Search Results (75)

Background: Left ventricular ejection fraction remains the primary focus in cardiac monitoring for oncology patients undergoing potentially cardiotoxic chemotherapy, while right ventricular function is seldom examined. This study evaluates how established risk factors for left ventricular dysfunction affect right ventricular function. Methods: This retrospective cohort study included 1770 patients undergoing cadmium–zinc–telluride equilibrium radionuclide angiocardiography before chemotherapy. Patients were categorized based on risk factors for left ventricular dysfunction—diabetes (DM), atrial fibrillation (AF), coronary heart disease (CHD), and previous oncological therapy—and compared to controls using independent t-tests. Results: Patients with previous oncological therapy exhibited a significantly lower right ventricular end-diastolic volume (RVEDV) (mean difference: −4.4 mL/m², 95% CI: −6.1 to −2.7, p < 0.001), lower right ventricular end-systolic volume (RVESV) (−2.3 mL/m², 95% CI: −3.4 to −1.2, p < 0.001), and lower right ventricular stroke volume (RVSV) (−2.1 mL/m², 95% CI: −3 to −1.2, p < 0.001). In patients with CHD, there was a higher right ventricular ejection fraction (RVEF) (3.0 mL/m², 95% CI: 0.8 to 5.2, p < 0.01), whereas patients with DM had lower RVEDV (−5.1 mL/m², 95% CI: −9.2 to −1, p < 0.05) and RVESV (−3.0 mL/m², 95% CI: −5.5 to −0.4, p < 0.05). No ventricular variables differed from the control group among patients with AF. Conclusions: Risk factors known to affect the left ventricle also impacted the right ventricle, with the exception of AF. Full article

Background/Objectives: Functional assessment of the fetal heart remains a significant challenge in contemporary perinatology due to the absence of a universally accepted gold standard for such evaluations. The aim of this study was to evaluate the reproducibility of parameters derived from two-dimensional speckle-tracking echocardiography (2D STE) using the FetalHQ software. Methods: We enrolled 87 pregnant women between 19 and 23 weeks of gestation who were undergoing mid-trimester screening at the Provincial Hospital Complex in Kielce. Two independent operators acquired 5 s cine-loops of four-chamber views (4CVs) according to a standardized protocol. Reproducibility was assessed by examining intra- and interobserver variability using the intraclass correlation coefficient (ICC) for several cardiac parameters, including the global sphericity index (GSI), global longitudinal strain (GLS), stroke volume (SV), and fractional area change (FAC). Results: Reproducibility varied substantially across the assessed parameters. The highest intraobserver reproducibility was observed for the 4CV GSI (ICC > 0.9). Moderate intraobserver reproducibility (ICCs ranging from 0.5 to 0.75) was noted for left ventricular (LV) parameters, such as end-diastolic area, end-systolic area, end-diastolic volume, and end-systolic volume. Interobserver variability demonstrated higher ICC values, with excellent reproducibility (ICC > 0.9) for the 4CV GSI and LV volume measurements. Good reproducibility (ICCs between 0.75 and 0.9) was observed for specific left ventricular segmental strain indices, whereas other parameters showed moderate to poor reproducibility (ICC < 0.5). Conclusions: Two-dimensional speckle-tracking echocardiography (2D STE) using FetalHQ exhibits variable reproducibility, which is influenced by the choice of parameters, operator experience, and technical factors. This method holds potential for fetal cardiac assessment; however, additional research is required to improve its predictive accuracy and streamline the evaluation process for routine clinical application. Full article

