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Left Ventricular Global Longitudinal Strain: An Imaging Marker Associated with Outcomes in Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis.

BACKGROUND: The clinical management and optimal timing of intervention in paradoxical low-flow, low-gradient severe aortic stenosis (PLFLG AS) is unclear. Left ventricular (LV) global longitudinal strain (GLS) has been shown to predict outcomes in high-flow severe AS, but there is a lack of data in patients with PLFLG AS. Given the exaggerated LV hypertrophy and remodeling pattern in PLFLG AS, LV GLS may be a mechanistic imaging parameter for outcomes by being a surrogate marker for subclinical myocardial fibrosis. We aimed to examine whether LV GLS in patients with PLFLG AS is associated with

Mitral annular disjunction in Marfan syndrome: a multicenter cardiovascular magnetic resonance study.

BACKGROUND: Data on the prevalence of mitral annular disjunction (MAD) in Marfan syndrome (MFS) based on cardiovascular magnetic resonance (CMR) is sparse. The purpose of this study was to assess prevalence, extent, and distribution of MAD in MFS using CMR and to examine its association with left heart parameters, aortic dimensions, and cardiovascular events. METHODS: This retrospective multicenter study included CMR studies of patients treated for MFS at four tertiary care medical centers with a (likely) pathogenic fibrillin-1 gene variant. Two radiologists (5 and 8 years of experience in CM

Repurposing the β3-Adrenergic Receptor Agonist Mirabegron in Patients With Structural Cardiac Disease: The Beta3-LVH Phase 2b Randomized Clinical Trial.

IMPORTANCE: Left ventricular (LV) hypertrophy contributes to the onset and progression of heart failure (HF), particularly for patients with pre-HF (stage B) for whom no treatment has yet proven effective to prevent transition to overt HF (stage C). The β3-adrenergic receptors (β3ARs) may represent a new target, as their activation attenuates LV remodeling. OBJECTIVE: To determine whether activation of β3ARs by repurposing a β3AR agonist, mirabegron, is safe and effective in preventing progression of LV hypertrophy and diastolic dysfunction among patients with pre- or mild HF. DESIGN, SETTIN

Postpartum cardiovascular function in patients with hypertensive disorders of pregnancy: a longitudinal study.

BACKGROUND: Women with a history of hypertensive disorders of pregnancy are at increased risk of cardiovascular diseases, which are usually mediated by the development of cardiovascular risk factors, such as chronic hypertension, metabolic syndrome, or subclinical myocardial dysfunction. Increasing evidence has been showing that little time elapses between the end of pregnancy and the development of these cardiovascular risk factors. OBJECTIVE: This study aimed to assess the persistence of hypertension and myocardial dysfunction at 4 months postpartum in a cohort of women with hypertensive di

Racial/Ethnic and Socioeconomic Disparities in Management of Incident Paroxysmal Atrial Fibrillation.

IMPORTANCE: In patients with paroxysmal atrial fibrillation (AF), rhythm control with either antiarrhythmic drugs (AADs) or catheter ablation has been associated with decreased symptoms, prevention of adverse remodeling, and improved cardiovascular outcomes. Adoption of advanced cardiovascular therapeutics, however, is often slower among patients from racial/ethnic minority groups and those with lower income. OBJECTIVE: To ascertain the cumulative rates of AAD and catheter ablation use for the management of paroxysmal AF and to investigate for the presence of inequities in AF management by ev

Akt2 ablation prolongs life span and improves myocardial contractile function with adaptive cardiac remodeling: role of Sirt1-mediated autophagy regulation.

Aging is accompanied with unfavorable geometric and functional changes in the heart involving dysregulation of Akt and autophagy. This study examined the impact of Akt2 ablation on life span and cardiac aging as well as the mechanisms involved with a focus on autophagy and mitochondrial integrity. Cardiac geometry, contractile, and intracellular Ca2+ properties were evaluated using echocardiography, IonOptix® edge-detection and fura-2 techniques. Levels of Sirt1, mitochondrial integrity, autophagy, and mitophagy markers were evaluated using Western blot. Our results revealed that Akt2 ablation

Large Variations in Phenylalanine Concentrations Associate Adverse Cardiac Remodelling in Adult Patients With Phenylketonuria-A Long-Term CMR Study.

