Search Results (9)

Breast cancer is the most common cancer in women worldwide. Anthracyclines (doxorubicin, epirubicin, daunorubicin, idarubicin) are among the most used drugs for the treatment of breast cancer. Unfortunately, anthracyclines cause cardiotoxicity, which is a limiting factor for its use, and the lifetime cumulative dose of anthracyclines is the major risk factor for cardiotoxicity. In our study, we focused on acute and subacute heart damage. One of the main factors is a genetic predisposition, which determines individual susceptibility to anthracycline cardiotoxicity. The main idea of this study was, for the first time, to evaluate drug metabolism-related genes as a risk factor for developing cardiovascular toxicity in breast cancer patients. The main objective of our study was to identify the impact of drug metabolism-related gene SNPs on the development of subclinical heart damage during and/or after doxorubicin-based chemotherapy in breast cancer patients. The data of 81 women with breast cancer treated with doxorubicin-based chemotherapy in an outpatient clinic were analyzed, and SNP RT-PCR tests were performed. The drug metabolism-related gene variants SULT2B1 rs10426377, UGT1A6 rs17863783, CBR1 rs9024, CBR3 rs1056892, NCF4 rs1883112, and CYBA rs1049255 did not reach a statistically important impact on ABCC in multivariate logistic regression analysis. However, we identified that NCF4 rs1883112 had a risk reduction tendency for ABCC (OR = 0.49, 95% CI 0.27–0.87, p = 0.015). Our findings suggest that some SNPs, such as NCF4 rs1883112, may be associated with a reduced risk of cardiotoxicity, while no variants in this study showed a statistically significant increased risk. Even though, NCF4 rs1883112 showed a risk reduction tendency, suggesting the potential for personalized risk stratification. We can conclude that multiple genes are involved in ABCC, with different impacts, and it is unlikely that there is a single driver gene in ABCC pathogenesis. Full article

Background: The aim of this pilot study was to determine the potential prognostic relevance of novel multidirectional myocardial and volumetric echocardiographic parameters in patients with non-ischemic dilated cardiomyopathy (NIDCM). Methods: Multidirectional myocardial parameters (longitudinal, radial, and circumferential left-ventricular (LV) strain using speckle tracking echocardiography) and a new volumetric parameter (the sum of the mitral and tricuspid regurgitation volume (mitral–tricuspid regurgitation volume) were assessed. The cardiovascular (CV) outcome was a composite of cardiac death and hospitalization for heart failure (HF) at 1 year. Results: Approximately 102 patients were included in this pilot study. The mean LV ejection fraction (LVEF) was 28.4 ± 8.9%. During a follow-up of 1 year, the CV outcome occurred in 39 patients (10 HF deaths, and 36 hospitalizations for HF). The LV global longitudinal systolic strain (GLS) and mitral–tricuspid regurgitation volume were the main parameters that were seen to be significantly altered in the comparison of patients with events vs. those without events (GLS (absolute values) 7.4 ± 2.7% vs. 10.3 ± 2.6%; mitral–tricuspid regurgitation volume 61.1 ± 20.4 mL vs. 40.9 ± 22.9 mL, respectively; p-value < 0.01). In line with these findings, in a multivariate continuous logistic regression analysis, the GLS and mitral–tricuspid regurgitation volume were the main parameters associated with worse CV outcomes (GLS: OR 0.77 (95%CI 0.65–0.92); mitral–tricuspid regurgitation volume OR 1.09 (95%CI 1.01–1.25)), whereas the radial and circumferential LV global strain and mitral regurgitation volume and tricuspid regurgitation volume were not linked to the CV outcome. Furthermore, in a receiver operating characteristic curve analysis, a GLS cutoff of <7.5% and mitral–tricuspid regurgitation volume > 60 mL were the identified values for the parameters associated with worse CV outcomes. Conclusions: The findings of this pilot study suggest that the GLS and a novel volumetric parameter (the sum of the mitral and tricuspid regurgitation volume) are linked to worse CV outcomes in patients with non-ischemic dilated cardiomyopathy. Hence, these promising results warrant further validation in larger studies. Full article

