Evidence suggests that adipose tissue (AT) infiltration in skeletal muscles may negatively influence cardiac function, yet its use as a biomarker remains unclear. This scoping review examined the relationship between AT infiltration and cardiac function in adults. A systematic search of PubMed, CINAHL and SCOPUS identified peer-reviewed studies reporting AT infiltration and cardiac function measures. Excluded were review-type studies, animal studies, abstracts and case series. Study quality was assessed using the Study Quality Assessment Tool (SQAT). Three good-quality studies were included. Findings demonstrated a negative association between AT infiltration and cardiac function parameters, including exercise capacity, left ventricular ejection fraction (LVEF) and heart failure events, in cancer survivors and healthy individuals. There is evidence supporting an association between increased AT infiltration of skeletal muscles and impaired cardiac function, highlighting the need for further research to validate AT infiltration as a potential biomarker. Despite the limited available studies, our findings highlight a distinct association between skeletal muscle AT infiltration and cardiac dysfunction, independent of general obesity.

Vascular calcification (VC), especially coronary artery calcification (CAC), serves as a robust predictor of cardiovascular mortality in chronic kidney disease (CKD) patients. Recent studies have revealed that the presence of extra-coronary calcifications (ECCs) contributes to cardiovascular disease (CVD). Elevated myocardial injury markers predict mortality risk in CKD patients and are associated with CVD. Nevertheless, the relationship between VC, including CAC and ECCs, and myocardial injury markers remain unexplored in non-dialysis CKD patients.

In 278 non-dialysis CKD patients of stage G3 to G5, we assessed calcified scores in CAC (Agatston score) and ECCs including thoracic aortic calcification (TAC), abdominal aortic calcification (AAC), carotid artery calcification, and valvular calcification. We analyzed the relationships between VC and myocardial injury markers of cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB).

A total of 278 non-dialysis CKD patients (median age 52.4 ± 13.2; male 65.1%; diabetes 33.5%) were enrolled. A total of 71.8% (227) of patients had cTnT levels above the upper limit of normal (> 0.014 ng/mL). Moderate to severe (calcified score ≥100 vs. <100), CAC (OR 6.39; 95% CI 1.03-39.61) and TAC (OR 6.16; 95% CI 1.76-21.55) were significantly associated with higher cTnT concentrations after adjustment for confounders. Additionally, male sex and a lower eGFR were also associated with cTnT elevation. However, when we included CAC and TAC in one model, only moderate to severe TAC (OR 4.85; 95% CI 1.38-16.96) was a risk factor for cTnT elevation, but not CAC. Furthermore, patients with severer TAC presented lower diastolic blood pressure (DBP), wider pulse pressure (p < 0.001) and higher prevalence of left ventricular hypertrophy (LVH).

Moderate to severe thoracic aortic calcification (TAC score ≥ 100) is significantly associated with elevated cTnT concentrations in non-dialysis CKD patients of stage G3 to G5. The linkage may result from decreased coronary perfusion and relative myocardial ischemia.

Much remains to be learned about patients with heart failure with improved ejection fraction (HFimpEF).

This study sheds light on the characteristics and clinical outcomes of HFimpEF patients, including the consequences of halting guideline-directed medical therapy (GDMT).

This retrospective study was conducted on patients diagnosed with heart failure with reduced ejection fraction (HFrEF) who underwent a second echocardiogram at least 6 months apart between January 2009 and February 2023. The primary outcomes were major adverse cardiovascular events (MACEs), including all-cause mortality and heart failure hospitalization. The second outcome was recurrent HFrEF.

Of 4,560 HFrEF patients were included, 3,289 (72.1%) achieved HFimpEF within a median follow-up period of 3.4 years (IQR: 1.8 - 5.9 years). Among these HFimpEF patients, recurrent HFrEF was observed in 941 (28.6%) patients during a median follow-up period of 2.3 years (IQR: 0.8-4.6 years). The proportion of patients who halted GDMT was 70.4%, 53.2%, 59.8% and 63.8% for MRA, beta-blockers, ACEI/ARB/ARNI and SGLT-2 inhibitors. Multivariable Cox analysis revealed ischemic heart disease, chronic kidney disease, coronary heart disease, lower left ventricular ejection fraction, larger left ventricular diastolic dimension and non-use GDMT are associated with recurrent HFrEF. Individuals without GDMT use exhibited lower chances of persistently recovering ejection fraction and high risks of MACEs compared to those who continue use.

HFimpEF is a common condition across all clinical follow-ups. Prevalent discontinuation of GDMT medications may contribute significantly to recurrent HFrEF, placing patients at a higher risk for poor prognosis.

The workload-indexed systolic blood pressure response to exercise (SBP/MET slope) has been proposed as a novel parameter for evaluating abnormal blood pressure response to exercise (ABPR) and its potential risks. Aim of our study was to assess the association between SBP/MET slope and clinical and cardiac dimensional parameters in normotensive athletes.

A cohort of 292 normotensive Olympic athletes (155 male, 53.1 %) underwent a pre-participation evaluation that included clinical, echocardiographic, and exercise-stress test parameters. The SBP/MET slope was calculated as the increase in systolic blood pressure indexed to metabolic equivalents achieved during maximal exercise. Athletes were stratified into quartiles based on their SBP/MET slope, and comparisons across quartiles were made.

Athletes in the highest SBP/MET slope quartile exhibited increased left ventricular wall thickness, i.e., interventricular septum (IVS) compared to those in lower quartiles (10.3 ± 0.9 vs. 9.5 ± 1.1, p = 0.014). Male athletes predominated in higher quartiles (p = 0.047), and endurance athletes were absent in the higher groups (p = 0.006). No differences were observed for systolic or diastolic function across quartiles. At multivariate analysis, SBP/MET slope was indipendently correlated to IVS (p = 0.040; R2 = 0.566, standardized beta coefficient = 0.368) and inversely correlated to W/Kg (p = 0.014; R2 = 0.566, standardized beta coefficient = -0.507). After a follow-up of 10.3 ± 2.6 years, 13.6 % of athletes in the highest quartile developed hypertension.

Athletes with higher SBP/MET slope exhibited increased wall thickness and lower exercise capacity and showed higher risk for late-onset hypertension. Long-term follow-up studies are warranted to further elucidate its prognostic implications.

Invasive right heart catheterization plays a central role in identifying pulmonary hypertension (PH) disorders. However, non-invasive biomarkers of portopulmonary hypertension (PoPH) are required. Liver stiffness evaluated by FibroScan® is useful for the assessment of liver fibrosis in patients with chronic liver diseases. This study sought to investigate the utility of liver stiffness for the classification of PoPH among precapillary PH patients.

A total of 46 patients [38 females, median (interquartile range) age 63.0 (50.8-72.0) years old] with precapillary PH were divided into a PoPH group (N = 6) and a non-PoPH group (N = 40) based on the presence of portosystemic shunts and/or portal hypertension with hepatic venous pressure gradient >5 mmHg.

