Background Catheter ablation for ventricular tachycardia(VT) in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC) has significantly evolved over the past decade. However, different ablation strategie...Background Catheter ablation for ventricular tachycardia(VT) in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC) has significantly evolved over the past decade. However, different ablation strategies showed inconsistency in acute and long-term outcomes. Methods We searched the databases of Medline, Embase and Cochrane Library through October 17, 2019 for studies describing the clinical outcomes of VT ablation in ARVC. Data including VT recurrence, all-cause mortality, acute procedural efficacy and major procedural complications were extracted. A meta-analysis with trial sequential analysis was further performed in comparative studies of endo-epicardial versus endocardial-only ablation. Results A total of 24 studies with 717 participants were enrolled. The literatures of epicardial ablation were mainly published after 2010 with total ICD implantation of 73.7%, acute efficacy of 89.8%, major complication of 5.2%, follow-up of 28.9 months, VT freedom of 75.3%, all-cause mortality of 1.1% and heart transplantation of 0.6%. Meta-analysis of 10 comparative studies revealed that compared with endocardial-only approach, epicardial ablation significantly decreased VT recurrence(OR: 0.50;95% CI: 0.30–0.85;P = 0.010), but somehow increased major procedural complications(OR: 4.64;95% CI: 1.28–16.92;P = 0.02), with not evident improvement of acute efficacy(OR: 2.74;95% CI: 0.98–7.65;P = 0.051) or all-cause mortality(OR: 0.87;95% CI: 0.09–8.31;P = 0.90). Conclusion Catheter ablation for VT in ARVC is feasible and effective. Epicardial ablation is associated with better long-term VT freedom, but with more major complications and unremarkable survival or acute efficacy benefit.展开更多
OBJECTIVE: To evaluate the effectiveness of an adjuvant therapy from Traditional Chinese Medicine for supplementing Qi and promoting blood circulation(CMSQPBC) on left ventricular remodeling in patients after myocardi...OBJECTIVE: To evaluate the effectiveness of an adjuvant therapy from Traditional Chinese Medicine for supplementing Qi and promoting blood circulation(CMSQPBC) on left ventricular remodeling in patients after myocardial infarction(MI).METHODS: Randomized controlled trials were identified in the Cochrane Library, Embase, Web of Science, PubMed, China National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, China Science and Technology Journal Database, Wanfang databases, reviews, and reference lists of relevant articles. The weighted mean difference(WMD) was calculated for changes in the left ventricular ejection fraction(LVEF), LV end-diastolic volume(LVEDV) and LV end-systolic volume(LVESV) from baseline to follow-up(> 3 months) by using random-effects Meta-analysis. The primary outcome was change in LVEF, and secondary outcomes were changes in LV dimensions including LVEDV and LVESV.RESULTS: A total of 10 trials(enrolling 854 participants, median follow-up six months) evaluated the association between CMSQPBC and changes in LV function and volume. Compared with the control group, CMSQPBC significantly improved LVEF(854 patients;WMD: 4.97%, 95% CI: 3.78-6.15;P < 0.001)and attenuated the enlargement of LVEDV(607 patients;WMD:-7.89 mL, 95% CI:-11.54 to-4.24;P<0.001) and LVESV(364 patients;WMD =-5.80 mL,95% CI,-9.60 to-2.01;P < 0.01).CONCLUSION: CMSQPBC may reverse deleterious pathological remodeling after myocardial infarction. Higher quality and more rigorous randomized trials with larger sample sizes are needed to further confirm the findings.展开更多
BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore...BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.展开更多
BACKGROUND Left ventricular hypertrophy(LVH) is a common manifestation of cardiovascular disease and a risk factor for cardiovascular morbidity and mortality, but available methods for its electrocardiographic(ECG) di...BACKGROUND Left ventricular hypertrophy(LVH) is a common manifestation of cardiovascular disease and a risk factor for cardiovascular morbidity and mortality, but available methods for its electrocardiographic(ECG) diagnosis have limited accuracy.AIM To investigate findings associated with LVH on ECG and developed an improved system for the diagnosis of LVH.METHODS A cohort study comparing ECG data acquired within 30 days of transthoracic echocardiography(TTE) was performed. Multivariate regression analysis identified ECG findings associated with increased LV mass and mass index. A scoring system was derived and performance compared to established criteria for LVH.RESULTS Data from 5486 outpatients with TTEs and corresponding ECGs were included in the derivation cohort, 333(6.1%) of whom had LVH by TTE. In the primary regression analysis, findings associated with LVH were amplitudes of Q in V3, R in V6, S in V3, T in V6, P' in V1, P in V6, as well as R and T-axis discordance, R peak time in V6, QRS duration, weight, height, sex, and age. From this we derived a score consisting of 5 criteria, and validated it in an independent cohort of 910 patients. With a threshold of 1.5 points, sensitivity and specificity were67.9% and 81.4%, and 62.5% and 83.2% in the derivation and validation cohorts,respectively. With a threshold of 2 points, sensitivity and specificity were 42.3% and 93.0%, and 37.5% and 93.4% in these cohorts.CONCLUSIONS This score had superior sensitivity for detection of LVH by ECG while making a modest sacrifice in specificity compared to conventional criteria.展开更多
