Search Results (372)

The prevalence of advanced heart failure (AdHF) is increasing globally, driven by population aging and improved survival rates in chronic heart failure (CHF). Durable Mechanical Circulatory Support (DMCS), particularly Left Ventricular Assist Devices (LVADs), has become a cornerstone in AdHF management. However, its successful implantation requires a comprehensive preoperative evaluation integrating cardiac, hemodynamic, and systemic assessments. Echocardiography and cardiac magnetic resonance (CMR) provide critical data for risk stratification—e.g., LV ejection fraction < 25%, LV end-diastolic diameter < 60 mm, or free wall RV longitudinal strain (fwRVLS) > −14% predict poorer outcomes. Right heart catheterization (RHC) identifies hemodynamic contraindications (PVR > 6 WU, PAPi < 1.5, cardiac index < 2 L/min/m²), while cardiopulmonary exercise testing (CPET) remains pivotal for assessing functional reserve (peak VO₂ < 12 mL/kg/min or <50% predicted). Systemic assessment must address renal, hepatic, oncologic, and psychiatric comorbidities that influence surgical risk. Integrating these multimodal data within a multidisciplinary framework—spanning cardiologists, cardiac surgeons, anesthesiologists, and psychologists—optimizes selection and outcomes for DMCS candidates. Full article

Background/Objectives: Moderate aortic stenosis (AS) with preserved ejection fraction (EF) is common, yet risk stratification remains challenging. Cardiopulmonary exercise testing (CPET) and myocardial mechanics analysis may identify subclinical dysfunction and impaired functional capacity. To evaluate the relationship between functional capacity (by % predicted peak VO₂), ventilatory efficiency (VE/VCO₂ slope), and myocardial mechanics (speckle tracking echocardiography—STE), and myocardial work (MW) indices) in moderate AS with preserved EF. Methods: We prospectively enrolled 107 patients with moderate AS (AVA 1.0–1.5 cm²; mean gradient 20–40 mmHg; EF ≥ 50%). Functional capacity was classified as preserved (≥83% predicted VO₂) or reduced (<83%). Ventilatory efficiency was defined as good (<30) or poor (≥30) VE/VCO₂ slope. STE assessed left ventricular (LV), left atrial (LA), and right ventricular (RV) strain, as well as myocardial work indices. Results: Patients with reduced % predicted VO₂ had higher LV end-systolic volume (p = 0.035), lower stroke volume index (p = 0.020), and smaller indexed aortic valve area (p = 0.025), with trends toward lower GLS and myocardial work. In contrast, patients with poor ventilatory efficiency (VE/VCO₂ ≥ 30) showed significant impairments in global longitudinal strain (GLS, p = 0.002), LA reservoir strain (PALS, p = 0.019) and LA conduit strain (LA Scd, p < 0.001), RV free wall strain (RW FWS, p = 0.029), and myocardial work indices (lower GWI and GCW, higher GWW, reduced GWE; all p < 0.05). LA Scd emerged as the strongest predictor of poor ventilatory efficiency. (receiver operating characteristic (ROC) area under the curve (AUC) 0.723, 95% confidence interval (CI) 0.623–0.823, p < 0.001). Conclusions: In moderate AS with preserved EF, impaired ventilatory efficiency is more strongly associated with subclinical LV, LA, and RV dysfunction than reduced % predicted VO₂, highlighting the key role of RV impairment. Integrating CPET and STE improves phenotyping, identifying high-risk patients who may benefit from closer surveillance or early intervention. These findings are exploratory and hypothesis-generating; longitudinal data are needed to confirm prognostic implications. Full article

