Search Results (325)

Myocardial viability assessment plays a critical role in the clinical management of patients with ischemic heart disease, particularly in guiding revascularization decisions. Various non-invasive imaging modalities have been developed and refined to evaluate viable myocardium, each offering unique insights into myocardial perfusion, metabolism, and contractile function. This review examines the comparative strengths and limitations of key imaging techniques. Understanding the pathophysiological basis and diagnostic capabilities of these modalities enables clinicians to tailor viability assessments to individual patient profiles, ultimately enhancing decision-making and optimizing outcomes in ischemic cardiomyopathy. Full article

Arrhythmogenic cardiomyopathies (ACMs) are a phenotypically and etiologically heterogeneous group of myocardial disorders characterized by fibrotic or fibro-fatty replacement of ventricular myocardium, electrical instability, and an elevated risk of sudden cardiac death. Initially identified as a right ventricular disease, ACMs are now recognized to include biventricular and left-dominant forms. Genetic causes account for a substantial proportion of cases and include desmosomal variants, non-desmosomal variants, and familial gene-elusive forms with no identifiable pathogenic mutation. Nongenetic etiologies, including post-inflammatory, autoimmune, and infiltrative mechanisms, may mimic the phenotype. In many patients, the disease remains idiopathic despite comprehensive evaluation. Cardiac magnetic resonance imaging has emerged as a key tool for identifying non-ischemic scar patterns and for distinguishing arrhythmogenic phenotypes from other cardiomyopathies. Emerging classifications propose the unifying concept of scarring cardiomyopathies based on shared structural substrates, although global consensus is evolving. Risk stratification remains challenging, particularly in patients without overt systolic dysfunction or identifiable genetic markers. Advances in tissue phenotyping, multi-omics, and artificial intelligence hold promise for improved prognostic assessment and individualized therapy. Full article

Cardiac devices have transformed the management of heart failure, ventricular arrhythmias, ischemic cardiomyopathy, and valvular heart disease. Technologies such as cardiac resynchronization therapy (CRT), conduction system pacing, left ventricular assist devices (LVADs), and implantable cardioverter-defibrillators have contributed to abated global cardiovascular risk through action onto pathophysiological processes such as mechanical unloading, electrical resynchronization, or hemodynamic optimization, respectively. While their clinical benefits are well established, their long-term molecular and structural effects on the myocardium remain under investigation. Cardiac devices dynamically interact with myocardial and vascular biology, inducing molecular and extracellular matrix adaptations that vary by pathology. CRT enhances calcium cycling and reduces fibrosis, but chronic pacing may lead to pacing-induced cardiomyopathy. LVADs and Impella relieve ventricular workload yet alter sarcomeric integrity and mitochondrial function. Transcatheter valve therapies influence ventricular remodeling, conduction, and coronary flow. Understanding these remodeling processes is crucial for optimizing patient selection, device programming, and therapeutic strategies. This narrative review integrates the current knowledge on the molecular and structural effects of cardiac devices, highlighting their impact across different disease settings. Full article

Background/Objectives: Atrial fibrillation (AF) is the most significant modifying risk factor for the development of cardioembolic stroke, which is associated with worse outcomes and higher intrahospital mortality compared to other types of ischemic stroke. Antithrombotic medications are administered as prophylactic treatment in patients with a risk of stroke. The aim of this study was to determine outcome measures in patients with first-ever ischemic stroke and AF regarding prior antithrombotic therapy. Methods: We collected data on stroke risk factors, CHADS₂ score, and international normalized ratio (INR) value in the context of warfarin therapy, as well as data related to localization, stroke severity, and functional outcome at discharge. Results: A total of 754 subjects with first-ever ischemic stroke and AF were included in this cross-sectional study (122 on warfarin, 210 on acetylsalicylic acid, and 422 without prior antithrombotic therapy). The diagnosis of AF was previously unknown in 31% of the subjects. Stroke risk factors (arterial hypertension, hyperlipidemia, diabetes mellitus, and cardiomyopathy) were significantly lower in the group without prior antithrombotic therapy. The anticoagulant group was significantly younger (p = 0.001). Overall, 45.4% of subjects with a previously known AF event and a high risk of developing stroke received anticoagulant therapy. Participants on warfarin had a significantly better functional outcome than those on antiplatelet therapy or without prior antithrombotic therapy (median mRS 4 vs. 5 vs. 5; p = 0.025) and lower NIHSS scores, although the difference was not statistically significant (median 10 vs. 12 vs. 12; p = 0.09). There was no difference between stroke localization among groups (p = 0.116). Conclusions: Our study showed that, in our cohort, first-ever ischemic stroke due to AF was more common in women. Subjects on prior anticoagulant therapy had more favorable outcomes at discharge. Full article