Background. Statins appear to be useful in patients with acute ischemic stroke. Our aim was to evaluate the association between premorbid statin treatment and CT perfusion characteristics of acute ischemic stroke. Methods. A retrospective analysis of patients with acute stroke secondary to occlusion of large vessels in the anterior circulation was performed to assess collateral flow, ischemic core volume, and ischemic penumbra using CT angiography and CT perfusion maps. Fisher’s exact test was used to compare baseline characteristics of patients in the two groups. The Wilcoxon rank-sum test for independent groups was used to compare all variables obtained for the two different groups with and without statin use. Results. We identified 61 patients, including 29 treated with statins and 32 not treated with statins before stroke onset matched by age, gender, and vascular risk factors except for hypercholesterolemia. The statin group showed lower National Institutes of health Stroke Scale scores at onset (14 ± 6.1 vs. 16 ± 4.5; p = 0.04) and lower volumes of brain tissue characterized by impaired cerebral blood flow (CBF), cerebral blood volume (CBV), and ${\mathrm{T}}_{\mathrm{m}\mathrm{a}\mathrm{x}}^{9.5-25\mathrm{s}}$; otherwise, no statistically significant difference was found in the volume of the ${\mathrm{T}}_{\mathrm{m}\mathrm{a}\mathrm{x}}^{16-25\mathrm{s}}$ between the two groups. Conclusions. Premorbid statin treatment is associated with a favorable imaging condition of acute ischemic stroke in terms of ischemic core and ischemic penumbra volume. Full article

Recent evidence suggests that sex-related differences in cardiovascular health extend beyond traditional risk factors, affecting vascular structure and function. This study aimed to examine sex differences in vascular parameters, including central and peripheral blood pressure, pulse wave velocity (PWv), augmentation index at 75 bpm (AIx75), cardiac output, stroke volume, and peripheral vascular resistance, using harmonized data from three population-based cohorts (EVasCu, VascuNET, and ExIC-FEp) as part of the MUJER-EVA project. A total of 669 adult participants were included in this pooled cross-sectional analysis. Sex-stratified comparisons were conducted using multiple linear regression models adjusted for anthropometric, sociodemographic, and clinical covariates. The results showed that men had significantly higher values for central and peripheral blood pressure (p < 0.001), PWv (p = 0.003), cardiac output (p < 0.001), and stroke volume (p < 0.001), whereas women presented higher values of AIx75 (p < 0.001) and peripheral vascular resistance (p = 0.002). These differences remained statistically significant after full adjustment for potential confounders. These findings highlight the need to consider sex as a key biological variable in cardiovascular research and clinical decision-making. Incorporating sex-specific reference values and personalized treatment strategies could improve vascular health assessment and the effectiveness of cardiovascular disease prevention. Full article

Background/Objectives: This study aimed to research the potential association between brain atrophy and hematoma expansion (HE) in intracerebral hemorrhage (ICH). Methods: A retrospective analysis was conducted using data from patients with primary ICH in our stroke database. ICH volumes from initial and follow-up CT scans were manually segmented. Total brain and intracranial volumes were quantified using an automated head CT segmentation method. Normalized brain volume (NBV) was calculated by dividing the total brain volume by the total intracranial volume to account for individual head size differences. The relationship between the NBV and hematoma expansion was assessed using linear regression, adjusting for other variables influencing hematoma expansion. Results: Our final analysis included 420 patients. Brain atrophy (lower NBV) was associated with hematoma growth (>0 mL) in patients not on oral anticoagulants (β = −0.159, p = 0.032). A strong association was observed in patients using vitamin K antagonists (β = −0.667, p = 0.006) but not in those on direct oral anticoagulants (DOACs; (β = −0.159, p = 0.436)). Results remained significant in patients not on oral anticoagulants and in those on VKAs when hematoma expansion was defined as a volume increase >6 mL or >33%. Conclusions: This research provides initial evidence that brain atrophy is a risk factor for hematoma expansion, depending on the patient’s coagulation status. These findings could enhance risk stratification for acute clinical management and deepen understanding of the biological mechanisms behind hematoma expansion. Full article

Background/Objectives: Aortic stenosis (AS) is the most common valvular pathology in the geriatric population and is the primary cause of valve replacement. However, misdiagnoses and delays in treatment are common due to comorbidities, frailty, and sedentary lifestyles among elderly individuals. MicroRNAs (miRNAs) are highly conserved molecular regulators involved in various cellular processes and have gained recognition as reliable biomarkers in cardiovascular diseases. In the present study, we evaluated plasma miRNAs as potential biomarkers for the early diagnosis of AS in the geriatric population to identify early therapeutic strategies. Methods: This prospective, case–control study included 87 individuals over 75 years of age. The participants were divided into AS (n = 58) and control (n = 29) groups. Results: Fifty-four miRNAs were differentially expressed between patients with AS and controls. Among those genes, 29 were upregulated and 25 were downregulated in patients with AS relative to controls. We selected seven candidate genes (miR-185-5p, miR-143-3p, miR-370-3p, let-7d-3p, miR-452-5p, miR-6787-3p, and miR-21-3p) for experimental validation by qRT–PCR. Only miR-143-3p and miR-452-5p were significantly upregulated in the plasma of patients with AS compared with controls. We developed a multiparametric model by combining the two-miRNA signature with echocardiographic parameters (left ventricular ejection fraction, stroke volume, and global longitudinal strain) to increase diagnostic power; this model yielded sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) values of 78.2%, 70.7%, and 0.837, respectively. Conclusions: In clinical practice, the use of a multiparametric model involving this set of miRNAs combined with echocardiographic variables may improve the accuracy of AS diagnosis and risk stratification. Full article

