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BACKGROUNDLeft ventricular hypertrophy (LVH) and dyslipidemia are strong, independent predictors for cardiovascular disease, but their relationship is less well studied. A longitudinal lipidomic profiling of left ventricular mass (LVM) and LVH is still lacking.METHODSUsing liquid chromatography-mass spectrometry (LC-MS), we repeatedly measured 1,542 lipids from 1,755 unique American Indians attending 2 exams (mean, 5 years apart). Cross-sectional associations of individual lipid species with LVM index (LVMI) were examined by generalized estimating equation (GEE), followed by replication in an independent biracial cohort (65% White, 35% Black). Baseline plasma lipids associated with LVH risk beyond traditional risk factors were identified by logistic GEE model in American Indians. Longitudinal associations between changes in lipids and changes in LVMI were examined by GEE, adjusting for baseline lipids, baseline LVMI, and covariates.RESULTSMultiple lipid species were significantly associated with LVMI or the risk of LVH in American Indians. Some lipids were confirmed in Black and White individuals. Moreover, some LVH-related lipids were inversely associated with risk of coronary heart disease (CHD). Longitudinal changes in several lipid species were significantly associated with changes in LVMI.CONCLUSIONAltered fasting plasma lipidome and its longitudinal change over time were significantly associated with LVMI and risk for LVH in American Indians. Our results offer insight into the role of individual lipid species in LV remodeling and risk of LVH, independent of known risk factors.FUNDINGThis study was supported by the NIH grant (R01DK107532). The Strong Heart Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, NIH, Department of Health and Human Services, under contract nos. 75N92019D00027, 75N92019D00028, 75N92019D00029, and 75N92019D00030.

BackgroundRecently shown to regulate cardiac development, the secreted axon guidance molecule SLIT3 maintains its expression in the postnatal heart. Despite its known expression in the cardiovascular system after birth, SLIT3's relevance to cardiovascular function in the postnatal state remains unknown. As such, the objectives of this study were to determine the postnatal myocardial sources of SLIT3 and to evaluate its functional role in regulating the cardiac response to pressure overload stress.MethodsWe performed in vitro studies on cardiomyocytes and myocardial tissue samples from patients and performed in vivo investigation with SLIT3 and ROBO1 (roundabout homolog 1) mutant mice undergoing transverse aortic constriction to establish the role of SLIT3-ROBO1 in adverse cardiac remodeling.ResultsWe first found that SLIT3 transcription was increased in myocardial tissue obtained from patients with congenital heart defects that caused ventricular pressure overload. Immunostaining of hearts from WT (wild-type) and reporter mice revealed that SLIT3 is secreted by cardiac stromal cells, namely fibroblasts and vascular mural cells, within the heart. Conditioned media from cardiac fibroblasts and vascular mural cells both stimulated cardiomyocyte hypertrophy in vitro, an effect that was partially inhibited by an anti-SLIT3 antibody. Also, the N-terminal, but not the C-terminal, fragment of SLIT3 and the forced overexpression of SLIT3 stimulated cardiomyocyte hypertrophy and the transcription of hypertrophy-related genes. We next determined that ROBO1 was the most highly expressed roundabout receptor in cardiomyocytes and that ROBO1 mediated SLIT3's hypertrophic effects in vitro. In vivo, Tcf21+ fibroblast and Tbx18+ vascular mural cell-specific knockout of SLIT3 in mice resulted in decreased left ventricular hypertrophy and cardiac fibrosis after transverse aortic constriction. Furthermore, α-MHC+ cardiomyocyte-specific deletion of ROBO1 also preserved left ventricular function and abrogated hypertrophy, but not fibrosis, after transverse aortic constriction.ConclusionsCollectively, these results indicate a novel role for the SLIT3-ROBO1-signaling axis in regulating postnatal cardiomyocyte hypertrophy induced by pressure overload.

Background: Metabolic syndrome (MetS) is associated with worse prognosis in patients with myocardial infarction (MI). However, it is unclear how MetS in MI patients is associated with left atrial (LA) and left ventricular (LV) deformation. Purpose: To determine the effect of MetS on LA and LV deformation and atrioventricular interactions in MI patients. Study Type: Retrospective. Population: One hundred eighty‐one MI patients (73 MetS+ and 108 MetS−), 107 age‐ and sex‐matched controls (49 MetS+ and 58 MetS−). Field Strength/Sequence: 3.0 T/balanced steady‐state free precession (SSFP)/segmented phase‐sensitive inversion recovery SSFP sequence. Assessment: LA strain and strain rates (reservoir, conduit, and active), left atrioventricular coupling index (LACI), and LV geometry and radial, circumferential and longitudinal global peak strains (PS) were compared among groups. Statistical Tests: Two‐way analysis of variance, Spearman and Pearson's correlation coefficients, and multivariable linear regression analysis. P value <0.05 indicated statistical significance. Results: Compared with controls, the MI patients with or without MetS showed impaired LA function (reservoir, conduit, and active) and LV deformation (radial, circumferential, and longitudinal PS) and higher LACI. The MetS+ group had lower LA reservoir and conduit function and LV deformation than MetS− group. The MetS‐MI interaction was not statistically significant. Furthermore, multivariable linear regression showed that MetS was independently associated with LA and LV deformation (β = −0.181 to −0.209) in MI patients; LA function was independently associated with LV circumferential PS (β = 0.230 to 0.394) and longitudinal PS (β = 0.189 to 0.420), and LA passive strain and strain rate were negatively associated with LV mass (β = −0.178 and −0.298). Data Conclusion: MetS may be associated with the LA and LV dysfunction in MI patients. Impaired LV deformation and LV hypertrophy are independently associated with LA dysfunction in MI patients, and the MI patients have higher LACI than controls, suggesting atrioventricular interaction alterations. Evidence Level: 4 Technical Efficacy: 3 [ABSTRACT FROM AUTHOR]

Left ventricular non compaction is a genetic cardiomyopathy with a high occurence in individuals of African ancestry and may present in adulthood with diagnostic challenges when there is advanced heart failure. Echocardiography and Magnetic Resonance Imaging have mostly been used in making a diagnosis. However, there is a lack of these diagnostic tools required to aid in early diagnosis in Low and Middle Income Countries. The potential usefulness of echocardiography in this population is the focus of this case presentation. [ABSTRACT FROM AUTHOR]

Introduction: The right ventricle (RV) lies on the left ventricle (LV), and their shapes and movements are characteristic and significantly different. The aim of the present study was to investigate the relationship between three-dimensional speckle-tracking echocardiography (3DSTE)-derived LV strains, which represent LV contractility as quantitative features, and tricuspid annular plane systolic excursion (TAPSE) as determined by M-mode echocardiography, which represents the longitudinal movement of the RV, in healthy adults. Methods: A total of 79 healthy adults (mean age: 28.1 ± 6.3 years; 33 men) were enrolled in the present study. After two-dimensional Doppler echocardiography, 3DSTE-derived data acquisition was carried out in all cases, and detailed 3DSTE-based analysis was performed offline at a later date. Results: Reduced TAPSE was associated with increased global and basal LV radial strain (RS). Increased TAPSE was also associated not only with increased global and basal LV-RS but also with global LV longitudinal strain (LS). An increase in global LV-RS and global LV circumferential strain (CS) showed associations with other strains except for global LV-LS. An increase in global LV-LS did not show associations with other strains. Increased global LV-RS was associated with reduced TAPSE, while the degree of global LV-LS and global LV-CS did not show associations with TAPSE. Conclusions: Three-dimensional speckle-tracking echocardiography-derived LV-RS and LV-LS are associated with the longitudinal shortening of the RV represented by TAPSE in healthy adults. [ABSTRACT FROM AUTHOR]

