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ardiovascular imaging has become the foundation of heart failure diagnostic studies. The most crucial technique for clinically diagnosing cardiac diseases is echocardiography. Depending on the positioning and angles of the probe, different cardiac views can be obtained during echocardiography. Therefore, the automatic classification of echo views, especially for computer systems and even automatic diagnosis in later stages, is the first step for echocardiogram diagnosis. In addition, the classification of heart views allows the tagging of echo videos to be done on a high scale and the possibility of database management and collection is provided. However, deep learning is an advanced machine learning method that is used to analyze both natural and medical images. But so far, it has not been widely used on cardiac ultrasound, the reason is the complexity of formats with multiple views and multi-view formats of echocardiogram. The proposed topic of this research is to provide novel and effective architectures for cardiac view classification. The aim of this study is to overcome the challenges in processing, categorizing and recognizing echo views stored as videos and images. In particular, in order to extract features, automatic methods and deep networks have replaced manual methods. In the presented solution, by using the transfer learning and the 3d-cnn method in image and video classification, we have improved the accuracy of echo views classification. [ABSTRACT FROM AUTHOR]

Background: There are high impact of COVID-19 disease on cardiovascular system in either acute or recovery phase. The cardiac complications of COVID-19 are easily reflected by electrocardiography and echocardiography. Aim: To predict significant cardiovascular affection throughout course of COVID-19 infection using electrocardiography and echocardiography. Methods: This retrospective cohort study was conducted at Cardiology Department, Faculty of Medicine and isolation department at Zagazig University Hospitals during the period of 2021 to 2022 on 100 cases with suspected or confirmed COVID-19. All patients were subjected to electrocardiographic and Echocardiographic assessment. Results: QTc and number of patients with abnormal ECG were significantly higher in severe group compared to non-severe group. PR interval was significantly higher in severe group compared to non-severe group. LV mass, EF, E, and E/A ratio were significantly lower in severe group compared to nonsevere group. LVEDD, A, number of patients with diastolic dysfunction and number of patients with pericardial effusion were significantly higher in severe group compared to non-severe group (P<0.05). Valvular lesion was significantly different between both groups. Conclusions: Patients with severe COVID-19 disease exhibit significantly worse cardiac pathology across structural, systolic, and diastolic functions compared to non-severe disease. Patients with severe disease showed markers of myocardial injury, elevated cardiac biomarkers, ECG changes, impaired left ventricular function, and higher rates of arrhythmias, valvular lesions, pericardial effusion, and diastolic dysfunction. [ABSTRACT FROM AUTHOR]

Abstract Background Echocardiography can be used to screen, confirm, and assist in the management of some cardiovascular diseases in people living with human immunodeficiency virus (HIV) (PLWH). Thus, complications from subclinical cardiovascular conditions or more apparent conditions, such as massive pericardial effusion with tamponade, can be promptly identified and managed to minimize cardiovascular morbidity and mortality associated with HIV infection. Since the introduction of antiretroviral therapy (ART) in Ghana approximately two decades ago, studies on the prevalence and patterns of echocardiographic abnormalities among PLWH on ART have been limited. This study was designed to assess the prevalence and patterns of echocardiographic abnormalities among PLWH on ART. Methods This was a cross-sectional study. PLWH on ART (cases) attending the HIV clinic at Komfo Anokye Teaching Hospital (KATH) and HIV-negative blood donors (controls) were consecutively recruited and enrolled in this study. The interviews were performed via a standardized questionnaire. After a clinical examination was performed, all patients underwent two-dimensional (2D) and Doppler transthoracic echocardiograms. The prevalence and patterns of echocardiographic abnormalities were characterized. Results There were 117 patients in each arm of the study. There were more females than males among both the cases (92 (78.6%) and controls (80 (68.4%)); however, the sex distribution was similar between the two groups (p = 0.075). For clinical characteristics such as age, weight, height and blood pressure, there were no statistically significant differences between the cases and controls. Echocardiographic abnormalities were more frequently observed and demonstrated a statistically significant difference between cases and controls, with an overall prevalence of 35.0% among cases and 19.7% among controls (p = 0.008). The echocardiographic abnormalities that demonstrated significant differences between the cases and controls were left ventricular (LV) diastolic dysfunction (28.2% versus 8.6%; p = 0.000) and LV hypertrophy (7% versus 0.9%; p = 0.017). Conclusion Nearly 1 in 3 PLWH on ART had an echocardiographic abnormality in this Ghanaian study. Echocardiograms are recommended as helpful screening modalities for diagnosing cardiac abnormalities among PLWH on ART.

Background: Echocardiography can be used to screen, confirm, and assist in the management of some cardiovascular diseases in people living with human immunodeficiency virus (HIV) (PLWH). Thus, complications from subclinical cardiovascular conditions or more apparent conditions, such as massive pericardial effusion with tamponade, can be promptly identified and managed to minimize cardiovascular morbidity and mortality associated with HIV infection. Since the introduction of antiretroviral therapy (ART) in Ghana approximately two decades ago, studies on the prevalence and patterns of echocardiographic abnormalities among PLWH on ART have been limited. This study was designed to assess the prevalence and patterns of echocardiographic abnormalities among PLWH on ART. Methods: This was a cross-sectional study. PLWH on ART (cases) attending the HIV clinic at Komfo Anokye Teaching Hospital (KATH) and HIV-negative blood donors (controls) were consecutively recruited and enrolled in this study. The interviews were performed via a standardized questionnaire. After a clinical examination was performed, all patients underwent two-dimensional (2D) and Doppler transthoracic echocardiograms. The prevalence and patterns of echocardiographic abnormalities were characterized. Results: There were 117 patients in each arm of the study. There were more females than males among both the cases (92 (78.6%) and controls (80 (68.4%)); however, the sex distribution was similar between the two groups (p = 0.075). For clinical characteristics such as age, weight, height and blood pressure, there were no statistically significant differences between the cases and controls. Echocardiographic abnormalities were more frequently observed and demonstrated a statistically significant difference between cases and controls, with an overall prevalence of 35.0% among cases and 19.7% among controls (p = 0.008). The echocardiographic abnormalities that demonstrated significant differences between the cases and controls were left ventricular (LV) diastolic dysfunction (28.2% versus 8.6%; p = 0.000) and LV hypertrophy (7% versus 0.9%; p = 0.017). Conclusion: Nearly 1 in 3 PLWH on ART had an echocardiographic abnormality in this Ghanaian study. Echocardiograms are recommended as helpful screening modalities for diagnosing cardiac abnormalities among PLWH on ART. [ABSTRACT FROM AUTHOR]

Introduction: Perinatal asphyxia is defined as the failure to initiate and sustain breathing at birth. Aim: compare functional echocardiographic parameters of perinatal asphyxiated term neonates with non asphyxiated term neonates. Methodology: This observational study, conducted at the Division of Pediatric Cardiology in M.D.M Hospital under the Department of Pediatrics, Dr. S.N. Medical College, Jodhpur, focused on perinatal asphyxia and hypoxic ischemic encephalopathy (HIE). Perinatal asphyxia severity was classified as moderate or severe based on breathing patterns and APGAR scores at 1 minute after birth. HIE diagnosis relied on physical examination, utilizing the modified Sarnat & Sarnat staging system to determine severity. Result: our observational study compared functional echocardiographic parameters between perinatal asphyxiated term neonates and non-asphyxiated term neonates. The findings revealed significant differences in certain parameters between the two groups: La and Ao did not differ significantly between the study and control groups.The ratio of La to Ao was significantly higher in the study group. LVES was significantly larger in the study group. EF and FS were significantly lower in the study group, indicating impaired cardiac function. Other parameters such as LVMPI, MAPSE and mitral E/A and E/e' ratios did not show significant differences between the two groups. However, the diastolic diameter of the tricuspid annulus was significantly larger in the study group compared to the control group. Conclusion: The perinatal asphyxia may impact specific echocardiographic parameters indicative of cardiac dysfunction, particularly in terms of left ventricular systolic function.Early recognition and management of cardiac involvement may improve outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR]

Efforts have been made over the last five decades to create effective ultrasonic contrast media (UCM) for cardiac and noncardiac applications. The initial UCM was established in the 1980s, following publications from the 1960s that detailed the discovery of ultrasonic contrast enhancement using small gaseous bubbles in echocardiographic examinations. An optimal contrast agent for echography should possess the following characteristics: non-toxicity, suitability for intravenous injection, ability to traverse pulmonary, cardiac, and capillary circulations, and stability for recirculation. Definity, Optison, Sonazoid, and SonoVue are examples of current commercial contrast media. These contrast media have shown potential for various clinical reasons, both on-label and off-label. Several possible UCMs have been developed or are in progress. Advancements in comprehending the physical, chemical, and biological characteristics of microbubbles have significantly improved the visualization of tumor blood vessels, the identification of areas with reduced blood supply, and the enhanced detection of narrowed blood vessels. Innovative advances are expected to enhance future applications such as ultrasonic molecular imaging and therapeutic utilization of microbubbles.

