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Keywords = global myocardial work

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17 pages, 1009 KiB  
Article
Sex-Specific Patterns and Predictors of Reverse Left Ventricular Remodeling and Outcomes in STEMI Patients with LVEF ≤ 50% After Successful Primary Angioplasty
by Bogdan-Flaviu Buz, Sergiu-Florin Arnautu, Mirela-Cleopatra Tomescu, Minodora Andor, Simina Crisan, Dan Gaita, Cristina Vacarescu, Constantin-Tudor Luca, Cristian Mornos, Dragos Cozma and Diana-Aurora Arnăutu
Biomedicines 2025, 13(7), 1782; https://doi.org/10.3390/biomedicines13071782 - 21 Jul 2025
Viewed by 319
Abstract
Background: Sex-related differences in left ventricular (LV) reverse remodeling following ST-segment elevation myocardial infarction (STEMI) remain underexplored. We aimed to investigate predictors of reverse remodeling and its association with clinical outcomes, with a focus on sex-specific differences. Methods: We enrolled 253 [...] Read more.
Background: Sex-related differences in left ventricular (LV) reverse remodeling following ST-segment elevation myocardial infarction (STEMI) remain underexplored. We aimed to investigate predictors of reverse remodeling and its association with clinical outcomes, with a focus on sex-specific differences. Methods: We enrolled 253 STEMI patients (91 women, 28%) and assessed echocardiographic parameters at baseline and six months. LV reverse remodeling was defined as a ≥15% reduction in LV end-diastolic volume (LVEDV). Multivariate logistic regression identified independent predictors of remodeling. Clinical outcomes were evaluated over a median follow-up of 17 months (IQR 14–22 months), including major adverse cardiac events (MACEs). Kaplan–Meier and Cox regression analyses were performed. Results: Reverse remodeling occurred in 43% of patients and was more frequent in men than women (47% vs. 37%, p = 0.04). Male sex (OR 0.30; 95% CI: 0.14–0.65; p < 0.0001) and baseline global work efficiency (GWE) (OR 1.64; 95% CI: 1.45–1.85; p < 0.0001) were independent predictors. Men exhibited greater reductions in LVEDV, greater improvements in LV ejection fraction, and superior myocardial work indices. Over the follow-up, patients with reverse remodeling had significantly lower MACE rates compared to those without (10% vs. 24%, p < 0.01). Cox regression demonstrated that reverse remodeling was associated with a reduced risk of MACEs (HR 0.318; 95% CI: 0.181–0.557; p < 0.0001). Conclusions: LV reverse remodeling after STEMI is associated with improved clinical outcomes and is influenced by sex-specific differences. Baseline myocardial work indices, particularly GWE, are strong predictors of reverse remodeling. Men demonstrated a more favorable remodeling profile and myocardial recovery compared to women. Full article
(This article belongs to the Special Issue Women’s Special Issue Series: Biomedicines (2nd Edition))
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15 pages, 2242 KiB  
Review
Early Echocardiographic Markers in Heart Failure with Preserved Ejection Fraction
by Annamaria Tavernese, Vincenzo Rizza, Valeria Cammalleri, Rocco Mollace, Cristina Carresi, Giorgio Antonelli, Nino Cocco, Luca D’Antonio, Martina Gelfusa, Francesco Piccirillo, Annunziata Nusca and Gian Paolo Ussia
J. Cardiovasc. Dev. Dis. 2025, 12(6), 229; https://doi.org/10.3390/jcdd12060229 - 16 Jun 2025
Viewed by 679
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Role of Cardiovascular Imaging in Heart Failure)
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15 pages, 480 KiB  
Article
Prognostic Significance of Left Ventricular Global Work Efficiency in Obese Patients with Acute ST-Segment Elevation Myocardial Infarction—A Pilot Study
by Alexandra-Cătălina Frișan, Marius Simonescu, Mihai-Andrei Lazăr, Simina Crișan, Aniko Mornoș, Raluca Șoșdean, Andreea-Roxana Morar, Daniel-Miron Brie, Constantin-Tudor Luca and Cristian Mornoș
Diagnostics 2025, 15(12), 1512; https://doi.org/10.3390/diagnostics15121512 - 14 Jun 2025
Cited by 1 | Viewed by 821
Abstract
Background/Objectives: Obesity is increasingly common among patients with acute ST-segment elevation myocardial infarction (STEMI), potentially influencing both clinical evaluation and outcomes. Traditional echocardiographic metrics may be suboptimal for prognosis estimation in this population. Left ventricular myocardial work (LVMW) represents an emerging, load-adjusted marker [...] Read more.
