The number of patients with transthyretin amyloid cardiomyopathy (ATTR-CM) has been increasing recently, and the early diagnosis and treatment of it are important. 99mTc pyrophosphate scintigraphy (99mTc-PYP) plays a key role in the early diagnosis of ATTR-CM. In patients who underwent 99mTc-PYP, the early diagnosis of ATTR-CM by echocardiography was evaluated, focusing on left ventricular myocardial form and left ventricular wall thickness. The present study was conducted on 144 patients who underwent 99mTc-PYP between February 2020 and March 2024. A comparison was made between the 99mTc-PYP positive (P) and negative (N) groups, and significant factors were subjected to multivariate analysis. 17 of 144 patients were positive (14.9%), and 15 patients were diagnosed with ATTR-CM by myocardial or skin (fat) biopsy. Other positive patients were also clinically considered to have ATTR-CM based on findings such as poor cardiac function and cerebral hemorrhage. 99mTc-PYP positive had a significantly larger CTR (60.3% in the P group vs. 53.9% in the N group, p = 0.007) and a larger left atrial diameter (42.8 mm in the P group vs. 40.0 mm in the N group, p = 0.047). On the other hand, the mean LV wall thickness was significantly thicker (15.7 mm in the P group vs. 12.8 mm in the N group, p < 0.001); however the LV end-diastolic diameter was smaller (41.9 mm in the P group vs. 48.4 mm in the P group, p < 0.001). The LV mass was similar in both groups, thus the relative left ventricular wall thickness (RWT), which indicates relative wall thickening, was significantly higher in the P group (0.85 in the P group vs. 0.52 mm in the N group, p < 0.001). The receiver operating characteristic curve of RWT for assessing 99mTc-PYP positivity had a cut-off value of 0.717 (area under the curve 0.862, 95%CI 0.763-0.961). The evaluation of wall thickness and RWT on echocardiography is important for diagnosing ATTR-CM.
Inflammatory myocardial involvement has been reported in canine leishmaniosis (CanL); however, studies evaluating the degree of myocardial dysfunction in affected dogs are limited. This prospective study aimed to investigate myocardial involvement in dogs with CanL using conventional and speckle-tracking echocardiography (STE), focusing on the assessment of left ventricular systolic function and myocardial strain. Symptomatic, initially untreated dogs with a diagnosis of leishmaniosis and free from other vector-borne diseases or underlying heart diseases were enrolled (Leish group). Healthy dogs matched for age, body weight, breed, and sex were selected for the control group (C group). At the time of inclusion (T0) and at each follow-up, laboratory tests as well as conventional echocardiographic examination and STE were performed. For strain analysis, apical longitudinal long-axis 4-chamber, 3-chamber, and 2-chamber views were used (2C, 3C, 4C, respectively) to obtain the average global longitudinal strain (GLSAV), which is recognised to have the maximum reliability as an indicator of left ventricular dysfunction in humans. The software obtains GLSAV by averaging the longitudinal strain values from all left-ventricular segments derived from the multiple apical views. After enrolment, dogs were treated with a combination of meglumine and allopurinol and were monitored for six months. Clinical-pathological and echocardiographic data were collected at follow-up at 1, 3, and 6 months after the start of treatment (T1, T2, T3) and compared between the two study groups using appropriate statistical tests. Sixteen dogs composed the C group and nine dogs the Leish group. At T0, none of these dogs had abnormalities in cardiac auscultation, plasma cardiac troponin concentration was within the reference range, and standard echocardiographic examination excluded underlying cardiac diseases. The comparison between C and Leish groups did not show a statistically significant difference in any of the strain parameters analysed (GLSAV, GLS4C, GLS3C, GLS2C). Moreover, strain values in the Leish group did not change significantly over time. In conclusion, in this preliminary study on a limited population of dogs with leishmaniosis, both conventional echocardiography and STE failed to reveal clear changes suggestive of left ventricular systolic dysfunction secondary to possible myocarditis or as a consequence of the systemic disease in dogs with active leishmaniosis. However, further STE studies in larger cohorts of dogs with leishmaniosis are needed to confirm and expand our findings.
