Search Results (154)

Myocardial infarction (MI) is an inflammatory disease responsible for approximately 75% of sudden cardiac deaths. In this study, we aimed to evaluate the cardio-protective influence of microencapsulated probiotic and synbiotic dietary supplements in vivo and in molecular docking studies. MI was induced in rats with the injection of isoproterenol (i.p. 67 mg/kg). Plasma lipid profiles and the levels of oxidative stress markers, inflammatory markers, and cardiac enzymes were determined. The expression levels of MMP-7 and IL-1β in the heart muscle were measured. The impact of dietary supplements on fecal bacterial counts was evaluated across all rat groups. A histopathological examination of cardiac tissue was performed. The cardio-protective potential of cyanidin 3-diglucoside 5-glucoside and arabinoxylan was studied using molecular docking. The results demonstrate that all tested dietary supplements induced an improvement in all the biochemical parameters in association with an improvement in myocardial muscle tissue. The mRNA expression levels of MMP-7 and IL-1β were significantly downregulated by all dietary supplements. All dietary supplements increased the fecal counts of probiotic strains. In the molecular docking analysis, cyanidin 3-diglucoside 5-glucoside exhibited binding affinity values of −8.8 and −10 for lactate dehydrogenase (LDH) and Paraoxonase 1 (PON1), respectively. Arabinoxylan showed similar binding affinity (−8.8) for both LDH and PON1. Conclusion: Microencapsulated probiotic and synbiotic dietary supplements demonstrated notable cardio-protective influence in vivo and in molecular docking studies. These supplements may serve as promising candidates for the prevention of myocardial infarction. Full article

Background and Objectives: Type 2 diabetes mellitus (T2DM) is associated with subclinical cardiovascular changes, such as increased arterial stiffness and myocardial dysfunction. Vitamin D deficiency has been recognized as a potential contributing factor to vascular disease; however, its impact on early cardiac changes associated with T2DM remains poorly understood. Our aim was to evaluate the association between serum levels of 25-hydroxyvitamin D3 [25(OH)D3], arterial stiffness, and left ventricular global longitudinal strain (LV GLS) in patients with T2DM who do not have a clinically evident cardiovascular disease. Material and methods: This cross-sectional study evaluated the carotid intima–media thickness (IMT), aortic pulse wave velocity (PWVao), LV GLS, and serum 25(OH)D3 levels in patients diagnosed with T2DM (n = 65) compared to healthy control subjects (n = 55). Independent predictors of arterial stiffness were identified by a multivariate logistic regression analysis. Results: Patients with T2DM showed a significant increase in IMT and PWVao, a reduction in LV GLS, and low levels of 25(OH)D3 compared to subjects in the control group (all p < 0.05). Both vitamin D deficiency and T2DM were found to be independently associated with an increased arterial stiffness, with odds ratios of 2.4 and 4.8, respectively. A significant inverse relationship was identified between 25(OH)D3 levels and markers of arterial stiffness, as well as LV GLS, suggesting a possible association between the vitamin D status and the early onset of cardiovascular dysfunction. Conclusions: Patients with T2DM show early signs of heart and blood vessel problems, even with an ejection fraction that remains within normal limits. There is a significant correlation between vitamin D deficiency and increased arterial stiffness, along with impaired LV GLS, indicating its possible involvement in cardiovascular complications associated with diabetes. These findings support the utility of integrating vascular, myocardial, and vitamin D assessments in early cardiovascular risk stratification for T2DM patients. Full article

Tricuspid regurgitation (TR) represents a significant, often silently progressing, valvular heart disease with historically suboptimal management due to perceived high surgical risks. Transcatheter tricuspid valve interventions (TTVI) offer a promising, less invasive therapeutic avenue. Central to the success of TTVI is Right Ventricular Reverse Remodelling (RVRR), defined as an improvement in RV structure and function, which strongly correlates with enhanced patient survival. The right ventricle (RV) undergoes complex multi-scale biomechanical maladaptations, progressing from adaptive concentric to maladaptive eccentric hypertrophy, coupled with increased stiffness and fibrosis. Molecular drivers of this pathology include early failure of antioxidant defenses, metabolic shifts towards glycolysis, and dysregulation of microRNAs. Accurate RV function assessment necessitates advanced imaging modalities like 3D echocardiography, Cardiac Magnetic Resonance Imaging (CMR), and Computed Tomography (CT), along with strain analysis. Following TTVI, RVRR typically manifests as a biphasic reduction in RV volume overload, improved myocardial strain, and enhanced RV-pulmonary arterial coupling. Emerging molecular biomarkers alongside advanced imaging-derived biomechanical markers like CT-based 3D-TAPSE and RV longitudinal strain, are proving valuable. Artificial intelligence (AI) and machine learning (ML) are transforming prognostication by integrating diverse clinical, laboratory, and multi-modal imaging data, enabling unprecedented precision in risk stratification and optimizing TTVI strategies. Full article