Efforts have been made over the last five decades to create effective ultrasonic contrast media (UCM) for cardiac and noncardiac applications. The initial UCM was established in the 1980s, following publications from the 1960s that detailed the discovery of ultrasonic contrast enhancement using small gaseous bubbles in echocardiographic examinations. An ideal contrast medium for echography should be nontoxic, capable of being injected intravenously, able to travel through pulmonary, cardiac, and capillary circulations, and stable for recirculation. Examples of current commercial contrast media include Definity, Optison, Sonazoid, and SonoVue, which have demonstrated potential for various clinical purposes, both on- and off-label. Several possible UCMs have been developed or are in progress. Advancements in comprehending the physical, chemical, and biological characteristics of microbubbles have significantly improved the visualization of tumor blood vessels, the identification of areas with reduced blood supply, and the enhanced detection of narrowed blood vessels. Innovative advances are expected to enhance future applications such as ultrasonic molecular imaging and therapeutic utilization of microbubbles.

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Efforts have been made over the last five decades to create effective ultrasonic contrast media (UCM) for cardiac and noncardiac applications. The initial UCM was established in the 1980s, following publications from the 1960s that detailed the discovery of ultrasonic contrast enhancement using small gaseous bubbles in echocardiographic examinations. An ideal contrast medium for echography should be nontoxic, capable of being injected intravenously, able to travel through pulmonary, cardiac, and capillary circulations, and stable for recirculation. Examples of current commercial contrast media include Definity, Optison, Sonazoid, and SonoVue, which have demonstrated potential for various clinical purposes, both on- and off-label. Several possible UCMs have been developed or are in progress. Advancements in comprehending the physical, chemical, and biological characteristics of microbubbles have significantly improved the visualization of tumor blood vessels, the identification of areas with reduced blood supply, and the enhanced detection of narrowed blood vessels. Innovative advances are expected to enhance future applications such as ultrasonic molecular imaging and therapeutic utilization of microbubbles.

Abstract Congenital heart disease (CHD), birth defect with the highest incidence rates worldwide, and is mainly characterized by the abnormal internal structure of the heart or/and the anatomical structure of great vessels. In the past few decades, CHD repair surgery through standard median sternotomy incision combined with cardiopulmonary bypass (CPB) technology has been considered the gold standard for surgical correction of heart and great vessels. With the promotion and clinical application of interventional catheterization technology, transcatheter closure of CHD under radioactive radiation has gradually been recognized and applied. However, its radiation exposure and potential complications related to arteriovenous vessels still face challenges. In recent years, an increasing number of surgeons have explored new surgical procedures, for the safe and effective treatment of CHD, as far as possible to reduce surgical trauma, avoid radiation exposure, and improve the cosmetic effect. Therefore, on the premise of satisfactory exposure or guidance, how to integrate ultrasound and percutaneous interventional technology remained the focus of the exploration. This mini-review highlights and summarizes the signs of progress of ultrasound intervention in the last decade that have proven the effectiveness and operability of a well-established procedure for percutaneous closure of congenital heart diseases under echocardiographic guidance only. We discuss potential diseases that will benefit from this emerging procedure based on this progress. Owing to the crucial advantages played by this strategy in the treatment of CHD, better understanding and promotion of this less exploited field may contribute to the development of therapeutics targeting CHD, improve medical utilization rate, promote the optimization of medical resources, and ultimately achieve precise and efficient medical treatment.

Congenital heart disease (CHD), birth defect with the highest incidence rates worldwide, and is mainly characterized by the abnormal internal structure of the heart or/and the anatomical structure of great vessels. In the past few decades, CHD repair surgery through standard median sternotomy incision combined with cardiopulmonary bypass (CPB) technology has been considered the gold standard for surgical correction of heart and great vessels. With the promotion and clinical application of interventional catheterization technology, transcatheter closure of CHD under radioactive radiation has gradually been recognized and applied. However, its radiation exposure and potential complications related to arteriovenous vessels still face challenges. In recent years, an increasing number of surgeons have explored new surgical procedures, for the safe and effective treatment of CHD, as far as possible to reduce surgical trauma, avoid radiation exposure, and improve the cosmetic effect. Therefore, on the premise of satisfactory exposure or guidance, how to integrate ultrasound and percutaneous interventional technology remained the focus of the exploration. This mini-review highlights and summarizes the signs of progress of ultrasound intervention in the last decade that have proven the effectiveness and operability of a well-established procedure for percutaneous closure of congenital heart diseases under echocardiographic guidance only. We discuss potential diseases that will benefit from this emerging procedure based on this progress. Owing to the crucial advantages played by this strategy in the treatment of CHD, better understanding and promotion of this less exploited field may contribute to the development of therapeutics targeting CHD, improve medical utilization rate, promote the optimization of medical resources, and ultimately achieve precise and efficient medical treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Sedation is sometimes necessary in veterinary practice to perform different medical procedures, such as echocardiography or radiography, due to uncooperative or aggressive patients. In patients with cardiovascular disease, anxiety needs to be reduced; however, hemodynamic conditions have to be preserved, so it is advisable to avoid sedatives such as alpha-2 agonists or phenothiazine, due to their cardiovascular side effects. Many studies support the cardiovascular stability obtained by the administration of alfaxalone, alone or in combination, in dogs. Butorphanol is a synthetic opioid characterized by minimal cardiovascular effects, making it an ideal drug for sedation protocols. We aimed to evaluate the hemodynamic impact of the administration of intramuscular alfaxalone and butorphanol in healthy dogs. The evaluation involved assessing the degree of sedation and the effects of the sedation on cardiorespiratory, echocardiographic, radiographic and electrocardiographic parameters at baseline and 30 min after the administration of sedation. Although statistically significant changes were observed in some of the studied parameters, no clinical alterations were found 30 min after drug administration. The results showed that alfaxalone and butorphanol at the doses used in this study provided moderate sedation for performing diagnostic procedures, and they caused mild hemodynamic and respiratory changes. The quality of sedation and changes in cardiorespiratory variables after the intramuscular administration of alfaxalone and butorphanol in Spanish greyhound dogs were evaluated. Twenty-one adult dogs were included. The dogs received alfaxalone (2 mg/kg) and butorphanol (0.2 mg/kg) intramuscularly. Sedation scoring, cardiorespiratory parameters (including blood gas analysis), echocardiography, thoracic radiography and electrocardiography were performed before sedation and 30 min after drug administration. Moderate sedation was observed, and side effects, such as tremors, nystagmus and auditory hyperesthesia, were noticed. Statistically significant changes in heart rate, invasive blood pressure, pH, arterial saturation of O2 and partial pressure of O2 and CO2 were found. Echocardiographic variables, including end-diastolic volume, left ventricular diameter in diastole, aortic and pulmonic flow, diastolic transmitral flow and left atrial/aortic ratio, and electrocardiography parameters, including PQ interval and QT interval, showed statistically significant changes. In conclusion, the intramuscular administration of alfaxalone and butorphanol to healthy dogs produced moderate sedation with mild cardiorespiratory, echocardiographic and electrocardiographic changes, without alterations in cardiac size on radiographic images. [ABSTRACT FROM AUTHOR]

