Search

Cardiac hypertrophy is a classical forerunner of heart failure and myocardial structural and metabolic remodeling are closely associated with cardiac hypertrophy. We aim to investigate the characteristics of myocardial structure and central carbon metabolism of cardiac hypertrophy at different stages. Using echocardiography and pathological staining, early and compensatory cardiac hypertrophy were respectively defined as within 7 days and from 7 to 14 days after transverse aortic constriction (TAC) in mice. Among mass-spectrometry-based metabolomics, we identified 45 central carbon metabolites. Differential metabolite analysis showed that six metabolites, including citrate, cis -aconitate and so on, decreased significantly on day 1 after TAC. Ten metabolites, including l-lactate, (S)-2-hydroxyglutarate and so on, were obviously changed on days 10 and 14. Pathway analysis showed that these metabolites were involved in seven metabolic pathways, including carbohydrates, amino acids and so on. Western blot showed the expression of ATP-citrate lyase, malate dehydrogenase 1 and lactate dehydrogenase A in myocardium changed markedly on day 3, while the phosphorylation level of AMP-activated protein kinase did not show significantly difference. We hope our research will promote deeper understanding and early diagnosis of cardiac hypertrophy in clinical practice. All raw data were deposited in MetaboLights (MTBLS10555).

Objective: To treat the fetus presenting with in utero compromise due to a large vein of Galen malformation (VOGM) using glue embolization., Methods: The fetus that was referred for termination of pregnancy at 30 weeks of gestation due to severe cardiomegaly, mild pericardial effusion and large VOGM was evaluated using ultrasound. There was reversed end diastolic flow in the umbilical artery Doppler indicating imminent fetal demise in the premature fetus weighing <1200 g. Considering the request of parents, a treatment similar to recently reported cases of VOGM embolization in utero was attempted as an emergency procedure to salvage the baby. Due to unavailability of coils, financial constraints and urgent need for intervention, n-butyl cyanoacrylate glue with lipiodol was used to embolize the venous outflow of VOGM outflow under ultrasonographic guidance., Results: There was immediate correction of the umbilical artery Doppler waveform with the establishment of a normal flow pattern. The cardiomegaly resolved over 3 weeks and fetal MRI done 2 weeks later showed normal brain architecture with no evidence of hemorrhage or infarction. Pregnancy was continued for 4 weeks after the procedure and terminated at 36 weeks. A female baby weighing 1900 g was delivered by Cesarean section with an Apgar of 8/10. Though initially the baby did well, with mild ventriculomegaly reported on postnatal day 5, she eventually presented at 3 months of age with cardiac failure. As the MRI showed encephalomalacia, due to uncertainty of neurological outcome, further treatment was not pursued by the parents and the baby died a few days later., Conclusion: To our knowledge, this is the first report on the use of glue to treat VOGM prenatally. Though technically successful in correcting the in utero compromise, the baby eventually expired. Cases of in utero embolization using coils and glue have shown success in reversing prenatal pathology and improving survival. However, long-term outcomes including neurological status are yet to be reported., (© 2024 John Wiley & Sons Ltd.)

Background: The post-processing technology of CTA offers significant advantages in evaluating left atrial enlargement (LAE) in patients with persistent atrial fibrillation (PAF). This study aims to identify parameters for rapidly and accurately diagnosing LAE in patients with PAF using CT cross-sections., Methods: Left atrial pulmonary venous (PV) CT was performed to 300 PAF patients with dual-source CT, and left atrial volume (LAV), left atrial anteroposterior diameter (LAD1), left atrial transverse diameter (LAD2), and left atrial area (LAA) were measured in the ventricular end systolic (ES) and middle diastolic (MD). LA index (LAI) = LA parameter/body surface area (BSA). Left atrial volume index (LAVI ES ) > 77.7 ml/m 2 was used as the reference standard for the LAE diagnosis., Results: 227 patients were enrolled in the group, 101 (44.5%) of whom had LAE. LAV ES and LAV MD (r = 0.983), LAVI ES and LAVI MD (r = 0.984), LAA ES and LAVI ES (r = 0.817), LAA MD and LAVI ES (r = 0.814) had strong positive correlations. The area under curve (AUC) showed that all measured parameters were suitable for diagnosing LAE, and the diagnostic efficacy was compared as follows: LAA/LAAI> LAD> the relative value index of LAD, LAD2> LAD1. LAA and LAAI demonstrated comparable diagnostic efficacy, with LAA being more readily available than LAAI., Conclusions: The axial LAA measured by CTA can be served as a parameter for the rapid and accurate diagnosis of LAE in patients with PAF., (© 2024. The Author(s).)

In veterinary medicine, the radiographic assessment of right heart enlargement (RHE) is essentially subjective. The aim of this study was to evaluate the vertebral right heart index (VRHi) as a new quantitative radiographic method to detect RHE in dogs. This was a multicenter, retrospective, observational study, including dogs with RHE and control dogs. All dogs had to have a thoracic radiographic study and a complete echocardiography on the same day. Right heart enlargement was defined as the presence of right atrial enlargement, right ventricular enlargement, and/or hypertrophy based on echocardiography. For the radiographic study, all the radiographic views available for each case were considered for measurement: right lateral (RL), left lateral (LL), ventrodorsal (VD), and dorsoventral (DV). The VRHi was measured using LL, RL, VD, and DV views. A total of 204 dogs were included: 91 dogs with RHE and 113 control dogs. The VRHi (RL), the VRHi (LL), and the VRHi (VD) were significantly greater in dogs with RHE compared with controls (P < .0001). The best diagnostic accuracy was observed for VRHi (LL) (area under the curve [AUC] 0.86, P < .0001; cutoff ≥ 3.5 vertebrae, sensitivity [Se] 71%, specificity [Sp] 89%), followed by VRHi (RL) (AUC 0.85, P < .0001; cutoff ≥ 3.5 vertebrae, Se 68%, Sp 86%) and VRHi (VD) (AUC 0.80, P = .0004; cutoff ≥ 3.0 vertebrae, Se 57%, Sp 95%). In conclusion, the lateral VRHi in LL and RL and the VD VRHi could represent useful radiological tools for the detection of RHE in dogs., (© 2024 American College of Veterinary Radiology.)

