Search Results (636)

Background: Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality, even at early stages. Postmenopausal women represent a particularly vulnerable population due to estrogen deficiency, which promotes adverse cardiovascular remodeling. However, data specifically characterizing the cardiac phenotype of hypertensive postmenopausal women with mild-to-moderate CKD remain limited. Methods: We conducted a prospective observational cohort study including 413 hypertensive postmenopausal women consecutively referred to a tertiary center between 2019 and 2022. Participants were stratified into a CKD group with stage 3 CKD (estimated glomerular filtration rate of 30–59 mL/min/1.73 m²; n = 213) and a control group without CKD (n = 200). All subjects underwent comprehensive clinical evaluation, laboratory testing, and standardized transthoracic echocardiography. The prevalence of left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and chronic coronary syndromes (CCS) was assessed. Multivariable logistic regression analyses were performed to evaluate independent associations between CKD and cardiovascular abnormalities. Results: Compared with controls, women with CKD showed a significantly higher prevalence of LVH (46.7% vs. 21.5%), LVDD (55.8% vs. 36.0%), and CCS (15.5% vs. 7.5%) (all p < 0.01). The coexistence of LVH and LVDD identified a high-risk cardiac phenotype that was markedly more frequent in the CKD group (41.3% vs. 12.5%). After adjustment for age, body mass index, blood pressure, duration of hypertension, smoking status, and antihypertensive therapy, stage 3 CKD remained independently associated with LVH, LVDD, and CCS. Conclusions: In hypertensive postmenopausal women, mild-to-moderate CKD is associated with a substantial burden of cardiac structural and functional abnormalities exceeding that attributable to hypertension alone, supporting early cardiovascular screening and an integrated cardiorenal approach. Full article

Cardiac fibrosis is a pathology induced by various conditions, such as myocardial infarction, or certain cardiomyopathies, and represents one of the most prevalent cardiac abnormalities. This process, defined as the excessive accumulation of extracellular matrix within damaged cardiac tissue, leads to significant complications, including impaired systolic and diastolic function as well as arrhythmias. Conventional therapies focus primarily on slowing down the progression of fibrosis. Recently, there has been a growing research interest in therapies based on stem cells and their derivatives, which hold the potential to greater decrease formation and area of fibrosis. In this review, we aim to systematise the most recent data regarding the application of these approaches. We focus on describing the types of cells employed, methods of their implementation, and strategies for optimising these processes. Particular attention is given to exosomes due to the reports highlighting their use as innovative and potentially effective tools in the treatment of cardiac diseases. Full article

Background and Objectives: Cardiovascular disease is the leading cause of mortality after kidney transplantation. “Cardio-ankle vascular index” (CAVI), a recently devised technique whose utility for evaluation of cardiac risk in kidney transplantation is not well known. We investigated the associations of CAVI with echocardiographic assessment of cardiac functions and atherosclerotic parameters including FGF-23 and klotho. Materials and Methods: Two age- and gender-matched groups were subjects in the study. Group 1 included 75 KT patients with kidney transplant durations of at least 2 years; group 2 included 55 non-uremic controls. All participants underwent CAVI measurement and echocardiographic assessment. Atherosclerosis-associated parameters were determined using standard methods. Results: CAVI levels were similar between transplant patients and controls (7.26 ± 1.68 vs. 7.02 ± 1.3 m/sec); however, the percentage of subjects with pathological CAVI score (>8) was higher in transplant group (p = 0.077). Echocardiographic parameters displayed a significant increase in KT patients with higher CAVI scores. Low klotho levels were found to be significantly correlated to increased CAVI scores. Independent predictors of CAVI levels, as revealed by stepwise regression analysis, included high E/e’ (p = 0.012) and low klotho (p = 0.001). Conclusions: Our findings showed that higher CAVI scores still persist to some extent even after successful kidney transplantation and are independently linked to impaired E/e’ levels, which is an indicator of impaired diastolic dysfunction and low klotho levels. These findings underscore the importance of cardiovascular risk control in KT patients and suggest a possible role for klotho-mediated mechanisms in the development of arterial stiffness. Full article

