Shuyuan Wang, Zubair Bashir, Edward W Chen, Vishnu Kadiyala, Charles F Sherrod, Phinnara Has, Christopher Song, Corey E Ventetuolo, James Simmons, Philip Haines
Right ventricular (RV) dysfunction is associated with poor prognosis in acute respiratory failure (ARF). Our study evaluates the efficacy of RV strain in detecting RV dysfunction in ARF patients requiring invasive mechanical ventilation (IMV) compared to tricuspid annular plane systolic excursion (TAPSE). In this retrospective study involving 376 patients diagnosed with ARF and requiring IMV, we extracted clinical and outcome data from patient records. RV global longitudinal strain (RVGLS), free wall longitudinal strain (FWLS), and TAPSE were measured retrospectively using speckle tracking echocardiography (STE) and traditional echocardiography, respectively. We divided the cohort into three groups: TTE during IMV (TTE-IMV, 223 patients), before IMV (TTE-bIMV, 68 patients), and after IMV (TTE-aIMV, 85 patients). Multivariable regression analysis, adjusted for covariates, revealed significantly higher RVGLS and FWLS in the groups not on IMV at the time of TTE compared to the TTE-IMV group. Specifically, the TTE-bIMV group showed higher RVGLS (β = 7.28, 95% CI 5.07, 9.48) and FWLS (β = 5.83, 95% CI 3.36, 8.31), while the TTE-aIMV group exhibited higher RVGLS (β = 9.39, 95% CI 6.10, 12.69) and FWLS (β = 7.54, 95% CI 4.83, 10.24). TAPSE did not reveal any significant differences across the groups. Our study suggests an association between IMV and lower RVGLS and FWLS in ARF patients, indicating that IMV itself may contribute to RV dysfunction. RVGLS and FWLS appear to be more sensitive than TAPSE in detecting changes in RV function that were previously subclinical in patients on IMV. Prospective studies with TTE before, during, and after IMV are necessary to assess the primary driver of RV dysfunction and to prognosticate STE-detected RV dysfunction in this population.
{"title":"Invasive Mechanical Ventilation Is Associated with Worse Right Ventricular Strain in Acute Respiratory Failure Patients.","authors":"Shuyuan Wang, Zubair Bashir, Edward W Chen, Vishnu Kadiyala, Charles F Sherrod, Phinnara Has, Christopher Song, Corey E Ventetuolo, James Simmons, Philip Haines","doi":"10.3390/jcdd11080246","DOIUrl":"10.3390/jcdd11080246","url":null,"abstract":"<p><p>Right ventricular (RV) dysfunction is associated with poor prognosis in acute respiratory failure (ARF). Our study evaluates the efficacy of RV strain in detecting RV dysfunction in ARF patients requiring invasive mechanical ventilation (IMV) compared to tricuspid annular plane systolic excursion (TAPSE). In this retrospective study involving 376 patients diagnosed with ARF and requiring IMV, we extracted clinical and outcome data from patient records. RV global longitudinal strain (RVGLS), free wall longitudinal strain (FWLS), and TAPSE were measured retrospectively using speckle tracking echocardiography (STE) and traditional echocardiography, respectively. We divided the cohort into three groups: TTE during IMV (TTE-IMV, 223 patients), before IMV (TTE-bIMV, 68 patients), and after IMV (TTE-aIMV, 85 patients). Multivariable regression analysis, adjusted for covariates, revealed significantly higher RVGLS and FWLS in the groups not on IMV at the time of TTE compared to the TTE-IMV group. Specifically, the TTE-bIMV group showed higher RVGLS (β = 7.28, 95% CI 5.07, 9.48) and FWLS (β = 5.83, 95% CI 3.36, 8.31), while the TTE-aIMV group exhibited higher RVGLS (β = 9.39, 95% CI 6.10, 12.69) and FWLS (β = 7.54, 95% CI 4.83, 10.24). TAPSE did not reveal any significant differences across the groups. Our study suggests an association between IMV and lower RVGLS and FWLS in ARF patients, indicating that IMV itself may contribute to RV dysfunction. RVGLS and FWLS appear to be more sensitive than TAPSE in detecting changes in RV function that were previously subclinical in patients on IMV. Prospective studies with TTE before, during, and after IMV are necessary to assess the primary driver of RV dysfunction and to prognosticate STE-detected RV dysfunction in this population.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11354324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Krisztina Munteanu, Ovidiu Ghirlea, Daniel Breban-Schwarzkopf, Alexandra-Ioana Dănilă, Roxana-Georgeta Iacob, Ioan Adrian Petrache, Gabriel Veniamin Cozma, Anca Bordianu, Sorin Lucian Bolintineanu
The anatomical variations in the lower limb veins play a critical role in venous reflux surgeries. This study presents an analysis of the great saphenous vein (GSV) proximal part's anatomical peculiarities, with 257 patients included, who were operated for venous reflux. This study highlighted a progressive increase in the GSV diameter in conjunction with the complexity of the anatomical variations, ranging from no tributaries to more than five tributaries, an anterior accessory GSV, or venous aneurysms. Statistical analysis evidenced this expansion to be significantly correlated with the variations. Additionally, the progression of the chronic venous disease (CVD) stages was notably more prevalent in the complex anatomical variations, suggesting a nuanced interplay between the GSV anatomy and CVD severity. Conclusively, our research articulates the paramount importance of recognizing GSV anatomical variations in optimizing surgical outcomes for CVD patients. These insights not only pave the way for enhanced diagnostic accuracy but also support the strategic framework within which surgical and interventional treatments are devised, advocating for personalized approaches to venous reflux surgery.