Cardiomegaly is among the disorders categorized by a structural enlargement of the heart by any of the situations including pregnancy, resulting in damage to heart muscles and causing trouble in normal heart functioning. Cardiomegaly can be defined in terms of dilatation with an enlarged heart and decreased left or biventricular contraction. The genetic origin of cardiomegaly is becoming more evident due to extensive genomic research opening up new avenues to ensure the use of precision medicine. Cardiomegaly is usually assessed by using an array of radiological modalities, including computed tomography (CT) scans, chest X-rays, and MRIs. These imaging techniques have provided an important opportunity for the physiology and anatomy of the heart. This review aims to highlight the complexity of cardiomegaly, highlighting the contribution of both ecological and genetic variables to its progression. Moreover, we further highlight the worth of precise clinical diagnosis, which comprises blood biomarkers and electrocardiograms (EKG ECG), demonstrating the significance of distinguishing between numerous basic causes. Finally, the analysis highlights the extensive variation of treatment lines, such as lifestyle modifications, prescription drugs, surgery, and implantable devices, although highlighting the critical need for individualized and personalized care., Competing Interests: Declaration of competing interest The authors declared that they have no competing interests among them., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Cancer is associated with an increased risk of atrial fibrillation. Whether cancer is also associated with atrial cardiopathy, another atrial pathology associated with heightened ischemic stroke risk, is uncertain., Methods: We conducted a retrospective cross-sectional study among consecutive patients hospitalized with acute ischemic stroke at a quaternary care center in New York, United States from 2011 through 2016. The study exposure was active cancer. The study outcome was atrial cardiopathy, defined as a left atrial volume index ≥35 mL/m 2 on echocardiography. We used multivariable logistic regression, adjusting for baseline characteristics, to evaluate the relationship between cancer (active or historical) and atrial cardiopathy. We performed a subgroup analysis among patients with embolic stroke of undetermined source (ESUS)., Results: The final cohort included 1104 patients with acute ischemic stroke, of whom 10 % had active cancer and 47 % had atrial cardiopathy. Patients with atrial cardiopathy, compared to those without, were older (median age, 77 versus 68 years), and more frequently had hypertension, coronary disease, and atrial fibrillation. Active cancer was present in 9.6 % of patients with atrial cardiopathy (n = 50/520) and 10.4 % of patients without (n = 61/584). There was no association between active cancer and atrial cardiopathy among the overall ischemic stroke cohort (adjusted odds ratio [OR], 0.91; 95 % confidence interval [CI], 0.60-1.37) nor in patients with ESUS (aOR, 0.64; 95 % CI, 0.30-1.36). When the cancer exposure was broadened to include any history of cancer (n = 236, 21.4 %), there still was no significant association with atrial cardiopathy (aOR, 0.93; 95 % CI, 0.68-1.25)., Conclusions: When defining atrial cardiopathy by left atrial volume, we did not find an association between cancer and atrial cardiopathy in patients with ischemic stroke, including among those with ESUS. Future studies, evaluating other atrial cardiopathy biomarkers and settings, are needed to further investigate any potential link between cancer and atrial cardiopathy., Competing Interests: Declaration of competing interest Dr. Beyeler has received research support from the University of Bern, Switzerland. Dr. Navi has received personal fees for serving on an adjudication committee for MindRhythm Inc. Dr. Kamel reports serving as a PI for the ARCADIA trial (NIH/NINDSU01NS095869), which received in-kind study drug from the BMS-Pfizer Alliance for Eliquis® and ancillary study support from Roche Diagnostics; other funding from NIH (R01HL144541, R01NS123576, U01NS106513); serving as Deputy Editor for JAMA Neurology; serving on clinical trial steering/executive committees for Medtronic, Janssen, and Javelin Medical; serving on endpoint adjudication committees for AstraZeneca, Novo Nordisk, and Boehringer Ingelheim; and household ownership interests in TETMedical, Spectrum Plastics Group, and Burke Porter Group. The other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of competing interest The authors declare no conflict of interest.

Background: Preterm delivery is associated with cardiovascular remodeling and dysfunction in children and adults. However, it is unknown whether these effects are caused by the neonatal consequences of preterm birth or if these are already present in utero., Objective: We evaluated fetal cardiac morphology and function in fetuses of mothers admitted for preterm labor or preterm prelabor rupture of membranes and the association of these changes with the presence of intra-amniotic infection and/or inflammation., Study Design: In this prospective cohort study, fetal echocardiography and amniocentesis were performed at admission in singleton pregnant women with preterm labor and/or preterm prelabor rupture of membranes between 24.0 and 34.0 weeks' gestation with (intra-amniotic infection and/or inflammation group, n=41) and without intra-amniotic infection and/or inflammation (non-intra-amniotic infection and/or inflammation, n=54). Controls (n=48) were outpatient pregnant women without preterm labor or preterm prelabor rupture of membranes. Intra-amniotic infection was defined by a positive amniotic fluid culture or positive 16S ribosomal RNA gene. Intra-amniotic inflammation was defined by using the amniotic fluid interleukin-6 cutoff levels previously reported by our group being >1.43 ng/mL in preterm prelabor rupture of membranes and >13.4 ng/mL in preterm labor. Fetal cardiac morphology and function was evaluated using echocardiography, and troponin-I and N-terminal pro-brain natriuretic peptide concentrations were measured in amniotic fluid from women with preterm labor or preterm prelabor rupture of membranes and compared with 20 amniotic fluid Biobank samples obtained for reasons other than preterm labor or preterm prelabor rupture of membranes or cardiac pathology. The data were adjusted for the estimated fetal weight below the 10th percentile and for preterm prelabor rupture of membranes at admission and also for gestational age at amniocentesis when amniotic fluid biomarkers were compared., Results: From 2018 to 2021, 143 fetuses were included; 95 fetuses were from mothers admitted with a diagnosis of preterm labor or preterm prelabor rupture of membranes, and among those, 41 (28.7%) were in the intra-amniotic infection and/or inflammation group and 54 (37.8%) were in the non-intra-amniotic infection and/or inflammation group. A total of 48 (33.6%) fetuses were included in the control group. Fetuses with preterm labor and/or preterm prelabor rupture of membranes had signs of subclinical cardiac concentric hypertrophy (median left wall thickness of 0.93 [interquartile range, 0.72-1.16] in the intra-amniotic infection and/or inflammation group; 0.79 [0.66-0.92] in the non-intra-amniotic infection and/or inflammation group; and 0.69 [0.56-0.83] in controls; P<.001) and diastolic dysfunction (tricuspid A duration 0.23 seconds [0.21-0.25], 0.24 [0.22-0.25], and 0.21 [0.2-0.23]; P=.007). Systolic function was similar among groups. Higher values of amniotic fluid troponin I (1413 pg/mL [927-2334], 1190 [829-1636], and 841 [671-959]; P<.001) and N-terminal pro-brain natriuretic peptide were detected (35.0%, 17%, and 0%; P=.005) in fetuses with preterm labor or preterm prelabor rupture of membranes when compared with the control group. The highest N-terminal pro-brain natriuretic peptide concentrations were found in the intra-amniotic infection and/or inflammation group., Conclusion: Fetuses with preterm labor or preterm prelabor rupture of membranes showed signs of cardiac remodeling and subclinical dysfunction, which were more pronounced in those exposed to intra-amniotic infection and/or inflammation. These findings support that the cardiovascular effects observed in children and adults born preterm have, at least in part, a prenatal origin., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Competing Interests: Conflict of interest: None declared.

Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Pressure overload-induced hypertrophy compromises cardiac stretch-induced compliance (SIC) after acute volume overload (AVO). We hypothesized that SIC could be enhanced by physiological hypertrophy induced by pregnancy's chronic volume overload. This study evaluated SIC-cardiac adaptation in pregnant women with or without cardiovascular risk (CVR) factors. Thirty-seven women (1st trimester, 1 st T) and a separate group of 31 (3rd trimester, 3 rd T) women [healthy or with CVR factors (obesity and/or hypertension and/or with gestational diabetes)] underwent echocardiography determination of left ventricular end-diastolic volume (LVEDV) and E/e' before (T0), immediately after (T1), and 15 min after (T2; SIC) AVO induced by passive leg elevation. Blood samples for NT-proBNP quantification were collected before and after the AVO. Acute leg elevation significantly increased inferior vena cava diameter and stroke volume from T0 to T1 in both 1 st T and 3 rd T, confirming AVO. LVEDV and E/e' also increased immediately after AVO (T1) in both 1 st T and 3 rd T. SIC adaptation (T2, 15 min after AVO) significantly decreased E/e' in both trimesters, with additional expansion of LVEDV only in the 1 st T. NT-pro-BNP increased slightly after AVO but only in the 1 st T. CVR factors, but not parity or age, significantly impacted SIC cardiac adaptation. A distinct functional response to SIC was observed between 1 st T and 3 rd T, which was influenced by CVR factors. The LV of 3 rd T pregnant women was hypertrophied, showing a structural limitation to dilate with AVO, whereas the lower LV filling pressure values suggest increased diastolic compliance. NEW & NOTEWORTHY The sudden increase of volume overload triggers an acute myocardial stretch characterized by an immediate rise in contractility by the Frank-Starling mechanism, followed by a progressive increase known as the slow force response. The present study is the first to characterize echocardiographically the stretch-induced compliance (SIC) mechanism in the context of physiological hypertrophy induced by pregnancy. A distinct functional adaptation to SIC was observed between first and third trimesters, which was influenced by cardiovascular risk factors.

Objective: We aimed to determine whether exposure to severe maternal preeclampsia (PE) in very low birth weight (VLBW) infants is associated with hypertrophic cardiac changes and altered hemodynamics., Study Design: Case-control study of VLBW infants born at Los Angeles General Medical Center from May 2015 to August 2023, who had an echocardiogram within the first 7 days of life. Cases were infants exposed to maternal PE and controls were infants not exposed to maternal PE matched by birth weight (BW) 1:1. Laboratory, placental pathology results, hemodynamic data and clinical outcomes were collected and compared between cases and control infants., Results: A total of 43 cases matched by BW with control infants were studied. There were no significant anatomical cardiac changes by echocardiography between cases and control infants. Cases had significantly higher blood pressure within the first 72 hours of life and lower ejection fraction (EF), fractional shortening, and peak systolic flow velocity through their patent ductus arteriosus (PDA) within the first week of life. Cases were more likely to be smaller despite being born at a later gestational age (GA), as well as small for GA with placental weight less than 10th percentile compared to control infants., Conclusion: Our findings indicate that infants born to mothers with PE have higher systemic vascular resistance as evidenced by elevated blood pressure, and lower EF and shortening fraction and higher pulmonary vascular resistance as evidenced by lower peak flow velocity through the PDA. We did not observe hypertrophic cardiac changes in exposed infants. These findings should be considered in clinical decision-making during management of these infants., Key Points: · VLBW infants exposed to severe PE have higher rate of Small for gestational age and smaller placentas.. · VLBW infants exposed to severe PE have higher systemic vascular resistance during transitional period and lower EF and fractional shortening.. · VLBW infants exposed to severe PE have higher pulmonary vascular resistance.., Competing Interests: None declared., (Thieme. All rights reserved.)

The successful integration of neural networks in a clinical setting is still uncommon despite major successes achieved by artificial intelligence in other domains. This is mainly due to the black box characteristic of most optimized models and the undetermined generalization ability of the trained architectures. The current work tackles both issues in the radiology domain by focusing on developing an effective and interpretable cardiomegaly detection architecture based on segmentation models. The architecture consists of two distinct neural networks performing the segmentation of both cardiac and thoracic areas of a radiograph. The respective segmentation outputs are subsequently used to estimate the cardiothoracic ratio, and the corresponding radiograph is classified as a case of cardiomegaly based on a given threshold. Due to the scarcity of pixel-level labeled chest radiographs, both segmentation models are optimized in a semi-supervised manner. This results in a significant reduction in the costs of manual annotation. The resulting segmentation outputs significantly improve the interpretability of the architecture's final classification results. The generalization ability of the architecture is assessed in a cross-domain setting. The assessment shows the effectiveness of the semi-supervised optimization of the segmentation models and the robustness of the ensuing classification architecture., (© 2024. The Author(s).)

Accurate identification and localization of multiple abnormalities are crucial steps in the interpretation of chest X-rays (CXRs); however, the lack of a large CXR dataset with bounding boxes severely constrains accurate localization research based on deep learning. We created a large CXR dataset named CXR-AL14, containing 165,988 CXRs and 253,844 bounding boxes. On the basis of this dataset, a deep-learning-based framework was developed to identify and localize 14 common abnormalities and calculate the cardiothoracic ratio (CTR) simultaneously. The mean average precision values obtained by the model for 14 abnormalities reached 0.572-0.631 with an intersection-over-union threshold of 0.5, and the intraclass correlation coefficient of the CTR algorithm exceeded 0.95 on the held-out, multicentre and prospective test datasets. This framework shows an excellent performance, good generalization ability and strong clinical applicability, which is superior to senior radiologists and suitable for routine clinical settings., (© 2024. The Author(s).)

Objectives: To assess whether right atrial enlargement (RAE) on electrocardiogram (ECG) correlates with true RAE on echocardiogram in previously healthy young patients and to understand which patients with RAE on ECG may warrant additional testing., Study Design: A single-center, retrospective review of previously healthy young patients with (1) ECGs that were read as RAE by a pediatric cardiologist and (2) echocardiograms obtained within 90 days of the ECG. ECGs were reviewed to confirm RAE and determine which leads met criteria. The echocardiograms were then reviewed and RA measurements with z scores obtained. A z score >2 was considered positive for RAE on echocardiogram., Results: In total, 162 patients with median age 10.8 years were included in the study. A total of 23 patients had true RAE on echocardiogram, giving a positive predictive value (PPV) of 14%. In patients <1 year of age, the PPV increased to 35%. In patients older than 1 year, the PPV was low at 7%. Patients with true RAE were more likely to meet criteria for RAE in the anterior precordial leads (V1-V3) (48% vs 5%, P < .001) and meet criteria for right ventricular hypertrophy (22% vs 6%, P = .023)., Conclusion: Our findings show that RAE on ECG has a low PPV for RAE on echocardiogram in previously healthy young patients. The highest yield for RAE on echocardiogram was observed in patients who were <1 year of age, had RAE in the anterior precordial leads, or displayed right ventricular hypertrophy on ECG., Competing Interests: Declaration of Competing Interest Statistical analysis for this project was supported by National Institutes of Health grant UL1-TR-001857. No additional funding was secured for this study. The authors have no conflicts of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Cardiac disease is one of the leading causes of death in dogs. Automatic cardiomegaly detection has great significance in helping clinicians improve the accuracy of the diagnosis process. Deep learning methods show promising results in improving cardiomegaly classification accuracy, while they are still not widely applied in clinical trials due to the difficulty in mapping predicted results with input radiographs. To overcome these challenges, we first collect large-scale dog heart X-ray images. We then develop a dog heart labeling tool and apply a few-shot generalization strategy to accelerate the label speed. We also develop a regressive vision transformer model with an orthogonal layer to bridge traditional clinically used VHS metric with deep learning models. Extensive experimental results demonstrate that the proposed model achieves state-of-the-art performance., (© 2023. The Author(s).)