Background: The number of patients with transthyretin amyloid cardiomyopathy (ATTR-CM) has been increasing recently, and the early diagnosis and treatment of it are important. ^99mTc pyrophosphate scintigraphy (^99mTc-PYP) plays a key role in the early diagnosis of ATTR-CM. In patients who underwent ^99mTc-PYP, the early diagnosis of ATTR-CM by echocardiography was evaluated, focusing on left ventricular myocardial form and left ventricular wall thickness. Methods: The present study was conducted on 144 patients who underwent ^99mTc-PYP between February 2020 and March 2024. A comparison was made between the ^99mTc-PYP positive (P) and negative (N) groups, and significant factors were subjected to multivariate analysis. Results: 17 of 144 patients were positive (14.9%), and 15 patients were diagnosed with ATTR-CM by myocardial or skin (fat) biopsy. Other positive patients were also clinically considered to have ATTR-CM based on findings such as poor cardiac function and cerebral hemorrhage. ^99mTc-PYP positive had a significantly larger CTR (60.3% in the P group vs. 53.9% in the N group, p = 0.007) and a larger left atrial diameter (42.8 mm in the P group vs. 40.0 mm in the N group, p = 0.047). On the other hand, the mean LV wall thickness was significantly thicker (15.7 mm in the P group vs. 12.8 mm in the N group, p < 0.001); however the LV end-diastolic diameter was smaller (41.9 mm in the P group vs. 48.4 mm in the P group, p < 0.001). The LV mass was similar in both groups, thus the relative left ventricular wall thickness (RWT), which indicates relative wall thickening, was significantly higher in the P group (0.85 in the P group vs. 0.52 mm in the N group, p < 0.001). The receiver operating characteristic curve of RWT for assessing ^99mTc-PYP positivity had a cut-off value of 0.717 (area under the curve 0.862, 95%CI 0.763–0.961). Conclusions: The evaluation of wall thickness and RWT on echocardiography is important for diagnosing ATTR-CM. Full article

Inorganic nitrate (NO₃⁻) has demonstrated therapeutic efficacy in several populations characterised by cardiovascular risk. However, it is unknown whether increasing nitric oxide (NO) bioavailability affects vascular and cardiovascular responses in men with androgenic–anabolic steroid (AAS) abuse. Objective: To investigate the effects of dietary NO₃⁻ on cardiovascular, autonomic, and strength performance in men with AAS abuse. Methods: In this double-blind, randomised, placebo-controlled crossover trial, participants consumed beetroot juice (12.8 mmol [800 mg] NO₃⁻) or a placebo (0.3 mmol NO₃⁻). After two hours, assessments included saliva collection, endothelial function, heart rate, and systolic (SBP) and diastolic (DBP) blood pressure at rest, during, and after an isometric handgrip test. Results: Thirteen resistance-trained males [mean (standard deviation) age: 31 (9) y; body mass index (BMI): 30 (4) kg/m²; SBP: 132 (3) mmHg; DBP: 70 (2) mmHg] completed the protocol. NO₃⁻-rich juice significantly increased salivary NO₃⁻ (40.6 μM, p < 0.001) and nitrite (NO₂⁻) (3.1 μM, p = 0.002) versus placebo. Flow-mediated dilation was greater with NO₃⁻ both at pre-exercise (2.37%, p = 0.02) and post-exercise (2.57%, p = 0.01). No between-group differences were observed in isometric strength (0.02 kgf, p = 0.99) or systolic/diastolic blood pressure across conditions. Conclusions: Dietary NO₃⁻ enhanced salivary NO₂⁻ and NO₃⁻ concentrations and modestly improved endothelial function but did not reduce the elevated blood pressure or alter cardiac autonomic responses associated with AAS abuse. Full article

