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Heart failure with reduced ejection fraction (HFrEF) is associated with structural and functional left ventricular changes. We compared intracardiac vortices between patients with HFrEF and normal participants using echocardiographic vector flow mapping, a novel intracardiac vortex analysis technology.Transthoracic echocardiography was performed on 20 patients with HFrEF (age: 61 ± 15 y, 15 men) and 20 normal participants (age: 59 ± 12 y, 12 men) age- and sex-balanced at the cohort level. Systolic and diastolic energy loss, area (indexed by left ventricular end-diastolic diameter), circulation (reflects vortex strength) and relative positions of the largest vortex during systole (S-vortex), early (E-vortex) and late (A-vortex) diastole and maximal number of vortices in a single frame (MNV) were assessed.Patients with HFrEF had disproportionately sized vortices with smaller indexed vortex areas (p0.0001), and more fragmented vortices with higher MNV during both systole (p = 0.030) and diastole (p0.0001). These accompanied higher diastolic energy loss (p = 0.001). Additionally, the E-vortex (p = 0.002) and A-vortex (p0.0001) were more apically positioned, and the S-vortex was weaker (p = 0.033) in patients with HFrEF. More severe fragmentation (higher MNV) correlated with worse energy efficiency (higher energy loss).Patients with HFrEF had more fragmented intracardiac vortices and lower energy efficiency predominantly during diastole.

While three-dimensional transesophageal echocardiography (3D TEE) has been increasingly used for assessing cardiac anatomy and function, it still suffers from a limited field of view (FoV) of the ultrasound transducer. Therefore, it is difficult to examine a complete region of interest without moving the transducer. Existing methods extend the FoV of 3D TEE images by mosaicing multiview static images, which requires synchronization between 3D TEE images and electrocardiogram (ECG) signal to avoid deformations in the images and can only get the widened image at a specific phase.This work aims to develop a novel multiview nonrigid registration and fusion method to extend the FoV of 3D TEE images at different cardiac phases, avoiding the bias toward the specifically chosen phase.A multiview nonrigid registration and fusion method is proposed to enlarge the FoV of 3D TEE images by fusing dynamic images captured from different viewpoints sequentially. The deformation field for registering images is defined by a collection of affine transformations organized in a graph structure and is estimated by a direct (intensity-based) method. The accuracy of the proposed method is evaluated by comparing it with two B-spline-based methods, two Demons-based methods, and one learning-based method VoxelMorph. Twenty-nine sequences of in vivo 3D TEE images captured from four patients are used for the comparative experiments. Four performance metrics including checkerboard volumes, signed distance, mean absolute distance (MAD), and Dice similarity coefficient (DSC) are used jointly to evaluate the accuracy of the results. Additionally, paired t-tests are performed to examine the significance of the results.The qualitative results show that the proposed method can align images more accurately and obtain the fused images with higher quality than the other five methods. Additionally, in the evaluation of the segmented left atrium (LA) walls for the pairwise registration and sequential fusion experiments, the proposed method achieves the MAD of (0.07 ± 0.03) mm for pairwise registration and (0.19 ± 0.02) mm for sequential fusion. Paired t-tests indicate that the results obtained from the proposed method are more accurate than those obtained by the state-of-the-art VoxelMorph and the diffeomorphic Demons methods at the significance level of 0.05. In the evaluation of left ventricle (LV) segmentations for the sequential fusion experiments, the proposed method achieves a DSC of (0.88 ± 0.08), which is also significantly better than diffeomorphic Demons at the 0.05 level. The FoVs of the final fused 3D TEE images obtained by our method are enlarged around two times compared with the original images.Without selecting the static (ECG-gated) images from the same cardiac phase, this work addressed the problem of limited FoV of 3D TEE images in the deformable scenario, obtaining the fused images with high accuracy and good quality. The proposed method could provide an alternative to the conventional fusion methods that are biased toward the specifically chosen phase.

Deep learning (DL) has been applied for automatic left ventricle (LV) ejection fraction (EF) measurement, but the diagnostic performance was rarely evaluated for various phenotypes of heart disease. This study aims to evaluate a new DL algorithm for automated LVEF measurement using two-dimensional echocardiography (2DE) images collected from three centers. The impact of three ultrasound machines and three phenotypes of heart diseases on the automatic LVEF measurement was evaluated. Using 36890 frames of 2DE from 340 patients, we developed a DL algorithm based on U-Net (DPS-Net) and the biplane Simpson's method was applied for LVEF calculation. Results showed a high performance in LV segmentation and LVEF measurement across phenotypes and echo systems by using DPS-Net. Good performance was obtained for LV segmentation when DPS-Net was tested on the CAMUS data set (Dice coefficient of 0.932 and 0.928 for ED and ES). Better performance of LV segmentation in study-wise evaluation was observed by comparing the DPS-Net v2 to the EchoNet-dynamic algorithm (

