<div style="text-align:justify;"> <strong>Introduction</strong><span "=""><span>: Ventricular non-compaction, a cardiomyopathy recently described as likely to be ...<div style="text-align:justify;"> <strong>Introduction</strong><span "=""><span>: Ventricular non-compaction, a cardiomyopathy recently described as likely to be rare, belongs to the group of unclassified cardiomyopathy according to European Society of Cardiology. Few studies have been published on the ventricular non-compaction in sub-Saharan Africa. We aim to find out the various aspects, being diagnosis, therapeutic, in Togolese patients carrying the ventricular non-compaction. </span><b><span>Methodology</span></b><span>: This is a three</span></span><span>-</span><span>year</span><span> </span><span "=""><span>prospective and descriptive study conducted from January 2017 to December 2019 in the two University Hospital of Lomé. Patients having echocardiographic criteria of ventricular non-compaction were included in our study. </span><b><span>Results</span></b><span>: 10 patients (6 men and 4 women) were diagnosed for ventricular non-compaction during the study period. The mean age of patients was 32.3 years. The most frequent clinical manifestation was heart failure (7 patients). The main electrocardiogram anomaly was left ventricle hypertrophy (9 patients). The preferential segments were: apical (9 cases), apicolateral (8 cases), and septoapical (7 cases). The average ratio of non-compaction/compaction was 3.31. The main complication was thromboembolic event (4 patients). Angiotensin converting enzyme inhibitors and beta-blockers were essentially the medicines used. After a three (3) year follow-up, two (2) of the patients died. </span><b><span>Conclusion</span></b><span>: Tough ventricular non-compaction has been recently described</span></span><span>.</span><span> It is present in Togo. It displays many clinical manifestations and the prognosis is often guarded.</span> </div>展开更多
INTRODUCTION Isolated ventricular non-compaction is a rare congenital cardiomyopathy occurs due to arrest of normal myocardial development during embryogenesis. It is mainly diagnosed by echocar- diography through the...INTRODUCTION Isolated ventricular non-compaction is a rare congenital cardiomyopathy occurs due to arrest of normal myocardial development during embryogenesis. It is mainly diagnosed by echocar- diography through the appearance of characteristic prominent myocardial trabeculation and deep inter-trabecular spaces. Heart failore,展开更多
Left atrialmyxoma is a common primary cardiac tumor that is accompanied by organic heart diseases.But left atrial myxoma coexistent with left ventricular non-compaction(LVNC)is extremely rare.A young male patient with...Left atrialmyxoma is a common primary cardiac tumor that is accompanied by organic heart diseases.But left atrial myxoma coexistent with left ventricular non-compaction(LVNC)is extremely rare.A young male patient with left atrial myxoma and LVNC was reported in this study.A 25-year-old manpresented to the emergency department with sudden shortness of breath and syncope,accompanied by fever and cough.He had a history ofacute ischemic strokeone year before hospitalization.Echocardiography revealed that the endocardium of the left ventricle was not smooth with raised muscle trabeculae and deep recesses.There was an oval-shaped strong echo mass with a pedicle in the left atrium attached to the atrial septum.Tumor resection was operated during extracorporeal circulation.Pathological results confirmed left atrium myxoma.In this case report,the patient had heart failure and an ischemic stroke likely of cardiogenic origin.He underwenttumor resection and started on therapeutic anticoagulation.Left atrial myxoma and LVNC are associated with poor outcomes.Early diagnosis and prompt treatment are crucial.展开更多
A 39-year-old male with no known comorbidities presented with sudden onset right-sided weakness.On examination,blood pressure was 128/79 mmHg,National Institutes of Health Stroke Scale score was 4 and there were no si...A 39-year-old male with no known comorbidities presented with sudden onset right-sided weakness.On examination,blood pressure was 128/79 mmHg,National Institutes of Health Stroke Scale score was 4 and there were no signs of heart failure.Emergent computerized tomography demonstrated an ischemic infarct of the left middle cerebral artery distribution and brain magnetic resonance imaging later confirmed it(Figure 1).展开更多
Isolated left ventricular non-compaction is recently described as a rare form of cardiomyopathy that is associated with a heart failure, life threatening cardiac arrhythmia and thromboembolic complications. The diagno...Isolated left ventricular non-compaction is recently described as a rare form of cardiomyopathy that is associated with a heart failure, life threatening cardiac arrhythmia and thromboembolic complications. The diagnosis is based on echocardiography demonstration of spongy myocardium. Here we report a case of 74 years old female patient diagnosed as an isolated left ventricular non-compaction with congestive heart failure, intramural thrombus and hypertension. There is no specific treatment for LVNC;therapeutic measures are directed towards the patient’s symptom (heart failure, arrhythmia and thrombotic events) and consideration of an implantable cardioverter defibrillator and cardiac transplantation.展开更多
Hypertrophic cardiomyopathy(HCM)is a genetically determined myocardial disease characterized by an increased thickness of the left ventricle(LV)wall that cannot be solely attributed to abnormal loading conditions.HCM ...Hypertrophic cardiomyopathy(HCM)is a genetically determined myocardial disease characterized by an increased thickness of the left ventricle(LV)wall that cannot be solely attributed to abnormal loading conditions.HCM may present with an intraventricular or LV outflow tract obstruction,diastolic dysfunction,myocardial fibrosis and/or ventricular arrhythmias.Differentiating HCM from other diseases associated with LV hypertrophy,such as hypertension,aortic stenosis,or LV non-compaction(LVNC),can at times be challenging.LVNC is defined by excessive LV trabeculation and deep recesses between trabeculae,often accompanied by increased LV myocardial mass.Previous studies indicate that the LVNC phenotype may be observed in up to 5%of the general population;however,in most cases,it is a benign finding with no impact on clinical outcomes.Nevertheless,LVNC can occasionally lead to LV systolic dysfunction,manifesting as a phenotype of dilated or non-dilated left ventricular cardiomyopathy,with an increased risk of thrombus formation and arterial embolism.In extreme cases,where LVNC is associated with a very thickened LV wall,it can even mimic HCM.There is growing evidence of an overlap between HCM and LVNC,including similar genetic mutations and clinical presentations.This raises the question of whether HCM and LVNC represent different phenotypes of the same disease or are,in fact,two distinct entities.展开更多