Acute mental stress is a common experience in daily life, significantly affecting both physiological and psychological well-being. While traditional pharmacological interventions can be effective, they often accompany undesirable side effects. Non-pharmacological alternatives, such as non-invasive transcutaneous peripheral neuromodulation, have promise in mitigating acute stress-induced arousal, possibly with fewer side effects. Median nerve stimulation (MNS) and auricular vagus nerve stimulation (AVNS), in particular, have demonstrated notable potential. However, efficacy and mechanism of action pertaining to MNS and AVNS remain largely unknown. This paper comparatively investigated MNS and AVNS in terms of efficacy and mechanism of action in the context of mitigating acute stress-induced arousal. Using an experimental dataset collected from 19 healthy participants who experienced acute mental stressors as well as MNS and AVNS, we showed that (i) MNS and AVNS are both effective in mitigating acute stress-induced cardiovascular arousal with MNS modestly superior to AVNS in terms of a synthetic multi-modal variable derived from physio-markers representing heart rate, blood pressure, stroke volume, cardiac output, and peripheral vasoconstriction: 74% vs. 71% in explainability; 86% vs. 69% in stimulation consistency; 0.77 vs. 0.40 in stimulation sensitivity; and 34% vs. 19% in stimulation effectiveness, respectively; and that (ii) MNS and AVNS mitigate acute stress-induced cardiovascular arousal in a distinct mechanism of action: MNS primarily mitigates the arousal pertaining to the physio-markers representing heart rate and peripheral vasoconstriction, while AVNS mitigates the arousal pertaining to the physio-markers representing heart rate, blood pressure, stroke volume, cardiac output, and peripheral vasoconstriction. These findings may help to support future device development for addressing acute mental stress-induced arousal through MNS or AVNS, and they pave the way toward a better understanding of how to quantify the efficacy of such interventions. Full article

Background: Early safety outcomes following transcatheter aortic valve implantation (TAVI) for severe aortic stenosis are critical for patient prognosis. Accurate prediction of adverse events can enhance patient management and improve outcomes. Aim: This study aimed to develop a machine learning model to predict early safety outcomes in patients with severe aortic stenosis undergoing TAVI. Methods: We conducted a retrospective single-centre study involving 224 patients with severe aortic stenosis who underwent TAVI. Seventy-seven clinical and biochemical variables were collected for analysis. To handle unbalanced classification problems, an adaptive synthetic (ADASYN) sampling approach was used. A fined-tuned random forest (RF) machine learning model was developed to predict early safety outcomes, defined as all-cause mortality, stroke, life-threatening bleeding, acute kidney injury (stage 2 or 3), coronary artery obstruction requiring intervention, major vascular complications, and valve-related dysfunction requiring repeat procedures. Shapley Additive Explanations (SHAPs) were used to explain the output of the machine learning model by attributing each variable’s contribution to the final prediction of early safety outcomes. Results: The random forest model identified left femoral artery diameter and aortic valve calcification volume as the most influential predictors of early safety outcomes. SHAPs analysis demonstrated that smaller left femoral artery diameter and higher aortic valve calcification volume were associated with poorer early safety prognoses. Conclusions: The machine learning model highlights of early safety outcomes after TAVI. These findings suggest that incorporating these variables into pre-procedural assessments may improve risk stratification and inform clinical decision-making to enhance patient care. Full article