{"title":"The Great Saphenous Vein Proximal Part: Branches, Anatomical Variations, and Their Implications for Clinical Practice and Venous Reflux Surgery.","authors":"Krisztina Munteanu, Ovidiu Ghirlea, Daniel Breban-Schwarzkopf, Alexandra-Ioana Dănilă, Roxana-Georgeta Iacob, Ioan Adrian Petrache, Gabriel Veniamin Cozma, Anca Bordianu, Sorin Lucian Bolintineanu","doi":"10.3390/jcdd11080242","DOIUrl":"10.3390/jcdd11080242","url":null,"abstract":"<p><p>The anatomical variations in the lower limb veins play a critical role in venous reflux surgeries. This study presents an analysis of the great saphenous vein (GSV) proximal part's anatomical peculiarities, with 257 patients included, who were operated for venous reflux. This study highlighted a progressive increase in the GSV diameter in conjunction with the complexity of the anatomical variations, ranging from no tributaries to more than five tributaries, an anterior accessory GSV, or venous aneurysms. Statistical analysis evidenced this expansion to be significantly correlated with the variations. Additionally, the progression of the chronic venous disease (CVD) stages was notably more prevalent in the complex anatomical variations, suggesting a nuanced interplay between the GSV anatomy and CVD severity. Conclusively, our research articulates the paramount importance of recognizing GSV anatomical variations in optimizing surgical outcomes for CVD patients. These insights not only pave the way for enhanced diagnostic accuracy but also support the strategic framework within which surgical and interventional treatments are devised, advocating for personalized approaches to venous reflux surgery.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11354398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marco Valerio Mariani, Nicola Pierucci, Vincenzo Mirco La Fazia, Pietro Cipollone, Marco Micillo, Andrea D'Amato, Francesca Fanisio, Giuseppe Ammirati, Nethuja Salagundla, Carlo Lavalle, Marco Alfonso Perrone
Pregnancy entails notable physiological alterations and hormonal fluctuations that affect the well-being of both the fetus and the mother. Cardiovascular events and arrhythmias are a major concern during pregnancy, especially in women with comorbidities or a history of arrhythmias. This paper provides an overview of the prevalence, therapies, and prognoses of different types of arrhythmias during pregnancy. The administration of antiarrhythmic drugs (AADs) during pregnancy demands careful consideration because of their possible effect on the mother and fetus. AADs can cross the placenta or be present in breast milk, potentially leading to adverse effects such as teratogenicity, growth restriction, or premature birth. The safety profiles of different classes of AADs are discussed. Individualized treatment approaches and close monitoring of pregnant women prescribed AADs are essential to ensure optimal maternal and fetal outcomes.