BACKGROUND: Despite a phenylalanine (Phe) restrictive diet, most adult patients with 'classical' phenylketonuria (PKU) maintain life-long Phe concentrations above the normal range and receive tyrosine (Tyr) and protein-enriched diets to maintain acceptable concentrations and ensure normal development. While these interventions are highly successful in preventing adverse neuropsychiatric complications, their long- term consequences are incompletely explored. We observed early cardiomyopathic characteristics and associated hemodynamic changes in adult PKU patients and present here the results of

Sex Differences in Left Ventricular Size and Function before and after Mitral Valve Repair.

BACKGROUND: Among healthy subjects, women have smaller cardiac size than men even after indexing for body surface area (BSA), as well as higher left ventricular ejection fraction (LVEF) and left ventricular (LV) global longitudinal strain (GLS). Despite this, little is known about sex differences in LV remodeling in patients with mitral valve prolapse (MVP) undergoing mitral valve repair (MVr). The aim of this study was to assess pre- and post-MVr sex differences in LV size and function in patients with MVP. METHODS: Patients with MVP who underwent surgery between 2007 and 2024 at two heart v

Collagen XV is necessary for modeling of the extracellular matrix and its deficiency predisposes to cardiomyopathy.

RATIONALE: The extracellular matrix (ECM) is a major determinant of the structural integrity and functional properties of the myocardium in common pathological conditions, and changes in vasculature contribute to cardiac dysfunction. Collagen (Col) XV is preferentially expressed in the ECM of cardiac muscle and microvessels. OBJECTIVE: We aimed to characterize the ECM, cardiovascular function and responses to elevated cardiovascular load in mice lacking Col XV (Col15a1(-/-)) to define its functional role in the vasculature and in age- and hypertension-associated myocardial remodeling. METHOD

Urgent neonatal balloon atrial septostomy in simple transposition of the great arteries: predictive value of fetal cardiac parameters.

OBJECTIVES: To investigate the impact of abnormal perinatal loading conditions on cardiac geometry and function in term fetuses and neonates with transposition of the great arteries with intact interventricular septum (simple TGA), and to explore the predictive value of fetal cardiac parameters for an urgent balloon atrial septostomy (BAS) after birth. METHODS: This was a prospective longitudinal follow-up study of women delivering at term, including both uncomplicated pregnancies with normal outcome and pregnancies affected by fetal simple TGA. Conventional, spectral-tissue Doppler and speck

Epigenetic Mechanism and Therapeutic Implications of Atrial Fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia attacking 1. 5-2.0% of general population worldwide. It has a significant impact on morbidity and mortality globally and its prevalence increases exponentially with age. Therapies like catheter ablation or conventional antiarrhythmic drugs have not provided effective solution to the recurrence for AF over the past decades. Over 100 genetic loci have been discovered to be associated with AF by Genome-wide association studies (GWAS) but none has led to a therapy. Recently potential involvement of epigenetics (DNA methylation, histone modific

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… Recent evidence suggested that lncRNAs in epicardial adipose tissue (EAT) may modulate atrial remodeling ( 50 , 51 ). … Valproic acid (VPA), an HDAC class I/IIA inhibitor, alleviated atrial remodeling in transgenic mice, animal AF models, and human AF ( 31 ). …

The Arrhythmic Burden of Cardiac Amyloidosis: A Comprehensive Review.

Cardiac amyloidosis (CA) represents a growing etiology of heart failure (HF) and arrhythmogenesis, driven by the intramyocardial deposition of aberrantly folded proteins, notably immunoglobulin light chains (AL) and transthyretin (ATTR). This infiltrative process compromises myocardial compliance and disrupts the cardiac conduction system, leading to a diverse spectrum of dysrhythmias. The escalating prevalence of CA, particularly within geriatric demographics and individuals with plasma cell dyscrasias, underscores the imperative for refined diagnostic and therapeutic paradigms. The considera

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… remodeling due to amyloid infiltration. … Prevention of pathological atrial remodeling and atrial fibrillation: JACC state-of-the-art review. J Am Coll Cardiol. 2021;77:2846–64. doi: 10.1016/j.jacc.2021.04.012. 23. Sagris M, Vardas EP, Theofilis P, Antonopoulos AS, Oikonomou E, Tousoulis D. …

Exploratory Analysis of Circulating miRNA Signatures in Atrial Fibrillation Patients Determining Potential Biomarkers to Support Decision-Making in Anticoagulation and Catheter Ablation.

