Evolution and Prognostic Impact of Left Ventricular Myocardial Work Indices After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis.

PURPOSE: Left ventricular myocardial work (LVMW) has been shown to better characterize LV function in patients with severe aortic stenosis by correcting LV afterload. The aim of this study was to evaluate the evolution in LVMW indices after transcatheter aortic valve replacement (TAVR) and their prognostic value. METHODS: The following LVMW indices were calculated before and immediately after TAVR in 255 patients (median age 82 years, 51% male): global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). The study endpoint was all-cause mortality. RESULTS: After TAVR, LV ejection fraction and LV global longitudinal strain (GLS) did not change significantly (from 56% to 55%, p = 0.470 and from 13.6% to 13.2%, p = 0.068). Concerning LVMW indices, while LV GWW remained unchanged after TAVR (from 247 to 258 mmHg%, p = 0.080), LV GWI, LV GCW, and LV GWE significantly decreased (from 1882 to 1291 mmHg%, p < 0.001, from 2248 to 1671 mmHg%, p < 0.001, and from 89% to 85%, p < 0.001, respectively). During a median follow-up of 59 [40-72] months, 129 patients died. After correcting for potential confounders (sex, diabetes, renal function, atrial fibrillation, Charlson comorbidity index, and pacemaker implantation post-TAVR), post-TAVR LV GLS, GWI, and GCW remained independently associated with all-cause mortality. However, post-TAVR LV GWI demonstrated the highest increase in model predictivity. CONCLUSION: In patients undergoing TAVR, LVMW parameters significantly change after intervention. LV GWI after TAVR showed the strongest association with all-cause mortality among both conventional and advanced parameters of LV systolic function both pre- and post-TAVR and might enable better risk stratification of these patients after intervention.

Effect of ertugliflozin on left ventricular function in type 2 diabetes and pre-heart failure: the Ertu-GLS randomized clinical trial.

BACKGROUND: The therapeutic effects of ertugliflozin, a sodium-glucose cotransporter 2 inhibitor, on cardiovascular outcome are not fully understood. This study aimed to evaluate the efficacy and safety of ertugliflozin on cardiac function in people with type 2 diabetes and pre-heart failure. METHODS: We conducted a 24-week randomized, double-blind, placebo-controlled trial involving individuals with type 2 diabetes inadequately controlled with antidiabetic medications. Participants with left ventricular hypertrophy, E/e' >15, or impaired left ventricular global longitudinal strain (LVGLS) were randomized 1:1 to receive either ertugliflozin (5 mg once daily) or a placebo. The primary outcome was the change in LVGLS. Secondary outcomes included changes in left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Prespecified exploratory outcomes, including angiotensin-converting enzyme 2 (ACE2) and angiotensin (1-7) levels, were also assessed. RESULTS: A total of 102 individuals (mean age, 63.9 ± 9.2 years; 38% women) were included. The ertugliflozin group showed a significant improvement in LVGLS (- 15.5 ± 3.1% to - 16.6 ± 2.8%, P = 0.004) compared to the placebo group (- 16.7 ± 2.7% to - 16.4 ± 2.6%, P = 0.509), with a significant between-group difference (P = 0.013). Improvements in LVMI and LVEF were also observed. Additionally, significant reductions in HbA1c, systolic blood pressure, whole-body and visceral fat, uric acid, proteinuria, N-terminal pro-B-type natriuretic peptide, and lipoprotein(a) were noted. ACE2 and angiotensin (1-7) levels significantly increased in the ertugliflozin group compared to the placebo group and correlated with changes in LVGLS [r = 0.456, P < 0.001 for ACE2; r = 0.541, P < 0.001 for angiotensin (1-7)]. Adverse events were similar between the two groups. CONCLUSIONS: This study demonstrated that ertugliflozin has beneficial effects on left ventricular function in individuals with type 2 diabetes and pre-heart failure, and it provided insights into potential underlying mechanisms. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03717194.

Assessment of Specific Biomarkers' Profile and Structural, Functional Parameters of the Left Ventricle in Patients With Lymphomas Undergoing Antitumor Therapy.