Background: Because obstructive sleep apnea (OSA) was once thought to be a condition exclusively affecting men, women with OSA were frequently underdiagnosed and undertreated in comparison to men. Consequently, this study aimed to study, the deleterious effect of sever obstructive sleep apnea on left ventricular functions (Systolic & Diastolic) in female patients. Methods: This case-control study was carried out at both Cardiology Department and chest department (sleep disorder & breathing unit), Faculty of Medicine, Zagazig University in the duration from August 2023 to February 2024. Included 32 patients were subdivided into 2 groups, Group I: Included 16 females with Severe Obstructive Sleep Apnea Syndrome as cases group. Group II: Included 16 healthy females similar gender and age as control group. Results: There are no statistical significant differences in demographic characters of studied groups P value (= 0.05). E/e' ratio was statistically significantly higher in Group I compared to Group II. PASP was significant higher in Group I compared to Group II. There was no significant difference in EF by SIMPSON between Group I and Group II. GLS was significant less negative in Group I in compared to Group II. Conclusion: We found that the sever cases of OSA were associated with subtle systolic and diastolic LV dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: In systole, when the left ventricle (LV) twists, the left atrium (LA) behaves like a reservoir, having a special wall contractility pattern opposite to that of the LV wall. Accordingly, the objective of the present study was to investigate the associations between LV rotational mechanics and LA peak (reservoir) strains as assessed simultaneously by three-dimensional speckle-tracking echocardiography (3DSTE) under healthy conditions. Methods: In the present study, 157 healthy adults (mean age: 33.2 ± 12.7 years, 73 men) were involved. Complete two-dimensional Doppler echocardiography with 3DSTE-derived data acquisition were performed in all cases. The 3DSTE-derived LV rotational and LA strain parameters were determined at a later date. Results: Global LA peak reservoir circumferential (22.7 ± 6.4% vs. 27.6 ± 6.8%, p < 0.05) and area (57.8 ± 20.0% vs. 66.0 ± 22.7%, p < 0.05) strains proved to be reduced in the case of the highest vs. lowest basal LV rotation; other LA peak reservoir strains were not associated with increasing basal LV rotation. Global LA peak radial strain was highest in the case of the lowest vs. highest apical LV rotation (−19.2 ± 9.4% vs. −13.0 ± 8.2%, p < 0.05). Global LA peak reservoir 3D strain was lowest in the case of the highest vs. lowest apical LV rotation (−9.9 ± 6.8% vs. −5.0 ± 4.2%, p < 0.05). Only apical LV rotation proved to be significantly reduced in the case of the highest vs. lowest global LA peak reservoir 3D strain (8.12 ± 3.23° vs. 10.50 ± 3.44°, p < 0.05). Other global LA peak reservoir strains were not associated with basal and apical LV rotations. Conclusions: In LV systole, LV rotational mechanics is associated with LA deformation represented by LA peak (reservoir) strains even in healthy circumstances. While basal LV rotation is associated with LA widening, apical LV rotation is associated with LA thinning, suggesting the close cooperation of the LV and LA in systole even in healthy adults. [ABSTRACT FROM AUTHOR]

ObjectiveFeline hypertrophic cardiomyopathy (HCM) remains a disease with little therapeutic advancement. Rapamycin modulates the mTOR pathway, preventing and reversing cardiac hypertrophy in rodent disease models. Its use in human renal allograft patients is associated with reduced cardiac wall thickness. We sought to evaluate the effects of once-weekly delayed-release (DR) rapamycin over 6 months on echocardiographic, biochemical, and biomarker responses in cats with subclinical, nonobstructive HCM.Animals43 client-owned cats with subclinical HCM.MethodsCats enrolled in this double-blinded, multicentered, randomized, and placebo-controlled clinical trial were allocated to low- or high-dose DR rapamycin or placebo. Cats underwent physical examination, quality-of-life assessment, blood pressure, hematology, biochemistry, total T4, urinalysis, N-terminal pro-B-type natriuretic peptide, and cardiac troponin I at baseline and days 60, 120, and 180. Fructosamine was analyzed at screening and day 180. Echocardiograms were performed at all time points excluding day 120. Outcome variables were compared using a repeated measures ANCOVA.ResultsNo demographic, echocardiographic, or clinicopathologic values were significantly different between study groups at baseline, confirming successful randomization. At day 180, the primary study outcome variable, maximum LV myocardial wall thickness at any location, was significantly lower in the low-dose DR rapamycin group compared to placebo (P = .01). Oral DR rapamycin was well tolerated with no significant differences in adverse events between groups.Clinical relevanceResults demonstrate that DR rapamycin was well tolerated and may prevent or delay progressive LV hypertrophy in cats with subclinical HCM. Additional studies are warranted to confirm and further characterize these results.

Using echocardiography to assess the left ventricular function is one of the most crucial cardiac examinations in clinical diagnosis, and LV segmentation plays a particularly vital role in medical image processing as many important clinical diagnostic parameters are derived from the segmentation results, such as ejection function. However, echocardiography typically has a lower resolution and contains a significant amount of noise and motion artifacts, making it a challenge to accurate segmentation, especially in the region of the cardiac chamber boundary, which significantly restricts the accurate calculation of subsequent clinical parameters. In this paper, our goal is to achieve accurate LV segmentation through a simplified approach by introducing a branch sub-network into the decoder of the traditional U-Net. Specifically, we employed the LV contour features to supervise the branch decoding process and used a cross attention module to facilitate the interaction relationship between the branch and the original decoding process, thereby improving the segmentation performance in the region LV boundaries. In the experiments, the proposed branch U-Net (BU-Net) demonstrated superior performance on CAMUS and EchoNet-dynamic public echocardiography segmentation datasets in comparison to state-of-the-art segmentation models, without the need for complex residual connections or transformer-based architectures. Our codes are publicly available at Anonymous Github https://anonymous.4open.science/r/Anoymous_two-BFF2/. [ABSTRACT FROM AUTHOR]

Introduction: While right ventricular pacing (RVP) is the conventional temporary pacing modality used for transcatheter aortic valve replacement (TAVR), this approach possesses inherent risks and procedural challenges. We aim to assess and compare the safety and efficacy of left ventricular pacing (LVP) and RVP during TAVR and balloon aortic valvuloplasty (BAV). Methods: Following PRISMA guidelines, a comprehensive literature search was conducted in four databases from inception to December 15th, 2023. We included observational studies and clinical trials comparing LVP with RVP during TAVR and BAV procedures. Primary outcomes included short‐term mortality, mortality due to cardiac tamponade, and procedural complications including bleeding, vascular complications, and cardiac tamponade. Secondary outcomes comprised procedure duration and length of hospital stay. Results: Five studies involving 830 patients with RVP and 1577 with LVP were included. Short‐term mortality was significantly higher in the RVP group (RR 2.32, 95% CI: [1.37–3.93], P =.002), as was the incidence of cardiac tamponade (RR 2.19, 95% CI: [1.11–4.32], P =.02). LVP demonstrated shorter hospital stays (MD = 1.34 d, 95% CI: [0.90, 1.78], P <.001) and reduced procedure duration (MD = 7.75 min, 95% CI: [5.08, 10.41], P <.00001) compared to RVP. New pacemaker implantation was higher in the RVP group (RR 2.23, 95% CI: [1.14, 4.39], P =.02). Conclusion: LVP during TAVR and BAV emerges a safer alternative to RVP, offering reduced mortality, hospital stays, and procedure durations. [ABSTRACT FROM AUTHOR]