Background: there are many prognostic factors of heart failure (HF) based on their evaluation from imaging, to laboratory tests. In clinical practice, it is crucial to use widely available, cheap, and easy-to-use prognostic factors, such as left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, 6 min walk test (6MWT), B-type natriuretic peptide (BNP), etc. We sought to evaluate the relationships between whole-heart myocardial mechanics and cardiac morphometrics with the main commonly used prognostic factors of HF in patients with non-ischemic dilated cardiomyopathy (NIDCM). Methods and results: two-dimensional (2D) echocardiography for myocardial mechanics (global longitudinal, radial, and circumferential strains of the left ventricle; right ventricular longitudinal strain; strain values of reservoir, conduit, and contraction function of both atria) and cardiac morphometric (diameters and volumes of both atria and ventricles) parameters were performed, and the HF main traditional prognostic factors were identified. We assessed 109 patients (68.8% male; 49.7 ± 10.5 years) with newly diagnosed NIDCM. Myocardial mechanics and morphometrics were weakly correlated with the patient’s age, gender, and smoking (R = 0.2, p < 0.05). Stronger relationships were observed with NYHA class, 6MWT, and BNP (the strongest correlations were with LVEF: R = −0.499, R 0.462, R = −0.461, p < 0.001, respectively). There were moderately strong correlations with LVEF and other whole-heart myocardial mechanics or morphometrics. Moreover, LVEF with global regurgitation volume (GRV) and right ventricle free wall longitudinal strain (RVFWLS) were the most usually detected parameters in multivariate analysis to be associated with changes in HF prognostic factors. Conclusions: in NIDCM patients, the main prognostic factors of HF are correlated with whole-heart myocardial mechanics and morphometrics. However, LVEF, GRV, and RVFWLS are the most usually found 2D echocardiographic factors associated with changes in HF prognostic factors. Full article

Background: In patients with non-ischemic dilated cardiomyopathy (NIDCM), myocardial fibrosis (MF) is related to adverse cardiovascular outcomes. The purpose of this study was to evaluate the potential relationship between the myocardial mechanics of different chambers of the heart and the presence of MF and to determine the accuracy of the whole-heart myocardial strain parameters to predict MF in patients with NIDCM. Methods: We studied 101 patients (64% male; 50 ± 11 years) with a first-time diagnosis of NIDCM who were referred for a clinical cardiovascular magnetic resonance (CMR) and speckle tracking 2D echocardiography examination. We analyzed MF by late gadolinium enhancement (LGE), and the whole-heart myocardial mechanics were assessed by speckle tracking. The presence of MF was related to worse strain parameters in both ventricles and atria. The strongest correlations were found between MF and left ventricle (LV) global longitudinal strain (GLS) (r = −0.586, p < 0.001), global circumferential strain (GCS) (r = −0.609, p < 0.001), LV ejection fraction (LVEF) (r = 0.662, p < 0.001), and left atrial strain during the reservoir phase (LASr) (r = 0.588, p < 0.001). However, the binary logistic regression analysis revealed that only LV GLS, GCS, and LASr were independently associated with the presence of MF (area under the curves of 0.84, 0.85, and 0.64, respectively). None of the echocardiographic parameters correlated with fibrosis localization. Conclusions: In NIDCM patients, MF is correlated with reduced mechanical parameters in both ventricles and atria. LV GLS, LASr, and LV GCS are the most accurate 2D echocardiography predictive factors for the presence of MF. Full article

We report the case of a 22-year-old male who visited a cardiologist after the first episode of atrial fibrillation (AF). Echocardiography and magnetic resonance imaging revealed decreased left ventricular (LV) systolic function with dilated LV. An intermittent second-degree AV (atrioventricular) block was detected during 24 h Holter monitoring. Genetic test revealed the pathogenic variant of the BAG3 (BLC2-associated athanogene 3) gene. Due to the high risk of heart failure (HF) progression and ventricular arrhythmias, an event recorder was implanted and a pathogenetic HF treatment was prescribed. The analysis of genealogy revealed that the patient’s father, at the age of 32, was diagnosed with dilated cardiomyopathy (DCM) and recurrent AF episodes. Genetic testing also confirmed a pathogenic variant of the BAG3 gene. Currently, with the optimal treatment of HF, the patient’s disease has been stable for three years and the condition is closely monitored on an outpatient basis. So, we demonstrate the importance of early detection for genetic testing and the unusual stability exhibited by the patient‘s optimal medical therapy for 3 years. Full article

Cardiac positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) are encouraging precise non-invasive imaging modalities that allow imaging of the cellular function of the heart, while other non-invasive cardiovascular imaging modalities are considered to be techniques for imaging the anatomy, morphology, structure, function and tissue characteristics. The role of cardiac PET has been growing rapidly and providing high diagnostic accuracy of coronary artery disease (CAD). Clinical cardiology has established PET as a criterion for the assessment of myocardial viability and is recommended for the proper management of reduced left ventricle (LV) function and ischemic cardiomyopathy. Hybrid PET/CT imaging has enabled simultaneous integration of the coronary anatomy with myocardial perfusion and metabolism and has improved characterization of dysfunctional areas in chronic CAD. Also, the availability of quantitative myocardial blood flow (MBF) evaluation with various PET perfusion tracers provides additional prognostic information and enhances the diagnostic performance of nuclear imaging. Full article