Importance:Pathogenic variants in theRBM20 gene are associated with aggressive dilated cardiomyopathy(DCM).Recently,RBM20 was found to be associated with left ventricular non-compaction cardiomyopathy(LVNC).Thus far,o...Importance:Pathogenic variants in theRBM20 gene are associated with aggressive dilated cardiomyopathy(DCM).Recently,RBM20 was found to be associated with left ventricular non-compaction cardiomyopathy(LVNC).Thus far,only five families with LVNC have been reported to carry variants inRBM20.It remains unknown whether the variants inRBM20 associated with DCM can also cause LVNC.Objective:To elucidate the causativeRBM20 variant in two unrelated patients with both LVNC and DCM,and to identify the clinical characteristics associated with variants inRBM20.Methods:Trio whole-exome sequencing(WES)was performed.Variants were filtered and classified in accordance with the guidelines of the American College of Medical Genetics and Genomics(ACMG).Results:We identified two distinctde novo variants inRBM20(one per patient)in these two patients with LVNC.Both variants have been reported in patients with DCM,without the LVNC phenotype.Patient 1 was an 11-year-old girl who had DCM,LVNC,and heart failure;the ratio of noncompacted-to-compacted myocardium was 2.7:1.Ade novo heterozygous variant c.1907G>A(p.Arg636His)in exon 9 was identified in this patient.Patient 2 was a 13-year-old boy who had clinical phenotypes identical to those of Patient 1;the ratio of noncompacted-to-compacted myocardium was 3.2:1 in this patient.WES revealed ade novo heterozygous variant c.1909A>G(p.Ser637Gly)in exon 9.Both variants were previously characterized as pathogenic,and our study classified them as pathogenic variants based on the ACMG guidelines.Interpretation:We found that two patients with LVNC had variants inRBM20.Our results extended the clinical spectrum of the twoRBM20 variants and illustrated that the same variant inRBM20 can cause DCM,with or without the LVNC phenotype.展开更多
Cardiomyopathies are among the most prevalent causes of premature death in the Western world.A significant amount of cardiomyopathies has a genetic etiology.Currently,mutations in more than 170 genes associated with d...Cardiomyopathies are among the most prevalent causes of premature death in the Western world.A significant amount of cardiomyopathies has a genetic etiology.Currently,mutations in more than 170 genes associated with different cardiomyopathies,channelopathies,or syndromes with cardiac involvement are described.展开更多
Non-compaction cardiomyopathy is a rare form of cardiomyopathy;its most common clinical manifestations are heart failure (HF), ventricular arrhythmia, thromboembolism, and sudden cardiac death. We report a rare case o...Non-compaction cardiomyopathy is a rare form of cardiomyopathy;its most common clinical manifestations are heart failure (HF), ventricular arrhythmia, thromboembolism, and sudden cardiac death. We report a rare case of a 63-year-old man with chest tightness, worsening lower leg edema, dyspnea, and decreased exercise tolerance. He had a medical history of gastric cancer treated with subtotal gastrectomy and post-operative chemotherapy with paclitaxel and fluorouracil three years ago. At that time, he was diagnosed with non-compaction cardiomyopathy, and the thickened and reticulated trabecular muscle was exclusively confined to left ventricular apex. Five months ago, he was admitted to our hospital with heart failure and treated for dilated cardiomyopathy, echocardiography revealed severe trabecular noncompact myocardium in both ventricles, which was confirmed by cardiac magnetic resonance imaging (CMR). It is generally accepted that non-compacted myocardium forms in the early embryonic stage, which raises a question in our case whether acquired factors, such as antineoplastic drugs, potentially accelerate the pathological progression of non-compaction cardiomyopathy. Considering there are disparities between current screening tools such as echocardiography and CMR regarding diagnostic criteria, multi-detector CT may be an alternative examination method that could provide a new perspective for diagnosis.展开更多
Arrhythmogenic right ventricular cardiomyopathy(ARVC)is a progressive disease characterized by adipose and fibrous replacement of the myocardium.While elevated testosterone levels have been implicated in the pathologi...Arrhythmogenic right ventricular cardiomyopathy(ARVC)is a progressive disease characterized by adipose and fibrous replacement of the myocardium.While elevated testosterone levels have been implicated in the pathological process of ARVC,its exact contribution to cardiac fibrosis in ARVC remains unclear.In this study,we analyzed the potential contribution of gender-based differences on the distribution of the low-voltage area in an ARVC cohort undergoing an electrophysiological study,which was indicated by feature selection.Additionally,we established engineered cardiac spheroid models in vitro using patient-specific induced pluripotent stem cell(iPSC)-derived cardiomyocytes(iPSC-CMs)and iPSC-derived cardiac fibroblasts(icFBs).We elucidated the pathogenicity of abnormal splicing in the plakophilin-2(PKP2)gene caused by an intronic mutation.Additionally,pathogenic validation of the desmoglein-2(DSG2)point mutation further confirms the reliability of the models.Moreover,testosterone exacerbated the DNA damage in the mutated cardiomyocytes and further activated myofibroblasts in a chain reaction.In conclusion,we designed and constructed an in vitro three-dimensionally-engineered cardiac spheroid model of ARVC based on clinical findings and provided direct evidence of the fibrotic role of testosterone in ARVC.展开更多
Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricl...Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricle(RV)is also affected by diabetes and may be independently responsible for adverse outcomes in diabetic patients with or without LV failure.Yu et al conducted a 30-week longitudinal evaluation of biventricular function and pathology in OVE26 diabetic mice and revealed early diastolic dysfunction preceding systolic decline,suggesting that early LV diastolic impairment precedes the later onset of systolic dysfunction.With age,the animals developed fibrosis,hypertrophy,and pulmonary arterial hypertension in the RV.The purpose of this editorial is to contextualize these findings within the existing literature by highlighting the interplay between cardiac chambers and the vasculature.We also seek to reiterate that DCM is a condition extending beyond left ventricular dysfunction.As the authors note,the right side of the heart may remain"the forgotten ventricle"in diabetic patients.We hope that the mechanisms discussed in this paper will help researchers to understand the pathogenesis of cardiovascular disease in this context and encourage clinicians to be more attentive to the associated clinical symptoms.展开更多
This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,e...This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,emphasizing innovative strategies like bioabsorbable occluders and tissue engineering to reduce complications and improve prognosis.The integration of artificial intelligence and big data analytics for treatment decision-making and personalized surgical timing models is highlighted as transformative.Our analysis underscores the need for early diagnosis and tailored interventions,proposing future research directions in molecular mechanisms,multidisciplinary collaboration,and technology integration.These innovations promise to enhance VSR management and extend to other cardiovascular diseases,heralding a new era of precision and regenerative cardiovascular medicine.展开更多
Background:Although Cone reconstruction has been shown to improve biventricular functionover time,postoperative right ventricular dysfunction(RVD)is frequently observed,signiffcantly affectingreoperation and long-term...Background:Although Cone reconstruction has been shown to improve biventricular functionover time,postoperative right ventricular dysfunction(RVD)is frequently observed,signiffcantly affectingreoperation and long-term prognosis.This study aims to identify the predictors for postoperative RVD.Methods:This retrospective cohort study included 51 patients with Ebstein’s anomaly who underwentthe Cone reconstruction.RVD was deffned as right ventricular fractional area change(RV-FAC)lessthan 35%and tricuspid annular plane systolic excursion(TAPSE)less than 17 mm through pre-dischargeechocardiography.Univariate and multivariate analyses were used to analyze the pre-operative predictors.Results:The median age at surgery was 37.7(±15.3)years,RVD was documented in 25 patients(49%)of the51 patients.Patients with RVD had signiffcantly higher right ventricular end-systolic volume index(RVESVi)(p=0.001),right ventricular end-diastolic volume index(RVEDVi)(p=0.03),and septal leaffet displacement(p=0.003).Multivariate analysis conffrmed that septal leaffet displacement was independently associatedwith postoperative RVD(p=0.02).Additionally,RVD was not related to the cardiopulmonary bypass time,ICU stay and total hospital time.Conclusions:This study suggests that preoperative right ventricularejection fraction(RVEF)reduction,severe septal leaffet displacement and signiffcant right ventriculardilatation are key predictors of early postoperative RVD.RVD may exacerbate tricuspid regurgitation,andthis ffnding indicates that predicting RVD may aid in identifying high-risk patients prone to recurrence oftricuspid regurgitation after Cone reconstruction.展开更多
Right ventricular(RV)failure accounts for significant morbidity and mortality in critically ill patients.The RV is particularly vulnerable in conditions characterized by elevated pulmonary vascular afterload,which are...Right ventricular(RV)failure accounts for significant morbidity and mortality in critically ill patients.The RV is particularly vulnerable in conditions characterized by elevated pulmonary vascular afterload,which are commonly encountered in the intensive care unit(ICU).Conditions such as acute respiratory distress syndrome,pulmonary embolism,and decompensated pulmonary arterial hypertension are associated with acute and acute-on-chronic RV failure.In the ICU,RV failure may develop or worsen in patients with parenchymal pulmonary disease who acutely experience fluctuations in preload,excessive afterload,and/or insufficient myocardial contractility,often in addition to mechanical ventilation and circulatory compromise.This dynamic clinical scenario demands early recognition and intervention tailored to an individual patient’s physiology.Distinguishing between acute and chronic RV failure in critical illness informs diagnostic workup,hemodynamic monitoring,and resuscitative efforts.This narrative review will provide an overview of common conditions associated with RV failure in critical illness,highlighting a practical,physiology-oriented approach to diagnosis and optimization of ventilator support,fluid resuscitation,vasopressor and inotrope use,and mechanical circulatory support.RV failure due to RV infarction or severe LV failure and decompensated congenital heart disease are distinct pathophysiologic entities.These conditions require distinct treatment approaches and are beyond the scope of this review.展开更多
BACKGROUND Right ventricular hypertrophy(RVH)occurs because of volume or pressure overload within the right ventricular(RV)system.RVH is associated with complex pathological changes,including myocardial cell injury,ap...BACKGROUND Right ventricular hypertrophy(RVH)occurs because of volume or pressure overload within the right ventricular(RV)system.RVH is associated with complex pathological changes,including myocardial cell injury,apoptosis,myocardial fibrosis,neuroendocrine disturbances,and abnormal water and liquid metabolism.Ferroptosis,a novel type of iron-dependent cell death characterized by lipid peroxide accumulation,is an important mechanism of cardiomyocyte death.However,the role of ferroptosis in RVH has rarely been studied.We hypothesize that hydrogen(H_(2)),an experimental medical gas with superior distri-bution characteristics,inhibits ferroptosis.AIM To explore the protective effect of H_(2) on RVH and the mechanism by which H_(2) regulates ferroptosis.METHODS An in vivo RVH rat model was induced by monocrotaline(MCT)in 30 male Sprague-Dawley rats.An H9C2 cell model was treated with angiotensin II to simulate pressure overload in the RV system in vitro.H_(2) was administered to rats by inhalation(2%for 3 hours daily for 21 days)and added to the cell culture medium.The Nrf2 inhibitor ML385(1μM)was used to investigate anti-ferroptotic mechanisms.RESULTS In MCT-treated rats,H_(2) inhalation decreased RVH;the RV wall thickness decreased from 3.5±0.3 mm to 2.8±0.2 mm(P<0.05)and the RV ejection fraction increased from 45±3%to 52±4%(P<0.05).In H9C2 cells,H_(2) alleviated hypertrophy.H_(2) inhibited ferroptosis by modulating the iron content,oxidative stress,and ferroptosis-related proteins,thereby restoring the Nrf2/HO-1 signaling pathway.CONCLUSION H_(2) retards RVH by inhibiting ferroptosis via Nrf2/HO-1 restoration,suggesting a new treatment strategy.展开更多
BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exa...BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exact relationship between depression and cardiac remodeling and left ventricular functional changes remains incompletely understood.This study sets out to explore,with a clinically grounded perspective,how depressive states may subtly or profoundly influence the trajectory of cardiac remodeling and the functional dynamics of the left ventricle in individuals grappling with CHF.Beyond mere observation,it also aims to untangle the underlying physiological or neurohormonal pathways that might bridge emotional distress and cardiac dysfunction.AIM To delve into how depressive symptoms might shape the progression of cardiac remodeling and impair left ventricular function among individuals living with CHF.Particular attention is given to the role of inflammatory signaling and disruptions in neuroendocrine balance as possible mediating factors.By examining these intertwined physiological and psychological processes,the study seeks to shed light on the reciprocal link between emotional distress and CHF,offering insights that may inform more precise,mechanism-based treatment strategies.METHODS In this retrospective clinical trial,248 patients diagnosed with CHF were analyzed in the tertiary treatment center between January 2018 and December 2022.According to Hamilton's Depression Scale score,participants were classified into two cohort of depression(score 17)and no significant depression characteristics(score 17).Cardiac morphology and functional parameters were assessed using a combination of hyperechocardiocardiocardiography,heart magnetic resonance,and associated blood biomarkers.RESULTS The results of this study underscore the significant effects that depression can have on both the structure and function of the heart in patients with CHF.In particular,the individuals in the cohort with depression were 42.3%±6.7%of the individuals without depression vs 51.6%±5.9%,P<0.01)In comparison,the left ventricular ejection fraction,an important measure of contractional performance,was significantly reduced,underlining the harmful physiological interaction between mood disorders and cardiac efficiency.The measurement of the left ventricular end-diastolic diameter showed a significant expansion of the ventricular envelope in the depression group(68.2±7.5 mm vs 59.6±6.3 mm,P<0.01).Inflammatory markers,including high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α),were significantly elevated in the depressed group(hs-CRP:8.7±2.3 mg/L vs 4.5±1.6 mg/L;TNF-α:42.5±7.6 pg/mL vs 28.3±5.4 pg/mL).Both B-type natriuretic peptide(1256±345 pg/mL vs 756±234 pg/mL)and angiotensin II(86.4±15.7 ng/mL vs 62.5±12.3 ng/mL)levels were significantly higher in the depressed group.CONCLUSION Among people with CHF,the presence of depressive symptoms appears to be closely related to pronounced changes in heart structure and impaired functional abilities.It is likely that depressive states contribute to the progress of heart reform and deterioration of left stomach function,possibly due to increased inflammatory cascades and increased activation of neuroendocrine regulatory pathways.展开更多
BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and he...BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.展开更多
This narrative review examines the use of imaging biomarkers for diagnosing and monitoring hydrocephalus from birth through childhood.Early detection and longitudinal follow-up are essential for guiding timely interve...This narrative review examines the use of imaging biomarkers for diagnosing and monitoring hydrocephalus from birth through childhood.Early detection and longitudinal follow-up are essential for guiding timely interventions and asse-ssing treatment outcomes.Cranial ultrasound and magnetic resonance imaging(MRI)are the primary imaging modalities,providing critical insights into ventri-cular size,cerebrospinal fluid dynamics,and neurodevelopmental implications.Key parameters,including Evans’index,Levene’s index,and the Cella Media index,as well as volumetric and diffusion-based MRI techniques,have been explored for their diagnostic and prognostic value.Advances in automated image analysis and artificial intelligence have further improved measurement precision and reproducibility.Despite these developments,challenges remain in standar-dizing imaging protocols and establishing normative reference values across different pediatric populations.This review highlights the strengths and limita-tions of current imaging approaches,emphasizing the need for consistent metho-dologies to enhance diagnostic accuracy and optimize patient management in hydrocephalus.展开更多
BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systo...BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systolic dysfunction(LVSD).In patients with type 2 diabetes(DM2)albuminuria is a predictor of symptomatic heart failure,but data on the relationship between GLS and albuminuria are conflicting.AIM To explore the relationship between GLS and albuminuria in a contemporary cohort of DM2 patients.METHODS The study was performed on DM2 patients consecutively enrolled in the TESEO study.Patients with symptoms/signs of heart failure,EF<50%,coronary artery,other cardiac diseases,or non-adequate acoustic window for GLS assessment were excluded.We collected clinical data,screened for complications,and measured GLS by speckle-tracking echocardiography.Univariate and multiple linear regression analyses were performed to identify independent explanatory variables associated with GLS.Logistic regression analysis was used to assess whether albuminuria was independently associated with GLS-diagnosed(GLS>-18%)LVSD.RESULTS Patients(n=193,age:60.6±8.1,male:57%)had a short DM2 duration(3.8±4.9 years)and good metabolic control(glycated haemoglobin A1c:6.5%±1.0).Preclinical GLS-LVSD was present in 21.8%of the patients.GLS values were significantly higher in patients with albuminuria(-19.88±2.16 vs-18.29±2.99,P<0.001)and in multivariate analysis natural logarithm of albumin-creatinine ratio and uric acid were independent predictors of GLS.In logistic regression analysis,albuminuria was associated with a 6.01(95%confidence interval:1.874-19.286)increased odds ratio of GLS-LVSD,independent of age,sex,diastolic blood pressure,chronic kidney disease,EF,mitral annulus velocity lateral,uric acid,and treatments.CONCLUSION Albuminuria was independently associated with subclinical LVSD in our contemporary cohort of DM2 patients.展开更多
Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complica...Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.展开更多
文摘<div style="text-align:justify;"> <strong>Introduction</strong><span "=""><span>: Ventricular non-compaction, a cardiomyopathy recently described as likely to be rare, belongs to the group of unclassified cardiomyopathy according to European Society of Cardiology. Few studies have been published on the ventricular non-compaction in sub-Saharan Africa. We aim to find out the various aspects, being diagnosis, therapeutic, in Togolese patients carrying the ventricular non-compaction. </span><b><span>Methodology</span></b><span>: This is a three</span></span><span>-</span><span>year</span><span> </span><span "=""><span>prospective and descriptive study conducted from January 2017 to December 2019 in the two University Hospital of Lomé. Patients having echocardiographic criteria of ventricular non-compaction were included in our study. </span><b><span>Results</span></b><span>: 10 patients (6 men and 4 women) were diagnosed for ventricular non-compaction during the study period. The mean age of patients was 32.3 years. The most frequent clinical manifestation was heart failure (7 patients). The main electrocardiogram anomaly was left ventricle hypertrophy (9 patients). The preferential segments were: apical (9 cases), apicolateral (8 cases), and septoapical (7 cases). The average ratio of non-compaction/compaction was 3.31. The main complication was thromboembolic event (4 patients). Angiotensin converting enzyme inhibitors and beta-blockers were essentially the medicines used. After a three (3) year follow-up, two (2) of the patients died. </span><b><span>Conclusion</span></b><span>: Tough ventricular non-compaction has been recently described</span></span><span>.</span><span> It is present in Togo. It displays many clinical manifestations and the prognosis is often guarded.</span> </div>
文摘INTRODUCTION Isolated ventricular non-compaction is a rare congenital cardiomyopathy occurs due to arrest of normal myocardial development during embryogenesis. It is mainly diagnosed by echocar- diography through the appearance of characteristic prominent myocardial trabeculation and deep inter-trabecular spaces. Heart failore,
基金supported by Research on Guangdong Provincial Science and Technology Innovation Strategy Special Project in 2022(Grant nos.Shantou Government Technology[2022]124-1)。
文摘Left atrialmyxoma is a common primary cardiac tumor that is accompanied by organic heart diseases.But left atrial myxoma coexistent with left ventricular non-compaction(LVNC)is extremely rare.A young male patient with left atrial myxoma and LVNC was reported in this study.A 25-year-old manpresented to the emergency department with sudden shortness of breath and syncope,accompanied by fever and cough.He had a history ofacute ischemic strokeone year before hospitalization.Echocardiography revealed that the endocardium of the left ventricle was not smooth with raised muscle trabeculae and deep recesses.There was an oval-shaped strong echo mass with a pedicle in the left atrium attached to the atrial septum.Tumor resection was operated during extracorporeal circulation.Pathological results confirmed left atrium myxoma.In this case report,the patient had heart failure and an ischemic stroke likely of cardiogenic origin.He underwenttumor resection and started on therapeutic anticoagulation.Left atrial myxoma and LVNC are associated with poor outcomes.Early diagnosis and prompt treatment are crucial.
文摘A 39-year-old male with no known comorbidities presented with sudden onset right-sided weakness.On examination,blood pressure was 128/79 mmHg,National Institutes of Health Stroke Scale score was 4 and there were no signs of heart failure.Emergent computerized tomography demonstrated an ischemic infarct of the left middle cerebral artery distribution and brain magnetic resonance imaging later confirmed it(Figure 1).
文摘Isolated left ventricular non-compaction is recently described as a rare form of cardiomyopathy that is associated with a heart failure, life threatening cardiac arrhythmia and thromboembolic complications. The diagnosis is based on echocardiography demonstration of spongy myocardium. Here we report a case of 74 years old female patient diagnosed as an isolated left ventricular non-compaction with congestive heart failure, intramural thrombus and hypertension. There is no specific treatment for LVNC;therapeutic measures are directed towards the patient’s symptom (heart failure, arrhythmia and thrombotic events) and consideration of an implantable cardioverter defibrillator and cardiac transplantation.
基金Supported by The Department of Scientific Research and Structural Funds of Medical College,Jagiellonian University,No.N41/DBS/000594.
文摘Hypertrophic cardiomyopathy(HCM)is a genetically determined myocardial disease characterized by an increased thickness of the left ventricle(LV)wall that cannot be solely attributed to abnormal loading conditions.HCM may present with an intraventricular or LV outflow tract obstruction,diastolic dysfunction,myocardial fibrosis and/or ventricular arrhythmias.Differentiating HCM from other diseases associated with LV hypertrophy,such as hypertension,aortic stenosis,or LV non-compaction(LVNC),can at times be challenging.LVNC is defined by excessive LV trabeculation and deep recesses between trabeculae,often accompanied by increased LV myocardial mass.Previous studies indicate that the LVNC phenotype may be observed in up to 5%of the general population;however,in most cases,it is a benign finding with no impact on clinical outcomes.Nevertheless,LVNC can occasionally lead to LV systolic dysfunction,manifesting as a phenotype of dilated or non-dilated left ventricular cardiomyopathy,with an increased risk of thrombus formation and arterial embolism.In extreme cases,where LVNC is associated with a very thickened LV wall,it can even mimic HCM.There is growing evidence of an overlap between HCM and LVNC,including similar genetic mutations and clinical presentations.This raises the question of whether HCM and LVNC represent different phenotypes of the same disease or are,in fact,two distinct entities.
