Search Results (91)

Background/Objectives: Iron deficiency (ID) is a common and prognostically relevant comorbidity in heart failure with reduced ejection fraction (HFrEF). It contributes to reduced functional status, exercise capacity, and survival. Intravenous ferric carboxymaltose (FCM) improves symptoms, but its effect on cardiac structure and function remains incompletely understood. The aim of this study was to assess the impact of intravenous FCM on echocardiographic indices of left ventricular (LV), left atrial (LA), and right ventricular (RV) morphology and function in HFrEF patients with ID and determine whether these changes correlate with improvements in exercise capacity. Methods: This sub-analysis of the RESAFE-HF registry (NCT04974021) included 86 HFrEF patients with ID (median age 71.8 years, 83% male). Transthoracic echocardiography was performed at baseline and 12 months post-FCM. Parameters assessed included LV ejection fraction (LVEF), LV global longitudinal strain (GLS), LV diastolic function grade, LAVi, LA strain, TAPSE, and RV free wall strain (FWS). Peak VO₂ was measured to assess exercise capacity. Results: LVEF improved from 29.3 ± 7.8% to 32.5 ± 10.6% (p < 0.001), LV GLS from −7.89% to −8.62%, and the LV diastolic dysfunction grade improved (p < 0.001). LAVi, peak LA strain, TAPSE, and RV FWS also showed significant improvement. Peak VO₂ increased from 11.3 ± 3.2 to 12.1 ± 4.1 mL/min/kg (p < 0.001). Improvements in LVEF, RV FWS, and LV GLS were independent predictors of VO₂ increase (p < 0.001, p < 0.001, and p = 0.01, respectively), explaining 42% of the variance. Conclusions: FCM therapy improves biventricular and atrial function, with echocardiographic gains correlating with an enhanced exercise capacity in HFrEF patients with ID. Full article

Background: Transthoracic echocardiography (TTE) is the primary imaging modality to assess cardiac morphology and function. In athletes, distinguishing physiological adaptations from pathological changes is essential. This study aimed to evaluate long-term cardiac structural and functional changes in professional soccer players. Methods: This retrospective study included 20 healthy male professional soccer players (mean age 21.2 ± 3.4 years) from the German first division, examined annually from 2016 to 2024 (mean follow-up 5.6 ± 2.0 years). TTE parameters associated with the “athlete’s heart” were assessed, including left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVSD), relative wall thickness (RWT), indexed LV mass (LVMi), and left atrial volume index (LAVi), along with 3D-derived LV and RV volumes. Advanced deformation imaging included global longitudinal strain (GLS), right ventricular strain (RVS), and left/right atrial reservoir strain (LASr and RASr, respectively). Baseline and final follow-up values were compared. Results: No significant changes were observed over time in conventional or advanced echocardiographic parameters (e.g., LVEDD: 54.5 ± 3.1 mm vs. 54.6 ± 3.9 mm; p = 0.868; GLS: −18.7% ± 2.2% vs. −18.4% ± 1.9%; p = 0.670). Ventricular volumes and strain values also remained stable throughout follow-up. Conclusions: Over a mean follow-up of more than five years, professional soccer players showed stable cardiac morphology and function without evidence of pathological remodeling. These findings support the concept that long-term high-level training in mixed-discipline sports leads to balanced, physiological cardiac adaptation. Full article

Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and remains diagnostically challenging due to its heterogeneous pathophysiology and often subtle myocardial dysfunction. Conventional echocardiographic parameters, such as left ventricular ejection fraction (LVEF) and the left atrial volume index (LAVI), frequently fail to detect early functional changes. Advanced echocardiographic techniques have emerged as valuable tools for early diagnosis and risk stratification. Global Longitudinal Strain (GLS) allows for the identification of subclinical systolic dysfunction, even with preserved LVEF. Left Atrial Strain (LAS), particularly reservoir and pump strain, provides sensitive markers of diastolic function and elevated filling pressures, offering additional diagnostic and prognostic insights. Myocardial Work (MW), through non-invasive pressure–strain loops, enables load-independent assessment of contractility, while Right Ventricular Free Wall Longitudinal Strain (RVFWLS) captures early right heart involvement, often present in advanced HFpEF. The integration of these advanced parameters can enhance diagnostic precision and guide personalized treatment strategies. This review highlights the current evidence and clinical applications of strain-based imaging in HFpEF, underscoring the importance of a multiparametric, pathophysiology-oriented approach in heart failure evaluation. Full article