Background/Objectives: Obesity is increasingly common among patients with acute ST-segment elevation myocardial infarction (STEMI), potentially influencing both clinical evaluation and outcomes. Traditional echocardiographic metrics may be suboptimal for prognosis estimation in this population. Left ventricular myocardial work (LVMW) represents an emerging, load-adjusted marker of myocardial performance. This study aimed to assess the prognostic relevance of LVMW in obese STEMI patients. Methods: A total of 143 patients presenting with STEMI were prospectively enrolled and categorized based on their obesity status (body mass index ≥30 kg/m2). LVMW parameters were measured using echocardiography within 72 ± 24 h of hospital admission. The patients were monitored for major adverse cardiovascular events (MACE), defined as cardiovascular death, malignant ventricular arrhythmias, or unplanned hospitalizations due to heart failure or acute coronary syndrome. Results: During a median follow-up of 13 months (interquartile range: 6–28 months), MACE occurred in 30 patients (21%). Among obese individuals, left ventricular global work efficiency (LVGWE) emerged as the most robust predictor of adverse events, with an area under the receiver operating characteristic curve of 0.736 (95% confidence interval [CI]: 0.559–0.914; p = 0.009). A threshold value of 79% for LVGWE was identified as optimal for predicting MACE. Kaplan–Meier analysis revealed significantly lower event rates in obese patients with LVGWE ≥79% (log-rank p = 0.006). In univariate Cox regression analysis, LVGWE <79% was associated with a markedly elevated risk of MACE in obese patients (hazard ratio [HR] = 5.59; 95% CI: 1.33–23.50; p = 0.019), and remained a significant predictor in the overall cohort (HR = 2.73; 95% CI: 1.26–5.90; p = 0.010). Conclusions: LVGWE demonstrates strong prognostic utility in STEMI, particularly among obese patients. The incorporation of myocardial work indices into routine evaluation may enhance risk stratification and guide management in this high-risk subgroup. Full article
(This article belongs to the Special Issue Pathogenesis, Diagnosis and Prognosis of Cardiovascular Diseases)
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41 pages, 10349 KiB  
Review
Recent Advances in Monitoring Technologies for Cardiac Troponin I: A Pivotal Biomarker in Cardiovascular Diseases
by Ning Zhang, Yusong Wang, Fachuang Li, Yuxin Zhu, Zheng Fu, Mengda Jia, Xiaoran Zhan and Wanqing Zhang
Biomolecules 2025, 15(6), 858; https://doi.org/10.3390/biom15060858 - 12 Jun 2025
Viewed by 1593
Abstract
Cardiovascular diseases (CVDs) are among the leading causes of morbidity and mortality rates globally, presenting a severe threat to human health and life. Acute myocardial infarction (AMI) is one of the most common and extremely severe disorders within CVDs, causing an estimated 17.5 [...] Read more.
Cardiovascular diseases (CVDs) are among the leading causes of morbidity and mortality rates globally, presenting a severe threat to human health and life. Acute myocardial infarction (AMI) is one of the most common and extremely severe disorders within CVDs, causing an estimated 17.5 million deaths each year. Cardiac troponin I (cTnI) is considered a biomarker for myocardial infarction and a “gold standard” method for diagnosing AMI due to its high specificity and sensitivity. The ability to rapidly detect cTnI with high sensitivity is critical throughout the diagnosis and treatment process of AMI. It is a necessary precursor for doctors to quickly assess the disease and initiate subsequent therapies. This work comprehensively explores various techniques for the analysis and detection of cTnI. We systematically review current cutting-edge technologies used for cTnI detection. According to optical, electrical, and intelligent technology dimensions, this study meticulously classifies and elaborates on the research progress of related sensors. Based on current research findings and technological development trends, we further project the future research directions and application prospects of cTnI sensors. This is geared towards providing valuable references for the further development of this field. Full article
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15 pages, 640 KiB  
Article
Myocardial Performance Improvement After Iron Replacement in Heart Failure Patients: The IRON-PATH II Echo-Substudy
by Raúl Ramos-Polo, Maria del Mar Ras-Jiménez, María del Carmen Basalo Carbajales, Sílvia Jovells-Vaqué, José Manuel Garcia-Pinilla, Marta Cobo-Marcos, Javier de Juan-Bagudá, Cândida Fonseca, Josep Francesch Manzano, Andreea Eunice Cosa, Sergi Yun-Viladomat, Cristina Enjuanes, Marta Tajes Orduña and Josep Comin-Colet
J. Clin. Med. 2025, 14(12), 4048; https://doi.org/10.3390/jcm14124048 - 7 Jun 2025
Viewed by 549
Abstract
Background: Iron deficiency (ID) is a commonly seen comorbidity in heart failure (HF) patients. It is often associated with a poor prognosis and impaired physical capacity. The functional limitations linked to ID may lead to cardiac function abnormalities. The functional limitations linked to [...] Read more.