文摘Importance:Pathogenic variants in theRBM20 gene are associated with aggressive dilated cardiomyopathy(DCM).Recently,RBM20 was found to be associated with left ventricular non-compaction cardiomyopathy(LVNC).Thus far,only five families with LVNC have been reported to carry variants inRBM20.It remains unknown whether the variants inRBM20 associated with DCM can also cause LVNC.Objective:To elucidate the causativeRBM20 variant in two unrelated patients with both LVNC and DCM,and to identify the clinical characteristics associated with variants inRBM20.Methods:Trio whole-exome sequencing(WES)was performed.Variants were filtered and classified in accordance with the guidelines of the American College of Medical Genetics and Genomics(ACMG).Results:We identified two distinctde novo variants inRBM20(one per patient)in these two patients with LVNC.Both variants have been reported in patients with DCM,without the LVNC phenotype.Patient 1 was an 11-year-old girl who had DCM,LVNC,and heart failure;the ratio of noncompacted-to-compacted myocardium was 2.7:1.Ade novo heterozygous variant c.1907G>A(p.Arg636His)in exon 9 was identified in this patient.Patient 2 was a 13-year-old boy who had clinical phenotypes identical to those of Patient 1;the ratio of noncompacted-to-compacted myocardium was 3.2:1 in this patient.WES revealed ade novo heterozygous variant c.1909A>G(p.Ser637Gly)in exon 9.Both variants were previously characterized as pathogenic,and our study classified them as pathogenic variants based on the ACMG guidelines.Interpretation:We found that two patients with LVNC had variants inRBM20.Our results extended the clinical spectrum of the twoRBM20 variants and illustrated that the same variant inRBM20 can cause DCM,with or without the LVNC phenotype.
文摘Cardiomyopathies are among the most prevalent causes of premature death in the Western world.A significant amount of cardiomyopathies has a genetic etiology.Currently,mutations in more than 170 genes associated with different cardiomyopathies,channelopathies,or syndromes with cardiac involvement are described.
文摘Non-compaction cardiomyopathy is a rare form of cardiomyopathy;its most common clinical manifestations are heart failure (HF), ventricular arrhythmia, thromboembolism, and sudden cardiac death. We report a rare case of a 63-year-old man with chest tightness, worsening lower leg edema, dyspnea, and decreased exercise tolerance. He had a medical history of gastric cancer treated with subtotal gastrectomy and post-operative chemotherapy with paclitaxel and fluorouracil three years ago. At that time, he was diagnosed with non-compaction cardiomyopathy, and the thickened and reticulated trabecular muscle was exclusively confined to left ventricular apex. Five months ago, he was admitted to our hospital with heart failure and treated for dilated cardiomyopathy, echocardiography revealed severe trabecular noncompact myocardium in both ventricles, which was confirmed by cardiac magnetic resonance imaging (CMR). It is generally accepted that non-compacted myocardium forms in the early embryonic stage, which raises a question in our case whether acquired factors, such as antineoplastic drugs, potentially accelerate the pathological progression of non-compaction cardiomyopathy. Considering there are disparities between current screening tools such as echocardiography and CMR regarding diagnostic criteria, multi-detector CT may be an alternative examination method that could provide a new perspective for diagnosis.
基金supported by the National Natural Science Foundation of China(Nos.82370322 to CC,82200352 to FZ,82300352 to YZ,22275034 to HX,and 82070343 to MLC)the Natural Science Foundation of Jiangsu Province of China(Nos.BK20220710 to FZ and BK20230733 to YZ)Postgraduate Research&Practice Innovation Program of Jiangsu Province(No.JX13414086 to HYC).
文摘Arrhythmogenic right ventricular cardiomyopathy(ARVC)is a progressive disease characterized by adipose and fibrous replacement of the myocardium.While elevated testosterone levels have been implicated in the pathological process of ARVC,its exact contribution to cardiac fibrosis in ARVC remains unclear.In this study,we analyzed the potential contribution of gender-based differences on the distribution of the low-voltage area in an ARVC cohort undergoing an electrophysiological study,which was indicated by feature selection.Additionally,we established engineered cardiac spheroid models in vitro using patient-specific induced pluripotent stem cell(iPSC)-derived cardiomyocytes(iPSC-CMs)and iPSC-derived cardiac fibroblasts(icFBs).We elucidated the pathogenicity of abnormal splicing in the plakophilin-2(PKP2)gene caused by an intronic mutation.Additionally,pathogenic validation of the desmoglein-2(DSG2)point mutation further confirms the reliability of the models.Moreover,testosterone exacerbated the DNA damage in the mutated cardiomyocytes and further activated myofibroblasts in a chain reaction.In conclusion,we designed and constructed an in vitro three-dimensionally-engineered cardiac spheroid model of ARVC based on clinical findings and provided direct evidence of the fibrotic role of testosterone in ARVC.
文摘Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricle(RV)is also affected by diabetes and may be independently responsible for adverse outcomes in diabetic patients with or without LV failure.Yu et al conducted a 30-week longitudinal evaluation of biventricular function and pathology in OVE26 diabetic mice and revealed early diastolic dysfunction preceding systolic decline,suggesting that early LV diastolic impairment precedes the later onset of systolic dysfunction.With age,the animals developed fibrosis,hypertrophy,and pulmonary arterial hypertension in the RV.The purpose of this editorial is to contextualize these findings within the existing literature by highlighting the interplay between cardiac chambers and the vasculature.We also seek to reiterate that DCM is a condition extending beyond left ventricular dysfunction.As the authors note,the right side of the heart may remain"the forgotten ventricle"in diabetic patients.We hope that the mechanisms discussed in this paper will help researchers to understand the pathogenesis of cardiovascular disease in this context and encourage clinicians to be more attentive to the associated clinical symptoms.