{"title":"Antiarrhythmic Drug Use in Pregnancy: Considerations and Safety Profiles.","authors":"Marco Valerio Mariani, Nicola Pierucci, Vincenzo Mirco La Fazia, Pietro Cipollone, Marco Micillo, Andrea D'Amato, Francesca Fanisio, Giuseppe Ammirati, Nethuja Salagundla, Carlo Lavalle, Marco Alfonso Perrone","doi":"10.3390/jcdd11080243","DOIUrl":"10.3390/jcdd11080243","url":null,"abstract":"<p><p>Pregnancy entails notable physiological alterations and hormonal fluctuations that affect the well-being of both the fetus and the mother. Cardiovascular events and arrhythmias are a major concern during pregnancy, especially in women with comorbidities or a history of arrhythmias. This paper provides an overview of the prevalence, therapies, and prognoses of different types of arrhythmias during pregnancy. The administration of antiarrhythmic drugs (AADs) during pregnancy demands careful consideration because of their possible effect on the mother and fetus. AADs can cross the placenta or be present in breast milk, potentially leading to adverse effects such as teratogenicity, growth restriction, or premature birth. The safety profiles of different classes of AADs are discussed. Individualized treatment approaches and close monitoring of pregnant women prescribed AADs are essential to ensure optimal maternal and fetal outcomes.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11354975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a']), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function.
使用左心房容积指数(LAVI)评估左心房(LA)的大小与临床息息相关,因为它对各种疾病的预后都有重要意义。然而,在 LAVI 的基础上增加 LA 功能评估可为不同心血管疾病提供更多临床和预后信息。超声心动图对 LA 功能的评估主要包括容积测量(LA 射血分数 [LAEF])、组织多普勒成像(TDI)(二尖瓣环舒张晚期速度 [a'])和斑点追踪方法,如 LA 纵向储层应变(LA 应变)。本综述分析并讨论了这些不同方法在分析 LA 功能方面的现有医学证据和潜在临床用途。
{"title":"Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function.","authors":"Mario Mangia, Emilio D'Andrea, Antonella Cecchetto, Riccardo Beccari, Donato Mele, Stefano Nistri","doi":"10.3390/jcdd11080241","DOIUrl":"10.3390/jcdd11080241","url":null,"abstract":"<p><p>The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a']), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11354374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alessandro Menotti, Paolo Emilio Puddu, Paolo Piras
Background and aim: To study the relationships of cardiovascular risk factors with cancer and cardiovascular mortality in a cohort of middle-aged men followed-up for 61 years.
Materials and methods: A rural cohort of 1611 cancer- and cardiovascular disease-free men aged 40-59 years was examined in 1960 within the Italian Section of the Seven Countries Study, and 28 risk factors measured at baseline were used to predict cancer (n = 459) and cardiovascular deaths (n = 678) that occurred during 61 years of follow-up until the extinction of the cohort with Cox proportional hazard models.
Results: A model with 28 risk factors and cancer deaths as the end-point produced eight statistically significant coefficients for age, smoking habits, mother early death, corneal arcus, xanthelasma and diabetes directly related to events, and arm circumference and healthy diet inversely related. In the corresponding models for major cardiovascular diseases and their subgroups, only the coefficients of age and smoking habits were significant among those found for cancer deaths, to which healthy diet can be added if considering coronary heart disease alone. Following a competing risks analysis by the Fine-Gray method, risk factors significantly common to both conditions were only age, smoking, and xanthelasma.
Conclusions: A sizeable number of traditional cardiovascular risk factors were not predictors of cancer death in a middle-aged male cohort followed-up until extinction.
{"title":"Cardiovascular Risk Factors Predicting Cardiovascular and Cancer Deaths in a Middle-Aged Population Followed-Up for 61 Years until Extinction.","authors":"Alessandro Menotti, Paolo Emilio Puddu, Paolo Piras","doi":"10.3390/jcdd11080240","DOIUrl":"10.3390/jcdd11080240","url":null,"abstract":"<p><strong>Background and aim: </strong>To study the relationships of cardiovascular risk factors with cancer and cardiovascular mortality in a cohort of middle-aged men followed-up for 61 years.</p><p><strong>Materials and methods: </strong>A rural cohort of 1611 cancer- and cardiovascular disease-free men aged 40-59 years was examined in 1960 within the Italian Section of the Seven Countries Study, and 28 risk factors measured at baseline were used to predict cancer (<i>n</i> = 459) and cardiovascular deaths (<i>n</i> = 678) that occurred during 61 years of follow-up until the extinction of the cohort with Cox proportional hazard models.</p><p><strong>Results: </strong>A model with 28 risk factors and cancer deaths as the end-point produced eight statistically significant coefficients for age, smoking habits, mother early death, corneal arcus, xanthelasma and diabetes directly related to events, and arm circumference and healthy diet inversely related. In the corresponding models for major cardiovascular diseases and their subgroups, only the coefficients of age and smoking habits were significant among those found for cancer deaths, to which healthy diet can be added if considering coronary heart disease alone. Following a competing risks analysis by the Fine-Gray method, risk factors significantly common to both conditions were only age, smoking, and xanthelasma.</p><p><strong>Conclusions: </strong>A sizeable number of traditional cardiovascular risk factors were not predictors of cancer death in a middle-aged male cohort followed-up until extinction.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11354922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Imma Romanazzi, Antonio Di Monaco, Ilaria Bonaparte, Noemi Valenti, Alessia Surgo, Fiorella Di Guglielmo, Alba Fiorentino, Massimo Grimaldi
Objectives: Sustained monomorphic ventricular tachycardia (SMVT) is a life-threatening condition that is often observed in patients with structural heart disease. Catheter ablation (CA) ablation is an effective and well-established treatment for the scar-related ventricular tachycardias (VTs). Sometimes, due to patient fragility or contraindications to CA, a noninvasive procedure is required. In these cases, VT ablation with stereotactic arrhythmia radioablation (STAR) for SMVTs supported by the CardioInsight mapping system seems to be a promising and effective noninvasive approach.
