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Keywords = morphofunctional assessment

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13 pages, 849 KiB  
Article
Morphofunctional Profile Focusing on Strength and Ultrasound of the Upper Limbs in Female Breast Cancer Survivors: A Comparative Cross-Sectional Study Between Groups with and Without Lymphoedema and Between Ipsilateral and Contralateral Limbs
by Ana Rafaela Cardozo Da Silva, Juliana Netto Maia, Vanessa Maria Da Silva Alves Gomes, Naiany Tenório, Juliana Fernandes de Souza Barbosa, Ana Claudia Souza da Silva, Vanessa Patrícia Soares de Sousa, Leila Maria Alvares Barbosa, Armèle de Fátima Dornelas de Andrade and Diego Dantas
Biomedicines 2025, 13(8), 1884; https://doi.org/10.3390/biomedicines13081884 (registering DOI) - 2 Aug 2025
Abstract
Background: Breast cancer is the most common neoplasm in women. Despite effective treatments, sequelae such as decreased muscle strength, upper limb dysfunction, and tissue changes are common, highlighting the need for functional assessments during rehabilitation. This study analysed the morphofunctional profile of [...] Read more.
Background: Breast cancer is the most common neoplasm in women. Despite effective treatments, sequelae such as decreased muscle strength, upper limb dysfunction, and tissue changes are common, highlighting the need for functional assessments during rehabilitation. This study analysed the morphofunctional profile of the upper limbs in breast cancer survivors, comparing muscle strength and ultrasound findings between groups with and without lymphoedema, as well as between ipsilateral and contralateral limbs. Methods: This cross-sectional study included female breast cancer survivors treated at an oncology physical therapy clinic. Muscle strength was measured using dynamometry (handgrip and arm flexor strength), and ultrasound assessed the thickness of the dermal–epidermal complex (DEC), subcutaneous tissue (SUB), and muscle (MT). Results: The upper limbs of 41 women were evaluated. No significant differences were observed between those with and without breast cancer-related lymphoedema (BCRL). When comparing the ipsilateral and contralateral limbs, significant reductions were observed in arm flexor strength (p < 0.001; 95% CI: −9.77 to −2.50), handgrip strength (p < 0.001; 95% CI: −4.10 to −1.22), and tissue thickness, with increased DEC thickness on the forearm (0.20 mm; p = 0.022) and arm flexors (0.25 mm; p < 0.001) of the ipsilateral limb. Conclusion: Significant differences in muscle strength and tissue structure between ipsilateral and contralateral limbs may reflect surgical and local pathophysiological effects. A trend toward reduced values for these parameters was also noted in limbs with BCRL, reinforcing the importance of future research to elucidate underlying mechanisms and guide more effective therapeutic strategies. Full article
(This article belongs to the Section Molecular and Translational Medicine)
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14 pages, 3243 KiB  
Review
Cardiac Magnetic Resonance Imaging and Arrhythmic Risk Stratification in Cardiomyopathies
by Gianluca Di Bella, Antonino Micari, Roberto Licordari, Pasquale Crea, Luigi Colarusso, Maurizio Cusmà-Piccione, Rocco Donato, Tommaso D’Angelo, Giuseppe Dattilo, Antonino Recupero, Cesare de Gregorio, Antonio Micari and Giovanni Donato Aquaro
J. Clin. Med. 2025, 14(14), 4922; https://doi.org/10.3390/jcm14144922 - 11 Jul 2025
Viewed by 294
Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Advances in Clinical Cardiovascular Magnetic Resonance Imaging)
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13 pages, 237 KiB  
Article
Nutritional and Morphofunctional Assessment in a Cohort of Adults Living with Cystic Fibrosis with or Without Pancreatic Exocrine and/or Endocrine Involvement
by Ana Piñar-Gutiérrez, José Luis Pereira-Cunill, Andrés Jiménez-Sánchez, Silvia García-Rey, María del Carmen Roque-Cuéllar, Antonio J. Martínez-Ortega, Irene González-Navarro, Esther Quintana-Gallego, Ángeles Pizarro, Francisco Javier Castell, Manuel Romero-Gómez and Pedro Pablo García-Luna
Nutrients 2025, 17(13), 2057; https://doi.org/10.3390/nu17132057 - 20 Jun 2025
Viewed by 376
Abstract
Objectives: To describe the results of nutritional and morphofunctional assessment in a cohort of adults with cystic fibrosis; to evaluate differences in nutritional status between patients with and without exocrine and/or endocrine pancreatic involvement. Methods: Cross-sectional study: A cohort of adults [...] Read more.