Brugada syndrome （BrS） is primary electrical disorder characterized by ST segment elevation with right bundle branch block morphology in patients with apparent structurally normal hearts, It predisposes affected in...Brugada syndrome （BrS） is primary electrical disorder characterized by ST segment elevation with right bundle branch block morphology in patients with apparent structurally normal hearts, It predisposes affected individuals to ventricular tachycardia/fibrillation （VT/VF） and sudden cardiac death （SCD）.A number of studies have identified risk factors that are associated with a more malignant course of disease. These include male gender, syncope, a spontaneous type 1 ECG pattern, family history of SCD, family history of Brugada syndrome,展开更多
BACKGROUND Isolated left ventricular apical hypoplasia(ILVAH),also known as truncated left ventricle(LV),is a very unusual cardiomyopathy.It is characterised by a truncated,spherical,and non-apex forming LV.The true a...BACKGROUND Isolated left ventricular apical hypoplasia(ILVAH),also known as truncated left ventricle(LV),is a very unusual cardiomyopathy.It is characterised by a truncated,spherical,and non-apex forming LV.The true apex is occupied by the right ventricle.Due to the rarity of the disease,just a few case reports and limited case series have been published in the field.AIM To analysing the so far 37 reported ILVAH cases worldwide.METHODS The electronic databases PubMed and Scopus were investigated from their establishment up to December 13,2022.RESULTS The majority of cases reported occurred in males(52.7%).Mean age at diagnosis was 26.1±19.6 years.More than a third of the patients were asymptomatic(35.1%).The most usual clinical presentation was breathlessness(40.5%).The most commonly detected electrocardiogram changes were T wave abnormalities(29.7%)and right axis deviation with poor R wave progression(24.3%).Atrial fibrillation/flutter was detected in 24.3%.Echocardiography was performed in 97.3%of cases and cardiac MRI in 91.9%of cases.Ejection fraction was reduced in more than a half of patients(56.7%).An associated congenital heart disease was found in 16.2%.Heart failure therapy was administered in 35.1%of patients.The outcome was favorable in the vast majority of patients,with just one death.CONCLUSION ILVAH is a multifaceted entity with a so far unpredictable course,ranging from benign until the elderly to sudden death during adolescence.展开更多
BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during...BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during BAV on aortic regurgitation(AR)in pediatric patients.METHODS A systematic review of the MEDLINE,Cochrane Library,and Scopus databases was conducted according to the PRISMA guidelines(end-of-search date:July 8,2020).The National Heart,Lung,and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment.RESULTS Five studies reporting on 72 patients were included.The studies investigated the use of RRVP-assisted BAV in infants(>1 mo)and older children,but not in neonates.Ten(13.9%)patients had a history of some type of aortic valve surgical or catheterization procedure.Before BAV,58(84.0%),7(10.1%),4(5.9%)patients had AR grade 0(none),1(trivial),2(mild),respectively.After BAV,34(49.3%),6(8.7%),26(37.7%),3(4.3%),patients had AR grade 0,1,2,and 3(moderate),respectively.No patient developed severe AR after RRVP.One(1.4%)developed ventricular fibrillation and was defibrillated successfully.No additional arrhythmias or complications occurred during RRVP.CONCLUSION RRVP can be safely used to achieve balloon stability during pediatric BAV,which could potentially decrease AR rates.展开更多
Background Left ventricular hypertrophy （LVH） induced by systemic hypertension represents a maladaptive response to the increased overload. However antihypertensive treatments are not always useful to regress or pre...Background Left ventricular hypertrophy （LVH） induced by systemic hypertension represents a maladaptive response to the increased overload. However antihypertensive treatments are not always useful to regress or prevent LVH. Thoroughly understanding the mechanisms will help to find new therapeutic targets that prevent or reverse left ventricular hypertrophy. A number of regulators and molecular signaling pathways have been shown to be involved in the hypertrophic process, such as angiotensin II, heat shock proteins 90, microRNAs, TRPC, mTOR, HDAC and PI3K/Akt signaling pathways. Therefore, other treatments, such as G1 cyclin antagonists, HSP90 inhibitor, Rho-kinase inhibitor, calcineurin blockers, CS866, statins, scutellarin, and aldosterone antagonist could prevent left ventricular hypertrophy.展开更多
Our aim was to investigate the changes in the myocardium stiffness index for patients suffering from systemic hypertension, and to assess their left ventricular performance. We studied 263 hypertensive patients and 16...Our aim was to investigate the changes in the myocardium stiffness index for patients suffering from systemic hypertension, and to assess their left ventricular performance. We studied 263 hypertensive patients and 166 healthy subjects as a control group. By using conventional Doppler echocardiography, the following parameters were measured—Left ventricular end diastolic diameter, left ventricular end systolic diameter, transmitral early velocity, isovolumic relaxation time, and isovolumic contraction time. Tissue Doppler imaging (TDI) was used in the measurements of the early mitral annular velocity (Ea) and the diastolic stiffness was obtained by calculating the ratio E\Ea\LVIDd. Index myocardial performance (IMP) was calculated according to following equation (IVCT + IVRT)/ET for both the control group and hypertensive group. Results reveal that the differences in the average value of transmitral early filling velocity (E) between patients and control groups for age range (20 - 49) and (50 - 80) were (𕒵.91%) and (𕒷.69%) respectively with p value >0.05 for both groups, and the changes in LVIDd between patients and control groups were 0.42% and 1.29% for age ranges (20 - 49) and (50 - 80) respectively with p value >0.05 for both age groups. A significant difference in IMP between patients and controls has also been observed and the changes were 29.54% and 30.43% for age range (20 - 49) and (50 - 80) respectively with p value <0.05 for both groups. The mean values for E/Ea ratio and for the measured LV stiffness index were significantly higher in hypertensive patients compared with control group (p value 0.05) for both age groups. In conclusion, LV myocardial diastolic stiffness index and IMP are increased in hypertensive patients.展开更多
Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remain...Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial.Therefore,we conducted a systematic review and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted.Methods:The PubMed,Embase,and Cochrane Library databases were searched up to August 1,2017,for randomized controlled trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing.Results:Eleven studies comprising 5705 participants(61%males,mean age 71 years[standard deviation 11 years])were fi nally included in the analysis.The mean follow-up duration was 24 months.Use of algorithms for minimizing ventricular pacing signifi cantly reduced the incidence of AF,with an odds ratio of 0.74(95%confi dence interval 0.55–1.00;P<0.05).There was moderate heterogeneity among studies(I 2=63%).Conclusions:The incidence of AF was reduced by 26%with use of algorithms for minimizing ventricular pacing.The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.展开更多
BACKGROUND Systemic sclerosis is a rare connective tissue disease characterized by localized or diffuse skin thickening and fibrosis,which usually accumulates in various organs throughout the body.Tachyarrhythmia is a...BACKGROUND Systemic sclerosis is a rare connective tissue disease characterized by localized or diffuse skin thickening and fibrosis,which usually accumulates in various organs throughout the body.Tachyarrhythmia is a common clinical manifestation of cardiovascular damage in systemic sclerosis patients.However,few studies have reported the use of catheter ablation and an implantable cardioverter defibrillator in patients with systemic sclerosis complicated by ventricular tachycardia.CASE SUMMARY A 39-year woman with an 11-year history of systemic sclerosis was referred to our hospital due to three syncopal episodes in the past 6 mo.The results of an electrocardiogram and a transthoracic echocardiogram revealed ventricular tachycardia and left ventricular systolic and ventricular septum segmental motion abnormalities,respectively.The results of an electrocardiogram showed a sinus rhythm with complete blockage of the left bundle branch.In light of the progressive nature of systemic sclerosis,the presence of a left bundle branch block,and the decreased ejection fraction,a cardiac resynchronization therapydefibrillator was implanted.The patient’s clinical conditions improved,and at the3-mo follow-up,the patient was free of ventricular tachycardia and all cardiac symptoms.CONCLUSION We report the first case of systemic sderosis complicated by ventricular tachycardia that was successfully treated with a cardiac resynchronization therapy-defibrillator.展开更多
Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry fo...Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry for analysis of LV remodeling after myocardial infarction in daily clinical routine. Methods: 26 patients were investigated directly after interventional therapy at hospital pre-discharge and at 6 month follow-up. Standardized 2D transthoracic native and contrast echocardiography were performed in all patients. Due to methodological aspects the results of LV volumes and LVEF using native echocardiography were compared to the results of LV opacification (LVO) imaging for analysis in mono-, bi- and triplane data sets using the Simpson’s rule. In addition corresponding multidimensional data sets were analyzed. Results: The assessment of LV volumes and LVEF is more accurate with contrast echocardiography. The comparison of LV volumes and LVEF shows significant increases using contrast echocardiography (p < 0.001). Larger left ventricular end-diastolic volumes (LVEDV) are measured at follow up (p < 0.05). Significant differences (p < 0.001) are found for the determination of LVEDV and LVEF relating to apical mono-, bi-, tri- and multiplane data sets. Standard deviations of the triplane approach, however, are significantly lower than using other modalities. Conclusion: Depending on the localization of the myocardial infarction LV volumes and LVEF are less reliably evaluated using the mono- or biplane approach. According to standardization and simultaneous acquisition of all LV wall segments the triplane approach is currently the best approach to determine LV systolic function. In addition, contrast echocardiography is indicated to improve endocardial border delineation in patients using the triplane or multiplane approach. To our knowledge the present study is the first systematic evaluation of all current possibilities for determination of LV volumes and LVEF by native and contrast echocardiography.展开更多