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome of shortness of breath and/or exercise intolerance secondary to elevated left ventricular filling pressures at rest or with exertion either as a result of primary diastolic dysfunction (primary HFpEF) or secondary to specific underlying causes (secondary HFpEF). In secondary HFpEF, early intervention of underlying valvular heart disease generally improves symptoms and prolongs survival. In primary HFpEF, there is increasing awareness of the existence and prognostic implications of secondary atrioventricular valve regurgitation. Further studies will clarify their mechanisms and the effectiveness of valvular intervention in this intriguing HFpEF subgroup.

PURPOSE Multiple efforts are underway to increase the inclusion of racial minority participants in genomic research and new forms of individualized medicine. These efforts should include studies that characterize how individuals from minority communities experience genomic medicine in diverse health-care settings and how they integrate genetic knowledge into their understandings of health-care needs. METHODS As part of a large, multisite genomic sequencing study, we surveyed individuals to assess their decision to pursue genomic risk evaluation. Participants included Latino patients recruited at Mountain Park Health Center, a Federally Qualified Health Center in Phoenix, Arizona, and non-Latino patients recruited at a large academic medical center (Mayo Clinic in Rochester, MN). Both groups agreed to receive individualized genomic risk assessments. RESULTS Comparisons between cohorts showed that Latino respondents had lower levels of decisional conflict about pursuing genomic screening but generally scored lower on genetic knowledge. Latino respondents were also more likely to have concerns about the misuse of genomic information, despite both groups having similar views about the value of genomic risk evaluation. CONCLUSION Our results highlight the importance of evaluating sociocultural factors that influence minority patient engagement with genomic medicine in diverse health-care settings.

ObjectiveTo examine whether Disease Activity in Psoriatic Arthritis (DAPSA) reflecting the inflammatory component of psoriatic arthritis (PsA) can predict cardiovascular (CV) events independent of traditional CV risk factors and subclinical carotid atherosclerosis.MethodsA cohort analysis was performed in patients with PsA who had been followed since 2006. The outcome of interest was first CV event. Four different CV disease (CVD) risk scores and DAPSA were computed at baseline. The presence of carotid plaque (CP) and carotid intima-media thickness (CIMT) was also determined in a subgroup of patients using high-resolution ultrasound. The association between DAPSA, CVD risk scores, CP, CIMT and the occurrence of CV events was assessed using Cox proportional hazard models.Results189 patients with PsA (mean age: 48.9 years; male: 104 (55.0%)) were recruited. After a median follow-up of 9.9 years, 27 (14.3%) patients developed a CV event. Higher DAPSA was significantly associated with an increased risk of developing CV events (HR: 1.04, 95% CI (1.01 to 1.08), p=0.009). The association remained significant after adjusting for all CV risk scores in the multivariable models. In the subgroup analysis, 154 patients underwent carotid ultrasound assessment and 23 (14.9%) of them experienced a CV event. CP was associated with increased risk of developing CV events after adjusting for three CV risk scores and DAPSA, with HR ranging from 2.35 to 3.42.ConclusionHigher DAPSA and the presence of CP could independently predict CVD events in addition to traditional CV risk scores in patients with PsA.

3D direct planimetry is increasingly used in clinical practice as a rapid way to measure the mitral valve area (MVA) in patients with rheumatic mitral stenosis (MS) who underwent three-dimensional transesophageal echocardiography (3D-TEE). However, data on its accuracy and reliability are scarce. This study aimed to compare the MVA measurements obtained by 3D direct planimetry to the conventional technique multiplanar reconstruction (MPR) in MS patients using 3D-TEE. We retrospectively included 49 patients with rheumatic MS undergoing clinically-indicated 3D-TEE in the study. We determined the 3D direct planimetry measurements of MVA from the left atria aspect (MVALA) and the left ventricle aspect (MVALV), and compared those with the MPR method (MVAMPR). We also assessed the major and minor diameters of the mitral valve orifice using MPR and 3D direct planimetry. We found an excellent agreement between the MVA measurements obtained by the MPR method and 3D direct planimetry (MVALA and MVALV) [intraclass correlation coefficients (ICC) = 0.951 and 0.950, respectively]. However, the MVAMPR measurements were significantly larger than the MVALA and MVALV (p