Modern gas sensor technology is becoming an important part of our lives. Hence, there has been considerable effort over the past 25 years towards the goal of creating low-cost gas sensors by employing modern microelectronics technology to manufacture both the sensing element and the signal conditioning circuitry on single silicon chips. CMOS sensors based on CMOS-SOI-MEMS technology seemed to be a good candidate for the monolithic approach. In this study, we critically review this approach. We show the advantages of chiplet-based designs for gas sensors that are based on CMOS-SOI-MEMS technology, dubbed GMOSs. The design of a monolithic GMOS system based on the voltage mode reading of a GMOS transistor connected in a three-terminal configuration is presented and validated for the first time. This study led to the understanding that a chiplet-like design should be preferred since the sensor and the readout circuitry of traditional gas sensors exhibit conflicting technological requirements. The innovation of this work is both in the readout design that it posits and in the resulting paradigm shift. Full article

The Gobi Wall is a 321 km-long structure made of earth, stone, and wood, located in the Gobi highland desert of Mongolia. It is the least understood section of the medieval wall system that extends from China into Mongolia. This study aims to determine its builders, purpose, and chronology. Additionally, we seek to better understand the ecological implications of constructing such an extensive system of walls, trenches, garrisons, and fortresses in the remote and harsh environment of the Gobi Desert. Our field expedition combined remote sensing, pedestrian surveys, and targeted excavations at key sites. The results indicate that the garrison walls and main long wall were primarily constructed using rammed earth, with wood and stone reinforcements. Excavations of garrisons uncovered evidence of long-term occupation, including artifacts spanning from 2nd c. BCE to 19th c. CE. According to our findings, the main construction and usage phase of the wall and its associated structures occurred throughout the Xi Xia dynasty (1038–1227 CE), a period characterized by advanced frontier defense systems and significant geopolitical shifts. This study challenges the perception of such structures as being purely defensive, revealing the Gobi Wall’s multifunctional role as an imperial tool for demarcating boundaries, managing populations and resources, and consolidating territorial control. Furthermore, our spatial and ecological analysis demonstrates that the distribution of local resources, such as water and wood, was critical in determining the route of the wall and the placement of associated garrisons and forts. Other geographic factors, including the location of mountain passes and the spread of sand dunes, were strategically utilized to enhance the effectiveness of the wall system. The results of this study reshape our understanding of medieval Inner Asian imperial infrastructure and its lasting impact on geopolitical landscapes. By integrating historical and archeological evidence with geographical analysis of the locations of garrisons and fortifications, we underscore the Xi Xia kingdom’s strategic emphasis on regulating trade, securing transportation routes, and monitoring frontier movement. Full article

Background/Objectives: The rate of recurrence after ablation for atrial fibrillation (AF) is considerable. Risk stratification for AF recurrence after ablation remains incompletely developed. Unsupervised clustering is a machine learning technique which might provide valuable insights in AF recurrence by identifying patient clusters using numerous clinical characteristics. We hypothesize that unsupervised clustering identifies patient clusters with different clinical phenotypes, including AF type and cardiovascular morbidities, and ablation outcomes. Methods: Baseline and procedural characteristics of 658 patients undergoing thoracoscopic ablation for advanced AF (persistent, with enlarged left atria, or with previous failed catheter ablation) between 2008 and 2021 were collected. Principal component analysis (PCA) was used as an unsupervised dimensionality reduction technique, followed by K-Means clustering for unsupervised data clustering. The silhouette score was used to determine the optimal number of clusters, resulting in the formation of three clusters. CHA₂DS₂-VASc score and AF recurrence were not included in the clustering, but were compared between clusters. Moreover, we compared the patients with and without previously established risk factors for AF recurrence for each cluster. Results: Unsupervised clustering resulted in three distinct clusters. Cluster I had a significantly lower rate of AF recurrence than Cluster II, which contained significantly more persistent AF patients than the other clusters. The CHA₂DS₂-VASc score in Cluster III was significantly higher than in the other clusters. In all clusters, but particularly in Cluster III, the recurrence risk was higher for persistent AF patients and female patients. In Cluster II, the recurrence risk was not influenced by an increased left atrial volume index, unlike other clusters. Conclusions: Using unsupervised clustering of clinical and procedural data, we identified three distinct advanced AF patient clusters with differences in AF type, CHA₂DS₂-VASc score, and AF recurrence. We found that established risk factors like BMI, AF type, and LAVI vary in importance across clusters. Full article

