease in longitudinal and circular myocardial deformation. Patients with hyperhomocysteinemia and vitamin D deficiency had significantly lower myocardial deformity. Comparing the data of echocardiography, it was found that in patients of all three groups – no significant difference in hemodynamic parameters was found, despite the difference in the level of HC and vitamin D. Conclusions. Hyperhomocysteinemia and hypovitaminosis D are risk factors for the development of CAD. It was revealed that the higher level of homocysteine and the pronounced deficiency of vitamin D, are associated with more pronounced changes in the functional state of the myocardium.

The accurate 3D left ventricular (LV) myocardium segmentation in short-axis (SAX) view of cardiac magnetic resonance (CMR) is challenged by the sparse spatial structure of CMR. The strategy of multi-view CMR fusion can provide fine-grained spatial structure for accurate segmentation. However, the large information misalignment & lack of dense 3D CMR as fusion target in multi-view CMR fusion, and the different spatial resolution between the fused cardiac model and the ground truth of segmentation in segmentation limit the strategy. In this study, we propose a multi-view spatial-aware adversarial network (MVSGAN). It studies the perception of fine-grained cardiac structure for accurate segmentation by the spatially consistent fusion of multi-view CMR. It consists of three modules: (1) A residual adversarial fusion (RAF) module takes inter-slices deep correlation and anatomical prior of multi-view CMR to refine the spatial structures by residual supplement and adversarial optimization. (2) A structural perception-aggregation (SPA) module establishes the spatial correlation between the spatially dense cardiac model and sparse segmentation label for accurate 3D CMR LV myocardium segmentation. (3) A joint training strategy utilizes the spatial dense SAX volume as explicit and implicit goals to jointly optimize the framework. The experiments are applied on a public dataset and a clinical dataset to evaluate the performance of MVSGAN. The average Dice and Jaccard score of LV myocardium segmentation obtained by MVSGAN are highest among seven existing state-of-the-art methods, which are up to 0.92 and 0.75. It is concluded that the spatial-aware multiview CMR fusion can provide meaningful spatial correlation for accurate 3D SAX LV myocardium segmentation.

Purpose To investigate the changes in deformation and myocardial microcirculation perfusion of left ventricular three-layer myocardium in patients with dilated cardiomyopathy (DCM) by using speckle tracking imaging (STI) and myocardial contrast echocardiography (MCE). Methods Twenty-four patients with DCM and 19 healthy controls were selected. Two-dimensional and MCE dynamic images of apical four-chamber, two-chamber, and three-chamber sections and left ventricular mitral valve, papillary muscle and apex sections were collected. The peak values of longitudinal strain (LS), circumferential strain (CS), cross-sectional area of a microvessel (A) and average myocardial microvascular lesion (β) were obtained by Qlab 10.8 workstation values, and myocardial blood flow (MBF) was calculated with A × β to evaluate the deformation and coronary microvascular perfusion of left ventricular three-layer myocardium. Results The brain natriuretic peptide (BNP), left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVEDS), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left atrial volume index (LAVI), E peak in early diastolic period/A peak velocity in late diastolic period (E/A) and average E/e' in the DCM group were higher than those in the control group (P P P middle > subepicardial. The correlation coefficients of LS with A, β, and A × β were − 0.500, -0.279 and − 0.190, respectively, and the correlation coefficients of CS with A, β, and A × β were − 0.383, -0.255 and − 0.208, respectively. Conclusions The deformation of the three-layer myocardium and coronary microcirculation perfusion in DCM patients were diffusely damaged from the endocardium to the epicardium, layer by layer. The longitudinal function of the left ventricular myocardium was closely related to changes in myocardial microcirculation perfusion. Echocardiography is helpful to evaluate myocardial blood flow and myocardial ischemia in patients with DCM.

Isolated left ventricular noncompaction, where broad trabeculae and deep intertrabecular recesses are observed in the left ventricular myocardium resulting from an arrest in normal embryogenesis, is a rare cardiomyopathy. We present a report on isolated trabeculectomy and postoperative echocardiographic follow-up showing recovery of cardiac function for isolated left ventricular noncompaction.