Screening questions for sarcopenia used in the community (SARC-F) may be regarded as indicators of exercise tolerance. Observational study. We tested the hypothesis that community-living older people who are screened positive for sarcopenia using the SARC-F tool but without a history of heart failure (HF) have a higher prevalence of cardiac abnormalities compared with those who are SARC-F negative. Participants were recruited from a territory-wide primary care needs assessment for older people based in community centres, and from non-acute hospitals in the same region as the study centre. Participants with a total score of >=4 and who did not have any history of HF were invited to attend for further cardiac assessment. Grip strength, walking speed, and the 6-minute walk test and echocardiography were carried out. Patients with frailty and at least Grade II diastolic dysfunction were considered to have heart failure with preserved ejection fraction (HFpEF) if they also had concomitant elevated N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) of at least 300 pg/ml. Diastolic dysfunction (DD) was significantly associated with SARC-F score >=4 and higher circulating NT-proBNP levels. ROC curves evaluating the predictive values of SARC-F, HGS and gait speed for DD showed that a combination of SARC-F and HGS or gait speed provided significant incremental value in predicting DD. Community living older people with sarcopenia detected using a simple questionnaire have a higher prevalence of DD accompanied by elevated NT proBNP. Addition of hand grip strength or walking speed improve the magnitude of the association. SARC-F may be used as a tool to detect early cardiac dysfunction in the community.

Objective PsA patients who achieved sustained minimal disease activity (sMDA) had less subclinical atherosclerosis progression. The vascular effects of achieving other potential treatment targets, including the PsA Disease Activity Score (PASDAS) and the Disease Activity in PsA (DAPSA) score, remained uncertain. This study aimed to compare the vascular effects of achieving different treatment targets in PsA patients. Method This is a post hoc analysis of a 2 year treat-to-target study aimed at MDA. A total of 101 consecutive PsA patients without overt cardiovascular disease were recruited. High-resolution carotid ultrasound and arterial stiffness markers were assessed annually. Low disease activity (LDA) was defined as MDA, DAPSA ≤14 or PASDAS ≤3.2. Sustained disease control was defined as achieving these targets at each visit from month 12 until month 24. Results Ninety patients [52 male (57.8%), age 50 years (s.d. 11)] who completed 24 months of follow-up were included in this analysis. A total of 44%, 48% and 45% of patients achieved sustained DAPSA LDA (sDAPDA-LDA), sustained PASDAS LDA (sPASDAS-LDA) and sMDA, respectively. Patients who achieved sMDA had significantly less progression of carotid intima-media thickness than those who did not (P = 0.031). Using multivariate analysis, achieving sMDA and sPASDAS-LDA had a protective effect on plaque progression, less increase in total plaque area, reduced mean intima-media thickness and reduced augmentation index after adjusting for covariates. In contrast, no significant differences in the progression of vascular parameters were demonstrated between patients who did or did not achieve sDAPSA-LDA. Conclusion Achieving sMDA/sDASPAS-LDA, but not sDAPSA-LDA, was associated with a protective effect in subclinical atherosclerosis and arterial stiffness progression. A multidimensional domain of disease control might be better in minimizing cardiovascular risk in PsA.

The commonly used left atrial appendage (LAA) occlusion (LAAO) devices, Watchman (Boston Scientific, Marlborough, MA, USA) and Amulet (Abbott, Plymouth, Minnesota, USA), both rely on oversizing for stabilization. Therefore, occluding large LAA (ostium g=31mm for Watchman or landing zone g=31mm for Amulet) are not possible. LAmbre (Lifetech Scientific Co., Shenzhen, China) device has an additional stabilization mechanism by catching the LAA trabeculations using its 8 claws1. This potentially allows LAmbre in occluding large LAA with ostium up to 40mm, i.e. size of its largest cover. The study aimed to evaluate procedural and short-term outcomes of LAmbre device in occluding large LAA.

Background Left ventricular thrombus (LVT) is associated with significant morbidity and mortality. Traditionally treated with anticoagulation by Warfarin, it is unclear if non-vitamin K oral anticoagulants (NOAC) are comparably efficacious and safe. Such data is also scarce in Asian patients. Purpose To compare the clinical efficacy and safety of NOAC with warfarin for managing LVT. Methods Clinical and echocardiographic records of all adult patients with echocardiography-confirmed LVT during January 2011 to January 2020 were retrieved. Any discontinuation of anticoagulation at one year was recorded. Outcomes of patients on NOAC were compared to those on warfarin. The primary outcomes were cumulative mortality and net adverse clinical events (NACE; any of cerebrovascular accident, systemic thromboembolism, intracranial haemorrhage, fatal bleeding, and overt bleeding). Secondary outcomes were complete LVT resolution and percentage reduction in LVT size at three-month follow-up, and the components of NACE. Results In total, 43 patients were included; 28 were treated by warfarin and 15 by NOAC, with mean follow-up periods of 20±12 months and 22±9 months respectively (p=0.522). Significantly fewer NACE were observed in the NOAC cohort (p=0.046; Figure 1), with a trend for lower cumulative mortality (p=0.058; Figure 2). There were no significant differences in the secondary outcomes. Additionally, given resolution of LVT, discontinuation of anticoagulation by one year was not associated with significantly different outcomes. Conclusion NOAC may be an efficacious and safe alternative to warfarin for treating LVT. Further studies are required to confirm our findings and delineate the optimal duration of anticoagulation. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Hong Kong Special Administrative Region Government Health and Medical Research Fund Figure 1Figure 2