Background: Iron deficiency (ID) is a commonly seen comorbidity in heart failure (HF) patients. It is often associated with a poor prognosis and impaired physical capacity. The functional limitations linked to ID may lead to cardiac function abnormalities. The functional limitations linked to ID may lead to cardiac function abnormalities, that can be reversible after iron repletion. Some echocardiographic parameters, such as global longitudinal strain (GLS), myocardial work (MW) and its derivatives constructive work (CW), wasted work (WW) and work efficiency (WE), may be of added value in advanced cardiac performance assessment. Methods: IRON-PATH II was a multicenter, prospective and observational study designed to describe the pathophysiological pathways associated with ID. The echo-substudy included 100 HF patients that had undergone a specific pilot echocardiographic evaluation. Patients had a left ventricular ejection fraction (LVEF) ≤50%, were in stable clinical condition and on standard HF medication with hemoglobin ≥11 g/dL. The final cohort included 98 patients. Results: The ID group showed worse cardiac function, with lower GLS (−8.5 ± 9% vs. −10 ± 10%), WE (74 ± 10% vs. 80 ± 10%) and MW (665 [453–1013] vs. 947 [542–1199] mmHg%), as well as higher WW (290 [228–384] vs. 212 [138–305] mmHg%) and lower RV free wall strain (−13 [−20–(−11)]% vs. −17 [−23–(−14)]%). Following iron repletion, ID patients demonstrated improved LV (GLS, MW, WE and WW) and RV performance (RV free wall strain), aligning with non-ID patients (all p-values >0.05 compared to the non-ID group). Conclusions: Among HF patients with reduced LVEF, ID was associated with worse myocardial performance in both the LV and RV. All the alterations seen were reversible after intravenous iron repletion. Full article
(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)
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16 pages, 828 KiB  
Article
Non-Invasive Myocardial Work Identifies Patients with Obstructive Coronary Lesions After Orthotopic Heart Transplantation
by Rebeca Manrique Antón, Marina Pascual Izco, Gorka Bastarrika, Agnés Díaz Dorronsoro, Ana Ezponda, Fátima de la Torre Carazo, Nahikari Salteráin, Leticia Jimeno-San Martín, Nerea Martín-Calvo, María Josefa Iribarren and Gregorio Rábago
Diagnostics 2025, 15(11), 1352; https://doi.org/10.3390/diagnostics15111352 - 28 May 2025
Viewed by 447
Abstract
Background/Objectives: Cardiac allograft vasculopathy (CAV) is a major complication following orthotopic heart transplantation (OHT). Graft denervation results in silent ischemia, even when already established, requiring regular screening for early diagnosis. This study explores whether myocardial work (MW) can non-invasively identify OHT patients with [...] Read more.