The PoPH group showed higher cardiac index and lower pulmonary vascular resistance than the non-PoPH group. Other hemodynamic variables and liver fibrosis biomarkers such as fibrosis-4 index and albumin-bilirubin score were comparable between the 2 groups. Liver stiffness measurements in the PoPH group were significantly higher than those in the non-PoPH group [12.8 kPa (9.4-17.3 kPa) vs 4.15 kPa (3.30-5.50 kPa), p < 0.001]. The cut-off value for the classification of PoPH was 8.50 kPa from the receiver operating characteristic curve (area under curve 0.979, 95 % Confidence interval 8.50 kPa - 11.00 kPa).

Liver stiffness evaluated by transient elastography may be a non-invasive biomarker to detect the liver status that caused PoPH among precapillary PH patients.

In rheumatic mitral stenosis (RMS), left atrial pressure elevation can lead to right heart dysfunction and fibrosis. The relationship between speckle-tracking echocardiography (STE) right-heart parameters, right atrial fibrosis, and its histological confirmation, remains unclear.

46 RMS patients (mean age of 53.0 ± 8.9 years, 67 % females) were enrolled. The exclusion criteria were the presence of moderate or severe aortic valve diseases, rheumatic tricuspid lesions and poor acoustic windows. RA tissue specimens were collected during the operation in RMS patients to analyze the degree of myocardial fibrosis. Echocardiographic evaluations and histological analysis of right atrial (RA) tissue were performed. Correlations between parameters and RA fibrosis were analyzed.

RA fibrosis was strongly correlation with RAsr (r = -0.860, P < 0.001). ROC analysis confirmed that RA stiffness (E/e'/RAsr) (AUC = 0.934, 95 %CI: 0.843-1.000) and STREI index (2 × RVFLWS + RAsr) (AUC = 0.802, 95 %CI: 0.672-0.933) had good diagnostic efficacy. RA fibrosis was verified histologically.

To a certain degree, RAsr serves as an indicator mirroring the extent of right atrial fibrosis. In the context of RMS patients, both RA stiffness and the STREI index emerge as potential harbingers of RA fibrosis, playing a significant role in unravelling the underlying mechanisms of disease progression and informing the formulation of efficacious treatment strategies.

Cancer and cardiovascular disease (CVD) are among the leading causes of death globally, and the rate of coexistence of the two diseases has been increasing in recent years, with the elevation of the susceptible population base in aging societies and the improvement of therapeutic approaches. Atrial fibrillation (AF), as a common type of cancer-related cardiovascular toxicity (CTR-CVT) in oncology patients, is a serious threat to patients' health and may lead to other cardiovascular complications. Therefore, early detection, timely recognition, and effective intervention of AF are essential to maintain long-term survival of tumor survivors. However, the causal mechanisms regarding its association are still inconclusive, and there is no consensus in the clinic on the optimal treatment. In this review, we will integrate existing guidelines and studies to summarize the current state of research on atrial fibrillation in oncology patients in terms of epidemiology, pathophysiological mechanisms, predictive diagnostics, and therapeutic measures, and propose some research directions to be improved. We hope to provide a more comprehensive review and provide assistance in clinical response.

Coronary artery disease (CAD) is a significant risk factor for heart failure with preserved ejection fraction (HFpEF). While the HFA-PEFF and H2FPEF scoring systems were developed to aid in the diagnosis of HFpEF, their predictive performance in patients with CAD remains underexplored.

This single-center retrospective cohort study included patients who underwent drug-eluting stent implantation between January 2018 and October 2022. The study's primary endpoint was a composite outcome of all-cause mortality and heart failure hospitalization during follow-up. Kaplan-Meier survival curves were used to evaluate time to adverse events, and differences between groups were analyzed using the log-rank test. Cox proportional hazards regression was applied to assess the independent predictive value of the HFA-PEFF and H2FPEF scores for adverse outcomes.

The HFA-PEFF score categorized 65.7 % of patients as intermediate, 25.1 % as high, and 9.2 % as low probability for HFpEF. The H2FPEF score placed 77.3 % in the intermediate group, 19.3 % in the low, and 3.4 % in the high-probability group. The median follow-up period was 29 months. Adjusted Cox proportional hazard regression revealed the HFA-PEFF score was significantly associated with the composite endpoint of all-cause mortality and heart failure hospitalization (HR: 1.33, 95 % CI:1.07-1.65). Each point increase in the HFA-PEFF score raised heart failure hospitalization risk by 26 % (HR:1.26, 95 % CI: 1.05-1.51). In contrast, the H2FPEF score did not show a significant association with adverse events.

The HFA-PEFF score demonstrated superior prognostic value for predicting adverse outcomes in CAD patients with preserved ejection fraction compared to the H2FPEF score.

Heart size is a critical indicator of cardiovascular health, is influenced by various anthropometric measures such as age, sex, body height, body weight, and fat-free mass, and associates with hand palm diameter. Understanding the relationship between heart size and these anthropometric indicators is vital for clinical practice and for understanding and exploring the anatomy and physiology of the heart. We designed a physiology teaching laboratory for second-year undergraduate students to facilitate this understanding. The laboratory had three primary learning objectives: 1) to observe heart size measurement with ultrasound by a professional cardiac sonographer; 2) to measure anthropometric parameters (age, sex, body height, body weight, body fat percentage, and hand palm diameter) alongside cardiovascular measures (heart rate and blood pressure); 3) to comprehend the basic qualitative and quantitative relationships between heart size and both the anthropometric and cardiovascular measurements.NEW & NOTEWORTHY Heart size is a key indicator of cardiovascular health, influenced by various factors such as sex and body height. We developed a physiology laboratory for second-year undergraduates to support learning of these relationships, which are crucial for understanding cardiac physiology. First, students observed heart size measurements with ultrasound by a professional. Second, they measured anthropometric and cardiovascular parameters. Finally, they explored the basic associations between heart size and the anthropometric and cardiovascular indicators.

Conflicting findings have been reported on the potential association between CAE and aortic dilatation. This study aimed to investigate the relationship between CAE extent and aortic dimensions in patients with acute coronary syndrome (ACS).

This retrospective cohort study included 448 adult patients who underwent coronary angiography for ACS between 2004 and 2015. The cohort was divided into 224 patients with CAE and 224 control patients without CAE, matched for age, sex, and hypertension. Aortic dimensions at the annulus, sinus of Valsalva (SOV), sinotubular junction (STJ), and ascending aorta were measured using transthoracic echocardiography and indexed to body surface area (BSA). The extent of CAE was classified using the Markis and Markis-Harirkrishnan systems. Statistical analysis included ANOVA to assess differences in aortic dimensions and their correlation with CAE extent.