Background/Objectives: Cardiovascular diseases are the most prevalent comorbidities in patients with acromegaly (APs). Acromegalic cardiomyopathy is the leading cause of mortality in APs. This study aimed to assess changes in morphology and function of the left heart in naïve APs 12 months after the beginning of acromegaly treatment and to explore the effects of disease activity and body composition parameters on changes in the left heart. Methods: This prospective study involved 34 APs and 34 healthy controls (CON) matched for age, gender, and BMI. DXA and 2D echocardiography were performed at diagnosis and 12 months after the beginning of the treatment. Results: In APs, the prevalence of left ventricular (LV) hypertrophy was 70%. LV mass index (LVMI) was greater in APs compared to CON (124 vs. 86 ± g/m², p < 0.001), but with no difference in size and systolic function of the LV. APs presented with increased left atrium volume (LAVI) and with diastolic dysfunction of the LV. Twelve months after the beginning of acromegaly treatment, IGF-1 levels decreased significantly (p < 0.001), and biochemical control of disease was achieved in 73.52% of APs. We found that in all APs, LAVI and LVMI decreased (all p < 0.05), and diastolic function of the LV improved without changes in systolic function. In multiple analyses, the changes in body surface area (β = −0.444, p < 0.001) and in lean body mass (β = −0.298, p = 0.027) were independent predictors of reverse remodelling of LVMI after the treatment. Conclusions: This study confirmed remodelling reversal of the left heart structure, followed by an improvement in diastolic function in naïve APs 12 months after the beginning of acromegaly treatment. Full article

Background: The purpose of the study is to investigate a possible predictive value of irisin for improved left ventricular (LV) ejection fraction (EF) in discharged patients with known heart failure with reduced ejection fraction (HFrEF). Methods: We included in the study 313 patients who were discharged with HFrEF (at admission, LVEF ≤ 40%) and monitored for 3 months. HF with improved LVEF (HFimpEF) was characterized as a >40% increase in LVEF on transthoracic B-mode echocardiography within 3 months of follow-up. Circulating biomarkers including NT-proBNP and irisin were detected at baseline and after 3 months of observation. By the third month, 117 (37.4%) patients had HFimpEF, whereas 196 individuals were categorized as having persistent HFrEF. Results: We found that HFimpEF was related to lower LV end-diastolic dimensions and concentrations of NT-proBNP and higher left atrial volume index (LAVI) and irisin concentrations than those with persistent HFrEF. The most balanced cut-offs of irisin and NT-proBNP concentrations (improved LVEF versus non-improved LVEF) were 10.8 ng/mL and 1540 pmol/L, respectively. Multivariate regression analysis showed that atrial fibrillation (odds ratio [OR] = 0.95; p = 0.010), LAVI < 39 mL/m² (OR = 1.23; p = 0.001), irisin levels ≥ 10.8 ng/mL (OR = 1.73; p = 0.001), and NT-proBNP < 1540 pmol/mL (OR = 1.47; p = 0.001) independently predicted HFimpEF. The discriminative ability of irisin ≥ 10.8 ng/mL was better than NT-proBNP < 1540 pmol/mL; the predictive ability of irisin alone was not improved by the combined model (irisin added to NT-proBNP). Conclusions: serum irisin ≥ 10.8 ng/mL predicted HFimpEF independently of natriuretic peptide in HFrEF patients. Full article

This paper explores the potential of AI-based digital tutors to enhance student learning by providing accurate, course-specific answers to complex questions, anchored in validated course materials. The Tel Aviv University Digital Tutor (TAUDT) exemplifies this approach, enabling students to navigate and comprehend academic content with ease. By citing specific passages in course materials, TAUDT ensures pedagogical accuracy and relevance while fostering independent learning. Its modular design allows for the seamless integration of advancements in AI and state-of-the-art technologies, ensuring long-term adaptability and performance. Designed to integrate effortlessly into existing academic workflows, TAUDT requires no technological expertise from instructors, addressing barriers posed by technophobia among faculty. A pilot study demonstrated high levels of student engagement, highlighting its potential as a scalable, adaptive solution for higher education. Full article