Analysis of the cardiac vortex has been used for a deeper understanding of the pathophysiology in heart diseases. However, physiological changes of the cardiac vortex with normal aging are incompletely defined. Vector flow mapping (VFM) is a novel echocardiographic technique based on Doppler and speckle tracking for analysis of the cardiac vortex. Transthoracic echocardiography and VFM analysis were performed in 100 healthy adults (33 men, age = 18–67 years). The intracardiac flow was assessed throughout the cardiac cycle. The size (cross-sectional area) and circulation (equivalent to the integral of normal component of vorticity) of the largest vortices in systole (S-vortex), early diastole (E-vortex), and late diastole (A-vortex) were measured. Peak energy loss (EL) was calculated from information of the velocity vector of intracardiac flow in systole and diastole. With normal aging, the circulation (p = 0.049) of the E-vortex decreased, while that of the A-vortex increased (both p &lt, 0.001). E-vortex circulation correlated directly to e’ (p = 0.003), A-vortex circulation correlated directly to A and a’ (both p &lt, 0.001), and S-vortex circulation correlated directly to s’ (p = 0.032). Despite changes in vortex patterns, energy loss was not significantly different in older individuals. Normal aging is associated with altered intracardiac vortex patterns throughout the cardiac cycle, with the late-diastolic A-vortex becoming physiologically more dominant. Maintained energy efficiency accompanies changes in vortex patterns in aging hearts.

Background Brugada syndrome (BrS) is an inherited ion channelopathy that may predispose affected individuals to atrial cardiomyopathy. We tested the hypothesis that BrS patients have higher degrees of atrial electrophysiological abnormalities compared to controls, and these can be reflected by changes in P-wave parameters determined on the electrocardiogram (ECG). Methods This was a single-center retrospective study comparing BrS patients to age- and gender-matched control subjects. Mean P-wave duration (PWDmean), maximum PWD (PWDmax) and minimum PWD (PWDmin), P-wave dispersion (PWDmax – PWDmin), and P-wave terminal force in V1 (PTFV1) were measured. PWDmax ≥ 120 ms, in the presence and absence of biphasic P-waves in the inferior leads, were termed advanced and partial inter-atrial block (IAB), respectively. Results The proportion of IAB was significantly higher in BrS patients (28/51; 55%) than in control subjects (14/51; 27%; Fisher's Exact test; P Conclusion Atrial conduction abnormalities are frequently observed in BrS. These patients may require monitoring for future development of atrial fibrillation and stroke.

To test the utility of the FRAIL questionnaire as a screening tool for heart failure. Cross sectional study. Chinese older people in Hong Kong. Participants aged 60 years and over were recruited from a territory-wide primary care needs assessment for older people based in community centers as well as two nonacute hospitals. Questionnaire administered included the five-item FRAIL scale, and information regarding sociodemographic data, smoking and alcohol use, history of cardiovascular disease and diabetes, and heart failure symptoms. Handgrip strength, walking speed and 6 minute walk distance were recorded. Cardiac assessment included electrocardiogram, echocardiography, and blood assay for N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). The prevalence of diastolic dysfunction was high, being 52% in the robust group, increasing to 65% in the pre-frail and 85% in the frail group. This finding is accompanied by a corresponding increase in NT-proBNP from 64.18 pg/ml in the robust group, to 118.57 pg/ml in the pre-frail and 167.98 pg/ml in the frail group. Three of the five components of the FRAIL scale, fatigue, resistance and ambulation, were associated with increased odds ratios of diastolic dysfunction among those aged 75 years and older, while resistance alone was associated with increased odds ratio among those less than 75 years old. Frailty is associated with heart failure with preserved ejection fraction (HFpEF), and frailty screening may be used to detect undiagnosed HFpEF. The findings support the proposal that HFpEF be considered a geriatric syndrome.