Objectives: To describe the results of nutritional and morphofunctional assessment in a cohort of adults with cystic fibrosis; to evaluate differences in nutritional status between patients with and without exocrine and/or endocrine pancreatic involvement. Methods: Cross-sectional study: A cohort of adults with cystic fibrosis evaluated in a multidisciplinary unit was analyzed. Pancreatic status was examined, and malnutrition was diagnosed according to GLIM criteria. Morphofunctional assessment consisted of nutritional ultrasound, bioelectrical impedance, handgrip dynamometry, and anthropometry. Qualitative variables are expressed as n (%), quantitative variables as median (IQR). For group comparisons, Fisher’s exact test was used for qualitative variables and the non-parametric median comparison test for quantitative variables. Results: n = 101 participants were recruited, of whom 44 (43.6%) were women. Median age was 33 (25–40.5) years. A total of 64 participants (63.4%) had exocrine pancreatic insufficiency (EPI), 44 (43.6%) had endocrine pancreatic insufficiency, and 28 (27.7%) had cystic fibrosis-related diabetes (CFRD). Median BMI was 23.4 (20.1–24.89) kg/m2. A total of 48 patients (47.5%) were malnourished. Males with EPI had a higher prevalence of undernourishment than those without (56.4% vs. 16.7%, p = 0.005), but not women. CFRD patients displayed no differences in morphofunctional assessment. Conclusions: Almost half the sample was undernourished using GLIM criteria. Males with exocrine pancreatic insufficiency had worse nutritional status. Endocrine pancreatic involvement did not affect nutritional status. Full article
(This article belongs to the Section Clinical Nutrition)
19 pages, 2375 KiB  
Technical Note
Synergizing Multi-Temporal Remote Sensing and Systemic Resilience for Rainstorm–Flood Risk Zoning in the Northern Qinling Foothills: A Geospatial Modeling Approach
by Dong Liu, Jiaqi Zhang, Xin Wang, Jianbing Peng, Rui Wang, Xiaoyan Huang, Denghui Li, Long Shao and Zixuan Hao
Remote Sens. 2025, 17(12), 2009; https://doi.org/10.3390/rs17122009 - 11 Jun 2025
Viewed by 502
Abstract
The northern foothills of the Qinling Mountains, a critical ecological barrier and urban–rural transition zone in China, face intensifying rainstorm–flood disasters under climate extremes and rapid urbanization. This study pioneers a remote sensing-driven, dynamically coupled framework by integrating multi-source satellite data, system resilience [...] Read more.
The northern foothills of the Qinling Mountains, a critical ecological barrier and urban–rural transition zone in China, face intensifying rainstorm–flood disasters under climate extremes and rapid urbanization. This study pioneers a remote sensing-driven, dynamically coupled framework by integrating multi-source satellite data, system resilience theory, and spatial modeling to develop a novel “risk identification–resilience assessment–scenario simulation” chain. This framework quantitatively evaluates the nonlinear response mechanisms of town–village systems to flood disasters, emphasizing the synergistic effects of spatial scale, morphology, and functional organization. The proposed framework uniquely integrates three innovative modules: (1) a hybrid risk identification engine combining normalized difference vegetation index (NDVI) temporal anomaly detection and spatiotemporal hotspot analysis; (2) a morpho-functional resilience quantification model featuring a newly developed spatial morphological resilience index (SMRI) that synergizes landscape compactness, land-use diversity, and ecological connectivity through the entropy-weighted analytic hierarchy process (AHP); and (3) a dynamic scenario simulator embedding rainfall projections into a coupled hydrodynamic model. Key advancements over existing methods include the multi-temporal SMRI and the introduction of a nonlinear threshold response function to quantify “safe-fail” adaptation capacities. Scenario simulations reveal a reduction in flood losses under ecological priority strategies, outperforming conventional engineering-based solutions by resilience gain. The proposed zoning strategy prioritizing ecological restoration, infrastructure hardening, and community-based resilience units provides a scalable framework for disaster-adaptive spatial planning, underpinned by remote sensing-driven dynamic risk mapping. This work advances the application of satellite-aided geospatial analytics in balancing ecological security and socioeconomic resilience across complex terrains. Full article
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29 pages, 1729 KiB  
Article
Morphofunctional Assessment of Malnutrition and Sarcopenia Using Nutritional Ultrasonography in Patients Undergoing Maintenance Hemodialysis
by José C. De La Flor, Estefanya García-Menéndez, Gregorio Romero-González, Celia Rodríguez Tudero, Elena Jiménez Mayor, Enrique Florit Mengual, Esperanza Moral Berrio, Beatriz Soria Morales, Michael Cieza Terrones, Secundino Cigarrán Guldris and Jesús Hernández Vaquero
Medicina 2025, 61(6), 1044; https://doi.org/10.3390/medicina61061044 - 5 Jun 2025
Viewed by 811
Abstract
Background and Objectives: Malnutrition and sarcopenia are highly prevalent and clinically impactful conditions in patients undergoing maintenance hemodialysis (MHD), yet their early detection remains challenging. This study aimed to assess the diagnostic performance of nutritional ultrasonography (NUS) in the morphofunctional evaluation of malnutrition [...] Read more.