Background/Objectives: Anatomical and functional damage of the mitral valve (MV) apparatus in patients with dilated cardiomyopathy (DCM) is secondary to left ventricular (LV) injury, leading to functional mitral regurgitation (FMR). Real-time four-dimensional echocardiography (RT 4DE) is a useful imaging technique in different pathologies, including DCM. Left atrial (LA) strain, as measured by left atrium quantification software, is an accurate technique for evaluating increased filling pressure. The MV has a complex three-dimensional morphology and motion. Four-dimensional echocardiography (4DE) has revolutionized clinical imaging of the mitral valve apparatus. This study aims (1) to characterize the mitral annulus (MA) parameters in patients with DCM and advanced-stage heart failure (HF) according to etiology and (2) to find correlations between left atrial function and MA remodeling in this group of patients, using 4DE quantification software. Methods: A total of 82 patients with DCM and an LV ejection fraction ≤ 40% were recruited. Conventional 2DE and RT 4DE were conducted in DCM patients with a compensated phase of HF before discharge. The measured parameters were left atrial reservoir strain (LASr), annular area (AA), annular perimeter (AP), anteroposterior diameter (A-Pd), posteromedial to anterolateral diameter (PM-ALd), commissural distance (CD), interregional distance (ITD), annular height (AH), nonplanar angle (NPA), tenting height (TH), tenting area (TA), and tenting volume (TV). Results: Measured parameters revealed more advanced damage of LA and MA parameters in ischemic compared to nonischemic etiology. Univariate analysis identified AA, AP, A-Pd, PM-ALd, CD, ITD, TH, TA, and TV (p < 0.0001) as determinants of LASr. Including these parameters in a stepwise multivariate logistic regression, PM-ALd (p = 0.03), TH (p = 0.043), and TV (p = 0.0001) were the best predictors of LAsr in these patients. Conclusions: The results of this study revealed the correlation between LA function depression and MA remodeling in patients with DCM. Full article

Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. The etiology of heart failure is multifactorial, encompassing ischemic heart disease, hypertension, valvular disorders, cardiomyopathies, and metabolic and infiltrative diseases. Despite advances in pharmacologic and device-based therapies, heart failure continues to carry a substantial burden of morbidity, mortality, and healthcare utilization. With the advancement and increased accessibility of cardiac imaging modalities, the diagnostic accuracy for identifying the underlying etiologies of nonischemic cardiomyopathy has significantly improved, allowing for more precise classification and tailored management strategies. This review aims to provide a comprehensive analysis of the current understanding of heart failure, encompassing epidemiology, etiological factors, with a specific focus on diagnostic imaging modalities including the role of echocardiography and strain imaging, cardiac magnetic resonance imaging (CMR), cardiac computed tomography (CT), and nuclear positron emission tomography (PET) imaging and recent advances in the diagnosis and management of heart failure. Full article

Cardiac magnetic resonance imaging (CMRI) has become an indispensable tool in evaluating arrhythmic risk and guiding therapeutic decisions in patients with non-ischemic cardiomyopathies (NICMs), including dilated (DCM), hypertrophic (HCM), and arrhythmogenic cardiomyopathies (ACM). Both European and American guidelines have given an additive and different value of late gadolinium enhancement (LGE) in specific morpho-functional (hypertrophic, dilated, and arrhythmogenic) phenotypes. In particular, LGE plays a different weight in relation to different cardiomyopathies. In dilated cardiomyopathy, LGE is able to predict arrhythmic risk in relationship to the presence and localization (septal and/or ring like LGE). On the contrary, in HCM, LGE is related to increased risk of cardiac death according to the extent (LGE >15%), while in ACM, it has a greater role in the presence of fat infiltration associated with LGE. In this review, we aim to identify predictors of sudden cardiac death related to myocardial structural features seen in CMRI in cardiomyopathies, going beyond the sole assessment of left ventricular function and ejection fraction. Full article

