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21 pages, 581 KiB  
Article
Exploring the Interplay of Stakeholder Pressure, Environmental Awareness, and Environmental Ethics on Perceived Environmental Performance: Insights from the Manufacturing Sector
by Oluwaleke Micheal Awonaike and Tarik Atan
Sustainability 2025, 17(11), 4870; https://doi.org/10.3390/su17114870 - 26 May 2025
Viewed by 516
Abstract
This study explores the relationships among stakeholder pressure (SP), environmental awareness (EA), leadership commitment (LC), and environmental ethics (EE) and their influence on perceived environmental performance (PEP) in the manufacturing industry. Partial least squares structural equation modeling (PLS-SEM) was employed to examine the [...] Read more.
This study explores the relationships among stakeholder pressure (SP), environmental awareness (EA), leadership commitment (LC), and environmental ethics (EE) and their influence on perceived environmental performance (PEP) in the manufacturing industry. Partial least squares structural equation modeling (PLS-SEM) was employed to examine the quantitative data collected from 386 managers across selected manufacturing firms in Lagos State, Nigeria. The outcome of the study reveals that stakeholder pressure influences environmental ethics and perceived environmental performance but not leadership commitment, while environmental awareness influences environmental ethics but not perceived environmental performance and leadership commitment, with EE not impacted by LC. Meanwhile, EE mediate the relationship between EA and PEP as well as SP and PEP but not LC and PEP, while LC does not mediate any of the relationship, and innovative climate (IC) does not moderate the relationship between EE and PEP. The study recommends that organizations should focus on enhancing EA and SP to improve environmental ethics and PEP. Full article
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28 pages, 988 KiB  
Article
The Impact of Entrepreneurial Self-Efficacy and Entrepreneurship on Entrepreneurial Intention: Entrepreneurial Attitude as a Mediator and Entrepreneurship Education Having a Moderate Effect
by Zi-Meng Ye and Kab-Won Kang
Sustainability 2025, 17(10), 4733; https://doi.org/10.3390/su17104733 - 21 May 2025
Viewed by 1701
Abstract
In recent years, the Korean government has begun to encourage college students to start businesses due to college students’ employment difficulties. The government has implemented various policies to support college students to start businesses. In this study, we attempted to determine the relationship [...] Read more.
In recent years, the Korean government has begun to encourage college students to start businesses due to college students’ employment difficulties. The government has implemented various policies to support college students to start businesses. In this study, we attempted to determine the relationship between ES (entrepreneurship), EA (entrepreneurial attitude), and ESE (entrepreneurial self-efficacy), psychological variables known to affect EI. Data were collected from 415 male and female college students in Korea via a mobile survey. The structural equation model analysis revealed that ES and ESE had positive effects on EI, and the effect of ESE was greater than that of the other variables. The effect of ESE on EA was significant only in the group without EE(NEL) but not in the group with EE(EL). When ES influenced EI, EA had no mediating effect, and when ESE influenced EI, EA played a mediating role positively only in the NEL group. This study identified previously unrecognized ES factors as predictors of EI and showed that ESE is a relatively strong predictor of EI again. This implies that, in order to increase the EI of college students, it is necessary to increase the entrepreneurial ability characterized as objective, rational, realistic, and stable, such as ESE. One of the useful methods is to provide entrepreneurship education to them. Full article
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18 pages, 924 KiB  
Article
Clinical Characteristics and Prognosis of Patients with End-Stage Hypertrophic Cardiomyopathy from a Tertiary Center Cohort: Systolic Dysfunction and Advanced Diastolic Dysfunction
by Andreea Sorina Afana, Robert Daniel Adam, Sebastian Militaru, Sebastian Onciul, Oana Andrei, Adela Chirita Emandi, Maria Puiu, Constantin Militaru and Ruxandra Jurcut
Diagnostics 2025, 15(9), 1134; https://doi.org/10.3390/diagnostics15091134 - 29 Apr 2025
Viewed by 780
Abstract
Background: Hypertrophic cardiomyopathy (HCM) is a genetic disorder marked by myocardial hypertrophy, leading to diastolic and systolic dysfunction and heart failure. Traditionally, the burn-out stage is defined by systolic dysfunction, but we propose expanding its definition to include advanced diastolic dysfunction. Methods [...] Read more.