Objective To investigate the effects of achieving minimal disease activity (MDA) on the progression of subclinical atherosclerosis and arterial stiffness in patients with psoriatic arthritis (PsA). Methods A total of 101 consecutive patients with PsA were recruited for this prospective cohort study. All patients received protocolized treatment targeting MDA for a period of 2 years. High-resolution carotid ultrasound and arterial stiffness markers were assessed annually. The primary outcome measure was the effect of achieving MDA at 12 months (MDA group) on the progression of subclinical atherosclerosis over a period of 24 months. Secondary objectives were to compare the changes in arterial stiffness markers over 24 months between the MDA and non-MDA groups, as well as the changes in subclinical atherosclerosis and arterial stiffness markers in patients who achieved MDA at each visit from month 12 through month 24 (sustained MDA [sMDA]). Results Ninety PsA patients (mean ± SD age 50 ± 11 years, 58% male [n = 52]) who completed 24 months of follow-up were included in this analysis. Fifty-seven patients (63%) had achieved MDA at 12 months. Subclinical atherosclerosis and arterial stiffness outcomes were similar between the MDA and non-MDA groups. Forty-one patients (46%) achieved sMDA. As shown by multivariate analysis, achieving sMDA had a protective effect on plaque progression (odds ratio 0.273 [95% confidence interval 0.088-0.846], P = 0.024), and less of an increase in total plaque area, mean intima-media thickness, and augmentation index values after adjustment for covariates. Conclusion Our results support the recommendation that once MDA is achieved, it should ideally be maintained for a prolonged period in order to prevent progression of carotid atherosclerosis and arterial stiffness in patients with PsA.

Left ventricular hypertrophy (LVH) caused by cardiac variant Fabry disease (FD) is typically late-onset and may mimic LVH caused by abnormal loading conditions. We aimed to determine the prevalence of FD in a non-selective patient population of everyday practice presenting with LVH, including those with hypertension and valve disease. We measured plasma alpha-galactosidase A activity using dried blood spot tests in 499 (age = 66 ± 13 years, 336 men) Hong Kong Chinese patients with LVH defined as maximal LV septal/posterior wall thickness ≥13 mm on echocardiography. Patients with low enzyme activity underwent mutation analysis of the GLA gene. Eight (age = 53−74 years, all men) unrelated patients (1.6%) had low plasma alpha-galactosidase A activity (0.57 ± 0.27 μmol/L wb/hr) and all were confirmed to have the GLA IVS4 + 919G &gt, A mutation. FD patients presented with heart failure (n = 5), heart block (n = 2), ventricular tachycardia (n = 1), chest pain (n = 3), and/or murmur (n = 1). Uncontrolled hypertension (n = 4) and/or severe mitral/aortic valve pathology (n = 2) were frequent. Ethnic subgroups included Teochew (n = 5), Canton (n = 2), and Wenzhou (n = 1). Endomyocardial biopsy (n = 6) revealed hypertrophic myocytes with vacuolization and dense lamellar bodies. Late-onset IVS4 + 919G &gt, A FD is prevalent among Chinese LVH patients, and should be considered as a cause of LVH in adult patients even when hypertension and/or valve pathology are present.

Background Functional mitral regurgitation (FMR) is common in patients with myocardial infarction or dilated cardiomyopathy, and portends a poor prognosis despite guideline-directed medical therapy (GDMT). Surgical or transcatheter mitral repair for FMR from recent randomized clinical trials showed disappointing or conflicting results. Aims To provide an update on the role of surgical repair in the management of FMR. Materials and methods A literature search was conducted utilizing PubMed, Ovid, Web of Science, Embase, and Cochrane Library. The search terms included secondary/FMR, ischemic mitral regurgitation, mitral repair, mitral replacement, mitral annuloplasty, transcatheter mitral repair, and percutaneous mitral repair. Randomized clinical trials over the past decade were the particular focus of the current review. Results Recent data underlined the complexity and poor prognosis of FMR. GDMT and cardiac resynchronization, when indicated, should always be applied. Accurate assessment of the interplay between ventricular geometry and mitral valve function is essential to differentiate proportionate FMR from the disproportionate subgroup, which could be helpful in selecting appropriate transcatheter intervention strategies. Surgical repair, most commonly performed with an undersized ring annuloplasty, remains controversial. Adjunctive valvular or subvalvular repair techniques are evolving and may produce improved results in selected FMR patients. Conclusion FMR resulted from complex valve-ventricular interaction and remodeling. Distinguishing proportionate FMR from disproportionate FMR is important in exploring their underlying mechanisms and to guide medical treatment with surgical or transcatheter interventions. Further studies are warranted to confirm the clinical benefit of appropriate surgical repair in selected FMR patients.

