Cardiovascular diagnosis and therapy最新文献

Background: Left ventricular, atrial and aortic dysfunction might be important disease drivers in patients with transposition of great arteries (TGA) that possibly influence pathophysiological processes beyond the underlying congenital disease. Therefore, this study aimed to assess their influence and relationship in TGA patients following arterial switch operation (ASO).

Methods: Patients with TGA after ASO were studied with cardiac magnetic resonance imaging (CMR) to measure (I) extracellular volume fraction (ECV); (II) global peak systolic longitudinal strain (GLS); (III) left atrial reservoir function (LA-EF-reservoir) and (IV) aortic distensibility (AD). Mediation analysis was performed to model the interplay of ventricular, atrial and aortic function.

Results: Eighty-one TGA patients (median age 16 years, 32% female) and 30 heart-healthy controls were included. TGA patients had significantly lower LA-EF-reservoir function (P<0.001) resulting in a shift from active to passive LA function (P<0.001), and AD was impaired in TGA patients (P<0.001). The ratio of active to passive LA function correlated with ECV (P=0.002). Both LA-EF-reservoir and AD correlated negatively with peak systolic GLS. In a mediation model, the effect of AD on peak systolic GLS encompassed both a direct effect on peak GLS (β=-0.2833), and an indirect effect mediated by LA-EF-reservoir (β=0.2087). LA-EF-reservoir had the strongest effect on ventricular function (β=-0.3193) and mediated 29% of the effect of AD on ventricular function (mediated β=-0.066).

Conclusions: Post ASO, impaired LA function and AD are associated with reduced systolic left ventricular function. These relationships are mediated through both direct effects, such as the direct impact of AD on GLS, and indirect pathways, including the mediating role of LA-EF reservoir function. Consequently, impaired left atrial and aortic function should be viewed not as isolated abnormalities but as interconnected physiological processes that jointly contribute to altered ventricular performance.

Background: There is no established regimen for antithrombotic therapy in patients with Kawasaki disease (KD) who develop giant coronary artery aneurysm (GA). This single-center retrospective study evaluated the outcome of a unified antithrombotic regimen in these patients.

Methods: Sixteen KD patients with GA onset between 1999 and 2013 were included. The patients were started on intravenous heparin and then switched to warfarin in addition to low-dose aspirin when blood tests indicated that the inflammatory response had subsided and the aneurysm had ceased dilating. The target prothrombin time-international normalized ratio (PT-INR) was 2.0-2.5. Patients with no cardiac events or thrombus formation within 2-3 years of onset were considered for discontinuation of anticoagulation and continuation on antiplatelet treatment alone.

Results: The median follow-up duration was 5.8 years (range, 0.25-9.9 years). There were 7 cases of myocardial infarction, including 1 that was fatal and 1 that were asymptomatic. There was no significant difference in the day of KD treatment initiation, onset of GA, or follow-up duration between patients with cardiovascular events (CEs; n=7) and those without CEs (n=9). CEs were significantly more common in patients with larger maximum Z-score (P=0.044) and multiple GAs than in those with a single GA (P=0.007). The prothrombin time at the time of events was below the management target in 3 of the 7 patients with CEs.

Conclusions: The prognosis of KD patients with GA was unsatisfactory in this study, especially in those with large and multiple GAs. In addition to antiplatelet therapy, we recommend continuation of strict anticoagulation therapy in these patients.

Previous studies have suggested associations between coronary microvascular dysfunction (CMD) and alterations in left ventricular (LV) structure and function Data are however scarce regarding the right ventricular (RV). In the context of CMD, the RV could be affected via mechanisms potentially involving ischemia from CMD, shared pathophysiological milieu leading to adverse ventricular remodeling, and/or increased afterload secondary to increased LV end-diastolic pressure or heart failure with preserved ejection fraction (HFpEF) with pulmonary hypertension. We evaluated the relationship between measures of RV structure/function and invasively measured CMD in individuals with suspected ischemia and no obstructive coronary artery (INOCA) disease. We included 297 participants from the WISE-HFpEF, WISE-preHFpEF and WISE-CVD cohorts, who underwent cardiac magnetic resonance imaging (CMRI) and coronary function testing to measure coronary flow reserve (CFR) in response to adenosine and coronary blood flow change in response to acetylcholine (∆CBF). We assessed the correlation between RV parameters on CMRI and coronary microvascular function (CFR and ∆CBF). Participants had a mean age 54±11 years. Of them, 104 (39%) had hypertension, 31 (11%) had diabetes, and 18 (7%) had chronic obstructive pulmonary disease. Mean RV end-diastolic volume was 66.6±11.0 mL/m², RV ejection fraction was 62.7%±5.6% and RV longitudinal strain was -27.2%±3.5%. We found no significant correlation between RV parameters and coronary microvascular function. This is the first study to report associations between invasively measured CMD and CMRI parameters of RV structure and function among patients with suspected INOCA. Despite a large sample size, we found no significant relationship between RV structure or function and CMD. These results suggest that RV abnormalities do not precede and are not concurrent with CMD in suspected INOCA participants. Longitudinal prospective studies are needed to evaluate if RV deterioration may occur later during the course of CMD and among patients with HFpEF.

Background: In the context of acute ST-segment elevation myocardial infarction (STEMI), epicardial fat volume (EFV) has a significant impact on the formation of microvascular obstruction (MVO). This study aimed to quantitatively measure the EFV and myocardial strain parameters by cardiac magnetic resonance (CMR) and to explore their relationship with the presence or absence of mcrocirculation dysfunction after myocardial infarction.