Background and objective: Mitral regurgitation (MR) after myocardial infarction (MI) carries adverse prognosis. The objective of this study was to assess the impact of functional MR on adverse in-hospital outcomes in acute MI.
Materials and methods: A total of 569 patients with first ever acute MI were divided into three groups: no MR, mild MR (regurgitant orifice area <0.2 cm2) and moderate-severe MR group (regurgitant orifice area more or equal >0.2 cm2). Clinical profile and in-hospital outcomes were compared among the groups.
Results: Patients with increasing grade of MR were elder (P < 0.001), more likely to be female (P = 0.003), have atrial fibrillation (P < 0.001), higher peak C-reactive protein values (P = 0.001), multivessel coronary artery disease (P < 0.001), and less likely to have dyslipidemia (P = 0.029). Ejection fraction, age, atrial fibrillation and left ventricular end diastolic diameter index were independent predictors of moderate and severe MR (P < 0.001). In hospital cardiac death and decompensated heart failure was more prevalent in moderate-severe MR group.
Conclusions: Moderate and severe MR in acute MI is related to age, atrial fibrillation, increased left ventricular diastolic dimensions and decreased ejection fraction. Moderate and severe, but not mild MR is an important clinical contributor to in-hospital cardiac death. Full article

The aim of our study was to evaluate left ventricular (LV) longitudinal, radial, and rotational function and its relationship with conventional LV parameters of systolic and diastolic function in patients with aortic regurgitation (AR) by speckle-tracking echocardiography.
Material and Methods. A total of 26 asymptomatic patients with moderate AR, 34 patients with severe AR, and 28 healthy controls were included into the study. LV rotation and longitudinal and radial strain were measured offline using speckle-tracking imaging.
Results. The systolic longitudinal strain (–18.3% [SD, 2.18%] vs. –21.0% [SD, 2.52%], P<0.05) and strain rate (–1.08 s^–1 [SD, 0.13 s^–1] vs. –1.27 s^–1 [SD, 0.15 s^–1], P<0.05) were significantly lower and apical rotation (11.3° [SD, 4.99°] vs. 8.30° [SD, 4.34°], P<0.05) as well as rotation rate (82.72°/s [SD, 28.24 °/s] vs. 71.00°/s [SD, 28.04 °/s], P<0.05) were significantly higher in the patients with moderate AR compared with the control patients. The LV systolic basal rotation, systolic radial strain, and diastolic radial strain rate were significantly reduced in the patients with severe AR compared with the control patients. The global longitudinal, radial strain, and LV systolic diameter were the independent predictors of LV ejection fraction in the patients with AR (R2=0.77). The LV systolic basal rotation in the control patients, diastolic longitudinal strain rate and systolic longitudinal strain in the patients with moderate and severe AR, respectively, were independent predictors of LV diastolic filling.
Conclusions. LV long-axis dysfunction with an increased apical rotation was present in the patients with moderate AR, while LV radial function and systolic basal rotation were found to be reduced in more advanced disease. LV diastolic filling depended on diastolic and systolic LV strain and rotation components in the patients with AR. Full article

Objective. Durability of mitral valve repair for ischemic mitral regurgitation remains questionable. The aim of our study was to reveal predictors of recurrent mitral regurgitation following ischemic mitral valve repair.
Material and methods. The study population consisted of 136 patients with ischemic heart disease and ischemic mitral regurgitation. Mitral valve repair was performed at the Kaunas University of Medicine Hospital in 2000–2004. Preoperative echocardiographic examinations were performed two days before surgery, early postoperative examinations 5–10 days after mitral valve repair, late postoperative examinations at 1.89±0.15 years after operation.
Results. Mitral regurgitation increased from 0.78±0.77 at early period to 1.46±0.81 at late postoperative period (P<0.001). At late follow-up mitral regurgitation increased in 13 (9.5%) patients in comparison with preoperative mitral regurgitation and in 69 (50.7%) patients in comparison with early postoperative mitral regurgitation. Left ventricular end-diastolic diameter decreased significantly from 56.44±6.29 mm at early period to 54.44±5.98 mm at late period (P<0.004). Left ventricular ejection fraction increased from 35±10% at early period to 38±10% at late period (P<0.047). Left atrial diameter decreased from 46.12±6.35 mm at early period to 43.95±6.94 mm at late period (P<0.034). Multivariate analysis revealed predictors of late postoperative mitral regurgitation: preoperative left ventricular end-systolic diameter index (P=0.037), left ventricular wall motion score index (P=0.042), mitral regurgitation (P=0.013), and systolic pulmonary artery pressure (P=0.04).
Conclusions. It is possible to predict the progression of mitral regurgitation following ischemic mitral valve repair. Late postoperative mitral regurgitation depends on these preoperative echocardiographic variables: left ventricular end-systolic diameter index, left ventricular wall motion score index, mitral regurgitation, and systolic pulmonary artery pressure. Full article