基金Supported by Science and Technology Department of Yunnan Province-Kunming Medical University,Kunming Medical Joint Special Project-Surface Project,China,No.202401AY070001-164Yunnan Provincial Department of Science and Technology Science and Technology Plan Project—Major Science and Technology Special Projects,No.202405AJ310003.
文摘This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,emphasizing innovative strategies like bioabsorbable occluders and tissue engineering to reduce complications and improve prognosis.The integration of artificial intelligence and big data analytics for treatment decision-making and personalized surgical timing models is highlighted as transformative.Our analysis underscores the need for early diagnosis and tailored interventions,proposing future research directions in molecular mechanisms,multidisciplinary collaboration,and technology integration.These innovations promise to enhance VSR management and extend to other cardiovascular diseases,heralding a new era of precision and regenerative cardiovascular medicine.
基金funded by E Fund Congenital Heart Disease Medical Talent Cultivation and Education Fund(grant number[2023QT0009])the Science and Technology Planning Project of Guangdong Province(grant number[2023B03J1255]).
文摘Background:Although Cone reconstruction has been shown to improve biventricular functionover time,postoperative right ventricular dysfunction(RVD)is frequently observed,signiffcantly affectingreoperation and long-term prognosis.This study aims to identify the predictors for postoperative RVD.Methods:This retrospective cohort study included 51 patients with Ebstein’s anomaly who underwentthe Cone reconstruction.RVD was deffned as right ventricular fractional area change(RV-FAC)lessthan 35%and tricuspid annular plane systolic excursion(TAPSE)less than 17 mm through pre-dischargeechocardiography.Univariate and multivariate analyses were used to analyze the pre-operative predictors.Results:The median age at surgery was 37.7(±15.3)years,RVD was documented in 25 patients(49%)of the51 patients.Patients with RVD had signiffcantly higher right ventricular end-systolic volume index(RVESVi)(p=0.001),right ventricular end-diastolic volume index(RVEDVi)(p=0.03),and septal leaffet displacement(p=0.003).Multivariate analysis conffrmed that septal leaffet displacement was independently associatedwith postoperative RVD(p=0.02).Additionally,RVD was not related to the cardiopulmonary bypass time,ICU stay and total hospital time.Conclusions:This study suggests that preoperative right ventricularejection fraction(RVEF)reduction,severe septal leaffet displacement and signiffcant right ventriculardilatation are key predictors of early postoperative RVD.RVD may exacerbate tricuspid regurgitation,andthis ffnding indicates that predicting RVD may aid in identifying high-risk patients prone to recurrence oftricuspid regurgitation after Cone reconstruction.
文摘Right ventricular(RV)failure accounts for significant morbidity and mortality in critically ill patients.The RV is particularly vulnerable in conditions characterized by elevated pulmonary vascular afterload,which are commonly encountered in the intensive care unit(ICU).Conditions such as acute respiratory distress syndrome,pulmonary embolism,and decompensated pulmonary arterial hypertension are associated with acute and acute-on-chronic RV failure.In the ICU,RV failure may develop or worsen in patients with parenchymal pulmonary disease who acutely experience fluctuations in preload,excessive afterload,and/or insufficient myocardial contractility,often in addition to mechanical ventilation and circulatory compromise.This dynamic clinical scenario demands early recognition and intervention tailored to an individual patient’s physiology.Distinguishing between acute and chronic RV failure in critical illness informs diagnostic workup,hemodynamic monitoring,and resuscitative efforts.This narrative review will provide an overview of common conditions associated with RV failure in critical illness,highlighting a practical,physiology-oriented approach to diagnosis and optimization of ventilator support,fluid resuscitation,vasopressor and inotrope use,and mechanical circulatory support.RV failure due to RV infarction or severe LV failure and decompensated congenital heart disease are distinct pathophysiologic entities.These conditions require distinct treatment approaches and are beyond the scope of this review.
文摘BACKGROUND Right ventricular hypertrophy(RVH)occurs because of volume or pressure overload within the right ventricular(RV)system.RVH is associated with complex pathological changes,including myocardial cell injury,apoptosis,myocardial fibrosis,neuroendocrine disturbances,and abnormal water and liquid metabolism.Ferroptosis,a novel type of iron-dependent cell death characterized by lipid peroxide accumulation,is an important mechanism of cardiomyocyte death.However,the role of ferroptosis in RVH has rarely been studied.We hypothesize that hydrogen(H_(2)),an experimental medical gas with superior distri-bution characteristics,inhibits ferroptosis.AIM To explore the protective effect of H_(2) on RVH and the mechanism by which H_(2) regulates ferroptosis.METHODS An in vivo RVH rat model was induced by monocrotaline(MCT)in 30 male Sprague-Dawley rats.An H9C2 cell model was treated with angiotensin II to simulate pressure overload in the RV system in vitro.H_(2) was administered to rats by inhalation(2%for 3 hours daily for 21 days)and added to the cell culture medium.The Nrf2 inhibitor ML385(1μM)was used to investigate anti-ferroptotic mechanisms.RESULTS In MCT-treated rats,H_(2) inhalation decreased RVH;the RV wall thickness decreased from 3.5±0.3 mm to 2.8±0.2 mm(P<0.05)and the RV ejection fraction increased from 45±3%to 52±4%(P<0.05).In H9C2 cells,H_(2) alleviated hypertrophy.H_(2) inhibited ferroptosis by modulating the iron content,oxidative stress,and ferroptosis-related proteins,thereby restoring the Nrf2/HO-1 signaling pathway.CONCLUSION H_(2) retards RVH by inhibiting ferroptosis via Nrf2/HO-1 restoration,suggesting a new treatment strategy.