Methods and results: We report a case of a 55-year-old male smoker and heavy alcohol consumer who developed ischemic heart disease and frequent refractory SMVT relative to antiarrhythmic drugs. Catheter ablation was not practicable due to the presence of an apical thrombosis in the left ventricle. The CardioInsightTM system (Cardioinsight Technologies Inc., Cleveland, OH, USA) was useful for noninvasively mapping the VTs, identifying two target areas on the septum and anterior wall of the left ventricle. A personalized STAR treatment plan was carefully designed, and it was delivered in a few minutes. During follow-up, a significant reduction in the arrhythmia burden was documented.
Conclusions: Stereotactic arrhythmia radioablation supported by the CardioInsight system could be an alternative treatment for VTs when catheter ablation is not possible. Larger studies are needed to investigate this technique.
目的:持续性单形室速(SMVT)是一种危及生命的疾病,通常见于结构性心脏病患者。导管消融术(CA)是治疗瘢痕相关性室性心动过速(VT)的有效且行之有效的方法。有时,由于患者体质虚弱或有 CA 的禁忌症,需要进行无创手术。在这些情况下,使用立体定向心律失常射频消融术(STAR)消融由 CardioInsight 制图系统支持的 SMVT 似乎是一种很有前景且有效的无创方法:我们报告了一例 55 岁男性吸烟者和酗酒者的病例,该患者患有缺血性心脏病,并经常出现抗心律失常药物治疗无效的难治性 SMVT。由于左心室存在心尖血栓,导管消融术不可行。CardioInsightTM 系统(美国俄亥俄州克利夫兰市 Cardioinsight Technologies Inc.精心设计的个性化 STAR 治疗方案在几分钟内就完成了。在随访期间,记录显示心律失常负荷明显减轻:结论:在导管消融术不可行的情况下,由 CardioInsight 系统支持的立体定向心律失常射频消融术可作为治疗 VT 的替代疗法。这项技术还需要更大规模的研究。
{"title":"Noninvasive Mapping System for the Stereotactic Radioablation Treatment of Ventricular Tachycardia: A Case Description.","authors":"Imma Romanazzi, Antonio Di Monaco, Ilaria Bonaparte, Noemi Valenti, Alessia Surgo, Fiorella Di Guglielmo, Alba Fiorentino, Massimo Grimaldi","doi":"10.3390/jcdd11080239","DOIUrl":"10.3390/jcdd11080239","url":null,"abstract":"<p><strong>Objectives: </strong>Sustained monomorphic ventricular tachycardia (SMVT) is a life-threatening condition that is often observed in patients with structural heart disease. Catheter ablation (CA) ablation is an effective and well-established treatment for the scar-related ventricular tachycardias (VTs). Sometimes, due to patient fragility or contraindications to CA, a noninvasive procedure is required. In these cases, VT ablation with stereotactic arrhythmia radioablation (STAR) for SMVTs supported by the CardioInsight mapping system seems to be a promising and effective noninvasive approach.</p><p><strong>Methods and results: </strong>We report a case of a 55-year-old male smoker and heavy alcohol consumer who developed ischemic heart disease and frequent refractory SMVT relative to antiarrhythmic drugs. Catheter ablation was not practicable due to the presence of an apical thrombosis in the left ventricle. The CardioInsight<sup>TM</sup> system (Cardioinsight Technologies Inc., Cleveland, OH, USA) was useful for noninvasively mapping the VTs, identifying two target areas on the septum and anterior wall of the left ventricle. A personalized STAR treatment plan was carefully designed, and it was delivered in a few minutes. During follow-up, a significant reduction in the arrhythmia burden was documented.</p><p><strong>Conclusions: </strong>Stereotactic arrhythmia radioablation supported by the CardioInsight system could be an alternative treatment for VTs when catheter ablation is not possible. Larger studies are needed to investigate this technique.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11355038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jordan Llerena-Velastegui, Sebastian Velastegui-Zurita, Kristina Zumbana-Podaneva, Melany Mejia-Mora, Ana Clara Fonseca Souza de Jesus, Pedro Moraes Coelho
Shifts from deep to moderate hypothermic circulatory arrest (HCA) in aortic arch surgery necessitate an examination of their differential impacts on neurocognitive functions, especially structured verbal memory, given its significance for patient recovery and quality of life. This study evaluates and synthesizes evidence on the effects of deep (≤20.0 °C), low-moderate (20.1-24.0 °C), and high-moderate (24.1-28.0 °C) hypothermic temperatures on structured verbal memory preservation and overall cognitive health in patients undergoing aortic arch surgery. We evaluated the latest literature from major medical databases such as PubMed and Scopus, focusing on research from 2020 to 2024, to gather comprehensive insights into the current landscape of temperature