Novel biomarkers are desired to improve risk management for patients with atrial fibrillation (AF). We measured 179 plasma miRNAs in 83 AF patients using multiplex qRT-PCR. Plasma levels of eight (i.e., hsa-miR-22-3p, hsa-miR-128-3p, hsa-miR-130a-3p, hsa-miR-140-5p, hsa-miR-143-3p, hsa-miR-148b-3p, hsa-miR-497-5p, hsa-miR-652-3p) and three (i.e., hsa-miR-144-5p, hsa-miR-192-5p, hsa-miR-194-5p) miRNAs showed positive and negative correlations with CHA2DS2-VASc scores, respectively, which also showed negative and positive correlations with catheter ablation (CA) procedure, respectively, within t

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… A key pathogenic factor for AF is left atrial remodeling. Moreover, advanced left atrial remodeling is associated with increased risk of thromboembolism, while less advanced one is associated with successful catheter ablation. … Atrial Remodeling Is Directly Related to End-Diastolic Left Ventricular Pressure in a Mouse Model of Ventricular Pressure Overload. PLoS ONE. 2013;8:e72651. doi: 10.1371/journal.pone.0072651. 4. Staerk L., Sherer J.A., Ko D., Benjamin E.J., Helm R.H. …

Left Ventricular Hypertrophy: Etiology-Based Therapeutic Options.

Determining the etiologies of left ventricular hypertrophy (LVH) can be challenging due to the similarities of the different manifestations in clinical presentation and morphological features. Depending on the underlying cause, not only left ventricular mass but also left ventricular cavity size, or both, may increase. Patients with LVH remain asymptomatic for a few years, but disease progression will lead to the development of systolic or diastolic dysfunction and end-stage heart failure. As hypertrophied cardiac muscle disrupts normal conduction, LVH predisposes to arrhythmias. Distinguishin

Cardiac amyloidosis and aortic stenosis: a state-of-the-art review.

Cardiac amyloidosis is caused by the extracellular deposition of amyloid fibrils in the heart, involving not only the myocardium but also any cardiovascular structure. Indeed, this progressive infiltrative disease also involves the cardiac valves and, specifically, shows a high prevalence with aortic stenosis. Misfolded protein infiltration in the aortic valve leads to tissue damage resulting in the onset or worsening of valve stenosis. Transthyretin cardiac amyloidosis and aortic stenosis coexist in patients > 65 years in about 4-16% of cases, especially in those undergoing transcatheter aort

Abstract

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Current Data and Future Perspectives on Patients with Atrial Fibrillation and Cancer

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Atrial fibrillation post hematopoietic stem cell transplant: incidence, risk factors, and management challenges.

Atrial fibrillation (AF) is the most frequent cardiovascular complication after hematopoietic stem cell transplantation (HSCT) and is linked to higher short-term and long-term morbidity and mortality. AF occurring within 30 days post-HSCT reflects an interplay of peri-transplant triggers, conditioning-related myocardial injury, systemic inflammation and infection, rapid fluid shifts with atrial stretch, and electrolyte disturbances. Beyond 30 days, AF is driven by chronic inflammation and graft-vs.-host disease, metabolic dysregulation from immunosuppression, and cumulative cardiotoxic cancer

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… This effect is thought to be due to off-target inhibition of kinases such as C-terminal Src kinase and disruption of PI3K-Akt signaling, which leads to atrial remodeling and abnormal calcium handling ( 37 ). … Structural heart factors Echocardiographic markers indicative of atrial remodeling significantly forecast AF risk. …

A review of chemotherapeutic drugs-induced arrhythmia and potential intervention with traditional Chinese medicines.

Significant advances in chemotherapy drugs have reduced mortality in patients with malignant tumors. However, chemotherapy-related cardiotoxicity increases the morbidity and mortality of patients, and has become the second leading cause of death after tumor recurrence, which has received more and more attention in recent years. Arrhythmia is one of the common types of chemotherapy-induced cardiotoxicity, and has become a new risk related to chemotherapy treatment, which seriously affects the therapeutic outcome in patients. Traditional Chinese medicine has experienced thousands of years of cli

HDAC Inhibitors: Therapeutic Potential in Fibrosis-Associated Human Diseases.

Fibrosis is characterized by excessive deposition of the extracellular matrix and develops because of fibroblast differentiation during the process of inflammation. Various cytokines stimulate resident fibroblasts, which differentiate into myofibroblasts. Myofibroblasts actively synthesize an excessive amount of extracellular matrix, which indicates pathologic fibrosis. Although initial fibrosis is a physiologic response, the accumulated fibrous material causes failure of normal organ function. Cardiac fibrosis interferes with proper diastole, whereas pulmonary fibrosis results in chronic hypo