Patients with CAE had significantly larger non-indexed aortic dimensions compared to those without CAE (e.g., ascending aorta diameter: 35.2 ± 4.0 mm vs. 33.6 ± 3.7 mm, p < 0.0001). However, when indexed to BSA, these differences were not significant. No significant correlation was found between CAE extent and aortic dimensions (e.g., indexed ascending aorta: F = 1.161, p = 0.325). The incidence of bicuspid aortic valve was similar between both groups (0.9 % vs. 0.4 %, p = 0.554).

In patients with ACS, there were no significant differences in indexed aortic diameters in those with and without CAE. Additionally, no correlation was found between CAE extent and aortic dimensions and the incidence of bicuspid aortic valve was comparable in both groups.

Iron deficiency (ID) is prevalent in heart failure (HF) patients and correlates with adverse outcomes. Serum soluble transferrin receptor (sTfR) levels reflect bone marrow and myocardial iron stores, potentially impacting HF prognosis. However, the specific role of sTfR in the progression of HF remains unclear.

In a retrospective cohort of 391 patients with HF and left ventricular ejection fraction (LVEF) < 50 %, multivariate logistic regression and Cox proportional hazard regression identified mortality-associated factors. The receiver operating characteristic (ROC) curve determined sTfR cut-off value based on the area under the curve. Kaplan-Meier curves were used to compare the cumulative survival rates. Spearman's rank correlation assessed sTfR's relation to left ventricular (LV) parameters. Mendelian randomization (MR) analysis explored causal associations.

High sTfR levels (≥1.96 mg/L) predicted worse survival and were associated with increased LV volume and lower LVEF. sTfR correlated significantly with LV end-diastolic volume (LVEDV) (r = 0.09, P = 0.0152), LV end-systolic volume (LVESV) (r = 0.16, P = 0.0018), body surface area-indexed LVEDV (LVEDVI) (r = 0.12, P = 0.0140), body surface area-indexed LVESV (LVESVI) (r = 0.14, P = 0.0058), and negatively with LVEF (r = -0.20, P = 0.0001). MR analysis showed a causal link between elevated sTfR and increased LVEDV (β = 0.092; 95 % CI: 1.031-1.162; P = 0.0056) and LVESV (β = 0.089; 95 % CI: 1.027-1.058; P = 0.0079).

Elevated sTfR levels identify HF patients at higher risk of mortality and are linked to detrimental LV structural and functional changes, particularly enlargement of LVEDV and LVESV.

Pulmonary hypertension (pH) is a well-documented complication in patients with connective tissue diseases, including Sjögren's syndrome (SS). However, the prevalence of PH in SS varies considerably across studies, likely due to differences in diagnostic methods.

This study aims to assess the prevalence of PH in a cohort of SS patients and to examine potential differences in age, cardiovascular risk factors, autoimmunity, pulmonary function tests, and echocardiographic parameters between male and female SS patients.

Sixty-three patients diagnosed with primary SS were included in this study. Male patients were compared to females regarding age, cardiovascular risk factors, autoimmunity, pulmonary function tests, and echocardiographic parameters. All patients underwent comprehensive cardiac echo-color-Doppler evaluations during their most recent follow-up.

The prevalence of PH in the study cohort was 1.6 %. Respiratory function tests revealed significantly lower values in male patients compared to females. Echocardiographic assessments also indicated more pronounced alterations in males in pulmonary artery diameter and TVI-RVOT. In left-sided heart parameters, males showed greater dilatation and signs of diastolic dysfunction. Mass 2D and ejection fraction FE2D were also altered in males.

The low prevalence of PH (1.6 %) in SS patients when diagnosed with RHC emphasizes the importance of using accurate diagnostic methods. As male patients demonstrated a greater predisposition to developing PH, as evidenced by altered respiratory function, and early diastolic dysfunction, regular echocardiographic monitoring is recommended for male SS patients, particularly those exhibiting early structural or functional cardiac changes.

Tissue-tracking mitral annular displacement (TMAD) is a simple marker for left ventricular (LV) systolic function. However, its clinical impact in aortic stenosis (AS) remains unclear. We aimed to investigate the significance of TMAD on LV mechanics in comparison with global longitudinal strain (GLS) and its prognostic value in AS.

We retrospectively reviewed 91 patients with moderate or severe AS and preserved LV ejection fraction (≥ 50 %). TMAD was measured from an apical four-chamber view and indexed to the LV long-axis length (%TMAD). The associations between TMAD and LV ejection fraction (LVEF) and GLS, including the regional distribution (apical, mid, and basal) of longitudinal strain (LS), were evaluated. We also assessed the impact of %TMAD on clinical outcomes, including cardiovascular death, heart failure hospitalization, and unplanned aortic valve replacement.

%TMAD showed a moderate correlation with LVEF (r = 0.45, P < 0.001) and a strong correlation with |GLS| (r = 0.81, P < 0.001). In the regional LS analysis, %TMAD correlated strongly with mid and basal LS, but modestly with apical. The cutoff value of %TMAD for predicting impaired GLS (|GLS| < 14.7 %, as previously reviewed) was 9.8 %, which also predicted event-free survival (Log-rank P = 0.001). In a Cox proportional hazards model, lower %TMAD was significantly associated with worse clinical outcomes, independent of AS severity and LVEF.

%TMAD is a marker of LV longitudinal systolic function, particularly reflecting mid-basal longitudinal systolic function, and can be a useful prognosticator in AS patients.

In adults with chronic kidney disease (CKD), abnormal left atrial reservoir strain (LASr) is an early, yet clinically significant, indicator of myocardial dysfunction. However, left atrial mechanics are understudied in youth with CKD. The objective of this study was to assess left atrial strain function in youth with CKD and similarly aged, healthy controls.

We performed a single-center, retrospective, observational study of persons aged 12-21 years with stage 3-4 CKD and healthy controls. Exclusion criteria included a history of a kidney or other solid organ transplant, congenital heart disease, and/or dialysis requirement < 3 months prior. We measured LAS (LASr, conduit, and contractile), E/e', E/A, left ventricular mass index (LVMI), and ejection fraction. Pearson correlations were performed between echocardiographic measures.

This study included 37 patients with CKD and 19 controls. Mean age was similar between groups, and male sex was over-represented in both groups (CKD 62%; healthy 63%). Mean ± standard deviation (SD) eGFR in the CKD group was 32 ± 14 mL/min/1.73 m2. Mean absolute LASr was lower in those with CKD (43.0 ± 8.5%) compared to healthy controls (47.4 ± 6.1%) p = 0.050. Patients with CKD had significantly higher LVMI and lower E/A and E' compared to controls. There was poor correlation between LASr with E/A, E/e', and LVMI.

As observed in adults with CKD, LASr trended lower in youth with CKD compared to healthy controls. Moreover, LASr poorly correlated with traditional measures of diastolic dysfunction such as E/e' and E/A.