Background/Objectives: Echocardiography reports are essential diagnostic tools, but their complexity and specialized English terminology frequently hinder comprehension for non-specialists and patients. This study addresses these accessibility gaps by developing a resource-efficient large language model (LLM) system designed to translate and summarize English echocardiography results into Traditional Chinese. Methods: To overcome significant hardware constraints, we utilized Quantized Low-Rank Adapter (QLoRA) techniques and the Unsloth acceleration framework to fine-tune LLaMA-3.2-1B and LLaMA-3.2-3B-Instruct models on a single mid-tier GPU. The system employs a dual-stage inference architecture: the first stage provides technical medical translation for clinicians, while the second stage generates simplified, patient-centric educational summaries to enhance health literacy. Results: Evaluation across multiple metrics, including BLEU, ROUGE, METEOR, and Perplexity, demonstrated that the LLaMA-3.2-3B-Instruct model with the AdamW 8-bit optimizer achieved the most stable validation performance, excelling in semantic coherence and structural consistency. A preliminary qualitative error analysis conducted in the Discussion section further identified clinical nuances, such as terminology simplification and minor hallucinations, underscoring the critical necessity of a Human-in-the-Loop verification procedure. Conclusions: These findings validate the feasibility of deploying cutting-edge medical AI in resource-limited clinical environments. While the results reflect validation-only performance on a specialized dataset, the platform offers a scalable foundation for enhancing clinical decision support and health literacy through accessible, automated medical text processing.
Background: Congenital heart disease (CHD) represents a major cause of perinatal morbidity and mortality, and fetal echocardiography is essential for its early diagnosis and management. Maternal smoking has been suggested as a potential teratogenic factor affecting fetal cardiovascular development; however, findings regarding its association with CHD remain inconsistent. This study aimed to evaluate the relationship between maternal smoking during pregnancy and the risk of CHD. Methods: A total of 2715 pregnant women and 2784 fetuses who underwent fetal echocardiography at ≥20 weeks' gestation between 1 January 2024 and 1 November 2025 were analyzed. Pregnancies complicated by known chromosomal or syndromic abnormalities, significant teratogenic exposure, duplicate assessments, or nonstandard examinations were excluded. Maternal smoking status during pregnancy was recorded and categorized according to daily cigarette consumption. The prevalence of CHD and the distribution of CHD subtypes were evaluated and compared according to smoking status. Fetal cardiac diagnoses were classified based on the classical morphological classification system. Results: A total of 2715 pregnancies (2784 fetuses) were analyzed, including 2530 fetuses in the non-smoking group and 254 in the smoking group. Congenital heart disease was detected in 12.5% of fetuses in the non-smoking group and 14.2% in the smoking group, with no statistically significant difference (p = 0.442). According to the classical morphological classification, the distribution of fetal echocardiographic pathologies did not differ significantly between groups (p = 0.607). Septal defects were the most common subtype in both groups. Although conotruncal defects were proportionally more frequent in the smoking group, this difference did not reach statistical significance. After reclassifying daily cigarette consumption into four exposure categories, no association was detected between maternal smoking and CHD risk (OR = 1.04; 95% CI: 0.86-1.26; p = 0.691). Conclusion: In this cohort referred for fetal echocardiographic evaluation, no association was detected between maternal smoking during pregnancy and the risk of congenital heart disease or alterations in CHD subtype distribution. No consistent dose-response relationship was observed. These findings suggest that no association was detected between maternal smoking exposure and CHD. Further large-scale prospective studies are needed to clarify phenotype-specific associations.