management during HCA. This comparative analysis highlights the viability of moderate hypothermia (20.1-28.0 °C), supported by recent trials and observational studies, as a method to achieve comparable neuroprotection with fewer complications than traditional deep hypothermia. Notably, low-moderate and high-moderate temperatures have been shown to support substantial survival rates, with impacts on structured verbal memory preservation that necessitate careful selection based on individual surgical risks and patient profiles. The findings advocate for a nuanced approach to selecting hypothermic protocols in aortic arch surgeries, emphasizing the importance of tailoring temperature management to optimize neurocognitive outcomes and patient recovery. This study fills a critical gap in the literature by providing evidence-based recommendations for temperature ranges during HCA, calling for ongoing updates to clinical guidelines and further research to refine these recommendations. The implications of temperature on survival rates, complications, and success rates underpin the necessity for evolving cardiopulmonary bypass techniques and cerebral perfusion strategies to enhance patient outcomes in complex cardiovascular procedures.
{"title":"Optimization of Hypothermic Protocols for Neurocognitive Preservation in Aortic Arch Surgery: A Literature Review.","authors":"Jordan Llerena-Velastegui, Sebastian Velastegui-Zurita, Kristina Zumbana-Podaneva, Melany Mejia-Mora, Ana Clara Fonseca Souza de Jesus, Pedro Moraes Coelho","doi":"10.3390/jcdd11080238","DOIUrl":"10.3390/jcdd11080238","url":null,"abstract":"<p><p>Shifts from deep to moderate hypothermic circulatory arrest (HCA) in aortic arch surgery necessitate an examination of their differential impacts on neurocognitive functions, especially structured verbal memory, given its significance for patient recovery and quality of life. This study evaluates and synthesizes evidence on the effects of deep (≤20.0 °C), low-moderate (20.1-24.0 °C), and high-moderate (24.1-28.0 °C) hypothermic temperatures on structured verbal memory preservation and overall cognitive health in patients undergoing aortic arch surgery. We evaluated the latest literature from major medical databases such as PubMed and Scopus, focusing on research from 2020 to 2024, to gather comprehensive insights into the current landscape of temperature management during HCA. This comparative analysis highlights the viability of moderate hypothermia (20.1-28.0 °C), supported by recent trials and observational studies, as a method to achieve comparable neuroprotection with fewer complications than traditional deep hypothermia. Notably, low-moderate and high-moderate temperatures have been shown to support substantial survival rates, with impacts on structured verbal memory preservation that necessitate careful selection based on individual surgical risks and patient profiles. The findings advocate for a nuanced approach to selecting hypothermic protocols in aortic arch surgeries, emphasizing the importance of tailoring temperature management to optimize neurocognitive outcomes and patient recovery. This study fills a critical gap in the literature by providing evidence-based recommendations for temperature ranges during HCA, calling for ongoing updates to clinical guidelines and further research to refine these recommendations. The implications of temperature on survival rates, complications, and success rates underpin the necessity for evolving cardiopulmonary bypass techniques and cerebral perfusion strategies to enhance patient outcomes in complex cardiovascular procedures.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11354408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Attila Nemes, Árpád Kormányos, Dorottya Lilla Olajos, Alexandru Achim, Zoltán Ruzsa, Nóra Ambrus, Csaba Lengyel
Introduction: Three-dimensional (3D) speckle-tracking echocardiography (STE) combines the advantages of STE and volumetric 3D echocardiography, which shows the left ventricle (LV) in 3D during the cardiac cycle and is also suitable for accurate strain measurements in addition to volumetric assessments using the same virtual 3D LV cast. The present study aimed to confirm the prognostic impact of 3DSTE-derived LV global longitudinal strain (GLS) in healthy adults during a 12-year follow-up period.