AIM: To evaluate the dynamics of specific biomarkers for cardiotoxicity, endothelial dysfunction, fibrosis, systemic inflammation, and morpho-functional alterations in the left ventricular (LV) myocardium in patients with newly diagnosed lymphomas during 6 courses of polychemotherapy (PCT). MATERIAL AND METHODS: The study included 30 patients with newly diagnosed lymphomas. All patients were evaluated for laboratory markers of cardiotoxicity at baseline and after 6 courses of chemotherapy (6 months), including N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hsTnI), endothelin-1 (ET-1), circulating cardiac biomarker ST-2, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and LV structural and functional echocardiographic (EchoCG) parameters. RESULTS: The changes in NT-proBNP and hsTnI concentrations during 6 courses of PCT were not statistically significant. Comparison of the baseline values with those after 6 courses of PCT showed increases in the median concentrations of ET-1 (3.38 and 5.5 pg/ml, respectively; p=0.438) and ST-2 (12.21 and 26.75 ng/ml, respectively; p=0.687). Markers of systemic inflammation were significantly decreased after 6 courses of PCT: the median CRP decreased from 15.2 to 0.72 mg/ml (p=0.006), and the median IL-6 decreased from 12.2 to 5.1 pg/ml (p=0.034). EchoCG data revealed a statistically significant impairment of the LV diastolic function parameters (E/A; E/e' lateral; E/e' average; left atrial volume index; isovolumic relaxation time). A moderate direct correlation was found between the ET-1 concentration and the isovolumic relaxation time at baseline and after 6 courses of PCT, respectively (r1 = 0.387, p=0.047 and r2 = 0.391, p=0.035). No changes in the LV systolic function were observed. CONCLUSION: The study showed that patients with lymphoproliferative diseases had no signs of cardiotoxicity during PCT according to the accepted criteria. This study described and highlighted for the first time the interrelation of endothelial dysfunction, profibrotic status, and LV diastolic dysfunction as manifestations of cardiovascular toxicity in patients with lymphoproliferative diseases. It is advisable to supplement the integrated strategies for the prevention and monitoring of PCT cardiovascular toxicity with a thorough evaluation of instrumental parameters of diastolic dysfunction for timely initiation/correction of cardioprotective therapy.

Assessment of Left Ventricular Functional Impairment in Patients With Chronic Kidney Disease Using Three-Dimensional Speckle Tracking Imaging.

BACKGROUND: Chronic kidney disease (CKD) is strongly linked to the incidence and mortality of cardiovascular diseases (CVDs), with left ventricular myocardial damage being the most prevalent. This study aimed to assess left ventricle (LV) dysfunction using three-dimensional speckle tracking imaging (3D-STI) in CKD patients. METHODS: A total of 110 CKD patients and 55 healthy volunteers underwent echocardiography. CKD patients were divided into CKD1 group and CKD2 group based on the estimated glomerular filtration rate (eGFR). Assessing cardiac function via two-dimensional speckle tracking echocardiography (2D-STE) and three-dimensional speckle tracking echocardiography (3D-STE) parameters, with strain presented in absolute terms. Collecting and comparing clinical and echocardiographic parameters from three groups, assessing 3D-STI's value in evaluating LV functional impairment in CKD patients via correlation and receiver operating characteristic (ROC) curve analyses, and identifying risk factors for CKD progression to end-stage renal disease (ESRD) through univariate and multivariate analyses. RESULTS: In CKD2 group, 2D-left ventricular ejection fraction (LVEF), 3D-LVEF, 2D left ventricular global longitudinal strain (2D-LVGLS), 3D-LVGLS, and 3D-left ventricular global circumferential peak strain (LVGCS) significantly worsen compared to the control and CKD1 groups, with statistically significant distinctions between the latter two (all p < 0.05). The absolute value of 3D-LVGLS shows a robust correlation with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and serum creatinine (Scr) (r = -0.598, -0.649, both p < 0.001). ROC curve analysis indicates higher diagnostic efficacy of 3D-LVGLS and 3D-LVGCS for LV systolic function than 2D-LVGLS. Univariate and multivariate analyses reveal an independent association of 3D-LVGLS with the progression to ESRD in CKD. CONCLUSION: 3D-LVGLS and 3D-LVGCS effectively detect LV dysfunction in CKD patients. Specifically, 3D-LVGLS demonstrates a robust correlation with NT-proBNP and Scr and is independently linked to CKD progressing to ESRD.