Evidence has been provided that in the normotensive population chronic coffee consumption does not adversely affect cardiovascular and total mortality. Whether and to what extent this is the case also in high risk cardiovascular patients such as those with elevated blood pressure (BP) is largely debated.

We analyzed data collected in 943 hypertensive patients belonging to the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, which were classified as coffee consumers and non-consumers (self report). Cardiovascular and total mortality were evaluated at the 25 year follow-up taking into account a number of variables including office and 24-h ambulatory BP. When data were analyzed as unadjusted values no significant difference in hazard ratios for cardiovascular and total mortality was detected in coffee consumers and non-consumers considering office (0.85 and 0.83 respectively, PNS) or 24-h (1.08 vs 0.80 respectively, PNS) BP. This was the case also when the data were adjusted for confounders (age, sex, BP, lipid profile, plasma glucose and cholesterol levels, renal function, previous cardiovascular events) or when analyzed according to presence or absence of antihypertensive treatment.

Thus in mild-to-moderate hypertensive patients chronic coffee consumption does not exert deleterious long-term effects on cardiovascular and total mortality. This is the case in both genders and in treated and untreated hypertensive patients.

The value of the association of arterial stiffness with left ventricular concentric remodelling/left ventricular hypertrophy (LVH) assessed by echocardiography, for prediction of masked hypertension defined by office and ambulatory blood pressure monitoring (ABPM) in the general population is largely undefined. We investigated this topic in the participants to the Pressioni Monitorate E Loro Associazioni (PAMELA) study.

The study included 272 participants (153 normotensives and 119 with masked hypertension) who attended the second and third survey of the PAMELA study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, physical examination, blood tests, office, ABPM, echocardiographic and Cardio-Ankle Vascular Index (CAVI) measurements.

Compared to normotensive individuals, participants with masked hypertension were younger, had significantly higher office, home, mean 24-h, day-time, night-time SBP/DBP and heart rate. The likelihood of having masked hypertension, was approximately more than two-fold higher [odds ratio (OR) = 2.29, confidence interval (CI): 1.01-5.31, P  = 0.04] in participants with increased CAVI and left ventricular remodelling/LVH compared to their counterparts without organ damage. This association showed a unique value in identifying masked hypertension compared to both isolated markers of organ damage (OR = 1.69, P  = 0.15 for increased CAVI and OR = 0.82, P  = 0.80 for left ventricular remodelling/LVH), after adjusting for age, sex, office SBP/DBP, antihypertensive treatment and diabetes.

The present study offers a new piece of evidence of the key value of looking for both vascular and cardiac organ damage to unmask MH and improve its clinical management in the general population.

Right heart failure (HF) is a poor prognostic factor in patients with HF. The right atrial (RA) function has attracted less attention than the right ventricular (RV) function. The association of RA reservoir strain evaluated by 2D speckle-tracking echocardiography (2DSTE) with clinical outcomes in patients with HF remains unclear. We prospectively enrolled patients with HF admitted to our hospital. We measured the RA, RV, left atrial (LA), and left ventricular (LV) strain using 2DSTE before discharge. The RA reservoir strain (RASr) was measured in the global right atrium. The primary endpoints were cardiac death and worsening of HF requiring rehospitalization or intravenous diuretics. Among 226 patients with HF, 72 primary endpoints were recorded during a median follow-up period of 1081 days. Kaplan-Meier analysis showed a higher cardiac event rate in the low RASr group than in the high RASr group (P = 0.0089). Multivariate Cox hazard analysis showed that RASr was independently associated with cardiac events after adjusting for confounding factors [hazard ratio (HR) 0.71; 95% confidence interval (CI) 0.51-0.96; P = 0.0347]. Decreased RASr could be a feasible marker of cardiac events in patients with HF.

The aim of the study was to evaluate the role of central pulse pressure (PP) in carotid wall thickening and coronary artery calcification (CAC).

In an asymptomatic general population ( N  = 396, 163 men, 47-89 years), central PP was measured by applanation tonometry, CAC by computed tomography, and common carotid artery intima-media thickness (cIMT), pulse wave velocity (cPWV) and the power of the signal reflected from carotid media (cMP) by radiofrequency-based carotid ultrasound. High cIMT was defined as cIMT equal to or greater than the 75th percentile for given sex and age, and CAC presence as a CAC score greater than 0.

In the entire population, luminal diameter and cMP increased with increasing central PP ( r  = 0.32 and 0.25; P  < 0.0001). One hundred and ninety-seven individuals had high cIMT; individuals with high cIMT had higher central PP, luminal diameter, cMP and cPWV ( P  = or <0.0001), but comparable wall tensile stress ( P  = 0.23). In a logistic regression model, high cIMT was independently associated with luminal diameter and central PP. One hundred and fifty-two individuals had CAC score greater than 0; in a logistic regression model, CAC score greater than 0 was independently associated with sex, age, central PP, LDL-cholesterol, triglycerides and T2DM.

Our findings indicate that high central PP contributes both to an increase in cIMT and the development of CAC. However, while central PP was the only risk factor linked to high cIMT, multiple atherosclerotic risk factors were associated with CAC. Therefore, both high cIMT and CAC reflect the adverse impact of high pulsatile load on the vascular system, yet only CAC can be considered a marker of atherosclerosis.

Danazol is frequently used in treating patients with acquired aplastic anaemia (AA) in resource-constraint settings. We aimed to evaluate the cardiometabolic side effects of Danazol in patients with AA.

This prospective study included newly-diagnosed AA patients ≥13 years of age who were eligible for Danazol monotherapy (10 mg/kg/day, capped at 600 mg/day). Lipid profile and two-dimensional echocardiogram were obtained at the baseline and after 6 months of Danazol treatment. Transfusion of blood products and liver function test-based dose adjustments were done as indicated. Pre- and post-treatment parameters were compared using SPSS software version 25.

36 patients (median age, 28.5 years) were enrolled. HDL cholesterol decreased by 30 % (p ≤0.001), and LDL cholesterol increased by 11 % (p = 0.002) at the end of 6 months. At the end of 6 months, there was a significant increase in the left ventricular (LV) ejection fraction (p = 0.001), LV mass (p ≤0.001), peak A-velocity (p = 0.01), isovolumetric relaxation time (p = 0.032), and a significant decrease in peak E-velocity (p ≤0.00) and Tei index (p = 0.031). Right ventricular E/A ratio also decreased significantly (p < 0.001).

Danazol treatment causes profound dyslipidaemia and potential cardiac dysfunction in patients with AA.

Acute dyspnea in emergency departments (ED) requires prompt and accurate diagnosis due to its high mortality and readmission rates. Conventional diagnostic methods are resource-intensive and time-consuming. This study aimed to evaluate the diagnostic accuracy and time to diagnosis of combined heart and lung ultrasound (HeaLus) compared to standard emergency department evaluation in patients presenting with dyspnea.