Patients and methods: The current study comprised 124 healthy individuals with a mean age of 31.0 ± 11.7 years (64 males) at the time of complete two-dimensional Doppler echocardiography (2DE) and 3DSTE.
Results: During a mean follow-up of 8.01 ± 4.12 years, 10 healthy individuals suffered cardiovascular events, including 2 cardiac deaths. Using ROC analysis, 3DSTE-derived LV-GLS ≥ 14.77% was found to be a significant predictor for cardiovascular event-free survival (sensitivity 70%, specificity 71%, area under the curve 76%, p = 0.007). Using 2DE, higher LV end-diastolic and end-systolic volumes, a larger LV end-systolic diameter and a lower LV ejection fraction could be detected in subjects with LV-GLS < 14.77% as compared to cases with LV-GLS ≥ 14.77%. Subjects with events had thicker interventricular septa, a larger LV mass and lower 3DSTE-derived LV-GLS and a higher ratio of cases had LV-GLS < 14.77%. From subjects with LV-GLS < 14.77%, seven individuals (18%) had events. Multivariate regression analysis identified age and LV-GLS as independent predictors of event-free survival.
Conclusions: 3DSTE-derived LV-GLS is a strong independent predictor of cardiovascular survival in healthy adults.
{"title":"Long-Term Prognostic Impact of Three-Dimensional Speckle-Tracking Echocardiography-Derived Left Ventricular Global Longitudinal Strain in Healthy Adults-Insights from the MAGYAR-Healthy Study.","authors":"Attila Nemes, Árpád Kormányos, Dorottya Lilla Olajos, Alexandru Achim, Zoltán Ruzsa, Nóra Ambrus, Csaba Lengyel","doi":"10.3390/jcdd11080237","DOIUrl":"10.3390/jcdd11080237","url":null,"abstract":"<p><strong>Introduction: </strong>Three-dimensional (3D) speckle-tracking echocardiography (STE) combines the advantages of STE and volumetric 3D echocardiography, which shows the left ventricle (LV) in 3D during the cardiac cycle and is also suitable for accurate strain measurements in addition to volumetric assessments using the same virtual 3D LV cast. The present study aimed to confirm the prognostic impact of 3DSTE-derived LV global longitudinal strain (GLS) in healthy adults during a 12-year follow-up period.</p><p><strong>Patients and methods: </strong>The current study comprised 124 healthy individuals with a mean age of 31.0 ± 11.7 years (64 males) at the time of complete two-dimensional Doppler echocardiography (2DE) and 3DSTE.</p><p><strong>Results: </strong>During a mean follow-up of 8.01 ± 4.12 years, 10 healthy individuals suffered cardiovascular events, including 2 cardiac deaths. Using ROC analysis, 3DSTE-derived LV-GLS ≥ 14.77% was found to be a significant predictor for cardiovascular event-free survival (sensitivity 70%, specificity 71%, area under the curve 76%, <i>p</i> = 0.007). Using 2DE, higher LV end-diastolic and end-systolic volumes, a larger LV end-systolic diameter and a lower LV ejection fraction could be detected in subjects with LV-GLS < 14.77% as compared to cases with LV-GLS ≥ 14.77%. Subjects with events had thicker interventricular septa, a larger LV mass and lower 3DSTE-derived LV-GLS and a higher ratio of cases had LV-GLS < 14.77%. From subjects with LV-GLS < 14.77%, seven individuals (18%) had events. Multivariate regression analysis identified age and LV-GLS as independent predictors of event-free survival.</p><p><strong>Conclusions: </strong>3DSTE-derived LV-GLS is a strong independent predictor of cardiovascular survival in healthy adults.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11354432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nancy A Pike, Bhaswati Roy, Cristina Cabrera-Mino, Nancy J Halnon, Alan B Lewis, Xingfeng Shao, Danny J J Wang, Rajesh Kumar