Stroke is one of the primary causes of morbidity and mortality worldwide, including a large proportionof cryptogenic strokes. Long-term electrocardiographic monitoring is beneficial in prospective studies fordetecting atrial fibrillation in patients with cryptogenic stroke. This review aimed to evaluate the advancedechocardiographic parameters and their roles in assessing left atrial (LA) function in the incidence ofcryptogenic and ischemic strokes. Main resources, including PubMed, Scopus, and ISI Web of Sciencedatabases, were evaluated for articles published in English from 2010 until May 2021. LA echocardiographicparameters such as LA strain and strain rate, isovolumetric relaxation time (IVRT), the mean left atrialvolume index (LAVI), LA reservoir volume, systole strain rate (SSR) of left atrial appendage, and lack ofLA function response to maximal exercise as measured by the LA ejection fraction during rest and exercisecould be considered for assessing the risk of cryptogenic strokes and ischemic strokes. The results indicatedthat increased LA volumes and reduced LA strain rate were correlated with cryptogenic stroke. Advancedparameters of LA function, measured by speckle tracking echocardiography, such as strain and strainrate values in different parts of the cardiac cycle, in addition to standard measures of LA function suchas LA ejection fraction and LAVI, will define an excellent understanding regarding LA myopathy and riskassessment of cryptogenic stroke, independent of considering conventional cardiovascular risk factors.

There have been numerous attempts over the past 50 years to develop efficient ultrasound contrast media (UCM) for both cardiac and noncardiac uses. In other words, the first UCM was created in the 1980s as a result of early reports from the 1960s documenting the findings of ultrasound contrast enhancement by microscopic gaseous bubbles during echocardiographic tests. A nontoxic UCM (Definity, Optison, Sonazoid, and SonoVue are some of the current commercial contrast media for echography that have shown promise in a range of on- and off-label clinical purposes) that may be injected intravenously, travels through the pulmonary, cardiac, and capillary circulations, and is stable for recirculation would be ideal. Many potential UCMs have been developed or are currently being worked on. The understanding of the physical, chemical, and biological behavior of microbubbles has greatly advanced in increase tumor vascularity, highlight sites of ischemia, and improve the ability to see vascular stenosis. Future potential, like ultrasonic molecular imaging and therapeutic uses of microbubbles, are anticipated to benefit from new inventive advancements.

Female and male dogs respond differently to cardiac volume overload as a result of stage B (B1+B2) Myxomatous mitral valve disease. The differences are more strongly related to the thickness of the heart walls in systole and diastole and less to the left ventricular internal diameter. They are similar to the differences found between women and men in people with low-grade mitral regurgitation. [ABSTRACT FROM AUTHOR]

ObjectiveWe aimed to use molecular biomarkers and clinical data and echocardiograms that were collected during admission to predict bronchopulmonary dysplasia (BPD) in preterm infants with gestational age ≤32 weeks.MethodsEighty-two patients (40 with BPD, BPD group and 42 healthy as controls, non-BPD group) admitted to the Department of Neonatology of the Children's Hospital of Soochow University between October 1, 2018, and February 29, 2020, were enrolled in this study at the tertiary hospital. Basic clinical data on the perinatal period, echocardiographic measurements, and molecular biomarkers (N-terminal-pro-B-brain natriuretic peptide, NT-proBNP) were collected. We used multiple logistic regression analysis to establish an early predictive model for detecting BPD development in preterm infants of gestational age ≤32 weeks. We also used a receiver operating characteristic curve to assess the sensitivity and specificity of the model.ResultsNo significant differences were found between the BPD and non-BPD groups in terms of sex, birth weight, gestational age, incidence of asphyxia, maternal age, gravidity, parity, mode of delivery, premature rupture of membranes >18 h, use of prenatal hormones, placental abruption, gestational diabetes mellitus, amniotic fluid contamination, prenatal infections, and maternal diseases. The use of caffeine, albumin, gamma globulin; ventilation; days of FiO2 ≥ 40%; oxygen inhalation time; red blood cell suspension infusion volume (ml/kg); and proportion of infants who received total enteral nutrition (120 kcal/kg.d) ≥24 d after birth were higher in the BPD group than in the non-BPD group. The levels of hemoglobin, hematocrit, and albumin in the BPD group were significantly lower than those in the non-BPD group. The total calorie intake was significantly lower in the BPD group on the 3rd, 7th, and 14th day after birth than in the non-BPD group (P

Background: The epicardial adipose tissue (EAT) plays an important role in the cardiac functions. Childhood obesity has significant effect on the circulatory system. However, till now the effect of obesity on cardiac function is not detected, but evaluation of visceral adipose tissue may be done by echocardiographic measurement and its relationship with cardiometabolic risk. Objectives: To detect measurements of EAT thickness among children with obesity and to correlate them with other cardiometabolic, anthropometric, clinical and laboratory variables. Methods: Target sample comprised 12 overweight and obese children (study group) of age ranged from (6-12 years) selected from the outpatient obesity clinic and all have Body Mass Index above 85th percentile for their corresponding age and sex. Twelve apparently healthy averagely weighted children (control group) matched with the study group for age and sex. A questionnaire performed for collection of personal, sociodemographic and clinical data, clinical examination, laboratory investigations for fasting blood sugar and plasma lipids with echocardiographic measurement of EAT thickness. Results: In overweight and obese children, the epicardial adipose tissue was significantly higher compared to normal weight children. Overweight and obese children had significantly higher body mass index, waist/hip ratio, blood pressure, triglycerides. EAT thickness correlated significantly with blood pressure and triglycerides. Conclusion: Overweight and obese children exhibit an increase in echocardiographic epicardial adipose tissue thickness. Changes in epicardial adipose tissue thickness are associated with increase in blood pressure and serum triglycerides. For assessment of cardiometabolic risk EAT is an easy and practical accurate parameter for assessing visceral obesity. [ABSTRACT FROM AUTHOR]

Objective: To explore short‐term changes after left bundle branch pacing (LBBP) using echocardiography and computed tomography (CT), especially for postoperative ventricular septal perforation. Methods: Between January and September 2019, 33 patients with atrioventricular block underwent LBBP at Beijing Anzhen Hospital. All the patients were evaluated using electrocardiography, pacing, parameters and echocardiographic measurements, including for major complications, during the 1, 3, 6, 12 and 24‐month follow‐up. Interval perforations were examined during a 1‐month follow‐up echocardiogram and CT. Results: Left bundle branch pacing was successfully performed in 100% (33/33) of patients. The mean seizure threshold was stable and unchanged postoperatively at the 1, 3, 6, 12 and 24‐month follow‐up. The paced QRS duration of the LBBP was 119.72 ± 2.53 ms and <130 ms in all patients. Unipolar impedance during the procedure was higher than 500 Ω (662.00 ± 181.50 Ω). No ventricular septal perforation occurred at the end of the procedure. At the 1‐month follow‐up, two patients reported transthoracic echocardiography, with CT revealing septal lead perforation. Through CT, two other patients were found to have septal lead perforation, and echocardiography indicated that the pacing lead had penetrated the interventricular septum and entered the left subendocardium. At the 1, 3, 6, 12 and 24‐month follow‐up, these four patients exhibited no significant increase in pacing threshold or impedance (p >.05). No ventricular thrombus or stroke was detected. Conclusion: Permanent LBBP is safe and feasible in patients with bradycardia. Echocardiography and/or CT can more accurately evaluate changes in cardiac structure and function after LBBP. [ABSTRACT FROM AUTHOR]