Background Pulmonary atresia with ventricular septal defect(PA/VSD)is a rare and complex congenital heart disease(CHD).The optimal palliative surgical strategy for pulmonary atresia with ventricular septal defect(PA/V...Background Pulmonary atresia with ventricular septal defect(PA/VSD)is a rare and complex congenital heart disease(CHD).The optimal palliative surgical strategy for pulmonary atresia with ventricular septal defect(PA/VSD)in neonates and young infants is controversial.Surgery mainly includes the following two options,right ventricle to pulmonary artery connection(RV-PA)and systemic-to-pulmonary artery shunt surgery(SPS).Objectives:To determine the impact of the right ventricle to pulmonary artery connection or systemic-to-pulmonary artery shunt surgery as the initially palliated surgical strategy on promoting the development of pulmonary vasculature in patients with pulmonary atresia and ventricular septal defect(PA/VSD).Methods:From January 2010 to December 2019,104 patients with PA/VSD in Guangdong Cardiovascular Institute who underwent right ventricle to pulmonary artery connection or systemic-to-pulmonary artery shunt surgery as the initially palliated surgical strategy to promoting the development of pulmonary vasculature were identified and enrolled in this retrospective study.The cohort was divided into two groups:group-Right Ventricle to Pulmonary Artery Connection(RV-PA),who underwent initial palliation with staged repair(n=51),and group-Systemic-to-Pulmonary Artery Shunt(SPS)(n=53).Preoperative and postoperative the development of pulmonary vasculature data have been collected and compared.Results:Before the surgery,the Mc Goon Ratio of the RV-PA group significantly high than and the SPS group(P<0.05).After the surgery,in the RV-PA group,the Nakata index,Mc Goon Ratio score significantly increased during the interstage period(P<0.01).At the meantime,the HCT,RBC and HB significantly reduced in the RV-PA group compared with the SPS group(P<0.05).The shunt group performed better in these areas:length of hospital stay,ACC time and CPB time(P<0.05).Conclusion:Compared with systemic-to-pulmonary artery shunt,right ventricle to pulmonary artery connection is more effective to promote the development of the pulmonary vasculature for pulmonary atresia with ventricular septal defect.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
Objectives This randomized study was designed to compare the safety and efficacy of intravenous diltiazem versus intravenous cedilanid-D （deslanoside） for ventricular rate control in patients with atrial fibrillati...Objectives This randomized study was designed to compare the safety and efficacy of intravenous diltiazem versus intravenous cedilanid-D （deslanoside） for ventricular rate control in patients with atrial fibrillation （AF）. Analysis of the effect on conduction system of these drugs was also performed. Methods Forty three patients with AF were randomly assigned to receive intravenous therapy with 0.25mg/kg diltiazem （n = 21） or 0.4rag cedilanid-D （n = 22）. If not effective at 120 minutes （〈 20% decrease in pretreatment ventricular rate or can not convert to sinus rhythm= another dose of diltiazem or 0.2mg cedilanid-D was administered. Blood pressure and electrocardiographic recordings were performed before and after 5, 10, 20, 30, 60 minutes of drug administration. Further recordings were performed at 120 minutes in noneffective patients, and at 180 minutes in patients who received second time drug administration. To evaluate the effect on conduction system of these two drugs by measuring PA, AH and HV intervals using His bundle electrogram test another nineteen sinus rhythm patients were randomized to dihiazem （n=9） and cedilanid （n= 10） group. His bundle electrogram recordings were performed before and after 5, 10, 20 and 30 minutes of drug administration. Statistical significance was assessed with the use of t test, Fisher＇s exact test, ANOVA and LSD methodology. Results At baseline and after 5, 10, 20, 30, 60 minutes of drug administration the heart rates （mean±SD） were（133±15）, （92±20）, （87±22）, （85 ±20）, （85±21）, （85 ±23）beats/minute in diltiazem group respectively and（ 140±21 ）, （ 122±24）, （118±25）, （110±26）, （112±25）, （110±28） beats/ minute in cedilanid-D group respectively. Heart rate reduction was higher in diltiazem group than cedilanid group during 5 （41±20 vs 17±14,P 〈 0.01）; 10 （46±21 vs 22±20, P〈0.01）; 20 （48±21 vs 29±22, P〈0.01 ） ; 30（48±22 vs 27±22,P〈0.01 ）and 60 minutes （48±23 vs 29±24, P〈 0.05）. Both drugs had no effect on both systolic and diastolic blood pressure （P 〉0.05） and no major side effects were noticed. Diltiazem maintained effective ventrieular rate in 20 patients, whereas eedilanid-D maintained in 15 patients within 180 minutes （95.2%vs 68.2%,P〈 0.05）. There were no statistical significance in baseline heart rate, age and weight between the two groups. Both diltiazem and cedilanid-D can increase AH interval, but have no effect on HV and PA intervals in sinus rhythm patients. Conclusions Both dihiazem and eedilanid-D decrease ventrieular heart rate, but heart rate reduction is significantly higher in diltiazem group, thus should be considered as a drug of choice for emergency control of ventrieular rate. Under clinical monitoring this dose of diltiazem seems to be safe and applicable in AF patients with congestive heart failure. Both drugs have no effect on PA and HV intervals but increase the AH interval thereby can reduce ventricular rate.展开更多
BACKGROUND Heart failure is generally regarded as a progressive and irreversible medical condition.The EVAHEART is an implantable left ventricular assist system.CASE SUMMARY We report the anesthesia management of a 56...BACKGROUND Heart failure is generally regarded as a progressive and irreversible medical condition.The EVAHEART is an implantable left ventricular assist system.CASE SUMMARY We report the anesthesia management of a 56-year-old male patient with dilated cardiomyopathy undergoing an EVAHEART implantation.Transesophageal echocardiography is crucial to ensure the correct positioning of the device and the proper aortic valve outflow.Because the continuous blood flow device functions best under low systemic and pulmonary vascular resistance,milrinone is the preferred drug.Our patient was accompanied by pulmonary hypertension,so during the operation,nitric oxide was used to reduce pulmonary artery pressure.CONCLUSION The cardiac output achieved by the patient with the assistance of EVAHEART can reach 4 L/min,which of course depends on the front load,rear load,and pump speed.展开更多
BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal ...BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.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
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
基金supported by the National Natural Science Foundation (81570309)National Key R&D Program of China (2017YFC1307800)。
文摘Background Catheter ablation for ventricular tachycardia(VT) in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC) has significantly evolved over the past decade. However, different ablation strategies showed inconsistency in acute and long-term outcomes. Methods We searched the databases of Medline, Embase and Cochrane Library through October 17, 2019 for studies describing the clinical outcomes of VT ablation in ARVC. Data including VT recurrence, all-cause mortality, acute procedural efficacy and major procedural complications were extracted. A meta-analysis with trial sequential analysis was further performed in comparative studies of endo-epicardial versus endocardial-only ablation. Results A total of 24 studies with 717 participants were enrolled. The literatures of epicardial ablation were mainly published after 2010 with total ICD implantation of 73.7%, acute efficacy of 89.8%, major complication of 5.2%, follow-up of 28.9 months, VT freedom of 75.3%, all-cause mortality of 1.1% and heart transplantation of 0.6%. Meta-analysis of 10 comparative studies revealed that compared with endocardial-only approach, epicardial ablation significantly decreased VT recurrence(OR: 0.50;95% CI: 0.30–0.85;P = 0.010), but somehow increased major procedural complications(OR: 4.64;95% CI: 1.28–16.92;P = 0.02), with not evident improvement of acute efficacy(OR: 2.74;95% CI: 0.98–7.65;P = 0.051) or all-cause mortality(OR: 0.87;95% CI: 0.09–8.31;P = 0.90). Conclusion Catheter ablation for VT in ARVC is feasible and effective. Epicardial ablation is associated with better long-term VT freedom, but with more major complications and unremarkable survival or acute efficacy benefit.
基金Supported by National Science Foundation(No.81703877,81703848)National Basic Research Program of China(973 Program,2015CB554400)。
文摘OBJECTIVE: To evaluate the effectiveness of an adjuvant therapy from Traditional Chinese Medicine for supplementing Qi and promoting blood circulation(CMSQPBC) on left ventricular remodeling in patients after myocardial infarction(MI).METHODS: Randomized controlled trials were identified in the Cochrane Library, Embase, Web of Science, PubMed, China National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, China Science and Technology Journal Database, Wanfang databases, reviews, and reference lists of relevant articles. The weighted mean difference(WMD) was calculated for changes in the left ventricular ejection fraction(LVEF), LV end-diastolic volume(LVEDV) and LV end-systolic volume(LVESV) from baseline to follow-up(> 3 months) by using random-effects Meta-analysis. The primary outcome was change in LVEF, and secondary outcomes were changes in LV dimensions including LVEDV and LVESV.RESULTS: A total of 10 trials(enrolling 854 participants, median follow-up six months) evaluated the association between CMSQPBC and changes in LV function and volume. Compared with the control group, CMSQPBC significantly improved LVEF(854 patients;WMD: 4.97%, 95% CI: 3.78-6.15;P < 0.001)and attenuated the enlargement of LVEDV(607 patients;WMD:-7.89 mL, 95% CI:-11.54 to-4.24;P<0.001) and LVESV(364 patients;WMD =-5.80 mL,95% CI,-9.60 to-2.01;P < 0.01).CONCLUSION: CMSQPBC may reverse deleterious pathological remodeling after myocardial infarction. Higher quality and more rigorous randomized trials with larger sample sizes are needed to further confirm the findings.
文摘BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.
文摘BACKGROUND Left ventricular hypertrophy(LVH) is a common manifestation of cardiovascular disease and a risk factor for cardiovascular morbidity and mortality, but available methods for its electrocardiographic(ECG) diagnosis have limited accuracy.AIM To investigate findings associated with LVH on ECG and developed an improved system for the diagnosis of LVH.METHODS A cohort study comparing ECG data acquired within 30 days of transthoracic echocardiography(TTE) was performed. Multivariate regression analysis identified ECG findings associated with increased LV mass and mass index. A scoring system was derived and performance compared to established criteria for LVH.RESULTS Data from 5486 outpatients with TTEs and corresponding ECGs were included in the derivation cohort, 333(6.1%) of whom had LVH by TTE. In the primary regression analysis, findings associated with LVH were amplitudes of Q in V3, R in V6, S in V3, T in V6, P' in V1, P in V6, as well as R and T-axis discordance, R peak time in V6, QRS duration, weight, height, sex, and age. From this we derived a score consisting of 5 criteria, and validated it in an independent cohort of 910 patients. With a threshold of 1.5 points, sensitivity and specificity were67.9% and 81.4%, and 62.5% and 83.2% in the derivation and validation cohorts,respectively. With a threshold of 2 points, sensitivity and specificity were 42.3% and 93.0%, and 37.5% and 93.4% in these cohorts.CONCLUSIONS This score had superior sensitivity for detection of LVH by ECG while making a modest sacrifice in specificity compared to conventional criteria.