Background: Acromegaly, typically caused by growth hormone (GH)-secreting pituitary adenomas, leads to chronic GH and insulin-like growth factor-1 overproduction, resulting in significant cardiovascular complications, including left ventricular (LV) hypertrophy, myocardial fibrosis, diastolic/systolic LV dysfunction, and frequent valvular disease. Although aortic root dilation has been documented, the morphology and function of the aortic valve annulus (AVA) and its relationship with LV performance remain unexplored. Methods: The present study comprised a total of 31 patients with acromegaly, from which eight subjects were excluded due to inferior image quality. The remaining group of acromegalics consisted of 23 cases (mean age: 54.3 ± 14.5 years, 6 males). Their results were compared to 31 age- and gender-matched healthy subjects (mean age: 50.0 ± 7.4 years, 9 males). Cardiac assessment involved routine two-dimensional Doppler echocardiography and three-dimensional speckle-tracking echocardiography (3DSTE) to quantify basal regional and global longitudinal strains. Detailed planimetric measurements of AVA dimensions and its spatial displacement, called AVA plane systolic excursion (AAPSE), were also obtained. Results: Among 12 patients with inactive acromegaly, 7 patients (58%) showed larger end-systolic AVA area (AVA-A), while 5 patients (42%) had larger end-diastolic AVA-A. Among the 11 patients with active acromegaly, 3 patients (27%) had larger end-systolic AVA-A and 5 patients (45%) had larger end-diastolic AVA-A, while in 3 patients (27%) end-systolic and end-diastolic AVA-A proved to be equal. All end-systolic and end-diastolic AVA dimensions were tendentiously greater in acromegaly, with more pronounced values seen in the presence of an active disease. AAPSE was reduced both in all acromegaly patients and in those with active disease compared to controls. From LV strains, basal and global LV longitudinal strain (LS) and basal LV circumferential strain (CS) were similar when comparing acromegaly patients and those with active and inactive disorder to controls. However, basal and global LV-LS tended to be reduced, while basal LV-CS tended to be increased. Significantly increased global LV-CS were present in active acromegaly patients compared to inactive acromegaly patients and controls Conclusions: Significant aortic valve annular dilation is present in acromegaly, which is associated with its reduced spatial systolic displacement. Full article

Catheter ablation (CA) has become a validated technique for treating patients with symptomatic or paroxysmal atrial fibrillation (AF), as recommended by the latest 2024 European society of cardiology (ESC) guidelines, class II level A. The procedure is also recommended for patients with persistent AF without major risk factors for AF recurrence, as an alternative to antiarrhythmic medications class I or III. However, CA carries the risk of AF recurrence in 30–35% of patients, sometimes after the procedure. Multiple factors impact the onset, maintenance, and recurrence of AF after CA, including clinical, biohumoral, echocardiographic, genetic, and lifestyle factors. Beyond traditional predictors, emerging factors such as obstructive sleep apnea syndrome, chronic renal failure, chronic lung disease, physical activity patterns, gut microbiota composition, and epicardial fat thickness significantly influence outcomes. Therefore, optimizing patient’s selection for CA is an important strategy to minimize the risk of AF recurrence. Many echocardiographic parameters emerged as predictors of AF recurrence post-CA, but none stood out as a potential single factor. These factors include traditional markers such as left atrial size by 2D echocardiography, LV ejection fraction, LV diastolic function parameters as well as myocardial deformation addressed by the recently developed speckle tracking analysis. Additionally, the duration and type of AF represent fundamental risk factors, with longstanding persistent AF showing significantly higher recurrence rates compared to paroxysmal forms. Novel biomarkers including MR-proANP, caspase-8, hsa-miR-206, and neurotrophin-3 show promise in enhancing risk prediction capabilities. The aim of this review is to explore the most relevant echocardiographic parameters, including myocardial deformation, that could accurately predict recurrence of AF after CA, while also examining the role of emerging clinical and biochemical predictors in comprehensive patient selection strategies. Full article