The article analyzes clinical guidelines oftheAmericanAcademy ofPediatrics dd 2017 “ClinicalPractice Guideline forScreening andManagement of High Blood Pressure in Children and Adolescents”. This document contains new values of blood pressure in children, replaces the term “prehypertension” with the term “elevated blood pressure”, provides a simplified classification of arterial hypertension in adolescents over 13 years and revisesthe guidelinesfor daily blood pressure monitoring and echocardiography. The documentspecifiesthe criteria for diagnosing increased body weight of the left ventricular myocardium, changesthe target blood pressure levels. This new guidelines helps to optimize the diagnostics and treatment of hypertension in children. At the same time there is need for further comprehensive analysis of clinicalrecommendations and assessment of their practicalsignificance for pediatrics.

The characterization of tissue-specific gene expression in failing hearts requires the identification of appropriately validated reference genes. This study sought to validate which commonly used reference genes were the most suitable for qRT-PCR data normalization in epicardial adipose tissue and left ventricular myocardium in patients with end-stage heart failure. The mRNA expression of 10 candidate reference genes was analyzed by qRT-PCR. The stability of their expression was evaluated by our novel scoring system and compared with known algorithms used to identify stable reference genes (Normfinder and Bestkeeper). Using these three methods, we selected the Ribosomal protein L13A (RPL13A) as the best reference gene when studying either epicardial adipose tissue or left ventricular myocardium in failing hearts. In contrast, the β2-microglobulin (B2M) gene was identified as a more suitable reference gene in studies comparing gene expression in epicardial adipose tissue to left ventricular myocardium.

The aim of this study is to create an automatic framework for sustained ventricular arrhythmia (VA) prediction using cardiac computed tomography (CT) images. We built an image processing pipeline and a deep learning network to explore the relation between post-infarct left ventricular myocardium thickness and previous occurrence of VA. Our pipeline generated a 2D myocardium thickness map (TM) from the 3D imaging input. Our network consisted of a conditional variational autoencoder (CVAE) and a classifier model. The CVAE was used to compress the TM into a low dimensional latent space, then the classifier utilised the latent variables to predict between healthy and VA patient. We studied the network on a large clinical database of 504 healthy and 182 VA patients. Using our method, we achieved a mean classification accuracy of \(75\% \pm 4\) on the testing dataset, compared to \(71\% \pm 4\) from the classification using the classical left ventricular ejection fraction (LVEF).

Aim of the paper was to address all strengths and weakness of cardiac magnetic resonance (CMR) in arrhythmogenic cardiomyopathy, trying to highlight areas where further research and investigations should be carried out to fill current gaps in scientific knowledge. Arrhythmogenic cardiomyopathy represents a multifaceted clinical entity associated with arrhythmias and sudden death. Even though different diagnostic tools are available for appropriate identification and risk stratification, over the last few years cardiac magnetic resonance (CMR) has surfaced as an unmatched non-invasive imaging tool. CMR is mandatory in the evaluation of arrhythmogenic cardiomyopathy. It is the only imaging technique providing the identification of myocardial fibrosis, particularly for left ventricular myocardium, as recent evidences demonstrated that left ventricular involvement in arrhythmogenic cardiomyopathy is associated with greater risk of sudden death than lone right ventricular involvement.

In this introductory chapter to our book, in the hope of providing uniformity for the chapters which follow, we begin by discussing the reasons why we describe the valve guarding the left atrioventricular junction of the human heart as the mitral valve. We then outline our preferred terms for describing its components. These components together produce the mitral valvar complex, which intimately involves the left atrioventricular junction. Making up the complex are the so-called “annulus,” the valvar leaflets, their supporting tendinous cords, the papillary muscles, and the underlying left ventricular myocardium. We provide a brief review of the reasoning underscoring our preferred nomenclature, expanding on these issues in our chapter devoted to the anatomy of the different components.