A prospective study was conducted in a cohort of 61 patients at the ED of Danderyd Hospital, Sweden. HeaLus examinations were performed alongside routine investigations. Diagnostic performance of HeaLus and ED evaluation was assessed for accuracy, sensitivity, specificity, positive predictive value, and negative predictive value, and agreement using Kappa index. Median time to diagnostics was compared between HeaLus and ED evaluation using Mann-Whitney U-test.

Heart failure was the most common diagnosis (20%) among patients presenting with dyspnea. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 95% (95% CI: [87%, 98%]), 98% (95% CI: [88%, 100%]), 90% (95% CI: [69%, 97%]), 95% (95% CI: [85%, 99%]), and 94% (95% CI: [74%, 99%]), respectively. The agreement between HeaLus and ED diagnoses was 0.88. Time to diagnosis was significantly reduced with HeaLus (21 min vs. 3 h and 28 min).

HeaLus offers rapid and accurate assessment of dyspnea. These results suggest that HeaLus could be valuable in optimizing patient management, particularly in settings with limited resources and long ED wait times.

In patients with heart failure (HF) with reduced left ventricular ejection fraction (HFrEF), low tricuspid annular plane systolic excursion (TAPSE) on echocardiography is associated with poor prognosis. The significance of TAPSE changes post-HF treatment among HFrEF patients remains unclear. We evaluated the factors associated with persistently low TAPSE and its prognostic impact in Japanese hospitalized patients with HFrEF. We prospectively examined 260 HFrEF patients from the prospective observational HIJ-HF III study of HF patients hospitalized at Tokyo Women's Medical University between 2015 and 2019. Persistently low TAPSE was defined as TAPSE < 17 mm on both pre- and 1-year post-discharge echocardiography. The primary endpoint of the study was all-cause mortality or re-hospitalization due to HF. Prognosis and characteristics were compared between patients with and without persistently low TAPSE. Using characteristics and echocardiography data, factors associated with persistently low TAPSE were assessed using logistic regression analysis. We identified the prognostic impact of persistently low TAPSE in HFrEF patients using Cox proportional hazards models. Seventy-eight (30%) of the 260 patients had persistently low TAPSE. They had higher New York Heart Association functional class; lower baseline TAPSE and left ventricular ejection fraction; and fewer angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Significant factors associated with persistently low TAPSE included higher brain natriuretic peptide level at 1 year after discharge, lower baseline levels of TAPSE and septal s'. Over a follow-up period of 32 months (range 12-69 months) after the 1-year echocardiography, the rate of the primary endpoint was significantly higher among patients with persistently low TAPSE than that among others (n = 31 (40%) vs. n = 39 (21%), respectively, log-rank p < 0.001). Cox multivariate analysis revealed that persistently low TAPSE was independently associated with adverse events (Hazard ratio, 1.975; 95% confidence interval 1.183-3.295; p = 0.009). Exactly 30% of hospitalized patients with HFrEF had low TAPSE both pre- and 1-year post-discharge. Persistently low TAPSE had independent predictive value of prognosis in these patients.

Vector Flow Mapping (VFM) is a novel technique for visualizing intracardiac blood flow. A few reports have been made regarding the reproducibility of energy loss (EL) measurements using VFM. This study aims to elucidate the intra-class and inter-class correlation coefficient (intra-ICC and inter-ICC) in the EL measurements.

Seven healthy participants were enrolled, and echocardiographic data were obtained by two cardiac sonographers (14 images). Three independent analysts analyzed all images in three different cardiac cycles three times: 378 data points (14 images × analysts × 3 cardiac cycles × 3 times). The intra-ICC (1, 1) and inter-ICC (2, 1) were calculated. Furthermore, the intra-ICC (1, k) and inter-ICC (2, k) were applied using the averaged EL value in three cardiac cycles. An ICC value greater than 0.75 was defined as acceptable reproducibility.

In diastole, the intra-ICC (1, 1) by the three analysts was 0.890, 0.830, and 0.802; the intra-ICC (1, k), using the average EL value was 0.986, 0.978, and 0.973. In systole, the intra-ICC (1, 1) was 0.729, 0.698, and 0.733; the intra-ICC (1, k) was 0.960, 0.954, and 0.961. In diastole, the inter-ICC (2, 1) was 0.950, and the inter-ICC (2, k) was 0.958. In contrast, in systole, the inter-ICC (2, 1) was 0.772, and the inter-ICC (2, k) was 0.774; these values were lower than those in diastole.

These findings indicate that the intra- and inter-measurer reproducibility of diastolic and systolic EL is favorable for clinical use.

Dilated cardiomyopathy (DCM) is a clinical diagnosis characterized by the presence of left ventricular dilatation and systolic dysfunction unexplained by abnormal loading conditions or coronary artery disease. However, a broad range of phenotypic manifestations, encompassing isolated scar, DCM with preserved ejection fraction, and overt DCM, should be regarded as a diagnostic classification representing a broad spectrum of underlying aetiologies, including both inherited and acquired heart muscle disorders. A multimodal non-invasive imaging approach is essential for accurate morpho-functional assessment of cardiac chambers and is key to establish the cardiac phenotype and to rule out an underlying ischaemic aetiology. Furthermore, advanced imaging techniques enable deep cardiovascular phenotyping and non-invasive tissue characterization. The aim of this review is to propose a systematic approach to the diagnosis of DCM, emphasizing the importance of genetics and clinical findings for a precise and practical clinical approach. Also, we strive to qualify the role of cardiac imaging in the diagnosis of DCM, particularly on the relevance of novel techniques and clinical utility of actionable parameters to improve current diagnostic schemes and risk stratification algorithms. We further elaborate on the role of cardiac imaging to deliver optimal guidance to aetiology-based therapeutic approaches, verification of treatment response and disease progression monitoring.

Right atrial (RA) strains (RASr, RAScd, and RASct) are increasingly used in clinical and research settings, such as heart failure and pulmonary hypertension, but their feasibility and reference ranges across different strain software vendors are not well established. We aim to evaluate and compare two-dimensional RA strain values, reference ranges, and related factors across four strain software vendors in healthy subjects.

Healthy subjects (n = 100) undergoing echocardiography during January-April 2023 were prospectively studied, with equal numbers by age groups, gender, and GE versus Philips scans. RA strains were quantified using TomTec version 51.02 (Autostrain LA), EchoPAC version 206 (AFI-LA), Velocity-Vector Imaging (VVI) version 2.00, and Epsilon software (5.0.2.11295) for statistical analyses.

Overall means and lower limits of normal (LLNs) of each type of RA strain by strain vendor, age group, sex, and scanner vendor were reported. For example, RASr (%) means and LLNs (95% confidence intervals) were 41.2 (38.5, 43.0) and 29.6 (26.5, 32.7) for TomTec, 35.9 (34.4, 37.3) and 27.0 (24.5, 29.5) for EchoPAC, 44.8 (42.3, 47.3) and 27.6 (23.3, 31.9) for VVI, and 38.9 (36.7, 41.0) and 25.5 (21.7, 29.3) for Epsilon, respectively. Linear mixed model regression showed EchoPAC and VVI had significantly lower RASr and higher RAScd magnitude than TomTec, with older age linked to lower RASr and RAScd magnitudes.