Myocardial deformation imaging has emerged as a valuable clinical tool for assessing right ventricular (RV) systolic function, providing additional diagnostic and prognostic insights compared to traditional indices of RV function. Two-dimensional speckle-tracking echocardiography is currently the standardized method of choice for measuring RV longitudinal strain (RVLS) in clinical practice. RVLS provides a more sensitive indicator of subtle myocardial dysfunction than conventional parameters for RV function assessment (i.e., tricuspid annular plane systolic excursion, tissue Doppler systolic velocity, fractional area change, or RV ejection fraction), with utility for the risk stratification and surveillance of conditions affecting the right heart. However, accurate interpretation of RVLS requires a comprehensive understanding of RV mechanics, pathology, and loading conditions across various cardiovascular conditions, as well as the effects of image quality and technical aspects of image acquisition and tracking in RV strain measurements. This review provides an updated overview of current practical guidelines for RV strain analysis, current clinical applications, and future directions for its potential use in clinical practice. Full article

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

Radiation therapy (RT) plays a vital role in managing thoracic cancers, though it can lead to adverse effects, including significant cardiotoxicity. Understanding the risk factors like hypertension in RT is important for patient prognosis and management. A Dahl salt-sensitive (SS) female rat model was used to study hypertension effect on RT-induced cardiotoxicity. Rats were fed a high-salt diet to induce hypertension and then divided into RT and sham groups. The RT group received 24 Gy of whole-heart irradiation. Cardiac function was evaluated using MRI and blood pressure measurements at baseline, 8 weeks and 12 weeks post-RT. Histological examination was performed after the last timepoint or animal death. The hypertensive RT rats demonstrated significant decreases in left-ventricular ejection fraction (EF) (45 ± 7.2%) compared to sham (68 ± 7.3%). Furthermore, circumferential (Ecc) and radial (Err) myocardial strains were significantly reduced (Ecc: −7.4 ± 2.0% RT rats vs. −11 ± 2.4% sham; Err: 15 ± 6.5% RT rats vs. 23 ± 8.9% sham). Histological analysis revealed significant pathophysiological remodeling post-RT, including nuclear size, interstitial fibrosis, necrosis, and the presence of inflammatory cells. This study provides valuable insights into the cardiotoxic effects of RT in the context of hypertension, highlighting the potential of using MRI for improved risk assessment with potential for future clinical translation. Full article

Background: Over the last 15 years, few echocardiographic studies have examined the biventricular mechanics by speckle tracking echocardiography (STE) in patients affected by chronic obstructive pulmonary disease (COPD) without advanced lung disease. We aimed to summarize the main findings of these studies and quantify the overall effect of COPD on biventricular mechanics in patients without severe airflow obstruction. Methods: Eligible studies assessing cardiac function by conventional transthoracic echocardiography (TTE), implemented with a STE analysis of left ventricular (LV)-global longitudinal strain (GLS) and/or right ventricular (RV)-GLS in COPD patients without severe airflow obstruction vs. healthy controls, were selected from the PubMed, Embase and Scopus databases. The primary endpoint was to quantify the effect of COPD on LV-GLS and RV-GLS in individuals without advanced lung disease. Continuous data [LV-GLS, RV-GLS, left ventricular ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE)] were pooled as the standardized mean difference (SMD) comparing COPD cohorts with healthy controls. Results: Ten studies were included, totaling 682 COPD patients and 316 healthy controls. Overall, COPD showed a large effect on LV-GLS (SMD −1.296; 95%CI −2.010, −0.582, p < 0.001) and RV-GLS (SMD −1.474; 95% CI −2.142, −0.805, p < 0.001), a medium-to-large effect on TAPSE (SMD −0.783, 95% CI −0.949, −0.618, p < 0.001) and a small effect on LVEF (SMD −0.366, 95% CI −0.659, −0.074, p = 0.014). The I² statistic value for the LV-GLS (91.1%), RV-GLS (88.2%) and LVEF (76.7%) studies suggested a high between-study heterogeneity, while that for the TAPSE (38.1%) studies was compatible with a low-to-moderate between-study heterogeneity. Egger’s test yielded a p-value of 0.16, 0.48, 0.58 and 0.50 for LV-GLS, RV-GLS, LVEF and TAPSE studies, respectively, indicating an absence of publication bias. Meta-regression analyses excluded that the effect of COPD on biventricular mechanics might be influenced by potential confounders (all p > 0.05). Sensitivity analysis confirmed the robustness of the LV-GLS, RV-GLS and TAPSE studies’ results. Conclusions: COPD appears to be independently associated with a mild attenuation of biventricular mechanics in patients with moderate airflow limitations, despite a preserved LVEF and TAPSE on conventional TTE. STE analysis may allow clinicians to identify COPD patients with subclinical myocardial dysfunction and an increased risk of heart failure and cardiovascular complications early. Full article