Background/Objectives: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused post-acute sequelae, especially for people with pre-existing conditions, including chronic kidney disease (CKD), which may impact the cardiovascular system. Yet, despite the preliminary description of the general population’s long-COVID-19 consequences, data on CKD patients is scarce. The aim of this study was to investigate the longitudinal effects of COVID-19 on echocardiographic parameters of cardiac function and on cardiac biomarkers in patients with CKD. Methods: A total of 163 patients were included in this observational prospective trial (listed under NCT05125913 code): 88 in the COVID-19 group and 75 in the control group. The serial echocardiographic characteristics in patients who survived beyond one year, focused on left and right ventricular systolic function, together with cardiac biomarkers evolution, were compared between the two groups. Results: At baseline, there were no significant differences in left ventricular (LV) function parameters, except for a higher Tei Index in the COVID-19 group (p < 0.01). Right ventricular (RV) systolic dysfunction was more frequent in the COVID-19 group, with worse fractional area change (FAC) (p = 0.01), RV free wall longitudinal strain (RVFWLS) (p = 0.01), and RV Tei Index (p = 0.01). Over time, the control group showed a decline in LV ejection fraction (EF), while the COVID-19 group slightly improved. RV global systolic function was better preserved in the COVID-19 group. To the best of our knowledge, this is the first study that demonstrates a statistically significant increase in LAVi in patients with COVID-19. Conclusions: Prior COVID-19 infection influenced the trajectory of LV and RV function in CKD patients over 12 months, suggesting potential transient myocardial adaptations. While overall cardiac function did not differ significantly between groups, COVID-19 survivors exhibited better preservation of some ventricular function parameters. Full article

Background: In heart failure with preserved ejection fraction (HFpEF) and decreased ejection fraction (HFrEF), LA strain, an indicator of the filling and discharge of the left atrium (LA), was recently identified as a sign of diastolic dysfunction. Our objective was to examine the significance of left atrial (LA) strain relative to tissue Doppler echocardiography and the left atrial volume index (LAVI) in evaluating left ventricular (LV) diastolic performance in individuals with chronic kidney disease (CKD). Methods: A prospective cross-sectional study was conducted on 220 outpatients with CKD who fulfilled the inclusion criteria and were referred to the cardiology clinic at Tanta University for routine echocardiographic assessment during a period of 6 months (April to September 2024). Based on their estimated glomerular filtration rate (eGFR), patients were divided into five groups: GFR ranges from 90 to 120 mL/min/1.73 m² in Group 1, 60 to 90 mL/min/1.73 m² in Group 2, 30 to 60 mL/min/1.73 m² in Group 3, 15 to 29 mL/min/1.73 m² in Group 4, and less than 15 mL/min/1.73 m² in Group 5. All participants were evaluated using echocardiographic measurements, such as the E/e ratio, left ventricular systolic and diastolic volumes, left atrial strain, left atrial volume index (LAVI), and ejection fraction (EF). Results: LA strain conduit and reservoir strain can significantly diagnose LV diastolic function in CKD patients (p < 0.001; AUC = 0.819 and 0.869, respectively) using cutoffs of ≤36 and ≥23, with 86% and 95.5% sensitivity, 65% and 60% specificity, 96.1% and 96% PPV, and 31.7% and 57.1%, NPV respectively. An AUC = 0.926 was observed with LAVI among grade 1 vs. grade 0 (0.9 is considered excellent in diagnosing patients with and without the disease). Other markers had AUC values of 0.5–0.6 among the grades of the diastolic function, suggesting no discrimination in diagnosing the disease. Conclusions: LA conduit strain and reservoir strain are independent markers that represent a superior and more sensitive approach than LAVI and tissue Doppler echocardiography for evaluating LV diastolic dysfunction in patients with CKD, even in the early stages. Full article

This research describes the development and thorough characterization of a novel, versatile, and biocompatible hybrid nanocarrier of the NO-releasing agent NOC-18, with a specific focus on optimizing the purification process. In this study, we focused on the sustained release of NO using biocompatible and diagnostic hybrid magnetic nanoparticles (hMNPs) containing cerium-doped maghemite (CM) NPs, embedded within human serum albumin (HSA) protein. A comprehensive study was conducted using electron paramagnetic resonance (EPR) alongside the Griess assay to evaluate NO release from the chosen NO donor, NOC-18, and to assess the limitations of the molecule under various reaction conditions, identifying the optimal conditions for binding NOC-18 with minimal NO loss. Two types of particles were designed: In-hMNPs, where NOC-18 is encapsulated within the particles, and Out-hMNPs, where NOC-18 is attached onto the surface. Our results demonstrated that In-hMNPs provided a sustained and prolonged release of NO (half-life, 50 h) compared to the rapid release for the Out-hMNPs, likely due to the strong bonds formed with cerium, which helped to stabilize the NO molecules. These results represent a promising approach to designing a dual-function agent that combines contrast properties for tumor MRI with the possibility of increasing the permeability of tumor vasculature. The employment of this dual-function agent in combination with nanotherapeutics could improve the latter’s efficacy by facilitating their access to the tumor. Full article