Background and Objectives: Malnutrition and sarcopenia are highly prevalent and clinically impactful conditions in patients undergoing maintenance hemodialysis (MHD), yet their early detection remains challenging. This study aimed to assess the diagnostic performance of nutritional ultrasonography (NUS) in the morphofunctional evaluation of malnutrition and sarcopenia, and to compare its utility with established tools such as bioimpedance analysis (BIA), biochemical markers, handgrip strength (HGS), and functional performance tests. Materials and Methods: A cross-sectional study was conducted in 74 stable MHD patients. Clinical, analytical, anthropometric, BIA, NUS, and functional parameters were collected, along with validated nutritional and frailty scales. NUS was used to assess the quadriceps rectus femoris (QRF) and preperitoneal visceral fat (PPVF), measuring Y-axis, Y-axis/height, cross-sectional muscle area rectus femoris (CS-MARF), muscle area rectus femoris index adjusted to height (MARFIh), and supramuscular fat (SMF). Sarcopenia was defined according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Results: The prevalence of risk, confirmed, and severe sarcopenia was 24.3%, 40.5%, and 20.3%, respectively. Severe-to-moderate protein-energy wasting (PEW) affected 44.6% of patients. Compared to non-sarcopenic individuals, sarcopenic patients had lower values of HGS, prealbumin, lean body mass, and phase angle. NUS-derived cut-off values for sarcopenia were Y-axis ≤ 8 mm, Y-axis/height ≤ 2.9 mm/m2, CS-MARF ≤ 2.4 cm2, and MARFIh ≤ 0.9 cm2/m2. The most discriminative NUS parameters were Y-axis and SMF (AUC 0.67), followed by Y-axis/height (AUC 0.65) and MARFIh (AUC 0.63). NUS measurements correlated significantly with ASMI, phase angle, HGS, and SPPB scores. Conclusions: Nutritional ultrasonography is a feasible, reproducible, and clinically valuable tool for assessing muscle mass and quality in MHD patients. Its incorporation into routine practice may enhance early detection of malnutrition and sarcopenia, thereby facilitating timely, individualized nutritional interventions. Full article
(This article belongs to the Section Urology & Nephrology)
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17 pages, 1414 KiB  
Article
Adherence to β-hydroxy-β-methylbutyrate-Enriched Oral Nutritional Supplements Enhances Survival and Nutritional Recovery in Malnourished Outpatients: Prognostic Insights
by Isabel Vegas-Aguilar, Rocío Fernández-Jiménez, Isabel Cornejo-Pareja, María Del Mar Amaya-Campos, Patricia Guirado-Peláez, Natalia Montero-Madrid, Álvaro Vidal-Suarez, Maria Angeles Martín-Fontalba, Victor Simon-Frapolli, Francisco J. Tinahones and José Manuel García-Almeida
Nutrients 2025, 17(9), 1601; https://doi.org/10.3390/nu17091601 - 7 May 2025
Viewed by 762
Abstract
Background: Disease-related malnutrition (DRM) in outpatients is associated with increased mortality and functional decline. Morphofunctional assessments, including phase angle (PA), rectus femoris cross-sectional area (RF-CSA), and handgrip strength (HGS), provide valuable prognostic insights in the ambulatory setting. Nutritional recovery programs enriched with [...] Read more.
Background: Disease-related malnutrition (DRM) in outpatients is associated with increased mortality and functional decline. Morphofunctional assessments, including phase angle (PA), rectus femoris cross-sectional area (RF-CSA), and handgrip strength (HGS), provide valuable prognostic insights in the ambulatory setting. Nutritional recovery programs enriched with β-hydroxy-β-methylbutyrate (HMB) offer potential benefits in improving nutritional and functional outcomes. Objective: To evaluate the effects of a six-month nutritional recovery program combining HMB-enriched oral nutritional supplements (HMB-ONS), dietary recommendations, and exercise on survival, morphofunctional markers, and adherence in malnourished outpatients. Methods: This retrospective observational study included 135 malnourished outpatients diagnosed using GLIM criteria. Morphofunctional assessments included PA (bioimpedance analysis), RF-CSA (nutritional ultrasound), HGS (dynamometry), and the Timed Up and Go (TUG) test. Adherence was assessed using pharmacy retrieval records and a validated questionnaire. Changes in morphofunctional markers and their association with mortality were analyzed using multivariate Cox regression models. Results: After six months, significant improvements were observed in PA (+0.47°), RF-CSA (+0.90 cm2), HGS (+4.1 kg), and TUG (−0.93 s) (all p < 0.001). These improvements were more pronounced in the high-adherence group, which also exhibited a reduced mortality risk (HR 0.42, p < 0.05). Changes in PA and HGS were strongly associated with survival, with ΔPA showing an HR of 0.27 (95% CI: 0.15–0.50, p < 0.001) and ΔHGS showing an HR of 0.82 (95% CI: 0.75–0.89, p < 0.001). Conclusions: A nutritional recovery program with HMB-ONS significantly improves survival and morphofunctional markers in malnourished patients, with the greatest benefits observed in those with high adherence. These findings underscore the importance of adherence-support strategies in optimizing clinical outcomes and highlight the need for further research to confirm long-term benefits. Full article
(This article belongs to the Special Issue Nutritional Status and Lifestyle in Metabolic Disorders)
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19 pages, 506 KiB  
Article
Feasibility of a Pre-Operative Morphofunctional Assessment and the Effect of an Intervention Program with Oral Nutritional Supplements and Physical Exercise
by Natalia Mudarra-García, Fernando Roque-Rojas, Almudena Nieto-Ramos, Visitación Izquierdo-Izquierdo and Francisco Javier García-Sánchez
Nutrients 2025, 17(9), 1509; https://doi.org/10.3390/nu17091509 - 29 Apr 2025
Cited by 1 | Viewed by 663
Abstract
Background: Surgical patients often experience nutritional imbalances due to their underlying condition and the forthcoming surgical procedure. These imbalances can increase the risk of post-operative complications. To mitigate such risks, a comprehensive nutritional assessment—also known as morphofunctional assessment—should be conducted. This includes evaluating [...] Read more.