Background: Hypertrophic cardiomyopathy (HCM) is a genetic disorder marked by myocardial hypertrophy, leading to diastolic and systolic dysfunction and heart failure. Traditionally, the burn-out stage is defined by systolic dysfunction, but we propose expanding its definition to include advanced diastolic dysfunction. Methods: We retrospectively analyzed HCM patients (2004–2023) with either systolic dysfunction (left ventricular ejection fraction [LVEF] < 50%) or advanced diastolic dysfunction (preserved LVEF with left atrial enlargement and elevated filling pressures: E/A ≥ 2 or E/e′ ≥ 14). Both subgroups were included under the term “end-stage HCM” and compared to HCM controls with preserved LVEF and impaired relaxation. Results: Of 696 HCM patients, 94 had end-stage HCM (23 with systolic dysfunction, 71 with advanced diastolic dysfunction). Median age was 56.5 years, and 55.3% were male. End-stage HCM patients were more symptomatic at follow-up than controls (91.5% vs. 75.0%, p-value = 0.006), with higher rates of dyspnea and advanced heart failure (38.3% vs. 6.3%, p-value < 0.001). Advanced diastolic dysfunction was associated with a more symptomatic profile (p-value = 0.013) and a high annual mortality rate (2.34%, p = 0.014). Male sex, older age, lower LVEF, and higher E/A predicted systolic dysfunction. Conclusions: Advanced diastolic dysfunction represents an alternative progression pathway in burn-out HCM, requiring distinct management strategies alongside systolic dysfunction. Full article
(This article belongs to the Section Clinical Diagnosis and Prognosis)
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21 pages, 5700 KiB  
Article
Diastolic Dysfunction with Vascular Deficits in HIV-1-Infected Female Humanized Mice Treated with Antiretroviral Drugs
by Fadhel A. Alomar, Prasanta K. Dash, Mahendran Ramasamy, Zachary L. Venn, Sean R. Bidasee, Chen Zhang, Bryan T. Hackfort, Santhi Gorantla and Keshore R. Bidasee
Int. J. Mol. Sci. 2025, 26(8), 3801; https://doi.org/10.3390/ijms26083801 - 17 Apr 2025
Viewed by 693
Abstract
Early-onset heart failure is a major treat to healthy aging individuals with HIV-1 infection. Women with HIV-1 infection (WLWH) are especially vulnerable and develop heart failure with preserved ejection fraction (HFpEF), of which left ventricular diastolic dysfunction, vascular deficits, myocardial infarction, and fibrosis [...] Read more.
Early-onset heart failure is a major treat to healthy aging individuals with HIV-1 infection. Women with HIV-1 infection (WLWH) are especially vulnerable and develop heart failure with preserved ejection fraction (HFpEF), of which left ventricular diastolic dysfunction, vascular deficits, myocardial infarction, and fibrosis are major components. HIV-infected rodent models that exhibit these pathophysiological features remain under-reported, and this has left a void in our understanding of their molecular causes and therapeutic strategies to blunt its development. Here, we show that female NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ humanized mice (Hu-mice) infected with HIV-1ADA and treated for 13 weeks with dolutegravir (DTG)/tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) develop progressive diastolic dysfunction with preserved ejection fraction (E:A ratio, E:e′, IVRT, left atrial volume and global longitudinal strain increased by 32.1 ± 5.1%, 28.2 ± 5.6%, 100.2 ± 12.6%, 26.6 ± 4.2% and 32.5 ± 4.3%, respectively). In vivo photoacoustic imaging revealed a 30.4 ± 6.8% reduction in saturated oxygenated hemoglobin in the anterior wall of the heart. The ex vivo analysis of hearts showed a reduction in density of perfused microvessels/ischemia (30.6 ± 6.2%) with fibrosis (20.2 ± 1.2%). The HIF-1α level was increased 2.6 ± 0.5-fold, while inflammation-induced serum semicarbazide amine oxidase and glycolysis byproduct methylglyoxal increased 2-fold and 2.1-fold, respectively. Treating H9C2 cardiac myocytes with DTG, FTC and TDF dose-dependently increased expression of HIF-1α. These data show that HIV-infected Hu-mice treated with DTG/TDF/FTC for thirteen weeks develop cardiac diastolic dysfunction, with vascular deficits, ischemia, and fibrosis like those reported in women living with HIV-1 infection (WLWH). They also show that DTG, TDF, and FTC treatment can increase total HIF-1α in H9C2 cells. Full article
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21 pages, 4416 KiB  
Systematic Review
Diagnostic Value of Comprehensive Echocardiographic Assessment Including Speckle-Tracking in Patients with Sarcoidosis Versus Healthy Controls: A Systematic Review and Meta-Analysis
by Hritvik Jain, Maryam Shahzad, Muneeba Ahsan, Rahul Patel, Jagjot Singh, Ramez M. Odat, Aman Goyal, Raveena Kelkar, Nishad Barve, Hina Farrukh and Raheel Ahmed
Diagnostics 2025, 15(6), 708; https://doi.org/10.3390/diagnostics15060708 - 12 Mar 2025
Viewed by 896
Abstract
Background: Cardiac involvement in sarcoidosis is often subclinical, with late manifestations associated with poorer prognosis. Speckle-tracking echocardiography (STE) is gaining attention due to its ability to detect subclinical alterations in myocardial contraction patterns and quantification of abnormal parameters. Methods: Databases, including [...] Read more.