文摘Brugada syndrome （BrS） is primary electrical disorder characterized by ST segment elevation with right bundle branch block morphology in patients with apparent structurally normal hearts, It predisposes affected individuals to ventricular tachycardia/fibrillation （VT/VF） and sudden cardiac death （SCD）.A number of studies have identified risk factors that are associated with a more malignant course of disease. These include male gender, syncope, a spontaneous type 1 ECG pattern, family history of SCD, family history of Brugada syndrome,
文摘BACKGROUND Isolated left ventricular apical hypoplasia(ILVAH),also known as truncated left ventricle(LV),is a very unusual cardiomyopathy.It is characterised by a truncated,spherical,and non-apex forming LV.The true apex is occupied by the right ventricle.Due to the rarity of the disease,just a few case reports and limited case series have been published in the field.AIM To analysing the so far 37 reported ILVAH cases worldwide.METHODS The electronic databases PubMed and Scopus were investigated from their establishment up to December 13,2022.RESULTS The majority of cases reported occurred in males(52.7%).Mean age at diagnosis was 26.1±19.6 years.More than a third of the patients were asymptomatic(35.1%).The most usual clinical presentation was breathlessness(40.5%).The most commonly detected electrocardiogram changes were T wave abnormalities(29.7%)and right axis deviation with poor R wave progression(24.3%).Atrial fibrillation/flutter was detected in 24.3%.Echocardiography was performed in 97.3%of cases and cardiac MRI in 91.9%of cases.Ejection fraction was reduced in more than a half of patients(56.7%).An associated congenital heart disease was found in 16.2%.Heart failure therapy was administered in 35.1%of patients.The outcome was favorable in the vast majority of patients,with just one death.CONCLUSION ILVAH is a multifaceted entity with a so far unpredictable course,ranging from benign until the elderly to sudden death during adolescence.
文摘BACKGROUND Balloon aortic valvuloplasty(BAV)is a well-established treatment modality for congenital aortic valve stenosis.AIM To evaluate the role of rapid right ventricular pacing(RRVP)in balloon stabilization during BAV on aortic regurgitation(AR)in pediatric patients.METHODS A systematic review of the MEDLINE,Cochrane Library,and Scopus databases was conducted according to the PRISMA guidelines(end-of-search date:July 8,2020).The National Heart,Lung,and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment.RESULTS Five studies reporting on 72 patients were included.The studies investigated the use of RRVP-assisted BAV in infants(>1 mo)and older children,but not in neonates.Ten(13.9%)patients had a history of some type of aortic valve surgical or catheterization procedure.Before BAV,58(84.0%),7(10.1%),4(5.9%)patients had AR grade 0(none),1(trivial),2(mild),respectively.After BAV,34(49.3%),6(8.7%),26(37.7%),3(4.3%),patients had AR grade 0,1,2,and 3(moderate),respectively.No patient developed severe AR after RRVP.One(1.4%)developed ventricular fibrillation and was defibrillated successfully.No additional arrhythmias or complications occurred during RRVP.CONCLUSION RRVP can be safely used to achieve balloon stability during pediatric BAV,which could potentially decrease AR rates.
文摘Background Left ventricular hypertrophy （LVH） induced by systemic hypertension represents a maladaptive response to the increased overload. However antihypertensive treatments are not always useful to regress or prevent LVH. Thoroughly understanding the mechanisms will help to find new therapeutic targets that prevent or reverse left ventricular hypertrophy. A number of regulators and molecular signaling pathways have been shown to be involved in the hypertrophic process, such as angiotensin II, heat shock proteins 90, microRNAs, TRPC, mTOR, HDAC and PI3K/Akt signaling pathways. Therefore, other treatments, such as G1 cyclin antagonists, HSP90 inhibitor, Rho-kinase inhibitor, calcineurin blockers, CS866, statins, scutellarin, and aldosterone antagonist could prevent left ventricular hypertrophy.
文摘Our aim was to investigate the changes in the myocardium stiffness index for patients suffering from systemic hypertension, and to assess their left ventricular performance. We studied 263 hypertensive patients and 166 healthy subjects as a control group. By using conventional Doppler echocardiography, the following parameters were measured—Left ventricular end diastolic diameter, left ventricular end systolic diameter, transmitral early velocity, isovolumic relaxation time, and isovolumic contraction time. Tissue Doppler imaging (TDI) was used in the measurements of the early mitral annular velocity (Ea) and the diastolic stiffness was obtained by calculating the ratio E\Ea\LVIDd. Index myocardial performance (IMP) was calculated according to following equation (IVCT + IVRT)/ET for both the control group and hypertensive group. Results reveal that the differences in the average value of transmitral early filling velocity (E) between patients and control groups for age range (20 - 49) and (50 - 80) were (𕒵.91%) and (𕒷.69%) respectively with p value >0.05 for both groups, and the changes in LVIDd between patients and control groups were 0.42% and 1.29% for age ranges (20 - 49) and (50 - 80) respectively with p value >0.05 for both age groups. A significant difference in IMP between patients and controls has also been observed and the changes were 29.54% and 30.43% for age range (20 - 49) and (50 - 80) respectively with p value <0.05 for both groups. The mean values for E/Ea ratio and for the measured LV stiffness index were significantly higher in hypertensive patients compared with control group (p value 0.05) for both age groups. In conclusion, LV myocardial diastolic stiffness index and IMP are increased in hypertensive patients.