Changes in the environment promote variations in fish physiological responses. Genetic variation also plays a role in physiological variation. To explore the role of genetics in physiological variation, we assessed variation of cardiac function (heart rate, stroke volume, and cardiac output), oxygen consumption, yolk conversion efficiency, and cost of development in embryonic and larval AB wild-type and NHGRI-1 zebrafish (low heterozygosity line backcrossed from AB wild-type) exposed to different temperature and oxygen regimes. Fish were exposed from fertilization to 7 days post-fertilization (dpf) to control conditions (28 °C, 21% O₂) or to low temperature (23 °C, 21% O₂), high temperature (33 °C, 21% O₂), moderate hypoxia (28 °C, 13% O₂), or severe hypoxia (28 °C, 10% O₂). We hypothesized that (1) assessed physiological variables will respond similarly in both fish lines and (2) data variability in the low heterozygosity NHGRI-1 zebrafish will be lower than in AB zebrafish. Cardiac function decreased at lower temperature and in hypoxia in both AB and NHGRI-1 zebrafish. Oxygen consumption was increased by higher temperature and hypoxia in AB fish and by severe hypoxia in NHGRI-1 fish. Yolk conversion efficiency was decreased by lower temperature and hypoxia in AB fish and increased by higher temperature and decreased by hypoxia in NHGRI-1 fish. Cost of development was higher mainly in hypoxia-treated fish. Supporting our hypothesis that genetics contributes to physiological variation, NHGRI-1 zebrafish data showed significantly lower coefficients of variation in 84% of assessed endpoints. We conclude that (1) there is a strong genetic component to physiological variation in fishes and (2) low heterozygosity NHGRI-1 zebrafish are useful models for reducing the ‘noise’ from genetic backgrounds in physiological research in fish, which may aid interpretation of experimental results and facilitate reproducibility. Full article

Background/Objectives: Examining hemodynamic changes during the early transition period aids in identifying variations in neonatal outcomes linked to ante- or intrapartum events. It facilitates the recognition of potential impacts stemming from common intrapartum management practices. The current literature provides scant insights into cardio-circulatory changes during the crucial first 10 min after birth. The application of Electrical Cardiometry (EC) emerges as a valuable noninvasive clinical tool for measuring neonatal hemodynamics. This prospective cohort study aimed to assess hemodynamic variables, including heart rate (HR), stroke volume index (SVI), index of contractility (ICON), and cardiac output index (COI) during the first hour of life in late preterm and full-term infants. Additionally, this study investigated the relationship between the mode of delivery and cardiovascular adaptation. Methods: Two hundred infants, encompassing both full-term and preterm, were enrolled, with categorization into four groups based on mode of delivery and gestational age. Hemodynamic variables were continuously evaluated using an EC device throughout the first hour of life. Findings: A significant decreasing trend was observed in HR, SVI, COI, and ICON over the first hour of life (p < 0.001). Infants delivered vaginally exhibited significantly higher HR, COI, SVI, and ICON compared to those born via Cesarean section (CS) (p = 0.006 and <0.001 and 0.035 and 0.001, respectively). Conclusions: This study highlights a consistent decreasing trend in HR, SVI, COI, and ICON over the first hour of life in both full-term and preterm infants. Notably, hemodynamic variables exhibited heightened levels in infants delivered vaginally compared to those born by CS. Full article

This study introduces a mechatronic biomedical device engineered for concurrent acquisition and analysis of four cardiac non-invasive signals: Electrocardiogram (ECG), Phonocardiogram (PCG), Impedance Cardiogram (ICG), and Photoplethysmogram (PPG). The system enables assessment of individual and simultaneous waveforms, allowing for detailed scrutiny of cardiac electrical and mechanical dynamics, encompassing heart rate variability, systolic time intervals, pre-ejection period (PEP), and aortic valve opening and closing timings (ET) through an application programmed with MATLAB App Designer, which applies derivative filters, smoothing, and FIR digital filters and evaluates the delay of each one, allowing the synchronization of all signals. These metrics are indispensable for deriving critical hemodynamic indices such as Stroke Volume (SV) and Cardiac Output (CO), paramount in the diagnostic armamentarium against cardiovascular pathologies. The device integrates an assembly of components including five electrodes, operational and instrumental amplifiers, infrared opto-couplers, accelerometers, and advanced filtering subsystems, synergistically tailored for precision and fidelity in signal processing. Rigorous validation utilizing a cohort of healthy subjects and benchmarking against established commercial instrumentation substantiates an accuracy threshold below 4.3% and an Interclass Correlation Coefficient (ICC) surpassing 0.9, attesting to the instrument’s exceptional reliability and robustness in quantification. These findings underscore the clinical potency and technical prowess of the developed device, empowering healthcare practitioners with an advanced toolset for refined diagnosis and management of cardiovascular disorders. Full article