Cardiac resynchronization therapy (CRT) is a cornerstone intervention for patients with heart failure (HF) and electrical dyssynchrony, improving quality of life, functional capacity, and survival. Beyond mechanical synchrony, mounting evidence suggests CRT exerts systemic and myocardial cardiometabolic benefits. CRT acutely enhances mechanical efficiency and shifts substrate utilization toward greater oxidation of fatty acids and ketones, effects that correlate with long-term reverse remodeling on cardiac magnetic resonance imaging. Earlier metabolomic profiling demonstrated that CRT normalizes circulating energy metabolites, improving Krebs cycle intermediates and substrate balance between glucose and lipids, while baseline metabolite patterns may differentiate responders from non-responders. These metabolic adaptations accompany favorable changes in diastolic performance, right ventricular function, and ventriculo-arterial coupling. In parallel, improved splanchnic perfusion and reduced congestion may ameliorate gut dysbiosis and endotoxemia, mitigating systemic inflammation. Collectively, these findings position CRT as a therapy capable of both mechanical and metabolic restoration in advanced HF. In this review, we discuss the emerging data on how CRT reconditions myocardial energy metabolism, influences ventricular–arterial interactions, and modulates peripheral and gut-derived metabolic pathways. Full article

Preeclampsia (PE), fetal growth restriction (FGR), and gestational diabetes mellitus (GDM) complicate approximately 15–20% of pregnancies and represent major contributors to perinatal morbidity, mortality, and long-term cardiovascular risk in offspring. Increasing evidence from longitudinal cohort studies indicates that adult cardiovascular disease, including hypertension, coronary artery disease, and stroke, may be programmed in utero through early alterations in fetal cardiac structure and function. Two-dimensional speckle-tracking echocardiography (2D-STE) has emerged as the most sensitive non-invasive technique for detecting subclinical myocardial deformation, often preceding abnormalities detected by conventional Doppler or biometric parameters. While numerous third-trimester studies have demonstrated impaired global longitudinal strain (GLS), altered ventricular geometry, and diastolic dysfunction in established disease, data from mid-gestation (18–28 weeks), the critical preclinical window, remain extremely limited. Therefore, this review aims to systematically synthesize the available evidence on fetal cardiac deformation parameters assessed by 2D-STE at mid-gestation in pregnancies that subsequently developed PE, FGR, or GDM, in order to identify the earliest detectable signatures of fetal cardiovascular programming and highlight key knowledge gaps that must be addressed prior to clinical implementation. Full article

Background: Speckle-tracking echocardiography (STE) has been increasingly used to uncover subtle cardiac dysfunction in patients with extracardiac sarcoidosis (ECS) who show no clinical evidence of heart disease. However, prior investigations were mostly retrospective, methodologically heterogeneous, and focused primarily on left ventricular (LV) function. We conducted a prospective study to provide a broader evaluation of myocardial deformation across both ventricles and atria in ECS without fibrotic pulmonary involvement. Methods: Forty-one patients with ECS (mean age 57.4 ± 10.2 years; 58.5% male) and 30 age- and sex-matched controls without ECS and without known structural heart disease (58.5 ± 11.1 years; 53.3% male) were enrolled. All participants underwent conventional transthoracic echocardiography (TTE) supplemented by comprehensive STE analysis of ventricular and atrial function. Subclinical myocardial dysfunction was defined as LV global longitudinal strain (GLS) less negative than −20%, and potential predictors were analyzed. Results: Standard TTE did not show echocardiographic features suggestive of overt infiltrative cardiomyopathy but revealed higher E/average e′ ratios in the ECS group, suggesting subtle diastolic dysfunction. While traditional indices of biventricular systolic function remained preserved, STE demonstrated significant reductions in LV-GLS, LV global circumferential strain, right ventricular-GLS, and both left and right atrial reservoir strain. Multivariate analysis identified disease duration as the sole independent determinant of LV-GLS impairment (OR 2.26, 95%CI 1.10–4.65; p = 0.03). A disease duration of ≥4.5 years predicted abnormal GLS with 88% sensitivity and 75% specificity (AUC 0.89; 95%CI 0.76–1.00). Conclusions: ECS without fibrotic pulmonary involvement is associated with early impairment of biventricular and biatrial strain despite preserved conventional function. The extent of dysfunction correlates strongly with disease duration, underscoring the value of STE for early detection and monitoring. Full article