Background: Cardiac involvement in sarcoidosis is often subclinical, with late manifestations associated with poorer prognosis. Speckle-tracking echocardiography (STE) is gaining attention due to its ability to detect subclinical alterations in myocardial contraction patterns and quantification of abnormal parameters. Methods: Databases, including PubMed, Cochrane Central, Embase, Scopus, and Web of Science, were searched to identify studies comparing echocardiographic parameters in sarcoidosis patients with healthy controls. Mean difference (MD) with 95% confidence intervals (CI) were pooled using the inverse-variance random-effects model in Review Manager Version 5.4.1. Statistical significance was considered at p-value <0.05. Results: Thirteen studies with 1416 participants (854—sarcoidosis; 562—healthy controls) were included. In a pooled analysis, patients with sarcoidosis demonstrated a significantly lower left ventricular global longitudinal strain (LV GLS) (Mean Difference [MD]: −3.60; 95% Confidence Interval [CI]: −4.76, −2.43; p < 0.0001) and left ventricular global circumferential strain (LV GCS) (MD: −2.52; 95% CI: −4.61, −0.43; p = 0.02), along with a significantly higher pulmonary artery systolic pressure (PASP) (MD: 4.19; 95% CI: 0.08, 8.29; p = 0.05), left ventricular end-systolic diameter (LVESD) (MD: 0.90; 95% CI: 0.10, 1.71; p = 0.03), A-wave velocity (MD: 3.36; 95% CI: 0.33, 6.39; p = 0.03), and E/E’ ratio (MD: 1.33; 95% CI: 0.42, 2.23; p = 0.004) compared to healthy controls. No significant differences were noted in left ventricular ejection fraction (LVEF), left ventricular global radial strain (LV GRS), interventricular septal thickness (IVST), tricuspid annular plane systolic excursion (TAPSE), left ventricular end-diastolic diameter (LVEDD), E-wave velocity, and E/A ratio. Conclusions: STE serves as a promising imaging modality in detecting subclinical cardiac involvement in sarcoidosis patients with no overt cardiac manifestations. A widespread cardiovascular evaluation of sarcoidosis patients with STE is recommended to detect these altered myocardial contractile patterns. The early detection of cardiac sarcoidosis is essential to prevent adverse clinical outcomes and improve mortality. Full article
(This article belongs to the Special Issue Sarcoidosis: From Diagnosis to Management)
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13 pages, 897 KiB  
Article
One-Year Echocardiographic Follow-Up in Transthyretin Cardiac Amyloidosis: Impact of Tafamidis Treatment
by Davide Restelli, Céline Van Wallendael, Nils De Marneffe, François Damas, Raluca Dulgheru and Patrizio Lancellotti
J. Clin. Med. 2025, 14(5), 1538; https://doi.org/10.3390/jcm14051538 - 25 Feb 2025
Viewed by 747
Abstract
Background/Objectives: Cardiac amyloidosis (CA) is a rare and severe multisystem disorder, associated with an average survival of approximately five years. Recently, Tafamidis has emerged as a promising treatment for transthyretin-related CA. This retrospective study aimed to assess disease progression through echocardiographic findings [...] Read more.
Background/Objectives: Cardiac amyloidosis (CA) is a rare and severe multisystem disorder, associated with an average survival of approximately five years. Recently, Tafamidis has emerged as a promising treatment for transthyretin-related CA. This retrospective study aimed to assess disease progression through echocardiographic findings in patients with transthyretin-related CA, with a specific focus on evaluating the impact of Tafamidis in a cohort managed at our Cardiomyopathy Clinic. Methods: A total of 39 patients were included, of whom 28 received Tafamidis treatment, while 11 did not. Clinical, electrocardiographic, echocardiographic, biological, and other imaging data were collected at diagnosis. Comprehensive echocardiographic data were collected every six months over a two-year period (2021–2023). Results: At 1-year follow-up, the Tafamidis-treated cohort demonstrated stable global systolic and diastolic function. Left ventricular (LV) global longitudinal strain (GLS) and global work index (GWI) showed minimal change (GLS −12.9% (−15.6; −10.7) vs. −13.0% (−14.0; −10.7), p = 0.054; GWI 1113 mmHg/% (963; 1301) vs. 1208 mmHg/% (850; 1420), p = 0.054), and there was no significant increase in indexed LV mass (135.0 g/m2 (118.0; 167.0) vs. 148.0 (128.0; 173.0), p = 0.25). Similarly, valvular heart disease severity remained unchanged. Longitudinal analysis using generalized linear mixed models further confirmed the stability of echocardiographic parameters over the 2-year follow-up period. Systolic function metrics, including LV ejection fraction (slope: −0.0098 ± 0.011, p = 0.38) and GLS (slope: 0.0036 ± 0.0041, p = 0.39) showed no significant decline. Diastolic function assessed through E/A ratio (slope: −0.0007 ± 0.0013, p = 0.59) and E/e’ (slope: −0.0042 ± 0.0073, p = 0.57) also remained stable. Indexed LV mass exhibited no significant progression (slope: 0.050 ± 0.061, p = 0.41). These findings were consistent across the various subgroups. Conclusions: Tafamidis appears to effectively stabilize transthyretin-related CA, limiting disease progression over the follow-up period. Full article
(This article belongs to the Special Issue Advances in Echocardiography and Its Clinical Applications)
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17 pages, 3022 KiB  
Systematic Review
Detection of Myocardial Deformation Patterns and Prognostic Value of Routine Echocardiographic Parameters in Patients with Cardiac Sarcoidosis Versus Extracardiac Sarcoidosis: Systematic Review and Meta-Analysis
by Hritvik Jain, Maryam Shahzad, Muhammad Usman, Anil KC, Jagjot Singh, Jyoti Jain, Ramez M. Odat, Aman Goyal, Faizan Ahmed and Raheel Ahmed
Diagnostics 2025, 15(5), 518; https://doi.org/10.3390/diagnostics15050518 - 20 Feb 2025
Cited by 1 | Viewed by 796
Abstract
Background: Sarcoidosis is a multisystem disorder characterized by non-caseating granulomas in various organs. While cardiac sarcoidosis (CS) is clinically rare, it has significant implications, including heart failure, ventricular arrhythmias, and sudden cardiac death. Speckle-tracking echocardiography has emerged as a promising tool for detecting [...] Read more.