文摘BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exact relationship between depression and cardiac remodeling and left ventricular functional changes remains incompletely understood.This study sets out to explore,with a clinically grounded perspective,how depressive states may subtly or profoundly influence the trajectory of cardiac remodeling and the functional dynamics of the left ventricle in individuals grappling with CHF.Beyond mere observation,it also aims to untangle the underlying physiological or neurohormonal pathways that might bridge emotional distress and cardiac dysfunction.AIM To delve into how depressive symptoms might shape the progression of cardiac remodeling and impair left ventricular function among individuals living with CHF.Particular attention is given to the role of inflammatory signaling and disruptions in neuroendocrine balance as possible mediating factors.By examining these intertwined physiological and psychological processes,the study seeks to shed light on the reciprocal link between emotional distress and CHF,offering insights that may inform more precise,mechanism-based treatment strategies.METHODS In this retrospective clinical trial,248 patients diagnosed with CHF were analyzed in the tertiary treatment center between January 2018 and December 2022.According to Hamilton's Depression Scale score,participants were classified into two cohort of depression(score 17)and no significant depression characteristics(score 17).Cardiac morphology and functional parameters were assessed using a combination of hyperechocardiocardiocardiography,heart magnetic resonance,and associated blood biomarkers.RESULTS The results of this study underscore the significant effects that depression can have on both the structure and function of the heart in patients with CHF.In particular,the individuals in the cohort with depression were 42.3%±6.7%of the individuals without depression vs 51.6%±5.9%,P<0.01)In comparison,the left ventricular ejection fraction,an important measure of contractional performance,was significantly reduced,underlining the harmful physiological interaction between mood disorders and cardiac efficiency.The measurement of the left ventricular end-diastolic diameter showed a significant expansion of the ventricular envelope in the depression group(68.2±7.5 mm vs 59.6±6.3 mm,P<0.01).Inflammatory markers,including high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α),were significantly elevated in the depressed group(hs-CRP:8.7±2.3 mg/L vs 4.5±1.6 mg/L;TNF-α:42.5±7.6 pg/mL vs 28.3±5.4 pg/mL).Both B-type natriuretic peptide(1256±345 pg/mL vs 756±234 pg/mL)and angiotensin II(86.4±15.7 ng/mL vs 62.5±12.3 ng/mL)levels were significantly higher in the depressed group.CONCLUSION Among people with CHF,the presence of depressive symptoms appears to be closely related to pronounced changes in heart structure and impaired functional abilities.It is likely that depressive states contribute to the progress of heart reform and deterioration of left stomach function,possibly due to increased inflammatory cascades and increased activation of neuroendocrine regulatory pathways.
文摘BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.
文摘This narrative review examines the use of imaging biomarkers for diagnosing and monitoring hydrocephalus from birth through childhood.Early detection and longitudinal follow-up are essential for guiding timely interventions and asse-ssing treatment outcomes.Cranial ultrasound and magnetic resonance imaging(MRI)are the primary imaging modalities,providing critical insights into ventri-cular size,cerebrospinal fluid dynamics,and neurodevelopmental implications.Key parameters,including Evans’index,Levene’s index,and the Cella Media index,as well as volumetric and diffusion-based MRI techniques,have been explored for their diagnostic and prognostic value.Advances in automated image analysis and artificial intelligence have further improved measurement precision and reproducibility.Despite these developments,challenges remain in standar-dizing imaging protocols and establishing normative reference values across different pediatric populations.This review highlights the strengths and limita-tions of current imaging approaches,emphasizing the need for consistent metho-dologies to enhance diagnostic accuracy and optimize patient management in hydrocephalus.
基金Supported by the Italian Ministry for Education,University and Research under the Programme“Dipartimenti di Eccellenza 2018-2022”Project,No.D15D18000410001Novo Nordisk“Gestione delle complicanze croniche del diabete:From bedside to bench?”,No.n1/2021.
文摘BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systolic dysfunction(LVSD).In patients with type 2 diabetes(DM2)albuminuria is a predictor of symptomatic heart failure,but data on the relationship between GLS and albuminuria are conflicting.AIM To explore the relationship between GLS and albuminuria in a contemporary cohort of DM2 patients.METHODS The study was performed on DM2 patients consecutively enrolled in the TESEO study.Patients with symptoms/signs of heart failure,EF<50%,coronary artery,other cardiac diseases,or non-adequate acoustic window for GLS assessment were excluded.We collected clinical data,screened for complications,and measured GLS by speckle-tracking echocardiography.Univariate and multiple linear regression analyses were performed to identify independent explanatory variables associated with GLS.Logistic regression analysis was used to assess whether albuminuria was independently associated with GLS-diagnosed(GLS>-18%)LVSD.RESULTS Patients(n=193,age:60.6±8.1,male:57%)had a short DM2 duration(3.8±4.9 years)and good metabolic control(glycated haemoglobin A1c:6.5%±1.0).Preclinical GLS-LVSD was present in 21.8%of the patients.GLS values were significantly higher in patients with albuminuria(-19.88±2.16 vs-18.29±2.99,P<0.001)and in multivariate analysis natural logarithm of albumin-creatinine ratio and uric acid were independent predictors of GLS.In logistic regression analysis,albuminuria was associated with a 6.01(95%confidence interval:1.874-19.286)increased odds ratio of GLS-LVSD,independent of age,sex,diastolic blood pressure,chronic kidney disease,EF,mitral annulus velocity lateral,uric acid,and treatments.CONCLUSION Albuminuria was independently associated with subclinical LVSD in our contemporary cohort of DM2 patients.
文摘Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.