Background/Objectives: Fetal growth restriction (FGR), historically termed intrauterine growth restriction (IUGR), is a multifactorial condition in which the fetus fails to reach its genetically determined growth potential, most often due to placental insufficiency. Beyond its link with increased perinatal morbidity and mortality, FGR has been associated with long-term cardiovascular risk through early-life programming. The developing fetal heart is vulnerable to chronic hypoxia and nutrient deprivation, potentially inducing structural and functional alterations with lifelong consequences. This narrative review summarizes and critically appraises experimental and clinical evidence on the impact of FGR on myocardial development and cardiovascular health from fetal life to adulthood. Methods: We conducted a narrative review using a structured literature search of studies published in the last 15 years in PubMed and Scopus, focusing on experimental, imaging, and epidemiological research evaluating cardiac structure, function, and long-term cardiovascular outcomes in FGR. Evidence from fetal and neonatal echocardiography, including Doppler and speckle-tracking techniques, as well as molecular and histological studies, was examined. No statistical meta-analysis was performed. Results: FGR has been associated with reduced cardiomyocyte number, altered myocardial architecture, increased interstitial fibrosis, and persistent ventricular remodeling. Functional studies suggest early impairments in systolic and diastolic performance, with alterations in cardiac energy metabolism and epigenetic regulation. Advanced imaging may enable detection of subclinical cardiac dysfunction in utero and early postnatally. Epidemiological data suggest an increased risk of hypertension, ischemic heart disease, heart failure, and metabolic disorders in adulthood among individuals born growth-restricted. Conclusions: FGR represents an early cardiovascular risk condition. Improved understanding of fetal cardiac programming may help refine risk stratification, surveillance, and preventive strategies to reduce long-term cardiovascular morbidity in individuals born growth-restricted. Full article

Introduction. The etiology of cardiac amyloidosis (CA) involves the systemic or localized deposition of misfolded amyloid proteins within the myocardial interstitium and valvular structures. The primary objective of this study was to employ three-dimensional speckle-tracking echocardiography (3DSTE) to perform a detailed analysis of the aortic valve annulus (AVA) and left ventricular (LV) strains in CA patients and to compare these parameters with those of matched healthy controls. Methods. The initial cohort for this study comprised 35 individuals diagnosed with CA. However, 12 patients were subsequently excluded from the final analysis due to suboptimal image quality precluding accurate measurement of AVA dimensions and/or LV strains. The final analytical group, therefore, consisted of 23 CA patients (14 males), with a mean age of 64.6 ± 7.1 years. The results obtained from the CA patient group were compared with those of a healthy control cohort comprising 23 individuals (14 males; mean age: 53.2 ± 5.3 years). Results. In CA patients, AVA area was greater in end-diastole in 11 out of 23 cases (48%), and in end-systole in 8 out of 23 cases (35%), while it proved to be equal in 4 out of 23 cases (17%). The ratio of healthy controls with greater end-diastolic AVA area (12 out of 23, 52%) and greater end-systolic AVA area (11 out of 23, 48%) did not differ from that of CA patients. End-diastolic and end-systolic maximum and minimum AVA diameters, areas and perimeters did not differ between CA patients and matched controls. AVA plane systolic excursion (AAPSE) was found to be significantly impaired in all CA patients irrespective of AVA area size. Basal LV radial (RS), circumferential (CS) and longitudinal (LS) strains were reduced in CA patients compared with those of controls. End-systolic AVA dimensions tended to be reduced in CA patients with greater end-diastolic AVA area compared with those with greater end-systolic AVA area. While basal LV-RS and LV-CS proved to be similar between CA subgroups, basal LV-LS tended to be higher in CA patients with greater end-systolic AVA area. Controls with greater end-diastolic AVA area showed lower basal LV-RS and LV-LS compared with those with greater end-systolic AVA area. CA patients with equal end-diastolic and end-systolic AVA area (n = 4) showed similarly reduced AAPSE, basal LV-RS, basal LV-CS and LV-LS. Conclusions. In the presence of CA, the AVA is not dilated; however, its spatial displacement is reduced, suggesting its functional impairment, as represented by AAPSE, possibly due to the reduction in all concomitant LV strain parameters. Full article