(1) Introduction: Adolescents with complex congenital heart disease (CCHD) show brain tissue injuries in regions associated with cognitive deficits. Alteration in cerebral arterial perfusion (CAP), as measured by arterial transit time (ATT), may lead to perfusion deficits and potential injury. Our study aims to compare ATT values between CCHD patients and controls and assess the associations between ATT values, MD values, and cognitive scores in adolescents with CCHD. (2) Methods: 37 CCHD subjects, 14-18 years of age, who had undergone surgical palliation and 30 healthy controls completed cognitive testing and brain MRI assessments using a 3.0-Tesla scanner. ATT values and regional brain mean diffusivity [MD] were assessed for the whole brain using diffusion tensor imaging. (3) Results: The mean MoCA values [23.1 ± 4.1 vs. 28.1 ± 2.3; p < 0.001] and General Memory Index, with a subscore of WRAML2 [86.8 ± 15.4 vs. 110.3 ± 14.5; p < 0.001], showed significant cognitive deficits in CCHD patients compared to controls. The mean global ATT was significantly higher in CCHD patients versus controls (mean ± SD, s, 1.26 ± 0.11 vs. 1.19 ± 0.11, p = 0.03), respectively. The partial correlations between ATT values, MD values, and cognitive scores (p < 0.005) showed significant associations in areas including the hippocampus, prefrontal cortices, cerebellum, caudate, anterior and mid cingulate, insula, thalamus, and lingual gyrus. (4) Conclusions: Adolescents with CCHD had prolonged ATTs and showed correlation with clinical measurements of cognitive impairment and MRI measurements of brain tissue integrity. This suggests that altered CAP may play a role in brain tissue injury and cognitive impairment after surgical palliation.
(1) 引言:患有复杂先天性心脏病(CCHD)的青少年会在与认知障碍相关的区域出现脑组织损伤。通过动脉转运时间(ATT)测量的脑动脉灌注(CAP)改变可能会导致灌注缺陷和潜在损伤。我们的研究旨在比较 CCHD 患者和对照组的 ATT 值,并评估 ATT 值、MD 值和 CCHD 青少年认知评分之间的关联。(2) 方法:37 名接受过手术姑息治疗的 14-18 岁 CCHD 受试者和 30 名健康对照者使用 3.0 特斯拉扫描仪完成认知测试和脑磁共振成像评估。使用弥散张量成像评估了全脑的 ATT 值和区域脑平均弥散率 [MD]。(3) 结果:与对照组相比,CCHD 患者的平均 MoCA 值[23.1 ± 4.1 vs. 28.1 ± 2.3; p < 0.001]和一般记忆指数(WRAML2 子分数)[86.8 ± 15.4 vs. 110.3 ± 14.5; p < 0.001]显示出明显的认知缺陷。与对照组相比,CCHD 患者的全局 ATT 平均值明显更高(平均值 ± SD,s,1.26 ± 0.11 vs. 1.19 ± 0.11,p = 0.03)。ATT 值、MD 值和认知评分之间的部分相关性(p < 0.005)显示,海马、前额叶皮质、小脑、尾状核、扣带回前部和中部、岛叶、丘脑和舌回等区域存在显著相关性。(4) 结论:患有先天性心脏病的青少年ATT时间延长,并与认知障碍的临床测量结果和脑组织完整性的磁共振成像测量结果相关。这表明,CAP的改变可能在手术姑息后的脑组织损伤和认知障碍中起作用。
{"title":"Compromised Cerebral Arterial Perfusion, Altered Brain Tissue Integrity, and Cognitive Impairment in Adolescents with Complex Congenital Heart Disease.","authors":"Nancy A Pike, Bhaswati Roy, Cristina Cabrera-Mino, Nancy J Halnon, Alan B Lewis, Xingfeng Shao, Danny J J Wang, Rajesh Kumar","doi":"10.3390/jcdd11080236","DOIUrl":"10.3390/jcdd11080236","url":null,"abstract":"<p><p>(1) Introduction: Adolescents with complex congenital heart disease (CCHD) show brain tissue injuries in regions associated with cognitive deficits. Alteration in cerebral arterial perfusion (CAP), as measured by arterial transit time (ATT), may lead to perfusion deficits and potential injury. Our study aims to compare ATT values between CCHD patients and controls and assess the associations between ATT values, MD values, and cognitive scores in adolescents with CCHD. (2) Methods: 37 CCHD subjects, 14-18 years of age, who had undergone surgical palliation and 30 healthy controls completed cognitive testing and brain MRI assessments using a 3.0-Tesla scanner. ATT values and regional brain mean diffusivity [MD] were assessed for the whole brain using diffusion tensor imaging. (3) Results: The mean MoCA values [23.1 ± 4.1 vs. 28.1 ± 2.3; <i>p</i> < 0.001] and General Memory Index, with a subscore of WRAML2 [86.8 ± 15.4 vs. 110.3 ± 14.5; <i>p</i> < 0.001], showed significant cognitive deficits in CCHD patients compared to controls. The mean global ATT was significantly higher in CCHD patients versus controls (mean ± SD, s, 1.26 ± 0.11 vs. 1.19 ± 0.11, <i>p</i> = 0.03), respectively. The