Background: Sarcoidosis is a multisystem disorder characterized by non-caseating granulomas in various organs. While cardiac sarcoidosis (CS) is clinically rare, it has significant implications, including heart failure, ventricular arrhythmias, and sudden cardiac death. Speckle-tracking echocardiography has emerged as a promising tool for detecting subclinical myocardial dysfunction, which is cost-efficient and readily available. This meta-analysis aims to evaluate differences in functional echocardiographic parameters between patients with CS and extracardiac sarcoidosis (ECS) to improve early recognition and management. Methods: A comprehensive search of major bibliographic databases was conducted to identify studies up to December 2024. Mean differences (MDs) with 95% CIs were pooled using the inverse-variance random-effect model. Results: Seven studies with 478 patients with sarcoidosis (CS: 159 and ECS: 319) were included. Patients with CS had a significant reduction in left ventricular global longitudinal strain (MD: −2.73; 95% CI: −4.09, −1.38; p < 0.0001) and tricuspid annular plane systolic excursion (MD: −0.59; 95% CI: −1.12, −0.05; p = 0.03) compared to patients with ECS. No significant differences in the LV global circumferential strain, interventricular septum thickness, left ventricular ejection fraction, E/A ratio, E/E’ ratio, LV end-diastolic diameter, and LV end-systolic diameter were noted. Conclusions: LV GLS and TAPSE are promising parameters for the early detection of cardiac involvement in sarcoidosis, with significant prognostic implications. Although STE provides a cost-effective and accessible alternative to CMR and FDG-PET, further research is needed to standardize its use and validate diagnostic cut-offs. Full article
(This article belongs to the Special Issue Sarcoidosis: From Diagnosis to Management)
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17 pages, 792 KiB  
Systematic Review
Echocardiographic Assessment of Cardiac Structure and Function of Centenarians: A Systematic Review
by Andrea Sonaglioni, Gian Luigi Nicolosi, Giovanna Elsa Ute Muti-Schünemann, Alessio Polymeropoulos, Michele Lombardo and Paola Muti
Geriatrics 2025, 10(1), 26; https://doi.org/10.3390/geriatrics10010026 - 12 Feb 2025
Viewed by 1133
Abstract
Background: During the last two decades, a limited number of studies have provided echocardiographic details regarding the cardiac structure and function of individuals aged ≥100 years. These studies analyzed limited sample sizes of centenarians using different methodologies. The present systematic review was primarily [...] Read more.
Background: During the last two decades, a limited number of studies have provided echocardiographic details regarding the cardiac structure and function of individuals aged ≥100 years. These studies analyzed limited sample sizes of centenarians using different methodologies. The present systematic review was primarily designed to summarize the main findings of these studies and to examine the overall influence of extremely advanced age on cardiac structure and function. Methods: All echocardiographic studies that evaluated the cardiac structure and function in individuals aged ≥100 years, selected from the PubMed, Embase, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases, were included. There was no limitation on the time period. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: A total of eight studies with 1340 centenarians [median age 101.4 years (IQR 101–103 years)] met the eligibility criteria and were analyzed. The centenarians were predominantly females [76.3% (IQR 60–85%)] with a small body surface area, long history of hypertension and slightly impaired renal functional reserve. The centenarian population showed a reduced burden of cardiovascular disease but an increased comorbidity burden, as assessed using the Charlson [median value 3.7 (IQR 1.8–5.5)] and Katz [median value 2.1 (IQR 1.1–3.1)] indexes. The echocardiographic findings comprised left ventricular (LV) concentric remodeling, with first-degree diastolic dysfunction [median E/A ratio 0.8 (IQR 0.7–0.9)], a moderate increase in LV filling pressure [median E/e’ ratio 16.8 (IQR 16.2–17)], normal LV systolic function [median left ventricular ejection fraction (LVEF) 