TomTec and VVI were vendor-neutral for measuring RA strains, while EchoPAC worked only on GE scans. Normal values, lower limits of normal, and related factors for RA strain measurements by vendor were established for clinical use.

Telemedicine has been associated with better cardiovascular outcomes, but its effects on the regression of mitral regurgitation (MR) and tricuspid regurgitation (TR) remain unknown.

This study aimed to evaluate whether telemedicine could facilitate the regression of MR and TR compared to usual care and whether it was associated with better survival.

This retrospective cohort study enrolled consecutive patients with moderate or greater MR or TR from 2010 through 2020, excluding those with concomitant aortic stenosis, aortic regurgitation, or mitral stenosis greater than mild severity. All patients underwent follow-up transthoracic echocardiography (TTE) at least 3 months apart. Patients receiving telehealth services for at least two weeks within 90 days of baseline TTE were categorized as the telehealth group; the remainder constituted the nontelehealth group. Telemedicine participants transmitted daily biometric data-blood pressure, pulse rate, blood glucose, electrocardiogram, and oxygen saturation-to a cloud-based platform for timely monitoring. Experienced case managers regularly contacted patients and initiated immediate action for concerning measurements. The primary endpoint was MR or TR regression from ≥moderate to

RESULTS

The MR cohorts consisted of 264 patients (mean age 67 years), including 97 regressors and 74 telehealth participants. Telehealth participation (hazard ratio 2.20, 95% CI 1.35-3.58; P=.001) was robustly associated with MR regression; MR regressors were linked to reverse cardiac remodeling, indicated by improved left ventricular ejection fraction (LVEF), and reduced left ventricular (LV) and left atrial (LA) dimensions (all P≤.005). Determinants of ACD were age (P<.001), LVEF (P<.001), percutaneous coronary intervention (P<.001), and MR regressors (P=.02). The TR cohort consisted of 245 patients (mean age 68 years), including 87 TR regressors and 61 telehealth participants. Telehealth (P=.05) was one of the univariable determinants of TR regression, while beta-blocker use (P=.048) and baseline TR severity (P=.01) remained strong predictors of TR regression in multivariable analysis.

CONCLUSIONS

Patients in the telehealth group were 2.2 times more likely to experience MR regression. Moreover, MR regressors had better survival and reverse cardiac remodeling compared to nonregressors. These findings may have important implications for future guidelines.

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Diastolic dysfunction and alterations in cardiac geometry are early indicators of diabetic cardiomyopathy. However, the association between cardiac changes across the glucose continuum and the contribution of epicardial adipose tissue (EAT) to these changes has not yet been investigated.

In this study, we aimed to investigate the EAT on cardiac diastolic function and structural alterations along the diabetic continuum using cardiac magnetic resonance imaging (CMRI).

We enrolled individuals who were categorized into groups based on glucose tolerance status. Left ventricular structure and diastolic function were assessed using echocardiography and CMRI to determine the EAT, intramyocardial fat, and associated parameters. Multivariable logistic regression models were also used.

In a study of 370 patients (209 normal glucose tolerance, 82 prediabetes, 79 diabetes), those with prediabetes and diabetes showed increased heart dimensions and diastolic dysfunction, including the ratio of early mitral inflow velocity to mitral annular early diastolic velocity (7.9 ± 0.51 vs 8.5 ± 0.64 vs 10.0 ± 0.93, P = .010), left atrial volume index (28.21 ± 14.7 vs 33.2 ± 12.8 vs 37.4 ± 8.2 mL/m2, P < .001), and left ventricular peak filling rate (4.46 ± 1.75 vs 3.61 ± 1.55 vs 3.20 ± 1.30 mL/s, P < .001). EAT significantly increased in prediabetes and diabetes (26.3 ± 1.16 vs 31.3 ± 1.83 vs 33.9 ± 1.9 gm, P = .001), while intramyocardial fat did not differ significantly. Prediabetes altered heart geometry but not diastolic function (odds ratio [OR] 1.22 [1.02-1.83], P = .012; and 1.70 [0.79-3.68], P = .135). Diabetes significantly affected both heart structure and diastolic function (OR 1.42 [1.11-1.97], P = .032; and 2.56 [1.03-5.40], P = .034) after adjusting for covariates.

Elevated EAT was observed in patients with prediabetes and is associated with adverse alterations in cardiac structure and diastolic function, potentially serving as an underlying mechanism for the early onset of diabetic cardiomyopathy.

The term "cardiosarcopenia" has been proposed to describe the interrelated decline in both skeletal muscle mass and cardiovascular function. This study aimed to (1) compare cardiac structure and function between individuals with low and normal handgrip strength (HGS) and (2) examine the correlation between cardiac structure and function with HGS, gait speed, and muscle mass measured via muscle ultrasound (US).

The study population comprised 93 older adults attending a geriatric outpatient clinic who reported no prior instances of atherosclerotic cardiovascular disease. Muscle strength was evaluated using HGS. Muscle mass was assessed using US to measure the thickness of the gastrocnemius medialis (GCM-thickness), rectus femoris (RF-thickness), and anterior thigh (AT-thickness) muscles, as well as the cross-sectional area of the RF (RF-CSA). Transthoracic echocardiography was performed, and left ventricular (LV) mass was calculated using the Devereux formula.

LV mass was significantly lower in the low HGS group compared with the normal HGS group (153.27 [32.31] g vs 175.02 [61.46] g, P = 0.029). Additionally, the low HGS group had lower LV posterior wall thickness compared with the normal HGS group (P = 0.017). LV mass was weakly correlated with GCM-thickness and gait speed, and LV end-diastolic diameter had weak/moderate correlations with HGS, RF-CSA, RF-thickness, and AT-thickness.

Ventricular mass in older adults significantly correlates with parameters of muscle mass, strength, and performance, which decline with age. To reveal the clinical effects of the reduced LV mass in patients with HGS further longitudinal studies are needed.

Maximal effort, defined by a respiratory exchange ratio (RER) ≥ 1.10, is crucial for accurate interpretation of cardiopulmonary exercise testing (CPET). Standard tests rely on non-metabolic thresholds, such as peak predicted heart rate (ppHR) ≥ 85 %, double product (DP) ≥ 20,000 bpm*mmHg and peak metabolic equivalent of task (MET) ≥ 5.0. This study aimed to assess the effectiveness of non-metabolic thresholds in detecting maximal effort, compared with the RER ≥ 1.10 criterion.

We retrospectively analyzed stable patients who underwent CPET from 2022 to 2023, regardless of test indication, history of heart failure (HF), or medication use. All patients also performed transthoracic echocardiography.