Objectives: This review aims to systematically evaluate the clinical outcomes of left ventricle-only fusion pacing (LV-only fCRTp) and identify evidence-based selection criteria that may optimize patient response and long-term therapeutic benefit. Background: Cardiac resynchronization therapy (CRT) is traditionally associated with biventricular pacing (BiVp). However, approximately 20–40% of patients seem to remain non-responders to this therapy. LV-only fCRTp offers a more physiological alternative by combining left ventricular epicardial pacing with the intrinsic ventricular activation wavefront. Beyond optimization strategies, the observed variability in response highlights the need for better patient selection in order to fully unlock its therapeutic potential. Methods: A systematic literature search was conducted in PubMed and Cochrane Library for original articles published up to April 2025, following PRISMA 2020 guidelines. The search focused on LV-only fCRTp performed either through standard RA/LV/RV biventricular devices or RA/LV dual-chamber systems. Results: Twenty-seven studies met the inclusion criteria. Among these, 17 studies obtained LV-only fCRTp using biventricular devices, and 10 were considered true LV-only fCRTp using RA/LV dual-chamber devices. Standard and specific selection criteria were used to qualify patients for LV-only fCRTp. Preserved atrioventricular conduction, ischemic cardiomyopathy, arrhythmic risk stratification, and the management of supraventricular arrhythmias were common overlapping parameters among studies with high variability, highlighting their potential role in response. RA/LV devices yielded consistent clinical benefits and low complication rates, particularly in nonischemic patients with stable AV conduction and low arrhythmic risk, while having a lower financial burden. Conclusions: Beyond guideline recommendations for CRT, this review identifies supplementary selection criteria that could further influence the effectiveness and stability of fusion pacing. Full article

Apoptosis is a highly regulated process of programmed cell death and plays a crucial pathogenic role in a variety of conditions including cardiovascular diseases. There are two pathways leading to apoptosis, the intrinsic and extrinsic pathways. In the intrinsic pathway, also known as the mitochondria-mediated pathway, the cell kills itself because it senses cell stress. Mitochondria account for 30% of cardiomyocyte volume, and therefore, the heart is vulnerable to apoptosis. The extrinsic pathway, also known as the death receptor-mediated pathway, is initiated by death receptors, members of the tumor necrosis factor receptor gene superfamily. Excessive apoptosis is involved in cardiac dysfunction in different cardiac conditions, including heart failure, ischemic heart disease, and cirrhotic cardiomyopathy. The last entity is a serious cardiac complication of patients with cirrhosis. To date, there is no effective treatment for cirrhotic cardiomyopathy. The conventional treatments for non-cirrhotic heart failure such as vasodilators are not applicable due to the generalized peripheral vasodilatation in cirrhotic patients. Exploring new approaches for the treatment of cirrhotic cardiomyopathy is therefore of utmost importance. Since apoptosis plays an essential role in the pathogenesis and progression of cardiovascular conditions, anti-apoptotic treatment could potentially prevent/attenuate the development and progression of cardiac diseases. Anti-apoptotic treatment may also apply to cirrhotic cardiomyopathy. The present review summarizes apoptotic mechanisms in different cardiac diseases, including cirrhotic cardiomyopathy, and potential therapies to regulate apoptosis in these conditions. Full article

Background: Cardiac magnetic resonance (CMR) is widely used to determine the underlying cause of left ventricular (LV) systolic dysfunction. Patients with ischemic disease are less frequently referred for CMR, as the underlying disease is often presumed to explain LV systolic dysfunction. However, various etiologies of myocardial impairment may coexist. Late gadolinium enhancement (LGE) is a technique used for tissue characterization, particularly visualization of myocardial fibrosis. Objectives: The aim of this study was to assess the prevalence of LGE patterns suggesting ischemic or non-ischemic etiology of myocardial damage in patients with LV systolic dysfunction with and without known coronary artery disease (CAD). Methods: 131 patients (76% male, 55 ± 15 years old) with LV ejection fraction (LVEF) ≤ 50% in echocardiography underwent CMR between December 2021 and November 2022. Patients were divided according to the known history of CAD. Regional subendocardial and transmural LGE was interpreted as ischemic etiology, whereas midmyocardial and subepicardial LGE was non-ischemic. Results: The mean LVEF assessed in CMR was 35 ± 10%. A total of 122 patients underwent CMR with LGE sequence. LGE was detected in 62% of patients: 34% had a non-ischemic pattern, 16% ischemic, and 11% mixed. LGE patterns did not differ between patients with and without CAD. In every third patient with CAD and almost every second patient without CAD, no myocardial fibrosis was detected. A completely normal CMR study was found in 6% of patients without CAD and 1% of patients with CAD (all p NS). Conclusions: The LGE patterns suggesting ischemic or non-ischemic myocardial damage are similarly prevalent in patients with and without known CAD. The diagnosis based solely on clinical information may be unreliable, as LV dysfunction might have multifactorial origins. The absence of local myocardial fibrosis is relatively common in patients with LV dysfunction, irrespective of its etiology. Full article