60.9% (IQR 55–84%)] and mild-to-moderate pulmonary hypertension [median systolic pulmonary artery pressure 42.1 mmHg (IQR 37–54 mmHg)]. The pooled prevalence of LV systolic dysfunction (LVEF < 50%) was 15.8%. Moderate-to-severe valvular heart diseases were detected in less than one-third of the centenarians. Compared with the outpatient and in-home cohorts, hospitalized centenarians were less commonly females and were more likely to be affected by significant LV hypertrophy with a supra-normal LVEF, higher degrees of valvulopathies and impaired pulmonary hemodynamics. Conclusions: The evidence currently suggests that centenarians have typical LV concentric remodeling with increased myocardial stiffness and diastolic dysfunction, which predispose them to heart failure with a preserved ejection fraction (HFpEF). Cardioprotective treatment should be considered for personalized implementation and uptitration in this special population. Full article
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20 pages, 2942 KiB  
Article
Endothelial-Protective Actions of Diethylether Extract from Gentiana kochiana and Xanthone Gentiacaulein Against Oxidized LDL-Induced Injury—In Vitro Evaluation
by Gordana Tovilović-Kovačević, Nevena Zogović, Đurđica Ignjatović, Mirko Tomić, Jelena Penjišević, Jelena Kukić-Marković and Dijana Krstić-Milošević
Int. J. Mol. Sci. 2025, 26(3), 1351; https://doi.org/10.3390/ijms26031351 - 5 Feb 2025
Viewed by 1003
Abstract
Endothelial dysfunction is an early pathophysiological event in atherosclerosis. The endothelial-protective abilities of diethylether extract (EE) from the Gentiana kochiana (Gentianaceae) herb and its main component, xanthone aglycone gentiacaulein (GC), were evaluated in an oxidized low-density lipoprotein (oxLDL)-treated EA.hy926 endothelial cell line. The [...] Read more.
Endothelial dysfunction is an early pathophysiological event in atherosclerosis. The endothelial-protective abilities of diethylether extract (EE) from the Gentiana kochiana (Gentianaceae) herb and its main component, xanthone aglycone gentiacaulein (GC), were evaluated in an oxidized low-density lipoprotein (oxLDL)-treated EA.hy926 endothelial cell line. The EE and GC actions were assessed using cell viability assays, flow cytometry, immunoblot, DPPH, NBT, TBARS, conjugated diene formation, and Griess tests. Both EE and GC prevented oxLDL-induced apoptosis by reducing intracellular reactive oxygen species levels, mitochondrial depolarization, and caspase activation in EA.hy926 cells. EE and GC dose-dependently diminished oxLDL-induced cellular lipid peroxidation. In cell-free conditions, EE moderately scavenged superoxide anions and had no affinity toward DPPH radicals, GC did not interact with either of investigated free radicals, while both EE and GC effectively delayed Cu²⁺-induced LDL oxidation. EE and GC upregulated oxLDL-suppressed protective Akt/CREB/eNOS and ERK signals and restored oxLDL-reduced nitric oxide levels. Therefore, EE and GC effectively counteract oxLDL-induced endothelial apoptosis by reducing oxidative stress, promoting mitochondrial recovery, and enhancing the prosurvival Akt/CREB/eNOS axis and ERK activity. Our study is the first to demonstrate that xanthone-rich EE from aerial parts of G. kochiana and xanthone GC alleviate oxLDL-induced endothelial cell injury, underscoring their potential for cardiovascular protection. Full article
(This article belongs to the Section Bioactives and Nutraceuticals)
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11 pages, 840 KiB  
Article
Three-Dimensional Echocardiographic Assessment of Right Ventricular Global Myocardial Work and Ventricular–Pulmonary Coupling in ATTR Cardiac Amyloidosis
by Ashwin Venkateshvaran, Fredrik Edbom, Sandra Arvidsson, Attila Kovacs and Per Lindqvist
J. Clin. Med. 2025, 14(3), 668; https://doi.org/10.3390/jcm14030668 - 21 Jan 2025
Viewed by 1054
Abstract
Background: Right ventricular (RV) function is inadequately investigated and routinely overlooked in transthyretin amyloid cardiomyopathy (ATTR-CM). Novel imaging distinguishers between intrinsic RV myocardial disease in ATTR-CM and primary RV overload disorder phenotypes may enhance mechanistic and pathophysiological understanding of RV dysfunction. We aimed [...] Read more.