Background: The left ventricular (LV) rotational mechanics are of particular importance in the function of the LV. The rotational movement is the consequence of the arrangement of the subepicardial and subendocardial muscle fibers. These muscle fibers are perpendicular to each other, their contraction creates a characteristic motion. The aim of the present study was to examine the prognostic impact of LV twist assessed by three-dimensional speckle-tracking echocardiography (3D-STE) in healthy circumstances. Methods: 302 healthy adults participated in the study, 181 subjects were excluded due to certain reasons (LV could not be analysed during 3D-STE, subjects were unidentifiable, or lost to follow-up). 121 subjects were involved in the final analysis (mean age of 33.1 ± 12.3 years, 75 males), who were willing to be examined on a voluntary basis. Results: During a mean follow-up of 7.93 ± 4.21 years, 11 healthy adults suffered a cardiovascular event including 2 cardiac deaths. Using receiver operating characteristic analysis, LV twist ≥14.65 degrees as assessed by 3D-STE proved to be significantly predictive regarding the cardiovascular event-free survival (area under the curve 0.70, specificity 70%, sensitivity 65%, p = 0.028). Subjects with LV twist ≥14.65 degrees had higher basal and apical rotations and a significantly higher ratio of these individuals developed cardiovascular events compared to cases with LV twist <14.65 degrees. Subjects with cardiovascular events had lower LV global longitudinal strain, higher basal LV rotation and twist and the ratio of subjects with LV twist ≥14.65 degrees was elevated as compared to cases without events. Conclusions: 3D-STE-derived LV twist independently predicts future cardiovascular events in healthy adults. [ABSTRACT FROM AUTHOR]

Cardiac amyloidosis is an infiltrative disease primarily caused by extracellular tissue deposition of amyloid fibrils in the myocardial interstitium. The aim of the present review was to summarize findings regarding changes in myocardial mechanics, valvular abnormalities, and vascular remodeling detected in patients with cardiac amyloidosis. [ABSTRACT FROM AUTHOR]

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KEY POINTS: Higher plasma and urine kidney injury molecule-1, urine monocyte chemoattractant protein-1, and lower urine alpha-1-microglobulin were associated with left ventricular hypertrophy, even after adjustment for confounders. Biomarkers of tubular injury, dysfunction, and inflammation may indicate the severity of kidney pathology and are associated with left ventricular hypertrophy. BACKGROUND: Left ventricular hypertrophy (LVH) is common in children with CKD and is associated with an increased risk of cardiovascular disease and mortality. We have shown that several plasma and urine biomarkers are associated with increased risk of CKD progression. As CKD is associated with LVH, we sought to investigate the association between the biomarkers and LVH. METHODS: In the CKD in Children Cohort Study, children aged 6 months to 16 years with an eGFR of 30–90 ml/min per 1.73 m2 were enrolled at 54 centers in the United States and Canada. We measured plasma biomarkers kidney injury molecule-1 (KIM-1), tumor necrosis factor receptor-1, tumor necrosis factor receptor-2, soluble urokinase-type plasminogen activator receptor and urine KIM-1, monocyte chemoattractant protein-1 (MCP-1), YKL-40, alpha-1-microglobulin (alpha-1m), and epidermal growth factor in stored plasma and urine collected 5 months after enrollment. Echocardiograms were performed 1 year after enrollment. We assessed the cross-sectional association between the log2 biomarker levels and LVH (left ventricular mass index greater than or equal to the 95th percentile) using a Poisson regression model, adjusted for age, sex, race, body mass index, hypertension, glomerular diagnosis, urine protein-to-creatinine ratio, and eGFR at study entry. RESULTS: Among the 504 children, LVH prevalence was 12% (n=59) 1 year after enrollment. In a multivariable-adjusted model, higher plasma and urine KIM-1 and urine MCP-1 concentrations were associated with a higher prevalence of LVH (plasma KIM-1 prevalence ratio [PR] per log2: 1.27, 95% confidence interval [CI], 1.02 to 1.58; urine KIM-1 PR: 1.21, 95% CI, 1.11 to 1.48; and urine MCP-1 PR: 1.18, 95% CI, 1.04 to 1.34). After multivariable adjustment for covariates, lower urine alpha-1m was also associated with a higher prevalence of LVH (PR: 0.90, 95% CI, 0.82 to 0.99). CONCLUSIONS: Higher plasma and urine KIM-1, urine MCP-1, and lower urine alpha-1m were each associated with LVH prevalence in children with CKD. These biomarkers may better inform risk and help elucidate the pathophysiology of LVH in pediatric CKD.

Objective: To investigate the evaluation of left ventricular longitudinal systolic function in patients with thyroid dysfunction by three-dimensional speckle tracking imaging (3D-STI) and its relationship with cardiac function indexes and serum myocardial injury markers. Methods: 120 patients with abnormal thyroid function (study group) and 80 patients with normal thyroid function (control group) were selected, the parameters of global circumferential strain (GCS), global longitudinal strain (GLS), left ventricular systolic global area strain (GAS), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic diameter (LVEDS) and left ventricular end-diastolic diameter (LVEDD) were compared between two groups, the levels of serum troponin 1 (cTn1), creatine kinase (CK) and CK isoenzyme (CK-MB) were detected in two groups. The correlation between 3D-STI parameters and conventional ultrasound parameters and the levels of serum cTn1, CK and CK-MB was analyzed by Pearson correlation analysis. Results: There was no significant difference in LVEDD, LVEDS, LVEDV and LVEF between study group and control group (P>0.05), the absolute values of GAS, GLS and GCS in study group were lower than those in control group, The levels of cTn1, CK and CK-MB were higher than those in control group (P<0.05). The absolute values of GAS, GLS and GCS in study group were negatively correlated with the levels of serum cTn1, CK and CK-MB (P<0.05), but not with LVEDD, LVEDS, LVEDV and LVEF (P>0.05). Conclusion: 3D-STI parameters GAS, GLS and GCS are decrease in patients with thyroid dysfunction, and the levels of serum cTn1, CK and CK-MB are increase, 3D-STI parameters can effectively assess the longitudinal function of the left ventricular contraction in patients with abnormal thyroid function. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cardiovascular screening is recommended for first-degree relatives (FDRs) of patients with dilated cardiomyopathy (DCM), but the yield of FDR screening is uncertain for DCM patients without known familial DCM, for non-White FDRs, or for DCM partial phenotypes of left ventricular enlargement (LVE) or left ventricular systolic dysfunction (LVSD). OBJECTIVES: This study examined the yield of clinical screening among reportedly unaffected FDRs of DCM patients. METHODS: Adult FDRs of DCM patients at 25 sites completed screening echocardiograms and ECGs. Mixed models accounting for site heterogeneity and intrafamilial correlation were used to compare screen-based percentages of DCM, LVSD, or LVE by FDR demographics, cardiovascular risk factors, and proband genetics results. RESULTS: A total of 1,365 FDRs were included, with a mean age of 44.8 ± 16.9 years, 27.5% non-Hispanic Black, 9.8% Hispanic, and 61.7% women. Among screened FDRs, 14.1% had new diagnoses of DCM (2.1%), LVSD (3.6%), or LVE (8.4%). The percentage of FDRs with new diagnoses was higher for those aged 45 to 64 years than 18 to 44 years. The age-adjusted percentage of any finding was higher among FDRs with hypertension and obesity but did not differ statistically by race and ethnicity (16.2% for Hispanic, 15.2% for non-Hispanic Black, and 13.1% for non-Hispanic White) or sex (14.6% for women and 12.8% for men). FDRs whose probands carried clinically reportable variants were more likely to be identified with DCM. CONCLUSIONS: Cardiovascular screening identified new DCM-related findings among 1 in 7 reportedly unaffected FDRs regardless of race and ethnicity, underscoring the value of clinical screening in all FDRs.