Two-dimensional speckle-tracking echocardiography (2D-STE) is an advanced imaging technique that offers quantitative insights into myocardial function by analyzing the motion of speckles created during ultrasound–tissue interactions. This study aims to evaluate the reliability of 2D-STE by examining the impact of key technical parameters on global longitudinal strain (GLS) measurement accuracy and comparing two speckle-tracking analysis methods provided by GE Healthcare: quantitative analysis of the 2D strain (2D strain) and automated function imaging (AFI). The prospective study consisted of two cohorts. In the first cohort, including 16 healthy dogs, the influence of frame rate, heart rate variation, zoom, transducer frequency, and image foreshortening on speckle-tracking values was assessed. In the second cohort, which included 10 healthy dogs, 2D-STE parameters were obtained with the 2D strain and AFI to assess agreement between the methods and observer variability. Our findings indicate that foreshortening (p < 0.01, Cohen’s d: 0.52, CI: −17.81 to −24.83) and heart rate variability (p = 0.02, Cohen’s d: 0.72, CI: −18.07 to −26.23) significantly affect speckle-tracking measurements. While zoom, frame rate, and frequency did not show a significant impact. Additionally, while the 2D strain and AFI exhibited a strong correlation, a significant systematic bias was identified, with AFI underestimating strain values compared to the 2D strain. Intra- and inter-observer coefficients of variation (CV) were below 9% for both methods, supporting their reliability. These findings emphasize the need to optimize image acquisition and selection criteria, which enhances the accuracy and reliability of the speckle-tracking analysis. Full article

Echocardiographic values can vary between dog breeds, making breed-specific reference intervals (RIs) preferable. Two-dimensional speckle tracking echocardiography (2-D STE) is an advanced imaging technique that enables the measurement of myocardial deformation parameters, contributing to the assessment of systolic function. The objective was to determine breed-specific RIs for 2-D, M-mode, and Doppler-derived echocardiographic parameters for Dutch Sheepdogs, and to obtain 2-D STE-derived strain and strain rate values in this breed. Apparently healthy, purebred Dutch Sheepdogs (1–7 years) were recruited. Each dog underwent a physical examination and transthoracic echocardiography. Conventional 2-D, M-mode, and Doppler measurements were obtained; strain analysis was performed with 2-D STE software. RIs were established for conventional echocardiographic parameters; clinically relevant parameters were compared with commonly used RIs. The effects of gender, age, body weight (BW) and heart rate were tested. Sixty dogs were included. Panting and/or tachycardia were observed in 24 dogs, which affected the quality of the analysis to varying degrees (e.g., out-of-sector movement, lung artefacts). The selected parameters for left ventricular (LV) and atrial dimension showed good agreement with published RIs. BW was an independent variable influencing LV dimensions. This study provides RIs for conventional echocardiographic measurements and reports 2-D STE-derived strain and strain rate values obtained in Dutch Sheepdogs. The selected parameters of LV and left atrial dimension showed good agreement with commonly used RIs. Anxious behavior could represent a breed peculiarity to take into account when performing echocardiography, as it can affect image quality. Full article