Background: Perioperative right ventricular (RV) dysfunction is a frequent complication of cardiac surgery linked to poor outcomes and may result from the loss of pericardial support. We investigated whether pericardial closure preserves early postoperative RV function. Methods: We compared patients with pericardial closure versus open pericardium. Co-primary endpoints were early postoperative RV longitudinal function by tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV). Adjusted comparisons used analysis-of-covariance (postoperative value adjusted for baseline) with prespecified covariates (baseline outcome, LV global longitudinal strain, left-ventricular ejection fraction, LVEDVI, sex, procedure; cardiopulmonary bypass and cross-clamp times when available). Holm correction-controlled multiplicity across the co-primary endpoints. Sensitivity linear mixed-effects models (time × group) were performed. Results: Pericardial closure was associated with better early RV longitudinal function after multivariable adjustment. TAPSE: adjusted mean difference (AMD, Closed–Open) 1.531 mm (95% CI 0.130–2.931; p = 0.033). TASV: AMD 1.694 cm/s (95% CI 0.437–2.951; p = 0.009; Holm-adjusted p = 0.018). Sensitivity analyses yielded consistent estimates. Conclusions: Pericardial closure was independently associated with improved early RV longitudinal function. These adjusted findings address baseline LV imbalances and support considering closure to preserve RV performance; confirmation in prospective trials is warranted. Full article

Background and Objectives: This study aimed to investigate changes in the descending thoracic aorta (DTA) values in athletes while performing a bench press exercise, and to evaluate their relationship with vitamin levels and nutritional values. Materials and Methods: The study used speckle tracking to assess changes in DTA parameters in athletes before and after bench press exercise, compared to non-athlete controls. Measurements included rotational and radial velocities, circumferential strain and strain rate, and displacement. Results: The study included 60 non-athlete controls and 178 athletes performing bench press exercises. In a 10-year follow-up of 30 weightlifters, aortic speckle tracking values were age-matched with controls. No significant baseline differences were observed between groups. However, following exercise, all measurements demonstrated increases: DTA rotational velocity (55.44 ± 16.15 vs. 88.98 ± 10.31°/s), radial velocity (1.02 ± 0.36 vs. 1.56 ± 0.42 cm/s), circumferential strain (−8.52 ± 0.31 vs. −12.55 ± 1.13), strain rate (−1.55 ± 0.72 vs. −2.28 ± 0.56 s⁻¹), rotational displacement (6.22 ± 0.36 vs. 14.91 ± 0.85°), and radial displacement (0.89 ± 0.31 vs. 1.19 ± 0.65 mm), with all p-values < 0.05. Rotational displacement correlated with maximal repetition (88.56 ± 12.59 Kg) and vitamin levels. Conclusions: This study hypothesizes that bench press exercise is linked to increased DTA velocities, strain, strain rate, and displacement. Full article

Takotsubo Cardiomyopathy (TTC), often referred to as stress-induced or “broken heart” syndrome, is characterized by transient left ventricular dysfunction predominantly involving apical hypokinesia and basal hyperkinesia in the absence of obstructive coronary artery disease. Traditionally viewed as an acute and reversible phenomenon, accumulating evidence suggests that TTC may emerge from a preexisting myocardial substrate shaped by chronic stress and hemodynamic loading. Basal Septal Hypertrophy (BSH), a morphological finding commonly observed in elderly, hypertensive, or emotionally stressed individuals, has been increasingly recognized in patients with TTC. This hypertrophic pattern, often accompanied by dynamic contractile gradients and regional perfusion mismatch, reflects a broader adaptive remodeling process conceptualized as Stressed Heart Morphology (SHM). SHM encompasses the structural and functional myocardial responses to cumulative neurohormonal and mechanical stress, with BSH representing a key imaging marker within this spectrum. Advanced echocardiographic techniques, such as tissue Doppler imaging, speckle-tracking strain analysis, and stress echocardiography, consistently reveal overlapping features between SHM and TTC, including basal hyperkinesis, septal thickening, and inducible left ventricular outflow tract obstruction. These findings support a continuum in which SHM serves as a predisposing substrate for TTC, representing a stress-provoked clinical expression within a unified myocardial stress–response framework. Full article