Background: Right ventricular (RV) function is inadequately investigated and routinely overlooked in transthyretin amyloid cardiomyopathy (ATTR-CM). Novel imaging distinguishers between intrinsic RV myocardial disease in ATTR-CM and primary RV overload disorder phenotypes may enhance mechanistic and pathophysiological understanding of RV dysfunction. We aimed to investigate RV performance in ATTR-CM employing comprehensive 2D and 3D echocardiography, and to compare these indices with primary RV afterload disease. Methods: We investigated conventional and novel indices of RV contractile function, myocardial work and ventricular–vascular coupling in 21 well-characterized ATTR-CM patients, 10 PAH patients and 12 healthy controls. RV long axis function and pulmonary artery (PA) systolic pressure were evaluated using 2D Doppler echocardiography. RV ejection fraction (RVEF), volumes, global longitudinal strain (GLS) and novel myocardial work indices were analyzed by 3D echocardiography. RV elastance (E_es), afterload (E_a) and RV-PA coupling (E_es/E_a) were estimated using the single-beat volume method. Results: ATTR-CM showed lower RVEF, GLS and E_es, and a higher RV global myocardial work index (GWI), constructive work (GCW), E_a and reduced RV-PA coupling compared with controls. RV EF, stroke volume, GLS and circumferential strain did not differ between ATTR-CM and PAH. However, GWI, GCW, E_es and E_a were lower in ATTR-CM. RV–pulmonary coupling displayed strong association with RV 3D strain (r = 0.84, p < 0.001), whereas RV E_es (contractility) was related to RV GWI (r = 0.54, p < 0.001). Conclusions: ATTR-CM displayed lower RV performance, higher GMW and reduced RV-PA coupling. Myocardial work indices E_es and E_a are novel distinguishers of RV dysfunction phenotypes. The clinical and prognostic value of these novel variables warrant further investigation. Full article

Introduction: The e-STROKE study is a prospective, multicenter observational study designed to assess the impact of various CT parameters (including e-ASPECT, CT perfusion (CTP), collateral flow status, and the size and location of the ischemic lesion) on the clinical outcomes of patients with ischemic stroke, as evaluated by the modified Rankins Scale (mRS) three months post-stroke. This study also aims to investigate whether the use of multimodal CT imaging increases the number of patients eligible for recanalization therapy. The analysis will integrate data from the RES-Q registry and radiological data from the e-STROKE system provided by Brainomix Ltd. Aims: The primary aim is to determine the predictive value of CT parameters (e-ASPECTS, CTP, collateral vessel status, and ischemic lesion volume and location) on three-month functional outcomes, as defined by the mRS, in patients with non-lacunar stroke following recanalization treatment (IVT and/or MT). The secondary aim is to evaluate whether multimodal CT examination leads to an increase in the number of patients eligible for recanalization therapy. Additionally, this study seeks to assess the specificity and sensitivity of multimodal CT in distinguishing stroke mimics from actual strokes. Methods: This multicenter observational study involves patients with suspected acute ischemic stroke and a premorbid mRS ≤ 4, who are treated with endovascular thrombectomy (EVT), intravenous thrombolysis (IVT), or managed conservatively in stroke centers within the Czech Stroke Research Network (STROCZECH), which is part of the Czech Clinical Research Infrastructure Network (CZECRIN). Data collection includes demographic, clinical, and imaging data variables such as age, sex, ethnicity, risk factors, treatment times (OTT, DNT, and OGT), TICI scores, post-treatment hemorrhage (ECAS II), mRS outcome, stroke etiology, e-ASPECTS, acute ischemic volume (AIV), thrombus length on NCCT, CTA collateral score and collateral vessel density, location of large vessel occlusion, ischemic core, hypoperfusion volume, mismatch ratio and volume, final infarct volume, hemorrhage volume, and MRI in case of negative follow-up NCCT. Conclusions: We anticipate collecting robust clinical and radiological data from approximately 2000 patients across 22 centers over a 12-month period. The results are expected to enhance the precision of diagnostic and prognostic radiological markers in managing acute stroke. Full article