Background/Objectives: Stress echocardiography (SE) had been recommended by professional societies for assessing patients with suspected angina. SE protocols are variable across hospitals and countries in the recommendation of the cessation of rate-controlling medication (RCMx) prior to SE. Some expert opinion papers recommend the cessation of beta receptor blockers (BBs) and rate-controlling calcium channel blockers 48 h prior to SE to improve the diagnostic accuracy of the test. There is no evidence that the continuation of RCMx can affect the outcome of SE and short-term major adverse cardiovascular events (MACEs). To investigate the efficacy of Dobutamine SE in a cohort of patients where the cessation of rate-controlling medication has not been mandated, we reviewed our data over a one-year period in patients investigated for suspected coronary artery disease (CAD). Methods: A retrospective data analysis was performed on 227 consecutive patients who underwent Dobutamine SE between January 2022 and January 2023 in a single centre. In addition to dobutamine, the protocol allowed the administration of intravenous atropine (maximum dose of 1.2 mg) and a "top up" handgrip exercise at the discretion of the performing cardiologist. We assessed the Dobutamine SE outcome (positive vs. negative), target heart rate (THR, 85% of maximum age predicted), and the achieved peak HR in the two groups with RCMx and without RCMx. We analysed the patients' characteristics and 12-month outcomes of a combined MACE of death, non-fatal MI, stroke, admission with angina, and unplanned revascularisation. Results: Of the 227 patients, 61% were on No-RCMx (male 40%). Ninety-three percent of the patients on RCMx were on BB and 7% on other rate-controlling medications. The THR was achieved in 74% of the patients with-RCMx and 90% in the without-RCMx groups p = 0.0018. Positive Dobutamine SE was observed in 48% (43/89) of patients on RCMx vs. 28% (39/138) on No-RCMx (p = 0.0022). Patients who did not reach THR 43% (16/37) had positive Dobutamine SE compared to 35% (66/190) who reached THR (p = 0.626). There was no difference between groups in the peak WMSI. Logistic regression analysis showed that being on RCMx was independently associated with positive Dobutamine SE (OR 2.03, 95% CI 1.06-3.91, and p = 0.034). The MACE rate was higher in patients where the THR was not achieved (9/37, 24.0%) vs. where THR was achieved (9/190, 4.7%), p < 0.001, in both the with-RCMx (7/30, 23% vs. 6/66, 9.1%, p = 0.013) and without-RCMx (2/14, 14% vs. 3/124, 2.4%; p = 0.025) groups, respectively. RCMx was independently associated with MACE (OR 3.68, 95% CI 1.227-11.046, and p = 0.020). Conclusions: The use of RCMx proved to be a predictor of both SE and MACE outcomes irrespective of the achieved THR. Our data supports the practice that patients referred for Dobutamine SE on RCMx can continue taking them without impact on the test accuracy.
Cardiac point-of-care ultrasound (cPOCUS) is used to obtain key information about the heart's structure and function when an echocardiogram is not available. This prospective, cross-sectional study aimed to compare fractional shortening (FS%) and left-atrium-to-aorta ratio (LA:Ao) obtained by cPOCUS in different body positions to echocardiography. Thirty-nine dogs had cPOCUS performed in three different body positions: left lateral recumbency (RT), right lateral recumbency (LT), and standing or sternal recumbency (RST). The cPOCUS values from each body position for FS% and LA:Ao were tested for agreement with the echocardiogram by Bland-Altman plots, correct clinical assessment by generalized estimated equation models, and quality score of the cPOCUS images as a percentage. Bland-Altman analysis showed a positive bias for FS% (0.9% to 9.8%) and both positive and negative bias for LA:Ao (within 0.2) for the cPOCUS values. The correct clinical assessment was made in the majority of cases for FS% in RST (67%) and RT (67%), and for LA:Ao in RST (55%). The clinical assessment was more often correct when the image quality score was higher. Intraclass correlation showed good agreement (≥0.61) between investigators for FS% in all body positions and LA:Ao in RT and RST. This study showed that cPOCUS performed from the right hemithorax can provide estimates and correct clinical assessment of FS% and LA:Ao. Obtaining measurements in the LT position is not recommended.