Background/Objectives: Diabetic cardiomyopathy in type 2 diabetes mellitus (T2DM) often progresses silently, manifesting as diastolic dysfunction or subtle systolic impairment despite preserved ejection fraction (EF). Detecting these changes early is critical to prevent symptomatic heart failure. This study assessed the prevalence of left ventricular (LV) diastolic dysfunction and impaired global longitudinal strain (GLS) in T2DM patients with preserved EF and identified related risk factors. Methods: We performed a cross-sectional study of 232 adults with T2DM and EF > 50% at a tertiary hospital. Standard transthoracic and speckle-tracking echocardiography were used to evaluate LV diastolic function and GLS. Logistic regression identified predictors of myocardial dysfunction. Results: LV diastolic dysfunction was found in 53.9% of patients, while 13.4% showed impaired GLS (>–17.9%). Independent predictors of diastolic dysfunction were age ≥ 60 years (OR = 2.51, 95% CI: 1.25–5.07, p = 0.010) and diabetes duration of 5–10 years (OR = 3.06, 95% CI: 1.46–6.40, p = 0.003). Reduced GLS was independently associated with male sex (OR = 2.45, p = 0.040) and the presence of diastolic dysfunction (OR = 3.14, p = 0.010). Conclusions: Subclinical myocardial dysfunction is common in Vietnamese T2DM patients with preserved EF. Both diastolic dysfunction and reduced GLS may occur independently or together, influenced by age, sex, and diabetes duration. Incorporating GLS into echocardiographic evaluation may enhance early detection and support tailored cardiovascular risk management in this high-risk group. Full article

Background/Objectives: Cardiovascular diseases are the most important cause of mortality in chronic obstructive pulmonary disease (COPD). Speckle-tracking echocardiography (2D-STE) can be used for assessing atrial and ventricular function, and its role in COPD is underexplored. The main objective of this study was to investigate prognostic associations in patients with COPD using 2D-STE echocardiography and laboratory biomarkers. Methods: The study included 70 participants, divided into two groups: 55 patients diagnosed with COPD and 15 healthy controls. All four cardiac chambers were analyzed with standard ultrasound and 2D-STE techniques. We measured NT-proBNP and several oxidative stress biomarkers: reduced glutathione (GSH), the GSH/GSSG ratio, malondialdehyde (MDA), and Caspase-3. Results: An NT-proBNP level above 325 pg/mL independently predicts advanced COPD stages (GOLD grades 3 and 4), with statistically significant results at a 95% confidence interval (CI) (p = 0.001). Additionally, 2D-STE identified reduced right ventricular (RV) and left ventricular (LV) strain in COPD patients before changes in LV ejection fraction. RV and LV strain measurements (RV4CLS < −16.15%, RVFWSL < −18.6%, LV GLS < −19.45%) along with PASP > 37.5 mmHg are independent predictors of advanced COPD stages, demonstrating significance at a 95% CI (p = 0.001). A positive correlation was observed between NT-proBNP, ultrasound parameters assessing RV systolic function, LV longitudinal strain impairment, and PASP. Conclusions: NT-proBNP serves as an independent biomarker of pulmonary hypertension and secondary right heart overload and independently predicts advanced COPD stages (GOLD grades 3 and 4) alongside RV and LV strain measurements. Full article