Background: Chronic Obstructive Pulmonary Disease (COPD) is defined by GOLD as a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. [1] The most common respiratory symptoms include dyspnea, cough and/or sputum production. These symptoms may be under-reported by patients. Material and Methods: This is a Prospective, observational, comparative study was conducted in the Departments of Physiology at Index Medical College. The sample size for this research study was calculated on the basis of prevalence of abnormal left and right ventricular dysfunction of 25% in known patients of COPD at 95% confidence interval and an absolute precision of 10%. Right atrial Pressure (RAP) was estimated from the evaluation of the inferior vena cava during respiration. If the inferior vena cava diameter is normal and the segment adjacent to the right atrium collapses by at least 50% with respiration, then right atrial pressure is estimated as 5 mm Hg. Results: Number of males is slightly higher than females in the study group. But there was no significant difference in sex between the study group and the control group. There is no significant difference in age between COPD and control group. The minimum age of the patient was considered to be 35 because COPD is usually a disease of middle age and is less likely below 35 years. The mean difference in FEV1 in the study group is 1.03±0.31 and in control group is 4.23± 0.91. By applying student t test, p value was found to be significant between the two groups. The mean difference in FVC is 2.03±0.34 in COPD group and 4.61±0.88 in the control group. P value was significant between the two groups. The mean difference in the FEV1/FVC in COPD group was 53.15±9.99 and control group was 83.88±6.66. p value was significant. Conclusions: This study on clinically stable patients with COPD with a wide range of severity of airways disease provides evidence of subclinical RV dysfunction and suggests that cardiovascular comorbidities may begin early in COPD and are often occult. RIMP and RV basal strain showed largest difference between controls and COPD cases irrespective of the presence or absence of PH. [ABSTRACT FROM AUTHOR]

Abstract Aims Dilated cardiomyopathy (DCM) is defined as a serious cardiac disorder caused by the presence of left ventricular dilatation and contractile dysfunction in the absence of severe coronary artery disease and abnormal loading conditions. The incidence of cardiac death is markedly higher in patients with DCM with pulmonary hypertension (PH) than in DCM patients without PH. No previous studies have constructed a predictive model to predict PH in patients with DCM. Methods Data from 218 DCM patients (68.3% man; mean age 57.33) were collected. Patients were divided into low, intermediate and high PH‐risk groups based on the echocardiographic assessment at the tricuspid regurgitation peak velocity (TRV) in conjunction with the presence of echocardiographic signs from at least two different categories. Basic information, vital signs, comorbidities and biochemical data of each patient were determined. The impact of each parameter on PH probability was analysed by univariable and multivariable analyses, the data from which were employed to establish a predictive model. Finally, the discriminability, calibration ability and clinical efficacy of the model were verified for both the modelling group and the external validation group. Results We successfully applied a history of chronic obstructive pulmonary disease (COPD) or chronic bronchitis, systolic murmur (SM) at the tricuspid area, SM at the apex and brain natriuretic peptide (BNP) level to establish a model for predicting PH probability in DCM. The model was proven to have high accuracy and good discriminability (area under the receiver operating characteristic curve 0.889), calibration ability and clinical application value. Conclusions A model for predicting PH probability in patients with DCM was successfully established. The new model is reliable for predicting PH probability in DCM and has good clinical applicability.

Abstract Objective To explore short‐term changes after left bundle branch pacing (LBBP) using echocardiography and computed tomography (CT), especially for postoperative ventricular septal perforation. Methods Between January and September 2019, 33 patients with atrioventricular block underwent LBBP at Beijing Anzhen Hospital. All the patients were evaluated using electrocardiography, pacing, parameters and echocardiographic measurements, including for major complications, during the 1, 3, 6, 12 and 24‐month follow‐up. Interval perforations were examined during a 1‐month follow‐up echocardiogram and CT. Results Left bundle branch pacing was successfully performed in 100% (33/33) of patients. The mean seizure threshold was stable and unchanged postoperatively at the 1, 3, 6, 12 and 24‐month follow‐up. The paced QRS duration of the LBBP was 119.72 ± 2.53 ms and .05). No ventricular thrombus or stroke was detected. Conclusion Permanent LBBP is safe and feasible in patients with bradycardia. Echocardiography and/or CT can more accurately evaluate changes in cardiac structure and function after LBBP.

(1) Importance: Abnormal left ventricular (LV) diastolic function, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). The association of diastolic function with duration of hospital stay after coronary artery bypass (CAB) is unknown. (2) Objective: To determine if selected TEE parameters of diastolic dysfunction are associated with length of hospital stay after coronary artery bypass surgery (CAB). (3) Design: Prospective observational study. (4) Setting: A single tertiary academic medical center. (5) Participants: Patients with normal systolic function undergoing isolated CAB from September 2017 through June 2018. (6) Exposures: LV function during diastole, as assessed by intra-operative TEE prior to coronary revascularization. (7) Main Outcomes and Measures: The primary outcome was duration of postoperative hospital stay. Secondary intermediate outcomes included common postoperative cardiac, respiratory, and renal complications. (8) Results: The study included 176 participants (mean age 65.2 ± 9.2 years, 73% male); 105 (60.2%) had LV diastolic dysfunction based on selected TEE parameters. Median time to hospital discharge was significantly longer for subjects with selected parameters of diastolic dysfunction (9.1/IQR 6.6–13.5 days) than those with normal LV diastolic function (6.5/IAR 5.3–9.7 days) (p < 0.001). The probability of hospital discharge was 34% lower (HR 0.66/95% CI 0.47–0.93) for subjects with diastolic dysfunction based on selected TEE parameters, independent of potential confounders, including a baseline diagnosis of heart failure. There was a dose–response relation between severity of diastolic dysfunction and probability of discharge. LV diastolic dysfunction based on those selected TEE parameters was also associated with postoperative cardio-respiratory complications; however, these complications did not fully account for the relation between LV diastolic dysfunction and prolonged length of hospital stay. (9) Conclusions and Relevance: In patients with normal systolic function undergoing CAB, diastolic dysfunction based on selected TEE parameters is associated with prolonged duration of postoperative hospital stay. This association cannot be explained by baseline comorbidities or common post-operative complications. The diagnosis of diastolic dysfunction can be made by TEE. [ABSTRACT FROM AUTHOR]

BackgroundEven if the beneficial cardiovascular effects of moderate exercise are recognized, effects of prolonged and intense exercise are still debated. This study aims to detect cardiovascular changes associated with long endurance running by assessing the relationship between echocardiographic parameters and cardiac biomarkers during long-distance trail running.MethodsWe performed a prospective observational study that included 20 participants who were all amateur runners (median age of 41 years old, still alive after a 7-year clinical follow-up) from 80-km trail running. All the participants underwent an echocardiographic examination and venous blood sampling before the race, at the intermediate refreshment checkpoints of the race (21st and 53rd km), and within 10 min after arrival.ResultsMitral E/A velocity ratio and mitral TDI e’ wave were significantly decreased at the 21st km to arrival (p < 0.05). Mitral S wave and global longitudinal strain (GLS) were significantly decreased from the 53rd km to arrival (p < 0.05 for 53rd and 80th km). As compared to baseline, T-troponin and NT-proBNP were significantly increased at the 21st km in all the participants, but T-troponin values were systematically increased above the significative threshold. Diastolic echocardiographic abnormalities were mainly observed among participants with highest NT-proBNP (> 77 ng.l–1) values at the 21st km. As compared to baseline, mitral e’ wave was significantly decreased (–35%) in participants with highest values of NT-proBNP. Similarly, GLS was also depressed among participants with highest troponin values at the 53rd km (p = 0.01 for 53rd km and p = 0.04 for arrival).ConclusionDuring the long-distance trail running, the early LV decrease in diastolic echocardiographic parameters is associated with increase in NT pro-BNP blood levels, and the decrease in LV systolic echocardiographic parameters later is associated with increase in T-troponin blood levels.