Background: Right ventricular (RV) function is inadequately investigated and routinely overlooked in transthyretin amyloid cardiomyopathy (ATTR-CM). Novel imaging distinguishers between intrinsic RV myocardial disease in ATTR-CM and primary RV overload disorder phenotypes may enhance mechanistic and pathophysiological understanding of RV dysfunction. We aimed to investigate RV performance in ATTR-CM employing comprehensive 2D and 3D echocardiography, and to compare these indices with primary RV afterload disease. Methods: We investigated conventional and novel indices of RV contractile function, myocardial work and ventricular–vascular coupling in 21 well-characterized ATTR-CM patients, 10 PAH patients and 12 healthy controls. RV long axis function and pulmonary artery (PA) systolic pressure were evaluated using 2D Doppler echocardiography. RV ejection fraction (RVEF), volumes, global longitudinal strain (GLS) and novel myocardial work indices were analyzed by 3D echocardiography. RV elastance (Ees), afterload (Ea) and RV-PA coupling (Ees/Ea) were estimated using the single-beat volume method. Results: ATTR-CM showed lower RVEF, GLS and Ees, and a higher RV global myocardial work index (GWI), constructive work (GCW), Ea and reduced RV-PA coupling compared with controls. RV EF, stroke volume, GLS and circumferential strain did not differ between ATTR-CM and PAH. However, GWI, GCW, Ees and Ea were lower in ATTR-CM. RV–pulmonary coupling displayed strong association with RV 3D strain (r = 0.84, p < 0.001), whereas RV Ees (contractility) was related to RV GWI (r = 0.54, p < 0.001). Conclusions: ATTR-CM displayed lower RV performance, higher GMW and reduced RV-PA coupling. Myocardial work indices Ees and Ea are novel distinguishers of RV dysfunction phenotypes. The clinical and prognostic value of these novel variables warrant further investigation. Full article
(This article belongs to the Section Cardiology)
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12 pages, 767 KiB  
Article
A First Diastolic Function Evaluation in the Personalized Exercise Prescription Program for Solid Organs Transplanted Subjects: Is Atrial Strain Useful?
by Melissa Orlandi, Marco Corsi, Vittorio Bini, Roberto Palazzo, Stefano Gitto, Claudia Fiorillo, Matteo Becatti, Marco Maglione and Laura Stefani
J. Pers. Med. 2025, 15(1), 32; https://doi.org/10.3390/jpm15010032 - 17 Jan 2025
Viewed by 1056
Abstract
Background/Objectives: Solid organ transplant recipients (OTR) have been recently involved in exercise prescription programs in order to reduce the high prevalence of cardiovascular diseases. The normal systolic and diastolic cardiac function is fundamental to personalizing the prescription. Diastolic dysfunction can be associated [...] Read more.
Background/Objectives: Solid organ transplant recipients (OTR) have been recently involved in exercise prescription programs in order to reduce the high prevalence of cardiovascular diseases. The normal systolic and diastolic cardiac function is fundamental to personalizing the prescription. Diastolic dysfunction can be associated to a higher risk of cardiovascular events and left atrial (LA) strain is an emerging parameter in the evaluation of diastolic compromising, especially in subjects with preserved ejection fraction. Left atrial (LA) strain has never been explored in this category. The study aimed to evaluate the contribution of the LA strain in the assessment of diastolic function of OTR and its potential contribution in the exercise program. Methods: 54 solid OTR (liver and kidney transplants) regularly trained for at least 12 months in a home-based, partially supervised model at moderate intensity estimated by cardiopulmonary exercise test, underwent a complete echocardiographic analysis. The measured variables included left ventricle systolic function (ejection fraction, EF), diastolic function (E/A and E/E’), LA indexed volumes, LA peak atrial longitudinal strain (PALS) and LA peak atrial contraction strain (PACS). The data were compared to those of 44 healthy subjects (HS). Results: The OTR showed an overweight condition (BMI: 25.79 ± 2.92 vs. 22.25 ± 2.95; p < 0.01). Both groups showed a preserved systolic function (EF: OTR 63.1 ± 3.5% vs. HS 66.9 ± 6.1; p < 0.001), while diastolic standard parameters were significantly different (E/A, 1.01 ± 0.4 vs. 1.96 ± 0.74; p < 0.001; E/E’, 9.2 ± 2.7 vs. 6.9 ± 1.3; p < 0.001, in OTR and HS respectively) despite being normal. LA strain was significantly lower in OTR vs. HS (4C PALS, 33.7 ± 9.7 vs. 45.4 ± 14.19; p < 0.001; 4C PACS, 15.9 ± 6.7 vs. 11.6 ± 7.5; p = 0.006; 2C PALS, 35.3 ± 11.1 vs. 47.6 ± 14.9; p < 0.001; 2C PALS, 17.4 ± 4.9 vs. 13.2 ± 14.97; p = 0.001; in OTR and HS respectively). A specific correlation of two- and four-chamber PACs and PALs with BMI has been observed (R for 4C PALS −0.406 ** and 2C PALS −0.276 *). Conclusions: These findings suggest that the coexistence of increased bodyweight in asymptomatic OTR patients can exacerbate the impairment of LA strains. LA strain detection could be useful in the development of a personalized exercise program for OTRs, especially for asymptomatic subjects and those with elevated cardiovascular risk profile, to potentially manage the exercise program in the long term. Larger studies will confirm the role via an eventual structured clinical score index. Full article
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23 pages, 2532 KiB  
Article
Fabrication of Thymoquinone and Ascorbic Acid-Loaded Spanlastics Gel for Hyperpigmentation: In Vitro Release, Cytotoxicity, and Skin Permeation Studies
by Ahlam Zaid Alkilani, Rua’a Alkhaldi, Haneen A. Basheer, Bassam I. Amro and Maram A. Alhusban
Pharmaceutics 2025, 17(1), 48; https://doi.org/10.3390/pharmaceutics17010048 - 2 Jan 2025
Cited by 2 | Viewed by 1640
Abstract
Background/Objectives: The demand for a safe compound for hyperpigmentation is continuously increasing. Bioactive compounds such as thymoquinone (TQ) and ascorbic acid (AA) induce inhibition of melanogenesis with a high safety profile. The aim of this study was to design and evaluate spanlastics [...] Read more.