Noninvasive Left Ventricular Pressure-Strain Loop for Quantitative Assessment of Early Left Ventricular Systolic Dysfunction in Patients With Chronic Kidney Disease.

BACKGROUND: Patients with chronic kidney disease (CKD) possess a pronounced risk for cardiovascular events. A noninvasive left ventricular pressure-strain loop (LV-PSL) has recently been introduced to detect subtler changes in cardiac function. This study aims to investigate the value of LV-PSL for quantitative assessment of myocardial work (MW) in patients with CKD. METHODS: Seventy-five patients with CKD were enrolled retrospectively (37 patients with CKD Stages 2-3, and 38 patients with CKD Stages 4-5), and 35 healthy volunteers were included as controls. All subjects underwent transthoracic echocardiography. LV-PSL analysis was performed to estimate LV MW and efficiency. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were obtained by echocardiography, and the differences among the groups were compared. RESULTS: There was a significant increase in GWW and reduction in GWE in patients with CKD compared to normal controls (p < 0.05). No significant difference in GWI and GCW was observed among the three groups. Multiple linear regression revealed that increased GWW was significantly associated with age, serum creatinine, and systolic pressure, and decreased GWE was associated with age, serum creatinine, and GLS. CONCLUSION: LV-PSL can be used for noninvasive quantitative assessment of MW in patients with CKD, providing a new sensitive approach for the clinical assessment of myocardial function.

How the Crystal Ball Helps to Beat Ejection Fraction as Predictor of Mortality After Myocardial Infarction.

Ejection fraction (EF) is an incomplete metric and requires consideration of an associated companion (EFC) metric. This figure is based on 96 cardiac patients, including those with acute myocardial infarction (MI). For mid-range EF (with values ranging from 40% to 50%) the brown-colored area indicates the distribution of the EFC for these patients. Only the combination of EF and EFC can define the unique location of each patient. Likewise, data points are spread for any other EF range, for example, those with 55

Left Ventricular Diastolic Dysfunction with Elevated Filling Pressures Is Associated with Embolic Stroke of Undetermined Source and Atrial Fibrillation.

Background/Objectives: Left ventricular diastolic dysfunction (LVDD) and elevated left ventricular filling pressure (LVFP) are strong predictors of clinical outcomes across various populations. However, their diagnostic utility in embolic stroke of undetermined source (ESUS) remains unclear. We hypothesized that LVDD with elevated LVFP (based on echocardiography) was more likely to be prevalent in ESUS compared to non-cardioembolic stroke (NCE) and to be associated with atrial fibrillation (AF) on follow-up monitoring. Methods: This is a single-center retrospective study that included adult patients with a diagnosis of acute ischemic stroke between January 2016 and June 2017. LV function was assessed by inpatient transthoracic echocardiogram (TTE), and stroke etiology was adjudicated by the neurologist per the consensus criteria. Patients with cardioembolic stroke and those with indeterminate diastolic function on TTE were excluded. Baseline patient characteristics and clinical variables were compared among patients with and without LVDD and elevated LVFP. Multivariable regression models were used to assess the associations between diastolic dysfunction, ESUS, and AF detection in ESUS patients. Results: We identified 509 patients with ESUS and NCE stroke who had reported diastolic function. The mean age was 64.19 years, 45.19% were female, and 146 had LVDD with available LVFP data. LVDD was not associated with ESUS (adjusted OR: 1.43, 95% CI: 0.90-2.27, p = 0.130) or atrial fibrillation (AF) detection on cardiac monitoring (adjusted OR: 1.88, 95% CI: 0.75-4.72, p = 0.179). However, LVDD with elevated LVFP was borderline associated with ESUS (adjusted OR: 2.17, 95% CI: 0.99-4.77, p = 0.054) and significantly associated with AF detection (adjusted OR: 3.59, 95% CI: 1.07-12.06, p = 0.038). Conclusions: Our data suggest that LVDD with elevated LVFP is borderline associated with ESUS and significantly associated with AF detection on follow-up cardiac monitoring. Therefore, the presence of LVDD with an increased probability of elevated LVFP may help identify a subset of stroke patients more likely to have ESUS, potentially due to atrial cardiopathy with underlying occult AF. Further studies are needed to confirm our findings and to evaluate the safety and efficacy of anticoagulation in patients with ESUS and LVDD with elevated LVFP.