Background and Objectives: Aortic stenosis (AS) leads to progressive left ventricular (LV) dysfunction, making early detection crucial. Global longitudinal strain (GLS) is an echocardiographic marker of subclinical LV dysfunction; however, echocardiography has limitations, including operator dependency and acoustic variability. Cardiac magnetic resonance (CMR) is a valuable complementary tool, and artificial intelligence (AI) may enhance strain measurement accuracy, though its role in AS remains underexplored. To evaluate the performance of an AI-based CMR feature tracking tool for the assessment of LV global and segmental GLS in AS patients and compare results with the respective measurements from healthy volunteers (control group), as well as with the GLS obtained using the echocardiographic speckle tracking technique. Materials and Methods: This retrospective study analysed 111 CMR exams (70 AS patients, 41 healthy controls) from a single centre. AI-derived GLS values from gradient echo 2-, 3-, and 4-chamber CMR views were manually reviewed for accuracy. Error rates, segmental, and global myocardial strain differences were assessed between AS patients and the control group. Results: AI-based CMR GLS strongly correlated with echocardiographic GLS (r = 0.694, p < 0.001) and showed lower variability. The AI-derived GLS from CMR was significantly lower in aortic stenosis patients compared to controls (−17.86 ± 3.47 vs. −20.70 ± 1.98). However, AI-based strain analysis had an overall error rate of 6%, which was significantly higher in AS patients (18.6%) compared to healthy controls (2.44%) (p = 0.0088). The 3-chamber CMR view was the most error-prone (50% of isolated errors). Segmental strain variability between AS patients and controls was most pronounced in basal segments, with smaller differences in middle and apical segments. CMR demonstrated greater precision than echocardiography, as indicated by a smaller standard deviation in GLS measurements (3.47 vs. 4.98). Conclusions: The AI-based CMR feature tracking technique provides accurate and reproducible GLS measurements, showing strong agreement with echocardiographic speckle tracking-based GLS. However, the higher error rates in AS patients compared to controls underscore the need for more advanced AI algorithms to improve performance in cardiac pathology. Full article

Transthyretin cardiac amyloidosis (ATTR-CA) leads to myocardial infiltration, affecting prognosis and survival. Diagnosing early-stage ATTR-CA remains challenging due to its subtle manifestations. This study investigates subclinical myocardial alterations in asymptomatic ATTR mutation carriers (ATTR-MC) using advanced cardiac magnetic resonance (CMR) techniques, including T1 mapping and myocardial strain analysis. A retrospective cohort of 60 subjects was analyzed, comprising 20 ATTR-CA patients, 20 asymptomatic ATTR-MC, and 20 controls. Standard CMR parameters were compared alongside myocardial strain analysis. Results indicated that despite preserved ejection fraction and myocardial morphology, ATTR-MC exhibited significantly impaired left ventricular global longitudinal strain (LV GLS), left atrial reservoir, conduit, and booster pump strain (LA RS, CS, and BPS) compared to controls. However, native T1 and extracellular volume (ECV) values remained within normal ranges, distinguishing early dysfunction from overt amyloid deposition seen in ATTR-CA. These findings suggest that myocardial strain analysis could serve as an early biomarker for subclinical ATTR-CA, offering a potential target for selecting patients who may benefit from early intervention. Implementing CMR-derived strain parameters in clinical practice may improve risk stratification and timely therapeutic decisions in ATTR-MC. Full article

Early-onset heart failure is a major treat to healthy aging individuals with HIV-1 infection. Women with HIV-1 infection (WLWH) are especially vulnerable and develop heart failure with preserved ejection fraction (HFpEF), of which left ventricular diastolic dysfunction, vascular deficits, myocardial infarction, and fibrosis are major components. HIV-infected rodent models that exhibit these pathophysiological features remain under-reported, and this has left a void in our understanding of their molecular causes and therapeutic strategies to blunt its development. Here, we show that female NOD.Cg-Prkdc^scidIl2rgt^m1Wjl/SzJ humanized mice (Hu-mice) infected with HIV-1_ADA and treated for 13 weeks with dolutegravir (DTG)/tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) develop progressive diastolic dysfunction with preserved ejection fraction (E:A ratio, E:e′, IVRT, left atrial volume and global longitudinal strain increased by 32.1 ± 5.1%, 28.2 ± 5.6%, 100.2 ± 12.6%, 26.6 ± 4.2% and 32.5 ± 4.3%, respectively). In vivo photoacoustic imaging revealed a 30.4 ± 6.8% reduction in saturated oxygenated hemoglobin in the anterior wall of the heart. The ex vivo analysis of hearts showed a reduction in density of perfused microvessels/ischemia (30.6 ± 6.2%) with fibrosis (20.2 ± 1.2%). The HIF-1α level was increased 2.6 ± 0.5-fold, while inflammation-induced serum semicarbazide amine oxidase and glycolysis byproduct methylglyoxal increased 2-fold and 2.1-fold, respectively. Treating H9C2 cardiac myocytes with DTG, FTC and TDF dose-dependently increased expression of HIF-1α. These data show that HIV-infected Hu-mice treated with DTG/TDF/FTC for thirteen weeks develop cardiac diastolic dysfunction, with vascular deficits, ischemia, and fibrosis like those reported in women living with HIV-1 infection (WLWH). They also show that DTG, TDF, and FTC treatment can increase total HIF-1α in H9C2 cells. Full article