partial correlations between ATT values, MD values, and cognitive scores (<i>p</i> < 0.005) showed significant associations in areas including the hippocampus, prefrontal cortices, cerebellum, caudate, anterior and mid cingulate, insula, thalamus, and lingual gyrus. (4) Conclusions: Adolescents with CCHD had prolonged ATTs and showed correlation with clinical measurements of cognitive impairment and MRI measurements of brain tissue integrity. This suggests that altered CAP may play a role in brain tissue injury and cognitive impairment after surgical palliation.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11354402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michał Święczkowski, Emil Julian Dąbrowski, Paweł Muszyński, Piotr Pogorzelski, Piotr Jemielita, Joanna Maria Dudzik, Tomasz Januszko, Małgorzata Duzinkiewicz, Maciej Południewski, Łukasz Kuźma, Marcin Kożuch, Paweł Kralisz, Sławomir Dobrzycki
Atrial fibrillation (AF) is the most common arrhythmia worldwide, and is associated with a significant risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative for patients with contraindications or intolerance to anticoagulant therapy. This review summarises the current evidence, indications, and technical advancements in surgical and percutaneous LAAO. Preprocedural planning relies on various imaging techniques, each with unique advantages and limitations. The existing randomised clinical trials and meta-analyses demonstrate favourable results for both percutaneous and surgical LAAO. Postprocedural management emphasises personalised anticoagulation strategies and comprehensive imaging surveillance to ensure device stability and detect complications. Future focus should be put on antithrombotic regimens, investigating predictors of device-related complications, and simplifying procedural aspects to enhance patient outcomes. In summary, LAAO is presented as a valuable therapeutic option for preventing AF-related thromboembolic events, with ongoing research aimed at refining techniques and improving patient care.
{"title":"A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion.","authors":"Michał Święczkowski, Emil Julian Dąbrowski, Paweł Muszyński, Piotr Pogorzelski, Piotr Jemielita, Joanna Maria Dudzik, Tomasz Januszko, Małgorzata Duzinkiewicz, Maciej Południewski, Łukasz Kuźma, Marcin Kożuch, Paweł Kralisz, Sławomir Dobrzycki","doi":"10.3390/jcdd11080234","DOIUrl":"10.3390/jcdd11080234","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is the most common arrhythmia worldwide, and is associated with a significant risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative for patients with contraindications or intolerance to anticoagulant therapy. This review summarises the current evidence, indications, and technical advancements in surgical and percutaneous LAAO. Preprocedural planning relies on various imaging techniques, each with unique advantages and limitations. The existing randomised clinical trials and meta-analyses demonstrate favourable results for both percutaneous and surgical LAAO. Postprocedural management emphasises personalised anticoagulation strategies and comprehensive imaging surveillance to ensure device stability and detect complications. Future focus should be put on antithrombotic regimens, investigating predictors of device-related complications, and simplifying procedural aspects to enhance patient outcomes. In summary, LAAO is presented as a valuable therapeutic option for preventing AF-related thromboembolic events, with ongoing research aimed at refining techniques and improving patient care.</p>","PeriodicalId":15197,"journal":{"name":"Journal of Cardiovascular Development and Disease","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11354510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}