Presence of Apical Aneurysm and Its Impact on Left Ventricular Mechanics and Mechano-Energetic Coupling in Patients With Apical Hypertrophic Cardiomyopathy.

BACKGROUND: Left ventricular (LV) apical aneurysms (ApAn+) occur in 10%-15% of apical hypertrophic cardiomyopathy (ApHCM) patients and confer considerable morbidity. We hypothesized that ApAn+ adversely impact ventricular mechanics and mechano-energetic coupling in ApHCM. METHODS: Ninety-eight ApHCM patients were identified, of which nine (9%) had ApAn+ and were compared with 89 (91%) who did not (ApAn-). 2D speckle-tracking echocardiography assessed ventricular mechanics using LV global longitudinal strain (GLS) and torsion, and mechano-energetic coupling as myocardial work indices. Clinical events over follow-up were adjudicated. RESULTS: Mean age was 64 ± 15 years, 46% were female, and 3% had an HCM family history, with similar clinical risk factors between groups. Of the nine ApAn+ patients, there were six small (<2 cm) and three moderate-sized (2-4 cm) aneurysms. There was no difference in LV ejection fraction (65 ± 15 vs. 67 ± 11%, p = 0.51) or GLS (-9.6 ± 3.3 vs. -11.9 ± 3.9%, p = 0.09) between ApAn+ versus ApAn-. ApAn+ patients had greater myocardial global wasted work (347 ± 112 vs. 221 ± 165 mmHg%, p = 0.03) and lower global work efficiency (GWE, 75 ± 5 vs. 82 ± 8%, p = 0.006). LV GLS (ß = -0.67, p < 0.001), ApAn+ (ß = -0.15, p = 0.04), and twist rate (ß = -0.14, p = 0.04) were independently associated with GWE. At 3.9-year follow-up, cardiovascular mortality (4%) and heart failure hospitalization (14%) events were similar between groups. CONCLUSION: ApHCM patients with ApAn+ are characterized by more impaired LV mechano-energetic coupling when compared with ApAn-. ApAn+ is independently associated with worse GWE.

EVALUATION OF LEFT VENTRICULAR SYSTOLIC FUNCTION IN POSTMENOPAUSAL WOMEN WITH BREAST CANCER RECEIVING ADJUVANT ANTHRACYCLINE AND TRASTUZUMAB THERAPY: A 2-YEAR FOLLOW-UP STUDY.