Background: Dilated Cardiomyopathy (DCM) is one of the leading causes of non-ischemic cardiomyopathy in the United States (US). The aim of our study is to analyze the general trends in DCM admissions between 2016 and 2021, and analyze social and healthcare disparities in terms of treatments and outcomes. Methods: National Inpatient Sample (NIS) data for the years 2016 to 2021 were used for the analysis. General population trends were analyzed. Normality of data distribution was tested using the Kolmogorov–Smirnov test and homogeneity was assessed using Levine’s test. One-way ANOVA was used after confirmation of normality of distribution to analyze social and healthcare disparities. Subgroup analysis was conducted, with the paired t-test for continuous variables and Fischer’s exact t-test for categorical variables to analyze statistical differences. Multivariate regression analysis was conducted to analyze the association of factors that were significant in the one-way ANOVA and paired t/chi square tests. A two-tailed p-value < 0.05 was used to determine statistical significance. Results: A total of 5262 admissions for DCM were observed between 2016 and 2021. A general declining trend was observed in the total number of DCM admissions, with a 33.51% decrease in total admissions in 2021 compared to 2016. All-cause in-hospital mortality remained stable across the years (between 3.5% and 4.5%). A total of 15.3% of admissions had CRT/ICD devices in place. A total of 425 patients (8.07%) for DCM underwent HT, and 214 admissions for DCM (4.06%) underwent LVAD placements between 2016 and 2021 In terms of interventions for DCM, namely Cardiac Resynchronization Therapy (CRT), Left Ventricular Assist Devices (LVADs) and Heart Transplantations (HTs), significant variance was observed in the mean age of the admissions with admissions over the mean age of 55 had lower number of interventions. Significant variance in terms of sex was observed for DCM admissions receiving HT, with lower rates observed for females. In terms of quarterly income, patients belonging to the lowest fourth quartile had higher rates of LVAD and HT compared to general DCM admissions. In the multivariate regression analysis, age at admission had significant association with lower chances of receiving LVADs and HT among DCM admissions, and significant association with higher chances of all-cause mortality during the hospital stay. Conclusions: A general declining trend in the total number of DCM admissions was observed between 2016 and 2021. Significant gender disparities were seen with lower rates of females with DCM receiving LVADs and HT. DCM admissions with mean age of 55 and above were found to have significantly lower rates of receiving LVADs and HT, and higher chances of all-cause mortality during the admission. Full article

Echocardiography is a cornerstone technique for evaluating cardiac function in preclinical research using murine models. This review provides a comprehensive overview of the echocardiographic approaches employed to assess ventricular function in mouse models of heart disease, highlighting methodological principles, technical challenges, and the translational relevance of findings. Various echocardiographic modalities enable the precise evaluation of systolic and diastolic function. This article emphasizes standardization in image acquisition and analysis to minimize inter-operator variability and ensure reproducibility. It details echocardiographic parameters and strain imaging across commonly used mouse models of non-ischemic dilated cardiomyopathy, diabetic cardiomyopathy, hypertensive heart disease, and ischemic heart disease. Furthermore, it explores the advantages and limitations of anesthesia, probe positioning, and physiological monitoring during imaging. The integration of advanced imaging technologies such as Speckle-Tracking Echocardiography (STE), Three-Dimensional (3-D), and Four-Dimensional (4-D) echocardiography is discussed as a promising avenue for enhancing data quality and improving the translational potential of preclinical cardiac studies. Full article

