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OBJECTIVES: The prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown. We sought to evaluate the prognosis role of LV papillary muscle abnormalities by CMR in patients with ventricular arrhythmias, preserved LVEF with no cardiac disease. METHODS: A total of 391 patients with > 500/24 h premature ventricular complexes and/or with non-sustained ventricular tachycardia (NSVT), preserved LVEF, and no cardiac disease were enrolled. Different features of LV papillary muscles were considered: supernumerary muscles, papillary thickness, the attachment, late gadolinium enhancement (LGE). Dark-Paps was defined as end-systolic signal hypointensity of both papillary muscles in early post-contrast cine CMR images. Mitral valve prolapse, mitral annular disjunction (MAD), and myocardial LGE were considered. RESULTS: Dark-Paps was found in 79 (20%) patients and was more frequent in females. It was associated with higher prevalence of mitral valve prolapse and MAD. During a median follow-up of 2534 days, 22 hard cardiac events occurred. At Kaplan-Meier curve analysis, patients with Dark-Paps were at higher risk of events than those without (p < 0.0001). Dark-Paps was significantly associated with hard cardiac events in all the multivariate models. Dark-Paps improved prognostic estimation when added to NSVT (p = 0.0006), to LGE (p = 0.005) and to a model including NSVT+LGE (p = 0.014). Dark-Paps allowed a significant net reclassification when added to NSVT (NRI 0.30, p = 0.03), to LGE (NRI 0.25, p = 0.04), and to NSVT + LGE (NRI 0.32, p = 0.02). CONCLUSIONS: In LV papillary muscles, Dark-Paps is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction. KEY POINTS: ⢠Papillary muscle abnormalities are seen in patients with ventricular arrhythmias and preserved left ventricular ejection fraction. ⢠Early post-contrast hypointensity of papillary muscles in end-systolic cine images (Dark-Paps) is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction. ⢠Dark-Paps had an additive prognostic role over late gadolinium enhancement and non-sustained ventricular tachycardia.
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Cardiopatias , Prolapso da Valva Mitral , Taquicardia Ventricular , Feminino , Humanos , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/patologia , Meios de Contraste/farmacologia , Volume Sistólico , Prolapso da Valva Mitral/diagnóstico por imagem , Prognóstico , Função Ventricular Esquerda , Gadolínio/farmacologia , Imagem Cinética por Ressonância Magnética/métodos , Arritmias Cardíacas , Taquicardia Ventricular/diagnóstico por imagem , Espectroscopia de Ressonância Magnética , Valor Preditivo dos TestesRESUMO
PURPOSE OF REVIEW: Cardiac masses frequently present significant diagnostic and therapeutic clinical challenges and encompass a broad set of lesions that can be either neoplastic or non-neoplastic. We sought to provide an overview of cardiac tumors using a cardiac chamber prevalence approach and providing epidemiology, imaging, histopathology, diagnostic workup, treatment, and prognoses of cardiac tumors. RECENT FINDINGS: Cardiac tumors are rare but remain an important component of cardio-oncology practice. Over the past decade, the advances in imaging techniques have enabled a noninvasive diagnosis in many cases. Indeed, imaging modalities such as cardiac magnetic resonance, computed tomography, and positron emission tomography are important tools for diagnosing and characterizing the lesions. Although an epidemiological and multimodality imaging approach is useful, the definite diagnosis requires histologic examination in challenging scenarios, and histopathological characterization remains the diagnostic gold standard. A comprehensive clinical and multimodality imaging evaluation of cardiac tumors is fundamental to obtain a proper differential diagnosis, but histopathology is necessary to reach the final diagnosis and subsequent clinical management.