Background: Surgical patients often experience nutritional imbalances due to their underlying condition and the forthcoming surgical procedure. These imbalances can increase the risk of post-operative complications. To mitigate such risks, a comprehensive nutritional assessment—also known as morphofunctional assessment—should be conducted. This includes evaluating body composition (muscle and fat mass), muscle strength, and functional capacity. Methods: We conducted an observational, prospective, pre-post interventional study involving 138 patients undergoing major elective surgery. Each patient received a morphofunctional assessment and an individualized prehabilitation program, including nutritional supplementation, physical exercise, and comorbidity optimization for 21 days before surgery and one month afterward. Outcomes were assessed through bioimpedance (muscle mass), muscle ultrasound (QRF thickness), dynamometry (strength), and visceral fat ultrasound (fat reduction). Results: The patient’s morphofunctional assessment and subsequent nutritional and physical exercise optimization performed during the month before surgery in the prehabilitation consultation led to an increase in muscle mass (measured by bioimpedance analysis, p = 0.001), and muscle ultrasound, (QRF thickness: p < 0.001) and dinamometry (muscle strength: p = 0.014); a reduction in preperitoneal visceral fat thickness (reduction p < 0.001); and an improvement in the patients’ nutritional status, with a decrease in malnutrition rates (64.8% vs. 31.8%). As a result, post-operative complications were effectively prevented (p < 0.001). Conclusions: Pre-operative patient optimization by means of a prehabilitation program led to increased muscle strength, improved muscle mass, reduced complication rates, and shorter hospital stays. In addition, patients maintained their quality of life and functional capacity following surgery. Full article
(This article belongs to the Section Clinical Nutrition)
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10 pages, 240 KiB  
Article
Ovarian Tissue Removed with Endometrioma May Reflect the Quality of the Adjacent Ovary
by Francesco G. Martire, Veronica Yacoub, Eliana Fuggetta, Valerio Carletti, Lucia Lazzeri, Gabriele Centini, Claudia D’Abate, Giuseppe Sorrenti, Errico Zupi and Francesco Maneschi
Healthcare 2025, 13(8), 948; https://doi.org/10.3390/healthcare13080948 - 20 Apr 2025
Viewed by 346
Abstract
Background/Objectives: Endometriosis is commonly associated with infertility due to multiple factors. In this paper, we investigated the histopathological factors underlying these effects by comparing microscopic samples obtained during laparoscopic stripping. Methods: Morpho-functional examination through the follicular Score (FS) of ovarian tissue [...] Read more.
Background/Objectives: Endometriosis is commonly associated with infertility due to multiple factors. In this paper, we investigated the histopathological factors underlying these effects by comparing microscopic samples obtained during laparoscopic stripping. Methods: Morpho-functional examination through the follicular Score (FS) of ovarian tissue adjacent to the cystic wall (Specimen 1) was compared with the FS of ovarian tissue inadvertently harvested during cystectomy (Specimen 2). The follicular score was compared with clinical factors such as age, parity, BMI, and CA-125 levels. Results: Cohen’s kappa analysis revealed a 77.8% concordance between the follicular score of the ovarian tissue alongside the endometrioma (S1) and the ovarian tissue inadvertently removed (S2), reflecting a moderate level of concordance between the two samples. A statistically significant positive correlation was observed between the FS of Specimen 1 and the preoperative CA-125 value (p = 0.01); in contrast, a negative correlation was found between the FS and both the patient’s age (p = 0.006) and parity (p = 0.03). Additionally, a statistically significant negative correlation was demonstrated between the FS of Specimen 2 and patient age (p = 0.04). Conclusions: The functional quality of the remaining ovary after endometrioma stripping may be assessed by evaluating the follicular score of the pericystic ovarian tissue. Full article
(This article belongs to the Special Issue Fertility-Sparing Gynaecological Surgery)
21 pages, 2076 KiB  
Article
The Nutritional Phenotyping of Idiopathic Pulmonary Fibrosis Through Morphofunctional Assessment: A Bicentric Cross-Sectional Case–Control Study
by Alicia Sanmartín-Sánchez, Rocío Fernández-Jiménez, Eva Cabrera-César, Francisco Espíldora-Hernández, Isabel Vegas-Aguilar, María del Mar Amaya-Campos, Fiorella Ximena Palmas-Candia, Josefina Olivares-Alcolea, Víctor José Simón-Frapolli, Isabel Cornejo-Pareja, Ana Sánchez-García, Mora Murri, Patricia Guirado-Peláez, Álvaro Vidal-Suárez, Lourdes Garrido-Sánchez, Francisco J. Tinahones, Jose Luis Velasco-Garrido and Jose Manuel García-Almeida
Life 2025, 15(4), 516; https://doi.org/10.3390/life15040516 - 21 Mar 2025
Viewed by 732
Abstract
There is increasing evidence supporting the use of morphofunctional assessment (MFA) as a tool for clinical characterization and decision-making in malnourished patients. MFA enables the diagnosis of malnutrition, sarcopenia, obesity, and cachexia, leading to a novel phenotype-based classification of nutritional disorders. Bioelectrical impedance [...] Read more.