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Introduction: Hypertrophic cardiomyopathy (HCM) is a common myocardial disease worldwide and is associated with heart failure symptoms and sudden cardiac death. In a subset of patients, it may produce dynamic left ventricular outflow tract obstruction (LVOTO) and systolic anterior motion (SAM)-related mitral valve dysfunction through drag forces and altered mitral-septal geometry. In contrast, subaortic stenosis caused by a subaortic membrane is an uncommon congenital lesion that may lead to fixed subvalvular LVOTO in adulthood. The coexistence of these entities is rare and can substantially complicate diagnosis and management. Case presentation: A 51-year-old woman with HCM, paroxysmal atrial fibrillation, and heart failure presented with acute decompensation and cardiogenic shock. After initial hemodynamic stabilization and cardioversion for atrial fibrillation with rapid ventricular response, multimodality imaging with transthoracic and transesophageal echocardiography, coronary computed tomography angiography, and cardiac magnetic resonance demonstrated dual LVOTO, with a dynamic component related to HCM/SAM physiology and a fixed component caused by an elongated subaortic membrane, accompanied by severe SAM-related mitral regurgitation. Echocardiography showed a resting peak LVOT gradient of 49 mmHg, increasing to 85 mmHg with the Valsalva maneuver. After exclusion of obstructive coronary artery disease and evaluation for selected phenocopies, the patient underwent septal myectomy, subaortic membrane resection, and adjunctive mitral valve plication. Early postoperative echocardiography showed reduction in the maximum provoked LVOT gradient to 38 mmHg and improvement of mitral regurgitation from severe to mild. At 3-month follow-up, she remained in sinus rhythm, improved to New York Heart Association functional class II, and had no documented readmissions for heart failure. Conclusions: Combined fixed and dynamic LVOTO due to concomitant subaortic membrane and HCM is exceedingly rare. Accurate diagnosis requires a high index of suspicion and a multimodality imaging strategy to define the obstructive mechanisms and support mechanism-based surgical management and avoid incomplete treatment when a coexisting fixed lesion is present.
Neonatal Ebstein's anomaly (EA) is a severe condition with significant hemodynamic instability and early myocardial dysfunction, where abnormal right-heart geometry limits conventional echocardiography and highlights the value of myocardial deformation imaging. We conducted a single-center retrospective observational study including 16 neonates with EA and 26 healthy neonates. All subjects underwent comprehensive transthoracic echocardiography during the neonatal period. Conventional two-dimensional imaging and speckle-tracking echocardiography (STE) were used to assess biventricular and biatrial myocardial deformation. Deformation parameters were compared between groups, and receiver operating characteristic (ROC) curve analysis evaluated diagnostic performance. Neonates with EA demonstrated significant structural remodeling and severe biventricular and biatrial dysfunction compared with controls. Speckle-tracking showed markedly reduced right ventricular longitudinal strain (LS) in all segments (all, p < 0.001), particularly in free-wall and four-chamber views. Left ventricular (LV) global LS (GLS) was significantly reduced in neonates with EA compared with controls (-14.53% vs. -22.32%, p < 0.001), indicating early involvement of LV myocardial function in the neonatal period. Atrial reservoir, conduit, and contractile strain were severely impaired in both atria (all, p < 0.001). ROC analysis revealed excellent diagnostic accuracy, especially for LVGLS (AUC 0.919) and right atrial contractile strain (AUC 0.958). STE enables the early detection of extensive biventricular and biatrial myocardial dysfunction in neonatal EA, including abnormalities not fully captured by conventional echocardiographic parameters, thereby providing significant incremental diagnostic value.
Myxomatous mitral valve disease (MMVD) is a common cardiac disorder in older small- to medium-sized dogs. Diagnosis and staging are primarily based on echocardiography; however, circulating cardiac biomarkers have gained increasing interest because they are rapid and easily measurable. In this context, the investigators' aim was to study the clinical value of galectin-3 (Gal-3) and trimethylamine N-oxide (TMAO), in dogs affected by MMVD, in comparison to cardiac troponin I (cTnI), a well-established biomarker of myocardial injury, and echocardiography. Twenty-two dogs were classified as healthy controls or affected by MMVD and staged according to American College of Veterinary Internal Medicine (ACVIM) guidelines. Serum concentrations of Gal-3, TMAO, and cTnI were measured and compared among groups. No significant differences in serum Gal-3 concentration were detected among groups (p = 0.955). In contrast, TMAO levels were significantly higher in both asymptomatic and symptomatic dogs compared with healthy controls (both p < 0.001). Serum cTnI showed limited sensitivity, with increased values observed only in some symptomatic dogs. Despite study limitations, including small sample size and demographic differences among groups, these preliminary findings suggest that TMAO could be a potential biomarker associated with MMVD development and progression; however, further studies are needed to confirm this association.