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Neoplasias Cardíacas , Imageamento por Ressonância Magnética , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/epidemiologia , Humanos , Imagem Multimodal , Tomografia por Emissão de Pósitrons , PrognósticoRESUMO
Diagnosis of etiology in early-stage ischemic heart disease (IHD) and dilated cardiomyopathy (DCM) patients may be challenging. We aimed at investigating, by means of classification and regression tree (CART) modeling, the predictive power of heart rate variability (HRV) features together with clinical parameters to support the diagnosis in the early stage of IHD and DCM. The study included 263 IHD and 181 DCM patients, as well as 689 healthy subjects. A 24 h Holter monitoring was used and linear and non-linear HRV parameters were extracted considering both normal and ectopic beats (heart rate total variability signal). We used a CART algorithm to produce classification models based on HRV together with relevant clinical (age, sex, and left ventricular ejection fraction, LVEF) features. Among HRV parameters, MeanRR, SDNN, pNN50, LF, LF/HF, LFn, FD, Beta exp were selected by the CART algorithm and included in the produced models. The model based on pNN50, FD, sex, age, and LVEF features presented the highest accuracy (73.3%). The proposed approach based on HRV parameters, age, sex, and LVEF features highlighted the possibility to produce clinically interpretable models capable to differentiate IHD, DCM, and healthy subjects with accuracy which is clinically relevant in first steps of the IHD and DCM diagnostic process.
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Cardiomiopatia Dilatada , Isquemia Miocárdica , Cardiomiopatia Dilatada/diagnóstico , Frequência Cardíaca/fisiologia , Humanos , Isquemia Miocárdica/diagnóstico , Volume Sistólico , Função Ventricular EsquerdaRESUMO
BACKGROUND: Myocarditis and pericarditis have been proposed to account for a proportion of cardiac injury during SARS-CoV-2 infection. The impact of COVID-19 the pandemic on the incidence of this acute inflammatory cardiac disease was not systematically evaluated. AIM: To examine the incidence and prevalence of inflammatory heart disorders prior to and during the COVID-19 pandemic. METHODS: We compared the incidence and prevalence of acute inflammatory heart diseases (myocarditis, pericarditis) in the provinces of Pisa, Lucca and Livorno in two time intervals: prior to (PRECOVID, from 1 June 2018 to 31 May 2019) and during the COVID-19 pandemic (COVID, from 1 June 2020 to May 2021). RESULTS: Overall 259 cases of inflammatory heart disease (myocarditis and/or pericarditis) occurred in the areas of interest. The annual incidence was of 11.3 cases per 100â000 inhabitants. Particularly, 138 cases occurred in the pre-COVID, and 121 in the COVID period. The annual incidence of inflammatory heart disease was not significantly different (12.1/100â000 in PRECOVID vs 10.3/100â000 in COVID, Pâ=â0.22). The annual incidence of myocarditis was significantly higher in PRECOVID than in COVID, respectively 8.1/100â000/year vs. 5.9/100â000/year (Pâ=â0.047) consisting of a net reduction of 27% of cases. Particularly the incidence of myocarditis was significantly lower in COVID than in PRECOVID in the class of age 18-24
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COVID-19 , Miocardite , Pericardite , Doença Aguda , Adolescente , Adulto , COVID-19/epidemiologia , Humanos , Incidência , Miocardite/complicações , Pandemias , Pericardite/epidemiologia , Pericardite/etiologia , SARS-CoV-2 , Adulto JovemRESUMO
Small-vessel disease (SVD), also known as microvascular endothelial dysfunction, is a disorder with negative consequences for various organs such as the heart and brain. Impaired dilatation and constriction of small vessels in the heart lead to reduced blood flow and ischemia independently of coronary artery disease (CAD) and are associated with major cardiac events. SVD is usually a silent form of subcortical vascular burden in the brain with various clinical manifestations, such as silent-lacunar-ischemic events and confluent white-matter hyperintensities. Imaging techniques are the main help for clinicians to diagnose cardiac and brain SVD correctly. Markers of inflammation, such as C-reactive protein, tumor-necrosis-factor α, and interleukin 6, provide insight into the disease and markers that negatively influence nitric-oxide bioavailability and promote oxidative stress. Unfortunately, the therapeutic approach against SVD is still not well-defined. In the last decades, various antioxidants, oxidative stress inhibitors, and superoxide scavengers have been the target of extensive investigations due to their potential therapeutic effect, but with unsatisfactory results. In clinical practice, traditional anti-ischemic and risk-reduction therapies for CAD are currently in use for SVD treatment.