Background: Indirect calorimetry is the gold standard field-testing technique for measuring energy expenditure and exercise intensity based on the volume of oxygen consumed (VO₂, mL O₂/min). Although heart rate is often used as a proxy for VO₂, heart rate-based estimates of VO₂ may be inaccurate after stroke due to changes in the heart rate–VO₂ relationship. Our objective was to evaluate in people post stroke the accuracy of using heart rate to estimate relative walking VO₂ (wVO₂) and classify exercise intensity. Moreover, we sought to determine if estimation accuracy could be improved by including clinical variables related to patients’ function and health in the estimation. Methods: Sixteen individuals post stroke completed treadmill walking exercises with concurrent indirect calorimetry and heart rate monitoring. Using 70% of the data, forward selection regression with repeated k-fold cross-validation was used to build wVO₂ estimation equations that use heart rate alone and together with clinical variables available at the point-of-care (i.e., BMI, age, sex, and comfortable walking speed). The remaining 30% of the data were used to evaluate accuracy by comparing (1) the estimated and actual wVO₂ measurements and (2) the exercise intensity classifications based on metabolic equivalents (METs) calculated using the estimated and actual wVO₂ measurements. Results: Heart rate-based wVO₂ estimates were inaccurate (MAE = 3.11 mL O₂/kg/min) and unreliable (ICC = 0.68). Incorporating BMI, age, and sex in the estimation resulted in improvements in accuracy (MAE Δ: −36.01%, MAE = 1.99 mL O₂/kg/min) and reliability (ICC Δ: +20, ICC = 0.88). Improved exercise intensity classifications were also observed, with higher accuracy (Δ: +29.85%, from 0.67 to 0.87), kappa (Δ: +108.33%, from 0.36 to 0.75), sensitivity (Δ: +30.43%, from 0.46 to 0.60), and specificity (Δ: +17.95%, from 0.78 to 0.92). Conclusions: In people post stroke, heart rate-based wVO₂ estimations are inaccurate but can be substantially improved by incorporating clinical variables readily available at the point of care. Full article

Background and Objective: The modified prone position, which is an alteration of the standard prone position, reduces cardiac preload. Dynamic variables including stroke volume variation (SVV), pulse pressure variation (PPV), and pleth variability index (PVI) are reliable predictors for fluid responsiveness during surgery. To the best of our knowledge, no studies assessing dynamic variables for fluid responsiveness have been conducted in the modified prone position. This study aimed to evaluate the ability of PVI to predict fluid responsiveness in the modified prone position during cervical spine surgery. Materials and Methods: PVI, SVV, and PPV were recorded at the following times: before and after a 4 mL/kg crystalloid load in the supine position (T1, T2); after placement in the modified prone position (T3); and before and after a 4 mL/kg crystalloid administration in the modified prone position (T4, T5). Fluid responsiveness was defined as stroke volume (SV) ≥ 15%, assessed by the FloTrac/Vigileo™ (Edwards Lifesciences Corp, Irvine, CA, USA). Receiver operating characteristic (ROC) curves were analyzed to identify changes in each dynamic variable that could predict fluid responsiveness in the modified prone position. Results: Data from a total of 43 subjects were analyzed. In the supine position, 21 subjects were responders. After subjects were placed in the modified prone position, SV significantly decreased, while PVI, SVV, and PPV significantly increased (p < 0.001 for all). In the modified prone position, 13 subjects were responders, and the areas under the ROC curves for ΔPVI, ΔSVV, and ΔPPV after fluid loading were 0.524 (95% confidence interval [CI] 0.329–0.730, p = 0.476), 0.749 (95% CI 0.566–0.931, p = 0.004), and 0.790 (95% CI 0.641–0.938, p < 0.001), respectively. Conclusions: Crystalloid pre-loading could not mitigate the decrease in SV caused by the modified prone position. Changes in PVI were less reliable in predicting fluid responsiveness in the modified prone position. Full article