Background/Objectives: The demand for a safe compound for hyperpigmentation is continuously increasing. Bioactive compounds such as thymoquinone (TQ) and ascorbic acid (AA) induce inhibition of melanogenesis with a high safety profile. The aim of this study was to design and evaluate spanlastics gel loaded with bioactive agents, TQ and AA, for the management of hyperpigmentation. Methods: Several spanlastics formulations were successfully fabricated and characterized in terms of morphology, vesicle size, zeta potential, and release. Results: The optimized TQ-loaded spanlastic formulation showed an average size of 223.40 ± 3.50 nm, and 133.00 ± 2.80 nm for AA-loaded spanlastic formulation. The optimized spanlastics formulation showed the highest entrapment efficiency (EE%) of 97.18 ± 2.02% and 93.08 ± 1.95%, for TQ and AA, respectively. Additionally, the edge activator concentration had a significant effect (p < 0.05) on EE%; it was found that by increasing the amount of EA, the EE% increases. Following that, the optimal spanlastics fomulation loaded with TQ and AA were incorporated into gel and explored for appearance, pH, spreadability, stability, rheology, in vitro release, ex vivo permeation study, and MTT cytotoxicity. The formulated spanlastics gel (R-1) has a pH of 5.53. Additionally, R-1 gel was significantly (p < 0.05) more spreadable than control gel, and exhibited a shear thinning behavior. Most importantly, ex vivo skin deposition studies confirmed superior skin deposition of TQ and AA from spanlastic gels. Additionally, results indicated that tyrosinase inhibition was primarily due to TQ. When comparing TQ alone with the TQ-AA combination, inhibition ranged from 18.35 to 42.73% and 24.28 to 42.53%, respectively. Both TQ spanlastics and the TQ-AA combination showed a concentration-dependent inhibition of tyrosinase. Conclusions: Spanlastic gel might represent a promising carrier for the dermal delivery of TQ and AA for the management of hyperpigmentation conditions. Full article
(This article belongs to the Section Nanomedicine and Nanotechnology)
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17 pages, 1134 KiB  
Article
Novel Biomarkers of Grade I Left Ventricular Diastolic Dysfunction in Type 2 Diabetes Patients with Metabolic-Dysfunction-Associated Steatotic Liver Disease
by Adina Braha, Bogdan Timar, Viviana Ivan, Monica Micloș Balica, Larisa Dăniluc and Romulus Timar
J. Clin. Med. 2024, 13(19), 5901; https://doi.org/10.3390/jcm13195901 - 2 Oct 2024
Cited by 3 | Viewed by 1603
Abstract
Background/Objectives: Prior research has identified a significant association between heart disease and metabolic-dysfunction-associated steatotic liver disease (MASLD); however, the underlying mechanisms are unclear. This study aimed to identify predictive biomarkers associated with grade I left ventricular diastolic dysfunction (LVDD) in patients with [...] Read more.
Background/Objectives: Prior research has identified a significant association between heart disease and metabolic-dysfunction-associated steatotic liver disease (MASLD); however, the underlying mechanisms are unclear. This study aimed to identify predictive biomarkers associated with grade I left ventricular diastolic dysfunction (LVDD) in patients with type 2 diabetes mellitus (T2DM). Methods: This single-center, cross-sectional study evaluated 73 T2DM patients for grade 1 LVDD and MASLD using 2D echocardiography, tissue analysis, spectral color Doppler, and Fibromax. Results: This study analyzed 50 patients (mean age 58.0 ± 11.3 years) with a median diabetes duration of 7 years, abdominal obesity (mean body mass index (BMI) 34.4 ± 5.9 kg/m2), and a mean HbA1c of 7.9 ± 1.5%. The prevalence of grade I LVDD, fibrosis, mild steatosis, moderate-to-severe liver steatosis, mild MASLD, and moderate MASLD was 54%, 44%, 14%, 80%, 43%, and 34%, respectively. Regression analysis revealed that grade 1 LVDD was positively associated with age, Fibrotest, α2-macroglobulin, epicardiac adipose tissue (EAT), and negatively associated with lateral s′, E wave, E/e′, E/A, medium E′, and septal e′ (p < 0.05 for all). α2-macroglobulin > 1.92 g/L (area under the receiver operating characteristic curve (AUROC) = 0.782, sensitivity 70.4%, specificity 81.2%) and fibrotest score > 0.11 (AUROC 0.766, sensitivity 92.6%, specificity 56.2%) were significant predictors of grade I LVDD. Conclusions: Although the underlying mechanisms remain unclear, innovative non-invasive biomarkers, such as α2-macroglobulin or fibrotest, could concurrently indicate liver stiffness and the likelihood of grade I LVDD, an early, asymptomatic HF stage in T2DM patients. Full article
(This article belongs to the Special Issue Cardiovascular Disease and Diabetes: Management of Risk Factors)
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23 pages, 2351 KiB  
Article
Prospecting of the Antioxidant Activity from Extracts Obtained from Chañar (Geoffroea decorticans) Seeds Evaluated In Vitro and In Vivo Using the Tenebrio molitor Model
by Ariana Pereira Silva, Maria Lucia da Silva Cordeiro, Verônica Giuliani de Queiroz Aquino-Martins, Luciana Fentanes de Moura Melo, Weslley de Souza Paiva, Georggia Fatima da Silva Naliato, Raquel Cordeiro Theodoro, Carlos Henrique Salvino Gadelha Meneses, Hugo Alexandre Oliveira Rocha and Katia Castanho Scortecci
Nutrients 2024, 16(17), 2813; https://doi.org/10.3390/nu16172813 - 23 Aug 2024
Cited by 1 | Viewed by 1745
Abstract
Geoffroea decorticans, commonly known as Chañar, is a native Chilean plant widely used in folk medicine for its expectorant, pain relief, and antinociceptive properties. This study explored the antioxidant, cytotoxic, and protective effects of its ethanolic (EE) and aqueous (EA) seed extracts against [...] Read more.