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INTRODUCTION: Cardiac tumors are rare and heterogeneous entities which still remain a diagnostic and therapeutic challenge. The treatment for most cardiac tumors is prompt surgical resection. We sought to provide an overview of surgical results from a series of consecutive patients treated at our tertiary care center during almost a 20-year experience. METHODS AND RESULTS: In this single center study, 55 consecutive patients with diagnosis of cardiac tumor underwent surgical treatment from January 2002 to April 2021. Of these, 23 (42%) were male and the mean age was 62â±â12âyears. Fifteen (27%) patients were symptomatic at the time of the diagnosis, mostly for dyspnea and palpitations. The most frequent benign cardiac tumor was myxoma (32; 58%), occurring mainly in the left atrium (31; 97%). Pleomorphic sarcoma was the most frequent primary malignant cardiac tumor (4; 7%), mainly located in the ventricles (1; 25% in the left ventricle; 2; 50% in the right ventricle). In all cases of benign tumors surgery was successful with no relapses. Two (50%) pleomorphic sarcomas showed subsequent relapses. After a median follow-up of 44âmonths, 15 (27%) patients died. Although malignant tumors presented a limited survival, benign tumors showed a very good prognosis. CONCLUSION: Cardiac tumors require a multidisciplinary approach to guarantee a prompt diagnosis and appropriate treatment. In our surgical experience, outcome after surgery of benign tumors was excellent, while malignant tumors had poor prognosis despite radical surgery.
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Neoplasias Cardíacas , Mixoma , Sarcoma , Idoso , Feminino , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/patologia , Mixoma/cirurgia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Sarcoma/patologia , Sarcoma/cirurgiaRESUMO
AIMS: To evaluate the prevalence and predictors of persistent sinus rhythm in a recent cohort of unselected patients undergoing electrical cardioversion for atrial fibrillation. METHODS: We enrolled all consecutive patients undergoing elective electrical cardioversion for atrial fibrillation between January 2017 and December 2018. We analysed baseline clinical and echocardiographic data as well as pharmacological antiarrhythmic therapy. Primary endpoint was the maintenance of sinus rhythm at 12 months after electrical cardioversion. RESULTS: Of the 300 patients enrolled, 270 (90%) had successful electrical cardioversion and among them, 201 patients have 12-month follow-up data (mean age 70â±â10âyears; 74% men). At 12âmonths, only 45.7% were in sinus rhythm. Patients without sinus rhythm compared with persistent sinus rhythm at 12âmonths had a lower baseline left ventricle ejection fraction (LVEF) (49.1â±â16 vs. 59.7â±â9%, Pâ=â0.02) and had more frequently a history of atrial fibrillation more than 12âmonths (55 vs. 34% Pâ=â0.003). At the multivariate analysis, only the duration of the disease beyond 12âmonths (OR 0.26, 95% CI: 0.08-0.88, Pâ=â0.032), LVEF (OR 1.06, 95% CI: 1.01-1.12, Pâ=â0.012) and the presence of sinus rhythm at 1-month follow-up (OR 18.28, 95% CI: 3.3-100, Pâ=â0.001) were associated with the probability of maintaining sinus rhythm at 12âmonths. CONCLUSION: In unselected patients with atrial fibrillation undergoing elective electrical cardioversion, only 45.7% were in sinus rhythm at 12 months. The presence of sinus rhythm at 1-month follow-up emerged as an independent predictor of maintenance of sinus rhythm. This highlights that early re-evaluation of these patients appears useful for assessing longer term outcomes also from the perspective of a possible selective approach to ablation strategies.