Significant challenges persist in diagnosing non-ischemic cardiomyopathies (NICMs) owing to early morphological overlap and subtle functional changes. While cardiac magnetic resonance (CMR) offers gold-standard structural assessment, current morphology-based AI models frequently overlook key biomechanical dysfunctions like diastolic/systolic abnormalities. To address this, we propose a dual-path hybrid deep learning framework based on CNN-LSTM and MLP, integrating anatomical features from cine CMR with biomechanical markers derived from intraventricular pressure gradients (IVPGs), significantly enhancing NICM subtype classification by capturing subtle biomechanical dysfunctions overlooked by traditional morphological models. Our dual-path architecture combines a CNN-LSTM encoder for cine CMR analysis and an MLP encoder for IVPG time-series data, followed by feature fusion and dense classification layers. Trained on a multicenter dataset of 1196 patients and externally validated on 137 patients from a distinct institution, the model achieved a superior performance (internal AUC: 0.974; external AUC: 0.962), outperforming ResNet50, VGG16, and radiomics-based SVM. Ablation studies confirmed IVPGs’ significant contribution, while gradient saliency and gradient-weighted class activation mapping (Grad-CAM) visualizations proved the model pays attention to physiologically relevant cardiac regions and phases. The framework maintained robust generalizability across imaging protocols and institutions with minimal performance degradation. By synergizing biomechanical insights with deep learning, our approach offers an interpretable, data-efficient solution for early NICM detection and subtype differentiation, holding strong translational potential for clinical practice. Full article

Background: Frequent premature ventricular complexes (PVCs) are associated with adverse outcomes in patients with structural heart disease (SHD), including increased risk of mortality and impaired left ventricular ejection fraction (LVEF). While radiofrequency ablation (RFA) of idiopathic PVCs is well established, its role in patients with SHD remains less clear. Objective: To review the evidence on the efficacy of RFA for PVC suppression in patients with SHD, specifically evaluating its impact on LVEF and clinical outcomes. Methods: A review of the literature was conducted using PubMed and the Cochrane Library, focusing on studies published after 2010 that included adult patients with SHD and a PVC burden >4% on 24 h Holter monitoring. Studies including patients with presumed PVC-induced cardiomyopathy without underlying SHD were excluded. Key outcomes were LVEF recovery, functional status, and procedural success rates. Results: In ischemic cardiomyopathy, RFA reduced PVC burden significantly and resulted in modest but significant LVEF improvement. In non-ischemic cardiomyopathy, successful ablation improved LVEF by 8–12% on average and enhanced NYHA class. Across mixed cohorts, patients with sustained PVC suppression showed significant improvements in LVEF, functional status, which, in many cases, removed the indication for implantable cardioverter-defibrillators. Notably, procedural success rates ranged from 60 to 94%, and the high baseline PVC burden (>13–20%) consistently predicted LVEF recovery regardless of SHD etiology. Conclusions: RFA of frequent PVCs in patients with SHD leads to meaningful improvements in systolic function and symptoms, particularly in those with high PVC burden. These benefits are seen across ischemic and non-ischemic substrates, although procedural complexity and recurrence rates may be higher. PVC burden, rather than SHD presence alone, should guide patient selection for ablation. Full article

Background: The HeartMate 3 (HM3) left ventricular assist device (LVAD) has demonstrated improved clinical outcomes in patients with advanced heart failure (HF). However, the influence of underlying HF etiology—ischemic cardiomyopathy (ICM) versus dilated cardiomyopathy (DCM)—on post-implantation outcomes remains insufficiently characterized. Objectives: This paper aims to evaluate early postoperative outcomes following HM3 LVAD implantation in patients with ICM versus DCM and to identify the preoperative hemodynamic and clinical predictors of early mortality and hemodynamic instability. Methods: We conducted a retrospective single-center cohort study of 30 patients who underwent HM3 LVAD implantation between 2017 and 2024. Patients were stratified by HF etiology (ICM, n = 17; DCM, n = 13), and preoperative clinical, echocardiographic, and right heart catheterization data were analyzed. The primary endpoint was 30-day postoperative survival. Secondary endpoints included postoperative hemodynamic stability and the need for vasopressor support. Results: Non-survivors (n = 13) demonstrated elevated central venous pressure (>16.5 mmHg), mean right ventricular pressure (>31.5 mmHg), and pulmonary vascular resistance (>7.5 Wood units), in addition to higher preoperative creatinine levels and longer cardiopulmonary bypass times. Vasopressor requirement postoperatively was associated with elevated pre-implant systolic pulmonary artery pressure. Conclusions: Preoperative right-sided pressures and renal dysfunction are strong predictors of early mortality following HM3 LVAD implantation. Patients with ICM exhibit greater early left ventricular recovery compared to those with DCM. These findings underscore the importance of comprehensive and personalized preoperative risk stratification—particularly in patients with DCM and pulmonary hypertension—to optimize postoperative outcomes and guide patient selection for durable LVAD support. Full article