BackgroundDuring left bundle branch (LBB) area pacing, it is important to confirm that the capture of the LBB is achieved, not just the capture of only the adjacent left ventricular myocardium (LV septal capture). Our aim was to establish ECG criteria for LBB capture by analyzing ECGs with confirmed LBB capture and non-capture. We hypothesized that since LBB pacing results in physiologic depolarization of the left ventricle then the native QRS can serve as a reference for the diagnosis of LBB capture in the same patient.MethodsOnly patients with direct evidence of LBB capture (output-dependent or refractoriness-dependent QRS morphology transition) were included. Several QRS characteristics were compared between the native rhythm and different types of LBB area capture. Receiver-operator characteristics analysis was performed to determine the optimal V6 R-wave peak time (RWPT) cut-off for LBB diagnosis.ResultsA total of 357 ECG tracing (124 patients) were analyzed: 118 with native rhythm, 124 with non-selective LBB capture, 69 with selective LBB capture and 46 with LV septal capture. Our hypotheses that during LBB capture the paced V6 RWPT (measured from QRS onset) equals the native V6 RWPT and that the paced V6 RWPT (measured from the stimulus) equals the LBB potential to V6 R-wave peak interval were positively validated. Criteria based on these rules had sensitivity and specificity of 98.0–88.2% and 85.7–95.4%, respectively. The optimal and 100% specific V6 RWPT values for differentiation between LBB capture and LV septal capture in patients with narrow QRS / right bundle branch block were 83 ms and 74 ms, respectively; while in patients with left bundle branch block/asystole/ventricular escape the optimal and 100% specific V6 RWPT values were 101 ms and 80 ms, respectively.ConclusionsNovel criteria for LBB capture were developed and optimal V6 RWPT cut-offs were determined.What this study addsWe showed that LBB pacing truly reproduce the physiological depolarization of the left ventricle since the paced V6 RWPT equals the native conduction V6 RWPT.Individualized LBB capture criteria, that use the native QRS as a reference, were developed.The optimal V6 RWPT values for differentiation between LBB capture and LV septal capture were determined, separately for patients with healthy and diseased LBB.

Introduction: 4D cardiac CT can reveal characteristics of arrhythmogenic right ventricular (RV) cardiomyopathy (ARVC) such as fat and fibrotic invasion into the RV and LV myocardium (RVM, LVM), an enlarged RV, reduced RV motion and bulging. Hypothesis: We could differentiate ARVC patients with fat and fibrotic invasion into the LVM from those without, using ECG, clinical, and other imaging characteristics. Methods: Retrospective analysis of 17 patients (11 males, 57±17 years) with suspected ARVC who underwent 4D cardiac CT. Results: 9 patients met the 2010 ARVC task force criteria. 4 had fat and fibrotic invasion into the LVM (group 1) but 5 did not (group 2). The remaining 8 did not fulfill the ARVC criteria (group 3). The proportion of males and age did not differ between groups. In groups 1, 2 and 3, respectively, 3 (75%), 4 (80%), and 1 (13%) patients had epsilon waves in V1-3 (group 1>3, P=0.033, group 2>3, P=0.005). 2 (50%), one (20%) and 4 (50%) had complete right bundle branch block (CRBBB) (all P=NS). Three (75%), 3 (60%), and 1 (13%) had inverted T waves in V1-3 or beyond (group 1>3, P=0.033). One (50%), 3 (75%), and 2 (50%) had terminal activation duration of QRS ≥55 ms measured from the nadir of the S wave to the end of the QRS, including R’, in V1, V2, or V3, in the absence of CRBBB (all P=NS). One (25%), 4 (80%) and 1 (13%) had sustained ventricular tachycardia (SVT; group 2>3, P=0.005). Two (50%), 1 (20%), and 3 (38%) had non-SVT (all P=NS). 4 (100%), 2 (40%), and 2 (25%) had clinical heart failure (group 1>2, P=0.019, group 1>3, P2, P=0.019, group 1>3, P3, P=0.002, group 2>3, P Conclusions: Most patients had RV enlargement on TTE and/or 4D CT. Presence of epsilon waves, reduced RV motion, and RV fat invasion on 4D CT may differentiate groups 1 and 2 from group 3, inverted T waves in V1-3 leads or beyond may differentiate group 1 from group 3, SVT may differentiate group 2 from group 3 but only clinical heart failure may differentiate groups 1 and 2.