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Assistência ao Convalescente , Fibrilação Atrial/terapia , Cardioversão Elétrica , Frequência Cardíaca , Assistência ao Convalescente/métodos , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Fibrilação Atrial/diagnóstico , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/métodos , Cardioversão Elétrica/estatística & dados numéricos , Feminino , Humanos , Masculino , Prognóstico , Recidiva , Volume Sistólico , Tempo , Fatores de Tempo , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
BACKGROUND: The analysis of the circadian rhythm of heart rate variability (HRV) represents a relevant physiological tool to assess the vagal system. However, the influence of age (mostly >75 years) on HRV is not widely known. AIMS: The aim of this study was to evaluate the influence of age on HRV, particularly in the elderly and to identify a model of this relationship. The study was carried out by examining linear and nonlinear parameters extracted from HRV, including individuals over 75 years for which there is no research available. METHODS: Data from 140 healthy subjects were sex matched and divided into young (young group: 15-39 years old), adult (adult group: 40-64 years old) and senior (senior group: 65-90 years old) groups. 24-h Holter monitoring was used and several HRV parameters were extracted from time, and spectral and nonlinear analyses were examined. RESULTS: Time-domain parameters, mainly standard deviation of the NN interval (SDNN) and number of successive differences of intervals which differ by more than 50âms, presented significant differences between the young group and the other two groups during the 24-h period, while normalized spectral parameters (LFn, HFn and low frequency/high frequency), as well as nonlinear parameters, mainly ß exponent and fractal dimension, showed significant difference between the senior group and the other two groups. All these parameters showed a similar circadian rhythm with significant differences between the mean day and night values, especially in young and adult group cohorts. Moreover, a parabolic relationship between these parameters and age was highlighted with an opposite trend over about 60 years compared with younger people. CONCLUSION: A progressive physiological autonomic imbalance is present in ageing. The inverse trend in the relation between HRV parameters and age found in the senior group could be mainly due to a faster fluctuation of RR. This should be considered when studying changes in the cardiac autonomic nervous control.
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Envelhecimento/fisiologia , Sistema Nervoso Autônomo , Ritmo Circadiano/fisiologia , Eletrocardiografia Ambulatorial , Frequência Cardíaca/fisiologia , Adolescente , Adulto , Fatores Etários , Idoso de 80 Anos ou mais , Sistema Nervoso Autônomo/fisiologia , Sistema Nervoso Autônomo/fisiopatologia , Variação Biológica da População/fisiologia , Eletrocardiografia Ambulatorial/métodos , Eletrocardiografia Ambulatorial/estatística & dados numéricos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Avaliação de Resultados em Cuidados de SaúdeRESUMO
The case highlights the value of contrast echocardiography in raising clinical suspicion of malignancy, allowing a diagnostic work-up and the treatment of the primitive heart tumors.
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Objective: Ischemic heart disease (IHD), in its chronic stable form, is a subtle pathology due to its silent behavior before developing in unstable angina, myocardial infarction or sudden cardiac death. The clinical assessment is based on typical symptoms and finally confirmed, invasively, by coronary angiography. Recently, heart rate variability (HRV) analysis as well as some machine learning algorithms like artificial neural networks (ANNs) were used to identify cardiovascular arrhythmias and, only in few cases, to classify IHD segments in a limited number of subjects. The goal of this study was the identification of the ANN structure and the HRV parameters producing the best performance to identify IHD patients in a non-invasive way, validating the results on a large sample of subjects. Moreover, we examined the influence of a clinical non-invasive parameter, the left ventricular ejection fraction (LVEF), on the classification performance.Approach: To this aim, we extracted several linear and non-linear parameters from 24 h RR signal, considering both normal and ectopic beats (heart rate total variability), of 251 normal and 245 IHD subjects, matched by age and gender. ANNs using several different combinations of these parameters together with age and gender were tested. For each ANN, we varied the number of hidden neurons from 2 to 7 and simulated 100 times, changing randomly the training and test dataset.Main results: The HRTV parameters showed significant greater variability in IHD than in normal subjects. The ANN applied to mean RR, LF, LF/HF, beta exponent, SD2 together with age and gender reached a maximum accuracy of 71.8% and, by adding as input LVEF, an accuracy of 79.8%.Significance: The study provides a deep insight into how a combination of some HRTV parameters and LVEF could be exploited to reliably detect the presence of subjects affected by IHD.