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Background and Objectives : The combination of aortic valve stenosis (AS) and ischemic heart disease (IHD) is quite common and is associated with myocardial fibrosis (MF). The purpose of this study was to evaluate the association between the histologically verified left ventricular (LV) MF and its geometry and function in isolated AS and AS within IHD groups. Materials and Methods : In a single-center, prospective trial, 116 patients underwent aortic valve replacement (AVR) with/without concomitant surgery. The study population was divided into groups of isolated AS with/without IHD. Echocardiography was used, and LV measurements and aortic valve parameters were obtained from all patients. Myocardial tissue was procured from all study patients undergoing elective surgery. Results : There were no statistical differences between isolated AS and AS+IHD groups in LV parameters or systolic and diastolic functions during the study periods. The collagen volume fraction was significantly different between the isolated AS and AS+IHD groups and was 7.3 ± 5.6 and 8.3 ± 6.4, respectively. Correlations between MF and left ventricular end-diastolic diameter (LVEDD) ( r = 0.59, p = < 0.001), left ventricular mass (LVM) ( r = 0.42, p = 0.011), left ventricular ejection fraction (LVEF) ( r = -0.67, p < 0.001) and an efficient orifice area (EOA) ( r = 0.371, p = 0.028) were detected in isolated AS during the preoperative period; the same was observed for LVEDD ( r = 0.45, p = 0.002), LVM ( r = 0.36, p = 0.026), LVEF ( r = -0.35, p = 0.026) and aortic annulus ( r = 0.43, p = 0.018) in the early postoperative period; and LVEDD ( r = 0.35, p ≤ 0.05), LVM ( r = 0.43, p = 0.007) and EOA ( r = 0.496, p = 0.003) in the follow-up period. In the group of AS and IHD, correlations were found only with LV posterior wall thickness ( r = 0.322, p = 0.022) in the follow-up period. Conclusions : Histological MF in AS was correlated with LVM and LVEDD in all study periods. No correlations between MF and LV parameters were found in aortic stenosis in the ischemic heart disease group across all study periods.

Cardiovascular (CV) imaging is an important tool in baseline risk assessment and detection of CV disease in oncology patients receiving cardiotoxic cancer therapies. This position statement examines the role of echocardiography, cardiac magnetic resonance, nuclear cardiac imaging and computed tomography in the management of cancer patients. The Imaging and Cardio-Oncology Study Groups of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in collaboration with the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the ESC have evaluated the current evidence for the value of modern CV imaging in the cardio-oncology field. The most relevant echocardiographic parameters, including global longitudinal strain and three-dimensional ejection fraction, are proposed. The protocol for baseline pre-treatment evaluation and specific surveillance algorithms or pathways for anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor tyrosine kinase inhibitors, BCr-Abl tyrosine kinase inhibitors, proteasome inhibitors and immune checkpoint inhibitors are presented. The indications for CV imaging after completion of oncology treatment are considered. The typical consequences of radiation therapy and the possibility of their identification in the long term are also summarized. Special populations are discussed including female survivors planning pregnancy, patients with carcinoid disease, patients with cardiac tumours and patients with right heart failure. Future directions and ongoing CV imaging research in cardio-oncology are discussed., (© 2020 European Society of Cardiology.)

Childhood blood pressure (BP) levels predict adult subclinical atherosclerosis. However, the best childhood BP component for prediction has not been determined. This study comprised 5925 participants aged 3 to 18 years from 6 cohorts who were followed into adulthood (mean follow-up 25.8±6.2 years). Childhood BP was measured by using a standard mercury sphygmomanometer in all cohorts. Study-specific carotid intima-media thickness ≥90th percentile was used to define subclinical atherosclerosis. Per SD change in the predictor, childhood systolic BP (SBP; age- and sex-adjusted odds ratio [95% CI], 1.24 [1.13-1.37]), mean arterial pressure (1.10 [1.07-1.13]), and pulse pressure (1.15 [1.05-1.27]) were associated with increased adulthood intima-media thickness. In age- and sex-adjusted analyses, area under the receiver operating characteristic curves for SBP ( C value [95% CI], 0.677 [0.657-0.704]) showed significantly improved prediction compared with diastolic BP (0.669 [0.646-0.693], P=0.006) or mean arterial pressure (0.674 [0.653-0.699], P=0.01). Pulse pressure provided a C value that was not different from SBP (0.676 [0.653-0.699], P=0.16). Combining different BP components did not improve prediction over SBP measurement alone. Based on the associations with adult carotid intima-media thickness, cut points for elevated SBP were 105 mm Hg for 3- to 6-year-old boys, 108 mm Hg for 3- to 6-year-old girls, 108 mm Hg for 7- to 12-year-old boys, 106 mm Hg for 7- to 12-year-old girls, 123 mm Hg for 13- to 18-year-old boys, and 115 mm Hg for 13- to 18-year-old girls. Our analyses suggest that several childhood BP measurement components are related to adulthood carotid intima-media thickness. Of these, SBP provided the best predictive ability.