There is increasing evidence supporting the use of morphofunctional assessment (MFA) as a tool for clinical characterization and decision-making in malnourished patients. MFA enables the diagnosis of malnutrition, sarcopenia, obesity, and cachexia, leading to a novel phenotype-based classification of nutritional disorders. Bioelectrical impedance analysis (BIVA), nutritional ultrasound® (NU) and computed tomography (CT) are included, along with functional tests like the Timed Up and Go test (TUG). Myoesteatosis, detectable via CT, can occur independently from nutritional phenotypes and has been identified as a significant mortality predictor in idiophatic pulmonary fibrosis (IPF). Our aim is to analyze the prevalence and overlap of nutritional phenotypes in IPF and evaluate the prognostic value of myoesteatosis. Our bicenter cross-sectional study included 82 IPF patients (84.1% male and with a medium age of 71.1 ± 7.35 years). MFA was performed using BIVA, NU, CT at the T12 level (CT-T12), the handgrip strength (HGS) test, and the TUG. CT-T12 BC parameters were analyzed using FocusedON® software, while statistical analyses were conducted with JAMOVI version 2.3.22. All four major nutritional phenotypes were represented in our cohort, with significant overlap. A total of 80.5% met the GLIM criteria for malnutrition, 14.6% had cachexia, 17% were sarcopenic, and 28% were obese. Of the obese patients, 70% were also malnourished, while 100% of sarcopenic obese patients (5.9% of total) had malnutrition. A total of 55% of sarcopenic patients with available CT also had myosteatosis, suggesting muscle quality deterioration as a potential driver of functional impairment. The presence of myosteatosis > 15% in T12-CT was an independent predictor of 12-month mortality (HR = 3.13; 95% CI: 1.01–9.70; p = 0.049), with survival rates of 78.1% vs. 96.6% in patients with vs. without myosteatosis, respectively. To conclude, this study underscores the relevance of MFA in the nutritional characterization of patients with IPF, demonstrating its potential to identify specific phenotypes associated with malnutrition, functional impairment, and the presence of myoesteatosis, thereby providing a valuable tool for clinical decision-making. Full article
(This article belongs to the Special Issue Advances in Pulmonary Fibrosis)
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14 pages, 279 KiB  
Article
The Cross-Talk Between the Heart and the Liver: The Involvement of the Mitral Valve as a Novel Actor upon the Ancient Scene of Liver Cirrhosis
by Domenico Cozzolino, Riccardo Nevola, Alberto Ruggiero, Ciro Romano, Giuseppina Rosaria Umano, Ernesto Aitella, Celestino Sardu, Aldo Marrone and Sandro Gentile
J. Cardiovasc. Dev. Dis. 2025, 12(2), 76; https://doi.org/10.3390/jcdd12020076 - 17 Feb 2025
Viewed by 622
Abstract
Background: To date, little is known about correlations between liver dysfunction and circulatory and cardiac abnormalities (e.g.,: mitral valve, MV) in patients with chronic liver disease (CLD). This study aimed to assess a potential parallelism between liver dysfunction and cardiovascular involvement and identify [...] Read more.
Background: To date, little is known about correlations between liver dysfunction and circulatory and cardiac abnormalities (e.g.,: mitral valve, MV) in patients with chronic liver disease (CLD). This study aimed to assess a potential parallelism between liver dysfunction and cardiovascular involvement and identify the factors associated with structural and functional MV disorders. Methods. Among 995 patients with CLD, 346 were enrolled and compared with 168 controls without liver disease. According to the degree of liver disease, patients were classified as patients with chronic hepatitis (142) or with liver cirrhosis (Child-A: 70; Child-B: 65; Child-C: 69). Results: Among the chronic hepatitis group, resting heart rate (HR) and left ventricular (LV) mass were higher than in the control group (p = 0.0008), whereas systemic vascular resistance (SVR) was lower (p = 0.01). Among cirrhotic patients, resting HR, left atrium dimensions/volumes, LV walls thickness, LV mass, cardiac output (CO), isovolumetric relaxation time (IVRT), deceleration time (DT) and prevalence of aortic stenosis were higher than in non-cirrhotic patients (p = 0.02), whereas the e/a ratio and SVR were lower (p = 0.0001). Among Child-B/C, CO, IVRT, DT, prevalence of MV regurgitation and MV calcification score were higher than in the remaining patients (p = 0.02), whereas SVR was lower (p < 0.0001). Among cirrhotic patients with MV regurgitation, Child–Pugh score, liver disease duration, resting HR, left chambers dimensions/mass, CO, IVRT, DT and MV calcification score were higher compared to patients without regurgitation (p < 0.000), whereas mean blood pressure, e/a ratio and SVR were lower (p = 0.008). At multivariate analysis, Child–Pugh score, liver disease duration, left chambers volume/mass and MV calcification score were independently associated with MV regurgitation in cirrhotic patients. Child–Pugh score and MV calcification score strongly correlated in cirrhotic patients (r = 0.68, 95% CI 0.60–0.75, p < 0.0001). Conclusions: The magnitude of cardiac morpho/functional abnormalities is associated with the severity of liver dysfunction. Structural and functional MV abnormalities could represent a novel sign of cardiac involvement in liver cirrhosis. The severity and duration of liver disease, the enlargement of cardiac chambers and leaflet calcium accumulation could play a key role. Full article
(This article belongs to the Section Acquired Cardiovascular Disease)
11 pages, 1429 KiB  
Article
Predicting Early Atrial Fibrillation Recurrence Post-Electrical Cardioversion: A Critical Look at Bilateral Atrial Function
by Fabio Anastasio, Guido Pastorini, Giacomo Pucci, Alessandro Gonella, Valentina Tardivo and Mauro Feola
J. Clin. Med. 2025, 14(3), 749; https://doi.org/10.3390/jcm14030749 - 24 Jan 2025
Viewed by 1143
Abstract
Background/Objectives: The recurrence rate of atrial fibrillation (AF) after electrical cardioversion (ECV) appears to correlate with morpho-functional changes in both the left (LA) and right atria (RA). The present study focuses on identifying predictors for AF recurrence post-ECV. Methods: Sixty-one patients [...] Read more.