Cardiovascular diseases (CVD) are the leading cause of disability and death worldwide. Many parameters based on left ventricular myocardium (LVM), including left ventricular mass, the left ventricular volume, and the ejection fraction (EF) are widely used for disease diagnosis and prognosis prediction. To investigate the relationship between parameters derived from the LVM and various heart diseases, it is crucial to segment the LVM in a fast and reproducible way. However, different diseases can affect the structure of the LVM, which increases the complexity of the already time-consuming manual segmentation work. In this work, we propose to use a 3D deep attention U-Net method to segment the LVM contour for cardiac CT images automatically. We used 50 patients’ cardiac CT images to test the proposed method. The Dice similarity coefficient (DSC), sensitivity, specificity, and mean surface distance (MSD) were 87% ± 5%, 87% ± 4%, 92% ± 3% and 0.68 ± 0.15 mm, which demonstrated the detection and segmentation accuracy of the proposed method.

In the clinical environment, myocardial infarction (MI) as one common cardiovascular disease is mainly evaluated based on the late gadolinium enhancement (LGE) cardiac magnetic resonance images (CMRIs). The automatic segmentations of left ventricle (LV), right ventricle (RV), and left ventricular myocardium (LVM) in the LGE CMRIs are desired for the aided diagnosis in clinic. To accomplish this segmentation task, this paper proposes a modified U-net architecture by combining multi-sequence CMRIs, including the cine, LGE, and T2-weighted CMRIs. The cine and T2-weighted CMRIs are used to assist the segmentation in the LGE CMRIs. In this segmentation network, the squeeze-and-excitation residual (SE-Res) and selective kernel (SK) modules are inserted in the down-sampling and up-sampling stages, respectively. The SK module makes the obtained feature maps more informative in both spatial and channel-wise space, and attains more precise segmentation result. The utilized dataset is from the MICCAI challenge (MS-CMRSeg 2019), which is acquired from 45 patients including three CMR sequences. The cine and T2-weighted CMRIs acquired from 35 patients and the LGE CMRIs acquired from 5 patients are labeled. Our method achieves the mean dice score of 0.922 (LV), 0.827 (LVM), and 0.874 (RV) in the LGE CMRIs.

The generation of kinematic models of the heart using 3D echocardiography (echo) can be difficult due to poor image contrast and signal dropout, particularly at the epicardial surface. 2D echo images generally have a better contrast-to-noise ratio compared to 3D echo images, thus wall thickness (WT) estimates from 2D echo may provide a reliable means to constrain model fits to 3D echo images. WT estimates were calculated by solving a pair of differential equations guided by a vector field, which is constructed from the solution of Laplace’s equation on binary segmentations of the left ventricular myocardium. We compared 2D echo derived WT estimates against values calculated using gold-standard cardiac cine magnetic resonance imaging (MRI) to assess reliability. We found that 2D echo WT estimates were higher compared to WT values from MRI at end-diastole with a mean difference of 1.3 mm (95% CI: 0.74–1.8 mm), 1.5 mm (95% CI: 0.91–2.1 mm) and 2.1 mm (95% CI: 1.6–2.6 mm) for basal, mid-ventricular and apical segments respectively. At end-systole, the WT estimates from MRI were higher compared to those derived from 2D echo with a mean difference of 2.6 mm (95% CI: 2.0–3.1 mm), 2.1 mm (95% CI: 1.5–2.7 mm) and 1.1 mm (95% CI: 0.49–1.7 mm) for basal, mid-ventricular and apical segments, respectively. The quantitative WT comparison in this study will contribute to the ongoing efforts to better translate kinematic modelling analyses from gold-standard cardiac MRI to the more widely accessible echocardiography.