Background/Objectives: Cardiac allograft vasculopathy (CAV) is a major complication following orthotopic heart transplantation (OHT). Graft denervation results in silent ischemia, even when already established, requiring regular screening for early diagnosis. This study explores whether myocardial work (MW) can non-invasively identify OHT patients with obstructive coronary lesions (OCL). Methods: During regular follow-ups, 55 OHT recipients underwent paired, prospective coronary computed tomography angiography (CCTA) and transthoracic echocardiography (TTE) examinations. Additionally, 57 healthy volunteers (HV) provided reference TTE data. Classic echocardiographic parameters, such as left ventricle global longitudinal strain (LV-GLS) and MW indices, were obtained in all individuals. Data from three groups were analyzed: HV, OHT patients without coronary lesions or with <50% lesions on the CCTA (OHT-non-OCL), and OHT patients with ≥50% lesions on the CCTA (OHT-OCL). Results: CCTA identified seven OHT patients with OCL. Significant differences across the groups existed for LV-GLS (OHT-OCL −10.6% CI −14 to −6.8 vs. OHT-non-OCL −15.6% CI −16.5 to −13.4% vs. HV −18% CI −20 to −16, p < 0.01) and global work efficiency (GWE) (OHT-OCL 87% CI 86 to 92 vs. OHT-non-OCL 94% CI 91 to 95 vs. HV 96% CI 95 to 97, p < 0.01). The optimal cut-off values identified using the Youden Index were LV-GLS < −14.4% (AUC 0.80, sensitivity 0.86, specificity 0.71) and GWE < 89% (AUC 0.75, sensitivity 0.71, specificity 0.85). Multivariate analysis showed GWE as the best marker for detecting OCL. Conclusions: GWE is the echocardiographic parameter that best identifies OHT patients that have OCL on CCTA. If validated in larger studies, GWE could become a readily accessible tool for CAV detection. Full article
(This article belongs to the Special Issue Diagnosis of Cardio-Thoracic Diseases)
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12 pages, 517 KiB  
Article
Donor-Derived Cell-Free DNA Versus Left Ventricular Longitudinal Strain and Strain-Derived Myocardial Work Indices for Identification of Heart Transplant Injury
by Timea Teszak, Timea Barcziova, Csaba Bödör, Lajos Hegyi, Luca Levay, Beata Nagy, Attila Fintha, Adam Szijarto, Attila Kovacs, Bela Merkely and Balazs Sax
Biomedicines 2025, 13(4), 841; https://doi.org/10.3390/biomedicines13040841 - 1 Apr 2025
Viewed by 564
Abstract
Background/Objectives: Donor-derived cell-free DNA (dd-cfDNA) is a marker of graft injury that increases in acute rejection and has excellent negative predictive value. Left ventricular global longitudinal strain (LVGLS) and strain-derived myocardial work indices are novel echocardiographic parameters with growing applications. Still, they have [...] Read more.
Background/Objectives: Donor-derived cell-free DNA (dd-cfDNA) is a marker of graft injury that increases in acute rejection and has excellent negative predictive value. Left ventricular global longitudinal strain (LVGLS) and strain-derived myocardial work indices are novel echocardiographic parameters with growing applications. Still, they have been poorly investigated in heart transplant (HTx) recipients so far. We sought to examine the diagnostic impact of left ventricular longitudinal strain-derived indices in diagnosing myocardial injury as assessed by dd-cfDNA after HTx. Methods: Since October 2022, HTx recipients have been shifted from our endomyocardial biopsy (EMB)-based rejection surveillance protocol to a monthly dd-cfDNA-led rejection assessment. We analysed the percentage of donor-derived to total cell-free DNA. For echocardiographic analysis, patient selection was restricted to those transplanted ≥ 6 months. We used 2D speckle-tracking echocardiography to assess LVGLS and strain-derived myocardial work parameters. Results: We analysed four hundred and forty-nine dd-cfDNA samples from seventy-one patients until November 2024. The mean dd-cfDNA fraction remained very low (0.13 ± 0.06%). Eighty-eight percent of surveillance EMBs that would have otherwise been performed were avoided. The mean LVGLS was lower than the literature reference values. We found no correlation between dd-cfDNA and LVGLS. Transplanted hearts had different myocardial work indices than the reference values reported in the literature. Conclusions: dd-cfDNA effectively rules out clinically significant acute rejection and decreases the need for invasive surveillance EMBs. LVGLS seems less sensitive than dd-cfDNA for the identification of myocardial injury in the early stages of HTx rejection in patients at low risk for rejection. Full article
(This article belongs to the Special Issue Advances in Biomarker Discovery for Cardiovascular Disease)
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15 pages, 1103 KiB  
Article
Effect of Different Isometric Exercise Modalities on Myocardial Work in Trained Hypertensive Patients with Ischemic Heart Disease: A Randomized Pilot Study
by Giuseppe Caminiti, Giuseppe Marazzi, Maurizio Volterrani, Valentino D’Antoni, Simona Fecondo, Sara Vadalà, Barbara Sposato, Domenico Mario Giamundo, Matteo Vitarelli, Valentina Morsella, Ferdinando Iellamo, Vincenzo Manzi and Marco Alfonso Perrone
J. Funct. Morphol. Kinesiol. 2025, 10(2), 108; https://doi.org/10.3390/jfmk10020108 - 27 Mar 2025
Cited by 2 | Viewed by 976
Abstract
Background: Isometric exercise effectively reduces blood pressure (BP) but its effects on myocardial work have been poorly studied. For the present study, we compared acute changes in myocardial work during two different isometric exercises, namely, bilateral knee extension and handgrip, in patients with [...] Read more.