Background: Differentiating cardiogenic vs noncardiogenic causes of respiratory signs can be challenging when echocardiography is unavailable. Radiographic vertebral left atrial size (VLAS) and vertebral heart size (VHS) have been shown to predict echocardiographic left heart size, with VLAS specifically estimating left atrial size., Hypothesis/objectives: Compare the diagnostic accuracy of VLAS and VHS to predict left-sided congestive heart failure (CHF) in dogs presenting with respiratory signs., Animals: One-hundred fourteen dogs with respiratory signs and radiographic pulmonary abnormalities., Methods: Retrospective cross-sectional study. Dogs had to have an echocardiogram and thoracic radiographs obtained within 24 hours. Diagnosis of CHF was confirmed based on the presence of respiratory signs, cardiac disease, LA enlargement, and cardiogenic pulmonary edema., Results: Fifty-seven dogs had CHF and 57 did not have CHF. Compared to VHS (area under the curve [AUC] 0.85; 95% confidence interval [CI], 0.77-0.91), VLAS was a significantly (P = .03) more accurate predictor of CHF (AUC, 0.92; 95% CI, 0.85-0.96). Optimal cutoff for VLAS was >2.3 vertebrae (sensitivity, 93.0%; specificity, 82.5%). Murmur grade (P = .02) and VLAS (P < .0001) were independently associated with CHF and VHS was not. Increased VHS (54%) was significantly (P = .01) more common than increased VLAS (24%) in dogs without CHF. Results were similar in a subsample of older and smaller dogs., Conclusions and Clinical Importance: When echocardiography is unavailable, VLAS and murmur grade have clinically utility to aid in differentiating cardiogenic from noncardiogenic respiratory signs. These findings might be especially useful to help rule out CHF in dogs with increased VHS that present with respiratory signs., (© 2023 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Purpose: This paper presents a hierarchical modeling approach for estimating cardiomyocyte major and minor diameters and intracellular volume fraction (ICV) using diffusion-weighted MRI (DWI) data in ex vivo mouse hearts., Methods: DWI data were acquired on two healthy controls and two hearts 3 weeks post transverse aortic constriction (TAC) using a bespoke diffusion scheme with multiple diffusion times ( Δ $$ \Delta $$ ), q-shells and diffusion encoding directions. Firstly, a bi-exponential tensor model was fitted separately at each diffusion time to disentangle the dependence on diffusion times from diffusion weightings, that is, b-values. The slow-diffusing component was attributed to the restricted diffusion inside cardiomyocytes. ICV was then extrapolated at Δ = 0 $$ \Delta =0 $$ using linear regression. Secondly, given the secondary and the tertiary diffusion eigenvalue measurements for the slow-diffusing component obtained at different diffusion times, major and minor diameters were estimated assuming a cylinder model with an elliptical cross-section (ECS). High-resolution three-dimensional synchrotron X-ray imaging (SRI) data from the same specimen was utilized to evaluate the biophysical parameters., Results: Estimated parameters using DWI data were (control 1/control 2 vs. TAC 1/TAC 2): major diameter-17.4 μ $$ \mu $$ m/18.0 μ $$ \mu $$ m versus 19.2 μ $$ \mu $$ m/19.0 μ $$ \mu $$ m; minor diameter-10.2 μ $$ \mu $$ m/9.4 μ $$ \mu $$ m versus 12.8 μ $$ \mu $$ m/13.4 μ $$ \mu $$ m; and ICV-62%/62% versus 68%/47%. These findings were consistent with SRI measurements., Conclusion: The proposed method allowed for accurate estimation of biophysical parameters suggesting cardiomyocyte diameters as sensitive biomarkers of hypertrophy in the heart., (© 2023 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

In our paper, we simulated cardiac hypertrophy with the use of shell elements in parametric and echocardiography-based left ventricle (LV) models. The hypertrophy has an impact on the change in the wall thickness, displacement field and the overall functioning of the heart. We computed both eccentric and concentric hypertrophy effects and tracked changes in the ventricle shape and wall thickness. Thickening of the wall was developed under the influence of concentric hypertrophy, while the eccentric hypertrophy produces wall thinning. To model passive stresses we used the recently developed material modal based on the Holzapfel experiments. Also, our specific shell composite finite element models for heart mechanics are much smaller and simpler to use with respect to conventional 3D models. Furthermore, the presented modeling approach of the echocardiography-based LV can serve as the basis for practical applications since it relies on the true patient-specific geometry and experimental constitutive relationships. Our model gives an insight into hypertrophy development in realistic heart geometries, and it has the potential to test medical hypotheses regarding hypertrophy evolution in a healthy and heart with a disease, under the influence of different conditions and parameters., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Building a reliable and precise model for disease classification and identifying abnormal sites can provide physicians assistance in their decision-making process. Deep learning based image analysis is a promising technique for enriching the decision making process, and accordingly strengthening patient care. This work presents a convolutional attention mapping deep learning model, Cardio-XAttentionNet, to classify and localize cardiomegaly effectively. We revisit the global average pooling (GAP) system and add a weighting term to develop a light and effective Attention Mapping Mechanism (AMM). The model enables the classification of cardiomegaly from chest X-rays through image-level classification and pixel-level localization only from image-level labels. We leverage some of the advanced ConvNet architectures as a backbone-model of the proposed attention mapping network to build Cardio-XAttentionNet. The proposed model is trained on ChestX-Ray14, which is a publicly accessible chest X-ray dataset. The best single model achieves an overall precision, recall, F-1 measure and area under curve (AUC) scores of 0.87, 0.85, 0.86 and 0.89, respectively, for the classification of the cardiomegaly. The results also demonstrate that the Cardio-XAttentionNet model well captures the cardiomegaly class information at image-level as well as localization at pixel-level on chest x-rays. A comparative analysis between the proposed AMM and existing GAP based models shows that the proposed model achieves a state-of-the-art performance on this dataset for cardiomegaly detection using a single model., (© 2023. The Author(s).)

Thoracic radiography is commonly used to assess the size of the heart and diagnose cardiac disease in ferrets. Several standardized radiographic heart size indicators have been introduced in this species and values in healthy ferrets have been reported. To date, none of these indicators has been tested in ferrets with cardiac disease. The aim of this prospective and retrospective, analytical observational design study was to assess the accuracy of the modified vertebral heart score (mVHS) and the cardio-vertebral ratio (CVR) in the radiographic detection of cardiomegaly in ferrets. Thoracic radiographs of 24 ferrets with confirmed heart diseases, 22 ferrets with non-cardiac diseases and normal-sized hearts on echocardiogram, and 24 healthy ferrets were mixed and examined by three independent and blinded radiologists who measured mVHS and CVR in right lateral (RL) and ventrodorsal (VD) radiographs. For all readers, ferrets with cardiac disease had significantly higher mVHS and CVR than ferrets without cardiac disease on echocardiography. Optimal cut-points for predicting cardiac enlargement were 6.25 vertebrae and 7.25 vertebrae for RL-mVHS and VD-mVHS, and 1.58 and 1.80 for RL-CVR and VD-CVR, respectively. Using these cut-points, the accuracy was good for indicators measured in RL radiographs (92.9% for RL-mVHS; 91.4% for RL-CVR) and moderate for indicators measured in VD radiographs (88.6% for VD-mVHS; 85.7% for VD-CVR). Findings supported the use of mVHS and CVR for evaluating the size of the heart in diseased ferrets, with caution in values interpretation when pericardial fat prevents precise delineation of the cardiac silhouette contour especially on VD radiographs., (© 2022 American College of Veterinary Radiology.)