Geoffroea decorticans, commonly known as Chañar, is a native Chilean plant widely used in folk medicine for its expectorant, pain relief, and antinociceptive properties. This study explored the antioxidant, cytotoxic, and protective effects of its ethanolic (EE) and aqueous (EA) seed extracts against oxidative stress induced by copper sulfate, using both in vitro and in vivo approaches. Phytochemical analyses revealed the presence of phenolic compounds and flavonoids in the extracts. High-Performance Liquid Chromatography (HPLC) coupled with Gas Chromatography-Mass Spectrometry/Mass Spectrometry (GC-MS/MS) identified significant components such as phytol, alpha-tocopherol, vitexin, and rutin, with the EE being particularly rich in phytol and vitexin. Antioxidant assays—measuring the total antioxidant capacity (TAC), reducing power, DPPH radical scavenging, and copper and iron chelation—confirmed their potent antioxidant capabilities. Both extracts were non-cytotoxic and provided protection against CuSO4-induced oxidative stress in the 3T3 cell line. Additionally, the use of Tenebrio molitor as an invertebrate model underscored the extracts’ antioxidant and protective potentials, especially that of the EE. In conclusion, this study highlights the significant antioxidant and protective properties of Chañar seed extracts, particularly the ethanolic extract, in both in vitro and in vivo models. Full article
(This article belongs to the Section Phytochemicals and Human Health)
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10 pages, 1480 KiB  
Article
Comparison of Left Ventricular End-Diastolic Volume Approximated from Mean Blood Pressure and Stroke Volume and End-Diastolic Volume Calculated from Left Ventricular-Aortic Coupling
by Takahiro Shiraishi, Yuka Matsuki, Yukiko Yamazaki and Kenji Shigemi
J. Clin. Med. 2024, 13(11), 3204; https://doi.org/10.3390/jcm13113204 - 29 May 2024
Viewed by 1249
Abstract
Objectives: The purpose of this study was to compare left ventricular end-diastolic volume (EDV), derived from left ventricular arterial coupling (Ees/Ea), and mean arterial blood pressure. Both of these methods of measuring EDV require some invasive procedure. However, the method of measuring EDV [...] Read more.
Objectives: The purpose of this study was to compare left ventricular end-diastolic volume (EDV), derived from left ventricular arterial coupling (Ees/Ea), and mean arterial blood pressure. Both of these methods of measuring EDV require some invasive procedure. However, the method of measuring EDV approximate is less invasive than the EDV coupling measuring method. This is because EDV approximate only requires arterial pressure waveform as an invasive procedure. Methods: This study included 14 patients with normal cardiac function who underwent general anesthesia. The point when blood pressure stabilized after the induction of anesthesia was taken as a baseline according to the study protocol. At the point when systolic arterial blood pressure fell 10% or more from the baseline blood pressure, 300 mL of colloid solution was administered over 15 min. EDV approximate and EDV coupling were calculated for each of the 14 patients at three points during the course of anesthetic. Each value was obtained by calculating a 5 min average. The timing of these three points was 5 min before, 5 min during, and 5 min after infusion loading. Results: The total number of comparable points was 42; 3 points were taken from each of the 14 participants. Both EDV approximate and EDV coupling increased through the infusion load testing. Scatter plots were prepared, and regression lines were calculated from the obtained values. A high correlation was shown between EDV approximate and EDV coupling (R2 = 0.96, p < 0.05). Conclusions: In patients with good cardiac function, EDV approximate can be substituted for EDV coupling, suggesting the possibility that EDV can be continuously and less invasively calculated under the situation of general anesthesia. Full article
(This article belongs to the Special Issue Anesthesia in General Surgery: Clinical Management and Challenges)
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