Background: Isometric exercise effectively reduces blood pressure (BP) but its effects on myocardial work have been poorly studied. For the present study, we compared acute changes in myocardial work during two different isometric exercises, namely, bilateral knee extension and handgrip, in patients with hypertension and underlying ischemic heart disease (IHD). Methods: This was a randomized pilot study in which 48 stable, trained patients with hypertension and IHD were enrolled. Patients were randomly assigned to perform a single session of bilateral knee extension (IKE) or handgrip (IHG) exercises or no exercise (control), with a 1:1:1 ratio. Both exercises were performed at 30% of maximal voluntary contraction and lasted three minutes. Echocardiography and BP measurements were performed at rest, during the exercise, and after ten minutes of recovery. Results: Both exercises were tolerated well, and no side effects occurred. During the exercise, the systolic BP increased significantly in the IKE group compared with the IHG and control groups (ANOVA p < 0.001). Left ventricular global longitudinal strain decreased significantly in the IKE group (−21%) compared with the IHG and control groups (ANOVA p 0.002). The global work index increased significantly in the IKE group (+28%) compared with the IHG and control groups (ANOVA p 0.034). Global constructive work and wasted work increased significantly in the IKE group compared with the IHG and control groups (ANOVA p 0.009 and <0.001, respectively). Global work efficiency decreased significantly in the IKE group (−8%) while remaining unchanged in the IHG and control groups (ANOVA p 0.002). Conclusions: Myocardial work efficiency was impaired during isometric bilateral knee extension but not during handgrip, which evoked a limited hemodynamic response. Full article
(This article belongs to the Section Physical Exercise for Health Promotion)
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16 pages, 1988 KiB  
Article
Myocardial Work Analysis in ST-Elevation Myocardial Infarction: Insights into Left Ventricular Ejection Fraction—A Pilot Study
by Alexandra-Cătălina Frișan, Mihai-Andrei Lazăr, Raluca Șoșdean, Marius Simonescu, Daniel-Miron Brie, Aniko Mornoș, Silvia Ana Luca, Ioana Ionac and Cristian Mornoș
Life 2025, 15(3), 338; https://doi.org/10.3390/life15030338 - 21 Feb 2025
Viewed by 1279
Abstract
(1) Background: Left ventricular ejection fraction (LVEF) is traditionally used to assess prognosis in acute ST-elevation myocardial infarction (STEMI) patients. However, LV myocardial work (MW), evaluated echocardiographically, offers additional prognostic information by considering loading conditions. (2) Methods: This prospective study investigated the prognostic [...] Read more.