Objective: To investigate heart size on chest X-ray via cardiothoracic ratio, and to correlate it with echocardiographic measurements., Methods: The comparative analytical, cross-sectional study was conducted at the Pakistan Navy Station Shifa Hospital, Karachi, between January 2021 and July 2021. The radiological parameters were measured on chest X-rays posterior-anterior view, and the echocardiographic parameters were measured using 2-dimensional transthoracic echocardiography. The absence or presence of cardiomegaly on both imaging modalities was modelled as a binary categorical variable and compared. Data was analysed using SPSS 23., Results: Of the 79 participants, 44(55.7%) were males and 35(44.3%) were females. The mean age of the sample was 52.71±14.54 years. There were 28(35.44%) enlarged hearts on chest X-ray and 46(58.22%) on echocardiography. The sensitivity and specificity of chest X-ray were 54.35% and 90.90%, respectively. The positive and negative predictive values were 89.28% and 58.82%, respectively. The accuracy of chest X-ray in identifying an enlarged heart was 69.62%., Conclusions: The cardiac silhouette on a chest X-ray could demonstrate heart size through simple measurements with high specificity and reasonable accuracy. However, a normal heart size on chest X-ray may not have a normal function.

The authors describe a case of fetal isolated right atrial enlargement or IDRA (idiopathic dilatations of the right atrium) evident in third trimester, complicated by arrhythmia in the female infant during the 1° month of life with ECG diagnosis of Wolf-Parkinson-White syndrome (WPW). The eldest sister died at 6 years because of an arrhythmia with the same diagnosis of WPW. The review of the literature on IDRA frequently shows a familial genetic aggregation. The pathogenetic mechanism underlying the dilation of the right atrium could consist of a myopathy or electrical conduction disorder. The exclusive involvement of the right atrium may be due to the increased pressure in the fetal right atrium. On the basis of our case and after review of the literature, we must be careful in defining as physiological the enlargement of the right fetal atrium in the third trimester of pregnancy. The ultrasound sign of IDRA may be a fetal prodrome of SIDS (sudden infant death syndrome).

The number of patients with heart failure and related deaths is rapidly increasing worldwide, making it a major problem. Cardiac hypertrophy is a crucial preliminary step in heart failure, but its treatment has not yet been fully successful. In this study, we established a system to evaluate cardiomyocyte hypertrophy using a deep learning-based high-throughput screening system and identified drugs that inhibit it. First, primary cultured cardiomyocytes from neonatal rats were stimulated by both angiotensin II and endothelin-1, and cellular images were captured using a phase-contrast microscope. Subsequently, we used a deep learning model for instance segmentation and established a system to automatically and unbiasedly evaluate the cardiomyocyte size and perimeter. Using this system, we screened 100 FDA-approved drugs library and identified 12 drugs that inhibited cardiomyocyte hypertrophy. We focused on ezetimibe, a cholesterol absorption inhibitor, that inhibited cardiomyocyte hypertrophy in a dose-dependent manner in vitro. Additionally, ezetimibe improved the cardiac dysfunction induced by pressure overload in mice. These results suggest that the deep learning-based system is useful for the evaluation of cardiomyocyte hypertrophy and drug screening, leading to the development of new treatments for heart failure., (Copyright © 2022. Published by Elsevier Inc.)

Objective: A set of cardiac MRI short-axis image dataset is constructed, and an automatic segmentation based on an improved SegNet model is developed to evaluate its performance based on deep learning techniques., Methods: The Affiliated Hospital of Qingdao University collected 1354 cardiac MRI between 2019 and 2022, and the dataset was divided into four categories: for the diagnosis of cardiac hypertrophy and myocardial infraction and normal control group by manual annotation to establish a cardiac MRI library. On the basis, the training set, validation set and test set were separated. SegNet is a classical deep learning segmentation network, which borrows part of the classical convolutional neural network, that pixelates the region of an object in an image division of levels. Its implementation consists of a convolutional neural network. Aiming at the problems of low accuracy and poor generalization ability of current deep learning frameworks in medical image segmentation, this paper proposes a semantic segmentation method based on deep separable convolutional network to improve the SegNet model, and trains the data set. Tensorflow framework was used to train the model and the experiment detection achieves good results., Results: In the validation experiment, the sensitivity and specificity of the improved SegNet model in the segmentation of left ventricular MRI were 0.889, 0.965, Dice coefficient was 0.878, Jaccard coefficient was 0.955, and Hausdorff distance was 10.163 mm, showing good segmentation effect., Conclusion: The segmentation accuracy of the deep learning model developed in this paper can meet the requirements of most clinical medicine applications, and provides technical support for left ventricular identification in cardiac MRI., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest for this paper., (Copyright © 2022. Published by Elsevier B.V.)

Purpose: We aimed to characterize novel coronavirus infections based on imaging [chest X-ray and chest computed tomography (CT)] at the time of admission., Materials and Methods: We extracted data from 396 patients with laboratory-confirmed COVID-19 who were managed at 68 hospitals in Japan from January 25 to September 2, 2020. Case patients were categorized as severe (death or treatment with invasive ventilation during hospitalization) and non-severe groups. The imaging findings of the groups were compared by calculating odds ratios (ORs) and 95% confidence intervals (95% CIs), adjusted for sex, age, and hospital size (and radiographic patient positioning for cardiomegaly). Chest X-ray and CT scores ranged from 0 to 72 and 0 to 20, respectively. Optimal cut-off values for these scores were determined by a receiver-operating characteristic (ROC) curve analysis., Results: The median age of the 396 patients was 48 years (interquartile range 28-65) and 211 (53.3%) patients were male. Thirty-two severe cases were compared to 364 non-severe cases. At the time of admission, abnormal lesions on chest X-ray and CT were mainly observed in the lower zone/lobe. Among severe cases, abnormal lesions were also seen in the upper zone/lobe. After adjustment, the total chest X-ray and CT score values showed a dose-dependent association with severe disease. For chest X-ray scores, the area under the ROC curve (AUC) was 0.91 (95% CI = 0.86-0.97) and an optimal cut-off value of 9 points predicted severe disease with 83.3% sensitivity and 84.7% specificity. For chest CT scores, the AUC was 0.94 (95% CI = 0.89-0.98) and an optimal cut-off value of 11 points predicted severe disease with 90.9% sensitivity and 82.2% specificity. Cardiomegaly was strongly associated with severe disease [adjusted OR = 24.6 (95% CI = 3.7-166.0)]., Conclusion: Chest CT and X-ray scores and the identification of cardiomegaly could be useful for classifying severe COVID-19 on admission., (© 2022. The Author(s).)

Aortic banding in mice is one of the most commonly used experimental models for cardiac pressure overload-induced cardiac hypertrophy and the induction of heart failure. The previously used technique is based on a threaded suture around the aortic arch tied over a blunted 27 G needle to create stenosis. This method depends on the surgeon manually tightening the thread and, thus, leads to high variance in the diameter size. A newly refined method described by Melleby et al. promises less variance and more reproducibility after surgery. The new technique, o-ring- aortic banding (ORAB), uses a non-slip rubber ring instead of a suture with a thread, resulting in reduced variation in pressure overload and reproducible phenotypes of cardiac hypertrophy. During surgery, the o-ring is placed between the brachiocephalic and left carotid arteries. Successful constriction is confirmed by echocardiography. After 1 day, correct placement of the ring results in an increased flow velocity in the transverse aorta over the o-ring-induced stenosis. After 2 weeks, impaired cardiac function is proven by decreased ejection fraction and increased wall thickness. Importantly, besides less variance in the diameter size, ORAB is associated with lower intra- and post-operative mortality rates compared with transverse aortic constriction (TAC). Thus, ORAB represents a superior method to the commonly used TAC surgery, resulting in more reproducible results and a possible reduction in the number of animals needed.