Introduction: The left atrial appendage )LAA( occlusion using a purpose-built device is a growing procedure. This study aimed to develop a computer-aided diagnostic system for the recognition of the LAA in echocardiographic images. Material and Methods: The three-dimensional (3D) echocardiographic images of the LAA of 26 patients successfully treated with an LAA occluder were used in this study. A total of 208 3D derived two-dimensional images in the axial plane were derived from each 3D dataset. Then, 562 images in which the LAA boundaries were highly recognizable were selected for this study. The proposed convolutional neural network (CNN) in this study was based on open-source object identification and classification platform compiled under the You Only Look Once algorithm. Finally, 419 and 143 images were used for training and testing the algorithm, respectively. Results: Algorithm performance on the identification of the LAA region on a set of 143 images was compared to that reported for the traced regions on the same images by an expert in echocardiography using an intersection over the union (IOU) algorithm. The algorithm was able to correctly identify the LAA region in all 143 examined images with an average IOU of 90.7%. Conclusion: The proposed image-based CNN algorithm in this study showed high accuracy in the recognition of the LAA boundaries in the echocardiographic images. The method can be used in the development of algorithms for the automated analysis of the area of the LAA used for device sizing and procedural planning in the LAA occlusion procedures.

Background: Potential complications of hemodynamic significant patent ductus arteriosus (hsPDA) after birth include heart failure, need for respiratory support, renal disfunction, intraventricular hemorrhage, as well as long term altered growth and development. Nevertheless, clinical signs of patent ductus arteriosus (PDA) are not sensitive and specific enough. Therefore, echocardiography still remains the preferred method to evaluate the ductal patency in preterm infant. The present study aimed to evaluate the echocardiography characteristic in preterm infant with hsPDA. Methods: A cross-sectional study was conducted on preterm infants aged 3-7 days with 24-336/7 weeks of gestation. Data taken were demographic, clinical and echocardiography. Diagnosis of hsPDA was carried out by echocardiography; defined as >1.5mm diameter of ductus and >1.4 left pulmonal artery and aorta (La/Ao) ratio. The statistical analysis was undertaken using SPSS 21.0. Results: There were 11 out of 52 preterm infants diagnosed hsPDA. Mean birth weight was 1213±293 gram; Mean gestational age was 30.72±2.01 weeks. In hsPDA group, mean ductus diameter was 2.84±0.93 mm, mean La/Ao ratio was 1.56±0.26, and mean ejection fraction (EF) was 71.55±5.72%. Conclusion: Echocardiographic evaluation is important for addressing hsPDA in preterm infants. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) contributes greatly to morbidity, mortality, and health care costs worldwide. Hospital readmission rates are tracked closely and determine federal reimbursement dollars. No current modality or technology allows for accurate measurement of relevant HF parameters in ambulatory, rural, or underserved settings. This limits the use of telehealth to diagnose or monitor HF in ambulatory patients., Objective: This study describes a novel HF diagnostic technology using audio recordings from a standard mobile phone., Methods: This prospective study of acoustic microphone recordings enrolled convenience samples of patients from 2 different clinical sites in 2 separate areas of the United States. Recordings were obtained at the aortic (second intercostal) site with the patient sitting upright. The team used recordings to create predictive algorithms using physics-based (not neural networks) models. The analysis matched mobile phone acoustic data to ejection fraction (EF) and stroke volume (SV) as evaluated by echocardiograms. Using the physics-based approach to determine features eliminates the need for neural networks and overfitting strategies entirely, potentially offering advantages in data efficiency, model stability, regulatory visibility, and physical insightfulness., Results: Recordings were obtained from 113 participants. No recordings were excluded due to background noise or for any other reason. Participants had diverse racial backgrounds and body surface areas. Reliable echocardiogram data were available for EF from 113 patients and for SV from 65 patients. The mean age of the EF cohort was 66.3 (SD 13.3) years, with female patients comprising 38.3% (43/113) of the group. Using an EF cutoff of ≤40% versus >40%, the model (using 4 features) had an area under the receiver operating curve (AUROC) of 0.955, sensitivity of 0.952, specificity of 0.958, and accuracy of 0.956. The mean age of the SV cohort was 65.5 (SD 12.7) years, with female patients comprising 34% (38/65) of the group. Using a clinically relevant SV cutoff of <50 mL versus >50 mL, the model (using 3 features) had an AUROC of 0.922, sensitivity of 1.000, specificity of 0.844, and accuracy of 0.923. Acoustics frequencies associated with SV were observed to be higher than those associated with EF and, therefore, were less likely to pass through the tissue without distortion., Conclusions: This work describes the use of mobile phone auscultation recordings obtained with unaltered cellular microphones. The analysis reproduced the estimates of EF and SV with impressive accuracy. This technology will be further developed into a mobile app that could bring screening and monitoring of HF to several clinical settings, such as home or telehealth, rural, remote, and underserved areas across the globe. This would bring high-quality diagnostic methods to patients with HF using equipment they already own and in situations where no other diagnostic and monitoring options exist., (©Martin Huecker, Craig Schutzman, Joshua French, Karim El-Kersh, Shahab Ghafghazi, Ravi Desai, Daniel Frick, Jarred Jeremy Thomas. Originally published in JMIR Cardio (https://cardio.jmir.org), 26.06.2024.)

Efforts have been made over the last five decades to create effective ultrasonic contrast media (UCM) for cardiac and noncardiac applications. The initial UCM was established in the 1980s, following publications from the 1960s that detailed the discovery of ultrasonic contrast enhancement using small gaseous bubbles in echocardiographic examinations. An optimal contrast agent for echography should possess the following characteristics: non-toxicity, suitability for intravenous injection, ability to traverse pulmonary, cardiac, and capillary circulations, and stability for recirculation. Definity, Optison, Sonazoid, and SonoVue are examples of current commercial contrast media. These contrast media have shown potential for various clinical reasons, both on-label and off-label. Several possible UCMs have been developed or are in progress. Advancements in comprehending the physical, chemical, and biological characteristics of microbubbles have significantly improved the visualization of tumor blood vessels, the identification of areas with reduced blood supply, and the enhanced detection of narrowed blood vessels. Innovative advances are expected to enhance future applications such as ultrasonic molecular imaging and therapeutic utilization of microbubbles., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Oglat AA.)

Acute coronary syndrome is one of the major causes of morbidity and mortality. It includes a spectrum of presentations, from unstable angina through to ST segment elevation myocardial infarction. Echocardiography is a valuable non-invasive diagnostic technique, which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, transthoracic echocardiography is essential and valuable both for diagnosing and evaluation of ventricular function in acute coronary syndrome whether systolic or diastolic dysfunctions. This study aimed to detect left ventricular systolic and diastolic dysfunction in patients with acute coronary syndrome using echocardiography, and to determine the relationship between echocardiographic findings with the type and extent of severity. One hundred forty Patients (140) with acute coronary syndrome of either gender with a mean age of 53 years, in addition to an age and gender matched normal subjects involved in this study. Each subject submitted to medical history, clinical and physical examination, electrocardiography and echocardiography. The result of the study revealed that systolic function is affected in ACS through reduced EF%, diastolic function also reduced through the reduction in E/A and E/É ratios, EF% and wall motion scores are improved following PCI, OE is positively correlated with EF%. In conclusion, this study concluded that systolic dysfunction discovered to be more than diastolic dysfunction, while ST elevation myocardial infarction (STEMI) type represented higher percent than Non ST elevation myocardial infarction (Non STEMI) and Unstable angina (UA), anterior myocardial infarction is the mostly reported type of ACS. [ABSTRACT FROM AUTHOR]