(1) Background: Left ventricular ejection fraction (LVEF) is traditionally used to assess prognosis in acute ST-elevation myocardial infarction (STEMI) patients. However, LV myocardial work (MW), evaluated echocardiographically, offers additional prognostic information by considering loading conditions. (2) Methods: This prospective study investigated the prognostic value of MW indices in 119 consecutive STEMI patients treated with primary percutaneous coronary angioplasty, stratified into three LVEF categories: reduced (≤40%), mildly reduced (41–49%), and preserved LVEF (≥50%). Transthoracic echocardiography was performed before discharge, and the primary endpoint included heart failure hospitalization, ventricular arrhythmias, all-cause mortality and new acute coronary syndromes. (3) Results: Patients with preserved or mildly reduced LVEF had higher global longitudinal strain, global work index, global constructive work (GCW), and global work efficiency, as well as lower global wasted work (GWW), compared to those with reduced LVEF. GCW was the strongest predictor of adverse outcomes in the preserved LVEF group (AUC = 0.730, p = 0.035), while GWW demonstrated robust predictive performance in the reduced LVEF group (AUC = 0.787, p = 0.001). (4) Conclusions: MW indices, particularly GCW and GWW, provide significant prognostic value in distinct LVEF categories in STEMI patients. These findings indicate that MW enhances risk stratification and informs management in this patient population. Full article
(This article belongs to the Special Issue Management of Ischemia and Heart Failure—2nd Edition)
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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 1058
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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11 pages, 691 KiB  
Article
Usefulness of Echocardiographic Parameters of Myocardial Work in Patients with Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation
by Anna Polewczyk, Edward Pietrzyk, Maciej Polewczyk, Dariusz Jarek and Dariusz Dudek
J. Clin. Med. 2025, 14(2), 512; https://doi.org/10.3390/jcm14020512 - 15 Jan 2025
Viewed by 789
Abstract
Background: Myocardial work (MW) is a new echocardiographic parameter used in the assessment of cardiac energy expenditure. The aim of the current study was to evaluate changes in left ventricular MW parameters in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation [...] Read more.
Background: Myocardial work (MW) is a new echocardiographic parameter used in the assessment of cardiac energy expenditure. The aim of the current study was to evaluate changes in left ventricular MW parameters in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Methods: One hundred and thirty five consecutive patients who underwent TAVI at one center were evaluated before and after the procedure using transthoracic echocardiography (TTE) to assess the following MW indices: global constructive work (GCW), global wasted work (GWW), global work index (GWI) and global work efficiency (GWE). Results: The comparison of MW parameters before and an average of 5.9 days after TAVI showed an increase in GCW, GWW and GWI, and no significant change in GWE. A detailed analysis showed an increase in GCW and GWI only in patients with the worst initial global longitudinal strain (GLS) > −8.0%: 845.2 vs. 852.2; p < 0.001 and 469.7 vs. 499.0 mmHg%; p < 0.001, respectively, whereas in the group of patients with GLS < −16.0%, a reduction in these indices was observed: 2135.8 vs. 2043.0; p < 0.001 and 1732.4 vs. 1633.1 mmHg%; p < 0.001. The significant increase in GWE was observed in patients with left ventricular ejection fraction (LVEF) < 30%: 77.7 vs. 72.0; p = 0.043 and GLS > −8.0%: 74.4 vs. 71.0 mmHg%; p < 0.001. The increase in GCW and GWI parameters after TAVI was strongly correlated with LVEF and pressure aortic gradient (PGA) before the procedure. Conclusions: Echocardiographic assessment of myocardial work parameters is a valuable method of documenting hemodynamic changes in patients with severe aortic stenosis before and after TAVI. Long-term left ventricular overload in patients with aortic stenosis results in a global reduction of myocardial work parameters; therefore, in patients with the lowest LVEF and GLS, the increased GCW, GWI and GWE reflect energy reserves enabling a rapid increase in the effective work of the heart. Full article
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14 pages, 2836 KiB  
Article
Causal Effects of Air Pollution, Noise, and Shift Work on Unstable Angina and Myocardial Infarction: A Mendelian Randomization Study
by Qiye Ma, Lin Chen, Hao Xu and Yiru Weng
Toxics 2025, 13(1), 21; https://doi.org/10.3390/toxics13010021 - 28 Dec 2024
Cited by 2 | Viewed by 1264
Abstract
Cardiovascular disease continues to be a major contributor to global morbidity and mortality, with environmental and occupational factors such as air pollution, noise, and shift work increasingly recognized as potential contributors. Using a two-sample Mendelian randomization (MR) approach, this study investigates the causal [...] Read more.