Background/Objectives: The recurrence rate of atrial fibrillation (AF) after electrical cardioversion (ECV) appears to correlate with morpho-functional changes in both the left (LA) and right atria (RA). The present study focuses on identifying predictors for AF recurrence post-ECV. Methods: Sixty-one patients were included in the study following an elective ECV with a successful conversion to SR, and were subjected to cardiovascular assessment immediately after ECV. Results: At 6-month follow-up, 24 patients (39.3%) experienced AF recurrence. Patients without AF recurrence showed a lower right atrial valvular index (RAVi) (32 ± 8 vs. 40 ± 10 mL/m2, p = 0.03), a higher LA strain S-R (15.8 ± 7.7 vs. 9.0 ± 4.2%, p = 0.003), and more pronounced lateral a’ wave (5 ± 3 vs. 3 ± 1 m/s, p = 0.01), tricuspid a’ wave (7 ± 3 vs. 4 ± 2 m/s, p = 0.02), average a’ wave (6 ± 2 vs. 3 ± 1, p = 0.005), and augmentation index corrected for 75 beats per minute (Aix75) (26 ± 13 vs. 37 ± 12, p = 0.01). Based on these results, patients were assigned one point for each of the following criteria: RAVi > 36 mL/m2, average a’ wave > 4, LA strain S-R > 13%. The ROC curve analysis showed that a score of 3 had an AUC for AF recurrence of 0.81 (p < 0.001, CI 0.69–0.91), with a sensitivity of 96% and a specificity of 62%. Conclusions: LA strain, TDI Doppler, RAVi, and Aix75 measured immediately post-ECV were independent predictors of AF recurrence after ECV. Full article
(This article belongs to the Section Cardiology)
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20 pages, 971 KiB  
Article
Relationship Between Vitamin D Levels with In-Hospital Complications and Morphofunctional Recovery in a Cohort of Patients After Severe COVID-19 Across Different Obesity Phenotypes
by Víctor J. Simón-Frapolli, Ángel López-Montalbán, Isabel M. Vegas-Aguilar, Marta Generoso-Piñar, Rocío Fernández-Jiménez, Isabel M. Cornejo-Pareja, Ana M. Sánchez-García, Pilar Martínez-López, Pilar Nuevo-Ortega, Carmen Reina-Artacho, María A. Estecha-Foncea, Adela M. Gómez-González, María Belén González-Jiménez, Elma Avanesi-Molina, Francisco J. Tinahones-Madueño and José Manuel García-Almeida
Nutrients 2025, 17(1), 110; https://doi.org/10.3390/nu17010110 - 30 Dec 2024
Cited by 2 | Viewed by 1765
Abstract
Background and objectives: the COVID-19 pandemic underscored the necessity of understanding the factors influencing susceptibility and disease severity, as well as a better recovery of functional status, especially in postcritical patients. evidence regarding the efficacy of vitamin D supplementation in reducing the severity [...] Read more.