Objectives: Hyperthyroidism frequently affects middle-to-older-aged cats that can present with cardiorespiratory signs. The effects of hyperthyroidism on cardiac size and function have been previously documented. Anecdotally, pulmonary hyperinflation identified on thoracic radiographs may also be associated with hyperthyroidism; however, there is no literature to support this claim. The goal of this study was to determine any association between hyperthyroidism, pulmonary hyperinflation and cardiomegaly with the following hypotheses: (1) hyperthyroid cats would not have evidence of radiographic pulmonary hyperinflation compared with control cats; and (2) hyperthyroid cats were more likely to have evidence of radiographic cardiomegaly than control cats., Methods: In this retrospective case-control study, the thoracic radiographs of 52 hyperthyroid cats and 46 non-hyperthyroid cats were evaluated for subjective and objective measurements of pulmonary hyperinflation and cardiomegaly., Results: There were no statistically significant differences between hyperthyroid and non-hyperthyroid cats for any variable indicative of pulmonary hyperinflation. The mean ± SD vertebral heart score on lateral views for hyperthyroid cats was 7.75 ± 0.53 and for control cats was 7.55 ± 0.54, which was significantly different ( P  = 0.05). Among all cats, a more severe total elevation in thyroxine (T4) was correlated with a larger vertebral heart score on lateral views (Spearman's correlation coefficient = 0.23, P  = 0.02)., Conclusions and Relevance: While the results of this study suggest that hyperthyroid cats are more likely to have a larger vertebral heart score on lateral views than control cats, the clinical relevance of this finding is unclear given the large degree of overlap between hyperthyroid and non-hyperthyroid cats. In addition, among all cats, a greater total T4 elevation was weakly correlated with a larger vertebral heart score. Hyperthyroidism is not associated with radiographic pulmonary hyperinflation and is an unlikely differential for this radiographic finding.

Since most of degenerative canine heart diseases accompany cardiomegaly, early detection of cardiac enlargement is main priority healthcare issue for dogs. In this study, we developed a new deep learning-based radiographic index quantifying canine heart size using retrospective data. The proposed "adjusted heart volume index" (aHVI) was calculated as the total area of the heart multiplied by the heart's height and divided by the fourth thoracic vertebral body (T4) length from simple lateral X-rays. The algorithms consist of segmentation and measurements. For semantic segmentation, we used 1000 dogs' radiographic images taken between Jan 2018 and Aug 2020 at Seoul National University Veterinary Medicine Teaching Hospital. The tversky loss functions with multiple hyperparameters were used to capture the size-unbalanced regions of heart and T4. The aHVI outperformed the current clinical standard in predicting cardiac enlargement, a common but often fatal health condition for small old dogs., (© 2022. The Author(s).)

Noninvasive imaging of cardiac fibrosis is important for early diagnosis and intervention in chronic heart diseases. Here, we investigated whether noninvasive, contrast agent-free MRI T 2 -mapping can quantify myocardial fibrosis in preclinical models of aging and pressure overload. Myocardial fibrosis and remodeling were analyzed in two animal models: (i) aging (15-month-old male CF-1 mice vs. young 6- to 8-week-old mice), and (ii) pressure overload (PO; by transverse aortic constriction in 4- to 5-month-old male C57BL/6 mice vs. sham-operated for 14 days). In vivo T 2 -mapping was performed by acquiring data during the isovolumic and early diastolic phases, with a modified respiratory and ECG-triggered multiecho TurboRARE sequence on a 7-T MRI. Cine MRI provided cardiac morphology and function. A quantitative segmentation method was developed to analyze the in vivo T 2 -maps of hearts at midventricle, apex, and basal regions. The cardiac fibrosis area was analyzed ex vivo by picro sirius red (PSR) staining. Both aged and pressure-overloaded hearts developed significant myocardial contractile dysfunction, cardiac hypertrophy, and interstitial fibrosis. The aged mice had two phenotypes, fibrotic and mild-fibrotic. Notably, the aged fibrotic subgroup and the PO mice showed a marked decrease in T 2 relaxation times (25.3 ± 0.6 in aged vs. 29.9 ± 0.7 ms in young mice, p = 0.002; and 24.3 ± 1.7 in PO vs. 28.7 ± 0.7 ms in shams, p = 0.05). However, no significant difference in T 2 was detected between the aged mild-fibrotic subgroup and the young mice. Accordingly, an inverse correlation between myocardial fibrosis percentage (FP) and T 2 relaxation time was derived (R 2  = 0.98): T 2 (ms) = 30.45 - 1.05 × FP. Thus, these results demonstrate a statistical agreement between T 2 -map-quantified fibrosis and PSR staining in two different clinically relevant animal models. In conclusion, T 2 -mapping MRI is a promising noninvasive contrast agent-free quantitative technique to characterize myocardial fibrosis., (© 2021 John Wiley & Sons, Ltd.)

Background: Ultrasound cardiogram is commonly used in the diagnosis of cardiac hypertrophy from hypertension. This study aimed to investigate the correlation between the occurrence of cardiac hypertrophy from hypertension with the expression of autophagy-related protein 9A (ATG9a)., Methods: In this study, 168 patients with hypertension in the Guizhou Medical University from February 2020 to September 2021 were selected. The patients were divided into an experimental group (cardiac hypertrophy group) and a normal group according to the results of ultrasound cardiogram examination, and serum ATG9a levels in the two groups were detected. The association between ATG9a and cardiac hypertrophy from hypertension and the relationship between serum ATG9a and ultrasound cardiogram indicators were analyzed. And a receiver operating characteristic (ROC) curve was drawn to analyze the value of ATG9a in the diagnosis of cardiac hypertrophy from hypertension., Results: The results showed that there were no significant differences in age, diastolic blood pressure, hypertension course, body mass index (BMI), smoking history, and drinking history between the experimental and normal groups (P>0.05). Binary logistic regression analysis showed that compared with the normal control group, ATG9a increased significantly (P<0.05) and systolic blood pressure decreased significantly in the experimental group. The results showed that the area under the curve (AUC) of serum ATG9a was 0.736, the sensitivity was 76.54%, and the specificity was 78.42% in the diagnosis of cardiac hypertrophy from hypertension. Pearson correlation analysis showed that ATG9a was positively correlated with left ventricular posterior wall thickness (LVPWT) and interventricular septal thickness (IVST) in patients with cardiac hypertrophy from hypertension, and was negatively correlated with left ventricular ejection fraction (LVEF) (P<0.05)., Conclusions: Serum ATG9a may be involved in the formation of cardiac hypertrophy in hypertensive patients. Our results, which showed that serum ATG9a level increased in cardiac hypertrophy patients, were consistent with the clinical ultrasonic cardiogram diagnosis result, and ATG9a is expected to be a marker for early ultrasonic cardiogram diagnosis.