Background: Severe aortic stenosis (AS) stratified by sex has been increasingly studied in the European population. Sex-specific outcomes in Asian patients with AS remain poorly defined. Hence, we aimed to study the clinical characteristics and impact of sex in moderate-to-severe AS, undergoing both invasive and conservative interventions in an Asian cohort over 10 years. Methods: Consecutive data with echocardiographic diagnoses of AS were stratified according to gender in a tertiary academic center between 2011 and 2021. Demographics, comorbidities, and clinical outcomes were compared. Results: Seven hundred and three (703) patients were included (56%, n = 397 were female). Calcific AS was the dominant etiology in both genders. Females had higher incidences of anemia (p < 0.001) and chronic kidney disease (p = 0.026); although, females had lower incidences of cardiovascular complications of coronary artery disease (CAD) (p = 0.002) and prior acute myocardial infarction (AMI) (p = 0.015). Echocardiographically, females had a smaller left ventricular outflow tract diameter (LVOTd) (p < 0.001), LV mass (p < 0.001), and left ventricle end diastolic volume (LVEDV) (p < 0.001). Conversely, the left atrial (LA) area (p < 0.001) and volume index (LAVI) (p < 0.001) were larger in females. Females had higher average E/e’ (p = 0.010) ratios compared to males. The mean follow-up duration between genders was 4.1 ± 3.3 years. Upon univariate analysis, a greater proportion of female AS patients encountered cardiovascular (CV) hospitalization during follow-up (female: 27.5%, n = 109 vs. male: 18.3%, n = 56; p = 0.005) compared to male patients, but there were no significant differences for the outcomes of heart failure (p = 0.612), stroke (p = 0.664), and all-cause mortality (p = 0.827). Fewer females underwent aortic valve (AV) intervention compared to males (21.2% vs. 27.8%, p = 0.042), albeit with a longer duration to AV intervention (3.6 years ± 2.4 vs. 2.6 years ± 2.3, p = 0.016). In the severe AS cohort, female sex remained an independent predictor for subsequent heart failure (aHR 2.89, 95% CI 1.01–8.29, p = 0.048) and CV hospitalization (aHR 20.0, 95% CI 1.19–335, p = 0.037) after adjustments for age, ethnicity, body mass index (BMI), comorbidities, left ventricular ejection fraction (LVEF), and AV intervention. Conclusions: There was no difference in heart failure, stroke, and all-cause mortality outcomes between male and female Asian patients with moderate-to-severe AS. However, there were more cardiovascular hospitalizations, with fewer and longer duration to AV intervention in females compared to males in our cohort. Full article

Objective: To assess the barriers to parental compliance with preschool vision screening tests and the recommended follow-up eye care. Methods: This prospective study included children aged 3–6 years attending 46 preschools. Parents were asked for consent for their children to participate in a vision screening test. Parents whose child did not participate due to lack of parental consent and parents whose child failed the screening test were contacted by telephone and given a standardized questionnaire to identify potential barriers to compliance. Results: A total of 1511 children (mean age 4.76 years ± 0.76, 51.3% boys) were eligible for vision screening. Consent was given by the parents of 1295 children (85.7%). Lack of consent in children who had never been examined by an ophthalmologist was primarily due to unawareness of the screening test or other logistical reasons (117 cases, 92.1%). Of the children screened, 140 (11.1%) failed the test and 80.0% of their parents adhered to the recommended follow-up eye care. Parents who followed the screening vision test recommendations were more likely to be native language speakers (82.8% vs. 58.8% mothers and 88.9% vs. 60.0% fathers; p = 0.049 and 0.015, respectively). There was a higher chance of at least one parent being native-born if recommendations were followed (90.6% vs. 58.8%, p = 0.004). All other factors tested were insignificant. Conclusions: Parental consent and cooperation with vision screening test and its recommendations were high. Migrant families are more likely to face challenges in following vision screening test recommendations, underscoring the need for tailored approaches for specific populations. Full article