Background and objectives: the COVID-19 pandemic underscored the necessity of understanding the factors influencing susceptibility and disease severity, as well as a better recovery of functional status, especially in postcritical patients. evidence regarding the efficacy of vitamin D supplementation in reducing the severity of COVID-19 is still insufficient due to the lack of primary robust trial-based data and heterogeneous study designs. the principal aims of our study were to determine the impact of vitamin D deficiency or insufficiency on complications during intensive care unit (icu) stay, as well as its role in muscle mass and strength improvement as well as morphofunctional recovery during a multispecialty 6-month follow-up program based on adapted nutritional support and specific physical rehabilitation. as a secondary objective, we compared the association mentioned above between patients with sarcopenic obesity and non- sarcopenic obesity. methods: this prospective observational study included 94 outpatients postcritical COVID-19. two weeks after hospital discharge, patients were divided into sufficient (≥30 ng/mL), insufficient (20.01–29.99 ng/mL), or deficient (≤20 ng/mL) vitamin D levels. the differences in in-hospital complications and morphofunctional parameters including phase angle (PhA), body cell mass (BCM), handgrip strength (HGS), timed get-up-and-go (UAG), 6 min walk test (6MWT), and proinflammatory biochemical variables were analyzed. Incremental (Δ) changes in these parameters were also analyzed at the end of follow-up according to vitamin D levels and the presence vs. absence of sarcopenic obesity. A multivariate linear regression analysis was performed to detect possible confounding factors in the impact analysis of vitamin D changes on functional recovery in patients with obesity. Results: A total of 36.2% of patients exhibited vitamin D deficiency, 29.8% vitamin D insufficiency, and only 32.9% showed sufficient levels at hospital discharge. A total of 46.8% of patients had obesity, and 36.1% had sarcopenic obesity. Vitamin D deficiency was associated with longer hospital stays (p = 0.04), longer ICU stays (p = 0.04), more days of invasive mechanical ventilation (IMV) (p = 0.04), lower skeletal muscle mass/weight (SMM/w) (p = 0.04) and skeletal muscle index (SMI) (p = 0.047), higher fat mass percentage (FM%) (p = 0.04), C-reactive-protein (CRP) (p = 0.04), and glycated hemoglobin (HbA1c) (p = 0.03), and better performance in R-HGS (p = 0.04), UAG (p = 0.03), and 6MWT (p = 0.034) when compared with those with normal vitamin D levels. At six months, Δvitamin D significantly correlated with ΔHbA1c (p = 0.002) and CRP (p = 0.049). Patients with normal vitamin D values showed better recovery of ΔSMI (p = 0.046), ΔSMM/w (p = 0.04), ΔR-HGS (p = 0.04), and ΔUAG (p = 0.04) compared to those with abnormal vitamin D levels, and these improvements in ΔR-HGS and ΔUAG were greater in the subgroup of sarcopenic obesity compared than in nonsarcopenic obesity (p = 0.04 and p = 0.04, respectively). Multivariate regression analysis detected that these results were also attributable to a longer hospital stay and lower ΔCRP in the subgroup of patients with sarcopenic obesity. Conclusions: Vitamin D deficiency was associated with longer hospital stays, longer VMI requirement, worse muscle health, and a higher degree of systemic inflammation. Furthermore, normal vitamin D levels at the end of the follow-up were associated with better morphofunctional recovery in postcritical COVID-19, particularly in patients with sarcopenic obesity partly due to a higher degree of inflammation as a result of a longer hospital stay. Full article
(This article belongs to the Special Issue Vitamin D in Relation to Diet-Related Diseases)
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20 pages, 1299 KiB  
Article
Phase Angle and Ultrasound Assessment of the Rectus Femoris for Predicting Malnutrition and Sarcopenia in Patients with Esophagogastric Cancer: A Cross-Sectional Pilot Study
by Erika Vieira Maroun, María Argente Pla, María José Pedraza Serrano, Bianca Tabita Muresan, Agustín Ramos Prol, Eva Gascó Santana, Silvia Martín Sanchis, Ángela Durá De Miguel, Andrea Micó García, Anna Cebrián Vázquez, Alba Durbá Lacruz and Juan Francisco Merino-Torres
Nutrients 2025, 17(1), 91; https://doi.org/10.3390/nu17010091 - 29 Dec 2024
Viewed by 1737
Abstract
Background: Disease-related malnutrition (DRM) and sarcopenia are prevalent conditions in gastrointestinal cancer patients, whose early diagnosis is essential to establish a nutritional treatment that contributes to optimizing adverse outcomes and improving prognosis. Phase angle (PhA) and rectus femoris ultrasound measurements are considered effort-independent [...] Read more.
Background: Disease-related malnutrition (DRM) and sarcopenia are prevalent conditions in gastrointestinal cancer patients, whose early diagnosis is essential to establish a nutritional treatment that contributes to optimizing adverse outcomes and improving prognosis. Phase angle (PhA) and rectus femoris ultrasound measurements are considered effort-independent markers of muscle wasting, which remains unrecognized in oncology patients. Objective: This study aimed to evaluate the potential utility of PhA, rectus femoris cross-sectional area (RFCSA), and rectus femoris thickness (RF-Y-axis) in predicting malnutrition and sarcopenia in patients with esophagogastric cancer (EGC). Methods: This was a cross-sectional study of patients diagnosed with EGC. PhA was obtained using bioelectrical impedance vector analysis (BIVA) along with ASMMI. The RFCSA and RF-Y-axis were measured using nutritional ultrasound (NU®). Muscle capacity was assessed using handgrip strength (HGS), and functionality by applying the Short Physical Performance Battery (SPPB). Malnutrition and sarcopenia were determined according to the GLIM and EWGSOP2 criteria, respectively. Results: Out of the 35 patients evaluated, 82.8% had malnutrition and 51.4% had sarcopenia. The RFCSA (r = 0.582) and RF-Y-axis (r = 0.602) showed significant, moderate correlations with ASMMI, unlike PhA (r = 0.439), which displayed a weak correlation with this parameter. However, PhA (OR = 0.167, CI 95%: 0.047–0.591, p = 0.006), RFCSA (OR = 0.212, CI 95%: 0.074–0.605, p = 0.004), and RF-Y-axis (OR = 0.002, CI 95%: 0.000–0.143, p = 0.004) all showed good predicting ability for sarcopenia in the crude models, but only the RF-Y-axis was able to explain malnutrition in the regression model (OR = 0.002, CI 95%: 0.000–0.418, p = 0.023). Conclusions: The RF-Y-axis emerged as the only independent predictor of both malnutrition and sarcopenia in this study, likely due to its stronger correlation with ASMMI compared to PhA and RFCSA. Full article
(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)
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15 pages, 1295 KiB  
Article
Predictive Factors of the Degrees of Malnutrition According to GLIM Criteria in Head and Neck Cancer Patients: Valor Group
by Francisco Javier Vílchez-López, María González-Pacheco, Rocío Fernández-Jiménez, María Teresa Zarco-Martín, Montserrat Gonzalo-Marín, Jesús Cobo-Molinos, Alba Carmona-Llanos, Araceli Muñoz-Garach, Pedro Pablo García-Luna, Aura D. Herrera-Martínez, Felisa Pilar Zarco-Rodríguez, María del Carmen Galindo-Gallardo, Luis Miguel-Luengo, María Luisa Fernández-Soto and José Manuel García-Almeida
Cancers 2024, 16(24), 4255; https://doi.org/10.3390/cancers16244255 - 21 Dec 2024
Cited by 1 | Viewed by 1130
Abstract
Background: Malnutrition is highly prevalent in patients with head and neck cancer, with relevant consequences in the treatment results. Methods: Multicenter observational study including 514 patients diagnosed with HNC. The morphofunctional assessment was carried out during the first 2 weeks of radiotherapy treatment. [...] Read more.