Background and Objectives: The aim of this study is to evaluate the changes in speckle tracking velocity vector analysis (VVI) values within the descending thoracic aorta (DTA) in patients with cardiogenic shock (CS) who are on mechanical ventilation (MV), under varying levels of positive end-expiratory pressure (PEEP). Materials and Methods: Transthoracic echocardiography (TTE) was performed during incremental increases in positive end-expiratory pressure (PEEP) from 0 to 15 cmH₂O over 15 to 30 min. The effects of increased PEEP on velocities, displacement, strain (S), and strain rate (SR) were evaluated. DTA speckle tracking values were analyzed to determine their association with patient mortality. A control group of healthy individuals was used to establish normal DTA variables. Results: Sixty-two mechanically ventilated patients were included in this study. The mean age was 62.48 ± 11.22 years. The highest values for various parameters were obtained with 5 cmH₂O PEEP. The values obtained for DTA using speckle tracking at increasing PEEP levels (ZEEP, PEEP 5, PEEP 10, and PEEP 15 cm H₂O) were as follows: DTA rotational velocity [55.18 ± 14.60, 107.39 ± 19.33, 60.05 ± 0.28, and 42.11 ± 0.34°/s], DTA radial velocity [0.80 ± 0.09, 2.21 ± 0.27, 0.99 ± 0.16, 0.56 ± 0.17 cm/s], DTA rotational displacement [5.68 ± 0.40, 15.71 ± 0.13, 5.98 ± 0.35, 6.64 ± 3.45°], circumferential strain for DTA [−8.55 ± 0.92, −11.86 ± 0.07, −9.88 ± 0.25, −8.76 ± 0.6%], and DTA circumferential SR [−0.87 ± 0.1, −1.91 ± 0.03, −1.21 ± 0.12, −0.97 ± 0.05/s]; all p-values < 0.05. Logistic binary regression found left ventricular strain and DTA rotational displacement on 5 cmH₂O PEEP level were associated with death. Conclusions: Changes in PEEP levels affect the speckle tracking measurements of the DTA. Speckle tracking can be used to assess the thoracic aorta, and certain parameters, such as rotational displacement, may relate to the prognosis of cardiogenic shock. Full article

Hypertrophic cardiomyopathy (HCM) is the most common cardiomyopathy in cats and is classified as obstructive (HOCM) or non-obstructive based on anatomical differences in the left ventricular outflow tract (LVOT). In severe obstructive cases, while beta-blockers are the recommended initial treatment in humans, some patients exhibit treatment resistance. For these cases, the addition of the antiarrhythmic agent disopyramide is common. However, its use in cats has only been documented in a case report. In this study, the use of disopyramide resulted in a significant reduction in the LVOT velocity and cardiac troponin I levels. Additionally, no significant adverse effects were observed. These findings suggest that disopyramide could be a potential therapeutic option for the treatment in cats with HOCM. Full article

Background and Clinical Significance: This article explores the application of fetal speckle tracking technology in evaluating critical aortic stenosis (AS) in fetuses, highlighting its potential for predicting neonatal outcomes. Case Presentation: We present two cases of fetuses diagnosed with critical AS and associated complications at late gestation. Case 1 demonstrated preserved left ventricular function, as indicated by favorable global strain (GS), fractional area change (FAC), and ejection fraction (EF) values, despite critical conditions. This infant underwent successful postnatal interventions and was discharged after an extended NICU stay. In contrast, Case 2 exhibited severely compromised left ventricular function with significantly reduced GS, FAC, and EF parameters, leading to a tragic outcome despite intensive management. Conclusions: Our findings suggest that innovative echocardiographic parameters such as GS, FAC, and EF for the left ventricle are crucial in prognostic evaluations for fetuses with critical AS. The study underscores the importance of advancements in fetal cardiology and the need for further research to enhance prognostic assessments and improve clinical outcomes in affected neonates. Full article

Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe post-infectious complication of SARS-CoV-2, often with cardiac involvement. Myocardial strain imaging may detect dysfunction missed by conventional echocardiography. The objectives of this study are to characterize cardiac manifestations of MIS-C and assess the value of strain imaging in children with preserved and reduced left ventricular ejection fraction (LV-EF). Methods: We retrospectively analyzed 22 MIS-C patients admitted between September 2020 and January 2024, all with cardiac involvement. Clinical, laboratory, and echocardiographic data—including 2D and speckle-tracking strain—were collected at the day of worst dysfunction (DWD) and discharge (DD) and compared with 22 matched controls. Results: Median age was 4.65 years; 59% male; 45% overweight/obese. LV systolic dysfunction (LV-EF < 50%) occurred in 54.5%, coronary abnormalities in 36.4%, and pericardial effusion in 95.5%. LV global longitudinal strain (LVGLS) was significantly lower than controls at the DWD (−15.45 ± 4.76%, p < 0.0001) and DD (−20.63 ± 4.66%, p = 0.014). Strain abnormalities persisted despite LV-EF recovery, and even patients with preserved LV-EF showed significant segmental strain reduction. LVGLS and apical infero-septal strain were strongest predictors of reduced LV-EF. Conclusions: MIS-C often causes systolic dysfunction and coronary changes, but strain imaging reveals persistent subclinical myocardial injury. Long-term cardiac monitoring is warranted. Full article