Background and Aim: Left heart remodeling is a well-known pathophysiological effect of arterial hypertension. Right Heart status is not considered in its evaluation. No data are available on right atrium (RA) and its impact on the outcome in hypertension. We wondering to understand whether RA may play a role as a marker of an increased risk for organ damage in well-controlled hypertensives, to probe the clinical significance and whether it could indicate an increased risk., Methods and Results: We studied well-controlled hypertensive patients. Heart damage was assessed by echocardiography. Patients were subdivided into those with RA area ≤18 cm 2 (normal RA - Group 1) (554 pts, 227 M, aged 60.35 ± 10.48 years) and those >18 cm 2 (Increased RA - Group 2) (101 pts, 71 M, age 61.65 ± 9.46 years). Group 2 had a higher left ventricle mass (LVM) and left atrium volume (LAV) both as absolute value (both p < 0.0001) and indexed for body surface area (LVMi p < 0.013; LAVi p = 0.0013). Group 2 showed an increased vascular stiffness (p < 0.0001) and carotid stenosis percentage (p = 0.011). TAPSE (p < 0.0001) resulted significantly increased. In The RA area was significantly correlated directly to LVM and LAV in both groups, but these correlations persisted in indexed values only in Group 2. Moreover, in this group there was a significant direct correlation between RA area and Tricuspid s'wave at echocardiography TDI analysis. Finally, Group 2 had an increased mortality rate compared to Group 1 (Log-Rank p = 0.0006)., Conclusion: Group 2 hypertensive patients showed more alterations in dimensional and volumetric left heart parameters, and an increased mortality., Competing Interests: Declaration of competing interest The authors have no financial conflicts of interest to declare., (Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Heart failure is often preceded by pathological cardiac hypertrophy, a thickening of the heart musculature driven by complex gene regulatory and signaling processes. The Drosophila heart has great potential as a genetic model for deciphering the underlying mechanisms of cardiac hypertrophy. However, current methods for evaluating hypertrophy of the Drosophila heart are laborious and difficult to carry out reproducibly. Here, we demonstrate that microcomputerized tomography (microCT) is an accessible, highly reproducible method for nondestructive, quantitative analysis of Drosophila heart morphology and size. To validate our microCT approach for analyzing Drosophila cardiac hypertrophy, we show that expression of constitutively active Ras ( Ras85D V12 ), previously shown to cause hypertrophy of the fly heart, results in significant thickening of both adult and larval heart walls when measured from microCT images. We then show using microCT analysis that genetic upregulation of store-operated Ca 2+ entry (SOCE) driven by expression of constitutively active Stim (Stim CA ) or Orai (Orai CA ) proteins also results in significant hypertrophy of the Drosophila heart, through a process that specifically depends on Orai Ca 2+ influx channels. Intravital imaging of heart contractility revealed significantly reduced end-diastolic and end-systolic dimensions in Stim CA - and Orai CA -expressing hearts, consistent with the hypertrophic phenotype. These results demonstrate that increased SOCE activity is an important driver of hypertrophic cardiomyocyte growth, and demonstrate how microCT analysis combined with tractable genetic tools in Drosophila can be used to delineate molecular signaling processes that underlie cardiac hypertrophy and heart failure. NEW & NOTEWORTHY Genetic analysis of Drosophila cardiac hypertrophy holds immense potential for the discovery of new therapeutic targets to prevent and treat heart failure. This potential has been hindered by a lack of rapid and effective methods for analyzing heart size in flies. Here, we demonstrate that analysis of the Drosophila heart with microcomputerized tomography yields accurate and highly reproducible heart size measurements that can be used to analyze heart growth and cardiac hypertrophy in Drosophila .

Background: Cardiomegaly is a relatively common incidental finding on chest X-rays; if left untreated, it can result in significant complications. Using Artificial Intelligence for diagnosing cardiomegaly could be beneficial, as this pathology may be underreported, or overlooked, especially in busy or under-staffed settings., Purpose: To explore the feasibility of applying four different transfer learning methods to identify the presence of cardiomegaly in chest X-rays and to compare their diagnostic performance using the radiologists' report as the gold standard., Material and Methods: Two thousand chest X-rays were utilized in the current study: 1000 were normal and 1000 had confirmed cardiomegaly. Of these exams, 80% were used for training and 20% as a holdout test dataset. A total of 2048 deep features were extracted using Google's Inception V3, VGG16, VGG19, and SqueezeNet networks. A logistic regression algorithm optimized in regularization terms was used to classify chest X-rays into those with presence or absence of cardiomegaly., Results: Diagnostic accuracy is reported by means of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), with the VGG19 network providing the best values of sensitivity (84%), specificity (83%), PPV (83%), NPV (84%), and overall accuracy (84,5%). The other networks presented sensitivity at 64.1%-82%, specificity at 77.1%-81.1%, PPV at 74%-81.4%, NPV at 68%-82%, and overall accuracy at 71%-81.3%., Conclusion: Deep learning using transfer learning methods based on VGG19 network can be used for the automatic detection of cardiomegaly on chest X-ray images. However, further validation and training of each method is required before application to clinical cases.

Background: COVID-19 can induce acute respiratory distress syndrome (ARDS). In patients with congenital heart disease, established treatment strategies are often limited due to their unique cardiovascular anatomy and passive pulmonary perfusion., Case Presentation: We report the first case of an adult with single-ventricle physiology and bidirectional cavopulmonary shunt who suffered from severe COVID-19 ARDS. Treatment strategies were successfully adopted, and pulmonary vascular resistance was reduced, both medically and through prone positioning, leading to a favorable outcome., Conclusion: ARDS treatment strategies including ventilatory settings, prone positioning therapy and cannulation techniques for extracorporeal oxygenation must be adopted carefully considering the passive venous return in patients with single-ventricle physiology., (© 2021. The Author(s).)

Although microRNA-7 (miRNA-7) is known to regulate proliferation of cancer cells by targeting Epidermal growth factor receptor (EGFR/ERBB) family, less is known about its role in cardiac physiology. Transgenic (Tg) mouse with cardiomyocyte-specific overexpression of miRNA-7 was generated to determine its role in cardiac physiology and pathology. Echocardiography on the miRNA-7 Tg mice showed cardiac dilation instead of age-associated physiological cardiac hypertrophy observed in non-Tg control mice. Subjecting miRNA-7 Tg mice to transverse aortic constriction (TAC) resulted in cardiac dilation associated with increased fibrosis bypassing the adaptive cardiac hypertrophic response to TAC. miRNA-7 expression in cardiomyocytes resulted in significant loss of ERBB2 expression with no changes in ERBB1 (EGFR). Cardiac proteomics in the miRNA-7 Tg mice showed significant reduction in mitochondrial membrane structural proteins compared to NTg reflecting role of miRNA-7 beyond the regulation of EGFR/ERRB in mediating cardiac dilation. Consistently, electron microscopy showed that miRNA-7 Tg hearts had disorganized rounded mitochondria that was associated with mitochondrial dysfunction. These findings show that expression of miRNA-7 in the cardiomyocytes results in cardiac dilation instead of adaptive hypertrophic response during aging or to TAC providing insights on yet to be understood role of miRNA-7 in cardiac function., (© 2021. The Author(s).)