[EN] Hypertrophic cardiomyopathy (HCM), hypertensive cardiomyopathy (HIP), and amyloidosis (AM) are pathologies in which a thickening of a portion of the myocardium occurs. All of them are manifested in a similar way on magnetic resonance images, which means that in most cases it is necessary to resort to the use of invasive diagnostic techniques. The objective of this work is to develop quantitative biomarkers that can differentiate between patients with these three pathologies using texture analysis on cardiac magnetic resonance imaging (MRI). In this study, a total of 103 patients underwent cine MRI. Two studies were carried out, one binary with patients with HCM and HIP and one multiclass considering the three pathologies. The left ventricular myocardium was segmented according to the standardized 17-segment model. A total of 43 features for each of the six segments were extracted using 5 different statistical methods. Four predictive models were implemented to evaluate the performance of the classification. Good precision results were obtained in both studies. For the binary study, a maximum AUC of 0.91 +/- 0.06 was obtained with the K-Nearest Neighbours model and for the multiclass study the best performance (AUC = 0.89 +/- 0.12) was achieved using the Support Vector Machine classifier., DM acknowledges financial support from the Conselleria d'Educació, Investigació, Cultura i Esport, Generalitat Valenciana (grants AEST/2019/037 and AEST/2020/029), from the Agencia Valenciana de la Innovación, Generalitat Valenciana (ref. INNCAD00/19/085), and from the Centro para el Desarrollo Tecnológico Industrial (Programa Eurostars-2, actuación Interempresas Internacional), Spanish Ministerio de Ciencia, Innovación y Universidades (ref. CIIP20192020).

This literature review in devoted to the potential of application of contrast-enhanced echocardiography (CEE) for assessment of structure and function of left cardiac chambers. It contains based on current recommendations discussion of main indications for CEE and analysis of its possibilities in evaluation of perfusion of the left ventricular myocardium, detection of myocardial ischemia, and assessment of myocardial viability. Data on CEE safety and possible side effects associated with the use of ultrasound contrasts are also presented.

Mitral regurgitation (MR) imposes left ventricular volume overload, triggering rapid ventricular dilatation, increased myocardial compliance, and, ultimately, cardiac dysfunction. Breakdown of the extracellular matrix has been hypothesized to drive these rapid changes, partially from an imbalance in the matrix metalloproteinases (MMPs) and their tissue inhibitors [tissue inhibitors of metalloproteinase (TIMPs)]. In the present study, we developed a rat model of severe MR that mimics the human condition and investigated the temporal changes in extracellular matrix-related genes, collagen biosynthesis proteins, and proteolytic enzymes over a 20-wk period. Male Sprague-Dawley rats were anesthetized to a surgical plane with mechanical ventilation, and a thoracotomy was performed to expose the apex. Using transesophageal ultrasound guidance, a needle was inserted into the beating heart to perforate the anterior mitral leaflet and create severe MR. Animals were survived for 20 wk, with some animals terminated at 2, 10, and 20 wk for analysis of left ventricular tissue. A sham group that underwent the same surgery without mitral leaflet perforation and MR were used as controls. At 2 wk post-MR, increased collagen gene expression was measured, but protein levels of collagen did not corroborate this finding. In parallel, MMP-1-to-TIMP-4, MMP-2-to-TIMP-1, and MMP-2-to-TIMP-3 ratios were significantly elevated, indicating a proteolytic milieu in the myocardium, possibly causing collagen degradation. By 20 wk, many of the initial differences seen in the proteolytic ratios were not observed, with an increase in collagen compared with the 2-wk time point. Altogether, this data indicates that an imbalance in the MMP-to-TIMP ratio may occur early and potentially contribute to the early dilatation and compliance observed structurally. NEW & NOTEWORTHY In this rodent model of severe mitral regurgitation that mimics the human condition, eccentric left ventricular dilatation occurred rapidly and persisted over the 20-wk period with parallel changes in myocardial collagen and matrix metalloproteinases that may drive the extracellular matrix breakdown.