Anti-cancer therapy with anthracyclines and trastuzumab has raised concerns regarding cancer therapy-related cardiac dysfunction (CTRCD) in breast cancer (BC) patients. This study aimed to assess left ventricular (LV) ultrasound parameters in BC postmenopausal women during a 2-year follow-up period after starting anti-cancer therapy. METHODS: We studied 74 women with early-stage BC with, a mean age of 62.3 (SD-8.6), who underwent adjuvant doxorubicin or doxorubicin + trastuzumab therapy. Parameters such as LV ejection fraction (LVEF), global longitudinal strain (LVGLS), and mitral annulus systolic velocity(S') were evaluated. Serial evaluations were conducted at baseline(T0) and the first (T1), second (T2), third (T3), sixth (T4), ninth (T5), twelfth (T6), and twenty-fourth month (T7) following the initiation of the chemotherapy. Cardioprotective therapy (CPT) was administered to high-risk patients and those with worsening LV systolic parameters. A multiple regression model was employed to assess the combined effects of various factors and co-factors on the outcome variables. Cardiotoxicity was evaluated using the survival analysis tools (Kaplan-Meier curves and Cox proportional model). RESULTS: A total of 27 (36.5%) patients developed CTRCD, although no patients were presented with symptomatic heart failure. LVGLS started to decline one month after the first anthracycline dose (T1) in 13.5% of the cohort and 34.5% of patients with CTRCD (p<0.000). From the third month, 10.8% of the patients showed a decrease in EF%, including 27.6% of patients with CTRCD in (P<0.000). Throughout, the study, S' remained within the normal range in patients without CTRCD, only patients with CTRCD showed a decline in S'. CONCLUSIONS: This prospective study revealed that:1) The dynamic assessment of GLS should be prioritized for the early detection of systolic dysfunction .2) S' possesses a high diagnostic value for identifying cardiotoxicity. 3) Implementing the optimal medical cardioprotective strategies and closely monitoring LV systolic function can prevent serious cardiac complications in patients undergoing highly cardiotoxic anti-cancer treatment.

Stylet-driven leads compared with lumenless leads for left bundle branch area pacing: a systematic review and meta-analysis.

OBJECTIVE: Left bundle branch area pacing (LBBAP) is a novel physiological pacing method for treating left ventricular dyssynchrony. LBBAP is often delivered using lumenless leads (LLL). However, recent studies have also reported the use of style-driven leads (SDL). This study is the first systematic review comparing the outcomes of LBBAP with SDL vs. LLL. METHODS: The review and meta-analysis included all available comparative studies published on Embase, PubMed, Web of Science, CENTRAL, and Scopus up to 6th March 2024. RESULTS: Eight observational studies were included in the review. Meta-analysis showed that success rates of LBBAP performed with LLL and SDL were comparable (OR: 1.72 95% CI: 0.94, 3.17 I2 = 38%). Duration of implantation and total procedural duration were significantly lower in LBBAP performed with SDL. The pacing threshold was significantly higher, while pacing impedance was significantly lower in the SDL compared to the LLL group. Pacing QRS interval, R-wave amplitude, and stimulus to peak left ventricular activation time were similar in the two groups. Intra-operative and post-operative dislodgement were significantly higher in the SDL group, but no difference was noted in intra-operative perforation and pneumothorax risk. CONCLUSION: Limited evidence from observational studies with inherent selection bias shows that success rates for LBBAP may not differ between SDL and LLL. While implantation of SDL may be significantly faster, it carries a higher risk of lead dislodgement. Both SDL and LLL are associated with comparable pacing characteristics except for reduced pacing impedance with SDL.

The Hidden Heart: Exploring Cardiac Damage Post-Stroke: A Narrative Review.

Stroke-heart syndrome (SHS), a critical yet underrecognized condition, encompasses a range of cardiac complications that arise following an ischemic stroke. This narrative review explores the pathophysiology, clinical manifestations, and implications of SHS, focusing on the complex interplay between the brain and the heart. Acute ischemic stroke (AIS) triggers autonomic dysfunction, leading to a surge in catecholamines and subsequent myocardial injury. Our review highlights the five cardinal manifestations of SHS: elevated cardiac troponin (cTn) levels, acute myocardial infarction, left ventricular dysfunction, arrhythmias, and sudden cardiac death. Despite the significant impact of these complications on patient outcomes, there is a notable absence of specific guidelines for their management. Through a comprehensive literature search, we synthesized findings from recent studies to elucidate the mechanisms underlying SHS and identified gaps in the current understanding. Our findings underscore the importance of early detection and multidisciplinary management of cardiac complications post-stroke. Future research should focus on establishing evidence-based protocols to improve clinical outcomes for stroke patients with SHS. Addressing this unmet need will enhance the care of stroke survivors and reduce mortality rates associated with cardiac complications.

Non-invasive pressure-volume loops show high arterial elastance in children with repaired tetralogy of Fallot.