Aims: Psoriatic arthritis (PsA) is associated with accelerated atherosclerosis due to underlying inflammation. Whether inflammatory burden and drugs used to suppress inflammation over time are associated with cardiovascular (CV) events remained unclear. This study aims to examine the time-varying effect of C-reactive protein (CRP) levels and the use of drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) and disease modifying anti-rheumatic drugs, on the risk of CV events independent of traditional CV risk factors in PsA patients. Methods: A retrospective cohort analysis was performed in patients with PsA who were recruited from 2008 to 2015 and followed until the end of 2019. The outcome was occurrence of a first CV event. Framingham risk score (FRS) was used to quantify the traditional CV risk. Cox proportional hazard models with time-varying CRP levels and drugs used were analysed to identify the risk factors for CV events in PsA patients. Results: Two hundred patients with PsA [median age: 47.5 (40.0–56.0); male: 119 (59.5%)] were recruited. After a mean follow-up of 8.8 ± 3.8 years, 30 (15%) patients developed a first CV event. The multivariable Cox regression model showed that time-varying CRP level [hazard ratio (HR) 1.02, 95% confidence interval (CI) 1.00–1.04] and NSAIDs exposure (HR 0.38, 95% CI 0.15–0.96) were significantly associated with CV events after adjusting for baseline FRS (HR 5.06, 95% CI 1.84–13.92). Conclusion: Increased inflammatory burden as reflected by elevated CRP level was associated with increased risk of CV events, while the risk was significantly reduced with NSAIDs use in PsA patients.

Background: Procedural success of transcatheter left atrial appendage closure (LAAC) is dependent on correct device selection. Three-dimensional transesophageal echocardiography (3DTEE) is more accurate than the two-dimensional (2D) modality for evaluation of the complex anatomy of LAA. However, 3D-TEE analysis of LAA is challenging and highly expertise dependent. In this study, we sought to evaluate the feasibility and accuracy of a novel software tool for automated 3D analysis of the LAA using 3D-TEE data. Methods: The intra-procedural 3D TEE data of 158 patients who underwent LAAC were retrospectively analyzed with a novel automated LAA analysis software tool. Based on the 3D TEE data, the software semi-automatically segmented the 3D LAA structure, determined the device landing zone (LZ), and generated measurements of the LZ dimensions and the LAA length, allowing manual editing if necessary. The accuracy of LAA pre-implantation anatomic measurement reproducibility, and time for analysis of the automated software were compared against expert manual 3D analysis. The software feasibility to predict the optimal device size was directly compared to implanted models. Results: Automated 3D analysis of the LAA on 3D-TEE was feasible in all patients. There were excellent agreements between automated and manual measurements of LZ maximal diameter (bias:-0.32, LOA:-3.56; 2.92), area-derived mean diameter (bias:-0.24, LOA:-3.12, 2.64), and LAA depth (bias:0.02, LOA:-3.14; 3.18). Automated 3D analysis, with manual editing if necessary, accurately identified the implanted device size in 90.5% of patients, outperforming 2DTEE (68.9%, p, This work was funded by the projects “NORTE-01-0145-FEDER-000045” and “NORTE-01-0145-FEDER-000059”, supported by Northern Portugal Regional Operational Programme (Norte2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER). It was also funded by national funds, through the FCT – Fundação para a Ciência e Tecnologia and FCT/MCTES in the scope of the project UIDB/05549/2020 and UIDP/05549/2020 and the grant CEECIND/03064/2018. This work was also funded by the Hong Kong Special Administrative Region Government Health and Medical Research Fund (05160976)

Atherosclerosis is an important medical problem of modern society. High environmental tobacco smoke in casino is associated with an accelerated atherogenic process. We have previously shown vitamin B12 and C supplementation improves vascular reactivity and may be beneficial in vascular protection. To evaluate the impact of vitamin supplementation on atherosclerosis (brachial artery reactivity FMD and carotid intima-media thickness IMT) in subjects exposed to high environmental tobacco smoke. Double-blind 2×2 factorial design fashion. Computer randomization in 4 treatment groups: placebo (n=24), vitamin B12 (n=21), vitamin C (n=23) and vitamin B12+C (n=23) groups. 91 passive-smoking casino employees (19.2% male, mean age 45.0±8.2 years). Subjects were randomized to receive vitamin B12 (500µg daily), vitamin C (200mg daily), vitamin B12+C or image-matched placebo capsules for 1 year. Measurement: Brachial FMD and carotid IMT (surrogate atherosclerotic markers) were measured by ultrasound at baseline and on completion at 12 months. 91 passive smoking casino employees (19.2% male, mean age 45.0±8.2 years) were randomized to receive vitamin B12 (500µg daily), vitamin C (200mg daily), vitamin B12+C or image-matched placebo capsules in double-blind 2 × 2 factorial design fashion for 1 year. Brachial FMD and carotid IMT (surrogate atherosclerotic markers) were measured by ultrasound at baseline and 12 months. Of the 78 (85.7%) passive-smoking employees completed the study, 11.5% had hypertension, 5.1% diabetes mellitus and 15.4% hypercholesterolemia. There were no significant changes in their blood pressures, lipid profiles, glucose and body mass index after supplementation for 1 year, but mild decrease in DBP (p