Background: Left bundle branch block (LBBB) and QRS prolongation are markers of electrical dyssynchrony in heart failure, but they do not fully reflect its mechanical consequences. Myocardial work (MW)-derived indices may provide a more comprehensive assessment of left ventricular (LV) mechanical dyssynchrony. We evaluated associations between LV MW parameters, QRS duration, and LBBB in patients with heart failure with reduced ejection fraction (HFrEF) referred for ICD/CRT implantation. Methods: In this single-centre observational cross-sectional study, 96 consecutive patients referred for ICD or CRT implantation were screened. All patients underwent standardized baseline comprehensive echocardiography followed by advanced MW analysis. Myocardial work index (MWI) dispersion was assessed using two complementary methods. MWI dispersion (SD) was calculated as the standard deviation of segmental MWI values across all LV segments, and MWI dispersion (IQR) was defined as the interquartile range (IQR) of segmental MWI values. We evaluated the associations between QRS duration and MW-derived dyssynchrony parameters (individual and composite), as well as their discriminative performance for LBBB. Seven patients were excluded from further analysis due to inadequate echocardiography image quality. Results: The final study group comprised 89 patients with HFrEF (median age 65.5 years), of whom 67.4% were assigned to CRT. LBBB was present in 41.6%, and the median QRS duration was 142 ms (112-162). All analyzed LV MW indices were significantly associated with QRS duration (all q < 0.01). The strongest correlations were observed for MWI dispersion (IQR) (r = 0.58), peak strain dispersion (PSD) (r = 0.54), lateral-septal work asymmetry (r = 0.53), and MWI dispersion (SD) (r = 0.52) (all q < 0.0001). All MW indices differed significantly between patients with and without LBBB (all q ≤ 0.0001). MWI dispersion (IQR) showed the best single-marker discrimination of LBBB (AUC = 0.852). Composite indices achieved AUC = 0.84 but did not significantly improve discrimination versus MWI dispersion (IQR) alone. Conclusions: Myocardial work-derived indices of left ventricular dyssynchrony are strongly associated with QRS duration and the presence of LBBB in patients with HFrEF. Among them, MWI dispersion (IQR) was shown to be the best-performing MW marker for identifying LBBB. These findings suggest that MW dispersion may serve as a robust echocardiographic marker of mechanical dyssynchrony and warrants further investigation as a potential tool for predicting CRT response.
IgG-4-related disease (IgG4-RD) is a systemic fibroinflammatory disease that can affect any organ system. Myocarditis is a rare manifestation. A 65-year-old woman with clinically diagnosed IgG4-RD, who had recently completed corticosteroid taper, presented with multiple admissions for recurrent chest pain and myocardial injury. Coronary angiography repeatedly showed preserved coronary anatomy, and initial transthoracic echocardiography showed preserved left ventricular systolic function. Subsequent transthoracic echocardiography showed rapid decline in ejection fraction, and cardiac magnetic resonance imaging (MRI) showed myocardial oedema, infarct scar, and patchy non-ischaemic fibrosis. A probable diagnosis of IgG4-RD myocarditis was made clinically based on medical history, multimodal imaging findings, and exclusion of alternative diagnoses, although tissue confirmation was not obtained. The patient improved clinically and radiographically with corticosteroid re-initiation followed by maintenance with mycophenolate mofetil (MMF). This case underscores the importance of considering IgG4-RD in the differential diagnosis of unexplained myocardial inflammation and highlights the potential reversibility of cardiac injury with early immunosuppression.
Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease characterized by microvascular dysfunction, immune activation, and progressive fibrosis affecting multiple organs, including the heart. Myocardial involvement represents an important but frequently underrecognized manifestation of SSc and may develop even in the absence of overt clinical symptoms. Cardiac manifestations include ventricular dysfunction, arrhythmias, conduction abnormalities, and heart failure, contributing substantially to morbidity and mortality. The underlying pathophysiology involves coronary microvascular dysfunction, immune-mediated myocardial inflammation, and progressive myocardial fibrosis, which often precede clinically apparent cardiac disease. This review aims to summarize the current understanding of myocardial involvement in SSc and to provide a comprehensive overview of contemporary multimodality cardiovascular imaging techniques for its detection, characterization, and risk stratification. A comprehensive overview of the current literature was conducted focusing on established and emerging cardiovascular imaging modalities for the evaluation of myocardial involvement in SSc. Particular attention was given to echocardiography, cardiac magnetic resonance (CMR), nuclear imaging techniques including positron emission tomography (PET) and single-photon emission computed tomography (SPECT), and cardiac computed tomography (CT). Recent advances in imaging biomarkers, parametric mapping, myocardial strain analysis, and emerging technologies such as artificial intelligence (AI), radiomics, and molecular imaging were also considered. Multimodality cardiovascular imaging plays a central role in the early detection and comprehensive assessment of myocardial involvement in SSc. Advanced imaging techniques enable improved identification of subclinical myocardial dysfunction, microvascular impairment, inflammation, and fibrosis. An integrated imaging approach combining echocardiography, CMR, nuclear imaging, and CT may facilitate earlier diagnosis, enhance risk stratification, and ultimately improve cardiovascular outcomes in patients with SSc.
Rheumatic heart disease (RHD) remains a leading cause of mitral stenosis (MS), particularly in developing countries like India, China or countries within Africa. Characterized by a long latent phase after acute rheumatic fever, rheumatic MS often leads to significant morbidity and mortality. This paper explores its epidemiology, natural history, and clinical consequences, including associations with atrial fibrillation, pulmonary hypertension, heart failure, systemic embolism, and infective endocarditis. We review diagnostic tools, particularly echocardiography, and management strategies such as balloon mitral commissurotomy and surgical interventions. Emerging therapies, including lithotripsy-facilitated procedures and trans-catheter valve replacement, offer promise for high-risk patients. Early detection and comprehensive care are essential to reduce the global burden of rheumatic MS. Rheumatic heart disease is still one of the main causes of mitral stenosis, a condition where a heart valve becomes narrow and stiff, making it harder for blood to flow. This problem is most common in India, China, and many countries in Africa. Mitral stenosis often develops years after rheumatic fever, which is caused by a throat infection that affects the heart. Over time, the valve damage can lead to shortness of breath, tiredness, chest discomfort, and swelling of the legs. It can also cause serious problems such as irregular heartbeat (atrial fibrillation), high pressure in the lungs, heart failure, blood clots, and heart infections.Doctors use heart ultrasound (echocardiography) to check how narrow the valve is. Treatment options include a balloon procedure to open the valve or surgery to repair or replace it. New, less invasive treatments, like catheter-based valve replacement, are being developed for patients who are too sick for surgery. Finding and treating rheumatic mitral stenosis early can help prevent serious complications and improve quality of life.
• TUSI ("pink cocaine") use may cause serotonin-mediated drug-induced valvular disease. • Echocardiography shows reproducible thickening and restricted atrioventricular valve motion. • Histology reveals myxoid degeneration without inflammatory infiltrate. • Young patients with unexplained regurgitation require drug-use screening. • Synthetic drug use poses emerging cardiovascular risks needing attention. [Figure: see text]
• DOMV is an uncommon congenital anomaly. • 3D TEE allows precise anatomical delineation. • Stress echocardiography reveals exercise-induced rise in transmitral gradients. • Shared decision-making led to a conservative approach given minimal symptoms. [Figure: see text]
Background: Metabolic syndrome (MetS) comprises coexisting risk factors enhancing the likelihood of developing cardiovascular disease (CVD). The aim of this study was to investigate the correlation between the number of MetS components and subclinical cardiac dysfunction, assessed via transthoracic echocardiography (TTE), in individuals without overt CVD. Methods: A retrospective analysis was performed using data from 100 patients (63% female; mean age 58.8 ± 16.81 years) hospitalized in the Department of Internal Medicine, Angiology and Physical Medicine at the Medical University of Silesia in Katowice, Poland, between June 2022 and February 2024. The inclusion criteria were the absence of diagnosed atherosclerotic CVD and no evidence of acute illness or exacerbation of chronic diseases. Each participant was evaluated for MetS components and underwent TTE. Results: Univariate analysis revealed significant correlations between the number of MetS components and selected TTE parameters, including left ventricular mass (LVM) (R = 0.406; p < 0.001), left ventricular mass index (LVMI) (R = 0.248; p = 0.013), left ventricular ejection fraction (LV EF) (R = -0.261; p = 0.009), left atrial volume (LAV) (R = 0.312; p < 0.001), and left atrial volume index (LAVI) (R = 0.273; p = 0.007). These correlations did not remain significant after adjusting for age, sex, and body mass index (BMI). Among patients not meeting the full diagnostic criteria for MetS, LAV and LAVI values remained significantly correlated with the number of MetS components, independent of confounding variables. Conclusions: The selected echocardiographic parameters were significantly correlated with the number of MetS components; however, most associations were explained by age, sex, and BMI.