Echocardiography is a standard diagnostic tool for assessment of cardiac functions and cardiovascular diseases in dogs, however published echocardiographic measurements have varied widely based on dog breeds. The objective of this prospective reference interval study was to provide breed‐specific echocardiographic values for healthy French Bulldogs. A total of 42 healthy French Bulldogs of both sexes (23 females and 19 males) were sampled. Furthermore, measurements for a control group (n = 16) were also conducted in four other dog breeds (Cocker Spaniel [n = 2], Cavalier King Charles Spaniel [n = 4], Terrier [n = 5], and Crossbreed [n = 5]). Standard M‐mode, two‐dimensional (2D), pulse wave (PW) Doppler, and tissue Doppler imaging (TDI) echocardiographic measurements were obtained from healthy French Bulldogs. The M‐mode echocardiographic data obtained from French Bulldogs were compared to the data obtained from the control group. The left ventricular internal dimension at end‐diastole (LVIDd; cm)/body surface area (BSA) (m2) ratio for the study group was 3.35/0.53 = 6.32. Left ventricular measurements for French bulldogs and internal dimension at end‐systole (21.23 ± 3.50 mm) and at end‐diastole (33.50 ± 4.12 mm) were found to be significantly higher (P <.001) compared to control group values (left ventricular internal dimension at end‐systole [LVIDs]; 17.46 ± 2.85 mm, LVIDd; 27.16 ± 4.20 mm, respectively). A significantly positive correlation in the French Bulldog group was noted between body weight and M‐mode measurements (EPSS, IVSd, IVSs, LVIDd, LVIDs, and LVPWd). French bulldogs had a greater systolic and diastolic left ventricular volume than the control group. As a result, values reported in this study could be used as specific reference ranges in French Bulldogs. [ABSTRACT FROM AUTHOR]

We found a lack of significant differences in the echocardiographic sizes LA/Ao, LVID-d/Aow and LVID-s/Aow in the examined dogs with myxomatous mitral valve disease (MMVD) after their division depending on the presence or absence of pulmonary hypertension. For the same echocardiographic sizes, we found a high degree of correlation with Mitral Valve E (m/sec). This shows that the echocardiographic M-mode sizes and Doppler measured speed Mitral Valve E rate, which depend on the left atrial pressure in dogs with MMVD prone to development of pulmonary hypertension, may be similar to the same parameters in dogs with MMVD without a tendency to develop pulmonary hypertension. [ABSTRACT FROM AUTHOR]

Aim. To assess the value of the complex analysis of electrocardiographic (ECG) variants and echocardiographic (echo) manifestation of left bundle branch block (LBBB) in predicting the success of cardiac resynchronization therapy (CRT). Materials and methods. The study included 39 patients (mean age 61.49±9.0 years) on sinus rhythm with LBBB, QRS duration ≥130 ms, left ventricular ejection fraction (LVEF) ≤35%, heart failure (HF) NYHA II-IV despite optimal pharmacological therapy during 3 month. All patients had undergone CRT-D implantation. Depending on presence or absence of ECG-criteria, proposed by D.G. Strauss et al., patients were divided into 2 groups: 1 group - strict LBBB, proposed by D.G. Strauss et al. (n=29) and 2 group - other patients (n=10). In addition to standard echocardiography, global longitudinal 2-dimensional strain (GLS) and LBBB contraction pattern have been performed initially and in 6 months after implantation. Response to CRT was defined as decrease in LV end-systolic volume by >15% after 6 months of follow-up. Results and discussion. Typical LBBB echo contraction pattern was detected in 25 patients (64% of all included). These patients had more pronounced longitudinal dissynchrony and a more expressed global longitudinal strain before CPT-D implantation (p

Myocarditis in acute meningococcemia is rare in children. Impaired cardiac contractile function may contribute to cardiovascular collapse in endotoxemia. We evaluated prospectively the clinical and echocardiographic findings in 25 consecutive children with acute meningococcemia. All of the patients had good prognostic indicators. Eleven (44%) of the 25 children bad echocardiographic evidence of myocardial dysfunction. The mean LVFS in these eleven children was 0.23 ± 6.00, as compared with the mean LVFS of0.34±8.87 in the remaining children. LVFS returned to normal within 7 days in all patients. We observed minimal pericardia/effusion in 4 patients (16%) that resolved within 3 days. We demonstrated that acute meningococcemia is frequently associated with myocardial dysfunction. We could not though, find the relation between myocardial dysfunction and mortality.

Introduction: The left atrial appendage) LAA (occlusion using a purpose-built device is a growing procedure. This study aimed to develop a computer-aided diagnostic system for the recognition of the LAA in echocardiographic images. Material and Methods: The three-dimensional (3D) echocardiographic images of the LAA of 26 patients successfully treated with an LAA occluder were used in this study. A total of 208 3D derived twodimensional images in the axial plane were derived from each 3D dataset. Then, 562 images in which the LAA boundaries were highly recognizable were selected for this study. The proposed convolutional neural network (CNN) in this study was based on open-source object identification and classification platform compiled under the You Only Look Once algorithm. Finally, 419 and 143 images were used for training and testing the algorithm, respectively. Results: Algorithm performance on the identification of the LAA region on a set of 143 images was compared to that reported for the traced regions on the same images by an expert in echocardiography using an intersection over the union (IOU) algorithm. The algorithm was able to correctly identify the LAA region in all 143 examined images with an average IOU of 90.7%. Conclusion: The proposed image-based CNN algorithm in this study showed high accuracy in the recognition of the LAA boundaries in the echocardiographic images. The method can be used in the development of algorithms for the automated analysis of the area of the LAA used for device sizing and procedural planning in the LAA occlusion procedures. [ABSTRACT FROM AUTHOR]

Introduction To enhance the diagnosis of anatomic left ventricular hypertrophy (LVH) using electrocardiography (ECG), we aimed to identify common ECG amplitude and non-amplitude abnormalities in Nigerian patients with hypertensive echocardiographic LVH. Method The study included 1,765 patients with essential hypertension aged 18 years and older from the Federal Medical Centre Abuja Hypertension Registry (FMCAHR). Participants underwent echocardiography and ECG following the American College of Cardiology and the American Society of Echocardiography guidelines. Results The prevalence of overall ECG LVH amplitude criteria (43.8%) and individual criteria of Cornell voltage (27.1%), Sokolow-Lyon voltage (23.2%), and Gubner-Ungerleider (13.9%) were higher than non-amplitude ECG abnormalities among patients with echocardiographic LVH. The sensitivity and specificity of LVH criteria were 43.8% and 79.5% for overall ECG LVH, 23.2% and 87.2% for Sokolow-Lyon voltage, 27.1% and 93.3% for Cornell voltage, and 13.9% and 95.4% for Gubner-Ungerleider criteria, respectively. After multivariable adjustment, non-amplitude ECG changes, including prolonged corrected QT (QTc) (odds ratio (OR): 1.68, 95% confidence interval (CI): 1.06-2.66), left ventricular (LV) strain pattern (OR: 1.83, CI: 1.23-2.72), left axis deviation (OR: 1.56, CI: 1.09-2.24), poor R wave progression (OR: 2.36, CI: 1.40-3.97), premature ventricular contractions (OR: 1.80, CI: 1.10-2.91), premature atrial contractions (OR: 2.06, CI: 1.10-3.87), atrial fibrillation (OR: 2.40, CI: 1.20-4.82), and left atrial abnormality (OR: 8.43, CI: 2.95-24.05), were associated with echocardiographic LVH (p < 0.05). Conclusion In our cohort of hypertensive patients, ECG LVH amplitude criteria were the most frequently observed abnormalities associated with echocardiographic LVH. Our findings suggest that despite the low sensitivity, ECG LVH amplitude criteria may remain valuable in diagnosing echocardiographic LVH., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Abiodun et al.)