Introduction We herein present an unusual case of a pseudoaneurysm of the left ventricular myocardium, which is a rare and fatal complication of myocardial infarction. Case report A 64-year-old man with a history of bipolar disorder and arterial hypertension was hospitalized for delayed presentation ST-elevation myocardial infarction. He was admitted to our hospital 24 hours after symptom onset. Diagnostic coronary angiography revealed 95% stenosis at the distal third of the right coronary artery, and he underwent a primary percutaneous coronary intervention to the culprit lesion. Despite administration of a diuretic and optimization of other pharmaceutical treatment, his heart failure deteriorated. Electrocardiography showed a sinus rhythm with Q-wave formation in the inferior wall leads (II, III, aVF), T-wave inversion in the same leads, and borderline QT prolongation (QTc of 490 ms). No ST elevation suggestive of left ventricular aneurysm formation was noticed. Forty days later, cardiac ultrasound revealed a dyskinetic cavity (pseudoaneurysm) in continuity with the posterior–inferior wall of the myocardium, resulting in severe mitral valve regurgitation. Unfortunately, the patient died while awaiting surgical treatment. Conclusion Although most patients with left ventricular pseudoaneurysm have a relatively benign outcome, those with symptoms of heart failure must be urgently diagnosed and treated.

Forward Projected Model-based Iterative Reconstruction SoluTion (FIRST) is a new reconstruction technique using CT, which provides successful reconstruction of high-quality CT images, especially in low contrast imaging. To evaluate improvements in the diagnostic accuracy of the detection of abnormal late enhancement (LE) in left-ventricular myocardium (LVM) using 320-slice CT with FIRST, we compared this modality with previous CT methods in patients with non-ischemic cardiomyopathy or a cardiac tumor.This was a retrospective study of 88 patients (56 males; 57 ± 15 years) suspected of having non-ischemic myocardial disease or a cardiac tumor. The first 52 consecutive patients (Group 1) underwent 16-slice CT at 140 kV tube voltage and an average tube current of 337 ± 20 mA, and 1.5 T MRI. The next 18 patients (Group 2) underwent 1st generation 320-slice CT at 120 kV tube voltage and an average tube current of 255 ± 106 mA, and 1.5T MRI; the remaining 18 patients (Group 3) underwent 2nd generation 320-slice CT with FIRST, at 80 kV tube voltage and a tube current of 800 mA, and 1.5T or 3T MRI.On patient-based analysis, no significant differences were observed between the 3 groups. For segment-based analysis, the specificity and overall accuracy were significantly higher (both P < 0.05) in Group 3 than in Group 1. Positive predictive value (PPV) was significantly higher in Group 3 than in Groups 1 and 2.The diagnostic accuracy of LE on CT for detecting myocardial fibrosis determined by late gadolinium-enhanced MRI was improved with the use of 2nd generation 320-slice CT with FIRST, in particular regarding specificity, PPV, and overall accuracy.

Cardiac activity can induce dose–volume evaluation errors for cardiac structures. The purpose of this study was to quantify the variation in dose–volume parameters for the heart, pericardium and left ventricular myocardium (LVM) throughout the cardiac circle. The heart, pericardium and LVM of 22 patients were contoured on 20 phases of electrocardiography-gated 4D computed tomography (4DCT) images acquired during breath-hold. Radiotherapy plans were designed on 0% phase of the 4DCT images, and the dose distributions of the plans were imported into MIM Maestro and deformed to each phase to generate distributions for all phases. Variations in dose–volume parameters for the heart, pericardium and LVM were compared among different phases. The rates of variation in Dmean for the heart and pericardium were 3.33 ± 1.04% and 2.66 ± 1.15%, respectively. The mean values of the maximum difference in V5, V10, V20, V30 and V40 were all 0.05). The rate of variation in Dmean for the LVM reached 87.05 ± 38.34%, and the maximum differences in V5, V10, V20, V30 and V40 were 13.76 ± 4.46%, 13.64 ± 4.33%, 12.84 ± 4.55%, 11.62 ± 4.85% and 3.63 ± 2.56%, respectively; all differences were statistically significant (P < 0.05). Variations in dose–volume parameters were more significant in the LVM than in the heart and pericardium (P < 0.05). The dose–volume parameters for the LVM were significantly influenced by cardiac activity, whereas those for the heart and pericardium were not; therefore, individual dosimetric evaluation and limitation must be performed for the LVM.