The close physiological relationship between the left atrium (LA) and left ventricle (LV) suggests that an index assessing both the cardiac chambers simultaneously could provide useful information about disease severity. Consequently, investigators have proposed the atrioventricular coupling index (LACi) and demonstrated its utility in predicting the likelihood of atrial fibrillation, heart failure, and other cardiovascular events in humans. No studies have been reported in veterinary medicine. Therefore, we measured the LACi in healthy dogs and dogs affected by myxomatous mitral valve disease (MMVD). Two hundred and thirty-three dogs (105 healthy dogs and 128 dogs with MMVD) were retrospectively included in the study. The LACi (LA volume/LV volume × 100) at LV end-diastole (LACi-ED) and LV end-systole (LACi-ES) of each dog was measured using a monoplane Simpson’s Method of Discs from the left apical four-chamber view. In healthy dogs, LACi-ED and LACi-ES showed no relationship with bodyweight, heart rate and age (R² < 0.03, for all variables). In MMVD dogs, LACi-ED and LACi-ES differed between ACVIM stages (p < 0.001 and p < 0.02, for all stages). The LACi-ED and LACi-ES had similar accuracy in identifying MMVD dogs with congestive heart failure (area under the curve of 0.920 and 0.906, respectively). Our data suggest that the LACi can be useful in assessing left atrioventricular function in dogs with MMVD but the diagnostic accuracy in identifying dogs with congestive heart failure was not superior to the left atrial-to-aortic ratio. Prospective studies are needed to evaluate the predictive value of this new echocardiographic index in dogs affected by MMVD. Full article

Background: Longitudinal strain is central to the echocardiographic diagnosis of cardiac amyloidosis, typically showing reduced global values with relative apical sparing. Longitudinal displacement—an absolute measure of myocardial motion—may provide complementary diagnostic and physiological information. Methods: We retrospectively studied 24 patients with cardiac amyloidosis and 24 age-, sex-, rhythm-, and ejection fraction–matched controls. Global and regional longitudinal strain and displacement were calculated. Diagnostic performance was evaluated using receiver-operating characteristic (ROC) analysis, and reproducibility was assessed using intraclass correlation coefficients (ICC), coefficient of variation (CV), and Bland–Altman analysis. Results: In amyloidosis, both global longitudinal strain (GLS) and global longitudinal displacement (GLD) were significantly reduced compared with controls (GLS: −10.2 ± 2.6% vs. −20.1 ± 2.4%, p < 0.0001; GLD: 6.6 ± 1.9 mm vs. 11.9 ± 1.4 mm, p < 0.0001). Amyloidosis was characterized by pronounced impairment of basal displacement (9.0 ± 4.4 vs. 17.0 ± 3.9 mm, p < 0.0001) and only modest reduction in absolute apical motion (3.0 ± 2.4 vs. 5.0 ± 2.3 mm, p < 0.0001), supporting the concept that apical sparing observed on strain reflects relative rather than absolute preservation of function. ROC analysis demonstrated strong discriminatory performance within this cohort for GLD (cutoff 8.8 mm), basal displacement (~13 mm), and GLS (absolute 15.8%), with areas under the curve approaching 1.0. GLD and GLS correlated with indices of diastolic burden and functional status (E/E′ and NYHA; |r| ≈ 0.32–0.41, all p ≤ 0.03). Reproducibility was good to excellent (ICC ≈ 0.84–0.89; CV 6–8%). Conclusions: Longitudinal displacement provides complementary and reproducible information alongside strain in cardiac amyloidosis. Combined assessment—reduced global or basal displacement together with reduced GLS and/or relative apical sparing—may refine the echocardiographic characterization of amyloid cardiomyopathy and link longitudinal mechanics to diastolic dysfunction and heart-failure burden. Full article

Our previous studies have shown that continuous infusion of angiotensin II (Ang II) in C57BL/6J mice causes dysfunction and a cachexia-like pathogenesis in both skeletal muscle and the left ventricle, which is significantly reduced by withaferin A (WFA), a steroidal lactone. However, it remains unknown whether WFA can reverse right ventricular (RV) dysfunction induced by Ang II. To determine the effects of WFA in attenuating Ang II-induced RV dysfunction, we employed a model in which continuous Ang II infusion via an osmotic pump in C57BL/6J mice induced cardiac remodeling. We then focused on investigating RV performance and structural changes using echocardiography and histopathological examination, as well as quantitative real-time PCR (qRT-PCR) for mRNA expression. Echocardiographic analysis demonstrated that Ang II significantly increased RV wall thickness and impaired RV systolic and diastolic function, as indicated by reductions in tricuspid annular plane systolic excursion, TV E/E′ ratio, RV S′, and RVOT VTI. The qRT-PCR analysis revealed marked upregulation of pro-fibrotic markers, including TGF-β, fibronectin, and collagen. WFA treatment restored RV functions and significantly attenuated Ang II-induced RV dysfunction and fibrosis. Our findings provide the first evidence that WFA attenuates Ang II-induced cachexia-like remodeling and dysfunction of the RV. These results position WFA as a compelling therapeutic candidate for cardiac cachexia, offering direct anti-fibrotic and cardioprotective benefits that warrant further translational development. Full article