BACKGROUND: Children with repaired tetralogy of Fallot (rToF) often have pulmonary regurgitation with right ventricular (RV) dilatation and dysfunction, whereas less is known about the effect on the left ventricle (LV). The aim was to investigate LV haemodynamic variables derived from non-invasive pressure-volume loops in children with rToF and how they compare to controls and previous research on adults. MATERIALS AND METHODS: Ten children with rToF and pulmonary regurgitation (12 years [10-13], 6 males) and 10 age- and sex-matched healthy controls (12 years [10-14], 6 males) underwent brachial blood pressure in conjunction with cardiac magnetic resonance imaging. Pressure-volume loops were derived by brachial blood pressure together with LV volumes throughout the cardiac cycle in short-axis cine images yielding several haemodynamic variables, including arterial elastance. The RV endocardial border was delineated in end-diastole and end-systole. RESULTS: Children with rToF and pulmonary regurgitation had larger RV end-diastolic volume (136 [114-156]) than controls (100 [94-112] ml/m2; p = 0.0015) and smaller LV end-diastolic volume (83 [58-91] ml/m2) than controls (101 [92-110] ml/m2; p = 0.002). Arterial elastance was higher in children with rToF (1.5 [1.3-2.7] mmHg/ml) than in controls (1.1 [1.0-1.5] mmHg/ml; p = 0.02). Heart rate was higher in children with rToF (77 [74-81] bpm) than in controls (69 [65-75] bpm; p = 0.027). CONCLUSION: Children with rToF had higher arterial elastance and heart rate than controls, likely due to increased sympathetic tone to compensate for impaired LV filling following pulmonary regurgitation. If this contributes to increased risk of adverse cardiovascular and cerebrovascular events remains to be studied.

Association of metabolically healthy obesity with risk of heart failure and left ventricular dysfunction among older adults.

BACKGROUND: Obesity is major cause of heart failure (HF), but it is related with a better prognosis among the elderly. Therefore, we aimed to examine whether metabolically healthy obesity (MHO) in late life increases HF risk and is reflected in impaired left ventricular (LV) function. METHODS: The participants were grouped into four metabolic phenotypes based on obesity and metabolic status: metabolically healthy non-obesity (MHN), MHO, metabolically unhealthy non-obesity (MUN), metabolically unhealthy obesity (MUO). Association of metabolic phenotypes with LV function was evaluated using multiple linear regression models. And association between metabolic phenotypes and risk of HF was assessed using multivariable logistic regression models. In addition, we validated the association of metabolic phenotypes and HF risk in a separate longitudinal cohort. RESULTS: In the primary cohort of 6335 participant, there were 434 participants diagnosed with HF. Compared to MHN participants, the risk of HF was higher among older individuals with MUN (OR = 1.51 [95% CI: 1.14-1.99]) and MUO (OR = 2.01 [95% CI: 1.39-2.91]), but not older individuals with MHO (OR = 0.86 [95% CI: 0.30-2.43). Regarding to LV function, worse LV diastolic function was noted among MUN and MUO individuals rather than MHO individuals. Older adults with MHO were also not associated with risk of HF in the validation cohort. CONCLUSION: Among older individuals, the metabolic health status might modify the association of obesity with risk of HF and LV diastolic dysfunction. Worse LV diastolic function and higher risk of HF were just noted in individuals with MUO, but not in those with MHO.

Quantitative Analysis of Myocardial Work in Gestational Diabetes Mellitus Using Noninvasive Left Ventricular Pressure-Strain Loop Measurement.