Background Real-time three-dimensional transesophageal echocardiography (3D TEE) has been increasingly used in clinic for fast 3D analysis of cardiac anatomy and function. However, 3D TEE still suffers from the limited field of view (FoV). It is challenging to adopt conventional multi-view fusion methods to 3D TEE images because feature-based registration methods tend to fail in the ultrasound scenario, and conventional intensity-based methods have poor convergence properties and require an iterative coarse-to-fine strategy. Methods A novel multi-view registration and fusion method is proposed to enlarge the FoV of 3D TEE images efficiently. A direct method is proposed to solve the registration problem in the Lie algebra space. Fast implementation is realized by searching voxels on three orthogonal planes between two volumes. Besides, a weighted-average 3D fusion method is proposed to fuse the aligned images seamlessly. For a sequence of 3D TEE images, they are fused incrementally. Results Qualitative and quantitative results of in-vivo experiments indicate that the proposed registration algorithm outperforms a state-of-the-art PCA-based registration method in terms of accuracy and efficiency. Image registration and fusion performed on 76 in-vivo 3D TEE volumes from nine patients show apparent enlargement of FoV (enlarged around two times) in the obtained fused images. Conclusions The proposed methods can fuse 3D TEE images efficiently and accurately so that the whole Region of Interest (ROI) can be seen in a single frame. This research shows good potential to assist clinical diagnosis, preoperative planning, and future intraoperative guidance with 3D TEE.

Background: Papillary fibroelastoma (PFE) is the most common benign cardiac tumor. Because PFEs have the potential to embolize, they typically are surgically excised. Prior studies have suggested that postoperative recurrence of PFE is rare or does not occur. Objectives: To determine the rate at which PFEs recurred after surgical removal and to identify any risk factors associated with recurrence. Methods: Patients with pathologically proven PFE were retrospectively identified from a single center. Patients were included in the study if they had an echocardiographic examination at least 1 year after surgery. Echocardiographic images obtained intraoperatively (after excision) and at dismissal were compared with those of the most recent examination to assess the possibility of PFE recurrence. Results: Ninety eight patients were identified. The mean (SD) duration of follow-up was 5.4 (3.7) years (range, 1-17 years). Twelve patients (12.2%) had echocardiographically proven PFE recurrence. Three patients had the recurrent lesion surgically re-excised, and pathologic analysis showed that 2 were recurrent PFEs and 1 was a Lambl excrescence. Clinical presentation of stroke or TIA was more common for the recurrence patients (for the first PFE) than for the nonrecurrence patients (83% vs 26%; P Conclusions: Contrary to published data, PFEs do recur after surgical excision. This emphasizes the importance of postoperative follow-up with transesophageal echocardiography for identifying recurrent masses. Table. Characteristics of Patients With Recurrent PFE Abbreviations: AV, aortic valve; LA, left atrium; LE, Lambl excrescence; LVOT, left ventricular outflow tract; MV, mitral valve; PV, pulmonary valve; RA, right atrium; RC, right cusp; TV, tricuspid valve. a Corresponds to the same location. b Corresponds to a different location .