Abstract Background Left ventricular thrombus (LVT) is a serious complication after myocardial infarction. However, due to its asymptomatic nature, early detection is challenging. We aimed to explore the differences in clinical correlates of LVT found in acute to subacute and chronic phases of myocardial infarction. Methods We collected data from 153 patients who were diagnosed with LVT after myocardial infarction at the Affiliated Hospital of Qingdao University from January 2013 to December 2022. Baseline information, inflammatory markers, transthoracic echocardiograph (TTE) data and other clinical correlates were collected. Patients were categorized into acute to subacute phase group (

Epidemiological studies have revealed that hypertensive heart disease is a major risk factor for heart failure, and its heart failure burden is growing rapidly. The need to act in the face of this threat requires first an understanding of the multifactorial origin of hypertensive heart disease and second an exploration of new mechanistic pathways involved in myocardial alterations critically involved in cardiac dysfunction and failure (eg, myocardial interstitial fibrosis). Increasing evidence shows that alterations of gut microbiota composition and function (ie, dysbiosis) leading to changes in microbiotaderived metabolites and impairment of the gut barrier and immune functions may be involved in blood pressure elevation and hypertensive organ damage. In this review, we highlight recent advances in the potential contribution of gut microbiota alterations to myocardial interstitial fibrosis in hypertensive heart disease through blood pressure–dependent and blood pressure–independent mechanisms. Achievements in this field should open a new path for more comprehensive treatment of myocardial interstitial fibrosis in hypertensive heart disease and, thus, for the prevention of heart failure. [ABSTRACT FROM AUTHOR]

Aims To assess the agreement between left ventricular end-diastolic diameter index (LVEDDi) and volume index (LVEDVi) to define LV dilatation and to investigate the respective prognostic implications in patients with heart failure (HF). Methods and results Patients with HF symptoms and LV ejection fraction (LVEF) < 50% undergoing cardiac magnetic resonance were evaluated retrospectively. LV dilatation was defined as LVEDDi or LVEDVi above the upper normal limit according to published reference values. Patients were followed up for the combined endpoint of cardiovascular death or HF hospitalization during 5 years. A total of 564 patients (median age 64 years; 79% men) were included. LVEDDi had a modest correlation with LVEDVi (r = 0.682, P < 0.001). LV dilatation was noted in 84% of patients using LVEDVi-based definition and in 73% using LVEDDi-based definition, whereas 20% of patients displayed discordant definitions of LV dilatation. During a median follow-up of 2.8 years, patients with both dilated LVEDDi and LVEDVi had the highest cumulative event rate (HR 3.00, 95% CI 1.15–7.81, P = 0.024). Both LVEDDi and LVEDVi were independently associated with the primary outcome (hazard ratio 3.29, 95%, P < 0.001 and 2.8, P = 0.009; respectively). Conclusion The majority of patients with HF and LVEF < 50% present both increased LVEDDi and LVEDVi whereas 20% show discordant linear and volumetric definitions of LV dilatation. Patients with increased LVEDDi and LVEDVi have the worst clinical outcomes suggesting that the assessment of these two metrics is needed for better risk stratification. [ABSTRACT FROM AUTHOR]

Background: Left ventricular thrombus (LVT) is a serious complication after myocardial infarction. However, due to its asymptomatic nature, early detection is challenging. We aimed to explore the differences in clinical correlates of LVT found in acute to subacute and chronic phases of myocardial infarction. Methods: We collected data from 153 patients who were diagnosed with LVT after myocardial infarction at the Affiliated Hospital of Qingdao University from January 2013 to December 2022. Baseline information, inflammatory markers, transthoracic echocardiograph (TTE) data and other clinical correlates were collected. Patients were categorized into acute to subacute phase group (< 30 days) and chronic phase group (30 days and after) according to the time at which echocardiograph was performed. The resolution of thrombus within 90 days is regarded as the primary endpoint event. We fitted logistic regression models to relating clinical correlates with phase-specific thrombus resolution. Results: For acute to subacute phase thrombus patients: C-reactive protein levels (OR: 0.95, 95% CI: 0.918–0.983, p = 0.003) were significantly associated with thrombus resolution. For chronic phase thrombus patients: anticoagulant treatment was associated with 5.717-fold odds of thrombus resolution (OR: 5.717, 95% CI: 1.543–21.18, p = 0.009). Conclusions: Higher levels of CRP were associated with lower likelihood of LVT resolution in acute phase myocardial infarction; Anticoagulant therapy is still needed for thrombus in the chronic stage of myocardial infarction. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to compare the structural and functional changes of the left ventricle (LV) in patients with various forms of atrial fibrillation (AF).Materials and methods. 70 patients with paroxysmal AF (group 1; median age 73 [64.75; 76.5] years, 49 (70%) women) and 54 patients with persistent or permanent forms of AF (group 2; median age 78.5 [68;83] years, 33 (61%) women) was included in the study/ All patients were underwent transthoracic echocardiography (EchoCG) using the speckle tracking technique.Results. In patients with permanent/persistent AF, compared with patients with paroxysmal AF, the several parametres were significantly lower: the stroke volume (SV) (49.2 [39.8; 57.8] ml versus 54.2 [46.2; 60.3] ml, respectively, p = 0.039), LV ejection fraction (EF) (61.4% [51.2; 67.1] versus 65.9% [61.4; 70.2], respectively, p < 0.001), absolute values of the global longitudinal LV strain (–15.1% [–18.5; –9.3] vs. –19.6% [–22.2; –16.2] respectively, p < 0.001), global LV circular strain (–16.4% [–22.9; –11.0] vs. –20.9% [–25.8; –17.6], respectively, p < 0.001), end-systolic LV elasticity (3.6 [2.7; 4.57] mmHg/ml vs. 4.3 [3.3; 5.3] mmHg/ml, respectively, p = 0.011). At the same time, the end-diastolic size (EDS), the end-diastolic volume (EDV) and its index, and the end-systolic volume (ESV) did not differ statistically significantly between the groups.Conclusion. In patients with persistent/permanent forms of AF, there is a more pronounced violation of LV systolic function compared with patients with paroxysmal AF, which manifests itself in lower values of SV, LV EF, absolute values of the global longitudinal strain and global circular strain of the LV.

Abstract Background The athlete’s heart (AH) defines the phenotypical changes that occur in response to chronic exercise training. Echocardiographic assessment of the AH is used to calculate LV mass (LVM) and determine chamber geometry. This is, however, interpreted using standard linear (ratiometric) scaling to body surface area (BSA) whereas allometric scaling is now widely recommended. This study (1) determined whether ratiometric scaling of LVM to BSA (LVMiratio) provides a size-independent index in young and veteran athletes of mixed and endurance sports (MES), and (2) calculated size-independent beta exponents for allometrically derived (LVMiallo) to BSA and (3) describes the physiological range of LVMiallo and the classifications of LV geometry. Methods 1373 MES athletes consisting of young ( 35 years old) (males n = 327 and females n = 220) were included in the study. LVMiratio was calculated as per standard scaling and sex-specific LVMiallo were derived from the population. Cut-offs were defined and geometry was classified according to the new exponents and relative wall thickness. Results LVMiratio did not produce a size independent index. When tested across the age range the following indexes LVMi/BSA0.7663 and LVMi/BSA0.52, for males and females respectively, were size independent (r = 0.012; P = 0.7 and r = 0.003; P = 0.920). Physiological cut-offs for LVMiallo were 135 g/(m2)0.7663 in male athletes and 121 g/(m2)0.52 in female athletes. Concentric remodelling / hypertrophy was present in 3% and 0% of young male and female athletes and 24% and 17% of veteran male and female athletes, respectively. Eccentric hypertrophy was observed in 8% and 6% of young male and female athletes and 9% and 11% of veteran male and female athletes, respectively. Conclusion In a large cohort of young and veteran male and female MES athletes, LVMiratio to BSA is not size independent. Sex-specific LVMiallo to BSA with LVMi/BSA0.77 and LVMi/BSA0.52 for male and female athletes respectively can be applied across the age-range. Population-based cut-offs of LVMiallo provided a physiological range demonstrating a predominance for normal geometry in all athlete groups with a greater percentage of concentric remodelling/hypertrophy occurring in veteran male and female athletes.