Background: The cardiothoracic ratio (CTR) is commonly assessed on chest radiography for detection of cardiac chamber enlargement, but the traditional cutpoint of 0.5 has low specificity. We sought to evaluate the diagnostic accuracy of new measurement techniques for the detection of cardiac enlargement on chest radiographs., Methods: We obtained retrospective cross-sectional data on consecutive patients who underwent both chest radiography and cardiac magnetic resonance imaging (MRI) within a 14-day interval between 2006 and 2016 at a large academic hospital network. We established the presence of cardiac chamber enlargement using cardiac MRI as the reference standard. We evaluated the diagnostic performance of different techniques for measuring heart size and CTR on frontal chest radiographs., Results: Of 152 patients included, 81 (53%) were men and the mean age was 52 years. Maximum heart diameter had the highest area under the receiver operating characteristic curve for detection of cardiac enlargement (0.827, 95% confidence interval 0.760-0.894). In the subgroup of posteroanterior chest radiography studies ( n = 101), a CTR cutpoint of 0.50 had only moderate sensitivity (72%) and specificity (72%). In men, a maximum heart diameter cutpoint of 15 cm had a sensitivity of 86% and a negative likelihood ratio of 0.24, and a cutpoint of 19 cm had a specificity of 100% and a positive likelihood ratio of infinity. In women, a maximum heart diameter cutpoint of 13 cm had a sensitivity of 91% and a negative likelihood ratio of 0.15, and a cutpoint of 17 cm had a specificity of 91% and a positive likelihood ratio of 3.5., Interpretation: A traditional CTR cutpoint of 0.5 has limited diagnostic value. Simple heart diameter measurements have higher diagnostic performance measures than CTR., Competing Interests: Competing interests: None declared., (© 2021 CMA Joule Inc. or its licensors.)

Background: The prevalence of diseases other than tuberculosis (TB) detected during chest X-ray screening is poorly described in sub-Saharan Africa. Computer-assisted digital chest X-ray technology is available for TB screening and has the potential to be a screening tool for non-communicable diseases as well. Low- and middle-income countries are in a transition period where the burden of non-communicable diseases is increasing, but health systems are mainly focused on addressing infectious diseases., Methods: Participants were adults undergoing computer-assisted chest X-ray screening for tuberculosis in a community-wide tuberculosis prevalence survey in Blantyre, Malawi. Adults with abnormal radiographs by field radiographer interpretation were evaluated by a physician in a community-based clinic. X-ray classifications were compared to classifications of a random sample of normal chest X-rays by radiographer interpretation. Radiographic features were classified using WHO Integrated Management for Adult Illnesses (IMAI) guidelines. All radiographs taken at the screening tent were analysed by the Qure.ai qXR v2.0 software., Results: 5% (648/13,490) of adults who underwent chest radiography were identified to have an abnormal chest X-ray by the radiographer. 387 (59.7%) of the participants attended the X-ray clinic, and another 387 randomly sampled normal X-rays were available for comparison. Participants who were referred to the community clinic had a significantly higher HIV prevalence than those who had been identified to have a normal CXR by the field radiographer (90 [23.3%] vs. 43 [11.1%] p-value < 0.001). The commonest radiographic finding was cardiomegaly (20.7%, 95% CI 18.0-23.7). One in five (81/387) chest X-rays were misclassified by the radiographer. The overall mean Qure.ai qXR v2.0 score for all reviewed X-rays was 0.23 (SD 0.20). There was a high concordance of cardiomegaly classification between the physician and the computer-assisted software (109/118, 92.4%)., Conclusion: There is a high burden of cardiomegaly on a chest X-ray at a community level, much of which is in patients with diabetes, heart disease and high blood pressure. Cardiomegaly on chest X-ray may be a potential tool for screening for cardiovascular NCDs at the primary care level as well as in the community., (© 2021 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.)

Qualitative assessment of individual cardiac chamber enlargement on thoracic radiographs was assessed using echocardiography as the gold standard in dogs. Using this method, the presence of severe left-sided cardiomegaly was hypothesized to contribute to the false identification of right-sided cardiomegaly on radiographs. 175 dogs with three-view thoracic radiographs were retrospectively included in this diagnostic accuracy study if echocardiography was done within 24 h, and no rescue therapy was provided in the interim. All radiographic studies were reviewed by two groups of five board-certified veterinary radiologists with greater and less than 10 years of experience for grading of cardiac chamber enlargement as normal or mildly, moderately, or severely enlarged. The agreement, sensitivity, and specificity of the radiologists' interpretation of cardiac chamber size on thoracic radiographs to measured echocardiographic grades were evaluated. A total of 147 cases had complete echocardiographic data available for analysis. Intragroup agreement was moderate for the evaluation of left atrial enlargement and slight to fair for all other cardiac chambers. Between the mode of the radiologists' responses in the two groups and the echocardiographic grades, there was slight agreement for all cardiac chambers with higher severity grades reported using echocardiography. When moderate to severe left-sided cardiomegaly was identified on echocardiography, the sensitivity, specificity, and accuracy of radiographs were low, identifying dogs with radiographic evidence of right-sided cardiomegaly in the absence of corresponding right-sided cardiomegaly on echocardiography. Therefore, thoracic radiographs should be used with caution for the evaluation of cardiac chamber enlargement, particularly in the presence of severe left-sided cardiomegaly., (© 2021 American College of Veterinary Radiology.)

Cardiomegaly is the main imaging finding for canine heart diseases. There are many advances in the field of medical diagnosing based on imaging with deep learning for human being. However there are also increasing realization of the potential of using deep learning in veterinary medicine. We reported a clinically applicable assisted platform for diagnosing the canine cardiomegaly with deep learning. VHS (vertebral heart score) is a measuring method used for the heart size of a dog. The concrete value of VHS is calculated with the relative position of 16 key points detected by the system, and this result is then combined with VHS reference range of all dog breeds to assist in the evaluation of the canine cardiomegaly. We adopted HRNet (high resolution network) to detect 16 key points (12 and four key points located on vertebra and heart respectively) in 2274 lateral X-ray images (training and validation datasets) of dogs, the model was then used to detect the key points in external testing dataset (396 images), the AP (average performance) for key point detection reach 86.4 %. Then we applied an additional post processing procedure to correct the output of HRNets so that the AP reaches 90.9 %. This result signifies that this system can effectively assist the evaluation of canine cardiomegaly in a real clinical scenario., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: The palpation of the apex beat, one of the most fundamental physical examinations, provides a clue to left ventricular (LV) dilatation and hypertrophy; however, its relation to left atrial (LA) volume has rarely been investigated., Methods: The clinical value of the apex beat, especially in relation to LA volume was studied in 138 consecutive patients. Patients were examined in the supine position for a palpable apex beat. When an apex beat was felt, the apex beat distance, defined as the distance from the mid-clavicular line to the lateral border of the apex beat, was measured. The LA and LV geometry were assessed using echocardiography., Results: Of the 138 patients, an apex beat was palpable in 52 (38%) patients and the apex distance of these 52 patients ranged from -2 to 8 cm. The parameters of LV dilatation or hypertrophy were significant according to univariate but not to multivariate analysis. Only LA volume index was significant both for the palpability of the apex beat (p=0.0042) and the apex distance (p=0.0017) by multivariate analysis. The best cut-off point for the apex distance was -1 cm for LA enlargement (sensitivity 61%, specificity 92%, p<0.0001)., Conclusions: The LA volume is the most significant factor for the palpability and leftward deviation of the apex beat. Palpation of the apex beat is a crucial diagnostic tool for the detection of not only LV dilatation or hypertrophy but also of LA enlargement., (Copyright © 2021. Published by Elsevier Ltd.)