Background: Cardiac amyloidosis (CA) is mainly characterized by diastolic dysfunction, with gradually worsening functional capacity and poor prognosis. Left atrial (LA) strain by speckle tracking echocardiography (STE) is an index of diastolic function and heart failure (HF) symptoms. The aim of this study was to evaluate the relationship of LA strain with functional capacity in CA and the potential prognostic value of speckle tracking variables. Methods: In this single-center study, we prospectively enrolled consecutive outpatients with CA (n = 75). Clinical, echocardiographic evaluation, six-minute-walking-test (6MWT) and Kansas City Cardiomyopathy Questionnaire (KCCQ) were performed on the same day. The primary endpoint was the correlation between global peak atrial longitudinal strain (PALS) and NTproBNP, 6MWT score, and KCCQ. The secondary endpoint was a combination of all-cause or cardiovascular death and HF hospitalization. Results: Overall, 48 ATTR and 27 AL patients (74 ± 11 years, 84% male) were enrolled. Global PALS showed a significant direct correlation with N-terminal-pro-brain natriuretic peptide (NTproBNP, p = 0.3, p = 0.017) and 6MWT (p = 0.4, R² = 0.2, p = 0.004), but no significant correlation with KCCQ (p = −0.13, p = 0.3). GLS showed a significant direct correlation with NTproBNP (p = 0.3, p = 0.017) but not with 6MWT and/or KCCQ. Over a mean follow up of 12 ± 3 months, 42 patients reached the combined endpoint. With ROC curves, both global PALS < 13.5% and GLS > −12% provided a good prediction of the combined endpoint (AUC = 0.72 [0.6–0.82] and 0.73 [0.63–0.83], respectively, p < 0.0001), higher than NTproBNP and other echocardiographic parameters. Conclusions: Global PALS is associated with congestion and functional capacity in CA, suggesting its role as a more objective marker of disease severity in CA. Speckle tracking parameters may be used to enhance prognostic stratification in CA. Full article

Background/Objectives: Obstructive Sleep Apnea Syndrome (OSAS) is a chronic disorder characterized by repeated upper airway obstruction during sleep, leading to intermittent hypoxia and elevated sympathetic activity. OSAS is strongly linked to cardiovascular comorbidities such as hypertension, arrhythmias, heart failure, and atherosclerosis, contributing to structural and functional cardiac alterations. Methods: This study enrolled 105 consecutive patients diagnosed with OSAS and a control group of 100 patients without the syndrome. All participants underwent a comprehensive echocardiographic evaluation using Doppler imaging to assess cardiac structure and function. Results: Hypertension was significantly more prevalent in the OSAS group (81%) compared to controls (74%). Left ventricular diastolic dysfunction occurred in 56.2% of OSAS patients versus 26% of controls. Left atrial enlargement and left ventricular hypertrophy were also more frequent in the OSAS group (21% and 51.4%, respectively) compared to controls (13% and 5%). Permanent atrial fibrillation was present in 17.1% of OSAS patients, significantly higher than the 7% observed in controls. These findings highlight the pronounced cardiac remodeling and arrhythmic burden associated with OSAS. Conclusions: The data confirm that OSAS is associated with increased cardiovascular abnormalities detectable by echocardiography, underscoring the need for routine cardiovascular screening in OSAS patients. Given the systemic implications of OSAS beyond sleep disturbances, a multidisciplinary approach is essential for early diagnosis and optimized management, aiming to mitigate cardiovascular risk and improve outcomes. OSAS is a significant cardiovascular risk factor requiring comprehensive clinical attention. Full article