Cardiovascular disease continues to be a major contributor to global morbidity and mortality, with environmental and occupational factors such as air pollution, noise, and shift work increasingly recognized as potential contributors. Using a two-sample Mendelian randomization (MR) approach, this study investigates the causal relationships of these risk factors with the risks of unstable angina (UA) and myocardial infarction (MI). Leveraging single nucleotide polymorphisms (SNPs) as genetic instruments, a comprehensive MR study was used to assess the causal influence of four major air pollutants (PM2.5, PM10, NO2, and NOx), noise, and shift work on unstable angina and myocardial infarction. Summary statistics were derived from large genome-wide association studies (GWASs) from the UK Biobank and the FinnGen consortium (Helsinki, Finland), with replication using an independent GWAS data source for myocardial infarction. The inverse-variance weighted (IVW) approach demonstrated a significant positive correlation between shift work and the increased risk of both unstable angina (OR with 95% CI: 1.62 [1.12–2.33], p = 0.010) and myocardial infarction (OR with 95% CI: 1.46 [1.00–2.14], p = 0.052). MR-PRESSO analysis identified outliers, and after correction, the association between shift work and myocardial infarction strengthened (OR with 95% CI: 1.58 [1.11–2.27], p = 0.017). No notable causal associations were identified for air pollution or noise with either outcome. The replication of myocardial infarction findings using independent data supported a possible causal link between shift work and myocardial infarction (OR with 95% CI: 1.41 [1.08–1.84], p = 0.012). These results provide novel evidence supporting shift work as a likely causal risk factor for unstable angina and myocardial infarction, underscoring the need for targeted public health strategies to mitigate its cardiovascular impact. However, further investigation is necessary to elucidate the role of air pollution and noise in cardiovascular outcomes. Full article
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14 pages, 1072 KiB  
Article
Non-Invasive Cardiac and Vascular Monitoring in Systemic Sclerosis: Impact of Therapy on Subclinical Dysfunction
by Ștefania Lucia Magda, Ana Maria Gheorghiu, Raluca Ileana Mincu, Andrea Olivia Ciobanu, Tudor Constantinescu, Elisa Cristina Popa, Carina Mihai and Dragoș Vinereanu
Medicina 2024, 60(12), 2080; https://doi.org/10.3390/medicina60122080 - 19 Dec 2024
Cited by 3 | Viewed by 1022
Abstract
Background and objectives: Systemic sclerosis (SSc) causes myocardial and microvascular impairment, with subclinical dysfunction and eventually permanent cardio-vascular damage. The long-term influence of SSc therapies on subclinical cardiovascular dysfunction is insufficiently investigated. We aimed to assess 2D and 4D cardiac ultrasound parameters [...] Read more.
Background and objectives: Systemic sclerosis (SSc) causes myocardial and microvascular impairment, with subclinical dysfunction and eventually permanent cardio-vascular damage. The long-term influence of SSc therapies on subclinical cardiovascular dysfunction is insufficiently investigated. We aimed to assess 2D and 4D cardiac ultrasound parameters of heart function in patients with different forms of SSc versus controls and to determine the evolution of cardiac function and arterial stiffness parameters under therapy. Materials and methods: A total of 60 subjects with SSc were studied at baseline; 30 SSc patients were compared to 30 matched controls. A total of 52 SSc subjects were reassessed after 1 year and 30 after 2 years of treatment. Cardiac function was evaluated through 2D standard echocardiography, tissue Doppler, speckle tracking and 4D auto LV quantification echo. Arterial stiffness was determined via the cardio-ankle vascular index and ankle brachial index. Results: At baseline, the standard echo parameters were normal. The 4D and myocardial work parameters, although in normal limits, were significantly altered in the SSc group vs. controls (4D ejection fraction 54.5 ± 8.5% in SSc vs. 63.8 ± 3.1% in controls; 4D longitudinal strain −14.2 ± 2.4% in SSc vs. −22.0 ± 2.7% in controls; global constructive work 2124.2 ± 449.5 mmHg% in SSc vs. 3102.8 ± 337.5 mmHg% in controls, for all p ≤ 0.02). Both at 1 year and 2 years of treatment, all echo and arterial stiffness parameters were similar to baseline, with no correlation to treatment type. Conclusions: SSc determines subclinical systolic dysfunction. Non-invasive assessment methods do not detect a functional cardiovascular decline in patients on classical therapy. Complex cardiac follow-up should be implemented in cases at risk for complications. Full article
(This article belongs to the Section Cardiology)
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11 pages, 2184 KiB  
Case Report
Advanced Speckle-Tracking Echocardiography Could Play a Crucial Role in the Diagnosis of Post-Implanted Cardiomyopathy Associated with a Leadless Pacemaker System
by Elżbieta Wabich, Ludmiła Daniłowicz-Szymanowicz, Szymon Budrejko, Anna Kochańska, Dariusz Kozłowski and Maciej Kempa
J. Clin. Med. 2024, 13(24), 7692; https://doi.org/10.3390/jcm13247692 - 17 Dec 2024
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Abstract
Background: A leadless pacemaker (LP) is a modern alternative to a transvenous pacemaker, allowing certain complications to be avoided; however, some cannot be eliminated. Aim: To highlight the essential role of advanced speckle-tracking echocardiography (STE) in diagnosing pacing-induced cardiomyopathy (PICM) caused by an [...] Read more.