To evaluate the relationship between intraoperative 3-dimensional (3D) echocardiographic measures of right ventricular (RV) function and invasively derived RV-pulmonary arterial (RV-PA) coupling metrics obtained from single-beat end-systolic pressure-volume analysis, identify echocardiographic surrogates capable of discriminating impaired RV-PA coupling during cardiac surgery. In a prospective observational study of 78 adult patients undergoing cardiac surgery with transesophageal echocardiography and pulmonary artery catheter monitoring, RV volumes and functional indices were quantified using 3D TEE, whereas RV-PA coupling (Ees/Ea) was calculated using the V0 single-beat method. Patients were stratified by coupling status using an Ees/Ea cutoff of 0.8. Relationships between echocardiographic variables and coupling metrics were analyzed using Spearman correlation, receiver operating characteristic analysis, and multivariable logistic regression adjusted for Society of Thoracic Surgeons risk score and perfusion time. Patients with impaired RV-PA coupling (28.2%) demonstrated significantly larger 3D end-systolic volume and reduced 3D ejection fraction (EF) and 4-dimensional-derived fractional area change (FAC) compared with those with preserved coupling. 3D EF showed the strongest correlation with coupling (ρ = 0.94, P < .001) and significant discriminative performance (area under the curve = 0.94; optimal cutoff <44.2%). Indexed end-systolic volume and 3D FAC also reliably identified impaired coupling, whereas TAPSE and TAPSE/PASP did not. Exploratory analyses showed that low Ees/Ea and reduced 3D FAC/right ventricular systolic pressure were associated with prolonged postoperative vasopressor/inotrope use. Intraoperative 3D volumetric indices, particularly 3D EF and FAC, may closely reflect invasively measured RV-PA coupling and potentially identify patients with impaired coupling. These findings may support the use of 3D echocardiography as a practical surrogate for intraoperative RV-PA coupling assessment during cardiac surgery.
Essential elements such as manganese (Mn), iron (Fe), and zinc (Zn) are critical in for cardiovascular function, whereas exposure to non-essential toxic metals, including cadmium (Cd) and chromium (Cr) may contribute to cardiac dysfunction and the development or progression of heart failure (HF). This study evaluated the blood levels of Mn, Fe, Zn, Cd, and Cr in adult Saudi patients with HF and in controls with normal ventricular function, and explored their associations with HF status, functional class, and echocardiographic parameters. Consecutive adult patients referred for clinically indicated transthoracic echocardiography at the outpatient department of King Fahad Medical City hospital between November 2019 and March 2020 were invited to participate. Clinical data were collected, echocardiograms were reviewed, and blood concentrations of of Mn, Fe, Zn, Cd, and Cr were measured using atomic absorption spectrophotometry. A total of 180 participants were included (mean age 60.3 years), of whom 65.6% had HF. Most measured element levels were within reference ranges, except for Mn, which was below the reference range (<4 ug/L) in 98% of participants, with median (IQR) of 0.40 (0.30, 0.60). Higher Cr levels were observed among younger participants (P = 0.046). Higher Cd levels were associated with increased left ventricular dilatation (P = 0.013; P < 0.001 after adjusting for confounders). Conversly, higher Mn levels were associated with lower lateral mitral annular velocity in univariate analysis (P = 0.04), but this association was not retained after multivariable adjustment (P = 0.099). This study provides insight into Mn, Fe, Zn, Cd, and Cr concentrations across a spectrum of HF severity. Alteration in Cd and Mn blood levels were associated with selected echocardiographic markers of HF severity. Further longitudinal studies are needed to establish the prognostic significance of element imbalances in HF.