Background: Anthracycline-based chemotherapy is associated with a risk of cancer therapy-related cardiac dysfunction (CTRCD), particularly in patients with moderate to high cardiovascular risk. Left ventricular global longitudinal strain (GLS) is a sensitive marker for early myocardial dysfunction, but the prognostic value of baseline GLS in this population remains unclear. Objective: We aimed to evaluate whether baseline GLS can predict CTRCD in moderate- to high-risk cancer patients undergoing anthracycline chemotherapy. Methods: In this prospective, single-center observational study, 80 anthracycline-naive cancer patients classified as moderate or high risk were enrolled. Baseline GLS was assessed via speckle-tracking echocardiography, with a threshold of ≥−18% considered decreased. Patients were followed for 12 months, and the primary endpoint was the development of CTRCD per ESC 2022 Cardio-oncology guidelines. Results: Of the 77 patients completing follow-up, 27.3% had decreased baseline GLS. CTRCD occurred in 62.4% of patients, with higher incidence among those with decreased GLS (76.7%) compared to those with normal GLS. In multivariable analysis, GLS ≥−18% was the only significant independent predictor of CTRCD (RR 12.0, 95% CI 2.0–71.9; p = 0.0065). All-cause mortality was also significantly higher in patients with decreased baseline GLS (19.1% vs. 1.8%, p = 0.018). Conclusions: Decreased baseline global longitudinal strain is an independent predictor of cancer therapy-related cardiac dysfunction and all-cause mortality in moderate- to high-risk patients receiving anthracycline therapy. These findings support the inclusion of baseline GLS in pre-treatment cardiovascular risk assessment, particularly in patients with an LVEF above 54%, to more effectively identify those who may benefit from early cardioprotective interventions. Full article

Background/Objectives: Aortic stenosis (AS) leads to progressive left ventricular (LV) pressure overload, adverse myocardial remodeling, and eventual functional decline. While traditional parameters such as left ventricular ejection fraction (LVEF) may remain preserved until advanced stages, they are insufficiently sensitive to early dysfunction. Global longitudinal strain (GLS) offers improved detection but remains load-dependent. In contrast, non-invasive myocardial work (MW)—derived from pressure-strain loops—offers a more load-independent assessment of myocardial function. This systematic review and meta-analysis aimed to evaluate the effects of transcatheter aortic valve implantation (TAVI) on MW indices in patients with severe AS. Methods: We performed a systematic review and meta-analysis of studies reporting non-invasive myocardial work parameters before and after TAVI (PROSPERO ID: CRD420250517138). Databases were searched through 31 March 2025. Pooled mean differences in global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were calculated using random-effects models. Sensitivity analyses and meta-regression were conducted to explore heterogeneity and the influence of baseline characteristics. Results: Eleven studies encompassing 1493 patients were included. TAVI was associated with a significant reduction in GWI (−236.67 mmHg% [95% CI: −373.82 to −99.52]; I² = 97.0%; p = 0.002) and GCW (−243.71 mmHg% [95% CI: −407.38 to −80.03]; I² = 97.4%; p = 0.006). No significant changes were observed in GWW or GWE. Meta-regression showed age and baseline LVEF significantly influenced GWE changes, but not other parameters. Conclusions: TAVI leads to a significant reduction in GWI and GCW, reflecting decreased myocardial workload and afterload relief. These findings support the utility of MW indices as valuable tools for assessing myocardial adaptation post-TAVI and potentially guiding clinical decision-making. Full article