Among 239 middle-aged patients (53 ± 14 years, 67 % male), 86 % achieved a RER ≥ 1.10, and 65 % had a diagnosis of HF. Non-metabolic thresholds correctly identified maximal efforts (RER ≥ 1.10) in 75 % of the cases (AUC < 0.600). Misclassified cases were more likely to have a history of atrial fibrillation (AF), paced rhythm, HF, and beta-blockers or RAAS inhibitors use. These patients exhibited lower VO2 peak and higher VE/VCO2 slope. Multivariable analysis identified HF history (OR 4.8, CI 95 % 1.6-15.6, p: 0.005), low resting DP (≤ 7500 mmHg*bpm), and ramp protocol as independent predictors of discordant tests.

Non-metabolic thresholds misclassified up to 25 % of tests with RER ≥ 1.10 as non-maximal, potentially leading to inaccurate interpretation. In patients with HF, poor expected functional capacity and low DP, direct referral to CPET-equipped facilities may provide more accurate assessment than relying on non-metabolic thresholds.

Ventricular-arterial coupling (VAC) plays a crucial role in cardiovascular physiology, affecting cardiac function and arterial properties for optimal organ perfusion. Considering that diabetes mellitus (DM) is a known risk factor for incident heart disease and vascular damage, this study aims to investigate whether changes in VAC due to DM occur earlier, even before the onset of clinically evident cardiovascular disease in the general population.

This retrospective study included 2,884 participants (mean age 57 years, 48% male) of the Swedish CArdioPulmonary BioImage Study (SCAPIS), where data on echocardiography and Pulse wave velocity (PWV) were available. Of these, 162 individuals (6%) had prevalent type 2 diabetes (DM), and 334 (12%) had prediabetes. VAC was quantified as the ratio of PWV to Global longitudinal strain (GLS). Linear regression models were used to assess associations between glycemic status (DM, prediabetes), HbA1c, fasting plasma glucose (fP-glucose), and VAC, adjusting for relevant covariates.

I the fully adjusted model, prevalent DM and the combination of DM and prediabetes were significantly associated with increased values of PWV/GLS (Beta = 0.28, p < 0.001 and Beta = 0.14, p < 0.001 respectively), while no significant association was found between prediabetes and PWV/GLS. Increasing values of HbA1c and fP-glucose were significantly associated with higher values of PWV/GLS (Beta = 0.01,p < 0.001 and Beta = 0.07,p < 0.001, respectively) signaling worse VAC. In participants without prevalent DM, higher HbA1c levels were linked to increased PWV/GLS in the age- and sex-adjusted model; however, this association was attenuated after further adjustment for additional confounders. Conversely, fP-glucose remained significantly associated with elevated PWV/GLS across all adjusted models.

This study demonstrates a significant association between DM and impaired VAC, as reflected by elevated PWV/GLS, while no such link was observed in prediabetes. The transition from prediabetes to DM appears critical for VAC deterioration. Additionally, higher HbA1c and fP-glucose levels, even in non-diabetic individuals, were associated with worsened VAC, highlighting the impact of glycemic control on vascular function.

This study evaluated the feasibility of HeartAssist, a novel automated tool designed for classification of fetal cardiac views, annotation of cardiac structures, and measurement of cardiac parameters. Unlike previous AI tools that primarily focused on classification, HeartAssist integrates classification, annotation and measurement capabilities, enabling a more comprehensive fetal cardiac assessment.Cardiac images from fetuses (gestational ages 20-40 weeks) were collected at Asan Medical Center between January 2016 and October 2018. HeartAssist was developed using convolutional neural networks to classify 10 cardiac views, annotate 26 structures, and measure 43 parameters. One expert performed manual classifications, annotations, and measurements, which were then compared to HeartAssist outputs to assess feasibility. A total of 65,324 images from 2,985 fetuses were analyzed. HeartAssist achieved 99.4% classification accuracy, with recall, precision, and F1-score of 0.93, 0.95, and 0.94, respectively. Annotation accuracy was 98.4%, while the automatic measurement success rate was 97.6%, with an error rate of 7.62% and caliper similarity of 0.613. HeartAssist is a reliable tool for fetal cardiac screening, demonstrating high accuracy in classifying cardiac views and annotating structures, with comparable outcomes in measuring cardiac parameters. This tool could enhance prenatal detection of congenital heart disease and improve perinatal outcomes.

This cross-sectional observational study investigated undetermined cardiac remodeling and functional adaptation in young tennis players. Fourteen males with regular tennis training (at least three times a week, mean playing age 8.3 ± 3.8 years, tennis group, tennis) and 12 males without any racket sports engagement (the control group, [CTL]) underwent comprehensive cardiac measurements using real-time three-dimensional echocardiography, recording of baseline characteristics, blood tests, and estimation of VO2 max by 12-min running. Data were analyzed to compare the two groups. Two groups were of similar age (mean age, CTL 20.9 ± 2.4 vs. tennis 22.5 ± 4.4 years, P = 0.235) and with similar body size. Compared with the CTL, Tennis group had slower pulse rate (70.9 ± 7.0/min vs. CTL 85.5 ± 9.6/min, P < 0.001), greater VO2 max (43.4 ± 3.8 mL/Kg/min vs. CTL 33.1 ± 4.8 mL/Kg/min, P < 0.001), but similar blood levels of hematocrit, NT-pro-brain natriuretic peptide, and creatinine phosphokinase. The tennis group had greater left ventricle posterior wall thickness (0.90 ± 0.06 cm vs. CTL 0.81 ± 0.10 cm, P < 0.001), greater right ventricle (RV) volume index (77.8 ± 9.6 mL vs. CTL 64.9 ± 10.1 mL, P = 0.003), and greater left atrial volume index (26.9 ± 5.5 mL/m2 vs. CTL 21.9 ± 2.7 mL/m2, P = 0.006). The tennis group had significantly increased RV strain (free wall strain, -26.5 ± 3.7% vs. CTL -23.3 ±2.8%, P = 0.025). However, the global longitudinal strains in the left atrium and left ventricle were similar between the two groups. Cardiac remodeling in young tennis players includes right ventricular dilatation with enhanced dynamic function, an enlarged left atrium with well-preserved function, and a predominant posterior wall thickening of the left ventricle.

Atrial functional tricuspid regurgitation (AFTR) is increasingly recognized as a distinct cause of tricuspid regurgitation, yet data on outcomes and their determinants are limited. This study examines the prognostic role of right atrial (RA) remodelling in patients with severe AFTR.