Introduction: In systole, when the left ventricle (LV) twists, the left atrium (LA) behaves like a reservoir, having a special wall contractility pattern opposite to that of the LV wall. Accordingly, the objective of the present study was to investigate the associations between LV rotational mechanics and LA peak (reservoir) strains as assessed simultaneously by three-dimensional speckle-tracking echocardiography (3DSTE) under healthy conditions. Methods: In the present study, 157 healthy adults (mean age: 33.2 ± 12.7 years, 73 men) were involved. Complete two-dimensional Doppler echocardiography with 3DSTE-derived data acquisition were performed in all cases. The 3DSTE-derived LV rotational and LA strain parameters were determined at a later date. Results: Global LA peak reservoir circumferential (22.7 ± 6.4% vs. 27.6 ± 6.8%, p < 0.05) and area (57.8 ± 20.0% vs. 66.0 ± 22.7%, p < 0.05) strains proved to be reduced in the case of the highest vs. lowest basal LV rotation; other LA peak reservoir strains were not associated with increasing basal LV rotation. Global LA peak radial strain was highest in the case of the lowest vs. highest apical LV rotation (−19.2 ± 9.4% vs. −13.0 ± 8.2%, p < 0.05). Global LA peak reservoir 3D strain was lowest in the case of the highest vs. lowest apical LV rotation (−9.9 ± 6.8% vs. −5.0 ± 4.2%, p < 0.05). Only apical LV rotation proved to be significantly reduced in the case of the highest vs. lowest global LA peak reservoir 3D strain (8.12 ± 3.23° vs. 10.50 ± 3.44°, p < 0.05). Other global LA peak reservoir strains were not associated with basal and apical LV rotations. Conclusions: In LV systole, LV rotational mechanics is associated with LA deformation represented by LA peak (reservoir) strains even in healthy circumstances. While basal LV rotation is associated with LA widening, apical LV rotation is associated with LA thinning, suggesting the close cooperation of the LV and LA in systole even in healthy adults.

BACKGROUND: Left ventricular hypertrophy (LVH) combined with elevations in cardiac biomarkers reflecting myocardial injury and neurohormonal stress (malignant LVH) is associated with a high risk for heart failure and death. OBJECTIVES: The aim of this study was to determine the impact of intensive systolic blood pressure (SBP) control on the prevention of malignant LVH and its consequences. METHODS: A total of 8,820 participants in SPRINT (Systolic Blood Pressure Intervention Trial) were classified into groups based on the presence or absence of LVH assessed by 12-lead ECG, and elevations in biomarker levels (high-sensitivity cardiac troponin T ≥14 ng/L or N-terminal pro-B-type natriuretic peptide ≥125 pg/mL) at baseline. The effects of intensive vs standard SBP lowering on rates of acute decompensated heart failure (ADHF) events and death and on the incidence and regression of malignant LVH were determined. RESULTS: Randomization to intensive SBP lowering led to similar relative reductions in ADHF events and death across the combined LVH/biomarker groups (P for interaction = 0.68). The absolute risk reduction over 4 years in ADHF events and death was 4.4% (95% CI: -5.2% to 13.9%) among participants with baseline malignant LVH (n = 449) and 1.2% (95% CI: 0.0%-2.5%) for those without LVH and nonelevated biomarkers (n = 4,361). Intensive SBP lowering also reduced the incidence of malignant LVH over 2 years (2.5% vs 1.1%; OR: 0.44; 95% CI: 0.30-0.63). CONCLUSIONS: Intensive SBP lowering prevented malignant LVH and may provide substantial absolute risk reduction in the composite of ADHF events and death among SPRINT participants with baseline malignant LVH.

Background: Computed tomography (CT) image integration is of limited use in left ventricular (LV) ablation due to inadequate accuracy of registration. The current study aimed to investigate the accuracy and feasibility of extra-cavity LV image registration via the coronary cusp. Methods: Consecutive patients were enrolled as the validation group (n = 41) and feasibility group (n = 48). After extra-cavity registration via the aortic root, the LV anatomy derived from CT image was activated and moved into real space. Accuracy of LV anatomy via this registration method was verified by intracardiac echocardiography reconstruction in the validation group and tested further in the feasibility group via measuring the location differences (<3 mm) and volume difference (<8 mL). Results: In validation group, the LV volume of CT image and ICE map were comparable (113.6 ± 15.5 mL vs. 109.0 ± 15.3 mL, P = .27), and the location difference was 3.1 ± 1.1 mm at LV summit, 1.8 ± 0.9 mm at the free wall, and 1.8 ± 0.7 mm at the LV apex. There was a mean of 2.9 ± 1.2 mm and 3.0 ± 1.0 mm length difference in anterior PM and posterior PM, the position difference of the PM's base was 2.8 ± 0.9 mm for anterior PM and 2.2 ± 0.9 mm for posterior PM. In feasibility group, the distance differences of LV summit, LV septum, LV apex, and LV free averaged 1.8 ± 0.8 mm, 1.5 ± 0.7 mm, 1.4 ± 0.6 mm, 1.3 ± 0.7 mm, respectively. Compared with validation group, acute success (100% vs. 96.5%, P = .51), complications rate (4.9% vs. 2.0%, P = 0.59) and fluoroscopic time (1.6 ± 1.1 vs. 1.9 ± 1.6 minutes, P = .30) exhibited no significant difference, but was significantly reduced with procedure time (74.5 ± 8.1 vs. 61.2 ± 9.5 minutes, P < .001) with CT image registration only. Conclusion: LV mapping and ablation could be successfully achieved by extra-cavity registration via coronary cusp without needing positions within LV beforehand. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course Background: Lymphocytic myocarditis is an inflammatory condition of the heart that may present with a wide spectrum of symptoms and signs, ranging from asymptomatic to life-threatening cardiogenic shock and ventricular arrhythmia. Lymphocytic myocarditis usually presents as chamber dilation. However, increased left ventricular thickness is relatively rare. We present a case of lymphocytic myocarditis with increased left ventricular thickness which mimics the presentation of cardiac amyloidosis. Case Report: An 80-year-old Chinese man presented to the emergency room due to recurrent chest tightness. Wheezing and crackling were heard in both lungs, along with bilateral lower-extremity edema. He had elevated cardiac troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Bedside echocardiogram showed left ventricular diastolic dysfunction and increased left ventricular thickness. Holter monitoring showed paroxysmal atrial fibrillation (AF) and atrial flutter. 99mTechnetium-pyrophosphate scintigraphy showed grade 1 myocardial uptake. Endomyocardial biopsy revealed lymphocytic myocarditis. The patient was put on steroids, managed with diuretics to alleviate the symptoms of congestion, and amiodarone for conversion of AF to sinus rhythm. He had no deterioration of cardiac function in the follow-ups, but there was still asymmetric interventricular septal hypertrophy. Conclusions: Lymphocytic myocarditis may lead to increased left ventricular thickness in some rare cases. In the setting of unexplained increased left ventricular thickness, one should consider lymphocytic myocarditis as a differential diagnosis. In addition, endomyocardial biopsy should be performed as early as possible to confirm the diagnosis and identify the type of inflammation, which helps with treatment and prognosis. [ABSTRACT FROM AUTHOR]

