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Behavior of mitral regurgitation after isolated tricuspid valve surgery: determinants and hemodynamic correlates.

BACKGROUND: Isolated tricuspid regurgitation (TR) is increasingly recognized as a clinically important disease associated with adverse outcomes. Surgical repair often improves right-sided hemodynamics, but its effects on mitral regurgitation (MR) are unclear. Early observations suggest that MR may worsen postoperatively, yet reliable predictors remain insufficiently defined. OBJECTIVES: To evaluate postoperative MR behavior following isolated surgical TR repair and identify echocardiographic predictors of MR worsening. METHODS: This retrospective cohort study included patients ≥ 14 years who

A blueprint of an integrated cardio-obstetric care pathway for women with intermediate- to high-risk cardiovascular disease in pregnancy and postpartum.

INTRODUCTION/BACKGROUND: Women with pre-existing cardiovascular disease (CVD) face elevated maternal and fetal risks and implementing existing cardio-obstetric guidelines remains challenging. A previous integrated preconception care pathway for this population has been developed. As a next step, the aim of the current work was to develop a practical, expert-based integrated care pathway (ICP) for women with intermediate to high CVD risk during antepartum and postpartum periods. METHODS: The integrated obstetric cardiology pathway was developed via a review of international cardiac and obstetr

Developing core indicators for identifying people at risk of delayed heart failure diagnosis.

BACKGROUND: Heart failure (HF) is frequently diagnosed during hospital admission, often after symptoms have been present for some time. Those diagnosed in hospital typically experience higher mortality reflecting not only possible diagnostic delay but also greater illness severity at presentation. The reasons behind delayed HF diagnosis are multifaceted and complex. This study aimed to achieve consensus on a priority list of patient, clinical, and service-level factors associated with delayed HF diagnosis, and to identify indicators that could support earlier detection of undiagnosed HF in pri

Development and validation of a machine learning model for diagnosis of ischemic heart disease using single-lead electrocardiogram parameters.

BACKGROUND: Ischemic heart disease (IHD) impacts the quality of life and has the highest mortality rate of cardiovascular diseases globally. AIM: To compare variations in the parameters of the single-lead electrocardiogram (ECG) during resting conditions and physical exertion in individuals diagnosed with IHD and those without the condition using vasodilator-induced stress computed tomography (CT) myocardial perfusion imaging as the diagnostic reference standard. METHODS: This single center observational study included 80 participants. The participants were aged ≥ 40 years and given an infor

Amyloidosis and Biopsy During Carpal Tunnel Release: A Survey of American Society for Surgery of the Hand Members.

PURPOSE: Our purpose was to assess the current surgical practices of hand surgeons with respect to carpal tunnel release (CTR) and biopsy for amyloidosis. In addition, we aimed to determine whether surgeon demographic factors were associated with higher rates of biopsy during CTR. METHODS: An anonymous, multiple-choice survey was distributed to all active American Society for Surgery of the Hand members, which included baseline demographic questions. Using a five-point Likert scale, the respondents were asked how frequently they obtain biopsies during CTR cases meeting tier 1 and tier 2 crite

Combination of Tele-Cardiology Tools for Cardiovascular Risk Stratification in Primary Care: Data from the PROVAR+ Study.

BACKGROUND: Tele-cardiology tools are valuable strategies to improve risk stratification. OBJECTIVE: We aimed to evaluate the accuracy of tele-electrocardiography (ECG) to predict abnormalities in screening echocardiography (echo) in primary care (PC). METHODS: In 17 months, 6 health providers at 16 PC units were trained on simplified handheld echo protocols. Tele-ECGs were recorded for final diagnosis by a cardiologist. Consented patients with major ECG abnormalities by the Minnesota code, and a 1:5 sample of normal individuals underwent clinical questionnaire and screening echo interpreted

Pit bull-type breeds with dilated cardiomyopathy eating nontraditional diets improve after diet change (2015-2022).

OBJECTIVE: To compare signalment, clinical signs, diet, echocardiographic findings, and outcome for pit bull-type breeds diagnosed between 2015 and 2022 with dilated cardiomyopathy (DCM) or with DCM diagnosed by a cardiologist but that did not meet all study echocardiographic criteria (DCM-C). ANIMALS: 91 dogs with DCM and 11 dogs with DCM-C. PROCEDURES: Data were collected on clinical findings, echocardiographic measurements, and diet at the time of diagnosis (for 76/91 dogs); echocardiographic changes; and survival. RESULTS: For dogs with diet information available for time of diagnosis,

Morbidity and Mortality in Adult Fontan Patients After Heart or Combined Heart-Liver Transplantation.