This retrospective study included consecutive patients with severe AFTR. The primary outcome was all-cause mortality. Cutoff values for RA and right ventricular (RV) sizes related to mortality were identified using receiver operating characteristic curves and maximally selected rank statistics. The cohort included 155 patients with severe AFTR, 96.1% of whom had atrial fibrillation. Of these, 121 received medical treatment, and 34 underwent surgery during follow-up. In the medical management group, 42 deaths (34.7%) occurred over a median of 3.3 years. Patients with high RV end-diastolic area and RA area indices (>14.5 cm2/m2 and >22 cm2/m2) had significantly lower survival compared to their counterparts (P = 0.012 and P = 0.001, respectively). Cox analyses demonstrated that increased RV end-diastolic area and RA area indices were associated with higher mortality (RV end-diastolic area index, per 1 cm2/m2 increase: adjusted hazard ratio 1.11, 95% confidence interval 1.02-1.22, P = 0.019; RA area index, per 1 cm2/m2 increase: adjusted hazard ratio 1.06, 95% confidence interval 1.02-1.10, P = 0.006). Mortality was highest in patients with both high RV end-diastolic area index (>14.5 cm2/m2) and RA area index (>22 cm2/m2) and lowest in those with low values for both indices (P = 0.001). In the surgical intervention group, four post-surgical deaths (11.8%) occurred exclusively in patients with both high RA area and RV end-diastolic area indices.

RA and RV enlargement are poor prognostic factors in patients with severe AFTR. These findings underscore the importance of assessing RA and RV remodelling to optimize the timing of intervention in this population.

The efficacy of catheter ablation in reducing major adverse events in atrial fibrillation (AF) is still inconclusive, warranting identification of clinical markers.

To explore whether the benefit from catheter ablation varied across different extent of atrial remodeling in CABANA trial.

The CABANA trial randomized 2204 participants with AF to catheter ablation or drug therapy. Patients underwent echocardiography measurement for left atrial diameter (LAD) at baseline constituted the current analysis population. The primary outcome was composite of death, disabling stroke, serious bleeding, or cardiac arrest.

Of 1130 patients with documented LAD at baseline (median LAD:44 mm), 570 were randomized to ablation and 560 to drug therapy. The estimated benefits of ablation versus drug therapy on primary outcome and total mortality were strongest in the lowest end of the LAD spectrum and declined substantially with LAD increasing. For primary outcome, the adjusted hazard ratios (aHRs) were 0.30 (95% CI, 0.11-0.78) in patients without LA enlargement (LAD≤40mm) and 0.92 (95% CI, 0.55-1.54) in those with LA enlargement (LAD>40mm) (Interaction P value= 0.035). The corresponding aHRs for total mortality were 0.09 (95% CI, 0.01-0.58) and 0.76 (95% CI, 0.40-1.41) in subgroups without and with LA enlargement (Interaction P value = 0.045).

Among CABANA patients without atrial enlargement, catheter ablation significantly reduced major cardiovascular events, while the prognostic benefit of ablation attenuated with atrial remodeling aggravation. Ablation at initial stage of atrial remodeling provided an effective early rhythm control strategy to reduce cardiovascular risk in AF.

The use of intracardiac echocardiography (ICE) has been well established for use in catheter ablation of arrhythmias and offers direct visualization of atrial septum and left-sided structures in adults. There, however, is a dearth of data in the pediatric population. The primary objective of this study was to determine the outcomes of left-sided accessory pathway catheter ablation in children and young adults where ICE was used in addition to 3-dimensional (3D)/traditional mapping and to compare outcomes in catheter ablations where only traditional fluoroscopy was used in addition to 3D/traditional mapping. The results of this study showed that the use of ICE showed no significant differences in major adverse events when compared to traditional fluoroscopy. In conclusion, ICE is an effective and safe modality to use in left-sided accessory pathway ablation in pediatric populations, but further large-scale studies and cost-benefit analysis are needed to determine its practical usage compared to traditional fluoroscopy.

Infective Endocarditis (IE) is a severe and potentially life-threatening infection of the heart valves, necessitating a comprehensive understanding of factors influencing patient outcomes.

The study aims to investigate the relationship between NPS and in-hospital mortality in patients diagnosed with Infective Endocarditis (IE).

A total of 153 IE patients were included in the study, with 32 (20,9%) experiencing in-hospital mortality. Patients were categorised into survivors and non-survivors, and detailed clinical and demographic characteristics were recorded. The final endpoint of the study was determined as in-hospital mortality. Regression analyses were conducted to identify the independent variables, and Kaplan-Meier estimates were created to determine survival outcomes, using a significance level of p < 0.05 for all statistical analyses.

The non-survivor group exhibited a significantly higher NPS compared to the survivor group (28 (87.5) vs. 56 (46.3); p < 0.001). ROC curve analysis, utilising NPS, the neutrophil-to-lymphocyte ratio (NLR), the lymphocyte-to-monocyte ratio (LMR), albumin, and total cholesterol values, identified NPS as the most robust parameter, with an area under the curve of 0.704 (95% CI: 0.612-0.797; p < 0.001). Multivariate regression analysis revealed Septic shock (p = 0.001), NPS (p = 0.004), and Age (p = 0.012) as independent determinants of in-hospital mortality in IE patients.

This study demonstrated a strong correlation between NPS and mortality in IE. This novel score, as it reflects both the level of inflammation and nutrition, can be used to predict the prognosis in IE.

The relationship of left atrial (LA) strain with cognition in the absence of atrial fibrillation is poorly understood. We investigated the association of LA strain with cognitive impairment and its pathogenetic subtype (vascular [VCI] or neurodegenerative) and underlying mechanisms via associations with circulating and neuroimaging markers of cerebrovascular disease.

LA strain (reservoir, conduit [LAScd], contractile) was determined using speckle-tracking echocardiography in a prospective memory clinic cohort with brain magnetic resonance imaging, neuropsychological assessments, and circulating biomarker measurements. Cognitive impairment was classified as VCI or neurodegenerative in the presence or absence of significant cerebrovascular disease, respectively. Among 251 subjects (age 75±8 years, 59% women) without atrial fibrillation, 178 (71%) had cognitive impairment (20% mild, 14% moderate, 37% dementia); of these impairments, 58% were VCI and 42% neurodegenerative. Only LAScd was associated with more severe cognitive impairment (moderate/dementia versus none/mild, adjusted odds ratio [aOR] for lowest versus highest tertile >2) and specifically, with worse Mini-Mental State Examination score and memory on neuropsychological testing. LAScd was independently associated with VCI (versus neurodegenerative; aOR for lowest versus highest tertile, 4.22 [95% CI, 1.59-11.2]) and not with neurodegenerative markers (circulating pTau-181 [phosphorylated tau-181], isolated lobar cerebral microbleeds). Both LAScd and LA reservoir strain were associated with increased burden of cerebral small vessel disease on magnetic resonance imaging, but only LAScd correlated with circulating biomarkers, reflecting inflammation, neurotrophic processes, and neuronal damage.

Reduced LA strain was associated with cognitive impairment, primarily of vascular origin, and a higher burden of cerebral small vessel disease. LAScd may be a biomarker of VCI in at-risk subjects without atrial fibrillation.