Background: The athlete's heart (AH) defines the phenotypical changes that occur in response to chronic exercise training. Echocardiographic assessment of the AH is used to calculate LV mass (LVM) and determine chamber geometry. This is, however, interpreted using standard linear (ratiometric) scaling to body surface area (BSA) whereas allometric scaling is now widely recommended. This study (1) determined whether ratiometric scaling of LVM to BSA (LVMiratio) provides a size-independent index in young and veteran athletes of mixed and endurance sports (MES), and (2) calculated size-independent beta exponents for allometrically derived (LVMiallo) to BSA and (3) describes the physiological range of LVMiallo and the classifications of LV geometry. Methods: 1373 MES athletes consisting of young (< 35 years old) (males n = 699 and females n = 127) and veteran (> 35 years old) (males n = 327 and females n = 220) were included in the study. LVMiratio was calculated as per standard scaling and sex-specific LVMiallo were derived from the population. Cut-offs were defined and geometry was classified according to the new exponents and relative wall thickness. Results: LVMiratio did not produce a size independent index. When tested across the age range the following indexes LVMi/BSA0.7663 and LVMi/BSA0.52, for males and females respectively, were size independent (r = 0.012; P = 0.7 and r = 0.003; P = 0.920). Physiological cut-offs for LVMiallo were 135 g/(m2)0.7663 in male athletes and 121 g/(m2)0.52 in female athletes. Concentric remodelling / hypertrophy was present in 3% and 0% of young male and female athletes and 24% and 17% of veteran male and female athletes, respectively. Eccentric hypertrophy was observed in 8% and 6% of young male and female athletes and 9% and 11% of veteran male and female athletes, respectively. Conclusion: In a large cohort of young and veteran male and female MES athletes, LVMiratio to BSA is not size independent. Sex-specific LVMiallo to BSA with LVMi/BSA0.77 and LVMi/BSA0.52 for male and female athletes respectively can be applied across the age-range. Population-based cut-offs of LVMiallo provided a physiological range demonstrating a predominance for normal geometry in all athlete groups with a greater percentage of concentric remodelling/hypertrophy occurring in veteran male and female athletes. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between left ventricular hypertrophy (LVH) diagnosed by Peguero-Lo-Presti index and recurrence of paroxysmal atrial fibrillation (AF) after radiofrequency ablation. Methods A total of 652 patients with paroxysmal atrial fibrillation who underwent radiofrequency ablation were selected. According to Peguero-Lo-Presti index, patients were divided into the LVH group (167 cases) and the normal left ventricle group (485 cases). Baseline data were collected, and regular follow-up was performed at 3, 6 and 12 months after radiofrequency catheter ablation. The recurrence of AF was assessed. Kaplan-Meier survival curve was used to analyze the recurrence rate of AF in the two groups. Cox proportional hazard model was used to assess risk factors for recurrent atrial fibrillation. Results The median follow-up time was 20.5 (15.0, 26.0) months. A total of 155 patients (23.8%) developed recurrence of AF, including 95 patients in the LVH group and 60 patients in the LVN group. The recurrence rate without AF was significantly lower in the LVH group than that in the LVN group (64.1% vs. 80.4%, Log-rank χ2 =26.361, P＜0.01). After adjusting for age, sex, body mass index, hypertension, diabetes, coronary heart disease, cardiac dysfunction, left anteroposterior and posterior atrial diameter, left ventricular end-diastolic diameter, and left ventricular ejection fraction, LVH diagnosed by Peguero-Lo-Presti index was still a risk factor for recurrent AF [HR (95%CI) : 2.359 (1.663-3.345), P＜ 0.01]. Conclusion In patients with paroxysmal AF, LVH diagnosed by Peguero-Lo-Presti index is a risk factor of AF recurrence after radiofrequency catheter ablation. [ABSTRACT FROM AUTHOR]

The left ventricular summit (LVS) refers to the highest portion of the left ventricular outflow tract (LVOT). It is an epicardially delimited triangular area by the left coronary arteries and the coronary venous circulation. Its deep myocardium correlates closely with the left coronary cusp, aortic‐mitral continuity, and right ventricular outflow tract (RVOT), complicating the anatomical relationship. Ventricular arrhythmias (VAs) originating from this area are common, accounting for 14.5% of all VAs origin from left ventricle. Specific electrocardiogram (ECG) characteristics may assist in locating LVS‐VAs pre‐procedure and facilitate procedure planning. However, catheter ablation of LVS‐VAs remains challenging because of anatomical constraints. This paper reviews the recent understanding of LVS anatomy, concludes ECG characteristics, and summarizes current mapping and ablation methods for LVS‐VAs. [ABSTRACT FROM AUTHOR]

Introduction: The left ventricle (LV) not only contracts, but its rotational mechanics have a significant role in systolic ejection, whereas the right ventricle (RV) is substantially different in shape and function, and its contractility is not accompanied by rotational features. Simple M-mode echocardiography-based tricuspid annular plane systolic excursion (TAPSE) reflects RV longitudinal contraction or shortening. The aim of the present study was to examine the relationship between the parameters characterizing the rotational mechanics of the LV as assessed by three-dimensional speckle-tracking echocardiography (3DSTE) and the TAPSE. The effects of different degrees of these parameters on each other were also examined. Methods: The present retrospective analysis evaluated the results of 80 healthy adult individuals with an average age of 28.1 ± 6.3 years (33 males) with LV rotational mechanics being directed normally. All cases have undergone complete two-dimensional Doppler echocardiography with the measurement of TAPSE and 3DSTE. Results: None of the LV volumes and rotational parameters showed any differences in healthy cases with TAPSE 18-21 mm vs. TAPSE >22 mm. Similarly, right atrial (RA) volumetric parameters did not differ either. TAPSE showed no associations with the degree of basal LV rotation. RA volumes were slightly increased with higher basal LV rotation. Similar to basal LV rotation, TAPSE did not change with the degree of apical LV rotation and a tendentious increase of RA volumes could be demonstrated with increasing apical LV rotation. No correlation could be demonstrated between apical and basal LV rotations and TAPSE. Conclusions: 3DSTE-derived LV rotational parameters and TAPSE are not associated suggesting that LV twist is independent of RV longitudinal shortening in healthy circumstances. [ABSTRACT FROM AUTHOR]

Introduction: During the heart cycle, left ventricular (LV) contractility is characterized by complex deformation and rotational mechanics, resulting in LV ejection. The present study seeks to expand our knowledge by examining dependence of LV strains representing LV deformation on left atrial (LA) volumes in healthy circumstances. Therefore, the aim of this study was to evaluate the associations between LA volumes and LV strains as assessed simultaneously by three-dimensional speckle-tracking echocardiography (3DSTE) in normal healthy adults. Methods: The present study consisted of 302 healthy adults, but according to exclusion criteria, 137 subjects were excluded due to inferior image quality. The final population comprised 165 individuals (mean age: 33.1 ± 12.3 years, 75 males) who were voluntarily recruited for screening. Two-dimensional echocardiography extended with 3DSTE was performed in all subjects for detailed LV/LA analysis. Results: Overall feasibility for simultaneous assessment of LV strains and LA volumes proved to be 55 % with excellent intra- and interobserver correlations. All global LV strains were similar, regardless of the LA volumes examined. All LA volumes and volume-based functional properties respecting the cardiac cycle were similar, regardless the global LV strains examined. Conclusions: LV strains and LA volumes can be simultaneously assessed by 3DSTE. Global LV strains and LA volumes are not associated in healthy adults.

BackgroundThere are limited data on structural heart disease among people living with HIV in southern Africa, where the success of antiretroviral therapy (ART) has drastically improved life expectancy and where risk factors for cardiovascular disease are prevalent.MethodsWe performed a cross-sectional study of screening echocardiography among adults (≥18 years) with HIV in Malawi presenting for routine ART care. We used univariable and multivariable logistic regression to evaluate correlates of abnormal echocardiogram.ResultsA total of 202 individuals were enrolled with a median age of 45 years (IQR 39-52); 52% were female, and 27.7% were on antihypertensive medication. The most common clinically significant abnormality was left ventricular hypertrophy (LVH) (12.9%, n=26), and other serious structural heart lesions were rare (

Ultrasound is a widely used imaging modality, which provides continuous real-time imaging of the human heart, brain, liver, and many other organs. Accurate cardiovascular evaluation plays an important role in early disease diagnosis. Real-time 3D echocardiography (RT3DE) imaging allows better three-dimensional (3D) imaging by extracting spatial features along with temporal information, thus improving clinical decision making. Although there have been technological advances, the majority of acquired RT3DE images tend to be of low quality, characterized by the absence of anatomical information, decreased spatial and temporal resolution, speckle noise, and a limited field of view (FOV). By registering RT3DE images obtained from several windows, it is possible to enhance the recognition of structures and achieve a substantial improvement in image quality as well as it is also useful in the fusion of echo images to image the entire heart. This study proposes a fully automatic point-based rigid registration technique, followed by nonrigid B-spline registration, to align four-dimensional (4D) echocardiogram images acquired from various sonographic windows. The methodology was evaluated using scans acquired from seven volunteers. The accuracy of registration was visually and quantitatively assessed by delineating the left ventricle in each scan and computing the Dice score overlap metric and the Hausdorff distance mutual proximity measure between the first scan and the rest. The overall findings demonstrate that the suggested registration method improves image alignment compared to the initial scans, which might be helpful in the fusion of echocardiographic images.