Introduction: The genetic mutation IVS4+919G>A commonly found among Chinese is associated with later-onset cardiac variant of Fabry disease (FD). Patients with left ventricular hypertrophy (LVH) may be screened for FD by measuring plasma α-galactosidase activity. Objective: The aim of our study is to determine the prevalence of FD among Chinese LVH patients and to define demographic and echocardiographic predictors of FD. Methods: We measured plasma α-galactosidase activity using dried blood spot test in 500 Hong Kong Chinese patients with LVH (defined as maximal left ventricular septal or posterior wall thickness ≥13 mm on transthoracic echocardiography). LVH and deficiency in α-galactosidase activity prompted genetic analysis of galactosidase alpha gene. Demographic and echocardiographic predictors of FD were analysed. Results: There are 9 (1.8%) of 500 LVH patients (all men, age 53–74 years) had low α-galactosidase activity (0.64±0.32 μmol/L wb/hr) and all were confirmed to have the FD genotype IVS4+919G>A. Among these 9 FD patients, 6 (66.7%) could be traced to the ancestral home Chaozhou (southern part of China), 4 had hypertension, but none exhibited extracardiac manifestations of FD. The left ventricular mass of FD patients ranged from 64.91–811.81 g. Ancestral home Chaozhou (odds ratio, 10.28; 95% confidence Interval, 2.52–41.94; p=0.001) and LVM ≥290 g (odds ratio, 7.39; 95% confidence Interval, 1.94–28.20; p=0.003) were predictors of FD. On receiver operating characteristic curve analysis, sensitivity and specificity of LVM ≥290 g to diagnose FD vs non-FD LVH are 67% and 86.4% respectively (area under curve, 0.8; p=0.002). Conclusion: There is a high prevalence of later-onset cardiac variant FD among Hong Kong Chinese LVH patients that is associated with IVS4+919G>A genotype. Male patients with ancestral home Chaozhou and LVM ≥290 g are at an increased risk of FD among Chinese LVH patients and should be screened with dried blood spot test.

3D printing materials are an important factor in the development of 3D printing technique in the cardiovascular field; however, the type and quality of materials for 3D printing remain a challenge. At present, polymeric materials and biomaterials are the ones mainly applied in the 3D printing cardiovascular field [1]. Of them, polymeric materials are mainly used currently to make cardiovascular demonstration models, preoperative planning models, and training tools, and their tissue mechanical property fidelity is the key [2–4]. The bio-printing materials are mostly used to manufacture the consumable items, such as stent, valve, tissue engineered scaffold, and other consumable items that can mimic physiological function of the heart [5, 6]. Therefore, the future development direction of cardiovascular medical 3D printing will focus on bio-printing that can generate the circulatory system, which can transport blood and nutrients.

Using imaging data of human anatomy, 3D printing technology can be used for computer reconstruction. The data are the input for a 3D printer, and a structural model is constructed, which is convenient for direct visual inspection and operation [1]. Through more than twenty years of development, outstanding progress has been made in oral, maxillofacial, orthopedic, and plastic surgery and other disciplines. Moreover, 3D printing technology has been widely used in implant and tissue design, surgical planning, medical research, and medical education and as a training tool [2, 3]. Because it has broad development prospects, 3D printing has become an important new technology in the manufacturing industry of “Strategic Emerging Industries Classification (2018)” issued by the National Bureau of Statistics.

The coronary artery, which divides into the left coronary artery and the right coronary artery, is the first branch of the ascending aorta. The left coronary artery is a short trunk that originates from the left aortic sinus. It passes through the beginning of the pulmonary artery and the left atrial appendage and travels 3–5 mm along the coronary sulcus to the front of the left side of the heart. It is immediately divided into the anterior descending branch and the circumflex branch. The anterior descending branch descends along the anterior interventricular sulcus, bypassing the apical notch to the diaphragm of the heart, and anastomoses with the posterior interventricular branch of the right coronary artery. The right coronary artery originates from the right aortic sinus, travels along the right coronary sulcus between the root of the pulmonary artery and the right auricle, bypasses the right edge of the heart, continues along the coronary sulcus of the diaphragm, and projects into the posterior descending branch near the atrioventricular junction, that is, the posterior interventricular branch.

Cardiomyopathy is a disease which involves heart tissue and is characterized by abnormal heart structure, heart failure, and arrhythmia, with great heterogeneity and diversity [1]. Cardiomyopathy can be classified into primary cardiomyopathy and secondary cardiomyopathy, and primary cardiomyopathy can be further classified into three types according to the etiology and pathology: dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), and restrictive cardiomyopathy (RCM). DCM and HCM are the two most common clinical phenotypes of primary cardiomyopathy, which are important causes of chronic heart failure and sudden cardiac death (SCD) in young patients. Dilated cardiomyopathy is the most common type of cardiomyopathy, accounting for approximately 60% of all the cases, and is more common in men than women, similar in adults and children. The incidence of dilated cardiomyopathy is approximately 7/100,000 per year, and it is most common among the 20-to-60-year-old age group. Obstructive hypertrophic cardiomyopathy accounts for approximately two-thirds of all hypertrophic cardiomyopathy cases. Epidemiological studies show that the incidence of hypertrophic cardiomyopathy in the normal population is approximately 0.2% and has a clear family hereditary, but a considerable number of patients have no obvious clinical symptoms.