文摘Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial.Therefore,we conducted a systematic review and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted.Methods:The PubMed,Embase,and Cochrane Library databases were searched up to August 1,2017,for randomized controlled trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing.Results:Eleven studies comprising 5705 participants(61%males,mean age 71 years[standard deviation 11 years])were fi nally included in the analysis.The mean follow-up duration was 24 months.Use of algorithms for minimizing ventricular pacing signifi cantly reduced the incidence of AF,with an odds ratio of 0.74(95%confi dence interval 0.55–1.00;P<0.05).There was moderate heterogeneity among studies(I 2=63%).Conclusions:The incidence of AF was reduced by 26%with use of algorithms for minimizing ventricular pacing.The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.
文摘BACKGROUND Systemic sclerosis is a rare connective tissue disease characterized by localized or diffuse skin thickening and fibrosis,which usually accumulates in various organs throughout the body.Tachyarrhythmia is a common clinical manifestation of cardiovascular damage in systemic sclerosis patients.However,few studies have reported the use of catheter ablation and an implantable cardioverter defibrillator in patients with systemic sclerosis complicated by ventricular tachycardia.CASE SUMMARY A 39-year woman with an 11-year history of systemic sclerosis was referred to our hospital due to three syncopal episodes in the past 6 mo.The results of an electrocardiogram and a transthoracic echocardiogram revealed ventricular tachycardia and left ventricular systolic and ventricular septum segmental motion abnormalities,respectively.The results of an electrocardiogram showed a sinus rhythm with complete blockage of the left bundle branch.In light of the progressive nature of systemic sclerosis,the presence of a left bundle branch block,and the decreased ejection fraction,a cardiac resynchronization therapydefibrillator was implanted.The patient’s clinical conditions improved,and at the3-mo follow-up,the patient was free of ventricular tachycardia and all cardiac symptoms.CONCLUSION We report the first case of systemic sderosis complicated by ventricular tachycardia that was successfully treated with a cardiac resynchronization therapy-defibrillator.
文摘Purpose: The aim of the present study was to evaluate the diagnostic accuracy for quantification of left ventricular (LV) volumes and LV ejection fraction (LVEF) with current echocardiographic methods of planimetry for analysis of LV remodeling after myocardial infarction in daily clinical routine. Methods: 26 patients were investigated directly after interventional therapy at hospital pre-discharge and at 6 month follow-up. Standardized 2D transthoracic native and contrast echocardiography were performed in all patients. Due to methodological aspects the results of LV volumes and LVEF using native echocardiography were compared to the results of LV opacification (LVO) imaging for analysis in mono-, bi- and triplane data sets using the Simpson’s rule. In addition corresponding multidimensional data sets were analyzed. Results: The assessment of LV volumes and LVEF is more accurate with contrast echocardiography. The comparison of LV volumes and LVEF shows significant increases using contrast echocardiography (p < 0.001). Larger left ventricular end-diastolic volumes (LVEDV) are measured at follow up (p < 0.05). Significant differences (p < 0.001) are found for the determination of LVEDV and LVEF relating to apical mono-, bi-, tri- and multiplane data sets. Standard deviations of the triplane approach, however, are significantly lower than using other modalities. Conclusion: Depending on the localization of the myocardial infarction LV volumes and LVEF are less reliably evaluated using the mono- or biplane approach. According to standardization and simultaneous acquisition of all LV wall segments the triplane approach is currently the best approach to determine LV systolic function. In addition, contrast echocardiography is indicated to improve endocardial border delineation in patients using the triplane or multiplane approach. To our knowledge the present study is the first systematic evaluation of all current possibilities for determination of LV volumes and LVEF by native and contrast echocardiography.