Background: We previously reported that myocardial fibrosis may be one of the causes of left ventricular hypertrophy and cardiac dysfunction in dogs with hyperglucocorticism (HGC). The detailed mechanism by which myocardial fibrosis of the left ventricle occurs in dogs with hyperglucocorticism (HGC) remains unclear. Aim: This study investigated the mechanism by which HGC causes fibrosis of the left ventricle. Methods: The impacts of HGC on the heart by comparing samples obtained from high-dose glucocorticoid-treated (P) and untreated (C) dogs. The P group included healthy Beagle dogs (n=6) treated with prednisolone (2 mg/kg, bid, po) for 84 days, and the C group included healthy Beagle dogs (n=6) euthanized for unrelated reasons. In three of the P group dogs, serum was collected before the start of administration (Day 0) and on Day 84 to measure angiotensin II concentrations and oxidative stress markers (8-hydroxy-2'-deoxyguanosine (8OHdG), NADPH oxidase, and superoxide levels). Samples of the left ventricular free wall (LVFW), right ventricular free wall (RVFW), interventricular septum (IVS), and aortic root were harvested from both groups (n = 6 for each group). Using these tissue samples, angiotensin II type 1 receptor (AT1R), 8OHdG, and transforming growth factor β1 (TGFβ1) immunohistochemical stains were performed. Results: The blood NADPH oxidase concentration was significantly higher (P=0.027) in the P group 84 days after initiation of the medication compared to that before prednisolone treatment. By contrast, there was no significant difference in serum angiotensin II (P=0.450), 8OHdG (P=0.068), and superoxide (P=0.057) concentrations. The positive staining rates of AT1R, 8OHdG, and TGFβ1 in the heart (LVFW, RVFW, IVS, and aortic root) were significantly higher in the P group than those in the C group. Conclusion: Angiotensin II and oxidative stress in HGC may cause left ventricular fibrosis in dogs. [Open Vet J 2023; 13(12.000): 1708-1717]

Background Left ventricular hypertrophy (LVH) is associated with increased mortality risk and rehospitalization after transcatheter aortic valve replacement among those with severe aortic stenosis. Whether cardiac troponin (cTnT) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) risk stratify patients with aortic stenosis and without LVH is unknown. Methods and Results In a multicenter prospective registry of 923 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement, we included 674 with core-laboratory-measured LV mass index, cTnT, and NT-proBNP. LVH was defined by sex-specific guideline cut-offs and elevated biomarker levels were based on age and sex cut-offs. Adjusted Cox proportional hazards models evaluated associations between LVH and biomarkers and all-cause death out to 5 years. Elevated cTnT and NT-proBNP were present in 82% and 86% of patients with moderate/severe LVH, respectively, as compared with 66% and 69% of patients with no/mild LVH, respectively (P

BackgroundAbnormalities in cardiac energy metabolism occur in heart failure (HF) and contribute to contractile dysfunction, but their role, if any, in HF-related pathologic remodeling is much less established. CK (creatine kinase), the primary muscle energy reserve reaction which rapidly provides ATP at the myofibrils and regenerates mitochondrial ADP, is down-regulated in experimental and human HF. We tested the hypotheses that pathologic remodeling in human HF is related to impaired cardiac CK energy metabolism and that rescuing CK attenuates maladaptive hypertrophy in experimental HF.MethodsFirst, in 27 HF patients and 14 healthy subjects, we measured cardiac energetics and left ventricular remodeling using noninvasive magnetic resonance 31P spectroscopy and magnetic resonance imaging, respectively. Second, we tested the impact of metabolic rescue with cardiac-specific overexpression of either Ckmyofib (myofibrillar CK) or Ckmito (mitochondrial CK) on HF-related maladaptive hypertrophy in mice.ResultsIn people, pathologic left ventricular hypertrophy and dilatation correlate closely with reduced myocardial ATP levels and rates of ATP synthesis through CK. In mice, transverse aortic constriction-induced left ventricular hypertrophy and dilatation are attenuated by overexpression of CKmito, but not by overexpression of CKmyofib. CKmito overexpression also attenuates hypertrophy after chronic isoproterenol stimulation. CKmito lowers mitochondrial reactive oxygen species, tissue reactive oxygen species levels, and upregulates antioxidants and their promoters. When the CK capacity of CKmito-overexpressing mice is limited by creatine substrate depletion, the protection against pathologic remodeling is lost, suggesting the ADP regenerating capacity of the CKmito reaction rather than CK protein per se is critical in limiting adverse HF remodeling.ConclusionsIn the failing human heart, pathologic hypertrophy and adverse remodeling are closely related to deficits in ATP levels and in the CK energy reserve reaction. CKmito, sitting at the intersection of cardiac energetics and redox balance, plays a crucial role in attenuating pathologic remodeling in HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00181259.

BackgroundGuidelines emphasize screening people with elevated BP for the presence of end-organ damage.MethodsWe characterized the prevalence, correlates, and prognosis of hypertension-mediated organ damage (HMOD) in the community-based Framingham Study. 7898 participants (mean age 51.6 years, 54% women) underwent assessment for the following HMOD: electrocardiographic and echocardiographic left ventricular hypertrophy, abnormal brain imaging findings consistent with vascular injury, increased carotid intima-media thickness, elevated carotid-femoral pulse wave velocity, reduced kidney function, microalbuminuria, and low ankle-brachial index. We characterized HMOD prevalence according to blood pressure (BP) categories defined by four international BP guidelines. Participants were followed up for incidence of cardiovascular disease.ResultsThe prevalence of HMOD varied positively with systolic BP and pulse pressure but negatively with diastolic BP; it increased with age, was similar in both sexes, and varied across BP guidelines based on their thresholds defining hypertension. Among participants with hypertension, elevated carotid-femoral pulse wave velocity was the most prevalent HMOD (40%-60%), whereas low ankle-brachial index was the least prevalent (

Background: The left ventricular (LV) rotational mechanics are of particular importance in the function of the LV. The rotational movement is the consequence of the arrangement of the subepicardial and subendocardial muscle fibers. These muscle fibers are perpendicular to each other, their contraction creates a characteristic motion. The aim of the present study was to examine the prognostic impact of LV twist assessed by three-dimensional speckle-tracking echocardiography (3D-STE) in healthy circumstances. Methods: 302 healthy adults participated in the study, 181 subjects were excluded due to certain reasons (LV could not be analysed during 3D-STE, subjects were unidentifiable, or lost to follow-up). 121 subjects were involved in the final analysis (mean age of 33.1 ± 12.3 years, 75 males), who were willing to be examined on a voluntary basis. Results: During a mean follow-up of 7.93 ± 4.21 years, 11 healthy adults suffered a cardiovascular event including 2 cardiac deaths. Using receiver operating characteristic analysis, LV twist ≥14.65 degrees as assessed by 3D-STE proved to be significantly predictive regarding the cardiovascular event-free survival (area under the curve 0.70, specificity 70%, sensitivity 65%, p = 0.028). Subjects with LV twist ≥14.65 degrees had higher basal and apical rotations and a significantly higher ratio of these individuals developed cardiovascular events compared to cases with LV twist