BACKGROUND: Gestational diabetes mellitus (GDM) poses a risk for cardiovascular damage during pregnancy. This study focused on evaluating changes in left ventricular myocardial performance in GDM patients using the left ventricular pressure-strain loop (LV-PSL) method and examining risk factors associated with reduced myocardial function. METHODS: A prospective, randomized study involving 112 pregnant women diagnosed with GDM was conducted from June 2021 to June 2024. Additionally, 84 healthy pregnant women from the same period served as the control group. Utilizing both conventional echocardiography and two-dimensional speckle tracking echocardiography, left ventricular myocardial work metrics were assessed using LV-PSL technology. RESULTS: GDM patients demonstrated significantly reduced values for global longitudinal strain (GLS), global work index (GWI), global work efficiency (GWE), and global constructive work (GCW) (p < 0.05), while conventional ultrasound measures showed no significant difference between GDM and control groups. GWI, GWE, GCW, and GLS had high predictive value for cardiac function changes in GDM patients, with GWE showing the highest predictive value {Area under curve (AUC) = 0.866, cutoff value = 95.5%, specificity = 0.77, sensitivity = 0.87}. GWI, GWE, and GCW were negatively correlated with GLS (r = -0.532, -0.411, -0.425, all p < 0.001), whereas global wasted work (GWW) showed a positive correlation with GLS (r = 0.325 and p < 0.001). These parameters were also correlated with HbA1c levels (r = -0.316, -0.256, -0.260, all p < 0.001 for negative correlations, and r = 0.172, p < 0.05 for positive correlations). Multivariate logistic regression indicated that 1-h OGTT (mmol/L), 2-h OGTT (mmol/L), and HbA1c (%) were significant predictors of left ventricular systolic function (GWE) in GDM patients. CONCLUSIONS: LV-PSL is an effective tool for early detection of left ventricular systolic function impairment in GDM patients.

Feasibility of a Cardiac Magnetic Resonance Protocol for "off-on" Cardiac Resynchronization Therapy Evaluation.

BACKGROUND: Cardiac resynchronization therapy (CRT) is a standard treatment for patients with heart failure and electrical dyssynchrony. Cardiac magnetic resonance (CMR) is the gold standard for assessing left ventricular (LV) function. However, the feasibility of using CMR with active CRT is still uncertain. PURPOSE: To assess the feasibility of a CRT "off-on" protocol during CMR and measure the acute effects of CRT interruption on LV function. METHODS: Patients underwent CMR before (pre-CRT) and 6 months after (post-CRT) an MR-conditional CRT defibrillator implantation. The post-CRT scan included two complete sets of cine images, one with inactive (post-CRTOFF) and one with active CRT (post-CRTON), maintaining a continuous connection between device and programmer. RESULTS: Out of 29 enrolled patients, 8 (28%) had complete and analyzable post-CRT data. Unsuccessful procedures were attributed to connection problems between the CRT device and the programmer (n = 10), poor image quality (n = 7), and lack of patient cooperation (n = 4). LV ejection fraction significantly increased between pre-CRT scan (28.1%) and both post-CRTOFF (37.9%; p = 0.046) and post-CRTON CMR (35.0%; p = 0.037), with a nonstatistically significant trend toward decreased LV volumes. No adverse events or significant changes in device electrical parameters (including battery level) were detected during the post-CMR scan period. CONCLUSION: A CRT "off-on" protocol during CMR studies can be safely executed in patients with an MR-conditional CRT defibrillator. However, technical improvements are needed to facilitate high-quality scans during active CRT. Favorable changes in LV function induced by CRT remodeling were not acutely reversed with the interruption of electrical therapy.

Evaluation of changes in the global longitudinal strain for left ventricular function before and after eight weeks of taking high dose of atorvastatin in patients with coronary slow flow phenomenon.