基金funding by Science and Technology Projects in Guangzhou,China(No.202206010049)Guangdong Provincial Clinical Research Center for Cardiovascular disease(No.2020B1111170011)。
文摘Background Pulmonary atresia with ventricular septal defect(PA/VSD)is a rare and complex congenital heart disease(CHD).The optimal palliative surgical strategy for pulmonary atresia with ventricular septal defect(PA/VSD)in neonates and young infants is controversial.Surgery mainly includes the following two options,right ventricle to pulmonary artery connection(RV-PA)and systemic-to-pulmonary artery shunt surgery(SPS).Objectives:To determine the impact of the right ventricle to pulmonary artery connection or systemic-to-pulmonary artery shunt surgery as the initially palliated surgical strategy on promoting the development of pulmonary vasculature in patients with pulmonary atresia and ventricular septal defect(PA/VSD).Methods:From January 2010 to December 2019,104 patients with PA/VSD in Guangdong Cardiovascular Institute who underwent right ventricle to pulmonary artery connection or systemic-to-pulmonary artery shunt surgery as the initially palliated surgical strategy to promoting the development of pulmonary vasculature were identified and enrolled in this retrospective study.The cohort was divided into two groups:group-Right Ventricle to Pulmonary Artery Connection(RV-PA),who underwent initial palliation with staged repair(n=51),and group-Systemic-to-Pulmonary Artery Shunt(SPS)(n=53).Preoperative and postoperative the development of pulmonary vasculature data have been collected and compared.Results:Before the surgery,the Mc Goon Ratio of the RV-PA group significantly high than and the SPS group(P<0.05).After the surgery,in the RV-PA group,the Nakata index,Mc Goon Ratio score significantly increased during the interstage period(P<0.01).At the meantime,the HCT,RBC and HB significantly reduced in the RV-PA group compared with the SPS group(P<0.05).The shunt group performed better in these areas:length of hospital stay,ACC time and CPB time(P<0.05).Conclusion:Compared with systemic-to-pulmonary artery shunt,right ventricle to pulmonary artery connection is more effective to promote the development of the pulmonary vasculature for pulmonary atresia with ventricular septal defect.
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Objectives This randomized study was designed to compare the safety and efficacy of intravenous diltiazem versus intravenous cedilanid-D （deslanoside） for ventricular rate control in patients with atrial fibrillation （AF）. Analysis of the effect on conduction system of these drugs was also performed. Methods Forty three patients with AF were randomly assigned to receive intravenous therapy with 0.25mg/kg diltiazem （n = 21） or 0.4rag cedilanid-D （n = 22）. If not effective at 120 minutes （〈 20% decrease in pretreatment ventricular rate or can not convert to sinus rhythm= another dose of diltiazem or 0.2mg cedilanid-D was administered. Blood pressure and electrocardiographic recordings were performed before and after 5, 10, 20, 30, 60 minutes of drug administration. Further recordings were performed at 120 minutes in noneffective patients, and at 180 minutes in patients who received second time drug administration. To evaluate the effect on conduction system of these two drugs by measuring PA, AH and HV intervals using His bundle electrogram test another nineteen sinus rhythm patients were randomized to dihiazem （n=9） and cedilanid （n= 10） group. His bundle electrogram recordings were performed before and after 5, 10, 20 and 30 minutes of drug administration. Statistical significance was assessed with the use of t test, Fisher＇s exact test, ANOVA and LSD methodology. Results At baseline and after 5, 10, 20, 30, 60 minutes of drug administration the heart rates （mean±SD） were（133±15）, （92±20）, （87±22）, （85 ±20）, （85±21）, （85 ±23）beats/minute in diltiazem group respectively and（ 140±21 ）, （ 122±24）, （118±25）, （110±26）, （112±25）, （110±28） beats/ minute in cedilanid-D group respectively. Heart rate reduction was higher in diltiazem group than cedilanid group during 5 （41±20 vs 17±14,P 〈 0.01）; 10 （46±21 vs 22±20, P〈0.01）; 20 （48±21 vs 29±22, P〈0.01 ） ; 30（48±22 vs 27±22,P〈0.01 ）and 60 minutes （48±23 vs 29±24, P〈 0.05）. Both drugs had no effect on both systolic and diastolic blood pressure （P 〉0.05） and no major side effects were noticed. Diltiazem maintained effective ventrieular rate in 20 patients, whereas eedilanid-D maintained in 15 patients within 180 minutes （95.2%vs 68.2%,P〈 0.05）. There were no statistical significance in baseline heart rate, age and weight between the two groups. Both diltiazem and cedilanid-D can increase AH interval, but have no effect on HV and PA intervals in sinus rhythm patients. Conclusions Both dihiazem and eedilanid-D decrease ventrieular heart rate, but heart rate reduction is significantly higher in diltiazem group, thus should be considered as a drug of choice for emergency control of ventrieular rate. Under clinical monitoring this dose of diltiazem seems to be safe and applicable in AF patients with congestive heart failure. Both drugs have no effect on PA and HV intervals but increase the AH interval thereby can reduce ventricular rate.
文摘BACKGROUND Heart failure is generally regarded as a progressive and irreversible medical condition.The EVAHEART is an implantable left ventricular assist system.CASE SUMMARY We report the anesthesia management of a 56-year-old male patient with dilated cardiomyopathy undergoing an EVAHEART implantation.Transesophageal echocardiography is crucial to ensure the correct positioning of the device and the proper aortic valve outflow.Because the continuous blood flow device functions best under low systemic and pulmonary vascular resistance,milrinone is the preferred drug.Our patient was accompanied by pulmonary hypertension,so during the operation,nitric oxide was used to reduce pulmonary artery pressure.CONCLUSION The cardiac output achieved by the patient with the assistance of EVAHEART can reach 4 L/min,which of course depends on the front load,rear load,and pump speed.
文摘BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.
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.
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.