Objectives: The aim of this study is to compare degree of left ventricular dyssynchrony as assessed with phase analysis from Gated myocardial perfusion SPECT (GMPS) to that assessed with Echocardiographic Tissue Doppler Imaging (TDI) in patients with left ventricular EF 120 ms. Patients & methodology: 30 patients were included, all scheduled for CRT. TDI was measured as standard deviation of time to peak systolic velocity in 6 basal segments. Gated SPECT TC-99m sestamibi acquisition was performed, software phase analysis parameters is histogram bandwidth which include 95% of the element of the phase distribution. Study population was divided into two groups: responders and non-responders according to increase of at least 15% of LVEF after 3 months. Results: ROC analysis was done to reveal that Phase analysis parameter acted in better way to predict CRT response with histogram bandwidth 55.5° Area Under Curve (AUC) 68.9% sensitivity 87% specificity 42.9% positive predictive value (PPV) 83.3% negative predictive value (NPV) 50% compared to TDI sensitivity 52.25%, specificity 71.4% PPV 85.7% NPV 31.3% When applying histogram bandwidth cutoff 55.5° dyssynchrony was illustrated in 20 (87%) patients in comparison to 14 (60%) patients with Echo TDI, there was significant difference in sensitivity of histogram bandwidth compared to TDI with p value 0.043. Conclusion: Histogram bandwidth of GMPS Tc99m sestamibi may be more predictive of significant response to CRT as compared to TDI.

Background: The role of echocardiography in deriving transvalvular mean gradients from transaortic velocities in aortic stenosis (AS) and in structural valve degeneration (SVD) is well established. However, reports following surgical aortic valve replacement, post-transcatheter aortic valve replacement (TAVR), and valve-in-valve-TAVR (ViV-TAVR) have cautioned against the use of echocardiography-derived mean gradients to assess normal functioning bioprosthesis due to discrepancy compared with invasive measures in a phenomenon called discordance., Methods: In a multicenter study, intraprocedural echocardiographic and invasive mean gradients in AS, SVD, post-native TAVR, and post-ViV-TAVR were compared, when obtained concomitantly, and discharge echocardiographic gradients were recorded. Absolute discordance (intraprocedural echocardiographic - invasive mean gradient) and percent discordance (intraprocedural echocardiographic - invasive mean gradient/echocardiographic mean gradient) were calculated. Multivariable regression analysis was performed to determine variables independently associated with elevated postprocedure invasive gradients ≥20 mm Hg, absolute discordance >10 mm Hg, and discharge echocardiographic mean gradient ≥20 mm Hg., Results: A total of 5,027 patients were included in the registry: 4,725 native TAVR and 302 ViV-TAVR. Intraprocedural concomitant echocardiographic and invasive mean gradients were obtained pre-TAVR in AS (n = 2,418), pre-ViV-TAVR in SVD (n = 101), in post-ViV-TAVR (n = 77), and in post-TAVR (n = 823). Echocardiographic and invasive mean gradients demonstrated strong correlation (r = 0.69) and agreement (bias, 0.11; 95% CI, -0.4-0.62) in AS, moderate correlation (r = 0.56) and agreement (bias, 1.08; 95% CI, -2.53 to 4.59) in SVD, moderate correlation (r = 0.61) and weak agreement (bias, 6.47; 95% CI, 5.08-7.85) post-ViV-TAVR, and weak correlation (r = 0.18) and agreement (bias, 3.41; 95% CI, 3.16-3.65) post-TAVR. Absolute discordance occurs primarily in ViV-TVR and is not explained by sinotubular junction size and increases with increasing echocardiographic mean gradient. Percent discordance in AS and SVD (1.3% and 4%, respectively) was lower compared with post-TAVR/ViV-TAVR (66.7% and 100%, respectively). Compared with self-expanding valves, balloon expanding valves were independently associated with elevated discharge echocardiographic but lower invasive mean gradient (odds ratio = 3.411, 95% CI, 1.482-7.852, P = .004; vs odds ratio = 0.308, 95% CI, 0.130-0.731, P = .008, respectively)., Conclusions: Post-TAVR/ViV-TAVR, echocardiography is discordant from invasive mean gradients, and absolute discordance increases with increasing echocardiographic mean gradient and is not explained by sinotubular junction size. Percent discordance is significantly higher post-TAVR/ViV-TAVR than in AS and SVD. Post-TAVR/ViV-TAVR, poor correlation and wide limits of agreement suggest echocardiographic and invasive mean gradients may not be used interchangeably and a high residual echocardiographic mean gradient should be confirmed invasively before considering any additional procedure to "correct" the gradient. Transcatheter aortic valve replacement valve types have variable impact on echocardiographic and invasive mean gradients., (Copyright © 2023 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Highlights • The benznidazole (Bz) treatment for chronic Chagas' disease (CCD) may improve immune response and myocardial function. • Higher levels of IL-17 were observed in treated CCD patients, specially after adjustment for time of disease and NYHA class. • The treated group of patients exhibited better parameters of myocardial function by tissue Doppler than the untreated group. Abstract Background The immunological and clinical impact of trypanocidal treatment in chronic Chagas' disease (CCD) is unclear. Methodology and findings Several cytokines were measured in plasma of 66 patients with CCD. Thirty-three patients had been previously treated with benznidazole and 33 had never been treated. The treated group exhibited higher levels of IL-17 (median 142.45 × 1.22 pg/ml, P = 0.025), which was the only one significantly associated with Bz treatment, especially after adjusting for time of disease and NYHA class (P = 0.024; OR 1.006, 95% CI 1.001-1.010). Compared to untreated patients, the treated group exhibited higher median values of mitral annular E' lateral (13.0 × 10.0 cm/s, P = 0.038), S' infero-lateral (8.9 × 7.6 cm/s, P = 0.013), S' septal (8.5 × 7.4 cm/s, P = 0.034), mean S' (9.0 × 7.9 cm/s, P = 0.013) and tricuspid annular S' (13.3 × 11.1 cm/s, P = 0.001) and lower values of E/E' septal (7.2 × 9.5 cm/s, P = 0.049). After adjustment for time of disease and NYHA class, S' infero-lateral (P = 0.031), mean S' (P = 0.049) and S' tricuspid (P = 0.024) persisted as significantly associated with treatment. Conclusion The present findings suggest that the group of CCD patients treated with Bz displayed increased plasma levels of IL-17 and preserved myocardial function, reinforcing the idea that Bz treatment may be beneficial. [ABSTRACT FROM AUTHOR]

This study is based on the findings of a single surgeon’s practice of mitral valve replacement of 167 patients from April 2005 to June 2017 who developed symptomatic mitral restenosis after closed or open mitral commisurotomy. Both clinical and color doppler echocardiographic data of peri-operative and six months follow-up period were evaluated and compared to assess the early outcome of the redo mitral valve surgery. With male-female ratio of 1: 2.2 and after a duration of 6 to 22 years symptom free interval between the redo procedures, the selected patients with mitral valve restenosis undergone valve replacement with either mechanical valve in 62% cases and also tissue valve in 38% cases. Particular emphasis was given to separate the adhered pericardium from the heart completely to ameliorate base to apex and global contraction of the heart. Besides favorable post-operative clinical outcome, the echocardiographic findings were also encouraging as there was statistically significant increase in the mitral valve area and ejection fraction with significant decrease in the left atrial diameter, pressure gradient across the mitral valve and pulmonary artery systolic pressure. Therefore, in case of inevitable mitral restenosis after closed or open commisurotomy, mitral valve replacement is a promising treatment modality.