Background: Malnutrition is highly prevalent in patients with head and neck cancer, with relevant consequences in the treatment results. Methods: Multicenter observational study including 514 patients diagnosed with HNC. The morphofunctional assessment was carried out during the first 2 weeks of radiotherapy treatment. A correlation analysis between nutritional variables and groups of malnutrition, a multivariate logistic regression analysis, and a random forest analysis to select the most relevant variables to predict malnutrition were performed. Results: In total, 51.6% were undernourished (26.3% moderately and 25.3% severely). There was a negative correlation between morphofunctional variables and a positive correlation between hsCRP and well vs. moderate and well vs. severe malnutrition groups. The increase in different bioelectrical and ultrasound parameters was associated with a lower risk of moderate and severe malnutrition when groups with different degrees of malnutrition were compared. To predict the importance of morphofunctional variables on the risk of undernutrition, a nomogram, a random forest, and decision tree models were conducted. For the well vs. moderate, for the well vs. severe, and for the moderate vs. severe malnutrition groups, FFMI (cut-off < 20 kg/m2), BCMI (cut-off < 7.6 kg/m2), and RF-Y-axis (cut-off < 0.94 cm), respectively, were the most crucial variables, showing a greater probability of mortality in the two last comparisons. Conclusions: Malnutrition is very prevalent in HNC patients. Morphofunctional assessment with simple tools such as electrical impedance and muscle ultrasound allows an early nutritional diagnosis with an impact on survival. Therefore, these techniques should be incorporated into the daily clinical attention of patients with HNC. Full article
(This article belongs to the Section Cancer Causes, Screening and Diagnosis)
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11 pages, 1672 KiB  
Article
Bioelectrical Impedance Vector Analysis in Extremely Low-Birth-Weight Infants to Assess Nutritional Status: Breakthroughs and Insights
by Raquel Núñez-Ramos, Diana Escuder-Vieco, Carolina Rico Cruz, Cristina De Diego-Poncela, Sara Vázquez-Román, Marta Germán-Díaz, Nadia Raquel García-Lara and Carmen Pallás-Alonso
Nutrients 2024, 16(24), 4348; https://doi.org/10.3390/nu16244348 - 17 Dec 2024
Cited by 2 | Viewed by 1065
Abstract
Background/Objectives: To obtain bioelectrical data to assess nutritional status for extremely low-birth-weight (ELBW) infants upon reaching term-corrected age. Methods: A descriptive, observational, prospective, and single-center study, which included ELBW preterm infants was performed. The study variables collected were gestational age, sex, [...] Read more.
Background/Objectives: To obtain bioelectrical data to assess nutritional status for extremely low-birth-weight (ELBW) infants upon reaching term-corrected age. Methods: A descriptive, observational, prospective, and single-center study, which included ELBW preterm infants was performed. The study variables collected were gestational age, sex, and anthropometry at birth and at term-corrected age. Bioelectrical impedance vector analysis (BIVA) was performed by a phase-sensitive device (BIA 101 BIVA PRO AKERN srl, Pisa, Italy). The components of the impedance vector—resistance (R) and reactance (Xc)—were normalized for body height (H). For each subject, the measurement was taken between the 36th and 44th weeks of postmenstrual age (PMA). A semi-quantitative analysis of body composition was performed using the vector modality of the BIA. Using the RXc graph method, the bivariate 95% confidence intervals of the mean vectors were constructed. From the bivariate normal distribution of R/H and Xc/H, the bivariate 95%, 75%, and 50% tolerance intervals for this cohort were drawn. The individual impedance vectors were compared with the distribution of the vectors from other populations. Results: 85 ELBW infants (40 male, 45 female) were included, with a mean gestational age at birth of 26 + 6 weeks (±1.76). Mean R/H was 870.33 (±143.21) Ohm/m and Xc/H was 86.84 (±19.05) Ohm/m. We found differences in the bioelectrical data with regard to gender, with resistance values being significantly higher in females. Our ellipses align closely with those from other term neonatal cohorts. Conclusions: Bioelectrical data and the confidence and tolerance ellipses of an ELBW infant cohort are presented and can be used as a reference standard for nutritional assessment at discharge. Full article
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