BACKGROUND: Coronary Slow Flow Phenomenon (CSFP) is a well-recognized clinical entity characterized by delayed opacification of coronary arteries in the presence of a normal coronary angiogram. The objective of this study was determined and compared left ventricle (LV)strain in patients with CSFP before and after receiving a high-dose atorvastatin. MATERIALS AND METHODS: This cross-sectional study was conducted on 51 patients with CSFP from the beginning of 2021 to the end of September 2022. Trans-thoracic Echocardiogram (TTE) was performed by an echocardiography specialist. Thereafter, the patient's basic information was entered into the researcher's checklist after treatment with atorvastatin 40 mg daily for eight consecutive weeks. After eight weeks, the patients were subjected again to TTE. The data were analyzed in SPSS statistical software. RESULTS: The mean LV-GLS before taking atorvastatin was - 16.53%±3.63%. The mean LV-GLS after taking atorvastatin was 17.57%±3.53% (P.value = 0.01). The mean LV function before taking atorvastatin was 48.82%±9.19%. Meanwhile, the mean LV function after taking atorvastatin was 50.59%±7.91% (P = 0.01). There was no significantly change in left atrium volume (49.88 ± 0.68 vs. 49.9 + 0.67) after 8 weeks taking atorvastatin (P = 0.884). CONCLUSION: The plasma ET-1 levels are elevated in CSFP patients, and atorvastatin improves coronary flow and endothelial function. As evidenced by the results of this study, the daily intake of 40 mg of oral atorvastatin during eight consecutive weeks in patients with CSFP significantly improved LV strain and LV function, however atorvastatin does not have a significant effect on improving the right ventricular function and pulmonary artery systolic pressure.

Sex-related differences concerning the profile and evolution of cardiovascular complications in patients with post-acute COVID-19 syndrome.

BACKGROUND: During the COVID-19 pandemic sex-related differences concerning the spectrum of cardiovascular complications have been observed in the acute infection, and during recovery. This study aims to emphasize sex-related disparities regarding left ventricular systolic function (LVSF), right ventricular function (RVF), diastolic dysfunction (DD), and pericardial pathologies during the post-COVID-19 syndrome. METHODS: 274 patients with post-acute COVID-19 syndrome, 127 men and 147 women, aged under 55, were evaluated within 90 days after the acute illness and followed at 3 and 6 months. RESULTS: Based on detailed transthoracic echocardiography (TTE), we identified significantly more frequently (p˂0.001) altered LVSF in men, while in women impaired RVF, and DD were significantly more common (p˂0.001). Pericardial impairment did not seem to be influenced by gender. The TTE parameters characterizing these patterns were correlated with the severity of the initial infection and the time elapsed since and alleviated in time. The multivariate regression analysis confirmed these sex-related associations and their impact on patients' functional status. CONCLUSIONS: Male patients had a higher tendency to develop altered LVSF, while female subjects had more frequently impaired RVF and DD. These abnormalities alleviated in time and exerted a significant influence on patients' functional status.

Myocardial Mechanics in Acromegaly: A Meta-Analysis of Echocardiographic Studies.

INTRODUCTION: Evidence on myocardial deformation, detected by speckle tracking echocardiography (STE), in patients with acromegaly is scanty. AIM: The aim of the present meta-analysis was to provide an updated information on left ventricular (LV) systolic function assessed by global longitudinal strain (GLS) in patients with acromegaly and preserved LVEF. METHODS: Following the PRISMA guidelines, systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE and Cochrane library) to identify eligible studies from inception up to June 30-2024. Clinical studies published in English reporting data on LV mechanics in patients with acromegaly and controls were included. The statistical difference of the echocardiographic variables of interest between groups such as LVEF and global longitudinal strain (GLS) was calculated by standardized mean difference (SMD) with 95% confidence interval (CI) by using random-effects models. RESULTS: Seven studies including 288 patients with acromegaly and 294 healthy individuals were considered for the analysis. Pooled average LVEF values were 64.6 ± 1.5% in the healthy control group and 64.0 ± 1.3% in the acromegaly group (SMD: - 0.21 ± 0.22, CI -0.62/0.22, p = 0.34); the corresponding values of GLS were - 19.1.1 ± 1.2% and - 17.5 ± 1.2% (SMD: -0.52 ± 0.27, CI - 1.05/0.01, p = 0.05). No difference was found between the two groups for both global circumferential strain (GCS) and global radial strain (GRS). CONCLUSIONS: Our findings suggest that patients with acromegaly in which LVEF is completely comparable to healthy controls show an impairment in GLS of borderline statistical significance. Whether GLS assessment can actually unmask early alterations of systolic function in patients with acromegaly better than LVEF will need to be investigated by future studies.