Background:  Systemic lupus erythematosus (SLE) is a multisystem autoimmune connective tissue disorder involving multiple organs and systems. Cardiovascular involvement in SLE patients is a major cause of morbidity and mortality. Although subclinical cardiac abnormalities exist among SLE patients, they are rarely screened for. Echocardiography has been demonstrated to be a useful tool for the early diagnosis of cardiac abnormalities in SLE patients, many of which are clinically silent. Early recognition of cardiovascular abnormalities is vital for the prompt initiation of the appropriate management. This study aims to determine the prevalence of various structural and functional cardiac abnormalities among SLE patients and to determine its association with the modified SLE Disease Activity Index 2000 (modified SLEDAI-2K)., Methods:  The study was a cross-sectional study of SLE patients at the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana, from June to December 2021. The setting was the rheumatology outpatient clinic of the KBTH and included adult men and women, 18 years and above, diagnosed with SLE with no known cardiac abnormalities. The baseline demographic and clinical characteristics of the participants were determined. A detailed transthoracic echocardiogram was performed for all patients. The frequency of common cardiac pathologies was determined and compared between those with a high modified SLEDAI-2K and those with a low modified SLEDAI-2K., Results:  Ninety-nine SLE patients participated in the study with a mean age of 35.12 years. Females formed the majority (90.9%) of the participants. The mean age at diagnosis of SLE was 28.7 years and the mean disease duration was 4.6 years. All of the participants were on at least two disease-modifying medications. The mean modified SLEDAI-2K score was 9.1. Thirty-five percent (35%) of the patients had mild to moderately active disease and 39% had severely active disease. Sixty-six (66%) out of the severely active disease group had abnormal echocardiographic findings, while 28% of those with mild to moderate disease had abnormal echocardiographic findings. Echocardiographic abnormalities were found in 56 patients (47%), out of which 8.7% had valvular involvement, 15.7% had diastolic dysfunction, 5.2% had left ventricular hypertrophy (LVH), and 0.9% had left ventricular systolic dysfunction (LVSD). About 12% of the participants had pulmonary hypertension and 1% had pericardial involvement. The odds of echocardiographic abnormalities were 13.7 times higher in SLE patients with high disease activity compared to those with low disease activity (odds ratio (OR) = 13.714, 95% confidence interval (CI) = 3.804-49.442, p < 0.001). There was no significant association between cardiac abnormalities and SLE duration. No significant correlation between cardiac abnormalities and modified SLEDAI-2K score was found.  Conclusion: Cardiac abnormalities, especially left ventricular diastolic dysfunction (LVDD), valvular involvement, and pulmonary hypertension, are common in SLE patients. For SLE patients, especially those with active diseases, echocardiographic assessment should be considered in the management of SLE patients to enable early detection of cardiac abnormalities, early treatment, and thus a decrease in morbidity and mortality associated with cardiovascular involvement in SLE patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Attuquayefio et al.)

Background and Aim:  Interpretation of imaging modalities depends on robust normal reference limits. Ethnicity is an essential determinant of cardiac chamber sizes. Though few studies from India have focused on this research, it has yet to include the Kashmiri population. We aimed to study normal echocardiographic values of healthy Kashmiri adults and compare them with Western and Indian studies., Methods:  It was a prospective observational study on healthy adults of Kashmir Valley. A comprehensive echocardiographic analysis following standardized protocols was performed., Results:  A total of 2245 study participants were analyzed. The mean age was 32.52±11.55 years. There were 1100 (49%) males. Males had higher absolute left ventricular volumes and mass, left atrial volumes, right ventricular diameter, and aortic size, while females had higher absolute left ventricular ejection fraction and early and late diastolic mitral inflow velocities. Males had higher indexed left ventricular end-systolic volume, while females had higher indexed left ventricular end diastole diameter, aorta diameter, right ventricle, and left and right atrial sizes. Left ventricular mass and diastolic parameters were significantly associated with age. Compared with the American Society of Echocardiography/European Association of Cardiovascular Imaging, absolute values of left ventricle size, volumes, mass, right ventricle size, aortic size, and left and right atrial size were higher than those in our study. Our study population had a higher left ventricle ejection fraction. Among indexed parameters, left ventricle volumes, left ventricle systolic diameter, aortic annulus, and left and right atrial volumes were still significantly higher in Western data. While comparing with Indian data, we noted significant regional differences., Conclusion:  We provide normal reference values for our local population. We noted significant differences with Western as well as other Indian populations. Our study highlights the need for developing ethnic-specific reference values of various echocardiographic measurements., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Rashid et al.)

The protective effect and the mechanism of estrogen receptor β (ERβ) on myocardial infarction (MI) in mice were explored. A total of 12 female Tg-ERβ transgenic mice and 12 non-transgenic littermate control (NLC) wild-type C57 mice were used for the present study. Both transgenic and wild-type mice had similar baseline data such as age, sex, and weight. The mouse model of MI was established by coronary artery ligation method, and the cardiac structure and function changes of the mouse were observed by ultrasonic echocardiography on days 1, 3 and 7 after the operation. RT-PCR method was used to detect the expression of collagen I, α-SMA, TGF-β mRNA in the mouse heart, and Masson staining was used to detect cardiac fibrosis. At 3 days after operation, echocardiographic posterior wall thickness at end diastole (PWTD) and end systolic PWTS of Tg-ERβ mice were significantly reduced, and left ventricular systolic diameter and left ventricular diastolic diameter significantly increased (P<0.05) compared with NLC mice. The levels of expression of Tg-ERβ cardiac tissue collagen I, α-SMA, TGF-β mRNA were significantly lower than those in the NLC mice (P<0.05). In conclusion, Tg-ERβ exerts a protective effect on MI. [ABSTRACT FROM AUTHOR]

Different factors seem to contribute to cognitive impairment in the elderly population. It is unclear which cardiovascular risk factors are the most significant contributors to cognitive decline. Although there is some recent neuropathological evidence that vascular lesions and atherosclerotic occlusion of the cerebral arteries may unmask or strengthen the clinical expression of cognitive decline and dementia, there is still little knowledge about the relevance of echocardiographic and arterial stiffness markers as predictors for cognitive decline. In the present study we decided to investigate whether and how the severity of cognitive impairment could be related to cerebral hemodynamic impairment, as well as the possible contribution of the alterations in cerebral hemodynamics (as expressed through some echocardiographic and arterial stiffness markers) to the progression of cognitive decline in a group of patients with cognitive impairments, as compared to a control group with no cognitive deficits. The main finding of our study indicated significant differences in terms of echocardiographic and arterial stiffness markers between the two groups, one composed of patients with cognitive impairment and one with normal-cognitive patients, which suggests an association between these parameters and poor cognitive function. While these functional changes of the cerebral vessel functions could have an important role in the pathogenesis of dementia, the identification of simple and accurate measures that are acceptable to patients and can serve as indicators of current cognitive impairment or the risk of cognitive decline could be very helpful in developing long-term preventive and therapeutic treatments for these patients.

Background: early diagnosis of left ventricular mass (LVM) inappropriateness and left ventricular hypertrophy (LVH) can result in preventing diastolic left ventricular dysfunction and its related morbidity and mortality. This study was performed to determine if diastolic dysfunction is associated with LVH and inappropriate LVM. Materials and Methods: one hundred and twenty five uncomplicated hypertension from Isfahan Healthy Heart Program underwent two-dimensional echocardiography. Inappropriate LVM was defined as an LVM index greater than 88 g/m2 of body-surface area in women and greater than 102 g/m2 in men. LVH-defined septal and posterior wall thickness greater than 0/9 cm in women and greater than 1 cm in men, respectively. Echocardiographic parameters, including early diastolic peak velocity (E)/late diastolic peak velocity (A), deceleration time (DT), and E/early mitral annulus velocity (E′) were measured. Results: the mean systolic and diastolic blood pressure at the patients′ admission day were 142.87 ± 18.12 and 88.45 ± 9.18 mmHg, respectively. Totally, 21.7% of subjects had inappropriate LV mass that moderate and severe abnormal LV mass was revealed in 5.6% and 5.6%, respectively. The mean of age and BMI was significantly higher in patients with moderate left ventricular hypertrophy (P < 0.05). Adjusted by age, gender, BMI, and systolic and diastolic blood pressures, both E/A ratio and deceleration time were higher in those with the severer ventricular hypertrophy. Subjects with severe showed significantly higher BMI 33. 7 ± 3.7 (P < 0.001). There was a slight difference between the grade of diastolic dysfunction and the severity of inappropriate LV mass (P = 0.065). But no significant difference was found between E/A, E/E′, and deceleration time and the level of inappropriate LV mass (P > 0.05). Spearman′s Rank test was used to test the correlation between diastolic dysfunction and LV mass (P = 0.025). Conclusion: LVH is correlated with the severity of diastolic dysfunction manifested by the E/A value and deceleration time, but inappropriate LVM can slightly predict diastolic dysfunction severity in uncomplicated hypertension.