Topical issues of evaluation, as well as practical application of longitudinal deformities of left ventricular myocardium in the diagnosis of cardiovascular diseases are considered. A study was conducted with an estimation of the segmented reference values for longitudinal deformation of the left ventricular myocardium in healthy middle-aged people using the technique of speckle tracking echocardiography. The essence of the methodic is to track coded areas of the myocardium (speckles) in the gray-scale image with subsequent automatic processing of data by special software. The data obtained are presented in the form of graphs and polar diagrams. This methodic has advantages over the method of tissue dopplerography, because it is more objective, sensitive and requires less time for data processing and analysis. At the same time speckle tracking has a number of limitations. To assess deformation, a good visualization of the image and a regular rhythm are required, and, most importantly, there are no generally accepted standards, since each manufacturer of echocardiographic equipment applies various filters that counteract the scattering of an ultrasonic beam. The effect of these filters on the results is unknown and, therefore, it is impossible to compare the data obtained on different devices. In addition, in the present work, correlation links between the structural and functional state of the myocardium and indices of longitudinal deformation of segments of the left ventricle are revealed. These results reveal the physiological features of the process in myocardial contractility occurring in the heart, both in norm and pathology.

Contained sinus of Valsalva dissection into the left ventricular myocardium is an extremely rare condition [(1,2)][1]. A 19-year-old phenotypically normal man underwent mitral valve replacement for spontaneous chordal rupture. Discharge echocardiogram showed no evidence of abnormality in the

We conducted a retrospective study of EchoCG from 33 males who had the myocardial infarction. Patients with a diagnosis of "neurocirculatory dystonia" (30 people) entered the control group. We studied the size of the left ventricle, the left atrium, the right ventricle, their relationship to each other, the mass of the myocardium and the mass index of the myocardium of the left ventricle. The study of the morphological structures of the heart revealed a change in the size of the left ventricle, the left atrium and the right ventricle in patients who had an acute myocardial infarction, manifested by an increase in the end-diastolic and end-systolic dimensions of the left ventricle, the left atrium, and the right ventricle. In 2/3 of the patients who had an acute myocardial infarction, the normal geometry of the left ventricle was observed. Around one-quarter of the patients had a concentric remodeling (24%), an eccentric hypertrophy of the left ventricle was the least common (15%). The heart of patients who had an acute myocardial infarction demonstrates a lower functionality being compared to the subjects in the control group. In these groups, the maximum value of the DAC / DDR ratio is observed, the ejection fraction is reduced. To a greater extent, the onset of acute myocardial infarction was determined by the size and mass of the left ventricular myocardium. Important meaning had also the body weight, BMI, surface area of the body, the size of the left atrium, and the right ventricle.

The left main coronary artery (LMCA) is responsible for supplying the majority of the left ventricular myocardium. Visual estimation of stenosis severity on angiography has major limitations and methods to assess functional significance, such as fractional flow reserve (FFR), have been shown to yield better outcomes; however, to date, major trials examining the use of such physiological indices have excluded LMCA disease. Furthermore, LMCA disease commonly co-exists with downstream disease, which complicates the interpretation of coronary physiological data. This review summarises existing evidence for physio-‌logy-guided management of LMCA disease. It will also explore the difficulties posed when functionally assessing LMCA lesions and outline potential solutions. Finally, we aim to provide insight into how novel physiological tools may improve the management of LMCA disease in the future.