Background: A leadless pacemaker (LP) is a modern alternative to a transvenous pacemaker, allowing certain complications to be avoided; however, some cannot be eliminated. Aim: To highlight the essential role of advanced speckle-tracking echocardiography (STE) in diagnosing pacing-induced cardiomyopathy (PICM) caused by an LP. Clinical case: A 79-year-old male, after LP implantation a year earlier, was admitted due to heart failure (HF). Left ventricular ejection fraction (LVEF) was 40%, global longitudinal strain (GLS) was −10%, and interventricular mechanical delay (IVMD) was 42 ms. All these parameters were significantly better before the operation. Myocardial work indices confirmed dyssynchrony due to the right ventricular (RV) stimulation pattern, and PICM was considered. To verify the impact of RV pacing on the LV, measurements were taken after restoring the native rhythm, showing an improvement in LVEF (45%), GLS (−13%), IVMD (7 ms), and myocardial work indices. After the next HF exacerbation with further deterioration of the LV function, a decision to convert the LP to a standard CRT-P system was made, with immediate relief in clinical symptoms and improved echocardiographic parameters. Conclusions: This case highlights the essential role of STE echocardiography in identifying the detrimental impact of RV pacing, diagnosing PICM, and selecting the appropriate treatment for patients with LPs. Full article
(This article belongs to the Section Cardiology)
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14 pages, 271 KiB  
Article
Advanced Parameters of Myocardial Strain and Cardiac Biomarkers Indicate Subclinical Systolic Myocardial Dysfunction in Patients with Systemic Lupus Erythematous
by Nikolaos P. E. Kadoglou, Alexandriani Dimopoulou, Ioannis Korakianitis and Konstantinos Parperis
Biomedicines 2024, 12(11), 2638; https://doi.org/10.3390/biomedicines12112638 - 19 Nov 2024
Cited by 1 | Viewed by 929
Abstract
Background: Systemic lupus erythematosus (SLE) is characterized by inflammation and cardiovascular complications. Our study aimed to investigate subclinical and early indicators of systolic myocardial dysfunction in SLE patients using advanced echocardiographic methods and biomarkers. Methods: In this cross-sectional study, we enrolled [...] Read more.
Background: Systemic lupus erythematosus (SLE) is characterized by inflammation and cardiovascular complications. Our study aimed to investigate subclinical and early indicators of systolic myocardial dysfunction in SLE patients using advanced echocardiographic methods and biomarkers. Methods: In this cross-sectional study, we enrolled 102 SLE patients without known cardiac impairment and 51 healthy controls. Demographics, disease characteristics, laboratory results, disease activity (SLEDAI), and organ damage (SDI) indices were recorded. Left ventricular global longitudinal strain (GLS) and myocardial work indices were assessed by utilizing speckle tracking echocardiography. In addition, high-sensitivity C-reactive protein (hsCRP), high-sensitivity troponin (hsTn), and N-terminal-pro B-type natriuretic peptide (NT-proBNP) levels were measured in blood samples. Results: In comparison with controls, SLE patients had significantly higher GLS (−19.94 ± 2.71% vs. −21.15 ± 1.55%, p < 0.001) and global wasted work (GWW) (94 ± 71 mmHg% vs. 71 ± 49 mmHg%, p = 0.025). Notably, NT-proBNP and hsTn were threefold and twofold higher in the SLE group compared with the control group, respectively (p < 0.001). Within the SLE cohort, in patients with at least moderate disease activity (SLEDAI ≥ 4), both biomarkers were significantly more elevated than those with low disease activity (SLEDAI < 4). Notably, hsTn levels remained within the normal range. Conclusions: Advanced echocardiographic parameters combined with specific biomarkers have a promising role in detecting systolic dysfunction in SLE patients, potentially enabling timely interventions to mitigate cardiovascular risk Full article
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