Background and Objective: Myocardial deformation indices are considered as sensitive markers of ischemia and may be useful in the quantification of hemodynamic significance of coronary artery disease (CAD). We sought to determine the diagnostic value of speckle-tracking echocardiography derived myocardial deformation parameters at rest and during stress to determine hemodynamically significance coronary artery stenosis in patients with moderate and high probability of CAD., Materials and Methods: In 81 patients (mean age, 64±8.6 years) with stable CAD inducible myocardial ischemia was evaluated by dobutamine stress echocardiography (DSE) and adenosine magnetic resonance imaging (AMRI). Based on AMRI patients were divided into two groups: nonpathologic (n=41) and pathologic (n=40). Strain and strain rate (SR) parameters and their changes from the rest (BASE) to low stress (MIN), peak stress (MAX), and recovery (REC) were analyzed using 2D speckle-tracking imaging (STI)., Results: In the nonpathologic group, systolic longitudinal and circumferential strain increased significantly from BASE to MIN, as well as systolic SR from BASE to MIN and from MIN to MAX in longitudinal plane. In contrast, in the pathologic group, insignificant longitudinal systolic SR increase and radial and circumferential systolic SR decrease from MIN to MAX was observed. Discriminant function analysis revealed that select STI derived parameters best classify patients into predefined AMRI groups (pathologic and nonpathologic) with the accuracy respectively 90.9% and 83.3%. According to ROC analysis these myocardial deformation parameters had the greatest predictive value of significant coronary artery stenoses: longitudinal strain at high dose (AUC 0.811, sensitivity 89.4%, specificity 64.7%), longitudinal strain rate at high dose (AUC 0.855, sensitivity 88.1%, specificity 71.0% at high doses). The sensitivity and specificity of inducible wall motion abnormalities were 74.0% and 85.0% (AUC 0.798) and was lower compared with the diagnostic value of longitudinal myocardial deformation parameters., Conclusions: Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD., (Copyright © 2016 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Coping with cardiovascular diseases (CVD), which are of the main causes of death worldwide, has influenced investigation of high sensitivity CRP (hsCRP) and its role in pathogenesis, prognosis and prevention of CVD. hsCRP can be synthesized in vascular endothelium, atherosclerotic plaques, and theory of inflammatory origin of atherosclerosis is being more widely debated, raising questions, whether higher hsCRP plasma concentration might be the cause or the consequence. Summing up controversial data from multiple studies, guidelines recommend hsCRP testing for both, primary (stratifying CVD risk groups, selecting patients for statin therapy) and secondary CVD prevention (prognosis of CVD and its treatment complications, evaluation of treatment efficacy in moderate CVD risk group). hsCRP testing also has role in heart failure, atrial fibrillation, arterial hypertension, valve pathology and prognosis of coronary stent thrombosis or restenosis. Medications (the well-known and the new specific - CRP binding) affecting its concentration are being investigated as well., (Copyright © 2016 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Cardiovascular (CV) disease remains the leading cause of death in Lithuania. Timely recognition of CV risk factors and intervention to reduce these risk factors is of absolute importance to prevent coronary heart disease and reduce its burden on society. This study aimed to compare the prevalence of major CV risk factors in general population and acute coronary syndrome (ACS) patients and to determine their association with the development of ACS. Five hundred and twenty-three ACS patients and 645 age- and gender-matched control subjects were enrolled in the study. Smoking, dyslipidaemia, diabetes, and hypertension, but not overweight or obesity, were significantly more prevalent in the ACS patients, compared with control group. The prevalence of smoking, overweight or obesity, and dyslipidaemia were significantly higher in younger patients. Hypertension was highly prevalent in all age subgroups. More than a half of all patients aged <45 years had three or four CV risk factors. Smoking [odds ratio (OR), 7.03, P < 0.0001], hypertension (OR, 1.82; P = 0.001), dyslipidaemia (OR, 1.99; P < 0.0001), and diabetes (OR, 2.30; P < 0.001) were significantly associated with ACS. Significant association of traditional CV risk factors, such as smoking, dyslipidaemia, hypertension, and diabetes with ACS, and high prevalence of these risk factors, especially in younger individuals, calls for attention, and implementation of prevention programmes to reduce the burden of CV morbidity and mortality in Lithuania.

Background and Objective: The objective of our study was to evaluate the predictive power of a combined assessment of heart rate variability (HRV) and impedance cardiography (ICG) measures in order to better identify the patients at risk of serious adverse events after ST-segment elevation myocardial infarction (STEMI): all-cause or cardiac mortality (primary outcomes) and in-hospital recurrent ischemia, recurrent nonfatal MI, and need for revascularization (secondary outcomes)., Material and Methods: A total of 213 study patients underwent 24-hour electrocardiogram (used for HRV analysis) and thoracic bioimpedance monitoring (used for calculation of hemodynamic measures) immediately after admission. The patients were examined on discharge and contacted after 1 and 5 years. Cox regression analysis was used to determine the predictors of selected outcomes. RESULTS. The standard deviation of all normal-to-normal intervals (SDNN) and cardiac power output (CPO) were found to be the significant determinants of 5-year all-cause mortality (SDNN ≤ 100.42 ms and CPO ≤ 1.43 W vs. others: hazard ratio [HR], 11.1; 95% CI, 4.48-27.51; P<0.001). The standard deviation of the averages of NN intervals (SDANN) and CPO were the significant predictors of 5-year cardiac mortality (SDANN ≤ 85.41 ms and CPO ≤ 1.43 W vs. others: HR, 11.05; 95% CI, 3.75-32.56; P<0.001). None of the ICG measures was significant in predicting any secondary outcome., Conclusions: The patients with both impaired autonomic heart regulation and systolic function demonstrated by decreased heart rate variability and impedance hemodynamic measures were found to be at greater risk of all-cause and cardiac death within a 5-year period after STEMI. An integrated analysis of electrocardiogram and impedance cardiogram helps estimate patient's risk of adverse outcomes after STEMI.