Background Cardiac hypertrophy and fibrosis are common adaptive responses to injury and stress, eventually leading to heart failure. Hypoxia signaling is important to the (patho)physiological process of cardiac remodeling. However, the role of endothelial PHD2 (prolyl-4 hydroxylase 2)/hypoxia inducible factor (HIF) signaling in the pathogenesis of cardiac hypertrophy and heart failure remains elusive. Methods and Results Mice with Egln1Tie2Cre (Tie2-Cre-mediated deletion of Egln1 [encoding PHD2]) exhibited left ventricular hypertrophy evident by increased thickness of anterior and posterior wall and left ventricular mass, as well as cardiac fibrosis. Tamoxifen-induced endothelial Egln1 deletion in adult mice also induced left ventricular hypertrophy and fibrosis. Additionally, we observed a marked decrease of PHD2 expression in heart tissues and cardiovascular endothelial cells from patients with cardiomyopathy. Moreover, genetic ablation of Hif2a but not Hif1a in Egln1Tie2Cre mice normalized cardiac size and function. RNA sequencing analysis also demonstrated HIF-2α as a critical mediator of signaling related to cardiac hypertrophy and fibrosis. Pharmacological inhibition of HIF-2α attenuated cardiac hypertrophy and fibrosis in Egln1Tie2Cre mice. Conclusions The present study defines for the first time an unexpected role of endothelial PHD2 deficiency in inducing cardiac hypertrophy and fibrosis in an HIF-2α-dependent manner. PHD2 was markedly decreased in cardiovascular endothelial cells in patients with cardiomyopathy. Thus, targeting PHD2/HIF-2α signaling may represent a novel therapeutic approach for the treatment of pathological cardiac hypertrophy and failure.

We report the case of a 77-year-old male who suffered from hypertension and died suddenly. At autopsy, he was found to have hypertensive cardiomegaly and a dissecting syphilitic saccular aneurysm of the ascending aorta and arch with tamponade. Chronic aortic regurgitation, which is often seen in syphilitic aortitis, produces an additive effect to the concentric left ventricular hypertrophy seen in hypertension.

Left ventricular (LV) non-compaction (LVNC) is a rare genetic cardiomyopathy due to abnormal intra-uterine arrest of compaction of the myocardial fibers during endomyocardial embryogenesis. Due to the partial or complete absence of LV compaction, the structure of the LV wall shows characteristic abnormalities, including a thin compacted epicardium and a thick non-compacted endocardium with prominent trabeculations and deep intertrabecular recesses. LVNC is frequently associated with chronic heart failure, life-threatening ventricular arrhythmias, and systemic embolic events. According to recent findings, in the presence of LVNC, dysfunctional LV proved to be associated with left atrial volumetric and functional abnormalities and consequential dilated and functionally impaired mitral annulus, partly explaining the higher prevalence of regurgitation. Although the non-compaction process morphologically affects only the LV, signs of remodeling of the right heart were also detected. Moreover, dilation and stiffening of the aorta were present. The aim of the present detailed review was to summarize findings regarding changes in cardiac mechanics, valvular abnormalities, and vascular remodeling detected in patients with LVNC. [ABSTRACT FROM AUTHOR]

Background: The benefits and safety of intensive blood pressure treatment in elderly hypertensive patients have been proved in the STEP trial. However, relevant mechanisms for intensive treatment are lacking. Hypothesis: We aimed to explore whether intensive blood pressure treatment is associated with left ventricular systolic function changes as evaluated by myocardial work (MW) parameters in elderly hypertensive patients compared to the standard. Methods: Patients were randomized to the intensive group (n = 66, median age 66 years, 42.4% male) with a systolic blood pressure (SBP) goal of 110 to <130 mmHg or the standard treatment group (n = 50, median age 63.5 years, 30% male) with an SBP goal of 130–<150 mmHg in this subcenter study of the STEP trial. There was no pre‐randomization echocardiographic collected. Echocardiographic exam was produced at 1‐year (phase 1) and 3‐year (phase 2) post‐randomization. Results: In phase 1, SBP was already significantly lower in the intensive treatment group than in the standard treatment group (126.5 vs. 132.1 mmHg, p <.05). During a median follow‐up of 40 months, in phase 2, the intensive group still had a lower SBP than the standard treatment group (125.0 vs. 135.3 mmHg, p <.05). Both global work index (GWI) and global constructive work (GCW) decreased significantly in phase in the intensive treatment group but not in the standard group (p <.05). Global wasted work (GWW) increased and global work efficiency (GWE) declined in both groups from phase 1 to phase 2 while no significant difference between the treatment effects. Similarly, left ventricular ejection function (LVEF) and global longitudinal strain (GLS) decreased in the two groups. The multivariate linear regression analysis showed the intensive treatment appeared to be an independent predictor of the ΔGWI (β = −110.92; 95% CI, −197.78 to −30.07, p =.008) and ΔGCW (β = −135.11; 95% CI, −220.33 to −49.88, p =.002). Conclusions: In elderly hypertensive patients, lower SBP was associated with decreased GWI and GCW and intensive BP treatment did not improve global MW efficiency. [ABSTRACT FROM AUTHOR]

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Introduction: Left ventricular (LV) strains are measures of deformation that reflect LV function quantifying the rate of LV contraction, providing information in three directions in space: radial (RS), longitudinal (LS) and circumferential directions (CS). The LV moves around its longitudinal axis in a special movement called LV rotational mechanics. The present study aimed to assess associations between three-dimensional speckle-tracking echocardiography (3DSTE)-derived LV rotational mechanics and LV strains in healthy adult subjects. Methods: The present study consisted of 174 healthy adults (mean age: 32.8 ± 12.2 years, 79 males). Complete two-dimensional Doppler echocardiography and 3DSTE were performed in all subjects. Results: While LV-gRS and LV-gLS did not show associations with increased basal LV rotation, the lowest LV-gCS was seen in the presence of the highest LV basal rotation. An increase in basal LV rotation and consequential LV twist were not associated with apical LV rotation. While LV-gLS was not associated with the increase in apical LV rotation, LV-gRS and LV-gCS showed a trend towards increasing values. An increase in LV-gRS was associated with an increasing trend towards apical LV rotation, LV twist and LV-gCS and the preservation of basal LV rotation. LV-gLS also increased but only up to a certain value. An increase in LV-gCS was associated with a tendency towards a decrease in basal LV rotation and a tendency towards an increase in LV-gRS and LV-gLS. The highest LV-gCS was associated with the highest apical LV rotation and LV twist. The highest apical LV rotation, LV twist and LV-gCS were seen in the presence of the highest LV-gLS, while basal LV rotation and LV-gRS were not associated with increasing LV-gLS. Conclusions: Basal LV rotation has been shown to have an inverse relationship with LV-gCS, but without being related to LV-gRS and LV-gLS, while apical LV rotation is associated with LV strains in all directions, but to a different extent, suggesting a complex relationship between LV rotational mechanics and LV strains in healthy adults. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in women in developed societies. Unfavorable structural and functional adaptations within the heart and central blood vessels with sedentary aging in women can act as the substrate for the development of debilitating CVD conditions such as heart failure with preserved ejection fraction (HFpEF). The large decline in cardiorespiratory fitness, as indicated by maximal or peak oxygen uptake (V_ O2max and V_ O2peak, respectively), that occurs in women as they age significantly affects their health and chronic disease status, as well as the risk of cardiovascular and all-cause mortality. Midlife and older women who have performed structured endurance exercise training for several years or decades of their adult lives exhibit a V_ O2max and cardiac and vascular structure and function that are on par or even superior to much younger sedentary women. Therefore, regular endurance exercise training appears to be an effective preventative strategy for mitigating the adverse physiological cardiovascular adaptations associated with sedentary aging in women. Herein, we narratively describe the aging and short- and long-term endurance exercise training adaptations in V_ O2max, cardiac structure, and left ventricular systolic and diastolic function at rest and exercise in midlife and older women. The role of circulating estrogens on cardiac structure and function is described for consideration in the timing of exercise interventions to maximize beneficial adaptations. Current research gaps and potential areas for future investigation to advance our understanding in this critical knowledge area are highlighted. [ABSTRACT FROM AUTHOR]

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