BACKGROUND: An increasing number of adult Fontan patients require heart transplantation (HT) or combined heart-liver transplant (CHLT); however, data regarding outcomes and optimal referral time remain limited. OBJECTIVES: The purpose of this study was to define survivorship post-HT/CHLT and predictors of post-transplant mortality, including timing of referral, in the adult Fontan population. METHODS: A retrospective cohort study of adult Fontan patients who underwent HT or CHLT across 15 centers in the United States and Canada was performed. Inclusion criteria included the following: 1) Fon

Quantitative estimation of pulmonary artery wedge pressure from chest radiographs by a regression convolutional neural network.

Recent studies reported that a convolutional neural network (CNN; a deep learning model) can detect elevated pulmonary artery wedge pressure (PAWP) from chest radiographs, the diagnostic images most commonly used for assessing pulmonary congestion in heart failure. However, no method has been published for quantitatively estimating PAWP from such radiographs. We hypothesized that a regression CNN, an alternative type of deep learning, could be a useful tool for quantitatively estimating PAWP in cardiovascular diseases. We retrospectively enrolled 936 patients with cardiovascular diseases who h

Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke.

BACKGROUND: Closure of a patent foramen ovale reduces the risk of recurrent stroke compared with medical therapy alone in young patients with cryptogenic strokes revealed by randomized control trials. Some cost-effectiveness analyses outside Japan have shown that patent foramen ovale closure is cost-effective, but no studies have examined cost-effectiveness in Japan. The objective of this study is to assess cost-effectiveness, from the perspective of a Japanese healthcare payer, of patent foramen ovale closure versus medical therapy alone for patients with patent foramen ovale related to crypt

Comparison of qualitative information obtained with the echocardiographic assessment using subcostal-only view and focused transthoracic echocardiography examinations: a prospective observational study.

PURPOSE: To evaluate whether echocardiographic assessment using the subcostal-only window (EASy) compared with focused transthoracic echocardiography (FTTE) using three windows (parasternal, apical, and subcostal) can provide critical information to serve as an entry-point technique for novice sonographers. METHODS: We conducted a retrospective study to compare diagnostic information acquired during EASy and FTTE examinations on qualitative left ventricular (LV) size, LV contractility, right ventricular (RV) size, RV contractility, interventricular septal position, and the presence of a signi

Progress and challenges in the treatment of cardiac amyloidosis: a review of the literature.

Cardiac amyloidosis is a restrictive cardiomyopathy determined by the accumulation of amyloid, which is represented by misfolded protein fragments in the cardiac extracellular space. The main classification of systemic amyloidosis is determined by the amyloid precursor proteins causing a very heterogeneous disease spectrum, but the main types of amyloidosis involving the heart are light chain (AL) and transthyretin amyloidosis (ATTR). AL, in which the amyloid precursor is represented by misfolded immunoglobulin light chains, can involve almost any system carrying the worst prognosis among amyl

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… The main role of the cardiologist during treatment is to evaluate the initial cardiac involvement, to stabilize the heart function (diuresis, prevention of embolic events, management of arrhythmias, and conduction disorders) during the treatment, and to assess the cardiac response to treatment. 63 CA … Multimodality imaging in cardiac amyloidosis: a primer for cardiologists. Eur Heart J Cardiovasc Imaging 2020; 21: 833–844. 21. Nochioka K, Quarta CC, Claggett B, Roca GQ, Rapezzi C, Falk RH, Solomon SD. Left atrial structure and function in cardiac amyloidosis. …

Objective Assessment of Physiologic Alterations Associated With Hemodynamically Significant Patent Ductus Arteriosus in Extremely Premature Neonates.

Delay in closure of ductus arteriosus in postnatal life may lead to serious consequences and complications in an extremely premature neonate secondary to hemodynamic alterations in regional blood flow pattern in various organs. Despite the widespread recognition amongst neonatologists to identify a hemodynamically significant patent ductus arteriosus (hsPDA) early in the postnatal course, there is lack of consensus in its definition and thus the threshold to initiate treatment. Echocardiographic assessment of PDA shunt size and volume combined with neonatologists' impression of clinical signif

A Life-Threatening Presentation of Primary Small Cell Colorectal Non-Hodgkin Lymphoma as Cardiac Tamponade and Its Challenging Management.