Background: Over the last two decades, a fair number of echocardiographic studies have investigated the influence of metabolic dysfunction-associated steatotic liver disease (MASLD) on myocardial strain and strain rate parameters assessed by speckle tracking echocardiography (STE) in individuals without overt heart disease, reporting not univocal results. We aimed at analyzing the main findings of these studies. Methods: All studies examining conventional echoDoppler parameters by transthoracic echocardiography (TTE) and left ventricular (LV) mechanics [LV-global longitudinal strain (GLS), LV-global strain rate in systole (GSRs), in early diastole (GSRe) and late diastole (GSRl)] by STE in MASLD patients without known heart disease vs. healthy individuals, were searched on PubMed, Embase and Scopus databases. The primary endpoint was to quantify the effect of MASLD on LV-GLS in individuals without overt cardiac disease. Continuous data [LV-GLS, LV-GLSRs, LV-GLSRe, LV-GLSRl and left ventricular ejection fraction (LVEF)] were pooled as the standardized mean difference (SMD) comparing MASLD cohorts with healthy controls. Results: A total of 11 studies were included, totaling 1348 MASLD patients and 6098 healthy controls. Overall, MASLD showed a medium effect on LV-GLS (SMD −0.6894; 95%CI −0.895, −0.472, p < 0.001) and LV-GLSRs (SMD −0.753; 95%CI −1.501, −0.006, p = 0.048), a large effect on LV-GLSRe (SMD −0.837; 95%CI −1.662, −0.012, p = 0.047) and a small and not statistically significant effect on LV-GLSRl (SMD −0.375; 95%CI −1.113, 0.363, p = 0.319) and LVEF (SMD −0.134; 95%CI −0.285, 0.017, p = 0.083). The overall I² statistic was 86.4%, 89.4%, 90.9%, 89.6% and 72.5% for LV-GLS, LV-GLSRs, LV-GLSRe, LV-GLSRl and LVEF studies, respectively, indicating high between-study heterogeneity. Egger’s test for LV-GLS studies gave a p value of 0.11, 0.26, 0.40, 0.32 and 0.42 for LV-GLS, LV-GLSRs, LV-GLSRe, LV-GLSRl and LVEF studies, respectively, thus excluding publication bias. Meta-regression analysis excluded any correlation between potential confounders and LV-GLS in MASLD individuals (all p > 0.05). Sensitivity analysis confirmed the robustness of study results. Conclusions: MASLD has a medium effect on LV-GLS, independently of demographics, anthropometrics and the cardiovascular disease burden. STE analysis may allow early detection of subclinical LV systolic dysfunction in MASLD patients, potentially identifying those who may develop heart failure later in life. Full article

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

Cardiac computed tomography (CT) has rapidly advanced, becoming an invaluable tool for diagnosing and prognosticating various cardiovascular diseases. While echocardiography and cardiac magnetic resonance imaging (CMR) remain the gold standards for myocardial assessment, modern CT technologies offer enhanced spatial resolution, making it an essential tool in clinical practice. Cardiac CT has expanded beyond coronary artery disease evaluation, now playing a key role in assessing cardiomyopathies and structural heart diseases. Innovations like photon-counting CT enable precise estimation of myocardial extracellular volume, facilitating the detection of infiltrative disorders and myocardial fibrosis. Additionally, CT-based myocardial strain analysis allows for the classification of impaired myocardial contractility, while quantifying cardiac volumes and function remains crucial in cardiomyopathy evaluation. This review explores the emerging role of cardiac CT in cardiomyopathy phenotyping, emphasizing recent technological advancements. Full article