Methods: This was a retrospective study. From June 2022 to December 2023, 56 consecutive patients diagnosed with acute STEMI who underwent percutaneous coronary intervention (PCI) were selected from The First Affiliated Hospital of Bengbu Medical University. Patients were divided into two groups based on the presence of MVO group and the non-MVO (NMVO) group, with 22 cases (39%) and 34 cases (61%) respectively. The characteristics of the infarction were assessed by delayed enhancement with gadolinium. Based on standard cine images, the global circumferential strain (GCS), global radial strain (GRS), and global longitudinal strain (GLS) of the left and right ventricles were evaluated using CMR feature tracking (CMR-FT) imaging. The volume of EFV was quantified along the short-axis slices of the left and right ventricles at the end of diastole by CMR imaging. The differences in baseline characteristics, EFV, and myocardial strain parameters between the groups were compared using Pearson or Spearman correlation analysis. The specificity and sensitivity of myocardial strain parameters in predicting MVO were obtained using receiver operating characteristic (ROC) curves. The predictive factors for MVO were analyzed using univariate and multivariate logistic regression analyses.

Results: A total of 56 patients were selected, with an average age of 59.84±12.37 years, including 42 males (75%) and 14 females (25%). There was a statistically significant difference in EFV between the MVO group and the NMVO group (P<0.001). The prediction model for MVO based on EFV [area under the ROC curve (AUC): 0.856; 95% confidence interval (CI): 0.736-0.935; sensitivity: 77.27%; specificity: 91.18%], GLS (AUC: 0.929; 95% CI: 0.828-0.980; sensitivity: 90.90%; specificity: 94.12%), GCS (AUC: 0.770; 95% CI: 0.638-0.872; sensitivity: 86.36%; specificity: 61.76%), GRS (AUC: 0.789; 95% CI: 0.659-0.886; sensitivity: 90.19%; specificity: 70.59%). The left ventricular ejection fraction in the MVO group was lower than that in the NMVO group (P=0.001). The GLS, GRS, and GCS in the MVO group were significantly lower than those in the NMVO group (P<0.001). Correlation analysis found that EFV (r=0.602, P<0.001), GLS (r=0.726, P<0.001), GCS (r=0.457, P<0.001) was significantly positively correlated with postoperative myocardial infarction with mcrocirculation obstruction, while GRS (r=-0.486, P<0.001) were negatively correlated with postoperative myocardial infarction with mcrocirculation obs

Background: Multiple studies have demonstrated that cardiac resynchronization therapy (CRT) effectively improves the prognosis of heart failure. CRT has been proven to improve patients' quality of life and reduce the risk of readmission and death in selected patients. Nevertheless, a notable proportion of individuals undergoing CRT showed no response. Therefore, we conducted this study to describe CRT characteristics and reported the outcomes 1 year after discharge in Vietnam, along with predictors of non-response to CRT.

Methods: This was a multicenter, ambispective cohort study that enrolled all CRT implantation patients at five hospitals in Ho Chi Minh City: University Medical Center Ho Chi Minh City, Heart Institute of Ho Chi Minh City, Tam Duc Heart Hospital, Thong Nhat Hospital, and Vinmec Central Park Hospital. All patients received treatment according to established guidelines and were monitored for up to 1 year after being discharged. Primary outcomes included rehospitalization and mortality rate 1 year after discharge. Secondary outcomes included early and late complications related to the procedure.

Results: Between April 2016 and April 2020, 88 cases of successful CRT implantation from five hospitals were enrolled. The majority of the population was male (68.2%), mean age was 62.5±13.4 years old, New York Heart Association (NYHA) III/IV at admission (98.9%), and the mean left ventricular ejection fraction (LVEF) was 24%±5.9%. The incidence of early complications was 9.1%. The overall mortality rate was 12.5%, with 6.8% occurring within the 1-year follow-up period. The population experienced a significant decrease in readmission rate within 1 year after discharge (P=0.001). Additionally, there was a notable improvement in the NYHA function (P<0.001) and an enhancement in the quality of life (P=0.001). Five characteristics correlated with the lack of response to CRT were history of dobutamine usage, QRS interval (QRS) length before implantation, severe ventricular arrhythmias before implantation, atrial fibrillation after implantation, and severe ventricular arrhythmias after implantation.

Conclusions: Properly used CRT device improves heart failure symptoms, mortality, and readmissions. There are several predictors of cardiac resynchronization treatment failure. This information helps us comprehend the restricted patient group and develop better treatments, especially in low-income countries.

Tetralogy of Fallot (TOF) is the most common type of cyanotic congenital heart disease expressing different severity. There is an increasing survival into adulthood and most patients now experience a good quality of life. Still, complications will develop over time related to the primary surgery and the resulting remodeling of the heart and vessels, which will require reintervention or operation several times during their lives. Imaging plays an increasingly important role in the diagnosis and follow-up of these patients, such as echocardiography as the basic modality, as well as computed tomography angiography (CTA) and cardiac catheterization, providing important anatomical data and the possibility for interventional treatment. Cardiovascular magnetic resonance (CMR) imaging is increasingly used and has a central role in finding the optimal time point for reintervention and provides excellent morphological as well as functional and hemodynamic data that have been proven indicative for reintervention and patient outcome. New MR techniques have been developed providing quantitative information of myocardial tissue characterization, deformation and 4-dimensional phase contrast (PC) imaging technique for advanced blood flow measurements with promising results to provide more refined indications for reoperations and interventions. This review will treat the current role of CMR in the diagnosis and follow up in TOF after repair involving the traditional MR sequences as well as new emerging techniques and their potential role in repaired TOF.