UNLABELLED: Colorectal non-Hodgkin lymphoma (NHL) is quite aggressive and rare, only constituting less than 1% of all cases of colorectal cancer. The pericardium is an extremely rare first site of metastasis. Cardiac tamponade can be a life-threatening initial presentation. We report a 55-year-old female who presented with severe shortness of breath, intermittent abdominal pain and altered bowel habits. She had low blood pressure with congested neck veins. Her echocardiogram showed pericardial and cardiac infiltration with tumour mass; a large pericardial effusion with signs of cardiac tampona

Economic impact of heart failure with preserved ejection fraction: insights from the ALDO-DHF trial.

AIMS: Although heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause for hospitalization, its overall costs remain unclear. Therefore, we assessed the health care-related costs of ambulatory HFpEF patients and the effect of spironolactone. METHODS AND RESULTS: The aldosterone receptor blockade in diastolic HF trial is a multicentre, prospective, randomized, double-blind, placebo-controlled trial conducted between March 2007 and April 2011 at 10 sites in Germany and Austria that included 422 ambulatory patients [mean age: 67 years (standard deviation: 8); 52% women]. A

Spectrum of Current Management of Pediatric Pulmonary Hypertensive Crisis.

UNLABELLED: Pulmonary hypertension is a growing pediatric problem and children may present with pulmonary hypertensive crisis-a life-threatening emergency requiring acute interventions. The aim of this study was to characterize the broad spectrum of care provided in North American PICUs for children who present with pulmonary hypertensive crisis. DESIGN: Electronic cross-sectional survey. Survey questions covered the following: demographics of the respondents, institution, and patient population; pulmonary hypertension diagnostic modalities; pulmonary hypertension-specific pharmacotherapies;

Guidelines impact cholesterol management.

BACKGROUND: Previous research demonstrates increased utilization of high-intensity statins, but unchanged low-density lipoprotein cholesterol (LDL-C) levels, immediately after the 2013 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline release. OBJECTIVE: The objective of this study was to determine achievement of statin therapy goals in patients with atherosclerotic cardiovascular disease (ASCVD) before and up to 4 years after the 2013 ACC/AHA guideline release compared with LDL-C goals of <70 mg/dL and <100 mg/dL previously recommended by other professio

"OPTImAL": an ontology for patient adherence modeling in physical activity domain.

BACKGROUND: Maintaining physical fitness is a crucial component of the therapeutic process for patients with cardiovascular disease (CVD). Despite the known importance of being physically active, patient adherence to exercise, both in daily life and during cardiac rehabilitation (CR), is low. Patient adherence is frequently composed of numerous determinants associated with different patient aspects (e.g., psychological, clinical, etc.). Understanding the influence of such determinants is a central component of developing personalized interventions to improve or maintain patient adherence. Medi

Impact of renal dysfunction on the management and outcome of acute heart failure: results from the French prospective, multicentre, DeFSSICA survey.

OBJECTIVES: Cardiorenal syndrome (CRS) is the combination of acute heart failure syndrome (AHF) and renal dysfunction (creatinine clearance (CrCl) ≤60 mL/min). Real-life data were used to compare the management and outcome of AHF with and without renal dysfunction. DESIGN: Prospective, multicentre. SETTING: Twenty-six academic, community and regional hospitals in France. PARTICIPANTS: 507 patients with AHF were assessed in two groups according to renal function: group 1 (patients with CRS (CrCl ≤60 mL/min): n=335) and group 2 (patients with AHF with normal renal function (CrCl >60 mL/min):

A step-wise approach for establishing a multidisciplinary team for the management of tuberous sclerosis complex: a Delphi consensus report.

BACKGROUND: Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder associated with mutations in TSC1 and TSC2 genes, upregulation of mammalian target of rapamycin signaling, and subsequent tumor formation in various organs. Due to the many manifestations of TSC and their potential complications, management requires the expertise of multiple medical disciplines. A multidisciplinary care approach is recommended by consensus guidelines. Use of multidisciplinary teams (MDTs) has been shown to be beneficial in treating other complex diseases, such as cancer. In a lifelong di