Objective: Тo examine the character of correlation and interaction of depressive disorders as well as the remodelling features of the left ventricle (LV) myocardium in elderly patients suffering from arterial hypertension (AH). Methods: 70 persons aged 60 to 74 years were examined. The main group consisted of 40 patients with AH: 22 men (57.5%) and 18 women (42.5%). The control group included 30 essentially healthy individuals, identical in gender and age. Structural changes in the myocardium were studied by echocardiography. Results: LV hypertrophy was significantly more common in hypertensive patients than in the control group (92.5% compared to 20%). Among the abnormalities of LV geometry in the main group, the leading place was occupied by concentric hypertrophy in 21 patients (52.5%), with eccentric hypertrophy was also significantly higher and was noted in 16 patients (40.0%). The LV ejection fraction in the average group exceeded 50%. However, when comparing individual data with indices of the control group, the falling tendency was noted (61.4±4.55 and 64.6±5.22, respectively). The same picture of the shortening of the anteroposterior size (ΔS%) of the LV (39.4±3.49 compared to 36.2±7.28). Significant differences occurred in the thickness of the posterior wall and interventricular septum. Conclusions: The revealed structural changes in the heart with AH, the development of LV hypertrophy, and its remodelling assists to the diastolic and then systolic dysfunction of the heart. Keywords: Arterial hypertension, depression, myocardial remodelling, elderly age.

Background: In the present study, we sought to describe a procedure for the creation of co-registered positron emission tomography (PET) and magnetic resonance imaging (MRI) polar plots of cardiac PET/MRI examinations, validate the resulting plots against available standard methods in patients with myocardial infarction and provide examples that demonstrate the advantage of the novel approach over existing standards. Methods: Co-registered LGE and PET short-axis images were transformed into polar maps based on a radial sampling pattern. LGE was automatically detected using an automated thresholding algorithm (ATA). In 20 PET/MRI examinations in patients with acute myocardial infarction, agreement between manual LGE assessment and the ATA classification was calculated. Also agreement between MRI-segmentation based PET polar plots and standard PET polar plots (created with the Corridor4DM software package) was assessed. Results: No statistically significant difference in infarct sizes between manual and ATA segmentation was found (p = 0.12). Both methods were highly correlated (Pearson’s r = 0.96, p < 0.01). Bland-Altman analysis revealed lower and upper limits of agreement of - 4.7 g and 3.6 g. Agreement between MRI-segmentation based PET polar plots and standard PET polar plots was very high (mean kappa of 0.91 ± 0.10; p < 0.01 in all cases). In three additional patients with myocardial inflammation, the software successfully created polar plots that demonstrate the location and extent of pathologic tracer uptake in the left ventricular myocardium. Conclusion: A straightforward software approach for the creation of co-registered PET and MRI polar plots was described and successfully demonstrated in PET/MRI studies of myocardial infarction and inflammation.

Liver radiotracer activity interfering with the inferior myocardial wall in a patient undergoing myocardial perfusion imaging (MPI) with 99mTc-Sestamibi is a known pitfall. We report a patient with pituitary macroadenoma who was subjected to stress-MPI study for pre-anesthetic clearance. The post-stress raw image showed the liver radiotracer activity in close approximation to the anteroseptal wall of the left ventricular myocardium, secondary to right hemi-diaphragmatic eventration.

Echinococcal lesions rarely involve the heart; nonetheless, echinococcal cysts of the left ventricular myocardium often demand surgical treatment due to the risk of rupture and anaphylaxis. Herein, an echinococcal cyst of the anteroapical left ventricular wall was managed through small left anterior thoracotomy; repair was achieved under cardioplegic arrest (endoaortic balloon occlusion) with an uneventful course. We discuss the usefulness of such a less invasive approach for the depicted lesion (minimized manipulation of the heart and reduced surgical aggressiveness) and for other lesions involving the apical/lateral LV region.